NURS 5334 EXAM 2 NOTES. COMPLETE STUDY GUIDE. LATEST 2022
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NURS 5334
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University Of Texas - Arlington
NURS 5334 EXAM 2 NOTES. COMPLETE STUDY GUIDE. LATEST 2022.Psychiatric Drugs
Two Groups:
o First Generation
Conventional Anti-psychotics
Block the receptors for dopamine in central nervous system (CNS)
Cause serious movement disorders (extra pyramidal symptoms, EPS)
Classif...
nurs 5334 exam 2 notes complete study guide latest 2022
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Exam 2 Notes
Psychiatric Drugs
Two Groups:
o First Generation
Conventional Anti-psychotics
Block the receptors for dopamine in central nervous system (CNS)
Cause serious movement disorders (extra pyramidal symptoms, EPS)
Classified by potency
Low, Medium, High
Low Potency
Chlorpromazine
o Indications
Schizophrenia
Schizoaffective disorder in the manic phase of bipolar disorder
Anti-nausea
Relief of hiccups
Control of severe behavioral problems in children
o Adverse effects:
Sedation
Orthostatic hypotension
Anticholinergic effects
o Drug interactions
Intensifies responses to CNS depressant
Antihistamines
Benzodiazepines
Barbiturates
Anticholinergic drugs
Antihistamines
Tricyclic antidepressants
Atropine-like drugs
Thioridazine
o Adverse effects:
Prolonged QT interval
Cause fatal cardiac dysrhythmias
Sedation
Orthostatic hypotension
Anticholinergic effects
Weight gain
o Black Box Warning:
Dysrhythmias
o Treats Schizophrenia only when patients have not responded to
anything else
High Potency
Haloperidol
o Butyrophenone family
1
, o Indications:
Schizophrenia
Acute psychosis
Preferred agent for Tourette Syndrome
o Adverse effects:
EPS
Neuroendocrine effects
Can prolong QT interval and cause dysrhythmias
Fluphenazine
o Phenothiazines subclass
o Indications
Schizophrenia
Other psych disorders
o Adverse effects:
EPS
Acute dystonia
Parkinsonism
Akathisia
Sedations
Orthostatic hypotension
Anticholinergic effects
Gynecomastia
Galactorrhea
Menstrual irregularities
Mechanism of Action (MOA)
Block a variety of receptors within and outside the central nervous system
Suppress symptoms of psychosis by blocking dopamine 2 receptors in the
mesolimbic area of the brain
Adverse Effects
Result of walking receptors for dopamine, acetylcholine, histamine, and
norepinephrine
Acute dystonia
Oculogyric crisis
Opisthotonos
Joint dislocation
Impaired respiration
Some anticholinergic meds can help
o Benztropine and diphenhydramine
Some are irreversible, so crucial to monitor
Can produce Parkinson-like symptoms
o Bradykinesia
o Mask-like faces
o Drooling
o Tremor
o Rigidity
2
, o Shuffling gait
o Cogwheeling
o Stopped posture
o Possible due to blockade of D2 receptors
Other EPS symptoms: akathisia
o Pacing and squirming brought on by uncontrollable need to be in
motion
Tardive dyskinesia and choreoathetoid movements of tongue and face
o Lip smacking
o Tongue flicks in and out
o A slow worm like movement of tongue
o Involuntary movements of limbs, toes, fingers, trunk
Neuroleptic Malignant Syndrome
o Rare but serious (risk of death if not treated)
o Lead pipe rigidity
o Sudden high fever
o Sweating
o Autonomic instability
o Dysrhythmic
o Fluctuations of blood pressure
o Altered level of consciousness
o Seizures or coma can develop
o Death is results of respiratory failure, cardiovascular collapse,
dysrhythmias
Anticholinergic effects
o Dry mouth, poor vision, photophobia, urinary hesitancy, constipation,
tachycardia
Can cause orthostatic hypotension
o due to blocking of alpha 1 adrenergic receptor at blood vessels
Other effects:
o Sedation, neuro endocrine affects seizures, sexual dysfunction,
dermatologic effects agranulocytosis and severe dysrhythmias
BLACK BOX WARNING:
Severe dysrhythmias
Do NOT abruptly withdraw
Can precipitate a mild abstinence syndrome
Schizophrenia is primary indication
Suppress symptoms during psychotic episodes
Continued use does reduce risk of relapse
Medication Interactions
Anticholinergic
o Can intensify anticholinergic effects
CNS depressants
o Can intensify the depressant effect
3
, Levodopa
o Indirect/direct dopamine receptor agonists can counteract the anti-
psychotic effects of neuroleptics
Overall safe and deaths from overdose rare
Overdose can cause:
o Hypertension
o CNS depression, EPS
Treatment of Overdose:
o Fluids
o Alpha adrengergic agonists
o Gastric lavage
o Emetics aren’t effective due to neuroleptics blocking antiemetic action
o Second Generation
Atypical-psychotics
Produce only moderate blockade of dopamine receptors and a stronger blockade of
serotonin
May have fewer EPS
Increased weight gain
Can cause diabetes and dyslipidemia
Clozapine
MOA
o Blocks the dopamine and serotonin
Indications:
o Schizophrenia
o Levodopa induced psychosis
Pharmokinetics
o Orally administered
o Metabolized in liver via CYP450 system
o 12-hour half life
Adverse effects
o Agranulocytosis
o Seizures
o EPS
o Diabetes
o Dyslipidemia
o Can affect total cholesterol
o Weight gain
o Affects older adults with dementia
Double the mortality rate
Black Box Warning:
o Myocarditis
Risperidone
Binds to multiple receptors
Pharmcokinetics:
4
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