NURS 660 PSYCHOPHARM EXAM 4 LATEST MARYVILLE UNIVERSITY COMPLETE 200
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
Minimum ANC level to prescribe Clozapine, general population: - (ANSWERS)1,500 μL
Severe Neutropenia - (ANSWERS)< 500μL
Moderate Neutropenia - (ANSWERS)500-999μL
Mild Neutropenia - (ANSWERS)1000-1499μL
BEN patients: Normal ANC range for Clozaril - (ANSWERS)≥1,000 μL
Clozaril BEN patient: severe neutropenia - (ANSWERS)<500 μL
BEN neutropenia - (ANSWERS)500-999 μL
Lower ANC threshold for starting clozapine: General population - (ANSWERS)≥1,500/μL
Lower ANC threshold for starting clozapine: Benign ethnic neutropenia (BEN) -
(ANSWERS)1,000/μL
Medical emergencies when prescribing anti-psychotics - (ANSWERS)- NMS
- Agranulocytosis
- Serotonin Syndrome
Clinical findings in agranulocytosis - (ANSWERS)
Clozaril: most likely side effect if pt develops fever within 6 weeks - (ANSWERS)Myocarditis
Clozaril: if pt develops fever within 6 weeks order a ______, _________ and _______. -
(ANSWERS)EKG, CRP, Troponin, as this is likely due to myocarditis
Common complaints in patients with neutropenia:
F,P, U, P - (ANSWERS)- Fever (low grade)
- painful swallowing (odynophagia)
- URI (sinusitis, otitis, cough)
- Perirectal pain/irritation
Symptoms of neuroleptic malignant syndrome (NMS): - (ANSWERS)- High fever
- Tachycardia/irregular pulse
- Increased respiratory rate
- Muscle Rigidity
- altered mental status
Off label TX for NMS - (ANSWERS)Amantadine (SYMMETREL)
,NURS 660 PSYCHOPHARM EXAM 4 LATEST MARYVILLE UNIVERSITY COMPLETE 200
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
Serotonin Syndrome onset: - (ANSWERS)-24 hours of combining antidepressants
Serotonin Syndrome Cardinal features - (ANSWERS)- Myoclonic jerks
- Hyperreflexia
- Mental status changes
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
- Confused/ restless/ hyperactive/ unresponsive
Management of Serotonin syndrome - (ANSWERS)- Discontinue meds, stablize vitals
Potentially
helpful meds with Serotonin syndrome: - (ANSWERS)Benzodiazepines for agitation
Cyproheptadine (anti-serotonergic antihistamine)
Methysergide (anti-serotonergic migraine medication)
5-HT "TWITCHY FROG" Serotonin Syndrome - (ANSWERS)-Agitated
-Sweating
-Fever
-Hyperreflexia
-Dilated pupils
Neuroleptic Malignant Syndrome - (ANSWERS)a potentially fatal hyperpyrexia with temp of over
104, looks like EPS except for temp
Neuroleptic Malignant Syndrome- "can't bender(er)" - (ANSWERS)Life-threatening muscle
rigidity, fever, and rhabdomyolysis.
Mental status changes
Mechanism of NMS.
-What's blocked? Where (2)? - (ANSWERS)Dopamine blockade in the hypothalamus (fever)
and nigrostriatal pathway (rigidity
Onset of NMS - (ANSWERS)30 days of starting or increasing antipsychotics or stoping a
domaminergic drug
NMS cardinal features - (ANSWERS)High fever 100% by definition
Rigidity 100% by definition
Mental status changes 99%
Elevated or labile BP most
NMS motor activity - (ANSWERS)Bradykinesia
, NURS 660 PSYCHOPHARM EXAM 4 LATEST MARYVILLE UNIVERSITY COMPLETE 200
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
Brain regions affected by schizophrenia (aggression and impulse control) (2) -
(ANSWERS)Orbitofrontal cortex and amygdala
Pathways affected by schizophrenia (4):
MMTN - (ANSWERS)-Mesolimbic
- Mesocortical
-Tuberoinfundibular
-Nigrostriatal
Mesolimbic DOPAMINE pathway:
Increased dopamine activity in the: ___, ____, and ____. - (ANSWERS)Nucleus accumbuns,
amygdala, hippocampus
Mesolimbic dopamine pathways are responsible for (adding something to the behavior): -
(ANSWERS)Positive symptoms - Delusions - bizarre behavior - hallucinations - disorganized
speech
Most antipsychotics treat ___________ symptoms. - (ANSWERS)positive
Mesocortical pathway: Responsible for a _______ in dopamine activity in ______ condition. -
(ANSWERS)decreased dopamine activity in schizophrenia
mesocortical pathway are responsible for ____ symptoms, such as (3) - (ANSWERS)Negative
Symptoms
1. Flat affect 2. Poverty of Speech 3. Adhedonia Apathy
Tuberoinfundibular pathways: Antipsychotics Decrease _______ causing side effects thru this
pathway - (ANSWERS)dopamine
In the Tuberinfundibular pathway, dopamine inhibits ________. - (ANSWERS)Prolactin
Tuberoinfundibular pathway: Less dopamine means more ______, more _______ causes less
________
< D = >P = <G - (ANSWERS)Less dopamine = more prolactin = less Gonadotropins (GnRH)
Tuberoinfundibular pathway: decreased _______ (a result of decreased dopamine and
increased prolactin causes these side effects: - (ANSWERS)GnRH =
- Decreased labido
- Sex dysfunction
- galactohrrea
- gynecomastia
