Psych Meds 1

  1. What are the typical (first generation) antipsychotics and their generic names?
    • Chlorpromazine (thorazine/CPZ)
    • Fluphenazine (Prolixin)
    • Perphenazine (Trilafon)
    • Haloperidol (Haldol)
    • Loxapine (Loxitane)
    • Thiothixene (Navane)
  2. What are the atypical (second generation) antipsychotics and their generic names?
    • Clozapine (Clozaril)
    • Risperidone (Risperdal)
    • Olanzepine (Zyprexa)
    • Quetiapine (Seroquel)
    • Paliperidone (Invega)
    • Lurasidone (Latuda)
    • Ziprasidone HCL (Geodon)
    • Aripiprazole (Abilify) [Technically 3rd generation]
  3. What are the characteristics of chlorpromazine (thorazine/CPZ)?
    • First anti-psychotic on the market
    • Strong sedative effect
    • Decreases BP, decreasing energy
    • Moderate EPSE risk
  4. What are the characteristics of Fluphenazine (prolixin)?
    • Low sedative effect
    • Neutral action on BP
    • Strong risk of EPSE
  5. What are the characteristics of Perphenazine (Trilafon)?
    • Low sedative effect
    • Neutral action on BP
    • Strong risk of EPSE
  6. What are the characteristics of Haloperidol (Haldol)?
    • Used mainly in emergency situations, acutely
    • Butyrophenone: most widely used in this class
    • Metabolized in the liver
    • PO, IV, IM, PRN, scheduled, long-acting
    • More likely to have anticholinergic effects
  7. What are the characteristics of Loxapine (Loxitane)?
    • Dibenzoxazepine
    • Moderately sedating
    • Strong risk of EPSE
    • Hypotension common
  8. What are the characteristics of Thiothixene (Navane)?
    • Thioxanthene
    • Low sedation and hypotension
  9. What does the 5150 emergency cocktail include, and what are the intended effects of each drug?
    • 5 mg Haldol, ↓ psychosis
    • 1 mg Ativan, ↓ anxiety, ↓ muscle tension
    • 50 mg Benadryl, ↓ sleep
  10. What is NMS?
    • Neuroleptic Malignant Syndrome
    • Potentially fatal
    • Symptoms: muscle rigidity, sudden high fever (up to 105* even!), altered LOC, fluctuations in BP (take it more than once), tachycardia, dysrhythmias, seizures, rhabdomyolysis (breaking down of muscles), ARF (acute renal failure), respiratory failure, coma, death.
  11. How do you treat NMS?
    • Immediately stop the antipsychotic medication.
    • IV fluids to hydrate
    • Hypothermia blankets
    • Administration of antipyretics, benzodiazepines, muscle relaxants
  12. What are the side effects of first generation anti-psychotic drugs?
    • Drowsiness
    • Extrapyramidal symptoms (EPS)
    • Orthostatic Hypotension
    • Dry mouth (anticholinergic effects)
    • Confusion
    • Dystonia
    • Hallucinations
    • ↑ HR
    • Urinary retention
    • Constipation
    • Hyperpyrexia
    • HTN
    • Tardive Dyskinesia
    • Akathisia
  13. How do you help reduce drowsiness from first generation anti-psychotic medications?
    Get the patient eating, drinking, and on a regular sleep cycle.
  14. How do you treat dystonia from first generation anti-psychotics?
    • Anticholinergic meds
    • IM diphenhydramine (Benadryl)
  15. What do you do when a patient develops tardive dyskinesia from their antipsychotic meds?
    Stop the medication and get them started on a different, less symptomatic med.
  16. How do you treat akathisia from antipsychotic meds?
    • Bring the med dose down slowly to reduce the side effect
    • Beta blockers (propanolol)
    • Benzodiazepines
  17. What are the adverse considerations for typical antipsychotic meds?
    • High doses and long term use can cause agranulocytosis.
    • Strong photo-sensitivity
    • Pruritis
    • Lowers seizure threshold
    • Sedative effect increased with use of alcohol, benzodiazepines, narcotics, hypnotics
  18. What do you do when a patient develops agranulocytosis?
    • Take labs (WBCs)
    • Monitor for infection
    • Stop their anti-psychotic med
  19. What important interventions should you do when dealing with a patient having adverse reactions to a typical antipsychotic?
