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96 Cards in this Set
- Front
- Back
what is the primary reason for the administration of antipsychotic medications? |
the treatment of schizophrenia spectrum disorders |
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the clinical course of schizophrenia usually involves ___________ |
acute exacerbations with intervals of semiremissions |
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what are the positive symptoms of schizophrenia spectrum/psychotic disorders? |
agitation, delusions, hallucinations, tangential speech patterns |
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what are the negative symptoms of schizophrenia spectrum/psychotic disorders? |
social withdrawal, lack of emotion, lack of energy (anergia), flattened affect, decreased motivation, decreased pleasure in activities |
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what are the goals of treatment for psychotic disorders/schizophrenia? |
1. suppressing acute episodes 2. preventing acute recurrence 3. maintaining the highest possible level of functioning |
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what is another name for first-generation antipsychotic medications? |
conventional |
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first-generation antipsychotic meds are control mainly _________ |
positive symptoms such as hallucinations, delusions and bizarre behavior of psychotic disorders |
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firt-generation (conventional) antipsychotic meds are usually reserved for clients who are _____ |
1. using them successfully and can tolerate the adverse effects 2. violent or particularly aggressive |
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second-generation antipsychotic agents are also referred to as _________ |
atypical |
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atypical antipyshotic agents are the meds of choice for what type of clients? |
those receiving initial treatment and for treating breakthrough episodes in clients on conventional med therapy, because atypicals are more effective with fewer adverse effects |
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what are the advantages of atypical/second-generation antipsychotic agents? |
1. relief of both the positive and negative symptoms of the disease 2. decrease in affective manifestations (depression, anxiety) and suicidal behaviors 3. improvement of neurocognitive deficits such as poor memory 4. fewer or no extrapyramidal side effects (EPSs) including tardive dyskinesia (TD), because of less dopamine blockade 5. fewer anticholinergic adverse effects because most atypical antipsychotics withe the exception of clozapine (Clozaril) cause little or no blockade of cholinergic receptors 6. less relapse |
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clozapine |
Clozaril |
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first-generations (conventional) antipsychotics used to treat psychotic disorders (also name their potencies) |
1. chlorpromazine (Thorazine) - low potency 2. haloperidol (Haldol) - high potency 3. fluphenazine - high potency 4. thiothixene (Navane) - high potency 5. perphazine - medium potency |
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what is the MOA of chlorpromazine (Thorazine)/conventional antipsychotics? |
1. blocka dopamine (Dsub2), acetylcholine, histamine, and norepi (NE) receptors in the brain and periphery 2. inhibition of psychotic manifestations, believed to be a result of Dsub2 blockade in the brain |
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Therapeutic uses of first-generation/conventional antipsychotics |
1. treatment of acute and chronic psychotic disorders 2. schizophrenia specturm disorders 3. bipolar disorders (primarily the manic phase) 4. Tourette's disorder 5. prevention of nausea/vomiting through blocking of dopamine in the chemoreceptor trigger zone of the medulla |
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what are the categories of adverse effects for chlorpromazine (Thorazine) when treating psychotic disorders? |
1. extrapyramidal side effects (EPSs) 2. Neuroleptic malignant syndrome 3. anticholinergic effects 4. neuroendocrine effects 5. seizures 6. skin effects 7. additional |
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what are the EPSs of chlorpromazine (Thorazine) |
1. acute dystonia 2. parkinsonism 3. akathisia 4. tardive dyskinesia (TD) |
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describe adverse side effects of chlorpromazine: acute dystonia |
client experiences severe spasms of tongue, neck, face, or back. this is a crisis situation which requires rapid treatment |
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describe adverse side effects of chlorpromazine: parkinsonism |
clinical findings include bradykinesia, rigidity, shuffling gait, drolling and tremors |
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describe adverse side effects of chlorpromazine: akathisia |
client is unable to stand still or sit and is continually pacing and agitated |
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describe adverse side effects of chlorpromazine: tardive dyskinesia (TD) |
manifestations include involuntary movements of the tongue and face such as lip-smacking which cause speech and/or eating disturbances; TD may also include involuntary movemnts of arms, legs, or trunk |
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nursing interventions for acute dystonia from chlorpromazine |
1. monitor for acute dystonia between 5 hrs to 5 days after administration of first dose 2. treat with anticholinergic agents such as benztropine (Cogentin) or diphenhydramine (Benadryl); use oral doses for less acute efects and IM or IV doses for serious effects |
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benztropine |
Cogentin |
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diphenhydramine |
Benadryl |
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chlorpromazine |
Thorazine |
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haloperidol |
Haldol |
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fluphenazine |
no brand name
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Thiothixenen |
Navane |
