[A] CNS drugs
(a) gen anesthetics
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商品名
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inhalation
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Desflurane
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Suprane 240ml/bt
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維持全麻
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Sevoflurane
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Ultane 250ml/bt
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引導/維持全麻
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IV
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Etomidate
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Etomidate-lipuro 20mg/10ml/amp
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引導全麻,
短效安眠藥
Iv 0.2-0.3mg/kg
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[副]: myoclonus
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Thiamylal sod
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Citosol (500mg/20ml/vial, 2.5%)
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引導全麻
Sedation:
iv 0.5-1.5mg/kg
Status epilepticus:
Iv 3-5mg/kg +
2-5mg/kg/h ivd
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C/I:
-resp obst
-severe CV instability or shock
-status asthmaticus
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Propofol
(GABAa agonist)
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Fresofol (200mg/20ml/amp)
稀釋 by D5W或直接用
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引導/維持全麻
Total IV anesthesia (TIVA),
ICU
sedation,
Iv 0.25-1mg/kg + 1.5-4.5mg/kg/h
status epilepticus:
1-2mg/kg+ 2-4mg/kg/h
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[副]: apnea, myoclonus, 低血壓, 高血脂,
Rare: 靜脈栓塞
尿液變色<1%
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用超過2天 (≥4mg/kg/h) 可導致propofol infusion synd (Major risk factor:
-poor oxygen delivery
-sepsis
-嚴重大腦受傷
-高劑量
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Ketamine
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Ketalar (50mg/ml,
10ml/vial=500mg)
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Induction: iv 0.5-2mg/kg
維持: iv 30-90 ug/kg/min
(60kg=1.8-5.4mg/min= 120mg/h
Sedation,
analgesia: iv (2-3’) 0.2-0.8mg/kg
Ivd 5-10ug/kg/min
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Barbiturate & ketamine 勿併用(ppt)
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麻醉藥輔助治療
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Fentanyl citrate
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Fentanyl (0.1mg/2ml/amp)
(0.5mg/10ml/amp)
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Premedication: iv 25-100ug or
0.5-2ug/kg
Adjunct to anesthesia:
Iv 1-3ug/kg
↓Stress response to插管: Iv 2-6ug/kg
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[副]: 口乾, CNS抑制, 呼吸抑制
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腎差不需調整劑量
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Midazolam
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Dormicum (5mg/1ml/amp)
Midation (15mg/3ml/amp)
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Pre-OP sedation: im 0.07-0.08
mg/kg
全麻:
導引:0.05-0.15 mg/kg維持: 0.05mg/kg prn
0.06mg/kg/h
ICU sedation:
0.02-0.1mg/kg + 0.04-0.2mg/kg/h
Status epilepticus: IM, intranasal:
0.1-0.2mg/kg
Iv: 0.1-0.2mg/kg + 0.05-0.6/kg/h
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[副]: 低血壓, 呼吸抑制,
Ffg需減低劑量:
-老者
-虛弱者
-併用CNS抑制劑時
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-Tachyphylaxis in status
epilepticus (24-48h後,需調高劑量數倍)
-給藥48h後,常會蓄積,造成過度sedation
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(B) Sedation & hypnotics
(1) BZD (GABAA
W1+W2)
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Brotizolam
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Lendormin (0.25mg/#)
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Insomnia: 0.5-1# hs
術前sedation: SL 1-2#
Duration 7h
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小心: 嚴重重症肌無力, COPD
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Flunitrazepam
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Modipanol (1mg/#) (FM2)
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Insomnia: 0.5-4# hs
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小心: 嚴重重症肌無力, COPD
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Estazolam
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Eurodine (2mg/#)
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Insomnia: 0.5-1# hs
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[副]: asthenia, hypokinesia
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Ditto
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Nitrazepam
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Limin (5mg/#)
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Insomnia: 1-2# hs
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Ditto
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(2)
Imidazopyridine (GABAA-W1)
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Zolpidem
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Stilnox (10mg/#)
Stilnox CR (6.25mg/#)
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Insomnia: 0.5-2# hs
CR 1-2#hs
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[副]:夢遊,
依賴/rebound insomnia
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Ditto
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Zaleplon
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Sonimax (10mg/#)
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Insomnia: 0.5-2# hs
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(3)
Barbiturate
