Mood stabilizers/Antidepressants/Antipsychotics

Question 1

symptoms of mild-moderate lithium toxicity

Answer 1

 Diarrhea
 Vomiting
 Fatigue
 Tremors
 Increased drowsiness
 Uncontrollable movement
 Blurred vision

Question 2

target Lithium levels for acute mania phase

Answer 2

0.8-1.2 mmol

Question 3

lithium ______ GABA

Answer 3

increases

Question 4

when do symptoms start to decrease after starting lithium

Answer 4

4-14 days

Question 5

half life of lithium

Answer 5

18-20 hours 36 hours in the elderly

Question 6

low serum sodium _______ lithium levels

Answer 6

increases

Question 7

hypernatremia leads to _______ lithium levels

Answer 7

decreased

Question 8

Nausea, vomiting, diarrhea, sweating, diuretics, ACE Inhibitors/ARB, Carbamazepine,
Calcium Channel Blockers, NSAIDS, fluoxetine (Prozac)

= things that promote water loss

________ lithium levels

Answer 8

increase

Question 9

true or false: lithium provides a suicidal protective factor?

Answer 9

true

Question 10

contraindications of lithium

Answer 10

 Severe cardiovascular disease
 Severe renal disease
 Severe sodium depletion
 Dehydration (Exercise  Diuretics  Hot environment  Diarrhea/vomiting)
 Concurrent use of diuretics
 Substance use
 Pregnancy/ Lactation
 Use of OTC ( NSAIDs Ibuprofen, Naproxen)
 Consider Developmental Variable

Question 11

excess fluid intake ____ lithium

Answer 11

dilutes

Question 12

what would indicate someone should be on a lower dose of lithium?

Answer 12

renal disease, older age, interacting medications

Question 13

SE of lithium

Answer 13

• GI: nausea, vomiting (usually resolve in a few days), metallic taste, polyuria,
  polydipsia
• muscle weakness, fine hand tremor, fatigue
• headache poor concentration and memory
• weight gain
• Acne, psoriasis, hair loss
• Decreased bone density
• Hypothyroidism
• Leukocytosis
• Assess for Metabolic Syndrome

Question 14

what levels indicate mild-moderate lithium toxicity

Answer 14

1-2 mEq/L

Question 15

symptoms of mild-moderate lithium toxicity

Answer 15

• Diarrhea
   Vomiting
   Fatigue
   Tremors
  *** Increased drowsiness
   Uncontrollable movement
   Blurred vision

Question 16

what levels indicate severe lithium toxicity

Answer 16

> 2 mEq/L

Question 17

symptoms of severe lithium toxicity

Answer 17

 Delirium
 Slurred Speech
 Seizures
 Rapid Heart Rate
 Hyperthermia
 Nystagmus
 Confusion
 Kidney failure
 Coma

Question 18

What is a commonly used analgesic that can increase lithium
levels and risk of nephrotoxicity?

Answer 18

IBprofin (advil) is hard on the kidneys (so take Tylenol) – both use the kidneys so it can cause lithium increase which can cause toxicity

Question 19

What is one of the most serious adverse effects of valproic acid?

Answer 19

hepatotoxicity

Question 20

serotonin syndrome

Answer 20

• reaction to too much serotonin
• occurs when combinations of agents given at same time without sufficient wash out period
• MAO-I in combo with SSRI, TCAm antipsychotics (increases dopamine and serotonin)
• potentially fatal

Question 21

S&S serotonin syndrome

Answer 21

Sudden onset
Fever (moderate)
Diaphoresis
Muscle Rigidity
Hyperreflexia
Increase HR
Increase BP
Delirium
Hyperarousal and agitation
shivering / tremors

Question 22

Neuroleptic Malignant
Syndrome (NMS)

Answer 22

Reaction to Dopamine
More gradual onset
Extreme Stiffness/Muscle rigidity
Hyporreflexia
Pupils normal
Elevated CPK
Fever
Increase HR
Increase BP
Diaphoresis
Changes to LOC
Confusion/coma/death

Question 23

which antidepressants are LEAST likely to be given to a pt at high risk for suicide

Answer 23

MAOI
TCA
highly lethal with overdose

Question 24

foods that must be avoided when taking MAOI -

why?

Answer 24

tyramine

Can result in Hypertensive Crisis

Question 25

S&S of hypertensive crisis

Answer 25

 Palpitations
 Increase HR
 Tight Chest
 Stiff neck
 Throbbing/radiating headache
 High BP

CAN BE FATAL

Question 26

“wash out period” for MAOI

Answer 26

Wash out period: when switching from MAOI you need to wait 14 days after frinishing it before starting a new medication.

Before starting an MAOI you have to have a one week wash out period from other antidepressant

Only exception is fluoxetine/Prozac 5-8 week wash out period before starting MAOI

May result in serotonin syndrome from too much serotonin

Question 27

why are tyramine foods contraindicated in MAOIs

Answer 27

o Liver can no longer metabolize tyramine
o Causes a release of norepinephrine – risk for hypertensive crisis – risk for stroke/fatal

Question 28

Dystonia

Answer 28

Muscle stiffening

Question 29

Akinesia

Answer 29

Loss of voluntary muscle movement
- Immobility, weakness
- Complaints of fatigue

Question 30

Akathesia

Answer 30

Restlessness, inability to sit

• Tx is NOT benztropine
• Tx is gabapentin

Question 31

Parkinsonism

Answer 31

• Resting tremor
• Shuffling gait/stooped posture
• Mask-like-face
• Hypersalivation (drooling)
• Tx is Atropine

Question 32

Tardive Dyskinesia (TD)

Answer 32

Involuntary muscle movements
- Develops after typical medication use is continued for a long period
- No treatment, just preventative measures

Question 33

Rabbit Syndrome

Answer 33

dyskinesia of the mouth, resembling a rabbit chewing

Question 34

Acute Dystonic Reaction

Answer 34

• Severe involuntary muscle spasms
• Difficulty swallowing
• Stiff neck, torticollis (twisting muscles of the neck), retrocollis (extension of the neck backwards involuntarily)
• Oculogyric Crisis (involuntary eye movement upwards and deviates to the right or left, blurry vision)
• Tx is Congentin
• Thick tongue/protrusion of tongue
• Extreme facial grimacing