Schizo Lecture 3

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foxyt14
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214377
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Schizo Lecture 3
Updated:
2013-04-19 20:02:04
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N171
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N171 test #2
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  1. EPS
    a side effect of antipsychotic medications from blockage of dopamine

    • psuedoparkinsoniasm-tremors
    • tardive dyskinisia
    • dystonia
    • akinesia
    • akithesia
  2. Suicidal ideation vs. intention
    ideation-thoughts about or unusual preoccupation with suicide

    intention-thoughts plus plan
  3. dystonia
    • involuntary muscle spasms of the:
    • face
    • arms
    • legs
    • neck

    Side effect of antipsychotic meds
  4. Suicide protective factors
    • intact positive support system
    • religious/faithful
    • dependent children
    • relationship with supportive caregiver
    • absence of mental disorder/drug user
    • living close to mental/medical health resource
    • good problem solving/coping skills
  5. pseudoparkinsonism
    symptoms occur 1-5 days after start of antipsychotic med

    tremor, shuffle, drools, rigid

    occurs most often in women, elderly and dehydrated
  6. What are suicide precautions?
    • monitor q10-15min
    • remove all harmful items
    • make sure haven't "pocketed" pills and saved to take as an OD
    • listen to them if they mention it
    • write a contract to seek staff if thinking to do
  7. tardive dyskinesia
    • antipsychotics cause....
    • bizarre facial and tongue movements
    • stiff neck
    • difficulty swallowing

    PERMANENT
  8. Self injurious behavior
    don't want to kill themselves, but are 18x more likely to do it by accident

    cutting/burning/opening existing wounds
  9. akathisia
    inner restlessness and feeling of having to move
  10. Neuroleptic Malignant Syndrome
    complication of neuroleptic drugs-fatal

    • sever muscle rigidity
    • high fever
    • tachy
    • fluctuations in BP
    • diaphoresis
    • rapid deterioration of mental status-stupor then coma
  11. Typical/Conventional antipsychotic meds
    • Thorazine
    • Haldol
    • Prolixin
  12. List 3 factors that reduce client compliance with taking antipsychotic meds
    • undesireable side effects
    • cost concerns
    • don't feel they have any or enough + benefits
    • stigma of meds
    • don't feel they need meds
  13. Why are atypical antipsychotics preferred?
    • Lower risk for EPS/NMS
    • ALSO-improve positive as well as negative symptoms of schizo which makes for a better quality of life
  14. What is meant by potency of a med and what this means in terms of comparing dosing.
    • high potency drugs are given at a lower dosage
    • higher potency drugs are responsible for a greater number of undesireable side effects

    meds are given and titrated up.

    Want to have the desired effect with the least amount of side effects, which is hopefully achieved at the lower dosage of a drug
  15. What ancillary medication may be used to treat side effects from antipsychotic meds?
    Benadryl-treats EPS

    Cogentin-prevents/treats EPS
  16. Geodon S/E
    • Prolonged QT
    • sedation
    • rhinitis(runny nose)
    • muscle weakness
  17. What do you need to check before giving Geodon?
    EKG
  18. Zyprexa S/E
    Weight gain

    Teach patient that will get really hungry, and need to pick healthy snacks...and drink water
  19. What do you need to watch out for when a persons on Zyprexa?
    may get diabetes
  20. What fatal side effect should be monitored with clozapine?
    agranulocytosis

    monitor CBC and WBC weekly for 1st 6 months

    tell patient to report signs of fever, sore throat or rash

    lowers seizure threshold
  21. How do you rate suicide lethality?
    • Is the pt rational....are they having hallucinations/delusions?
    • Do they have a plan?
    • Do they have the means to carry out the plan?
    • Do they have access to the means?
  22. All typical psychotics cause
    • disorders of movement-EPSE
    • endocrine disorders-gynocomatsia and galacturia
    • cognitive problems-cant problem solve, sluggish and slow to respond
  23. What do typical antipsychotics do?
    causes a reduction in hallucinations and delusions ONLY
  24. List atypical antipsychotics
    • Clozaril
    • Risperdal
    • Zyprexa
    • Seroquel
    • Geodon
  25. S/E for all Atypical antipsychotic meds
    • sedation
    • hypotension
    • weight gain
    • anticholinergic

    LOWER POTENTIAL for EPS, but still can occur
  26. What's an anticholinergic s/e look like?
    Cant:

    • see
    • pee
    • spit
    • poop
  27. Which type of antipsychotic is more likely to cause seizures?
    typical....with an exception of clozapine
  28. Which type of antipsychotic is more likely to cause agranulocytosis?
    Typicals....with the exception of clozapine
  29. Which drug causes hypersalvation?
    clozapine
  30. Which type of antipsychotic is more likely to cause tardive dyskinesia?
    typical
  31. Which type of antipsychotic is more likely to cause NMS?
    typical
  32. Which type of antipsychotic is more likely to cause diabetes and hyperglycemia?
    atypicals
  33. Which type of antipsychotic is more likely to have anticholinergic effects?  Exception?
    typicals

