psych exam 2 mini lecture
levels of lithium in maintenance therapy
0.4-1
critical level for lithium (sign of lithium toxicity)
1.5, some say 1.4
how long should a patient wait after having NMS before starting a new antipsychotic med?
2 weeks
lithium onset of action
5-7 days
most common drug combinations that lead to serotonin syndrome
SSRI plus MAOI or TCA
3 acute movement disorders assoc w/ EPS
acute dystonia, akasthisia, parkinsonism
meds for NMS
bromocriptine (Parlodel) amantadine (Symmetrel) anticholinergic drugs
medication for acute dystonia
cogentin or benadryl IM
s/s of serotonin syndrome
confusion, autonomic dysfunction, muscular rigidity, ataxia
s/s of NMS
muscular rigidity, hyperthermia, altered LOC
Z-track method, best for IM injections
pull muscle to one side, inject all meds, release muscle. do not massage
s/s of lithium toxicity
severe diarrhea, vomiting, drowsiness, muscle weakness, lack of coordination
diagnosis of serotonin syndrome involves having 3 of these 8 s/s [SHAM DAD F]
shivers hyperreflexia agitation myoclonus diaphoresis ataxia diarrhea fever
how to treat lithium toxicity
stop meds
remedy for akathisia
stop the causing meds
movement disorder assoc w/ late-appearing EPS
tardive dyskinesia
when does NMS usually appear?
when antipsychotic meds are first started or when adjusting dose