Chapter 4 Pharm: Mood Stabilizing Agents + Antipsychotics Flashcards
Mood stabilizing agents: Indications
Ind: Prevention and treatment of manic episodes associated with bipolar disorder
Examples: Lithium. Anticonvulsant meds, and second-gen atypical antipsychotics
Mood stabilizing agents: Lithium
Gold standard for mood stabilization
Never take if pregnant
Never take long term
Know this med! Definitely will be on the Kaplan
Mood stabilizing agents: action of Lithium
Lithium is thought to modulate the effects of norepinephrine, serotonin, dopamine, glutamate, and GABA, which may contribute to the symptoms of bipolar
The role of anticonvulsants, verapamil, and antipsychotics in the treatment of bipolar mania is not fully understood.
Mood stabilizing agents: interactions w/ Lithium & one contraindication
Because lithium is an imperfect substitute for sodium, anything that depletes sodium will make more receptor sites available to lithium and increase the risk for lithium toxicity
Therefore, sweating can cause lithium toxicity. Stay consistent + talk with doctor if training etc.
Avoid with kidney damage
Mood stabilizing agents: Planning & implementation. Lithium’s therapeutic ranges?
Lithium toxicity is very possible
Ranges:
1. 1.0 - 1.5 mEq/L (acute mania)
2. 0.6 - 1.2 mEq/L (maintenance)
MUST have periodic blood level monitoring
Mood stabilizing agents: Lithium toxicity
Initial symptoms: Feeling sick. Blurred vision, tinnitus, nausea & vomiting, severe diarrhea
Escalates to: Tremors, sedation, confusion, delirium, seizures, coma, cardio collapse, death
Many providers now choose to prescribe___ or ___ ___ as first line treatment instead of lithium
Anticonvulsants or Atypical antipsychotics
Antipsychotics: Indications
Used for the treatment of schizophrenia and other psychotic disorders: selected agents are also used in the treatment of intractable hiccoughs, and for control of tics and vocal utterances in Tourette’s disorder.
— Basically: they help decrease psychosis
Antipsychotics: Action of typical antipsychotics (1st generation — FGA)
Blocks dopamine receptors
These are the older types of antipsychotics
They work well, but they’re sedating
Antipsychotics: Action of atypical antipsychotics (second generation — SGA)
More metabolic disorders like diabetes occur with these meds
Weaker dopamine receptor antagonists than typicals
Potent antagonists of serotonin receptors
Some antagonism for cholinergic, adrenergic, histaminic receptors.
Antipsychotics: Contraindicated
In hypersensitive, comatose, or severely depressed patients
Elderly patients with dementia related psychosis
Certain meds for Hist of QT prolongation and other heart issues
Antipsychotics: Caution
With elderly or debilitated patients
Patients with cardiac, hepatic, or renal insufficiency
Pts with history of seizures, diabetes, temperature extremes, hypotension, pregnant people, or children
Antipsychotics: Are they addictive?
No. But it can take years to find the right med for the client.
Antipsychotics: Clozapine (Clozaril) details
Good for suicidal pts
Used for “the sickest”
S/E that causes death via a drop in neutrophil count. Needs constant blood monitoring, for in and out patient. Very rare but can happen.
Some antipsychotics come in long-acting shot forms. Works for a month or a few months. Most are A-Typical, some typical.
Antipsychotics: List of common Typical Meds
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
Haloperidol (Haldol)
Perphenazine (Trilafon)
Thiothixene (Navane)
Antipsychotics: 4 from the long list of common ATYPICALS
Aripiprazole (Abilify)
Asenapine (Saphris)
Lloperidone (Fanapt)
Lurasidone (Latuda)
Antipsychotics: S/E… there are MANY but some to note:
Deanna: for dry mouth and eyes just get eye drops or water + ice chips
Study them over time
Nausea, GI upset, skin rash, sedation, orth. Hypotension, tardive dyskinesia
Issues in antipsychotic maintenance therapy
Clozapine (Clozaril) and agranulocytosis risk
Extrampyramidal side effects
Hormonal side effects
Extrapyramidal S/E (EPS) & what med to give to help
EPS is possible with any antipsychotic
Pseudoparkinsons’s (tremor, shuffling gait, drooling, rigidity)
Akinesia (Muscle weakness)
Dystopia and oculogyric crisis- can be life threatening (Rigid muscles)
GIVE: benztropine (oral or shot) to help reverse effects
Antipsychotics: Neuroleptic malignant syndrome
NMS: rare but life threatening complication of neuroleptic drugs. Fever is the first sign.
Symptoms: Muscle rigidity, high fever, tachycardia, Bo fluctuations, panting and sweating, stupor, coma
Antipsychotics: Tardive dyskinesia
TD can occur with long-term use of antipsychotics
Symptoms can be permanent
Abnormal involuntary movement scale (AIMS) developed to screen for TD by NIMH
Antipsychotics: Tardive dyskinesia + treatment
Traditionally treatment for TD is to stop antipsychotics immediately
FDA approved 1st med for tx of TD in 2017:
Valbenazine (Ingrezza)
Deutetrabenazine (Austedo)
These two meds are not tested on in 331
