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a_nclex > Psychotherapeutic Drugs > Flashcards

Psychotherapeutic Drugs Flashcards

1
Q

Alprazolam (Xanax)

Chemical Classification

A

Benzodiazepine (short/intermediate acting)

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2
Q

Alprazolam (Xanax)

Mechanism of Action

A

Depresses subcortical levels of CNS, including limbic system, reticular formation

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3
Q

Alprazolam (Xanax)

Uses

A

Anxiety, panic disorders with or without agoraphobia, anxiety with depressive symptoms

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4
Q

Alprazolam (Xanax)

Contraindications

A

Pregnancy (D), breastfeeding, hypersensitivity to benzodiazepines, closed-angle glaucoma, psychosis, addiction

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5
Q

Alprazolam (Xanax)

Side Effects

A

CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, memory impairment, poor coordination
CV: Orthostatic Hypotension, ECG CHANGES, TACHYCARDIA, hypotension
EENT: Blurred Vision, tinnitus, mydriasis
GI: constipation, dry mouth, nausea, vomiting, anorexia, diarrhea, weight gain/loss, increased appetite
GU: decreased libido
INTEG: rash, dermatitis, itching, angioedema

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6
Q

Alprazolam (Xanax)

Nursing Considerations

A

ASSESS:

  • Mental status: anxiety, mood, sensorium, orientation, affect, sleeping pattern, drowsiness, dizziness, especially in geriatric patients both before and during treatment
  • BP lying, standing; pulse; if systolic BP drops 20mmHg, hold product, notify prescriber
  • Hepatic, blood studies: AST, ALT, bilirubin, creatinine, LDH, alk phos, CBC; may cause neutropenia, decreased Hct, increased LFTs
  • PHYSICAL DEPENDENCY, WITHDRAWAL SYMPTOMS: anxiety, panic attacks, agitation, seizures, headache, nausea, vomiting, muscle pain, weakness; withdrawal seizures may occur after rapid decrease in dose or abrupt discontinuation; because duration of action is short, considered to be the product of choice for geriatric patients
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7
Q

Alprazolam (Xanax)

Overdose Treatment

A

Lavage, VS, supportive care, flumazenil

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8
Q

Amitriptyline

Functional Classification

A

Antidepressant - tricyclic

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9
Q

Amitriptyline

Chemical Classification

A

Tertiary Amine

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10
Q

Amitriptyline

Mechanism of Action

A

Blocks reuptake of norepinephrine, serotonin into nerve endings, thereby increasing action of norepinephrine, serotonin in nerve cells

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11
Q

Amitriptyline

Uses

A

Major Depression

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12
Q

Amitriptyline

Contraindications

A

Hypersensitivity to tricyclics, recovery phase of myocardial infarction

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13
Q

Amitriptyline

Side Effects

A

CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, weakness, insomnia, nightmares, EPS (geriatric patients), increased psychiatric symptoms, SEIZURES, SUICIDAL THOUGHTS
CV: Orthostatic Hypotension, ECG CHANGES, TACHYCARDIA, HYPERTENSION, palpitations, DYSRHYTHMIAS
EENT: Blurred Vision, tinnitus, mydriasis, ophthalmoplegia
GI: Constipation, Dry Mouth, weight gain, nausea, vomiting, PARALYTIC ILEUS, increased appetite, cramps, epigastric distress, jaundice, HEPATITIS, stomatitis
GU: Urinary Retention
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA, EOSINOPHILIA, LEUKOPENIA, APLASTIC ANEMIA
INTEG: rash, urticaria, sweating, pruritus, photosensitivity

