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CC Jan 2016 Atypical Antipsychotics and Diabetes

rename
echoecho's version from 2016-03-27 21:39

Section

Question Answer
What generation of antipsychotics are particularly useful for schizophrenia, bipolar disorders and depression?second-generation (atypical) antipsychotics (SGAs)
The use of SGAs is associated with what sequela?1) weight gain 2) prediabetes 3) diabetes 4) dyslipidemia
The estimated risk of diabetes is ___ to ___ fold?2; 3
Are child and adolecents just as likely to develop these metabolic changes as adults?yes
In a retropective cohort study in children and adolescents (6-24 years of age), the risk of developing diabetes increased with _____ dose and remained elevated for ___ year after discontinuing the medications?1) cumulative 2) one
What are the multiple proposed mechanisms for the development of diabets with SGAs?1) weight gain 2) antagonism of hypothalamic receptors 3) alterations in beta cells
Can some patients on SGAs develop diabetes in the absence of weight gain?yes
The American Diabetes Association recommends that any patient starting a SGA have what evaluation?baseline
List the 6 parts of a baseline evaluation mentioned for those starting a SGA?1) personal and family hx of obesity, diabetes, dyslipidemia, HTN, or cardiovascular disease 2) weight and height (so that BMI can be calculated) 3) waist circumference 4) BP 5) fasting glucose 6) fasting lipids
What should happen for patients noted to have dyslipidemia, diabetes or prediabetes on the inital assessment?should receive treatment as inidicated by current organizational guidelines
What might be considered when a patient starts a SGA as to SGA selection?1) patients already at increased risk of diabetes (positive family hx, overweight or obese, prediabetes)
What, however should be the primary driver of initial SGA selection?the efficacy of a SGA for the underlying psychiatric disorder
Due to its high efficacy, what medication may be the initial medication selected, with a switch to a medication with a better adverse effect profile once psychiatric stabilization attained?olanzapine (Zyprexa)
*** Following initiation of SGA therapy, weight should be monitored at ____, ____. ____ weeks, then ______?4, 8, 12, quarterly
What weight gain should prompt considertation of a SGA switch?weight gain > 5% of baseline body weight
For children, what calculation is necessary to assess for excessive weight gain?BMI
What parameters should be checked at 12 weeks and then annually?1) BP 2) blood glucose or HgbA1c 3) lipids
What lifestyle changes can reduce the risk of the cardiometabolic abnormalities of the SGAs?1) regular daily exercise (30 minutes) 2) diet modification (AHA step 2 diet)
Adding what medication to the patient's medication regimen can prevent the development of diabetes or treat it, should it develop?metformin (Glucophage)
List the effect of SGAs on glucose and lipids as to Aripiprazole (Abilify)?1) weight gain/diabetes = 1+ 2) dyslipidemia = none
List the effect of SGAs on glucose and lipids as to Clozapine (Clozaril)?1) weight gain/diabetes = 4+ 2) dyslipidemia = 4+
List the effect of SGAs on glucose and lipids as to Olanzapine (Zyprexa)1) weight gain/diabetes = 4+ 2) dyslipidemia = 4+
List the effect of SGAs on glucose and lipids as to Quetiapine (Seroquel)?1) weight gain/diabetes = 3+ 2) dyslipidemia = 3+
List the effect of SGAs on glucose and lipids as to Risperidone (Risperdal)?1) weight gain/diabetes = 3+ 2) dyslipidemia = 1+
List the effect of SGAs on glucose and lipids as to Ziprasidone (Geodon)?1) weight gain /diabetes = 1+ 2) dyslipidemia = none
*** SUMMARY = Atypical antipsychotics increase the risk for diabetes ___ to ___ fold?2; 3
*** SUMMARY = What medication may be the initial medication used due to high efficacy; switching to another medication after stabilization is an option if adverse effects arise?Olanzapine (Zyprexa)
*** SUMMARY = Consider changed medications if the patient has weight gain > _____% from baseline?5
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