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Week 2 Flashcards

1
Q

Which drug class is Chlorpromazine in?

A

Typical antipsychotic (works on positive symptoms)
Phenothiazine first gen antipsychotic

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2
Q

Which drugs are first generation (typical psychotics)?

A

Haloperidol and chlorpromazine hydrochloride

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3
Q

What are delusions?

A

False beliefs that persist even in the absence of reason

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4
Q

What is paranoia?

A

Belief that others are trying to control their thoughts and are out to get them

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5
Q

What is the basic patho of schizophrenia

A

Abnormal neurotransmission systems - Especially dopamine, serotonin, and glutamate

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6
Q

When does schizophrenia usually present in males and females?

A

Early 20s for males
Later 20s, early 30s females

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7
Q

What are positive symptoms?

A

Present but should not be there

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8
Q

What are negative symptoms?

A

Missing but should be there

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9
Q

What is the goal when treating psychosis?

A

Relieve symptoms with minimal/tolerable side effects

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10
Q

What do first generation antipsychotics do?

A

Block dopamine receptors
Depress RAS

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11
Q

What is the MOA of chlorpromazine?

A

Blocks dopamine receptors in the brain

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12
Q

How is chlorpromazine given?

A

PO or IM (Ventrogluteal)

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13
Q

What is the pathway for chlorpromazine?

A

Metabolized in the liver and excreted in the urine

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14
Q

What are the indications for chlorpromazine?

A

Schizophrenia
Treatment of psychotic symptoms r/t brain impairment

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15
Q

When can chlorpromazine be used in children?

A

Pre-op anxiety
Psychosis in children older than 6 months
Treatment of nausea/vomiting

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16
Q

What is a precaution r/t to giving chlorpromazine to older adults?

A

Small doses and titrate

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17
Q

How else can Chlorpromazine be used?

A

In the critically ill to treat delirium

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18
Q

What are some side effects of chlorpromazine in the critically ill?

A

Anticholinergic symptoms
Hypotension/tachycardia
Arrhythmias
Extrapyramidal symptoms
Lowers seizure threshold

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19
Q

What are adverse effects of chlorpromazine?

A

Seizures and sedation
Extrapyramidal movements
Neuroleptic malignant syndrome
Prolonged QT
agranulocytosis

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20
Q

What drug can cause neuroleptic malignant syndrome and what are the symptoms?

A

Chlorpromazine

Fever, muscle rigidity, decreased LOC, diaphoresis, arrhythmia

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21
Q

What are the contraindications for chlorpromazine?

A

Liver disease
Coronary artery disease
Parkinson’s disease
Bone marrow depression
Severe hypo/hypertension

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22
Q

What are some nursing considerations for chlorpromazine?

A

Inpatient for psychosis: IM s 48-72 hours until pt can take PO meds
IM: supine positioning for 30-60 minutes
PO: 1-2 hours before bedtime; contact dermatitis can happen if the liquid hits the skin
Take with food

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23
Q

How to assess if chlorpromazine is working?

A

Decreased- agitation, combativeness, psychomotor activity
Decreased hallucinations and/or delusions

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24
Q

What are some monitoring rules for chlorpromazine?

A

Baseline ECG
I/O and daily weight to assess for dehydration
CBC, renal/hepatic function
CNS depression and abnormal movements
Aspiration risk

