Mental Health Medications
Antianxiety Medications
BENZODIAZEPINES Alprazolam (Xanax) Lorazepam (Ativan) Clonazepam (Klonopin) Diazepam (Valium) Chlordiazepoxide (Librium) Clorazepate (Tranxene) Oxazepam (Serax) Also, Temazepam. Midazolam OTHER ANTIANXIETY MEDICATIONS Buspirone (BuSpar) Gabapentin (Neurontin) Pregabalin Clonidine (Catapres) Prazosin (Minipress) Propranolol (Inderal) Atenolol (Tenormin) Hydroxyzine (Atarax, Vistaril) Guanfacine (Tenex) Meprobamate tranquilizer
Hallucinogen/cannabinols intoxication/withdrawal
Benzodiazepines Antipsychotics
ADHD
CNS Stimulants Dextroamphetamine, methamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate, dextroamphetamine/amphetamine mixture Methylphenidate (Ritalin)! Side effects: Insomnia, anorexia, weight loss, tachycardia, decrease in rate of growth and development Interferes with growth and development, so assess at intervals over time Cardiac assessment before prescribing Children on ADHD drugs had a higher risk of injury-related hospital admissions. Monitor cardiovascular functioning Psychiatric symptoms may worsen NON-stimulants include Atomoxetine, Bupropion, anti-hypertensive drugs (Clonidine, guanfacine)
SNRIs
Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) (Think dual (or dull pain) - also treats generalized anxiety disorder. For chronic pain (neuropathy, fibromyalgia) and depression) Venlafaxine (Effexor) (levomilancipran)
For anorexia nervosa
Fluoxetine (Prozac) Clomipramine (Anafranil) Cyproheptadine (Pariactin) Chlorpromazine (Thorazine) Olanzapine (Zyprexa)
For bbuliimia
Fluoxetine (Prozac) Imipramine (Tofranil) Desipramine (Norpramine) Amitriptyline (Elavil) Nortriptyline (Aventyl) Phenelzine (Nardil)
Medications for sleep disturbances
Flurazepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Trazodone (Desyrel) Mirtazapine (Remeron) Ramelteon (Rozerem) Eszopiclone (Lunesta) Zolpidem (Ambien) Zaleplon (Sonata)
Stimulant intoxication/withdrawal
Minor tranquilizers Major tranquilizers Anticonvulsants Antidepressants
Pharmacology for alcoholism
Naltrexone (ReVia) Nalmefene (Revex) Selective serotonin reuptake inhibitors (SSRIs) Acamprosate (Campral) For intoxication/withdrawal Benzodiazepines Anticonvulsants Multivitamin therapy Thiamine
Medications for Trauma
SSRIs: Paroxetine and Sertraline approved by FDA for tx of PTSD TCAs: Amitriptyline and Imipramine MAOIs Trazodone Alprazolam to help with panic Buspirone Beta Blockers Prazosin for nightmares
Treatment for Somatic Symptom
use phenobarbital (truth serum) for group psychotherapy to help disinhibit people (also benzos)
Treatment for Bipolar disorder
Lithium (Catalog) Carbamazepine or Clonazepam Anticonvulsants Topiramate (!) Atypical antipsychotics Lamotrigine (!) Oxcarbazepine (!) Gabapentin Divalproex Valproic acid, Verapamil (Channel Blocker) Antipsychotics (Olanzapine, Aripiprazole, Chlorpromazine, Quetiapine, Risperidone, Ziprasidone, Asenapine.) Symbyax is a combination Olanzapine (atypical) and Fluoxetine (SSRI)
Meds for Trichotilomania
Lithium carbonate SSRIs Amitriptyline Olanzapine Chlorpromazine Pimozide
Mood Stabilizing Agent General (Indication, Example, Interaction, Contraindication, Toxicity)
Lithium is thought to modulate the effects of norepinephrine, serotonin, dopamine, glutamate, and GABA, which may contribute to the symptomatology of bipolar disorder, the role of anticonvulsants, verapamil, and antipsychotics in the treatment of bipolar mania is not fully understood. For bipolar mania, attempting to distract and redirect the client is the proper course they have lots of energy for which they must have an outlet by redirecting and distracting, the nurse recognizes the client's need for outlets, and demonstrates an acceptance and understanding of the manic individual's needs. Provide some external controls. Decrease stimuli. Assign the client to a single room away from activity, and limit interactions with people Interactions Because lithium is an imperfect substitute for sodium, anything that depletes sodium will make more receptor sites available to lithium and increase the risk for lithium toxicity Contraindications/precautions Avoid with kidney damage Lithium toxicity Therapeutic range 1.0-1.5 mEq/L (acute mania) 0.6-1.2 mEq/L (maintenance) There is no antidote to lithium Diuretics lead to accumulation of lithium levels by promoting sodium loss NSAIDS increase renal absorption of lithium, causing levels to rise Initial symptoms of toxicity include Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea CAN LEAD TO TREMORS, SEDATION, CONFUSION, DELIRIUM, SEIZURES, COMA, CARDIOVASCULAR COLLAPSE, DEATH Ensure that the client consumes adequate sodium and fluid in diet. MUST HAVE PERIODIC BLOOD LEVEL MONITORING MANY PROVIDERS NOW CHOOSE TO PRESCRIBE ANTICONVULSANTS OR ATYPICAL ANTIPSYCHOTICS AS FIRST-LINE TREATMENT INSTEAD OF LITHIUM.
