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193 Cards in this Set
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Common SSRIs |
citalopram (celexa) escitalopram (lexapro) paroxetine (paxil) fluoxetine (prozac) fluvoxamine (luvox) sertraline (zoloft) |
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Mode of Action: SSRIs |
block the reuptake of 5HT, increasing occupancy at the post synaptic receptor and prolonging the effect |
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how long should you wait to evaluate the effect of SSRIs after starting them. |
4 weeks |
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General Side effects of SSRIs |
insomnia, agitation, weight loss, nausea, GI, discomfort, sexual dysfunction, QTc prolongation, orthostatic hypotension |
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Side effects of Citalopram (celexa) |
QTc prolongation, sexual dysfunctionosm |
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most common side effect of citalopram (celexa) |
QTc prolongation |
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Side effects of Escitalopram (lexapro) |
QTC prolongation, sexual dysfunction |
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Side effects of Fluoxetine (prozac) |
QTC prolongation, agitation/insomina, sexual dysfunction |
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Side effects of Fluvoxamine (luvox) |
drowsiness, orthostatic hypotension, weight gain, sexual dysfunction |
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Side effects of Sertraline (zoloft) |
agitation/insomnia, nausea/gi discomfort, diarrhea, sexual dysfunction |
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SSRI most likely to cause weight gain and sexual dysfunction |
Paroxetine (paxil)
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what is the brand name of Paroxetine |
Paxil |
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what is the brand name of Citalopram |
Celexa |
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what is the brand name of Escitalopram |
Lexapro |
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what is the brand name of Fluoxetine |
Prozac |
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what is the brand name of Fluvoxamine |
Luvox |
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what is the brand name of Sertraline |
Zoloft |
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sexual dysfunction symptoms associated with SSRIs |
anorgasmia, increased ejaculation ejaculation latency in men |
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what to do if patient experiences sexual dysfunction associated with SSRIs |
1. Decrease the dose of SSRIs 2. Switch to another antidepressant with less side effects (buproprion, nefazodone, mirtazapine) 3. Add adjunctive therapy (sildenafil, bupropion, buspirone) |
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Serotonin Syndrome |
-caused by high concentration of 5HT -potentially lethal condition -typically caused by SSRI+MAOI or SSRI+TCA -symptoms:diaphoresis, agitation, tachcardia+more -treatment: cyproheptadine |
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symptoms of serotonin syndrome |
anxiety, agitation, delirium, diaphoresis, tachycardia, hypertension, hyperthermia, GI discomfort, tremor, muscle rigidity, myoclonus, hyperreflexia |
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treatment for serotonin syndrome |
1. discontinue serotonin agents 2. sedation w/ benzodiazepines 3. if benzos fail give cyproheptadine (5HT antagonist) 4. supportive therapy (O2, IV fluids, cardiac monitoring and vitals) |
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SSRIs increase the risk of these disorders: |
increased risk of stroke, GI bleed and bone fractures |
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Common SNRIs and atypical antidepressants |
Desvenlafaxine (Pristiq) Venlafaxine (Effexor) Duloxetine (Cymbalta) Milnacipran (Savella) Buproprion (Wellbutrin, Zyban) Mirtazapine (Remeron) |
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What is the brand name of Desvenlafaxine |
Pristiq |
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What is the brand name of Duloxetine |
Cymbalta
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What is the brand name of Milnacipran |
Savella
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What is the brand name of Buproprion |
Wellbutrin, Zyban
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What is the brand name of Mirtazapine |
Remeron |
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2nd line treatment for depressions after poor response or intolerability to SSRIs |
SNRIs |
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Mode of Action: SNRIs |
block reuptake of both 5HT and NE (norepinephrine) |
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SNRIs are used to treat these conditions: |
