Miscellaneous Psychiatric Medications

Question 1

brand name and class

generic: lithium

Answer 1

brand: eskalith, eskalith-cr, lithobid
class: antimanic (mood stabilizer)

Question 2

indication

lithium

Answer 2

bipolar disorder

Question 3

MOA

lithium

Answer 3

alters the actions of several second-messenger systems (eg, adenylate cyclase and phosphoinositol). Alters cation transport across cell membrane in nerve and muscle cells and influences reuptake of serotonin and/or norepinephrine; second-messenger systems involving the phosphatidylinositol cycle are inhibited.

Question 4

common ADRs

lithium

Answer 4

cardiac dysrhythmiasm, fine tremor, hypothyroidism, leukocytosis, thrombocytosis, xerostomia

Question 5

rare but serious ADRs

lithium

Answer 5

hypotension, nephrotoxicity, seizure, hypercalcemia, hyperparathyroidism

Question 6

key counseling points

Answer 6

• FDA-approved patient medication guide must be dispensed with this medication.
• Swallow extended-release tablets whole; do not crush or chew.
• Avoid activities requiring mental alertness or coordination until drug effects are realized. Report signs/symptoms of toxicity, including diarrhea, vomiting, tremor, ataxia, drowsiness, muscle weakness, lack of coordination, giddiness, blurred vision, tinnitus, or large volumes of dilute urine.
• Maintain adequate fluid intake and normal salt intake.

Question 7

brand name and class

generic: atomoxetine

Answer 7

brand: strattera
class: Norepinephrine reuptake inhibitor (NRI)

Question 8

indication

atomoxetine

Answer 8

ADHD

Question 9

common ADRs

atomoxetine

Answer 9

abdominal pain, headache, insomnia, loss of appetite, nausea, weight loss, xerostomia

Question 10

rare but serious ADRs

atomoxetine

Answer 10

Dyskinesia, mania, prolonged QTc interval, psychotic disorders, seizure, suicidal thoughts, sudden cardiac death, tachycardia, hepatotoxicity

Question 11

BBW

atomoxetine

Answer 11

suicidal ideation in children and adolescents

Question 12

contraindications

atomoxetine

Answer 12

• hypersensitivity
• use within 2 weeks of MAOI
• narrow angle glaucoma
• pheochromocytoma
• severe cardiovascular disorders

Question 13

key counseling points

atomoxetine

Answer 13

• Avoid activities requiring mental alertness or coordination until drug effects are realized.
• Growth rate and weight may need to be monitored more frequently in children.
• Report new or worsened psychiatric problems, chest pain, palpitations, dyspnea, or signs/symptoms of cardiac dysrhythmias, MI, or cerebrovascular accident.
• Do not open capsules as atomoxetine is an ocular irritant.

Question 14

brand name and class

generic: buspirone

Answer 14

brand: buspar
class: antianxiety

Question 15

indication

buspar

Answer 15

anxiety

Question 16

MOA

buspar

Answer 16

selective serotonin-5-HT1A receptor partial agonists

Question 17

common ADRs

buspar

Answer 17

drowsiness, dizziness

Question 18

rare but serious ADRs

buspar

Answer 18

mania, psychiatric disorder

Question 19

key couseling points

Answer 19

• Patient should avoid activities requiring mental alertness or coordination until drug effects are realized.
• Advise patient that symptomatic improvement may not be seen for a few weeks.
• Advise patient against sudden discontinuation of drug.
• Patient may take with or without food but should always take drug consistently.
• Patient should not drink alcohol or large amounts of grapefruit juice while taking this drug.
• Avoid concomitant use with MAOI.