Anti Psych

Question 1

Lithium clinical indications

Answer 1

bipolar

Question 2

what is the lithium dosing acute phase?

Answer 2

300mg BID/TID increase dose every 4-5days

Question 3

what is the lithium concentration goal for acute phase dosing?

Answer 3

0.8-1 meq/L

Question 4

how often do we check lithium labs until clinically stable?

Answer 4

2x per week

Question 5

maintenance dose for lithium

Answer 5

900-1200mg/d

Question 6

what is the maintenance lithium concentration?

Answer 6

0.6-0.8 meq/L

Question 7

what labs should you monitor on lithium

Answer 7

CBC

BMP-K, Ca, Na

Question 8

how do we monitor renal function on lithium?

Answer 8

checking BUN/CR, UA @ baseline and every 2-3mon for 6 months, then twice a year

Question 9

how do we monitor TFT on lithium?

Answer 9

baseline
2-3mon
6 month
then 2 times a year

Question 10

what RF increase lithium toxicity risks?

Answer 10

renal impairement
elderly
dehydration

Question 11

major ADR of lithium

Answer 11

Nausea
Fatigue
wt gain
polyuria/dypsia

Question 12

long term ADR of lithuum

Answer 12

CKD/ESRD
arrythmias
hypo>hyperthyroid

Question 13

what drugs can you not use on lithium?

Answer 13

HTN drugs–loop/thiazide/spiro/ACEI/ARB

Question 14

use of chlorpromazine

Answer 14

intractable hiccups

Question 15

haloperidol formulations

Answer 15

oral
IV
IM–1x month

Question 16

use of haloperiodol

Answer 16

schizophrenia

emergency sedation for agitated/delirious pts

Question 17

ADR for haloperidol

Answer 17

hypotension
sedation
EPS
NMS
QT prolongation
increase prolactin

Question 18

what drug can you not use with haloperidol

Answer 18

PD drugs or anti-HTN or CNS depressants

Question 19

what is colzapine used for?

Answer 19

refractory schizo

Question 20

what drugs are IM that are 2nd gen anti-psychotic

Answer 20

risperidone
olanzapine
ariprprazole
paliperidone

Question 21

what 4 2nd gen anti-psychs are depression adjunts?

Answer 21

olazapine
Quetiapine
Brexpiprazole
Aripiprazole

Question 22

what is the BB warning for 2nd gen anti psych?

Answer 22

increase mortality in dementia related-psychosis and suicidality for depression

Question 23

who should we specifically minimize anti-psych use in?

Answer 23

elderly
those w/ depression
insomnia pts

Question 24

what should be monitored while on 2nd gen antipsych?

Answer 24

weight
lipids
A1C
BMP–K, Mg

Question 25

how often should we check wt for 2nd gen anti-psych?

Answer 25

baseline 1x month for 3 months then every 3 months

Question 26

how often should we check lipids/A1c?

Answer 26

baseline 3 months then annually

Question 27

how often should we check BMP?

Answer 27

baseline | then in ppl @ risk for electrolyte abnormalities

Question 28

ADR for all 2nd gen anti-psych?

Answer 28

``` sedation hypotension increase prolactin wt gain/DM/dyslipidemia EPS ```

Question 29

Colzapine specific ADR

Answer 29

``` DM wt gain QT prolongation GI hypomotility myocarditis angraulocytosis ```

Question 30

Olanzapine and Colzapine specific ADR

Answer 30

worse DM and wt gain drugs

Question 31

iloperidone and ziprasidone specific ADR

Answer 31

worse QT prolongers

Question 32

Asenapine specific ADR

Answer 32

type 1 hypersensitivity rxn

Question 33

Aripiprazole specific ADR

Answer 33

complusive urges--gamble, sex, eating

Question 34

Olanzapine and ziprasidone specific ADR

Answer 34

DRESS

Question 35

what drugs should you not combine w/ 2nd gen anti-psych?

Answer 35

QT prolongers CNS depressants Anti-HTN anti-cholinergic drugs

Question 36

what are the 3 phases of tx for bipolar

Answer 36

acute continuation maintenance

Question 37

how is acute severe mania treated?

Answer 37

atyp. antipsych + lithium or valproate

Question 38

how is mod/mild mania treated

Answer 38

monotherapy of lithium, valpropate, atyp. antipsych

Question 39

how is acute bipolar depression treated?

Answer 39

lithium | atypical antipsych

Question 40

what is a maintenance therapy drug for mania

Answer 40

lithium

Question 41

what is a maintenance therapy drug for dpression

Answer 41

lamotrigine

Question 42

what is a maintenance therapy drug for mania + depression

Answer 42

lithium or VPA, CBZ, lamotrigine, atypical antipsych

Question 43

what symptoms don't go away w/ schizo tx?

Answer 43

negative sxs (withdrawl, loss of motivation)

Question 44

what EPS are reversible?

Answer 44

acute dystonia pseudoparkinsonism akathisia

Question 45

what EPS are NOT reversible

Answer 45

tardive dyskinesia

Question 46

1st step in managing EPS

Answer 46

reduce dose

Question 47

2nd step in managing EPS

Answer 47

switch anti-psych to one w/ less EPS

Question 48

3rd step in managing EPS

Answer 48

benzotropine--1st drug to anti-psych parkinsonism | or amantaine