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NU664C Study Guide for Midterm Exam Questions and Answers
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NU664C Study Guide for Midterm ExamQuestions and Answers
Know the route of administration for newer agent asenapine (Saphris) and
what instructions should be given to the patient regarding administration. - -
Route- Sublingual
Not to eat or drink for 10 minutes after medication administration
Not to swallow or chew the capsule.
Asenapine is an atypical antipsychotic (serotonin-dopamine antagonist, as a
mood stabilizer). Asenapine is not absorbed after swallowing (less than 2%
bioavailable orally) and thus must be administered sublingually (35%
bioavailable), as swallowing would render asenapine inactive.
Patients should be instructed to place the tablet under the tongue and allow
it to dissolve completely, which will occur in seconds; tablet should not be
divided, crushed, chewed, or swallowed.
Patients may not eat or drink for 10 minutes following sublingual
administration so that the drug in the oral cavity can be absorbed locally and
not washed into the stomach (where it would not be absorbed).
Due to rapid onset of action, can be used as a rapid acting "prn" or "as
needed" dose for agitation or transient worsening of psychosis or mania
instead of an injection.
Treatment should be suspended if absolute neutrophil count falls below
1,000/mm3.
-Know and describe the top atypical antipsychotic with greatest incidence of
prolonged QTc interval. - -Ziprasidone (Geodon).
Normal QTc =450.
>470, Call Cardiologist
>500, stop all meds.
Ziprasidone (Geodon) has been associated with a dose-related prolongation
of the QTc
QTc interval prolongation is greatest with ziprasidone and least with
olanzapine.
Ziprasidone (Geodon) an atypical antipsychotic (serotonin-dopamine
antagonist; second-generation antipsychotic; also a mood stabilizer.
Ziprasidone is prescribed for Schizophrenia, delaying relapse in
schizophrenia, acute agitation in schizophrenia (intramuscular), acute
mania/mixed mania, bipolar maintenance, other psychotic d/o, bipolar
depression, behavioral disturbances in dementias, behavioral disturbances in
children and adolescents, and disorders associated with problems with
impulse control.
Ziprasidone 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 possible improving cognitive and affective
symptoms.
EKGs may be useful for selected patients (e.g., those with personal or family
history of QTc prolongation; cardiac arrhythmia; recent myocardial infarction;
uncompensated heart failure; or those taking agents that prolong QTc
interval (such as pimozide, thioridazine, selected antiarrhythmics,
moxifloxacin, sparfloxacin, etc.)
Ziprasidone prolongs QTc interval more than some other antipsychotics.
Ziprasidone is associated with rare but serious skin condition known as Drug
Reaction with Eosinophilia (DRESS). DRESS may begin as a rash but can
progress to other parts of the body and can include symptoms such as fever,
swollen lymph nodes, swollen face, inflammation of organs, and an increase
in white blood cells known as eosinophilia. In some cases, DRESS can lead to
death. Clinic
-Know which antipsychotics have specific instructions for minimum food
intake or diet restrictions. - -Geodon because food affects the absorption of
the drug.
Lurasidone - Latuda
-Know an alternative atypical antipsychotic for a patient who has developed
diabetes and has a significant weight gain from treatment with olanzapine. -
-Abilify or Geodon, or Lurasidone (Latuda)
Because they are weight neutral or causes minimal weight gain.
-Know whether a patient is demonstrating efficacy to clozapine 500 mg/day
if this week's granulocyte count is less than 500mm3. What is the most
appropriate recommendation for drug therapy? - -Stop the drug, because of
the risk of agranulocytosis and patient can be infected.
The most appropriate recommendation for drug therapy is to repeat CBC
weekly.
> 1500, watch carefully if is at 1000
-Know the common effects of smoking along with antipsychotic drug therapy
such as olanzapine. - -Smoking reduces the level of Olanzapine because of
its metabolism at CYP450 enzyme.
-Be able to describe three positive symptoms and three negative symptoms
of schizophrenia. - -Positive symptoms-Delusions, Hallucinations, Ideas of
reference, Catatonic, Disorganized speech, thinking or behavior
Negative symptoms-Flat affect, Asocial, Monotone, Anhedonia, Avolition,
Isolation, Poverty of Speech, Decreased self-care
-Know what a painful muscle spasm with neck muscles pulling a patient's
head to the side called and Name a common drug therapy to relieve this
symptom. - -·Torticollis or Acute Dystonic
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