Chapter 22 Antipsychotics and Anxiolytics

Spasms of tongue, face, neck, and back

Acute dystonia

Restlessness, inability to sit still, foot tapping

Akathisia

Used to treat anxiety and insomnia

Anxiolytics

Anxiolytics (are/are not) usually given for secondary anxiety

Are not

2 Atypical antipsychotic medication

Clozapine, Risperidone

2 types of Phenothiazine medications

Chlorpromazine, fluphenazine

Phenothiazines (increase/decrease) the seizure threshold; adjustment of anticonvulsants may be required.

Decrease

Muscle tremors, rigidity, shuffling gait

Extrapyramidal symptoms

Losing contact with reality

Psychosis

2 types of Non-phenothiazine

Molindone hydrochloride, haloperidol

Drug that modifies psychotic behavior

Neuroleptic

Protrusion and rolling of the tongue, sucking and smacking movements of the lips, chewing motion

Tardive dyskinesia

What drug would the nurse expect to give to decrease EPS? a.) Benztropine b.) Bethanechol c.) Buspirone Hydrochloride d.) Doxepine

a.) Benztropine

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? a.) Blocking actions of dopamine b.) Blocking actions of epinephrine c.) Promoting prostaglandin synthesis d.) Enhancing the action of gamma-aminobutyric acid

a.) Blocking actions of dopamine

An atypical antipsychotic is prescribed for a patient with psychosis. The nurse understands that this category of medications include which drugs? (select all that apply) a.) Clozapine b.) Fluphenazine c.) Haloperidol d.) Olanzapine e.) Aripiprazole

a.) Clozapined.) Olanzapine e.) Aripiprazole

A patient has been diagnosed with neuroleptic malignant syndrome. The nurse anticipates administration of which medication to treat this patient? a.) Dantrolene b.) Tetrabenazine c.) Propranolol d.) Lorazepam

a.) Dantrolene Treatment of NMS involves immediate withdrawal of antipsychotics, adequate hydration, hypothermic blankets, and administration of antipyretics, benzodiazepines, and muscle relaxants such as dantrolene (Dantrium). Tetrabenazine (Xenazine), used to improve symptoms of Huntington's disease, seems to be effective in treating tardive dyskinesia. Propanolol (Inderal) has been found to be effective in the treatment of akathisia. Acute dystonia may be treated with lorazepam (Ativan).

The 58 year old patient presents to the ER. He is highly agitated and combative and is presenting a danger to self and others. The health care provider has ordered haloperidol 5 mg IM. What should the nurse know about this medication when giving it as an antipsychotic? a.) It has a sedative effect on agitated combative patients b.) it is the drug of choice for older patients with liver disease c.) it will not cause EPS d.) It can sefely be used in patient with narrow angle glaucoma

a.) It has a sedative effect on agitated combative patients

A patient is prescribed lorazepam. What does the nurse know to be true regarding lorazepam? a.) It is used to treat anxiety, status epilepticus, insomnia, and sedation induction b.) It has max adult dose of 25 mg.day c.) It causes plasma levels to be decreased when combined with cimetidine d.) It interferes with the binding of dopamine receptors

a.) It is used to treat anxiety, status epilepticus, insomnia, and sedation induction

Lorazepam is an anxiolytic drug; however it may be prescribed for other purposes. For which other condition(s) might it be prescribed? (select all that apply) a.) alcohol withdrawal b.) anxiety associated with depress c.) muscle spasms d.) preoperative nduction e.) status epilepticus

a.) alcohol withdrawal b.) anxiety associated with depression d.) preoperative induction e.) status epilepticus

A patient appears to have had an overdose of phenothiazines. The nurse anticipates that which intervention(s) may be used to treat phenothiazine overdose? (select all that apply) a.) gastric lavage b.) adequate hydration c.) maintaining an airway d.) fluphenazine e.) risperidone f.) activated charcoal administration

a.) gastric lavage b.) adequate hydration c.) maintaining an airway f.) activated charcoal administration

The nurse realizes more medication teaching is necessary when the 30-year-old patient taking lorazepam states a.) "I must stop drinking coffee and colas." b.) "I can stop this drug after 3 weeks if I feel better." c.) "I must stop drinking alcoholic beverages." d.) "I should not become pregnant while taking this drug."

b.) "I can stop this drug after 3 weeks if I feel better." Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects.