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Phenobarbital
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Phenobarbital 30mg/#
Phenobital 100mg/ml/amp
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Sedation:
PO, 1#tid, 2#bid
IM: 0.5-1 amp
抗痙攣:
PO, 2# b-tid
IM: 0.5-1amp b-tid
Status epilepticus:
IM: 20mg/kg (≦60mg/min), 20分後仍SZ, add another
10mg/kg
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(C) 抗焦慮藥
(1) BZD
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Diazepam
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Diazepam (2mg/#)
Dupin (5mg/#)
Dupin (10mg/2ml/amp)
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Anxiety: PO 1# tid,
Deep IM 1支
肌肉鬆弛: PO 2-10mg tid
IM, IV 5-10mg
Status epilepticus
IV 10mg (0.3mg/kg), may repeat after 10-20’
Acute Alc w/d:
PO 10mg t-qid
IV 5-10mg q5-10’ until calm
Insomnia: 1-5mg hs
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[副]: 呼吸變慢
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Prefer slow iv, if iv not
available, ->IM deltoid only
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Lorazepam
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Lowen (0.5mg/#)
Anxicam (2mg/ml/amp)
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Hypnotics: 1-8#hs
焦慮: 1-4# tid (max 20#/d)
Acute Alc w/d:
PO,SL: 2-4# q4-6h
IM,IV: 1-2支q15-20’ till calm或改ivd
Status epilepticus:
Iv,IM 2支(0.1mg/kg), 10-20’後可repeat
止吐: IV, PO/SL: 1-2mgq4-6
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小心: 嚴重重症肌無力, COPD
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Bromazepam
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Lexotan (1.5mg/#)
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焦慮: 1-2-4-6# tid
老人: 減半
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Alprazolam
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Xanax (0.25mg/#)
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Anxiety, depression, panic d/o
1-2# tid, max 5-6mg/d
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小心: 嚴重重症肌無力, COPD
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Oxazolam
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Secorin (10mg/#)
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Anxiety: 1-2# tid
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Ditto
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(D) Antidepressants
SSRI/ SNRI w/d syndrome
Criterion A: 使用該藥4-8wk 後,
停藥/interrupted or 減藥
Criterion B: 使用該藥4-8wk 後, 停/減藥 1-10天內, 產生至少2個ffg symp
Dizziness; N
and/or V; HA; lethargy; anxiety and/or agitation; 頭or四肢有tingling(paresthesia),numbness, “’electric”-shock-like 感
Tremors;
sweating; insomnia; irritability; vertigo; diarrhea
(1)
SSRI
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Fluoxetin
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Fluronin (20mg/cap)
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Depression, OCD, panic d/o: 1#
qd (max 80mg/d)
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[副]: 緊張,HA,GI, insomnia, anorgasm, bruising, mydriasis,
delayed ejaculation
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Sertraline
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Zoloft (50mg/#)
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Depression, OCD, Panic
1-2#/d (max 4#)
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Ditto
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Paroxetine
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Seroxat (20mg/#)
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Depression, OCD, panic
1-2#/d (max 3#)
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Ditto
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Escitalopram
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Lexapro (10mg/#)
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Depression, OCD, panic
1-2# qd
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Ditto
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(2) SNRI
(serotonin/NE reuptake inhibitors)
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Venlafaxine
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Efexor XR (3.75mg/cap)
Efexor XR (75mg/cap)
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Depression, OCD, panic
初:1-2
cap qd (max 75mg x3-4 cap/d)
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Ditto
BW↓or↑(edema)
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<150mg: 只serotonergic effect
150mg: dual effect (+NE)
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Duloxetine
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Cymbalta (30mg/cap)
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Depression, anxiety, neuropathic pain, stress incontinence, fibromyalgia
1-2 cap qd (max 4#/d)
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Ditto
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(3)
NE/dopamine reuptake inhibitor (NDRI)
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Bupropion
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Wellbutrin XL (150mg/#)
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Depression
1-2# qd (max 3)
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[副]: agitation, tremor, insomnia, Nausea, nightmare,
SZ (0.1%)
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小心: epilepsy
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(4) 5HT2
/α2/ 5HT3
antagonist
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Mirtazapine
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Smilon (30mg/#)
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Depression, pruritus, migraine: 0.5-2#/d hs-bid
