NURS 660: PSYCHOPHARM 2024
COMPLETE QUESTIONS AND VERIFIED
ANSWERS|ACTUAL EXAM| ACCURATE
SOLUTIONS WITH
RATIONALES/ALREADY GRADED A+
Minimum ANC level to prescribe Clozapine, general population: - ✔✔1,500 μL
Severe Neutropenia - ✔✔< 500μL
Moderate Neutropenia - ✔✔500-999μL
Mild Neutropenia - ✔✔1000-1499μL
BEN patients: Normal ANC range for Clozaril - ✔✔≥1,000 μL
Clozaril BEN patient: severe neutropenia - ✔✔<500 μL
BEN neutropenia - ✔✔500-999 μL
Lower ANC threshold for starting clozapine: General population - ✔✔≥1,500/μL
Lower ANC threshold for starting clozapine: Benign ethnic neutropenia (BEN) -
✔✔1,000/μL
Medical emergencies when prescribing anti-psychotics - ✔✔- NMS
- Agranulocytosis
- Serotonin Syndrome
1|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,Clinical findings in agranulocytosis - ✔✔
Clozaril: most likely side effect if pt develops fever within 6 weeks -
✔✔Myocarditis
Clozaril: if pt develops fever within 6 weeks order a ______, _________ and
_______. - ✔✔EKG, CRP, Troponin, as this is likely due to myocarditis
Common complaints in patients with neutropenia:
F,P, U, P - ✔✔- Fever (low grade)
- painful swallowing (odynophagia)
- URI (sinusitis, otitis, cough)
- Perirectal pain/irritation
Symptoms of neuroleptic malignant syndrome (NMS): - ✔✔- High fever
- Tachycardia/irregular pulse
- Increased respiratory rate
- Muscle Rigidity
- altered mental status
Off label TX for NMS - ✔✔Amantadine (SYMMETREL)
Serotonin Syndrome onset: - ✔✔-24 hours of combining antidepressants
Serotonin Syndrome Cardinal features - ✔✔- Myoclonic jerks
2|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,- Hyperreflexia
- Mental status changes
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
- Confused/ restless/ hyperactive/ unresponsive
Management of Serotonin syndrome - ✔✔- Discontinue meds, stablize vitals
Potentially
helpful meds with Serotonin syndrome: - ✔✔Benzodiazepines for agitation
Cyproheptadine (anti-serotonergic antihistamine)
Methysergide (anti-serotonergic migraine medication)
5-HT "TWITCHY FROG" Serotonin Syndrome - ✔✔-Agitated
-Sweating
-Fever
-Hyperreflexia
-Dilated pupils
Neuroleptic Malignant Syndrome - ✔✔a potentially fatal hyperpyrexia with
temp of over 104, looks like EPS except for temp
3|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
, Neuroleptic Malignant Syndrome- "can't bender(er)" - ✔✔Life-threatening
muscle rigidity, fever, and rhabdomyolysis.
Mental status changes
Mechanism of NMS.
-What's blocked? Where (2)? - ✔✔Dopamine blockade in the hypothalamus
(fever)
and nigrostriatal pathway (rigidity
Onset of NMS - ✔✔30 days of starting or increasing antipsychotics or stoping a
domaminergic drug
NMS cardinal features - ✔✔High fever 100% by definition
Rigidity 100% by definition
Mental status changes 99%
Elevated or labile BP most
NMS motor activity - ✔✔Bradykinesia
Brain regions affected by schizophrenia (aggression and impulse control) (2) -
✔✔Orbitofrontal cortex and amygdala
Pathways affected by schizophrenia (4):
MMTN - ✔✔-Mesolimbic
4|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
COMPLETE QUESTIONS AND VERIFIED
ANSWERS|ACTUAL EXAM| ACCURATE
SOLUTIONS WITH
RATIONALES/ALREADY GRADED A+
Minimum ANC level to prescribe Clozapine, general population: - ✔✔1,500 μL
Severe Neutropenia - ✔✔< 500μL
Moderate Neutropenia - ✔✔500-999μL
Mild Neutropenia - ✔✔1000-1499μL
BEN patients: Normal ANC range for Clozaril - ✔✔≥1,000 μL
Clozaril BEN patient: severe neutropenia - ✔✔<500 μL
BEN neutropenia - ✔✔500-999 μL
Lower ANC threshold for starting clozapine: General population - ✔✔≥1,500/μL
Lower ANC threshold for starting clozapine: Benign ethnic neutropenia (BEN) -
✔✔1,000/μL
Medical emergencies when prescribing anti-psychotics - ✔✔- NMS
- Agranulocytosis
- Serotonin Syndrome
1|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,Clinical findings in agranulocytosis - ✔✔
Clozaril: most likely side effect if pt develops fever within 6 weeks -
✔✔Myocarditis
Clozaril: if pt develops fever within 6 weeks order a ______, _________ and
_______. - ✔✔EKG, CRP, Troponin, as this is likely due to myocarditis
Common complaints in patients with neutropenia:
F,P, U, P - ✔✔- Fever (low grade)
- painful swallowing (odynophagia)
- URI (sinusitis, otitis, cough)
- Perirectal pain/irritation
Symptoms of neuroleptic malignant syndrome (NMS): - ✔✔- High fever
- Tachycardia/irregular pulse
- Increased respiratory rate
- Muscle Rigidity
- altered mental status
Off label TX for NMS - ✔✔Amantadine (SYMMETREL)
Serotonin Syndrome onset: - ✔✔-24 hours of combining antidepressants
Serotonin Syndrome Cardinal features - ✔✔- Myoclonic jerks
2|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,- Hyperreflexia
- Mental status changes
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
- Confused/ restless/ hyperactive/ unresponsive
Management of Serotonin syndrome - ✔✔- Discontinue meds, stablize vitals
Potentially
helpful meds with Serotonin syndrome: - ✔✔Benzodiazepines for agitation
Cyproheptadine (anti-serotonergic antihistamine)
Methysergide (anti-serotonergic migraine medication)
5-HT "TWITCHY FROG" Serotonin Syndrome - ✔✔-Agitated
-Sweating
-Fever
-Hyperreflexia
-Dilated pupils
Neuroleptic Malignant Syndrome - ✔✔a potentially fatal hyperpyrexia with
temp of over 104, looks like EPS except for temp
3|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
, Neuroleptic Malignant Syndrome- "can't bender(er)" - ✔✔Life-threatening
muscle rigidity, fever, and rhabdomyolysis.
Mental status changes
Mechanism of NMS.
-What's blocked? Where (2)? - ✔✔Dopamine blockade in the hypothalamus
(fever)
and nigrostriatal pathway (rigidity
Onset of NMS - ✔✔30 days of starting or increasing antipsychotics or stoping a
domaminergic drug
NMS cardinal features - ✔✔High fever 100% by definition
Rigidity 100% by definition
Mental status changes 99%
Elevated or labile BP most
NMS motor activity - ✔✔Bradykinesia
Brain regions affected by schizophrenia (aggression and impulse control) (2) -
✔✔Orbitofrontal cortex and amygdala
Pathways affected by schizophrenia (4):
MMTN - ✔✔-Mesolimbic
4|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
