(2) Meds for Various MH Disorders

Extrapyramidal Symptoms (EPSs)

• involuntary motor symptoms like Parkinson’s

• akathisia: restlessness, pacing, dificulty standing still, feet constantly in motion/rocking

• dystonia: facial grimacing, laryngeal spasms, involuntary eye movements, muscle spasms of face/tongue/neck/back

Tardive Dyskinesia

• protrusion and rolling of the tongue

• lip smacking and sucking

• chewing motions

• facial dyskensia (involuntary facial movements)

• involuntary movements

Neuroleptic Malignant Syndrome

• acute, life threatening (life-threatening med emergency caused by dopamine receptor blockade —> requires immediate recognition and intervention)

• muscle rigidity

• altered LOC

• autonomic instability (hyperthermia, increased BP, diaphoresis)

• can be treated with Dantrolene (antidote)

Haloperidol (/Haldol)

• class: 1st gen Antipsychotic

• uses: schizophrenia, Tourette’s, agitation

• admin: IV (acute Tx), IM (acute and long term dose depend), PO (mild Tx)

• SE: EPSs, Tardive dyskinesia, Neuroleptic syndrome, anticholingeric effects, seizures, OH, sedation, increased risk for infection, severe dysthymias, liver impairment

• BLACK BOX: shud NOT be used dementia related psychosis

• NI:

  • monitor for therapeutic effect (like improvements in hallucinations/delusions)

  • only use acute(IV) form in severe situations (violence)

  • monitor for abnormal/involuntary movements

  • could take 2-6 weeks for effects in chronic management

  • report fever, sore throat

  • monitor CBC and liver functions (ALTs and ASTs)

dont stop med abruptly

Risperidone

• class: 2nd gen Antipsychotic (“pine” “done”)

• use: Schizophrenia, bipolar, impulse control disorders

• admin: IM, PO

• SE: elevated glucose, weight gain, dyslipidemia, EPS (altho less common than 1st gen)

• NI:

  • prevent falls (can cause OH)

  • monitor blood glucose lvls (to watch for signs of metabolic syndrome)

other common 2nd gen Antipsychotics

• aripiprazole (Abilify)

• olanzapine (Zyprexa)

• quentiapine (Seroquel)

• ziprasidone (Geodon)

  • this is used for acute psychosis

Methadone

• class: Opioid agonist

• use: w/drawal for illegal opioids (opioid addiction)

• NI:

  • monitor for signs of opioid w/drawal

    • flu like symptoms, agitation, sweating, insomnia

  • pt shud be monitored thru an approved Tx center

  • taper dose slowly to decrease w/drawal Sx

Nicotine Replacement Therapy

Admin: Lozenge, patch, gum, inhaler, nasal spray

• Lozenge — allow to dissolve in mouth; do not eat/drink while dissolving; no more than 20 a day

• Gum — do not use more than 6 months

• Patch — remove patch for MRI; apply new patch daily, removing the old

• Inhaler — do not use if pt has asthma; taper over 2-3 months

• Nasal Spray — effects of nicotine are rapid; one spray in ea. nostril = one cigarette