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Ashland ABSN > treatment of schizophrenia (329 E1) > Flashcards

treatment of schizophrenia (329 E1) Flashcards

1
Q

goals for treatment

A

-safety in all settings
-physical care
-stabilization on meds
-education to pt & fam
-psychosocial support

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2
Q

failure of pt to take prescribed meds can lead to

A

-risk of relapse
-risk of suicide or self harm
-risk of violence toward others
-increased mortality rates
-potential for hospital readmission
-decline in quality of life
-social and occupational difficulty

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3
Q

antipsychotic medications are used to treat

A

schizophrenia
takes 2 to 6 weeks for meds to become effective

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4
Q

antipsychotics

A
  • work better on positive symptoms
  • typical have less side effects
  • do not have risk for overdose
  • are not addictive
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5
Q

what type of medication is best for adherence

A

long term injectable

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6
Q

common side effects of antipsychotic medications

A

-extrapyramidal SE
-anticholinergic SE
-neuroleptic malignant syndrome
-metabolic syndrome

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7
Q

extrapyramidal SE (EPS)

A

-acute dystonic reactions
-akathisia
-pseudoparkinsonism
~the above start w/n a few weeks of starting new med or w/ inc dose
-tardive dyskinesia
worst SE of typical antipsychotics, leads to lack of adherence

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8
Q

first gen typical antipsychotics

A

-chlorpromazine
-haloperidol
-fluphenazine
-thioridazine
-perphenazine

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9
Q

typical antipsychotics typically treat

A

the positive symptoms of schizophrenia & little effect on negative symptoms
used less than atypical d/t lack of effect on negative sx

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10
Q

advantages of typical antipsychotics

A

less expensive than atypical antipsychotics

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11
Q

disadvantages of typical antipsychotics

A

-EPS
-anticholinergic
-sedation, wt gain, metabolic syndrome, neuroleptic malignant syndrome, sexual dysfunction, endocrine disturbances, cardiovascular issues
-increased risk of seizures

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12
Q

EPS: acute dystonic reactions

A

-a sudden, sustained contraction of one or several muscle groups, usually of the head & neck areas
-can be painful, frightening & uncomfy (inc anixety)
-not dangerous unless they involve muscles affecting the airway
-an emergency

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13
Q

acute dystonic reactions: torticollis

A

spasmodic and painful spasm of muscles (head pulled to one side)

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14
Q

acute dystonic reactions: oculogyric crisis

A

eyes roll back toward the head

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15
Q

acute dystonic reactions: laryngeal dystonia

A

spasm of throat impairing breathing and swallowing

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16
Q

EPS: akathisia

A

-motor restlessness manifested as excessive pacing, inability to remain still for any length of time, rocking while seated or shifting from one foot to the other while standing
-can be severe and distressing and can be mistaken for anxiety or agitation (dx correctly bc admin of more of the med will make it worse)
-should go away w/ treatment but can persist despite treatment

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17
Q

Akathisia treatment

A

-a dose reduction or change in medication
-give anticholinergic agent such as benztropine
-provider may add meds such a propranolol, lorazepam or diazepam (short term use only)
-relaxation exercises

18
Q

Pseudoparkinsonism

A

temporary sx that resemble parkinson’s
-stiff & stooped posture
-shuffling gait
-bradykinesia
-pill rolling
-treumulousness
-dysphagia

19
Q

Pseudoparkinsonism treatments

A

-ID of the med and slow / safe discontinuation
-dosage reduction
-addition of oral anticholinergic agents such as benztropine or trihexyphenidyl to alleviate sx

20
Q

EPS: tardive dyskinesia

A

-involuntary rhythmic movement disorder that can occur w/ long term antipsychotic treatment; varies from mild to severe
-usually involves the oral and facial muscles and progresses to include the fingers, toes, neck, trunk or pelvis (tongue protruding)
-changes may be very slow or gradual and dx can be missed

