Midterm Exam: NR546 / NR 546
(Latest Update )
Advanced Pharmacology
Psychopharmacology for the
Psychiatric-Mental Health Nurse
Practitioner | Questions and
Answers | 100% Correct | Grade A -
Chamberlain
Question:
Prescribing Considerations (antipsychotics)
Answer:
-Start with lowest dose, eval tolerance, then titrate dose
-no evidence that high antipsychotic doses are more effective than standard
doses
-Dose adjustments should be made after two weeks of taking medication
-Establish efficacy and an effective med dose before switching to a long-acting
injectable (LAI). dose of LAI will be same as the effective oral dose.
-Most antipsychotic side effects and adverse effects are dose-related.
,Question:
When prescribing, document the _____________ at every visit.
Answer:
targeted symptoms, response, and any adverse effects
Question:
Many persons with schizophrenia are treated successfully in an
______________, though some clients may require ________________ for
initial treatment and subsequent treatment of psychotic episodes
Answer:
outpatient setting, inpatient hospitalizations
Question:
Why begin with monotherapy? (antipsychotics)
Answer:
The use of multiple antipsychotics can increase the risk of QT prolongation.
-Combinations considered only after single med have provided inadequate
response.
,Question:
If antipsychotics switched too quickly
Answer:
can develop agitation, activation, insomnia, and experience withdrawal
-due to the binding differences in each medication subcategory
*Cross titration over several days to weeks is required to prevent side effects
Question:
Clients are more likely to experience side effects when changing from a
medication in one ___________ to a medication in another ____________
Answer:
subcategory, subcategory
(ex: pine to done)
Question:
special considerations: Pregnancy (antipsychotics)
Answer:
-Risk of withdrawal symptoms in the newborn: extrapyramidal symptoms
may be present at delivery.
-atypical antipsychotics appear more harmful than typical antipsychotics due
to increased risk of gestational metabolic complications, increased
gestational age weight, and increased birth weight.
-Avoid Clozapine, Ziprasidone, olanzapine, risperidone, and quetiapine,
especially in the third trimester
, Question:
special considerations: breast feeding (antipsychotics)
Answer:
All antipsychotics are assumed to be secreted in breast milk.
-recommended drug is discontinued or the infant bottle feeds.
Question:
special considerations: Older Adult (antipsychotics)
Answer:
2019 American Geriatric Society (AGS) Beers Criteria recommendations:
Avoid the use of haloperidol, ziprasidone, and olanzapine due to an increased
risk of cerebrovascular accident (CVA), cognitive decline, and death in
persons with dementia and with dementia-related psychosis.
Question:
special consideration: children (antipsychotics)
Answer:
Black box warnings:
-Aripiprazole: Increased risk of suicide in children.
-Quetiapine: Increased risk of suicidal ideation and suicidal behavior in
adolescents/young adults during the initial 1-2 months of treatment
(Latest Update )
Advanced Pharmacology
Psychopharmacology for the
Psychiatric-Mental Health Nurse
Practitioner | Questions and
Answers | 100% Correct | Grade A -
Chamberlain
Question:
Prescribing Considerations (antipsychotics)
Answer:
-Start with lowest dose, eval tolerance, then titrate dose
-no evidence that high antipsychotic doses are more effective than standard
doses
-Dose adjustments should be made after two weeks of taking medication
-Establish efficacy and an effective med dose before switching to a long-acting
injectable (LAI). dose of LAI will be same as the effective oral dose.
-Most antipsychotic side effects and adverse effects are dose-related.
,Question:
When prescribing, document the _____________ at every visit.
Answer:
targeted symptoms, response, and any adverse effects
Question:
Many persons with schizophrenia are treated successfully in an
______________, though some clients may require ________________ for
initial treatment and subsequent treatment of psychotic episodes
Answer:
outpatient setting, inpatient hospitalizations
Question:
Why begin with monotherapy? (antipsychotics)
Answer:
The use of multiple antipsychotics can increase the risk of QT prolongation.
-Combinations considered only after single med have provided inadequate
response.
,Question:
If antipsychotics switched too quickly
Answer:
can develop agitation, activation, insomnia, and experience withdrawal
-due to the binding differences in each medication subcategory
*Cross titration over several days to weeks is required to prevent side effects
Question:
Clients are more likely to experience side effects when changing from a
medication in one ___________ to a medication in another ____________
Answer:
subcategory, subcategory
(ex: pine to done)
Question:
special considerations: Pregnancy (antipsychotics)
Answer:
-Risk of withdrawal symptoms in the newborn: extrapyramidal symptoms
may be present at delivery.
-atypical antipsychotics appear more harmful than typical antipsychotics due
to increased risk of gestational metabolic complications, increased
gestational age weight, and increased birth weight.
-Avoid Clozapine, Ziprasidone, olanzapine, risperidone, and quetiapine,
especially in the third trimester
, Question:
special considerations: breast feeding (antipsychotics)
Answer:
All antipsychotics are assumed to be secreted in breast milk.
-recommended drug is discontinued or the infant bottle feeds.
Question:
special considerations: Older Adult (antipsychotics)
Answer:
2019 American Geriatric Society (AGS) Beers Criteria recommendations:
Avoid the use of haloperidol, ziprasidone, and olanzapine due to an increased
risk of cerebrovascular accident (CVA), cognitive decline, and death in
persons with dementia and with dementia-related psychosis.
Question:
special consideration: children (antipsychotics)
Answer:
Black box warnings:
-Aripiprazole: Increased risk of suicide in children.
-Quetiapine: Increased risk of suicidal ideation and suicidal behavior in
adolescents/young adults during the initial 1-2 months of treatment