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14
Q

Amitriptyline

Nursing Considerations

A

ASSESS:
-BP lying, standing; pulse q4hr; if systolic BP drops 20mmHg, hold product, notify prescriber; take vital signs q4hr with CV disease; ECG for flattening of T wave, prolongation of QTc interval, bundle branch block, AV block, dysrhythmias in cardiac patients
-Blood studies: CBC, leukocytes, differential, cardiac enzymes if patient is receiving long-term therapy
-Hepatic studies: AST, ALT, bilirubin
-Weight q wk; appetite may increase with product
-EPS primarily in geriatric patients: rigidity, dystonia, akathisia
-Mental status: mood, sensorium, affect, suicidal tendencies; increase in psychiatric symptoms: depression, panic; suicidal tendencies are higher in those =24yr, restrict amount of product available
-Urinary retention, constipation; constipation is most likely to occur in children and geriatric patients
-WITHDRAWAL SYMPTOMS: headache, nausea, vomiting, muscle pain, weakness; do not usually occur unless product was discontinued abruptly
-Alcohol consumption; if alcohol is consumed, hold dose until morning
PAIN SYNDROMES (UNLABELED): intensity, location, severity; use pain scale; product may be taken for 1-2 months before effective
-SEXUAL DYSFUNCTION: erectile dysfunction, decreased libido

PERFORM/PROVIDE:
-Gum, hard sugarless candy, frequent sips of water for dry mouth

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15
Q

Amitriptyline

Overdose Treatment

A

ECG monitoring, lavage; administer anticonvulsant, sodium bicarbonate

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16
Q

Bupropion (Wellbutrin, Zyban)

Functional Classification

A

Antidepressant-miscellaneous

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17
Q

Bupropion (Wellbutrin, Zyban)

Chemical Classification

A

Aminoketone

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18
Q

Bupropion (Wellbutrin, Zyban)

Mechanism of Action

A

Inhibits reuptake of DOPamine

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19
Q

Bupropion (Wellbutrin, Zyban)

Uses

A

Depression (Wellbutrin), smoking cessation (Zyban); seasonal affective disorder

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20
Q

Bupropion (Wellbutrin, Zyban)

Contraindications

A

Hypersensitivity, eating disorders, seizure disorders

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21
Q

Bupropion (Wellbutrin, Zyban)

Side Effects

A

CNS: Headache, Agitation, Dizziness, Akinesia, Bradykinesia, Confusion, SEIZURES, delusions, Insomnia, Sedation, Tremors, SUICIDAL IDEATION
CV: Dysrhythmias, Hypertension, palpitations, Tachycardia, hypotension, COMPLETE AV BLOCK; QRS PROLONGATION (OVERDOSE)
EENT: Blurred Vision, Auditory Disturbances
GI: Nausea, Vomiting, anorexia, diarrhea, Dry Mouth, increased appetite, Constipation, altered taste
GU: impotence, urinary frequency, retention, Menstrual Irregularities
INTEG: Rash, pruritus, Sweating, STEVENS-JOHNSON SYNDROME
MISC: Weight Loss or Gain

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22
Q

Bupropion (Wellbutrin, Zyban)

Nursing Considerations

A

ASSESS:

  • Hepatic/renal function in patients with hepatic, kidney impairment
  • For increased risk of seizures; if patient has excessively used CNS depressants and OTC stimulants, dosage of buPROPion should not be exceeded
  • For smoking cessation after 7-12wk; if progress has not been made, product should be discontinued
  • Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms

PERFORM/PROVIDE:

  • Assistance with ambulation during beginning therapy because sedation occurs
  • Safety measures, primarily for geriatric patients
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23
Q

Bupropion (Wellbutrin, Zyban)

Overdose Treatment

A

ECG monitoring; lavage, activated charcoal; administer anticonvulsant

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24
Q

Diazepam (Valium)

Functional Classification

A

Antianxiety, anticonvulsant, skeletal muscle relaxant, central acting

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25
Q

Diazepam (Valium)

Chemical Classification

A

Benzodiazepine, long-acting

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26
Q

Diazepam (Valium)

Mechanism of Action

A

Potentiates the actions of GABA, especially in the limbic system, reticular formation; enhances presympathetic inhibition, inhibits spinal polysynaptic afferent paths

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27
Q

Diazepam (Valium)

Uses

A

Anxiety, acute alcohol withdrawal, adjunct for seizure disorders; preoperatively as a relaxant for skeletal muscle relaxation; rectally for acute repetitive seizures

