NURS 660 PSYCHOPHARM EXAM 1 LATEST MARYVILLE UNIVERSITY | QUESTIONS AND ANSWERS | VERIFIED ANSWERS (100% CORRECT) | LATEST EXAM UPDATE

NURS 660 PSYCHOPHARM EXAM 1 LATEST MARYVILLE
UNIVERSITY | QUESTIONS AND ANSWERS | VERIFIED ANSWERS
(100% CORRECT) | LATEST EXAM UPDATE




Minimum ANC level to prescribe Clozapine, general population: - CORRECT
ANSWER- 1,500 μL


Severe Neutropenia - CORRECT ANSWER- < 500μL


Moderate Neutropenia - CORRECT ANSWER- 500-999μL


Mild Neutropenia - CORRECT ANSWER- 1000-1499μL


BEN patients: Normal ANC range for Clozaril - CORRECT ANSWER-
≥1,000 μL


Clozaril BEN patient: severe neutropenia - CORRECT ANSWER- <500 μL


BEN neutropenia - CORRECT ANSWER- 500-999 μL


Lower ANC threshold for starting clozapine: General population - CORRECT
ANSWER- ≥1,500/μL


Lower ANC threshold for starting clozapine: Benign ethnic neutropenia (BEN) -
CORRECT ANSWER- 1,000/μL

,Medical emergencies when prescribing anti-psychotics - CORRECT
ANSWER- - NMS
- Agranulocytosis
- Serotonin Syndrome


Clinical findings in agranulocytosis - CORRECT ANSWER-


Clozaril: most likely side effect if pt develops fever within 6 weeks -
CORRECT ANSWER- Myocarditis


Clozaril: if pt develops fever within 6 weeks order a ______, _________ and
_______. - CORRECT ANSWER- EKG, CRP, Troponin, as this is likely due
to myocarditis


Common complaints in patients with neutropenia:
F,P, U, P - CORRECT ANSWER- - Fever (low grade)
- painful swallowing (odynophagia)
- URI (sinusitis, otitis, cough)
- Perirectal pain/irritation


Symptoms of neuroleptic malignant syndrome (NMS): - CORRECT
ANSWER- - High fever
- Tachycardia/irregular pulse
- Increased respiratory rate
- Muscle Rigidity
- altered mental status


Off label TX for NMS - CORRECT ANSWER- Amantadine (SYMMETREL)

,Serotonin Syndrome onset: - CORRECT ANSWER- -24 hours of combining
antidepressants


Serotonin Syndrome Cardinal features - CORRECT ANSWER- - Myoclonic
jerks
- Hyperreflexia
- Mental status changes
- Shivering
- Fever
- Tachycardia, HTN, hypotension (AUTONOMIC instability)
- Confused/ restless/ hyperactive/ unresponsive


Management of Serotonin syndrome - CORRECT ANSWER- - Discontinue
meds, stablize vitals


Potentially
helpful meds with Serotonin syndrome: - CORRECT ANSWER-
Benzodiazepines for agitation
Cyproheptadine (anti-serotonergic antihistamine)
Methysergide (anti-serotonergic migraine medication)


5-HT "TWITCHY FROG" Serotonin Syndrome - CORRECT ANSWER- -
Agitated
-Sweating
-Fever
-Hyperreflexia
-Dilated pupils

, Neuroleptic Malignant Syndrome - CORRECT ANSWER- a potentially fatal
hyperpyrexia with temp of over 104, looks like EPS except for temp


Neuroleptic Malignant Syndrome- "can't bender(er)" - CORRECT ANSWER-
Life-threatening muscle rigidity, fever, and rhabdomyolysis.
Mental status changes


Mechanism of NMS.
-What's blocked? Where (2)? - CORRECT ANSWER- Dopamine blockade in
the hypothalamus (fever)
and nigrostriatal pathway (rigidity


Onset of NMS - CORRECT ANSWER- 30 days of starting or increasing
antipsychotics or stoping a domaminergic drug


NMS cardinal features - CORRECT ANSWER- High fever 100% by
definition
Rigidity 100% by definition
Mental status changes 99%
Elevated or labile BP most


NMS motor activity - CORRECT ANSWER- Bradykinesia


Brain regions affected by schizophrenia (aggression and impulse control) (2) -
CORRECT ANSWER- Orbitofrontal cortex and amygdala


Pathways affected by schizophrenia (4):
MMTN - CORRECT ANSWER- -Mesolimbic
- Mesocortical