Psych ATI – Psychosis Meds

What are the positive symptoms of schizophrenia?
Symptoms related to behavior, thought, and speech, such as agitation, delusions, hallucinations, tangential speech patterns.

What are the negative symptoms of schizophrenia?
Social withdrawal, lack of emotion, lack of energy, flattened affect, decreased motivation, decreased pleasure in activities.

What do the first-generation (conventional) antipsychotic medications control in schizophrenia?
Positive symptoms. These drugs should only be used in clients who can tolerate the adverse effects, or are violent/aggressive.

What are the second-generation (atyptical) antipsychotic agents used for in schizophrenia?
They are the first choice for clients receiving initial treatment, and for treating breakthrough episodes in clients on conventional therapy.

What are the advantages of atypical antipsychotic agents?
Relief of both positive and negative symptoms, decrease in affective findings (depression, anxiety) and suicidal behaviors, improvement of neurocognitive effects such as poor memory, fewer or no extrapyramidal symptoms, fewer anticholinergic effects (except clozapine), and less relapse.

What is the expected pharmacological action of thorazine?
Blockage of dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery. Inhibition of psychotic symptoms is believed to be a result of the dopamine blockade in the brain.

What disorders is thorazine used for?
Acute and chronic psychotic disorders, schizophrenia disorders, bipolar disorder (primarily for the manic phase), Tourette’s, and prevention of n/v through blocking of dopamine in the chemoreceptor trigger zone.

What are the complications of thorazine?
Agranulocytosis, anticholinergic effects, extrapyramidal symptoms, acute dystonia, parkinsonism, akathisia, tardive dyskinesia, neuroendocrine effects, neuroleptic malignant syndrome, orthostatic hypotension, sedation, seizures, severe dysrhythmias, sexual dysfunction, and skin effects.

What are the proper nursing interventions and client education for a client that may experience agranulocytosis due to taking thorazine?
Observe for indications of infection (fever, sore throat), and notify HCP if they occur. If they do occur, obtain baseline WBC. The medication should be discontinued if a laboratory test indicates the presence of infection.

What are the anticholinergic manifestations associated with taking thorazine?
Dry mouth, photophobia, constipation, blurred vision, urinary hesitancy/retention, and tachycardia.

What are the proper nursing interventions and client education for a client that may experience anticholinergic effects due to taking thorazine?
Chew sugarless gum, sip water, avoid hazardous activities, wear sunglasses when outdoors, eat foods high in fiber, exercise regularly, maintain fluid intake of 2-3L/day, void just before taking med.

What are the extrapyrimidal manifestations associated with taking thorazine?
Severe spasm of the tongue, neck, face, and back. This is a crisis situation that requires rapid treatment.

What are the proper nursing interventions and client education for a client that may experience extrapyramidal effects due to taking thorazine?
Begin to monitor for acute dystonia anywhere between 5hr to 5d after administration of first dose. Treat with anticholinergic agents, such as benztropine or diphenhydramine.

What are the parkinsonism manifestations associated with taking thorazine?
Bradykinesia, rigidity, shuffling gait, drooling, tremors.

What are the proper nursing interventions and client education for a client that may experience parkinsonism due to taking thorazine?
Observe for parkinsonism for the first month after initiation of therapy. This should be treated with benztropine, diphenhydramine, or amantadine.

What are the akathisia manifestations associated with taking thorazine?
Inability to sit or stand still, continual pacing and agitation.

What are the proper nursing interventions and client education for a client that may experience akathisia due to taking thorazine?
Observe for akathisia for the first 2 months after the initiation of treatment. Manage with beta-blockers, benzodiazepines, or anticholinergic medications.

What are the tardive dyskinesia manifestations associated with taking thorazine?
Late EPS, involuntary movements of the tongue and face, such as lip smacking and tongue fasiculations, and involuntary movements of the arms, legs, and trunk.

What are the proper nursing interventions and client education for a client that may experience tardive dyskinesia due to taking thorazine?
Administer lowest possible dosage to control the manifestations. Evaluate the client after 12 months of therapy and then about every 3 months. Manifestations may occur months to years after the initiation of therapy. If TD appears, dosage should be lowered or the client should be switched to an atypical agent.

