Transcript Medications - Roger Peele

Medications
Most of the medication questions are covered
as part of specific Disorders. The following
are some outside Disorders.
As of 15January2012.
Main source, Stahl’s: The Prescribers
Guide.2009
This PowerPoint Section
This PowerPoint Section only addresses a
few meds as most meds are covered in
the psychiatric management parts of the
PowerPoints devoted to specific
Disorders.
Gabapentin
Q. Gabapentin is FDA approved for?
Benzodiazepines
Q. How do benzodiazepines work?
Benzodiazepines
Ans. Binds to benzodiazepine receptors at
the GABA-A ligand-gated chloride channel
complex.
Gabapentin
Ans.
1] partial seizures
2] post-herpetic neuralgia
[So, much as many of us have had good
results with gabapentin, it will frequently
be the wrong answer on exams where
FDA approval is implied.]
Clozapine
Q. FDA approves clozapine for?
Clozapine
Ans.
1] “Resistant” schizophrenia
2] People with schizophrenia who are high
suicide risk.
SSRIs
Q. List the SSRIs.
SSRIs
Ans.
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Flumazenil
Q. FDA approves flumzenil for?
Flumazenil
Ans. Reversal of sedative side effects of
benzodiazepines, such as overdose,
including such a need in children.
Risperidone
Q. Risperidone’s notable side effects?
Risperidone
Ans. Stahl lists four:
Increase risk for diabetes
Increase risk for dyslipidemia
Dose-related hyperprolactinemia
Modafinil
Q. Modafinil is FDA approved for?
Modafinil
Ans.
Reducing excessive sleepiness associated
with:
-- narcolepsy
-- shift-work sleep disorder
-- obstructive sleep apnea
Acamprosate
Q. Acamprosate is thought to work on which
receptor sites?
Acamprosate
Ans. Stabilize glutamatergic function.
Carbamazepine – lab tests
Q. What lab tests are needed when using
carbamazepine?
Carbamazepine – lab tests
Ans.
Blood count: every two weeks for 2 months,
then every three months.
Liver, kidney and thyroid function: every 6 to
12 months
Consider monitoring sodium
Carbamazepine – life
threatening
Q. What are the life-threatening conditions
to worry about when using
carbamazepine?
Carbamazepine – life
threatening
Ans.
1. Rare, aplastic anemia, agranulocytosis
2. Rare, Stevens-Johnson syndrome
3. Rare, SIADH = syndrome of
inappropriate antidiuretic hormone
secretion with hyponatremia
Clozapine – tests/monitoring
Q. What tests are to be run with clozapine?
What do you want to monitor in addition to
the lab test and physical findings
Clozapine – tests - 1
Ans.
Complete blood count:
-- before treatment
-- weekly for 6 months
-- then biweekly for months 6-12
-- after one year, then every four weeks
-- then 4 weeks after treatment discontinued
See next screen
Clozapine – tests - 2
Ans. Continued:
Track:
weight, q 3 months
BMI, q 3 months
waist circumference, q 3 months
fasting glucose, q 3 months
lipids, q 3 months
Clozapine – monitoring - 3
Ans. Vigilant for diabetic ketoacidosis by monitoring:
rapid onset of polyuria
rapid onset of polydipsia
weight lost
nausea or vomiting
dehydration
increased R
weakness
clouding of sensorium, [including, of course, coma]
Valproate – tests and
monitoring
Q. What to test and monitor for when
prescribing valproate?
Valproate – tests and
monitoring
Ans.
Lab tests before beginning treatment:
platelet count
coagulation test
liver function tests
Also monitor
weight
Follow above frequently, especially in first six
months, then once or twice a year.
Prazosin
Q. Use of prazosin [Minipress] in psychiatry?
Prazosin
Ans: PTSD’s nightmares.
Bupropion’s use in
anorexia nervosa
Q. Discuss bupropion’s use in anorexia
nervosa.
Bupropion’s use in
anorexia nervosa
Ans. Has FDA black box because of
increased of seizures in pts with eating
disorders.
Warfarin
Q. What should not be used with warfarin
[Coumadin]?
Warfarin
Ans.
bupropion
citalopram
disulfiram
mifeprestone [RU 486
[may not be complete]
[answer may be to use with caution, rather
than not at all]
Anticholinergic signs
Q. What are the untoward anticholinergic
signs?
Anticholinergic signs
Ans.
1. dry mouth
2. blurred vision
3. constipation
4. tachycardia
5. urinary retention
6. hyperthermia
7. decreased cognition
8. [also, bad for narrow-angle glaucoma]