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NURS 660: PSYCHOPHARM Questions and
Correct Answers
Minimum ANC level to prescribe Clozapine, general population:
Ans: — 1,500 μL
Severe Neutropenia Ans: — < 500μL
Moderate Neutropenia Ans: — 500-999μL
Mild Neutropenia Ans: — 1000-1499μL
BEN patients: Normal ANC range for Clozaril Ans: — ≥1,000 μL
Clozaril BEN patient: severe neutropenia Ans: — <500 μL
BEN neutropenia Ans: — 500-999 μL
Lower ANC threshold for starting clozapine: General population
Ans: — ≥1,500/μL
Lower ANC threshold for starting clozapine: Benign ethnic
neutropenia (BEN) Ans: — 1,000/μL
Medical emergencies when prescribing anti-psychotics Ans: — -
NMS
- Agranulocytosis
- Serotonin Syndrome
Clozaril: most likely side effect if pt develops fever within 6 weeks
Ans: — Myocarditis
Clozaril: if pt develops fever within 6 weeks order a ______,
_________ and _______. Ans: — EKG, CRP, Troponin, as this is likely
due to myocarditis
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Common complaints in patients with neutropenia:
F,P, U, P Ans: — - Fever (low grade)
- painful swallowing (odynophagia)
- URI (sinusitis, otitis, cough)
- Perirectal pain/irritation
Symptoms of neuroleptic malignant syndrome (NMS): Ans: — -
High fever
- Tachycardia/irregular pulse
- Increased respiratory rate
- Muscle Rigidity
- altered mental status
Off label TX for NMS Ans: — Amantadine (SYMMETREL)
Serotonin Syndrome onset: Ans: — -24 hours of combining
antidepressants
Serotonin Syndrome Cardinal features Ans: — - Myoclonic jerks
- Hyperreflexia
- Mental status changes
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
- Confused/ restless/ hyperactive/ unresponsive
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Management of Serotonin syndrome Ans: — - Discontinue meds,
stablize vitals
Potentially
helpful meds with Serotonin syndrome: Ans: — Benzodiazepines
for agitation
Cyproheptadine (anti-serotonergic antihistamine)
Methysergide (anti-serotonergic migraine medication)
5-HT "TWITCHY FROG" Serotonin Syndrome Ans: — -Agitated
-Sweating
-Fever
-Hyperreflexia
-Dilated pupils
Neuroleptic Malignant Syndrome Ans: — a potentially fatal
hyperpyrexia with temp of over 104, looks like EPS except for
temp
Neuroleptic Malignant Syndrome- "can't bender(er)" Ans: — Life-
threatening muscle rigidity, fever, and rhabdomyolysis.
Mental status changes
Mechanism of NMS.
-What's blocked? Where (2)? Ans: — Dopamine blockade in the
hypothalamus (fever)
and nigrostriatal pathway (rigidity
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Onset of NMS Ans: — 30 days of starting or increasing
antipsychotics or stoping a domaminergic drug
NMS cardinal features Ans: — High fever 100% by definition
Rigidity 100% by definition
Mental status changes 99%
Elevated or labile BP most
NMS motor activity Ans: — Bradykinesia
Brain regions affected by schizophrenia (aggression and impulse
control) (2) Ans: — Orbitofrontal cortex and amygdala
Pathways affected by schizophrenia (4):
MMTN Ans: — -Mesolimbic
- Mesocortical
-Tuberoinfundibular
-Nigrostriatal
Mesolimbic DOPAMINE pathway:
Increased dopamine activity in the: ___, ____, and ____. Ans: —
Nucleus accumbuns, amygdala, hippocampus
Mesolimbic dopamine pathways are responsible for (adding
something to the behavior): Ans: — Positive symptoms - Delusions
- bizarre behavior - hallucinations - disorganized speech
Most antipsychotics treat ___________ symptoms. Ans: — positive
