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Summary

Psych drugs for mental health ...

Description

Typical Antipsychotics - 1st Generation (targets positive symptoms: delusions, catatonia, bizarre behavior, hallucinations) Drug haloperidol (Haldol) useful for outpatients in long-acting form

Uses

Actions/ Contraindications

acute psychosis chronic schizophrenia

Action: blocks dopamine receptors in brain

mental retardation with hyperkinesia tourettes in children autism spectrum disorder targets positive symptoms conversion disorder

Side Effects akathisia (restlessness) dystonia (uncontrollable muscle contraction- results in twisting of body) Assess for: EPS, TD, parkinsonism

don't give if pt has: parkinson’s, seizures, severe mental depression

Therapeutic Effects sedation, decreased agitation, decreased combativeness, decreased psychomotor activity, decreased hallucinations, decreased delusions, decreased psychotic behavior

uncontrollable temper outburst stereotypic behavior (banging head on wall) NMS - assess temp. alopecia urinary retention amenorrhea breast engorgement galactorrhea priapism gynecomastia seizures hyperthermia Assess for: laryngospasm / bronchospasm hyperglycemia, hypoglycemia, hyponatremia

Thiothixene (Navane)

acute psychosis

orthostatic hypotension

NMS = Neuroleptic Malignant Syndrome:escalates rapidly - usually starts w/ fever - life threatening hyperpyrexia, severe HTN, diaphoresis, (103 °, 116 bpm, 34 Resp, 100/50 BP) stop immediately; bring to ER benztropine (Cogentin) anticonvulsant for EPS usually taken with 1st gen. antipsychotics, also treats symptoms of Parkinson’s disease. If antipsychotics are abruptly stopped, can get acute psychosis. If taking antipsychotics watch glucose & TSH

Atypical Antipsychotics - 2nd Generation Not typically used...too expensive

(Targets positive and negative symptoms (-pine, -done) Drug Clozapine (Clozaril)

Uses schizophrenia, used in pts who respond poorly to other antipsychotics

targets positive & negative symptoms

Actions/ Contraindications

Side Effects

Actions: dopamine & serotonin receptor blocker also blocks glutamate, anticholinergic, alpha adrenergic blocker

dizziness, decreased alertness, agranulocytosis - rare

do weekly blood test for safe dosing for 6 mos

Notify Dr if: increased HR, lethargy, weakness, flu-like symptoms

do WBC count with neutrophils weekly. Watch for sore throat because of infections.

don't give to pt with agranulocytosis

EPS, TD, dystonia, akathisia seizures hyperglycemia weight gain

don’t give to older pt with dementia orthostatic hypotension Olanzapine (Zyprexa)

derivative of clozapine

weight gain

short acting antipsychotic

schizophrenia, bipolar disorder, depression, anxiety

monitor for hyperglycemiapotentially dangerous side effect of agranulocytosis increased death in older adults with dementia-related psychosis watch glucose; great for anorexia if used with metformin, can counterbalance weight changes.

give to anorexia nervosa pts Aripiprazole (Abilify)

Therapeutic Effects

drug is sedating, administer at bedtime lowers dopamine

akathisia [restlessness]

D2, D3, 5-HT2a receptors

orthostatic hypotension - goes away with time

Asenapine (Saphris) Iloperidone (Fanapt)

Lurasidone (Latuda)

major depression,

D2, 5HT2a receptors

avoid grapefruit and grapefruit juice

bipolar 1 disorder Paliperidone

schizo/psychotic

administer in the morning

(Invega)

disorders SNRI

Ziprasidone (Geodon)

Quetiapine (Seroquel)

schizophrenia, bipolar disorder

Risperidone (Risperdal)

schizophrenia, incarcerated for violent acts

Cariprazine (Vraylar)

schizophrenia, bipolar disorder

dizziness, sedation,

watch EKG, risk for pacemaker

DRESS: (drug reaction with eosinophilia & systemic symptoms) - a serious skin reaction

take with food

Low binding D2receptors, H1 and serotonin receptor blocker, A1 receptor

weight gain

somnolence

D2-receptor blockage 5-HT2 receptor

orthostatic hypotension, sedation, weight gain, sexual dysfunction

do not take if older adult has dementia

risk for metabolic syndrome orthostatic hypotension CBC, LFT, UA , renal function increased death in older adults with dementia-related psychosis

Granulocytosis - fever, sore throat, mouth sores Metabolic Syndrome- hypertension, hyperglycemia, hyperlipidemia, increased weight, diabetes, increased BP,

(Typical) Phenothiazine Antipsychotics 1st Gen Neuroleptics (typical & traditional) (-azine) Drug

chlorpromazine (Thorazine)

Uses

excessive anxiety,

Action: blocks dopamine

schizophrenia,

don't give if pt has: liver damage, severe depression, parkinsonism, CAD, bone marrow depression, coma

depression

fluphenazine (Prolixin) perphenazine (Trilafon) prochlorperazine (Compazine) thioridazine (Mellaril) trifluoperazine (Stelazine)

Actions/ Contraindications

Side Effects

photosensitivity, EPS effects: akathisia (can't sit still), TD, dystonias, drug-induced parkinsonism, NMS

Therapeutic Effects

Teach pt: stay hydrated; dark urine is normal, pale stools, or yellowing of eyes or skin.

