Psych Review Notes Flashcards
(27 cards)
What mood stabilizer is first-line for bipolar?
Lithium
What two drugs are suicide-protective?
Lithium and Clozaril (Clozapine)
What 4 tests do you need to order for Lithium?
Serum Level (0.6-1.2 approps, >1.4 toxic)
Thyroid Level (risk hypothyroid)
Bun/Cr (Li not metabolized, is renal excretion)
ECG (may cause arrhythmias)
What patients should not receive Lithium?
Pts who are PREGNANT (Class D-heart def-Epstein)
Pts on Diuretics (drug interactions), NSAIDS (meds that impair renal fxn may increase Li levels)
Pts w/ RENAL PROBLEMS (not metabolized)
Pts w/HEART CONDITIONS (arrhythmia risk)
What is the treatment of overdose of lithium?
Divalproex sodium, hydration and DIALYSIS
-remember renal excretion
What are common side FX of lithium?
GI effects, weight GAIN, ACNE, FINE tremor (not course as in OD or toxicity), Thirst (2/2 polyuria), Hair loss
-rarer: hypothyroid, arrhythmias/CHF, neurotoxicity
Which anticonvulsant is potentially hepatotoxic? What labs should you check? What are 2 potential side effects?
Valproic Acid (Depakote)
Check LFT’s (CBC for platelets)
Can affect liver and pancreas (hemorrhagic pancreatitis)
May increase risk of PCOS
Which anticonvulsant may cause agranulocytosis?
What electrolyte abnormality may you also see?
Carbamazepine (Tegretol)
-worried about the blood and heart
Check CBC (LFT’s—is hepatic inducer) and CMP
-rare risk of hyponatremia w/Tegretol
Which anticonvulsant may cause arrhythmias in overdose?
Carbamazepine (Tegretol)
OD=stop the heart
Which anticonvulsants may cause neural tube defects?
Heart defect?
Cleft lip/palate?
Valproic Acid (Depakote) & Carbamazepine (Tegretol) *note Lithium=heart defect Lamictal=cleft lip/palate
What could happen if a patient gets Lamotrigine + Depakote?
Stevens-Johnson Syndrome (fatal skin rash)
-advance Lamictal slowly to avoid SJS
What is an appropriate blood serum level of Depakote (Valproic acid?)
50-100 is in the therapeutic range.
What anticonvulsant is associated with a risk of Kidney Stones?
Topiramate (Topamax)
Which has a higher risk of EPS and TD, Haldol or Thorazine?
Haldol (high-potency) does, but has less other SE
-Compazine (Thorazine) has less risk of EPS/TD but has less favorable overall s/e profile including: alpha1 orthostasis, anticholinergic and sedation (histamine R)
Which three antipsychotics need an EKG done b/c they may inc qTc?
Compazine (Thorazine)
Ziprasidone (Geodon)
Clozapine (Clozaril)
Which antipsychotic is NOT metabolized hepatically (almost all renal exc)?
- think of it for liver patients
- is contraindicated in kidney pts or in renal failure
Paliperidone (Invega)
Which two antipsychotics have the least risk of weight gain?
(metabolic syndrome?)
Ziprasidone, aripiprazole (Abilify), Latuda and asenapine
-Geodon also has less risk of sexual s/e
Which two antipsychotics have the lowest risk of EPS and TD? What risks do they have?
Quetiapine (Seroquel) and Clozapine (Clozaril)
- but seroquel has mod wt gain risk and cataract risk
- clozapine=need ECG, WBC, lots of antichol, musc s/e
What are the 3 treatment options for EPS (parkinsonism, rigidity, bradykinesia)?
Amantadine (Symmetrel), Benadryl, Benztropine (Cogentin)
What drug is the best at helping negative symptoms?
What is it’s s/e profile (5 things)?
What’s it’s benefit?
Clozapine (Clozaril)
- risk Agranulocytosis (need WBC cts q wk x1 yr)
- may prolong qTc interval (need EKG’s)
- worst WEIGHT GAIN and metabolic syndrome
- lots of anticholinergic, antimuscarinic, antihistamine s/e
- highly sedating
- significant seizures
- but is protective vs. suicide
Which of the antipsychotics is most associated with akathisia?
Aripiprazole (Abilify)
What atypical causes most increase in PRL?
Risperidone
Orthostatic hypotension in elderly?
Quetiapine
Best atypical to use in Parkinson’s or LB dementia?
Quetiapine
