By Michael Robertson
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Extra info for Acute Psychiatric Management
Ethnic neutropenia and clozapine. Australian and New Zealand Journal Psychiatry. 2008;42:342-345. 48. Ahokas A, Elonen E. Circadian rhythm of white blood cells during clozapine treatment. Psychopharmacology. 1999;144(3):301–2. 49. Perry PJ, Miller DD, Arndt SV, et al. “Clozapine and norclozapine plasma concentrations and clinical response of treatmentrefractory schizophrenic patients”. American Journal Psychiatry. 1991;148:231-235. 50. Treatments 2 Psychotropics Sertraline Citalopram Carbamazepine Fluoxetine Fluvoxamine Paroxetine Phenytoin St John’s Wort Phenobarbitone Risperidone Modafinil Lithium Diazepam Haloperidol Valproate Lamotrigine Nicotine Grapefruit juice Clarithromycin Ketoconazole Rifampicin Ritonavir Social/Recreational Caffeine 35 Anti-infectives Ciprofloxacin Erythromycin Cardiac Lisinopril Quinidine GI Cimetidine Other Disulfiram Oral contraceptive pill Table 3 – Potential Drug Interactions with clozapine d) Neurological Monitoring Drug induced movement disorders are uncommon with clozapine therapy, however there should be routine examination assessing for obvious abnormal involuntary movements, parkinsonism, and motor restlessness.
Pharmacology of antipsychotic long-acting injections. In Antipsychotic Long-acting injections. Oxford University Press. 35. Australian Consensus Panel for Treatment-Refractory Schizophrenia. au 36. 5mg Quetiapine (oral) 150mg Risperidone (oral) 1mg Thioridazine (oral) 100mg Trifluoperazine (oral) 5mg Ziprasidone (oral) 40mg Zuclopenthixol HCl (oral) 20mg Flupenthixol Decanoate (IM) 13mg every 2 weeks Fluphenazine Decanoate (IM) 8mg every 2 weeks Haloperidol Decanoate (IM) 33mg every 4 weeks Zuclopenthixol Decanoate (IM) 67mg every 2 weeks Risperidone LAI Olanzapine Pamoate LAI Paliperidone Palmitate LAI 2 29 13mg every 2 weeks 75 mg every 2 weeks; 135mg every 4 weeks 27mg every 4 weeks Table 2 – Chlorpromazine dose equivalents HET I AC U T E PS Y C H IATRI C M A N A G E M E N T LEARNING OBJECTIVES • To know the important effects and side effects of lithium • To be able successfully to commence and maintain lithium treatment Lithium therapy Introduction 30 Lithium has well-established efficacy as an antimanic agent and antidepressant in bipolar disorder, and for prophylaxis against mood episodes in bipolar disorder.
OR • Olanzapine 5-10mg IMI 2 hourly (prescribed as stat doses not as prn) for patients at risk of EPSE or in antipsychotic naïve patients. IM Olanzepine should not be given in combination with benzodiazepine or in those who are intoxicated with any substance. There should be a gap of 2 hours between IM benzodiazepines and IM olanzepine because of potential higher risk of respiratory depression. Maximum dose of regular, prn and stat dose of olanzepine should be 30 mg in 24 hours. Concentration peaks 15-45 minutes.