week 4 pharm Flashcards
antipsychotics & mood stabilizers
Lithium
*range 0.5 to 1.2 mEq/L
- inverse relationship w sodium
- first line of treatment for acute mania & depression
-prevents manic & depressive episodes - mood stabilizer that prevents mood cycling (3-6 weeks)
*interacts w NSAIDS & diuretics & anticholinergics & antidepressants
expected side effects of Lithium
sedation
acne
nausea
excessive thirst
hand tremors
weight gain
early lithium toxicity
1.2 - 1.5
* hold med & call dr
n/v/d
muscle weakness
slurred speech
advanced lithium toxicity
> 1.5
-excess sweating
-vomiting
-diarrhea
EEG changes
-hand tremor
- muscle hyper-irritability
- GI upset
- confusion
-incoordination
*stupor
*blurrred vision
*affects KIDNEYS
**treated w normal saline bolus
long term effects of Lithium
hypothyroidism - goiter
kidney dysfuction
weight gain
*assess levels every 6 months
Anticonvulsants
1st line of treatment mood stabilizer – bipolar mania, hypomania, mixed states, cycling
*ValPROic Acid
*DivalPROex
*ValPROate
Expected side effects of valPROic Acid
*anticonvulsant
tremor
sedation
GI pain
hair loss
weight gain
blood dyscarias – anemia & thrombocytosis
hepatotoxicity
pancreatitis
*taken in patients w kidney dysfunction
lithium affects ____ buut anticonvulsants affect _____
lithium = kidneys
anticonvulsants = liver
anticonvulsant therapeutic levels & toxicity symptoms
*ValPROic Acid
*DivalPROex
*ValPROate
85 - 125 ug/mL
toxic = intentional overdose
- ataxia (loss of body movement)
- confusion
- somnolence
-coma
Carbamazepine
anticonvulsant
treats bipolar disorder, rapid cycling, mixed states
treats & prevents acute mania
*MONITOR FOR RASHES
Adverse effects of Carbamazepine
*anticonvulsant = mood stabilizer
- hyponatremia & fluid overload
- decreases effectoveness of birth control
- blood dyscrasias
- hepatic disease
RASH
*fatigue & nausea
*diplopia (double vision)
*ataxia
Lamotrigine treats ___ & adverse effects
**anticonvulsant = bipolar depression–acute &maintenance
- monitor for FEVER = aseptic meningitis
- lower birth control effectiveness
- Steven Johnsons
Anxiolytics are
Benzodiazepenes = Clonazepam & Lorazepam
given when concerned about heart or delirium
adjunctive agents for acute mania & psychomotor agitation
second - generation antipsychotics are best for
non-compliance for acute mania, bipolar depression, & their prevention
first-generations antipsychotics
Chlorpromazine
Loxapine
Fluphenazine
Haloperidol
- treat POSITIVE symptoms
- used less = adverse effects
extrapyramidal symptoms of first-generation antipsychotics
*PSEUDOPARKINSONISM - fall risk
*ACUTE DYSTONIA - (muscle & laryngeal symptoms - concern for airway)
*AKATHISIA- (restless feet & extreme stress- suicide risk)
*TARDIVE DYSKINESIA - (face droop- irreversible)
other side effects of 1st gen antipsychotics
lowered seizure threshold
orthostatic hypotension
sedation
increased prolactin = sex dysfunction, amenorrhea, galactorrhea
*high fall risk
adverse effects of first gen antipsychotics
*METABOLIC SYNDROME
*prolonged QT interval
*anticholinergic toxicity
*neuroleptic malignant syndrome
metabolic syndrome presents as..
weight gain, hypertension, diabetes, & dyslipidemia
anticholinergic toxicity presents with..
*dry mouth
*urinary retention
anxiety, hallucinations, hyperactivity, seizures, & delirium
symptoms disappear w stop of first gens
Neuroleptic Malignant Syndrome presents as
*high fever (103-105)
*muscle rigidity (monitor DVT & rhabdomyolysis)
*increased vitals
*altered mental status
Second & Third Generation Antipsychotics
*CLOZAPINE - last resort
*ARIPIPRAZOLE - sedating
*RISPERIDONE - stroke risk
*LURASIDONE
*OLANZIPINE - gain weight
*QUETIAPINE - high street value & homeless
treat NEGATIVE & POSITIVE
when using clozapine
*monitor for FEVER
*AGRANULOCYTOSIS - WBC’s
drooling
mycarditis
*last-resort
Injectable Antipsychotics
Haldol
Aripriprazole
Risperidone
Olanzipine
Ziprasidone
*must be stable on PO verison first
when evaluation antipsychotic medication effectiveness the nurse should ask about..
*have the symptoms LESSENED
*medication ADHERENT
*support system
lithium levels during a manic episode
0.8 to 1.4
okay to administer next dose if patient is within the range
a client’s lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse?
- Perform immediate gastric lavage
- Prepare the client for hemodialysis
- Administer an additional oral dose of lithium
- Request a stat repeat of the lab test
- Perform immediate gastric lavage
when a client has a lithium level of 2.5 mEq/L the nurse should..
prepare the client for hemodialysis
When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following?
- Avoid the use of acetaminophen for headaches
- restrict intake of foods rich in sodium
- decrease fluid intake to less than 1,500 ml daily
- limit aerobic activity in hot water
- limit aerobic activity in hot water — avoid activities that have the potential to cause sodium & water depletion
a nurse is caring for a client who has a new prescription for valproic acid. the nurse should instruct the client to have which of the following laboratory tests completed periodically? sap
- thrombocyte count
- glucose
- amylase
- liver function tests
- potassium
- thrombocyte count
- amylase (pancreatitis)
- liver function tests
a nurse is assessing a client who recently egan taking haloperidol. which of the following findings in the priority to report to the provider?
- shuffling gait
- neck spasms
- drowsiness
- sexual dysfunction
- neck spasms
*acute dystonia=respiratory insufficiency
a nurse is providing teaching for a client who is to begin taking risperidone. which of the following instructions should the nurse include?
- “add extra snacks to your diet to prevent weight loss. “
- “notify the provider if you have trouble sleeping.”
- “you may begin to have mild seizures while taking this medication.”
- “this medication is likely to increase your libido.”
- “notify the provider if you have trouble sleeping.”
a nurse is following up witha client who takes chlorpromazine for treatment of schizophrenia. the nurse should expect to find the greatest improvement in which of the following manifestations? sap
- disorganized speech
- bizarre behavior
- impaired social interactions
- hallucinations
- decreased motivation
- disorganized speech
- bizarre behavior
- hallucinations
chlorptomazine = 1st gen = positive manifestations
