2 medications

Question 1

treatment of schizophrenia has 3 main phases

Answer 1

1 acute phase
2 stabilization
3 maintenance phase

Question 2

schizophrenia is a ____ state and requires ___ medication

Answer 2

psychotic state

-antipsychotic med

Question 3

1st generation medications

Answer 3

1 Chlorpromazine (THORazine)
2 Haloperidol (Haldol)
3 Fluphenazine (Prolixin)
4 Thioridazine (Mellaril)
5 Loxapine (Loxitane)

Question 4

1st generation meds are also called…

Answer 4

• conventional
• typical
• neuroleptic

Question 5

If chlorpromazine is administered, make sure to monitor ______

Answer 5

resp.rate (12-20 breaths)

Question 6

when pt is starting a new med, let them come in after ___ for evaluation

Answer 6

2 weeks

Question 7

haloperidol is ___ potency

Answer 7

HIGH

Question 8

1st gen [conventnl, typcl, neuroleptc]

MOA

Answer 8

-block dopamine, acetylcholine, histamine, + norepinephrine

Question 9

1st gen [conventnl, typcl, neuroleptc]

A/E

Answer 9

• agranulocytosis
• antichol effects
• EPS (acute dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia, neuroendocrine, neuroleptic malignant syndrm, etc)
• sedation
• wt gain
• orthostatic hypotension
• seizures

Question 10

if pr has WBC less than ____, hold the 1st gen med

Answer 10

3k mm3

Question 11

anticholinergic manifestations

Answer 11

• dry mouth
• blurred vision
• photophobia
• urinary hesitancy/retention
• constipation
• tachycardia

Question 12

nursing actions to decr antichol effects

Answer 12

• chew sugarless gum
• sip on water
• avoid hazardous activities
• wear sunnies
• high fiber food
• reg exercise
• 2-3L fluid
• void before taking med

Question 13

acute dystonia

Answer 13

severe spasm of tongue, neck face, back

**crisis situation, requires rapid treatment!!!

Question 14

begin to monitor for acute dystonia anywhere between ______ after admin of first dose

Answer 14

1-5 days

Question 15

treat acute dystonia with…

Answer 15

antiparkinsonian agent

• BENZOTROPINE or trihexyphenidyl
• IM or IV of diphenhydramine (benadryl)

Question 16

if pt is experiencing acute dystonia,

Answer 16

• stay w client

- monitor airway until spasms subside (5-15min)

Question 17

pseudoparkinsonism

manifestations

Answer 17

• bradykinesia
• rigidity
• shuffling gait
• drooling
• tremors

Question 18

observe for pseudoparkinsonism for _____ after initiation of therapy. can occur _____ following first dose

Answer 18

• first month

- 5-30 days

Question 19

pseudoparkinsonism is a ___ risk

Answer 19

fall

Question 20

treat pseudoparkinsonism w…

Answer 20

antiparkinsonian agent

-BENZOTROPINE or trihexyphenidyl

Question 21

THOR the 1st TRIed CHLOrine, he got the FLU + got LOX

Answer 21

CHLOrpromazine (THORazine)
check pt’s BP (90/60),
pulse ox (99%)

Question 22

1st gen/typical/neuroleptic/conventional treat ____ symptoms of schizo

Answer 22

POSITIVE

Question 23

Neuroleptic malignant syndrome - FEVER

Answer 23

Fever
Encelopathy
Vitals
Elevated bld enzyme lvl
Rigidity

Question 24

meds to cure NMS

Answer 24

dantrolene + bromocriptine

Question 25

w/ 1st gen meds... ___ is common

Answer 25

diarrhea

Question 26

NMS occurs when _____ and is ____

Answer 26

too much antipsychotic is given likely permanent brain damage

Question 27

akinesia

Answer 27

spontaneous mvmt

Question 28

akathisia

Answer 28

cant sit still | -muscle quivering

Question 29

tardive dyskinesia

Answer 29

repetitive face mvmt

Question 30

akathisia can be managed with...

Answer 30

- antiparkinsonian agents (BENZOTROPINE or trihexyphenidyl) - beta blockers - lorazepam/diazepam

Question 31

severe akathisia is at risk for ___

Answer 31

suicide

Question 32

late EPS

Answer 32

tardive dyskinesia

Question 33

for tardive dyskinesia, evaluate pt ____ after therapy, and then Q___

Answer 33

12 months after therapy, | Q3months after

Question 34

TD is permanent but pt can try to ____ to minimize the effects

Answer 34

use purposeful muscle mvmt

Question 35

haloperidol is used to control...

Answer 35

aggressive + impulsive behavior

Question 36

with haloperidol, monitor for clinical findings of ...

Answer 36

parkinsonian + anticholinergic effects

Question 37

nursing actions with haloperidol

Answer 37

- keep client hydrated - check VS - test for muscle rigidity (NMS)

Question 38

2nd generation aka

Answer 38

- unconventional | - atypical

Question 39

2nd gen medications

Answer 39

``` 1 prisperidone (Risperdal) 2 clozapine (clozaril) 3 olanzapine (zyprexa) 4 quitiapine (seroquel) 5 ziprasidone (Geodon) ```

Question 40

which 2nd gen med is considered a last resort? and why?

Answer 40

clozapine (Clozaril) | -bc pt often die fr agranulocytosis

Question 41

which med is linked w obesity and what is it also used to treat?

Answer 41

olanzapine (Zyprexa) | -also used for bipolar bc its a mood stabilizer

Question 42

normal range for WBC

Answer 42

5-10k

Question 43

when pt is started on clozapine (Clozaril), we monitor ____, Q___

Answer 43

WBC | for 6 months, Qweek

Question 44

pt on clozapine (Clozaril) will be...

Answer 44

put on national registrar

Question 45

if pt is allergic to haloperidol, then u can give ___

Answer 45

olanzapine

Question 46

before you admin ziprasidone, make sure to obtain...

Answer 46

a baseline EKG

Question 47

we use ___ generation meds first because it treats ___ symptoms + it has a lower risk for ___

Answer 47

2ND gen POS+NEG EPS

Question 48

2nd gen MOA

Answer 48

blocks serotonin + dopamine | -blocks receptors for norepinephrine, histamine, + acetylcholine

Question 49

3RD generation s/e

Answer 49

- insomnia | - akathisia

Question 50

tardive dyskinesia can be treated w...

Answer 50

- deutetrabenazine | - valvalbenazine

Question 51

anticholinergic meds + MOA

Answer 51

- benztropine, diphenhydramine, trihexyphenidyl | - used to treat EPS s/e fr antipsychotics

Question 52

long term use of diphenhydramine can lead to...

Answer 52

dementia