NU664C Study Guide for Midterm Exam 2023 Questions
and Answers (Verified Answers)
Know the route of administration for newer agent asenapine (Saphris) and what
instructions should be given to the patient regarding administration.
Route- Sublingual
Not to eat or drink for 10 minutes after medication administration
Not to swallow or chew the capsule.
Asenapine is an atypical antipsychotic (serotonin-dopamine antagonist, as a mood
stabilizer). Asenapine is not absorbed after swallowing (less than 2% bioavailable orally)
and thus must be administered sublingually (35% bioavailable), as swallowing would
render asenapine inactive.
Patients should be instructed to place the tablet under the tongue and allow it to
dissolve completely, which will occur in seconds; tablet should not be divided, crushed,
chewed, or swallowed.
Patients may not eat or drink for 10 minutes following sublingual administration so that
the drug in the oral cavity can be absorbed locally and not washed into the stomach
(where it would not be absorbed).
Due to rapid onset of action, can be used as a rapid acting "prn" or "as needed" dose
for agitation or transient worsening of psychosis or mania instead of an injection.
Treatment should be suspended if absolute neutrophil count falls below 1,000/mm3.
Know and describe the top atypical antipsychotic with greatest incidence of prolonged
QTc interval.
Ziprasidone (Geodon).
Normal QTc =450.
>470, Call Cardiologist
>500, stop all meds.
Ziprasidone (Geodon) has been associated with a dose-related prolongation of the QTc
QTc interval prolongation is greatest with ziprasidone and least with olanzapine.
Ziprasidone (Geodon) an atypical antipsychotic (serotonin-dopamine antagonist;
second-generation antipsychotic; also a mood stabilizer.
Ziprasidone is prescribed for Schizophrenia, delaying relapse in schizophrenia, acute
agitation in schizophrenia (intramuscular), acute mania/mixed mania, bipolar
maintenance, other psychotic d/o, bipolar depression, behavioral disturbances in
dementias, behavioral disturbances in children and adolescents, and disorders
associated with problems with impulse control.
Ziprasidone blocks dopamine 2 receptors, reducing positive symptoms of psychosis and
stabilizing affective symptoms. Blocks serotonin 2A receptors, causing enhancement of
dopamine release in certain brain regions and thus reducing motor side effects and
possible improving cognitive and affective symptoms.
EKGs may be useful for selected patients (e.g., those with personal or family history of
QTc prolongation; cardiac arrhythmia; recent myocardial infarction; uncompensated
heart failure; or those taking agents that prolong QTc interval (such as pimozide,
thioridazine, selected antiarrhythmics, moxifloxacin, sparfloxacin, etc.)
Ziprasidone prolongs QTc interval more than some other antipsychotics.
, Ziprasidone is associated with rare but serious skin condition known as Drug Reaction
with Eosinophilia (DRESS). DRESS may begin as a rash but can progress to other
parts of the body and can include symptoms such as fever, swollen lymph nodes,
swollen face, inflammation of organs, and an increase in white blood cells known as
eosinophilia. In some cases, DRESS can lead to death. Clinicians prescribing
ziprasidone should inform patients about the risk of DRESS; patients who develop a
fever with rash and swollen lymph nodes or swollen face should seek medical care. Pt
are not advised to stop their medication without consulting their prescribing clinician.
Use with caution in patients with conditions that predispose to hypotension
(dehydration, overheating).
Priapism has been reported.
Dysphagia has been associated with antipsychotic use, and ziprasidone should be used
cautiously in patients at risk for aspiration pneumonia.
Do Not Use: If pt is taking agents capable of significantly prolonging QTc interval (such
as pimozide, thioridazine, selected antiarrhythmics, moxifloxacin, sparfloxacin, etc.)
If there is a history of QTc prolongation or cardiac arrhythmia, recent acute myocardial
infarction, uncompensated heart failure.
Know which antipsychotics have specific instructions for minimum food intake or diet
restrictions.
Geodon because food affects the absorption of the drug.
Lurasidone - Latuda
Know an alternative atypical antipsychotic for a patient who has developed diabetes and
has a significant weight gain from treatment with olanzapine.
Abilify or Geodon, or Lurasidone (Latuda)
Because they are weight neutral or causes minimal weight gain.
Know whether a patient is demonstrating efficacy to clozapine 500 mg/day if this week's
granulocyte count is less than 500mm3. What is the most appropriate recommendation
for drug therapy?
Stop the drug, because of the risk of agranulocytosis and patient can be infected.
The most appropriate recommendation for drug therapy is to repeat CBC weekly.
> 1500, watch carefully if is at 1000
Know the common effects of smoking along with antipsychotic drug therapy such as
olanzapine.
Smoking reduces the level of Olanzapine because of its metabolism at CYP450
enzyme.
Be able to describe three positive symptoms and three negative symptoms of
schizophrenia.
Positive symptoms-Delusions, Hallucinations, Ideas of reference, Catatonic,
Disorganized speech, thinking or behavior
Negative symptoms-Flat affect, Asocial, Monotone, Anhedonia, Avolition, Isolation,
Poverty of Speech, Decreased self-care
Know what a painful muscle spasm with neck muscles pulling a patient's head to the
side called and Name a common drug therapy to relieve this symptom.