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頭嗜睡, 口乾, 便秘
REM behavior d/o
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特性: block major receptor s/w pruritus (H1, 5HT2, 5HT3)
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(5) 5HT2
antagonist
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Trazodone
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Mesyrel (50mg/#)
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Depression: 1# b-tid
(max 8-12#)
Insomnia: 0.5-3# hs, Erectile dysfxn: 1-2# hs
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[副]: 嗜睡, GI, 姿態低血壓, priapism, HA
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(6)
melatonergic agonist/ 5-HT2C antagonist
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Agomelatine
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Valdoxan
(25mg/#)
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Depression: 1-2# hs
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S/E: GI, drowsy
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(7)
Tricyclic drugs
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Imipramine
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Fronil
(25mg/#)
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Depression, enuresis,
neuralgia: 1-4#/d or hs
Insominia: 1-4# hs
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S/E: 心悸,口乾,便秘,尿滯留,視力模糊
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Doxepine
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Sinequan
(2mg/cap)
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Depression<
anxiety, insomnia, urticaria:
1-6# hs or divided (max 12#)
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Ditto
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Deanxit 複方
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Flupentixol
0.5mg (neuroleptics極低劑量)
Melitracen
10mg (TCA)
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Depression, anxiey,
apathy:
初:1-2# om, 1# noon
維: 1# om
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(8)
Reversible MAO-A inhibitor
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Moclobemide
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Moclod
(150mg/#)
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Atypical depression,
depression in dementia, resistant depression:
1-2# b-tid (max 4-6#/d)
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S/E: sleep disturbance,
dizziness, nausea, HA
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含tyramine高食物勿食用過量
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(e) anti-manic drug
Lithium
carbonate
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Ligilin (300mg/cap)
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Acute mania or 預防
預防migraine or cluster HA: 1-4 cap HS or 2 cap
bid
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S/E: 多尿/口渴,無力, tremor, 水腫, vertigo, acne
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下列情形很易造成鋰中毒: 嚴重腎病,脫水,低血鈉,利尿劑
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(f) Anti-psychotic drug
-突然停用此類藥, 可能在數日到數周內導致psychotic symp rebound akathisia /
Parkinsonism or w/d dyskinesia惡化/復發,
-如果需停藥, taper it over 4-8 wks
(1) Typical
anti-psychotic
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Flupentixol
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Fluanxol depot
(20mg/amp)
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Psychotic d/o:
1-2 amp deep IM q2-4wk
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Prochlorperazine
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Novamin (5mg/#)
Novamin (5mg/1ml/amp)
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Nausea/ vomiting,
acute or chronic psychosis:
1-2# t-qid; IM 1-2 amp q3-4h (max 8支/d)
Post-OP N/V: 術後1-2支IM
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S/E: EPS, dyspnea, HA, drowsy, 姿態低血壓
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Haloperidol
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Binin-U (5mg/#)
Haldol (5mg/1ml/amp)
Haldol decanoas (50mg/1ml/amp)
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Psychotic d/o:
1-5mg hs-tid (max 6#/d)
IM 1-2支, q1-4h prn
Decanoas:
IM 1-3支q4wk
Tourette’s d/o, hiccup
PO: 0.5-5mg hs (max 2-3#/d)
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S/E: EPS, drowsy, 姿態低血壓, QT延長
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在甲狀腺亢進病人May cause嚴重neurotoxic
反應
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Sulpiride
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Dogmatyl (50mg/#)
Sulpin (200mg/#)
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Depression: 50-100-200 tid
Psychosis/schizophrenia:
100-200mg tid or
200-400mg bid (max 1.2-2.4g/d
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[副]: agitation, dizzy, sedation, 乳漏, 無月經, ESP (rare)
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(2)
Novel anti-psychotic
|
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Multi-receptor
antagonist
|
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Clozapine
|
Clozaril (25mg/#)
Clozaril (100mg/#)
|
Schizophrenia:
初: 0.5-1#/d(12.5-25mg/d), then ↑
1-2#/d (25-50mg/d) q2-3 wk
Dose range 200mg hs or 100-150mg b-tid
(max: 600-900mg/d)
|
副: 姿態低血壓, 體重↑, granulocytopenia,
drowsy, SZ,
便秘,尿失禁, 流口水,
高血糖 (in wks to yrs)
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C/I: WBC ≦3000
|
Olanzapine
|
Zyprexa zydis (5mg/#)
口溶錠
|
Schizophrenia, bipolar
d/o,
1-4# qd
Depression:輔助藥 1-2.5#qd
|
副: HA, 嗜睡, dizzy,
乳漏 (↑PRL)
體重↑/水腫,
口渴,便秘,尿失禁,
高血糖 (in wks to yrs)
高TG.
