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NURS6630 Antipsychotic Medications

NURS6630 Antipsychotic Medications

Psychosis and schizophrenia greatly impact the brain’s
normal processes, which interferes with the ability to think clearly. When
symptoms of these disorders are uncontrolled, clients may struggle to function
in daily life. However, clients often thrive when properly diagnosed and
treated under the close supervision of a psychiatric mental health
practitioner. For this Assignment, as you examine the client case study in this
week’s Learning Resources, consider how you might assess and treat clients
presenting with psychosis and schizophrenia.

Learning Objectives

Students will:

Assess client factors and history to develop personalized
plans of antipsychotic therapy for clients

Analyze factors that influence pharmacokinetic and
pharmacodynamic processes in clients requiring antipsychotic therapy

Evaluate efficacy of treatment plans

Analyze ethical and legal implications related to
prescribing antipsychotic therapy to clients across the lifespan

Learning Resources

Note: To access this week’s required library resources,
please click on the link to the Course Readings List, found in the Course
Materials section of your Syllabus.

Required Readings

Note: All Stahl
resources can be accessed through the Walden Library using this link. This link
will take you to a log-in page for the Walden Library. Once you log into the
library, the Stahl website will appear.

Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical
applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential
Psychopharmacology, 4th ed tab on the Stahl Online website and select the
appropriate chapter. Be sure to read all sections on the left navigation bar
for each chapter.

Chapter 4, “Psychosis and Schizophrenia”

Chapter 5, “Antipsychotic Agents”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New
York, NY: Cambridge University Press.

To access information on the following medications, click on
The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the
appropriate medication.

Review the following medications:

amisulpride

aripiprazole

asenapine

chlorpromazine

clozapine

flupenthixol

fluphenazine

haloperidol

iloperidone

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NURS6630 Antipsychotic Medications

NURS6630 Antipsychotic Medications

loxapine

lurasidone

olanzapine

paliperidone

perphenazine

quetiapine

risperidone

sulpiride

thioridazine

thiothixene

trifluoperazine

ziprasidone

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS
studies in schizophrenia: Results and implications for clinicians. CNS Drugs,
23(8), 649-659. doi:10.2165/00023210-200923080-00002

Note: Retrieved from Walden Library databases.

Document: Midterm
Exam Study Guide (PDF)

Kay, S. R., Fiszbein,
A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS)
for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

Note: Retrieved from Walden Library databases.

Clozapine REMS.
(2015). Clozapine REMS: The single shared system for clozapine. Retrieved from
https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Walden University.
(2016). ASC success strategies: Studying for and taking a test. Retrieved from
http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

Required Media

Laureate Education.
(2016j). Case study: Pakistani woman with delusional thought processes
[Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this
week’s Assignment.

Optional Resources

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D.,
Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic
medication use during treatment of schizophrenia patients: Longitudinal results
from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3),
124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E.,
Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with
antipsychotic drugs in patients with schizophrenia: Trends in multiple health
care systems. American Journal of Health-System Pharmacy, 71(9), 728-738.
doi:10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A.
(2015). Comparing antipsychotic treatments for schizophrenia: A health state
approach. The Psychiatric Quarterly, 86(1), 107-121.
doi:10.1007/s11126-014-9326-2

To prepare for this Assignment:

Review this week’s Learning Resources. Consider how to
assess and treat clients requiring anxiolytic therapy.

NURS-6630 Approaches to Treatment quiz QUESTION 1

  1. Richard is a 54-year-old male who suffers from schizophrenia. After exhausting various medication options, you have decided to start him on Clozapine. Which of the statements below is true regarding Clozapine?a.Regular blood monitoring must be performed to monitor for neutropenia.b.Clozapine can only be filled by a pharmacy that participates in the REMS program.c.Bradycardia is a common side effect of Clozapine.d.A & Be.All of the above

3.75 points  

QUESTION 2

  1. Which of the following statements are true?a.First-generation (typical) antipsychotics are associated with a higher incidence of EPS.b.Second-generation (atypical) antipsychotics are associated with a higher risk of metabolic side effects.c.There is evidence that atypical antipsychotics are significantly more effective than typical antipsychotics in the treatment of cognitive symptoms associated with schizophrenia.d.A & Be.A, B, and C

