Need to Know – Exam 1
generations
Chapter 2
Typical or 1st Generation
❊ Developed in 1950; used less often in pts
❊ Reduce agitation/violent behavior
❊ Block dopamine receptors
❊ Little effect on negative symptoms
❊ Extrapyramidal side effects (very common on this one)
Tardive dyskinesia – repetitive, involuntary, purposeless movements
❊ Maintenance dosages to prevent relapse
❊ Drugs:
Perphenazine (Trilafon)
Pimozide (Orap)
❊ Haloperidol (Haldol)
Duration of 4 weeks; after pt’s condition is stabilized w/ oral doses of these
medication, admin of dept injection is required Q2-4 weeks to maintain
therapeutic effect.
Don’t use it w/ opioids; risk for torsades de pointes and QT prolongation
Used to restraint a patient in emergency cases.
❊ Chlorpromazine (Thorazine)
EPS can occur.
Should be avoided in children and adolescents whose s/s suggest Reye’s
syndrome.
Smooth muscle relaxants; worry about falls/injury
It’s an ampule or pills; has to be diluted; can cause HTN so it’s hold on certain
BP range.
Atypical or 2nd Generation
❊ Developed in 1994
❊ Impacts serotonin receptors
❊ Fewer motor side effects; less likely to cause movement disorders (shuffling walk,
tongue sticking out of mouth, drooling, etc.); produce less extrapyramidal side
effects
Therapy for EPSs include lowering the dosage of antipsychotic, changing to a
different antipsychotic, or administering anticholinergic meds.
❊ Less tx noncompliance
❊ Reduce relapse
❊ Can impair immune symptom functioning
❊ Drugs:
Aripiprazole (Abilify) and Quetiapine (Seroquel)
Not approved for depression in under age 18 or the older adult
population.
Increased the risk of suicidal thinking and behavior in short-term
studies in pts and adolescents w/ MDD and other psychiatric disorders.
Risperidone (Risperdal)
Lurasidone (Latuda)
Ziprasidone (Geodon)
Contraindicated in pts w/ known hx of QT prolongation, recent MI, or
uncompensated HF, it shouldn’t be used w/ other QT-prolonging drugs.
❊ Common side effects:
Sleepiness/tiredness/fatigue; dizziness
Blurred vision; dry mouth; constipation
, Difficulty urinating; sensitivity to lights; weight gain; change in menstrual
cycle
Seizures
❊ Less common side effects:
Dystonia: muscle spasms/rigidity and cramping; stiff neck; tongue sticking
out of mouth; trouble swallowing; in severe cases, laryngospasm and
respiratory difficulties. Give anticholinergic drugs for immediate tx and it
usually brings rapid relief
Akathisia: restlessness, unable to sit still
Akinesia: rigid muscles; shuffling walk; drooling; tremor
❊ Possible Adverse Reactions
Tardive dyskinesia: permanent involuntary movements of tongue, mouth,
face, trunk, arms and legs that are more common w/ typical
Overheating or heat stroke: prevent this by drinking water and staying out
of heat
Metabolic Syndrome: excess weight gain, increased blood pressure, high
blood sugar and triglyceride levels
Type 2 Diabetes; Heart Disease; Stroke
Neuroleptic malignant syndrome: extreme muscle stiffness, high fever,
sweating, tremors, confusion, unstable BP and HR. This is a medical
emergency.
❊ Newer meds that may improve cognitive function:
Clozapine (Clozaril)
Black box: Risk of life threatening agranulocytosis; seizures;
myocarditis; other adverse CV and respiratory effects
Can cause a dangerous drop in WBC (agranulocytosis)
Characterized by fever, malaise, ulcerative sore throat and
leukopenia
Requires weekly blood work for 6 mos, every 2 weeks for the next 6
mos and then every 4 weeks thereafter
Usually used only when other tx fail
They’ll be on neutropenic precautions
Olanzapine (Zyprexa)
Can be given 210 mg Q2weeks or 405 mg every 4 weeks
Must be directly observed by a HCP for 3 hrs after the injection and
must be alert, oriented, and symptom-free before s/he can be released.
Has the potential to cause:
Post injection
Delirium/sedation syndrome including:
Sedation; confusion/disorientation
Agitation; cognitive impairment that can progress to
ataxia, convulsions, weakness and HTN
❊ Warning: Elderly pts w/ dementia-related psychosis treated w/ atypical
antipsychotic drugs are at an increased risk for death. Cause of death were varied,
but most of the deaths appeared to be either CV or infectious in nature.
Client Teaching
❊ Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth.
❊ Avoid calorie-laden beverages and candy because they promote dental caries,
contribute to weight gain, and do little to relieve dry mouth.
❊ Method to prevent or relieve constipation include exercising and increasing water
and bulf-forming foods in the diet.
❊ Stool softeners are permissible, but pt should avoid laxatives.
