NR546 WEEK 3: TEST QUESTIONS WITH COMPLETE
SOLUTIONS
There is no single first-line antipsychotic medication choice because _________,
_________, & _________ differ. -- Answer ✔✔ client symptom profiles, treatment
responses, and side effects
FGAs -- Answer ✔✔ -Higher risk of extrapyramidal side effects (EPS)
-Treats positive symptoms
-Developed first
SGAs -- Answer ✔✔ -Effective for treatment-resistant clients
-Does not increase prolactin levels
-Treats positive and negative symptoms
-Lower risk of EPS
Prescribing Considerations -- 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.
When prescribing, document the _____________ at every visit. -- Answer ✔✔
targeted symptoms, response, and any adverse effects
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
Why begin with monotherapy? -- Answer ✔✔ The use of multiple antipsychotics can
increase the risk of QT prolongation.
-Combinations considered only after single med have provided inadequate response.
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
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)
special considerations: Pregnancy -- 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
special considerations: breast feeding -- Answer ✔✔ All antipsychotics are assumed to
be secreted in breast milk.
-recommended drug is discontinued or the infant bottle feeds.
special considerations: Older Adult -- 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.
special consideration: children -- 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
special considerations: caution -- Answer ✔✔ -Olanzapine - exercise caution in
suspected alcohol withdrawal, stimulant intoxication, or anticholinergic intoxication
-High and repeated doses of amphetamines or cocaine can mimic positive symptoms of
paranoid schizophrenia
factors that may impact medication adherence include: -- Answer ✔✔ -Individual clients
behaviors
-lack of social support
-illness-related factors
-lack of housing
-substance use
-adverse effects of med
-new dianosis
-younger age
-financial restraints
legal issues/considerations when prescribing antipsychotics -- Answer ✔✔ informed
consent
-required due to serious side effects
challenges
-psychosis can be an obstacle
-provide education before obtaining a signature in outpatient setting
contingency planning
-establish a plan with client and family for emergencies
-designate a mental healthcare proxy if possible
Prescribing Pearls -- Answer ✔✔ -Use the lowest effective dose and slow dosage
titration.
-Avoid agents with anticholinergic properties.
SOLUTIONS
There is no single first-line antipsychotic medication choice because _________,
_________, & _________ differ. -- Answer ✔✔ client symptom profiles, treatment
responses, and side effects
FGAs -- Answer ✔✔ -Higher risk of extrapyramidal side effects (EPS)
-Treats positive symptoms
-Developed first
SGAs -- Answer ✔✔ -Effective for treatment-resistant clients
-Does not increase prolactin levels
-Treats positive and negative symptoms
-Lower risk of EPS
Prescribing Considerations -- 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.
When prescribing, document the _____________ at every visit. -- Answer ✔✔
targeted symptoms, response, and any adverse effects
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
Why begin with monotherapy? -- Answer ✔✔ The use of multiple antipsychotics can
increase the risk of QT prolongation.
-Combinations considered only after single med have provided inadequate response.
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
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)
special considerations: Pregnancy -- 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
special considerations: breast feeding -- Answer ✔✔ All antipsychotics are assumed to
be secreted in breast milk.
-recommended drug is discontinued or the infant bottle feeds.
special considerations: Older Adult -- 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.
special consideration: children -- 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
special considerations: caution -- Answer ✔✔ -Olanzapine - exercise caution in
suspected alcohol withdrawal, stimulant intoxication, or anticholinergic intoxication
-High and repeated doses of amphetamines or cocaine can mimic positive symptoms of
paranoid schizophrenia
factors that may impact medication adherence include: -- Answer ✔✔ -Individual clients
behaviors
-lack of social support
-illness-related factors
-lack of housing
-substance use
-adverse effects of med
-new dianosis
-younger age
-financial restraints
legal issues/considerations when prescribing antipsychotics -- Answer ✔✔ informed
consent
-required due to serious side effects
challenges
-psychosis can be an obstacle
-provide education before obtaining a signature in outpatient setting
contingency planning
-establish a plan with client and family for emergencies
-designate a mental healthcare proxy if possible
Prescribing Pearls -- Answer ✔✔ -Use the lowest effective dose and slow dosage
titration.
-Avoid agents with anticholinergic properties.
