Sample Answer for NURS 6630 STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS Assignment Included After Question
Psychosis and schizophrenia greatly impact the brain’s normal processes, which interfere with the ability to think clearly. When symptoms of these disorders are uncontrolled, patients may struggle to function in daily life. However, patients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, you will develop a study guide for an assigned psychotropic agent for treating patients with Schizophrenia Spectrum and Other Psychotic Disorders. You will share your study guide with your colleagues. In sum, these study guides will be a powerful tool in preparing for your course and PMHNP certification exam.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare for this Assignment:
- Review this week’s Learning Resources, including the Medication Resources indicated for this week.
- Reflect on the psychopharmacologic treatments you might recommend for treatment of patients with Schizophrenia Spectrum and Other Psychotic Disorders.
- Research your assigned psychotropic medication agent using the Walden Library. Then, develop an organizational scheme for the important information about the medication.
- Review Learning Resource: Utah State University. (n.d.). Creating study guides. https://www.usu.edu/academic-support/test/creating_study_guides
The Assignment
Create a study guide for your assigned psychotropic medication agents. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the FDA-approved and Evidenced-Based, Clinical Practice Guidelines Research but also supported by at least three other scholarly resources.
Areas of importance you should address, but are not limited to, are:
- Title page
- Description of the Psychopharmacological medication agent including brand and generic names and appropriate FDA indication uses
- Any supporting, valid and reliable research for non-FDA uses
- Drug classification
- The medication mechanism of action
- The medication pharmacokinetics
- The medication pharmacodynamics
- Mechanism of Action
- Appropriate dosing, administration route, and any considerations for dosing alterations
- Considerations of use and dosing in specific specialty populations to consider children, adolescents, elderly, pregnancy, suicidal behaviors, etc.
- Definition of Half-life, why half-life is important, and the half-life for your assigned medication
- Side effects/adverse reaction potentials
- Contraindications for use including significant drug to drug interactions
- Overdose Considerations
- Diagnostics and labs monitoring
- Comorbidities considerations
- Legal and ethical considerations
- Pertinent patient education considerations
- Reference Page
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting
By Day 7
You will need to submit your Assignment to two places: the Week 7 Study Guide discussion forum as an attachment and the Week 7 Assignment submission link. Although no responses are required in the discussion forum, a collegial discussion is welcome. You are encouraged to utilize your peers’ submitted guides on their assigned psychotropic medication agent for study.
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK7Assgn_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Schizophrenia is characterized mainly by a clear sensory but a marked thinking disturbance. The psychotic disorder is highly linked with abnormalities of amine neurotransmitter function, especially dopamine. Antipsychotic medications, also called neuroleptic or major tranquilizers, are the first-line drug therapy for schizophrenia. They target the positive symptoms of schizophrenia, like hallucinations, delusions, and disorganized behavior. Antipsychotics act by controlling neurotransmitter dopamine and serotonin levels in the brain. They are classified into two major groups: Typical and Atypical. The antipsychotic effects of Typical antipsychotics owe their competitive blockage to dopamine receptors. Atypicals have fewer extrapyramidal adverse effects than the typical and block both serotonin and dopamine receptors. The purpose of this assignment is to develop a study guide for Risperidone.
Drug Description
- Risperidone is also called Risperdal.
- It is an Atypical neuroleptic medication.
- The FDA approves it for use in the USA in the treatment of:
- Schizophrenia in adults and children aged above 13 years.
- Bipolar I acute manic or mixed episodes as monotherapy in adults and children above 10 years (Álamo, 2022).
- Bipolar I acute manic or mixed episodes adjunctive with lithium or valproate in adults.
- Autism-associated irritability in children above five years.
Off-label uses include:
- Borderline personality disorder
- Delusional disorder
- Delirium
- Depression
- Brain injury
- Pedophilia
- PTSD
- Bipolar disorder
- Conduct disorder
- Lesch-Nyhan
- Tourette Syndrome
- Stuttering, movement disorders
- Developmental disorders
The medication mechanism of action
- Risperidone has a high affinity for serotonin type 2 (5-HT2) receptors.