3.75 points  

QUESTION 3

  1. Cindy is a 55-year-old patient who presents with symptoms consistent with Generalized anxiety disorder. The patient has an unremarkable social history other than she consumes two or three glasses of wine per night. Which of the following would be an appropriate therapy to start this patient on?a.Xanax 0.25mg BID PRN Anxietyb.Escitalopram 10mg dailyc.Buspirone 10mg BIDd.Aripiprazole 10mg daily

3.75 points  

NURS-6630 Approaches to Treatment quiz QUESTION 4

  1. Mirza is a 75-year-old patient with a long history of schizophrenia. During the past 5 years, she has shown significant cognitive decline consistent with dementia. The patient has been well controlled on a regimen of risperidone 1mg BID. As the PMHNP, the most appropriate course of action for this patient is:a.Increase the risperidone to 1mg QAM, 2mg QPMb.Discontinue risperidone and prescribe a long-acting injectable such as Invega Sustenna.c.Discontinue risperidone and initiate therapy with clozapine.d.Augment the patient’s risperidone with brexpiprazole.

3.75 points  

QUESTION 5

  1. The patient in the previous question states, “I can’t even last 1 more day without feeling like my insides are going to explode with anxiety.” The most appropriate course of action would be:a.Inform the patient to try yoga or other natural remedies until the vortioxetine takes effect.b.Prescribe a short-term course of low dose benzodiazepine, such as alprazolam.c.Prescribe an SNRI, such as venlafaxine, in addition to the vortioxetine.d.Recommend in-patient mental health for the foreseeable future.

3.75 points  

QUESTION 6

  1. Thomas is a 28-year-old male who presents to the clinic with signs and symptoms consistent with MDD. He is concerned about starting antidepressant therapy, however, because one of his friends recently experienced erectile dysfunction when he was put on an antidepressant. Which of the following would be the most appropriate antidepressant to start Thomas on?a.Vilazodoneb.Sertralinec.Paroxetined.Citalopram

3.75 points  

QUESTION 7

  1. Stephanie is a 36-year-old female who presents to the clinic with a history of anxiety. Social history is unremarkable. For the last 4 years, she has been well controlled on paroxetine, however she feels “it just doesn’t work anymore.” You have decided to change her medication regimen to vortioxetine 5mg, titrating up to a max dose of 20mg per day based on tolerability. The patient asks, “When can I expect this to start kicking in?” The best response is:a.3 or 4 daysb.1 or 2 weeksc.3 or 4 weeksd.10 weeks

3.75 points  

QUESTION 8

  1. Jane is a 17-year-old patient who presents to the office with signs consistent with schizophrenia. She states multiple times that she is concerned about gaining weight, as she has the perfect prom dress picked out and she finally got a date. Which of the following is the least appropriate choice to prescribe Jane?a.Aripiprazoleb.Olanzapinec.Haloperidold.Brexpiprazole

3.75 points  

NURS-6630 Approaches to Treatment quiz QUESTION 9

  1. John is a 41-year old-patient who presents to the clinic with diarrhea, fatigue, and recently has been having tremors. He was diagnosed 19 years ago with bipolar disorder and is currently managed on Lithium 300mg BID. As the PMHNP, you decide to order a lithium level that comes back at 2.3mmol/l. What is the most appropriate course of action?a.Investigate other differential diagnoses for his symptoms.b.Tell John to skip his next four Lithium doses and resume therapy.c.Tell John he needs to go to the hospital and call an ambulance to bring him.d.Prescribe loperamide to treat the diarrhea and ropinirole to treat the tremors

