Nu664C Study Guide For Midterm Exam

NU664C STUDY GUIDE FOR MIDTERM
EXAM

Knowxcthexcroutexcofxcadministrationxcforxcnewerxcagentxcasenapinexc(Saphris)xcandxcwhat
xcinstructionsxcshouldxcbexcgivenxctoxcthexcpatientxcregardingxcadministration.xc-xcanswer--

Route-xcSublingual
Notxctoxceatxcorxcdrinkxcforxc10xcminutesxcafterxcmedicationxcadministration
Notxctoxcswallowxcorxcchewxcthexccapsule.
Asenapinexcisxcanxcatypicalxcantipsychoticxc(serotonin-
dopaminexcantagonist,xcasxcaxcmoodxcstabilizer).xcAsenapinexcisxcnotxcabsorbedxcafterxcs
wallowingxc(lessxcthanxc2%xcbioavailablexcorally)xcandxcthusxcmustxcbexcadministeredxcsub
linguallyxc(35%xcbioavailable),xcasxcswallowingxcwouldxcrenderxcasenapinexcinactive.
Patientsxcshouldxcbexcinstructedxctoxcplacexcthexctabletxcunderxcthexctonguexcandxcallowxcitxc
toxcdissolvexccompletely,xcwhichxcwillxcoccurxcinxcseconds;xctabletxcshouldxcnotxcbexcdivide
d,xccrushed,xcchewed,xcorxcswallowed.
Patientsxcmayxcnotxceatxcorxcdrinkxcforxc10xcminutesxcfollowingxcsublingualxcadministrationx
csoxcthatxcthexcdrugxcinxcthexcoralxccavityxccanxcbexcabsorbedxclocallyxcandxcnotxcwashedxcint

oxcthexcstomachxc(wherexcitxcwouldxcnotxcbexcabsorbed).
Duexctoxcrapidxconsetxcofxcaction,xccanxcbexcusedxcasxcaxcrapidxcactingxc"prn"xcorxc"asxcneed
ed"xcdosexcforxcagitationxcorxctransientxcworseningxcofxcpsychosisxcorxcmaniaxcinsteadxcofxc
anxcinjection.
Treatmentxcshouldxcbexcsuspendedxcifxcabsolutexcneutrophilxccountxcfallsxcbelowxc1,000/
mm3.

Knowxcandxcdescribexcthexctopxcatypicalxcantipsychoticxcwithxcgreatestxcincidencexcofxcprol
ongedxcQTcxcinterval.xc-xcanswer--Ziprasidonexc(Geodon).
NormalxcQTcxc=450.
>470,xcCallxcCardiologist
>500,xcstopxcallxcmeds.
Ziprasidonexc(Geodon)xchasxcbeenxcassociatedxcwithxcaxcdose-
relatedxcprolongationxcofxcthexcQTc
QTcxcintervalxcprolongationxcisxcgreatestxcwithxcziprasidonexcandxcleastxcwithxcolanzapine.
Ziprasidonexc(Geodon)xcanxcatypicalxcantipsychoticxc(serotonin-
dopaminexcantagonist;xcsecond-generationxcantipsychotic;xcalsoxcaxcmoodxcstabilizer.
ZiprasidonexcisxcprescribedxcforxcSchizophrenia,xcdelayingxcrelapsexcinxcschizophrenia,xc
acutexcagitationxcinxcschizophreniaxc(intramuscular),xcacutexcmania/
mixedxcmania,xcbipolarxcmaintenance,xcotherxcpsychoticxcd/
o,xcbipolarxcdepression,xcbehavioralxcdisturbancesxcinxcdementias,xcbehavioralxcdisturba
ncesxcinxcchildrenxcandxcadolescents,xcandxcdisordersxcassociatedxcwithxcproblemsxcwithxc
impulsexccontrol.
Ziprasidonexcblocksxcdopaminexc2xcreceptors,xcreducingxcpositivexcsymptomsxcofxcpsych
osisxcandxcstabilizingxcaffectivexcsymptoms.xcBlocksxcserotoninxc2Axcreceptors,xccausingxc
enhancementxcofxcdopaminexcreleasexcinxccertainxcbrainxcregionsxcandxcthusxcreducingxcm
otorxcsidexceffectsxcandxcpossiblexcimprovingxccognitivexcandxcaffectivexcsymptoms.
EKGsxcmayxcbexcusefulxcforxcselectedxcpatientsxc(e.g.,xcthosexcwithxcpersonalxcorxcfamilyxch
istoryxcofxcQTcxcprolongation;xccardiacxcarrhythmia;xcrecentxcmyocardialxcinfarction;xcunc

