Pharm Competency 3: Antipsychotics

The nurse is caring for a patient who is starting clozapine (Clozaril). Which nursing intervention is a priority for this patient? A. Assess baseline white blood cell count and absolute neutrophil count. B. Evaluate suicidal tendencies. C. Take a baseline EEG. D. Evaluate creatinine clearance.

A. Assess baseline white blood cell count and absolute neutrophil count. Patients taking clozapine (Clozaril) must be monitored for the life-threatening side effect of agranulocytosis. A baseline white blood cell count and absolute neutrophil count must be taken. Patients started on this medication are chronically and severely ill. Evaluation of suicidal tendencies would not need to happen before the patient started the medication. Patients on this medication may have an increased risk of seizures; however, a baseline EEG will not assist in predicting or preventing this side effect. This medication is metabolized before excretion. Evaluation of creatinine clearance is not a priority for the patient starting on the medication.

A therapeutic benefit of fluphenazine decanoate (Prolixin Decanoate) is that the individual: A. does not have to remember to take medication daily. B. will not experience extrapyramidal side effects (EPSEs). C. may have daily doses titrated up or down. D. will experience a reduction in both negative and positive symptoms.

A. does not have to remember to take medication daily. This medication is not given daily but rather by injection every 2 to 3 weeks and does not require titration. Fluphenazine, a traditional first-generation antipsychotic drug, targets only positive symptoms of schizophrenia.

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics? (Select all that apply.) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia

A. Auditory hallucunations C. Delusions of grandeur D. Severe agitation Positive symptoms of schizophrenia, such as auditory hallucinations, are effectively treated with first-generation antipsychotics. Positive symptoms of schizophrenia, such as delusions of grandeur, are effectively treated with first-generation antipsychotics. Positive symptoms of schizophrenia, such as severe agitation, are effectively treated with first-generation antipsychotics.

A nurse is preparing to perform a follow-up assessment on a client who takes chlorpromazine for the treatment of schizophrenia. The nurse shoudl expect to find the greatest improvement in which of the following manifestations? (Select all that apply.) A. Disorganized speech B. Bizarre behavior C. Impaired social interactions D. Hallucinations E. Decreased motivation

A. Disorganized speech B. Bizarre behavior D. Hallucinations A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as disorganized speech. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as bizarre behavior. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as hallucinations.

The patient has been ordered a medication regimen that includes loxitane (Loxapine). During instructional sessions regarding the medication, the nurse should emphasize which information? (Select all that apply.) A. Sedation can occur. B. Hypotension is likely. C. Extrapyramidal symptoms can occur. D. Nausea reduction will occur.

A. Sedation can occur. B. Hypotension is likely. C. Extrapyramidal symptoms can occur. Loxitane (Loxapine) is known to cause sedation, hypotension, and extrapyramidal symptoms. Nausea may result as a side effect of loxitane.

Which statement is true concerning the use of antipsychotic medications during pregnancy? A.Their use should be monitored closely by the mother's healthcare provider. B. Such medication poses severe risks when used during pregnancy. C. Medications in this class do not cross the placental barrier. D. There is no record of side effects in newborns exposed to such medications.

A. Their use should be monitored closely by the mother's healthcare provider. While antipsychotics do pose some risks to the pregnant woman, these risks are not generally considered severe; nonetheless, their use should be carefully monitored by the woman's healthcare provider. These drugs do pass the placental barrier and can cause EPSEs in some newborns but the risks of such exposure is small and levels are carefully monitored when a pregnant woman is prescribed this classification of medications in order to minimize the risk

A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects? A. Take the medication in the morning to prevent insomnia. B. Chew sugarless gum to moisten the mouth. C. Use cooling measure to decrease fever. D. Take an antacid to relieve nausea.

B. Chew sugarless gum to moisten the mouth. Chewing sugarless gum can help the client cope with dry mouth, a potential anticholinergic effect of fluphenazine.

A nurse is providing teaching for a male client who has schizophrenia and is taking risperidone. Which of the following instructions should the nurse include in the teaching? A. "Add extra snacks to your diet to prevent weight loss." B. "Notify the provider if you develop breast enlargement." C. "You may begin to have mild seizures while taking this medication." D. "This medication is likely to increase your libido."

B. "Notify the provider if you develop breast enlargement." Gynecomasia (breast enlargement) and galactorrhea can occur due to an increase in prolactin levels while taking risperidone. The client should inform the provider is theses manifestations occur.

The nurse is assessing a patient taking antipsychotics and notes that he has difficulty sitting still. The patient states that he is feeling "restless," as he paces the floor. What is the nurse's primary intervention? A. Stop the medication immediately and notify the health care provider. B. Administer the prescribed benzodiazepine. C. Administer benztropine (Cogentin) as ordered. D. Stay with the patient and offer reassurance.

B. Administer the prescribed benzodiazepine. Akathisia presents with restlessness and trouble standing still. This side effect is best treated with a benzodiazepine such as lorazepam. The medication is not stopped if a patient exhibits this type of effect. Cogentin is administered for Parkinson-like side effects, which this patient is not exhibiting. The symptoms displayed are most likely not just typical nervousness. Staying with the patient will not change the symptoms.

