Week 1 Flashcards
Fluoxetine
Class, Use, SE, Contradictions
SSRI
Depression:
Line treatment for major depressive disorder.
Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)
SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME
Medications potentially Serotonin Syndrome
TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng
Citalopram
Class, Use, SE, Contradictions
SSRI
Depression:
Line treatment for major depressive disorder.
Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)
SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME
Medications potentially Serotonin Syndrome
TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng
Excitalopram
Class, Use, SE, Contradictions
SSRI
Depression:
Line treatment for major depressive disorder.
Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)
SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME
Medications potentially Serotonin Syndrome
TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng
Fluvoxamine
Class, use, SE, Contradictions
SSRI
Depression:
Line treatment for major depressive disorder.
Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)
SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME
Medications potentially Serotonin Syndrome
TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng
Paroxetine
Class, use, SE, Contradictions
SSRI
Depression:
Line treatment for major depressive disorder.
Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)
SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME
Medications potentially Serotonin Syndrome
TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng
Sertraline
Class, use, SE, Contradictions
SSRI
Depression:
Line treatment for major depressive disorder.
Anxiety Disorders:
generalized anxiety disorder (GAD), panic disorder,
social anxiety disorder, obsessive-compulsive disorder (OCD).
(PTSD)
SE:
Libido decrease
Akathisia
SUICIDE
GI upset (5-HT) Receptors are in the gut
Bone loss
Photosensitivty
Apathy
SEROTONIN SYNDROME
Medications potentially Serotonin Syndrome
TCA, Bupriprion, Migrane Meds, Lithium, OTC cough syrup, Antiemetics, Pain Meds, Venalfaxine / Trazodone, MAOI, LSD, L-tryptophan, St. Johns Wort, Ginseng
Paroxetine an SSRI has 2 majors issues involved with its use.
Snap-back effect I’d stopped abruptly
Anticholinergic (Inhibits Acetylcholine)
Everything goes up is a severe SE of SSRI esp when dosage is increased or take with Contradicted medications
Serotonin syndrome
Zyprexa maybe used for…
Treating mild symptoms of serotonin syndrome
Why won’t Tylenol or Motrin help the fever associated with Serotonin syndrome?
Elevated temperature is due to excessive muscle activity Not Hypothalamus
Venalfaxine & desvenalfaxine are this type of medication
Watch for HTN
SNRI
Serotonin & Norepinephrine Reuptake inhibitor
Duloxetine SNRI has this off lable use
GAD, Neuropathic Pain
Atomoxetine (this type of med) is indicated for ADHA
SNRI
Duloxetine
SNRI Serotonin Norepinephrine Reuptake Inhibitor
Use
Major Depressive Disorder (MDD):
Generalized Anxiety Disorder (GAD)
Panic Disorder
Fibromyalgia
Social Anxiety Disorder (SAD)
PTSD
SE
Nausea: Common when starting the medication.
Dry Mouth: A frequent side effect.
Dizziness: Often reported, especially when standing up quickly.
Insomnia or Sleep Disturbances: SNRIs can affect sleep patterns.
Sweating: Increased sweating is common.
Loss of Appetite: Some patients experience weight loss.
Sexual Dysfunction: Reduced libido, delayed ejaculation, or orgasm
SERIOUS SIDE EFFECTS
Increased Risk of Bleeding
Serotonin Syndrome
Mania , in bipolar patients
Contradictions
MAOI
HTN
Liver or Kidney disease
Venalfaxine & Desvenlafaxine
SNRI Serotonin Norepinephrine Reuptake Inhibitor
Use
Major Depressive Disorder (MDD):
Generalized Anxiety Disorder (GAD)
Panic Disorder
Fibromyalgia
Social Anxiety Disorder (SAD)
PTSD
SE
Nausea: Common when starting the medication.
Dry Mouth: A frequent side effect.
Dizziness: Often reported, especially when standing up quickly.
Insomnia or Sleep Disturbances: SNRIs can affect sleep patterns.
