Psycopharmacology Medications

Xanax category generic name action treatment

(alprazolam) is a benzodiazepine that probably potentiates the effects of gamma-aminobutyric acid (GABA), depresses the central nervous system, and suppresses the spread of seizure activity. is used to treat anxiety disorders, panic disorders, and for the short term relief of anxiety symptoms. Xanax is contraindicated in persons who have acute angle-closure glaucoma.

Elavil category generic name action treatment

(amitriptyline) is a TCA that increases the amounts of norepinephrine, serotonin, or both in the CNS by blocking their reuptake by the presynaptic neurons. It is used primarily to treat depression. However, it has also been prescribed for bulimia, chronic pain, migraine headaches, and the weeping and laughing syndrome associated with multiple sclerosis.

antianxiety drugs

(anxiolytics) Benzodiazepines BuSpar (buspirone) Antidepressants Beta Blockers

BuSpar category generic name action treatment

(buspirone) non-benzodiazepine that has been approved for the treatment of anxiety This drug acts by inhibiting the action of serotonin. It is a good treatment choice because it: Is effective within three to six weeks. Does not interact with alcohol. Produces few or no withdrawal symptoms. Does not cause sedation or produce relaxant muscular effects.

Tegretol category generic name action treatment

(carbamazepine) is believed to inhibit nerve impulses by limiting the influx of sodium ions across cell membranes in the motor cortex. It is chemically related to the tricyclic antidepressants (TCAs). It is being used as an add-on, or a switch to, in manic episodes that have shown no response to lithium and in the long-term maintenance for clients who cannot tolerate lithium. The sedative effects have been useful in managing acute agitation and psychoses with mood cycling.

Celexa category generic name action treatment

(citalopram) SSRI inhibits the reuptake of serotonin into the CNS neurons, resulting in an increased amount of serotonin in the synapses. It has minimal effect on the reuptake of epinephrine and dopamine. used to treat major depression. It is also being investigated for the treatment of alcoholism, panic disorder, premenstrual dysphoria, post-traumatic stress disorder, and social phobia.

Norpramin category generic name action treatment

(desipramine), like the other TCAs, is thought to increase the levels of the neurotransmitters, especially serotonin and norepinephrine, in the brain and to adjust the brain's response to them. (desipramine) is used in the treatment of depression. It has also been used to treat bulimea and attention disorder and to help with cocaine withdrawal.

Lexapro category generic name action treatment

(escitalopram) SSRI blocks the reuptake of the neurotransmitter serotonin at the presynaptic membrane, increasing its availability at the postsynaptic receptor site. It produces an antidepressant effect. used for both treatment and maintenance therapy for clients with major depressive disorder.

Prozac category generic name action treatment

(fluoxetine) is felt to be the same as the other SSRIs -- selectively inhibiting the neuronal reuptake of serotonin in the CNS. prescribed for major depression and obsessive-compulsive disorder. It is also being used for the treatment of bulimia, other eating disorders, obesity, premenstrual dysphoric disorder, and alcohol dependence.

Luvox category generic name action treatment

(fluvoxamine) SSRI selectively inhibits the neuronal reuptake of serotonin. It produces both antidepressant and antiobsessive effects. used to treat obsessive-compulsive disorder (OCD) and depression.

Paxil category generic name action treatment

(paroxetine) is felt to be the same as the other SSRIs -- selectively inhibiting the neuronal reuptake of serotonin in the CNS with slight inhibition of norepinephrine reuptake. prescribed for major depression, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and more recently for generalized anxiety disorder.

Emsam category generic name action treatment

(selegiline) may inhibit MAO type B (mainly found in the brain) and dopamine metabolism. The transdermal patch formulation bypasses the digestive system so it has the benefit of no dietary restrictions, unlike other MAOIs. However, drug interactions still exist.

Zoloft category generic name action treatment

(sertraline) SSRI is a potent and selective inhibitor of neuronal seritonin reuptake. It has a very weak effect on the reuptake of norepinephrine and dopamine. prescribed for major depression and obsessive-compulsive disorders. It is also used in the treatment of panic disorders, premenstrual dysphoric disorders, and post-traumatic stress disorders.

