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Question Answer
Any drugs that modifies psychotic behavior and exerts an antipsychotic effect is referred to as a __________ drug.
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Neuroleptic
Positive symptoms of schizophrenia include:
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Any exaggeration of normal function or symptom that is present that shouldn't be like agitation, incoherent speech, hallucinations, delusions, and paranoia.
What is the major difference between typical and atypical antipsychotic medications?
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Typical antipsychotics treat positive symptoms (blocking D2 receptors) and atypical antipsychotics treat positive and negative symptoms (blocking D2 and D4 receptors).
Typical antipsychotics are further categorized as phenothiazines, thioxanthenes and butyrophenones. What is the difference between the different subcategories?
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Phenothiazines & thioxanthenes block norepinephrine which causes sedative and hypotensive effects early in treatments. Butyrophenones block only dopamine.
Acute dystonia and akathisia are more likely to develop from typical antipsychotics early or late in the treatment regimen?
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Early
Tardive dyskinesia is more likely to develop from typical antipsychotics early or late in the treatment regimen?
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Late
What class of medications are used to treat the acute dystonia and/or akathisia side effects from typical antipsychotics?
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Anticholinergic agents
Which EPS? Muscle spasms of the face, tongue, back, and neck, facial grimacing, abnormal or involuntary upward eye movement, and laryngeal spasms which can impair breathing?
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Acute dystonia
What medications are typically used to treat acute dystonia?
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Cogentin/benztropine and lorazepam/Ativan
What medications are typically used to treat akathisia?
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Lorazepam/Ativan and/or a beta blocker like propranolol
You have a patient with s/s of tardive dyskinesia. What is the first thing that should be done?
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Stop all antipsychotic medications
__________ is a rare condition associated with the use of antipsychotic medications characterized by muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure and coma.
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NMS-Neuroleptic Malignant Syndrome
What is the usual treatment of NMS?
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Immediate cessation of all antipsychotics, hydration, hypothermic blankets, antipyretics, benzodiazepines, and muscle relaxants like dantrolene/Dantrium.
What is the major common side effect of Thorazine/Chlorpromazine?
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Pronounced orthostatic hypotension
What are the major common side effects of fluphenazine/Prolixin and perphenazine/Trilafon?
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Strong antiemetic effect, low effect on blood pressure, but more incidence of EPS symptoms.
What are the major common side effects of thioridazone/Mellaril and mesoridazine/Serentil?
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Strong sedative effect, causes few EPS symptoms, and a low to moderate effect on BP.
What group of typical antipsychotic medications cause a harmless pinkish to brownish change in urine color?
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The phenothiazines (Thorazine, Prolixin, Trilafon, etc.)
Which typical antipsychotic should be administered cautiously for patients with glaucoma?
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fluphenazine/Prolixin
What common OTC can slow absorption of phenothiazines and therefore should be taken one hour before or two hours after their medication?
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Antacids
How long does it typically take to reach the full therapeutic effect of antipsychotics?
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3-6 weeks
Which antipsychotic medications can be given in long-acting preparations, allowing for dosing via injectin every 2-4 weeks?
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fluphenazine/Prolixin & haloperidol/Haldol
What herb is known to interact negatively with antipsychotic medications, increasing the risk of dystonic reactions?
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Kava kava
Which antipsychotic medication is administered in much lower doses than the others due to its potency?
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Haloperidol/Haldol
What are some special considerations with respect to injection of Haldol and Prolixin?
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Use a dry, large-gauge needle (at least 21 gauge) because it is very viscous. Use the Z-track method in a deep muscle and don?t rub or massage the area afterward. Injection sites should be rotated. The solution should remain in a plastic syringe no longer than 15 minutes.
What are the common side effects of typical antipsychotic agents?
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Drowsiness, orthostatic hypotension, dry mouth, increased heart rate, urinary retention and constipations.
What are some common adverse effects of typical antipsychotics?
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EPS (usually with 5-30 days), blood dyscrasias, lowering of the seizure threshold.
What are the four atypical antipsychotic medications?
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Clozapine/Clozaril, risperidone/Risperdal, olanzapine/Zyprexa and quetiapine/Seroquel.
What is the most common side effect of atypical antipsychotics?
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Weight gain
Which atypical antipsychotic is associated with agranulocytosis, requiring frequent WBC monitoring?
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Clozapine/Clozaril
What are the most common SE of atypical antipsychotics?
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Dizziness, sedation, tachycardia, orthostatic hypotenstion, and constipation.


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