- It binds to dopamine D2 receptors with 20 times lower affinity than that for 5-HT2 receptors (Zhao et al., 2022).
- It antagonizes alpha1-adrenergic, alpha2-adrenergic, and histaminergic receptors.
- Risperidone has a moderate affinity for serotonin type 1 receptors.
- Has a weak affinity for dopamine D1 receptors.
- No affinity for muscarinic, beta1-adrenergic, and beta2-adrenergic receptors (Zhao et al., 2022).
Pharmacokinetics Pharmacodynamics
- Risperidone decreases dopamine neurotransmission for the five classes of dopamine receptors (D1 to D5).
- It reduces the hallucinations and delusions associated with schizophrenia by blocking dopamine receptors in the brain’s mesolimbic system (Zhao et al., 2022).
Appropriate dosing and administration route,
- Oral: Initial dose at 2 mg/day; Recommended target dosage of 2-8 mg/day OD or BD.
- The oral dose may be increased by 1-2 mg/day at intervals ≥24 hr.
- Intramuscular: 12.5-50 mg into the deltoid or gluteal muscle every 2 weeks; The dose should not be adjusted more often than every 4 weeks.
- Subcutaneous: 90 mg or 120 mg SC once monthly.
Considerations For Dosing Alterations
- Renal Impairment: If Creatine clearance is below 30, PO Risperidone should be initiated at 0.5 mg BD.
- It can be increased by up to 0.5 mg BD to a max of 1.5 mg BD.
Considerations of use and dosing in specific specialty populations
Geriatrics: Lower initial doses are recommended and should be adjusted more gradually.
PO initial dose at 0.5 mg q12hr; IM: 12.5-25 mg (Álamo, 2022).
Pediatrics >13 years: Initiated at lower doses of 0.5 mg/day PO in the morning or evening.
Half-life: This is the time taken for the plasma or blood level of a drug to fall by half.
- Half-life is determined by drug distribution, metabolism, and excretion.
- Half-life is important because drugs that have a short half-life stay in the body for a shorter period and thus have a shorter duration of action (Andrade, 2022).
- Drugs with a short half-life thus need to be administered more frequently.
- Drugs with a long half-life stay longer in the body and thus have a longer duration of action (Andrade, 2022).
- These drugs can conveniently be dosed once a day or less frequently.
- Extensive Risperidone metabolizers have a half-life of 3 hrs (parent and metabolite combined).
- Poor metabolizers have a half-life of 20 hrs (parent and metabolite combined).
Side effects/adverse reaction potentials
- The most significant side effects are Weight gain, metabolic changes, and sedation.
- It is associated with extrapyramidal symptoms (EPS): Acute dystonia, tardive dyskinesia, akathisia, and parkinsonian features (Hodkinson et al., 2021).
- Neuroleptic malignant syndrome (NMS) is a serious side effect of Risperidone.
- Other side effects: Somnolence, Insomnia, Agitation, Anxiety, Headache, Rhinitis, Fatigue, Increased appetite, Vomiting, Drooling, and Urinary incontinence (Hodkinson et al., 2021).
Contraindications for use and drug-to-drug interactions
- Risperidone is contraindicated in patients with known allergy/hypersensitivity to Risperidone or paliperidone (Hodkinson et al., 2021).
- Contraindicated in dementia-related psychosis due to increased risk of death.
Overdose Considerations
- Risperidone overdose is life-threatening.
- Patients with risperidone overdose should be monitored for hypotension, sedation, and respiratory depression.
Diagnostics and labs monitoring
- Monitoring plasma concentrations for Risperidone is strongly recommended.
- Monitor for leukopenia/neutropenia and agranulocytosis.
- Monitor complete blood count frequently in the first few months of therapy in patients with a history of low WBC count (Álamo, 2022).
