Drugs - Psych

Question 1

Lithium Adverse Reactions?

Answer 1

Common:

• N/V/D
• edema
• polyuria
• polydipsia
• fatigue
• ↑WBC
• alopecia
• acne
• psoriasis
• hypothyroidism
• hyperparathyroidism
• ↑Ca++ >2.85
• ↑SCr
• ↑K+
• tremor (propanolol can help, or may be sign of toxicity & need to reduce dose)
• weight gain (25-60%, mean ↑ of 7.5kg).

Question 2

Lithium Contraindications?

Answer 2

usually avoid in renal impairment due to ↑ risk of toxicity.

Caution:

• CVD
• pregnancy (1st trimester CV malformations ~2.5%)
• breastfeeding - ↑risk if infant dehydrated

Question 3

What drugs increase Lithium Levels?

Answer 3

↑lithium level:

• ACEIs
• ARBs
• CBZ
• CCBs
• diuretics
• fluoxetine
• metronidazole
• NSAIDs (not low-dose ASA)
• sodium depletion
• spironolactone

Question 4

What drugs decrease Lithium Levels?

Answer 4

↓lithium level:

• caffeine
• metamucil
• NaCl
• theophylline
• topiramate

Maintain a consistent salt (Na+) diet and adequate fluid intake!

Question 5

Lithium Theraputic Range?

Question 6

Anitpsychotic Drug Side Effects?

Answer 6

iSHADE

• Impotance
• Sedation, Seizures
• Hypotension
• Akathisia
• Dermatologic effects
• Extrapyramidal Symptoms

Question 7

Side effects of:

Risperidone

Clozapine

Olanzapine

Aripirpazole

Answer 7

• Resperidone: restlessness (increased motor activity)
• Clozapine: closes cell productions (agranulocytosis)
• Olanzapine: makes you fat like an O (weight gain) - most of all atypicals
• Clozapine, Olanzapine and Quetiapine (C, O and Q - fat alphabets)
  
  • hyperglycemia
  • weight gain
  • hypertriglyceridemia
• Aripiprazole: anxiety and insomina due to partial agonist properties

Question 8

Extrapyramidal Side Effects: Rules of 4s? for TYPICAL antipsychotic use

Answer 8

These side effects occur at the indicated times following initiation of therapy with TYPICAL antipsychotic use:

• 4 hours - Acute dystonia (Tx with anticholinergics)
• 4 days - Akinesia (Parkinson-like syndrome) Tx w/ dopamine agonists
• 4 weeks - Akathesia (inability to sit still/continuous movement/restlessness)
• 4 months - tArdive dyskinesia (often permanent)