panic disorder generalized anxiety disorder (GAD) social anxiety disorder OCD PTSD body dysmorphic disorder diabetic peripheral neuropathy fibromyalgia menopausal hot flashes vulvodynia urinary incontinence |
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Most common side effect of SNRIs: |
nausea, relieved by taking medication with food |
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Atypical Antidepressants |
Bupropion Mirtazapine |
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Mode of Action: Bupropion |
blocks reuptake of dopamine/norepinephrine |
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Mode of Action: Mirtazapine |
blocks alpha 2-adrenergic and 5HT receptors which increases the released on NE and 5HT |
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General Side effects of SNRIs |
Nausea, insomnia , agitation, GI discomfort, sexual dysfunction |
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Side effects of Desvenlafaxine |
insomnia/agitation, NAUSEA/gi discomfort, sexual dysfunction |
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Side effects of Duloxetine |
insomnia/agitation, nausea, sex dysfunction |
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Side effects of Milnacipran |
nausea/GI discomfort
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The only SNRI that rarely causes sexual dysfunction and insomnia/agitation |
Milnacipran |
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A SNRI that is a moderate inhibitor of P450 enzyme and contraindicated in narrow angle glaucoma, renal disease and liver disease |
Duloxetine |
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Side effects of Venafaxine |
insomnia/agitation, nausea/GI upset, sex dysfunction |
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Side effects of Buproprion |
insomnia, dry mouth, nausea, *drug of choice for depressed pt with sexual dysfunction, or also smokers |
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drug of choice for depressed pt with sexual dysfunction, or also smokers |
Buproprion |
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Atypical Antidepressant that is a moderate P450 inhibitor, and contraindicated in seizure disorder |
Buproprion |
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Side effects of Mirtazapine |
Drowsiness/sedation, weiht gain, sexual dysfuction, dry mouth |
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Which Antidepressants can have sever drug interactions with MAOi SSRIs and TCAs? |
SNRIs: must be careful no prevent serotonin syndrome |
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Common TCAs |
Amitriptyline (Tryptomer) Imipramine (Tofranil) Clomipramine (Anafranil) Desipramine (Norpramin) Nortryiptyline (Pamelor) Protriptyline (Vivactil) Amoxapine (Asendin) Butriptyline (Evadyne) |
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Mode of Action: TCAs |
block reuptake of serotonin and norepinephrine back into the presynaptic neuron, prolonging the effect |
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Most commonly prescribed TCA's |
Amitriptyline (Tryptomer) Imipramine (Tofranil) Desipramine (Norpramin) Nortryiptyline (Pamelor)
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What is the brand name of: Amitriptyline |
Tryptomer
Amitriptyline (Tryptomer) Imipramine (Tofranil) Clomipramine (Anafranil) Desipramine (Norpramin) Nortryiptyline (Pamelor) Protriptyline (Vivactil) Amoxapine (Asendin) Butriptyline (Evadyne)
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What is the brand name of: Imipramine |
Tofranil
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What is the brand name of: Clomipramine |
Anafranil
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What is the brand name of: Desipramine |
Norpramin
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What is the brand name of: Nortriptyline |
Pamelor
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What is the brand name of: Protryptyline |
Vivactil
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What is the brand name of: Amoxapine |
Asendin |
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What is the brand name of: Butryptyline |
Evadyne |
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General Side Effects of TCAs |
anticholinergic, drowsiness, antihistomine, QTC prolongation, weight gain, sexual dysfunction |
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Side effects of:Side effects of Amitriptyline |
Anticholinergic, drowsiness, orthostatic hypotension, QTc prolongation, weight gain, sexual dysfunction |
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Side effects of: Imipramine |
Anticholinergic, drowsiness, orthostatic hypotension, QTc prolongation, weight gain, sexual dysfunction |
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Side effects of: Nortriptyline |