Antidepressant (Types - 5)
MAOI (monoamine oxidase inhibitor) Many side effects, dietary restrictions (tyramine - see table 4-6 Pg. 71) Tricyclics antidepressants (TCAs) Serotonin Reuptake Inhibitors (SSRIs) Serotonin/norepinephrine reuptake inhibitors (SNRIs) sometimes called S-SNRI Heterocyclics
Medication for opioid intoxication/withdrawal
Narcotic antagonists Naloxone (Narcan) (widely available) Naltrexone (ReVia) Nalmefene (Revex) Methadone Buprenorphine Clonidine
Medications for Cognitive Impairment
Physostigmine (Antilirium) Rivastigmine (Exelon) Galantamine (Razadyne) Memantine (Namenda) Regulates excessive glutamate, and calcium ions are slowed down Donepezil (Aricept) Mild to moderate alzheimer's disease (slows progression) Improves cholinergic function by inhibiting certain enzymes (acetylcholine)
Atomoxetine (Strattera) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Psychotherapeutic - miscellaneous (selective norepinephrine reuptake inhibitor) Action: selective norepinephrine reuptake inhibitor; may inhibit presynaptic norepinephrine transporter Use: ADHD (nocturnal enuresis) Contra: hypersensitivity, glaucoma, MAOI therapy, history of pheochromocytoma (hepatic disease, angioedema, bipolar disorder, dysrhythmias, CAD< hypo/hypertension, arteriosclerosis, cardiac disease, cardiomyopathy, heart failure, jaundice) Assess: mental status; VS/BP; priapism (urinary function, hesitancy, retention, sexual changes); appetite; ADHD Teach: avoid OTC; avoid alcohol and hazardous activity; get needed rest because patient will feel more tired at the end of the day (not to take dose late in day because insomnia may occur); report suicidal ideation; notify prescriber immediately if erection >4 hours; report fainting, chest pain, difficulty breathing
Medication for autism
Risperidone Drowsiness Increased appetite Nasal congestion Fatigue Constipation Drooling Dizziness Weight gain Aripiprazole Sedation Fatigue Weight gain Vomiting Somnolence Tremor possible side effects Neuroleptic malignant syndrome (NMS) Tardive dyskinesia (TD) Hyperglycemia Extrapyramidal symptoms (EPS) Metabolic Disorder for Aggression Deliberate self-injury Temper tantrums Quickly changing moods
MAOIs
SPIT of (PIAST - please ignore and shun tyramine) Phenelzine (Nardil) Selegiline (Emsam)-patch Isocarboxazid (Marplan) Tranylcypromine (Parnate) Beer, red wine, and other alcohol is avoided with MAO inhibitors This is a monoamine oxidase inhibitor. The client should avoid foods such as aged cheese, beer, red wine, dry sausage, sauerkraut, and liver because they are high in tyramine and may precipitate a hypertensive crisis (Firstgen) M: massive HTN Crisis risk (headache) A: avoid tyramine (trigger HTN, regulate BP) O: OTC drugs calcium, antacid, acetaminophen/tylenol NSAIDS O: other antidepressants (leads to serotonin syndrome) Washout for 2 weeks I: increased suicide risk Med not working after 2 weeks
Meds for gambling addiction
SSRIs (often in higher doses than used for depression) Clomipramine Lithium Carbamazepine Naltrexone
Lorazepam (Ativan) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Sedative, hypnotic, antianxiety (benzodiazepine) Potentiates actions of GABA, especially in limbic system and reticular formation Use: anxiety, irritability, preoperatively, insomnia, status epileptics, insomnia, antiemetic before chemotherapy, alcohol withdrawal, seizure prophylaxis Contraindication: hypersensitivity to benzodiazepine, history of drug abuse, suicidal ideation, glaucoma, sleep apnea, COPD (precaution children, geriatric, debilitated, addicted) Black box: coadminiistartion with other CNS depressants S/E: dizzy, drowsy, orthostatic hypotension, blurred vision (ECG change, tachycardia, apnea, cardiac arrest) Assess: anxiety, physical dependency/withdrawal symptoms, pregnancy/breastfeeding, renal/hepatic/blood, therapeutic response, insomnia Teach: don't take more than prescribed, may take with food, avoid OTC preparations, avoid driving or activities that require alertness, rise slowly, drowsiness worse at beginning, report suicidal ideation. OD: lavage, VS, supportive care, flumazenil
Sedative Hypnotic Medications
Sedative-Hypnotics Temazepam (Restoril) Triazolam (Halcion) Diphenydramine (Benadryl) Doxepin Ramelteon (Rozerem) Eszopiclone (Lunesta) Zolpidem (Ambien)
Antipsychotic Medications
TYPICAL (1st generation) Perphenazine Chlorpromazine (Thorazine) (An antipsychotic, s/e: postural hypotension. Contraindicated in clients with blood dyscrasias. s/e could include: drooling, facial tics, shuffling gait, tongue rolling, restless movement) Thiothixene Fluphenazine (Prolixin) (Can be taken every 2 weeks instead of every day) Haloperidol (Haldol) ATYPICAL (2nd generation) THERE ARE MORE, BUT THESE ARE THE ONES YOU WILL TYPICALLY SEE GIVEN (Crapola) Clozapine (Clozaril)(monitoring required. (Clozapinie is more effective than other second generation antipsychotics. Poses a risk for development of agranulocytosis, especially when combined with a selective serotonin reuptake inhibitor. (this would affect neutrophil and WBC). Contraindicated in clients with bone marrow depression. Used with caution in clients with seizures. Ketoconazole and erythromycin will increase clozapine levels in blood by inhibiting P450 isoenzymes. Rifampin and phenytoin reduce clozapine levels in the blood by inducing cytochrome P450 isoenzymes.)) Risperidone (Risperdal) Asenapine (Saphris) Paliperidone (Invega) Olanzapine (Zyprexa) Lurasidone (Latuda) Aripiprazole (Abilify) Quetiapine (Seroquel) Iloperidone (Fanapt) Ziprasidone (Geodon)
For Binge eating disorder (with obesity)
Topiramate (Topamax) Lisdexamfetamine (Vyvanse)
Medications for Depression (other - 2)
Trazodone (Desyrel) Good choice for clients with insomnia Dopaminergic agents Helpful in treatment of severe apathy
Lithium (Carbolith, Lithane, Lithamax, Lithobid) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
psychotropic agent - antimanic (alkali metal ion salt) may alter sodium, potassium ion transport across cell membrane ion nerve, muscle cells. may balance biogenic amines of norepinephrine, serotonin in CDNS areas involved in emotional response Use: bipolar disorder (manic), prevention of manic-depressive psychosis of bipolar, borderline personality disorder Contra: pregnancy, breastfeeding, children <12, hepatic disease, brain trauma, organic brain syndrome, schizophrenia, severe cardiac/renal disease, severe dehydration Precaution: geriatric patients, thyroid disease, seizures, diabetes, systemic infection, urinary retention Black box: lithium >1.5 mol/L S/E: headache, drowsy, dizzy, hypotension, dry mouth, anorexia, n/v/d (seizure, dysrhythmia, circulatory collapse, polyuria, glycosuria, proteinuria, albuminuria, leukocytosis) Assess: mental status; lithium toxicity (diarrhea, vomiting, tremor, twitching, lassitude, poor coordination); major toxicity (coarse tremors, severe thirst, tinnitus, dilutte urine, blood level); weight daily; sodium intake (decreased sodium and fluid intake could lead to lithium retention and increased sodium and fluids may decrease retention); skin turgor; urine (albuminuria, glycosuria, uric acid); neurologic status; ECG Teach: symptoms of toxicity, monitor urine specific gravity, not to operate machinery until levels are stable, emergency ID, beneficial effects take 1-3 weeks, products that interact with lithium; stable intake of salt and fluid OD: induce emesis or lavage; airway; respiratory; dialysis
Medications for agitation, aggression, hallucinations, wandering
(ROQZ) Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Ziprasidone (Geodon) These drugs cause fewer anticholinergic and extrapyramidal side effects (EPS) than do older antipsychotics. Black box warning that all antipsychotics are associated with an increased risk of death in elderly patients with dementia.
