Test 2: Antipsychotics

Question 1

What are anti-psychotics indicated for?

Answer 1

Schizophrenia, delusional disorders, bipolar disorder, depressive psychoses, and drug-induced psychoses.

Question 2

Outside of their normal uses antipsychotics are also used to treat:

Answer 2

Emesis

Tourette’s syndrome Huntington’s chorea

Question 3

Should antipsychotics be used to treat dementia related psychosis in older adults?

Answer 3

No

Question 4

What are the 2 groups of antipsychotic drugs?

Answer 4

FGA (First Generation Antipsychotics_

SGA (Second generation antipsychotics)

Question 5

What type of movement disorders can antipsychotics cause?

Answer 5

extrapyramidal movement

Question 6

It is crucial for the RN to monitor patients treated with antipsychotic medications for symptoms of ___, and to report them immediately if present.

Answer 6

EPS

Question 7

Which type of Antipsychotics cause EPS?

Answer 7

FGA

Question 8

What receptors do FCA’s block?

Answer 8

Dopamine

Question 9

What receptors do SGA’s block?

Answer 9

Dopamine, serotonin (much stronger)

Question 10

In which type of antipsychotics is the risk of EPS less?

Answer 10

SGA’s

Question 11

Why is the risk of EPS less in SGA’s?

Answer 11

Only moderate blockage of dopamine unlike FGA’s

Question 12

Chronic illness characterized by disordered thinking and reduced comprehension of reality:

Answer 12

Schizophrenia

Question 13

When do symptoms of schizophrenia usually emerge?

Answer 13

Adolescence or early adulthood

Question 14

Schizophrenia symptoms can be divided into 3 groups what are they?

Answer 14

Positive
Negative
Cognitive

Question 15

Which type of antipsychotics have an increased risk of: metabolic effects but not EPS
EX: (weight gain, diabetes, and dyslipidemia- causes cardiovascular events and early death. )

Answer 15

SGA’s

Question 16

Schizophrenia symptoms that: exaggeration or distortion of normal function

Answer 16

Positive

Question 17

Examples of positive symptoms:

Answer 17

(1) Hallucinations
(2) Delusions (fixed false beliefs)
(3) Agitation
(4) Tension
(5) Paranoia

Question 18

Schitzophrenia symptoms that include: loss or diminution of normal function.

Answer 18

Negative symptoms

Question 19

Examples of negative schizophrenia symptoms:

Answer 19

(1) lack of motivation
(2) poverty of speech
(3) blunted affect
(4) poor self-care
(5) social withdrawal

Question 20

Schotzophrenia symptoms that include: Disordered thinking, Reduced ability to focus attention and Prominent learning and memory difficulties would fall into which category?

Answer 20

Cognitive

Question 21

All FGA’s have the ability to relieve psychosis, but how do they differ? In terms of _______

Answer 21

Potency

Question 22

The term potency refers only to the _____ of the dose needed to elicit a given response; potency implies nothing about the maximal effect a drug can produce.

Answer 22

size

Question 23

How do FGA’s differ the most? In terms of their ____________

Answer 23

Side Effects

Question 24

How long do antipsychotics take to have full effects?

Answer 24

2-4 weeks for substantial effects, possible months for full

Question 25

What is the worst side effect FGA's can produce?

Answer 25

Tardive Dyskinesia

Question 26

Why can parkinson's-like symptoms occur in patients taking antipsychotics?

Answer 26

Because antipsychotics affect the extrapyramidal motor system which is the same neuronal network that parkinsons symptoms come from.

Question 27

How would parkinsons-like symptoms present in a patient taking an antipsychotic?

Answer 27

- Bradykinesia (slow movement) - masklike facies (staring eyes and slightly open mouth) - drooling - tremor - rigidity - shuffling gait - cogwheeling (muscles move with slight hesitations) - stooped posture.

Question 28

Slow involuntary facial movements (lip smacking, tongue flickin) are a side effect experienced by 15-20% of patients taking long term FGAs. What is this disorder called?