QTC prolongation, (other general TCA side effects to lesser degree) |
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Side effects of: Desipramine |
QTC prolongation, (other general TCA side effects to lesser degree) |
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QTc prolongations can lead to |
cardiac arrythmias which can lead to death |
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Why is it so easy to overdose on TCAs |
rapid absorption in the GI tract |
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signs/symtpoms of TCA overdose |
general: confusion, delirium, hallucinations, hyperthermia, flushing, dilated pupils, dry mouth, blurred vision, urinary retention
cardiac: tachycardia, arrythmias, Vfib, hypotension
CNS: altered mental status, seizures
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treatment of TCA overdose |
1. IV fluids to treat hypotension 2. NaHCO3 for QRS>100ms or any ventricular arrhythmia (1-2 mEq/kg initial dose) 3. Benzos for TCA induced seizures (lorazepam 1 mg IV) |
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Common MAOIs |
Isocarboxazid (Marplan) Phenelzine (Nardil) Procarbazine (Matulane) Tranylcypromine (Parnate) Rasagiline (Azilect) Selegiline (Deprenyl) |
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Mode of Actions: MAOIs |
blocks the activity of monoamine oxidase enzyme, preventing breakdown of monamine neurotransmitters and increasing their availability |
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What is the brand name of: Isocarboxazid |
Marplan
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What is the brand name of: Phenelzine |
Nardil |
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What is the brand name of: Procarbazine |
Matulane |
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What is the brand name of: Tranylcypromine |
Parnate |
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What is the brand name of: Rasagiline |
Azilect |
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What is the brand name of: Selegiline |
Deprenyl |
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MAOis commonly used to treat |
atypical depression (hyperphagia, hypersomnia, leaden paralysis, rejection sensitivity)
refractory depression |
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Symptoms of Atypical Depression |
hyperphagia, hypersomnia, leaden paralysis, rejection sensitivity |
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When do you clinically evaluate the effectiveness of MAOIs |
after 4 weeks |
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Most Commonly prescribes MAOIs |
tranylcypromine phenelzine selegiline |
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General Side effects of: MAOIs |
orthostatic hypotension, sexual dysfunction, sleep disturbance, activation/insomnia, drowsiness, anticholinergic, weight gain
*No risk of QTc prolongation |
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Side effects of: Tranylcypromine |
activation/insomnia, weight change, sexual dysfunction
*may have a transient BP rise after dosing which should subside 3-4 hrs later. Give last dose early in day due to activation side effect |
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Side effects of: Phenelzine |
weight gain, sedation/drowsiness, sexual dysfunction, orthostatic hypotension
*high side effect profile |
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Side effects of: Selegiline |
The only MAOI that rarely causes sexual dysfunction, weight change, GI discomfort or drowsiness
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The only MAOI that rarely causes sexual dysfunction, weight change, GI discomfort or drowsiness |
Selegiline |
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At low dose, this MAOI is used to treat Parkinson's, at high dose it is used to treat depression |
Selegiline |
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The only antidepressant patch (transdermal medication) |
Selegiline |
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MAOI induced hypertensive crises |
*when MAOI mixed with tyramine rise foods (smoked meats/cheese, alcohol, sour cream yogurt) *MAOI presents metabolism of tyramine in the GI tract, so it gets absorbed in the GI tract |
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Hypertensive crises occurs most commonly with which MAOI? |
tranylcypromine |
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Presentation of Hypertensive Crises |
*occurs 1-2 hrs after ingestion of tyramine *BP can rise to 160/90 to 220/115 mmHg *headache most common symptom+ palpitations and tachycardia *complications: cerebral bleed, cardiac arrhthmias and failure, pulmonary edema, death
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Management of Hypertensive Crises |
