Edited Psyche Drugs

8/6/2019 Edited Psyche Drugs

1/49

DRUGS NAME MECHANISM OFACTION

ADMINISTRATION

INDICATION CONTRAINDICATION ADVERSEEFFECT

NURSING RESPONSIBILITIES

GenericName:Maprotilinehydrochloride

Brand Name:Ludiomil

Classification:

Antidepressants

Themechanism of action of Maprotiline is

not preciselyknown. It doesnot actprimarily bystimulation of the centralnervoussystem and isnot amonoamineoxidaseinhibitor. The

postulatedmechanism of Maprotiline isthat it actsprimarily bypotentiation of centraladrenergicsynapses byblockingreuptake of norepinephrine

at nerveendings. Thispharmacologicaction isthought to beresponsible forthe drug'santidepressantand anxiolyticeffects.

Adult: PO 25-75mg/day in 3divided doses,

up to 150mg/day if needed. Severe:Up to 225mg/day.

Maprotilinehydrochloridetablets are

indicated for thetreatment of depressiveillness inpatients withdepressiveneurosis(dysthymicdisorder) andmanicdepressiveillness,

depressed type(majordepressivedisorder).Maprotiline isalso effectivefor the relief of anxietyassociated withdepression.

Maprotilinehydrochloride tabletsare contraindicated in

patientshypersensitive toMaprotiline and inpatients with knownor suspected seizuredisorders. It shouldnot be givenconcomitantly withmonoamine oxidase(MAO) inhibitors. Aminimum of 14 daysshould be allowed to

elapse afterdiscontinuation of MAO inhibitors beforetreatment withMaprotiline isinitiated. Effectsshould be monitoredwith gradual increasein dosage untiloptimum response isachieved. The drug isnot recommended for

use during the acutephase of myocardialinfarction.

Dry mouth,constipation,blurred vision,drowsiness,

dizziness,tremor,nervousness,anxiety,insomnia,agitation,confusion,nausea,weakness andfatigue,headache, CVdisorders,

altered liverfunction,changes inblood glucoseconcentrations, allergic skinmanifestations.PotentiallyFatal: Seizures

carefully monitorpatients receivingantidepressants forpossible and/or

persistent worsening of depression or emergentsuicidality, especially atthe beginning of therapyor when the dose eitherincreases or decreases.

instruct patients, theirfamilies and theircaregivers to be alert forthe emergence of agitation, irritability, and

the other symptomsdescribed above, as wellas the emergence of suicidality and worseningdepression, and to reportsuch symptomsimmediately to theirhealth care provider.

patients should beadequately screened todetermine if they are at

risk for bipolar disorderbefore initiatingantidepressant treatmentso that they can beappropriately monitoredduring treatment. Suchscreening should includea detailed psychiatrichistory, including afamily history of suicide,bipolar disorder, anddepression.
http://www.drugs.com/mtm/ludiomil.htmlhttp://www.drugs.com/mtm/ludiomil.html


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3/49


ADMINISTRATION



GenericName:selegiline

Brand Name:Eldepryl,Zelapar

Selegilinehydrochlorideis alevorotatoryacetylenicderivative of phenethylamine. It is

commonlyreferred to inthe clinical andpharmacological literature asl-deprenyl.

The chemicalname is: (R)-(-)- N,2-dimethyl- N -2-propynylphenethylaminehydrochloride.It is a white tonear whitecrystallinepowder, freelysoluble inwater,chloroform,and methanol,and has amolecularweight of 223.75. Themolecularformula isC13 H17 HCl.

Therecommendedregimen for theadministrationof SelegilineHydrochloride

Tablets USP is10 mg per day

administered asdivided doses of 5 mg eachtaken atbreakfast andlunch. Ther

Indicated as anadjunct in themanagement of Parkinsonianpatients beingtreated withlevodopa/carbidopa who exhibit

deterioration inthe quality of their responseto this therapy.

There is noevidence fromcontrolledstudies thatselegiline hasany beneficialeffect in theabsence of concurrentlevodopatherapy.

Selegiline iscontraindicated inpatients with a knownhypersensitivity tothis drug.

Selegiline iscontraindicated foruse with meperidine(DEMEROL & othertrade names). Thiscontraindication isoften extended toother opioids

nausea,hallucinations,confusion,depression,loss of balance,insomnia,orthostatic

hypotension,increasedakineticinvoluntarymovements,agitation,arrhythmia,bradykinesia,chorea,delusions,hypertension,new orincreasedanginapectoris, andsyncope.

patients being treated withantidepressants for anyindication should bemonitored appropriately andobserved closely for clinicalworsening, suicidality, andunusual changes in behavior,especially during the initialfew months of a course of therapy, or at times of dosechanges, either increases ordecreases.