In which patient(s) is/are fluphenazine contraindicated? (select all that apply) a.) a 32 year old with narrow angle glaucoma b.) 35 year old in a coma c.) 47 year old with subcortical brain damage d.) 53 year old with continued blood dycrasias despite lowering dose e.) 62 year old with neuromuscular pain

b.) 35 year old in a coma c.) 47 year old with subcortical brain damage d.) 53 year old with continued blood dycrasias despite lowering dose

The nurse suspects that a patient who is experiencing facial grimacing, involuntary upward eye movement, and muscle spasms of the tongue and fce may have which condition? a.) Akathisia b.) Acute Dystonia c.) Tardive Dyskinesia D.) Pseudoparkinsonism

b.) Acute Dystonia

The patient has been started on chlorphromazine hydrochloride for treatment of intractable hiccups. What information will the nurse include in patient education abou this class of drug? a.) A therapeutic response to this drug will be immediate b.) Change positions slowly from sitting to standing to prevent orthostatic hypotension c.) It is all right to have alcohol when taking this drug d.) This drug may be stopped abruptly as soon as your pain stops

b.) Change positions slowly from sitting to standing to prevent orthostatic hypotension

A young woman is being treated for psychosis with fluphenazine. Which sign would indicate the need to add an anticholinergic to the patient's medication regimen? a.) A decrease in pulse and respiratory rate b.) Facial grimacing and tongue spasms c.) An increase in hallucinations d.) A decrease in the patient's level of orientation

b.) Facial grimacing and tongue spasms Pseudoparkinsonism, which resembles symptoms of Parkinson's disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.

Phenothiazines are grouped into 3 categories based on their side effect. In which group is fluphenazine? a.) Aliphatic b.) Piperazine c.) piperidine d.) thioxanthene

b.) Piperazine

A patient is receiving aripiprazole. Which nursing intervention(s) will the nurse include in the patients care plan? (select all that apply) a.) Administer before meals on an empty stomach to facilitate absorption 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

b.) Remain with the patient until the medication is swallowed c.) Monitor vitals 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

The drug alprazolam belongs to which anxiolytic drug group? a.) antihistamines b.) benzodiazepines c.) buspirinones d.) phenothiazines

b.) benzodiazepines

A 34 year old patient with bipolar disorder has just been prsecribed risperidone. What side effect should the nurse include in the health teaching abou this drug? a.) hepatotoxicity b.) hyperglycemia c.) hearing loss d.) urinary frequency

b.) hyperglycemia

A patient on risperidone may be at increased risk for injury due to a.) increased potential for aspiration due to sedation. b.) increased risk for falls due to orthostatic hypotension. c.) increased risk for infection due to neutropenia. d.) increased risk for suicide due to changes in thought processes.

b.) increased risk for falls due to orthostatic hypotension. Orthostatic hypotension is the most common adverse reaction seen in patients treated with risperidone (Risperdal).

The patient has been started on an antipsychotic drug for treatment of her schizophrenia. She asks the nurse when she will start to feel better. What is the nurse's best response? a.) It may take up to 1 week to start to feel the effects. b.) Responses vary, but it may be about 6 weeks. c.) You will only feel better when you start psychotherapy too d.) You should start to feel better within 30-60 minutes.

b.) responses vary, but it may take up to 6 weeks.

A nurse caring for a patient in an outpatient setting notes that the patient is currently taking lorazepam for anxiety and her breath smells of alcohol. The nurse reports this to the health care provider because a.) taking alcohol with Ativan can be fatal. b.) taking alcohol with Ativan may increase sedative effects. c.) all patients using alcohol should be referred for assistance. d.) Ativan and alcohol antagonize one another.

b.) taking alcohol with Ativan may increase sedative effects. Alcohol and other CNS depressants should not be taken with benzodiazepines because respiratory depression could result.

