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1

What mood stabilizer is first-line for bipolar?

lithium

2

What two drugs are suicide-protective?

lithium
clozapine

3

) What 4 tests do you need to order for Lithium?

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)

4

What patients should not receive Lithium?

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)

5

What is the treatment of overdose of lithium?

Divalproex sodium, hydration and DIALYSIS

6

What are common side FX of lithium?

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

7

Which anticonvulsant is potentially hepatotoxic?

Valproic Acid (Depakote)
Check LFT’s (CBC for platelets)
-Valproic can affect liver & pancreas (hemorrhagic pancreatitis) -Valproic may increase risk of PCOS

8

Which anticonvulsant may cause agranulocytosis?

Carbamazepine (Tegretol)
Check CBC (LFT’s—is hepatic inducer)

9

Which anticonvulsant may cause arrhythmias in overdose?

Carbamazepine (Tegretol)

10

Which anticonvulsants may cause neural tube defects?

Valproic Acid (Depakote)
& Carbamazepine (Tegretol)

11

What could happen if a patient gets Lamotrigine + Depakote?

Stevens-Johnson Syndrome (fatal skin rash)

12

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

50-100 is in the therapeutic range.

13

What anticonvulsant is associated with a risk of Kidney Stones?

Topiramate (Topamax)

14

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

Haldol (high-potency) does, but has less other s/e (anti-cholinergic, antihistamine, orthostatic hypotension)

15

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

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

16

Which antipsychotic is NOT metabolized hepatic ally and all renally

Paliperidone

17

Which FOUR antipsychotics have the least risk of weight gain?

Ziprasidone, aripiprazole (Abilify) & Latuda & asenapine

18

Which two antipsychotics have the lowest risk of EPS and TD?

Quetiapine (Seroquel) and Clozapine (Clozaril)

19

What is the treatment for EPS (parkinsonism, rigidity, bradykinesia)?

Amantadine (Symmetrel), Benadryl,benztropine (Cogentin)

20

What is the only proven treatment for TD?
-face, mouth, tongue, trunk movements

Clozapine (Clozaril)

21

What drug is the best at helping negative symptoms?

Clozapine

22

clozapine side effects

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

23

Which of the antipsychotics is most associated with akisthesia?

Aripiprazole (Abilify)

24

What atypical causes most increase in PRL?

Risperidone

25

Orthostatic hypotension in elderly?

Quetiapine

26

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

Quetiapine

27

Which antipsychotics have the worst (highest) weight gain?

Clozapine (Clozaril), Olanzapine (Zyprexa), Thorazine

28

Best antipsychotic for liver fail?

Paliperidone (kidney excreted)

29

AP needed to take with meals?

Ziprasidone