Selegiline transdermalsystem is contraindicated foruse in patients withpheochromocytoma.

Consideration should begiven to changing thetherapeutic regimen,including possiblediscontinuing the drug, inpatients whose depression ispersistently worse, or whoare experiencing emergentsuicidality or symptoms thatmight precursors toworsening depression orsuicidality, especially if thesesymptoms are severe,abrupt in onset, or were notpart of the patient'spresenting symptoms.

Families and caregiversbeing treated withantidepressants for MDD orother indications, bothpsychiatric andnonpsychiatric, should bemade aware about the needto monitor patients for theemergence of agitation,irritability, unusual changesin behavior, and the othersymptoms


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5/49


ADMINISTRATION



Genericname:

Tranylcypromine sulfate

Brandname:

Parnate

Tranylcypromine is a non-hydrazinemonoamineoxidaseinhibitor with arapid onset of activity. Itincreases theconcentrationof epinephrine,norepinephrine, and serotoninin storage sitesthroughout thenervoussystem and, in

theory, thisincreasedconcentrationof monoaminesin the brainstem is thebasis for itsantidepressantactivity. When

Tranylcypromine is withdrawn,monoamine

oxidase activityis recovered in3 to 5 days,although thedrug isexcreted in 24hours.

Initial dose: 10mg orally twicea dayMaintenancedose: Usually 30mg/day individed doses iseffective;however,dosage shouldbe adjusted toindividual needs

For thetreatment of MajorDepressiveEpisode WithoutMelancholia.

Tranylcypromine sulfate shouldbe used in adultpatients whocan be closelysupervised. Itshould rarely bethe firstantidepressantdrug given.

Rather, the drugis suited forpatients whohave failed torespond to thedrugs morecommonlyadministered fordepression.

Tranylcyprominesulfate should notbe administeredin combinationwith any of thefollowing: MAOinhibitors ordibenzazepinederivatives;sympathomimetics (includingamphetamines);some centralnervous systemdepressants(includingnarcotics and

alcohol);antihypertensive,diuretic,antihistaminic,sedative, oranesthetic drugs;bupropion HCl;buspirone HCI;dextromethorphan; cheese or otherfoods with a hightyramine content;

or excessivequantities of caffeine.

Overstimulationwhich mayincludeincreasedanxiety,agitation,and manicsymptomsis usuallyevidenceof excessivetherapeutic action.Dosageshould be

reduced,or aphenothiazinetranquilizer should beadministeredconcomitantly.

Take drug exactly asprescribed; do not stoptaking drug (long-term

therapy) without

consulting health careprovider.

Report severe dizziness,weakness, drowsinessthat persists, rash or skinlesions,

palpitations, edema of the extremities; visualchanges; difficultyvoiding

Patients should beadequately screened todetermine if they are atrisk for bipolar disorderprior to initiatingtherapy

Tranylcypromine iscontraindicated inpatients undergoingelective surgery. Electivesurgery requiring generalanesthesia is not

recommended duringtreatment withtranylcypromine.
http://www.drugs.com/cdi/parnate.htmlhttp://www.drugs.com/cdi/parnate.html


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7/49

DRUGS NAME MECHANISMOF ACTION

ADMINISTRATION



Generic name:phenelzine

Brand name:Nardil

Classification:

Phenelzine is amonoamineoxidaseinhibitor(MAOI) thatworks byincreasing thelevels of certain

chemicals inthe brain.

Phenelzine isused to treatsymptoms of depression thatmay includefeelings of sadness, fear,anxiety, orworry about

physical health(hypochondria). Thismedication isusually givenafter otheranti-depressantshave beentried withoutsuccessfultreatment of

symptoms.Phenelzine isnot for treatingseveredepression orbipolardisorder(manicdepression).

Initial dose: 15mg orally 3times daily.Maintenancedose: Dosageshould beincreased to atleast 60 mgdaily and in

some cases 90mg daily will berequired toobtain sufficientMAO inhibition.After maximumbenefit has beenachieved, thedose may bereduced slowlyover severalweeks to 15 mg

daily or everyother day.

NARDIL(phenelzine) hasbeen found tobe effective indepressedpatientsclinicallycharacterized as

atypical ,nonendogenous, orneurotic.