3.75 points  

QUESTION 10

  1. Jordyn is a 27-year-old patient who presents to the clinic with GAD. She is 30 weeks pregnant and has been well controlled on a regimen of sertraline 50mg daily. Jordyn says that “about once or twice a week my husband really gets on my nerves and I can’t take it.” She is opposed to having the sertraline dose increased due to the risk of further weight gain. You have decided to prescribe the patient a short-term course of benzodiazepines for breakthrough anxiety. Which of the following is the LEAST appropriate benzodiazepines to prescribe to this patient?a.diazepamb.alprazolamc.clonazepamd.lorazepam

3.75 points  

QUESTION 11

  1. Rebecca is a 32-year-old female who was recently prescribed escitalopram for MDD. She presents to the clinic today complaining of diaphoresis, tachycardia, and confusion. The differential diagnosis for this patient, based on the symptoms presenting, is:a.Panic disorderb.Gastroenteritisc.Abnormal gaitd.Serotonin syndrome

3.75 points  

QUESTION 12

  1. Mark is a 46-year-old male with treatment-resistant depression. He has tried various medications, including SSRIs, SNRI, and TCAs. You have decided to initiate therapy with phenelzine. Which of the following must the PMHNP take into consideration when initiating therapy with phenelzine?a.There is a minimum 7-day washout period when switching from another antidepressant to phenelzine.b.Patient must be counseled on dietary restrictions.c.MAOIs may be given as an adjunctive therapy with SSRIs.d.A & Be.All of the above

3.75 points  

QUESTION 13

  1. Melvin is an 89-year-old male who presents to the clinic with signs/symptoms consistent with MDD. Which of the following would be the LEAST appropriate medication to prescribe to this elderly patient?a.nortriptylineb.amitriptylinec.desipramined.trazodone

3.75 points  

QUESTION 14

  1. Earle is an 86-year-old patient who presents to the hospital with a Community Acquired Pneumonia. During stay, you notice that the patient often seems agitated. He suffers from cognitive decline and currently takes no mental health medications. Treatment for the CAP include ceftriaxone and azithromycin. The LEAST appropriate medication to treat Earle’s anxiety is:a.sertralineb.duloxetinec.citalopramd.venlafaxine

3.75 points  

NURS-6630 Approaches to Treatment quiz QUESTION 15

  1. Martin is a 92-year-old male who presents to the clinic with signs/symptoms consistent with MDD. The patient suffers from glaucoma and just recently underwent surgery for a cataract. Which of the following is the LEAST appropriate course of therapy when treating the MDD?a.sertralineb.amitriptylinec.duloxetined.vilazodone

3.75 points  

QUESTION 16

  1. Sam is a 48-year-old male who presents to the clinic with signs and symptoms consistent with GAD & MDD. Which of the following medications would be the LEAST appropriate choice when initiating pharmacotherapy?a.duloxetineb.sertralinec.mirtazapined.buproprion

3.75 points  

QUESTION 17

  1. Steve is a 35-year-old male who presents to the primary care office complaining of anxiety secondary to quitting smoking cold turkey 2 weeks ago. The patient has a 14-year history of smoking two packs per day. The patient has an unremarkable social history other than a recent divorce from his wife, Brittany. Which of the following would be the LEAST effective medication to treat Steve’s anxiety?a.Buproprionb.Sertralinec.Vareniclined.Alprazolam

3.75 points  

QUESTION 18

  1. Amber is a 26-year-old female who presents to the clinic 6 weeks postpartum. The patient states that she has been “feeling down” since the birth of her son. She is currently breastfeeding her infant. You diagnose the patient with Postpartum depression. Which of the following is the LEAST appropriate option in treating her PPD?a.paroxetineb.escitalopramc.citalopramd.sertraline

3.75 points  

QUESTION 19

  1. Which of the following medications, when given intramuscularly, is most likely to cause severe postural hypotension?a.haloperidolb.lorazepamc.benztropined.chlorpromazine

3.75 points  

NURS-6630 Approaches to Treatment quiz QUESTION 20

  1. Jason is a 6-year-old child whose mother presents to the clinic with him. The mother says that “he’s not himself lately.” After a thorough workup, you diagnose the patient as having GAD. Which of the following medications would be the LEAST appropriate to prescribe to this child?a.Sertralineb.Paroxetinec.Venlafaxined.Buspirone
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