Tuberoinfundibular pathway: GNRH - (ANSWERS)SEX and Boobs
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
Minimum ANC level to prescribe Clozapine, general population: - (ANSWERS)1,500 μL
Severe Neutropenia - (ANSWERS)< 500μL
Moderate Neutropenia - (ANSWERS)500-999μL
Mild Neutropenia - (ANSWERS)1000-1499μL
BEN patients: Normal ANC range for Clozaril - (ANSWERS)≥1,000 μL
Clozaril BEN patient: severe neutropenia - (ANSWERS)<500 μL
BEN neutropenia - (ANSWERS)500-999 μL
Lower ANC threshold for starting clozapine: General population - (ANSWERS)≥1,500/μL
Lower ANC threshold for starting clozapine: Benign ethnic neutropenia (BEN) -
(ANSWERS)1,000/μL
Medical emergencies when prescribing anti-psychotics - (ANSWERS)- NMS
- Agranulocytosis
- Serotonin Syndrome
Clinical findings in agranulocytosis - (ANSWERS)
Clozaril: most likely side effect if pt develops fever within 6 weeks - (ANSWERS)Myocarditis
Clozaril: if pt develops fever within 6 weeks order a ______, _________ and _______. -
(ANSWERS)EKG, CRP, Troponin, as this is likely due to myocarditis
Common complaints in patients with neutropenia:
F,P, U, P - (ANSWERS)- Fever (low grade)
- painful swallowing (odynophagia)
- URI (sinusitis, otitis, cough)
- Perirectal pain/irritation
Symptoms of neuroleptic malignant syndrome (NMS): - (ANSWERS)- High fever
- Tachycardia/irregular pulse
- Increased respiratory rate
- Muscle Rigidity
- altered mental status
Off label TX for NMS - (ANSWERS)Amantadine (SYMMETREL)
,NURS 660 PSYCHOPHARM EXAM 4 LATEST MARYVILLE UNIVERSITY COMPLETE 200
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
Serotonin Syndrome onset: - (ANSWERS)-24 hours of combining antidepressants
Serotonin Syndrome Cardinal features - (ANSWERS)- Myoclonic jerks
- Hyperreflexia
- Mental status changes
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
- Confused/ restless/ hyperactive/ unresponsive
Management of Serotonin syndrome - (ANSWERS)- Discontinue meds, stablize vitals
Potentially
helpful meds with Serotonin syndrome: - (ANSWERS)Benzodiazepines for agitation
Cyproheptadine (anti-serotonergic antihistamine)
Methysergide (anti-serotonergic migraine medication)
5-HT "TWITCHY FROG" Serotonin Syndrome - (ANSWERS)-Agitated
-Sweating
-Fever
-Hyperreflexia
-Dilated pupils
Neuroleptic Malignant Syndrome - (ANSWERS)a potentially fatal hyperpyrexia with temp of over
104, looks like EPS except for temp
Neuroleptic Malignant Syndrome- "can't bender(er)" - (ANSWERS)Life-threatening muscle
rigidity, fever, and rhabdomyolysis.
Mental status changes
Mechanism of NMS.
-What's blocked? Where (2)? - (ANSWERS)Dopamine blockade in the hypothalamus (fever)
and nigrostriatal pathway (rigidity
Onset of NMS - (ANSWERS)30 days of starting or increasing antipsychotics or stoping a
domaminergic drug
NMS cardinal features - (ANSWERS)High fever 100% by definition
Rigidity 100% by definition
Mental status changes 99%
Elevated or labile BP most
NMS motor activity - (ANSWERS)Bradykinesia
, NURS 660 PSYCHOPHARM EXAM 4 LATEST MARYVILLE UNIVERSITY COMPLETE 200
QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
Brain regions affected by schizophrenia (aggression and impulse control) (2) -
(ANSWERS)Orbitofrontal cortex and amygdala
Pathways affected by schizophrenia (4):
MMTN - (ANSWERS)-Mesolimbic
- Mesocortical
-Tuberoinfundibular
-Nigrostriatal
Mesolimbic DOPAMINE pathway:
Increased dopamine activity in the: ___, ____, and ____. - (ANSWERS)Nucleus accumbuns,
amygdala, hippocampus
Mesolimbic dopamine pathways are responsible for (adding something to the behavior): -
(ANSWERS)Positive symptoms - Delusions - bizarre behavior - hallucinations - disorganized
speech
Most antipsychotics treat ___________ symptoms. - (ANSWERS)positive
Mesocortical pathway: Responsible for a _______ in dopamine activity in ______ condition. -
(ANSWERS)decreased dopamine activity in schizophrenia
mesocortical pathway are responsible for ____ symptoms, such as (3) - (ANSWERS)Negative
Symptoms
1. Flat affect 2. Poverty of Speech 3. Adhedonia Apathy
Tuberoinfundibular pathways: Antipsychotics Decrease _______ causing side effects thru this
pathway - (ANSWERS)dopamine
In the Tuberinfundibular pathway, dopamine inhibits ________. - (ANSWERS)Prolactin
Tuberoinfundibular pathway: Less dopamine means more ______, more _______ causes less
________
< D = >P = <G - (ANSWERS)Less dopamine = more prolactin = less Gonadotropins (GnRH)
Tuberoinfundibular pathway: decreased _______ (a result of decreased dopamine and
increased prolactin causes these side effects: - (ANSWERS)GnRH =
- Decreased labido
- Sex dysfunction
- galactohrrea
- gynecomastia
Tuberoinfundibular pathway: GNRH - (ANSWERS)SEX and Boobs