- Specific parameters to be monitored: Serum prolactin level, hepatic functioning, metabolic functioning, thyroid functioning, blood pressure, fasting plasma glucose, fasting lipid profile, and QTc (Álamo, 2022).
Comorbidities considerations
- It should be administered with caution in patients with a history of Parkinson’s disease, Lewy body dementia, seizures, cardiovascular disease, hypovolemia, and dehydration (Álamo, 2022).
Legal and ethical considerations
- The prescribing clinician should consider legal and ethical factors of beneficence, nonmaleficence, informed consent, and confidentiality when prescribing Risperidone (Hodkinson et al., 2021).
- Beneficence is fostered by prescribing the drug when evidence supports its efficacy and benefits in treating schizophrenia in patients.
- Nonmaleficence is upheld by examining the associated side effects of Risperidone and ensuring the benefits outweigh the possible harm.
- The clinician should obtain consent from the patient by explaining the mechanism of action, benefits, and potential side effects of Risperidone before starting treatment (Hodkinson et al., 2021).
- The clinician should maintain the confidentiality of the patient’s diagnosis and treatment and seek consent before sharing the information with other providers.
Pertinent patient education considerations
- Patient education with regard to Risperidone includes informing the patient of the drug’s benefits in alleviating schizophrenia symptoms and possible side effects.
- Patients should be educated on extrapyramidal symptoms and signs of NMS (Hodkinson et al., 2021).
- They should be instructed on the action to take when serious side effects occur.
Conclusion NURS 6630 STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS Assignment
Risperidone is an Atypical neuroleptic used to treat schizophrenia in adults and children above 13 years. It is also FDA-indicated to treat Bipolar 1 acute manic or mixed episodes and Autism-associated irritability in children above 5 years. It exhibits its therapeutic effects by blocking serotonin and dopamine receptors. The most significant side effects of Risperidone are weight gain, metabolic changes, and sedation. Neuroleptic malignant syndrome and Extrapyramidal symptoms are serious side effects of Risperidone.
References NURS 6630 STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS Assignment
Álamo, C. (2022). Risperidone ISM as a New Option in the Clinical Management of Schizophrenia: A Narrative Review. Advances in therapy, 39(11), 4875–4891. https://doi.org/10.1007/s12325-022-02299-8
Andrade, C. (2022). The practical importance of half-life in psychopharmacology. The Journal of Clinical Psychiatry, 83(4), 41940. https://doi.org/10.4088/JCP.22f14584
Hodkinson, A., Heneghan, C., Mahtani, K. R., Kontopantelis, E., & Panagioti, M. (2021). Benefits and harms of Risperidone and Paliperidone for treatment of patients with schizophrenia or bipolar disorder: a meta-analysis involving individual participant data and clinical study reports. BMC medicine, 19(1), 195. https://doi.org/10.1186/s12916-021-02062-w
Zhao, M., Ma, J., Li, M., Zhu, W., Zhou, W., Shen, L., Wu, H., Zhang, N., Wu, S., Fu, C., Li, X., Yang, K., Tang, T., Shen, R., He, L., Huai, C., & Qin, S. (2022). Different responses to risperidone treatment in schizophrenia: a multicenter genome-wide association and whole exome sequencing joint study. Translational psychiatry, 12(1), 173. https://doi.org/10.1038/s41398-022-01942-w
NURS_6630_Week7_Assignment_Rubric
| NURS_6630_Week7_Assignment_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning Outcome Create a study guide, in outline form with references, for your assigned medication. Incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Study guide completion elements addressed in Week 7 assignment area |
|
50 pts | ||||
| This criterion is linked to a Learning Outcome Support your guide with references and research providing at least five evidence-based, peer-reviewed journal articles or evidenced-based guidelines. Be sure they are current (no more than 5 years old). |
|
10 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||
NURS 6630 STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS Assignment Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
|
Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
|
Presentation of information was good, but was superficial in places and included all of the following elements:
|
Presentation of information was minimally demonstrated in all of the following elements:
|
Presentation of information is unsatisfactory in one of the following elements:
|
Presentation of information is unsatisfactory in two of the following elements:
|
Presentation of information is unsatisfactory in three or more of the following elements
|
| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
|
Presentation of information was good, but was superficial in places and included all of the following elements:
|
Presentation of information was minimally demonstrated in the all of the following elements:
|
Presentation of information is unsatisfactory in one of the following elements:
|
Presentation of information is unsatisfactory in two of the following elements:
|
Presentation of information is unsatisfactory in three of the following elements
|
| 10 Points | 9 Points | 6 Points | 0 Points | |||
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
|
Demonstrated 3 of the following:
|
Demonstrated 2 of the following:
|
Demonstrated 1 or less of the following:
|
||
| 8 Points | 7 Points | 6 Points | 5 Points | 4 Points | 0 Points | |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
AND
AND
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
| 0 Points Deducted | 5 Points Lost | |||||
| Participation
Requirements |
Demonstrated the following:
|
Failed to demonstrate the following:
|
||||
| 0 Points Lost | 5 Points Lost | |||||
| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Read Also: NURS 6630 psychiatric and mental health nurse practitioner Assignment
As we begin this session, I would like to take this opportunity to clarify my expectations for this course:
Please note that GCU Online weeks run from Thursday (Day 1) through Wednesday (Day 7).
Course Room Etiquette:
- It is my expectation that all learners will respect the thoughts and ideas presented in the discussions.
- All postings should be presented in a respectful, professional manner. Remember – different points of view add richness and depth to the course!
Office Hours:
- My office hours vary so feel free to shoot me an email at [email protected] or my office phone is 602.639.6517 and I will get back to you within one business day or as soon as possible.
- Phone appointments can be scheduled as well. Send me an email and the best time to call you, along with your phone number to make an appointment.
- I welcome all inquiries and questions as we spend this term together. My preference is that everyone utilizes the Questions to Instructor forum. In the event your question is of a personal nature, please feel free to post in the Individual Questions for Instructor forumI will respond to all posts or emails within 24 or sooner.
Late Policy and Grading Policy
Discussion questions:
- I do not mark off for late DQ’s.
- I would rather you take the time to read the materials and respond to the DQ’s in a scholarly way, demonstrating your understanding of the materials.
- I will not accept any DQ submissions after day 7, 11:59 PM (AZ Time) of the week.
- Individual written assignments – due by 11:59 PM AZ Time Zone on the due dates indicated for each class deliverable.
Assignments:
- Assignments turned in after their specified due dates are subject to a late penalty of -10%, each day late, of the available credit. Please refer to the student academic handbook and GCU policy.
- Any activity or assignment submitted after the due date will be subject to GCU’s late policy
- Extenuating circumstances may justify exceptions, which are at my sole discretion. If an extenuating circumstance should arise, please contact me privately as soon as possible.
- No assignments can be accepted for grading after midnight on the final day of class.
- All assignments will be graded in accordance with the Assignment Grading Rubrics
Participation
- Participation in each week’s Discussion Board forum accounts for a large percentage of your final grade in this course.
- Please review the Course Syllabus for a comprehensive overview of course deliverables and the value associated with each.
- It is my expectation that each of you will substantially contribute to the course discussion forums and respond to the posts of at least three other learners.
- A substantive post should be at least 200 words. Responses such as “great posts” or “I agree” do notmeet the active engagement expectation.
- Please feel free to draw on personal examples as you develop your responses to the Discussion Questions but you do need to demonstrate your understanding of the materials.
- I do expect outside sources as well as class materials to formulate your post.
- APA format is not necessary for DQ responses, but I do expect a proper citation for references.
- Please use peer-related journals found through the GCU library and/or class materials to formulate your answers. Do not try to “Google” DQ’s as I am looking for class materials and examples from the weekly materials.