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28
Q

Diazepam (Valium)

Contraindications

A

Pregnancy (D), hypersensitivity to benzodiazepines, closed-angle glaucoma, coma, myasthenia gravis, ethanol intoxication, hepatic disease, sleep apnea

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29
Q

Diazepam (Valium)

Side Effects

A

CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, ataxia
CV: Orthostatic Hypotension, ECG CHANGES, TACHYCARDIA, hypotension
EENT: Blurred Vision, tinnitus, mydriasis, nystagmus
GI: constipation, dry mouth, nausea, vomiting, anorexia, diarrhea
HEMA: NEUTROPENIA
INTEG: rash, dermatitis, itching
RESP: RESPIRATORY DEPRESSION

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30
Q

Diazepam (Valium)

Nursing Considerations

A

ASSESS:

  • BP (lying, standing), pulse; respiratory rate, if systolic BP drops 20mmHg, hold product, notify prescriber, respirations q5-15min if given IV
  • Blood studies: CBC during long-term therapy; blood dyscrasias (rare); hepatic studies: AST, ALT, bilirubin, creatinine, LDH, alk phos
  • DEGREE OF ANXIETY; what precipitates anxiety and whether product controls symptoms
  • ALCOHOL WITHDRAWAL SYMPTOMS, including hallucinations (visual, auditory), delirium, irritability, agitation, fine to coarse tremors
  • Seizure control and type, duration, intensity of seizures
  • For muscle spasms; pain relief
  • IV site for thrombosis or phlebitis, which may occur rapidly
  • Mental status: mood, sensorium, affect, sleeping pattern, drowsiness, dizziness, suicidal tendencies
  • PHYSICAL DEPENDENCY, WITHDRAWAL SYMPTOMS: headache, nausea, vomiting, muscle pain, weakness after long-term use

PERFORM/PROVIDE:

  • Assistance with ambulation during beginning therapy, for drowsiness, dizziness, safety measures
  • Check to confirm PO medication swallowed
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31
Q

Diazepam (Valium)

Overdose Treatment

A

Lavage, VS, supportive care, flumazenil

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32
Q

Fluoxetine (Prozac)

Functional Classification

A

Antidepressant, SSRI (Selective Serotonin Reuptake Inhibitor)

33
Q

Fluoxetine (Prozac)

Mechanism of Action

A

Inhibits CNS neuron uptake of serotonin but not of norepinephrine

34
Q

Fluoxetine (Prozac)

Uses

A

Major depressive disorder, obsessive-compulsive disorder (OCD), bulimia nervosa; Sarafem: premenstrual dysphoric disorder (PMDD), panic disorder

35
Q

Fluoxetine (Prozac)

Contraindications

A

Hypersensitivity

36
Q

Fluoxetine (Prozac)

Side Effects

A

CNS: Headache, Nervousness, Insomnia, Drowsiness, Anxiety, Tremor, Dizziness, Fatigue, Sedation, Poor Concentration, Abnormal Dreams, Agitation, SEIZURES, apathy, euphoria, hallucinations, delusions, psychosis, SUICIDAL IDEATION, NEUROLEPTIC MALIGNANT SYNDROME-LIKE REACTIONS, serotonin syndrome
CV: Hot Flashes, Palpitations, angina pectoris, hypertension, TACHYCARDIA, 1ST-DEGREE AV BLOCK, BRADYCARDIA, MI, THROMBOPHLEBITIS
EENT: visual changes, ear/eye pain, photophobia, tinnitus
GI: Nausea, Diarrhea, Dry Mouth, Anorexia, Dyspepsia, Constipation, Cramps, Vomiting, Taste Changes, Flatulence, Decreased Appetite
GU: Dysmenorrhea, Decreased Libido, Urinary Frequency, UTI, amenorrhea, cystitis, impotence, urine retention
HEMA: HEMORRHAGE
INTEG: Sweating, Rash, Pruritus, acne, alopecia, urticaria, ANGIOEDEMA, EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS
META: hyponatremia
MS: Pain, arthritis, twitching
RESP: Infection, Pharyngitis, Nasal Congestion, Sinus Headache, Sinusitis, Cough, Dyspnea, Bronchitis, asthma, hyperventilation, pneumonia
SYST: Asthenia, Viral Infection, Fever, Allergy, Chills

