Term
haloperidol Haldol
10-20mg/d PO |
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Definition
TA, high potency
PO, IM, and depot IM (decanoate)
LAI (long acting injection)
Blocks D2 |
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Term
fluphenazine Prolixin
1-20mg/d PO |
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Definition
TA, high potency
PO, IM, and depot IM (decanoate)
LAI |
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Term
pimozide Orap
1-10mg/d (Titrate 1-2mg x2/d, increase every other day; Genotyping for >4mg/d)
Substrate: CYP3A4 |
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Definition
TA, high potency
IM available |
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Term
tiotixene Navane
2-30mg/d (MAX 60mg/d) |
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Definition
TA, high potency
IM Available |
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Term
trifluoperazine Stelazine
2-5 mg PO BID; usual effective dosage is 15-20 mg/day (MAX dosage is 40 mg/d) |
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Definition
TA, high potency
IM available |
|
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Term
perphenazine Trilafon
Initial, 4 to 8 mg ORALLY 3 times daily (manufacturer dose) [1]; maintenance, 8 to 32 mg/d, QDS or BID |
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Definition
TA, mid potency
PO, IM forms available |
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Term
molindone Moban
50-75mg qhs, x4/d can increase to 100mg (MAX: 225mg/d) |
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Definition
TA, mid potency
DOSE EQUIVALENTS
Chlorpromazine 100 milligrams
Trifluoperazine 3 to 7.5 milligrams
Molindone 6 to 10 milligrams |
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Term
loxapine Loxitane
10mg PO BID (25mg BID initial dose max, MAX 250mg/d, Maintenance range 60-100mg/d)
[ x7-10/days to reach therapeutic range 60-100mg/d BID or QID ] |
|
Definition
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Term
chlorpromazine Thorazine
300-800mg/d |
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Definition
TA, low potency
highly sedating (good for pts w/ difficulty sleeping)
siginificant antiadrenergic (hypotension) & anticholinergic SE
low EPS |
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Term
|
Definition
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Term
|
Definition
TA, low potency
least EPS of all TA, but most anticholinergic
significant QT prolongation! & retinitis pigmentosa |
|
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Term
clozapine Clozaril
300-900 mg/d
Substrate: CPY1A2
most efficacious antipsychotic |
|
Definition
AtA
Antagonism at : 5HT2a, D1, D2, H1, muscarnic, alpha-1 rctpr
Indications:
TA indications
Treatment-refractory Sz
Sz concurrent w/ tardive dyskinesia
Contraindications:
Granulocytopenia
Diabetes/hyperlipidemias
SE:
sedation
anticholinergic SE
orthostatic hypotentsion
weight gain, substantial
hypersalivation
seizures (especiall high doses/fast titrations)
Metabolic
Agranulocytosis (need frequent WBC monitoring)
-Think Ms. Dormurat |
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Term
risperidone Risperdal
1-6mg/d (Psychosis>2-6mg, Mood>1-4mg)
Substrate: CPY2D6
PO, dissolvable tab, and depot forms
LAI |
|
Definition
AtA
Antagonism at 5HT2a, D2, alpha-1 rctprs
Indications:
TA indications
Acute mania
SE:
orthostatic hypotension
insomina
agitation
weight gain
hyperprolactinemia
EPS (high doses above 6 mg)
metabolic
Risperdal Consta
Cont. PO f/ 4-weeks, 37.5mg IM q 2-weeks (increase to 50mg if needed) |
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Term
olanzapine Zyprexa
start 10mg/qhs monitor sedation --> 15-20mg/qhs (Mood>15-20mg, Psychosis>Up to 40mg/d)
Substrate: CPY2D6, CPY1A2
PO, IM, and dissolvable tab forms available
LAI
among atypicals, efficacy second only to clozapine |
|
Definition
AtA
Antagonism at 5HT2a, D1, D2, D4, H1, muscarinic, alpha-1 rcptrs
Indications:
TA indications
Acute mania
Bipolar Maintenance
Contraindications:
Diabetes/HL
SE:
anticholinergic
orthostatic hypotension
sedation
weight gain
hyperglycemia, T2D, diabetic ketoacidosis
HL |
|
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Term
quetiapine Seroquel
150-800mg (Mood>300-600mg, Psychosis>600-800mg, Unipolar>150-300mg)
Substrate: CYP3A4 |
|
Definition
AtA
antagonism at 5HT2a, D2, alpha-1 and alpha-2, H1 rcpts
Indications:
TA indications
Acute mania
BP depression
adjunct for unipolar depression
SE:
orthostatic hypotension
sedation
weight gain
metabolic
Rare: cataracts
Annual eye exams. |
|
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Term
ziprasidone Geodon
60-80mg/d1, 120-160mg/d2
Substrate: CYP3A4
PO and fast-acting IM forms |
|
Definition
AtA
Antagonism at 5HT1a, 5HT2a, D2, D3 rcptrs and monoamine (NE, 5HT, DA) reuptake pumps!
