Comprehensive exams for Mental Health Q 193
Which of the following interventions is important for a Cely experiencing a paranoid personality disorder taking olanzapine (Zyprexa)?
A. Explain effects of serotonin syndrome.
B. Teach the client to watch for extrapyramidal adverse reactions.
C. Explain that the drug is less effective if the client smokes.
D. Discuss the need to report paradoxical effects such as euphoria.
Correct Answer: C. Explain that the drug is less effective if the client smokes.
Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes. Olanzapine is a second-generation (atypical) antipsychotic medication. Olanzapine also has approval for use with fluoxetine, a selective serotonin reuptake inhibitor (SSRI), in patients with episodes of depression associated with bipolar disorder type 1 and treatment-resistant depression.
Option A: Serotonin syndrome occurs with clients who take a combination of antidepressant medications. Serotonin syndrome is a potentially life-threatening condition precipitated by the use of serotonergic drugs. It may be a consequence of therapeutic medication use, accidental interactions between medications or recreational drugs, or intentional overdose. Symptoms can range from mild to fatal and classically include altered mental status, autonomic dysfunction, and neuromuscular excitation.
Option B: Extrapyramidal adverse reactions aren’t a problem. However, the client should be aware of adverse effects such as tardive dyskinesia. Olanzapine’s mechanism of action also lends itself to directly causing adverse reactions associated with the dopaminergic blockade. Patients taking olanzapine have a risk of developing akathisia, extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome. However, the risk of developing these side effects is lesser than first-generation antipsychotics due to the loose association and quick dissociation of olanzapine with the D2 receptors.
Option D: Olanzapine doesn’t cause euphoria. One of the most common adverse effects of olanzapine is the potential for gaining weight. Olanzapine causes an increase in appetite leading to hyperphagia with a consequence of weight gain. Therefore, it should be used cautiously in patients who are obese, have little control over their food intake, and do not exercise regularly to combat weight gain.