Psy 201 Pharm Ch 9

Front 1

Antipsychotic drugs are used mainly for the treatment of ___________

Back 1

psychosis

Front 2

__________ are sensory perceptions for people or objects that are not present in the external environment.

Back 2

Hallucinations

Front 3

Deluded people often believe that other people control their thoughts feelings and behaviors or seek to harm them; these beliefs are called______________.

Back 3

Paranoia

Front 4

Antipsychotic drugs called_______ are derivered from several chemical groups.

Back 4

Neurolepitcs

Front 5

The first drug to effectively treat psychotic disorders.

Back 5

chlorpromazine

Front 6

__________ are false beliefs that persist in the absence of reason or evidence.

Back 6

Delusions

Front 7

___________ are sensory perceptions of people or objects that are not present in external environment.

Back 7

Hallucinations

Front 8

True or false?

The etiology of schizophrenia is unknown.

Back 8

True

Front 9

True or false?

The neurodevelopment model proposes that schizophrenia results when abnormal brain synapses are formed in response to an intrauterine insult during the second trimester of pregnancy when neuronal migration is normally taking place.

Back 9

True

Front 10

True or false

Genetics is strongly suspected to play a role in the development of schizophrenia.

Back 10

True

Front 11

Possible genes linked to schizophrenia include mutations in ___________ on chromosome __________ which is thought to play a role in catatonic schizophrenia.

Back 11

WKL1; 22

Front 12

__________ is a butyrophenone used in psychiatric disorders. It may be used as the initial drug for treating psychotic disorders or as a substitute in patient who are hyper sensitive or refractory to the phenothiazines.

Back 12

Haloperidol (Haldol)

Front 13

This drug is used only for anti-psychotic effects. and is more likely to cause orthostatic hypotension.

Back 13

Thiothixene (Navane)

Front 14

Name the first generation nonphenothiazinesTypical antipsychotics.

Back 14

Haloperidol, Thiothexene

Front 15

____________ may cause life threatening angranjulocytosis and some of these drugs have been associated with weight gain, hyperglycemia, diabetes, and neuroleptic malignant syndrome.

Back 15

Clozapine

Front 16

True or false?

All second generation or atypical anti-psychotics share a BBW for elderly patients with dementia related psychosis. For these patients the second generation anti-psychotics are associated with increased mortality risk primarily due to cardiovascular disorders or infections.

Back 16

True

Front 17

____________is the prototype of the atypical agents and is chemically different form the older anti psychotic drugs. This drug is restricted to patients with treatment resistant schizophrenia and those patients who have exhibited recurrent suicidal behavior.

Back 17

Clozapine (Clozaril)

Front 18

True or false?

The reason for the second line status of clozapine is its associated with agranulocytosis a life threatening decrease in white blood cells which usually occurs during the first 3 months of therapy.

Back 18

True

Front 19

____________ is indicated for treatment of schizophrenia and the acute phase of bipolar disorder. Although similar to clozapine it causes less sedation effects but has been associated with weight gain , hyperglycemia and aggravation of diabetes mellitus

Back 19

Olanzapine (Zyprexa)

Front 20

____________ and __________ blocks both dopamine and serotonin receptors and relieves both postive and negative symptoms of psychosis and is also indicative for the acute manic phase of bipolar disorder.

Back 20

Quetiapine (Seroquel)
Risperidone (Risperdal)

Front 21

____________ is an active metabolite of risperidone, blocks dopamine and serotonin receptors. Adverse effects are akathisia, extrapyramidal effects, QT prolongation, orthostatic hypotension, orthostatic hypotension, syncope hyperprolactinemia, and hyperglycemia

Back 21

Paliperidone (Invega)

Front 22

_____________ is approved for the treatment of schizophrenia and acute mania associated with bipolar disorder. However, this drug my also cause neuroleptic malignant syndrome tardive dyskinesia, weight gain, hyperglycemia and diabetes mellitus.

Back 22

Aripiprazole (Abilify)

Front 23

Antipsychotic drugs are used mainly for the treatment of ____________

Back 23

Psychosis

Front 24

_________ are sensory perceptions of people or objects that are not present in the external environment.

Back 24

Hallucinations

Front 25

_________ are false beliefs that persist in the absence of reason or evidence.

Back 25

Delusions

Front 26

Deluded people often believe that other people control their thoughts feelings and behaviors or seek to harm them; these beliefs are called?

