Psychiatric Medication Class
Adverse Reaction for Clozaril
: agranulocytosis, drowsiness, dizziness, GI symptoms, Neuroleptic malignant syndrome.
Adverse Reaction for Seroquel
: drowsiness, dizziness, headache, EPS, weight gain, anticholinergic effects.
Nursing Implications Fluphenazine (Prolixin)
Absorbed slowly Used with noncompliant clients because it can be administered IM once every 14 days
Amantadine (Symmetrel)
Anti-parkinson
Benztropine (Cogentin)
Anti-parkinson
Diphenhydramine (Benadryl)
Anti-parkinson
Trihexyphenidyl (Artane)
Anti-parkinson
What happens if acetylcholine ACh does not stimulate Muscarinic receptors
Antiparasympathetic effects blurred vision dry mouth constipation urinary retention/hesitancy nasal congestion
What drug has the lowest risk of Metabolic syndrome
Aripiprazole (Abilify) - it's a dopamine system stabilizer
what is Aripiprazole (Abilify) class
Atypical
Aripiprazole (Abilify)
Atypical Anti-psychotic
Clozapine (Clozaril)
Atypical Anti-psychotic
Olanzapine (Zyprexa)
Atypical Anti-psychotic
Olanzapine + Fluoxetine (Symbyax)
Atypical Anti-psychotic
Olanzatine long acting injectable (Relprevv)
Atypical Anti-psychotic
Paliperidone (Invega)
Atypical Anti-psychotic
Paliperidone long-acting injectable (Sustenna)
Atypical Anti-psychotic
Quetiapine (Seroquel)
Atypical Anti-psychotic
Risperidone (Risperdal)
Atypical Anti-psychotic
Ziprasidone (Geodon)
Atypical Anti-psychotic
Asenapine (Saphris)
Atypical Anti-psychotic approved 2009
iloperidone (Fanapt)
Atypical Anti-psychotic approved 2009
What causes increased weight increased blood glucose increased tryglyceride levels
Blockade of Histamine and serotonin receptors
Traditional Drugs Phenothiazine
Chlorpromazine (Thorazine) Trifluoperazine (Stelazine) Thioridazine (Mellari) Perphenazine (Trilafon) Triflupromazine (Vasprin) Loxapine (Loxitane) Molindone (Moban) Fluphanazine (Prolixin)
Examples of Low Potency Drugs include
Chlorpromazine (Thorazine) T Thioridazine (Mellaril) T Clozapine (Clozaril) AT
Phenothiazine - Traditional Drugs
Chlorpromazine - Thorazine Fluphanazine - Prolixin Long Thioridazine - Mellari Trifluoperazine - Stelazine Perphenazine - Trilafon Following listed as Phenothiazines in HESI & Non-Phenothiazines in HCC Learning Packet Triflupromazine - Vasprin Loxapine - Loxitane Molindone - Moban
Indications for Use of Long Acting Traditional Standard & Typical
Clients who require supervision with medication regimens
Indications for use of following drugs Fluphenazine (Prolixin Decanoate) Haloperidol (Haldol Decanoate)
Clients who require supervision with medication regimens
What class of Anti-psychotic drugs are used to treat Tourette's Syndrome Post-surgical intractable hiccoughs Antiemetics
Conventional or traditional
Beside psychosis, what other psychiatric disorders are Anti-psychotic drugs used to treat
Depression Autism Bipolar (mania) disorder Tourette's Syndrome Post-surgical intractable hiccoughs Antiemetics
Extrapyramidal effects - can result from a blockage of what hormone
Dopamine
Adverse Reactions Fluphenazine (Prolixin) Phenothaiazine
Drowsiness Orthostatic hypotension Weight gain Anticholinergic effects Extrapyramidal effects Pseudo-Parkinsonism Akathisia Dystonia Tardive Dyskinesia Photosensitivity Blood Dyscrasias granulocytosis leukopenia Neuroleptic Malignant syndrome
Adverse Reactions For Use of Traditional or Typical Phenothiazine - Antipsychotic Drugs
Drowsiness Orthostatic hypotension Weight gain Anticholinergic effects Extrapyramidal effects Pseudo-Parkinsonism Akathisia Dystonia Tardive Dyskinesia Photosensitivity Blood Dyscrasias granulocytosis leukopenia Neuroleptic Malignant syndrome
Nursing Implications For Use of Traditional or Typical Phenothiazine - Antipsychotic Drugs
Extrapyramidal effects are major concern - Monitor elderly clients closely - Takes 2 to 3 weeks to acheive therapeutic effect - Keep client supine for 1 hour after -- adminstration and advise to change positions slowly because of effects of orthoestatic hypotension - Teach client to avoid Alcohol Sedatives (Potentiate effect of CNS depressants) Antiacids (reduce absorption of drug)