These patientsoften havemixed anxiety and depression and phobic orhypochondriacal

features. Thereis lessconclusiveevidence of itsusefulness withseverelydepressedpatientswith endogenous features.

NARDIL(phenelzine)should rarely bethefirst antidepressant drug used.Rather, it ismore suitablefor use withpatients who

have failed torespond to thedrugs morecommonly used

should not beused in patientswho arehypersensitive tothe drug or itsingredients, withpheochromocytoma, congestiveheart failure ,

severe renal impairment or renaldisease, a historyof liver disease ,or abnormal liverfunction tests.

-sudden andsevereheadache,rapidheartbeat,stiffness inyour neck,

nausea,vomiting, coldsweat,sweating,visionproblems,sensitivity tolight;

-chest pain,fast or slowheart rate;

-swelling,rapid weightgain;

-agitation,unusualthoughts orbehavior; or

-feeling light-

headed,fainting.

Blood pressure should bemonitored regularly to detectchanges in pressor response,if hypertensive crisis occurstherapy should bediscontinued immediately.

If palpitations or frequentheadaches occur duringtherapy, phenelzine shouldbe discontinued immediately.

Patients who are started ontherapy should be observedclosely for clinical worsening,suicidality, or unusualchanges in behavior. The risk

of suicidality appears to begreatest during the first fewmonths of treatment, orwhen there is a dosagechange.

Families and caregiversshould be advised to closelyobserve the patient and tocommunicate with the

prescriber.

Safety and efficacy inchildren younger than 16years old have not beenestablished.
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Drug Name Mechanism of actions

Administration

Indication Contraindication AdverseEffect

Nursing Responsibility

Brand Name:Elavil

GenericName:Amitriptyline

Unknown. Atricylicantidepressantthat increasesthe amount of norepinephrine,serotonin orboth in the CNSby blockingtheir reuptakeby thepresynapticneurons.

Injection:10mg/ml

Tablets:10mg,25mg, 50mg,75mg, 100mg,150mg.

-Depression

Adults: Initially50-100mg P.O.hs, increasing to150mg daily.Maximum300mg daily, if needed.Maintenance50-100mg daily.Or 20-30mg I.M.qid

Elderly patientandadolescents:10mg P.O. t.i.d.and 20mg h.sdaily.

Contraindicated withpatientshypersensitive todrug and in thosewho have received anMAO inhibitor withinthe past 14 days.-Contraindicatedduring acute recoveryphase of MI.

CNS: ataxia,tremor,

peripheralneurophaty,anxiety,insomnia,restlessness,drowsiness,dizziness,weakness,fatigue,headache,extrapyramidal reactions,coma,seizures,stroke,hallucination,delusion,disorientation.

EENT: blurredvision,tinnitus,mydriasis,increaseintraocularpressure.

GI: Drymouth ,nausea,vomiting,anorexia,epigastricpain, diarrhea,constipation,

paralytic ileus.

-Alert:Parenteral form of drugis for I.M. administration only.

Drug shouldnt be given I.V.

-Amitriptyline has stronganticholinergic effect and isone of the most sedatingtricyclic antidepressants.

-if signs and symptoms of psychosis occur or increase,expect prescriber to reducedosage. Record moodchanges.

Monitor patients to suicidaltendencies and allow onlyminimum supply of drug.


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Drug Name Mechanism of Action Administration Indication Contraindication Adverse Effect Nursing Responsibilities

Generic

name:

Haloperidol

Brand name:

Haldol

CLASSIFICAT

ION

Antipsychotics

ACTION:

Alters theeffects of

dopamine in

the CNS

Also has

anticholinergic

and alpha-

adrenergicblocking

activity.

Diminished sig

ns and

symptoms of

psychoses

Dosage:

-0.5mg/day,1mg/day,2mg/day,5mg/day,10mg/day

Route:

- Oral

Frequency:

-Once a day

OrganicPsychoses

acute psychoticsymptoms

Relievehallucinations,delusions,

disorganizedthinking

severe anxiety

seizures

seizure disorder

glaucoma

elderly clients

CNS:extrapyramidal symptomsuch asmuscle rigidityor spasm,shuffling gait,postureleaning

forward,drooling,masklike facialappearance,dysphagia,akathisia,tardivedyskinesia,headache,seizures.CV:tachycardia,

arrhythmias,hypertension,orthostatichypertension.EENT:blurred vision,glaucoma GI: drymouth,anorexia,nausea,vomiting,

constipation,diarrhea,

Assess mental status prior toand periodically duringtherapy. Monitor BP and pulse prior toand frequently during theperiod of dosage adjustment. Observe patient carefullywhen administeringmedication, to ensure that

medication is actually takenand not hoarded.Monitor I&O ratios and dailyeight. Assess patient for signsand symptoms of dehydration.


