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SCCT Quiz 3 - Coggle Diagram
SCCT Quiz 3
levetiracetam (Keppra, Keppra XR)
common ADRs: asthenia, fatigue, HA, somnolence, vomiting
rare ADRs: pancytopenia, hepatotoxicity, suicidal thoughts, suicide, SJS
interactions: carbamazepine (increased risk of CBZ toxicity)
efficacy: reduction in frequency and severity of seizures
indications: myoclonic seizure (adjunct), partial seizure (adjunct), tonic-clonic seizure/primarily generalized (adjunct)
toxicity: emergence or worsening of depression, suicidal behavior or ideation, or unusual changes in behavior, WBC, LFTs
class: anticonvulsant
counseling: instruct patient to swallow ER tab whole, do not chew, break, or crush; avoid activities requiring mental alertness or coordination until drug effects are realized; report mood swings, agitation, hostile behavior, suicidal ideation, or unusual changes in behavior; avoid sudden D/C of drug, may increase seizure activity
olanzapine (Zyprexa)
common ADRs: akathisia, asthenia, dizziness, hypercholesterolemia, hyperglycemia, increased appetite, increased prolactin levels, increased triglycerides, somnolence, tremor, weight gain, xerostomia, orthostatic hypotension, increased LFTs
rare ADRs: neuroleptic malignant syndrome, pancreatitis, sudden cardiac death, suicidal thoughts, tardive dyskinesia, DRESS, slowed or difficult breathing when used in combo with opioids
interactions: tramadol (additive serotonergic effects), haloperidol (increased risk of Parkinsonism), metoclopramide (increased risk of EPS), CYP1A2 inducers/inhibitors, QTc-prolonging agents (may increase QTc interval)
efficacy: improvement in schizophrenia, bipolar disorder, agitation, or treatment-resistant depression
indications: bipolar disorder (acute mixed or manic episodes and maintenance therapy), schizophrenia, treatment-resistant depression in combination with fluoxetine
toxicity: FBG/HbA1c prior to tx and periodically in patients with DM; CBC, lipid profiles at baseline and periodically thereafter; check body weight and BMI regularly during tx; LFTs, electrolytes, and vital signs; symptoms of neuroleptic malignant syndrome and involuntary movement/Parkinsonian signs
class: thienobenzodiazepine, atypical antipsychotic
counseling: avoid activities requiring mental alertness or coordination until drug effects are realized; drug may impair heat regulation; rise from sitting/lying-down position slowly; report symptoms of tardive dyskinesia, neuroleptic malignant syndrome of DRESS syndrome; diabetic patients should monitor for hyperglycemia and report difficulties with glycemic control; avoid EtOH while taking drug
quetiapine (Seroquel, Seroquel XR)
common ADRs: agitation, HA, HTN, somnolence, weight gain, xerostomia
rare ADRs: neuroleptic malignant syndrome, neutropenia, pancreatitis, sudden cardiac death, syncope, tardive dyskinesia, slowed or difficulty breathing when used in combo with opioids
interactions: CYP3A4/5 inducers/inhibitors, agents that prolong QTc interval (increased risk of QTc prolongation)
efficacy: improvement in S/S of schizophrenia, manic or mixed episodes associated with bipolar disorder, depression
indications: bipolar or schizophrenia, MDD adjunct to antidepressants
toxicity: BP, FPG, and CBC with differential, eye examination at baseline and periodically during therapy; fasting lipid profile/HgA1c at baseline, 3 mo, and annually; weight, growth, BMI; TSH/T4; patients at high risk for suicide should be closely supervised
class: antipsychotic (atypical)
counseling: take with food but avoid EtOH; avoid activities requiring mental alertness or coordination; use caution with activities leading to increased core temp; rise slowly from sitting/supin position; report s/s of hyperglycemia, bradycardia, arrhythmia, tardive dyskinesia, or neuroleptic malignant syndrome
risperidone (Risperdal)
rare ADRs: neuroleptic malignant syndrome, pancreatitis, stroke, pancytopenia, sudden cardiac death, syncope, tardive dyskinesia, priapism, slowed or difficulty breathing when used in combo with opioids, seizure, suicidal ideation or behavior
efficacy: improvement in S/S of schizophrenia, manic or mixed episodes associated with bipolar, depression
common ADRs: EPS, insomnia, anxiety, fatigue, metabolic changes (hyperglycemia, dyslipidemia, weight gain, DM)
interactions: CYP2D6 inhibitors, P-gp inhibitors/inducers, agents that prolong QTc interval (increased risk of QTc prolongation), valproic acid (increased VPA concentrations), antichoniergics (additive anticholinergic activity)
toxicity: BP (including orthostatic), FPG, HbA1c in diabetic patients, lipid panel, weight, BMI, abdominal circumference, CBC w/ differential, symptoms of tardive dyskinesia; closely supervise patients at high risk for suicide
indications: autistic disorder (irritability), acute manic or mixed episodes of bipolar I disorder, schizophrenia
counseling: take with food; avoid EtOH or other CNS depressants; avoid activities requiring mental alertness or coordination until drug effects are known; use caution during activities leading to increased core temp; rise slowly from sitting/supine position; report S/S of hyperglycemia, arrhythmia, tardive dyskinesia, or neuroleptic malignant syndrome; keep dissolvable tablet in blister pack until use; place on tongue and swallow after dissolved; oral solution may be mixed with water, coffee, OJ, or low fat milk, but should not be mixed with cola or tea
class: benzisoxazole, antipsychotic