NURS 660 PSYCHOPHARM
n n
1. Minimum ANC level to prescribe Clozapine, general population::
n n n n n n n
1,500 L
¼ n
2. Severe Neutropenia:
n
< 5 0 0 L¼
n
3. Moderate Neutropenia: n
500-9 9 9 L¼
4. Mild Neutropenia:
n
1000-1 4 9 9 L¼
5. BEN patients: Normal ANC range for Clozaril:
n n n n n n
e1,000¼
L
6. Clozaril BEN patient: severe neutropenia:
n n n n
<500 L
¼ n
1n/n21
,7. BEN neutropenia:
n
500-999 L
¼ n
8. Lower ANC threshold for starting clozapine: General population:
n n n n n n n
e1,500L
¼/
9. Lower ANC threshold for starting clozapine: Benign ethnic neutropenia (
n n n n n n n n n
BEN):
1,000/L
¼
10. Medical emergencies when prescribing anti-psychotics: -
n n n n n
n NMS
- Agranulocytosis
- Serotonin Syndrome n
11. Clinical findings in agranulocytosis:
n n n
12. Clozaril: most likely side effect if pt develops fever within 6 weeks:
n n n n n n n n n n n
My-ocarditis
13. Clozaril: if pt develops fever within 6 weeks order a
n n n n n n n n n , and
.:
2n/n21
,EKG, CRP, Troponin, as this is likely due to myocarditis
n n n n n n n n n
14. Common complaints in patients with neutropenia:
n n n n n n
F,P, U, P: -
n n n
Fever (low grade)
n n
- painful swallowing (odynophagia)
n n
- URI (sinusitis, otitis, cough)
n n n
- Perirectal pain/irritation n
15. Symptoms of neuroleptic malignant syndrome (NMS):: -n n n n n n
High fever n
- Tachycardia/irregular pulse n
- Increased respiratory rate n n
- Muscle Rigidity n
- altered mental status
n n
16. Off label TX for NMS:
n n n n
Amantadine (SYMMETREL) n
17. Serotonin Syndrome onset:: - n n n
24 hours of combining antidepressants
n n n n
3n/n21
, 18. Serotonin Syndrome Cardinal features: -
n n n n
Myoclonic jerks
n
- Hyperreflexia
- Mental status changes
n n
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
n n n n
- Confused/ restless/ hyperactive/ unresponsive
n n n
19. Management of Serotonin syndrome: -
n n n n
Discontinue meds, stablize vitals
n n n
4n/n21
n n
1. Minimum ANC level to prescribe Clozapine, general population::
n n n n n n n
1,500 L
¼ n
2. Severe Neutropenia:
n
< 5 0 0 L¼
n
3. Moderate Neutropenia: n
500-9 9 9 L¼
4. Mild Neutropenia:
n
1000-1 4 9 9 L¼
5. BEN patients: Normal ANC range for Clozaril:
n n n n n n
e1,000¼
L
6. Clozaril BEN patient: severe neutropenia:
n n n n
<500 L
¼ n
1n/n21
,7. BEN neutropenia:
n
500-999 L
¼ n
8. Lower ANC threshold for starting clozapine: General population:
n n n n n n n
e1,500L
¼/
9. Lower ANC threshold for starting clozapine: Benign ethnic neutropenia (
n n n n n n n n n
BEN):
1,000/L
¼
10. Medical emergencies when prescribing anti-psychotics: -
n n n n n
n NMS
- Agranulocytosis
- Serotonin Syndrome n
11. Clinical findings in agranulocytosis:
n n n
12. Clozaril: most likely side effect if pt develops fever within 6 weeks:
n n n n n n n n n n n
My-ocarditis
13. Clozaril: if pt develops fever within 6 weeks order a
n n n n n n n n n , and
.:
2n/n21
,EKG, CRP, Troponin, as this is likely due to myocarditis
n n n n n n n n n
14. Common complaints in patients with neutropenia:
n n n n n n
F,P, U, P: -
n n n
Fever (low grade)
n n
- painful swallowing (odynophagia)
n n
- URI (sinusitis, otitis, cough)
n n n
- Perirectal pain/irritation n
15. Symptoms of neuroleptic malignant syndrome (NMS):: -n n n n n n
High fever n
- Tachycardia/irregular pulse n
- Increased respiratory rate n n
- Muscle Rigidity n
- altered mental status
n n
16. Off label TX for NMS:
n n n n
Amantadine (SYMMETREL) n
17. Serotonin Syndrome onset:: - n n n
24 hours of combining antidepressants
n n n n
3n/n21
, 18. Serotonin Syndrome Cardinal features: -
n n n n
Myoclonic jerks
n
- Hyperreflexia
- Mental status changes
n n
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
n n n n
- Confused/ restless/ hyperactive/ unresponsive
n n n
19. Management of Serotonin syndrome: -
n n n n
Discontinue meds, stablize vitals
n n n
4n/n21