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weight gain. GU: urinaryfrequency,urineretention,impotence,enuresis,amenorrhea,

gynecomastiaHematologic:anemia,leucopenia,agranulocytosis Skin: rash,dermatitis


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Drug Name Mechanism of Action

Administration Indication Contraindication Adverse Effect Nursing Responsibilities

Generic

name:

Molindone

Brand name:

Moban

CLASSIFICAT

ION

Antipsychotics

ACTION: MOBAN(molindonehydrochloride)is adihydroindolone compoundwhich is notstructurallyrelated to thephenothiazines, thebutyrophenones or thethioxanthenes.

Dosage:1. Mild-5 mg-15mg three or fourtimes a day.2. Moderate-10mg-25 mg threeor four times aday.3. Severe-225mg/day may berequired.

Route:- Oral

Frequency:-Mild and

Moderate- threeor four times aday

- Severe- Oncea day

MOBAN isindicated for themanagement of schizophrenia.

The efficacy of MOBAN inschizophreniawas establishedin clinical studieswhich enrollednewlyhospitalized andchronicallyhospitalized,acutely ill,

schizophrenicpatients assubjects.

MOBAN iscontraindicated insevere centralnervous systemdepression (alcohol,barbiturates,narcotics, etc.) orcomatose states,and in patients withknownhypersensitivity tothe drug.

Constipation;drowsiness;dry mouth;increasedsalivaproduction;nausea;restlessness.

Assess mental status prior toand periodically duringtherapy. Monitor BP and pulse prior toand frequently during theperiod of dosage adjustment. Observe patient carefullywhen administeringmedication, to ensure thatmedication is actually takenand not hoarded.


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Administration Indication Contraindication Adverse Effect Nursing Responsibilities

Generic

name:

Loxapine

Brand name:

Loxitane

CLASSIFICAT

IONAntipsychotic

ACTION:Loxapine isa tranquilizer f or which theexact mode of action has notbeenestablished.However,changes in thelevel of excitability of subcorticalinhibitoryareas havebeen observedin severalanimal species

in associationwith suchmanifestationsof tranquilizationas calmingeffects andsuppressionof aggressive behavior.

Dosage:

-10 mg, 15 mg,25 mg, 50 mg

Route:-Oral

Frequency:-twice a day

Loxitane(loxapine) is indicated for

the managementof themanifestations of psychoticdisorders.

The antipsychotic efficacy of Loxiyane(loxapine) wasestablished inclinical studieswhich enrollednewlyhospitalized andchronicallyhospitalizedacutely illschizophrenicpatients assubjects.

Loxitane (loxapine)

is contraindicated in

comatose or severe

drug-induced

depressed states

(alcohol ,

barbiturates,

narcotics, etc.).

Loxitane (loxapine)

is contraindicated inindividuals with

known

hypersensitivity to

dibenzoxazepines.

Constipation(severe)

Difficulturination

Inability tomove eyes

Musclespasmsespecially of the neck andback

Skin rash

Sore Throatand fever

Increasedspasms of theeyelids

Monitor BP and pulse prior toand frequently during the

period of dosage adjustment. Assess mental status prior toand periodically duringtherapy.Monitor I&O ratios and dailyeight. Assess patient for signsand symptoms of dehydration.
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Administration

Indication Contraindication Adverse Effect Nursing Responsibilities

Generic

name:

Thiothixene

Brand name:

Navane

CLASSIFICATION:Antipsychotic

ACTION:Navane (thiothixenehcl) is anantipsychotic of thethioxanthene series.Navane (thiothixenehcl) possessescertain chemicalandpharmacologicalsimilarities to thepiperazinephenothiazines anddifferences from thealiphatic group of phenothiazines.

Dosage:1.Mild- 2 mgthree timesdaily

2.Severe- 5mg twicedaily

Route: Oral

Frequency:1.Mild- three

times daily

2.Severe-twice daily

Navane(thiothixene hcl)is effective in themanagementof schizophrenia. Navane

(thiothixene hcl)has not beenevaluated in themanagement of behavioralcomplications inpatientswith mentalretardation .

Navane (thiothixenehcl) iscontraindicated inpatients withcirculatory collapse,comatose states,

central nervoussystem depressiondue to any cause,and blooddyscrasias. It is alsocontraindicated inindividuals who haveshownhypersensitivity tothe drug. It is notknown whetherthere is a cross

sensitivity betweenthe thioxanthenesand thephenothiazinederivatives, but thispossibility should beconsidered.