37
Q

Fluoxetine (Prozac)

Nursing Considerations

A

ASSESS:

  • Mental Status: mood, sensorium, affect, suicidal tendencies (child/young adult), increase in psychiatric symptoms, depression, panic; monitor for seizures, seizures potential increased
  • BULIMIA NERVOSA: appetite, weight daily, increase nutritious foods in diet, watch for bingeing and vomiting
  • ALLERGIC REACTIONS/SERIOUS SKIN REACTIONS: angioedema, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, itching, rash, urticaria; product should be discontinued, may need to give antihistamine
  • BP (lying/standing), pulse q4hr, if systolic BP drops 20mmHg, hold product, notify prescriber; ECG for flattening of T wave, bundle branch, AV block, dysrhythmias in cardiac patients
  • Blood studies: CBC, leukocytes, differential, cardiac enzymes if patient is receiving long-term therapy; check platelets; bleeding can occur, thyroid function, growth rate, weight
  • Hepatic studies: AST, ALT, bilirubin, creatinine, weight weekly; appetite may decrease with product
  • Alcohol consumption; if alcohol is consumed, hold dose until AM

PERFORM/PROVIDE
-Safety measures, primarily for geriatric patients

38
Q

Haloperidol (Haldol)

Functional Classification

A

Antipsychotic, neuroleptic

39
Q

Haloperidol (Haldol)

Chemical Classification

A

Butyrophenone

40
Q

Haloperidol (Haldol)

Mechanism of Action

A

Depresses cerebral cortex, hypothalamus, limbic system, which control activity and aggression; blocks neurotransmission produced by DOPamine at synapse; exhibits strong alpha-adrenergic, anticholinergic blocking action; mechanism for antipsychotic effects unclear

41
Q

Haloperidol (Haldol)

Uses

A

Psychotic disorders, control of tics, vocal utterances in Gilles de la Tourette’s syndrome, short-term treatment of hyperactive children showing excessive motor activity, prolonged parenteral therapy in chronic schizophrenia, organic mental syndrome with psychotic features, hiccups (short-term), emergency sedation of severely agitated or delirious patients, ADHD

42
Q

Haloperidol (Haldol)

Contraindications

A

Children s disease, angina, epilepsy, urinary retention, closed-angle glaucoma

43
Q

Haloperidol (Haldol)

Side Effects

A

CNS: EPS: Pseudoparkinsonism, Akathisia, Dystonia, Tardive Dyskinesia, Drowsiness, Headache, SEIZURES, NEUROLEPTIC MALIGNANT SYNDROME, confusion
CV: Orthostatic Hypotension, hypertension, CARDIAC ARREST, ECG changes, TACHYCARDIA, QT PROLONGATION, SUDDEN DEATH, TORSADES DE POINTES
EENT: blurred vision, glaucoma, dry eyes
GI: Dry Mouth, Nausea, Vomiting, Anorexia, Constipation, diarrhea, jaundice, weight gain, ILEUS, HEPATITIS
GU: urinary retention, dysuria, urinary frequency, enuresis, impotence, amenorrhea, gynecomastia
INTEG: Rash, photosensitivity, dermatitis
RESP: LARYNGOSPASM, dyspnea, RESPIRATORY DEPRESSION
SYST: RISK FOR DEATH (DEMENTIA)

44
Q

Haloperidol (Haldol)

Nursing Considerations

A

ASSESS:

