Antipsychotics/Lithium- 2 Flashcards
ADEs of Clozapine or Haloperidol?
- Sedation: +
- EPS: ++++
- Anticholinergic: +
- Orthostasis: +
- Weight gain: +
- Prolactin: +++
Haloperidol
(opposite effects as Clozapine)
ADEs of Clozapine or Haloperidol?
- Sedation: ++++
- EPS: +
- Anticholinergic: ++++
- Orthostasis: ++++
- Weight gain: ++++
- Prolactin: +
Clozapine
(opposite effects as Haloperidol)
What is the main thing Risperidone causes an increase in?
B/c of this, what might you see on physical exam?
Increase in Prolactin
Galactorrhea
T/F: the following side effects are for ALL antipsychotic medicaitons:
Akathisia, Anticholinergic, Glucose intolerance, Hyperlipidemia, Orthostatic hypotension, Hyperprolactinemia, Sedation, Sexual dysfunction, Tardive dyskinesia, Weight gain
True
Which antipsychotic has agranulocytosis?
Clozapine
Which medication has Sialorrhea (excess drooling) as a side effect?
Clozapine
Which antipsychotic has the following adverse effects:
- Bronchospasm
- Respiratory distress
- Respiratory depression
4. Respiratory arrest
Inhaled loxapine
(Can only be administered in approved healthcare facilities registered in REMS program)
Which antipsychotic has post injection sedation/delerium syndrome?
Long-acting olanzapine pamoate monohydrate
What are 5 examples of dose-dependent extrapyramidal effects caused by antipsychotics?
Parkinson like syndrome:
- Bradykinesia, rigidity, tremor
- Akathsia, dystonias
What are the 5 treatment options for dose-dependent extrapyramidal effects (parkinson-like syndrome) caused by antipsychotics?
(“BAD AB”)
- Antimuscarinics (Benztropine, Trihexyphenidyl)
- Antihistaminic (Diphenhydramine)
- Dopamine Agonist (Amantadine)
- Benzos (Lorazepam, Diazepam, Clonazepam)
- B-blockers (Propanolol)
What are the two toxicities of antipsychotics?
- Dose-dependent extrapyramidal effects
- Tardive dyskinesias (may appear as early as 6mo, usually years)
What is the treatment goal for schizophrenia in the first 7 days?
Decreased agitation, hostility, anxiety and aggression
Normalization of sleep and eating
What is the treatment goal for schizophrenia during weeks 2 and 3?
Improve socialization, self-care and mood
What is the goal of maintenance therapy for Schizophrenia?
Avoidance of relapses
Schizophrenia maintenance therapy:
How long should you continue medication after remission of the first psychotic episode?
at least 12 months
(many experts recommend tx for at least 5 years)
Schizophrenia maintenace therapy:
Which group of meds should be tapered slowly before discontinuation to avoid cholinergic rebound?
Antipsychotics (especially FGAs and clozapine)
Schizophrenia maintenance therapy:
What should you do when switching from one antipsychotic to another?
the first should be tapered and discontinued over at least 1 to 2 weeks while the second antipsychotic is initiated and tapered upward
The following meds are used for what?
- Lithium
- Valproate
- Carbamazepine
- Aripiprazole
- etc
Acute mania treatment in Bipolar disorder
What are the 4 meds used as maintenance treatment for Bipolar disorder?
- Lithium
- Aripirazole
- Olanzepine
- Lamotrigine
(LOLA has bipolar disorder)
What 2 meds are used to tx bipolar depression?
- Quetiapine
- Lurasidone
Bipolar Disorder treatment:
Which two groups of meds may need to be included during initiation because of the slow onset of lithium or valproic acid?
Antipsychotics and benzos
What can precipitate mania in bipolar patients?
(KNOW)
Monotherapy with antidepressants
______ appears to preserve or increase the volume of brain structures involved in emotional regulation such as the prefrontal cortex, hippocampus and amygdala, possibly reflecting its neuroprotective effects.
Lithium
At a neuronal level, lithium reduces ______ but increases _______
At a neuronal level, lithium reduces excitatory (dopamine and glutamate)** but increases **inhibitory (GABA) neurotransmission
T/F: Lithium has a narrow margin of safety
True
Lithium is excreted virtually entirely how?
in the urine
Toxicities associated with lithium are seen when there is too low of what?
sodium
What needs to be closely controlled when prescribing lithium?
sodium
Does therapy with Lithium make sense in a high performing atheletes?
No because can’t maintain the sodium
Does litihium cause sedation?
no
Clearance of Lithium is decreased by taking what 2 medications?
Thiazides and NSAIDs
What is the first sign of lithium toxicity?
tremor
What are the 4 toxicities of Lithium?
- Tremor (1st sign of toxicity)
- Edema
- Hypothyroidism
- Renal dysfunction
Lithium is a pregnancy category _____
D
Where can Lithium substitute for sodium?
In proximal tubule cells and principal cells of the collecting duct in kidney cells
- Lithium inhibits GSK-3 leading to increased ______expression and PGE2 synthesis.
- This results in diminished _______ activity and decreased AQP2 levels on apical membrane of principal cells, which leads to increased _______.
- Lithium inhibits GSK-3 leading to increased COX-2 expression and PGE2 synthesis.
- This results in diminished Vasopressin activity and decreased AQP2 levels on apical membrane of principal cells, which leads to increased Urination
(This is Lithium induced nephrogenic diabetes insipidis)
How do you treat an acute hypomania episode in a patient with bipolar disorder?
- optimize current mood stabilizer or initiate one (Lithium, Valproate, Carbamazepine or SGAs)
- +/- Benzos for short term tx of agitation or insomnia
How do you treat an acute manic episode in a person with bipolar disorder? (3)
2-3 drug combo (Lithium, valproate, or SGA)
+
Benzo (Lorazepam or clonazepam)
+/- antipsychotic (short term for agitation/insomnia)x
What are the 5 general guidelines for treatment of acute manic or mixed episodes in a patient with bipolar I disorder?
- Assess for secondary cuases of mania or mixed states (ex: alcohol, drugs)
- Discontinue antidepressants
- Taper off stimulants and caffeine if possible
- Treat substance abuse
- Encourage good nutrition, exercise, sleep, stress reduction, etc
What are the 4 general guidelines for treatment of an acute depressive episode in a patient with bipolar I disorder?
- Assess for secondary causes of depression (ex: alcohol, drugs)
- Taper off antipsychotics, benzos or sedative hypnotic agents if possible
- Treat substance abuse
- Encourage good nurtition, exercise, sleep, etc
How do you treat a severe depressive episode in a patient with Bipolar I disorder
- Optimize current mood stabilizer or initiate mood-stabilizing med (lithium or quetiapine or lurasidone)
- If psychosis: initiate antispychotic
*do not combine antipsychotics*