Alprazolam (Xanax) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Anti anxiety (Benzodiazepine - short intermediate strong acting) Action: depresses subcortical levels of CNS, including limbic system and reticular formation Use: anxiety, panic disorders with or without agoraphobia, anxiety with depressive symptoms (premenstrual dysphoric disorders, insomnia, PMS, alcohol withdrawal syndrome) Contra: hypersensitivity to benzodiazepines, glaucoma, psychosis, addiction (precaution: debilitated, hepatic disease, obesity, severe pulmonary disease) S/E: dizziness, drowsiness, blurred vision (suicide) Assess: mental status; suicidal thoughts; hepatic and blood studies; physical dependency and withdrawal Teach: not to double dose. if dose missed, take within 1 hr as scheduled; not for everyday stress or for more than 4 months; avoid OTC; avoid driving or alcohol; rise slowly; drowsiness may worsen at beginning
Chlordiazepoxide (Librium, Solium) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antianxiety (long acting benzodiazepine) Action: potentiates action of GABA, especially in limbic system and reticular formation Use: short term management of anxiety, acute alcohol withdrawal, and preoperative relaxation Contra: children <6, hypersensitivity to benzodiazepines, glaucoma, psychosis Precaution: geriatric, debilitated, renal/hepatic disease, suicidal ideation; respiratory depression; Parkinson; myasthenia graves S/E: dizziness, drowsiness, orthostatic hypotension, blurred vision Assess: BP, hepatic studies, ataxia, physical dependency, check to confirm PO medication its swallowed if patient is suicidal Teach: can be taken with food, not for everyday stress or for more than 4 months, can be habit forming, avoid OTC, avoid driving, avoid alcohol, rise slowly, drowsiness worse at beginning, report suicidal thoughts or pregnancy OD: lavage, VS, supportive, flumazenil
Benztropine (Cogentin) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Anticholinergic, antiparkinson (tertiary amine). Action: blockade of central acetylcholine receptors, balances cholinergic activity. Used to reverse signs and symptoms of dystonia (EPS). (trihexyphenidyl also helps) Use: Parkinson's symptoms, EPS associated with neuroleptic products; acute dystonic reactions Contra: children <3, glaucoma, dementia, tardive dyskinesia (tachycardia, renal/hepatic, substance abuse history, dysrhythmias, hypo/hypertension; myasthenia graves; GI/GU obstruction; peptic ulcer; megacolon; prostate hypertrophy; psychosis) S/E: confusion, dry mouth, constipation Assess: Parkinsonism (EPS, shuffling gait, muscle rigidity, involuntary movement, loss of balance, tardive dyskinesia); I&O ratio; constipatiion; mental status; caution during hot weather; withdrawal symptoms Teach: report urinary hesitancy, retention, or dysuria; avoid driving; avoid OTC; change positions slowly; good oral hygiene; avoid strenuous exercise in hot weather; routine exams; separate antacids by 2 hours of this product
Sertraline (Zoloft) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antidepressant (SSRI) Action: inhibits serotonin reuptake in CNS; increases action of serotonin Use: major depressive disorder, OCD, PTSD, panic disorder; social anxiety disorder; premenstrual dysphoric disorder (generalized anxiety disorder) Contraindications: hypersensitivity, (renal/hepatic, epilepsy, recent MI; latex sensitivity) S/E: insomnia, agitation, dizziness, headache, fatigue, confusion, d/n/v/c, anorexia, dry mouth, vomiting, flatulence, male sexual dysfunction (neuroleptic malignant syndrome like reaction, serotonin syndrome, suicidal ideation, neonatal abstinence syndrome) Assess: premenstrual dysphoric disorder, serotonin syndrome; bleeding; hypotension; thyroid function; urinary retention and constipation; alcohol consumption Teach: may take >1 week; caution when driving; follow up exams needed; avoid alcohol; will be dizzy; without regard to food; suicidal ideation
Duloxetine (Cymbalta) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antidepressant (Serotonin norepinephrine reuptake inhibitor SNRI) Action: potentiate serotonergic, noadrenergic activity in the CNS: potent inhibitor of neuronal serotonin and norepinephrine reuptake Use: major depressive disorder, neuropathic pain, generalized anxiety disorder, fibromyalgia, chronic low back pain, osteoarthritis pain (stress, urinary incontinence) Contra: alcohol, glaucoma, hepatic disease, hepatitis, jaundice, hypersensitivity (precaution: mania, HTN, renal/cardiac, seizures, intraocular pressure, anorexia, bleeding, dehydration, diabetes, hyponatremia, hypotension, hypovolemia, orthostatic hypotension, abrupt product withdrawal) S/E: headache, abnormal vision (neuroleptic malignant, seizures, thrombbophlebbitis, supra ventricular dysrhythmia, hepatic failure, Stevens Johnson syndrome, anaphylaxis, angioedema, serotonin syndrome) Assess: depression, suicide, BP; hypo/hyperglycemia; withdrawal symptoms; malignant neuroleptic like syndrome; serotonin syndrome; sexual dysfunction Teach: report urinary retention; caution when driving; avoid alcohol, MAOIs, CNS depressants; notify of n/v, dizziness, flushing, shiver, sweating, confusion, hallucinations, sunscreen
Bupropion (Aplenzin, Forfivo, Wellbutrin, Zyban) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antidepressant - miscellaneous smoking deterrent (aminoketone) Action: inhibits reuptake of dopamine, norepinephrine, serotonin Use: depression (Wellbutrin), smoking cessation (zyban), seasonal affective disorder, substance abuse, glaucoma, smoking, cardiac disease, heart failure (ADHD; increase libido in women) Contra: hypersensitivity, head trauma, stroke, intracranial mass, eating disorders, seizure disorders (Pre: recent MI, cranial trauma, seizure disorder, substance abuse, glaucoma, smoking, cardiac disease, heart failure, head trauma, stroke, intracranial mass, Tourette's, tics, tobacco smoke) S/E: headache, agitation, dizziness, akinesia, confusion, insomnia, sedation, tremors, hypertension, tachycardia, blurred visioin, auditory disturbance, n/v/c, dry mouth, rash, hot flashes, sweating (seizures, suicidal/homicidal ideation; dysrhythmias) Assess: smoking, seizures, monitor weight, beer Teach: may take 2-4 week; use caution, avoid alcohol, notify of all supplements; no nicotine patches; notify if urinary retention occurs; the risk of seizures increases when dose is exceeded, if patient has seizure disorder OD: ECG monitoring, lavage, administer anticonvulsant
