Wednesday, January 22, 2014

1. Haldol is a good drug for delirium in older people because it has the least anticholinergic, least orthostatic hypotension, less QT-prolonging effect (at least when given IM or PO) than many other antipsychotics.
2. Pimozide causes bad QT-prolongation, as does IV haldol, clozapine, ziprasidone.
3. Mood stabilization & pregnancy: 
-Clonazepam is a mood stabilizer that doesn't have any teratogenic effects.
-Monitor lithium closely around the time of birth, given fluid shifts.
4. Things that increase lithium levels in the blood:
-Thiazide diuretics
-K sparing diuretics
-Dehydration
-Anything that compromises renal function: NSAIDs, ACE-I
-Metronidazole, tetracycline
5. Equivalent doses of benzodiazepines: 25mg librium = 5 mg valium/diazepam = 1 mg ativan/lorazepam
-Avoid benzos for sleep in someone with a history of alcoholism
6. Risperidone: 
-Less anticholinergic effects, more extrapyramidal effects
-Worst galactorrhea
-Good for negative symptoms
-Comes in a long acting depot injection, as does haldol, but has better side effect profile.
7. Treating the side effects of antipsychotics:
-Dystonia: benadryl, benztropine
-Akathesia: benzos, propanolol
-Bradykinesia/parkinsonism: amantadine, benztropine
-TD: clozapine
8. Treating the side effects of clozapine: 
-Sialorrhea: PTU (anticholinergic)
-Orthostatic hypotension and tachycardia (from significant alpha-blockage): selective b-blockers (a and b blockers like labetalol will exacerbate the problem)
9. Lamotrigine is very good for treating bipolar depression, and it's a good drug to use in people who have depression and a strong family history of bipolar disease.
10. Venlafaxine causes clinically significant increases in resting diastolic BP

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