psychotropic agents

Question 1

uses for antipsychotic agents

Answer 1

Schizophrenia
Antiemetics
Dementia

Question 2

antipsychotic gets classifications

Answer 2

Phenothiazines

Nonphenothiazines

Question 3

schizophrenia patho

Answer 3

Excessive activation of CNS receptors for dopamine. Insufficient activation of CNS receptors for glutamate.

Question 4

positive schizophrenia symptoms

Answer 4

things in addition to normal thinking (hallucinations and delusions)

Question 5

negative schizophrenia symptoms

Answer 5

a decrease or loss of normal function (stop talking, no motivation, no display of emotions, decrease in ability to think)

Question 6

goals of schizophrenic therapy

Answer 6

Suppression of acute episodes
Prevention of acute exacerbations
Maintenance of the highest level of functioning
Done primarily through medications
Patients have a high noncompliance with pharmacologic therapy

Question 7

antipsychotic meds info

Answer 7

Initial effects seen in 1-2 days.
Substantial improvement takes 2-4 weeks.
Full effects not seen for months.
Drugs are not curative; symptomatic relief.

Question 8

antipsychotic meds SE

Answer 8

EPS-extrapyramidal symptoms
Anticholinergic effects
Orthostatic hypotension
Sedation
Seizures
Sexual dysfunction
Dermatologic effects- acne, rash
Increased risk that patients will become diabetic

Question 9

EPS side effects

Answer 9

acute dystonia
Parkinsonism
akathisia
tardive dyskinesia

Question 10

acute dystonia

Answer 10

Severe spasm of muscles of tongue, face, neck or back
Oculogyric crisis: involuntary upward deviation of the eyes (medical emergency)
Treated with Benadryl

Question 11

akathisia

Answer 11

restlessness
Characterized by pacing, squirming brought on by an uncontrolled need to be in motion
Treated with beta blockers
Develops within first two months of treatment

Question 12

parkinsonism

Answer 12

Bradykinesia, drooling, tremor, rigidity
Shuffling gait, stooped posture
Cogwheeling or pill rolling
Develops within first month of therapy
Treated with Symmetrel, Cogentin-PRN 
No Levodopa

Question 13

tardive dyskinesia

Answer 13

Twisting, writhing worm-like movements of tongue and face.
Lip smacking
Fly catching
Interferes with swallowing, chewing, speaking
Treatment: decrease dosage
Symptoms irreversible if left untreated

Question 14

phenothiazines

Answer 14

Thorazine (chlorpromazine)

Associated with EPS side effects

Question 15

antipsychotics and caffeine

Answer 15

negates the effects of the drug

Question 16

tricyclic antidepressants

Answer 16

elavil (amitriptyline)
for major depression
Block reuptake of NE and serotonin (increase levels)

Question 17

tricyclic antidepressants SE

Answer 17

orthostatic hypotension, sedation, anticholinergic effects, cardiac toxicity

Question 18

tricyclic antidepressants nursing precautions

Answer 18

Take at Bedtime (drowsiness)
Avoid alcohol
Therapeutic effects 2-6 weeks
Monitor for suicide
Oral contraceptives decrease efficacy
Contraindicated if cardiac history
Used as adjunctive analgesics chronic pain

Question 19

MAO inhibitors

Answer 19

rarely used
MAO in the brain inactivate NE and seratonin. MAO-B inactivates dopamine. In GI tract MAO inactivates tyramine. MOA inhibitors block these effects
marplan (isocarboxazid)

Question 20

MAO inhibitors SE

Answer 20

Cause direct CNS stimulation: anxiety, mania, headache, insomnia
Orthostatic hypotension
Hypertension if eats foods high in tyramine

Question 21

MAO inhibitors nursing precautions

Answer 21

No foods high in tyramine
No combination with SSRIs
4-8 weeks for full effects
No caffeine
No phenylethylamine
No Ginseng

Question 22

SSRI side effects

Answer 22

CNS: headache, drowsiness, anxiety, tremors
GI: changes in taste, N/V, weight gain
GU: painful menstruation, cystitis, sexual dysfunction

Question 23

SSRI nursing precautions

Answer 23

Can’t give with an MAO inhibitor
Monitor LFTs- can be toxic to the liver
Suicide precautions
Takes 5 weeks to achieve full effects
May cause weight gain
Take once a day in the morning
Can’t be taken during pregnancy

Question 24

lithium salts

Mood Stabilizers- Antimanic Drugs

Answer 24

Need to closely monitor drug levels
Normal level: 0.6-1.6 mEq/L
As levels rise: lethargy, slurred speech, muscle weakness, polyuria
Toxic levels: Clonic movements, hyporeflexia, seizures, hypotension, renal toxicity, pulmonary toxicity

Question 25

antigenic drug nursing precautions

Answer 25

Multiple drug interactions
Watch drug levels
Monitor symptoms
Give with food or milk to enhance absorption
Maintain adequate fluid intake
Monitor sodium intake
Too much salt decreases the effects of the lithium
Limit caffeine (can also decrease the effects of lithium)
No ETOH