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P2 E2 Shea > Antipsychotics/Lithium- 2 > Flashcards

Antipsychotics/Lithium- 2 Flashcards

1
Q

ADEs of Clozapine or Haloperidol?

  • Sedation: +
  • EPS: ++++
  • Anticholinergic: +
  • Orthostasis: +
  • Weight gain: +
  • Prolactin: +++
A

Haloperidol

(opposite effects as Clozapine)

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2
Q

ADEs of Clozapine or Haloperidol?

  • Sedation: ++++
  • EPS: +
  • Anticholinergic: ++++
  • Orthostasis: ++++
  • Weight gain: ++++
  • Prolactin: +
A

Clozapine

(opposite effects as Haloperidol)

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3
Q

What is the main thing Risperidone causes an increase in?

B/c of this, what might you see on physical exam?

A

Increase in Prolactin

Galactorrhea

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4
Q

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

A

True

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5
Q

Which antipsychotic has agranulocytosis?

A

Clozapine

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6
Q

Which medication has Sialorrhea (excess drooling) as a side effect?

A

Clozapine

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7
Q

Which antipsychotic has the following adverse effects:

  1. Bronchospasm
  2. Respiratory distress
  3. Respiratory depression

4. Respiratory arrest

A

Inhaled loxapine

(Can only be administered in approved healthcare facilities registered in REMS program)

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8
Q

Which antipsychotic has post injection sedation/delerium syndrome?

A

Long-acting olanzapine pamoate monohydrate

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9
Q

What are 5 examples of dose-dependent extrapyramidal effects caused by antipsychotics?

A

Parkinson like syndrome:

  • Bradykinesia, rigidity, tremor
  • Akathsia, dystonias
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10
Q

What are the 5 treatment options for dose-dependent extrapyramidal effects (parkinson-like syndrome) caused by antipsychotics?

(“BAD AB”)

A
  1. Antimuscarinics (Benztropine, Trihexyphenidyl)
  2. Antihistaminic (Diphenhydramine)
  3. Dopamine Agonist (Amantadine)
  4. Benzos (Lorazepam, Diazepam, Clonazepam)
  5. B-blockers (Propanolol)
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11
Q

What are the two toxicities of antipsychotics?

A
  1. Dose-dependent extrapyramidal effects
  2. Tardive dyskinesias (may appear as early as 6mo, usually years)
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12
Q

What is the treatment goal for schizophrenia in the first 7 days?

A

Decreased agitation, hostility, anxiety and aggression

Normalization of sleep and eating

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13
Q

What is the treatment goal for schizophrenia during weeks 2 and 3?

A

Improve socialization, self-care and mood

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14
Q

What is the goal of maintenance therapy for Schizophrenia?

A

Avoidance of relapses

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15
Q

Schizophrenia maintenance therapy:

How long should you continue medication after remission of the first psychotic episode?

A

at least 12 months

(many experts recommend tx for at least 5 years)

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16
Q

Schizophrenia maintenace therapy:

Which group of meds should be tapered slowly before discontinuation to avoid cholinergic rebound?

A

Antipsychotics (especially FGAs and clozapine)

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17
Q

Schizophrenia maintenance therapy:

What should you do when switching from one antipsychotic to another?

A

the first should be tapered and discontinued over at least 1 to 2 weeks while the second antipsychotic is initiated and tapered upward

18
Q

The following meds are used for what?

  • Lithium
  • Valproate
  • Carbamazepine
  • Aripiprazole
  • etc
A

Acute mania treatment in Bipolar disorder

19
Q

What are the 4 meds used as maintenance treatment for Bipolar disorder?

A
  1. Lithium
  2. Aripirazole
  3. Olanzepine
  4. Lamotrigine

(LOLA has bipolar disorder)

20
Q

What 2 meds are used to tx bipolar depression?

A
  1. Quetiapine
  2. Lurasidone
21
Q

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?

A

Antipsychotics and benzos

22
Q

What can precipitate mania in bipolar patients?

(KNOW)

A

Monotherapy with antidepressants

23
Q

______ 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.

A

Lithium

24
Q

At a neuronal level, lithium reduces ______ but increases _______

A

At a neuronal level, lithium reduces excitatory (dopamine and glutamate)** but increases **inhibitory (GABA) neurotransmission

25
Q

T/F: Lithium has a narrow margin of safety

A

True

26
Q

Lithium is excreted virtually entirely how?

A

in the urine

27
Q

Toxicities associated with lithium are seen when there is too low of what?

A

sodium

28
Q

What needs to be closely controlled when prescribing lithium?

A

sodium

29
Q

Does therapy with Lithium make sense in a high performing atheletes?

A

No because can’t maintain the sodium

30
Q

Does litihium cause sedation?

A

no

31
Q

Clearance of Lithium is decreased by taking what 2 medications?

A

Thiazides and NSAIDs

32
Q

What is the first sign of lithium toxicity?

A

tremor

33
Q

What are the 4 toxicities of Lithium?

A
  1. Tremor (1st sign of toxicity)
  2. Edema
  3. Hypothyroidism
  4. Renal dysfunction
34
Q

Lithium is a pregnancy category _____

A

D

35
Q

Where can Lithium substitute for sodium?

A

In proximal tubule cells and principal cells of the collecting duct in kidney cells

36
Q
  • 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 _______.
A
  • 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)

37
Q

How do you treat an acute hypomania episode in a patient with bipolar disorder?

A
  1. optimize current mood stabilizer or initiate one (Lithium, Valproate, Carbamazepine or SGAs)
  2. +/- Benzos for short term tx of agitation or insomnia
38
Q

How do you treat an acute manic episode in a person with bipolar disorder? (3)

A

2-3 drug combo (Lithium, valproate, or SGA)

+

Benzo (Lorazepam or clonazepam)

+/- antipsychotic (short term for agitation/insomnia)x

39
Q

What are the 5 general guidelines for treatment of acute manic or mixed episodes in a patient with bipolar I disorder?

A
  1. Assess for secondary cuases of mania or mixed states (ex: alcohol, drugs)
  2. Discontinue antidepressants
  3. Taper off stimulants and caffeine if possible
  4. Treat substance abuse
  5. Encourage good nutrition, exercise, sleep, stress reduction, etc
40
Q

What are the 4 general guidelines for treatment of an acute depressive episode in a patient with bipolar I disorder?

A
  1. Assess for secondary causes of depression (ex: alcohol, drugs)
  2. Taper off antipsychotics, benzos or sedative hypnotic agents if possible
  3. Treat substance abuse
  4. Encourage good nurtition, exercise, sleep, etc
41
Q

How do you treat a severe depressive episode in a patient with Bipolar I disorder

A
  • Optimize current mood stabilizer or initiate mood-stabilizing med (lithium or quetiapine or lurasidone)
  • If psychosis: initiate antispychotic

*do not combine antipsychotics*

P2 E2 Shea (19 decks)

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