Long Acting Traditional or Standard Antipsychotic Drugs
Fluphenazine (Prolixin Decanoate) Haloperidol (Haldol Decanoate)
Name Long Acting Traditional Antipsychotic Drugs
Fluphenazine (Prolixin Decanoate) Haloperidol (Haldol Decanoate)
Traditional Long Acting
Fluphenazine Deconate (Prolixin) Haloperidol Decanote (Haldol)
Anticholinergic outcome for Low potency drugs
Greater Anticholinergic side effects
extrapyramidal (motor) side effect outcome with High potency drugs
Greater frequency of extrapyramidal side effects
Sediation outcome for Low potency drugs
Greater sedation
Standard / Traditional HCC Nonphenothiaxines
HESI Nonphenothiaxines 1 to 4 1 Haloperidol (Haldol) 2 Chlorprothixene (Taractan) 3 Thiothixene (Navane) 4 Pimozide (Orap) Reconciliation Between HESI & Learning Packet Haloperidol (Haldol) Same in Both Thiothixene (Navane) Same in Both Loxapine (Loxitane) Listed as Phenothiaxines in HESI Molindone (Moban) Listed as Phenothiaxines in HESI Chlorprothixene (Taractan) Not Listed in Learning Packet - Listed in HESI Pimozide (Orap) Not listed in Learning Packet - Listed in HESI
Adverse Reactions for Long Acting Traditional drugs
Haldol Decanoate Severe extrapyramidal reactions Leukocytosis Blurred vision Dry mouth Urinary retention Fluphenazine (Prolixin Decanoate) Drowsiness Orthostatic hypotension Weight gain Anticholinergic effects Extrapyramidal effects Pseudo-Parkinsonism Akathisia Dystonia Tardive Dyskinesia Photosensitivity Blood Dyscrasias granulocytosis leukopenia Neuroleptic Malignant syndrome
Sumptoms Schizophrenia
Hallucinations Delusions Bizarre Ideations Paranoia Agitation Disruptive & Violent behavior Disorientation Social withdrawal Catatonia Blunted affect Thought Blocking
Traditional Nonphenothiaxines
Haloperidol (Haldol) Chlorprothixene (Taractan) Thiothixene (Navane) Pimozide (Orap)
Knowing whether a drug is Low or High Potency is helpful why
Helpful in predicting side effects.
Low-Potency Drugs require
High dosage levels & produce Greater sedation Greater Anticholinergic side effects fewer extrapyramidal (motor) side effects.
What happens when communication via Extrapyramidal tracts is disturbed
Involuntary motor abnormalities can occur including: acute dystonia pseudoparkinsonism akathisia tardive dyskinesia
Sediation outcome for High potency drugs
Less sedation
High Potency Drugs require
Low dosage levels. Produce Less sedation fewer anticholinergic side effects Greater frequency of extrapyramidal side effects
Serious side effect of Atypical A-P
Metabolic syndrome
Atypical Antipsychotics Nursing Implications
Monitor WBC weekly for first 6 months, then biweekly Baseline VS & ECG; report abnormal VS Monitor for symptoms of NMS and EPS Teach to change positions slowly Abilify is a new class of anti psychotic drugs dopamine system stabilizers (DSSs) for schizophrenia and acute bipolar mania. Seroquel monitor lipids especially for obease, diabetic , or hypertensive clients.
Effects of Dopamine Antagonism - Blockade
Movement defects Pseudoparkinsonism Akinesia akathisia tardive dyskinesia Increased prolactin galactorrhea amenorrhea gynecomastia
acetylcholine ACh impacts what receptors
Muscarinic receptors
Adverse Reaction for Risperdal
NMS- Neuroleptic maligant syndrome. EPS. dizziness GI symptome (nausea, constipation), anxiety
Extrapyramidal effects are impacted by what pathway
Nigrostrialtal dopamine pathway
What pathway does Serotonin antagonism cause dopamine to be released
Nigrostriatal pathway tuberoinfundibular pathway
Effects of Alpha Antagonism NE blockade
Orthostatic hypotension Liability to ejacluate
Muscarinic receptors impact what system
Parasympathetic nervous system
Fluphenazine (Prolixin) Phenothaiazine or NonPhenothaizine
Phenothaiazine
tuberoinfundibular pathway impacts what hormone
Prolactin
What hormone does dopamine inhibit
Prolactin.
