NR668 Week 4 Psychopharmacology- Test Questions
and Answers| Latest Update
Antipsychotics: 2nd generation or atypical ✔️✔️-block D2 receptors but with lower EPS and
lower hyperprolactinemia
-MOA: Serotonin - Dopamine antagonism, 5HT2A receptor antagonism & simultaneous 5HT1A
& D2 partial agonism
• 5HT2A antagonism helps prevent EPS by stimulating Dopamine release in the striatum
reducing the D2 binding capacity just enough so the drug doesn't act like a conventional 1st
generation antipsychotic
-Other effects:
• Antimanic effects
• a few with antidepressant effects (Quetiapine XR & Aripiprazole)
-Pines:
• Clozapine
• Olanzapine
• Quetiapine
-Dones:
• Risperidone
• Paliperidone
• Ziprasidone
Clozaril ✔️✔️-Unique atypical antipsychotic
-potentially fatal side effects
-5 black box warnings:
• severe neutropenia (ANC < 500/mcl)
,➣baseline ANC must be 1500/mcl to start or 1000mcl with documented benign ethnic
neutropenia (why Clozaril has a REMS program or RISK Evaluation Mitigation Strategy)
-associated with:
• orthostatic hypotension
• bradycardia
• syncope
• Seizures
• Myocarditis
• Cardiomyopathy
• increased mortality in elderly patients with dementia related psychosis
• massive weight gain
-Reduces the risk of suicide in Schizophrenia
Clozaril Monitoring parameters ✔️✔️-CBC/ANC prior to initiation
-ANC monitored weekly for first 6 months
• Then Q2 weeks if the ANC remains > 1500/ mcl
• After 1 year, the ANC monitoring can drop to Q4 weeks if the ANC remains > 1500/mcl.
-In addition to the metabolic parameters discussed earlier
Complementary and alternative treatments (CAM) ✔️✔️-Holism
-Integrative Medicine
• Complementary therapies
• Alternative therapies
-62% of US adults utilize some form of CAM
-Beneficence: weighing the benefits of an action vs the cost & risk to the ind involved
-Autonomy: respect for person or the right or self determination
, -PMHNP engages & partners with the client, collaborates with healthcare team members
-PMHNP has obligation to notify patients about risk of a CAM tx when one exists
National Center for Contemporary and Alternative medicine (NCCAM): A division of the NIH
which funds research & provides practitioners & consumers info on CAM categorizes CAM as:
✔️✔️-whole system approach
-natural products
-mind body approaches
-manipulative body-based practices
Integrative Medicine ✔️✔️-Consider the body, mind, lifestyle & utilize both conventional &
alternative approaches
• Complementary therapies: A non-mainstream practice used together with conventional
medicine
• Alternative therapies: A non-mainstream practice used instead of conventional medicine
Holism ✔️✔️-Identifying the interrelationships of the biopsychosocial & spiritual dimensions of
the whole individual
• Meaning 1+1 = 3 or the whole is greater than the sum of its parts
-Treating the whole individual not just symptoms of a physical or mental health disorder
Yoga ✔️✔️-System of spirituality which encompasses breathing, mindfulness, meditation &
posture
-Evidence for reduction in anxiety, depressed mood & decreased low back pain
Tai chi & Qigong ✔️✔️-Mind-body exercise involves martial arts, meditation, dance
-Qigong meditation:
• chanting, visualization, breath awareness & intentional thoughts
and Answers| Latest Update
Antipsychotics: 2nd generation or atypical ✔️✔️-block D2 receptors but with lower EPS and
lower hyperprolactinemia
-MOA: Serotonin - Dopamine antagonism, 5HT2A receptor antagonism & simultaneous 5HT1A
& D2 partial agonism
• 5HT2A antagonism helps prevent EPS by stimulating Dopamine release in the striatum
reducing the D2 binding capacity just enough so the drug doesn't act like a conventional 1st
generation antipsychotic
-Other effects:
• Antimanic effects
• a few with antidepressant effects (Quetiapine XR & Aripiprazole)
-Pines:
• Clozapine
• Olanzapine
• Quetiapine
-Dones:
• Risperidone
• Paliperidone
• Ziprasidone
Clozaril ✔️✔️-Unique atypical antipsychotic
-potentially fatal side effects
-5 black box warnings:
• severe neutropenia (ANC < 500/mcl)
,➣baseline ANC must be 1500/mcl to start or 1000mcl with documented benign ethnic
neutropenia (why Clozaril has a REMS program or RISK Evaluation Mitigation Strategy)
-associated with:
• orthostatic hypotension
• bradycardia
• syncope
• Seizures
• Myocarditis
• Cardiomyopathy
• increased mortality in elderly patients with dementia related psychosis
• massive weight gain
-Reduces the risk of suicide in Schizophrenia
Clozaril Monitoring parameters ✔️✔️-CBC/ANC prior to initiation
-ANC monitored weekly for first 6 months
• Then Q2 weeks if the ANC remains > 1500/ mcl
• After 1 year, the ANC monitoring can drop to Q4 weeks if the ANC remains > 1500/mcl.
-In addition to the metabolic parameters discussed earlier
Complementary and alternative treatments (CAM) ✔️✔️-Holism
-Integrative Medicine
• Complementary therapies
• Alternative therapies
-62% of US adults utilize some form of CAM
-Beneficence: weighing the benefits of an action vs the cost & risk to the ind involved
-Autonomy: respect for person or the right or self determination
, -PMHNP engages & partners with the client, collaborates with healthcare team members
-PMHNP has obligation to notify patients about risk of a CAM tx when one exists
National Center for Contemporary and Alternative medicine (NCCAM): A division of the NIH
which funds research & provides practitioners & consumers info on CAM categorizes CAM as:
✔️✔️-whole system approach
-natural products
-mind body approaches
-manipulative body-based practices
Integrative Medicine ✔️✔️-Consider the body, mind, lifestyle & utilize both conventional &
alternative approaches
• Complementary therapies: A non-mainstream practice used together with conventional
medicine
• Alternative therapies: A non-mainstream practice used instead of conventional medicine
Holism ✔️✔️-Identifying the interrelationships of the biopsychosocial & spiritual dimensions of
the whole individual
• Meaning 1+1 = 3 or the whole is greater than the sum of its parts
-Treating the whole individual not just symptoms of a physical or mental health disorder
Yoga ✔️✔️-System of spirituality which encompasses breathing, mindfulness, meditation &
posture
-Evidence for reduction in anxiety, depressed mood & decreased low back pain
Tai chi & Qigong ✔️✔️-Mind-body exercise involves martial arts, meditation, dance
-Qigong meditation:
• chanting, visualization, breath awareness & intentional thoughts
