Medications of Note

Question 1

clozapine/ Clozaril

Answer 1

• treatment resistant schizophrenia
• initial dose of 25mg - increase to 300-450mg/day
• patient management system - WBC count prior to initiation, weekly for first 6 months, for 4 weeks after discontinuation
• warnings: agranulocytosis, myocarditis, pericarditis, ECG changes, seizures
• side effects: constipation, dizziness, hypersalivation, glaucoma, sedation

Question 2

anticholinergics

Answer 2

• the majority are antimuscarinics
• blocks acetylcholine in CNS and PNS
• dry mouth, constipation, urinary retention, dilated pupils, increased heart rate and BP

Question 3

antiparkinsonian agents

Answer 3

• used in the treatment of EPS

- anticholinergics, antihistaminergics, dopamine agonists, beta blockers, benzodiazepines

Question 4

lithium

Answer 4

indications: manic episodes, depression in bipolar, long-term therapy to reduce frequency and severity
- takes 10-21 days to take complete effects
- VERY fine line between therapeutic/toxic effects (1.2-1.5 meq)
- antipsychotics often a beneficial adjunct
- bloodwork for therapeutic levels - 12hrs after last dose - in maintenance stage if unproblematic once every 2-12 months
- HIGH SODIUM levels LOWER LITHIUM concentration - vice versa
- FLUID STATUS - rapid decrease in fluid volume (ie hot climate, excessive sweating, vomiting, diarrhea, fever, dehydration, etc) can rapidly increase lithium levels leading to toxicity
- lithium lab work: serum creatinine, TSH, serum calcium, creatinine clearance
- routine records of weight (likey to cause weight gain)

Question 5

Early Lithium Toxicity

Answer 5

• severe diarrhea
• vomiting
• weakness
• drowsiness

Question 6

Digoxin

Answer 6

• decreases HR

- dont give if HR <60

Question 7

Beta Blockers

Answer 7

• decrease stress on heart and blood vessels
• brings down BP
• blocks effects of epinepherine (adrenaline)

Question 8

Prednisone

Answer 8

• steroidal anti-inflammatory

Question 9

Cimetidine

Answer 9

• antiulcer

Question 10

valproic acid

Answer 10

• anticonvulsant

- also used in the treatment of bipolar depression

Question 11

clobazam

Answer 11

• benzo/anticonvulsant

Question 12

Antipsychotic General Side Effects

Answer 12

• orthostatic hypotension
• anticholinergic side effects
• weight gain
• endocrine and sexual side effects
• photosensitivity
• EPS

Question 13

Lithium Side Effects

Answer 13

• weight gain
• thyroid abnormalities
• ECG/EEG changes
• acute renal dysfunction
• dermatological changes ie acne, psoriasis, hair thinning

Question 14

Common Side Effects of SSRIs

Answer 14

• headache
• insomnia
• anxiety
• nausea/vomiting/diarrhea
• sexual dysfunction

Question 15

MAOIs

Answer 15

• block the breakdown of tyramine (vasoconstrictor) - hypertensive emergency (severe headache)
• must avoid foods containing tyramine - aged cheeses, preserved meats, alcohol and non-alcoholic beverages, marmite, sauerkraut, soy sauce basically anything fermented