Atypical Antipsychotics Adverse Reactions
Risperdal: NMS- Neuroleptic maligant syndrome. EPS. dizziness GI symptome (nausea, constipation), anxiety Zyprexa: drowsiness, dizziness, EPS, agitation Seroquel: drowsiness, dizziness, headache, EPS, weight gain, anticholinergic effects. Clozaril: agranulocytosis, drowsiness, dizziness, GI symptoms, Neuroleptic malignant syndrome.
Atypical Antipsychotic Drugs HESI List
Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Aripiprazole (Ability) Ziprasidone (Geodon) Clozapine (Clozaril) Aripiprazole (Abilify)
Atypical Drugs - HCC Learning Packet
Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Aripiprazole (Ability) Ziprasidone (Geodon) Clozapine (Clozaril) Aripiprazole (Abilify) Additional Items listed in HCC Learning Packet - Not listed in HESI Paliperidone (Invega) Asenapine (Saphris) Iloperidone (Fanapt) Lurasidone (Latuda)
Adverse Reactions for - Haloperidol (Haldol) - Chlorprothixene (Taractan) - Thiothixene (Navane) - Pimozide (Orap)
Severe extrapyramidal reactions Leukocytosis Blurred vision Dry mouth Urinary retention
Adverse Reactions for Nonphenethiazines
Severe extrapyramidal reactions Leukocytosis Blurred vision Dry mouth Urinary retention
Nursing Implications for Long Acting
Similar to Prolixin and Haldol Fluphenazine (Prolixin Decanoate) Haloperidol (Haldol Decanoate) Prolixin can be given every 7 to 28 days Haldol can be given every 4 weeks Requires several months to reach steady state drug levels.
Seizures occur while taking what type of Anti P drugs
Standard
What type of drugs lower brains seizure threshold
Standard A-P
Nursing Implications for Nonphenethiazines
Teach client to avoid alcohol Orap is used only for Tourettes syndrome
Nursing Actions Implications for Haloperidol (Haldol) - Chlorprothixene (Taractan) - Thiothixene (Navane) - Pimozide (Orap)
Teach client to avoid alcohol Orap is used only for Tourettes syndrome
Indications for Use for Fluphenazine (Prolixin) Phenothaiazine
To Control psyhotic behavior Useful in treatment of psychomotor agitation associated with thought disorders
Indications for Use Typical or Traditional Nonphenothiaxines
To control psychotic behavior Less sedative than phenothiazines
Indications for use of following drugs - Haloperidol (Haldol) - Chlorprothixene (Taractan) - Thiothixene (Navane) - Pimozide (Orap)
To control psychotic behavior Less sedative than phenothiazines
Indications For Use Traditional or Typical Phenothiazine
To control psychotic behavior: Hallucinations, Delusions, and bizarre behavior
Chlorpromazine (Thorazine)
Traditional Anti-psychotic
Fluphenazine (Prolixin)
Traditional Anti-psychotic
Halperidol (Haldol)
Traditional Anti-psychotic
Loxapine (Loxitane)
Traditional Anti-psychotic
Molindone (Moban)
Traditional Anti-psychotic
Perphenazine (Trilafon)
Traditional Anti-psychotic
Thioridazine (Mellaril)
Traditional Anti-psychotic
Thiothixene (Navane)
Traditional Anti-psychotic
Trifluoperazine (Stelazine)
Traditional Anti-psychotic
Indications for use of Atypical Antipsychotics
Treat positive and negative symptoms of schizophrenia without significant EPS Clients who have not responded well to typical antipsychotics or have side effects with typical antipsychotics Fewer side effects Clozapine has superior effecacy in clients who have been treatment resistant.
Indications for use of following drugs Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Aripiprazole (Ability) Ziprasidone (Geodon) Clozapine (Clozaril) Aripiprazole (Abilify)
Treat positive and negative symptoms of schizophrenia without significant EPS Clients who have not responded well to typical antipsychotics or have side effects with typical antipsychotics Fewer side effects Clozapine has superior effecacy in clients who have been treatment resistant.