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25
What are some teaching points for chlorpromazine?
Avoid OTC meds and alcohol Keep hydrated Orthostatic hypotension
26
What drug class is Haloperidol?
Nonphenothiazine first generation antipsychotic Typical antipsychotic
27
What is the MOA of haloperidol?
Blocks dopamine receptors in the brain Not fully understood
28
What is Haloperidol used for?
Used to control symptoms of schizophrenia and psychotic disorders
29
What is the pathway for Haloperidol?
Metabolized in the liver and Excreted in urine and bile
30
How is Haloperidol given?
PO or IM ventrogluteal
31
What are some special precautions for Haloperidol?
Black box warning for children- Extrapyramidal and withdraw symptoms in those exposed Older adults- Not approved for dementia-related psychosis- increased risk of death in those with a hx of it
32
What are some adverse effects of Haloperidol?
Prolonged QT Extrapyramidal, Neuroleptic malignant syndrome Hyper/hypoglycemia
33
What are contraindications for Haloperidol?
Parkinson’s disease Seizure disorder Severe depression
34
Nursing considerations for haloperidol?
Put in a light protected container Deep in dorsogluteal muscle
35
How to assess if Haloperidol is working?
Pt is thinking clearer Pt is calmer and less anxious
36
What are some monitoring tidbits for Haloperidol?
Heart rate blood pressure Watch for respiratory depression Adverse effect includes increase in temperature Have pt lay down for an hour after giving if they have orthostatic hypotension
37
What are some labs to watch when someone is given Haloperidol?
EKG- prolonged QT blood glucose Baseline renal and hepatic
38
What are some education topics for Haloperidol?
Report symptoms of adverse effects including: tardive dyskinesia (uncontrolled facial movements), dystonia (uncontrolled muscle spasms), and akathisia (hard to stay still)
39
What do typical and atypical antipsychotics work on?
Positive symptoms- typical Negative symptoms- atypical
40
What is the drug class of Clozapine?
Second generation antipsychotic
41
What is the drug example for second generation antipsychotics?
Clozapine
42
What is the MOA of clozapine?
Unclear Blocks dopamine, serotonin, and glutamate receptors
43
What is the use of clozapine?
For treatment resistant schizophrenia To reduce suicide risk in schizophrenia or schizo affective disorders
44
What is the pathway of clozapine?
Liver metabolizes, excreted in urine/feces
45
What are some special population considerations for clozapine?
Children should only receive with treatment resistant disease- higher risk of agranulocytosis Black box warning for elderly with dementia - not approved for dementia related psychosis
46
When is clozapine contraindicated?
Pregnancy Immunocompromised Diabetics Those with seizure disorders
47
What are adverse effects of clozapine?
Severe constipation Myocarditis Infection risk Hyperglycemia
48
How should the nurse assess a pt who is given clozapine during an acute psychotic episode?
The nurse should observe for sedation, decreased agitation, combativeness, and psychomotor activity
49
How should the nurse assess a pt who is given clozapine for an acute or chronic psychosis?
Decreased psychotic behaviors
50
What are some monitoring rules for clozapine?
CBC frequent ANC Glucose temperature
51
What are some teaching points for clozapine?
Take 1 week of medication at a time Report lethargy, weakness, flu like symptoms to provider
52
What do the dopamine sites of action relate to with addiction?
Alcohol, amphetamines, cocaine, nicotine
53
What do the norepinephrine sites relate to with addiction?
Amphetamines and cocaine
54
What drug class is Chlordiazepoxide?
Benzo for acute alcohol withdrawal
55
What is the pathway of Chlordiazepoxide?
Metabolized in liver and excreted in kidneys
56
What are contraindications for Chlordiazepoxide?
Pregnancy and lactation Glaucoma Shock Acute alcohol intoxication
57
What are adverse effects of Chlordiazepoxide?
CNS depression Paradoxical reactions Anticholinergic symptoms Jaundice
58
How to monitor and assess pts on Chlordiazepoxide?
Neuro assessment and sedation level Check for adverse effects Monitor heart rate and BP and 02 levels Keep eye on urine and liver enzymes labs
59
What is the drug that is a benzo for acute alcohol withdrawal?
Chlordiazepoxide
60
What drug class is Disulfiram in?
Enzyme inhibitor for maintenance alcohol sobriety
61
What is the drug that is an enzyme inhibitor for maintenance of alcohol sobriety?
Disulfiram
62
What is the MOA of disulfiram?
Inhibits aldehyde dehydrogenase to block the oxidation of alcohol
63
What happens when disulfiram is taken with alcohol?
Produces unpleasant reactions when taken with alcohol
64
What is the pathway of disulfiram?
Metabolized in the liver slowly and excreted in the lungs and feces
65
What is the indication for disulfiram
Chronic alcoholism to maintain sobriety
66
What are adverse effects when disulfiram is taken with alcohol?
Arrhythmia Cardiovascular collapse MI Death
67
What are contraindications for disulfiram?
Use with alcohol Multiple drug dependence History of MI, coronary occlusion, or psychosis
68
Teaching for disulfiram?
Never consume alcohol in any form or hold the medication if alcohol is consumed Includes mouthwash, OTC cold meds, vinegars, sauces
69
What drug class is methadone hydrochloride in?
Opioid agonist
70
What is the drug within the class opioid agonist
Methadone hydrochloride
71
What is the MOA of methadone hydrochloride?
Binds And activates opioid receptors
72
What is an important consideration for methadone hydrochloride?
Risk of death when started; emergency services on standby, QT prolongation
73
What are contraindications for methadone hydrochloride?
Acute/severe asthma in uncontrolled setting Paralytic ileus Significant respiratory depression
74
What are some adverse effects of methadone hydrochloride?
Prolonged QT bronchospasm
75
What are some nursing considerations and teaching for methadone hydrochloride?
Compliance with daily dosing at clinic Monitor QT prolongation Many pts abuse other drugs while on methadone
76
What drug class is Naltrexone in?
Opioid antagonist
77
What drug is within the class opioid antagonist?
Naltrexone
78
What is the MOA of naltrexone?
Block opioid from binding to receptor sites Suppresses/blocks cravings
79
What are the uses for naltrexone?
Opioid dependence and treatment of alcoholism
80
What are contraindications for naltrexone?
Hepatitis Acute opioid withdrawal Concurrent use of opioid meds (positive urine screening)
81
What are adverse effects of naltrexone?
Suicidal ideation ITP pneumonia Hepatotoxicity
82
What are some nursing considerations and teaching for naltrexone?
Risks of using large doses of opioids during/after naltrexone therapy can result in coma, serious injury, and death Monitor suicidal ideation
83
What drug class is Buprenorphine?
Opioid-agonist antagonist
84
What drug is in the class opioid-agonist antagonist?
Buprenorphine
85
What is the MOA of Buprenorphine?
Binds to opioid receptors to cause sedation and decreased pain
86
What are the uses for Buprenorphine?
Opioid withdrawal/maintenance and treatment of severe pain
87
What drug are side effects of Buprenorphine similar to?
Morphine
88
What is the pathway of Buprenorphine?
Metabolized in the liver and excreted in the urine or feces
89
What are some nursing considerations and teaching r/t Buprenorphine?
Fatal overdose in children who accidentally ingest it Naloxone (Narcan) is the overdose anecdote Has serious drug interactions with other CNS depressants

Pharm (9 decks)

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