ATI Pharm 2 Exam 3

Clozapine (Clozaril) - -not a first line agent. For severe schizophrenia not responding to other drugs -adverse: agranulocytosis & seizures -interventions: monitor wbc counts, absolute neutrophil count -if ANC drops below 100/mm drug must be d/c permanently -fever, sore throat , and mouth ulcers are symptoms of agranulocytosis and should be immediately reported Olanzapine (Zyprexa) - -doesent cause EPS Adverse: weight gain, DM, dyslipedemka, leukopenia, neutropenia -wbc before starting and for several months afterwards, if ANC less than 100/mm stop drug and monitor for infection -IM available ANC - absolute neutrophil count Risperidone (Risperdal) - -doesent cause agranulocytosis -adverse: low risk of eps, weight gain, DM, dyslipedemia, agitation, fatigue, dizziness, orthostatic hypotension Long acting im available Ziprasidone (Geodon) - Prolonged QT interval Leukopenia/neutropenia-monitor WBC, ANC, signs of infection -safe handling training requiredPaliperidone (Invega) - Safe handling training required Once a day dosing do not chew Prolonged QT interval Aripiprazole (Abilify) - Low risk metabolic changes Safer option but not always effective- patient dependent Compliance- extended release options - Haloperidol, ziprasidone, olanzapine, paliperidone, risperidone, arpiprazole -long acting IM, given every 1-4 weeks -large gauge needle 21 -no massage after injection -z track method Acute dystonia treatment - Benztropine, diphenhydramine Parkinsonism treatment - Benztropine, diphenhydramine, amantadine Akathsia treatment - Beta blocker (propranolol), benzo (lorazepam), Anticholinergic drug tardive dyskinesia treatment - Stop antipsychotic Benzo Valbenazine Neuro malignant syndrome - Lead pipe rigiditySudden high fever Autonomic instability Symptoms: altered mental status, seizures, muscle rigidity, sudden high fever, BP fluctuations, tachycardia, dysthymia, rhabdomyolosis, acute renal failure, respiratory failure, coma Neuroleptic Malignant Syndrome treatment - Immediate withdrawal of antipsychotics Iv fluids and cooking blanket Antipyretics Benzos Dantrolene=relaxes muscles reduce heat Bromocriptine: dopamine receptor agonist, relieves CNS toxicity Fluphenazine - FGA -blocks dopamine receptors in brain -interactions: increase depression when taken with alcohol or other CNS depressants, kava kava increases EPS Long term im available after stable on oral dose Haloperidol - FGA -blocks dopamine receptors -treats acute and chronic psychoses, dementia -treats schizophrenia & Tourette's Caution: hx of dysthymia, MI, potassium irretgularities r/t prolonged QT interval Long acting IM availableChlorpromazine (Thorazine) - FGA -used for schizophrenia, psychotic disorders, bipolar disorders SE: orthostatic hypotension, Anticholinergic effects, tardive dyskinesia , prolonged QT interval Thioridazine (Mellaril) - FGA Lots of side effects use other meds first Atypical SGA sode effects - Weight gain DM2 Constipation Fatigue Insomnia Increased appetite Headache Benzo overdose "antidote" - Flumazenil Buspirone (Buspar) - -anxiety & depression -2-4 weeks to start being effective full effect up to 6 weeks SE: dizziness, headache, nausea, nervousness, and excitement NO GRAPEFRUIT