Schizophrenia
Hyperprolactinemia is highest in these 3 agents
Risperidone, Paliperidone, Iloperidone, FGAs
This agent causes the most GI upset of the SSRI class but is preferred in patients with high risk of cvd events
Sertraline (Zoloft)
2 agents used for situational or performance anxiety
Atenolol and Propranolol
Monitoring paramaters for Depakote
Obtain Liver function tests
- Care when upper level is 3x the normal level
- monitor trough level 10-12 hours psot dose
monitor platelet levels [ammonia can be toxic]
Black Box Warning for all FGAs in dementia related psychosis
increased risk of death
These 3 antipsychotics have greater risk for weight gain & metabolic syndrome
Clozapine, Olanzapine, Quetiapine
This class has highest risk of cardiotoxicity and avoided in patients with high suicide risk
Tricyclic Antidepressants
Patient has overdosed on Valium, what is the antidote?
Flumazenil
This agent is a potent cyp3a4 autoinducer.
Carbamazepine
Identify the movement disorder and treatment:
Muscle stiffness in head, face and neck. Twitching
Dystonia
treatment: trihexyphenidyl or benztropine
Treatment for acute psychotic symptoms
Haldol (Haloperidol)
can also be used for neuropathy and fibromyalgia. (Mnemonic: can be used for DUAL purposes in pts with depression and neuropathy)
At a higher dose can cause orthostatic Hypotension
Duloxetine (Cymbalta)
These 3 Benzodiazepines are preferred in elderly or in those with liver impairment.
Lorazepam , Oxazepam, Temazepam
Carbamazepine is a potent CYP3A4 Inducer, how do you adjust the dose?
Increase the dose
Tardive Dyskinesia can occur when patient has been on antipsychotic for too long. What is the treatment?
VMAT-2 Inhibitors
- deutetrabenazine, valbenazine
Clozapine has a Black Boxed Warning for what? And must be above what number to start?
Agranulocytosis and ANC > 1500
SSRI with the longest half-life and less risk of withdrawal syndrome
Fluoxetine (Prozac)
This agent is considered a second-line agent for short-term anxiety and is an antihistamine that works by sedating the patient vs. treating the underlying cause
Hydroxyzine
Starting dose of Lamotrigine is 25mg/day but what is the starting dose when given with carbamazepine?
50mg/day
Interactions with Lithium
Ace inhibitors, ARBS, Thiazide diuretics, NSAIDS = Increase Lithium
Caffeine = Decrease Lithium
2 week overlap 10-20mg Abilify
4 weeks of Abilify Maintena
Washout period when going from Prozac to Phenelzine
5 weeks
Escitalopram 20mg is equivalent to Citalopram?
[citalopram 40mg = escitalopram 20mg]
Monitoring Parameters for Lithium.
Serum Lithium Levels: 0.5-1.5
Renal Function: Can worsen kidney function and accumulate
Thyroid Function: lithium induced hypothyroidism
Sodium: hyponatremia
EEG: Arrythmia
Lithium concentrated is increased/decreased by?
3 things
NSAIDS - Increased
Caffeine - Decreased
ACEIs, ARBs, Thiazide Diuretics - Increased