·Torticollis or Acute Dystonic
The common drug therapy is Cogentin (Benztropine) relieves the symptoms
Benadryl or Ativan can also be used.
and Answers (Verified Answers)
Know the route of administration for newer agent asenapine (Saphris) and what
instructions should be given to the patient regarding administration.
Route- Sublingual
Not to eat or drink for 10 minutes after medication administration
Not to swallow or chew the capsule.
Asenapine is an atypical antipsychotic (serotonin-dopamine antagonist, as a mood
stabilizer). Asenapine is not absorbed after swallowing (less than 2% bioavailable orally)
and thus must be administered sublingually (35% bioavailable), as swallowing would
render asenapine inactive.
Patients should be instructed to place the tablet under the tongue and allow it to
dissolve completely, which will occur in seconds; tablet should not be divided, crushed,
chewed, or swallowed.
Patients may not eat or drink for 10 minutes following sublingual administration so that
the drug in the oral cavity can be absorbed locally and not washed into the stomach
(where it would not be absorbed).
Due to rapid onset of action, can be used as a rapid acting "prn" or "as needed" dose
for agitation or transient worsening of psychosis or mania instead of an injection.
Treatment should be suspended if absolute neutrophil count falls below 1,000/mm3.
Know and describe the top atypical antipsychotic with greatest incidence of prolonged
QTc interval.
Ziprasidone (Geodon).
Normal QTc =450.
>470, Call Cardiologist
>500, stop all meds.
Ziprasidone (Geodon) has been associated with a dose-related prolongation of the QTc
QTc interval prolongation is greatest with ziprasidone and least with olanzapine.
Ziprasidone (Geodon) an atypical antipsychotic (serotonin-dopamine antagonist;
second-generation antipsychotic; also a mood stabilizer.
Ziprasidone is prescribed for Schizophrenia, delaying relapse in schizophrenia, acute
agitation in schizophrenia (intramuscular), acute mania/mixed mania, bipolar
maintenance, other psychotic d/o, bipolar depression, behavioral disturbances in
dementias, behavioral disturbances in children and adolescents, and disorders
associated with problems with impulse control.
Ziprasidone blocks dopamine 2 receptors, reducing positive symptoms of psychosis and
stabilizing affective symptoms. Blocks serotonin 2A receptors, causing enhancement of
dopamine release in certain brain regions and thus reducing motor side effects and
possible improving cognitive and affective symptoms.
EKGs may be useful for selected patients (e.g., those with personal or family history of
QTc prolongation; cardiac arrhythmia; recent myocardial infarction; uncompensated
heart failure; or those taking agents that prolong QTc interval (such as pimozide,
thioridazine, selected antiarrhythmics, moxifloxacin, sparfloxacin, etc.)
Ziprasidone prolongs QTc interval more than some other antipsychotics.
, Ziprasidone is associated with rare but serious skin condition known as Drug Reaction
with Eosinophilia (DRESS). DRESS may begin as a rash but can progress to other
parts of the body and can include symptoms such as fever, swollen lymph nodes,
swollen face, inflammation of organs, and an increase in white blood cells known as
eosinophilia. In some cases, DRESS can lead to death. Clinicians prescribing
ziprasidone should inform patients about the risk of DRESS; patients who develop a
fever with rash and swollen lymph nodes or swollen face should seek medical care. Pt
are not advised to stop their medication without consulting their prescribing clinician.
Use with caution in patients with conditions that predispose to hypotension
(dehydration, overheating).
Priapism has been reported.
Dysphagia has been associated with antipsychotic use, and ziprasidone should be used
cautiously in patients at risk for aspiration pneumonia.
Do Not Use: If pt is taking agents capable of significantly prolonging QTc interval (such
as pimozide, thioridazine, selected antiarrhythmics, moxifloxacin, sparfloxacin, etc.)
If there is a history of QTc prolongation or cardiac arrhythmia, recent acute myocardial
infarction, uncompensated heart failure.
Know which antipsychotics have specific instructions for minimum food intake or diet
restrictions.
Geodon because food affects the absorption of the drug.
Lurasidone - Latuda
Know an alternative atypical antipsychotic for a patient who has developed diabetes and
has a significant weight gain from treatment with olanzapine.
Abilify or Geodon, or Lurasidone (Latuda)
Because they are weight neutral or causes minimal weight gain.
Know whether a patient is demonstrating efficacy to clozapine 500 mg/day if this week's
granulocyte count is less than 500mm3. What is the most appropriate recommendation
for drug therapy?
Stop the drug, because of the risk of agranulocytosis and patient can be infected.
The most appropriate recommendation for drug therapy is to repeat CBC weekly.
> 1500, watch carefully if is at 1000
Know the common effects of smoking along with antipsychotic drug therapy such as
olanzapine.
Smoking reduces the level of Olanzapine because of its metabolism at CYP450
enzyme.
Be able to describe three positive symptoms and three negative symptoms of
schizophrenia.
Positive symptoms-Delusions, Hallucinations, Ideas of reference, Catatonic,
Disorganized speech, thinking or behavior
Negative symptoms-Flat affect, Asocial, Monotone, Anhedonia, Avolition, Isolation,
Poverty of Speech, Decreased self-care
Know what a painful muscle spasm with neck muscles pulling a patient's head to the
side called and Name a common drug therapy to relieve this symptom.
·Torticollis or Acute Dystonic
The common drug therapy is Cogentin (Benztropine) relieves the symptoms
Benadryl or Ativan can also be used.