❊ Use of sunscreen is recommended because photosensitivity can cause the pt to
sunburn easily.
, ❊ Monitor the amount of sleepiness or drowsiness they feel.
❊ Avoid driving and performing other potentially dangerous activities until response
times and reflexes seem normal.
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
❊ Usually prescribed when SSRIs haven’t worked.
❊ Drugs:
Venlafaxine (ER Effexor XR)
Duloxetine (Cymbalta)
Desevenlafixe (Pristiq)
Wellbutrin (Bupropion)
Can cause seizure at a rate 4x that of other antidepressants. Risk for
seizures increases when doses exceed 450 mg/day (400 mg SR); dose
increases are sudden or in large increments; pt has a hx of seizures,
cranial trauma, excessive use of or withdrawal from alcohol, or
addiction to opiates, cocaine, or stimulants; pt uses OTC stimulants or
anorectics; or pt has diabetes being treated w/ oral hypoglycemics or
insulin.
Remeron (Mirtazapine)
❊ Side effects:
Abnormal dreams; n/v
Nervousness; chills
Body weakness
Cough; HA; dizziness
HTN; increased sweating
Loss of appetite or weight
Stomach or colon problems
❊ Adverse reactions:
Thoughts of suicide
Panic attacks
Selective Serotonin Reuptake inhibitors (SSRIs)
❊ Often used to treat depression and other disorders in pts; helps w/ low level anxiety
❊ Safer than some of the older antidepressant if OD occurs
❊ Warning: caregiver of pts taking SSRIs should monitor them for depression that’s
getting worse and thoughts about suicide. Caregiver/medical consenter should
immediately talk to the Dr. if this happens.
❊ Drugs:
Citalopram hydrobromide (Celexa)
Escitalopram Oxalate (Lexapro)
Fluvocamine Maleate (Luvox)
Paroxetine HCl (Paxil)
Fluoxetine HCl (Prozac)
Sertraline HCl (Zoloft)
❊ Side effects:
Sexual problems
Low sex drive; difficulty achieving an erection or orgasm
Dizziness; HA; nausea right after a dose/stomach upset
Insomnia and jitters
Dry mouth; extreme sweating
Trouble sleeping; irritability; weight gain
Anxiety/agitation
Akathisia (motor restlessness); hand tremor
❊ Should take SSRIs first thing in the morning unless sedation is a problem; generally,
paroxetine most often causes sedation.
generations
Chapter 2
Typical or 1st Generation
❊ Developed in 1950; used less often in pts
❊ Reduce agitation/violent behavior
❊ Block dopamine receptors
❊ Little effect on negative symptoms
❊ Extrapyramidal side effects (very common on this one)
Tardive dyskinesia – repetitive, involuntary, purposeless movements
❊ Maintenance dosages to prevent relapse
❊ Drugs:
Perphenazine (Trilafon)
Pimozide (Orap)
❊ Haloperidol (Haldol)
Duration of 4 weeks; after pt’s condition is stabilized w/ oral doses of these
medication, admin of dept injection is required Q2-4 weeks to maintain
therapeutic effect.
Don’t use it w/ opioids; risk for torsades de pointes and QT prolongation
Used to restraint a patient in emergency cases.
❊ Chlorpromazine (Thorazine)
EPS can occur.
Should be avoided in children and adolescents whose s/s suggest Reye’s
syndrome.
Smooth muscle relaxants; worry about falls/injury
It’s an ampule or pills; has to be diluted; can cause HTN so it’s hold on certain
BP range.
Atypical or 2nd Generation
❊ Developed in 1994
❊ Impacts serotonin receptors
❊ Fewer motor side effects; less likely to cause movement disorders (shuffling walk,
tongue sticking out of mouth, drooling, etc.); produce less extrapyramidal side
effects
Therapy for EPSs include lowering the dosage of antipsychotic, changing to a
different antipsychotic, or administering anticholinergic meds.
❊ Less tx noncompliance
❊ Reduce relapse
❊ Can impair immune symptom functioning
❊ Drugs:
Aripiprazole (Abilify) and Quetiapine (Seroquel)
Not approved for depression in under age 18 or the older adult
population.
Increased the risk of suicidal thinking and behavior in short-term
studies in pts and adolescents w/ MDD and other psychiatric disorders.
Risperidone (Risperdal)
Lurasidone (Latuda)
Ziprasidone (Geodon)
Contraindicated in pts w/ known hx of QT prolongation, recent MI, or
uncompensated HF, it shouldn’t be used w/ other QT-prolonging drugs.
