PSYCHOPARMACOLOGY
There are certain psychotropic drugs you must know about in detail and others you
should recognize on the NCLEX-RN. The test writers want to make sure you know the
major classifications, side effects, and indications for drug. They want you to know the
proper methods of drug administration and the importance of educating your client about
medications. We think the following information is most likely to appear on your exam.
But first, a little review.
ANTIPSYCHOTIC AGENTS
The following tables summarize the most important aspects of antipsychotic medications:
Antipsychotic drugs have a high incidence of troublesome side effects. The nurse must
be aware of these potential side effects, make ongoing assessments of a client’s
condition, and intervene to alleviate or minimize these symptoms.
Common Side Effects of Antipsychotics
Because antiparkinsonian agents are often administered to control the extrapyramidal side
effects of antipsychotic medications, we’ll now focus on this classification of drugs.
Side effects of the antiparkinsonian drugs are most often associated with high dosages in
middle-aged and young adults; the elderly may experience side effects with moderate or
even low doses.
ANTIANXIETY AGENTS
BENZODIAZEPINES
BUSPIRONE
BuSpar (buspirone) lacks the anticonvulsant and muscle relaxant properties of the
benzodiazepines, causes minimal sedation, and has a lower interactive effect with other
C.N.S. depressants. Headache, dizziness, nervousness, and lightheadedness are common
side effects of BuSpar.
ANTIDPRESSANTS
Here are a few things you should keep in mind about antidepressants for the NCLEX-RN:
• Antidepressants affect the actions of norepinephrine, dopamine, or serotonin in
the brain.
• Response time to the antidepressants varies, but in general it takes from 2 to 3
weeks to see therapeutic effects.
• SSRIs are generally seen as the first line of treatment because of their lower side
effect profile and decreased potential for overdose.
• Tricyclic and tetracyclic antidepressants have anticholinergic side effects: dry
mouth, blurred vision, constipation, urinary hesitancy, orthostatis hypotension,
and drowsiness.
• Adverse effects include exacerbation of psychosis and cardiac arrhythmias.
MAO INHIBITORS
MAO inhibitors are not considered the first line for treatment of depression because of
their more serious and potentially life-threatening side effects.
The most serious side effect of the MAO inhibitors is the hypertensive crisis, which is
considered a medical emergency with potential for producing intracranial hemorrhage or
death. The MAO inhibitors produce hypertension in combination with foods that are
tyramine-rich. (Clients taking MAO inhibitors should avoid the tyramine-rich foods
listed below.) Several medications are also contraindicated in combination with the
MAO inhibitors.
In order to avoid a hypertensive crisis, a client taking MAO inhibitors must consult his
provider before taking any over-the-counter medication or any other prescription
medication.
LITHIUM CARBONATE
Lithium carbonate is the drug of choice of acute manic symptoms, as well as for
prophylactic treatment of cyclical mood swings. Lithium’s mode of action is not known,
but it takes 7-10 days for the medication to work. During that time, antipsychotic drugs
are often used to control the acute symptoms of mania until lithium takes effect. Serum
lithium blood levels are used to titrate the dose, with therapeutic levels ranging from 0.5
to 1.5 mEq/L. Dose stabilization usually takes 1 year.
ANTICONVULSANTS
The second line of treatment for mood stabilization I bipolar disorder is anticonvulsants.
These drugs are usually prescribed for those who do not respond to lithium or for whom
lithium may be contraindicated.
1. Review the five rights of medication administration: client, dose, drug, route, and
time.
2. G tardive dyskinesia - Irreversible side effect of antipsychotic medication causing a
syndrome characterized by bizarre facial and tongue movements, stiff neck, and
difficulty swallowing.
3. A agranulocytosis - Potentially fatal blood disorder in which the client’s white blood
cells drop to dangerously low levels. Associated with antipsychotic medications, in
particular clozapine (Clozaril).
4. C dystonia - Involuntary movement or spasms of the face, arms, legs, and neck;
usually an acute side effect of antipsychotic medication.
5. E oculogyric crisis - Uncontrollable upward or rolling back movement of the eyes;
may occur as an extrapyramidal side effect of antipsychotic drugs.
6. D neuroleptic malignant syndrome - Rare but potentially fatal complication of
treatment with neuroleptic drugs. Symptoms include severe muscle rigidity, high
fever, tachycardia, fluctuating blood pressure, diaphoresis, and rapid deterioration of
mental status into stupor and coma
7. B akathisia - Sensation of restlessness or a feeling of the need to move; shifting
from one foot to the other. An extrapyramidal side effect of antipsychotic
medications.
8. F pseudoparkinsonism - Symptoms of drooling, shuffling gait, tremor and rigidity,
mask-like face, pill-rolling of the fingers, and cogwheel rigidity that may occur early
in treatment with antipsychotic medications.
4. A psychiatric client is receiving temazepam (Restoril). The client tells the nurse,
“I’m feeling dizzy, and I can’t think right.” What would be an appropriate response
by the nurse?
(1) “Try to get some rest and you will feel better.”
(2) “That is because you’re not eating. With the medication you’re taking you
must eat to feel better.”
(3) “The dizziness and confusion you are experiencing are more common side
effects of the drugs you are taking.”
(4) “Don’t worry, the dizziness will go away in a few days.”
(1) drowsiness
(2) increase urine output
(3) metallic taste and diarrhea
(4) restlessness and muscle spasms
6. A client has been very despondent, withdrawn, and apathetic for about 6 months.
Recently, the client began to attend an outpatient clinic for treatment of depressive
disorder. Fluoxetine (HCL) Prozac) is prescribed, and after 3 days the client shows
improvement. What is the most appropriate nursing intervention at this time?
8. A client has been attending th partial hospitalization program for several weeks.
Clozapine (Clozaril) 100 mg po tid is prescribed. Today the client did not come for a
schedule appointment and when the nurse telephoned the client, it was stated that he
had a “fever and sore throat.” The nurse interprets these complaints as the client
experiencing
(1) akathisia
(2) akinesia
(3) anticholinergic crisis
(4) another episode of his psychiatric symptoms.
10. A client has just been place on haloperidol (Haldol) for a psychosis. When doing
an assessment, the nurse finds that the client is displaying tongue thrusting and jerky
movements of the extremities. The client asks why this is happening. The nurse’s
best response is
(1) “You have developed Huntington’s chorea, which is a side effect of the
drug you’re taking.”
(2) “You’re having extrapyramidal side effects.”
(3) “You’re having tardive dyskinesia, which is a side effect of the drug
you’re taking.”
(4) “You’re having akathesia, which is a side effect of the drug you’re
taking.”
CHAPTER 31: NCLEX-RN STYLE ANSWERS
3. (3) CORRECT These are side effects of Anafranil. Other side effects are
dry mouth, dizziness, seizures, and sexual dysfunction.
(1) ELIMINATE Not the most common side effects of Anafranil.
(2) ELIMINATE Not the most common side effects of Anafranil.
(3) ELIMINATE Not the most common side effects of Anafranil.
6. (4) CORRECT Antidepressant therapy may take 1-6 weeks for the client to
demonstrate an improvement and reduction of suicidal
behaviors.
(1) POSSIBLE This should be done, but only after the risk of suicide has
been evaluated.
(2) POSSIBLE This is not the most appropriate nursing intervention at this
time
(3) POSSIBLE This would be done at a later date.