1. BP lowering meds (nifedipine, nicardipine, nitroprusside, phentolamine) 2. stop MAOI temporarily and stop consumption of tyramine-rish foods |
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To prevent serotonin syndrome when starting a pt on MAOI: |
*pt must stop current SSRI or TCA for 2 weeks prior to starting MAOI *pt must wait 2 weeks after stopping MAOI before starting another serotonergic med |
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Common Benzos used in psychiatry |
Alprazolam (Xanax) Lorazepam (Ativan) Diazepam (Valium) Clonazepam (Klonopin) Temazepam (Restoril) Estazolam (Prosom) Flurazepam (Dalmane) Midazolam (Versed) Oxazepam (Serax) Triazolam (Halcion) |
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What is the brand name of: Alprazolam |
Xanax |
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What is the brand name of: Lorazepam |
Ativan |
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What is the brand name of: Diazepam |
Valium
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What is the brand name of: Clonazepam |
Klonopin |
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What is the brand name of: Temazepam |
Restoril |
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What is the brand name of: Estazolam |
Prosom
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What is the brand name of: Flurazepam |
Dalmane |
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What is the brand name of: Midazolam |
Versed |
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What is the brand name of: Oxazepam |
Serax
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What is the brand name of: Triazolam |
Halcion |
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Common uses of benzos |
treats anxiety, alcohol withdraw, cocaine overdose, agitation, insomnia, seizures |
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Mode of Action of: Benzos |
increase the affinity of GABA-A receptor for GABA (the main inhibitory CNS neurotransmitter) |
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Most commonly used benzos |
Alprazolam (Xanax) Lorazepam (Ativan) Diazepam (Valium) Clonazepam (Klonopin) Temazepam (Restoril)
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Pharmacokinetics of: Chlordiazepoxide (Librium) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: intermediate (PO) peak onset: 2-4 hrs half-life parent: 5-30 hrs half-life metabolite: 3-100 hrs comparative oral dose: 10 mg |
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Pharmacokinetics of: Diazepam (Valium) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: rapid (PO, IV) peak onset: 1 hr (PO) half-life parent: 20-50 hrs half-life metabolite: 3-100 hrs comparative oral dose: 5 mg |
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What is the brand name of: Chlordiazepoxide |
Librium |
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Pharmacokinetics of: Flurazepam (Dalmane) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: rapid peak onset: 30min -2hrs half-life parent: inactive half-life metabolite: 47-100 hrs comparative oral dose: 30 mg |
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Long Acting Benzos |
Chlordiazepoxide (Librium) Diazepam (Valium) Flurazepam (Dalmane) |
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Intermediate Acting Benzos |
Alprazolam (Xanax) Clonazepam (Rivotril) Lorazepam (Ativan) Oxazepam (Serax) Temazepam (Restoril) |
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Pharmacokinetics of: Alprazolam (Xanax) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: intermediate peak onset: 0.7-1.6 hrs half-life parent: 6-20 hrs half-life metabolite: comparative oral dose: 0.5 mg |
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Pharmacokinetics of: Clonazepam (Rivotril) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: intermediate peak onset: 1-4 hrs half-life parent: 18-39 hrs half-life metabolite: comparative oral dose: 0.25 mg |
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Pharmacokinetics of: Lorazepam (Ativan) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: intermediate (PO), rapid (IV) peak onset: 1-1.5 hrs (PO) half-life parent: 10-20 hrs half-life metabolite: comparative oral dose: 1 mg |
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Pharmacokinetics of: Oxazepam (Serax) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: slow peak onset: 2-3 hrs half-life parent: 3-21 hrs half-life metabolite: comparative oral dose: 15 mg |
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Pharmacokinetics of: Temazepam (Restoril) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: slow peak onset: 0.75-1.5 hrs half-life parent: 10-20 hrs half-life metabolite: comparative oral dose: 30 mg |
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Short Acting Benzos |
Midazolam (Versed) Triazolam (Halcion) |
