Chapter 27 Study Guide - Lecture notes 27 PDF

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Chapter 27 Psychosis: losing contact w reality; increase in dopamine in the CNS, over-excitation Schizophrenia: positive (exaggeration of normal function) + negative (decreased level of function, more chronic) symptoms *Signs/symptoms of psychosis/schizo:  Delusions, hallucinations, paranoia, aggression/violence, poor self-care, social withdrawal Extrapyramidal Syndrome (EPS)  Cause: decreasing dopamine  Creates Parkinson’s-like symptoms: shuffling gait, tremors*, rigidity  Acute dystonia: muscle spasms of face, neck, tongue, back  Akathisia: constant motion (pacing)  Tardive dyskinesia (TD): protrusion + rolling of tongue, chewing action Neuroleptic Malignant Syndrome (NMS)  Rare, potentially fatal  Symptoms: acute change in mental status, muscle rigidity, sudden high fever (105F+), rhabdomyolysis (breakdown of skeletal muscle, can cause acute renal failure), respiratory failure, coma  Treatment: o Supportive therapy: hypothermic blanket, hydration o *Tylenol – antipyretic o *Dantrium – antidote, muscle relaxant Antipsychotic Agents  Typical  more side effects o Phenothiazines: block dopamine  Drugs: Chlorpromazine, Fluphenazine, Perphenazine  *SE: sedation, dizziness, QT prolongation, seizures, anti-SLUD (dry mouth, urinary retention, tachycardia)  Avoid alcohol + CNS depressants – sedation  *Contraindications:  Hx of vent. arrhythmia  Alcohol withdrawal – increased risk of seizure  Parkinson’s  Glaucoma o Nonphenothiazines: block dopamine  Drugs: Haloperidol (Haldol) = most common  IV, IM, PO: convenient to treat acute + chronic psychosis  SE: drowsiness, seizures, QT prolongation, anti-SLUD, orthostatic hypotension (risk especially in elderly)  Avoid alcohol + CNS depressants – sedation  Contraindications: same as phenothiazines o Nursing interventions: monitor risk of falls, EPS, NMS

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Atypical  newer drugs, less side effects o Dual action: block dopamine + serotonin o Treat both positive and negative symptoms of schizo o Less likely to cause EPS than typical drugs o Drugs  Clozapine  “gold standard”; not 1st drug you use, must exhaust other options first  Adverse effect: agranulocytosis – decreases WBC production and immune function o Pt will get weekly blood therapy/draws  Olanzapine  Quetiapine  Risperidone  Aripiprazole o SE: sedation, weight gain, hyperglycemia, sexual dysfunction, anti-SLUD o Contraindications: same as phenothiazines o Nursing interventions: monitor blood glucose – hyperglycemia Anxiety: involves norepinephrine, serotonin, GABA Types: Primary = not caused by medical condition or drug use; managed w meds Secondary = r/t drug use, medical or psychiatric condition; not managed w meds Anxiolytics  Benzodiazepines (BZD) o Stimulate GABA – relaxation + calming effect o Advantage: inexpensive, effective, sedative/hypnotic effect o Disadvantage: physical + psychological dependence may occur (C4 substance) o Drugs  Chlordiazepoxide – long acting, increases GABA  Use: acute alcohol withdrawal (stimulates GABA w/o alcohol)  Diazepam (Valium)—gel inserted into rectum for quick absorption  Use: sedative in pre-op setting  Alprazolam (Xanax) – treats anxiety, short-acting  Lorazepam (Ativan) – treats anxiety  Use: IV for sedative effects in ICU  Use: treats status epilepticus via IV bolus o SE: *drowsiness, dizziness, confusion, blurred vision o Interactions: sedative effects when combined w alcohol or opioids o OD: respiratory depression  monitor vitals  Antidote: flumazenil (Romazicon) binds to GABA + stops stimulation  IV; can cause seizures/withdrawal effects o Nursing Interventions: no driving, check pt’s drug history, fall risk, 3-4 months on drug – pt will develop tolerance and effectiveness will decrease; taper off slowly

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Buspirone hydrochloride (BuSpar) o Non-benzo anxiolytic o Interferes w dopamine + serotonin receptors o Less sedation, no dependence  Good for pt with history of substance abuse o SE: drowsiness, dizziness, headache, nausea, nervousness o Do not give w grapefruit juice...