PSYCH PART 3.docx

[PSYCH PART 3] BIPOLAR DISORDER Tx: mood stabilizers, antipsychotics, and antidepressants (bupropion, venlafaxine, and SSRIs such as fluoxetine and sertraline). MOOD STABILIZERS Lithium and valproate are preferred w/ combination of 2^nd^ gen (atypical) antipsychotic - Lithium - Drug of...

[PSYCH PART 3] BIPOLAR DISORDER Tx: mood stabilizers, antipsychotics, and antidepressants (bupropion, venlafaxine, and SSRIs such as fluoxetine and sertraline). MOOD STABILIZERS Lithium and valproate are preferred w/ combination of 2^nd^ gen (atypical) antipsychotic - Lithium - Drug of choice. Monitor levels! - Short halflife contributing to rapid excretion daily divided doses - Excreted by kidneys. If Na are low, kidneys retain lithium to compensate toxicity. Normal Na intake! Use diuretics w/caution. - Plasma levels: 0.8-1.4. must be kept below 1.5! monitor q2-3 days initially then q3-6mo - Level 1.5-2: GI, hand tremor, confusion, hyperirritability of muscles, ecg changes, sedation, and incoordination - 2-2.5: high output of dilute urine, clonic seizure, hypotension, coma and death - Can cause goiter and hypothyroidism - Interactions: diuretics, NSAIDS (can inc lithium), and anticholinergic drugs due to urinary hesitancy ANTIEPILEPTIC DRUGS - Divalproex - Carbamazepine - Trough: 4-12 - Lamotrigine - Long-term maintenance ANTI-PSYCHOTICS Olanzapine, quetiapine, risperidone, aripiprazole, lurasidone, cariprazine, asenapine, and ziprasidone Clozapine agranulocytosis Only aripiprazole, olanzapine, and ziprasidone are approved for long term use to prevent recurrence of mood episodes SEDATIVES/HYPNOTICS - Barbiturates - Schedule III - Cause tolerance and dependence, more powerful respiratory depressants that can be fatal in OD - Important applications in seizure and anesthesia, insomnia - Should be w/drawn slowly - Benzos - First choice to tx insomnia and anxiety - s/e: confusion and anterograde amnesia - weak respiratory depressants only when combined w/ other CNS depressants. Caution with COPD - alprazolam greatest problem with dependence - Benzo-like drugs (zolpidem, zaleplon, and eszopiclone) - For insomnia - Eszopiclone - No limitation on how long to use - Helps you fall asleep, stay asleep, and lessen the number of times you awaken - bitter aftertaste - Zaleplon - Short term insomnia - For falling asleep only - Zolpidem - Short term insomnia - For falling asleep and staying asleep Ramelteon (new hypnotic) - Can increase levels of prolactin and reduce levels of testosterone amenorrhea, galactorrhea, reduced libido, and fertility problems. - Fluvoxamine can increase levels of ramelteon - Caution w/ hepatic impairment Suvorexant and Lemborexant (sedatives) - Tx chronic insomnia - Do not give w/ inhibitors of CYP (ketoconazole, clarithromycin) - Inc digoxin levels - Do not use w/ COPD, OSA or narcolepsy Trazadone (atypical antidepressant) - No tolerance - AE: daytime grogginess, postural hypotension