schizophrenia/parkinsons Flashcards
What is schizophrenia?
A chronic psychotic illness characterized by disordered thinking and a reduced ability to comprehend reality.
What are the three types of schizophrenia symptoms?
Positive (added behaviors), Negative (loss of normal behaviors), and Cognitive (thinking and memory difficulties).
What are examples of positive symptoms of schizophrenia?
Hallucinations, acting out, psychotic behavior, disordered thinking, delusions, “the voices.”
What are examples of negative symptoms of schizophrenia?
Social and emotional withdrawal, lack of affect, lack of motivation.
What are examples of cognitive symptoms of schizophrenia?
Poor concentration/attention, impaired working memory, difficulty processing and making decisions.
What are extrapyramidal side effects (EPSs) of FGAs?
Acute dystonia, parkinsonism, akathisia, tardive dyskinesia.
What is acute dystonia, and how is it treated?
Spasms of the tongue, neck, face, or back that occur within hours to days of medication. Treated with IM/IV diphenhydramine or benztropine.
What is parkinsonism, and how is it treated?
Bradykinesia, rigidity, shuffling gait, drooling, tremors. Treated with IM/IV/PO diphenhydramine, benztropine, or amantadine.
What is akathisia, and how is it treated?
Inability to stand still or sit, pacing, agitation. Treated with beta-blockers, benzodiazepines, or anticholinergics.
What is tardive dyskinesia (TD), and how is it treated?
Involuntary movements of the tongue, face (lip-smacking), arms, legs, or trunk after months to years of use. Treated with valbenazine.
What is Neuroleptic Malignant Syndrome (NMS)?
A life-threatening reaction to antipsychotic medications.
What are the symptoms of NMS?
Fever, rigidity, autonomic instability, altered mental status.
How is NMS treated?
Stop antipsychotic, monitor VS, cooling blanket, antipyretics, hydration, benzodiazepines, dantrolene & bromocriptine for muscle relaxation, treat dysrhythmias, transfer to ICU.
What are metabolic adverse effects of second-generation antipsychotics (SGAs)?
Diabetes mellitus, weight gain, hypercholesterolemia.
Which SGAs are contraindicated in pregnancy and lactation?
Clozapine, risperidone.
What interactions should be considered with SGAs?
Clozapine & immunosuppressants, alcohol, opioids, antihistamines, levodopa, TCAs, amiodarone, clarithromycin, CYP450 interactions.
What are depot preparations, and why are they used?
Long-acting IM injections given once every few weeks to improve medication adherence in patients with paranoia.
What are oral disintegrating tablets, and why are they used?
Tablets that dissolve in the mouth to prevent patients from “cheeking” or hiding the medication.
What are the goals of schizophrenia treatment?
Suppress acute episodes, prevent recurrence, and maintain the highest possible level of function.
What is Parkinson’s disease?
A neurodegenerative disorder caused by decreased dopamine levels, leading to motor impairment.
What is the first-line treatment for Parkinson’s disease?
Carbidopa/Levodopa (Sinemet).
What are second-line treatments for Parkinson’s disease?
Dopamine agonists (Pramipexole, Ropinirole, Rotigotine transdermal).
What are third-line treatments for Parkinson’s disease?
MAO-B inhibitors (Selegiline, Rasagiline, Safinamide).
What are anticholinergics used for in Parkinson’s?
To block acetylcholine and improve dopamine function (Trihexyphenidyl, Benztropine).
What are dopamine releasers used for in Parkinson’s?
Amantadine increases dopamine release.
What are COMT inhibitors used for in Parkinson’s?
Prevent the breakdown of dopamine (Entacapone, Opicapone, Tolcapone).
What is the “wearing-off” effect in Parkinson’s treatment?
Loss of drug effectiveness over time, requiring dose adjustments or additional medications.
What is “on-off syndrome” in Parkinson’s treatment?
Periods of good symptom control followed by sudden loss of effectiveness.
What are adverse effects of levodopa/carbidopa?
N/V, drowsiness, orthostatic hypotension, dyskinesias, psychosis, impulse control disorders, discoloration of sweat/urine, risk of malignant melanoma.
How should protein intake be managed with levodopa?
Avoid high-protein meals at dosing times to prevent absorption interference.
What is an important nursing consideration for Parkinson’s medications?
Do not discontinue abruptly, monitor for “on-off” and “wearing-off” effects, avoid pregnancy.