Answer 28

Tardive Dyskinesia

Question 29

What are the early onset extra pyramidal side effects of antipsychotic drugs?

Answer 29

Acute Dystonia Parkinsonism Akathisia

Question 30

Spasms of muscles of tongue, face, neck, and back; opisthotonus (spasm of the muscles causing backward arching of the head, neck, and spine) is an extrapyramidal side effect of antipsychotics called:

Answer 30

Acute Dystonia

Question 31

Bradykinesia, mask-like facies, tremor, rigidity, shuffling gait, drooling, cogwheeling (rigidity in upper limb), stooped posture are an extrapyramidal side effect of antipsychotics called:

Answer 31

Parkinsonism

Question 32

Compulsive, restless movement; | Symptoms of anxiety, agitation are an extrapyramidal side effect called:

Answer 32

Akathisia

Question 33

What is the late onset extrapyramidal side effect that comes with antipsychotics

Answer 33

Tardive Dyskinesia

Question 34

Compare high and low potency FGA's

Answer 34

Compared to low potency FGAs, high potency ones cause more early EPS, but less sedation, orthostatic hypotension, and anticholinergic effects. High potency are generally preferred for initial therapy

Question 35

Characterized by “lead pipe” rigidity, sudden high fever, and autonomic instability. Level of consciousness may rise and fall.

Answer 35

Neuroleptic Malignant Syndrome

Question 36

If a patient develops NMS what should the nurse do?

Answer 36

1. Report Immediately 2. Withdraw the drug 3. Supportive measures

Question 37

What two drugs can help NMS?

Answer 37

1. Dantrolene-( a direct-acting muscle relaxant that reduces rigidity and hyperthermia.) 2. Bromocriptine-( a dopamine receptor agonist that may relieve CNS toxicity.)

Question 38

FGAs produce varying degrees of muscarinic cholinergic blockade, and can elicit the full spectrum of __________ responses.

Answer 38

anticholinergic

Question 39

Antipsychotic drugs promote orthostatic hypotension by blocking _______-adrenergic receptors on blood vessels.

Answer 39

alpha1

Question 40

Antipsychotic drugs can increase circulating levels of prolactin, a hormone that can cause:

Answer 40

gynecomastia and galactorrhea

Question 41

Can FGA's cause sexual dysfunction?

Answer 41

Yes

Question 42

Three FGAs—(haloperidol, thioridazine, and pimozide)—pose a risk of fatal cardiac dysrhythmias. What is the mechanism of this?

Answer 42

Prolonged QT interval

Question 43

When used off-label to treat older adult patients with dementia-related psychosis, all antipsychotics (FGAs and SGAs) about _______ the rate of mortality.

Answer 43

double

Question 44

Which type of FGA's produce more EPS?

Answer 44

High Potency

Question 45

Which type of FGA's initially produce less side effects?

Answer 45

High Potency

Question 46

What is the common well known SGA that is the most affective against schitzophrenia?

Answer 46

Clozapine

Question 47

Why is clozapine more dangerous?

Answer 47

It can cause agranulocytosis

Question 48

Because of the risk of agranulocytosis with SGA's what must be monitored?

Answer 48

White blood cell and neutrophil count

Question 49

Which type of antipsychotic can cause new onset diabetes?

Answer 49

SGA

Question 50

Drug therapy of schizophrenia has three major objectives:

Answer 50

(1) to suppress acute episodes, (2) to prevent acute exacerbations, (3) to maintain the highest possible level of functioning.

Question 51

A nurse assesses a patient receiving haloperidol. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings.

Answer 51

Akathisia

Question 52

Antipsychotics should be avoided in what population due to an increased risk of mortailty?

Answer 52

Elderly patients with dementia

Question 53

A patient taking an antipsychotic who experiences sudden high fever is likely experiencing a symptom of:

Answer 53

Neuroleptic Malignant Syndrome