Precautions for Benzodiazepines

-Hypotension and respiratory depression -Sedation, disorientation, paradoxical excitement -Dizziness, unsteady gait, ataxia, muscle weakness Pregnant and nursing women should not take (unless by doc order) Abrupt withdrawal can cause withdrawal symptoms such as intense anxiety, seizures, delirium, and even death. May interact with other drugs, such as hormonal contraceptives, digoxin, anticonvulsants, barbiturates, narcotics, antidepressants, OTC drugs. etc. Alcohol enhances the effects of these medications and should not be used concurrently. Benzodiazepines that work rapidly may be abused by clients and even offered to their family and friends as a "quick fix" to relieve stress.

Atypical Antidepressants

Along with the SSRIs, the atypical antidepressants join the classification entitled second-generation antidepressants. They appear to act in ways similar to the TCAs and the SSRIs. They are generally prescribed when the SSRIs or the TCAs do not seem to be effective in relieving the client's depressive symptoms. The heterocylics are sometimes included in this category. Cymbalta (duloxetine) Desyrel (trazodone) Effexor (venlafaxine) Remeron (mirtazapine) Wellbutrin (bupropion)

Anxiety and mania

Antianxiety drugs, primarily the benzodiazepines, can be useful in treating this extreme and uncomfortable state, especially in the acute phase. Fairly large doses of short-acting benzodiazepines, such as Ativan (lorazepam), may help calm the client with severe mania. Klonopin (clonazepam), a long acting benzodiazepine with potent anticonvulsant properties, has been used as a treatment or adjunct for acute mania and is sometimes helpful in promoting sleep.

Cymbalta category generic name action treatment

Atypical (duloxetine) is thought to work by correcting an imbalance of two brain chemicals known to influence mood--serotonin and norepinephrine. It belongs to a class of antidepressants called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). is also used to treat diabetic peripheral neuropathy, a painful nerve disorder associated with diabetes that affects the hands, legs, and feet.

Desyrel category generic name action treatment

Atypical (trazodone) is a heterocyclic introduced in the 1980s after the TCAs. It is thought to potentiate serotonin through receptor antagonism and is prescribed because of its virtual lack of anticholinergic side effects and its low potential for adverse cardiac effects. It is used primarily to treat depression.

Remeron category generic name action treatment

Atypical (mirtazapine) is a relatively new antidepressant with a unique structure and mechanism of action. It is thought to enhance noradrenergic and serotonergic activity and adjust the brain's natural chemical balance, especially of norepinephrine and serotonin. is a superb and unique addition to the antidepressant group of drugs. It may be preferred for clients with SSRI-induced sexual dysfunction, depressed clients with sleep disturbances, poor appetite, or pain, and for depressed clients who are medically ill and taking multiple medications. It does not appear to interfere with the metabolism of other drugs.

Librium category generic name action treatment

Benzodiazepines (chlordiazepoxide) enhances the action of gamma-aminobutyric acid (GABA) neurotransmission in the central nervous system, producing an anxiolytic effect. is used to relieve the symptoms of anxiety, acute alcohol withdrawal, and preoperative anxiety and tension. It has also been used to treat panic disorders, tension headaches, and tremors.

Serax category generic name action treatment

Benzodiazepines (oxazepam) potentiates the effects of gamma-aminobutyric acid (GABA) and other inhibitory neurotransmitters in the central nervous system, producing an anxiolytic effect and skeletal muscle relaxation. is used for the treatment of anxiety with depressive effects and in the management of acute alcohol withdrawal symptoms. This drug seems to be particularly effective for anxiety, tension, agitation, and irritability in older persons.

Tranxene category generic name action treatment

Benzodiazepines The action of (clorazepate) is unknown. It is thought to potentiate the action of gamma-aminobutyric acid (GABA), which depresses the central nervous system. Tranxene is used to treat anxiety, preoperative tension, and acute alcohol withdrawal and to assist in the treatment of some convulsive disorders.