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what are the nursing interventions for Parkinsonism from chlorpromazine (Thorazine) |
1. observe for parkinsonism within one month of initiation of therapy 2. treat with benztropine, diphenhydramine, or amantadine (Symmetrel); discontinue these meds to determine if they are still needed; if manifestations return, administer atypical antipsychotic as prescribed |
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what are the nursing interventions for akathisia from chlorpromazine (Thorazine) |
1. observe for akathisia within 2 months of the initiation of treatment 2. manage effects with beta-blockers, benzodiazepine, or anticholinergic medication |
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what are the nursing interventions for tardive dyskinesia (TD) from chlorpromazine (Thorazine)? |
1. TD is a late EPS that may occur months to years after the start of therapy and may improve following med change or may be permanent 2. administer lowest dose possible to control manifestations 3. evaluate client after 12 months of therapy and then every 3 months; if indications of TD appear, dosage should be lowered or the client should be switched to an atypical agent |
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what are the manifestations of neuroleptic malignant syndrome as an adverse effect of chlorpromazine (Thorazine)? |
sudden high-grade fever, BP fluctuations, dysrhythmias, muscle rigidity, and change in level of consciousness developing into coma |
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what are the nursing interventions of neuroleptic malignant syndrome from chlorpromazine (Thorazine)? |
1. stop antipsychotic med 2. monitor vitals 3. apply cooling blankets 4. administer antipyretics (aspirin, acetaminophen) 5. increase fluid intake 6. admin diazepam (Valium) to control anxiety 7. admin dantrolene (Dantrium) to induce muscle relaxation 8. wait 2 weeks before resuming therapy; consider switching to atypical agent |
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what are the adverse anticholinergic effects from chlorpromazine (Thorazine)? |
dry mouth, blurred vision, photophobia, urinary hesitancy/retention; constipation; tachycardia |
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what are the nursing interventions for adverse anticholinergic effects from chlorpromazine (Thorazine)? |
1. chewing sugarless gum 2. sipping water 3. avoid hazardous activities 4. wearing sunglasses when outdoors 5. eating foods high in fiber 6. participating in regular exercise 7. maintatining fluid intake of 2 to 3L of water each day from food and bev sources 8. voiding just before taking medication |
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what are the adverse neuroendocrine effects of chlorpromazine (Thorazine)? (name nursing intervention) |
gynecomastia (breast enlargement); galactorrhea, and menstrual irregularities -> manifestations inform and notify provider |
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what are the nursing interventions for seizures from chlorpromazine (Thorazine)? |
1. advise clients to report seizure activity to the provider 2. an increase in antiseizure med may be necessary |
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what puts someone at greatest risk for developing seizures as an adverse effect of a medication? |
previously exisiting condition of seizures/previous seizure disorders |
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what are the adverse skin effects of chlorpromazine (Thorazine) (name nursing interventions) |
photosensitivity resulting in severe sunburn and contact dermatitis from handling meds -> 1. advise client to avoid sunlight exposure/use sunscreen/protective clothing 2. advise avoid direct contact with meds |
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what are the additional adverse effects of chlorpromazine (Thorazine) |
1. orthostatic hypotension 2. sedation 3. sexual dysfunction 4. agranulocytosis 5. severe dysrhythmias |
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in which gender is sexual dysfunction more common as an adverse effect of chlorpromazine (Thorazine) |
common in both males/females |
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name nursing interventions for orthostatic hypotension effects of chlorpromazine (Thorazine) |
1. should develop tolerance in 2 to 3 months 2. in the hospital setting, monitor BP and HR for orthostatic changes; if significant decrease in BP/HR is noted don't administer med and notify provider 3. instruct clients about signs of postural hypotension (lightheadedness, dizziness). advise client to lie or sit down if occur; changing positions slowly |
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nursing intervention for chlorpromazine (Thorazine): sedation |
1. inform clients that effects shoudl diminish within a few weeks 2. clients may take med at bedtime to avoid daytime sleepiness 3. advise not to drive |
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nursing intervention for chlorpromazine (Thorazine): sexual dysfunction |
1. advise of possible adverse effects 2. encourage clients to report adverse effects to provider 3. client may need a lower dosage or switched to a high-potency agent |
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nursing intervention for chlorpromazine (Thorazine): agranulocytosis |
1. advise clients to observe for indications of infection (fever, sore throat, and to notify the provider if these occur) 2. if indications of infection appear, obtain the client's baseline WBC. med should be discontinued if labs indicate presence of infection |
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nursing intervention for chlorpromazine (Thorazine): severe dysrhythmias |
1. obtain baseline ECG and potassium level prior to treatment and throughout 2. avoid concurrent use with other meds that prolong QT interval |
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first-generation/conventional antipsychotics are contraindicated for clients who ________ |
are in a coma, have severe depression, parkinson's disease, prolactin-dependent cancer of the breast, and severe hypotension, older clients who have dementia |
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use conventional antipsychotics cautiously in clients who have _________ |
glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver/kidney disease, and seizure disorders
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med/food interactions of chlorpromazine (Thorazine) |
1. use with anticholinergic agents with other anticholinergic meds will increase anticholinergic effects 2. alcohol, opiods, and antihistamines have additive CNS depressant effects 3. by activating dopamine receptors, levodopa counteracts the effects of antipsychotic agents |
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nursing interventions of med/food interactions of con |
1. anticholinergic additive effects -> advise clients to avoid OTC meds that contain anticholinergic agents such as sleep aids 2. alcohol, opiods, antihistamine -> advise to avoid alcohol and CNS depressants, advise against hazardous activity such as driving 3. levodopa -> avoid concurrent use and other dopamine receptor agonists |
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how should you screen for the presence of EPS? |
the Abnormal Involuntary Movement Scale (AIMS) |
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to control early EPS of conventional antipsychotics, what should be used; if adverse effects are intolerable what is the next step? |
1. anticholinergics, beta-blockers, benzodiazepines 2. switch to low-potency conventional or atypical antipsychotic |
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do antipsychotic meds cause addiction? |
no |
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do antipsychotic meds work immediately? |
no, therapeutic within a few days but significant improvement can be up to 2-4 weeks and possibly months for full effects |
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if client is having difficulty maintaining med regime for conventional antipsychotics, what is an option? |
depot regime, IM once every 2 to 4 weeks; lower doses can be used with depot which decreases risk of adverse effects and development of TD (tardive dyskinesia) |
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how should you plan the dosing for conventional psychotics? |
start with twice-a-day dosing then switch to daily dosing at bedtime to decrease daytime drowsiness and promote sleep |
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name the second-generation (atypical) antipsychotics |
1. risperidone (Risperdal) 2. olanzapine (Zyprexa) 3. quetiapine (Seroquel) 4. aripiprazole (Abilify) 5. ziprasidone (Geodon) 6. clozapine (Clozaril) 7. asenapine (Saphris) 8. lurasidone (Latuda) 9. paliperidone (Invega) 10. iloperidone (Fanapt) |
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MOA of atypical antipsychotics |
work mainly by blocking serotonin and to a lesser degree, dopamine receptors; these meds also block receptors for norepi, histamine, and acetylcholine |
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what are the therapeutic uses for atypical antipsychotics? |
1. schizophrenia spectrum disorder (negative and positive symptoms) 2. psychotic episodes induced by levodopa therapy 3. relief of psychotic manifestations in other disorders such as bipolar disorders |
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what are the different sort of formulations you can find for atypical antipsychotics (note not all are found in each form) |
1. tablets 2. quick-dissolving tabs 3. oral solution 4. IM depot preparation (Risperdal Consta) |
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what are the adverse effects of risperidone (Risperdal) |
1. new onset of DM or loss of glucose control in clients who have diabetes 2. weight gain 3. hypercholesterolemia with increased risk for hypertension and other cardiovascular disease 4. orthostatic hypotension 5. anticholinergic effects 6. agitation, dizziness, sedation, and sleep disruption 7. mild EPS such as tremor |
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what are the anticholinergic effects of risperidone (Risperdal)? |
urinary hesitancy or rentention, dry mouth |
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what are the nursing interventions for the adverse effects of risperidone (Risperdal)? |
1. onset of DM -- obtain baseline fasting blood glucose and monitor, instruct to report indications (thirst, urination and appetite) 2. weight gain -- advise client to follow a healthy low-calorie diet, engange in regular exercise, monitor weight gain 3. hypercholesterolemia -- monitor cholesterol, triglycerides, and blood glucose if weight gain is more than 14 kg (30 lbs) 4. anticholinergic -> monitor for effects and report to provider, educate measure to relieve dry mouth such as sipping fluids 5. agitation etc -> monitor/notify; alternate med if prescribed 6. milds EPS -> monitor for/teach to recognize EPS, use AIMS assessment to screen for EPS |
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risperidone is Pregnancy Risk Category ______ |
C |
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atypical antiosychotics like risperidone (Risperdal) are contraindicated for which clients? what can happen? |
clients who have dementia; can cause death related to CVA or infection |
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clients taking atypical antipsychotics should avoid use of _________ |
alcohol |
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use atypical antipsychotics cautiously in clients who have __________ |
cardiovascular or cerebrovascular disease, seizures, or DM; obtaining a fasting blood glucose for clients who have DM and monitor blood glucose carefully |
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formulations and complications of olanzapine |
Forms -- tablets, short-acting injectable, extended release injections comps -- low risk of EPS, high risk of DM, weight gain, and dyslipidemia, others include sedation, orthostatic hypotension and anticholinergic effects |
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quetiapine formulations and complications |
forms -- tablets, extended release tablets comps -- low risk of EPS, moderate risk for DM,weight gain and dyslipidemia; others include cataracts sedation, orthos hypotension, and anticholinergic effects, clients should have screening eye exam and then every 6 months |
