Ch. 22 Antipsychotics and Anxiolytics

Primary anxiety

-not caused by medical condition or drug use -managed with short-term anxiolytics

The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine. The patient is exhibiting spasms of facial muscles along with grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect?

Acute dystonia

Which type of med is indicated to help a patient manage alcohol withdrawal symptoms?

Benzodiazepine

Which lab test would be monitored frequently to assess for potential life-threatening adverse reaction to clozapine?

CBC

Positive symptoms of schizo

exaggeration of normal function - delusions, hallucinates - incoherent speech, paranoia

Assessment findings for a patient with neuroleptic malignant syndrome include

hyperthermia

Which effect does alcohol consumption have while a patient is on haloperidol therapy?

increased sedation

Benzodiazepine : Anxiolytics action

inhibits GABA neurotransmission by binding to specific benzodiazepine receptors

Abrupt discontinuation of benzodiazepine can intend

insomnia

Which nursing intervention is essential for a patient who is prescribed paliperidone?

instruct the patient to swallow the tablet whole

tardive dyskinesia

involuntary movements of the body and extremities

acute dystonia

involuntary upward eye movement, facial grimming, spasms of muscle groups

A patient is prescribed lorazepam. What does the nurse know to be true regarding lorazepam?

it is used to treat anxiety, status epi, insomnia, and sedation induction

Which is the best advice for a patient taking buspirone?

limit the intake of grapefruit juice

Fluphenazine use

manage symptoms of schizophrenia and psychosis

Which intervention is most important to ensure safety in a patient being treated with anxiolytic medications?

monitor for orthostatic hypotension

Typical groups of antipsychotics

phenothiazines and nonphenothiazines

akathisia

restlessness

A patient arrives in the emergency department complaining of difficulty breathing, dizziness, sweating, and heart palpitations. The patient reports having had similar episodes previously due to stress at work. The nurse will expect the provider to order which medication?

Lorazepam

Which medication is administered via intramuscular injection for anxiety?

Lorazepam

Overdose of Phenothiazines

Maintain airway, gastric lavage, activated charcoal administration, adequate hydration, anticholinergics, and norepinephrine

Aripiprazole use

Manage symptoms of schizophrenia bipolar disorder, autism, depression, Tourette syndrome

A patient who takes thioridazine to treat schizophrenia is noted to be restless and fidgety and is pacing around the room. The nurse caring for this patient will perform which action

Notify the provider of these symptoms and request an order for lorazepam

A patient who is about to begin taking the atypical antipsychotic medication clozapine is concerned about side effects. What information will the nurse include when teaching the patient about this medication?

Some common side effects that you may experience are dizziness, drowsiness, and constipation

The nurse is preparing to administer intramuscular haloperidol to a patient who has schizophrenia. What action will the nurse perform?

Use the Z-track method and inject the medication into deep muscle tissue

Which consideration would the nurse need to remember when preparing to administer haloperidol, a viscous liquid, intramusculary?

administer the medication using the Z track technique

Which intervention would be appropriate when observing that a patient on an antipsychotic has difficulty sitting still, paces around the room, and reports feeling restless?

administer the prescribed benzodiazepine

Which statement explains why a patient would be cautioned not to drink alcohol while taking benaodiazepines?

alcohol combined with benzo, may result in respiratory depression

Which condition may be treated with the benzodiazepine chlordiazepoxide?

alcohol withdrawal

Which condition is a contraindication to lorazepam therapy?

alcoholism

Which instruction would the nurse provide to a patient who has been prescribed an oral phenothiazine?

avoid taking this drug and an antihypertensive simultaneously

A patient is receiving aripiprazole. Which nursing intervention(s) will the nurse include in the patient's care plan?

b. Remain with the patient until medication is swallowed. c. Monitor vital signs to detect orthostatic hypotension. d. Assess the patient for evidence of neuroleptic malignant syndrome. e. Observe the patient for acute dystonia, akathisia, and tardive dyskinesia.

Buspirone action

binds to serotonin and dopamine receptors - more of a chronic treatment

antipsychotics action

block dopamine receptors in brain

Fluphenazine action

block dopamine receptors in the brain

A patient asks the nurse to explain how antipsychotic drugs work to make him feel better. The nurse understands that antipsychotics act in which way?

blocking actions of dopamine

atypical antipsychotics

- treat schizophrenia and other psychotic disorders - block dopamine and serotonin receptors - Risperidone

A patient has begun taking buspirone 7.5 mg twice daily to treat acute anxiety and calls 1 week later to report little change in symptoms. What will the nurse tell the patient?