-very stiff (rigid)muscles, highfever,sweating,

confusion, fastor unevenheartbeats,feeling likeyou mightpass out

-restlessmusclemovements inyour eyes,tongue, jaw,or neck

-tremor(uncontrolledshaking)

-difficulty inswallowing

Monitor BP and pulse prior toand frequently during theperiod of dosage adjustment. Assess mental status prior toand periodically duringtherapy.Monitor I&O ratios and dailyeight. Assess patient for signsand symptoms of dehydration.
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Administration


Nursing Responsibilities

Generic

name:

Perphenazine

Brand name:

Trilafon

CLASSIFICATION:Antipsychotic

ACTION:Perphenazine hasactions at all levelsof the centralnervous system,particularly thehypothalamus.However, the siteand mechanism of action of therapeutic effectare not known.

Dosage:-8 to 16 mg

Route:-Oral

Frequency:-Three to fourtimes a day

Perphenazine isindicated foruse in thetreatment of schizophrenia;and for thecontrol of severe nauseaand vomiting inadults.

Perphenazineproducts arecontraindicated incomatose or greatly

obtunded patientsand in patientsreceiving large dosesof central nervoussystem depressants(barbiturates,alcohol, narcotics,analgesics, orantihistamines); inthe presence of existing blooddyscrasias, bone

marrow depression,or liver damage; andin patients who haveshownhypersensitivity toperphenazinetablets, theircomponents, orrelated compounds.

Appetite loss;blurredvision;confusion;

constipation;diarrhea;dizziness;drowsiness;dry mouth;headache;nasalcongestion;nausea;sleeplessness; tiredfeeling;

vomiting.

Assess mental status prior toand periodically duringtherapy. Monitor BP and pulse prior to

and frequently during theperiod of dosage adjustment. Observe patient carefullywhen administeringmedication, to ensure thatmedication is actually takenand not hoarded.Monitor I&O ratios and dailyeight. Assess patient for signsand symptoms of dehydration.


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DRUG NAME MECHANISM OFACTION

ADMINISTRATION



GENERICNAME:

Aripiprazole

BRAND NAME:

Abilify

Antipsychotic

Partial agonist atdopamine D2 andserotonin 5-HT 1Areceptors, andantagonist atserotonin 5-HT 2Areceptor

Dose:10 or 15 mg

Route:PO

FrequencyOD

Treatment of schizophrenia;treatment of acute manic andmixed episodesassociated withbipolar disorder.

C/I in:HypersensitivityOB: lactation

Use cautiously in:-knowncardiovascular orcerebrovasculardisease-Conditions whichcause hypotension

(dehydration,treatment withantihypertensives ordiuretics)

CV: HPN,tachycardia,hypotension,bradycardiaCNS:Headache,anxiety,agitation,insomnia,akathisia,somnolence,

lightheadednessGI:constipation

-Assess patients mentalstatus before and periodicallyduring therapy.-Monitor blood pressure(sitting, standing, lying), pulse,and respiratory rate beforeand periodically duringtherapy-Monitor for development of neuroleptic malignantsyndrome (fever, muscle

rigidity, altered mental status,respiratory distress,tachycardia, seizures,diaphoresis, HPN orhypotension, pallor, tiredness,loss of bladder control). Notifyphysician immediately if thesesymptoms occur.-Monitor for tardive dyskinesia(uncontrolled rhythmicmovement of mouth, face andextremities; lim smacking or

puckering; puffing of cheeks;uncontrolled chewing; rapid


16/49

of=r worm-like movements of tongue). Notify physician if these symptoms occur, asthese side effects may beirreversible.


ADMINISTRATION



Generic Name:Clozapine

Brand Name:

Clozaril

Antipsychotic

Interferes withdopamine bindingat D1, D2, D3 andD5 receptors inCNS; antagonizesadrenergic,cholinergic,histaminergic, andserotonergicneurotransmission.

Dose:300 900mg.

Route:PO

Frequency:OD

Management of severely andchronicallymentally ill

schizophrenicpatients whohave notresponded to orcannot toleratestandardantipsychoticdrug treatment;to reduce risk of recurrent suicidalbehavior inpatients with

schizophrenia orschizoaffective

History of clozapine- inducedagranulocytosis orsevere

granulocytopenia;myeloproliferativedisorders;simultaneousadministration withother agents knownto cause bonemarrowsuppression; severeCNS depression orcomatose states;uncontrolled

epilepsy;hypersensitivity to

CNS:neurolepticmalignantsyndrome,

seizures,dizzinss,sedation.CV:myocarditis,hypotension,tachycardiaGI:constipationHemat:agranulocytosis, leukopenia.

