psychosis and neuropharmacology

1.5 - 2.5

mild lithium toxicity levels

2.5 - 3.5

moderate lithium toxicity levels

> 3.5

severe lithium toxicity levels

tremors

uncontrolled shaking

ataxia

coordination and balance issues

myoclonus

muscle twitches

dysarthria

slurred speech

hyperreflexia

overactive reflex responses

nystagmus

uncontrolled eye movements

acute dystonia

spasm of the muscles of the tongue, face, neck, and back

parkinsonism bradykinesia

mask-like face, tremor, rigidity, shuffling gait, drooling

akathisia

compulsive restless movement, symptoms of anxiety and agitation

tardive dyskinesia

oral/facial dyskinesias, choreoathetoid movements

extrapyramidal side effects

drug-induced movement disorders that primarily occur as adverse reactions to medications that block dopamine receptors, such as antipsychotics and certain antiemetics

MAOI

cause sudden, severe hypertensive crisis when interacting with thiamine rich foods or certain medications

MAOI

prevent breakdown of norepinephrine and tyramine

tyramine

found in cheese, coffee, chocolate, bananas, raisins, italian green beans, liver, pickled foods, sausage, soy sauce yeast, beer, and red wines

lead pipe rigidity

uniform, smooth resistance through the entire range of passive joint movement

hypertonia

lead pipe rigidity; feels like bending a lead pipe; sign of neuroleptic malignant syndrome

dantrolene

reverses symptoms of malignant hyperthermia

malignant hyperthermia

caused by paralytics

stevens johnson syndrome

adverse effect of antipsychotic medications

atypical antipsychotics

less likely to cause SJS or NMS

carbamazepine

anticonvulsant medication primarily used to treat epilepsy, trigeminal neuralgia, and bipolar disorder

epilepsy

manages partial seizures with complex symptomatology, generalized tonic-clinic seizures, and mixed seizure patterns

trigeminal neuralgia

chronic pain in the face or jaw

antipsychotics and mood stabilizers

treats acute manic and mixed episodes in bipolar 1 disorder

chlorpromazine

conventional antipsychotic used to treat schizophrenia, bipolar disorder, and severe behavioral problems; also intractable hiccups, severe nausea, and pre-surgical anxiety

tardive dyskinesia

irreversible side effect of chlorpromazine

chlorpromazine

works by blocking dopamine receptors to help manage hallucinations and delusions; known for sedation, tremors, weight gain, and dizziness

duloxetine

major concern is liver toxicity; do not give to patients with pre-existing liver disease or those who drink heavily

quetiapine

atypical antipsychotic that can be used for insomnia; associated with weight gain, metabolic syndrome, and hyperglycemia

hyperglycemia

polydipsia, polyphagia, polyuria

antipsychotics and mood stabilizer

both are needed in the case of bipolar disorder; antidepressant alone will cause hypomanic or manic episode due to elevated mood

amitriptyline

cause dizziness and orthostatic hypotension; change positions slowly

haldol

antipsychotic that blocks dopamine and cholinergic function; treat schizophrenia; many side effects that make it difficult for patients to remain compliant

donepezil

acetylcholinesterase inhibitor that increases the available acetylcholine to improve Alzheimer’s symptoms

pyridostigmine

acetylcholinesterase inhibitor that can increase cholinergic effects leading toxicity symptoms; used to treat myasthenia gravis

cholinergic effects

the stimulation of the parasympathetic nervous system, which controls the body's "rest and digest" functions

anticholinergic medications

amitriptyline, atropine, and diphenhydramine; block activity of acetylcholine working against donepezil

pyridostigmine and donepezil

synergistic; both increase acetylcholine; causes cholinergic crisis with nausea, bradycardia, and muscle cramps

donepezil and amitriptyline

antagonistic; reduced effectiveness of alzheimer’s treatment; increased dementia symptoms

pyridostigmine and amitriptyline

antagonists; works against each other to reduce function of medication designed to improve neuromuscular transmission