Chapter 4: Rapid tranquilisation Which of the following are side effects when using drugs such as lorazepam, haloperidol and olanzapine? Excessive sedation Damage to therapeutic relationship Weight loss Atrial fibrillation Loss of consciousness What should be readily available when monitoring rapid tranquilisation? Pulse oximeter Watch Facilities for mechanical ventilation Flumazenil Defibrillator A patient with a diagnosis of acute paranoid psychosis has become very agitated, threatening staff, kicking doors, breaking windows and refusing medication. Which of the following intramuscular medications would best manage the patient? Chlorpromazine with lorazepam Chlorpromazine with haloperidol Lorazepam with diazepam Lorazepam with haloperidol Lorazepam with olanzapine It is suggested that you stop tranquilisation if which of the following occur? Fall in systolic blood pressure to less than 80 mmHg There is a sudden drop in blood oxygen saturation Fall in diastolic blood pressure to less than 80 mmHg Fall in diastolic blood pressure to less than 60 mmHg What is the commonest route and dose for parenteral (injectable) diazepam? IM 5mg IM 10mg IV 10mg IV 5mg IM 2mg Which of the following might be considered a ‘last resort’ if all other means of rapid tranquilisation have failed? Midazolam 10mg Phenytoin sodium 20mg Amylobarbitone 250mg Fosphenytoin sodium 10-15mg Paraldehyde 5-10mg Which of the following are true for clonazepam? It has a half-life of 4-12 hours It is used as a treatment for epilepsy It has a half-life of 19-60 hours It is used as a treatment for agitation It is used in the treatment of vertigo Which of the following are factors that can affect pulse oximeter readings? Heat Tight restraint Nail varnish Diet Smoking When restraining an acutely disturbed patient which of the following must you try to avoid? Restraining in the prone position Checking the patient’s circulation Same-sex staffing Talking to the patient Restraining on the floor Which of the following are advantages of zuclopenthixol acetate (acuphase) compared to conventional intramuscular medication according to Fitzgerald (1999)? Less muscle injury Replacement of rapid tranquilisation Less physical injury Less psychological trauma Speeds up the antipsychotic effect In Pilowsky et al’s (1992) survey of 102 incidents of rapid tranquilisation how many cases reported cardiovascular or respiratory complications? 2 4 6 8 10 Which of the following are factors that can affect choice of drug used for rapid tranquilisation? Sex differences Physical health state Interactions with other prescribed medication Capacity and willingness History of extrapyramidal symptoms Which of the following pairs are commonly associated? Prolonged QTc interval and torsade de pointes Neuroleptic malignant syndrome and treatment with promethazine Antipsychotic medication and respiratory depression Prolonged QTc interval and antipsychotic medication Torsade de pointes and sudden death Which of the following are factors that minimise the need for rapid tranquilisation? Low staffing levels Anticipating violence Forcing medication De-escalation Loading …