-Monitot patients mentalstatus (delusions,hallucinations, and behavior)before and periodically during

therapy.-Monitor for signs of myocarditis(unexplainedfatigue, dyspnea, tachypnea,fever, chest pain, palpitations,other signs and symptoms of heart failure, ECG changes,such as ST-T waveabnormalities, arrhythmias, ortachycardia during the firstmonth of therapy). If theseoccur, clozapine should be

discontinued and notrestarted.


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disorder who are judged to be atchronic risk forre-experiencingsuicidal behavior(except orallydisintegratingtablets).

product. -clozapine lowers the seizurethreshold. Institute seizureprecautions for patients withhistory of seizure disorder.


ADMINISTRATION



GENERICNAME:

Risperidone

BRAND NAME:

Risperdal

Antipsychotic

Has antipsychoticeffect, apparentlycaused by

dopamine andserotonin receptorblocking in CNS

Dose:2-8 mg

Route:PO

Frequency:

BID

Treatment of schizophrenia;short termtreatment of acute manic ormixed episodesassociated with

bipolar disorder(oral only) aseithermonotherapy oradjunct therapyto lithium orvalproate.

Hypersensitivity

Use cautiously inGeriatric ordebilitated patients,underlyingcardiovascular

disease, history of seizures, diabetesor risk factors fordiabetes,pregnancy,lactation, orchildren.

CNS:neurolepticmalignantsyndrome,aggressivebehavior,dizziness,

extrapyramidal reactions,headache,increaseddreams,increasedsleepduration,insomnia,sedation.EENT:pharyngitis,

rhinitis, visualdisturbances.RESPI: coughGI:constipation,diarrhea, drymouth,nausea

--Monitot patients mentalstatus (delusions,hallucinations, and behavior)before and periodically duringtherapy.-Monitor moodchanges.Suicidal tendencies

- Monitor for development of neuroleptic malignantsyndrome (fever, musclerigidity, altered mental status,respiratory distress,tachycardia, seizures,diaphoresis, HPN orhypotension, pallor, tiredness,loss of bladder control). Notifyphysician immediately if thesesymptoms occur.-Advise patient to change

positions slowly to minimizeorthostatic hypotension.

DRUG NAME MECHANISM OF ADMINISTRAT INDICATION CONTRAINDICATION ADVERSE NURSING RESPONSIBILITIES


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ACTION ION EFFECT

GENERICNAME:

Olanzapine

BRAND NAME:

Zyprexa

Antipsychotic

Antagonizesdopamine andserotonin type 2 inthe CNS.

Dose:5-15 mg

Route:PO

Frequency:OD

Treatment of schizophrenia(oral); short-termtreatment of acute mixed ormanic episodeswith bipolardisorder(oral); incombination withlithium orvalproate forshort-termtreatment of acute episodesassociated withbipolar

disorder(oral);agitationassociated withschizophreniaand bipolar Imania (IM).

HypersensitivityLactation

Use cautiously in:Patients withhepatic impairment,geriatric patients,cardiovascular orcerebrovasculardisease

CNS:neurolepticmalignantsyndrome,seizures,agitation,dizziness,headache,restlessness,sedation,weaknessCV: orthostatichypotension,tachycardiaGI:constipation,

dry mouthMetab: wt.gainNeuro: tremor

--Monitot patients mentalstatus (delusions,hallucinations, and behavior)before and periodically duringtherapy.-Monitor BP, ECG, pulse andRR before and frequentlyduring dose adjustment.-Assess fluid intake and bowelfunction. Increased bulk andfluids in the diet may helpminimize constipation.-Monitor patient for onset of akathisia(restlessness ordesire to keep moving) andestrapyramidal side effects(parkinsonian- difficulty

speaking or swallowing, loss of balance, pill rolling, mask-likeface, shuffling gait, rigidity,tremors)-Monitor for tardive dyskinesia(uncontrolled rhythmicmovement of mouth, face andextremities; lim smacking orpuckering; puffing of cheeks;uncontrolled chewing; rapid

of=r worm-like movements of tongue). Notify physician if these symptoms occur, asthese side effects may beirreversible.