Back 26

paranoia

Front 27

Antipsychotic drugs called _________ are derived from several chemical groups.

Back 27

neuroleptics

Front 28

Acute dystonia, parkinsonism, and akathisia are what kind of side effects?

Back 28

Extra-pyramidal side effects

Front 29

The first drug to effectively treat psychotic disorders

Back 29

Chlorpromazine

Front 30

Blurred vision, constipation and dry mouth are side effects of?

Back 30

Anticholinergic drugs

Front 31

Orthostatic hypotension and CNS depression. are side effects of?

Back 31

Antiadrenergic effects

Front 32

A rare but potentially fatal adverse side effect characterized by rigidity.

Back 32

Neuroleptic malignant syndrome.

Front 33

Discuss the signs and symptoms that a patient may experience with the diagnosis of psychosis and their impact on the patients ability to perform activities of daily living and interact within home and work environments.

Back 33

Pyschosis is a severe metal disorder characterized by disordered thought processes such as disorganized and often bizarre thinking, blunted or inappropriate emotional responses; bizarre behavior ranging from hypo-activity to hyperactivity with agitation, aggressiveness, hostility, and combativeness; social withdrawal, in which a person pays less than normal attention to the environment and other people; deterioration from previous levels of occupational and social functioning (poor self care and interpersonal skills) hallucinations and paranoid delusions.

Front 34

Identify and discuss the factors that may precipitate an acute psychotic episode.

Back 34

Acute psychotic episodes also called confusion or delirium have a sudden onset over hours to days and may be precipitated by physical disorders ex. brain damange, or head injury, metabolic disorders, infections, drug intoxication, or drug withdrawal after chronic use.

Front 35

Discuss the neurodevelopmental model in relation to the development of schizophrenia.

Back 35

The neurodevelopmental model proposes that schizophrenia results when abnormal brain synapses are formed in response to an intrauterine insult during the second trimester of pregnancy when neuronal migration is normally taking place. Intrauterine events such as a upper respiratory infection, obstetric complications and neonatal hypoxia have been associated with schizophrenia. The emergence of psychosis in response to the formation of these abnormal circuits in adolescence or early adulthood corresponds to the time period of neuronal maturation.

Front 36

Discuss the role of genetics and the development of schizophrenia.

Back 36

Genetics is strongly suspected to play a role in the development of schizophrenia. Family studies identify increased risk if a first degree relative as the illness (10%) if a second degree relative has the illness a (3%), if both parents have the illness (40%) and is a monozogotic twin as the illness (48%). Adoption studies of twins suggest that heredity rather than environment is a key factor in the development of schizophrenia. Many genetic studies are underway to identify the gene or genes responsible for schizophrenia. Possible genes linked to schizophrenia include WKL1 on chromosome 22 which is thought to play a role in catatonic schizophrenia. DISC1 mutations of which cause delays in migration of the brain neurons in mouse models; and gene responsible for the glutamine in synapses.

Front 37

Discuss the impact of negative symptoms of schizophrenia have on a clients ability to cope within home and work environments.

Back 37

Negative symptoms of schizophrenia include lack of pleasure (Anhedonia) lack of motivation, blunted affect, poor grooming, and hygiene, poor social skills, poverty of speech, and social withdrawal.

Front 38

Mr. Smith asks you whether he will have the same extra-pyramidal effects with clozapine that he had with his other anti-psychotic medication. How would you reply?

Back 38

Advantages of clozapine include improvement of negative symptoms without the extra-pyramidal side effects associated with older anti-psychotic drugs. However, despite these advantages, it is a second line drug recommended only for clients who have not responded to treatment with at least two other anti-psychotic drugs or who exhibit recurrent suicidal behavior.

Front 39

Explain the rationale for weekly laboratory tests for a client taking clozapine.

Back 39

Clozapine is associated with agranulocytosis a life threatening decrease in white blood cells WBC's that usually occurs during the first 3 months of therapy. A black box warning alerts health care practitioners to this dangerous side effect. Weekly WBC counts are required during the first 6 months of therapy; if acceptable WBC counts are maintained then WBC counts can be monitored every 2 weeks thereafter.

Front 40

Mr. Smith returns to the office weekly for his blood work. During an interview 1 month later he states that he feels able to cope within his environment but gets dizzy often. Discuss the elements of your focused assessment and explain your rationale for this assessment.

