Psych Review Notes

Question 1

What mood stabilizer is first-line for bipolar?

Answer 1

Lithium

Question 2

What two drugs are suicide-protective?

Answer 2

Lithium and Clozaril (Clozapine)

Question 3

What 4 tests do you need to order for Lithium?

Answer 3

Serum Level (0.6-1.2 approps, >1.4 toxic)
Thyroid Level (risk hypothyroid)
Bun/Cr (Li not metabolized, is renal excretion)
ECG (may cause arrhythmias)

Question 4

What patients should not receive Lithium?

Answer 4

Pts who are PREGNANT (Class D-heart def-Epstein)
Pts on Diuretics (drug interactions), NSAIDS (meds that impair renal fxn may increase Li levels)
Pts w/ RENAL PROBLEMS (not metabolized)
Pts w/HEART CONDITIONS (arrhythmia risk)

Question 5

What is the treatment of overdose of lithium?

Answer 5

Divalproex sodium, hydration and DIALYSIS

-remember renal excretion

Question 6

What are common side FX of lithium?

Answer 6

GI effects, weight GAIN, ACNE, FINE tremor (not course as in OD or toxicity), Thirst (2/2 polyuria), Hair loss
-rarer: hypothyroid, arrhythmias/CHF, neurotoxicity

Question 7

Which anticonvulsant is potentially hepatotoxic? What labs should you check? What are 2 potential side effects?

Answer 7

Valproic Acid (Depakote)
Check LFT’s (CBC for platelets)
Can affect liver and pancreas (hemorrhagic pancreatitis)
May increase risk of PCOS

Question 8

Which anticonvulsant may cause agranulocytosis?

What electrolyte abnormality may you also see?

Answer 8

Carbamazepine (Tegretol)
-worried about the blood and heart
Check CBC (LFT’s—is hepatic inducer) and CMP
-rare risk of hyponatremia w/Tegretol

Question 9

Which anticonvulsant may cause arrhythmias in overdose?

Answer 9

Carbamazepine (Tegretol)

OD=stop the heart

Question 10

Which anticonvulsants may cause neural tube defects?
Heart defect?
Cleft lip/palate?

Answer 10

Valproic Acid (Depakote) & Carbamazepine (Tegretol)
*note Lithium=heart defect
Lamictal=cleft lip/palate

Question 11

What could happen if a patient gets Lamotrigine + Depakote?

Answer 11

Stevens-Johnson Syndrome (fatal skin rash)

-advance Lamictal slowly to avoid SJS

Question 12

What is an appropriate blood serum level of Depakote (Valproic acid?)

Answer 12

50-100 is in the therapeutic range.

Question 13

What anticonvulsant is associated with a risk of Kidney Stones?

Answer 13

Topiramate (Topamax)

Question 14

Which has a higher risk of EPS and TD, Haldol or Thorazine?

Answer 14

Haldol (high-potency) does, but has less other SE

-Compazine (Thorazine) has less risk of EPS/TD but has less favorable overall s/e profile including: alpha1 orthostasis, anticholinergic and sedation (histamine R)

Question 15

Which three antipsychotics need an EKG done b/c they may inc qTc?

Answer 15

Compazine (Thorazine)
Ziprasidone (Geodon)
Clozapine (Clozaril)

Question 16

Which antipsychotic is NOT metabolized hepatically (almost all renal exc)?

• think of it for liver patients
• is contraindicated in kidney pts or in renal failure

Answer 16

Paliperidone (Invega)

Question 17

Which two antipsychotics have the least risk of weight gain?
(metabolic syndrome?)

Answer 17

Ziprasidone, aripiprazole (Abilify), Latuda and asenapine

-Geodon also has less risk of sexual s/e

Question 18

Which two antipsychotics have the lowest risk of EPS and TD? What risks do they have?

Answer 18

Quetiapine (Seroquel) and Clozapine (Clozaril)

• but seroquel has mod wt gain risk and cataract risk
• clozapine=need ECG, WBC, lots of antichol, musc s/e

Question 19

What are the 3 treatment options for EPS (parkinsonism, rigidity, bradykinesia)?

Answer 19

Amantadine (Symmetrel), Benadryl, Benztropine (Cogentin)

Question 20

What drug is the best at helping negative symptoms?
What is it’s s/e profile (5 things)?
What’s it’s benefit?

Answer 20

Clozapine (Clozaril)

• risk Agranulocytosis (need WBC cts q wk x1 yr)
• may prolong qTc interval (need EKG’s)
• worst WEIGHT GAIN and metabolic syndrome
• lots of anticholinergic, antimuscarinic, antihistamine s/e
• highly sedating
• significant seizures
• but is protective vs. suicide

Question 21

Which of the antipsychotics is most associated with akathisia?

Answer 21

Aripiprazole (Abilify)

Question 22

What atypical causes most increase in PRL?

Answer 22

Risperidone

Question 23

Orthostatic hypotension in elderly?

Answer 23

Quetiapine

Question 24

Best atypical to use in Parkinson’s or LB dementia?

Answer 24

Quetiapine

Question 25

Which antipsychotics have the worst (highest) weight gain?

Answer 25

Clozapine (Clozaril), Olanzapine (Zyprexa), Thorazine

Question 26

Best antipsychotic for liver failure?

Answer 26

Paliperidone (kidney excreted)

Question 27

AP needed to take with meals?

Answer 27

Ziprasidone