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46 terms

Antipsychotics

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First Generation
D2 Antagonism. Effective against positive symptoms of schizphrenia.
Second Generation
D2/5-HT2a antagonism. Effective against positive and negative symptoms.
Drug specific side effects: metabolic (weight gain, glucose dysregulation, dyslipidemia), cardiac, sedation, EPS/hyperprolactinemia
Also known as Atypical antipsychotics. Are used for first line treatment (except for Clozaril)
First generation side effects
extrapyramidal symptoms, tardive dyskinesia, sedation and weight gain, orthostatic hypotension and tachycardia, dry mouth,constipation, blurred vision, hyperprolactinemia
Akathesia Symptoms
restlessness, jumping out of skin, uncomfortable, may be miss diagnosed as anxiety symptoms
Akathesia Nursing implications
reduce dose of antipsychotic and treat with a beta blocker (propanolol)
Parkinsonism Onset and etiology
Onset: later in treatment
Etiology: Blockade of D2 eceptor in basal ganglia
Parkinsonism Symptoms and Nursing implications
Symptoms re identical to symptoms of Parkinson's
Intervention: treat with anticholinergic medication.
Can increase confusion and psychosis
Nursing interventions for EPS
Diphenhydramine hydrochloride (Benadryl), Bromocriptine Mesylate (Parlodel), Benztropine mesylate (Congentin), Trihexyphenidyl (Artane)
Dystonia Onset, etiology and risk factors
Onset: 1st week of treatment
Etiology: imbalance of DA and ACH, more ACH
Risk factors: young men more vulnerable
Dystonia Symptoms
Oculogyric crisis (rotating eyeballs), torticollis (twisted neck), retrocollis, facial grimacing and laryngeal spasms
Dystonia Nursing intervention
Immediate administration of Benadryl 25-50 mg IM
Tardive Dyskinesia Symptoms
Onset: 6-8 months after initiation of antipsychotics
Initial stages are in facial-buccal area (lip smacking, sucking etc)
Later stages: impairment of involuntary movement, constant motion, movements in trunk, rocking
Tardive Dyskinesia Nursing Implications
IRREVERSIBLE, no treatment. See primarily with typical antipsychotics. Would d/c antipsychotic and switch to a newer atypical or Clozapine. Use AIMS to screen
Risk Factors for Tardive Dyskinesia
Older adult, women, African American, Psychiatric diagnosis, cognitive deficits, chemical abuse, extrapyramidal symptoms, brain damage, diabetes mellitus, history of mood disorders, treatment inconsistencies, early onset of EPSs. Higher rates in 1st generation antipsychotics
Second Generation Antipsychotics mechanism of action
Block dopamine and serotonin
Are newer and more efficacious and safer
Risperidone (Risperdal, M-Tabs and Consta)
second generation atypical.
Side effects: hypotension, insomnia, sedation, Rare TD or NMS, sexual dysfunction, weight gain, moderate lipid abnormalities
Olanzapine (Zyprexa)
Second generation atypical.
Side effects: Significant weight gain, high lipid abnormalities, drowsiness, agitation and restlessness, insomnia, possibly akathisia or parkinsonism
Quetiapine (seroquel)
second generation atypical
Side effects: weight gain, moderate lipid abnormalities, headache, drowsiness, orthostasis
Ziprasidone (Geodone)
Second generation atypical
Side effects: ECG changes, QT prolongation, low propensity for weight gain, targets depressive symptoms
Aripiprazole (Abilify)
Second generation atypical.
Side effects: Little or no weight gain or increase in glucose, HDL, LDL or triglyceride levels
Monitoring and administering second generation
takes 1-2 weeks to start working, will be some improvement immediately . Adequate trial is 6-12 weeks. Adherence to the prescribed medication is the best prevention of relapse
Second generation efficacy
Reduction of positive and negative symptoms, some improvement of cognition, broad range of efficacy
Side effects of second generation
Low rates of EPS and TD. Few anticholinergic effects. Pronounced weight gain (half of patients will have 20% increase), type II diabetes, QT prolongation
Risk factors for type II DIabetes
Obesity, >45 years of age, African American, hispanic, asian, south asian, native american, pacific islander, gestational diabetes, hypertension, dyslipidemia, impaired fasting glucose or glucose tolerance
Novel/ atypical Antipsychotics
Clozapine (Clozaril)
Efficacy of novel antipsychotics
reduction of positive and negative symptoms. Improvements for patients considered treatment-refractory. Decreased suicidal behavior
Side effects of Atypical antipsychotics
Low EPS, TD. Risk of agranulocytosis. Risk of significant orthostatic hypotension. Risk of respiratory/cardiac arrest. Moderate to high weight gain. Potential for seizures. Anticholinergic adverse effects
Agranulocytosis Symptoms
Onset: 4-10 weeks on medication.
Symptoms: sore throat, fever, malaise.
Lab values: Neutrophil count <500/mm, WBC =2,000-3,000/mm
Agranulocytosis Nursing interventions
Hold medication, reverse isolation, carefully monitor CBC's. Is often misdiagnosed as the flu.
Neuroleptic Malignant Syndrome Symptoms
severe muscle rigidity, elevated temperature. Change in level of consciousness, leukocytosis, elevated creatinine phosphokinaase, elevated liver enzymes or myoglobinuria
Neuroleptic Malignant syndrome Nursing interventions
Stop administration of drug, take vital signs, reduce body temperature, safety, protect muscles, IV fluids, cardiac monitoring, Dantrolene
Anticholinergic Crisis
potentially life threatening, anticholinergic delirium
Anticholinergic crisis Risk factors
Can occur in patients who are taking several medications with anticholinergic effects
Anticholinergic Crisis Symptoms
Confusion, hallucinations, dilated pupils, blurred vision, facial flushing,dry mucous membranes, difficulty swallowing, fever, tachycardia, hypertension, decreased bowel sounds, urinary retention, nausea, vomiting, seizures, coma

