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34 Cards in this Set
- Front
- Back
What are some common uses for antipsychotic meds?
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Tx primary and secondary psychosis
Acute rage/agitation Vomiting and vertigo Intractable hiccoughs To augment analgesics in tx of pain Tourette's Syndrome |
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What are the side effects of antipsychotics?
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Sedation (chemical straight-jacket effect)
Orthostatic hypotension (fall precautions) Seizures (decreased threshold) Alterations in sexual functioning Anticholinergic effects Decreased tolerance to alcohol Photosensitivity (wear sunglasses) Cardiac Changes GI distress Other: increased appetite; false/positive pregnancy, amenorrhea, galactorrhea (breast milk production) |
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What are the extrapyramidal side effects (EPS)?
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Apathy
Akathisia Dyskinesia Dystonia Pseudo-parkinsonism TardiveDyskinesia |
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What it acute dystonic reactions? (DEF & DESCRIPTION)
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Severe muscle spasms that can be life-threatening if not treated immediately.
1. Torticollis- twisting of neck and back 2. Opisthotonus- arching of the back 3. Oculogyric Crisis- eye rolling to back of head 4. Laryngospasm- throat spasm affecting breathing 5. Oral/facial/maxillary spasms |
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DEF
Torticollis |
Severe twisting of the neck and back
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DEF
Opisthotonus |
Severe arching of back
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DEF
Oculogyric Crisis |
Severe rolling back of the eyes into the head
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DEF
Laryngospasm |
Spasm of the throat in which breathing and swallowing become severely impaired and emergency tracheotomy maybe required
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DEF
Oral-facial-maxillary spasms |
Spasms of the face, lips, and tongue making it very difficult to talk, chew, and eat.
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What is the treatment for acute dystonic reactions?
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IM administration of diphenhydramine, 25mg or benzotropine, 0.5-1mg.
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DEF & DESCRIPTION
Dyskinesias |
Abnormal muscle movements, not as severe as spasms
1. Facial tics/twitches 2. Chewing movements 3. Lip smacking 4. Blinking 5. Aimless movement of the tongue 6. Shoulder shrugging 7. Pedaling movements of legs 8. Flailing arms |
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What is the treatment for dyskinesias?
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Decrease dose
Some pt require prophylactic tx with anti-parkinsonian agents (ex:benztropine 1-2mg up to QID) |
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DEF & DESCRIPTION
Tardive Dyskinesia |
Late onset of any dyskinesias. Usually does not occur until 4-6 months after tx with a neuroleptic has begun.
Can also occur with antidepressants that affect dopamineneurons |
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What is the treatment for tardive dyskinesia?
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1. Prevention (reg re-evaluation of drug dosages and assessments for beginning side effects
Must be tx after first symptom to prevent permanent damage 2. Maintenance on lowest dose of medication |
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DESCRIPTION
Parkinsonian reactions |
1. Stiffness & slowness of voluntary movement
2. Masklike immobility of facial muscles 3. Stooped posture 4. Slow, monotonous speech 5. Shuffling gait speeds up on its own 6. Immobility |
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What is the treatment for parkinsonian reactions?
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IM or IV administration of diphenhydramine or benzpine
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DEF & DESCRIPTION
Akathisia |
Nearly continuous muscle activity, less intense than dystonias or dyskinesias
1. Intolerance of inactivity 2. Continuous agitation and restlessness 3. Pacing 4. Constant leg and finger movements |
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What is the treatment for akathisia?
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Changing to a different neuroleptic or decreasing the dose
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What is an Abnormal Involuntary Movement Scale (AIMS)?
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An objectiv.e scale to assess for tardive dyskinesia
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What are some metabolic syndromes that occur as a complication of antipsychotic meds.
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1. Insulin resistance
2. Hypertension 3. High serum lipids 4. Obesity 5. Coagulation abnormalities 6. Associated with higher rates of diabetes |
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What are some frequently used neuroleptics?
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His Hadol
Majesty Mellaril Promises Prolixin Successful Stelazine and Novel Navane Treatment Thorazine |
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What are nursing implications for Clozaril (Clozapine)
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1. Adverse reaction: agranulocytosis (decreased WBC)
2. Blood must be monitored frequently and regularly when on maintenance |
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What are the doses and uses for Risperidone (Risperdal)?
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1. Start with 1mg BID and titrate up to 4-8mg/day
2. Other uses: behavioral problems, mental retardation, dementia, thought rumination * available in depot as Risperdal Consta |
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What are the side effects and doses of Olanzapine (Zyprexa)?
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1. Sedation is a major side effect
2. Titrate up to 20mg/day |
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What are the doses, side effects nursing implications of Ziprasidone (Geodon)?
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1. Sedation and headache are major side effects; not reported to cause weight gain
2. Average dose is 10-15mg/day *Available as an injection *Must be taken with 1g of fat to be efficient |
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What are the doses and side effects of Aripiprazole (Abilify)?
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1. Can be dosed daily
2. Side effects: headache, anxiety, insomnia; less sedating, weight change of 1kg over 1 year |
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What drugs are used to treat EPS?
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Cogentin (benztropine)
Artane (trihexyphenidyl) Benedryl (diphenydramine) Inderal (propranolol) |
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What is the classification and actions of Cogentin (benztropine)?
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Anticholinergic
Dopamine blocked= decreased ratio of actylcholine/dopamine: restores balance |
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What is the dosage range for Cogentin (benztropine)?
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1-3mg BID; available in IM
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What are the side effects of Cogentin (benztropine)?
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dry mouth
blurred vision urinary hesitancy constipation memory impairments |
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What is Cogentin (benztropine) commonly used to treat?
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pseudo-parkinsonian
dystonia EPS |
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What is the classification of Artane (trihexyphenidyl); is the med available in IM?
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Anticholinergic
No IM available |
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What is the classification and indication for Benadryl (diphenydramine)?; is it available in IM?
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Antihistamine
Available in IM Often given for acute episodes of dystonia |
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What is the classification and indication for Inderal (propranolol)?
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Beta blocker
May be given to treat akathsia |