Ativan category generic name action treatment

Benzodiazepines The exact action is unknown. It is thought to potentiate the effect of gamma-aminobutyric acid (GABA), which depresses the central nervous system. (lorazepam) is used to treat anxiety, tension, insomnia, status epilepticus, and alcohol withdrawl. It is also being investigated as an antiemetic in cancer chemotherapy.

TCA adverse effects

CNS confusion, nightmares, hallucinations, delusions, agitation -Monitor for changes Anticholinergic rebound from abrupt withdrawal -Abdominal pain -Anorexia -Chills, sweating -Diarrhea, nausea, vomiting -Fatigue, weakness, malaise -Headache -Autonomic instability -Dilated pupils, flushed skin, dry mouth, parched lips -Difficulty swallowing -Urinary retention -Nausea, vomiting -Coma, death HOT AS A HARE, BLIND AS A BAT, MAD AS A HATTER, DRY AS A BONE

anticonvulsants

Depakote (divalproex sodium) Lamictal (lamotrigine) Tegretol (carbamazepine) used alone or in combination with lithium, can be effective in the treatment of bipolar disorder. Anticonvulsants are sometimes prescribed when lithium does not produce the desired beneficial effects.

SSRI Withdrawal Syndrome

Dizziness, headaches, nausea, vomiting, diarrhea, insomnia, irritability, visual disturbances, lethargy, anorexia, tremors, electric shock sensations, lowered mood

SSRI adverse effects

Do not mix with MAOI and Prozac type drugs Co-administration with MAOI's may produce Serotonin Syndrome Hyperthermia, rigidity, myoclonus (muscle twitching), autonomic instability with rapid fluctuations in vital signs, mental status changes, extreme agitation progressing to delirium and coma. Do not stop abruptly Black Box

most influential chemical substance in the neurotransmitter studies related to schizophrenia.

Dopamine

two antidepressants specifically indicated for GAD:

Effexor XR (venlafaxine HCL) Paxil (paroxetine)

MAOIs dietary precautions

Foods high in tyramine need to be restricted ...hypertensive crisis aged cheeses/sour cream/yogurt red wines/beer/sherry pickled herring/dry sausage/chicken liver/meat tenderizer Avocados/bananas/fava beans/canned figs Other foods: caffeine, colas, tea,licorice, soy sauce, yeast, excessive amounts of chocolate

Benzodiazepine withdrawal syndrome

Hyperexcitability Agitation, anxiety, hyperactivity Neuropsychiatric symptoms Ataxia, depression, dizziness, delusions, seizures, tremors, hallucinations GI symptoms Abd pain, constipation, diarrhea, vomiting Cardiovascular symptoms Chest pain, flushing, <BP, palpitations GU symptoms Incontinence, <libido, urinary frequency/urgency

SNRI common side affects

Increased BP -Monitor HR and BP, especially when exercising Somnolence, nervousness, agitation, insomnia -Avoid driving and machinery when sedated Dizziness -Rise slowly

Parnate category generic name action treatment

MAOI (tranylcypromine) is the most effective MAOI for the treatment of severe or endogenous depression. A clinical effect may be experienced in about 10 days, which is faster than that achieved with the other MAOIs. Like the other MAOIs, increases the concentration of the neurotransmitters epinephrine, norepinephrine, and serotonin by preventing their degradation by the enzyme monoamine oxidase.

Marplan category generic name action treatment

MAOI The mechanism of action of (isocarboxazid) is not established. It is thought to involve the elevation of brain levels of biogenic amines. Inhibits MAO in the brain, heart and liver.

Nardil category generic name action treatment

MAOI (phenelzine) is the most studied MAOI and the most effective one in treating clients with atypical depression. It is also the most sedating one. Like the other MAOIs, it is thought to promote the accumulation of the neurotransmitters epinephrine, norepinehrine, and serotonin by inhibiting their metabolism by the enzyme monoamine oxidase.