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Zotepine
|
Lodopin (50mg/#)
|
Schizophrenia:
0.5-1# tid
(max 6-9#/d)
|
S/E: 嗜睡/失眠, dizzy 心悸,
口渴, 便秘,體重↑(less), 乳漏(↑PRL),
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Quetiapine
|
Seroquel XR (50mg/#)
Seroquel XR (300mg/#)
|
Schizophrenia/ bipolar
d/o:
300-600mg qd (晚上) (max 800-1200mg/d)
MDD (major depressive
d/o):
輔助藥:初:50mg, then 150-300mg qd
失眠: 25-100mg
Anxiety: 50-150mg/d
|
副: 姿態低血壓,
嗜睡/失眠, HA, dizzy, 水腫,
口乾, 體重↑(less),
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5HT2/D2 antagonist
|
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Risperidone
|
Risperdal (2mg/#)
Risperdal oral solution (1mg/ml,
30ml/bt)
Risperdal Consta 25mg/vial
Risperdal Consta 37.5mg/vial
|
Schizophrenia, bipolar
d/o:
PO: 0.5-4# qd or divided
IM: 1-2支Q2WK
Onset: 3wk duration:3-4wk
|
[副]: Sedation, HA,
口乾/便秘,尿滯留
乳漏(↑PRL), 水腫
EPS (≥6mg/d)
|
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Paliperidone
|
Invega ER (6mg/#)
Invega ER (9mg/#)
|
Schizophrenia, bipolar
d/o:
6-12mg
(1-2#) qd
|
-為risperidone之主要活性代謝物
|
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Zaprasidone
|
Geodon (60mg/cap)
|
Schizophrenia, bipolar
d/o:
1 cap qd-bid (max 4 cap/d)
|
S/E: sedation, HA, N/V,
rash, 便秘,
EPS(rare), QT延長(rare)
|
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D2/D3 antagonist
|
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Amisulpride
|
Solian (200mg/#)
|
Schizophrenia
Negative synd: 0.25-1.5# qd
Positive synd: 2# hs-bid (max 3# bid)
|
S/E: 嗜睡,乳漏,
姿態低血壓(rare)
|
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Dopamine/5-HT partial agonist
|
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Aripiprazole
|
Abilify (10mg/#)
|
Schizophrenia, bipolar
d/o:
1-3# qd
憂鬱症: 輔助藥 0.25-1.5# qd
|
S/E:
HA, 失眠, 嗜睡,
體重↑(less)
PRL(No or輕微↑)
|
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(g) Anti-convulsants
(1) Hydantoin
|
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Phenytoin (DPH)
|
Dilantin (100mg/cap)
Aleviatin (250mg/5ml/amp)
-give undiluted or in N/S
|
Grand mal, complex partial SZ,
neuralgia
Seizure d/o: PO
Load:
3 cap tid or 5 cap bid (15-20mg/kg/d)
維:3 cap hs
Status epilepticus: IV
15-20mg/kg (60kg=900-1200mg=4支) (25-50mg/min)
|
S/E: N/V, 嗜睡, nystagmus,
牙齦hyperplasia,
acne, 多毛
|
Give additional 5-10mg/kg if SZ 持續
|
L.A 複方
|
Phenytoin 50mg
Phenobarbital 20mg
|
1-2# tid
|
||
(2) Barbiturate
|
||||
Phenobarbital
|
Phenobarbital 30mg/#
Phenobital (100mg/amp)
|
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(3) BZD
|
||||
Diazepam
|
Diazepam (2mg/#)
Dupin (5mg/#)
Diazepam (10mg/2ml/amp)
|
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Nitrazepam
|
Limin (5mg/#)
|
