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25 Cards in this Set

  • Front
  • Back

delirium

remove underlying cause




antipsychotics first line


-haloperidol most studied (po or iv/im) or loxapine


-SGA: olanz, risp, quet

dementia

SGA > FGA


-risp favourable w alzheimer's


-little evidence for quet


-haloperidol not routinely recommended




pts w NCD with Lewy bodies avoid antipsychotics


-cholinesterase inhibitors or mementine




BZDs w anxiety


-loraz (po, iv) or oxaz (po) -no active metabolites

brain injury

beta-antagonist best evidence


-high dose propranolol w agression




AED: CBZ or DVP




antipsychotics

psychosis

acute psychosis


-short-acting parenteral antipsychotic +/- parenteral loraz


-AVOID olanz IM + BZD (cardiac & resp complications)




po risperidone or olanzapine

mania

SGA


-risp, olanz, qet, aripip, zipras




IM olanz or FGA + BZD

situational agitation/aggression

FGA + BZD (po or im)




SGA

CBZ ADRs

rash


cognitive impairment


sedation


hyponatremia

CBZ DI

induce cyp enzymes:


-may increase clearance of oral contraceptives, lovastatin, meperidine, morphine, oxycodone, trazodone

DVP ADRs

nausea


tremor


sedation


rarely edema

DVP DI

inhibits glucuronidation


-may decrease clearance of lamotrigine, lorazepam

haloperidol ADRs

sedation


parkinsonism


akathisia


acute dystonia


neuroleptic malignant syndrome


QTc prolongation

haloperidol DI

-additive CNS depression


-antagonism of dopamine agonists


-avoid other QT prolonging drugs

aripiprazole ADRs

akathisia


dizziness


orthostatic hypotension


headache


GI


tremor


sedation

aripiprazole DI

-CBZ (induce CYP2D6 or 3A4) decrease aripip levels


-ketoconazole, quinidine, fluoxetine, paroxetine (inhibit CYP 2D6 or 3A4) increase levels

olanzapine ADRs

anticholinergic effects


akathisia


dizziness


neuroleptic malignant syndrome

olanzapine DI

-additive sedation w CNS depressants


-antagonism of dopamine agonists


-potentiate antihypertensive drug effects




IM olanzapine should not be administered w parenteral BZDs due to cardiac & respiratory problems including death

quetiapine ADRs

sedation


dizziness


neuroleptic malignant syndrome

risperidone ADRs

akathisia


dizziness


nerolepti malignant syndrome

risperidone DI

-additive sedation w CNS depressants


-antagonism of dopamine agonists


-may potentiate antihypertensive drug effects

ziprasidone ADRs

-insomnia


-EPS


-consider ECG at baseline and periodically to monitor effect on QTc interval

ziprasidone DI

-CBZ decreases ziprasidone levels


-do not use w other QT prolonging drugs

clonazepam ADRs

sedation


dizziness


cognitive impairment


rarely respiratory depression

clonazepam DI

-additive sedation and possibly cardiorespiratory depression w other CNS depressants

propranolol ADRs

bradycardia


hypotension


heart block


sedation

propranolol DI

-additive hypotension w other antihypertensives


-additive sedation w other CNS depressants