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aripiprazole formulations and complications |
forms -- tablets, orally disintegrating tablets, oral solution, short-acting injectable comps -- aripiprazole has low or no risk of EPS, DM, weight gain, dyslipidemia, hypotension, and anticholinergic effects; other adverse effects include headache, anxiety, insomnia, sedation, and GI upset |
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formulations and complications of ziprasidone (1 comment) |
comment: affects both dopamine and serotonin, can be used for clients who have concurrent depressions forms -- capsules; short-acting injectable comps -- low risk of EPS, DM, weight gain, and dyslipidemia; other effects include sedation, ortho hypotension, anticholinergic effects, and rash; ECG changes and QT prolongation may lead to torsades de pointes |
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forms and complications of clozapine (comments) |
comments: first atypical antipsychotic developed; despite its effectiveness for schizo spectrum disorders, no longer considered first-line b/c of adverse effects forms -- tablets, orally disintegrating tablets comps -- low risk of EPS, high risk of weight gain, DM, and dyslipidemia; agranulocytosis may occur (obtain baseline WBC and monitor weekly); monitor for indications of infection (fever, sore throat, lesions in mouth, notify provider); other adverse effects include sedation, ortho hypotensionl and anticholinergic effects |
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formulations and complications of paliperidone |
forms -- extended-release tablets, extended-release injections comps -- high risk for DM, weight gain, and dyslipidemia; other include sedations, prolonged QT interval ortho hypotension, anticholinergic effects, and mild EPS |
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formulations and complications of asenapine |
forms -- sublingual tablets comps -- adverse effects include drowsiness, prolonged QT interval and EPS (higher doses); contemporary numbing of mouth, low risk for DM, weight, dyslipidemia, and antichol effects |
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iloperidone formulations ad complicatoins |
forms -- tablets comps -- dry mouth, sedation, fatigue, nasal congestion; significant risk for weight gain, prolonged QT interval and orthostatic hypotension (advise to follow titration schedule during initial therapy to minimize hypotension); low risk for DM, dyslipidemia and EPS |
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lurasidone formulations and complications |
forms -- tablets comps-- sedation, akathisia, parkinsonism, agitation, and anxiety; low risk for DM, weight gain, dyslipidemia; does not cause anitcholinergic effects |
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med/food interaction of clozapine (nursing intervention) |
immunosuppressive meds such as anticancer medications (avoid use of these meds with clozapine) |
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med/food interactions of atypical antipsychotics (nursing interventions) |
1. alcohol opioids and antihistamines have additive CNS depressant effects (avoid these avoid hazardous activities) 2. levodopa counteracts effects of antipsychotics (avoid concurrent use and with other direct dopamine receptor agonists) |
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med/food interactions of ziprasidone |
TCAs amiodarone (Cordarone) and clarithromycin (Blaxin) prolong QT interval and thus increase risk of cardiac dysrhythmias in clients taking ziprasidone (atypical antipsychotics that prolong QT interval should nose be used with meds with same effect) |
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med/food interactions of aripiprazole, quetiapine, and ziprasidone (nursing intervention) |
1. barbiturates and phenytoin (Dilantin) stimulate hepatic medication-metabolizing enzymes and thereby decreases drug levels of a,q,z ( monitor med effectivness) 2. fluconazole (Diflucan) inhibits hepatic medication-metabolizing enzymes and thereby increases levels of a,q,z (monitor for adverse effects of toxicity) |
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name of risperidone depot injeciton, what do you need to know? |
Risperdal Consta; once every 2 weeks, therapeutic effects occur 4 to 6 weeks after first depot oftenoral preperations required until this is achievered |
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are low or high doses given initially for antipsychotics? |
low then gradually increase |
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what use do oral distengrating tablets have? |
for clients who attempt to cheek or pocket tablets or have difficulty swallowing |
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what do clients taking asenapine need to know? |
avoid eating or drinking 10 min after each dose |
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what do clients taking lurasidone need to know? |
administer with food to increase absorption |
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what is a problem with antipsychotics with many clients? what can a nurse due to help? |
cost is a factor; assess need for case management intervention |
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nursing evaluation of antipsychotics |
1. improvement of manifestations (prevention of acute psychotic manifestations, absence of hallucinations, delusions, anxiety, and hositility) 2. improvement in ability to perform ADLs 3. improvement in ability to interact socially with peers 4. improvement of sleeping and eating habits |
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olanzapine |
Zyprexa |
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quetiapine |
Seroquel |
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aripiprazole |
Abilify |
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ziprasidone |
Geodon |
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clozapine |
Clozaril |
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asenapine |
Saphris |
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lurasidone |
Latuda |
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paliperidone |
Invega |
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iloperidone |
Fanapt |