What are the neuroendocrine effects associated with taking thorazine?
Gynecomastic, galactorrhea, and menstrual irregularities.

What are the proper nursing interventions and client education for a client that may experience neuroendocrine effects due to taking thorazine?
Advise the client to notify the provider if they occur.

What are the neuroleptic malignant syndrome manifestations associated with taking thorazine?
Sudden high fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, changes in LOC, and coma.

What are the proper nursing interventions and client education for a client that may experience neuroleptic malignant syndrome due to taking thorazine?
This condition most commonly occurs within the first two weeks of treatment. Stop the medication, monitor the VS, apply cooling blankets, administer antipyretics, increase the client’s food intake, administer dantrolene and bromocriptine to induce muscle relaxation, and wait two weeks before resuming therapy.

What are the proper nursing interventions and client education for a client that may experience orhtostatic hypotension due to taking thorazine?
The client should develop tolerance in 2-3 months. Monitor BP and HR for orthostatic changes. Hold medication until provider is notified of significant changes. Educate client about proper handling of postural hypotension.

What are the proper nursing interventions and client education for a client that may experience sedation due to taking thorazine?
Inform the client that the effects should diminish within a few weeks. Instruct the client to take the medication at bedtime to avoid daytime sleepiness. Advise the client not to drive until the sedation has subsided.

What are the proper nursing interventions and client education for a client that may experience seizures due to taking thorazine?
Clients with greatest risk are those with existing seizure disorders. Advise client to report seizure to provider, as an increase in antiseizure medication may be necessary.

What are the proper nursing interventions and client education for a client that may experience severe dysrhythmia due to taking thorazine?
Obtain base ECG and potassium level prior to treatment, ad periodically throughout treatment. Avoid concurrent use with other drugs that prolong the QT interval.

What are the proper nursing interventions and client education for a client that may experience sexual dysfunction due to taking thorazine?
Common in both males and females. Advise the client of these effects, encourage the client to report these symptoms to provider. The client may need dosage lowered or be switched to a high-potency agent.

What are the skin effects that can occur as a result of taking thorazine?
Photosensitivity leading to severe sunburn and contact dermatitis from handling medications.

What are the proper nursing interventions and client education for a client that may experience skin manifestations due to taking thorazine?
Adv client to avoid excessive exposure to sunlight, use sunscreen, and wear protective clothing. Avoid direct contact with medication.

What are the contraindications of thorazine?
Clients who are in a coma, have severe depression, have Parkinson’s, have prolactin-dependent cancer of the breast, or have severe hypotension. Contraindicated in older clients who have dementia.

What are the precautions of thorazine?
Use cautiously in clients who have glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver or kidney disease, and seizure disorders.

What medications and foods interact with thorazine?
Anticholinergic agents, CNS depressants (alcohol, opioids, antihistamines), and levodopa.

How do anticholinergic agents affect the action of thorazine?
The concurrent use of an anticholinergic with thorazine will increase effects.

How does levodopa affect the action of thorazine?
It activates dopamine receptors, counteracting the effect of antipsychotic agents.

What patient teaching should be provided to the client taking thorazine in regards to anticholinergics?
Avoid OTC medications that contain anticholinergic agents, such as sleeping pills.

What patient teaching should be provided to the client taking thorazine in regards to CNS depressants?
Avoid alcohol and other medications that cause CNS depression, avoid hazardous activities (driving).

What patient teaching should be provided to the client taking thorazine in regards to levodopa?
Avoid concurrent use of levodopa and other direct dopamine receptor agonists.

What are the nursing administration guidelines for thorazine?
Use the Abnormal Involuntary Movement Scale to screen for presence of EPS. Assess client to differentiate between EPS and worsening psychotic disorder. Administer anticholinergics, beta-blockers, and benzodiazepines to control early EPS; if symptoms are intolerable, a client can be switched to a low-potency or atypical antipsychotic agent. Adv clients that antipsychotics do not cause addiction. Adv that some therapeutic effects may be noticeable within a few days, but significant improvement may take 2-4 weeks and possibly months to take full effect. Begin administration at twice-daily dosing, but switch to daily dosing at bedtime to decrease daytime drowsiness and promote sleep.

