Midterm Exam Study Guide Flashcards
LITHIUM
USES
- Lithium is the drug of choice for controlling acute manic episodes in patients with bipolar disorders AND for long-term prophylaxis for against recurrence for mania and/or depression. Gotta stabilize that mood fam.
- Reduced euphoria, hyperactivity, BUT does not cause sedation.
LITHIUM
DANGER
- DANGER DANGER: Because lithium is excreted by the kidneys, watch out for patients who have renal problems! If ya can’t piss it out, we in trouble.
- Dehydration will cause lithium retention , so increase fluids!
- Taking diuretics and drinking alcohol increases your serum lithium levels
LITHIUM
LEVELS
- Maintenance (What we should keep it around): 0.4 - 1.0 mEq/L
- What dose should we give: 900 to 1200 mg
- TOXICITY: Lithium levels must be kept under 1.5 mEq/L, levels above this can produce significant toxicity.
- So make sure, you gotta draw lithium blood levels to see how your body handles it!
LITHIUM
SIDE EFFECTS
- GI effects such as nausea, vomiting, abdominal bloating, and diarrhea.
- Tremor (Produce fine hand tremor)
- POLYURIA - You piss alot, like a bunch. Some patients almost 3 L a day.
- Renal Toxicity (Assess kidney function before treatment
- Goiter & Hypothyroidism
- Teratogenesis
- Use in lactation (Lithium goes into breast milk. So no no lithium guys)
- Rare chance of leukocytosis.
LITHIUM
TOXICITIES TABLE
SIDE EFFECTS OF
MOOD-STABILIZERS
(ANTI-CONVULSANTS)
- Anticonvulsant medications also are used as mood stabilizers.
- DANGER WILL ROBINSON, DANGER! Life-threatening side effect is Stevens-Johnson Syndrome (SJS), a severe rash which can affect the trunk OR mucous membranes can occur with anticonvulsants, esp. lamotrigine (Lamictal). Advance dose VERY SLOWLY:
- Patient needs regular blood draws to measure therapeutic levels. Can cause weight gain, sleepiness, N&V. May increase the risk of suicidal thoughts.
- -Hives, a rash, fever, or swollen glands.
- -Signs of Stevens-Johnson syndrome, which causes dangerous sores on the mucous membranes of the mouth, nose, genitals, and eyelids.
- -Confusion.
- -Slurred speech.
- -Nausea, vomiting, and diarrhea.
- -Trembling.
- -Increased thirst and increased need to urinate.
- -Weight gain in the first few months of use.
- -Drowsiness.
WHICH NEUROTRANSMITTERS
ARE AFFECTED BY
WHICH FAMILIES
OF ANTIDEPRESSANTS (SSRIs, SNRIs)
- SSRI’s (Guys its in the name!!) - Selective SEROTONIN reuptake inhibitors
- SNRI’s - SEROTONIN and NOREPINEPHRINE reuptake inhibitors
- NDRI’s- NOREPINEPHRINE and DOPAMINE reuptake inhibitors
- Monoamine Oxidase Inhibitors (TRICK QUESTION), it doesn’t affect a neurotransmitter directly. Monoamine oxidase is an enzyme responsible for breaking down the three (Serotonin, Norepinephrine, and Dopamine). SO by inhibiting the enzyme, we increase the levels of all three! Tho its a bad medication lol…
EPS and Metabolic Syndrome
Which drugs are they associated with
- EPS (Extrapyramidal Symptoms): rigidity, persistent muscle spasms, tremors, restlessness . Parkinsonianism is another type of EPS.
- Metabolic Syndrome: significant weight gain, increased blood sugar, increased triglycerides . This increases risk for CVD and diabetes . Some people get gynecomastia & galactorrhea. Patient’s weight, glucose levels, prolactin levels and lipid levels should be monitored regularly.
FOR ANTIPSYCHOTICS!!!
- First Gen Antipsychs: Causes EPS
- Second Gen Antipsychs: Metabolic syndrome AND a little bit of EPS as well!!
CLOZAPINE
TOXIC EFFECTS
Agranulocytosis
(Must be in registry for it) Make sure neutrophil count above 1500
LITHIUM
TOXIC EFFECTS
DEATH - GAME OVER
convulsions, oliguria.
TOXIC to kidneys and thyroid
ANTIPSYCHOTICS
TOXIC EFFECTS
all antipsychotic medications was determined, that death rates are higher for elderly people with dementia when taking this medication
FGA
FIRST GENERATION ANTIPSYCHOTICS
TOXIC LEVELS
Extrapyramidal Symtoms (EPS)-rigidity, persistent muscle spasms, tremors, restlessness
especially Tardive Dyskinesia - causes repetitive, involuntary movements, such as grimacing and eye blinking (Give Cogentin!)
SGA
SECOND GENERATION ANTIPSYCHOTICS
TOXIC LEVELS
Metabolic Syndrom: significant weight gain, increased blood sugar, increased triglycerides . This increases risk for CVD and diabetes .
Extrapyramidal Symtoms (EPS): rigidity, persistent muscle spasms, tremors, restlessness
SSRI
SELECTIVE SEROTONIC REUPTAKE INHIBITOR
TOXIC LEVELS
Celexa (Citalopram) : Can cause cardiac problems above 40 mg daily dose
ANTIDEPRESSANT
TOXIC LEVELS
Serotonin syndrome
- Agitation or restlessness
- Confusion
- Rapid heart rate and high blood pressure
- Dilated pupils
- Loss of muscle coordination or twitching muscles
- Muscle rigidity
- Heavy sweating
- Diarrhea