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Benzos with slow onset of action |
Oxazepam (Serax) Temazepam (Restoril) |
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Pharmacokinetics of: Midazolam (Versed) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: most rapid (IV) peak onset: 0.5-1 hrs (IV) half-life parent: 1-4 hrs half-life metabolite: comparative oral dose: |
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Pharmacokinetics of: Triazolam (Halcion) onset of action: peak onset: half-life parent: half-life metabolite: comparative oral dose: |
onset of action: intermediate peak onset: 0.75-2 hrs half-life parent: 1.6-5.5 hrs half-life metabolite: comparative oral dose: 0.5 mg |
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General Side Effects: Benzos |
*prone to habit forming, toxicity and withdrawal *drowsiness, dizziness, GI upset, blurred vision, headache, depression, impaired coordination, falls, "hangover effect" grogginess, weakness, memory loss, excessive dreams/nightmares |
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Benzo toxicity |
*usually in context of intentional overdose *often occurs with co-ingestion of alcohol, or surgical sedationP |
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Presentation of Benzo Toxicity |
CNS depression with NORMAL VITLA SIGNS slurred speech, ataxia, altered mental status in severe cases: comatose respiratory depression can occur *benzo overdose has low rate of morbidity and mortality |
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Management of Benzo Toxicity |
1. ensure patent airway, breathing, circulation 2. supportive therapy (O2, IV fluids) 3. Flumazenil 0.2 mg IV doses (usually considered for procedural benzo sedation reversal on benzo-naive patients), it does not reverse respiratory depression
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Benzo Withdrawal |
*can be fatal *symptoms present as dry as 24-48 hrs from last dose *benzos with long half life can present up to 3 weeks after use *to prevent benzo withdrawal: chose long half life benzos and gradually taper over several months |
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to prevent benzo withdrawal: |
chose long half life benzos and gradually taper over several months |
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Presentation of Benzo Withdrawal |
similar to etoh withdrawal tremors anxiety altered mental status dysphoria psychosis high BP tachycardia chest pain blurred vision seizures
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Management of Benzo Withdrawal |
1. IV Diazepam (because of long half-life) titrated to effect, taper to 2-3 months 2. If mild benzo withdrawal effect: consider giving the same benzo that patient normally takes
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Antipsychotics: 1st generation: (nueroleptics/conventional)
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Antipsychotics: 1st generation: Haloperidol (Haldol), Chlorpromazine (Thorazine), Loxapine (Loxitane), Tloridazine (Mellaril), Molidone (Moban), Fluphenazine (Prolixin), Trifluoperazine (Stelazine), Perphenazine (Trilafon)
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Antipsychotics: 2nd generation: |
Antipsychotics: 2nd generation: Aripiprazole (Abilify), Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Clozapine (Clozaril), Ziprasidone (Geodon) |
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Mode of Action: Antipsychotics |
blocks to D2 dopamine receptor, others antipsychotics can also block (5Ht, alpha, histamine, muscarinic) |
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Antipsychotics are used to treat: |
schizophrenia bipolar disorder psychosis |
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Commonly prescribed 1st generation antipsychotics |
1st generation: Haloperidol (Haldol) Chlorpromazine (Thorazine) Loxapine (Loxitane) Mellaril (thioridazine) Molidone (Moban) Fluphenazine (Prolixin) Trifluoperazine (Stelazine) Perphenazine (Trilafon) |
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What is the brand name of: Haloperidol |
Haldol |
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What is the brand name of: Chlorpromazine |
Thorazine
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What is the brand name of: Lozapine |
Loxitane
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What is the brand name of: Mellaril |
Thioridazine
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What is the brand name of: Molidone |
Moban
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What is the brand name of: Fluphenazine |
Prolixin
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What is the brand name of: Trifluoperazine |
Stelazine
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What is the brand name of: Perphenazine |
Trilafon |
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Commonly prescribed 2nd generation antipsychotics |