Back 40

Black Box warnings for clozapine (especially in the first months of treatment) include increased risk for fatal myocarditis, orthostatic hypotension with our without syncope, and rarely cardiopulmonary arrest. Clozapine is also more likely to cause constipation, drowsiness, and weight gain than other atypical drugs. Clozapine is metabolized primarily by CYP1A2 enzymes and to a lesser degree by CYP2D6 and CYP3A4 enzymes.

Front 41

Ms. Cases mother states that her daughter is often noncompliant with her medication. After you report this to the physician, how may the medication administration of haloperidol be changed to improve compliance?

Back 41

For clients who are unable or unwilling to take the oral drug as prescribed a slowly absorbed long acting formulation (Haloperidol decanoate) may be given IM once monthly.

Front 42

You discuss the signs and symptoms of the extra-pyramidal effects of haloperidol. Explain the signs and symptoms in layman's terms.

Back 42

The signs and symptoms of extra-pyramidal side effects include twisting and rhythmic movements (accute dystonia) tremors (parkinsonism), and the inability to sit or remain still (akathisia).

Front 43

A client who is taking antipsychotic medication present to the ER with symptoms of dyspnea, delirium, tachycardia, and respiratory distress. The physician initial diagnosis is neuroleptic malignant syndrome. You expect physicians orders for which of the following treatment modalities? (select all that apply)

a. Hydration, cooling measures, and benzoiazepines to reduce agitation.

b. Dantrolene to directly relax muscles.

c. CNS depressants

d. Bronchodilators

Back 43

a, b

Rationale: Neroleptic malignant syndrome is treated with hydration cooling measures and antipyretics to reduce fever, benzodiazepines to reduce agitation, dantrolene to directly relax muscles and bromocriptine or amantadine (dopamine agonists) to reduce CNS depression.

Front 44

Tardive dyskinesia a late extrapyramidal effect is generally considered to be irreversible. What is one method used to treat tardive dyskinesia?

a. Increasing the dosage of the medication.

b. Discontinuing the medication abruptly.

c. Referring the client to a psychiatrist for evaluation.

d. Reducing the dosage.

Back 44

d.

Rationale: Tardive dyskinesia a late extra-pyramidal effect, may occur with all phenothiazine and typical nonphenothiazine drugs and is generally considered to be irreversible. It may be treated by reducing the dosage or switching to a second generation anti-psychotic. Prevention through early detection is key.

Front 45

Mrs. Swett consults her physician because she cant seem to sit still. She is currently taking antipsychotic medications. Her symptoms may be treated with which of the following agents?

a. Cardiotonics

b. Antihistamines

c. Beta blockers

d. Antiepilepics

Back 45

c.

Rationale: Early extra-pyramidal effects are treated by reducing dosage, changing to a second generation anti-psychotic, or using anticholinergic medication. Akathisia may also be treated with benzodiazepines and beta blockers to reduce the urge to move.

Front 46

Mrs. Sage makes an appointment with her physician 2 weeks after beginning her
prescription anti-psychotic therapy. She states that she is still unable to cope and concentrate at work. Which of the following statements would be appropriate to include in your teaching?

a. Anti-psychotics may take several weeks to achieve maximum therapeutic effect.

b. The medication should be effective by this time; I will consult the physician.

d. Therapeutic effects of anti-psychotics should be evaluated every 2 weeks by your physician.

Back 46

a.

Rationale: Anti-psychotics may take several weeks to achieve maximum therapeutic effect.

Front 47

The physician prescribed anti-psychotic medication for Ms. Janz 2 months ago. She is non-compliant with her medication regimen and is symptomatic. You are responsible for developing a plan of care to facilitate medication compliance. Which of the following would your plan include?

a. A written contract to ensure compliance

b. Coordination of the efforts of several health and social service agencies or providers.

c. Immediate hospitalization for medication noncompliance lasting 1 week.

d. Administering of daily oral medications by the community health nurse.

Back 47

b.

Rationale: The home care nurse must assist and support caregiver efforts to maintain medications and manage adverse drug effects other aspects of daily care and follow up psychiatric care. In addition the home care nurse may need to coordinate the efforts of several health and social service agencies or providers.