  • Swallowing of PO medication; check for hoarding or giving of medication to other patients
  • Prolactin, CBC, urinalysis, opthalmic exam before and during prolonged therapy
  • Dementia, affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances
  • BP standing, lying; take pulse, respirations q4hr during initial treatment; establish baseline before starting treatment; report drops of 30mmHg
  • Dizziness, faintness, palpitations, tachycardia on rising
  • EPS including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
  • NEUROLEPTIC MALIGNANT SYNDROME/SEROTONIN SYNDROME: hyperthermia, muscle rigidity, altered mental status, increased CPK, seizures, hypo/hypertension, tachycardia; notify prescriber immediately
  • Constipation, urinary retention daily; if these occur, increase bulk, water in diet

PERFORM/PROVIDE

  • Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program, fainting is possible; patient should not stand still for long periods
  • Sips of water, sugarless candy, gum for dry mouth
  • Storage in tight, light-resistant container
45
Q

Haloperidol (Haldol)

Overdose Treatment

A

Activated charcoal, lavage if orally ingested; provide an airway; don not induce vomiting

46
Q

Lithium

Functional Classification

A

Antimanic, antipsychotic

47
Q

Lithium

Chemical Classification

A

Alkali metal ion salt

48
Q

Lithium

Mechanism of Action

A

May alter sodium, potassium ion transport across cell membrane in nerve, muscle cells; may balance biogenic amines of norepinephrine, serotonin in CNS areas involved in emotional responses

49
Q

Lithium

Uses

A

Bipolar disorders (manic phase), prevention of bipolar manic-depressive psychosis

50
Q

Lithium

Contraindications

A

Pregnancy (D), breastfeeding, children <12yr, hepatic disease, brain trauma, organic brain syndrome, schizophrenia, severe cardiac/renal disease, severe dehydration

51
Q

Lithium

Side Effects

A

CNS: Headache, Drowsiness, Dizziness, tremors, twitching, ataxia, SEIZURE, slurred speech, restlessness, confusion, stupor, memory loss, clonic movements, fatigue
CV: Hypotension, ECG changes, DYSRHYTHMIAS, CIRCULATORY COLLAPSE, edema
EENT: tinnitus, blurred vision
ENDO: hyponatremia, goiter, hyperglycemia, hypo/hyperthyroidism
GI: Dry Mouth, Anorexia, Nausea, Vomiting, Diarrhea, incontinence, abdominal pain, metallic taste
GU: POLYURIA, GLYCOSURIA, PROTEINURIA, ALBUMINURIA, urinary incontinence, polydipsia
HEMA: LEUKOCYTOSIS
INTEG: drying of hair, alopecia, rash, pruritus, hyperkeratosis, acneiform lesions, folliculitis
MS: muscle weakness

52
Q

Lithium

Nursing Considerations

A

ASSESS:

  • MENTAL STATUS: manic symptoms, mood, behavior before, during treatment
  • LITHIUM TOXICITY: diarrhea, vomiting, tremor, twitching
  • weight daily; check for, report edema in legs, ankles, wrists
  • sodium intake; decreased sodium intake with decreased fluid intake may lead to lithium retention; increased sodium, fluids may decrease lithium retention
  • skin turgor at least daily
  • urine for albuminuria, glycosuria, uric acid during beginning treatment, q2mo thereafter
  • neurologic status: LOC, gait, motor reflexes, hand tremors
  • Serum Lithium levels 2x/wk initially then q2mo (therapeutic level: 0.5-1.5mEq/L); toxic level >1.5mcg/L
  • ECG in those >50yr with CV disease
53
Q

Lithium

Overdose Treatment

A

Induce emesis or lavage, maintain airway, respiratory function; dialysis for severe intoxication

54
Q

Lorazepam (Ativan)

Functional Classification

A

Sedative, hypnotic; antianxiety

55
Q

Lorazepam (Ativan)

Chemical Classification

A

Benzodiazepine, short acting

56
Q

Lorazepam (Ativan)

Mechanism of Action

A

Potentiate the actions of GABA, especially in the limbic system and the reticular formation

57
Q

Lorazepam (Ativan)

Uses

A

Anxiety, irritability with psychiatric or organic disorders, preoperatively; insomnia; adjunct for endoscopic procedures, status epilepticus

