NUR2474 Pharmacology Module 3 Quiz Review NUR2474 Pharmacology Module 3 Quiz Review Test tips: Be cautious of negatively worded questions! They are easy, but often misinterpreted due to not paying attention to them. Topics review: 1. General features of schizophrenia and Chlorpromazine (class, mechanism of action, adverse effects, administration/withdrawal teaching, and review early and late EPS specifically). a. Chlorpromazine . i. Class: Antipsychotic (low-potency) ii. Mechanism of action: blocks dopamine. Many cause serious movement disorders known as (Extrapyramidal symptoms EPS). None if the Schizophrenia medications are addictive. Suppress symptoms during acute psychotic episodes. iii. Adverse effects (First Generation Antipsychotics) 1. EPS 2. Neuroleptic malignant syndrome: Risk of death without treatment due to cardiovascular collapse & dysrhythmias. a. “Lead pipe” rigidity, sudden high fever, sweating, autonomic instability, dysrhythmias, fluctuations in blood pressure, altered level of consciousness, and seizures or coma may develop. 3. Parkinsonism: Bradykinesia, mask-like facies, drooling, tremor, rigidity, shuffling gait, cogwheeling, and stooped posture. 4. Akathisia: Pacing and squirming brought on by an uncontrollable need to be in motion. 5. Tardive Dyskinesia: Choreoathetoid movements of the tongue and face; lip-smacking movements; tongue flicks out in a “flycatching” motion; slow, worm-like movement of the tongue; and involuntary movements of the limbs, toes, fingers, and trunk iv. Administration/withdrawal teaching 1. Contraindications a. Parkinson’s Disease because it further reduces dopamine. Levodopa counteracts antipsychotic effects. v. Early and late EPS 1. What causes it a. Taking first or second generation antipsychotic drugs that antagonize dopamine receptors. 2. Symptoms (first generation drugs) a. Acute dystonia: involuntary muscle contractions that may cause repetitive twisting movements.
b. Oculogyric crisis: prolonged upward deviation of the eyes. c. Opisthotonos: Muscle spasm causing a backward arching of the head, neck, and spine. d. Joint dislocation e. Impaired respiration f. Anticholinergic medications (benztropine and diphenhydramine): May further complicate by causing dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, and tachycardia. b. Haloperidol (High-Potency) i. Indications 1. Schizophrenia 2. Acute Psychosis 3. Preferred agent for Tourette’s Syndrome ii. Adverse Effects 1. EPS 2. Neuroendocrine effects 3. Can prolong QT interval and cause dysrhythmias 2. Review strategies and treatments for EPS. a. Strategies i. Stop the causing agent immediately. b. Treatments i. Benzodiazepines ii. Beta blockers iii. Anticholinergic drugs 3. Review general teaching topics for patients on antipsychotics (adherence). a. Teaching topdiaics i. A few days to kick in, a few weeks to take full therapeutic effect ii. Adherence 1. Withdrawal syndrome 4. General features of depression and Fluoxetine (Prozac) (class, mechanism of action, adverse effects, teaching, administration/withdrawal, and review serotonin syndrome). a. Class: antidepressant b. Mechanism of action: selective inhibition of serotonin reuptake (SSRI), makes more serotonin available at synapse. c. Adverse effects i. Serotonin syndrome ii. Insomnia iii. Withdrawal syndrome (don’t stop abruptly, taper off slowly) iv. Teratogenesis (only drug safe for breast feeding is sertraline/Zoloft) v. EPS vi. Bruxism (clenching/grinding teeth) vii. Bleeding disorders
viii. Sexual dysfunctions ix. Weight gain x. Hyponatremia xi. Suicidal tendencies xii. Mood/behavior changes d. Teaching i. May take up to 1-4 weeks to take effect ii. No alcohol iii. Advise about suicidal thoughts, behavior may occur in young adults, children, during early treatment. e. Admin/withdrawal i. Taper off slowly ii. Do not mix with MAOIs iii. Wait 14 days before administering antidepressants after stopping MAOIs f. Serotonin Syndrome i. can take place 2-72 hours after starting the medication (fluoxetine) ii. deaths have occurred iii. altered mental status (agitation, confusion, disorientation, anxiety, hallucinations, poor concentration) iv. Incoordination (hyperreflexia, excessive sweating, tremor, and fever) 5. Bipolar Disorder a. Treated by mood stabilizers (lithium), antipsychotics, antidepressants 6. Review implication of Lithium therapy (class, mechanism of action, adverse effects, teaching, administration/withdrawal, blood levels, etc.) a. Class: mood-stabilizers b. Mechanism of action i. lithium excretion will be reduced with decreased sodium, neurotrophic, neuroprotective. Short half-life. c. Therapeutic Uses i. BPD ii. Alcoholism iii. Bulimia iv. Schizophrenia v. Glucocorticoid-induced psychosis d. Adverse effects @ therapeutic level i. GI effects ii. Tremors iii. Polyuria iv. Renal toxicity v. Goiter and hypothyroidism vi. Teratogenesis e. Teaching i. Interacts with diuretics, NSAIDs, anticholinergic drugs