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