19/49

DRUGNAME

MECHANISM OFACTION

ADMINISTRATION



GENERICNAME:

QuetiapineFumarate

BRANDNAME:

Seroquel

Antipsychotic

Has antipsychoticeffects, apparentlycaused by dopamineand receptor receptorblockade in the CNS

Dose:150-750 mg.

Route:PO

Frequency:Bid in divideddoses

Treatment of

schizoprhrenia;short-termtreatment of acute manicepisodesassociated withbipolar disorder,as eithermonotherapy oradjunct therapyto lithium ordivalproex

C/I in:

HypersensitivityLactation

Use cautiously in:-CVD, dehydrationor hypovolemia-Hx of seizures,Alzheimersdementia or age>65 y/o-hepaticimpairment-hypothyroidism(may beexacerbated)-Hx of suicideattempt-pregnancy orchildren

CNS:

neurolepticmalignantsyndrome,seizures,dizzinessMetab: weightgain

-Monitot patients mental

status (delusions,hallucinations, and behavior)before and periodically duringtherapy.-Monitor BP(sitting, standing,lying) and pulse before andfrequently during initial dosetitration.-Monitor for development of neuroleptic malignantsyndrome (fever, musclerigidity, altered mental status,respiratory distress,tachycardia, seizures,diaphoresis, HPN orhypotension, pallor, tiredness,loss of bladder control). Notifyphysician immediately if thesesymptoms occur.-Advise patient to changepostions slowly to minimize

orthostatic hypotension.-Advise patient to avoidextremes in temperature; thisdrug impairs body temp.regulation.-Assess fluid intake and bowelfunction. Increased bulk andfluids in the diet may helpminimize constipation.


20/49


21/49

DRUGNAME

MECHANISM OFACTION

ADMINISTRATION



GENERICNAME:

Ziprasidone HCL

BRANDNAME:

Geodon

Antipsychotic

Effects probablymediated byantagonism of

dopamine type 2 (D2)and serotonin type 2(5-Ht2). Alsoantagonizes alpha2adrenergic receptors.

Dose:40-160 mg

Route:PO

Frequency:OD

Treatment of schizophrenia;treatment of acute manic ormixed episodesassociated with

bipolar disorder;treatment of acute agitation inschizophrenicpatients

-recent acute MI;uncompensatedheart failure; knownhypersensitivity tothe product.

CNS:neurolepticmalignantsyndrome,dizziness,drowsiness,

restlessness.CV: prolongedQT intervalGI:constipation,diarrhea,nausea

-Monitot patients mentalstatus (delusions,hallucinations, and behavior)before and periodically duringtherapy.--Monitor BP(sitting, standing,

lying) and pulse before andfrequently during initial dosetitration.-Patients who experiencedizziness, palpitations, orsyncope may require furtherevaluation.-Monitor patient for onset of akathisia(restlessness ordesire to keep moving) andestrapyramidal side effects(parkinsonian- difficulty

speaking or swallowing, loss of balance, pill rolling, mask-likeface, shuffling gait, rigidity,tremors)-Monitor for development of neuroleptic malignantsyndrome (fever, musclerigidity, altered mental status,respiratory distress,tachycardia, seizures,diaphoresis, HPN orhypotension, pallor, tiredness,

loss of bladder control). Notifyphysician immediately if thesesymptoms occur.


22/49

DRUGNAME

MECHANISM OFACTION

ADMINISTRATION



GENERICNAME:

Chlorpromazine

BRANDNAME:

Thyrazine

Antipsychotic

-Alters the effects of dopamine in the CNS-Has significantanticholinergic / alpha-adrenergic blockingactivity

Dose:10-25 mg

Route:PO

Frequency:2-4x daily

-Acute chronicpsychoses,

particularly whenaccompanied byincreasedpsychomotoractivity-Nausea andvomiting-Intractablehiccups-Preoperativesedation-Treatment of

acuteintermittentporphyria.

-Hypersensitivity-Hypersensitivity to

sulfites(injectables)or benzyl alcohol.-Cross-sensitivitywith otherphenothiazines mayoccur-Narrow-angleglaucoma-Bone marrowdepression-Severe liver /cardiovascular

disease

CNS:neuroleptic

malignantsyndrome,sedation.EENT: blurredvision, dryeyes.CV:hypotensionGI:constipation,dry mouthDERM:

photosensitivityHemat:agranulocytosis.

