NU664C Study Guide for Midterm Exam - Regis College Know the route of administration for newer agent asenapine (Saphris) and what instructions should be given to the patient regarding administration. - ✔️ Route- Sublingual Not to eat or drink for 10 minutes after medication administration Not to swallow or chew the capsule.Asenapine is an atypical antipsychotic (serotonin-dopamine antagonist, as a mood stabilizer). Asenapine is not absorbed after swallowing (less than 2% bioavailable orally) and thus must be administered sublingually (35% bioavailable), as swallowing would render asenapine inactive.Patients should be instructed to place the tablet under the tongue and allow it to dissolve completely, which will occur in seconds; tablet should not be divided, crushed, chewed, or swallowed.Patients may not eat or drink for 10 minutes following sublingual administration so that the drug in the oral cavity can be absorbed locally and not washed into the stomach (where it would not be absorbed).Due to rapid onset of action, can be used as a rapid acting "prn" or "as needed" dose for agitation or transient worsening of psychosis or mania instead of an injection.Treatment should be suspended if absolute neutrophil count falls below 1,000/mm3.Know and describe the top atypical antipsychotic with greatest incidence of prolonged QTc interval. - ✔️ Ziprasidone (Geodon).Normal QTc =450.>470, Call Cardiologist >500, stop all meds.Ziprasidone (Geodon) has been associated with a dose-related prolongation of the QTc QTc interval prolongation is greatest with ziprasidone and least with olanzapine.Ziprasidone (Geodon) an atypical antipsychotic (serotonin-dopamine antagonist; second-generation antipsychotic; also a mood stabilizer.Ziprasidone is prescribed for Schizophrenia, delaying relapse in schizophrenia, acute agitation in schizophrenia (intramuscular), acute 1 / 2
mania/mixed mania, bipolar maintenance, other psychotic d/o, bipolar depression, behavioral disturbances in dementias, behavioral disturbances in children and adolescents, and disorders associated with problems with impulse control.Ziprasidone blocks dopamine 2 receptors, reducing positive symptoms of psychosis and stabilizing affective symptoms. Blocks serotonin 2A receptors, causing enhancement of dopamine release in certain brain regions and thus reducing motor side effects and possible improving cognitive and affective symptoms.EKGs may be useful for selected patients (e.g., those with personal or family history of QTc prolongation; cardiac arrhythmia; recent myocardial infarction; uncompensated heart failure; or those taking agents that prolong QTc interval (such as pimozide, thioridazine, selected antiarrhythmics, moxifloxacin, sparfloxacin, etc.) Ziprasidone prolongs QTc interval more than some other antipsychotics.Ziprasidone is associated with rare but serious skin condition known as Drug Reaction with Eosinophilia (DRESS). DRESS may begin as a rash but can progress to other parts of the body and can include symptoms such as fever, swollen lymph nodes, swollen face, inflammation of organs, and an increase in white blood cells known as eosinophilia. In some cases, DRESS can lead to death. Clinicians prescribing ziprasidone should inform patients about the risk of DRESS; patients who develop a fever with rash and swollen lymph nodes or swollen face should seek medical care. Pt are not advised to stop their medication without consulting their prescribing clinician.Use with caution in patients with conditions that predispose to hypotension (dehydration, overheating).Priapism has been reported.Dysphagia has been associated with antipsychotic use, and ziprasidone should be used cautiously in patients at risk for aspiration pneumonia.
Do Not Use: If pt is taking agents capable of significantly prolonging QTc
interval (such as pimozide, thioridazine, selected antiarrhythmics, moxifloxacin, sparfloxacin, etc.) If there is a history of QTc prolongation or cardiac arrhythmia, recent acute myocardial infarction, uncompensated heart failure.Know which antipsychotics have specific instructions for minimum food intake or diet restrictions. - ✔️ Geodon because food affects the absorption of the drug.Lurasidone - Latuda
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