Sweating: Increased sweating is common.
Loss of Appetite: Some patients experience weight loss.
Sexual Dysfunction: Reduced libido, delayed ejaculation, or orgasm
SERIOUS SIDE EFFECTS
Increased Risk of Bleeding
Serotonin Syndrome
Mania , in bipolar patients
Contradictions
MAOI
HTN
Liver or Kidney disease
Levomilnacipran
SNRI Serotonin Norepinephrine Reuptake Inhibitor
Use
Major Depressive Disorder (MDD):
Generalized Anxiety Disorder (GAD)
Panic Disorder
Fibromyalgia
Social Anxiety Disorder (SAD)
PTSD
SE
Nausea: Common when starting the medication.
Dry Mouth: A frequent side effect.
Dizziness: Often reported, especially when standing up quickly.
Insomnia or Sleep Disturbances: SNRIs can affect sleep patterns.
Sweating: Increased sweating is common.
Loss of Appetite: Some patients experience weight loss.
Sexual Dysfunction: Reduced libido, delayed ejaculation, or orgasm
SERIOUS SIDE EFFECTS
Increased Risk of Bleeding
Serotonin Syndrome
Mania , in bipolar patients
Contradictions
MAOI
HTN
Liver or Kidney disease
Atomoxetine
Class, use, SE & Contradictions
SNRI Serotonin Norepinephrine Reuptake Inhibitor
Use
Major Depressive Disorder (MDD):
Generalized Anxiety Disorder (GAD)
Panic Disorder
Fibromyalgia
Social Anxiety Disorder (SAD)
PTSD
SE
Nausea: Common when starting the medication.
Dry Mouth: A frequent side effect.
Dizziness: Often reported, especially when standing up quickly.
Insomnia or Sleep Disturbances: SNRIs can affect sleep patterns.
Sweating: Increased sweating is common.
Loss of Appetite: Some patients experience weight loss.
Sexual Dysfunction: Reduced libido, delayed ejaculation, or orgasm
SERIOUS SIDE EFFECTS
Increased Risk of Bleeding
Serotonin Syndrome
Mania , in bipolar patients
Contradictions
MAOI
HTN
Liver or Kidney disease
Type of Antidepressant that prevents the breakdown of neurotransmitters by enzyme Monoamine Oxidase - Increasing availability of 5-HT, NE, DA
MAOI
Used for major depression when other antidepressants have failed. Give examples
MAOI
Isocarboxazid
Phenelzine Sulfate
Tranylcypromine Sulfate
Selegiline
Isocaboxazid
Class, use, SE & Contradictions
MAOI
Use:
Depression when other meds didn’t work.
Anxiety
Parkinsons: Increase dopamine
Dizziness and Lightheadedness: Especially when standing up quickly, due to a drop in blood pressure (orthostatic hypotension).
Dry Mouth: A frequent side effect.
Constipation: Often reported by users.
Insomnia: MAOIs can interfere with sleep patterns.
Weight Gain: Some patients experience increased appetite and weight gain.
Sexual Dysfunction: Includes decreased libido, delayed ejaculation, or anorgasmia.
Serious Side Effects
HTN Crisis with Tyramine (Cheese Effect)
Serotonin Syndrome
Contradictions
Other antidepressants
Foods containing Tyramine
Pheochromocytoma: A rare tumor of the adrenal glands that can cause dangerous spikes in blood pressure.
Phenelzine
Class, use, SE, Contradictions
MAOI
Use:
Depression when other meds didn’t work.
Anxiety
Parkinsons: Increase dopamine
Dizziness and Lightheadedness: Especially when standing up quickly, due to a drop in blood pressure (orthostatic hypotension).
Dry Mouth: A frequent side effect.
Constipation: Often reported by users.
Insomnia: MAOIs can interfere with sleep patterns.
Weight Gain: Some patients experience increased appetite and weight gain.
Sexual Dysfunction: Includes decreased libido, delayed ejaculation, or anorgasmia.
