bipolar and schizophrenia Flashcards
schiz positive sx
Presence of abnormal behaviors: delusions, hallucinations, disorganized thinking
or speech, grossly disorganized or catatonic behavior
schiz negative sx
Absence of appropriate behaviors: blunted affect, social withdrawal, lack of
motivation or interest, speech poverty
class:
o Low potency:
§ Chlorpromazine
§ Thiordazine
o High potency:
§ Haloperidol
§ Droperidol
§ Fluphenazine
1st gen /typical antipsychotics
class:
Clozapine
o Risperidone
o Olanzapine
o Aripiprazole
o Quetiapine
o Ziprasidone
2nd gn antipsychotics
which gen of antipsychotics is more effective against hegative sx
2nd
ch gen of antipsycothics is more liekly to have metabjolic abnormalities like metabolic syndrome
2nd
which antispychotics come in long acting IM?
haloperidol, fluphenazine, risperidone, olanzapine, aripiprazole
MOA:
o Block D2 receptors
1st gen antipsychotics
AEs:
o Non-motor effects:
§ Sedation
§ Anticholinergic effects
§ Orthostatic hypotension
EPS
1st gen antip
how to treat dystonia EPS
benztropine or diphenhydramine
how to treat akathisia
cautious reduction of dose if possible
o Beta blockers (propranolol) to treat – first line
o Benztropine (Cogentin) second line
how to treat pseudo parkinsonism EPS
cautious reduction of dose if possible
o Benztropine or amantadine daily to decrease
how to treat tardive dyskinesia EPS
change to quetiapine or clozapine if possible
main SEs of chlorpromazine
very sedating, blood dycrasias (agranulocytosis)
main SE of thiordazine
sedation
thiordazine BBW
PRO-ARRHYTHMIC EFFECTS (QT PROLONGATION)
AEs: marked EPS, hyperprolactinemia, sedation, anxiety, weight gain, milder antimuscarinic, QT prolongation
haloperidol
give what w/ haldol to prevent EPS
benztropine or diphenhydramine
haldol cautions
Use extreme caution in patient w/ possible electrolyte abnormality
§ Avoid in any withdrawal or seizure history
§ Beer’s List – continuous EKG monitoring and cut dose by half
main 2nd gen SEs
Glucose dysregulation
o Dyslipidemia
clozapine BBW
BBW: agranulocytosis (neutropenia) à monitor CBC every week, orthostatic
hypotension, cardiomyopathy, seizures
which 2nd gen AP has lowest risk for EPS?
clozapine
AEs:
§ Sedation, weight gain, metabolic syndrome (worst of all SGAs)
§ Low risk of EPS and hyperprolactinemia
olanzapine
olanzapine DI
cipro (will raise concentrations)
worst AP for metabolic syndrome
olanzapine
which APs have lowest risk of metabolic syndrome?
aripiprazole, ziprasidone
tell pt to take quetiapine when?
at night due to sedation
qutiapine main SEs
sedation, prolonged QT
ziprasidone main SEs
seizures,, SJS and DRESS
pt counseling for lurasidone
Take w/ at least 350 calories for maximum absorption
tx for acute manic episode
Mood stabilizers (lithium OR valproic acid) AND a second-generation antipsychotic
tx for more manic pts
Mood stabilize w/ lithium OR anticonvulsants (valproic acid)
tx for more depressed pts
First line: quetiapine or lurasidone
o Second line: cariparzine, olanzapine-fluoxetine
1st line for bipolar 1
lithium
lithium consieraions
renal elimination - anything altering GFR will alter clearance of Lithium
Narrow therapeutic index
§ Should only prescribe if you have ability to monitor serum levels
§ Dosed in micrograms
o AEs:
§ Rash/psoriasis – discontinue
§ Tremor – reduce dose, add BB
§ CNS toxicity (agitation/confusion) – reduce dose
§ GI (N/V/D) – reduce dose, try XR, split dose, take w/ food
§ Hypothyroidism – discontinue, or initiate levothyroxine
§ Polydipsia/polyuria (nephrogenic diabetes insipidus) – reduce dose, manage fluid intake,
try amiloride or HCTZ (will lithium levels, decrease dose by 30-50%)
§ Interstitial fibrosis/glomerulosclerosis – keep dose at lowest effective concentrations,
avoid dehydration
§ Teratogenicity – avoid during 1st trimester if possible
lithium
lithium monitoring
EKG if pre-existing cardiac dz or >40
§ CBC, BMP (renal function, electrolytes), dematologic exams
lithium DIs
Thiazide diuretics, furosemide, NSAIDs, ACEI - lithium, avoid use to reduce toxicity
§ Theophylline - ¯lithium concentration
§ Neuromuscular blockers – lithium prolongs action
§ Neuroleptics – lithium may potentiate EPS
§ Carbamazepine – increase CNS toxicity
other potential 1st line med for bipolar 1
valproic acid
main SEs of VPA
thrombocytopenia
Hepatotoxicity – hepatic necrosis
* Severe pancreatitis
o AEs:
§ Common:
* Drowsiness, dizziness, ataxia, lethargy, confusion, GI upset
* Hyponatremia (may induce SIADH)
* Hepatotoxicity
§ Mildly toxic levels:
* Diplopia, dysarthria
§ Rare, serious
* Agranulocytosis, aplastic anemia
§ BBW: TEN, SJS – related to HLAB1502
carbamazepine
how long to see if bipolar meds work?
2 wks
