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Anticholinergic effects
- Dry mouth
- Blurred vision
- Constipation
- Urinary Retention
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Interventions with dry mouth
- provide the clients with sugarless candy or gum ice and frequent sips of water
- Strict oral hygiene
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Interventions with blurred vision
- explain that this sympton will most likely subside after a few weeks
- advise client not to drive a car until vision clears
- clear small items from pathways to prevent falls
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Inverventions with constipation
order food high in fiber, encourage increase physical activity , and fluid intake if not contradicted
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Interventions with urinary retention
- instruct client to report any difficulty urinating
- monitor intake and output
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Which drugs are more common with the reduction on seizure threshold
more common with the typical than the atypical antipsychotic drugs, with the exception on clozapine
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Which drug should be closely observed for seizures, and should be used with extreme caution when there is a history of seizures
Clozaril- atypical
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Which drugs are more common with agranulocytosis
Typical than the atypical , with the exception of clozapine
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When does agraulocytosis usually occur, and what are the signs and symptoms
- Within the first 3 months of treatment
- Sore throat, fever, and malise (CBC should be done immediately)
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If given Clozapine, what should you expect to be monitored in refrence to agranulocytosis?
acceptable range?
- base line wbc and anc
- counts done weekly for the first 6 months
- then biweekly and monthly after that
- wbc- 3500
- anc-2000
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EPS Is more common with what drugs?
Typical antipsychotics
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EPS signs and symptoms (5)
- Pseudoparkinsonism
- akinesia
- akathisia
- dystonia
- oculogyric crisis
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Tremor, shuffling, gait, drooling, rigidity
symptoms appear 1-5 days following initition of antipsychotic meds, occurs mostly in women, the elderly and dehydrated clients
Pseudoparkinsonism
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Muscular weakness
Akinesia
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Continuous restlessness and fidgeting
Occurs mostly in women, symptoms may occur 50-60 days folloiwing intiation of therapy
Akathisia
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involuntary muscular movement (spasms) of face arms legs and neck
this occurs most often in mena and in people younger than 25 yrs old
Dystonia
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Uncontrolled rolling back of the eyes
oculogyric crisis
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what eps symptoms should be treated as a medical emergency?
Dystonia and oculogyric crisis
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What drug is mostly common with tardive dyskinesia
may occur with all classifications but more common with typical antipsychotic drugs
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Bizarre facial and tongue movements, stiff neck and difficulty swallowing
Tardive dyskinesia
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Who is more at risk for developing tardive dyskinesia
reversible or no?
what is usually the first sign?
all clients receiving long term therapy
potentially irreversible
vermiform movements of the tongue
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What drugs are more common to have neuroleptic malignant syndrome?
More common with the typical thatn the atypical medications
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signs and symptons of nms
- severe parkinsonian muscle rigidity
- very high fever
- tachycardia
- tachpnea
- fluctuations in bp
- diaphoresis
- rapid deterioration of mental status to stupor and coma
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when can onset occur for nms
within hours or even years after drug initiation and progression is rapid over the following 24-72 hours
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what should you monitor for nms
- Vital signs
- degree of muscle rigidity
- intake and output
- level of consciousness
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Antiparkinsonian agents used for symptoms of eps
side effects for these?
- Cogentin- anticholinergics
- Benadryl- antihistamin
Anticholinergic effects, n&v, sedation, dizziness, orthostatic hypotention, exacerbation of psychoses
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