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