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Injecting Pharmaceutical Skill into Schizophrenia CarePharmacist Post-testPharmacist Learning Objectives:1. Pharmacist Learning Objectives:Discuss how schizophrenia's propensity to cause internal conflict and subjective distress often leads to non-adherence and use patient centered approaches to improve careImplement pharmacologic approaches to address suboptimal outcomes for persons with schizophreniaIdentify situations in which oral, long-acting injectable (LAI) antipsychotics, or a combination of both are reasonable choices Compare available long-acting injectable antipsychotic agents' indications, risks and benefits, pharmacokinetic profiles, dosing, and administration techniques in the pharmacyDiscuss emerging opportunities for pharmacists administer and monitor LAI antipsychotic medication 1. Which of the following is mostly likely to contribute to non-adherence for patients with schizophrenia?A. Impaired insight into illnessB. Use of LAIAs while hospitalizedC. Pharmacist-administered LAIA2. Substance use may contribute to which of the following for patients with schizophrenia? A. Decreased severity of negative symptomsB. Worsening metabolic symptomsC. Treatment non-adherence3. Some patients with schizophrenia prefer to remain in a psychotic condition rather than to be treated and achieve a relatively “normal” state. This phenomenon is known as _______. A. Subjective distressB. Persecutory delusion C. Disorganized thoughts 4. Patient KU is a 34-year-old Hispanic male with schizophrenia. His symptoms include severe auditory hallucinations and delusions. He has been treated with adequate trials of oral risperidone and perphenazine, but neither medication had a significant impact. He is currently being treated with perphenazine. He refuses all injectable antipsychotics. Which of the following is a reasonable recommendation for next steps in treatment? A. Initiate treatment with clozapine and continue perphenazine for better symptom control B. Initiate treatment with clozapine and begin decreasing dose of perphenazineC. Initiate treatment with aripiprazole to augment the perphenazine 5. Patient LL is a 30-year-old Caucasian female who arrives at a community pharmacy to fill a prescription for aripiprazole. She is concerned about weight gain and asks you for more information about this potential adverse effect. Which of the following is the most appropriate counseling point for this patient? A. Only the first-generation antipsychotics, such as haloperidol and fluphenazine, are known to cause weight gain. B. Some second-generation antipsychotics may cause weight gain, but aripiprazole is not one of them.C. Although the risk of weight gain with aripiprazole is lower than with other antipsychotics, there is still a chance that this can occur.6. LL returns a month later to refill her prescription for aripiprazole. While she is in the waiting area, you notice that she cannot sit still and constantly is standing up, walking around, and then sitting back down. She also continuously swings her legs as she sits in the chair. You suspect that she may be experiencing akathisia. Which of the following would be the most appropriate medication to recommend to her provider?A. DiphenhydramineB. ValbenazineC. Propranolol7. MJ is a 35 year old male with schizophrenia wanting to receive a long-acting injectable antipsychotic since it is more convenient and doesn’t require significant safety monitoring. He wants an LAIA that allows him to get his shot quickly and not wait around. He has only been treated with ziprasidone in the past. Which of the following is the BEST recommendation to make him and the prescriber?A. Discontinue ziprasidone and start oral risperidoneB. Discontinue ziprasidone and start olanzapine C. Discontinue ziprasidone and start brexpiprazole8. The doctor wants to start TB, a 46 year old male, immediately on an LAIA once it is determined the oral form is safe and acceptable. He does not want to overlap the oral and LAIA forms. Which of the following medications would be the BEST choice to recommend TB to start given the doctor’s request?: A. haloperidol deconateB. risperidone microspheresC. subcutaneous risperidone9. Which of the following LAIAs can be dosed longer than every four weeks?A. aripiprazole lauroxilB. fluphenazine deconateC. paliperidone palmitate 10. Patient PT indicates not wanting to receive IM injections. The following LAIA may be option for her to receive:A. paliperidone palmitateB. risperidoneC. olanzapine11. Which of the following is FALSE regarding pharmacist roles in administering LAIAs?A. CPAs outline pharmacist-prescriber relationships in specific terms.B. Most states lack regulations about specific products pharmacists can administer.C. Pharmacists require additional training to administer LAIAs.12. The following are considerations when starting up a pharmacist LAIA service:A.Promote service to retail health clinics and area emergency rooms.B.Establish stigma-free environment to promote patient comfort.C.Insist that pharmacists can do more than be safety-net providers. ................
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