NURS660
NURS 660 PSYCHOPHARM COMPLETE
EXAM 2025
Minimum ANC level to prescribe Clozapine, general population: - Correct Ans-1,500 μL
Severe Neutropenia - Correct Ans-< 500μL
Moderate Neutropenia - Correct Ans-500-999μL
Mild Neutropenia - Correct Ans-1000-1499μL
BEN patients: Normal ANC range for Clozaril - Correct Ans-≥1,000 μL
Clozaril BEN patient: severe neutropenia - Correct Ans-<500 μL
BEN neutropenia - Correct Ans-500-999 μL
Lower ANC threshold for starting clozapine: General population - Correct Ans-
≥1,500/μL
Lower ANC threshold for starting clozapine: Benign ethnic neutropenia (BEN) - Correct
Ans-1,000/μL
Medical emergencies when prescribing anti-psychotics - Correct Ans-- NMS
- Agranulocytosis
- Serotonin Syndrome
Clinical findings in agranulocytosis - Correct Ans-
Clozaril: most likely side effect if pt develops fever within 6 weeks - Correct Ans-
Myocarditis
Clozaril: if pt develops fever within 6 weeks order a ______, _________ and _______. -
Correct Ans-EKG, CRP, Troponin, as this is likely due to myocarditis
Common complaints in patients with neutropenia:
F,P, U, P - Correct Ans-- Fever (low grade)
- painful swallowing (odynophagia)
- URI (sinusitis, otitis, cough)
- Perirectal pain/irritation
Symptoms of neuroleptic malignant syndrome (NMS): - Correct Ans-- High fever
- Tachycardia/irregular pulse
NURS660
,NURS660
- Increased respiratory rate
- Muscle Rigidity
- altered mental status
Off label TX for NMS - Correct Ans-Amantadine (SYMMETREL)
Serotonin Syndrome onset: - Correct Ans--24 hours of combining antidepressants
Serotonin Syndrome Cardinal features - Correct Ans-- Myoclonic jerks
- Hyperreflexia
- Mental status changes
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
- Confused/ restless/ hyperactive/ unresponsive
Management of Serotonin syndrome - Correct Ans-- Discontinue meds, stablize vitals
Potentially
helpful meds with Serotonin syndrome: - Correct Ans-Benzodiazepines for agitation
Cyproheptadine (anti-serotonergic antihistamine)
Methysergide (anti-serotonergic migraine medication)
5-HT "TWITCHY FROG" Serotonin Syndrome - Correct Ans--Agitated
-Sweating
-Fever
-Hyperreflexia
-Dilated pupils
Neuroleptic Malignant Syndrome - Correct Ans-a potentially fatal hyperpyrexia with
temp of over 104, looks like EPS except for temp
Neuroleptic Malignant Syndrome- "can't bender(er)" - Correct Ans-Life-threatening
muscle rigidity, fever, and rhabdomyolysis.
Mental status changes
Mechanism of NMS.
-What's blocked? Where (2)? - Correct Ans-Dopamine blockade in the hypothalamus
(fever)
and nigrostriatal pathway (rigidity
Onset of NMS - Correct Ans-30 days of starting or increasing antipsychotics or stoping
a domaminergic drug
NMS cardinal features - Correct Ans-High fever 100% by definition
Rigidity 100% by definition
NURS660
, NURS660
Mental status changes 99%
Elevated or labile BP most
NMS motor activity - Correct Ans-Bradykinesia
Brain regions affected by schizophrenia (aggression and impulse control) (2) - Correct
Ans-Orbitofrontal cortex and amygdala
Pathways affected by schizophrenia (4):
MMTN - Correct Ans--Mesolimbic
- Mesocortical
-Tuberoinfundibular
-Nigrostriatal
Mesolimbic DOPAMINE pathway:
Increased dopamine activity in the: ___, ____, and ____. - Correct Ans-Nucleus
accumbuns, amygdala, hippocampus
Mesolimbic dopamine pathways are responsible for (adding something to the behavior):
- Correct Ans-Positive symptoms - Delusions - bizarre behavior - hallucinations -
disorganized speech
Most antipsychotics treat ___________ symptoms. - Correct Ans-positive
Mesocortical pathway: Responsible for a _______ in dopamine activity in ______
condition. - Correct Ans-decreased dopamine activity in schizophrenia
mesocortical pathway are responsible for ____ symptoms, such as (3) - Correct Ans-
Negative Symptoms
1. Flat affect 2. Poverty of Speech 3. Adhedonia Apathy
Tuberoinfundibular pathways: Antipsychotics Decrease _______ causing side effects
thru this pathway - Correct Ans-dopamine
In the Tuberinfundibular pathway, dopamine inhibits ________. - Correct Ans-Prolactin
Tuberoinfundibular pathway: Less dopamine means more ______, more _______
causes less ________
< D = >P = <G - Correct Ans-Less dopamine = more prolactin = less Gonadotropins
(GnRH)
Tuberoinfundibular pathway: decreased _______ (a result of decreased dopamine and
increased prolactin causes these side effects: - Correct Ans-GnRH =
- Decreased labido
- Sex dysfunction