Imipramine (Impril, Tofranil) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antidepressant - tricyclic (Dibenzazepine, tertiary amine) Action: block reuptake of norepinephrine, serotonin into nerve endings, thereby increasing action of norepinephrine and serotonin in nerve cells. Use: depression, enuresis, (chronic pain, migraine headaches/cluster headaches, incontinence, ADHD, neuralgia, bluemia, neuropathic pain, social phobia) Contra: hypersensitivity to this or carbamazepine, acute MI Precaution: breastfeeding, geriatric, suiiciidal, severe depression, intraocular pressure, glaucoma, urinary retentiion, cardiac/hepatic disease, hyperthyroidism, electroshock therapy, elective surgery, seizure disorder, prostatic hypertrophy, MI, AV block, bundle branch block, isles Administer: don't break, with food or milk, at bedtime tif over sedation occurs S/E: dizziness, drowsiness, orthostatic hypotension, tachycardia, diarrhea, dry mouth, (seizures, suicidal ideation, dysrhythmias, paralytic ileum, agranulocytosis, thrombocytopenia, eosinophilia, leukopenia) Assess: depression, enuresis, BPblood studies, hepatic, weight, QT prolongation, urinary retention/constipation, EPS, withdrawal symptoms, serotonin syndrome, hypertensive episode, assistance with ambulation, alcohol Teach: take 2-3 weeks, dispensed in small amounts d/t suicide potential, caution with driving, report urinary retention, avoid alcohol and CNS depressants, wear sunscreen, rise slowly OD: ecg, lavage, sodium bicarbonate (cardiac effects), anticonvulsant, antidysrrhythnmic
Paroxetine (Paxil) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antidepressant, SSRI (phenylpiperidine derivative) Action: inhibits CNS neuron uptake of serotonin but not of norepinephrine or dopamine Use: major depressive disorder; OCD; panic disorder; generalized anxiety disorder; PTSD; premenstrual disorder; social anxiety disorder; hot flashes; menopause (premature ejaculation) Contraindications: hypersensitivity to MAOI; alcohol (precautions: seizures; history of mania; renal/hepatic disease) Administer: do not substitute peeve with Paxil, Paxil CR, or paroxetine; increase fluid/bulk; with food or milk; avoid with other CNS depressants S/E: headache, drowsiness, anxiety, tremors, sedation, n/v/d, dry mouth, abnormal ejaculation, sweating (seizures, Steven Johnson syndrome, neuroleptic malignant syndrome; suicidal thoughts) Assess: depression/ocd/anxiety/panic; postural hypotension; hepatic/renal studies; weight; EPS; renal status; withdrawal symptoms; alcohol; serotonin, neuroleptic malignant syndrome Teach: may take 1-4 weeks; caution driving; report bleeding, headache, nausea, anxiety, depression; sexual side effects OD: gastric lavage; airway; for seizures, give diazepam
Fluoxetine (Prozac, sarafem, selfemura) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antidepressant, SSRI (selective serotonin reuptake inhibitor) Action: inhibit CNS neuron uptake of serotonin but not of norepinephrine Use: major depressive disorder, OCD< bulimia nervosa, premenstrual dysphoric disorder, panic disorder, (anorexia nervosa, obesity, PTSD< fibromyalgia, social phobia, ADHD, diabetic neuropathy, Raynaud's) Contraindication: hypersensitivity, MAOI therapy Precaution: geriatric, diabetes, narrow angle glaucoma, cardiac malformations in infants, osteoporosis Give in Am unless sedation occurs, sarafem used only for premenstrual dysphoric disorder S/E: headache, nervous, insomnia, drowsy, anxiety, tremor, dizzy, fatigue, sedation, poor concentration, abnormal dreams, agitation, hot flashes, palpitations, n/v/d/c, dry mouth, anorexia, dyspepsia, dysmenorrhea, decreased libido, sweating, rash, UTI, pruritus,, pain, pharyngitis, cough, dyspnea, bronchitis, asthenia Assess: mental status, serotonin syndrome, QT prolongation, neuroleptic malignant syndrome, bulimia nervosa, allergic reactions, BP, blood studies, hepatic studies Evaluate: OCD, absence of suicidal thoughts Teach: may take 1-4 weeks, caution when driving, avoid alcohol and depressants, change position slowly, avoid all OTC, decreased libido/ED, worsening symptoms (notify), serotonin syndrome
Clomipramine (Anafranil) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antidepressant, tricyclic (tertiary amine) Action: potentiates serotonin and norepinephrine; moderate anticholinergic effect Use: OCD (autism, depression, premature ejaculation) Contraindication: hypersensitivity to this or carbamazepine, tricyclics, immediate post MI, MAOI therapy (Precaution: seizures, cardiac disease, glaucoma, prostatic hypertrophy, urinary retention) Administer: increase fluids and bulk for constipation, without regard to food S/E: dizziness, tremors, mania, constipation, dry mouth, nausea, dyspepsia, delayed ejaculation, anorgasmia (seizures, neuroleptic malignant syndrome, cardiac arrest, hepatic toxicity, agranulocytosis, neutropenia, pancytopenia, pharyngitis, rhinitis, bronchospasm, suicide) Assess: BP, serotonin syndrome, ECG (flattening T wave, QT prolongation, bundle branch block, AV block); blood studies; hepatic studies; urinary retention/constipation; withdrawal symptoms (headache, nausea, vomiting, muscle pain, weakness); alcohol Teach: 4-6 weeks to appear; seizures; caution when driving; avoid alcohol; wear sunscreen; high incidence of sexual dysfunction; serotonin syndrome OD: Ecg monitoring; induce emesis; lavage; anticonvulsant; diazepam IV
Meds for OCD and body dysmorphia
Antidepressants (clomipramine, fluoxetine, paroxetine, sertraline, fluvoxamine are approved by FDA for OCD)
Diphenhydramine (Allerdryl, allermax, banjo-hen, Benadryl, diphedryl, diphenhist, silphen, sominex, unisom, benylin, calmex, dormex, dormiphen) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antihistaminie (1st generation, non selective - ethanolaminie derivative, H1 receptor antagonist) Action: acts on blood vessels, GI, respiratory system by competing with histamine for H1 receptor site; decreases allergic response by blocking histamine Use: allergy symptoms; rhinos; motion sickness; antiiparkinsonism; nighttime sedation; infant colic; nonproductive cough; insomnia Contra: hypersensiitivity to H1 receptor antagonist; neonates (increased intraocular pressure; cardiac/renal; HTN; bronchial asthma; seizure disorder; stenosed peptic ulcers; hyperthyroidism; prostatic hypertrophy; bladder neck obstruction) S/E: dizziness, drowsiness, retention (seizures, thrombocytopenia, agranulocytosis, hemolytic anemia, anaphylaxis) Assess: urinary retention; CBC; respiratory status; EPS; cough; anaphylaxis Teach: notify if confusion, sedation, or hypotension occurs; avoid driving; photosensitivity; avoid alcohol and depressants; mouth dryness; discontinued 4 days before allergy tests; don't use in child <4 OD: diazepam, vasopressors, phenytoin
