PHRM4012 Lecture Notes - Lecture 4: Carbamazepine, Orthostatic Hypotension, Diplopia
25 Jul 2018
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Acute manic symptoms 2nd gen antipsychotics + haloperidol: se adeshow anticholinergic (constipation, urinary retention, blurred vision, dry mouth), dyslipidaemia, epse, sedation, weight gain, hyperglycaemia, orthostatic hypotension. Contraindications: respiratory failure, gi obstruction, diabetes, low wbc/dyscrasia, hyperthyroidism increased risk of acute dystonia, parkinson"s disease. Monotherapy failure first line antipsychotic + lithium/sodium valproate. Monitor glucose levels, weight, symptoms, blood count, lipids. Do not stop taking abruptly prevent symptoms/reduce risk of relapse. May cause drowsiness so don"t drive/don"t take alcohol. May cause dizziness so careful when getting up. Avoid recreational drugs exacerbate bipolar symptoms look out for epse dyskinesia, rigidity, tremor, bradykinesia. Haloperidol 1st gen increased movement se. Withdraw after acute manic symptoms resolve sodium valproate/lithium. 750-1000mg in divided doses onset of action ~1 week titrate acute manic dose (0. 5-1. 2mmol/l) prophylaxis (0. 4-1mmol/l) Se metallic taste, acne, nausea/vomiting, diarrhea, fatigue, hypothyroidism, serotonin toxicity (man, dfs h) Monitor blood levels, renal impairment, lithium toxicity (nausea, vomiting, extreme thirst), thyroid.