58
Q

Lorazepam (Ativan)

Contraindications

A

Pregnancy (D), breastfeeding, hypersensitivity to benzodiazepines, benzyl alcohol; closed-angle glaucoma, psychosis, history of drug abuse, COPD, sleep apnea

59
Q

Lorazepam (Ativan)

Side Effects

A

CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, weakness, unsteadiness
CV: Orthostatic Hypotension, ECG CHANGES, TACHYCARDIA, hypotension; APNEA, CARDIAC ARREST (IV, RAPID)
EENT: Blurred Vision, tinnitus, mydriasis
GI: Constipation, dry mouth, nausea, vomiting, anorexia, diarrhea
INTEG: rash, dermatitis, itching
MISC: acidosis

60
Q

Lorazepam (Ativan)

Nursing Considerations

A

ASSESS:

  • ANXIETY: decrease in anxiety; mental status: mood, sensorium, affect, sleeping pattern, drowsiness, dizziness, suicidal tendencies
  • renal/hepatic/blood status if receiving high-dose therapy
  • PHYSICAL DEPENDENCY, WITHDRAWAL SYMPTOMS: headache, nausea, vomiting, muscle pain, weakness, tremors, seizures, after long-term, excessive use

PERFORM/PROVIDE:

  • Assistance with ambulation during beginning therapy, since drowsiness, dizziness occurs
  • Check to confirm that PO medication has been swallowed
61
Q

Lorazepam (Ativan)

Overdose Treatment

A

Lavage, VS, supportive care, flumazenil

62
Q

Mirtazapine

Functional Classification

A

Antidepressant

63
Q

Mirtazapine

Chemical Classification

A

Tetracyclic

64
Q

Mirtazapine

Mechanism of Action

A

Blocks reuptake of norepinephrine and serotonin into nerve endings, thereby increasing action of norepinephrine and serotonin in nerve cells; antagonist of central alpha2-receptors; blocks histamine receptors

65
Q

Mirtazapine

Uses

A

Depression; dysthymic disorder; bipolar disorder: depressed, agitated depression

66
Q

Mirtazapine

Contraindications

A

Hypersensitivity to tricyclics, recovery phase of MI, agranulocytosis, jaundice

67
Q

Mirtazapine

Side Effects

A

CNS: Dizziness, Drowsiness, confusion, headache, anxiety, tremors, stimulation, weakness, nightmares, EPS (geriatric patients), increased psychiatric symptoms, SEIZURES
CV: Orthostatic Hypotension, ECG Changes, Tachycardia, HYPERTENSION, palpitations
EENT: Blurred Vision, tinnitus, mydriasis
GI: Diarrhea, Dry Mouth, nausea, vomiting, PARALYTIC ILEUS, increased appetite, cramps, epigastric distress, constipation , JAUNDICE, HEPATITIS, stomatitis, weight gain
GU: Urinary Retention, ACUTE RENAL FAILURE
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA, EOSINOPHILIA, LEUKOPENIA
INTEG: rash, urticaria, sweating, pruritus, photosensitivity
SYST: flulike symptoms, increased cholesterol levels

68
Q

Mirtazapine

Nursing Considerations

A

ASSESS:

  • BP (lying, standing), pulse q4hr; if systolic BP drops 20mmHg, hold product, notify prescriber; vital signs q4hr in patient with CV disease
  • Blood studies: CBC, leukocytes, differential, cardiac enzymes, lipid profile, blood glucose if patient is receiving long-term therapy
  • Hepatic studies: AST, ALT, bilirubin, creatinine
  • Weight weekly; appetite may increase with product
  • ECG for flattening of T wave, bundle branch block, AV block, dysrhythmias in cardiac patients
  • Mental status: mood, sensorium, affect, suicidal tendencies (especially among adolescents, young adults), increase in psychiatric symptoms: depression, panic; EPS primarily in geriatric patients: rigidity, dystonia, akathisia
  • SEROTONIN SYNDROME: hyperthermia, hypertension, myoclonus, rigidity, delirium, coma; if using other serotonergic products
  • Alcohol consumption; if alcohol consumed, hold dose until morning

