NUR 114 #3 schizophrenia/delirium

Examples of typical antipsychotics?

Chlorpromazine, fluphenazine, haloperidol, loxapine, perphenazine, pimozide, prochloperazine, thiothixene, trifluoperazine

Examples of atypical antipsychotics?

Aripiprazole, asenapine, clozapine, iloperidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone

Typical antipsychotic MOA?

The typical antipsychotic drugs block dopamine receptors, preventing the stimulation of the postsynaptic neurons by dopamine. They depress the reticular activating system (RAS), limiting the stimuli coming into the brain. They also have anticholinergic, antihistamine, and alpha-adrenergic blocking effects,

Atypical antipsychotic MOA?

block both dopamine and serotonin receptors. This dual action may help alleviate some of the unpleasant neurological effects and depression associated with the typical antipsychotics

Antipsychotics contraindications?

Parkinson’s disease, dementia (increased risk of CV events & death), glaucoma, peptic ulcer, urinary/intestinal obstruction, seizure disorder, caution with alcohol use (CNS depression)

Antipsychotic adverse effects?

Weakness, tremor, drowsiness, and extrapyramidal side effects (pseudoparkinsonism, dystonia, akathisia, tardive dyskinesia), dry mouth, nasal congestion, flushing, constipation, urinary retention, impotence, glaucoma, blurred vision, and photophobia, hypotension, orthostatic hypotension, cardiac arrhythmias, congestive heart failure, and pulmonary edema, laryngospasm, dyspnea, and bronchi spasms

Treatment for trice dyskinesia?

Deutetrabenazine & valbenazine

What is neuroleptic malignant syndrome?

rare but potentially life-threatening adverse effect of the antipsychotic medications. It is thought to be related to the blockade of dopamine receptors that triggers in some people excessive calcium release from the sarcoplasmic reticulum of the skeletal muscle cells

How does neuroleptic malignant syndrome manifest?

sudden high-grade fever, blood pressure fluctuations, dyshythmias including extreme tachycardia, muscle rigidity, sweating, and change in level of consciousness that can lead to coma and death )Males are at higher risk than females, and there is a genetic component)

Nursing considerations for neuroleptic malignant syndrome?

Stopping the medication that triggered the syndrome, cooling the patient with ice packs and/or cool fluids, and administering antipyretic medication. The patient will require close monitoring of vital signs and mental status. Medication such as dantrolene can be administered to decrease muscle rigidity. The patient may also require medications to treat dysrhythmias

Which drugs cause prolonged QT intervals?

Haloperidol, thioridazine, mesoridazine, ziprasidone

What is delirium?

Acute syndrome of brain failure that can last from hours to weeks

When is delirium most likely to occur?

Cognitive impairment, sleep deprivation, immobility, visual/hearing impairment & dehydration

What is catatonia?

Psychomotor disturbance either motionless or excessive behavior

What is alogia?

A lack of any real meaning or substance in what the client says

Peak age for schizophrenia?

15-25 for men & 25-35 for women

What are positive (hard) symptoms?

Ambivalence, associative looseness, bizarre behavior, delusions, echopraxia, flight of ideas, hallucinations, ideas of reference, perseveration

What is associative looseness?

Fragmented or poorly related thoughts and ideas

What is echopraxia?

Imitation of the movements and gestures of another person whom the client is observing

What is ideas of reference?

False impressions that external events have special meaning for the person

What is perseveration?

Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic

What are negative (soft) symptoms?

Alogia, anhedonia, apathy, asociality, avolition or lack of volition, blunted affect, catatonia, flat affect, inattention

What is alogia?

Tendency to speak little or to convey little substance of meaning (poverty of content)

What is apathy?

Feelings of indifference toward people, activities, and events

What is asociality?

Social withdrawal, few or no relationships, lack of closeness

What is avolition or lack of volition?

Absence of will, ambition, or drive to take action or accomplish tasks

What is blunted affect?

Restricted range of emotional feeling, tone, or mood

What is catatonia?

Psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless, as if in a trance

What is flat affect?

Absence of any facial expression that would indicate emotions or mood

What is schizophrenia onset?

abrupt or insidious, but most clients slowly and gradually develop signs and symptoms such as social withdrawal, unusual behavior, loss of interest in school or at work, and neglected hygiene.

How is schizophrenia usually diagnosed?

when the person begins to display more actively positive symptoms of delusions, hallucinations, and disordered thinking (psychosis).

Which drugs are available as long acting injections?

Fluphenazine, haloperidol, risperidone, paliperidone, olanzapine, aripiprazole

Why are injections preferred?

They eliminate the need for oral antipsychotics

How long do injections last?

2-4 weeks to 3 months

How long does injection haloperidol last?

4 weeks

How long does injection fluphenazine last?

7-28 days

What are Extrapyramidal side effects EPS?

Reversible movement disorders induced by neuroleptic medication (dystonic reactions, Parkinsonism, akathisia)

What are dystonic reactions?

Muscle spasms in neck (torticollis) or eyes (oculogyric crisis), protrusion of the tongue, dysphasia, and laryngeal spasms → compromise airway → medical emergency

Dystonic reaction treatments?

They’re given diphenhydramine (Benadryl) IM OR IV, or benztropine (cogentin) IM

What is akathisia?

Restless mvmt, pacing, inability to remain still, and the clients report is inner restlessness

What is tardive dyskinesia?

Late appearing side effects of antipsychotic med → involvtary mvmts, such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform mvmts of limbs and feet

Assessment tool for tardive dyskinesia?

AIMS Scale, patient in different positions and symptoms are rated 0-4

What is agranulocytosis?

Failure of the bone marrow to produce adequate WBCs

How does agranulocytosis manifest?

Suddenly; fever, malaise, ulcerative sore throat, and leukopenia

Clozapine important info?

Agranulocytosis most fatal side effect, need weekly ANC for the first 6 months of clozapine therapy and every 2 weeks for 6 months and monthly thereafter