Risperidone (Risperdal) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antipsychotic (Benziisoxazole) Action: unknown; may be mediated through both dopamine type 2 (D2) and serotonin type 2 (5HT2) antagonism Use: irritability associated with autism; bipolar disorder; mania; schizophrenia (acute psychosis, agitation, ADHD, dementia, psychotic depression, Tourette's) Contraindication: hypersensitivity (cardiac/renal/hepatic, breast cancer, Parkinson's, CNS depression, brain tumor, dehydration, diabetes, hematologic disease, seizure disorders, abrupt discontinuation, suicidal ideation, phenylketonuria) S/E: EPS, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsiness, insomnia, agitation, anxiety, headache, diarrhea, abdominal pain, nausea, taste perversion, vomiting, anorexia (QT/PR interval prolongation, angioedema, anaphylaxis, Steven Johnson syndrome, toxic epidermal necrolysis, immune reconstitution syndrome, rhabdomyolysis, leukopenia, thrombocytopenia, seizures, neuroleptic malignant syndrome, suicidal ideation, tachycardia, heart failure, sudden death) Assess: suicidal thoughts; thyroid function; affect/mood; QT prolongation; dizziness; EPS; neuroleptic malignant syndrome; constipation/urinary retention Teach: orthostatic hypotension, avoid OTC, avoid hazardous, report impaired vision, tremors, muscle twitching; heat stroke may occur; use contraception; suicidal thoughts/behavior OD: lavage; provide airway; do not induce vomiting
Fluphenazine (decanoate, modecate concentrate, fluphenazine hydrochloride) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antipsychotic (phenothiazine, piperazine) Action: depresses cerebral cortex, hypothalamus, limbic system, which control activity and aggression; blocks neurotransmissions produced baby dopamine at synapse; exhibits strong a adrenergic and anticholinergic blocking action Use: schizophrenia (agitation) Contraindicatin: hypersensitivity, blood dycrasias, coma, bone marrow depression (seizure, HTN, cardiac/hepatic, accidental exposure, agranulocytosis, ambient temperature increase, angina, QT prolongation, suicidal ideation, renal failure, Parkinson's, hypocalcemia, head trauma, prostatic hypertrophy, pulmonary disease, infection, ileum, chemotherapy, breast cancer) S/E: EPS: pseudoparkinosism, akathisia, dystonia, tardive dyskinesia, drowsiness, headache, orthostatic hypotension, dry mouth, n/v/c, anorexia, rash (seizures, neuroleptic malignant syndrome, cardiac arrest, tachycardia, paralytic ileum, hepatic, leukopenia, leukocytosis, agranulocytosis, aplastic anemia, thrombocytopenia, laryngospasm, respiratory depression) Assess: Qt prolongation, bilirubin, urinalysis, orientation/LOC, BP, dizziness, EPS, anticholinergic effects (constipation, urinary retention) Teach: orthostatic hypotension, avoid hot tubs/showers, avoid OTC, use sunscreen, EPS, report sore throat, malaise, fever, bleeding, mouth sores; urine may turn pink to reddish brown OD: lavage; if orally ingested, provide an airway; do not induce vomiting
Aripiprazole (abiilify, aristada) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antipsychotic (quinolone) Action: exact mechanism unknown; may be mediated through both dopamine type 2 and serotonin type 2 Use: schizophrenia and bipolar disorder, major depressive disorder, irritability in patients with autism Contra: seizure Precaution: geriatric, renal/hepatic/cardiac disease, neutropenia Side effects: drowsiness, insomnia, agitation, anxiety, headache, light headedness, akathisia, tremor, rash, blurred vision, rhinitis, dry skin, sweating, cough (seizures, neuroleptic malignant syndrome, suicidal ideation, tachycardia, agranulocytosis, anemia, leukemia, death, hypersensitivity) Assess: mental status (suicidal ideation), AIMS, neurologic function, LFTS, weight, lipid profile; Affect, orientation, LOC, reflexes, gait, coordination, sleep; BP, Dizziness, EPS; neuroleptic malignant syndrome Teach: orthostatic hypotension, avoid hot tub/showers, avoid OTC, alcohol, CNS depressants; avoid hazardous activities; report impaired vision, tremors, muscle twitching; weight gain may occur; heat stroke OD: lavage, airway; do not induce vomiting
Clozapine (Clozaril, fazaClo, Versacloz) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antipsychotic (tricyclic dibenzodiazepine derivative) action: interferes with dopamine receptor binding with lack of EPS; also acts as adrenergic, cholinergic, histaminergic, serotonergic antagonist Use: psychotic symptoms for schizophrenia when other antipsychotics fail, recurrent suicidal behavior Contra: hypersensitivity, granulocytopenia, coma, ilieus Precaution: <16, geriatric, CV, pulmonary; cardiac; renal; hepatic disease; seizures; prostatic enlargement; stroke; closed angle glaucoma Black box: bone marrow suppression, hypotension, myocardial, orthostatic hypotension, seizures, syncope S/E: dizzy, sedation, headache, insomnia, tachycardia, hypo/hypertensiion, blurred vision, drooling or excessive saliva, c/n/v, abdominal discomfort, dry mouth, dyspepsia Assess: myocarditis (dyspnea, fever, palpitations, ecg); seizures (higher dosages); bone marrow depression (bilirubin, CBC, LFT); AIMS; blood glucose; CBC; glycosylated hemoglobin; neurologic function; thyroid function tests; weight; lipid profile; prolactin; electrolytes; affect, orientation, LOC, reflexes, gait, coordination; hypotension; bradycardia; syncope; extrapyramidal symptoms; neuroleptic malignant syndrome; beer; pregnancy teach: agranulocytosis; orthostatic hypotension; avoid OTC; report sore throat, malaise, fever, bleeding, mouth sores; heat stroke; avoid driving; seizures; pregnancy; don't breastfeed j OD: lavage; airway; do not induce vomiting
Quetiapine (Seroquel) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antipsychotic, atypical (Dibenzothiazepine) Action: functions as an antagonist at multiple neurotransmitter receptors in the brain including 5HT1A, 5HT2, dopamine D1, D2, H1, and adrenergic A1, A2 receptors Use: bipolar disorder, bipolar 1 disorder, depression, mania, schizophrenia, borderline personality disorder Contraindications: hypersensitivity (hepatic/cardiac, breast cancer, long term use, seizures, QT prolongation, brain tumor, hematologic disease, torsades de pointes, cataracts, dehydration) S/E: drowsiness, headache, nausea, anorexia, pancreatitis, c/n, (seizures, neuroleptic malignant syndrome, tachycardia, QT prolongation, leukopenia, agranulocytosis, DRESS, rhabdomyolysis, Steven Johnson syndrome, anaphylaxis) Assess: CV status, suicide; baseline blood glucose; BP; dizziness/fainting; EPS; serious rash; pancreatitis; neuroleptic malignant syndrome; constipation; DRESS; hyperprolactinemia; beers Teach: not to become overheated; rise slowly; if drowsy, avoid driving; avoid OTC; notify if difficulty breathing, fatigue, sore throat, rash, bleeding; eye exam before treatment
