Antipsychotic Drugs Overview
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Questions and Answers

What is the therapeutic class of chlorpromazine?

Conventional antipsychotic.

Identify one major action of chlorpromazine.

It provides symptomatic relief of positive symptoms of schizophrenia.

What distinguishes clozapine from older antipsychotics?

Clozapine blocks both dopamine and serotonin receptors.

What is a key symptom of neuroleptic malignant syndrome (NMS)?

<p>Muscle rigidity.</p> Signup and view all the answers

Name one drug that can be used to treat NMS.

<p>Dantrolene.</p> Signup and view all the answers

What is the prototype drug for nonphenothiazines?

<p>Haloperidol.</p> Signup and view all the answers

How long might some patients need to take chlorpromazine before seeing improvement?

<p>7 or 8 weeks.</p> Signup and view all the answers

What is the primary pharmacologic class of chlorpromazine?

<p>D2 dopamine receptor antagonist.</p> Signup and view all the answers

What are the main uses of antipsychotic drugs?

<p>Antipsychotic drugs are primarily used for the treatment of psychosis, including disorders like schizophrenia.</p> Signup and view all the answers

Describe the difference between positive and negative symptoms of schizophrenia.

<p>Positive symptoms include behaviors like hallucinations and delusions, while negative symptoms involve lack of motivation and social withdrawal.</p> Signup and view all the answers

What role do dopamine receptors play in schizophrenia?

<p>Dopamine receptors, particularly D2 receptors, are believed to be overactive in schizophrenia, contributing to the disorder's symptoms.</p> Signup and view all the answers

What are the two categories of antipsychotic drugs?

<p>Antipsychotic drugs are categorized into typical (first-generation) and atypical (second-generation) agents.</p> Signup and view all the answers

How do antipsychotic drugs reduce symptoms of schizophrenia?

<p>Antipsychotic drugs reduce symptoms by entering dopaminergic synapses and blocking D2 receptors, which decreases dopamine activity.</p> Signup and view all the answers

What types of behaviors are associated with the positive symptoms of schizophrenia?

<p>Positive symptoms include bizarre behaviors such as agitation, delusions, hallucinations, and paranoia.</p> Signup and view all the answers

Can you explain what social withdrawal looks like in individuals with schizophrenia?

<p>Social withdrawal in schizophrenia is characterized by a person paying less attention to the environment and avoiding interactions with others.</p> Signup and view all the answers

Give an example of a typical antipsychotic medication.

<p>Haloperidol (Haldol) is a commonly used typical antipsychotic medication.</p> Signup and view all the answers

How does lithium affect sodium transport in nerve and muscle cells?

<p>Lithium alters sodium transport, inhibiting norepinephrine and dopamine release while slightly increasing their intraneuronal stores.</p> Signup and view all the answers

What is the significance of sodium depletion or dehydration when taking lithium?

<p>Sodium depletion or dehydration leads to increased renal reabsorption of lithium, which can result in toxic levels in the serum.</p> Signup and view all the answers

List two contraindications for lithium use.

<p>Significant renal or cardiac disease and hypersensitivity to lithium are two main contraindications.</p> Signup and view all the answers

What is the recommended therapeutic level of lithium in the serum?

<p>The therapeutic level of lithium is between 0.5 to 1.5 meq/L.</p> Signup and view all the answers

Why should women of childbearing age use birth control while taking lithium?

<p>Lithium crosses the placenta and is associated with congenital abnormalities, necessitating birth control to prevent pregnancy.</p> Signup and view all the answers

How should patients be encouraged to manage fluid intake while taking lithium?

<p>Patients should be encouraged to increase their fluid intake to prevent dehydration and subsequent lithium toxicity.</p> Signup and view all the answers

What are the common side effects of using antidepressants in managing depression?

<p>Common side effects can include weight gain, sexual dysfunction, and insomnia.</p> Signup and view all the answers

At what age is depression most commonly initiated, and which gender is more affected?

<p>Depression most often starts in early adulthood and is more common in women.</p> Signup and view all the answers

What are some conditions that may contraindicate the use of certain drugs mentioned?

<p>Angle-closure glaucoma, urinary retention, prostate hypertrophy, and renal or hepatic disease are contraindications.</p> Signup and view all the answers

Which population groups should be monitored closely due to increased risk of suicidality?

<p>Children, adolescents, and young adults should be monitored for suicidality.</p> Signup and view all the answers

How do alcohol and tricyclic antidepressants affect the effectiveness of epinephrine?

<p>Alcohol decreases the effectiveness and increases sedation, while tricyclic antidepressants can lead to increased effects of epinephrine, causing high blood pressure.</p> Signup and view all the answers

What baseline assessments are essential before starting therapy with the mentioned drugs?