Aripiprazole (Abilify) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Clozapine (Clozaril) Ziprasidone (Geodon) Olanzapine/Fluoxetine (Symbyax) |
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What is the brand name of: Aripiprazole |
Abilify |
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What is the brand name of: Risperidone |
Risperdal
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What is the brand name of: Olanzapine |
Zyprexa
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What is the brand name of: Quetiapine |
Seroquel |
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What is the brand name of: Clozapine |
Clozaril |
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What is the brand name of: Ziprasidone |
Geodon |
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What is the brand name of: Olanzapine/Fluoxetine |
Symbyax |
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General Side Effects of 1st generation antipsychotics |
weight gain/DM, extrapyramidal signs, tardive dyskinesia, hyperprolactinemia, sedation |
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antipsychotics noted for causing extra pyramidal symptoms, tardive dyskinesia, hyperprolactinemia |
1st generation antipsychotics |
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1st generation antipsychotic with greatest risk of weight gain/DM and sedations |
Chlorpramazine *also significant anticholinergic side effects *lowest risk for EPS/TD |
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1st generation antipsychotic with significant risk for EPS/TD, hyperprolactinemia *most commonly used antipsychotic used for agitation in the elderly |
Haloperidol (Haldol) |
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*most commonly used antipsychotic used for agitation in the elderly |
Haloperidol (Haldol) |
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1st generation antipsychotic with lowest risk of EPS/TD, BUT has significant risk of hyperprolacteinemia, retinitis pigmentosa and QTc prolongation |
Thioridazine (Mellaril) |
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1st generation antipsychotic that can cause retinitis pigmentosa+QTc prolongation and hyperprolactinemia |
Thioridazine (Mellaril) |
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Common side effect of Pimozide |
QTc prolongation |
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General Side Effects of 2nd generation antipsychotics |
weight gain/DM, hypercholesterolemia, sedation, orthostatic hypotension, QTc prolongation *noted for their weight gain and metabolic effects |
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2nd generation antipsychotics: lowest side effect profiles |
Aripiprazole Ziprasidone |
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2nd generation antipsychotics: Clozapine |
weight gain/DM, hypercholesterolemia, anticholergic, orthostatic hypotension *risk of agranulocytosis, myocarditis, thromboembolism |
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2nd generation antipsychotic with risk of agranulocytosis, myocarditis, thromboembolism |
Clozapine |
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2nd generation antipsychotics: prone to cause weight gain/DM and hypercholesterolemia |
Olanzapine and Quetiapine |
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2nd generation antipsychotic: greatest risk for EPS/TD and hyperprolactinemia (like 1st gen) |
Risperidone |
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2nd generation antipsychotics with mild QTc prolongation |
Ziprasidone Quetiapine Risperidone |
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2nd generation antipsychotic: used to treat persistent psychosis, but carries risk of agranulocytosis |
Clozapine |
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Nueroleptic Malignant Syndrome |
*potentially fatal neuroleptic emergency *mortality 10-20%, incidence 0.02-3%, men:woman 2:1 *typically manifests in first 2 weeks of neuroleptic use *often seen w/ high potency neuroleptics (Haloperidol, Fluphenazine) |
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Tetrad presentation of Nueroleptic Malignant Syndrome |
1. altered mental status: initial symptom in 82%, usually agitation, although catatonia and mutism possible 2. lead pipe rigidity 3. hyperthermia (can be> 104 F) 4. autonomic instability: tachycardia, high BP, tachypnea, diaphoresis |
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Diagnostic clues of Nueroleptic Malignant Syndrome |
elevated CK (1,000-100,000) leukocytosis electrolyte abnormalities possible AKI 2/2 myoglobinuria low Fe (92-100% sensitive, not specific) |
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Management of Nueroleptic Malignant Syndrome |