Indications:
TA Indications
Acute Mania
SE:
sedation
weight gain (lesser than clozapine, olanzapine, and risperidone)
Metabolic (less than clozapine and olanzapine)
QT prolongation
Take with food. |
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Term
aripiprazole Abilify
2mg/qam week1, 5mg/qam week2 (MAX 10mg)
(Maintaina 400mg IM q4weeks)
Substrate: CYP3A4, CPY2D6 |
|
Definition
AtA
Antagonism at 5HT2a, partial agonist at D2 and 5HT1a
Indications:
TA indications
Acute mania
BP maintenance
adjunct for unipolar depression
SE:
sedation
weight gain (lesser than clozapine, olanzapine, and risperidone)
Metabolic
weight gain |
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Term
paliperidone Invega
6-12mg (start 6mg/d, may increase by 3mg every 4d)
metabolite of risperidone |
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Definition
AtA
TA indications
less EPS than risperidone |
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Term
iloperidone Fanapt
Titration Starter: 1mg PO BID x1/d, 1mg PO BID x1/d, increase 2mg/d until target -->6-12mg bid (MAX 24mg) |
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Definition
AtA
TA indications
less weight gain than other AtA
increased risk of QT prolongation |
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Term
asenapine Saphris
10-20mg/qhs > sublingual
Substrate: CPY1A2 |
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Definition
AtA
TA indications
?novel mechanism of action |
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Term
lurasidone Latuda
20-160mg/d (Mood>20-60mg [MAX 120mg], Psychosis>40-120mg [MAX 160mg]) |
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Definition
AtA
TA indications
?less weight gain than other AtA
-Think Mr. Khondaker |
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Term
amitryptyline Elavil
50-200mg/d
Substrate: CYP3A4 |
|
Definition
TCA
tertiary amine
-pain, headached, insomnia |
|
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Term
clomipramine Anafranil
30-250mg/d |
|
Definition
TCA
tertiary amine
-highly serotonergic, indicated for OC |
|
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Term
doxepin Sinequan
30-300mg/d (up to 100mg single dose) |
|
Definition
TCA
tertiary amine
-pain, insomnia, anxiety
-SE: sedation, weight gain |
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Term
imipramine Tofranil
50-200mg/d (up to 100mg single dose) |
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Definition
TCA
tertiary amine
-panic, enuresis
-pure noradrenergic |
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Term
nortriptyline Pamelor
25mg PO TID or QUID or as a single daily dose; MAX 150 mg/day
Substrate: CPY2D6 |
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Definition
TCA
Secondary amine (fewer SE, less sedation, safer in OD)...like tertiary TCA antagonism at 5HT & NE, but less H.A.M blockade
-demethylated amitriptyline
-least orthostasis
-pure nor adrenergic |
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Term
desipramine Norpramin
100-200mg/d PO (MAX 300mg/d) |
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Definition
TCA
Secondary amine (fewer SE, less sedation, safer in OD)...like tertiary TCA antagonism at 5HT & NE, but less H.A.M blockade
-demethylated imipramine
-least anticholinergic |
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Term
phenelzine Nardil
15mg tid-quid (MAX 60-90mg/d as tolerated) |
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Definition
MAOi
Pro DA, Pro NE, Pro 5HT |
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Term
tranylcypromine Parnate
15mg PO bid (Increase 10mg/2-weeks to a MAX 60mg/d, doses >30mg/d close supervision) |
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Definition
MAOi
Pro DA, Pro NE, Pro 5HT |
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Term
| transdermal selegiline Emsam |
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Definition
MAOi
Pro DA, Pro NE, Pro 5HT
-patch form
-lower dietary restrictions at lower doses |
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Term
fluoxetine Prozac, Sarafem
Minimum Dose: 20mg/d PO
Substrate: CYP3A4, CPY2D6
Inhibits: CYP3A4, CYP2D6 |
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Definition
SSRI (selective antagonism at 5HT presynaptic reuptake pumps)
-longest 1/2 life
-efficacy in bulimia
-activating |
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Term
paroxetine Paxil
Minimum Dose: 20mg/d PO
Substrate: CYP3A4 |
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Definition
SSRI (selective antagonism at 5HT presynaptic reuptake pumps)
-more sedating than fluoxetine & sertraline
-short 1/2 life
-social anxiety d/o |
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Term
sertraline Zoloft
Minimum Dose: 50mg/d PO
Substrate: CPY2B6 |
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Definition
SSRI (selective antagonism at 5HT presynaptic reuptake pumps)
