NURS 5334 EXAM 2 NOTES. COMPLETE STUDY GUIDE. LATEST 2022

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
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, 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

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, 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

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, 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:

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