Serious Side Effects
HTN Crisis with Tyramine (Cheese Effect)
Serotonin Syndrome
Contradictions
Other antidepressants
Foods containing Tyramine
Pheochromocytoma: A rare tumor of the adrenal glands that can cause dangerous spikes in blood pressure.
Tranylcypromine
Class, Use, SE & Contradictions
MAOI
Use:
Depression when other meds didn’t work.
Anxiety
Parkinsons: Increase dopamine
Dizziness and Lightheadedness: Especially when standing up quickly, due to a drop in blood pressure (orthostatic hypotension).
Dry Mouth: A frequent side effect.
Constipation: Often reported by users.
Insomnia: MAOIs can interfere with sleep patterns.
Weight Gain: Some patients experience increased appetite and weight gain.
Sexual Dysfunction: Includes decreased libido, delayed ejaculation, or anorgasmia.
Serious Side Effects
HTN Crisis with Tyramine (Cheese Effect)
Serotonin Syndrome
Contradictions
Other antidepressants
Foods containing Tyramine
Pheochromocytoma: A rare tumor of the adrenal glands that can cause dangerous spikes in blood pressure.
Selegiline
Class, use, se & Contradictions
MAOI
Use:
Depression when other meds didn’t work.
Anxiety
Parkinsons: Increase dopamine
Dizziness and Lightheadedness: Especially when standing up quickly, due to a drop in blood pressure (orthostatic hypotension).
Dry Mouth: A frequent side effect.
Constipation: Often reported by users.
Insomnia: MAOIs can interfere with sleep patterns.
Weight Gain: Some patients experience increased appetite and weight gain.
Sexual Dysfunction: Includes decreased libido, delayed ejaculation, or anorgasmia.
Serious Side Effects
HTN Crisis with Tyramine (Cheese Effect)
Serotonin Syndrome
Contradictions
Other antidepressants
Foods containing Tyramine
Pheochromocytoma: A rare tumor of the adrenal glands that can cause dangerous spikes in blood pressure.
How do MAOIs affect 5-HT, NE, DA
Increases them
SSRI have this precaution with Warfarin/ NSAIDS
Bleeding Risk, consult HCP
Amitriptyline
Class: Tricyclic antidepressants
Use: Depression, Anxiety, Neuropathic pain, Bed wetting in children (anticholinergic), migraines.
SE:
Tachycardia
Dry mouth
Urine retention
Blurred vision
Sedation
Constipation
SUICIDE
LEATHAL IN OD
Nortriptyline
Class: Tricyclic antidepressants
Use: Depression, Anxiety, Neuropathic pain, Bed wetting in children (anticholinergic), migraines.
SE:
Tachycardia
Dry mouth
Urine retention
Blurred vision
Sedation
Constipation
SUICIDE
LEATHAL IN OD
Doxepine
Class: Tricyclic antidepressants
Use: Depression, Anxiety, Neuropathic pain, Bed wetting in children (anticholinergic), migraines.
SE:
Tachycardia
Dry mouth
Urine retention
Blurred vision
Sedation
Constipation
SUICIDE
LEATHAL IN OD
Imipramine
Class: Tricyclic antidepressants
Use: Depression, Anxiety, Neuropathic pain, Bed wetting in children (anticholinergic), migraines.
SE:
Tachycardia
Dry mouth
Urine retention
Blurred vision
Sedation
Constipation
SUICIDE
LEATHAL IN OD
These medications are 5-HT & NE reuptake inhibitors
Amitriptyline
Nortriptyline
Doxepine
Imipramine
Tricyclic antidepressants
NE & D2 reuptake inhibitor
No sexual Dysfunction
Contradicted with seizures, ETOH & Benzo withdrawal
Can cause weight loss & anorexia
Buproprion (Wellbutrin)
Vilazodone SSRI & 5-HT1A receptor partial agonist
Caution with Glaucoma & Seizures due to abnormal bleeding
SE Weight gain, GI problems
Can it be used for Bipolar?
