Which side effects are more common in second generation antipsychotics (SGA) medication than in first generation antipsychotic (FGA) medications. (Select all that apply)

Metabolism by CYP34A

Agranulocytosis

Prolactin elevation

Extrapyramidal symptoms

Anticholinergic effects

Answer and Explanation

Correct Answer : B,E

Second-generation antipsychotics (SGAs), also called atypical antipsychotics, differ from first-generation antipsychotics (FGAs) in receptor binding profiles, particularly with greater serotonin (5-HT2A) antagonism and less potent dopamine blockade. This results in fewer extrapyramidal symptoms but a different set of adverse effects. SGAs are more associated with metabolic, hematologic, and anticholinergic effects depending on the agent. Understanding these differences helps guide safe medication selection and monitoring.

Rationale:
A. Metabolism by CYP3A4 is a pharmacokinetic characteristic rather than a side effect. Both FGAs and SGAs can be metabolized through cytochrome P450 enzymes, including CYP3A4. This however does not represent a clinical adverse effect.

B. Agranulocytosis is more commonly associated with SGAs, particularly Clozapine. This serious adverse effect involves suppression of bone marrow leading to dangerously low white blood cell counts. Because of this risk, strict and routine blood monitoring is required, making it a distinguishing feature of certain SGAs compared to FGAs.

C. Prolactin elevation is more commonly associated with FGAs due to strong dopamine blockade in the tuberoinfundibular pathway. While some SGAs (like risperidone) can elevate prolactin, this effect is generally less consistent and less pronounced across the class. Therefore, it is not considered more common in SGAs overall.

D. Extrapyramidal symptoms (EPS) are significantly more common in FGAs due to potent D2 receptor antagonism in the nigrostriatal pathway. SGAs have a lower risk because of their serotonin-dopamine balance.

E. Anticholinergic effects such as dry mouth, constipation, urinary retention, and blurred vision are more prominent with certain SGAs, especially those with strong muscarinic receptor blockade like olanzapine and clozapine. These effects can impact multiple body systems and require monitoring, making them more characteristic of SGAs compared to many FGAs.

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Free Nursing Study Resources

Correct Answer is ["A","C","E"]

Explanation

Management of Bipolar disorder requires a combination of pharmacologic and non-pharmacologic interventions to stabilize mood fluctuations and reduce relapse risk. While medications remain the cornerstone of treatment, adjunctive lifestyle strategies and psychotherapy play a critical role in long-term stability. Patients are often encouraged to actively participate in self-monitoring, maintain routine behaviors, and engage in structured psychological support. These approaches help improve insight, early recognition of mood changes, and overall functional outcomes.

Rationale:
A. Using a chart to monitor mood changes helps patients identify early warning signs of manic or depressive episodes. This self-monitoring strategy improves insight into patterns and triggers of mood instability. Early detection allows timely intervention, which can prevent full relapse or hospitalization.

B. Moderate use of alcohol to reduce stress is unsafe and contraindicated in bipolar disorder management. Alcohol can worsen mood instability, interfere with medications, and increase the risk of depressive episodes or mania. It also impairs judgment and may reduce adherence to treatment plans.

C. Regular sleep and exercise are essential non-pharmacologic interventions that help stabilize circadian rhythms and mood regulation. Sleep disruption is a well-known trigger for manic episodes, while consistent physical activity supports overall mental health. Maintaining routine habits reduces the likelihood of mood cycling.

D. Electroconvulsive therapy (ECT) is not a routine self-management strategy and is typically reserved for severe, treatment-resistant, or life-threatening episodes of mood disorder. It is performed under strict medical supervision and is not considered a general recommendation for patients seeking to minimize medication use.

E. Psychotherapy is a key component of bipolar disorder management, particularly cognitive-behavioral therapy and psychoeducation. It helps patients develop coping skills, improve medication adherence, and recognize early symptoms of mood changes. Psychotherapy supports long-term stability and reduces relapse risk when used alongside medication or as part of a comprehensive treatment plan.

A. Diabetes B. Anorexia C. Asthma D. Cancer

Correct Answer is C

Explanation

Opioid analgesics such as Morphine act on the central nervous system to provide pain relief but also produce respiratory depression, histamine release, and suppression of cough reflex. These effects can significantly impact patients with underlying respiratory conditions. Careful assessment is required before administration to prevent life-threatening complications. Pre-existing respiratory diseases increase the risk of opioid-induced respiratory compromise.

Rationale:
A. Diabetes does not directly contraindicate morphine use, although careful monitoring is needed due to potential effects on gastrointestinal motility and masking of hypoglycemia symptoms. Morphine does not significantly worsen glucose metabolism or insulin function. Therefore, diabetes alone is not a reason to question its administration.

B. Anorexia is not a direct contraindication to morphine use. However, patients may experience worsened nausea, constipation, and decreased appetite as side effects. While caution is warranted, it does not pose an immediate life-threatening interaction with opioid administration.

C. Asthma is a condition in which morphine use should be questioned due to its ability to cause histamine release and respiratory depression. These effects can trigger bronchospasm and worsen airway obstruction in susceptible patients. Reduced respiratory drive further increases the risk of hypoventilation, making opioid administration potentially dangerous in uncontrolled or severe respiratory disease.

D. Cancer patients commonly receive morphine for moderate to severe pain management, particularly in palliative care settings. There is no contraindication in cancer, and opioids are often essential for quality of life improvement. Dose adjustments and monitoring are used to manage side effects safely.

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Which side effects are more common in second generation antipsychotics (SGA) medication than in first generation antipsychotic (FGA) medications. (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient with bipolar disorder who wants to minimize the need for drug therapy asks the nurse what else can be done to treat the disorder. The nurse will recommend which measure? (Select all that apply)

Correct Answer is ["A","C","E"]

Explanation

The nurse would question the administration of morphine in the patient with a history of which condition?

Correct Answer is C

Explanation

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