Which statement by a patient indicates that more teaching on phenothiazine therapy for the treatment of psychosis is needed? a.) "It might take 6 weeks or more for the drug to take effect." b.) "I will get up slowly from a seated position." c.) "When I start to feel better, I will cut the dose of my medication in half." d.) "I will avoid exposure to direct sunlight."

c.) "When I start to feel better, I will cut the dose of my medication in half." The drug should be taken exactly as ordered. Antipsychotics do not cure the mental illness but do alleviate symptoms. Compliance with drug regimen is extremely important.

The atypical antipsychotics have a weak affinity for the D2 receptors. Consequently, what happens to the occurrence of EPS when taking these drugs? a.) an absence of EPS b.) an increase in EPS c.) fewer EPS d.) no effect on EPS

c.) Fewer EPS

The patient has been prescribed fluphenazine for treatment of schizophrenia. What information should the nurse include in the patient teaching for this drug? ( select all that apply) a.) Blood pressure changes are not an indication of an adverse reaction b.) It is all right to take all herbal drugs when taking fluphenazine c.) notify your health care provider if you have dizziness, headache, or nausea. d.) this medication must be taken every day e.) You should not drink alcohol when taking this drug

c.) Notify your health care provider if you have dizziness, headache, or nausea d.) this medication must be taken every day e.) you should not drink alcohol when taking this drug

The 72 year old patient diagnosed with schizophrenia was prescribed fluphenazine 20 mg/day. In reviewing his drugs before dishcharge from the hospital the nurse notes the dose. What should concern the nurse about the amount of the drug prescribed? a.) Nothing, the patient is an adult and this is the normal adult range b.) The patient's dose should be 10% less than the adult dose. c.) The patient's dose should be 25%-50% less than the usual adult dose d.) This drug is contraindicated in patients more than 70 years old.

c.) The patient's dose should be 25%-50% less than the usual adult dose.

Neuroleptic drugs are useful in the management of which type of illness? a.) Anxiety disorders b.) depressive disorders c.) psychotic disorders d.) psychosomatic disorders

c.) psychotic disorders

Which of the following is a drug class of atypical antipsychotics? a.) butyrophenones b.) phenotiazines c.) serotonin/dopamine antagonists d.) thioxanthenes

c.) serotonin/dopamine antagonists

Atypical antipsychotics have a stronger affinity for which type of receptors that block serotonin receptors? a.) D1 b.) D2 c.) D3 d.) D4

d.) D4

An antipsychotic agent, fluphenazine, is ordered for a patient with psychosis. The nurse understands that this agent can lead to symptoms of extrapyramidal syndrome (EPS). What are the symptoms of EPS? a.) Parkinsonism b.) Nausea and vomiting c.) Hyperthermia and dysrhythmias d.) Tremors, rigidity, and shuffling gait

d.) Tremors, rigidity, and shuffling gait

A patient presents to the ER department with an overdose of chlorpromazine hydrochloride. What is the priority action by the nurse? a.) administer activated charcoal b.) administer anticholinergic drugs c.) establish an IV d.) maintain an airway

d.) maintain an airway

Assessment findings for a patient with neuroleptic malignant syndrome (NMS) include a.) bradycardia. b.) hypothermia. c.) muscle weakness. d.) rhabdomyolysis.

d.) rhabdomyolysis. NMS symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma.

Typical antipsychotics may cause EPS or pseduoparkinsonism. Which symptoms is considered an extrapyramidal symptom? a.) Downward eye movement b.) intentional tremors c.) loss of hearing d.) shuffling gait

d.) shuffling gait

Typical antipsychotics are subdivided into phenothiazines and nonphenothiazines. Non-phenothiazines are divided into 4 classes ______, ______, ______, and ______.

dihydroindolones, thioxanthenes, butyrophenones, dibenzoxazepines

The most common side effect of all antipsychotics is _______.

drowsiness

Antipsychotics may lead to dermatologic side effect that include ______ and _________.

pruritus, photosensitivity

The action of anxiolytics resembles that of ______ not antipsychotics.

sedative-hypnotics

Antipsychotic drugs were developed to improve the ______ ______ and ______ of patients with psychotic symptoms resulting from an imbalance of ______ a neurotransmitter.

thought process, behavior, dopamine

Long-term use of anxiolytics is not recommended because ______ may develop within a short time.

tolerance