6521 Final Study Guide.docx - 1 Final Review for NURS 6521 Antipsychotics First-generation antipsychotics can be classified as low potency medium

1 Final Review for NURS 6521 Antipsychotics First-generation antipsychotics can be classified as low potency, medium potency, or high potency (Table 24.2). The low-potency drugs, represented by chlorpromazine, and the high-potency drugs, represented by haloperidol. Block dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery. Acute and chronic psychosis, schizophrenia, manic phase of bipolar disorders, Tourette's syndrome, delusional and schizoaffective disorders, dementia. Conventional (typical) or atypical. Patient education: s/s of orthostatic hypotension - move slowly when standing up. Sedation - avoid hazardous activities such as driving until sedation wears off. Impaires libido and erection / ejaculation. *avoid anticholinergic drugs, barbiturates, benzos and alcohol. First generation antipsychotics - a group of medications originally developed to combat psychotic symptoms by reducing dopamine levels in the brain; also called conventional or typical antipsychotics block receptors for dopamine, acetylcholine, histamine, and norepinephrine Schizophrenia is the primary indication for antipsychotic drugs. These agents effectively suppress symptoms during acute psychotic episodes and, when taken chronically, can greatly reduce the risk for relapse. Initial effects may be seen in 1 to 2 days, but substantial improvement usually takes 2 to 4 weeks, and full effects may not develop for several months. Adverse Effects: Among the many side effects FGAs can produce, the most troubling are the extrapyramidal reactions—especially tardive dyskinesia (TD). Acute dystonia: muscle spasms of tongue, face, neck, back, and opisthotonus. Parkinsonism: bradykinesia, mask-like facies, tremor, rigidity, shuffling gait, drooling, cogwheeling, stooped posture. Akathisia: compulsive, restless movement; symptoms of anxiety, agitation. TD: oral-facial dyskinesias, choreoathetoid movements. Neuroleptic Malignant Syndrome - A rare and sometimes fatal reaction to high-potency neuroleptic drugs. Symptoms include muscle rigidity "lead pipe", fever, Sweating, autonomic instability and elevated white blood cell count. It is thought to result from dopamine blockage at the basal ganglia and hypothalamus. Treatment: supportive measures, drug therapy and immediate withdrawal of antipsychotic medication. Ex. (low potency): Chlorpromazine, Thioridazine

2 s/e orthostatic hyposension, long Q-T syndrome, high sedation (medium potency): loxapine, perhenazine, s/e moderate sedation (high potency):fluphenazine, haloperidol, pimozide, thiothoxene, frifluoperizine s/e movement problems Second gen antipsycs - drugs that alleviate schizophrenia with less likelihood of movement problems S/E: are associated with metabolic adverse effects (eg. weight gain, dyslipidemia, hyperglycemia, and increased risk of diabetes). As such they should be monitored for changes. Olanzapine and clozapine carry the greatest risk.