Haloperidol (Haldol Decanoate, Haldol) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antipsychotic, neuroleptic Blocks neurotransmission produced by dopamine at the synapse. Exhibits anticholinergic blocking action Psychotic disorders, controlling tics, vocal utterances, Tourette's, ADHD, hyperactive children (short term treatment), chronic schizophrenia, psychotic features, hiccups (short-term), emergency sedation of severely agitated/delirious patients (so reduced dose) Contraindication: Parkinson's Precautiion: elderly, seizure, HTN, increased mortality in elderly patients with dementia related psychosis PO with food or milk. avoid skin contact (may cause contact dermatitis); do not mix with coffee or tea; avoid use with CNS depressants S/E: EPS: pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsiness, headache. Dry mouth, anorexia, constipation, rash Assess: mental status, dementia, affect, orientation, LOC, reflexes, gait, coordination, sleep, dizziness, extrapyramidal symptoms (akathisia - inability to sit still, no pattern to movement), tar dive dyskinesia (bizarre movement of jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling), dehydration, neuroleptic malignant syndrome/serotonin syndrome (hyperthermia, muscle rigidity, altered mental status, seizures, hypo/hypertension, tachycardia), constipation, urinary retention, QT prolongation Teaching: orthostatic hypotension, avoid hazardous activity or abrupt withdrawal, avoid OTC preparations, about PES, oral hygiene, report impaired vision/jaundice/tremor/muscle twitch, photosensitivity
Chlorpromazine (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antipsychotic/antiemetic (phenothiazine-aliphatic) action: depresses cerebral cortex, hypothalamus, and limbic system, which control activity and aggression. this blocks neurotransmission produced by dopamine at synapse. exhibits strong anticholinergic action. Use: psychotic disorders, mania, schizophrenia, anxiety, hiccups, n/v, preoperative relaxation, porphyria, behavioral problems, demented patients, Tourette's, vascular headache, agitation, neonatal abstinence Contraindications: infant, hypersensitivity, liver damage, circulatory collapse, cerebral arteriosclerosis, coronary disease, coma Precaution: geriatric,; seizure, HTN, hepatiic/cardiac disease, enlarged prostate, Parkinson's , pulmonary disease, brain damage, bone marrow depression, alcohol/barbituate withdrawal, closed angle glaucoma S/E: EPS (pseudoparkinsonism, akathisia, dystonia, tardive duskinesia, headache), orthostatic hypotension, dry mouth, n/v, anorexia, constipation, rash Black box: beer (increased risk for stroke and greater rate of cognitive decline and mortality in dementia) Assess: mental status (AIMS, orientation, mood, behavior, hallucination), I&O ratio, BP, respiration, dizzy, neuroleptic malignant syndrome, extrapyramidal symptoms, constipation Add: increase fluids, candy/gum/water Teach: oral hygiene, dry mouth, hazardous activities, orthostatic hypotension, lie down 30 min after IM, avoid hot tubs/shower due to HTN, heat stroke during hot weather, avoid OTC, use sunscreen/sunglasses for burns and photophobia, antacids 2 hr before or after, urine may be pink or brown, report sore throat, malaise, fever, bleeding, mouth sores OD: lavage, airway, do not induce vomiting or EPI
Ziprasidone (Geodon, Zeldox) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Antipsychotic/neuroleptic (Benzisoxazole derivative) Action: unknown; may be mediated through both dopamine type 2 (D2) and serotonin type 2 (5HT2) antagonism Use: schizophrenia, acute agitation, acute psychosis, bipolar disorder, mania, psychotic depression Contraindication: acute MI, heart failure, QT prolongation (cardiac/renal/hepatiic, breast cancer, diabetes, seizure disorders, AV block, CNS depression, agranulocytosis, ambient temperature increase, suicidal ideation, tornados de pointes, strenuous exercise) S/E: EPS, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsiness, insomnia, agitation, anxiety, headache, anorexia, n/v/c (seizures, neuroleptic malignant syndrome, tachycardia, prolonged QT, sudden death, heart failure, tornados de pointes, DRESS< Steven Johnson syndrome) Assess: mental status; DRESS; seizures; bilirubin; urinalysis; BP; dizziness; EPS; neuroleptic malignant syndrome; constipation; beers Teach: orthostatic hypotension; avoid hot tubs/showers; avoid OTC; avoid hazardous activities if drowsy/dizzy; report impaired vision, tremors, muscle twitching; continue follow up exams; in hot weather, that heat stroke may occur OD: lavage if orally ingested; provide airway; do not induce vomiting
Tourette's medication
Antipsychotics (Haloperidol, Pimozide, Risperidone, Olanzapine, Ziprasidone) Alpha agonists (Clonidine,Guanfacine)
Med for phobic disorders
Anxiolytics (short-term use except Buspirone) Antidepressants Antihypertensive agents
Treatment for postpartum depression
Brexanolone (IV use)
Methylphenidate (Aptensio, Biphentin, Concerta, Cotempla, Daytrana, Jornay, Metadate, Methylin, Quillivant, Ritalin, QuilliChew) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Cerebral stimulant (piperidine derivative) action: increases release of norepinephrine, dopamine in cerebral cortex to reticular activating system use: ADD, ADHD, narcolepsy (depression) contraindications: hypersensitive, anxiety, history of Gilles de la Tourette's syndrome; glaucoma; fructose intolerance Precaution: HTN, depression, seizures, acute MI, aortic stenosis, arteriosclerosis, bipolar, dysrhythmia, cardiomyopathy, depression, dysphagia, esophageal stricture, growth inhibition, heart failure, hepatic disease, HTN, hyperthyroidism, ileum, mania, peripheral vascular disease, PKU, psychosis, Raynaud's disease, schizophrenia, stroke, suiicidal ideation, visual disturbances S/E: hyperactivity, insomnia, restlessness, talkativeness, palpitations, tachycardia (seizures, malignant neuroleptic syndrome, cerebral vasculitis, hemorrhage stroke, dysrhythmias, leukopenia, anemia, thrombocytopenia purpura, exfoliative dermatitis, permanent loss of skin color, anaphylaxis, angioedema, rhabdomyolysis) Assess: ADHD; VS; CBC; urinalysis; height/growth rate; mental status; withdrawal symptoms; narcolepsy; skin pigmentation; beers Teach: decrease caffeine; avoid OTC; taper off product (depression, sleeping, lethargy otherwise); get needed rest; shell of tab may appear in stool; 6hr before sleep, 10 hr for ext related; seizures OD: fluids; hemodialysis; antihypertensive for increased BP; short acting barbiturate before lavage
SSRIs
Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil)(Avoided in pregnancy because may cause birth defects) Sertraline (Zoloft) Vilazodone (Viibyrd) SSRI S: suicide risk increase (lookout for change in energy but nto depression) S: slow onset and taper S: serotonin syndrome Sweaty and hot fever Rigid muscle, restlessness, hyperreflexia Increased heart rate