<p>Vital signs, weight, skin color and lesions, affect, orientation, reflexes, vision, and bowel sounds should be assessed.</p> Signup and view all the answers

Why are MAOIs considered more difficult to manage than other antidepressants?

<p>MAOIs interact with many prescription and nonprescription drugs, as well as certain foods, making them difficult to manage.</p> Signup and view all the answers

What potential adverse reactions should be avoided when a patient is on MAOIs?

<p>Patients on MAOIs should avoid stimulants and other antidepressants to prevent severe adverse reactions.</p> Signup and view all the answers

What considerations should be made when assessing patients with a history of seizures?

<p>Patients with a history of seizures may have a decreased seizure threshold due to drug stimulation of receptor sites.</p> Signup and view all the answers

What is the role of MAOIs in the treatment of depression?

<p>MAOIs treat depression by preventing the breakdown of norepinephrine, dopamine, and serotonin.</p> Signup and view all the answers

What is the primary mechanism by which SSRIs help alleviate symptoms of depression?

<p>SSRIs prevent the reuptake of serotonin in the brain, increasing serotonin availability.</p> Signup and view all the answers

List two common side effects associated with SSRIs.

<p>Common side effects include nausea and trouble sleeping.</p> Signup and view all the answers

Name one condition other than depression for which SSRIs may be indicated.

<p>SSRIs can also be indicated for obsessive-compulsive disorder (OCD).</p> Signup and view all the answers

Explain why SSRIs do not produce more serotonin in the body.

<p>SSRIs do not cause the body to produce more serotonin; instead, they help the body use existing serotonin more effectively.</p> Signup and view all the answers

What populations should be assessed for increased suicidality when prescribing SSRIs?

<p>Children, adolescents, and young adults should be monitored for increased suicidality.</p> Signup and view all the answers

Describe the pharmacokinetics of SSRIs regarding their absorption and excretion.

<p>SSRIs are well absorbed from the GI tract, metabolized in the liver, and excreted in urine and feces.</p> Signup and view all the answers

What caution should be taken for patients with renal or hepatic impairment when prescribing SSRIs?

<p>Patients with impaired renal or hepatic functions may experience altered metabolism and toxicity from SSRIs.</p> Signup and view all the answers

Identify one nursing consideration to assess before starting an SSRI in female patients.

<p>Assess if the female patient is pregnant or breastfeeding.</p> Signup and view all the answers

Study Notes

Antipsychotic Drugs

  • Used to treat psychosis, severe mental disorder characterized by disordered thought processes, blunted or inappropriate emotional responses, bizarre behavior, social withdrawal, hallucinations, and paranoid delusions.
  • Schizophrenia is caused by imbalances in neurotransmitters in specific brain areas.
  • Positive symptoms of schizophrenia include: agitation, behavioral disturbances, delusions, disorganized speech, hallucinations, insomnia, and paranoia.
  • Negative symptoms of schizophrenia include: lack of pleasure, lack of motivation, blunted affect, poor grooming and hygiene, poor social skills, poverty of speech, and social withdrawal.
  • Antipsychotic drugs compete with dopamine by blocking dopamine 2 receptors, which reduces symptoms of schizophrenia.
  • Antipsychotics are categorized as "typical" or "atypical," "conventional" or "second generation."

Phenothiazines

  • Prototype drug: Chlorpromazine Hydrochloride (Thorazine)
  • Therapeutic Class: Conventional Antipsychotic, schizophrenia drug
  • Pharmacologic Class: D2 dopamine receptor antagonist; phenothiazine
  • Actions: Provides symptomatic relief of positive symptoms of schizophrenia and control manic symptoms in patients with schizoaffective disorder.

Nonphenothiazines

  • Prototype: Haloperidol (Haldol)
  • First-Generation “Typical” Antipsychotics
  • Frequently used, potent, long-acting drug.
  • It is well absorbed after oral or intramuscular (IM) administration and is metabolized in the liver.
  • It may cause adverse effects similar to those of the phenothiazines.

Side Effects

  • Neuroleptic malignant syndrome (NMS): A rare but potentially fatal reaction that may occur hours to months after initial drug use. Symptoms include fever, muscle rigidity, confusion, delirium, dyspnea, tachycardia, respiratory failure, and acute renal failure.

Second-Generation “Atypical” Antipsychotics

  • Prototype: Clozapine (Clozaril)
  • Clozapine is chemically different from the older antipsychotic drugs.
  • It blocks both dopamine and serotonin receptors in the brain.
  • It is indicated for clients with schizophrenia, including those who have exhibited recurrent suicidal behavior.
  • Advantages of clozapine include improvement of negative symptoms, without causing the extrapyramidal effects associated with older antipsychotic drugs.

