Schizo Medicaitons Flashcards

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1
Q

what are Typical Antisychotics and what do they target

A

Dopamine antagonists (D2 recepto Antagonists)

target positive symptoms

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2
Q

adv of typical antipsychotics

A

less expensive

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3
Q

disadv of typical antipsychotics

A

Extrapyramidal side effects (EPS)
Anticholinergic (ACh) side effects
Tardive dyskinesia
Weight gain, sexual dysfunction, endocrine disturbances
2-6 wks for effect

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4
Q

2 Typical antipsychotics

A

chlorpromazine (Thorazine)*
haloperidol (Haldol)*

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5
Q

side effects of typical antipsychotics

A

anticholinergic, sedation, EPS, hypotension,
seizure, photosensitivity, skin rash, GI upset,
EKG changes, hormonal/endocrine,
Agranulocytosis, Neuromalignant Syndrome,
Tardive Dyskinesia

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6
Q

S/E of antipsychotic meds

A

Anticholinergic (Ach) Side Effects
Dry mouth, urinary retention/hesitancy, constipation, blurred vision, dry eyes, sexual dysfunction
Hypotension & orthostatic hypotension
Extrapyramidal Side Effects (EPS)
–Acute Dystonia
–Akathisia
–Pseudoparkinsonism
–Tardive Dyskinesia (TD)
Agranulocytosis
Neuroleptic Malignant Syndrome (NMS)
Metabolic Syndrome
Prolongation of QT Interval
Liver Impairment

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7
Q

what is pseudoparkinsonism

A

simulates Parkinson’s
disease and is a reversible syndrome that
includes the following symptoms:

tremulousness in the hands and arms
rigidity in the arms and shoulders
Bradykinesia
Akinesia
Hypersalivation
masked facies
shuffling gait

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8
Q

Tx of pseudoparkinsonism

A

dosage reduction or the addition of oral anticholinergic agents

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9
Q

what is akathisia

A

feeling of inner restlessness that can be manifested as excessive pacing or inability to remain still for any length of time.

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10
Q

Tx of akathisia

A

dosage reduction when possible, or the addition of a low-dose beta blocker, such as propranolol (Inderal)

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11
Q

dystonia’s extrapyramidal S/E

A

Torticollis - spasmodic and painful spasm of muscles ( head pulled to one side)
Oculogyric Crisis: eyes roll back toward the head. Emergency Situation
Opisthotonus –A type of spasm in which the head and heels arch backward in extreme hyperextension and the body forms a reverse bow;
Laryngospasm- spasm of throat impairing breathing and swallowing
Oral-facial maxillary spasms- treat emergently as they may progress

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12
Q

T/F Dystonia extrapyramidal S/E are emergent

A

True

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13
Q

Tx for mild S/E

A

reduce dosage
d/c med (taper)
switch to another class med

add anticholinergic ageny:
benztropine
diphenhydramine
trihexphenidyl

add beta blocker = propranolol

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14
Q

what is tardive dyskinesia

A

involuntary movement disorder that can occur with long-term antipsychotic treatment and may not be reversible even if the medication is discontinued.

usually involves the orofacial region, but all parts of the body can be involved. Abnormal movements can include myoclonic jerks, tics, chorea, and dystonia. They become most evident when patients are aroused, but ease during relaxation and disappear during sleep.

Attempts to treat tardive dyskinesia usually begin by discontinuing the offending agent or switching to one with a lower risk, but evidence is insufficient to show that this or any other treatment markedly reduces symptoms after onset

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15
Q

Risk factors for tardive dyskinesia

A

long-term therapy with FGAs at higher dosages, older age, female sex, and concurrent affective disorders

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16
Q

TX of tardive dyskinesia

A

D/C med or reduce dosage

Clozapine (Clozaril) shown some efficiancy

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17
Q

New med for tardive dyskinesia

A

avobenzone

18
Q

S/S of neuroleptic malignant syndrome

A

fever 103- 105 degrees Fahrenheit or greater
diaphoresis
muscle rigidity: arm/abdomen board like-with corresponding increased CPK levels
labile BP: hypotension or hypertension
tachycardia: > 130 bpm
Tachypnea: >25 rpm
agitation: r/t respiratory distress
mental status changes; stupor /coma

19
Q

predisposing factor to neuroleptic malignant syndrome

A

dehydration

usually associated with antipsychotics

20
Q

Interventions with neuroleptic maligant syndrome

A

stop all antipsychotics

Dantrolene
Bromocriptine
Levodopa
lorazepam

21
Q

What are Atypical antipsychotics and what do they treat

A

serotonin and dopamine antagonists

treat positive and neg symptoms

22
Q

benefits to atypical antipsychotics

A

minimal to no EPS or tardive dyskinesia

23
Q

Disadv to atypical antipsychotics

A

weight gain
metabolic syndrome

24
Q

Atypical Antipsychotic meds

A

clozapine (Clozaril)
olanzapine (Zyprexa)
quentiapine (Seroquel)
respiridone (Respiradol)
Respiradol Consta
ziprasidone (Geodon)

25
Q

3rd Gen antipsychotic meds

A

aripiprazole (Abilify)
brexpiprazole (Rexulti)
cariprazine (Vraylar)

26
Q

what are 3rd gen antipsychotics

A

dopamine system stabilizers (pos and neg; improve cognitive function)
subset of 2nd gen atypicals

27
Q

S/E of Atypical Antipsychotics

A

Sedation
Nausea & vomiting (usually stops after 2 weeks)
Less likely to cause anticholinergic effects, orthostatic hypotension, seizures, EPS
More likely to cause major weight gain and changes in a person’s metabolism leading to metabolic/endocrine problems including diabetes and hyperprolactinemia
Potential for cardiac dysrhythmias / even sudden cardiac death
Rhinitis
Sexual dysfunction
More costly than the typical antipsychotics

28
Q

Nursing considerations with metabolic syndrome

A

monitor weight and girth
initial glucose tolerance test
monitor blood glucose
provide nutrition & activity,
support
consider lifestyle

29
Q

Tx of refractory schizo

A

Clozaril

30
Q

Fatal side effect of Clozaril

A

agranulocytosis

31
Q

what is agranulocytosis

A

A reduction in the number of circulating
granulocytes and decreased production of
granulocytes that limit one’s ability to
fight off infection.

32
Q

discontinue clozaril if…and monitor timeline

A

WBC falls below 3000 mm or granulocytes
fall below 1500

Monitor WBC weekly for first 6 months; then
every other week

33
Q

long acting medications that only require admin every 2-4 wks

A

fluphenazine decanoate
haloperidol decanoate
risperidone microspheres
paliperidone palmitate
olanzapine long-acting injectable
aripiprazole microspheres

34
Q

psychotic depot injections = long lasting 2 weeks

A

haloperidol (Haldol decanoate)
risperidone (Consta)
paliperidone (Invega Sustenna)

35
Q

what must patients have to obtain long acting depot meds

A

transportation

36
Q

what is Invega Trinza

A

3 month injection atypical antipsychotic

37
Q

what must patients have before invega Trinza

A

invega sustenna = 1 month for at least 4 months

38
Q

todissolvable antipsychotic meds

A

olanzapine (Zydis)
risperidone (Risperdal M-tab)
asenapine (Saphris)

39
Q

CANS

A

toxins effecting meds

caffeine
Alcohol
Nicotine
Sugar

40
Q

what med is not given to children

A

Typical AP due to risk of Tardive Dyskinesia

41
Q

T/F For most individuals’ symptoms improve with medications & psychosocial interventions

A

True