-less sedating than paroxetine
-increased risk of GI disturbances
-activating |
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Term
fluvoxamine Luvox
Minimum Dose: 50mg/d PO
100-300mg/d (bid if >150)
Substrate: CYP3A4 |
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Definition
SSRI (selective antagonism at 5HT presynaptic reuptake pumps)
-indicated for OCD only
-many drug/drug interactions
-sedating |
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Term
citalopram Celexa
Minimum Dose: 20mg/d PO |
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Definition
SSRI (selective antagonism at 5HT presynaptic reuptake pumps)
-fewest drug-drug interactions |
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Term
escitalopram Lexapro
Minimum Dose:10mg/d PO
Substrate: CPY2C19 |
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Definition
SSRI (selective antagonism at 5HT presynaptic reuptake pumps)
-s-enantiomer of citalopram, more expensive
-less medication interactions |
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Term
venlafaxine Effexor
75mg/d, TID or BID(MAX:225mg/d)
(Extended-release capsules and tablets) 37.5 to 75 mg/day orally (single dose); may increase dosage by 75 mg/day every 4 days to a max dose of 225 mg/day
Substrate: CYP3A4, CPY2D6 |
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Definition
SNRI (No HAM blockade, cleaner than TCAs, give in morning)
-Dual-acting (NE & 5HT), SUPERIOR EFFICACY, best single drug there is. NE effect at higher doses |
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Term
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Definition
SNRI (No HAM blockade, cleaner than TCAs, give in morning)
-nauseau common SE
-treats diabetic nephorpathy & fibromyalgia |
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Term
|
Definition
SNRI (No HAM blockade, cleaner than TCAs, give in morning)
-metablite of venlafaxine (but more $)
-dual action at lower doses |
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Term
mirtazapine Remeron
Minimum Dose: 30mg/d |
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Definition
NaSSAs (Noradrenergic and Specific Serotonergic Antidepressants). Central alpha-2 rcptr antagonist --> subsequent disinhibition so increased NE and 5HT release!
-MDD and refractory MDD (especially for those that need sleep and need to gain weight)
-Think Mr. Rodriguez |
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Term
| Trazadone Minimum Dose: 150mg/d Substrate: CYP3A4 |
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Definition
SARI (Serotonin Antagonist and Reuptake Inhibitor) -most prescribed for chronic insomnia and depressive Sx
SE priapism! MUST EDUCATE! |
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Term
|
Definition
| SARI (Serotonin Antagonist and Reuptake Inhibitor) -SE liver toxicity (Black box) |
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Term
| bupropion Wellbutrin, Zyban Substrate: CYP2A6, CPY2B6 |
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Definition
| Noradrenergic and Dopamine Reuptake Inhibitors (NDRI) -activating, NE gives energy -For: MDD, BP depression, ADHD, smoking cessation -avoid with: anorexia, bulimia, seizures, MAOis -can cause seizures at high doses! -lack of sexual SE compared to SSRIs |
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Term
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Definition
| Selective Serotonin Reuptake inhibitor and partial agonist -for MDD, avoid with MAOis -similar to SSRIs, less sexual dysfxn & weight gain |
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Term
| alprazolam Xanax MAX 3mg/d |
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Definition
| Benzodiazepine -short 1/2 life, worry abt seizures w/ w/d -greater addictive potential, highest potency -effective for panic -bimodal metabolism, don't give PRN!! |
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Term
| lorazepam Ativan 0.5mg PO QD or BID (MAX 3mg/d) |
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Definition
| Benzodiazepine -short 1/2 life -PO, IM, and IV forms -widely used *Safer option in the elderly. |
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Term
|
Definition
| Benzodiazepine -short 1/2 life |
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Term
| temazepam Restoril 7.5-15mg PO QHS (MAX 30mg/QHS) |
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Definition
| Benzodiazepine -short 1/2 life -effective short-term sleep aid, lowest potency of short 1/2 lives |
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Term
| clonazepam Klonopin 0.5mg PO QD or BID (MAX 3mg/d) |
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Definition
| Benzodiazepine -long1/2 life, once daily dosing possible. Don't worry abt seizures w/ w/d (self-tapers). -most potent, anxiety -AVOID w/ renal dysfxn |
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Term