Olanzapine REMS (zyprexa) (class, action, indication, assessment, dose/route, side effects (3-5), precautions, implication, teaching)
Class: Antipsychotic 1st generation, neuroleptic (thienobenzodiazepine) Action: May mediate antipsychotic activity by both dopamine and serotonin antagonists. may antagonize muscarinic receptors and histaminic receptors Use: schizophrenia, acute manic episodes of bipolar, acute agitation, chemotherapy related nausea, vomiting, diarrhea Contraindication: hypersensitivity precaution: geriatric, HTN, diabetes, agranulocytosis, asian, glaucoma, coma, leukopenia, QT prolongation, tardive dyskinesia, suicidal ideation, stroke history, TIA Black box: increased mortality in elderly with dementia related psychosis Use gloves to prepare, deep IM gluteal injection S/E: dizziness, tremors, drowsiness, dry mouth, n/v, appetite, dyspepsia, constipation, weight gain, joint pain, cough, pharyngitis (seizures, neuroleptic malignant syndrome, hepatitis, neutropenia, agranulocytosis, leukopenia, suicidal thoughts, heart failure) Assess: postinjection delirium/sedatiion syndrome (coma, delirium, EPS, slurred speech, altered gait, aggression, dizzy, weak, HTN, seizure); mental status; EPS (akathisia, tardive dyskinesia, pseudoparkiinsonism); sucidial thoughts, renal status; BP; fatal pneumonia, heart failure, ;or stroke for geriatric; neuroleptic malignant syndrome; weight gain; hyperglycemia; metabolic syndrome (large weight gain); DRESS (fever, hepatitis, cutaneouss reactions, eosinophilia, nephritis, pneumonia) Teaching: oral hygiene; dry mouth (sugarless gum, hard candy, ice chips), avoid hazardous activity, orthostatic hypotension; avoid hot tub/showers; avoid OTC preparations; suiciidal thought; without regard to food OD: lavage; airway; do not induce vomiting or use EPI
Disulfiram (Antabuse)
Deterrent to drinking If they drink alcohol while on disulfiram, they get very sick (nausea, vomiting). Not a cure, but the discomfort that comes along with it is a deterrent Interferes with breakdown of alcohol In presence of alcohol, causes Nausea and vomiting Hypotension and rapid pulse Flushing and confusion Respiratory and circulatory collapse, death Patient education No alcohol in any form Abstain 12 hours before taking disulfiram No alcohol for 2 weeks after last dose Side effects: headache, dry mouth, flushing Carry ID re: antabuse
Flunitrazepam
Illegal in US, used in date rapes s/e: sedation, muscle relaxation, confusion, memory loss, dizziness, impaired coordination
TCAs
Imipramine (Tofranil)((Inhibits my peeing). Can't see, can't pee, can't spit, can't shit (anticholinergic effects - such as dryness of mouth, decreased perspiration) Clomipramine (Anafranil)(also used for OCD) Amitriptyline (Elavil) (Amy trips over things (orthostatic hypo)→ slow position change) Nortriptyline (Pamelor) Doxepin (also desipramine (norpramin) and amoxapine)
Antianxiety General (Indication, Action, Contraindications, Interactions, Overdose)
Indications: Anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation Action: Depression of the central nervous system (CNS; exception: buspirone) Contraindications/precautions Contraindicated in known hypersensitivity, in combination with other CNS depressants, in pregnancy and lactation, narrow-angle glaucoma, shock, and coma. Avoid in hepatitis (prolongs elimination of medication --> toxic accumulation) Caution with elderly and debilitated clients, clients with renal or hepatic dysfunction, those with a history of drug abuse or addiction, and those who are depressed or suicidal Interactions Increased effects when taken with alcohol, barbiturates (sedative, low and slow - phenobarbital), narcotics, antipsychotics, antidepressants, antihistamines, neuromuscular blocking agents, cimetidine, disulfiram (interacts with alcohol), kava kava, or valerian root (& other herbal depressants) Decreased effects with cigarette smoking and caffeine consumption After overdose Most important and first step in assessessing this client. Establish exactly what substances were taken, how much, and when they were taken.. The nurse can then decide what emergency interventions are necessary Side effects Drowsiness, confusion, lethargy, tolerance, physical and psychological dependence, potentiation of other CNS depressants, aggravation of depression, orthostatic hypotension, paradoxical excitement, dry mouth, nausea and vomiting, blood dyscrasias, delayed onset (with buspirone only)
ADHD General (Indication, Action, Nonstimulant, Contraindication, Precaution, Side effects)
Indications: Attention deficit/hyperactivity disorder (ADHD) in children and adults Action: The CNS stimulants (Amphetamines, Methylphenidate) increase levels of norepinephrine, dopamine, and serotonin in the CNS. Their effectiveness in the treatment of ADHD is thought to be based on the activation of dopamine D4 receptors in the basal ganglia and thalamus, which depress, rather than enhance, motor activity. NONSTIMULANTS: Atomoxetine (Straterra) inhibits the reuptake of norepinephrine, and bupropion (Wellbutrin) blocks the neuronal uptake of serotonin, norepinephrine, and dopamine. Clonidine and guanfacine stimulate central alpha-adrenergic receptors in the brain resulting in reduced sympathetic outflow from the CNS. The exact mechanism by which these nonstimulant drugs produce the therapeutic effect in ADHD is unclear. Contraindications CNS stimulants: Contraindicated in clients with hypersensitivity to sympathomimetic amines; clients with advanced arteriosclerosis, cardiovascular disease, hypertension, hyperthyroidism, glaucoma, agitated or hyperexcitability states; clients with a history of drug abuse; clients during or within 14 days of receiving therapy with MAOIs; in children younger than 3 years of age; and in pregnancy and lactation Atomoxetine and bupropion: Contraindicated in clients with hypersensitivity to the drugs, in lactation, and in concomitant use with or within 2 weeks of using MAOIs Bupropion: Contraindicated in clients with known or suspected seizure disorder, acute phase of MI, and in clients with bulimia or anorexia nervosa Alpha agonists: Contraindicated in clients with known hypersensitivity to the drugs Precautions CNS stimulants: Use caution in children with psychoses; clients with Tourette's disorder, anorexia, or insomnia; elderly, debilitated, or asthenic clients; and clients with history of suicidal or homicidal tendencies; prolonged use may result in tolerance and physical or psychological dependence. Atomoxetine and bupropion: Use caution in clients with urinary retention; hepatic, renal, or cardiovascular disease; suicidal clients; pregnancy; and elderly and debilitated clients. Alpha agonists: Caution in clients with coronary insufficiency, recent MI, or cerebrovascular disease; in chronic renal or hepatic failure; the elderly; and in pregnancy and lactation Monitor client for the following side effects: Overstimulation, restlessness, insomnia, palpitations, tachycardia, anorexia, weight loss, tolerance, physical and psychological dependence, nausea and vomiting, constipation, dry mouth, sedation or rebound syndrome (alpha agonists), potential for seizures (bupropion), liver damage (atomoxetine), and new or worsened psychiatric symptoms (CNS stimulants and atomoxetine)
