Title ANNOTATED PSYCH HAND OUT NOVEMBER 2025 PNLE blk5&6.pdf ✅

2 TOPRANK REVIEW ACADEMY - Prof. Kenneth Arzadon, RN DECANOATE NEUROLEPTICS / ANTIPSYCHOTICS 1 st generation 2 nd generation 3 rd generation Typical / Conventional MOA: ↓ DOPAMINE Indication: + signs chlorpromazine haloperiDOL thioridazine loxapine fluphenazine molindone Atypical MOA: ↓ DOPAMINE / SEROTONIN Indication: + / - signs olanzapine risperidone quetiapine ziprasidone clozapine lurasidone Dopamine System Stabilizers MOA: regulates receptors Indication: + signs aripiprazole brexpiprazole Not recommended for elderly patients SAFE for elderly (>65 y/o) Less side effects Depot Treatment / Long Term Injection (LTI) Indication: non-compliance Common cause: side effects, memory problem SIDE EFFECTS OF ANTIPSYCHOTICS Constipation – increase fluid, fiber in the diet Agranulocytosis – Monitor ____________, report any signs of infection (fever, sore throat) Tooth decay – sugarless hard candy or gum Dry mouth – sugarless hard candy or gum to stimulation salivation Orthostatic hypotension – change position gradually Galactorrhea – use cotton underwear Photosensitivity – avoid direct sunlight, use umbrella and sunglasses, apply SPF 25 lotion Arrhythmias – immediately report abnormal heart beat Weight gain – lessen intake of sugary food and beverages Sedation – avoid driving and operating machineries EXTRA PYRAMIDAL SYNDROME Cause: ↓dopamine (1st and 2nd generation neuroleptics) Nursing Action: Notify the physician, DO NOT discontinue to prevent relapse! Intervention: Decrease the dose, shift to another generation NEUROLEPTIC MALIGNANT SYNDROME TARDIVE DYSKINESIA Muscle spasms laryngeal spasms → airway obstruction → DEATH Hyperthermia Hypertension Nursing Action: Discontinue the Medication Treatment: dantrolene, baclofen (muscle relaxants) Prevention: Hydrate the patient Delayed involuntary movements (after 6 months) Tongue protrusion Tongue twisting Teeth grinding Lip Smacking Nursing Action: Notify the physician Treatment: Ingrezza (valbenazine) Prevention: Start with the lowest dose Treatment: Akineton (biperidine) Benadryl (diphenhydramine) Cogentin (benztropine) ARTANE (Trihexyphenidyl) Dysphagia Oculogyric crisis Torticollis Dystonia – uncontrollable muscle spasms Akathisia – agitation, intense need to move Pseudoparkinsonism – tremors and unstable gait
3 TOPRANK REVIEW ACADEMY - Prof. Kenneth Arzadon, RN Diagnostic criteria: ≥5 symptoms lasting for ≥ 2 weeks which impairs educational, social, and occupational functioning Difficulty thinking Insomnia/Hypersomnia Weight loss/gain (5%) Anhedonia (lack of pleasure) Guilt feeling Anergia (lack of energy) Suicidal thoughts MAJOR DEPRESSIVE DISORDER Exogenous: Loss, self-reproach, self-depreciation Endogenous: ↓ SEROTONIN and NOREPINEPHRINE Defense Mechanism: Introjection Initial Sign: Sleeplessness Hallmark sign: Hopelessness, Helplessness, Worthlessness ANTIDEPRESSANTS MONOAMINE OXIDASE INHIBITOR (MAOI) PARNATE MARPLAN NARDIL ELDEPRYL tranylcypromine isocarboxazid phenelzine selegiline Nursing considerations: Tyramine + MAOI = Hypertension Avoid TYRAMINE-rich foods Frozen, Fermented, Preserved (ex. Salami) Dried, Pickled, and Overripe Fruits Aged-cheese (Cheddar, Parmesan) TRICYCLIC ANTIDEPRESSANTS (TCA) TROFRANIL ANAFRANIL ELAVIL PAMELOR SINEQUAN imipramine clomipramine nortriptyline amitriptyline doxepin Side effect: ANTICHOLINERGIC stimulation Adverse effect: Tachycardia Sign of toxicity: Bradycardia SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) ZOLOFT PAXIL LUVOX PROZAC LEXARPO CELEXA sertraline paroxetine fluvoxamine fluoxetine escitalopram citalopram SAFEST and FASTEST! Side effects: Sexual dysfunction (impotence) Gastrointestinal upset (nausea) SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI) CYMBALTA EFFEXOR venlafaxine duloxetine Side effect: ↑Blood Sugar ↑ Cardiac Rate ATYPICAL ANTIDEPRESSANTS WELLBUTRIN DESYREL REMERON bupropion trazodone mirtazapine Side effect: Dry mouth, tiredness, dizziness