No may make problems worse
Vortioxetine (Trintellix)
Serotonergic antidepressant
Caution with (2)
Avoid use in these types of patients…
SE: May cause angioedema, abnormal bleeding, flatulence
Expensive
Caution: Abrupt Withdrawal & Seizure disorder
Avoid in Elderly
Mirtazapine (Remeron)
Tricyclic antidepressants
Antagonist of NE & 5-HT2 receptors
Smoking changes levels in blood quickly
Common SE: Weight gain, xerostomia, Constipation, Sedation
Serious SE
Agranulocytosis, neutropenia, torsades de pointes, Steven-Johnson syndrome
Trazodone
Antidepressants but given for Sleep
Caution with heart problems
Priapism (>4 hr erection)
SE xerostomia, drowsiness, blurred vision, HTN, confusion, Sexual Dysfunction
Some patients may have a paradoxical reaction. Describe…
Paradoxical reaction is oppsite of what you expect to happen
They will become agitated
Brexanolone injection (Zulresso)
Works on GABA
Expensive 34,000$
Used for….
How does it work…
Postpartum- Given immediately after birth
Works: Mimics hormone allopregnanolone
Zuranolone (Pill form for postpartum)
How long is it taken
When to expect to see improvement
1qDay x 14 days
Improvement in 3 days
Lithium
Carbamazepine
Valproate
Lamotrigine
Clonazepam
Not FDA approved
Oxcarbazepine
Gabapentin
Topiramate
This type of medication….
Works by…..
Mood stabilizers
Provide a balance between GABA & Glutamate
Patients with Bipolar I & II
Poor control of anxiety & depression symptoms
Kids Behavior issues or OCD
PTSD
Treatment resistant depression
Hormone dysfunction
Mood stabilizer
Lithium
Carbamazepine
Valproate
Lamotrigine
Clonazepam
Not FDA approved
Oxcarbazepine
Gabapentin
Topiramate
Check these labs before giving Lithium
Kidney function.. Serum Creatinine, GFR, BUN
Electrolytes… Which electrolyte level is a concern
Lithium levels …. Therapeutic vs Toxic levels
Thyroid….
Pregnancy…
Serum Creatinine:
Hold if: Creatinine >1.3 mg/dL (indicates impaired kidney function).
Glomerular Filtration Rate (GFR):
Hold if: GFR <60 mL/min/1.73 m² (suggests reduced kidney filtration).
Blood Urea Nitrogen (BUN):
Hold if: BUN >20 mg/dL, especially with high creatinine (suggests kidney dysfunction).
Electrolytes:
Hold if: Sodium <135 mEq/L (hyponatremia can increase lithium toxicity risk).
Thyroid:
TSH >4.5 mIU/L is particularly significant because it indicates hypothyroidism, which can be caused or worsened by lithium. Elevated TSH suggests that the thyroid is not producing enough thyroid hormones (T3 and T4), and this could warrant holding lithium to prevent further thyroid dysfunction.
Contradicted in preggers
Lithium toxicity
Describe Toxicity Level and # associated with it.