Lithium

  • Therapeutic Actions: Lithium alters sodium transport in nerve and muscle cells; inhibits the release of norepinephrine and dopamine but not serotonin from stimulated neurons.
  • Pharmacokinetics: Lithium is readily absorbed from the GI tract and excreted from the kidney.
  • Contraindications: Hypersensitivity to lithium, significant renal or cardiac disease, history of leukemia, metabolic disorders including sodium depletion, dehydration, pregnancy, and lactation.

Nursing Management (Lithium)

  • Obtain baseline: renal, cardiac, thyroid
  • Monitor WBC for Leukocytopenia and Agranulocytosis
  • Increase fluid intake
  • Avoid excessive exercises and warm environment
  • Assess for signs of lithium toxicity
  • Therapeutic level of lithium: 0.5 to 1.5meq/L

Antidepressant Drugs

  • Depression is a mental health issue that starts most often in early adulthood, and is more common in women.

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • Most commonly prescribed class of antidepressants.
  • Fight depression symptoms by decreasing serotonin reuptake in the brain.
  • Examples: Sertraline (Zoloft), Fluoxetine (Prozac, Sarafem), Citalopram (Celexa), Escitalopram (Lexapro), Paroxetine (Paxil, Pexeva, Brisdelle), Fluvoxamine (Luvox)

Common Side Effects of SSRIs

  • Nausea, trouble sleeping, nervousness, tremors, sexual problems

SSRIs are also indicated for:

  • Obsessive-compulsive disorder (OCD), panic disorder, bulimia, post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), hot flashes caused by menopause, anxiety

How SSRIs Work

  • Serotonin is a brain chemical that transmits messages between brain cells.
  • SSRIs work by preventing blood from absorbing some of the serotonin from the brain, leaving a higher level of serotonin in the brain.
  • SSRIs do not cause the body to make more serotonin but help the body use what it has more effectively.

Pharmacokinetics (SSRIs)

  • SSRIs are well absorbed from the GI tract, metabolized in the liver and excreted in the urine and feces.
  • Half-life varies widely with the drug being used.

Caution (SSRIs)

  • Patients with impaired renal or hepatic functions, severely depressed/suicidal patients, especially children, adolescents & young adults, pregnant women.

Nursing Considerations (SSRIs)

  • Assess for allergies to SSRIs, severe depression, angle-closure glaucoma, bipolar disorder, impaired liver and renal functions, pregnant or breastfeeding women.

Interactions (SSRIs)

  • Alcohol decreases effectiveness, increases sedation effects.

Tricyclic Antidepressants (TCAs)

  • These drugs have a greater sedative effect than SSRIs, and are less commonly prescribed due to serious side effects.
  • Act by blocking receptors for serotonin and norepinephrine, increasing the availability of these neurotransmitters in the brain.
  • Examples: Amitriptyline (Elavil), Imipramine (Tofranil), Desipramine (Norpramin), Doxepin (Sinequan)

Common Side Effects of TCAs

  • Drowsiness, blurred vision, dry mouth, constipation, urinary retention, orthostatic hypotension

Cautions (TCAs)

  • Angle-closure glaucoma, urinary retention, prostate hypertrophy, GI or genitourinary surgery, psychiatric patients, manic-depressive patients, children, adolescents, & young adults, history of seizures, elderly, hepatic or renal disease.

Nursing Considerations (TCAs)

  • Assess allergies, liver or kidney function, glaucoma, benign prostatic hypertrophy, cardiac dysfunction, GI obstruction, surgery or recent myocardial infarction, history of seizures, psychiatric problems, suicidal thoughts, myelography within the past 24 hours or in the next 48 hours, or if taking MAOIs.
  • Assess vital signs, weight, skin color & lesions, affect, orientation, reflexes, vision & bowel sounds.

Monoamine Oxidase Inhibitors (MAOIs)

  • Older drugs that treat depression.
  • Work by stopping the breakdown of norepinephrine, dopamine, and serotonin.
  • Examples: Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan), Selegiline (Emsam).

MAOIs Should Not be Combined With:

  • Stimulants or other antidepressants.

Food Interactions (MAOIs)

  • Foods high in tyramine should be avoided as it can cause a hypertensive crisis.
  • Examples of foods: aged cheeses, cured meats, beer, red wine, yeast extracts, pickled products, some fruits and vegetables.

Nursing Considerations (MAOIs)

  • Assess for known allergies, liver or kidney function, pregnancy, history of seizures or psychiatric problems, recent surgery, and current medication list (especially other antidepressants, sympathomimetics, stimulants), vital signs, affect, LOC, and orientation for any potential adverse effects.

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Description

This quiz delves into the use and classification of antipsychotic drugs, particularly in relation to schizophrenia. Explore the differences between typical and atypical antipsychotics, and understand the symptoms of the disorder they aim to treat. Test your knowledge on the therapeutic classes and the mechanism of action of these medications.

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