Mood stabilizers/Antidepressants/Antipsychotics Flashcards
symptoms of mild-moderate lithium toxicity
Diarrhea
Vomiting
Fatigue
Tremors
Increased drowsiness
Uncontrollable movement
Blurred vision
target Lithium levels for acute mania phase
0.8-1.2 mmol
lithium ______ GABA
increases
when do symptoms start to decrease after starting lithium
4-14 days
half life of lithium
18-20 hours 36 hours in the elderly
low serum sodium _______ lithium levels
increases
hypernatremia leads to _______ lithium levels
decreased
Nausea, vomiting, diarrhea, sweating, diuretics, ACE Inhibitors/ARB, Carbamazepine,
Calcium Channel Blockers, NSAIDS, fluoxetine (Prozac)
= things that promote water loss
________ lithium levels
increase
true or false: lithium provides a suicidal protective factor?
true
contraindications of lithium
Severe cardiovascular disease
Severe renal disease
Severe sodium depletion
Dehydration (Exercise Diuretics Hot environment Diarrhea/vomiting)
Concurrent use of diuretics
Substance use
Pregnancy/ Lactation
Use of OTC ( NSAIDs Ibuprofen, Naproxen)
Consider Developmental Variable
excess fluid intake ____ lithium
dilutes
what would indicate someone should be on a lower dose of lithium?
renal disease, older age, interacting medications
SE of lithium
- GI: nausea, vomiting (usually resolve in a few days), metallic taste, polyuria,
polydipsia - muscle weakness, fine hand tremor, fatigue
- headache poor concentration and memory
- weight gain
- Acne, psoriasis, hair loss
- Decreased bone density
- Hypothyroidism
- Leukocytosis
- Assess for Metabolic Syndrome
what levels indicate mild-moderate lithium toxicity
1-2 mEq/L
symptoms of mild-moderate lithium toxicity
- Diarrhea
Vomiting
Fatigue
Tremors
*** Increased drowsiness
Uncontrollable movement
Blurred vision
what levels indicate severe lithium toxicity
> 2 mEq/L
symptoms of severe lithium toxicity
Delirium
Slurred Speech
Seizures
Rapid Heart Rate
Hyperthermia
Nystagmus
Confusion
Kidney failure
Coma
What is a commonly used analgesic that can increase lithium
levels and risk of nephrotoxicity?
IBprofin (advil) is hard on the kidneys (so take Tylenol) – both use the kidneys so it can cause lithium increase which can cause toxicity
What is one of the most serious adverse effects of valproic acid?
hepatotoxicity
serotonin syndrome
- reaction to too much serotonin
- occurs when combinations of agents given at same time without sufficient wash out period
- MAO-I in combo with SSRI, TCAm antipsychotics (increases dopamine and serotonin)
- potentially fatal
S&S serotonin syndrome
Sudden onset
Fever (moderate)
Diaphoresis
Muscle Rigidity
Hyperreflexia
Increase HR
Increase BP
Delirium
Hyperarousal and agitation
shivering / tremors
Neuroleptic Malignant
Syndrome (NMS)
Reaction to Dopamine
More gradual onset
Extreme Stiffness/Muscle rigidity
Hyporreflexia
Pupils normal
Elevated CPK
Fever
Increase HR
Increase BP
Diaphoresis
Changes to LOC
Confusion/coma/death
which antidepressants are LEAST likely to be given to a pt at high risk for suicide
MAOI
TCA
highly lethal with overdose
foods that must be avoided when taking MAOI -
why?
tyramine
Can result in Hypertensive Crisis
S&S of hypertensive crisis
Palpitations
Increase HR
Tight Chest
Stiff neck
Throbbing/radiating headache
High BP
CAN BE FATAL
“wash out period” for MAOI
Wash out period: when switching from MAOI you need to wait 14 days after frinishing it before starting a new medication.
Before starting an MAOI you have to have a one week wash out period from other antidepressant
Only exception is fluoxetine/Prozac 5-8 week wash out period before starting MAOI
May result in serotonin syndrome from too much serotonin
why are tyramine foods contraindicated in MAOIs
o Liver can no longer metabolize tyramine
o Causes a release of norepinephrine – risk for hypertensive crisis – risk for stroke/fatal
Dystonia
Muscle stiffening
Akinesia
Loss of voluntary muscle movement
- Immobility, weakness
- Complaints of fatigue
Akathesia
Restlessness, inability to sit
- Tx is NOT benztropine
- Tx is gabapentin
Parkinsonism
- Resting tremor
- Shuffling gait/stooped posture
- Mask-like-face
- Hypersalivation (drooling)
- Tx is Atropine
Tardive Dyskinesia (TD)
Involuntary muscle movements
- Develops after typical medication use is continued for a long period
- No treatment, just preventative measures
Rabbit Syndrome
dyskinesia of the mouth, resembling a rabbit chewing
Acute Dystonic Reaction
- Severe involuntary muscle spasms
- Difficulty swallowing
- Stiff neck, torticollis (twisting muscles of the neck), retrocollis (extension of the neck backwards involuntarily)
- Oculogyric Crisis (involuntary eye movement upwards and deviates to the right or left, blurry vision)
- Tx is Congentin
- Thick tongue/protrusion of tongue
- Extreme facial grimacing