Neural Tracts Affected by Dopamine

Mesocortical mesolimbic tuberoinfundibular nigrostriatal

(MAOIs)

Monoamine Oxidase Inhibitors MAOI's...prevents the destruction of MAO and inhibits monoamine oxidase enzyme system. Enzyme used to breakdown serotonin, dopamine and NE MAO also breaks down tyramine which is a vasopressor Emsam (selegiline) Marplan (isocarboxazid) Nardil (phenelzine) Parnate (tranylcypromine)

Common side effects of antidepressants Atypical

Orthostatic hypotension Somnolence, agitation, insomnia Dizziness Headache Nausea, constipation, increased appetite and weight gain

SNRI adverse effects

Overdose can produce hallucinations, seizures, tachycardia and neurotoxicity Do not stop abruptly

Atypical Antidepressants precautions

Overdose: grand mal seizures, hallucinations,tachycardia and neurotoxicity. Hepatic failure: (Serzone) Yellowing of the skin, nausea, yellow/green sclera of the eyes, dark urine, loss of appetite, abdominal pain Do not stop abruptly

SSRI common side effects

Palpitations Potential for falling "Dangle" and get up slowly Loss and/or gain weight Diet and exercise Increase fiber Drink fluids Excessive sweating

Beta blockers

Propranolol (Inderal) used to treat cardiac disorders, may be prescribed by psychiatrists to eliminate the physical symptoms of anxiety. NOT a first choice or first-line treatment for GAD. They are used only for the symptomatic relief of the physiological manifestations.

Pristiq category generic name action treatment

SNRI (desvenlafaxine) is a serotonin and norepinephrine reuptake inhibitor indicated for the treatment of major depressive disorder (MDD) in adults.

Effexor category generic name action treatment

SNRI (venlafaxine) structurally novel antidepressant that causes clinically significant inhibition of serotonin and norepinephrine uptake. Effexor XR (sustained release) is also prescribed to relieve generalized anxiety disorder.

SSRI

Selective Serotonin Reuptake Inhibitors Celexa (citalopram) Lexapro (escitalopram) Luvox (fluvoxamine) Paxil (paroxetine) Prozac (fluoxetine) Zoloft (sertraline)

SNRIs

Serotonin and Norepinephrine Reuptake Inhibitors increase the levels of both serotonin and norepinephrine by inhibiting their reabsorption into the cells of the brain. The resultant higher levels of these hormones enhance neurotransmission - the sending of nerve impulses - and thus improve and elevate mood. Cymbalta (duloxetine) Effexor (venlafaxine) Pristiq (desvenlafaxine)

MAOI precautions

Sympathomimetic drugs OTC cold medications, ephedrine Amphetimines TCA's Demerol Anticholinergic drugs Anesthetics Antihypertensives CNS depressants Methyldopa Atypical antidepressants Increased hypoglycemic reactions with diabetics.

Anafranil category generic name action treatment

TCA (clomipramine) is a chemical cousin of the tricyclic antidepressants Tofranil and Elavil. It has potent serotonin and epinephrine reuptake inhibition. It is primarily indicated and used in the treatment of obsessive-compulsive disorder (OCD). However, it is also being used to treat panic disorder, depression, and chronic pain.

Tofranil category generic name action treatment

TCA (imipramine) is thought to increase the levels of serotonin, epinephrine, or both in the central nervous system. Although it has relatively high anticholinergic and sedative effects, none of the newer antidepressants has proven to be more effective. It is used to treat depression as well as childhood enuresis in children age 5 or older. Some doctors also prescribe (imipramine) for bulimia, attention deficit disorder in children, obsessive-compulsive disorder, and panic disorder.

A client taking the tricyclic Elavil (amitriptyline) reports feeling dizzy when moving from a sitting to a standing position. To decrease the effects of orthostatic hypotension, what should the nurse tell the client? Decrease the dosage of the drug. Rise gradually from a supine position. Drink more fluids, especially fruit juices. Take the drug in the morning rather than at bedtime.

The BEST advice is option 2 -- "Rise gradually from a supine position." The tricyclic Elavil (amitriptyline) may cause orthostatic hypotension. Tell the client experiencing this side effect to change positions slowly and to rise gradually from a supine position.

