Pharm for Bipolar & psychotic disorders Flashcards
Lithium mechanism of action
Thought to potentiate serotonergic neurotransmission
Lithiums therapeutic range
0.6-1.2mEq/L
What should be monitored with Lithium?
Sodium levels…inverse corolation between lithium and sodium levels….it’s given in a salt form.
Lithium Side Effects
Nausea Loose Stools Tremor Polyuria Weight gain Cognitive Impairment such as: Apathy, decreased creativity, changes in verbal learning, memory and concentration
What happens in Lithium Toxicity general
-Nausea, vomiting, diarrhea
-Sluggishness, ataxia, confusion, tremors, myoclonic jerks
Severe- seizures, nonconvulsive status epilepticus, encephalopathy, death
-ECG changes
Prolonged QTc intervals
Bradycardia
Lithium toxicity symptoms at 1.5-2 mEq/L
GI- Nausea, vomiting, diarrhea
Mental confusion, poor coordination, course tremors
Lithium toxicity symptoms at 2-2.5 mEq/L
Sluggishness, ataxia, blurred vision, seizures
Severe hypotension Coma, Death
Lithium toxicity symptoms at > 2.5 mEq/L
Coma, Death
Lithium interactions
The following Increase Lithium level: Thiazide Diuretics NSAIDS (except aspirin) ACE Inhibitors Calcium Channel Blockers Tetracyclines The following Decrease Lithium Level: Potassium-sparing diuretics
Things that increase lithium toxicity
Dehydration (Sodium imbalance)
Major Renal or Cardiovascular disease
What should be monitored with Lithium
Plasma lithium levels need to be between 0.4-1.0
How long does it take for lithium to start working?
7-14 days
Patient teaching
Take with food to minimize GI upset
First-generation Antipsychotics (FGAs)
-“Conventional Antipsychotics”
-More effective at treating Positive symptoms
-Cause serious movement disorders (EPS)
-less expensive
Less adverse effects
Second-generation Antipsychotics (SGAs)
- “Atypical Antipsychotics”
- Equal efficacy to FGA’s
- Fewer adverse effects of EPS
- More Metabolic effects-weight gain & glucose intollerance
- More expensive
First-generation Antipsychotics examples
Chlorpromazine (Thorazine) Haloperidol (Haldol) Thiothixene (Navane) Molindone (Moban) Loxapine (Loxitane
How do First-generation Antipsychotics work
Block dopamine (D²) Also block acetylcholine, histamine and norepinephrine
Extrapyramidal effects: Acute Dystonia
Painful severe spasms of tongue, face, neck or back
Usually in first few hours to days
Requires rapid treatment
Benzotropine, Diphenhydramine IV
Extrapyramidal effects: Parkinsonism
Bradykinesia
Mask-like face, drooling
Rigidity, shuffling gait, stooped posture
Treat with Antiparkinsonian drugs: Benzotropine
Extrapyramidal effects: Akathisia
Uncontrollable need to be in motion
Pacing or squirming
Unable to sit or stand still