First, Second, and Third-Generation Antipsychotics: Uses, Side Effects, and Treatments

What are the 1st-generation atypical antipsychotics? (4)

Fluphenazine

Haloperidol

Chlorpromazine

Perphenazine

What do 1st gen antipsychotics block?

They block D2 dopamine

Therapeutic uses for 1st gen antipsychotics

Acute & chronic psychotic disorders

Schizophrenia

Bipolar (usually manic)

Tourette syndrome

agitation

N & V

What are extrapyramidal symptoms for 1st gen antipsychotics?

Acute dystonia

Parkinsonism

Akathisia

Tardive dyskinesia (CHRONIC)

Acute dystonia

Severe spasms of the tongue, neck, face, back, or extremities

(oculoguyric, buccolingual, torticolic, laryngeal dystonia)

Is laryngeal dystonia life-threatening?

YES! Can stop breathing and cause stridor too

Nursing actions for acute dystonia

Monitor for first few hrs - 5 days

TREAT with anticholinergic agents (Benztropine & Diphenhydramine)

Parkinsonism

Having tremor, muscle rigidity, stooped posture, drooling, and a shuffling gait.

Akithisia

a movement disorder characterized by a feeling of inner restlessness and inability to stay still

can occur as a side effect of antipsychotics

Tardive dyskinesia (TD)

LONG TERM USE, MAY EVEN BE PERMANENT

Abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and movement of limbs and feet

How can you treat TD?

Valbenazine

What assessment would you use for tardive dyskinesia?

AIMS (Abnormal Involuntary Movement Scale)

What is another potential adverse effect that can happen when taking 1st gen antipsychotics?

Neuroleptic Malignant Syndrome

Neuroleptic Malignant Syndrome (NMS)

SUDDEN high-grade fever

MUSCLE RIGIDITY

Blood pressure fluctuates

Dysrhythmias

Diaphoresis

Tachy

LOC changes

Anticholinergic effects from 1st antipsych meds

Can't see, can't spit, can't pee, can't shit

(dry mouth, blurred vision, constipation, urinary retention)

Agranulocytosis

A life-threatening drop in white blood cells. This condition is sometimes produced by the atypical antipsychotic meds most common is clozapine

SEVERE nuetropenia

Which med helps ONLY with positive (delusions) sx?

1st gen atypical antipsych med

Which med helps with positive and negative (no social cue) sx?

2nd gen

What are the 2nd-gen atypical antipsychotic meds? ((6)

Risperidone

Olanzapine

Quetiapine

ZIprasidone

Paliperidone

Clozapine

What are the 3rd-gen atypical antipsychotic meds? (1)

Ariprprazole

What are some advantages of antipsych 2nd-gen meds? (5)

- Relieves both positive and negative

- decrease in depression, anxiety, and suicide

- FEWER EPS including TD

- FEWER anticholinergic effects

- LESS relapse

Complications of antipsych 2nd gen meds?

- METABOLIC SYNDROME

- orthostatic hypotension

- anticholinergic effect

- agitation, dizzy, sedation

- MILD EPS

- ELEVATED prolactin levels

- SEXUAL dysfunction

Tricyclic antidepressants MOST COMMON (2)

Amitriptyline

Doxepin

T or F

TCAs are lethal in overdose?

True

What are the side effects for TCAs?

- Tachycardia

- Cardiac effects (increase QT, arrhythmias)

- Anticholinergic

- Sexual dys, sedcation

What are monoamine oxidase inhibitors (MAOIs)?

antidepressants

monoamine oxidase inhibitors (MAOIs) (2)

-Phenyizne

-Selegiline (transdermal MAOI)

What is a big risk for MAOIs?

Hypertensive CRISIS (no cheese, wine, pickled foods)

What are selective serotonin reuptake inhibitors (SSRIs)?

Anxiety meds

Selective Serotonin Reuptake Inhibitors (SSRIs) (6)

- Fluoxetine

- Fluvoxamine

- Sertraline

- Paroxetine

- Citalopram

- Escitalopram

Side effects of SSRI

anxiety, akathisia, N, insomnia, sexual dysfunction, weight gain or loss

LESS COMMON: sedation, sweating, D, hand tremor, HA

MAOIS should be discontinued for... days before starting an SSRI

14 days

If taking fluoxetine, must wait ____ weeks after stopping this to start an MAOI

5 weeks

SSRI can displace___ from bounding to protein causing increased levels of___

warafarin monitor for BLEEDING (PT/INR)

SSRIS can increase levels of ____ and ____. AVOID using together

lithium and TCAS

Bupropion RISK

Risk for seizures

Anxiolytics

drugs that reduce anxiety

Anxiolytic = benzodiapine true or false

True, Anxiolytic = benzodiapine

Benzodiazpine usually ends with PAM!

PAM= Anxiolytic = benzodiapine

Benzodiazepines complications

- CNS depression

- Anterogrdae amensia

- Toxicity

- paradoxical response (insomnia, anxiety, euphoria, etc)

- withdrawal effects (can be addicted to it)

Lithium carbonate

FIRST-LINE TREATMENT OF BIPOLAR DISORDER

SX for lithium

N, D, A, temor, polydipsia, polyuria, metallic taste, hypothyroidism, hypotension, etc,

What does lithium take from the body?

REDUCES WATER

IMPORTANT TO DRINK WATER

LITHIUM toxicity

Severe diarrhea, muscle weakness, slurred speech,

What should the nurse do if lithium toxicity occurs

HOLD MED, may require hemodialysis

NO NSAID, NO DIURETIC

Anticonvulsant mood stabilizers

Valproic acid

valproate

divalproex sodium