When an older adult is prescribed an antipsychotic medication, which intervention has priority regarding the patient's safety? A. Wearing sunglasses when outdoors B. Changing from a sitting to standing position slowly C. Being frequently monitored for suicidal ideations D. Avoiding foods with high fat content

B. Changing from a sitting to standing position slowly Hypotension is the major antiadrenergic effect of antipsychotic drugs. Hypotension occurs most often in older adults and when the individual stands or changes positions suddenly (orthostatic hypotension); thus, precautions against falls must be instituted. Frequent monitoring for suicidal ideation is appropriate for antidepressant medications. While wearing sunglasses and avoiding high-fat foods are appropriate health habits, they are not associated directly with antipsychotic medication therapy.

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply.) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing

B. Drooling C. Involuntary arm movements E. Continual pacing Drooling is an indication of pseudoparkinsonism, which is an EPS. Incoluntary arm movements are an indication of tardive dyskinesia, which is an EPS. Continual pacing is an indication of akathesia, which is an EPS.

The patient is suspected of having overdosed on a benzodiazepine medication. The nurse expects that the health care provider will prescribe which medication? A. Lorazepam (Ativan) B. Flumazenil (Romazicon) C. Oxazepam (Serax) D. Buspirone HCl (BuSpar)

B. Flumazenil (Romazicon) Of the medications listed, flumazenil (Romazicon) is the only one that would be effective as a benzodiazepine antagonist.

A nurse is assessing a male client who recently began taking haloperidol. Which of the following findings is the highest priority to report to the provider? A. Shuffling gait B. Neck spasms C. Drowsiness D. Impotence

B. Neck spasms Neck spasms are an indication of acute dystonia which is a crisis situation requiring rapid treatment. This is the greatest risk to the client and is therefore the priority finding.

The nurse will hold the next dose of antipsychotic medication for which patients? (Select all that apply.) A. The patient with a sitting blood pressure of 130/90 mm Hg and 100/80 mm Hg when standing B. The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips C. The patient who has pill-rolling motions of the hand D. The patient who has a sudden high fever

B. The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips D. The patient who has a sudden high fever The patient with protrusion and rolling of the tongue and smacking movements of the lips most likely is displaying symptoms of tardive dyskinesia. The medication should be stopped in any patient displaying these symptoms. A patient with a sudden high fever may be experiencing neuroleptic malignant syndrome; immediate withdrawal of the medication is needed. Orthostatic hypotension is a common occurrence with many antipsychotic medications and is not a reason to stop the medication. Pill-rolling motions of the hand may indicate Parkinson-like extrapyramidal side effects. This is not a reason to stop the medication. Treatment is aimed at controlling the side effects.

A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? A. "Iwill be able to stop taking this meciation as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while I am taking this medication." D. "This medication is highly addictive and must be withdrawal slowly.

C. "I will be careful not to gain too much weight while I am taking this medication." Antipsychotic medications, such as iloperidone, have a high risk for significant weight gain.

A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A. Olanzapine B. Quetiapine C. Aripiprazole D. Clozapine E. Asenapine

C. Aripiprazole D. Clozapine E. Asenapine Aripiprazole is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. Clozapine is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. Asenapine is available in a sublingual tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection.

What nutritional education should a nurse provide when managing the care of a patient who has been prescribed a newer antipsychotic medication? A. Limit protein intake. B. Increase fluid intake by 200 ml daily. C. Prepare to cope with a craving for carbohydrates. D. Increase calories to manage an expected weight loss.

C. Prepare to cope with a craving for carbohydrates. Carbohydrate craving is a common feature of this type of medication therapy. Weight gain can be significant, particularly for patients taking the newer agents. There is no need to limit protein or to increase fluid intake above normal consumption.

A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticiptae a prescription of which of the following? A. Chlorpromazine B. Thiothixene C. Risperdone D. Haloperidol

C. Risperdone Second-generation antipsychotics, such as risperidone, are effective in treating negative symptoms of schizophrenia, such as lack of grooming and flat affect.

The multidisciplinary team discusses the patient's negative symptoms of schizophrenia. The nurse expects which medication to be ordered? A. Prolixin (fluphenazine) B. Haldol (haloperidol) C. Seroquel (quetiapine) D. Thorazine (chlorpromazine)

C. Seroquel (quetiapine) Quetiapine, an atypical second-generation antipsychotic drug, targets both the positive and negative symptoms of schizophrenia. Fluphenazine predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication. Haloperidol predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication. Chlorpromazine predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication.

A preceptor is working with a new RN. The preceptor will note understanding of Clozaril (clozapine) by the new RN when he or she says: A. "I need to carefully assess each patient for EPSEs, since it is a major risk factor with clozapine." B. "The team decided to offer clozapine to the patient who was newly admitted and diagnosed with schizophrenia. I will discuss it with his family today." C. "I gave the first dose of clozapine this morning. He is experiencing no abnormal motor movements so far." D. "The patient's WBC and ANC meet the criteria to start clozapine."

