Week 1

Question 1

What is the clinical rationale for using long-acting injectables (LAIs) in mental health care?

Answer 1

LAIs help ensure medication adherence, reduce relapse rates, and improve overall treatment outcomes

LAIs are particularly beneficial for patients with chronic mental health conditions who may struggle with daily medication adherence.

Question 2

Identify the four types of extrapyramidal symptoms (EPS).

Answer 2

• Acute Dystonia
• Akathisia
• Pseudo-parkinsonism
• Tardive Dyskinesia

Each type has distinct characteristics and onset times associated with antipsychotic medication use.

Question 3

What are the common first-generation LAIs used in Canada?

Answer 3

• Haloperidol decanoate (Haldol)
• Fluphenazine (Modecate)
• Zuclopenthixol (Clopixol)

These medications are often used for their efficacy in managing symptoms of severe mental illnesses.

Question 4

What are the common second-generation LAIs used in Canada?

Answer 4

• Risperdal Consta (Risperidone)
• Invega Sustenna, Trinza (Paliperidone)
• Abilify Maintena (Aripiprazole)

Second-generation LAIs are generally associated with a lower risk of EPS compared to first-generation options.

Question 5

What is the preferred IM injection site for LAIs?

Answer 5

Ventrogluteal

The ventrogluteal site is preferred due to its safety and capacity for larger volume injections.

Question 6

What is the maximum volume for an IM injection in the deltoid site?

Answer 6

Up to 1 mL

The deltoid site is mainly used for vaccines and low-volume LAIs.

Question 7

What is the purpose of the AIMS and EPSS screening tools?

Answer 7

To assess and evaluate the presence and severity of extrapyramidal symptoms (EPS)

These tools help clinicians monitor patients on antipsychotic medications for potential side effects.

Question 8

What is Acute Dystonia?

Answer 8

Sudden, involuntary sustained muscle contractions leading to abnormal postures or twisting movements

Commonly affects the neck (torticollis), eyes (oculogyric crisis) , jaw, or back and can be painful and distressing often occurring within hours to days

Question 9

What is Akathisia?

Answer 9

A subjective sense of inner restlessness and a compelling need to be in constant motion

Patients may pace or shift weight frequently, typically occurring within days to weeks of antipsychotic initiation.

Question 10

What are the symptoms of Pseudo-parkinsonism?

Answer 10

Caused by dopamine blockade in the nigrostriatal pathway
*Resting tremor
* Muscular rigidity (cogwheel rigidity)
* Stooped posture
* Postural instability
* Bradykinesia
* Shuffling gait
* En bloc turning

Symptoms may appear within days to weeks after starting antipsychotics.

Question 11

What characterizes Tardive Dyskinesia?

Answer 11

A late-onset, often irreversible, involuntary movement disorder characterized by purposeless rhythmic, repetitive movements

Movements typically involve the face, tongue, lips, and can appear months to years after chronic use of antipsychotics.
- characterized by purposeless rhythmic, repetitive movements of face, tongue and less commonly limbs or trunk
- appears months t years after chronic use

Question 12

What is the initial treatment for Pseudo-parkinsonism?

Answer 12

• Benztropine (Cogentin): 0.5–1 mg once or twice daily
• Amantadine (Symmetrel): 100 mg once or twice daily

Dosages may be adjusted based on patient tolerance and response.

Question 13

What treatment options are available for Tardive Dyskinesia?

Answer 13

• Switch to a low-risk SGA (e.g., Clozapine, Quetiapine)
• Tetrabenazine (VMAT-2 inhibitor)

Tetrabenazine requires monitoring for depression and other side effects.

Question 14

How should students practice landmarking for IM injections?

Answer 14

In pairs or triads, practicing on Deltoid, Ventrogluteal, and Dorsogluteal sites

Accuracy, safety, and professionalism are emphasized during practice.

Question 15

True or False: Z-tracking is required for IM injections.

Answer 15

True

Z-tracking helps to minimize tissue irritation and leakage of the medication.

Question 16

What roles do the students assume during the EPS simulation experience?

Answer 16

• Nurse
• Recorder
• Observers/Scorers
• Student Actor

Each role is crucial for effective assessment and discussion of EPS scenarios.

Question 17

What is one key takeaway from the EPS assessment experience?

Answer 17

Reflect on personal feelings and insights gained during the assessment process

This reflection is essential for personal and professional growth in nursing practice.

Question 18

What are the 4 types of EPS

Answer 18

1. Acute dystonia
2. Akathisia
3. Pseudo Parkinsonism
4. Tardive dyskinesia