Antipsychotics/Mood Stabilizers

Question 1

What FDA approved anti-bipolar drugs can be used as adjunct therapy?

Answer 1

ziprasidone
quetiapine
quietiapine XR

Question 2

What bipolar drugs can also be used for treatment of depression?

Answer 2

seroquel XR

one other…

Question 3

33 y/o with one episode of mania and no other PMH (no depression). What drug would you treat her with?

Answer 3

lithium

Question 4

What is the DOC for mania associated with bipolar disorder?

Answer 4

lithium

Question 5

What three tests do you need to do prior to starting lithium?

Answer 5

pregnancy test
serum creatinine
TSH

Question 6

What is the average dose of lithium?

Answer 6

300 mg bid

Question 7

What is a common AE of lithium that many complain of?

Answer 7

GI irritation including diarrhea

-have them drink adequate fluid, leave at current dose to see if symptoms resolve

Question 8

What would you treat someone with who has had multiple manic/depressive (5/7 a year) episodes with an ETOH abuse problem?

Answer 8

depakote would be a good choice given his h/o ETOH abuse (he is also a rapid cycler)

start at 250 bid and titrate to 500

Question 9

You’ve started a pt on depakote and you see a rise in their liver enzymes….what do you do?

Answer 9

nothing yet

-don’t change the dose until the LFT levels have at least tripled in value from their baseline

Question 10

What is trichotillomania?

Answer 10

pulling out hair

can treat with antipsychotics

Question 11

What is the MOA of typical antipsychotics?

Answer 11

D2 dopamine receptor antagonists

Question 12

D2 dopatine receptor antagonists have a high risk of _________________

Answer 12

extrapyramidal side effects

Question 13

What are the D2 dopamine receptor antagonists (high potency)?

Answer 13

fluohenazine
haloperidol
pimozide

Question 14

What are the low potency typical antipsychotics?

Answer 14

chlorpromaine

thioridazine

Question 15

What are the AE of low potency typical antipsychotics

Answer 15

sedation

hypotension

Question 16

What are the D2 dopamine receptor antagonists?

Answer 16

fluhenazine
halperidol*
pimozide
chlorpromaine*
thioridazine 
*most commonly used

Question 17

What is the MOA of the atypical antipsychotics?

Answer 17

serotonin-dopamine 2 antagonists DSAs

they block both receptors

Question 18

What kind of drug is risperidone?

Answer 18

atypical D2 receptor antagonists

acts as typical at high doses

Question 19

Risperidone is the most likely atypical to induce ________________

Answer 19

hyperprolactinemia

*know this

Question 20

What are the common AE of risperidone?

Answer 20

weight gain
sedation
(dose dependent)

Question 21

Risperidone acts as a typical antipsychotic at doses greater than ___________

Answer 21

6mg

Question 22

Those on olanzapine or seroquel may see rises in what lab values?

Answer 22

hypertriglyceridemia
hypercholesterolemia
hyperglycemia

Question 23

____________ may cause transaminitis

Answer 23

olanzapine

seroquel

Question 24

What drug is most likely to cause orthostatic hypotension

Answer 24

seroquel

Question 25

What EKG change may you see with ziprasidone?

Answer 25

QT prolongation

Question 26

Is ziprasidone associated with weight gain?

Answer 26

nope

Question 27

What is the MOA of aripiprazole?

Answer 27

its a D2 partial agonists

Question 28

What drug interacts with CYP2D6 and 3A4?

Answer 28

aripiprazole

Question 29

What drug is associated with agranulocytosis?

Answer 29

clozapine | *last resort drug

Question 30

How often do you draw blood when taking clozapine?

Answer 30

every 2 weeks for 6 months

Question 31

What dont you want to combine with clozapine?

Answer 31

lithium

Question 32

What antipsychotic drug has the highest incidence of sedation, weight gain and transaminitis?

Answer 32

clozapine

Question 33

How do you administer iloperidone?

Answer 33

titate over 4 days to avoid orthostatic hypotension

Question 34

What two receptors does iloperidone interact with?

Answer 34

3A4 (ketoconazole) | 2D6 (fluozetine)

Question 35

Does iloperidone cause EKG changes?

Answer 35

yes | QT prolongation

Question 36

In what form does asenapine come in?

Answer 36

sublingual (no food or liquid for 10 minutes)

Question 37

What does asenapine inhibit?

Answer 37

CYP1A2 | anything to do with the liver

Question 38

How must you administer latuda?

Answer 38

with food >350 kcal

Question 39

Most antipsychotics interact with what receptor?

Answer 39

CYP 3A4

Question 40

What is neuroleptic malignant syndrome?

Answer 40

severe muscle rigidity, fever, AMS, autonomic instability, elevated WBC, CPK and LFTs-potentially fatal

Question 41

What are the extrapyramidal side effects?

Answer 41

acute dystonia parkinson syndrome akathisia

Question 42

What is tardive dyskinesia?

Answer 42

involuntary muscle movements | a common AE of antipsychotics

Question 43

What are some agents used to combat extrapyramidal side effects?

Answer 43

anticholinergics dopamine facilitators beta blockers

Question 44

What baseline blood work should you get before starting an antipsychotic?

Answer 44

lipids glucose LFT CBC

Question 45

What antipsychotic drug would you treat a person with that had a poor lipid panel?

Answer 45

risperidone ziprasidone aripiprazole

Question 46

What is a person experiencing when they say they feel "uncomfortable" in their skin while taking an antipsychotic?

Answer 46

akathisia | *lower the dose or give a beta blocker or anticholinergic

Question 47

In anxiety disorders you often give what kinds of drugs along with anxiolytics?

Answer 47

SSRIs | SNRIs

Question 48

With what can you treat insomnias and parasomnias?

Answer 48

anxiolytics

Question 49

MOA of buspirone

Answer 49

serotonin agonists | 5HT1A

Question 50

What is a con of buspirone?

Answer 50

will not reduce anxiety in pts that are used to taking BZDs because there is no sedation effect to buspirone

Question 51

What disorders do you treat with benzos?

Answer 51

insomnia parasomnias anxiety

Question 52

What kind of drug is commonly used for someone going through ETOH w/d?

Answer 52

benzodiazapines

Question 53

What is a major con of using benzos?

Answer 53

dependence