D. "The patient's WBC and ANC meet the criteria to start clozapine." The new RN demonstrates knowledge of clozapine with establishing a baseline for the white blood cell count (WBC)/absolute neutrophil count ANC with the potential risk of agranulocytosis in mind. EPSE liability is lower with clozapine rather than higher. Clozapine is not the first-line treatment for schizophrenia because of the expense and dedication necessary to monitor bone marrow health and WBC. Abnormal motor movements are not expected following a first dose of clozapine.

A nurse is providing discharge teaching to a client who has a new prescription for clozapine. Which of the following statements should the nurse include in the teaching? A. "You should have a high-carbohydrate snack between meals and at bedtime." B. "You are likely to develop hand tremors if you take this medication for a long period of time." C. "You may experience temporary numbness of your mouth after each dose." D. "You should have your white blood cell count monitored every week."

D. "You should have your white blood cell count monitored every week." Due to the risk for fatal agranulocytosis weekly monitoring of the client's WBC count is recommended while taking clozapine.

There is an anticholinergic effect on the peripheral nervous system resulting from the effects of some antipsychotic medication. Tachycardia, constipation, and urinary hesitation are the result of this effect on which cranial nerve (CN)? A. CN III B. CN VII C. CN IX D. CN X

D. CN X The anticholinergic effects on CN X, the vagus nerve, would include tachycardia, constipation, and urinary hesitation. Anticholinergic effects on CN IX, the glossopharyngeal nerve, include dry mouth and dry nasal passages, while effects on CN VII, the facial nerve, result in dry mouth, decreased tearing, and dry nasal passages. An anticholinergic effect on CN III, the oculomotor nerve, would bring about dilated pupils, impaired accommodation, and blurred vision.

What aspect of traditional antipsychotic medication therapy is most responsible for a patient's medication nonadherence and resulting rehospitalization? A. The cost of the medication B. The need for frequent blood tests C. The biases against such medications D. The occurrence of EPSEs.

D. The occurrence of EPSEs. EPSEs → nonadherence → relapse → rehospitalization. It has been estimated that most patients who receive antipsychotic medications have EPSEs and, in turn, EPSEs account for many readmissions. High-potency traditional antipsychotics are most likely and atypical antipsychotics are least likely to cause EPSEs. While the cost of medication, the need for monitoring, and biases against medication can all be factors, the greatest impact on nonadherence is the development of EPSEs.

Prior to administering Clozaril (clozapine) and at regular intervals during treatment, the nurse will evaluate the patient's: A. electroencephalogram (EEG). B. electrocardiogram (ECG). C. lipids. D. complete blood count (CBC).

D. complete blood count (CBC). Related to the risk for agranulocytosis from bone marrow suppression, monitoring of the WBC count by the prescriber, nurse, and/or pharmacist is required. This medication does not require monitoring of EEG, ECG, or serum lipids.

Name the 4 Dopamine Pathways

Mesocortical Pathway Mesolimbic Pathways: Antipsychotic effects Nigrostriatal pathway: Extrapyramidal Symptoms Tuberoinfundibular pathway: Hyperprolactinemia

A patient asks the nurse to explain how antipsychotic drugs work to make him feel better. The nurse understands that antipsychotics act in which way? a. Blocking actions of dopamine b. Blocking actions of epinephrine c. Promoting prostaglandin synthesis d. Enhancing the action of gamma-aminobutyric acid

a. Blocking actions of dopamine

A patient appears to have had an overdose of phenothiazines. The nurse anticipates that which intervention(s) may be used to treat phenothiazine overdose? (Select all that apply.) a. Gastric lavage b. Adequate hydration c. Maintaining an airway d. Fluphenazine (Prolixin) e. Risperidone (Risperdal) f. Activated charcoal administration

a. Gastric lavage b. Adequate hydration c. Maintaining an airway f. Activated charcoal administration

An atypical antipsychotic is prescribed for a patient with psychosis. The nurse understands that this category of medications includes which drugs? (Select all that apply.) a. clozapine (Clozaril) b. fluphenazine (Prolixin) c. haloperidol (Haldol) d. olanzapine (Zyprexa) e. aripiprazole (Abilify)

a. clozapine (Clozaril) d. olanzapine (Zyprexa) e. aripiprazole (Abilify)

The nurse suspects that a patient who is experiencing facial grimacing, involuntary upward eye movement, and muscle spasms of the tongue and face may have which condition? a. Akathisia b. Acute dystonia c. Tardive dyskinesia d. Pseudoparkinsonism

b. Acute dystonia

An antipsychotic agent, fluphenazine (Prolixin), is ordered for a patient with psychosis. The nurse understands that this agent can lead to extrapyramidal symptoms that may be treated with which medication? a. quetiapine (Seroquel) b. aripiprazole (Abilify) c. benztropine (Cogentin) d. chlorpromazine (Thorazine)

c. benztropine (Cogentin)

Video on schizophrenia

https://www.youtube.com/watch?v=PURvJV2SMso

Mesocortical pathway

too little dopamine-cause negative symptoms