Description

1.       JK was recently diagnosed with psychosis and a decision is being made to start an anti-psychotic.  What is the difference between atypical antipsychotics and the older typical ones?

2.       LB is a 45 yo to be started on lithium.  What is the most common use of this medication and what would you monitor for efficacy and toxicity?

3.       JH is a 7 yo male recently diagnosed with ADHD.  In the management of ADHD stimulants are commonly used.  Is there a diff in efficacy between the various agents?  Can you predict in advance which med would be best for which patient?

4.       IT is a 36 yo on a vent. He has been receiving propofol for 4 days. Pharmacy notifies you that if you continue using propofol for  sedation there is a risk of life threatening side effects. What is the problem?

5.       Mk is a 65 yo with a DVT in the right leg.  He has been started on heparin.  What are the monitoring parameters of heparin?  What is its mechanism of action for unfractionated heparin vs low molecular weight heparins?

6.       LT is a 45 yo that has been on heparin.  He requires immediate surgery and his PTT is very high.   How can the heparin be reversed so he can go to surgery?

7.       PT has had a valve replacement.  He saw a commercial for Dabigatran and wants to know if he can use that vs warfarin.   What is this med and what are its indications?

Quetiapine (Seroquel) is a second-generation (atypical) antipsychotic medication that is indicated for the treatment of schizophrenia, acute manic episodes associated with bipolar I disorder, and depressive episodes associated with bipolar disorder (Seroquel [quetiapine fumarate], 2013). Off-label use of quetiapine includes short-term treatment of agitation, psychosis, and delirium (Quetiapine: Drug information, 2019). It was proposed that the efficacy of quetiapine is mediated through a combination of dopamine type 2 (D2) and serotonin type 2 (5-HT2) antagonism. Quetiapine is not approved for use in children younger than ten years, and in elderly patients with dementia-related psychosis (Seroquel [quetiapine fumarate], 2013).

Adverse reactions associated with quetiapine therapy in adults include somnolence, dizziness, postural hypotension, weight gain, dry mouth, dyspepsia, abdominal pain, constipation, asthenia, pharyngitis, lethargy, increased alanine aminotransferase (ALT), increased incidence of cerebrovascular adverse events, neuroleptic malignant syndrome, hyperglycemia, dyslipidemia, tardive dyskinesia, leukopenia, seizures, hypothyroidism, and cataracts (Seroquel [quetiapine fumarate], 2013). Adverse reactions associated with quetiapine therapy in children and adolescents include somnolence, dizziness, fatigue, nausea, vomiting, dry mouth, increased appetite, tachycardia, increased weight, and increased blood pressure (Seroquel [quetiapine fumarate], 2013).