Gastrointestinal Symptoms: Nausea, vomiting, diarrhea
Neurological Symptoms: Hand tremors, mild confusion, drowsiness
Muscle Symptoms: Weakness, fatigue
Describe Lithium toxicity level
Neurological Symptoms: Severe tremors, confusion, ataxia (loss of coordination), muscle twitching
Cognitive Symptoms: Slurred speech, agitation, worsening confusion
Cardiovascular Symptoms: Arrhythmias, increased heart rate
Describe Lithium Toxicity level
Neurological Symptoms: Seizures, coma, severe confusion, stupor
Renal Symptoms: Decreased urine output, kidney failure
Cardiovascular Symptoms: Hypotension, severe arrhythmias
Other Symptoms: Respiratory failure, potential death if untreated
Mild Toxicity (Lithium Level: 1.5–2.0 mEq/L): N/V, hand tremors, mild confusion, drowsiness, weak
Moderate Toxicity (Lithium Level: 2.0–2.5 mEq/L): Severe tremors, confusion, ataxia, muscle twitch, Slurred Speech, Worsening confusion , agitation, Arrhythmia
Severe Toxicity (Lithium Level: >2.5 mEq/L): Seizures, coma, severe confusion, decrease urine output, kidney failure, hypotension, Respitory failure
Bradycardia
Ataxia (Jerky Movement) & acne
Tremour & hypothyroid
Teratogenic ( birth defects or abnormalities in a developing fetus )
Edema
Rash & Renal Toxicity
Leukocytosis
BATTERY
Describes side effects for …
Lithium
Match the mood stabilizers
Valproate, carbamazepine, lamotrigine
Maintenance, not for acute mania, frequently used in borderline personality
Acute mania
Mixed episodes of mania & depression
Lamotrigine
Maintenance, not for acute mania, frequently used in borderline personality
Carbamazepine
Acute mania
Valproate
Mixed episodes of mania & depression
Carbamazepine: Acute Mania
(Mood Stabilizer)
Therapeutic range….
SE: Anticholinergic, Orthostatic Hypotension, pruritus, HTN, ataxia, arrhythmias
Serious SE
Therapeutic range 4 - 12
Serious: Agranulocytosis & Steven Johnson Syndrome
Valproate: Mixed Episodes
(Mood Stabilizer)
*boost gaba
SE: weight gain, mental dull, tremor, hair loss, libido loss, thrombocytopenia, pancreatitis, liver failure
Contradiction Pregnancy & liver issues
Therapeutic range:…..
Labs….
Therapeutic range 50 - 100mL
Labs
AST (Aspartate Aminotransferase):
Safe Range: 10-40 U/L
Why: Elevated AST can indicate liver damage, so levels should be within the normal range to safely start or continue valproate.
ALT (Alanine Aminotransferase):
Safe Range: 7-56 U/L
Why: ALT is more specific to the liver, and elevated levels suggest liver injury, which is a concern with valproate use.
Albumin:
Safe Range: 3.5-5.0 g/dL
Why: Albumin reflects liver function and nutritional status. Low albumin may indicate liver dysfunction or malnutrition, which can increase the risk of valproate-related side effects.
CBC (Complete Blood Count):
Safe Findings:
White Blood Cells (WBC): 4,500-11,000 cells/mcL
Platelets: 150,000-450,000/mcL
Hemoglobin: 13.8-17.2 g/dL (men), 12.1-15.1 g/dL (women)
Why: Valproate can cause thrombocytopenia (low platelets) and affect white blood cell counts, so a normal CBC is important before starting the medication.
Ammonia:
Safe Range: 15-45 µmol/L
Why: Elevated ammonia levels can indicate a risk of hyperammonemia, a possible side effect of valproate, which can lead to serious complications like encephalopathy.
Lamotrigine (Depression in Bipolar)
Moderates release of Glutamate
SE: Dizzy, Ataxia, blurred vision, HA, Anticholinergic, Photosensitivity
Therapeutic range….
Major dangerous SE:….
Therapeutic range 3 - 14
Steven Johnson Syndrome. Rash first sign
Oxcarbazepine
Not FDA approved
Mood Stabilizer
Similar to Carbamazepine
Lesser risk of Rash & Hepatotoxicity
Adverse reactions…..
CNS depression & hyponatremia
Erythema multiforme
Hypersensitivity reaction to meds or infections
Symptoms
Fever
Itching
Joint aches
Skin lesions
RASH
AKA…..
Stevens-Johnson syndrom
Life threatening
Avolition vs Anhedonia
Avolition = Lack or inability to start or complete goals
Anhedonia = lack of interest in things you once enjoyed
Low Potency / High Dose:
Examples: (2)
Characteristics:
These drugs require higher doses to achieve the desired antipsychotic effect.
Low potency antipsychotics have weaker dopamine-blocking effects but tend to have more sedative effects and anticholinergic side effects (like dry mouth, constipation, and blurred vision).