Front 48

Mr. Bagman is admitted to your ER via ambulance. He is attempting to pull out is IV line and is exhibiting symptoms of agitation and thrashing about. They physician orders a benzodiazepine type sedative. What information is needed prior to administration of the drug?

a. Whether the client has a history of agitation.

b. Whether the client is currently taking antibiotics

c. Whether the client is experiencing drug intoxication or withdrawal.

d. Whether the client is currently taking a diuretic.

Back 48

c.

Rationale: Some clients become acutely agitated or delirious and need sedation to prevent their injuring themselves by thrashing about, removing tubes and IV catheters and so forth. Some physicians prefer a benzodiazepine type sedative where as other may use Haloperidol (AKA vitamin H). Before giving either drug, causes of delirium (ex drug intoxication or withdrawal) should be identified and eliminated if possible.

Front 49

Mr. Dowe is admitted to your mental health unit with symptoms of acute psychosis. The physician orders haloperidol IV by bolus injection. The dose depends on the severity of the agitation. What initial dose would you expect the physician to order?

a. 7 to 10mg

b. 3 to 5mg

c. 2 to 4 mg

d. 0.5 to 10mg

Back 49

d.

Rationale: If haloperidol is used it is usually given IV by bolus injection. The initial dose is 0.5mg to 10mg, depending on the severity of the agitation. It should be injected at a rate no faster then 5mg/min. The dose may be repeated every 30 to 60mins up to a total amount of 30mg if necessary.

Front 50

Mr. Baths physician order anti-psychotic medication for him. He experiences little or no side effects from the medications and is able to function successfully in both is home and work environments. Six weeks later he is diagnosed with Hep B. He begins to experience adverse reactions to his medications. A possible reason for the adverse reactions might be that in the presence of liver disease which of the following may happen?

a. Metabolism may be accelerated and drug elimination half lives shortened, causing an increased risk of adverse effects.

b. Metabolism may be slowed and the drug elimination half lives shorted with resultant accumulation and increased risk of adverse effects.

c. Metabolism may be slowed and drug elimination half lives prolonged with resultant accumulation and increased risk of adverse effects.

d. Metabolism may be accelerated and drug elimination half lives prolonged with resultant accumulation and increased risk of adverse effects.

Back 50

c.

Rationale: Anti-psychotic drugs undergo extensive hepatic metabolism and then elimination in urine. In the presence of liver disease metabolism and then elimination in urine. In the presence of liver disease metabolism may be slowed and drug elimination half lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefor these drugs should be used cautiously in clients with hepatic impairment.

Front 51

Mr. Anspar is diagnosed with renal insufficiency. You develop a teaching plan based on her diagnosis and anti pyschotic drug usage. She asks you why it is so important to have renal function tests routinely. You reply that if renal function test results become abnormal, which of the following my be a consequence?

a. The drug may need to be lowered in dosage or discontinued.

b. The drug will be discontinued immediately.

c. The drug will be continued with caution.

d. The drug dosages will be increased to increase adsorption.

Back 51

a.

Rationale: Because most antipyschotic drugs are extensively metabolized in the liver and metabolites are excreted through the kidneys the drugs should be used cautiously

Front 52

Mrs. Rhodes presents to the physicians office with yellow sclera. He is concerned that he has hepatitis. Mr. Rhodes began a new medication regiment about 1 month ago that includes phenothiazine administration is consider4ed to be which of the following.

a. An adverse reaction

b. A hypersensitivity reaction

c. a rare occurrence

d. A life threatening occurrence.

Back 52

b.

Rationale: Jaundice has been associated with phenothiazines usually after 2 to 4 weeks of therapy. It is considered a hypersensitivity reaction, and clients should not be re exposed to a phenothiazine.

Front 53

Mr. Adams an African American man routinely takes haloperidol to manage his psychosis. Recently, he presents to the physicians office with signs of tardive dyskinesia, and his physician modified the drug regimen over time. Mr. Adams will now take the drug olazapine and discontinue the haloperidol. To reduce his fears you could tell this patient which of the following?

a. The signs of tardive syskinesia will diminish over time.

b. African Americans always experience tardive dykinesia with anti-psychotics.

c. When compared with haloperidol, olazapine has been associated with fewer extra-pyramidal reactions in African Americans.

d. The olazapine does not produce side effects in African American males.

Back 53

c.

Rationale: African Americans tend to respond more rapidly; experience a higher incidence of adverse effects, including tardive dyskinesia; and metabolize anti-psychotic drugs more slowly than whites. When compared with haloperidol, olanzapine has been associated with fewer extra pyramidal reactions in African Americans.