- I will not accept responses that are from Wikipedia, Business com, or other popular business websites. You will not receive credit for generic web searches – this does not demonstrate graduate-level research.
- Stay away from the use of personal pronouns when writing.As a graduate student, you are expected to write based on research and gathering of facts. Demonstrating your understanding of the materials is what you will be graded on. You will be marked down for lack of evidence to support your ideas.
Plagiarism
- Plagiarism is the act of claiming credit for another’s work, accomplishments, or ideas without appropriate acknowledgment of the source of the information by including in-text citations and references.
- This course requires the utilization of APA format for all course deliverables as noted in the course syllabus.
- Whether this happens deliberately or inadvertently, whenever plagiarism has occurred, you have committed a Code of Conduct violation.
- Please review your LopesWrite report prior to final submission.
- Every act of plagiarism, no matter the severity, must be reported to the GCU administration (this includes your DQ’s, posts to your peers, and your papers).
Plagiarism includes:
- Representing the ideas, expressions, or materials of another without due credit.
- Paraphrasing or condensing ideas from another person’s work without proper citation and referencing.
- Failing to document direct quotations without proper citation and referencing.
- Depending upon the amount, severity, and frequency of the plagiarism that is committed, students may receive in-class penalties that range from coaching (for a minor omission), -20% grade penalties for resubmission, or zero credit for a specific assignment. University-level penalties may also occur, including suspension or even expulsion from the University.
- If you are at all uncertain about what constitutes plagiarism, you should review the resources available in the Student Success Center. Also, please review the University’s policies about plagiarism which are covered in more detail in the GCU Catalog and the Student Handbook.
- We will be utilizing the GCU APA Style Guide 7th edition located in the Student Success Center > The Writing Center for all course deliverables.
LopesWrite
- All course assignments must be uploaded to the specific Module Assignment Drop Box, and also submitted to LopesWrite every week.
- Please ensure that your assignment is uploaded to both locations under the Assignments DropBox. Detailed instructions for using LopesWrite are located in the Student Success Center.
Assignment Submissions
- Please note that Microsoft Office is the software requirement at GCU.
- I can open Word files or any file that is saved with a .rtf (Rich Text Format) extension. I am unable to open .wps files.
- If you are using a “.wps” word processor, please save your files using the .rtf extension that is available from the drop-down box before uploading your files to the Assignment Drop Box.
Grade of Incomplete
- The final grade of Incomplete is granted at the discretion of the instructor; however, students must meet certain specific criteria before this grade accommodation is even possible to consider.
- The grade of Incomplete is reserved for times when students experience a serious extenuating circumstance or a crisis during the last week of class which prevents the completion of course requirements before the close of the grading period. Students also must pass the course at the time the request is made.
- Please contact me personally if you are having difficulties in meeting course requirements or class deadlines during our time together. In addition, if you are experiencing personal challenges or difficulties, it is best to contact the Academic Counselor so that you can discuss the options that might be available to you, as well as each option’s academic and financial repercussions.
Grade Disputes
- If you have any questions about a grade you have earned on an individual assignment or activity, please get in touch with mepersonally for further clarification.
- While I have made every attempt to grade you fairly, on occasion a misunderstanding may occur, so please allow me the opportunity to learn your perspective if you believe this has occurred. Together, we should be able to resolve grading issues on individual assignments.
- However, after we have discussed individual assignments’ point scores, if you still believe that the final grade you have earned at the end of the course is not commensurate with the quality of work you produced for this class, there is a formal Grade Grievance procedurewhich is outlined in the GCU Catalog and Student Handbook.