Mark has a history of alcohol abuse. Which antianxiety medication would be most appropriate for Mark? Xanax BuSpar Tranxene Valium

The BEST drug for Mark is BuSpar. BuSpar does not interact with alcohol. All of the other drugs are benzodiazepines, which, when combined with alcohol, have an additive depressive effect on the central nervous system.

Advantages of using BuSpar (buspirone) instead of one of the benzodiazepines for GAD include all of the following EXCEPT: It produces few or no withdrawal symptoms. This drug has not shown any potential for abuse. It is less sedating than the other anxiolytics. The client will experience a noticeable effect within a few hours.

The EXCEPTION is option 4 - "The client will experience a noticeable effect within a few hours." When using the drug BuSpar, improvement may be noted in 7 to 10 days, but an optimum therapeutic effect generally takes 3 to 4 weeks.

Drugs from which of the following categories are now considered as a first-line choice for the treatment of depression? SSRIs TCAs MAOIs Atypical Antidepressants

The SSRIs have achieved wide spread popularity and are now a first-line choice for the treatment of depression.

Wellbutrin category generic name action treatment

The action of (bupropion) is unknown, but it is thought to be a weak inhibitor of norepinephrine, dopamine, and serotonin reuptake. It is used as a second-line agent in cases of treatment-resistant depression. It also appears to be quite useful in bipolar depression. In addition, it has a low risk for sexual side effects, which may be an important consideration for a client. This drug has the same ingredients as the drug Zyban (bupropion), which is used to aid smoking cessation. Therefore, the two drugs should never be used together.

Depakote category generic name action treatment

The action of (divalproex sodium) is unknown. It is thought to facilitate the effects of the inhibitory neurotransmitter gamma-aminobutyric acid. The delayed release forms are used to control the manic episodes that occur in bipolar disorder.

Lamictal category generic name action treatment

The action of (lamotrigine) is unclear. It is believed that the drug may decrease the release of glutamate and aspartate (excitatory neurotransmitters) and therefore inhibits the spread of seizure activity in the brain. It has proven to be useful in delaying the onset of mood episodes that occur in bipolar disorder and is generally well tolerated.

Pamelor category generic name action treatment

The action of (nortriptyline) is similar to the other TCAs. It is thought to increase the levels of serotonin and norepinephrine in the brain by blocking their reuptake by the presynaptic neurons. (nortriptyline) is used to relieve the symptoms of depression. Some doctors also prescribe this drug to treat chronic hives, premenstrual depression, attention deficit hyperactivity, and bed wetting.

If a male client was very concerned about the side effect of impotence or other sexual dysfunctions, the best choice of an antidepressant would be Anafranil (clomipramine) Paxil (paroxetine) Remeron (mirtazapine) Lexapro (escitalopram)

The best choice of the drugs listed is "Remeron (mirtazapine)," which is an atypical/novel antidepressant. Remeron may be preferred for clients with SSRI-induced sexual dysfunction, depressed clients with sleep disturbances, poor appetite, or pain, and for depressed clients who are medically ill and taking multiple medications. It does not appear to interfere with the metabolism of other drugs. Remeron decreases anxieties and sleep disturbances in as little as 1 to 2 weeks with little effect on libido and a low incidence of gastrointestinal upset.

Because many of the TCAs have both cardiac and anticholinergic side effects, they would be contraindicated for all of the following clients EXCEPT Mary, who has narrow-angle glaucoma Harry, who has prostatic hypertrophy Agnes, who has had a recent heart attack Charlie, who has osteoarthritis Cythia, who has a history of seizures

The client that is the exception is option 4 -- "Charlie, who has osteoarthritis." There is no suggestion of any contraindication in the information provided for Charlie. Osteoarthritis is not mentioned in this tutorial as a contraindication for the TCA drugs. Many of the TCAs are contraindicated for clients with narrow-angle glaucoma, a history of a recent heart attack, clients with a history of seizures, clients with limited kidney function, or those having difficulty urinating. In addition, the safety of these drugs has not been established during pregnancy.