HOT as a hare, BLINd as a bat, MAD as a hatter, DRY as a bone
Anticholinergic crisis nursing implications
discontinue medication. Gastric lavage. Charcoal, catharsis. Physiostigmine 1-2 mg IV (an inhibitor of cholinesterase, improves in 24-36 hours)
Clozapine (Clozaril)
Not first line, for refractory cases only. Side effects: Agranulocytosis, high seizure rate, significant weight gain, high lipid abnormalities, excessive salivation, tachycardia
Haloperidol (Haldol)
High potency. First generation. Low sedative properties. Used in large doses for assaultive patients
Less chance of falls from dizziness or hypotension
High incidence of extrapyramidal effects
Trifluoperazine (Stelazine)
High potency. First generation. Low sedative effect. Good for symptoms of withdrawal or paranoia. high incidence of extrapyramidal side effects. Neuroleptic malignant syndrome may occur
Fluphenazine (Prolixin)
High potency. First generation. least sedating. Effective when given every 2-4 weeks
Thiothixene (Navane)
High potency. First generation. High incidence of akathisia
Loxapine (Loxitane)
Medium potency. First generation. Possibly associated with weight reduction
Molindone 9Moban)
Medium potency. First generation. Possibly associated with weight reduction
Perphenazine (Trilafon)
Medium Potency. First generation. Can help control severe vomiting
Chlorpromazine (Thorazine)
Low Potency. First generation. Increases sensitivity to sun. Highest sedative and hypotensive effects. May cause irreversible retinitis pigmentosa
Chloroprothixene (Taractan)
Low potency. First generation. Weight gain is common
Thioridazine (Mellaril)
Low potency. First generation. NOT Recommended as frst-line antipsychotic. Dose-related severe ECG changes, may cause sudden death