Antipsychotics/manics and Stimulants

What is the MOA of Neuroleptics?

typical antipsychotics block dopamine receptors preventing stimulation via dopamine

What are examples of Neuroleptics?

Typical: Haloperidol (haldol) and Chlorpromazine (thorazine)\

Atypical: Quetiapine (seroquel), Risperidone (Risperdal), and Olanzapine (Zyprexa)

What are the indications for Neuroleptics?

Schizophrenia

Psychotic

Bipolar disorder

Severe nausea

What are the side effects for Neuroleptics?

Typical: dystonia, tardive dyskinesia, pseudo parkinson’s, akathisia, and muscle spams

Atypical: new onset diabetes, weight gain, and tremors

Both: anticholinergic, hypotension, sedation, and prolonged QT interval

Life Threatening: agranulocytosis and neuroleptic malignant syndrome

What is neuroleptic malignant syndrome?

Fever

Encephalopathy

Vital signs

Elevated renal enzymes

Rigidity of muscles

What are the patient teachings for Neuroleptics?

Therapeutic effects may take several weeks

Do not stop abruptly

What are the nursing considerations for Neuroleptics?

Monitor for extrapyramidal effects

Monitor vital signs

CBC

Monitor adherence

Monitor s/s of diabetes

What is the MOA of Anti-Manics?

alters sodium transport in the nerve and muscle cell

increases norepinephrine and serotonin re-uptake

What are examples of Anti-Manics?

Lithium

What are the indications for Anti-Manics?

Bipolar disorder

Mania

What are the side effects of Anti-Manics?

Primary: drowsiness, polyuria, nausea, and weight gain

Wild Card: hypothyroidism and leukocytosis

Life Threatening: toxicity

What are the patient teachings for Anti-Manics?

Maintain Hydration and salt intake

Avoid herbal drug psyllium

Do not drive or perform hazardous tasks

What are the nursing considerations for Anti-Manics?

Lithium therapeutic level is 0.6-1.2

Caution with concurrent diuretic use

Monitor TSH for risk of hypothyroidism

Monitor lithium level

Monitor renal function

Monitor sodium levels

What is the MOA of Stimulants?

increases the release of dopamine and norepinephrine in the brain and PNS which leads to arousal of RAS

What are examples of Stimulants?

Adderall

Ritalin

Concerta

Modafinil

What are the indications for Stimulants?

ADHD

Narcolepsy

Shift work sleepiness

What are the side effects of stimulants?

Primary: insomnia, nervousness, HTN, tachycardia, and palpitations

Wild Card: weight loss and growth suppression

Life Threatening: toxicity, psychosis, seizures, and arrhythmias

What are the patient teachings for Stimulants?

Take during the day to avoid impaired sleep

Drug holidays

Avoid Caffeine

What are the nursing considerations for Stimulants?

Monitor for abuse

Taper dose

Monitor BP