Helen has a history of acute angle-closure glaucoma. Steve takes anti-hypertensive medication. Marlene is a breast cancer survivor. All three have been diagnosed with GAD. Treatment with Xanax is contraindicated for which of these individuals? Helen Steve Marlene

The correct answer is Helen. Xanax is contraindicated in persons who have acute angle-closure glaucoma.

Which of the following drugs would be used mainly to control the physiological symptoms of generalized anxiety disorder? BuSpar (buspirone) Effexor XR (venlafaxine HCL) Xanax (alprazolam) Lopressor (metoprolol)

The correct answer is Lopressor (metoprolol), which is a beta blocker. Although the Food and Drug Administration (FDA) has not approved beta blockers for the treatment of anxiety, these drugs have been found to decrease nervous tension, diaphoresis, hypertension, and feelings of panic -- the physiological manifestations of anxiety.

Mrs. Martin's has been prescribed the drug lithium to treat her Bipolar Disorder. Why would it be important to monitor Mrs. Martin's urinary output? Fluid volume deficits may occur as a result of polyuria. This drug causes elevated potassium levels. Serum glucose levels are decreased by this drug. Caffeine influences the drug's effectiveness.

The correct answer is option 1 -- "Fluid volume deficits may occur as a result of polyuria." Lithium is believed to interfere with the ionic pump mechanism in brain cells and to compete with or alter sodium ions. It may cause sodium depletion and a fluid volume deficit as a result of polyuria. Lithium toxicity can cause cardiac dysrhythmias and circulatory collapse.

Which of the following antianxiety drugs is also administered intravenously to treat status epilepticus? Valium (diazepam) Xanax (alprazolam) Librium (chlordiazepoxide) Serax (oxazepam)

The correct answer is option 1 -- "Valium (diazepam)." Valium (diazepam) has many uses. It is prescribed for the short term relief of anxiety, acute alcohol withdrawal, preoperative sedation, the relief of acute musculoskeletal conditions, and given IV for the termination of status epilepticus.

Jesse has been diagnosed with Generalized Anxiety Disorder. Her physician prescribes the benzodiazepine Xanax (alprazolam). It is believed that the benzodiazepines help to relieve anxiety by inhibiting the action of the enzyme that dissolves the neurotransmitters. selectively blocking the reuptake of serotonin by the presynaptic neurons. enhancing the effectiveness of the neurotransmitter GABA. blocking dopamine receptors.

The correct answer is option 3. In general, the benzodiazepines enhance the effectiveness of the neurotransmitter GABA. This action not only reduces anxiety but improves the client's ability to concentrate, manage activities of daily living, and function more effectively.

All of the following are important nursing interventions for the client taking the drug lithium. Which one is the MOST critical? Monitoring the client's serum electrolytes. Periodically monitoring the client's ECG. Checking the client's urine specific gravity. Monitoring the client's serum drug levels.

The correct answer is option 4 -- "Monitoring the client's serum drug levels." The determination of serum lithium levels is CRUCIAL to the safe use of this drug. Therapeutic blood levels are 0.6 - 1.2 mEq/L for adults and 0.4 - 0.8 mEq/L for elderly clients. Levels during an acute manic phase may be kept slightly higher -- between 1.0 - 1.5 mEq/L. Serum lithium levels should be monitored 8 to 12 hours after the first dose, in the morning before the second dose is administered, then weekly to monthly during maintenance therapy.

Which of the following medications is the most effective for the treatment of rapid-cycling disorder? Carbamazapine Lithium Valium Valproate

The correct answer is option 4. In fact, (as of this writing), Valproate is more effective for rapid-cycling disorder than any of the other drugs.