Benzodiazepine - Schedule IV Drugs (-lam, -pam) Anxiolytic - Therapeutic category Withdrawal symptoms occur (rebound insomnia, nightmares) if stopped abruptly, taper off SHORT ACTING (a,o,l) LONG ACTING (c,c,d,f) Drug alprazolam (Xanax)

diazepam (Valium)

Uses anxiety [avoid in mania]

anxiety, prevents agitation & delirium in alcohol withdrawal

Actions/ Contraindications Action: acts directly on GABA receptors and increases amount of GABA available

do not use in narrow angle glaucoma

clonazepam (Klonopin) chlordiazepoxide (Librium)

short acting are preferred

impaired memory

should be used for 1.5 = mild to moderate toxicity >2 = moderate to severe toxicity >2.5 = Death

Higher Toxicity level S/S: ataxia, giddiness, tinnitus, blurred vision, large output of dilute urine

Pemoline (Cyclert) - ADHD Methylphenidate (Concerta)- ADHD drug makes child not want to eat, so give after breakfast.

Prep U Psych Meds Quiz 1. Which of the following neurotransmitters is elevated in schizophrenia?

○ ○ ○ ○

Dopamine Serotonin Histamine GABA

2. Which of the following medications requires a tyramine restricted diet? ○ Fluoxetine ○ Lithium ○ Phenelzine ○ Amitriptyline 3. A client taking fluphenazine presents with a BP of 200/110, a HR of 130, a temp of 103.4 and muscle rigidity. What is the possible cause for these symptoms? ○ Acute dystonic reaction ○ Neuroleptic malignant syndrome ○ Serotonin syndrome ○ Hypertensive crisis 4. A 44 year old male with a past alcohol addiction is being prescribed a medication to decrease his anxiety. Which of the following medications would be appropriate for this client? ○ Flurazepam ○ Alprazolam ○ Lorazepam ○ Buspirone 5. A client taking olanzapine should have which lab value monitored closely? ○ White blood cell count ○ Glucose ○ Temperate ○ TSH 6. Which of the following assessment findings is most concerning with a client taking clozapine? ○ 96.6 temperature ○ Sore throat [because of agranulocytosis] ○ WBC 11,000 ○ 2lb weight gain 7. A new client admitted to the mental health unit is taking ziprasidone. Which of the following labs/diagnostics should be in the chart? ○ TSH ○ EKG ○ Glucose ○ RBC

KEY TERMS (Abram’s chap 55) Psychotic disorders Akathisia: motor restlessness and inability to be still, usually occurs in the rst few months of treatment with antipsychotic agents Anhedonia: lack of pleasure Delusions: false beliefs that persist in the absence of reason or evidence Drug-induced parkinsonism: loss of muscle movement, muscular rigidity and tremors, shuffling gait, masked facies, and drooling Dystonia: uncoordinated, twisting, and repetitive movements Extrapyramidal effects: movement disorders such as tardive dyskinesia, akathisia, dystonia, and druginduced parkinsonism that may occur with usage of antipsychotic drugs Hallucinations: sensory perceptions of people or objects that are not present in the external Environment Neuroleptics: antipsychotic drugs used to treat disorders that involve thought processes [ex: schizophrenia] Neuroleptic malignant syndrome: a rare but potentially fatal adverse effect; characterized by rigidity, severe hyperthermia, respiratory failure, and acute renal failure Paranoia: belief that other people control their thoughts, feelings, and behaviors or seek to harm them Psychosis: severe mental disorder characterized by disorganized thought processes, hallucinations, and delusions Schizophrenia: variety of related psychotic disorders; symptoms include agitation, behavioral disturbances, delusions, disorganized speech, hallucinations, insomnia, and paranoia Tardive dyskinesia: irreversible late extrapyramidal effect of some antipsychotic drugs

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Psych Questions 1. Andrea has been diagnosed with depression and her physician is starting her on a medication based on a decision tree clinical resource. Which of the following resources did Dr. Finch most likely use? a. Clinical steps b. Clinical practice Guidelines c. Clinical algorithm d. Clinical pathway 2. Mandy is 22 years old female with schizophrenia, obsessive compulsive personality disorder and

diabetes. Her cat went missing on thursday and this caused Mandy to attempt suicide. According to DSM IV which of the following is labeled correctly? a. Axis II Schizophrenia (mental retardation) b. Axis IV Cat went missing (stressor) c. Axis III OCPD d. Axis III Diabetes (medical) 3. Dr Arnold states “ Patient Rodney reminds me of my dad and I hate my dad “. What is Dr Arnold exhibiting? a. Depression b. Transference ( pt to you) c. Anxiety d. Countertransference (me to the pt) 4. Which of the following psychiatric nursing diagnosis is labeled correctly? a. Recurrent thoughts R/T traumatic experience b. Depression R/T weight gain c. Risk for falls R/T Hypotension d. Disturbed thought process R/T ineffective coping 5. Ron wants to go out with his friends and when she asks Stacy (his wife) she says “ go ahead, i’ll just sit here and fold your clothes, it's fine, really” . Which type of message is Stacy sending? a. Double message b. Spoken word c. Double-bind message d. Double-blind message 6. During which phase of the nurse-patient relationship would mutual goals be agreed upon? a. Orientation phase b. Termination phase c. Pre Orientation phase d. Working phase 7. Which of the following responses is an example of empathy? a. My father went through that too and it was horrible b. You should lie down and take a nap so that you feel better c. Why do you think that you feel that way? d. I had a similar experience, how does it make you feel 8. Sandy tells you that her husband ahs been cheating on her for five months and he makes her feel horrible. Which of the following responses is more appropriate? a. Can you tell me more about the way your husband makes you feel b. That is awful my husband did that too c. Don’t you think that is unusual that this happened d. Lets focus on why you are here...