Pharmacological Considerations in Psychiatry

Lamotrigine (Lamictal)

  • Medication Class: Mood Stabilizer
  • Considerations:
    • Rash (SJS): Always monitor for rash, as it can lead to Stevens-Johnson Syndrome (SJS).

Clozapine (Clozaril)

  • Medication Class: Second Generation Antipsychotic
  • Key Concerns:
    • Tardive Dyskinesia (TD): Potential side effect that needs to be monitored.
    • Signs & Symptoms to Monitor:
    • Don't miss doses or self-discontinue medication.
    • Do not stop abruptly to avoid complications.
    • Education: Look for rash and be vigilant about any side effects.

Therapeutic Lithium Level

  • Therapeutic Range:
    • Lithium levels should ideally be maintained between 0.5 - 1.5 meg/L (70.6 - 1.2 meg).

Amitriptyline (Elavil)

  • Medication Class: Tricyclic Antidepressant (TCA)
  • Important Considerations:
    • Potential for Agranulocytosis (a severe drop in white blood cell count, assess through labs that monitor Absolute Neutrophil Count (ANC) and WBC).
    • Symptoms to monitor for Agranulocytosis:
    • Sore throat
    • Common Side Effects:
    • Anticholinergic side effects (dry mouth, constipation, urinary retention).
    • Orthostatic Hypotension: Patients may experience blood pressure drops upon standing.
    • Danger in Overdose:
    • Should be regarded as lethal if overdosed.
    • Symptoms of Dystonia:
    • Fever, tongue protrusion, rapid blinking, lip smacking.

Treatment Options for Dystonia

  • Medications for Symptomatic Management:
    • Benztropine (Cogentin)
    • Diphenhydramine (Benadryl)

Carbamazepine (Tegretol)

  • Medication Class: Anticonvulsant
  • Side Effects:
    • Pseudoparkinsonism: Patients may present with symptoms resembling Parkinson's disease, such as rigidity and tremors.
    • Other conditions to monitor: Akathisia.

Example of Monoamine Oxidase Inhibitors (MAOIs)

  • Examples:
    • Tranylcypromine
    • Phenelzine
    • Selegiline
  • Key Considerations:
    • Avoid tyramine foods:
    • Eating aged cheese, cured meats, alcohol, and fermented products can cause a Hypertensive Crisis due to dietary tyramine interacting with MAOIs.

Lithium Contraindications

  • Medications to Avoid:
    • NSAIDs: Can lead to increased lithium levels.
    • Diuretics and ACE Inhibitors: Must be monitored due to their effects on kidney function and sodium levels.
  • Signs & Symptoms of Lithium Toxicity:
    • Tremors, rigid muscles, and fever.

Understanding Schizophrenia Symptoms

  • Positive Symptoms:
    • Hallucinations, delusions, and disorganized speech.
  • Negative Symptoms:
    • Flat affect, poor hygiene, anhedonia.
  • Tolerance:
    • Patients may require higher doses over time to elicit the same effects, signifying a tolerance development.

Regular Monitoring

  • Key Aspects:
    • Ensure regular monitoring of lithium blood levels and kidney function.
    • Maintain consistent hydration and sodium intake to balance lithium levels effectively.