Schizophrenia Q 48
Important teaching for a client receiving risperidone (Risperdal) would include advising the client to:
A. Double the dose if missed to maintain a therapeutic level.
B. Be sure to take the drug with a meal because it’s very irritating to the stomach.
C. Discontinue the drug if the client reports weight gain.
D. Notify the physician if the client notices an increase in bruising.
Correct Answer: D. Notify the physician if the client notices an increase in bruising.
Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. Although there are no mandatory requirements for therapeutic drug monitoring (TDM) with risperidone, monitoring plasma concentrations for this medication is strongly recommended by European guidelines because of data that shows interdependent variability. Therapeutic monitoring can be of benefit to assess compliance and in identifying low drug concentrations that may be low resulting in therapeutic failure. Also, monitoring the drug level can aid in evaluating for potential drug interactions and side effects.
Option A: Don’t double the dose. Certain parameters should be monitored while the patient is on antipsychotics, especially in children who are more sensitive to adverse effects. In the case of risperidone, it may be of benefit to monitoring serum prolactin level, hepatic functioning, metabolic functioning, thyroid functioning, weight/BMI, height, waist circumference, blood pressure, fasting plasma glucose and insulin, fasting lipid profile, and QTc.
Option B: This drug doesn’t irritate the stomach. This medication may be administered in oral form (tablets, solution, or dissolvable M-TABs) or as a long-acting injection. The use of risperidone has also been linked to a higher probability of cerebrovascular events in elderly patients with dementia, leading to an FDA warning about the use of this medication in the context of dementia-related psychosis. Studies have even shown an increase in all-cause mortality among the elderly with dementia who are on this medication.
Option C: Weight gain isn’t a problem. Unlike the older antipsychotics, tardive dyskinesia is less frequently seen with the newer atypical antipsychotics like risperidone. Nevertheless, the onus is on the healthcare provider to detect any movement disorder and manage it. Countless litigations have occurred chiefly due to the lack of proper management of the adverse effects of risperidone. Serious side effects of antipsychotic medications (like risperidone) can include neuroleptic malignant syndrome (NMS). Although the pathogenesis of NMS is not clear, it is a life-threatening condition that can manifest with altered mental status, fever, “lead pipe” rigidity, and autonomic instability including hypertension, tachypnea, and tachycardia.