Medications Overview
Trade name:
Generic name:
Geodon
Ziprasidone
Typical daily
dose:
20 - 200 mg
Seroquel
Quetiapine
25- 400 mg
Clozaril
Risperidal
Olanzapine
Clozapine
Risperidone
Zyprexa
2-6 mg
5-20 qhs
Geodon = [1]
Comments:
Newer atypical antipsychotic
Some cardiac side effects possible; avoid if
recent heart attack or history of arrhythmia
Sedation, dizziness, constipation all possible side
effects
May cause stiffness at higher doses
Very sedating
Weight gain a strong possibility
Excellent mood stabilization properties
[1] ziprasidone; [2] 20b ++
100b max; adj dose q2d; se:
increased QTC
Geodon is contraindicated if [1] CHF or recent mi or arrhythmia
hx
Acute management of
Hal 3, Ativan .5 IVP, then rpt
sundowning, delirious pt: [1]
aft 20", then 5/1 x 2, then 10/2 x
2, 20/4, etc.
Avoid more than 800 mg of [1] qd [1] mellaril
b/o retinopathy.
T/F No more than 100 mg of
F => There is no limit!
Haldol should be given a day.
If Haldol, ativan protocol for
[1] that the line is flushed if
delirium doesn't work, check [1] used w/ heparin, [2] add
and add [2].
Dilaudid .5 q 3 hrs
[1] lowers the seizure threshold
[1] thorazine (chlorpromazine)
more than any antipsychotic.
Orap aka [1] should be dosed [2] [1] pimozide, [2] 1-2 qd -> 10
and has a potency of [3].
qd, [3] 1:1 haldol
Trilafon aka [1] has a potency of [1] perphenazine, [2] 10:1, [3]
[2] and is dosed [3].
8-16 bid - qid
[1] is used to tx impotence; avoid [1] Yohimbine 5.4 mg po tid.,
in pts w/ [2]; also try: [3].
[2] panic d/o else anx, [3]
naloxone
The least anticholinergic
[1] Clozaril, [2] Mellaril
antipsychotic = [1], then [2]
(thioridazine)
0.5 mg Klonopin = [1] mg Xanax [1] 1, [2] 5
= [2] mg valium
Akithisia is best txed with a [1]
(class), eg [2]
Seroquel aka [1]; common se =
[2]; dosing = [3]
[1] beta blocker, [2] inderal
quetiapine, [2] sed, dizziness,
dry mouth, constip; 25++ 300400 qhs
dosing of risperidone: [1]
beg @ 1b, then 2b, 3bx7d; max
eff dose = 6b
A pt requires a neuroleptic but
Seroquel -> only 2% weight
wants to avoid weight gain; tx: [1] gain
Deprenyl, aka [1], is a [2] used for [1] eldepryl, [2] dopamine
[3].
agonist, [3] Parkinsonism
time to reach steady state with
one week, so don't increase if
risperidone: [1]
no response in 3 ds
Risperidone's chief biochemical antagonism of 5HT-2 and D2
effects: [1-2]
receptors
Amantadine aka [1], is a [2] used [1] symmetrel, [2] a dopamine
in [3]
agonist, [3] Parkinsonism or
influenza
risperidone aka [1] (trade name) Risperdal
SE of risperidone: [1-4]
hypersalivation, ?TD, ?EPS,
orthostatic hypotension, weight
gain
Olanzapine selectively inhibs
[1] mesolimbic, [2] nigrostriatal
dopaminergic tracts in th [1] not
the [2], ldg to no eps.
Bipolar f/u: [1]% relapse in 1st yr; [1] 1/2, [2] only 41% hv good 5
[2]% hv good 5 y f/u.
y f/u
Olanzapine aka [1]; se: [2]; mech: Zyprexa, se: wt gain, prolactin
[3]; 1/2 life: [4]
inc, somnolence, dizziness, no
acute dystonia or bone marrow
supp; [3] 5HT2A antag, D2
antag, [4] 1/2 life = 21-54 h
To prvnt relapse aft ECT, pts are [1] txed w/ antiD meds x 6 mos
[1]
aft ECT
Insight-oriented psychotx = [1]
[1] tx w/ relatively narrow txic
goals; focuses on resistances
and tferance
ECT regimin: [1]; improvemt
[1] 1 tx/d, qod x 6-12 for D; 10w/in [2] if it will b effective.
20 for mania/catatonia, [2] 2-6
txs
CNS SE of ECT: [1-2]
[1] diffuse EEG slowing, [2]
mem loss, both anterograde &
retrograde
A pt on theophylline is at risk of [1] status epilepticus.
[1] from ECT.
anterograde amnesia = [1]
[1] loss of mem for events
AFTER an accident
Indics of ECT in schizo: [1-3]
[1] catatonia, [2] xtreme,
uncontrollable agitation, [3]
prom affective s/s
Indics for bilateral ECT: [1-3]
[1] severe sxs of catatonia, [2]
failed unilat, [3] h/o response to
bilat
retrograde amnesia = [1]
[1] loss of mem for past events
that occurred BEFORE an
accident
Pre-ECT w/u includes [1-5]
[1] EEG, [2] ECG, [3] CXR &
SPINAL FILMS, [4] MRI, [5]
ANESTHESIA CONSULT
Those who respond best to ECT [1] nnvegetative - dec sleep,
are those who are most [1].
guilt, sui rumin, dec appet,
psychomot retrard/agi
Tx of psychotic D: [1], then [2] if [1] AD + neuroleptic x 4 weeks,
failed.
[2] ECT
[1] oft get ECT bcse [2]; response [1] elderly, [2] they don't
improves/worsens [2] w age.
tolerate antiD as well, [3]
improves if older
Absolute contraindications to
[1] None.
ECT: [1].
Contraindics for ECT are [1-2]
[1] inc ICP, [2] recent MI
[1] = #1 cause of M&M a/w ECT. [1] CV complics
Sz threshold [1] inc/dec durg ECT [1] inc (ECT has anticonvulsant
tx; the ECT-induced sz shld last eff), [2] 25-30 s.
[2].
T/F ECT is dang s/p CVA; antiD F; the dgs' hypotensive SEs are
dgs are preferable here.
more dang than ECT's
hypertensive SEs.
To potentiate and enhance ECT [1] caffeine
seizures, [1] may b given.
MADRAS = [1]
[1] Montgomery-Ashbury D
Scale; series of 10 qs, rngg fr 06
Anafranil aka [1]
[1] clomipramine
Olanzapine should be begun at [1] [1] 15 mg
mg per day for the treatment of
acute mania
3 medications, [1-3], have
lithium, divalproex sodium, and
indications from the US Food and olanzapine
Drug Administration (FDA) for
the treatment of manic (and
mixed) episodes of bipolar
disorder.
True or False? There is no clear
way to distinguish between major
depressive disorder and bipolar
depression.
Gabatril = [1]
False: atypical features of
hypersomnia, hyperphagia, and
leaden paralysis might be more
prevalent in bipolar depression.
[1] tiagabine 4 mg qd ++ 32 qd;
se: dizziness, weakness,
drowsiness, V