Sedative Hypnotics General (Indication, Action, Contraindication, Side effects)
Indications: Short-term management of various anxiety states and treatment of insomnia; selected agents are used as anticonvulsants, as preoperative sedatives, and to reduce anxiety associated with alcohol withdrawal. Action: Depression of the CNS Exception: Ramelteon's sleep-promoting properties are the result of agonist activity on selective melatonin receptors. Contraindications/precautions Contraindicated in known hypersensitivity, pregnancy, and lactation, and in severe hepatic, cardiac, respiratory, or renal disease. Precautions Caution is advised with clients with hepatic, cardiac, renal, or respiratory insufficiency. Caution is also advised with those who are suicidal and those who have been addicted to drugs. Monitor client for the following side effects: Drowsiness, confusion, lethargy, tolerance, physical and psychological dependence, potentiation of other CNS depressants, aggravation of depression, orthostatic hypotension, paradoxical excitement, dry mouth, nausea, vomiting, and blood dyscrasias Abnormal thinking and behavioral changes
Antipsychotics General (Indication, Action, Contraindication)
Indications: Used for the treatment of schizophrenia and other psychotic disorders; selected agents are also used in the treatment of bipolar mania, as antiemetics, in the treatment of intractable hiccoughs, and for control of tics and vocal utterances in Tourette's disorder. Action Typical antipsychotics (first-generation -FGA) Block postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla. Demonstrate varying affinity for cholinergic, alpha-1-adrenergic, and histaminic receptors. Inhibit dopamine-mediated transmission of neural impulses at the synapses. Atypical antipsychotics (second generation - SGA) Weaker dopamine receptor antagonists than the typical antipsychotics Potent antagonists of the serotonin type 2A (5HT-2A) receptors Exhibit antagonism for cholinergic, histaminic, and adrenergic receptors Contraindications/precautions Contraindicated in hypersensitive, comatose, or severely depressed patients; elderly patients with dementia-related psychosis; certain medications are contraindicated in patients with a history of QT prolongation or other heart issues. Caution with elderly or debilitated patients; patients with cardiac, hepatic, or renal insufficiency; those with a history of seizures; patients with diabetes or risk factors for diabetes; clients exposed to temperature extremes under conditions that cause hypotension; and pregnant clients or children. Side effects Monitor client for the following side effects: Anticholinergic effects, nausea, gastrointestinal upset, skin rash, sedation, orthostatic hypotension, photosensitivity, hormonal effects, electrocardiogram changes, reduction of seizure threshold, agranulocytosis (especially with clozapine), hypersalivation (with clozapine), extrapyramidal symptoms, tardive dyskinesia, neuroleptic malignant syndrome, hyperglycemia and diabetes, increased risk of mortality in elderly patients with NCD-related psychosis Issues in Antipsychotic Maintenance Therapy Clozapine (Clozaril) and Agranulocytosis risk Extrapyramidal side effects Hormonal side effects EXTRAPYRAMIDAL SIDE EFFECTS (EPS) EPS IS POSSIBLE WITH ANY ANTIPSYCHOTIC Pseudoparkinsonism (tremor, shuffling gait, drooling, rigidity) Akinesia (muscle weakness) Akathisia (continual restlessness) Dystonia and Oculogyric crisis - CAN BE LIFE THREATENING ANTIPSYCHOTICS: NEUROLEPTIC MALIGNANT SYNDROME NMS - Rare, but Life threatening complication of neuroleptic drugs. Symptoms: Severe muscle rigidity High fever - 104 Tachycardia Fluctuations in blood pressure Diaphoresis - Panting Stupor Coma ANTIPSYCHOTICS: TARDIVE DYSKINESIA TD can occur with long-term use of antipsychotics Symptoms can be permanent ABNORMAL INVOLUNTARY MOVEMENT SCALE (AIMS) DEVELOPED TO SCREEN FOR TD by NIMH TRADITIONALLY TREATMENT FOR TD IS TO STOP ANTIPSYCHOTICS IMMEDIATELY (IF TD OCCURS< medicate with Valbenazine (Ingrezza) Deutetrabenazine (Austedo))
Antidepressants General (Indication, Action, Contraindication)
Indications: Dysthymia, major depressive disorder, depression associated with organic disease, alcoholism, schizophrenia, intellectual disability, depressive phase of bipolar disorder, and depression accompanied by anxiety Action: Increase concentration of norepinephrine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, heterocyclics, SSRIs, SNRIs) or by inhibiting the release of monoamine oxidase (MAOIs). The enzyme, Monoamine oxidase breaks down excess tyramine in the body; blocking this enzyme helps decrease depression Contraindications/precautions Contraindicated in known hypersensitivity (all), acute phase of recovery from myocardial infarction (MI) and in angle-closure glaucoma (tricyclics), and concomitant with MAOIs (all). Caution with elderly or debilitated clients; clients with hepatic, cardiac, or renal insufficiency; psychotic clients; clients with benign prostatic hypertrophy; and those with a history of seizures. Side effects May occur with all chemical classes Dry mouth, sedation, nausea Discontinuation syndrome (flu-like, insomnia, nausea, imbalance, hyperarousal) Most commonly occur with tricyclics and heterocyclics Blurred vision, constipation, urinary retention, orthostatic hypotension, reduction of seizure threshold, tachycardia, arrhythmias, photosensitivity, weight gain Most commonly occur with SSRIs and SNRIs Insomnia, agitation, headache, weight loss, sexual dysfunction, serotonin syndrome Most commonly occur with MAOIs Hypertensive crisis (can be fatal) Site reactions (selegiline transdermal system) Miscellaneous side effects (not common) Priapism Hepatic failure Educate client and family about medication. Signs/Symptoms Restlessness, agitation Confusion Tachycardia High Blood Pressure Dilated Pupils Muscle rigidity Loss of muscle coordination Diarrhea Sweating (Severe: high fever, seizure, arrhythmia, unconsciousness)
