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Medications for Psychotic Disorders (ATI Ch. 22)
Terms in this set (50)
This type of medication is primarily administered for schizophrenia spectrum disorder. (positive and negative symptoms)
schizophrenia (clinical course)
involves acute exacerbations with interval of semi remission in which manifestations remain present but are less severe.
2 types of symptoms (schizophrenia)
positive and negative symptoms
these types of symptoms are related to behavior, thought, and speech. agitation, delusions, hallucinations, tangential speech patterns.
these types of symptoms consist of social withdrawal, lack of emotion, lack of energy, flattened affect, decreased motivation and anhedonia. (think of a person who looks depressed).
suppression of acute episodes, prevention of acute recurrence and the maintenance of the highest possible level of function.
1st generation antipsychotic (conventional)
are used to control positive symptoms of psychotic disorders and are reserved for client who are using them successfully and can tolerate the adverse effects and violent or particularly aggressive. Act on dopamine but are possibly related to the increase appearance of negative symptoms.
2nd generation antipsychotic (atypical)
This is the current medication of choice for clients receiving initial treatment, and for treating breaking episodes in client on conventional medication therapy, because they are more effective with fewer adverse effects.
atypical antipsychotic (advantages)
are used to control positive and negative symptoms, decreased in affective findings (depression, anxiety) and suicidal behaviors. Improvement of neurocognitive defects, such as poor memory. Fewer or no EPS, including tradeoff dyskinesia, due to less dopamine blockage, fewer anticholinergic effects (except clozaril) little to no blockage of cholinergic receptors and less relapse.
1st generation medications
haldol (high potency), thorazine (low potency), prolaxine
1st generation medication (purpose)
block dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery. Inhibition of psychotic symptoms is believed to be a result of dopamine blocked in the brain.
1st generation medication (therapeutic uses)
used to treat acute or chronic psychotic disorders, schizophrenia spectrum disorder, bipolar disorder primary for the manic phase, toutter's disorder and the prevention of nausea/vomiting through blocking of dopamine in the chemoreceptor trigger zone of the medulla.
1st generation mediation (complications)
agranuloxytosis, anticholinergic effects, acute dystonia, parkinsonism, akathisia, tradive dyskineneia, neuroendocrine effects, neuroleptic malignant syndrome, orthostatic hypotension, sedation, seizures, severe dysrhythmias, sexual dysfunction and skin effects.
agranulocytosis (1st gen)
advise client for indications of infection (fever, sore throat). Need to obtain baseline WBC. Medication needs to be discontinued if laboratory test indicate infection.
anticholinergic effects (1st gen)
dry mouth, photophobia, constipation, blurred vision, urinary hesitancy or retention and tachycardia. 2 to 3 L/day, voiding before taking medications, exercise, high fiber, sip water, sunglasses and gum.
acute dystonia (1st gen)
severe spasm of the tongue, neck, face and back. this is a crisis situation that requires rapid treatment. Monitor anywhere between 5hr to 5 days after administration of first dose. Treat with anticholinergic agents such as cogent or benadryl.
parkinsonism (1st gen)
bradykinesia, shuffling gait, tremors, rigidity and drooling. Observe for this for the first month after the initiation of therapy. Treat with cogent, benadryl or Symmetrel.
akathisia (1st gen)
inability to sit or stand still and continual pacing and agitation. Observe for akathisia for the first 2 month after the initiation of treatment. Manage with beta-blockers, benzo or anticholinergic medications.
tardive dyskinesia (1st gen)
Late EPS, involuntary moment of the tongue and face, such as lip smacking and tongue fasciculations. Involuntary movement of the arms, legs and trunk. Administer lowest dosage possible to control manifestation. Evaluate the client after 12 months of therapy and then every 3 months. Manifestations may occur months to years after the initiation of therapy. If TD appears dosages should be lowered or the client should with to an atypical agent.
neuroendocrine effects (1st gen)
menstrual irregularities, galactorrhea and gynecomastia (men boobs)
neuroleptic malignant syndrome (1st gen)
sudden high fever, dysrhythmias, changes in level of consciousness, coma, muscle rigidity, blood pressure fluctuation. occurs within the first 2 weeks of treatment, stop medication, monitor vitals, apply cooling blanket, administer aspirin or acetaminophen, increase fluid intake, administer tantrum and paralleled to induce muscle relaxation and wait 2 weeks before resuming therapy.
orthostatic hypotension (1st gen)
client should develop tolerance in 2 to 3 months. if lightheadedness or dizziness occurs advise client to lie back down. Can be minimized by getting up or changing positions slowly.
sedation (1st gen)
should diminish within a few weeks. take the medication at bedtime to avoid daytime sleepiness. Don't drive until sedation has subsided.
seizures (1st gen)
at a greater risk of client already has existing seizure disorder. an increase of anti seizure medication may be necessary.
severe dysrhythmias (1st gen)
obtain clients ECG and potassium levels prior to treatment and periodically throughout the treatment period. avoid medications that prolong QT intervals.
sexual dysfunction (1st gen)
will affect both males and females. advise the client of possible adverse effects. May need dosage lowered or switched to a high-potency agent.
skin effects (1st gen)
photosensitivity and avoid direct contact with the medication.
