Antipsychotics/Mood Stabilizers Flashcards
What FDA approved anti-bipolar drugs can be used as adjunct therapy?
ziprasidone
quetiapine
quietiapine XR
What bipolar drugs can also be used for treatment of depression?
seroquel XR
one other…
33 y/o with one episode of mania and no other PMH (no depression). What drug would you treat her with?
lithium
What is the DOC for mania associated with bipolar disorder?
lithium
What three tests do you need to do prior to starting lithium?
pregnancy test
serum creatinine
TSH
What is the average dose of lithium?
300 mg bid
What is a common AE of lithium that many complain of?
GI irritation including diarrhea
-have them drink adequate fluid, leave at current dose to see if symptoms resolve
What would you treat someone with who has had multiple manic/depressive (5/7 a year) episodes with an ETOH abuse problem?
depakote would be a good choice given his h/o ETOH abuse (he is also a rapid cycler)
start at 250 bid and titrate to 500
You’ve started a pt on depakote and you see a rise in their liver enzymes….what do you do?
nothing yet
-don’t change the dose until the LFT levels have at least tripled in value from their baseline
What is trichotillomania?
pulling out hair
can treat with antipsychotics
What is the MOA of typical antipsychotics?
D2 dopamine receptor antagonists
D2 dopatine receptor antagonists have a high risk of _________________
extrapyramidal side effects
What are the D2 dopamine receptor antagonists (high potency)?
fluohenazine
haloperidol
pimozide
What are the low potency typical antipsychotics?
chlorpromaine
thioridazine
What are the AE of low potency typical antipsychotics
sedation
hypotension
What are the D2 dopamine receptor antagonists?
fluhenazine halperidol* pimozide chlorpromaine* thioridazine *most commonly used
What is the MOA of the atypical antipsychotics?
serotonin-dopamine 2 antagonists DSAs
they block both receptors
What kind of drug is risperidone?
atypical D2 receptor antagonists
acts as typical at high doses
Risperidone is the most likely atypical to induce ________________
hyperprolactinemia
*know this
What are the common AE of risperidone?
weight gain
sedation
(dose dependent)
Risperidone acts as a typical antipsychotic at doses greater than ___________
6mg
Those on olanzapine or seroquel may see rises in what lab values?
hypertriglyceridemia
hypercholesterolemia
hyperglycemia
____________ may cause transaminitis
olanzapine
seroquel
What drug is most likely to cause orthostatic hypotension
seroquel
What EKG change may you see with ziprasidone?
QT prolongation
Is ziprasidone associated with weight gain?
nope
What is the MOA of aripiprazole?
its a D2 partial agonists
What drug interacts with CYP2D6 and 3A4?
aripiprazole
What drug is associated with agranulocytosis?
clozapine
*last resort drug
How often do you draw blood when taking clozapine?
every 2 weeks for 6 months
What dont you want to combine with clozapine?
lithium
What antipsychotic drug has the highest incidence of sedation, weight gain and transaminitis?
clozapine
How do you administer iloperidone?
titate over 4 days to avoid orthostatic hypotension
What two receptors does iloperidone interact with?
3A4 (ketoconazole)
2D6 (fluozetine)
Does iloperidone cause EKG changes?
yes
QT prolongation
In what form does asenapine come in?
sublingual (no food or liquid for 10 minutes)
What does asenapine inhibit?
CYP1A2
anything to do with the liver
How must you administer latuda?
with food >350 kcal
Most antipsychotics interact with what receptor?
CYP 3A4
What is neuroleptic malignant syndrome?
severe muscle rigidity, fever, AMS, autonomic instability, elevated WBC, CPK and LFTs-potentially fatal
What are the extrapyramidal side effects?
acute dystonia
parkinson syndrome
akathisia
What is tardive dyskinesia?
involuntary muscle movements
a common AE of antipsychotics
What are some agents used to combat extrapyramidal side effects?
anticholinergics
dopamine facilitators
beta blockers
What baseline blood work should you get before starting an antipsychotic?
lipids
glucose
LFT
CBC
What antipsychotic drug would you treat a person with that had a poor lipid panel?
risperidone
ziprasidone
aripiprazole
What is a person experiencing when they say they feel “uncomfortable” in their skin while taking an antipsychotic?
akathisia
*lower the dose or give a beta blocker or anticholinergic
In anxiety disorders you often give what kinds of drugs along with anxiolytics?
SSRIs
SNRIs
With what can you treat insomnias and parasomnias?
anxiolytics
MOA of buspirone
serotonin agonists
5HT1A
What is a con of buspirone?
will not reduce anxiety in pts that are used to taking BZDs because there is no sedation effect to buspirone
What disorders do you treat with benzos?
insomnia
parasomnias
anxiety
What kind of drug is commonly used for someone going through ETOH w/d?
benzodiazapines
What is a major con of using benzos?
dependence
