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Questions and Answers
What is the mechanism of action of dantrolene, a muscle relaxant?
Which of the following is NOT an extrapyramidal effect associated with antipsychotic drugs?
What is the nursing implication related to elderly patients with dementia-related psychosis who are treated with antipsychotics?
What is a common adverse effect associated with phenothiazines like chlorpromazine?
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What should nurses do in terms of dosing when caring for patients on antipsychotic therapy?
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Which symptom is clozapine most effective against?
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What adverse effect has a higher risk with second-generation antipsychotics like quetiapine and risperidone?
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How long may it take for the therapeutic effects of second-generation antipsychotics to be fully seen?
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What should be monitored before starting specific drugs like clozapine?
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Which muscle should IM injections be given into for acute psychotic episodes?
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What should a patient do after receiving an IM injection of second-generation antipsychotics to prevent orthostatic hypotension?
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What are the symptoms associated with Neuroleptic Malignant Syndrome?
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What is the recommended treatment for Neuroleptic Malignant Syndrome?
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Which medication can be used for muscle relaxation in the treatment of Neuroleptic Malignant Syndrome?
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What is a potential cardiovascular effect associated with Neuroleptic Malignant Syndrome?
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What is the role of Haloperidol in the management of schizophrenia according to the text?
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Which adverse effect is a Black Box Warning for clozapine?
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What should be monitored in a patient prescribed clozapine to assess for extrapyramidal side effects?
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Which is NOT a potential anticholinergic effect to assess for while a patient is taking clozapine?
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What should be done if a patient on clozapine develops decreased white blood cell count?
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Which potential effect of clozapine requires monitoring to prevent falls in patients?
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What is the mechanism of action of flumazenil?
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Which medication is used for the maintenance of alcohol sobriety?
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What is the major adverse effect of disulfiram if alcohol is consumed?
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Which medication works slower than other opioids and produces less euphoria?
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What is the main use of buprenorphine-naloxone in opioid abuse treatment?
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What is the Black Box Warning associated with disulfiram?
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Study Notes
Neuroleptic Malignant Syndrome (NMS)
- Caused by depletion of dopamine
- Symptoms: Fever, Altered mental status, Tachycardia, Hypertension, Rigid muscles, and Decreased reflexes
- Treatment: Quickly taper off antipsychotic, Provide supportive care, Benzodiazepines or Dantrolene for muscle relaxation
Antipsychotics
- Nonphenothiazine: Haloperidol (Haldol)
- Uses: First-line therapy for schizophrenia and depression
- Adverse Effects: Cardiovascular (EKG changes), Antiadrenergic (Hypotension, Dizziness, Fatigue), Hematologic (Agranulocytosis, Pancytopenia), Photosensitivity
- Nursing Implications: Administer with food, avoid contact with skin, give 1-2 hours before bedtime
Benzodiazepine Reversal Agent
- Prototype: Flumazenil
- Mechanism of Action: Inhibits BZD activity at receptor sites
- Use: Reverse effects of benzodiazepines
- Adverse Effects: Risk of seizures
- Contraindications: Not for use with benzodiazepine-dependent patients
- Nursing Implications: Monitor for seizures
Enzyme Inhibitors for Maintenance of Alcohol Sobriety
- Prototype: Disulfiram
- Mechanism of Action: Prevents normal metabolism of alcohol, resulting in unpleasant reaction when consumed with alcohol
- Use: Maintain state of sobriety
- Adverse Effects: Headache, Chest pain, Seizures, N/V, Heart failure, MI, Death
- Contraindications: Not for patients who consumed alcohol in past 12 hours, or patients with heart conditions
- Nursing Implications: Patient must know they are taking this medication, monitor for side effects
Opioid Agonists for Treatment of Opioid Abuse
- Prototype: Methadone
- Mechanism of Action: Same as other opioids, but works slower and produces less euphoria
- Use: Detoxification/maintenance therapy for opioid addiction
- Adverse Effects: QT prolongation
- Contraindications: Not for use without approved opioid addiction treatment program
- Nursing Implications: Monitor for QT prolongation
Opioid Antagonist/Agonist for Treatment of Opioid Abuse
- Prototype: Buprenorphine-Naloxone
- Mechanism of Action: Buprenorphine blocks opiate receptors, Naloxone reverses effects of opioids
- Use: Maintenance therapy for short-acting opioid dependence
- Adverse Effects: Risk of addiction, abuse, and misuse leading to respiratory depression
- Contraindications: Not for use with buccal and transdermal routes
- Nursing Implications: Monitor for respiratory depression
Extrapyramidal Effects
- Dystonia
- Drug-induced Parkinsonism
- Akathisia
- Tardive Dyskinesia
- Nursing Implications: Assess for EPSE, monitor for adverse effects
First-Generation Antipsychotics
- Phenothiazines: Chlorpromazine
- Mechanism of Action: Blocks postsynaptic dopamine in the brain
- Use: Effective against positive and negative symptoms
- Adverse Effects: Extrapyramidal effects, weight gain, hyperglycemia, diabetes, hyperlipidemia
- Nursing Implications: Obtain baseline EKG, monitor for idiopathic edema and muscle necrosis
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Description
Test your knowledge on antipsychotic medications including drug names, classes, mechanisms of action, uses, adverse effects, contraindications, and nursing implications. Focus on first generation antipsychotics like phenothiazines such as Chlorpromazine.