, ompensatedxcheartxcfailure;xcorxcthosexctakingxcagentsxcthatxcprolongxcQTcxcintervalxc(suc
hxcasxcpimozide,xcthioridazine,xcselectedxcantiarrhythmics,xcmoxifloxacin,xcsparfloxacin,xc
etc.)
ZiprasidonexcprolongsxcQTcxcintervalxcmorexcthanxcsomexcotherxcantipsychotics.
ZiprasidonexcisxcassociatedxcwithxcrarexcbutxcseriousxcskinxcconditionxcknownxcasxcDrugxcR
eactionxcwithxcEosinophiliaxc(DRESS).xcDRESSxcmayxcbeginxcasxcaxcrashxcbutxccanxcprogr
essxctoxcotherxcpartsxcofxcthexcbodyxcandxccanxcincludexcsymptomsxcsuchxcasxcfever,xcswoll
enxclymphxcnodes,xcswollenxcface,xcinflammationxcofxcorgans,xcandxcanxcincreasexcinxcwhit
excbloodxccellsxcknownxcasxceosinophilia.xcInxcsomexccases,xcDRESSxccanxcleadxctoxcdeath
.xcClinic

Knowxcwhichxcantipsychoticsxchavexcspecificxcinstructionsxcforxcminimumxcfoodxcintakexco
rxcdietxcrestrictions.xc-xcanswer--
Geodonxcbecausexcfoodxcaffectsxcthexcabsorptionxcofxcthexcdrug.
Lurasidonexc-xcLatuda

Knowxcanxcalternativexcatypicalxcantipsychoticxcforxcaxcpatientxcwhoxchasxcdevelopedxcdiab
etesxcandxchasxcaxcsignificantxcweightxcgainxcfromxctreatmentxcwithxcolanzapine.xc-
xcanswer--AbilifyxcorxcGeodon,xcorxcLurasidonexc(Latuda)

Becausexctheyxcarexcweightxcneutralxcorxccausesxcminimalxcweightxcgain.

Knowxcwhetherxcaxcpatientxcisxcdemonstratingxcefficacyxctoxcclozapinexc500xcmg/
dayxcifxcthisxcweek'sxcgranulocytexccountxcisxclessxcthanxc500mm3.xcWhatxcisxcthexcmostxca
ppropriatexcrecommendationxcforxcdrugxctherapy?xc-xcanswer--
Stopxcthexcdrug,xcbecausexcofxcthexcriskxcofxcagranulocytosisxcandxcpatientxccanxcbexcinfect
ed.
ThexcmostxcappropriatexcrecommendationxcforxcdrugxctherapyxcisxctoxcrepeatxcCBCxcweekl
y.
>xc1500,xcwatchxccarefullyxcifxcisxcatxc1000

Knowxcthexccommonxceffectsxcofxcsmokingxcalongxcwithxcantipsychoticxcdrugxctherapyxcsu
chxcasxcolanzapine.xc-xcanswer--
SmokingxcreducesxcthexclevelxcofxcOlanzapinexcbecausexcofxcitsxcmetabolismxcatxcCYP450
xcenzyme.



Bexcablexctoxcdescribexcthreexcpositivexcsymptomsxcandxcthreexcnegativexcsymptomsxcofxcs
chizophrenia.xc-xcanswer--Positivexcsymptoms-
Delusions,xcHallucinations,xcIdeasxcofxcreference,xcCatatonic,xcDisorganizedxcspeech,xct
hinkingxcorxcbehavior
Negativexcsymptoms-
Flatxcaffect,xcAsocial,xcMonotone,xcAnhedonia,xcAvolition,xcIsolation,xcPovertyxcofxcSpeec
h,xcDecreasedxcself-care

Knowxcwhatxcaxcpainfulxcmusclexcspasmxcwithxcneckxcmusclesxcpullingxcaxcpatient'sxcheadx
ctoxcthexcsidexccalledxcandxcNamexcaxccommonxcdrugxctherapyxctoxcrelievexcthisxcsymptom.x

c-xcanswer--·TorticollisxcorxcAcutexcDystonic

ThexccommonxcdrugxctherapyxcisxcCogentinxc(Benztropine)xcrelievesxcthexcsymptoms
BenadrylxcorxcAtivanxccanxcalsoxcbexcused.