21
Q

treatment for tardive dyskinesia

A

-reduce or discontinue antipsychotic med (sx will continue)
-switch to 2nd gen med
-give med to help with sx if cannot change med (valbenazine or deutetrabenazine)

22
Q

anticholinergic SE

A

-dry mouth, blurred vision, dry eyes, constipation, urinary retention/hesitancy, drowsiness, dizziness, confusion, hallucinations, tachycardia, skin flushing

23
Q

neuroleptic Malignant Syndrome (NMS)

A

-rare
-usually associated w/ antipsychotics
-early detection increases pt’s chance of survival

24
Q

NMS S/s

A

-severe muscle rigidity
-altered mental status
-inc body temp over 103
-htn
-tachycardia
-tachypnea
-diaphoresis
-incontinence

25
Q

progressive S/s of NMS

A

-rhado / protein in the blood causing organ failure
-acute resp failure (strongest predictor of mortality)
-acute kidney injury
-sepsis

26
Q

treatment of NMS

A

-prompt detection
-immediately stop all antipsychotics
-supportive treatment of sx
-ICU
-meds to treat: dantrolene sodium, bromocriptine mesylate, lorazepam

27
Q

2nd generation atypical antipsychotics

A

-clozapine
-riseridone
-olanzapine
-questiapine
-ziprasidone

28
Q

third generation atypical antipsychotic overview

A

(subset of 2nd gen)
-dopamine system stabilizers
-may improve positive & negative sx + cognitive functions
-little risk of EPS or tardive dyskinesia

29
Q

third gen drugs

A

-aripiprazole
-brexpiprazole
-cariprazine

30
Q

2nd generation overview

A

-treat both positive and negative sx
-less likely to cause TD or EPS
-less antipsychotics classic side effects

31
Q

disadvantages of 2nd gen

A

-tendency to cause significant wt gain
-risk of metabolic syndrome
-expensive

32
Q

atypical antipsychotics SE

A

-sedation
-major wt gain leading to metabolic/endocrine problems
-potential for cardiac dysrhythmias / sudden cardiac death
-sexual dysfunction
-less likely for anti chol SE, orthostatic hypotension, seizures & EPS

33
Q

if pt is at risk for metabolic syndrome

A

-monitor wt & girth
-initial glucose tolerance test
-monitor blood glucose
-provide nutrition & activity support
-consider lifestyle

34
Q

clozapine

A

-has been effective in treating refractory schizophrenia that doesn’t respond to normal treatment has to have failed success w/ other meds
-results in decreased negative symptoms, inc impulse control, reduced violence to self and others & improved quality of life

35
Q

clozapine SE

A

potentially fatal SE of agranulocytosis

36
Q

agranulocytosis

A

-a reduction in the number of circulating granulocytes and decreased production of granulocytes that limit one’s ability to fight off infection
-life threatening condition
-particularly risky w/ clozapine; greater risk during first months of treatment
-WBCs drops to dangerous levels
-monitor WBC weekly for first 18 wks of treatment and then based on provider thereafter

37
Q

agranulocytosis

A

-discontinue medicine if pt develops leucopenia or neutropenia
-reversible if treated early

38
Q

long acting injectable medications

A

-pts that are at risk non adherence to prescribed treatments may take medication that is available in injectable form
-long acting and require administration only once every 2 to 4 wks or even up to months
-must have transportation to receive the injection

39
Q

long acting drugs

A

haloperidol decanoate
risperidone microspheres
aripiprazole

40
Q

additional treatment approaches from meds

A

-ECT
-cognitive behavioral therapy
-group therapy
-family therapy
-social skills training
-case mgt
-support groups

41
Q

prognostic consideration of schizophrenia

A

-meds improve sx
-good quality of life
-some do not fully response to treatment leaving mild to severe residual sx & varying degree of disability
-few require repeated or lengthy inpatient care

42
Q

factors contributing to repeated or lengthy inpatient care

A

-slow onset of the disease
-younger age at onset
-longer duration between first sx and first treatment
-longer periods of untreated illness
-more negative sx

Ashland ABSN (172 decks)

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