They are more likely to cause orthostatic hypotension (a drop in blood pressure when standing up) and weight gain
High Sedation & Ach SE (Wine Coolers)
Chlorpromazine, Thioridazine
First gen Traditional Antipsychotics
High Potency / Low Dose:
Examples: (2)
Characteristics:
These drugs require lower doses to be effective.
High potency antipsychotics have stronger dopamine-blocking effects, which means they are effective at lower doses.
They are more likely to cause extrapyramidal symptoms (EPS), such as tremors, rigidity, and bradykinesia (slow movements), which are movement disorders.
These drugs generally have fewer sedative and anticholinergic side effects compared to low potency antipsychotics.
Fluphenazine, Haloperidol
List
Positive & Negative symptoms of Psychosis
Positive
Hallucinations
Delusions
Disorganized thoughts
Agitated body movements
Negative symptoms
Flat affect
Anhedonia
Avolition
Poverty of speech & thought
Neglect ADLs
Chlorpromazine
1st generation antipsychotic (Blocks dopamine)
Low Potency/ High Dose
SE:
High Sedation/ Ach SE
Low EPS
Agranulocytosis
Orthostatic hypotension
Thioridazine
1st generation antipsychotic (blocks dopamine)
Low Potency/ High Dose
High Sedation & Ach
Low EPS
ORTHOSTATIC HYPOTENSION
Fluphenazine
1st generation antipsychotic (Blocks dopamine)
High Potency/ Low Dose
Low Sedation/ Ach SE
High EPS
Haloperidol
1st generation antipsychotic (Blocks dopamine)
High Potency/ Low Dose
Low Sedation/ Ach SE
High EPS
Trifluoperazine
1st generation antipsychotic (Blocks dopamine)
High Potency/ Low Dose
Low Sedation/ Ach SE
High EPS
Perphenazine
1st generation antipsychotic (Blocks dopamine)
High Potency/ Low Dose
Low Sedation/ Ach SE
High EPS
1st generation antipsychotics work well controlling which type of symptoms associated with psychosis
Positive
Hallucinations
Delusions
Disturbed thought process
Risperidone
Class, Use, SE, Contradictions
Labs before starting Normal values: BMI, BP, A1c, fasting lipids
2nd generation atypical antipsychotics.
First line treatment
Target Postive & Negative Symptoms
SE: Lower risk for ESP
Weight gain
Increased cholesterol
Contradicted Dementia / CVA
Body Mass Index (BMI):
Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):
Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):
Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:
Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL
Olanzapine
Labs to check
2nd generation atypical antipsychotics.
First line treatment
Target Postive & Negative Symptoms
SE: Lower risk for ESP
Weight gain
Increased cholesterol
Contradicted Dementia / CVA
Body Mass Index (BMI):
Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):
Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):
Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:
Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL
Quetiapine
Class, use, SE, Contradictions
Labs to check first
2nd generation atypical antipsychotics.
First line treatment
Target Postive & Negative Symptoms
SE: Lower risk for ESP
Weight gain
Increased cholesterol
Contradicted Dementia / CVA
Body Mass Index (BMI):
Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):
Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):
Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:
Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL
Ziprasidone
Class, use, SE, Contradictions
Labs to assess first
2nd generation atypical antipsychotics.
First line treatment
Target Postive & Negative Symptoms
SE: Lower risk for ESP
Weight gain
Increased cholesterol
Contradicted Dementia / CVA
Body Mass Index (BMI):
Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):
Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):
Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:
Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL
Paliperidone
Class, use, SE, Contradictions
Labs to assess first
2nd generation atypical antipsychotics.
First line treatment
Target Postive & Negative Symptoms
SE: Lower risk for ESP
Weight gain
Increased cholesterol
Contradicted Dementia / CVA
Body Mass Index (BMI):
Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):
Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):
Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:
Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL
Lurasidone
Class, use, SE, Contradictions
Labs to assess first
2nd generation atypical antipsychotics.
