Meds-Guidlines - 8 Flashcards by Arteen Ahmed

Agent that lowers level of ALT (Liver function)

Vigabatrin

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Agents that lowers level of ALPPPP

BuprenorPPPhine

ZolPPPPidem (rarely)

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Agents that lower level of ASTTTT?

TTTTrifluperazine

VigabaTTTTTtrin

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agent that lowers THS?

Moclobemide

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Agent that lowers thyroxine

Lithium

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antipsychotics that increase level of liver enzyme?

Haloperidol
Olan
Quetiapine
SSRIs
Clozapine

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Agents that increase TSH?

Lithium
Aripiprazole
Carbamazepine
Que
Sertraline

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what are patients on antiepliptic at high risk for?

Depression
Anxeity
Psychosis
Suicide

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link between antiepileptics and psychiatric disease is ……..!

bidirectional

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Antidepressant with low risk for epilepsy?

SSRIs
Mirtazapine
Duloxetine

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Antidepressant with high risk of epilepsy?

Bupropion
Maprotiline
TCAs

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antidepressant with moderate risk for epilepsy?

lithium
Trazadone
Venlafaxine

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antipsychotic with low risk for seizure?

amisul/sulpride
aripiprazole
ziprasidone
High potency FGA (haloperidol)

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antipsychotic with high risk for seizure?

clozapine
depots
low potency (chlorpromazine)
zotepine
loxapine

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antipsychotic with moderate risk for seizure

quetiapine
olanzapine

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stimulants with high rsk for seizure?

amfetamines

atomoxetine

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stimulants with low risk for seizure?

methylpphenidate

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How QTc is measured

The start of Q wave to T wave corrected for hear rate

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How QTc is calculated?

By Bazett’s formula

QT interval divided by the square root of the RR INTERVAL

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what QTc is very risky?

> 550

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What can QTc >550 lead to

Torsades de pointes

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Rate of sudden death in Torsade de pointes?

1 out of 10

Normal QTc in man

<440

Normal QTc in Woman

>470

Cardiac risk for QTc prolongation

Long QT syndrome Bradychardia Ischemic Heart Disease Myocarditis MI LVH

Metabolic risk of QTc Prolong.

Hypo ka, ca, mg

Other risk for QTc prolongation

Extreme exertion Stress Anorexia Extreme of age Female

Main drug class that cause QT c prolongation

Antipsychotic

A patient put on antipsychotics , QTc <440

No action unless T wave morphology changes

QTc in Male (>440) and female (>470) on anti psychotics

Consider switch & reduce dose Repeat ECG Call cardiologist

QTc >500

Stop the causitive agent switch to less problematic agent call cardiologist

Anti psychotic with high risk of QT c prolongation

Pimozide

Anti psychotic with no effect on QT c prolongation

Lurasidone

Anti psychotic with moderate risk of QT c prolongation

Haloperidol Quetiapine Chlorpromazine Ziprasidone Amisulpride

Which SSRI can prolong. QTc

Citalopram and escitalopram

Which antidepressants may prolong QTc

Tricyclics Trazadone

Antibiotics that can cause QTc prolongation

Erythromycin ampicilin

Antimalarias that can cause QTc Prolongation

Quinine Chloroquinine

Other misc. drugs that cause QTc prolongation

Tamoxifen Methadone Amantadine

Antiarrythmatics that cause qtc prolongation

Amiodarone sotalol

Rate of akathisia antipsychotic use

haloperidol 57%, risperidone 20%, aripiprazole 18%, ziprasidone 17%, olanzapine 4% and quetiapine 3.5%. (mausley)

Rx suggested to be better for patients who develop/at risk of developing akathisia

Lumateperone and pimavanserin

what is lumaterperone signficance?

less risk for akathisia

what is pimavanserin signficance?

might ameliorate haloperidol-induced akathisia

Lumateperone indications

Schizophrenia & Biplar both FDA approved

mechanism of action of lumateperone

potent antagonist at serotonin 5-HT2A receptors partial agonist at dopamine presynaptic D2 receptors antagonist at dopamine postsynaptic D2 receptors

antagonist at serotonin 5-HT2A receptors

improve sleep, treat depression, and have antipsychotic properties

How lumateperone compares to other antipsychotics

Lumateperone's occupancy of dopamine D2 receptors at its effective doses Lower risk of movement disorders and hyperprolactinemia

what is so especial about pimavanserin?

first antipsychotic drug that shows selectivity for serotonin 5-HT2 receptors (5-HT2Rs) & lacks affinity for dopamine D2 receptors (D2Rs)

Pimavanserin Comparison to other antipsychotics: Quetiapine

more effective better tolerance

which antipsychotic should be avoided in cognitive impairmed (like Parkison's dementia)

Quetiapine

Pimavanserin Comparison to other antipsychotics: Onalzapine

More effective Better choice

Pimavanserin Comparison to other antipsychotics: Clozapine

similar efficacy in psychosis less somnolence