diazepam Valium
2mg PO QD or BID (MAX 30mg/d) |
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Definition
Benzodiazepine
-long1/2 life, once daily dosing possible
-dissolves highly in body fat, can accumulate
-fast onset but with active metabolite
-can use with detox & seizures |
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Term
|
Definition
Benzodiazepine
-long1/2 life, once daily dosing possible
-can use with alcohol detox |
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Term
| Benzos not metabolized by liver |
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Definition
"LOT" / "ASR"
lorazepam Ativan
oxazepam Serax
temazepam Restoril |
|
|
Term
| Benzo overdose, use what BX antagonist? |
|
Definition
|
|
Term
buspirone BuSpar
Substrate: CYP3A4 |
|
Definition
Non BZ Anxiolytic, non-addictive
-partial agonist at 5HT, effective in anxiety
-onset of action 2 wks, slower than BZs: GAD, adjunct for MDD w/ SSRI |
|
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Term
| hydroxyzine Atarax, Vistaril |
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Definition
Non BZ Anxiolytic, non-addictive
-sedating anti-Histamine
-for situational anxiety, quick acting, for pts who can't take BZs |
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Term
|
Definition
Non BZ Anxiolytic, non-addictive
-beta adrenergic blocker (treats palpitations, sweating, tachycardia)
-for performance anxiety, and akathesia
-avoid w/ asthma |
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Term
zolpidem Ambien
Substrate: CYP3A4 |
|
Definition
Non BZ Hypnotics, for insomnia
-GABAergic, yields progressive tolerance and dependence
-binds BZ-rctpr --> sedation
-shorter 1/2 life
-SE: GI distress, anterograde amnesia, hallucinations, sleep walking |
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Term
|
Definition
Non BZ Hypnotics, for insomnia
-GABAergic, yields progressive tolerance and dependence
-short-acting, can dose in middle of night (shorter 1/2 life than ambien) |
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Term
|
Definition
Non BZ Hypnotics, for insomnia
-GABAergic
-suggested to not yield tolerance
-longest 1/2 life (Lunesta>ambien>sonata) |
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Term
|
Definition
Non BZ Hypnotics, for insomnia
-sedating antihistamine
-SE: sedation, weight fain, antichol SE |
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Term
|
Definition
Non BZ Hypnotics, for insomnia
-agonist at melatonin MT-1 and MT-2 rcptrs, thought to normalize circadian rhythms
-no tolerance or dependence |
|
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Term
lithium Eskalith, Lithobid
900-1200mg (Serum 0.4-1.2) |
|
Definition
Mood Stabilizer
-modulates 2nd messenger system in brain, neurogenesis, BDNF, arborization. Increases brain health!
-good for: BAD I (*euphoric mania), BAD II, BP maintenance, Intermittent Explosive D/o, adjunct to antidepressants (potentiation)
-not metabolized by liver but by KIDNEY
-AVOID in pregnant women (Ebstein's anomaly), thiazide diuretics, ACE-inhibitors, NSAIDs (all can raise Li levels)
-may decrease suicidality |
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Term
carbamazepine Tegretol
600mg/d (Titrate 200mg qhs x5/d, 400mg qhs x5/d, 600mg qhs)
Substrate: CYP3A4
Inducer: CYP3A4 |
|
Definition
Mood Stabilizer - Anticonvulsant
-inhibits AP (effects Na/K channels, possibly enhance GABA)
-good for: BAD I (*mixed mania, *rapid cycling), BAD II, Epilepsy, Neuralgias, alcohol w/d
-onset of action: 5-7 days
-autoinducer (more take, more CYP3A4 activity), drug
clearance and half life speeds up
-AVOID in pregnant women (neural tube defects)
-Serious SE: Blood dyscrasias
-Must monitor blood count, liver and metabolic fxn
Warning: Steven-Johnson Syndrome |
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Term
oxycarbazepine Trileptal
900-1800mg (300mg qhs x1/week, 600mg qhs x1/week, 900mg qhs x1/week) |
|
Definition
Anticonvulsant/Mood Stabilizer
SE: Lowers efficacy of birth control
Labs: AST, ALT, Sodium. |
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Term
lamotrigine Lamictal
25-200mg (Titrate: 25mg qd x2/weeks, 25mg BID x2/weeks, 100mg qd, may increase by 50-100mg week, Mood>200mg/d) |
|
Definition
Anticonvulsant/Mood Stabilizer
Good for PTSD.
Minimal Weight gain, no sedation, minimal liver effect.
*Always Taper
Warning Steven-Johnson Syndrome - Instruct to stop medication and start with Benadryl in case of rash. |
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|
Term
gabapentin Neurontin
300mg-1200mg/d qhs(MAX 3600mg/d) |
|
Definition
Anticonvulsant
Used to treat nerve pain and anxiety, sensory overload |
|
|
Term
| Benzodiazapine dosing equivalents and tapering |
|
Definition
Decrease dose by 0.5-1mg equivalence q2weeks.
_Equivalents_
Xanax 1mg
Klonopin 1mg
Valium 10mg
Ativan 0.5mg (approx. 0.75mg)
Restoril 20mg |
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