Chapter 59: Schizophrenia/Psychosis Flashcards
A pharmacist will counsel a patient beginning therapy with Zyprexa. Which of the following are correct counseling statements? (Select all that apply)
A. This medication is taken in the morning; do not take at night or you will have difficulty sleeping.
B This medication can cause seizures.
C The other name for this medication is olanzapine.
D This medication can make the patient feel “wired” and worsen psychosis.
E This medication can cause the patient to gain weight and can increase blood sugar and cholesterol. It is important to try and get regular exercise, such as walking, and to eat healthy foods.
C and E are correct
Olanzapine is sedating and is taken QHS. It causes weight gain, elevated blood glucose and lipids and (like the others that cause similar problems) the patient will need all of these monitored, along with the blood pressure. The SGA notable for seizures is clozapine.
Rosie McDonald is a 52 year-old female patient with schizophrenia, depression, elevated cholesterol, pre-diabetes and hypothyroidism. The physician is considering a trial with olanzapine. Choose the correct statements: (Select ALL that apply.)
Answer
A Olanzapine can increase her blood pressure and blood glucose.
B Olanzapine requires white blood cell monitoring and cannot be initiated with neutropenia.
C Olanzapine is sedating and is generally taken at bedtime.
D Olanzapine can cause hypothyroidism or hyperthyroidism.
E Olanzapine can increase her weight and cholesterol.
A, C, and E are correct
Some of the second-generation antipsychotics, including (most notably) olanzapine, quetiapine and clozapine, can increase weight, elevate lipids, increase blood pressure and cause or worsen hyperglycemia.
Ruby Reynolds has been diagnosed with schizophrenia and has been prescribed risperidone. Her heart rate becomes tachycardic and the physician wishes to use an agent with the lowest cardiovascular risk. Choose the agent on the patient’s formulary that is not considered to be among the higher risk options:
Answer
A Thioridazine B Paliperidone C Ziprasidone D Haloperidol E Lurasidone
E is correct, Lurasidone
Thioridazine (Mellaril) and ziprasidone (Geodon) should be two of the antipsychotics that stick in your mind as “high QT risk.” Most have some QT risk.
Lurasidone is contraindicated with strong CYP3A4 inhibitors/inducers, but low CV risk (QT prolongation). It is also claimed to be nearly weight, lipid, and BG neutral.
A pharmacist has instructed a patient’s caregiver to draw up the medication in the oral syringe she has supplied and administered directly down the patient’s feeding tube. Which medication is the pharmacist dispensing?
Answer
A Risperidone B Ziprasidone C Quetiapine D Olanzapine E Chlorpromazine
A is correct, Risperidone
Alternatively, the solution can be mixed with water, coffee, orange juice or low-fat milk. It cannot be mixed with cola or tea.
Phenylalanine must be avoided in patients with PKU. Which of the following formulations may contain phenylalanine? (Select ALL that apply.)
Answer
A Granules B Patches C Injectables D Chewable formulations E ODTs or sublingual formulations
A, D, and E are correct
These do not all contain this sweetener, but it is often used in medications the patient can taste. The pharmacist should examine the specific formulation when dispensing to patients with PKU.
Charlene Fitzpatrick is a 74 year-old female who has a unilateral tremor in her right hand. She may have Parkinson’s disease. The physician needs to choose a second generation antipsychotic for Ms. Fitzpatrick. Among the following second generation agents, which agents have a high risk for movement disorders and should not be chosen for this patient? (Select ALL that apply.)
Answer
A Paliperidone B Risperidone C Clozapine D Quetiapine E Olanzapine
A and B are correct, Paliperidone and Risperidone
Also, lurasidone has a high risk of EPS.
Clozapine and quetiapine have low risk of EPS. Olanzapine can cause EPS, but is low risk
