Anti Psych Flashcards
Lithium clinical indications
bipolar
what is the lithium dosing acute phase?
300mg BID/TID increase dose every 4-5days
what is the lithium concentration goal for acute phase dosing?
0.8-1 meq/L
how often do we check lithium labs until clinically stable?
2x per week
maintenance dose for lithium
900-1200mg/d
what is the maintenance lithium concentration?
0.6-0.8 meq/L
what labs should you monitor on lithium
CBC
BMP-K, Ca, Na
how do we monitor renal function on lithium?
checking BUN/CR, UA @ baseline and every 2-3mon for 6 months, then twice a year
how do we monitor TFT on lithium?
baseline
2-3mon
6 month
then 2 times a year
what RF increase lithium toxicity risks?
renal impairement
elderly
dehydration
major ADR of lithium
Nausea
Fatigue
wt gain
polyuria/dypsia
long term ADR of lithuum
CKD/ESRD
arrythmias
hypo>hyperthyroid
what drugs can you not use on lithium?
HTN drugs–loop/thiazide/spiro/ACEI/ARB
use of chlorpromazine
intractable hiccups
haloperidol formulations
oral
IV
IM–1x month
use of haloperiodol
schizophrenia
emergency sedation for agitated/delirious pts
ADR for haloperidol
hypotension sedation EPS NMS QT prolongation increase prolactin
what drug can you not use with haloperidol
PD drugs or anti-HTN or CNS depressants
what is colzapine used for?
refractory schizo
what drugs are IM that are 2nd gen anti-psychotic
risperidone
olanzapine
ariprprazole
paliperidone
what 4 2nd gen anti-psychs are depression adjunts?
olazapine
Quetiapine
Brexpiprazole
Aripiprazole
what is the BB warning for 2nd gen anti psych?
increase mortality in dementia related-psychosis and suicidality for depression
who should we specifically minimize anti-psych use in?
elderly
those w/ depression
insomnia pts
what should be monitored while on 2nd gen antipsych?
weight
lipids
A1C
BMP–K, Mg
how often should we check wt for 2nd gen anti-psych?
baseline
1x month for 3 months
then every 3 months
how often should we check lipids/A1c?
baseline
3 months
then annually
how often should we check BMP?
baseline
then in ppl @ risk for electrolyte abnormalities
ADR for all 2nd gen anti-psych?
sedation hypotension increase prolactin wt gain/DM/dyslipidemia EPS
Colzapine specific ADR
DM wt gain QT prolongation GI hypomotility myocarditis angraulocytosis
Olanzapine and Colzapine specific ADR
worse DM and wt gain drugs
iloperidone and ziprasidone specific ADR
worse QT prolongers
Asenapine specific ADR
type 1 hypersensitivity rxn
Aripiprazole specific ADR
complusive urges–gamble, sex, eating
Olanzapine and ziprasidone specific ADR
DRESS
what drugs should you not combine w/ 2nd gen anti-psych?
QT prolongers
CNS depressants
Anti-HTN
anti-cholinergic drugs
what are the 3 phases of tx for bipolar
acute
continuation
maintenance
how is acute severe mania treated?
atyp. antipsych + lithium or valproate
how is mod/mild mania treated
monotherapy of lithium, valpropate, atyp. antipsych
how is acute bipolar depression treated?
lithium
atypical antipsych
what is a maintenance therapy drug for mania
lithium
what is a maintenance therapy drug for dpression
lamotrigine
what is a maintenance therapy drug for mania + depression
lithium or VPA, CBZ, lamotrigine, atypical antipsych
what symptoms don’t go away w/ schizo tx?
negative sxs (withdrawl, loss of motivation)
what EPS are reversible?
acute dystonia
pseudoparkinsonism
akathisia
what EPS are NOT reversible
tardive dyskinesia
1st step in managing EPS
reduce dose
2nd step in managing EPS
switch anti-psych to one w/ less EPS
3rd step in managing EPS
benzotropine–1st drug to anti-psych parkinsonism
or amantaine