A Sample Answer 2 For the Assignment: NURS 6630 STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS Assignment
Title: NURS 6630 STUDY GUIDE FOR MEDICATION TREATMENT SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOSIS DISORDERS Assignment
Schizophrenia is characterized mainly by a clear sensory but a marked thinking disturbance. The psychotic disorder is highly linked with abnormalities of amine neurotransmitter function, especially dopamine. Antipsychotic medications, also called neuroleptic or major tranquilizers, are the first-line drug therapy for schizophrenia. They target the positive symptoms of schizophrenia, like hallucinations, delusions, and disorganized behavior. Antipsychotics act by controlling neurotransmitter dopamine and serotonin levels in the brain. They are classified into two major groups: Typical and Atypical. The antipsychotic effects of Typical antipsychotics owe their competitive blockage to dopamine receptors. Atypicals have fewer extrapyramidal adverse effects than the typical and block both serotonin and dopamine receptors. The purpose of this assignment is to develop a study guide for Risperidone.
Drug Description
- Risperidone is also called Risperdal.
- It is an Atypical neuroleptic medication.
- The FDA approves it for use in the USA in the treatment of:
- Schizophrenia in adults and children aged above 13 years.
- Bipolar I acute manic or mixed episodes as monotherapy in adults and children above 10 years (Álamo, 2022).
- Bipolar I acute manic or mixed episodes adjunctive with lithium or valproate in adults.
- Autism-associated irritability in children above five years.
Off-label uses include:
- Borderline personality disorder
- Delusional disorder
- Delirium
- Depression
- Brain injury
- Pedophilia
- PTSD
- Bipolar disorder
- Conduct disorder
- Lesch-Nyhan
- Tourette Syndrome
- Stuttering, movement disorders
- Developmental disorders
The medication mechanism of action
- Risperidone has a high affinity for serotonin type 2 (5-HT2) receptors.
- It binds to dopamine D2 receptors with 20 times lower affinity than that for 5-HT2 receptors (Zhao et al., 2022).
- It antagonizes alpha1-adrenergic, alpha2-adrenergic, and histaminergic receptors.
- Risperidone has a moderate affinity for serotonin type 1 receptors.
- Has a weak affinity for dopamine D1 receptors.
- No affinity for muscarinic, beta1-adrenergic, and beta2-adrenergic receptors (Zhao et al., 2022).
Pharmacokinetics Pharmacodynamics
- Risperidone decreases dopamine neurotransmission for the five classes of dopamine receptors (D1 to D5).
- It reduces the hallucinations and delusions associated with schizophrenia by blocking dopamine receptors in the brain’s mesolimbic system (Zhao et al., 2022).
Appropriate dosing and administration route,
- Oral: Initial dose at 2 mg/day; Recommended target dosage of 2-8 mg/day OD or BD.
- The oral dose may be increased by 1-2 mg/day at intervals ≥24 hr.
- Intramuscular: 12.5-50 mg into the deltoid or gluteal muscle every 2 weeks; The dose should not be adjusted more often than every 4 weeks.
- Subcutaneous: 90 mg or 120 mg SC once monthly.
Considerations For Dosing Alterations
- Renal Impairment: If Creatine clearance is below 30, PO Risperidone should be initiated at 0.5 mg BD.
- It can be increased by up to 0.5 mg BD to a max of 1.5 mg BD.
Considerations of use and dosing in specific specialty populations
Geriatrics: Lower initial doses are recommended and should be adjusted more gradually.
PO initial dose at 0.5 mg q12hr; IM: 12.5-25 mg (Álamo, 2022).
Pediatrics >13 years: Initiated at lower doses of 0.5 mg/day PO in the morning or evening.
Half-life: This is the time taken for the plasma or blood level of a drug to fall by half.
- Half-life is determined by drug distribution, metabolism, and excretion.
- Half-life is important because drugs that have a short half-life stay in the body for a shorter period and thus have a shorter duration of action (Andrade, 2022).
- Drugs with a short half-life thus need to be administered more frequently.
- Drugs with a long half-life stay longer in the body and thus have a longer duration of action (Andrade, 2022).
- These drugs can conveniently be dosed once a day or less frequently.
- Extensive Risperidone metabolizers have a half-life of 3 hrs (parent and metabolite combined).