1. Stop offending agent 2. supportive therapy (O2, IV Fluids, cooling blanket for fever) 3.Nitroprusside or Clonidine to lower BP 4. Benzos for agitation 5. Heparin or enoxaparin for DVT prophylaxis 6. Dantrolene 1 mg/kg IV dose (max 10 mg/day) for 10 days with slow taper or Bromocriptine 2.5 mg NGT Q6-8hrs (max 40 mg/day) continued for 10 days after NMS is controlled, then slowly taper
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Restarting neuroleptics after Nueroleptic Malignant Syndrome |
*wait at least 2 weeks before resuming neuroleptics *choose lower potency over higher potency neuroleptics *start with lower dose first |
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Extrapyramidal Symptoms (EPS) |
*a concern for pt on neuroleptics and some antipsychotics *most commonly caused by Haloperidol, Fluphenazine, Pimozide, Trifluoperazine, Thiothixene and Risperdone |
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Symtoms of Extrapyramidal Symptoms (EPS) |
*akathisia (most common form of EPS, restlessness, urge to move, can't sit still) *acute dystonia *parkinsonian syndrome *tardive dyskinesia |
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Management of Extrapyramidal Symptoms (EPS) symptom of Akathishia |
1. decrease dose of antipsychotic 2. start lorazepam 0.5 mg BID, increase to 10 mg/day if needed 3. start propanolol 10 mg BID or Benztropine 1 mg BID |
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Akathisia (EPS symptom) |
most common form of EPS, restlessness, urge to move, can't sit still
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Acute dystonia (EPS symptom) |
involuntary muscle contractions, torticollis, retrocollis, oculogyric crisis (eyes deviate upward), opisthotonos, laryngospasms (can be fatal)
*risk factors: young male, cocaine use, hx of dystonia |
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Risk Factors for Acute dystonia (EPS symptom) |
young male, cocaine use, hx of dystonia |
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Management of Acute dystonia (EPS symptom) |
1. mild dystonia->Benztropine 1mg BID, mod dystonia->Benztropine or Diphenhydramine 50 mg IV or IM Qday 2. change antipsychotic to own with lower risk for EPS or consider prophylactic Benztropine (especially with Haloperidol) |
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What should be given prophylactically with Haloperidol to prevent Acute dystonia (EPS symptom) |
Benztropine 1 mg IM, especially in antipsychotic naive patients |
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Parkinsonian Syndrome (EPS symptom) presentation: |
mask-like facies resting tremor cogwheel rigidity shuffling gait bradykinesia |
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Management of Parkinsonian Syndrome (EPS symptom) |
1. Benztropine 1-2 mg/day or Amantadine 100 mg PO BID |
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Tardive Dyskinesia (EPS symptom) |
involuntary movements of the face and extremities that occurs after years of antipsychotic treatment |
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Presentation of Tardive Dyskinesia (EPS symptom) |
lip smacking choreoathetoid tongue movements facial grimacing lateral jaw movements choreiform movements of extremities/trunk blepharospasm |
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How often should you evaluate patients on antipsychotics for tar dive dyskinesia |
annually |
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Management of Tardive Dyskinesia (EPS symptom) |
1. stop offending drug 2. switch from 1st gen to 2nd gen antipsychotic with lower risk of TD (clozapine or quetiapine) *currently no drug to treat TD |
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When a patient is admitted who has a psychiatric history, you must... |
continue home psych medications (unless part of the chief complaint), to prevent withdrawal |
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Withdrawal Symptoms: Mirtazapine |
dizziness abnormal dreams paresthesias agitation anxiety/fatigue/confusion headache tremor nausea/vomiting diaphoresis |
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Withdrawal Symptoms: Buproprion |
NONE |
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Withdrawal Symptoms: SSRIs *most commonly with paroxetine and fluvoxamine |
dysphoria, dizziness, GI distress, fatigue, chills, MYALGIAS |
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Withdrawal Symptoms: Venlafaxine |
dizziness, flu-like symptoms, anxiety |
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Withdrawal Symptoms: MAOI |
delirium, agitation, myoclonic jerks and insomnia |
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Withdrawal Symptoms: TCAs |
irritability, agitation, sleep disturbances, flu-like symptoms, rarely cardiac arrhythmias |
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Withdrawal Symptoms: Benzos |
tremors, anxiety, perceptual disturbances, dysphoria, psychosis and seizures |