    clozapine and olanzapine
  34. What side effects will you see in both typical and atypical antipsychotics
    • Nausea
    • rash
    • sedation
    • orthostatic hypotension
    • photosensitivity
    • hormonal effects
    • ecg changes
  35. How do you treat EPSE?
    • IM Benadryl
    • Cogentin PO for ongoing prevention
  36. How do you treat NMS?
    • stop medication immediately
    • fluids
    • monitor heart and labs
  37. How do you treat photosensitivity?
    sunscreen and wear protective clothing
  38. How do you treat anticholinergic side effects?
    • sip on water/chew ice chips
    • chew gum/suck on candy
    • good oral care
    • high fiber diet
    • use caution when driving
  39. Who's at risk for suicide culturally?
    • whites....in the highest and lowest socioeconomic classes
    • professional healthcare personnel and business executives.
    • Also...law enforcement, attorneys and mechanics
  40. Discuss community strategies to reduce incidence of suicide....
    • community mental health
    • assist pt with creating crisis care card
    • teach pt/family how to handle recurrent suicidal thoughts and behaviors
    • encourage pt/family to read books on suicide for knowledge
    • provide support to family of a successful suicide
  41. Name community mental health facilities
    • outpatient clinics
    • supportive housing
    • clubhouse model
  42. What's listed in a crisis care card?
    • names and phone numbers of family/friends
    • same for community resources and support groups
    • reasonable, non suicidal responses to problems
    • list of activities that have helped in the past
  43. What are curative factors?
    interpersonal growth a person can achieve through group therapy
  44. List some Yalom curative factors
    • instillation of hope
    • universatility
    • imparting information
    • altruism
    • corrective recapitulation of primary family
    • socialization
    • imitative behavior
    • interpersonal learning
    • existential factors
    • catharsis
    • group cohesiveness
  45. If I am going to give antipsychotics I first need to....
    make sure there is a signed consent on file.

    Doctor or prescriber is responsible to get this
  46. Do I need a signed consent to administer Benzos ("pams")?
    NO
  47. Steady state
    it takes 5 half lives to achieve affected by food, fluid and exercise

    after steady state is reach, it will take 4 more weeks for change to occur in the brain
  48. definition of steady state
    the same amount is in the body as there is being excreted
  49. Only medication you see immediate effects from?
    sedatives
  50. Dopamine=
    Norepinephrine=
    Serotonin=
    • DA
    • NE
    • 5HT
  51. Effects of dopamine
    • reward
    • motivation
    • motor activity
    • learning
    • short term memory development

    occurs in hypothalamus
  52. Describe dystonia
    • arched back
    • oculogyric crisis
    • asapiration
  53. Tardive dyskinesia is commonly seen in...
    elderly.

    prescribed in ltc facility....doctor prescribes then doesn't seen them for awhile
  54. schizo and what go together?
    diabetes
  55. When a person has NMS and severe muscle rigidity what happens?
    CPK levels rise causing renal failure
  56. Risperdal causes
    • weight gain
    • drowsiness
  57. Seroquel make sure....
    • you get a baseline EKG and watch for
    • hypotension
  58. Which drug doesn't cause weight gain?
    Geodon
  59. Which drug is an antidepressant but is given as an antipsychotic too?
    Abilify
  60. General medication teaching for atypical antipsychotics
    • how to prevent dizziness
    • management of dry mouth
    • oral hygiene
    • constipation
    • sun exposure
    • reportable symptoms to provider
  61. most important thing to teach a pt on atypical antipsychotics
    what to do if miss a dose.

    Don't double up....take next dose close to the next scheduled dose
  62. Atypical antipsychotics are black box for
    elderly and pregos
  63. Most common way to commit suicide
    fire arms
  64. Most common way for women to commit suicide?
    Children?
    • overdose for women
    • and
    • hanging/jumping for kids
  65. What does ambivalence of act mean?
    they want to end their pain and turmoil, but don't necessarily want to end their life
  66. chorea
    involuntary movements

    brief non repetitive muscle contractions
  67. Who shouldn't have Prolixin?
    person with Parkinsons
  68. What is the minimum WBC count for pt on Clozapine?
    3500
  69. Which two antipsychotics need to have EKG's done prior to administration and during?
    Seroquel and Geodon
  70. Teach patients to NEVER....
    stop medication abruptly
  71. Nursing process...intervene for pt. suicidal or schizo
    • observe for signs of hallucinations
    • convey acceptance of clients need for the false belief, but indicate you don't share the belief
    • convey acceptance by brief/frequent contacts
    • observe clients behavior frequently...while doing routine activities
  72. Common factors with Self Injurious Behavior
    • starts between 10-16 yo
    • caused by major change in life-divorce/death
    • history of family violence, abuse or sexual abuse
    • intense feelings of fear, hurt, anger, rejection, abandonment, loss or need for control
  73. By attending Yalom's curative factors people get:
    • hopeful from watching others
    • know they aren't alone
    • gain knowledge from others
    • feel good about sharing/helping others
    • resolve old issues
    • gain social skills
    • become a role model/empowered
    • will get help with accountability
    • cathartic
    • sense of belonging
  74. Don't use typicals on people with
    • blood dyscrasias
    • Parkinsons
    • Narrow angle glaucoma
    • people in a coma
    • people with CNS depression
  75. Give atypicals cautiously to elderly cuz....
    • cause hypotension when given with antihypertensives
    • cause further CNS depression when taking meds that cause CNS depression

    additive effects
  76. What does depression look like in the elderly?
    • dementia
    • memory loss
    • confused thinking
    • apathy
  77. What's the best way to treat elderly for depression
    ECT
  78. crises intervention does not include....
    psychological interpretations
  79. Outcome of a crisis
    through adaptive change a person will have resolution of the crisis and growth will occur
  80. Precautions for antipsychotics and elderly
    • watch for...
    • anticholinergic rxns
    • parkinsonian
    • tardive dyskinesia
    • orthos
    • cardiac conduction disturbances
    • sedation
    • cognitive slowing

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