In addition to psychosis Anti psychotic drugs are used for accute
acute management of aggressive or violent behavior
Increases in Prolactin levels can cause what
amenorrhea galactorrhea lactation gynecomastia - enlargement of breasts in men
Antiparasympathetic effects include
blurred vision dry mouth constipation urinary retention/hesitancy nasal congestion
Effects of Muscarinic Antagonism include
blurred vision dry mouth constipation urinary retention/hesitancy nasal congestion
Blockage of acetylocholine results in what symptoms related to what body system
blurred vision dry mouth constipation urinary retention/hesitancy nasal congestion parasympathetic nervous system
What impact can Serotonin antagonism have on other neurotransmitters
can reverse effect of dopamine antagonism, depending on number and affinity of receptors in dopamine pathways.
Impact of SDA in the mesocortical pathways
causes release of dopamine and helps modify negative symptoms
Extrapyramidal tracts do what
control and coordinate the mechanisms that result in contractions of muscles and groups of same
atypical A-P blocking dopamine receptors in limbic system does what
decreases positive symptoms as effectively ad typical A-P
What impact does Serotonin antagonism resulting release of dopamine have
decreases the side effects of dopamine blockade - movement defects (EPS) - increased prolactin.
Schizophrenia negative symptoms
deficits in social interaction blunted or inappropriate emotional expression and lack of motivation
How does he Parasympathetic nervous system function
depends on the stimulation of muscarinic receptors by acetylcholine ACh
What are the "other" side effects of A-P drugs
dermatological changes photosensitivity sedation Rare effects of "other side effects" include agranulocytosis cholestatic jaundice.
Decision on which drug to use for a given patient is based on what
desired effects (sedation for an agitated patient) and or avoidance of certain side effects.
What does Serotonin antagonism cause to be released
dopamine
In addition to dopamine receptors, standard AP also block other neurotransmitters including
dopamine acetylcholine ACh norepinephrine NE
what is Aripiprazole (Abilify) describe
dopamine system stabilizer
Adverse Reaction for Zyprexa
drowsiness, dizziness, EPS, agitation
Positive Schizophrenia symptoms accociated with what neruotranmitter and at what level
excess dopamine
Anticholinergic outcome for High potency drugs
fewer anticholinergic side effects
extrapyramidal (motor) side effect outcome with Low potency drugs
fewer extrapyramidal (motor) side effects.
Examples of High - potency drugs include
fluphenazine (Prolixin) SD haloperidol (haldol) SD risperidone (Risperdal)
what what kind of properities does Aripiprazole (Abilify) have - describe
has both dopamine antagonist and dopamine agonist properties
tuberoinfundibular pathway project from
hpothalamus pituitary
Blockade of Histamine and serotonin receptors leads results in
increased weight increased blood glucose increased tryglyceride levels
Metabolic syndrome symptoms ??? confirm
increased weight increased blood glucose increased tryglyceride levels
Positive Schizophrenia symptoms are accociated with what pathway or system
limbic system
Blockage of acetylcholine ACh occurs in what pathway
muscarinic pathway
What is the result of a lack of dopamine in the mesocortical dopamine pathway
negative symptoms of schizophrenia
what neurotransmitter impacts ability to ejaculate
norepinephrine
alpha 1 receptors are impacted by what neurotransmitter
norepinephrine NE
Muscarinic receptors exist where
on smooth muscle cardiac muscle exocrine gland cells
What happens when dopamine is blocked in the tuberoinfundibular pathway
prolactin levels increase
Symptoms listed below can result from blockage of what blurred vision dry mouth constipation urinary retention/hesitancy nasal congestion
receptors/pathway muscarinic
Dopamine major role is in
regulation of movement
What type of antagonists are atypical antipsychotic drugs
sertonin-dopamine antagonists (SDA)
receptors/pathway muscarinic exist where
smooth muscle cardiac muscle and exocrine gland cells
alpha 1 receptors are found where
smooth muscle cells
what does norepinephrine do
stimulates alpha 1 causing vasoconstriction and maintenance of BP while standing upright position causes propulsive contractions in vas deferens leading to ejaculation
Negative symptoms are associated with what what neruotranmitter and at what location
too little dopamine in frontal cortex.
Aside from smooth muscle, where else are alpha 1 receptors located.
vas deferens
alpha 1 receptors stimulated by NE causes
vasoconstriction and maintenance of blood pressure - while in upright position.
What can blocking NE cause
vasodilation and orthostatic hypotension
What can blocking alpha 1 receptors cause
vasodilation and orthostatic hypotension
