psychotic disorders Flashcards
describe psychosis
psychosis can be acute or chronic
acute:
- also called confusion or delirium
- sudden onset over hours to days
- may be precipitated by physical disorders (metabolic or infectious)
- may be superimposed on chronic dementias and psychoses such as schizophrenia
name some different possible pathophysiologies of psychosis
- neutransmitter theories
- abnormal brain development
others i dont care enough about
what are two drug therapies for psychosis
- first generation antipsychotics (typical): haloperidol, more adverse effects
- second generation antipsychotics (atypical): clozapine, more weight gain, more expensive
give an example of first generation antipsychotics
haloperidol
describe the action of first generation antipsychotics (haloperidol)
blocks postsynaptic dopamine receptors in the brain
what are first generation antipsychotics (haloperidol) used for
schizophrenia
psychotic symptoms associated with brain impairment
what are the different onsets for IM and PO first generation antipsychotics (haloperidol)
IM: 10-15min
PO: 30-60min
what are some adverse effects of first generation antipsychotics (haloperidol)
CNS: EPS - tardive dyskinesia, akathisia, dystonia, drug induced parkinsonism
CV: prolonged QT
heme: agranulocytosis
what is tardive dyskinesia
drug induced movement disorder, typically facial tics
what is akathisia
feeling of muscles quivering, extremely restless, inability to sit still
what is dystonia
causes muscles to contract involuntarily, repetitive twisting movements
what are some contraindications of first generation antipsychotics (haloperidol)
- liver damage
- coronary artery disease
- cerebrovascular disease
describe administration of first generation antipsychotics (haloperidol)
- need baseline EKG
- gradual reduction prior to discontinuation
- IM injections given in ventrogluteal with 1.5 inch needle
- check injection site
- monitor for orthostatic hypotension
- pre/post mood assessment
what are some nursing implications for first generation antipsychotics (haloperidol)
- do NOT give with herbals such as KAVA
- avoid antacids
- avoid CNS depressants
describe patient education for first generation antipsychotics (haloperidol)
- take only as prescribed
- take with a glass of water and food if GI upset occurs
- do not stop abruptly
- avoid alcohol
- wear protective sunscreen outdoors
- use caution when changing positions
- report yellowing of the eyes and skin to healthcare provider
an elderly woman with dementia is receiving Haloperidol, what adverse effect is this patient at an increased risk of developing?
- muscle rigidity
- bradycardia
- increased temp
- tardive dyskinesia
- tardive dyskinesia
this is an adverse effect of haloperidol that can developany time after taking the medication
give an example of a second generation antipsychotic
clozapine
describe the action of second generation antipsychotic (clozapine)
blocks dopamine receptors in the brain
what are second generation antipsychotics (clozapine) used for
schizophrenia
- psychotic symptoms
- recurrent suicidal behavior in patients with schizophrenia
whats the PO onset of second generation antipsychotics (clozapine)
1-6hr
what are the black box warnings for second generation antipsychotics (clozapine)
- administration of clozapine of elderly patient with dementia, risk of death is increased
- increased risk of seizure activity as clozapine dose increased
- risk of fatal agranulocytosis
- risk of hyperglycemia
what are some contraindications of second generation antipsychotics (clozapine)
- clozapine induced agranulocytosis
- seizure disorder
- CNS depression
describe administration of second generation antipsychotics (clozapine)
- need baseline WBC count and neutrophil count
- monitor blood glucose level
- taper dose if discontinued
- pre/post mood assessment
what are some nursing implications for second generation antipsychotics (clozapine)
- do NOT give with herbals
- avoid antacids
- avoid CNS depressants
describe patient education for second generation antipsychotics (clozapine)
- take only as prescribed
- take with a glass of water and food if GI upset occurs
- do not stop abruptly
- avoid alcohol
- obtain weekly blood tests
- report flu like symptoms
- only one week of medication will be dispensed at a time
