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Schizophrenia, Bipolar, anxiety, depression,

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vitohuxo's version from 2016-06-22 23:22

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schizophrenia involves both positive and negative signs
antiphsychotics mainly blockdopamine
first line for psychosisthe second generations due to less extrapyramidal side effects...some patints respond better to first generations though
first generation antipsychoitics associated with high risk of EPS, moderate sedation, and low risk of CV effects
second gen antipsychoitics associated withlower risk of EPS, but a high degree of sedation and CV effects like ortho hypotension, tachycardia, and anticholinergic effects.
risk of QT is significant this antipsychoticthioridazine (ziprasidone)
more metabolic side effects and weight gainwith the second gen antipsychoitics
clozapine may be tried when at leasttwo other antipsychoitics did not work...one being a second gen at least
antipsychoitic highest seizure riskclozapine dose dependent
antispychotiic highest proloactin increaserisperidone and paliperidone
antipsychoitic highest metabolic sEclozapine, olanzapine, quetapine,
EPS lowest risk antipshycyoicsquetapine- use this in parkinsons patients
do not give this antipsychoitic with benzos=olanzapine
NMS (neuroleptic malignant syndrome)is rare but highly lethal....most cases occurs within a couple weeks when injectibles and orals given...intense muscle contractions lead to acute renal injury
NMS signshyperthermia, muscle rigidity which can lead to resp failure
NMS treatment taper off antipsyhcoitic quickly and consider another choice. provide supportive care and cool the patient down. muscle relaxants with benzos or dantrolene
first gen dystonias• Dystonias can occur during initiation (prolonged contraction muscles), more common younger men, can treat with Benadryl or benztropine to help
first gen haloperidolrestlessness and anxiety inability be still. treat with anticholinergics, benzos, or propranolol
parkinsonism symptoms from first gen treat with anticholinergics or propranolol
tardive dyskinesias first genabnormal facial movements (tongue or mouth)...risk higher females. stop as soon as possible drug and replace with second generation. can become irreversible
patients with bipolar and psychosis are most suscetible to EPS
bipolar patients- antidepressants can inducea manic episode....not recc unless on a mood stabilizer too
first line treatment for bipolar present in manic statevalproate or lithium plus antipsychotic.
first line treatment for bipolar depressionlithium or lamotrigine.
lamotrigine cannot be used for acute mania becauseslow titration- can be used for maintenance.
lithium, valproate, and carbamazepine are pregnancy catD
lamotrigine is preg categoryC- safer option
akathisia abilify
tongue numbnessasenapine
sedationseroquel
QT riskziprasidone
first line agents for anxietySSRIs and SNRIS and some TCAS
fluvoxamine rarely used anxiety even though first one approved for OCD due todrug interactions
the SSRIS and SNRIS are dosed half for anxiety compared to depression so thatminimize axiousness and jitterness common during first couple weeks treatment
buspirone for anxietyapproved for generalized anxiety disorder and can be used as adjunct, poor response to antidepressants, if at risk benzo abuse, or if elderly. less sedating than benzos but dizziness. takes 2-4 weeks to have effect.
hydroxyzine for anxietysecond line. altenrative to benzos short term use. sedating antihistamine.
lyrica for anxietyuseful with anxiety with neuropathic pain.
benzos for anxietyshould only be used short term for 1-2 weeks. not long term.
wash out period how long start SSRI after MAOI 2 weeks except 5 weeks with fluoxetine
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