1st generation mediation (precautions)
contraindicated in clients who have severe depression, parkinson's disease or severe hypotension, dementia. use cautiously in clients who have liver, kidney disease and seizure disorders.
1st generation mediation (interactions)
anticholinergic agents like (sleep aids) may increase effects. CNS depressants (alcohol, opioids and antihistamines). Levodopa because it activate dopamine receptors.
1st generation mediation (nursing)
Use AIMS abnormal Involuntary Movement Scale (AIMS) to screen EPS, observe for worsening of a psychotic disorder, administer anticholinergic, beta-blockers, and benzo to control early EPS. Antipsychotic medication do not cause addiction, take on a regular schedule, therapeutic effects not noticeable within a few days but significant improvement may take 2 to 4 weeks or possibly several months for full effects. Begin administration with twice daily dosing, but switch to daily dosing at bedtime to decrease daytime drowsiness and promote sleep.
2nd generation medications atypical
Risperdal/invega, abilify saphris, latuda, clozaril, zyprez, geodon, seroquel.
2nd generation medications (purpose)
these antipsychotic agents work mainly by blocking serotonin, and to a lesser degree, dopamine receptors. These medication also block receptors for norepinephrine, histamine, and acetylcholine.
2nd generation medications (uses)
negative and positive symptoms of schizophrenia spectrum disorders, psychosis induced by levodopa therapy and relief of psychotic manifestation in other disorders such as bipolar disorder.
2nd generation medications (adverse)
new onset of diabetes, weight gain, hypercholesterolemia, orthostatic hypotension, anticholinergic effects, mild EPS and agitation, dizziness, sedation and sleep disruption.
2nd generation medications (diabetes)
loss of glucose control for those who had diabetes or client who has no history of diabetes. base line fasting blood glucose throughout therapy. thirst, urination and appetite.
2nd generation medications (weight)
may increase weight, advise client to eat healthy, monitor weight gain and exercise.
2nd generation medications (hypercholesterolemia)
increase hypertension and other cardiovascular disease. monitor cholesterol, triglycerides and blood glucose if weight gain is greater than 30 lbs.
2nd generation medications (orthostatic hypotension)
monitor BP and heart rate for orthostatic changes. Hold medication if significant changes.
2nd generation medications (agitation, dizziness, sedation and sleep disruption)
administer an alternative medication if prescribed.
2nd generation medications (mild EPS)
this includes tremors use the AIMS test to screen for EPS.
Not for client who have dementia. my cause death related to cerebrovascular accident of infection. avoid use of alcohol and use cautiously in client who have Cardio and cerebrovascular disease, seizure, or diabetes.
low or no risk of EPS, diabetes, weight gain, orthostatic hypotension and anticholinergic effects. Adverse effects include sedation, headache, anxiety, insomnia and GI upset.
only sublingual tablets, low risk of diabetes, weight gain, dyslipidemia and anticholinergic effects. adverse effects include drowsiness, PROLONG QT interval, EPS (high dose) temporary numbing of the mouth.
low risk for diabetes, weight gain and dyslipidemia. does not have anticholinergic effects and common adverse effects include sedation, akathisia, parkinsonism, agitation and anxiety and nausea.
low risk of EPS, high risk of diabetes, weight gain, dyslipidema. adverse effects include sedation, orthostatic hypotension and anticholinergic effects.
significant risk for diabetes, weight gain, and dylipidemia. adverse effects include sedation, prolonged QT interval, orthostatic hypotension, anticholinergic effects and mild EPS.
low risk of EPS, moderate risk of diabetes, weight gain, and dyslipidemia. adverse affect include cataracts, sedation, orthostatic hypotension and anticholinergic effects.
low risk of EPS, high risk of weight gain, diabetes, and dyslipidemia. risk of fatal agranulocytosis. baseline weekly monitoring of WBC recommended. adverse effects include sedation, orthostatic hypotension and anticholinergic effects. Need to monitor for signs of immune suppression. First of all the other 2nd generation medications.
2nd generation medications (nursing)
advise client that low doses of medication are given initially, and dosages are then gradually increased. can use abilify, saphris and clozaril if client attempts to pocket or cheek medications. can administer lurasidone with food to increase absorption. Cost can be a factor.
2nd generation medications (med effectiveness)
improved by preventing acute psychotic manifestations, absence of hallucinations, dulusions, anxiety, hostility. Improved ADL's, socially with peers, sleeping and eating habits.
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