PERFORM/PROVIDE

  • Assistance with ambulation during beginning therapy, since drowsiness, dizziness occurs
  • Safety measures, including side rails, primarily for geriatric patients
69
Q

Mirtazapine

Overdose Treatment

A

ECG monitoring, lavage, activated charcoal; administer anticonvulsant, IV fluids

70
Q

Risperidone (Risperdal)

Functional Classification

A

Antipsychotic

71
Q

Risperidone (Risperdal)

Chemical Classification

A

Benzisoxazole derivative

72
Q

Risperidone (Risperdal)

Mechanism of Action

A

Unknown; may be mediated through both dopamine type 2 (D2) and serotonin type 2 (5-HT2) antagonism

73
Q

Risperidone (Risperdal)

Uses

A

Irritability associated with autism, bipolar disorder, mania, schizophrenia

74
Q

Risperidone (Risperdal)

Contraindications

A

Hypersensitivity

75
Q

Risperidone (Risperdal)

Side Effects

A

CNS: EPS, Pseudoparkinsonism, Akathisia, Dystonia, Tardive Dyskinesia; Drowsiness, Insomnia, Agitation, Anxiety, Headache, SEIZURES, NEUROLEPTIC MALIGNANT SYNDROME, dizziness, SUICIDAL IDEATION, head titubation (shaking)
CV: orthostatic hypotension, TACHYCARDIA; HEART FAILURE, SUDDEN DEATH (GERIATRIC PATIENTS), AV block
EENT: blurred vision, tinnitus
GI: Nausea, vomiting, Anorexia, Constipation, jaundice, weight gain
GU: hyperprolactinemia, gynecomastia, dysuria
HEMA: NEUTROPENIA, GRANULOCYTOPENIA
MISC: RENAL ARTERY OCCLUSION; weight gain, hyperprolactinemia (child)
MS: RHABDOMYOLYSIS
RESP: rhinitis, sinusitis, upper respiratory infection, cough

76
Q

Risperidone (Risperdal)

Nursing Considerations

A

ASSESS:

  • SUICIDAL THOUGHTS/BEHAVIORS: often when depression is lessened; mental status before initial administration
  • Swallowing of PO medication; check for hoarding or giving of medication to other patients
  • I&O ratio; palpate bladder if urinary output is low
  • Bilirubin, CBC, hepatic studies monthly
  • Urinalysis before, during prolonged therapy
  • Affect, orientation, LOC, reflexes gait, coordination, sleep pattern disturbances
  • QT PROLONGATION: BP standing, lying; pulse, respirations; take these q4hr during initial treatment; establish baseline before starting treatment; report drops of 30mmHg; watch for ECG changes
  • Dizziness, faintness, palpitations, tachycardia on rising
  • EPS: akathisia, tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
  • SERIOUS REACTIONS IN GERIATRIC PATIENT: fatal pneumonia, heart failure, sudden death, dementia
  • NEUROLEPTIC MALIGNANT SYNDROME: hyperthermia, increased CPK, altered mental status, muscle rigidity, seizures, change in BP, fatigue, tachycardia
  • Constipation, urinary retention daily; if these occur, increase bulk, water in diet
  • Weight gain, hyperglycemia, metabolic changes in diabetes

PERFORM/PROVIDE:

  • Decreased stimuli by dimming lights, avoiding loud noises
  • Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program because fainting is possible; patient should not stand still for a long time
  • Increased fluids to prevent constipation
  • Sips of water, candy, gum for dry mouth
  • Storage in tight, light-resistant container (PO); unopened vials in refrigerator, protect from light; do not freeze
77
Q

Risperidone (Risperdal)

Overdose Treatment

A

Lavage if orally ingested; provide airway; do not induce vomiting

78
Q

Alprazolam (Xanax)

Functional Classification

A

Antianxiety

a_nclex (40 decks)

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