"Therapeutic effects may not be evident until you have taken the med for several weeks"

The nurse is teaching a patient who will be discharged home on a typical (first generation) antipsychotic medication to treat schizophrenia. Which statement by the patient indicates a need for further teaching?

"I should use a heating pad to treat muscle spasms while taking this med"

Benzodiazepine : Anxiolytics withdrawal symptoms

- Develops slowly, in 2 to 10 days, and may last several weeks - Withdrawal symptoms *Paranoia, delirium/panic *Hypertension, seizures *Status epilepticus

Psychosis characteristics

- Difficulty in processing information - Disorganized thoughts, incoherence - Distortion of reality - Delusions, hallucinations, catatonia - Aggressive or violent behavior

clozapine side effects

- Dizziness, sedation, constipation - Tachycardia, orthostatic hypotension - Tremors, occasional rigidity - Seizures, Low possibility of EPS

Benzodiazepine : Anxiolytics side effects

- Drowsiness, dizziness, ataxia, restlessness, weakness - Headache, confusion, amnesia, blurred vision - Bradycardia, hypotension/hypertension- Seizures, erectile dysfunction

Aripiprazole side effects

- Drowsiness, dizziness, headache, dry mouth - Anxiety, agitation, memory impairment - Blurred vision, weight gain/loss, insomnia - Urinary retention, GI distress, constipation - Tachycardia, orthostatic hypotension, erectile dysfunction - Low possibility of EPS and tardive dyskinesia

atypical antipsychotics advantages

- Effective in treating both positive and negative symptoms of schizophrenia - Less likely to cause EPS or tardive dyskinesia

neuropsychology

- Impulse triggers release of various neurotransmitters - After action exerted, NT removed and broken down, diffused away, or reuptaken - GABA: inhibitory NT - Dopamine: regulates cognition, emotion, motivation - Serotonin: regulates emotions and digestion44

secondary anxiety

- It is related to selected drug use, medical or psychiatric conditions. - Medications are not usually given for secondary anxiety - treat the causative condition

risperidone use

- Manage symptoms of psychosis - Treats positive and negative symptoms of schizophrenia

risperidone side effects

- Sedation, headaches, photosensitivity, dry mouth, weight gain, tachycardia, orthostatic hypotension, urinary retention, sexual dysfunction, seizures - Low risk EPS and TD

Nursing Process : Phenothiazines and Nonphenothiazines

- VS - remain with patient while med is taken and swallowed - observe for EPS - may take 6 weeks to achieve full effect - caution patients not to consume alcohol or other CNS depressants such as opioids

Which treatment may be necessary to manage a patient with a benzodiazepine overdose?

- admin IV flumazenil - provide O2 for respiratory depression - provide IV vasopressors for severe hypo

Phenothiazines

- block norepinephrine, causing sedative and hypotensive effects early in treatment - Chloropromazine (Thorazine)

Nonphenothiazines

- block only the neurotransmitter dopamine - Butyrophenones: Haloperidol, droperidol

cognitive symptoms of schizo

- disorganized thinking, memory difficulty - decreased ability to focus attention

atypical antipsychotics side effects

- drowsiness, headache, unsteady gait, insomnia - depression, weight gain, dyslipidemia, diabetes mellitus

antipsychotics adverse effects

- extrapyramidal symptoms (EPS) or pseudoparkinsonism - tremors, masklike facies, rigidity, shuffling gait

psychosis

- loss of contact with reality - theory: results from imbalance in neurotransmitter dopamine in the brain

Non pharmacological therapy for anxiety

- relaxation - meditation - support system establishment - exercise - CBT

Pharmacological treatment for anxiety

- short term: benzodiazepine - long term: SNRI or SSRI (takes 2-4 week for clinical effects)

Benzodiazepine nursing process

- side effects of anxiolytics - VS - encourage family to be supportive - do not drive bc of sedation side effect - do not consume alcohol or CNS depressant

Which consideration would the nurse take when administering haloperidol decanoate?

Administer the injection using the Z-track method

Haloperidol action

Alters dopamine effect by blocking dopamine receptors

Which action would the nurse take when providing care to a patient who has recently been prescribed a benzodiazepine?

Assess sedation level

Which condition is the patient most likely experiencing when prescribed alprazolam?

Anxiety with depression

Benzodiazepine

Anxiolytics - Lorazepam, diazepam, alprazolam - gradually decrease dose with discontinuation

atypical antipsychotics action

Block serotonin and dopaminergic D4 receptors

Miscellaneous Anxiolytics

Buspirone

A patient arrives in the emergency department with dehydration. The patient reports taking fluphenazine to treat schizophrenia. The nurse notes rigid muscles and an altered mental status. The patient has a temperature of 103.6 F, a heart rate of 98 beats per minute, and a blood pressure of 90/58 mm Hg. The nurse will anticipate administering which medication?