Front 54

Mrs. Keys is diagnoses with Alzheimer type dementia. She resides in a long term care facility. Mrs. Keys daughter asks the physician to prescribe an anti-psychotic to control her mothers outbursts of anger and depression. The physician orders a psychiatric consultation for the client. Mrs. Keys daughter asks Why doesn't the doctor just order the anti-psychotic? You explain that decision by saying which of the following?

a. Clients with dementia routinely become agitated due to their disease.

b. Clients with dementia respond poorly to anti-psychotic medications.

c. Clients with dementia respond well to anti-psychotic medications.

d. Use of anti-psychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems.

Back 54

d.

Rationale: Clients with dementia may become agitated because of environmental or medication problems. Alleviating such causes when is safer and more effective than administering anti-psychotic drugs. Inappropriate use of anti-psychotic exposes clients to adverse drug effects and does not resolve the underlying problems.

Front 55

Mrs. Keys physician order a low dose anti-psychotic to manage her acute agitation Her daughter states that her mother is improved bu her cognitive functions are the same, if not worse, than last moth. Which of the following is the explanation for this development?

a. Anti-psychotics cause a gradual return of cognitive ability.

b. Anti-psychotics reduce memory loss.

c. Anti-psychotics increase the risk of long term memory loss.

d. Anti-psychotics do not improve memory loss and may further impair cognitive functioning.

Back 55

d.

Rationale: If anti-psychotic drugs are used to control acute agitation in older adults they should be used in the lowest effective dose for the shortest effective duration. If the drugs are used to treat dementia, they may relieve some symptoms but they do not improve memory loss and may further impair cognitive functioning.

Front 56

Jane Nils is 9yrs old and receives anti-psychotics to manage her disease. Jane's mother asks why her daughter receives such a high dose of the medication compared with an adult. Which of the following explanations is correct?

a. Children usually have a slower metabolic rate than adults and may therefore require relatively high doses for their size and weight.

b. Children usually have a faster metabolic rate relatively high doses for their height and weight.

c. Children usually have a faster metabolic rate than adults and may therefore require relatively high doses for their size and weight.

Back 56

c.

Rationale: Children usually have a faster metabolic rate than adults and may therefore require relatively high doses of anti-psychotic for their size and weight.

Front 57

Mr. Ghee is scheduled for a major abdominal surgery in the morning. He is concerned that eh is receiving a lower than normal dose of his anti-psychotic. You explain that anti-psychotics may do which of the following?

a. Potentiate the effects of general anesthetics

b. Diminish the effects of general anesthetics.

c. Cause increased tardive dyskinesia when used with anesthetics.

d. Cause a hypertensive crisis when combined with anesthetics.

Back 57

a.

Rationale: A major concern about giving traditional anti-psychotic drugs preoperatively is their protenital for adverse interactions with other drugs. For example, anti-psychotic drugs potentiate the effects of general anesthetics and other CNS depressants that are often used before during and after surgery. As a result risks of hypotension and excessive sedation are increased unless doses of other drugs are reduced.

Front 58

Acute dystonia is manifested by which of the following? (select all that apply)

a. Severe spams of muscles of the face neck tongue or back.

b. Oculogyric crisis

c. Opisthotonus

d. Anuria

e. Hypoxia

Back 58

a, b, c.

Rationale: Acute dystonia (manifested by severe spasms of muscles of the face neck tongue or back) typically occurs early in treatment and constitutes an emergency. Severe manifestations of acute dystonia include oculogyric crisis (severe involuntary upward rotation of the eyes) and opisthotonus (severe spasm of back muscles causing head and heals to bend backward with the body bowed forward.

Front 59

Acute dystonia is treated with intramuscular or intravenous administration of which of the following agents?

a. Cardiotonics

b. Diphenhydramine

c. Cholinergic medications

d. Narcan

Back 59

b.

Rationale: Acute dystonia is treated with intramuscular or intravenous administration of anticholinergic medications such as benztropine or diphenhydramine.

Front 60

_______ is approved for the treatment of schizophrenia and acute mania assoicated with bipolar disorder. It is the first new category of drugs called partial dopamine agonists.

Back 60

Aripiprazole (Abilify)

Front 61

A ______________ is a drug that has the ability to block a receptor if ti is overstimulated and to stimulate a receptor if it is under-stimulated.

Back 61

Partial agonist