You have a patient that has just started an antipsychotic medication. What is the most important thing to monitor after the start of this medication?
Bradycardia
Hypertension
Orthostatic blood pressure
Abdominal distention
The Correct Answer is C
Initiation of Antipsychotics requires close monitoring for cardiovascular and neurological side effects due to their impact on dopamine, histamine, and alpha-adrenergic receptors. Many antipsychotics can cause vasodilation and impaired autonomic regulation, leading to blood pressure instability. Early adverse effects are most prominent during the initial dosing period. Preventing falls and syncope is a key nursing priority during the start of therapy.
Rationale:
A. Bradycardia is not a common primary concern with antipsychotic initiation. While some medications may indirectly affect heart rate, they mostly cause tachycardia or blood pressure changes rather than clinically significant slowing of the heart. Monitoring heart rate is important but not the highest priority compared to orthostatic changes.
B. Hypertension is not a typical adverse effect of antipsychotic medications. Many antipsychotics are more likely to cause hypotension due to alpha-adrenergic blockade. Therefore, elevated blood pressure is not the primary concern during early therapy.
C. Orthostatic blood pressure is the most important parameter to monitor because antipsychotics commonly cause orthostatic hypotension. This occurs due to alpha-1 adrenergic receptor blockade, leading to vasodilation and impaired compensatory vascular response when standing. It increases the risk of dizziness, syncope, and falls, especially during initial dosing or dose escalation.
D. Abdominal distention is not a primary early safety concern with antipsychotic initiation. While gastrointestinal side effects such as constipation can occur, they are not as immediately dangerous as cardiovascular instability. Orthostatic changes pose a more urgent risk requiring early monitoring.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Lithium is a narrow therapeutic index mood stabilizer commonly used in the treatment of bipolar disorder. Early in therapy, patients may experience mild gastrointestinal side effects such as nausea, abdominal discomfort, and bloating as the body adjusts to the medication. Therapeutic levels must be carefully monitored because toxicity can occur with small increases in serum concentration. Clinical decisions are guided by serum levels, symptom severity, and signs of toxicity.
Rationale:
A. Contacting the prescriber to request serum electrolytes is not the priority because lithium therapy is already being appropriately monitored with a therapeutic level provided. While electrolytes may be assessed in some situations, mild gastrointestinal side effects without toxicity do not warrant immediate additional lab testing.
B. Administering the dose and reassuring the patient is appropriate because a lithium level of 0.8 mEq/L is within the therapeutic range (generally 0.6–1.2 mEq/L for maintenance). Mild nausea and abdominal bloating are common early side effects that typically improve with continued therapy. Taking the medication with food or adjusting timing can also help reduce gastrointestinal discomfort.
C. Requesting an order for amiloride (Midamor) is not indicated in this situation. Amiloride is sometimes used in lithium management to reduce renal lithium reabsorption in specific cases of toxicity or nephrogenic diabetes insipidus. The patient has a therapeutic level and only mild expected side effects, so this intervention is unnecessary.
D. Holding the dose and notifying the prescriber is inappropriate because there are no signs of lithium toxicity and the serum level is within therapeutic range. Toxicity would present with symptoms such as coarse tremors, confusion, vomiting, or ataxia, which are not present here. Interrupting therapy could destabilize mood control unnecessarily.
Correct Answer is ["C","D","E","F"]
Explanation
Depot (long-acting injectable) antipsychotics are used in the long-term management of schizophrenia to improve medication adherence and maintain stable therapeutic drug levels. These formulations are administered intramuscularly at extended intervals ranging from weeks to months. They are especially useful in patients with poor adherence to oral therapy or recurrent relapses. These medications include both first- and second-generation antipsychotics formulated for sustained release.
Rationale:
A. Amantadine (Symmetrel) is an antiviral and antiparkinsonian medication used to treat influenza A and drug-induced extrapyramidal symptoms. It is not an antipsychotic and has no depot injectable formulation for schizophrenia maintenance therapy. It is not classified as a long-acting antipsychotic.
B. Clozapine is a second-generation antipsychotic used for treatment-resistant schizophrenia and reducing suicidal risk. However, it is only available in oral form due to the risk of agranulocytosis requiring frequent blood monitoring. It does not have a depot injectable formulation.
C. Aripiprazole (Abilify) is available in long-acting injectable form for maintenance treatment of schizophrenia and bipolar disorder. The depot formulation allows sustained dopamine partial agonist activity, improving adherence and symptom stability over time. It is a recognized second-generation depot antipsychotic.
D. Risperidone microspheres (Risperdal Consta) is a long-acting injectable second-generation antipsychotic used for maintenance therapy in schizophrenia. It is administered every two weeks and provides steady plasma levels to reduce relapse risk. It is one of the most commonly used depot formulations.
E. Haloperidol decanoate is a long-acting first-generation antipsychotic used for maintenance treatment of schizophrenia. It provides extended dopamine blockade and is typically administered every 4 weeks. It is widely used in patients requiring long-term adherence support.
F. Olanzapine pamoate (Zyprexa) is a long-acting injectable second-generation antipsychotic used for schizophrenia maintenance therapy. It has a risk of post-injection delirium/sedation syndrome, requiring monitoring after administration. Despite this risk, it is an approved depot formulation.
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