NURS 5334 EXAM 2 NOTES. COMPLETE STUDY GUIDE. LATEST 2022.

NURS 5334 EXAM 2 NOTES. COMPLETE STUDY GUIDE. LATEST 2022.Psychiatric Drugs  Two Groups: o First Generation  Conventional Anti-psychotics  Block the receptors for dopamine in central nervous system (CNS)  Cause ...

NURS 5334 EXAM 2 NOTES. COMPLETE STUDY GUIDE. LATEST 2022.Psychiatric Drugs  Two Groups: o First Generation  Conventional Anti-psychotics  Block the receptors for dopamine in central nervous system (CNS)  Cause serious movement disorders (extra pyramidal symptoms, EPS)  Classified by potency  Low, Medium, High  Low Potency  Chlorpromazine o Indications  Schizophrenia  Schizoaffective disorder in the manic phase of bipolar disorder  Anti-nausea  Relief of hiccups  Control of severe behavioral problems in children o Adverse effects:  Sedation  Orthostatic hypotension  Anticholinergic effects o Drug interactions  Intensifies responses to CNS depressant  Antihistamines  Benzodiazepines  Barbiturates  Anticholinergic drugs  Antihistamines  Tricyclic antidepressants  Atropine-like drugs  Thioridazine o Adverse effects:  Prolonged QT interval  Cause fatal cardiac dysrhythmias  Sedation  Orthostatic hypotension  Anticholinergic effects  Weight gain o Black Box Warning:  Dysrhythmias o Treats Schizophrenia only when patients have not responded to anything else  High Potency  Haloperidol o Butyrophenone family 1 o Indications:  Schizophrenia  Acute psychosis  Preferred agent for Tourette Syndrome o Adverse effects:  EPS  Neuroendocrine effects  Can prolong QT interval and cause dysrhythmias  Fluphenazine o Phenothiazines subclass o Indications  Schizophrenia  Other psych disorders o Adverse effects:  EPS  Acute dystonia  Parkinsonism  Akathisia  Sedations  Orthostatic hypotension  Anticholinergic effects  Gynecomastia  Galactorrhea  Menstrual irregularities  Mechanism of Action (MOA)  Block a variety of receptors within and outside the central nervous system  Suppress symptoms of psychosis by blocking dopamine 2 receptors in the mesolimbic area of the brain  Adverse Effects  Result of walking receptors for dopamine, acetylcholine, histamine, and norepinephrine  Acute dystonia  Oculogyric crisis  Opisthotonos  Joint dislocation  Impaired respiration  Some anticholinergic meds can help o Benztropine and diphenhydramine  Some are irreversible, so crucial to monitor  Can produce Parkinson-like symptoms o Bradykinesia o Mask-like faces o Drooling o Tremor o Rigidity 2 o Shuffling gait o Cogwheeling o Stopped posture o Possible due to blockade of D2 receptors  Other EPS symptoms: akathisia o Pacing and squirming brought on by uncontrollable need to be in motion  Tardive dyskinesia and choreoathetoid movements of tongue and face o Lip smacking o Tongue flicks in and out o A slow worm like movement of tongue o Involuntary movements of limbs, toes, fingers, trunk  Neuroleptic Malignant Syndrome o Rare but serious (risk of death if not treated) o Lead pipe rigidity o Sudden high fever o Sweating o Autonomic instability o Dysrhythmic o Fluctuations of blood pressure o Altered level of consciousness o Seizures or coma can develop o Death is results of respiratory failure, cardiovascular collapse, dysrhythmias  Anticholinergic effects o Dry mouth, poor vision, photophobia, urinary hesitancy, constipation, tachycardia  Can cause orthostatic hypotension o due to blocking of alpha 1 adrenergic receptor at blood vessels  Other effects: o Sedation, neuro endocrine affects seizures, sexual dysfunction, dermatologic effects agranulocytosis and severe dysrhythmias  BLACK BOX WARNING:  Severe dysrhythmias  Do NOT abruptly withdraw  Can precipitate a mild abstinence syndrome  Schizophrenia is primary indication  Suppress symptoms during psychotic episodes  Continued use does reduce risk of relapse  Medication Interactions  Anticholinergic o Can intensify anticholinergic effects  CNS depressants o Can intensify the depressant effect 3  Levodopa o Indirect/direct dopamine receptor agonists can counteract the antipsychotic effects of neuroleptics  Overall safe and deaths from overdose rare  Overdose can cause: o Hypertension o CNS depression, EPS  Treatment of Overdose: o Fluids o Alpha adrengergic agonists o Gastric lavage o Emetics aren’t effective due to neuroleptics blocking antiemetic action