© 2025 All rights reserved
NURS 660: PSYCHOPHARM Questions and
Correct Answers
Minimum ANC level to prescribe Clozapine, general population:
Ans: — 1,500 μL
Severe Neutropenia Ans: — < 500μL
Moderate Neutropenia Ans: — 500-999μL
Mild Neutropenia Ans: — 1000-1499μL
BEN patients: Normal ANC range for Clozaril Ans: — ≥1,000 μL
Clozaril BEN patient: severe neutropenia Ans: — <500 μL
BEN neutropenia Ans: — 500-999 μL
Lower ANC threshold for starting clozapine: General population
Ans: — ≥1,500/μL
Lower ANC threshold for starting clozapine: Benign ethnic
neutropenia (BEN) Ans: — 1,000/μL
Medical emergencies when prescribing anti-psychotics Ans: — -
NMS
- Agranulocytosis
- Serotonin Syndrome
Clozaril: most likely side effect if pt develops fever within 6 weeks
Ans: — Myocarditis
Clozaril: if pt develops fever within 6 weeks order a ______,
_________ and _______. Ans: — EKG, CRP, Troponin, as this is likely
due to myocarditis
© 2025 All rights reserved
, 2 | Page
Common complaints in patients with neutropenia:
F,P, U, P Ans: — - Fever (low grade)
- painful swallowing (odynophagia)
- URI (sinusitis, otitis, cough)
- Perirectal pain/irritation
Symptoms of neuroleptic malignant syndrome (NMS): Ans: — -
High fever
- Tachycardia/irregular pulse
- Increased respiratory rate
- Muscle Rigidity
- altered mental status
Off label TX for NMS Ans: — Amantadine (SYMMETREL)
Serotonin Syndrome onset: Ans: — -24 hours of combining
antidepressants
Serotonin Syndrome Cardinal features Ans: — - Myoclonic jerks
- Hyperreflexia
- Mental status changes
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
- Confused/ restless/ hyperactive/ unresponsive
© 2025 All rights reserved
, 3 | Page
Management of Serotonin syndrome Ans: — - Discontinue meds,
stablize vitals
Potentially
helpful meds with Serotonin syndrome: Ans: — Benzodiazepines
for agitation
Cyproheptadine (anti-serotonergic antihistamine)
Methysergide (anti-serotonergic migraine medication)
5-HT "TWITCHY FROG" Serotonin Syndrome Ans: — -Agitated
-Sweating
-Fever
-Hyperreflexia
-Dilated pupils
Neuroleptic Malignant Syndrome Ans: — a potentially fatal
hyperpyrexia with temp of over 104, looks like EPS except for
temp
Neuroleptic Malignant Syndrome- "can't bender(er)" Ans: — Life-
threatening muscle rigidity, fever, and rhabdomyolysis.
Mental status changes
Mechanism of NMS.
-What's blocked? Where (2)? Ans: — Dopamine blockade in the
hypothalamus (fever)
and nigrostriatal pathway (rigidity
© 2025 All rights reserved
, 4 | Page
Onset of NMS Ans: — 30 days of starting or increasing
antipsychotics or stoping a domaminergic drug
NMS cardinal features Ans: — High fever 100% by definition
Rigidity 100% by definition
Mental status changes 99%
Elevated or labile BP most
NMS motor activity Ans: — Bradykinesia
Brain regions affected by schizophrenia (aggression and impulse
control) (2) Ans: — Orbitofrontal cortex and amygdala
Pathways affected by schizophrenia (4):
MMTN Ans: — -Mesolimbic
- Mesocortical
-Tuberoinfundibular
-Nigrostriatal
Mesolimbic DOPAMINE pathway:
Increased dopamine activity in the: ___, ____, and ____. Ans: —
Nucleus accumbuns, amygdala, hippocampus
Mesolimbic dopamine pathways are responsible for (adding
something to the behavior): Ans: — Positive symptoms - Delusions
- bizarre behavior - hallucinations - disorganized speech
Most antipsychotics treat ___________ symptoms. Ans: — positive
© 2025 All rights reserved