Name the atypical antipsychotics.
Risperidone, aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, ziprasidone.

What is the expected pharmacological action of the atypical antipsychotics?
Blockage of serotonin and dopamine receptors, and to a lesser degree, receptors for norepinephrine, histamine, and acetylcholine.

What are the therapeutic uses for the atypical antipsychotics?
Negative and positive symptoms of schizophrenia spectrum disorders, psychosis induced by levodopa therapy, and relief of psychotic manifestations in other disorders (such as bipolar).

What are the complications of atypical antipsychotic therapy?
New onset of DM or loss of glucose control in clients that have DM, weight gain, hypercholesterolemia with increased risk for HTN and cardiovascular disease, orthostatic hypotension, anticholinergic effects such as urinary retention and dry mouth, agitation, dizziness, sedation, sleep disruption, and mild EPS.

What are the proper nursing interventions and client education for a client that may experience new DM or loss of glucose control due to atypical antipsychotics?
Obtain fasting BG and monitor throughout treatment. Instruct client to report increased thirst, urination, and appetite to HCP.

What are the proper nursing interventions and client education for a client that may experience weight gain due to atypical antipsychotics?
Follow healthy, low-calorie diet, engage in regular exercise, and monitor weight gain.

What are the proper nursing interventions and client education for a client that may experience hypercholesterolemia due to atypical antipsychotics?
Monitor cholesterol, triglycerides, and BG if weight gain is greater than 30lb.

What are the proper nursing interventions and client education for a client that may experience anticholinergic effects due to atypical antipsychotics?
Report occurrence to provider, use measures to relieve effects, such as sipping water throughout the day.

What are the proper nursing interventions and client education for a client that may experience agitation, dizziness, sedation, and sleep disruption due to atypical antipsychotics?
Report occurrence to provider, administer alternative medication if prescribed.

What are the proper nursing interventions and client education for a client that may experience mild EPS due to atypical antipsychotics?
Monitor for and teach clients to recognize EPS, use AIMS test to screen for EPS.

What are the contraindications and precautions for atypical antipsychotics?
Pregnancy category C, do not use in dementia pts due to increased risk of CVA or infection, avoid concurrent use of alcohol. Use cautiously in clients who have cardiovascular or cerebrovascular disease, seizures, or DM.

What are the medication/food interactions for atypical antipsychotics?
Immunosuppressive meds (anticancer), CNS depressants, levodopa, tricyclic antidepressants, amiodarone, and clarithromycin, barbiturates, phenytoin, fluconazole.

What is the interaction between tricyclic antidepressants, amiodarone, and clarithromycin with atypical antipsychotics?
They prolong QT intervals, thus increasing the risk of cardiac dysrhythmias.

How do barbiturates and phenytoin interact with atypical antipsychotics?
They stimulate hepatic drug-metabolizing enzymes, thereby decreasing the antipsychotic drug level.

How does fluconazole interact with atypical antipsychotics?
It inhibits hepatic drug-metabolizing enzymes, thereby increasing the antipsychotic drug level.

What is another route for the administration of risperidone?
Depot IM injection every 2 weeks. Therapeutic effect occurs 4-6 weeks after first depot injection.

What are the nursing administration guidelines for atypical antipsychotics?
Adv clients that low doses of medication are given initially, then gradually increased. Use oral disintegrating tablets for clients who may attempt to “cheek” or for those with dysphagia. Assess client’s ability to pay for meds, as antipsychotics are expensive.

What is an additional nursing administration guideline for asenapine?
Avoid eating or drinking for 10 min after each dose.

What is an additional nursing administration guideline for lurasidone?
Take with food, as it increases absorption.

How can the nurse evaluate the effectiveness of atypical antipsychotics?
Improvement of acute psychotic manifestations, absence of hallucinations, delusions, anxiety, and hostility; improvement in ability to perform ADLs; Improvement in social peer interaction; improvement of sleeping and eating habits.

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