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NURS 663 EXAM 2 - SCHIZ, PSYCHOSIS, ANTIPSYCHOTICS – Q&A
NURS 663 EXAM 2 - SCHIZ, PSYCHOSIS, ANTIPSYCHOTICS – Q&A
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NURS 663 EXAM 2 - SCHIZ, PSYCHOSIS,ANTIPSYCHOTICS – Q&A
Lurasidone (Latuda)-atypical antipsychotic MOA ✔️Ans - serotonin-
dopamine antagonist; second generation antipsychotic
Blocks dopamine 2 receptors, reducing positive symptoms of psychosis and
stabilizing affective symptoms
Blocks serotonin 2A receptors, causing enhancement of dopamine release in
certain brain regions and thus reducing motor side effects and possibly
improving cognition and affective symptoms
Potently blocks serotonin 7 receptors, which may be beneficial for mood,
sleep, cognitive impairment, and negative symptoms in schizophrenia, and
also in bipolar disorder and major depressive disorder
Partial agonist at 5HT1A receptors, and antagonist actions at serotonin 7 and
alpha 2A and alpha 2C receptors, which may be beneficial for mood, anxiety
and cognition in a number of disorders
Lacks potent actions at dopamine D1, muscarinic M1, and histamine H1
receptors, theoretically suggesting less propensity for inducing cognitive
impairment, weight gain, or sedation compared to other agents with these
properties
Lurasidone (Latuda) common s/e ✔️Ans - Dose-dependent sedation
Akathisia
Nausea
Dose-dependent hyperprolactinemia
May increase risk for diabetes and dyslipidemia
Rare tardive dyskinesia (much reduced risk compared to conventional
antipsychotics)
Lurasidone (Latuda) adverse s/e ✔️Ans - Tachycardia, first-degree AV
block
Hyperglycemia, in some cases extreme and associated with ketoacidosis or
hyperosmolar coma or death, has been reported in patients taking atypical
antipsychotics (class warning)
Increased risk of death and cerebrovascular events in elderly patients with
dementia-related psychosis (class warning)
Rare neuroleptic malignant syndrome (much-reduced risk compared to
conventional antipsychotics) (class warning)
,Rare seizures (class warning)
Lurasidone (Latuda) Lab Tests ✔️Ans - Determine if the patient is
overweight (BMI 25.0-29.9)
obese (BMI ≥30)
has pre-diabetes (fasting plasma glucose 100-125 mg/dL)
has diabetes (fasting plasma glucose ≥126 mg/dL)
has hypertension (BP >140/90 mm Hg)
has dyslipidemia (increased total cholesterol, LDL cholesterol, and
triglycerides; decreased HDL cholesterol)
Lurasidone (Latuda) dosing ✔️Ans - 40-80 mg/day for schizophrenia
(some may benefit from up to 160 mg/day)
20-60 mg/day for bipolar depression (may benefit from doses up to 120
mg/day)
*TAKE WITH 300 calories worth of FOOD
Lurasidone (Latuda) drug-drug interactions ✔️Ans - Inhibitors of CYP450
3A4 (e.g., nefazodone, fluvoxamine, fluoxetine, ketoconazole) may increase
plasma levels of lurasidone
Coadministration of lurasidone with a strong CYP450 3A4 inhibitor (e.g.,
ketoconazole) or with a strong CYP450 3A4 inducer (e.g., rifampin) is
contraindicated
Coadministration of lurasidone with moderate CYP450 3A4 inhibitors can be
considered; recommended starting dose is 20 mg/day; recommended
maximum dose is 80 mg/day
Moderate inducers of CYP450 3A4 may decrease plasma levels of lurasidone
May increase effects of antihypertensive agents
May antagonize levodopa, dopamine agonists
Thorazine (chlorpromazine) MOA ✔️Ans - Antiemetic, antipsychotic
Dopamine receptor antagonist with greatest action at D2 receptors. Also has
antihistamine, anticholinergic effects, and blocks alpha-adrenergic receptors
Thorazine (chlorpromazine) common s/e ✔️Ans - Akathisia,
extrapyramidal symptoms, parkinsonism
•Dizziness, sedation, orthostatic hypotension, tachycardia, urinary retention,
depression
, •Long-term use: weight gain, glucose intolerance, sexual dysfunction,
hyperprolactinemia
Thorazine (chlorpromazine) adverse effects ✔️Ans - Tardive dyskinesias
Neuroleptic malignant syndrome (rare)
Jaundice, agranulocytosis (rare)
Thorazine (chlorpromazine) dosing ✔️Ans - Oral: Give 10-25 mg and
repeat as needed every 4-6 hours. Patients with previous exposure and few
significant AEs may increase dose and use up to 200 mg/day in divided doses
IV/IM: Give 12.5-50 mg every 4-8 hours up to 200 mg/day
Thorazine (chlorpromazine) drug-drug interactions ✔️Ans - Use with CNS
depressants (barbiturates, opiates, general anesthetics) potentiates CNS AEs
•May enhance effects of antihypertensives
•Use with alcohol or diuretics may increase hypotension
•May decrease effectiveness of dopaminergic agents
•Reduces effectiveness of anticoagulants
•May increase phenytoin levels
•The combination of lithium and neuroleptics has been reported to produce
an encephalopathy similar to neuroleptic malignant syndrome
Thorazine (chlorpromazine) lab tests ✔️Ans - Obtain blood pressure and
pulse before initial IV and monitor QTc with ECG
Clozapine (clozaril) MOA ✔️Ans - Blocks D2 receptors similar to other
antipsychotics, but also blocks serotonin 2A receptors, which improves motor
side effects and perhaps depression and cognitive problems. Also blocks alpha
adrenergic receptors, and has anticholinergic and antihistamine effects. May
stimulate serotonin 1A receptors
***FDA approved for recent suicidal behavior in patients with schizophrenia
or schizoaffective disorder***
Clozapine (Clozaril) side effects ✔️Ans - Motor AEs - blocking of D2
receptors
•Sedation, weight gain - blocking of histamine 1 receptors
•Hypotension - blocking of alpha-1 adrenergic receptors
•Dry mouth, constipation - blocking of muscarinic receptors
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