TCAs

Triclyclic Antidepressants blocking re-uptake of norepinephrine and to a lesser degree serotonin Muscarinic and alpha1-andrenergic receptors blocking ability Doxepin Hydrochloride Norpramin (desipramine) Anafranil (clomipramine) Pamelor (nortriptyline) Elavil (amitriptyline) Tofranil (imipramine)

Adverse Effects of the Antipsychotics

anticholinergic effects. Signs and symptoms of these effects include: Dry mouth (the most common) Nasal drying Blurred vision Upset stomach, nausea, vomiting Constipation or diarrhea Urinary retention Agitation and confusion in some individuals

atypical antipsychotics

believed not only block D2 receptors but other dopamine receptors as well. In addition, they are believed to block the receptors of other neurotransmitters such as serotonin, norepinephrine, and histamine. This enables them to be more effective for diminishing the negative as well as positive symptoms of schizophrenia. Negative symptoms refer to the loss of normal behaviors or functions usually performed by mentally healthy adults.

typical antipsychotics

believed to act by blocking the effects of dopamine 2 (D2) receptors believed to be overactive in persons with schizophrenia. The suppression of dopamine seems to reduce schizophrenic symptoms, especially the positive ones, such as hallucinations, hyperactivity, and bizarre behaviors.

Valium category generic name action treatment

benzodiazepine (diazepam) The exact mechanism of action is unknown. It is thought to potentiate the effects of gamma-aminobutyric acid, depress the central nervous system, and suppress the spread of seizure activity. (diazepam) is used for the short term relief of anxiety, acute alcohol withdrawal, preoperative sedation, and the relief of acute musculoskeletal conditions. In addition, it is given IV for the termination of status epilepticus.

Antipsychotics and manic disorder

can be used to treat psychotic symptoms during a manic episode. They are administered at the lowest possible dose and discontinued as soon as possible because of the potential for serious long-term side effects. Zyprexa (olanzapine) has been approved by the FDA for the treatment of mania. Clinical trials at dosages of 15 to 45 mg have demonstrated good efficacy for mania. Clozaril (clozapine) has also been used successfully for the treatment of resistant mania and for prophylaxis in bipolar mood disorder. Effective dosages seem to be similar to those used for schizophrenia (100 mg to 600 mg). Also, it appears that this drug may be more effective than ECT in the treatment of refractory cases.

Antidepressants and manic disorder

can trigger manic or hypomanic episodes and/or rapid cycling between moods. These drugs can help the depressive episode to resolve more quickly, but the next manic or hypomanic episode in the disorder may occur sooner than usual.

Benzodiazepines

enhance the effectiveness of the neurotransmitter GABA. This action not only reduces anxiety but improves the client's ability to concentrate, manage activities of daily living, and function effectively. Ativan (lorazepam) Librium (chlordiazepoxide) Serax (oxazepam) Tranxene (clorazepate) Valium (diazepam) Xanax (alprazolam)

antimanic or mood stabilizer

help control the manic phase of Bipolar Disorder. Lithium Anticonvulsants Antidepressants Antipsychotics Antianxieties

Doxepin Hydrochloride category generic name action treatment

is a TCA that mostly potentiates serotonin. It is sedating and claimed to be a drug that effectively enhances sleep and reduces anxiety. In addition, it is generally well tolerated by cardiac patients.

Lithium

most effective in clients who tend to be more manic in their experience of the disorder. The action is actually unknown, but it is thought to alter chemical transmitters in the Central Nervous System (CNS). It is believed to interfere with the ionic pump mechanism in brain cells and may compete with or alter sodium ions. used for the prevention and control of mania in Bipolar Disorder. It helps to control the client's accelerated thought processes and hyperactivity without sedating effects. It is beneficial in preventing recurrence of manic and depressive episodes. However, it is NOT USEFUL for the treatment of acute depression.

antipsychotic drugs use can be classified as:

primary ones used in the treatment of schizophrenia. These medications reduce hallucinations and delusions and generally improve the client's ability to function. They seem to be effective in reducing symptoms for approximately 80% of clients. The antipsychotic drugs can be classified as the traditional (typical) drugs and the atypical drugs. The Typical Antipsychotics The Atypical Antipsychotics Depot Antipsychotics Safety Alert

traditional antipsychotics

typical antipsychotics were the first drugs used for schizophrenia. Thorazine (chlorpromazine) and Haldol (haloperidol) are well known ones in this category. Haldol (haloperidol) Loxitane (loxapine) Mellaril (thioridazine) Navane (thiothixene) Orap (pimozide) Prolixin (fluphenazine) Thorazine (chlorpromazine)