NU664C Midterm Exam Study Guide – Graduate Nursing Practice & Clinical Prep
Know the route of administration for newer agent asenapine (Saphris) and what instructions should be
given to the patient regarding administration. - (answer)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. -
(answer)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.
, NU664C Midterm Exam Study Guide – Graduate Nursing Practice & Clinical Prep
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. -
(answer)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. - (answer)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? -
(answer)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. -
(answer)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. -
(answer)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 the route of administration for newer agent asenapine (Saphris) and what instructions should be
given to the patient regarding administration. - (answer)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. -
(answer)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.
, NU664C Midterm Exam Study Guide – Graduate Nursing Practice & Clinical Prep
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. -
(answer)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. - (answer)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? -
(answer)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. -
(answer)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. -
(answer)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
