ANTIPSYCHOTIC Flashcards
MANAGEMENT
HYPOTENSION
1-2 L Normal Saline Bolus
REFRACTORY HYPOTENSION
Norepinephrine:
0.05 - 0.5 ug / kg / min ~ (0.1-0.3 most common), if BP in boots (SBP 70 start at 0.3)
titrate by 0.02 μg/kg/minute every 5 minutes
OR
5 - 20 ug / min
QRS WIDENING (>100 ms) OR R WAVE AMPLITUDE aVR (>3 mm)
Sodium Bicarbonate Bolus: 8.4% 1-2 mEq / kg IV, repeat dose until QRS narrows
Sodium Bicarbonate infusion 150 mEq (3 amps in 1 L 5% dextrose in water) at 1.5-2× maintenance
QTc PROLONGATION (>500 ms)
Magnesium 2 g IV
Optimise Potassium
DYSTONIA
Diphenhydramine
50 mg intramuscular (IM)/IV/PO
Benztropine
1-2 mg IV/IM/PO q8-12h in adults
NEUROLEPTIC MALIGNANT SYNDROME
Discontinue all antipsychotics
Active Cooling
Muscle Rigidity: 1-2 mg lorazepam IV
Adjunct therapy (consultation with toxicologist/poison control center).
Bromocriptine 2.5 mg orally (PO) q6-8h titrated to maximum of 40 mg per d
Dantrolene 2.5 mg/kg IV q5-15 min, with a maximum cumulative dose of 10 mg/kg (used with variable efficacy, but not Food and Drug Administration-approved for neuroleptic malignant syndrome).
SEVERE AGGITATION
Lorazepam 1-2 mg IV
SEIZURE
Lorazepam (Ativan): 2-4 mg (0.01-0.03 mg / kg IV or IM, max 0.1 mg / kg or 8 mg)
Repeat up to 3 times total
REFRACTORY SEIZURES
DO NOT LOAD WITH PHENYTOIN
KEPPRA: 40-60 mg / kg IV loading dose at a rate of 5-15 min), max 2000-4000 mg IV load
INVESTIGATIONS
blood gas
comprehensive metabolic panel, complete blood count
creatine kinase
ECG
MONITORING
> 6 hours
CP Monitoring
CNS depression
Tachycardia
Extrapyrimidal Symptoms
QTc prolongation
Neuroleptic Malignant Syndrome: hyperthermia, lead pipe rigidity, AMS, autononic instability
DOCUMENTATION
CLINICAL FEATURES
CNS depression
Tachycardia
Extrapyrimidal Symptoms
QTc prolongation
Neuroleptic Malignant Syndrome: hyperthermia, lead pipe rigidity, AMS, autononic instability
PHYSICAL EXAM
Temperature
Heart Rate
Blood Pressure
GCS
Pupils
Spasticity / Rigidity
Reflexes
Babinsky
ECG:
QTc interval > 480