- Poor metabolizers have a half-life of 20 hrs (parent and metabolite combined).
Side effects/adverse reaction potentials
- The most significant side effects are Weight gain, metabolic changes, and sedation.
- It is associated with extrapyramidal symptoms (EPS): Acute dystonia, tardive dyskinesia, akathisia, and parkinsonian features (Hodkinson et al., 2021).
- Neuroleptic malignant syndrome (NMS) is a serious side effect of Risperidone.
- Other side effects: Somnolence, Insomnia, Agitation, Anxiety, Headache, Rhinitis, Fatigue, Increased appetite, Vomiting, Drooling, and Urinary incontinence (Hodkinson et al., 2021).
Contraindications for use and drug-to-drug interactions
- Risperidone is contraindicated in patients with known allergy/hypersensitivity to Risperidone or paliperidone (Hodkinson et al., 2021).
- Contraindicated in dementia-related psychosis due to increased risk of death.
Overdose Considerations
- Risperidone overdose is life-threatening.
- Patients with risperidone overdose should be monitored for hypotension, sedation, and respiratory depression.
Diagnostics and labs monitoring
- Monitoring plasma concentrations for Risperidone is strongly recommended.
- Monitor for leukopenia/neutropenia and agranulocytosis.
- Monitor complete blood count frequently in the first few months of therapy in patients with a history of low WBC count (Álamo, 2022).
- Specific parameters to be monitored: Serum prolactin level, hepatic functioning, metabolic functioning, thyroid functioning, blood pressure, fasting plasma glucose, fasting lipid profile, and QTc (Álamo, 2022).
Comorbidities considerations
- It should be administered with caution in patients with a history of Parkinson’s disease, Lewy body dementia, seizures, cardiovascular disease, hypovolemia, and dehydration (Álamo, 2022).
Legal and ethical considerations
- The prescribing clinician should consider legal and ethical factors of beneficence, nonmaleficence, informed consent, and confidentiality when prescribing Risperidone (Hodkinson et al., 2021).
- Beneficence is fostered by prescribing the drug when evidence supports its efficacy and benefits in treating schizophrenia in patients.
- Nonmaleficence is upheld by examining the associated side effects of Risperidone and ensuring the benefits outweigh the possible harm.
- The clinician should obtain consent from the patient by explaining the mechanism of action, benefits, and potential side effects of Risperidone before starting treatment (Hodkinson et al., 2021).
- The clinician should maintain the confidentiality of the patient’s diagnosis and treatment and seek consent before sharing the information with other providers.
Pertinent patient education considerations
- Patient education with regard to Risperidone includes informing the patient of the drug’s benefits in alleviating schizophrenia symptoms and possible side effects.
- Patients should be educated on extrapyramidal symptoms and signs of NMS (Hodkinson et al., 2021).
- They should be instructed on the action to take when serious side effects occur.
Conclusion
Risperidone is an Atypical neuroleptic used to treat schizophrenia in adults and children above 13 years. It is also FDA-indicated to treat Bipolar 1 acute manic or mixed episodes and Autism-associated irritability in children above 5 years. It exhibits its therapeutic effects by blocking serotonin and dopamine receptors. The most significant side effects of Risperidone are weight gain, metabolic changes, and sedation. Neuroleptic malignant syndrome and Extrapyramidal symptoms are serious side effects of Risperidone.
References
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Andrade, C. (2022). The practical importance of half-life in psychopharmacology. The Journal of Clinical Psychiatry, 83(4), 41940. https://doi.org/10.4088/JCP.22f14584
Hodkinson, A., Heneghan, C., Mahtani, K. R., Kontopantelis, E., & Panagioti, M. (2021). Benefits and harms of Risperidone and Paliperidone for treatment of patients with schizophrenia or bipolar disorder: a meta-analysis involving individual participant data and clinical study reports. BMC medicine, 19(1), 195. https://doi.org/10.1186/s12916-021-02062-w
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