Antimania
What are the levels of lithium?
Therapeutic levels: 0.6-1.2
Mild: 1.5-2
Moderate: 2-3
Severe: >3
Name all the drugs in the anticonvulsants!
-Valproic Acid (Depakote)
-Lamotrigine (Lamitcal)
-Carbamazepine (Tegretol)
-Oxcarbazepine (Trileptal)
-Gabapentin (Neurontin)
-Topiramate (Topamax)
A rare potentially life-threatening immune reaction to a foreign antigen can occur with exposure to any anticonvulsant drug. What am I and what symptoms do I cause?
-SJS
-Severe rash: “burning” rash, skin sloughing. Prodromal headache, malaise, painful mucous membranes may occur before rash. ● Fever ● Facial swelling ● Tongue swelling
Mechanism of action for FGA.
Blocks/inhibits DOPAMINE from being released. Helps diminish +positive symptoms of schizophrenia.
Mechanism of action for SGA.
Blocks/inhibits DOPAMINE & acts on SEROTONIN. Helps diminish +positive symptoms of schizophrenia & helps negative symptoms as well
What is the mechanism of action for lithium carbonate?
Inhibits dopamine and glutamate and promotes GABA-mediated neurotransmission.
I can cause a weight loss of 5-15lbs & mental dulling. What am I?
Topiramate (Topamax)
Side effects for both FGA & SGA.
-anticholinergic, photophobia, photosensitivity, sedation/lethargy
List the importance of Haloperidol.
High rate of EPS, Often used for acute psychosis and when restraining a patient via IM injection. Potent.
What is the importance of cariprazine?
Schizophrenia, bipolar mania, bipolar depression, MDD. Lesser metabolic issues. Longer ½ life so missed doses not as much of problem
● Helps regulate the “mood swings” with mania and depression.
● Gold Standard for treating mania.
● Neuroprotective
● Antisuicidal effects
I can cause agranulocytosis and aplastic anemia. What am I?
Carbamazepine (Tegretol)
List the education for lithium.
Carry ID that shows they are taking lithium.
● Educate on signs & symptoms of toxicity: Vomiting, nausea, diarrhea, GI distress are EARLY signs of toxicity.
● Educate and stress importance of taking medication regularly. ● Serum lithium levels should be checked every 1-2 months. Don’t take medication before getting level checked. 12 hours post last dose. Then take medication after level drawn. Otherwise will get false reading.
● Educate on drinking plenty of water to avoid dehydration (therefore avoiding toxicity)
● Avoid starting a low salt diet. Sudden ↓ in salt = ↑ in lithium blood levels.
What are the side effects of FGA?
-Higher Risk TD, EPS & NMS- FGA’s high dopamine blocking induce parkinson’s & movement symptoms
-Orthostatic Hypotension
What is the importance of Clozapine?
Risk for agranulocytosis- use if failed 2 or more trials. Watch “clozely”, monitor CBC. Most effective antipsychotic. Stop ANC <1000. Antisuicidal effects.
How does toxicity happen?
Dehydration
● Hyponatremia
● Decreased kidney function
● Old age = decreased renal function
● NSAIDS
● Diuretics
Signs of toxicity for Valproic acid.
Disorientation, lethargy, respiratory depression, nausea & vomiting. DC med, check Depakote level, LFT & ammonia levels.
What is TD & what are the s/s?
-Involuntary movements of the face, tongue, or limbs that may be irreversible. Buccal movement, jerking movements, buff cheeking, etc
I'm rarely used, and have a wide side effect profile. Acute agitation or aggression IM. Lower potency. High risk of seizures.
Chlorpromazine (thorazine)
What is the importance of olanzapine?
Excellent 1st line, worst for metabolic side effects “O” for obesity. Acute agitation inpatient. Teens can take.
What are the s/s of toxicity & the common s/s of lithium?
Toxicity: Confusion, Blurred vision, Diarrhea, Tinnitus (ringing in ears), Slurred speech, Coma, Convulsion
Common: Weight gain, increase thirst, nausea, polyuria, & fine hand tremor
What are the important information about Valproic Acid (Depakote)?
-Metabolized by liver
-Can cause hepatotoxicity (liver toxicity)
● Check liver function tests (LFT’s) Normals: AST (5-40) ALT (5-35)
● Hepatotoxicity: abdominal pain, reddish brown urine, yellowing of skin, and whites of eyes.
● Increases GABA, useful for mania
List the description of each pathway.
Mesolimbic pathway: decrease DA=decrease positive symptoms
Mesocortical pathway: decrease DA=increase negative symptoms
Nigrostriatal pathway: decrease DA=increase acetylcholine which induce parkinsonism. FGA worse than SGA.
Tuberoinfundibular pathway: decrease DA= increase prolactin causing galactorrhea, decrease follicle stimulating causing ammenorrhea.
What drug has "Both dopamine & serotonin partial agonists- good for maintenance therapy but not acute psychosis. Augment antidepressant medication. Least sedating. Teens can take. Both dopamine & serotonin partial agonists- good for maintenance therapy but not acute psychosis. Augment antidepressant medication. Least sedating. Teens can take."
Aripiprazole (Abilify)
Side affects for SGA.
-Lower Risk of TD, EPS, & NMS-SGA’s have lower dopamine blocking and give back some serotonin.
-Metabolic Syndrome: increase weight, cholesterol, triglyceride, and BS