First line treatment
Target Postive & Negative Symptoms
SE: Lower risk for ESP
Weight gain
Increased cholesterol
Contradicted Dementia / CVA
Body Mass Index (BMI):
Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):
Normal range:
Systolic: 90-120 mm Hg
Diastolic: 60-80 mm Hg
Hemoglobin A1c (HbA1c):
Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
Fasting Lipid Panel:
Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL
Clozapine
Class, use, SE, Contradictions
Special Requirements:……
Teach:…..
2nd generation atypical antipsychotics.
Atypical antipsychotics
Used to prevent suicide
First line treatment
Target Postive & Negative Symptoms
SE: Lower risk for ESP
Agranulocytosis in 1%
Weight gain
Increased cholesterol
Contradicted Dementia / CVA
Maybe the labs associated with 2nd generation apply?
Special requirements
Patients must be on federal mandatory registry (REMS)
Required CBC (ANC >1500)
Teach Monitor for sore throat, fever, s/s infection Get Flu Vaccines
Brexipipazole (Used with antidepressants, agitation in dementia)
Class, use, SE & Contradictions
3rd generation antipsychotic
Less Sedation
Less weight Gain
Insomnia
Akathisia (Restlessness)
Cariprazine (Bipolar I disorder, MDD) WITH Antidepressants
Class, use, SE & Serious side effects
3rd generation antipsychotic
Less Sedation
Less weight Gain
Insomnia
Akathisia (Restlessness)
Aripiprazole
Class, use, SE, Contradictions
3rd generation antipsychotic
Less Sedation
Less weight Gain
Insomnia
Akathisia (Restlessness)
Long Acting Injectable Antipsychotics
LAIs
Distinguish 1st from 2nd generation
Fluphenazine
Aripiprazole
Olanzapine
Paliperidone
Haloperidol
Risperidone
1st generation
Fluphenazine
Haloperidol
2nd Generation
Aripiprazole
Olanzapine
Paliperidone
Risperidone
This heart wave pattern is seen with Antipsychotics
Leading to which problems
Q-T prolongation
Arythmias, torsade de pointes, V Fib
Movement Disorders:
Extrapyrmidal Symptoms
Dopamine DOWN & Acetylcholine UP
Dystonia: Involuntary muscle contractions causing abnormal postures or movements, often due to antipsychotic use.
Medical emergency?
Onset after ingestion of antipsychotic meds
Medical emergency: Yes, if muscles in throat or neck are affected
Onset: can start within 4 hrs.
Movement Disorders:
Extrapyrmidal Symptoms
Dopamine DOWN & Acetylcholine UP
____: Restlessness of mind and body associated with antipsychotic use.
High risk suicide (According to PP)
Akathesia
Movement Disorders:
Extrapyrmidal Symptoms
Dopamine DOWN & Acetylcholine UP
Slowed movements
Muscle stiffness
Shuffling walk
Flat affect
Pill rolling
Stooped posture
Reduced arm swinging
Pseudoparkinsonism
EPS symptoms such as akathisia & Tardive dyskinesia will stop when antipsychotic medications are Discontinued
T or F
F
All EPS symptoms will stop upon discontinuation Except Tardive dyskinesia
Neuroleptic Malignant Syndrome (NMS)
Life threatening condition from use or with drawl of Antipsychotic medication
Symptoms: ______
Fever
Muscle rigidity
Decreased LOC
Arythmia
Tachycardia
Diaphoresis
BP changes
Treatment for NMS incldue:
Discontinuation of Meds
Continuation of Meds if Withdrawal is problem
Dantrolene (Muscle Relaxant)
Cool measures
Stabilize electrolyte levels
Which medications cause NMS…
1st generation antipsychotic
SSRI mixed with…..
