withdrawal sx occurs abnormal thinking behaviors female is more sensitive to

Withdrawal sx occurs abnormal thinking behaviors

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withdrawal sx occurs; abnormal thinking & behaviors; female is more sensitive to Zolpidem ADRs Persistent sedation & drowsiness; rebound status epilepticus; risk of suicide HA, mild transient amnesia, dizziness, Nausea Monitoring Frequent monitor for therapeutic (15-40mcg/mL) & toxic levels especially concurrent use with drug metabolized by CYP450 No drug level test needed Mood stabilizers Lithium carbonate (Lithobid, Eskalith) Valproic acid ( Depaken, Depakote) Nonclassifie d Mood stabilizers MOA (bipolar is like epilepsy) thought to replace sodium during depolarization in neuronal pathways (unknown) Blocks GABA uptake into presynaptic neurons without affecting the benzodiazepine binding site (unkown) lamotrigine (Lamictal), gabapentin (Neurontin), topiramate (Topamax) Classic bipolar mood disorder & adjunct for tx resistant unipolar depression maintenance of mood stability and prevention of mania or hypomania Treatment of seizures; the first- or second-choice drug in the treatment of bipolar disorder, especially in acute mania and maintenance for bipolar, manic disorder Borderline personality, PTSD, anger & aggression Pharmaco -kinetics NOT metabolized in liver, excreted by kidney; food not affecting absorption Max level in .5 -3 hr, half- life 17-36 hr, steady state 5-7days Reach peak in 1-4 hr, half-life 6- 16hr Carbamazepine & warfarin displace valproic toxic side effects; metabolized in liver by CYP450 & excreted in urine Pharamco - therapeut ics Baseline Chem w/ BUN/Cr, TSH level Contraindication in children <12 yr Therapeutic level: 0.6-1.5 mEq/L Pregnancy C Therapeutic level 50-100 mcg/mL, safer than lithium Pregnancy D but only beyond the first trimester Pregnancy C ADRs Most common: fine tremors of fingers, nausea, dry mouth, HA, drowsiness Overdose causes arrhythmias Toxicit y: coarse tremors of the, N/V, diarrhea, confusion, Toxicity: dizziness, hypotension, tachycardia or bradycardia, drowsiness, visual hallucinations, and respiratory depression. Coma and death Uncommon: prolong bleeding time; liver failure; false + ketone in DM
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stupor, polydipsia and polyuria , muscle weakness, and ataxia Drug interactio ns Altering fluid balance (diuretics) or NSAIDs & COX 2 inhibitor (reduce renal elimination) and lithium increases risk of toxicity Decrease lithium level theophylline, sodium salt, Combined with TCA causes cardiotoxicity Monitorin g Lithium level obtains 14 days after initiation & adjustment & routine check every 3-6mo; Annual check for chem, TSH; baseline ECG Education Maintain adequate salt intake Antipsychotics Typical Aps Atypical APs MOA Blocks D2 receptors in basal ganglia, hypothalamus, limbic system, brainstem, medulla Reduce positive Sx of Schizophrenia Thought to block serotonin in cortex more dopamine released in prefrontal cortex; Less blockade on D2 Phenothiazine agents: Chlorpromazine (Thorazine), Thioridazine (Mellaril), Fluphenazine (Prolixin), Perphenazine (Trilafon), Trifluoperazine (Stelazine) Non-phenothiazine agents: haloperidol (Haldol) , thiothixene (Navane), loxapine (Loxitane), and molindone (Moban) Aripiprazole (Abilify); Clozapine (Clozaril); Olanzapine (Zyprexa)
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  • Spring '14
  • Henrikson,J
  • Major depressive disorder

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