    • Do not leave the patient
    • Put them on their back when taking them down, not on their stomach
    • Educate them about the side effects of the medication
  20. What are the metabolic considerations for typical antipsychotics?
    • Highly protein bound
    • Metabolized in the liver and excreted in the urine
    • Metabolites can cause urine to turn pinkish/brown, which is harmless
    • Document urine color change
    • Take labs before, during and after administration to monitor for toxicity
  21. When do you expect to see improvement after administration of anti-psychotic meds and when do they reach their full therapeutic effect?
    • Some improvement in 7-10 days
    • Full therapeutic effect in 3-6 weeks
  22. Why is there a high non-compliance rate for anti-psychotic meds?
    • Anosognosia
    • Not thinking clearly in psychotic state
    • Side effects
    • Most people do not want to be forced to take drugs
  23. What is the most common expected side effect of typical antipsychotic meds?
  24. When do extrapyramidal symptoms usually show up?
    5-30 days after starting anti-psychotic meds
  25. What are the common anticholinergics?
    • Benztropine (Cogentin)
    • Trihexyphenidyl HCl (Artane)
    • Diphenhydramine (Benadryl)
  26. What are the common side effects of anticholinergic meds?
    • Dry mouth
    • Constipation
    • Blurred vision
    • Fever
    • Hot/dry skin
    • Sexual dysfunction
  27. What are other side effects of anticholinergic meds?
    • Decreased production of sweat, saliva and secretions
    • Decreased gut motility
    • Urinary retention
    • Eczema
    • Increased esophageal reflux
    • Cardiac infarction
    • May increase absorption of neuroleptic drugs, resulting in higher plasma levels
    • Increases hepatic enzymes
  28. What are the symptoms of anticholinergic toxicity?
    • Confused state/delirium
    • Flushed, dry skin
    • Fever
    • Tachycardia
    • Arrhythmias
    • Rapid breathing
    • Widely dilated pupils
    • Urinary retention
    • Constipation
  29. What are the special considerations for Ziprasidone HCl (Geodon)?
    • It is limited to people without heart conditions and are younger. 
    • Check EKG regularly
  30. What are the common side effects for atypical antipsychotic meds?
    Weight gain, metabolic complications, metabolic syndrome (diabetes, hyperlipidemia, coronary artery disease)
  31. What medication is most likely to cause weight gain and metabolic syndrome?
    Olanzepine (Zyprexa)
  32. What are the nursing implications for a patient taking atypical anti-psychotic medications?
    • LDL/HDL labs
    • BP
    • BG
    • Weight
  33. How does cigarette smoking affect anti-psychotic drug use?
    Increases metabolism, affecting half-life.
  34. What important patient teaching points should a patient taking atypical anti-psychotics consider?
    • Lab work q 3 months
    • Wear a medical ID band
    • Avoid direct sunlight
    • Quit smoking
    • Orthostatic hypotension
    • Caution use of alcohol, narcotics, OTC meds
  35. What are the different types of anxiolytics?
    • Benzodiazepines
    • Azapirones
    • Metathizanone
  36. What are the benzodiazepines?
    • Lorazepam (Ativan)
    • Clonazepam (Klonopin)
  37. What is the trade name for Buspirone and what type of drug is it?
    • BuSpar
    • Azapirone anxiolytic
  38. What is the trade name for Chlormezanone and what type of drug is it?
    • Trancopal
    • Metathizanone anxiolytic
  39. What other type of drug is used as an antianxiety besides anxiolytics?
    • Antidepressants:
    • SSRIs (escitalopram (Lexapro))
    • SNRIs (venlafaxine (Effexor))
    • NaSSA: (mirtazapine (Remeron))
  40. What is the important patient teaching for anxiolytics?
    • Benzos are short term and PRN due to dependence
    • Wean off drug
    • Best taken at night
    • Available as tablet or disintegrating tablet
  41. What are the common side effects of anxiolytics?
    • Sedation
    • Lightheadedness
    • Ataxia
    • Decreased cognitive fxn
  42. What are the withdrawal symptoms for anxiolytics?
    • Irritation
    • Insomnia
    • Tremors
    • Nausea
    • Sweating
  43. What is the important drug-drug interaction for MAOIs?
    • It can be fatal if used with an antipsychotic
    • Need a 14 day lapse before starting
  44. What drugs do you want to caution a patient when taking antipsychotics and anxiolytics, and why?
    • Digoxin (potentiates)
    • Warfarin (potentiates)
    • Diazepam (potentiates)
    • Increased risk of bleeding with ASA/NSAIDS
  45. What drugs, when taken concurrently with antipsychotics and anxiolytics, increases the risk for serotonin syndrome?
    • St. John's Wort
    • SAMe
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Psych Meds 1
Psych Meds 1 of 2