Meds-Guidlines - 8 Flashcards
Agent that lowers level of ALT (Liver function)
Vigabatrin
Agents that lowers level of ALPPPP
BuprenorPPPhine
ZolPPPPidem (rarely)
Agents that lower level of ASTTTT?
TTTTrifluperazine
VigabaTTTTTtrin
agent that lowers THS?
Moclobemide
Agent that lowers thyroxine
Lithium
antipsychotics that increase level of liver enzyme?
Haloperidol
Olan
Quetiapine
SSRIs
Clozapine
Agents that increase TSH?
Lithium
Aripiprazole
Carbamazepine
Que
Sertraline
what are patients on antiepliptic at high risk for?
Depression
Anxeity
Psychosis
Suicide
link between antiepileptics and psychiatric disease is ……..!
bidirectional
Antidepressant with low risk for epilepsy?
SSRIs
Mirtazapine
Duloxetine
Antidepressant with high risk of epilepsy?
Bupropion
Maprotiline
TCAs
antidepressant with moderate risk for epilepsy?
lithium
Trazadone
Venlafaxine
antipsychotic with low risk for seizure?
amisul/sulpride
aripiprazole
ziprasidone
High potency FGA (haloperidol)
antipsychotic with high risk for seizure?
clozapine
depots
low potency (chlorpromazine)
zotepine
loxapine
antipsychotic with moderate risk for seizure
quetiapine
olanzapine
stimulants with high rsk for seizure?
amfetamines
atomoxetine
stimulants with low risk for seizure?
methylpphenidate
How QTc is measured
The start of Q wave to T wave corrected for hear rate
How QTc is calculated?
By Bazett’s formula
QT interval divided by the square root of the RR INTERVAL
what QTc is very risky?
> 550
What can QTc >550 lead to
Torsades de pointes
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