❊ Common side effects:
Sleepiness/tiredness/fatigue; dizziness
Blurred vision; dry mouth; constipation
, Difficulty urinating; sensitivity to lights; weight gain; change in menstrual
cycle
Seizures
❊ Less common side effects:
Dystonia: muscle spasms/rigidity and cramping; stiff neck; tongue sticking
out of mouth; trouble swallowing; in severe cases, laryngospasm and
respiratory difficulties. Give anticholinergic drugs for immediate tx and it
usually brings rapid relief
Akathisia: restlessness, unable to sit still
Akinesia: rigid muscles; shuffling walk; drooling; tremor
❊ Possible Adverse Reactions
Tardive dyskinesia: permanent involuntary movements of tongue, mouth,
face, trunk, arms and legs that are more common w/ typical
Overheating or heat stroke: prevent this by drinking water and staying out
of heat
Metabolic Syndrome: excess weight gain, increased blood pressure, high
blood sugar and triglyceride levels
Type 2 Diabetes; Heart Disease; Stroke
Neuroleptic malignant syndrome: extreme muscle stiffness, high fever,
sweating, tremors, confusion, unstable BP and HR. This is a medical
emergency.
❊ Newer meds that may improve cognitive function:
Clozapine (Clozaril)
Black box: Risk of life threatening agranulocytosis; seizures;
myocarditis; other adverse CV and respiratory effects
Can cause a dangerous drop in WBC (agranulocytosis)
Characterized by fever, malaise, ulcerative sore throat and
leukopenia
Requires weekly blood work for 6 mos, every 2 weeks for the next 6
mos and then every 4 weeks thereafter
Usually used only when other tx fail
They’ll be on neutropenic precautions
Olanzapine (Zyprexa)
Can be given 210 mg Q2weeks or 405 mg every 4 weeks
Must be directly observed by a HCP for 3 hrs after the injection and
must be alert, oriented, and symptom-free before s/he can be released.
Has the potential to cause:
Post injection
Delirium/sedation syndrome including:
Sedation; confusion/disorientation
Agitation; cognitive impairment that can progress to
ataxia, convulsions, weakness and HTN
❊ Warning: Elderly pts w/ dementia-related psychosis treated w/ atypical
antipsychotic drugs are at an increased risk for death. Cause of death were varied,
but most of the deaths appeared to be either CV or infectious in nature.
Client Teaching
❊ Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth.
❊ Avoid calorie-laden beverages and candy because they promote dental caries,
contribute to weight gain, and do little to relieve dry mouth.
❊ Method to prevent or relieve constipation include exercising and increasing water
and bulf-forming foods in the diet.
❊ Stool softeners are permissible, but pt should avoid laxatives.
❊ Use of sunscreen is recommended because photosensitivity can cause the pt to
sunburn easily.
, ❊ Monitor the amount of sleepiness or drowsiness they feel.
❊ Avoid driving and performing other potentially dangerous activities until response
times and reflexes seem normal.
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
❊ Usually prescribed when SSRIs haven’t worked.
❊ Drugs:
Venlafaxine (ER Effexor XR)
Duloxetine (Cymbalta)
Desevenlafixe (Pristiq)
Wellbutrin (Bupropion)
Can cause seizure at a rate 4x that of other antidepressants. Risk for
seizures increases when doses exceed 450 mg/day (400 mg SR); dose
increases are sudden or in large increments; pt has a hx of seizures,
cranial trauma, excessive use of or withdrawal from alcohol, or
addiction to opiates, cocaine, or stimulants; pt uses OTC stimulants or
anorectics; or pt has diabetes being treated w/ oral hypoglycemics or
insulin.
Remeron (Mirtazapine)
❊ Side effects:
Abnormal dreams; n/v
Nervousness; chills
Body weakness
Cough; HA; dizziness
HTN; increased sweating
Loss of appetite or weight
Stomach or colon problems
❊ Adverse reactions:
Thoughts of suicide
Panic attacks
Selective Serotonin Reuptake inhibitors (SSRIs)
❊ Often used to treat depression and other disorders in pts; helps w/ low level anxiety
❊ Safer than some of the older antidepressant if OD occurs
❊ Warning: caregiver of pts taking SSRIs should monitor them for depression that’s
getting worse and thoughts about suicide. Caregiver/medical consenter should
immediately talk to the Dr. if this happens.
❊ Drugs:
Citalopram hydrobromide (Celexa)
Escitalopram Oxalate (Lexapro)
Fluvocamine Maleate (Luvox)
Paroxetine HCl (Paxil)
Fluoxetine HCl (Prozac)
Sertraline HCl (Zoloft)
❊ Side effects:
Sexual problems
Low sex drive; difficulty achieving an erection or orgasm
Dizziness; HA; nausea right after a dose/stomach upset
Insomnia and jitters
Dry mouth; extreme sweating
Trouble sleeping; irritability; weight gain
Anxiety/agitation
Akathisia (motor restlessness); hand tremor
❊ Should take SSRIs first thing in the morning unless sedation is a problem; generally,
paroxetine most often causes sedation.