NURS660
NURS 660 PSYCHOPHARM COMPLETE
EXAM 2025
Minimum ANC level to prescribe Clozapine, general population: - Correct Ans-1,500 μL
Severe Neutropenia - Correct Ans-< 500μL
Moderate Neutropenia - Correct Ans-500-999μL
Mild Neutropenia - Correct Ans-1000-1499μL
BEN patients: Normal ANC range for Clozaril - Correct Ans-≥1,000 μL
Clozaril BEN patient: severe neutropenia - Correct Ans-<500 μL
BEN neutropenia - Correct Ans-500-999 μL
Lower ANC threshold for starting clozapine: General population - Correct Ans-
≥1,500/μL
Lower ANC threshold for starting clozapine: Benign ethnic neutropenia (BEN) - Correct
Ans-1,000/μL
Medical emergencies when prescribing anti-psychotics - Correct Ans-- NMS
- Agranulocytosis
- Serotonin Syndrome
Clinical findings in agranulocytosis - Correct Ans-
Clozaril: most likely side effect if pt develops fever within 6 weeks - Correct Ans-
Myocarditis
Clozaril: if pt develops fever within 6 weeks order a ______, _________ and _______. -
Correct Ans-EKG, CRP, Troponin, as this is likely due to myocarditis
Common complaints in patients with neutropenia:
F,P, U, P - Correct Ans-- Fever (low grade)
- painful swallowing (odynophagia)
- URI (sinusitis, otitis, cough)
- Perirectal pain/irritation
Symptoms of neuroleptic malignant syndrome (NMS): - Correct Ans-- High fever
- Tachycardia/irregular pulse
NURS660
,NURS660
- Increased respiratory rate
- Muscle Rigidity
- altered mental status
Off label TX for NMS - Correct Ans-Amantadine (SYMMETREL)
Serotonin Syndrome onset: - Correct Ans--24 hours of combining antidepressants
Serotonin Syndrome Cardinal features - Correct Ans-- Myoclonic jerks
- Hyperreflexia
- Mental status changes
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
- Confused/ restless/ hyperactive/ unresponsive
Management of Serotonin syndrome - Correct Ans-- Discontinue meds, stablize vitals
Potentially
helpful meds with Serotonin syndrome: - Correct Ans-Benzodiazepines for agitation
Cyproheptadine (anti-serotonergic antihistamine)
Methysergide (anti-serotonergic migraine medication)
5-HT "TWITCHY FROG" Serotonin Syndrome - Correct Ans--Agitated
-Sweating
-Fever
-Hyperreflexia
-Dilated pupils
Neuroleptic Malignant Syndrome - Correct Ans-a potentially fatal hyperpyrexia with
temp of over 104, looks like EPS except for temp
Neuroleptic Malignant Syndrome- "can't bender(er)" - Correct Ans-Life-threatening
muscle rigidity, fever, and rhabdomyolysis.
Mental status changes
Mechanism of NMS.
-What's blocked? Where (2)? - Correct Ans-Dopamine blockade in the hypothalamus
(fever)
and nigrostriatal pathway (rigidity
Onset of NMS - Correct Ans-30 days of starting or increasing antipsychotics or stoping
a domaminergic drug
NMS cardinal features - Correct Ans-High fever 100% by definition
Rigidity 100% by definition
NURS660
, NURS660
Mental status changes 99%
Elevated or labile BP most
NMS motor activity - Correct Ans-Bradykinesia
Brain regions affected by schizophrenia (aggression and impulse control) (2) - Correct
Ans-Orbitofrontal cortex and amygdala
Pathways affected by schizophrenia (4):
MMTN - Correct Ans--Mesolimbic
- Mesocortical
-Tuberoinfundibular
-Nigrostriatal
Mesolimbic DOPAMINE pathway:
Increased dopamine activity in the: ___, ____, and ____. - Correct Ans-Nucleus
accumbuns, amygdala, hippocampus
Mesolimbic dopamine pathways are responsible for (adding something to the behavior):
- Correct Ans-Positive symptoms - Delusions - bizarre behavior - hallucinations -
disorganized speech
Most antipsychotics treat ___________ symptoms. - Correct Ans-positive
Mesocortical pathway: Responsible for a _______ in dopamine activity in ______
condition. - Correct Ans-decreased dopamine activity in schizophrenia
mesocortical pathway are responsible for ____ symptoms, such as (3) - Correct Ans-
Negative Symptoms
1. Flat affect 2. Poverty of Speech 3. Adhedonia Apathy
Tuberoinfundibular pathways: Antipsychotics Decrease _______ causing side effects
thru this pathway - Correct Ans-dopamine
In the Tuberinfundibular pathway, dopamine inhibits ________. - Correct Ans-Prolactin
Tuberoinfundibular pathway: Less dopamine means more ______, more _______
causes less ________
< D = >P = <G - Correct Ans-Less dopamine = more prolactin = less Gonadotropins
(GnRH)
Tuberoinfundibular pathway: decreased _______ (a result of decreased dopamine and
increased prolactin causes these side effects: - Correct Ans-GnRH =
- Decreased labido
- Sex dysfunction
NURS660