MAIO mixed with……
Can cause Serotonin Syndrome
SSRI St. Johns Wort
MAIO mixed with Any Antidepressants
How long after stopping MAIO to wait before starting new Antidepressants
2 weeks
SSRI
Paroxetine, Sertraline, Fluvoxamine Fluoxetine, Citalopram, Exitalopram
Most common SE
Dangerous SE
Usually improve 3 months
Weight Gain
Sexual Dysfunction
Insomnia
Dangerous:
Suicide high risk 18 - 24
(Report more energy without change in depression)
Serotonin Syndrome
Sexual Dysfunction
Weight gain
Insomnia
GI Disturbances
Anxiety
Headache
Common SE with SSRIs
Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram Exitalopram
Name the common SE with SNRI
Same as SSRI also
Increased BP
Xerostomia
Diaphoresis
Atomoxetine Levomilnacipran Venalfaxine Desvenlafaxine Duloxetine
Atomoxetine Levomilnacipran Venalfaxine Desvenlafaxine Duloxetine
Name common and serious SE
Type of medication…
SNRI
Common SE
Sexual Dysfunction
Weight gain
Insomnia
GI upset
Headache
Anxiety
Increase BP
Xerostomia
Diaphoresis
Serious
Suicide
Serotonin Syndrome
Watch for HTN with these SNRIs
Venalfaxine & desvenalfaxine
2nd generation antipsychotics have SE of weight gain leading to Diabetes.
What is a normal range for.
Body Mass Index (BMI):
Normal range: 18.5 to 24.9 kg/m²
Blood Pressure (BP):
2nd generation Antipsychotics have a SE of weight gain leading to Diabetes
What is a normal
Hemoglobin A1c (HbA1c):
Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
2nd generation Antipsychotics have a SE of weight gain leading to Diabetes
What is a normal
Hemoglobin A1c (HbA1c):
Normal range: 4.0% to 5.6%
Pre-diabetes range: 5.7% to 6.4%
Diabetes: 6.5% or higher
2nd generation Antipsychotics have a SE of weight gain leading to Diabetes
What is a normal
Fasting Lipid Panel:
Total Cholesterol:
Low-Density Lipoprotein (LDL):
High-Density Lipoprotein (HDL):
Men:
Women:
Triglycerides:
Total Cholesterol: < 200 mg/dL
Low-Density Lipoprotein (LDL): < 100 mg/dL
High-Density Lipoprotein (HDL):
Men: > 40 mg/dL
Women: > 50 mg/dL
Triglycerides: < 150 mg/dL
Valporate - mood stable
Therapeutic range 50 - 100mL
Labs
AST (Aspartate Aminotransferase):
Safe Range: 10-40 U/L
Why: Elevated AST can indicate liver damage, so levels should be within the normal range to safely start or continue valproate.
Valporate Treats Mood Disorders
Therapeutic range 50 - 100
ALT (Alanine Aminotransferase):
Safe Range: 7-56 U/L
Why: ALT is more specific to the liver, and elevated levels suggest liver injury, which is a concern with valproate use.
Valporate Treats mood disorders
Therapeutic range 50 - 100
Albumin: (Safe Range)
Safe Range: 3.5-5.0 g/dL
Why: Albumin reflects liver function and nutritional status. Low albumin may indicate liver dysfunction or malnutrition, which can increase the risk of valproate-related side effects.
Valporate Treats mood disorders
Therapeutic range 50 - 100
CBC (Complete Blood Count):
Safe Range
WBC
Platelets
Hemoglobin
Safe Findings:
White Blood Cells (WBC): 4,500-11,000
Platelets: 150,000-450,000
Hemoglobin: 13.8-17.2 g/dL (men), 12.1-15.1 g/dL (women)
Why: Valproate can cause thrombocytopenia (low platelets) and affect white blood cell counts, so a normal CBC is important before starting the medication.
Valporate Treats mood disorders
Therapeutic range 50 - 100
Ammonia: Safe range
Safe Range: 15-45 µmol/L
Why: Elevated ammonia levels can indicate a risk of hyperammonemia, a possible side effect of valproate, which can lead to serious complications like encephalopathy
Why might an MAOI be given to a Parkinsons patient?
To increase dopamine.
Lack of dopamine makes them shake.
Type of medication which maybe prescribed for neuropathic pain.
SNRI
