Antipsychotics/Lithium- 2 Flashcards Preview

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Flashcards in Antipsychotics/Lithium- 2 Deck (41)
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1

ADEs of Clozapine or Haloperidol?

  • Sedation: +
  • EPS: ++++
  • Anticholinergic: +
  • Orthostasis: +
  • Weight gain: +
  • Prolactin: +++

Haloperidol

(opposite effects as Clozapine)

2

ADEs of Clozapine or Haloperidol?

  • Sedation: ++++
  • EPS: +
  • Anticholinergic: ++++
  • Orthostasis: ++++
  • Weight gain: ++++
  • Prolactin: +

Clozapine

(opposite effects as Haloperidol)

3

What is the main thing Risperidone causes an increase in?

B/c of this, what might you see on physical exam?

Increase in Prolactin

Galactorrhea

4

T/F: the following side effects are for ALL antipsychotic medicaitons:

Akathisia, Anticholinergic, Glucose intolerance, Hyperlipidemia, Orthostatic hypotension, Hyperprolactinemia, Sedation, Sexual dysfunction, Tardive dyskinesia, Weight gain

True

5

Which antipsychotic has agranulocytosis?

Clozapine

6

Which medication has Sialorrhea (excess drooling) as a side effect?

Clozapine

7

Which antipsychotic has the following adverse effects:

1. Bronchospasm

2. Respiratory distress

3. Respiratory depression

4. Respiratory arrest

Inhaled loxapine

(Can only be administered in approved healthcare facilities registered in REMS program)

8

Which antipsychotic has post injection sedation/delerium syndrome?

Long-acting olanzapine pamoate monohydrate

9

What are 5 examples of dose-dependent extrapyramidal effects caused by antipsychotics?

Parkinson like syndrome:

  • Bradykinesia, rigidity, tremor
  • Akathsia, dystonias

10

What are the 5 treatment options for dose-dependent extrapyramidal effects (parkinson-like syndrome) caused by antipsychotics? 

 

("BAD AB")

1. Antimuscarinics (Benztropine, Trihexyphenidyl)

2. Antihistaminic (Diphenhydramine)

3. Dopamine Agonist (Amantadine)

4. Benzos (Lorazepam, Diazepam, Clonazepam)

5. B-blockers (Propanolol)

11

What are the two toxicities of antipsychotics?

1. Dose-dependent extrapyramidal effects

2. Tardive dyskinesias (may appear as early as 6mo, usually years)

12

What is the treatment goal for schizophrenia in the first 7 days?

Decreased agitation, hostility, anxiety and aggression 

Normalization of sleep and eating

13

What is the treatment goal for schizophrenia during weeks 2 and 3?

Improve socialization, self-care and mood

14

What is the goal of maintenance therapy for Schizophrenia?

Avoidance of relapses

15

Schizophrenia maintenance therapy:

How long should you continue medication after remission of the first psychotic episode?

at least 12 months

(many experts recommend tx for at least 5 years)

16

Schizophrenia maintenace therapy:

Which group of meds should be tapered slowly before discontinuation to avoid cholinergic rebound?

Antipsychotics (especially FGAs and clozapine)

17

Schizophrenia maintenance therapy:

What should you do when switching from one antipsychotic to another? 

the first should be tapered and discontinued over at least 1 to 2 weeks while the second antipsychotic is initiated and tapered upward

18

The following meds are used for what?

  • Lithium
  • Valproate
  • Carbamazepine
  • Aripiprazole
  • etc

Acute mania treatment in Bipolar disorder

19

What are the 4 meds used as maintenance treatment for Bipolar disorder?

1. Lithium

2. Aripirazole

3. Olanzepine

4. Lamotrigine

(LOLA has bipolar disorder)

20

What 2 meds are used to tx bipolar depression?

1. Quetiapine

2. Lurasidone

21

Bipolar Disorder treatment:

Which two groups of meds may need to be included during initiation because of the slow onset of lithium or valproic acid?

Antipsychotics and benzos

22

What can precipitate mania in bipolar patients?

(KNOW)

Monotherapy with antidepressants

23

______ appears to preserve or increase the volume of brain structures involved in emotional regulation such as the prefrontal cortex, hippocampus and amygdala, possibly reflecting its neuroprotective effects.

Lithium

24

At a neuronal level, lithium reduces ______ but increases _______

At a neuronal level, lithium reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission

25

T/F: Lithium has a narrow margin of safety

True

26

Lithium is excreted virtually entirely how?

in the urine

27

Toxicities associated with lithium are seen when there is too low of what?

sodium

28

What needs to be closely controlled when prescribing lithium?

sodium

29

Does therapy with Lithium make sense in a high performing atheletes?

No because can't maintain the sodium

30

Does litihium cause sedation?

no