What direct-acting dopamine receptor agonist is recommended to be used in the treatments of
neuroleptic malignant syndrome (NMS) fo help lower the dopamine blockade?
A) benzotropine (Cogentin)
B) bromocriptine (Parlodel)
C) dantrolene (Dantrium)
D) trihexyphenidyl (Artane)
{{Correct Ans- A) Bromocriptine (Parlodel) is the recommended direct acting dopamine receptor agonist
to help decrease the dopamine blockade. Danrolene (Dantrium) is a muscle relaxant. Benzotropine
(Cogentin) and Trihexyphenidyl (Artane) are anticholinergic medications used for extrapyramidal side
effects (EPS).
Mr. Smith is a 56 year old white male who has been successfully treated on Selegiline for over 4 years.
Mr. Smith is going in for elective surgical procedure. Which medication is strictly contraindicated with
Selegiline?
A) Non-steroidal anti-inflammatory drugs (NSAIDS)
B) Codeine
C) Morphine
D) Meperidine
{{Correct Ans- D) Meperidine is strictly prohibited when a patient is treated on a monoamine oxidase
inhibitor (MAOI) due to the risk of hypertensive crisis and death.
A WBC of 4,000 in a patient taking Clozapine would prompt the PMHNP to take which of the following
actions?
A) Consult with hematologist to determine appropriate antibiotic regimen and monitor closely.
B) Institute twice-weekly complete blood count with differentials and monitor closely.
C) Discontinue clozapine, initiate alternative antipsychotic medication and monitor closely.
D) Institute daily complete blood count with differentials and monitor closely.
{{Correct Ans- B) Institute twice-weekly complete blood count with differentials and monitor closely.
The recommended cut-points for discontinuation of clozapine are WBC of 2,000 to 3,000 or
granulocytes of 1,000 to 1,500 for agranulocytosis and severely compromised immune system. At a WBC
of 4,000, the recommendation is to closely monitor CBC with differential twice a week while patient may
continue clozapine in the absence of any other signs or symptoms.
A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The
PMHNP should consider which antipsychotic medication that is the only antipsychotic to reduce the risk
of suicide in schizophrenia?
A) Abilify (aripriprazole)
B) Latuda (lurasidone)
C) Invega (iloperidone)
D) Clozaril (clozapine)
{{Correct Ans- D) Clozaril (clozapine) is the only known antipsychotic medication that had been shown to
reduce the risk of suicide in patients diagnosed with schizophrenia.
A patient being treated for major depressive disorder and on sertraline (Zoloft), 150 mg po daily for the
past 16 years, presents to the psychiatric mental health practitioner for an outpatient follow-up visit.
During the visit she states that she has not been feeling well, reporting the flu. She also states she has
not taken her medication in the last five days. Which of the following symptoms would she be describing
if you suspect selective serotonin reputable inhibitors (SSRIs) discontinuation syndrome?