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All antipsychotic agents have following risk.
monitor / counsel and counsel:
NMS, EPS, sedation, anticholinergic effects, seizure, cardiac changes (EKG), Leukopenia, temperature regulation, dermatological rxn, sexual dysfunction
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BBW for all antipsychotic agnets?
dementia- related psychosis
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clozapine BBW **
- fatalities due to myocarditis & cardiomyopathy
- seizure
- orthostatic hypotension, bradycardia, syncope and cardiac arrest
- potentially life-threatening agranulocytosis, defined as ANC<500/mm3
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antipsychotics are CYP substrates
what are the 2 drugs and it's enzyme highlighted in the lecture?
what are the inducers of it?
how do you mange interaction?
- 1A2: olanzapine, clozapine
- inducers: carbamazepine, smoking
should lower the dose after quit smoking otherwise for clozapine, seizure occurs
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why would 2D6 important?
- lots of psych meds inhibit 2D6
- prozac, zoloft, paxil,, etc
- switch to Escitalopram(lexapro) or citalopram (celexa)
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what are the antiemetic drugs which are FGA antipsychotics and what do you have to counsel about?
- Counsel the pts who gets Compazine (prochlorperazine) and Reglan(metoclopramide)
- about EPS Sx.
1/5 pts develope EPS w/ compazine
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one FGA mentioned for acute psychosis tx in the lecture.
DOC for delirium & last line agent for chronic management psychosis?
what AE do you think about?
- Haloperidol (Haldol)
- think about QT prolongation!!
- avoid in alcohol withdrawal
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what is inital dose for clozapine?
brand name?
how do you dose 5days?
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what is initial dose for risperidone?
brand name?
what 's max vs clinical max dose and associated
AE?
- 2mg BID, max 16mg vs clinical max 6.
- risperdal
- after >6mg, no E but more EPS
- in terms of D2 blockade, causing EPS, and hyperprolactemia above 6mg, it's like FGA
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Quetiapine low dose is commonly prescried off label. what?
what is starting dose for anti psychosis?
what is dose for off label use?
- commonly for sleep
- 25mg QHS initial dose for antipsychotic
- but 150-750 for maintenance dose
- 25-50mg on for a while is for sleep
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what is SGA mentioned in the lecture that needs to be taken with food?
Geodon should be w/ food for efficacy
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what is BBW of antipsychotics?
- Elderly patients with dementia-related
- psychosis treated with antipsychotics are at an increased risk of death
- compared to placebo. Most
- deaths appeared to be either cardiovascular (eg, heart failure, sudden death) or
- infectious (eg,
- pneumonia) in nature. Antipsychotics
- are not approved for the treatment of dementia-related psychosis.
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