Week 4 Study Guide - Antipsychotics and Antidepressants PDF

**Week 4 Study Guide** - What are the clinical indications for anti-psychotics? What should they not be used to treat? **Indications:** **Should NOT be used for:** - Which antipsychotics cause metabolic symptoms, including weight gain? - **Clozapine** - **Olanzapine** - **Qu...

**Week 4 Study Guide** - What are the clinical indications for anti-psychotics? What should they not be used to treat? **Indications:** **Should NOT be used for:** - Which antipsychotics cause metabolic symptoms, including weight gain? - **Clozapine** - **Olanzapine** - **Quetiapine** (moderate risk) - **Risperidone** (moderate risk) **Metabolic Symptoms Include:** **Monitoring Required:** - **Weight & BMI:** Baseline, weeks 4, 8, 12, then annually - **Fasting blood glucose & A1C:** Baseline, 3 months, then yearly - **Lipid panel:** Baseline, 3 months, then yearly - **Blood pressure:** Baseline, 12 weeks, then yearly - How does the side effect profile of first- and second-generation antipsychotics differ? **Feature** **First-Generation (FGAs)** **Second-Generation (SGAs)** ----------------------------------- -------------------------------------------- ------------------------------------------------------- **MOA** Strong **D2 blockade** **D2 blockade + 5-HT2A antagonism** **Extrapyramidal Symptoms (EPS)** **High risk** (rigidity, tremor, dystonia) **Lower risk**, but possible at high doses **Metabolic Syndrome** **Lower risk** **Higher risk** (weight gain, diabetes, dyslipidemia) **Prolactin Elevation** **High risk** (especially haloperidol) **Lower risk** (except risperidone & paliperidone) **Sedation** Moderate Higher in **quetiapine & clozapine** **QT Prolongation** High in thioridazine, haloperidol Moderate (caution with ziprasidone) **Examples** Haloperidol, chlorpromazine Clozapine, risperidone, quetiapine, aripiprazole - What patient teaching related to drug therapy should be completed for a patient starting on an antidepressant? - **Delayed onset:** May take **4-6 weeks** for full effect. - **Do not stop abruptly**: Risk of **discontinuation syndrome** (dizziness, nausea, headache, flu-like symptoms). - **Risk of suicidal thoughts** (Black Box Warning -- especially in ages **\ - List 2-3 clinical pearls for each of the following drugs/drug classes: Lithium, Sertraline, Citalopram, Paroxetine, Fluoxetine, Benzodiazepines, Eszopiclone, Bupropion, and Clozapine. (HINT: It\'s a matching question) --------------------------------------------------------------------------------------------------------- **Drug/Class** **Clinical Pearls** ---------------------------- ---------------------------------------------------------------------------- **Lithium** \- **Gold standard for bipolar disorder** but requires close monitoring. \ - **Therapeutic range:** 0.6-1.2 mEq/L (toxicity \1.5 mEq/L). \ - **Monitor kidney, thyroid, and ECG regularly.** **Sertraline (SSRI)** \- **First-line for depression & anxiety.**\ - Can cause **GI upset, sexual dysfunction, insomnia**. \ - **Safer in cardiac patients** than citalopram. **Citalopram (SSRI)** \- **Higher risk of QT prolongation.**\ - Limit dose to **40 mg/day** (or 20 mg/day in elderly). **Paroxetine (SSRI)** \- **Most sedating SSRI** → take at bedtime. \ - **Anticholinergic effects** (avoid in elderly). \ - **Short half-life → severe withdrawal if stopped abruptly.** **Fluoxetine (SSRI)** \- **Longest half-life** (good for non-adherent patients). \ - **Activating** → best taken in the **morning**. **Benzodiazepines** \- Used short-term for **anxiety & insomnia**. \ - **Risk of dependence, withdrawal, and cognitive impairment**. \ - **Preferred in elderly**: Lorazepam, Oxazepam, Temazepam (LOT drugs). **Eszopiclone (Lunesta)** \- **Approved for long-term insomnia treatment.**\ - **Bitter aftertaste, headache, dizziness.** **Bupropion (Wellbutrin)** \- **No sexual dysfunction, weight loss potential**. \ - **Can lower seizure threshold** (avoid in epilepsy). \ - Used for **smoking cessation (Zyban).** **Clozapine (SGA)** \- **Gold standard for treatment-resistant schizophrenia.**\ - **Risk of agranulocytosis** → **Monitor ANC regularly**. \ - **Lowest risk of EPS but highest risk of weight gain & sedation.** ---------------------------------------------------------------------------------------------------------