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29 Cards in this Set
- Front
- Back
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DSM-IV Criteria for schizophrenia
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-two or more for at least 1 month: hallucination,delusion,
disorg.speech, flat affect, avolition, anhedonia AND significant social function |
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First generation antipsychotics for schizophrenia
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-chlorpromazine(Thorazine)
-Thioridazine (Mellaril) -Fluphenazine (Prolixin) -Haloperidol (Haldol) |
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Second generation antipsychotics for schizophrenia
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-Clozapine (Clozaril)
-Risperidone (Risperdal) -Olanzapine (Zyprexa) -Quatiapine (Seroquel) -Ziprasidone (Geodon) -Aripiprazole (Abilify) -Paliperidone (Invega) |
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General side effect profile of antipsychotics
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-Sedation (antihistaminic)
-Orthostasis (alpha blockers) -Weight gain, cardiac effects -Anticholinergic effects -EPS/TD/pseudo-parkinsonism -Dystonic react./akathisia -Neuroleptic malignant syndrom |
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Dystonic reactions
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-w/in 24-96 hours of initiating antipsychotics
-painful, involuntary muscle spasms -1-2 mg benztropine IM or 25-50 mg Benadryl IM q30min until resolved |
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Treatment of akathisia as a SE of antipsychotics (w/i weeks)
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-Restlessness
-lipophilic beta blockers (propranolol), benzos, clonidine, anticholinergics |
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Treatment of pseudoparkinsonism as a SE of antipsychotics (w/i months to years)
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-amantidine (Symmetrel) 100 BID
-Anticholinergics |
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Tardive Dyskinesia: triad of symptoms (w/i several years)
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-Choreoathetosis: writhing fingers
-Oral movements: grimacing, lip smacking, tongue protrusion -No tx, just prevention |
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Neuroleptic malignant syndrome
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-High mortality
-Rapid progression with high fever, rigidity, HTN, increased HR, incontinence, increased LFTs,CPK,WBC -tx with bromocriptine and dantrolene |
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Thioridazine Black Box Warning
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-QT prolongation
-Others have it too, Geodon in particular |
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Pigmentary retinopathy
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-deposition of melanin in cornea.
-Thioridazine know to do this |
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Clozapine
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-Only indicated for refractory schizo
-Dose 300-900 mg/d titrated -Weekly CBC: if WBC<3500 OR ANC <1500 must D/C ->600 mg seizure risk -Fazaclo: disintegrating tab |
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Risperidone
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-Max dose of 16 mg/day
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Treatment of acute schizophrenia
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-5-10 mg IM haloperidol or fluphenazine
-2 mg IM lorazepam q 4h -benztropine/Benadryl (EPS) -Olanzapine 10 mg IM,repeat after 2h and 4 h -Ziprasidone 10 mg IM q2h |
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Long acting antipsychotic injections (in sesame seed oil--> allergies)
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-Haloperidol decanoate (Haldol-D): PO dose x 10=IM dose q4weeks
-Fluphenazie decanoate (Prolixin D): PO x 1.25 -Risperdal Consta: overlap with PO for 3 weeks |
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Bipolar I
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Manic episodes and major depressive episodes
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Bipolar II
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hypomanic episodes and major depressive episodes
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Definition of mania
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-Heightened mood (euphoria)
-increased risk taking -psychosis (hallucinations) -change in sleeping patterns initiates manic episodes |
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Treatment options for bipolar disorder
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-Lithium
-Divalproex sodium -Carbamazepine -lamotrigine -atypical antipsychotics -CCB |
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Lithium for bipolar disorder
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-acute tx and prophylaxis
-dose: start at 900-1200 up to 1800 in divided doses - |
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Lithium contraindications
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-renal disease
-Hx of leukemia (reactivation) -severe CV disease -first trimester (CV defects) -Caution: pt. with thyroid disease (hypo) |
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Lithium Monitoring
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-BUN/SCr
-CBC: leukocytosis -Electrolytes:(hyponatremia can increase Li levels) -Thyroid panel -ECG: flat T-wave - |
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Lithium toxicity
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-Therap. levels: 0.8-1 MEq/L
-Toxicity: tremor, GI upset, muscle weakness, concentration problems, seizure, coma, death |
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Divalproex sodium for bipolar disorder
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-First line for acute, but also used for prophylaxis
-Manages agitation/aggression -If alopecia: give selenium and zinc |
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Contraindications for Divalproex
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-Hepatic dysfunction
-<2 years old -Pregnancy (if pt. needs to be on it, give 4-5 mg of folic acid) |
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Monitoring on Divalproex
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-LFTs:hepatotoxic
-CBC:thrombocytopenia -Levels: 50-125 mcg/mL |
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Carbamazepine for bipolar disorder
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-second line tx for acute and prophylaxis
-Contraindicated in hx of bone marrow depression |
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Carbamazepine monitoring
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-CBC: aplastic anemia
-LFT: hepatotoxic -Levels: 4-12 mcg/mL -ECG: if age>40 or heart disease |
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Lamotrigine for bipolar disorder
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-approved for maintenance
-titrate dose -valproic acid increases levels of lamotrigine |