Dantrolene

Which medication would the nurse anticipate administering to a critically ill patient with delusions and paranoia who has been observed hallucinating and has not responded to any typical antipsychotic drugs?

Clozapine

Pseudoparkinsonism (EPS)

Dopamine dysregulation (associated with dopamine altering meds) - Sx: tremors, masklike facies, rigidity, shuffling gait - taper off and discontinue med - mild-mod form treated with anticholinergic (atropine)

A patient has been taking risperidone for 2 weeks. The patient reports drowsiness and headache. What will the nurse do?

Explain to the patient that these are common side effects of medication

Typical Antipsychotic adverse reactions

Extrapyramidal syndrome (4 sets of symptoms) - pseudoparkinsonsim - acute dystonia (early within days) - akathisia (early, within weeks) - tardive dyskinesia (later, 1-2 years) Neuroleptic malignant syndrome - onset within first two weeks - hyperthermia, muscle ridigidity, altered mental status - treated with muscle relaxant dantrolene

A patient is brought to the emergency department with decreased respirations and somnolence. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 80/58 mm Hg. The patient is known to take alprazolam to treat anxiety. Which medication will the nurse anticipate the provider to order?

Flumazenil

Which medication does the nurse anticipate administering to a patient with a suspected overdose of oxazepam?

Flumazenil

antipsychotics treat

Mental illness to improve thought processes and behavior

Haloperidol contraindications

Narrow-angle glaucoma CNS depression Severe liver, kidney, and cardiovascular disease Blood dyscrasias

In which clinical disorder must antipsychotic drugs be used with caution?

Parkinson disease

Which med is appropriate for the patient with psychosis who is experiencing adverse effects of conventional antipsychotic pharmacotherapy, dystonia, akathisia, or abnormal limb movements?

Risperidone

Fluphenazine side effects

Sedation, dizziness, headache, seizures Dry mouth, nasal congestion, blurred vision, photosensitivity, urinary retention GI distress, peripheral edema, tachycardia, cerebral edema , EPS

Clozapine use

Severe schizophrenic patients unresponsive to traditional antipsychotics

Which statement explains why atypical antipsychotics are prescribed more often than typical antipsychotics?

There are fewer side effects with atypical antipsychotics

The nurse is caring for a patient who is taking chlorpromazine HCl 75 mg BID to treat schizophrenia. A family member tells the nurse that the patient's agitation, hallucinations, and delusions have improved with use of the drug, but the patient continues to withdraw from social interaction and won't bathe unless reminded to do so. The nurse will tell the family member that

They should consider discussing changing the chlorpromazine to an atypical antipsychotic

antipsychotics major categories

Typical (traditional) and Atypical

Which occurrence would the nurse attribute to a patient taking clonzapem reports a 3 day history of dizziness and sudden onset aggressiveness and confusion?

Withdrawal symptoms of benzo

Which piece of objective data contraindicates the nurse of clozapine?

acute lymphocytic leukemia

Which intervention would the nurse anticipate for a patient on fluphenazine therapy who has a sudden high fever, altered mental status, and BP fluctuations?

administer antipyretics and provide adequate hydration

Which action would the nurse take to ensure the well-being of a patient taking lorazepam who reports headaches, dry mouth, and constipation?

check whether the drug dosage has been reduced gradually

Schizophrenia

chronic psychotic disorder - usually occurs in adolescence or early adulthood

Which intervention would be the nurses priority upon learning that a patient taking fluphenazine has a history of blood dyscrasias?

consulting with the PCP

negative symptoms of schizo

decrease or loss in function and motivation - poverty of speech, blunted affect, inertia - poor self-care, social withdrawal

Which nursing intervention is a priority for the patient who is starting clozapine therapy?

determine baseline white blood cell count and absolute neutrophil count

Which nursing intervention is most appropriate with schizophrenia prescribed fluphenazine and reports that the medication does not taste good?

diluting the med in milk

Which side effect does the nurse include when providing medication teaching to a patient who has been prescribed alprazolam for the management of an anxiety disorder?

drowsiness

Buspirone side effects

drowsiness, dizziness, headache, nausea, nervousness, excitement - fewer side effects of sedation and physical and psychological dependency

The nurse is performing a medication history on a patient who reports taking lorazepam for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as it previously did. The nurse will

understand that the patient has likely developed tolerance to this drug