Medication Information

Question 1

D2 partial agonist

Answer 1

• Improved positive and negative sx.
• EPS, prolactin changes.

Question 2

5HT1A partial agonist

Answer 2

• Improved negative sx. Improved anxiety.

Question 3

5HT2A antagonist

Answer 3

• Reduced negative sx.
• Sexual dysfxn.
• Reduced EPS.

Question 4

Alpha 1 adrenergic antagonist

Answer 4

• Postural hypotension, dizziness, reflex tachycardia.

Question 5

H1 antagonist

Answer 5

• Sedation, increased appetite, weight gain, postural hypotension.

Question 6

M1 muscarinic antagonist

Answer 6

• Minimal impact on burred vision, dry mouth, constipation, urinary retention, sinus tachy.

Question 7

Clozapine black box warnings

Answer 7

• Agranulocytosis.
• Myocarditis (highest risk in first 4 weeks, considering monitoring CRP).
• Seizures.
• Orthostatic hypotension (with syncope or cardiac arrest).
• Increased mortality in elderly pts w/ dementia related psychosis.

Question 8

New onset neuro Sx in a pt on DVP

Answer 8

Think hyperammonemic enchephalopathy

Question 9

Risk factors for NMS

Answer 9

• Initial stages or with a dose change
• IV/IM formulation
• Restrained/dehydrated pt
• High ambient temp
• Older age
• Other medical/psych comorbidities
• Hx of NMS (personal, fhx), hx of catatonia

Question 10

Carbamazapine - heme side effect

Answer 10

Leukopenia

Question 11

Li - endo side effects

Answer 11

Hypothyroid
Hyperparathyroid

Question 12

Li - renal side effects

Answer 12

• Chronic tublointerstitial nephropathy
• ATN
• NDI
• Polyuria
• Decreased GFR and CKD (increased risk with + daily dosing, concurrent NSAID/ARB/ACEi/diuretic use, other medical illness, older age, Li toxicity)

Question 13

TENS/SJS

Answer 13

• Most associated with lamotrigine
• Can also occur with DVP and carbamazepine but the risk is lower

Question 14

Li - derm side effects

Answer 14

• Acne
• Psoriasis
• Hair loss
• Nail dystrophy
• Hydradenitis suppurtiva
• Mucosal lesions

Question 15

Li monitoring

Answer 15

• TSH, parathyroid, Ca, renal fxn
• 6 mo and annually

Question 16

Li serum levels

Answer 16

• Acute: 0.8-1.2 for adults, 0.4-0.8 for geri
• Maintenance: 0.6-1
• Check 5 days after last dose titration

Question 17

DVP monitoring

Answer 17

• Menstrual hx
• Hematology, LFT
• q3-6 mo for first year, then annually

Question 18

Carbamazepine monitoring

Answer 18

• Annual Na
• Skin rash

Question 19

Lamotrigine monitoring

Answer 19

Skin rash

Question 20

AP monitoring

Answer 20

• Weigh monthly x3 mo, then q3mo//BMI after a month, at 3 months, then yearly
• BP, FG, lipid panel, HBA1c at 3 mo then annually (can do BP, FG, lipid panel after 1 mo as clinically indicated)
• EPS one month after starting, 3 months, then annually
• Endocrine fxn history at 3 mo then annually
• Lytes, Cr, LFTs, TSH as clinically indicated
• Prolactin at any time if clinically indicated
• ECG for QTc basically at clinical discretion (if on multiple QTc-prolonging meds or indication)

Question 21

Fracture risk and osteoporosis

Answer 21

• All AP, AD, and mood stabilizers decrease BMD
• Screening may be indicated

Question 22

Li and DVP - neuro side effect

Answer 22

• Tremor (10%)
• If the tremor is coarse, worry that the pt is toxic

Question 23

Li toxicity

Answer 23

• Mild: N/V, tremor, hyperreflexia, agitation, weakness, ataxia, dysarthria
• Moderate: stupor, rigidity, hypertonia, hypotension
• Severe: myoclonus, CV collapse, seizure, coma

Cardinal signs: N/V/D, dizziness, coarse tremor, dysarthria, ataxia, hyperreflexia

Question 24

Valproate s/e

Answer 24

• Sedation
• Weight gain
• GI upset
• Tremor
• Decreased plt
• Rare: hepatotoxicity, pancreatitis, encephalopathy (hyperammonemic)

Question 25

Li s/e

Answer 25

- Polyuria, polydipsia - Decreased thyroid fxn - Alteration in salt/fluid balance - Derm: acne, psoriasis, nail changes, hair loss, mucosal lesions - Tremor