-Monitot patients mentalstatus (delusions,hallucinations, and behavior)

before and periodically duringtherapy.-Monitor BP(sitting, standing,lying) and pulse before andfrequently during initial dosetitration.-Assess fluid intake and bowelfunction. Increased bulk andfluids in the diet may helpminimize constipation.-Monitor patient for onset of akathisia(restlessness or

desire to keep moving) andestrapyramidal side effects(parkinsonian- difficultyspeaking or swallowing, loss of balance, pill rolling, mask-likeface, shuffling gait, rigidity,tremors)-Monitor for development of neuroleptic malignantsyndrome (fever, musclerigidity, altered mental status,respiratory distress,

tachycardia, seizures,diaphoresis, HPN orhypotension, pallor, tiredness,loss of bladder control). Notifyphysician immediately if thesesymptoms occur.


23/49

DrugName

Mechanism of actions

Administration



BrandName:Wellbutrin

GenericName:

Bupropion

Unknown. Drugdoesnt inhibit Maobut weakly inhibitsnorepinephrine ,dopamine, serotoninreuptake.Noradrenergic or

dopaminergicmechanism, or bothmay cause drugseffect.

Tablets(extended-release):150mg,300mg.

Tablets(immediate-release): 7mg,100mg.

Tablets(sustained-release):100mg,150mg,200mg.

-Depression

Adults:

For immediate-release initially100mg P.O. b.i.d.increases after 3days to 100mgP.O. b.i.d. if needed. if patient doesntimprove afterseveral weeks of therapy, increasedosage to 15mgt.i.d. No singledose shouldexceed 150mg.Allow atleast 6hours betweensuccessivedoses.

.

Contraindicatedwith patientshypersensitive todrug and in thosewho have receivedan MAO inhibitorwithin the past 14

days and in thosewith seizuredisorders or historyof bulimia oranorexia nervosabecause of a higherrisk of seizure.-Dont use withZyban or otherdrugs containingbupropion that areused for smoking

cessation.-contraindicated inpatients abruptlystopping use of alcohol or sedatives(includingbenzodiazepines).

CNS: fever,headache,seizure, anxiety,confusion,delusions,euphoria,hostility,

impaired sleepquality,insomnia,sedation,tremor,akinesia,agitation,dizziness,fatigue,syncope,suicidalbehaviors.

CV:hypertension,hypotension,palpitations,tachycardia,arrhythmias,chest pain.

EENT: auditorydisturbances,blurred vision,epistaxis,

-In switching patients fromregular or sustained- releasetablets to extended-releasetablets, give the same totaldaily dose ( when possible) asthe once-daily dosageprovided.

-Closely monitor patients withhistory of bipolar disorder.Antidepressants can causemanic episodes during thedepressed phase of bipolardisorder. This may be lesslikely to occur with buprprionthan with otherantidepressant.


24/49

pharyngitis,sinusitis.

Other:feverand chills.


ADMINISTRATION

INDICATION CONTRAINDICATION ADVERSEEFFECTS


Generic

Name:

Buspirone

Brand Name:

Buspar

Classification:

Anti-anxiety

Mode of Action:

Its mechanism of

action is not clearlyunderstood but

may involve effects

on

neurotransmitters,

chemicals that

nerves use to

communicate with

one another.

Dosage:

5, 10, 15, and

30 mg

Form:

Tablet

Management of

anxiety disorders

or for the short-

term relief of the

symptoms of

anxiety

Generalized

anxiety of a

limited or

moderate

degree

Contraindicated to

patients

hypertensive to

Buspirone

Contraindicated in

patients with severehepatic or severe

renal impairment

Dizziness , nau

sea , headache

, nervousness,

lightheadedne

ss,

excitement,and insomnia .

Less frequent

side effects

include

unsteady

gait, diarrhea ,

excitement, w

eakness,

Monitor blood pressure as it

may increase when interacting

with other drugs.

Instruct nursing mothers not

to take drug as it is not known

if the drug will be excreted inmilk.
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Serotonin and

dopamine are two

of these

neurotransmitters.

Buspirone may

work by stimulating

serotonin type 1A

receptors on nerves

hostility, skin

rash ,

and tremors .

Drug Name Mechanism of

actions

Administrati

on

Indication Contraindication Adverse

Effect


BrandName:Anafranil

GenericName:clomipramine

Unknown. A tricyclicantidepressant thatinhibits reuptake of serotonin, andnoepinephrine atthe presynapticneuron.

Capsule:25mg,50mg, 75mg.

-Obsessive compulsivedisorder.

-To managepanic disorderwith orwitgoutagoraphobia.

-Depression,

Contraindicatedwith patientshypersensitive todrug or oyhertricyclicantidepressants, inthose who havetaken MAOinhibitors within

previous 14 daysand in patients in

CNS:Somnolence,tremor,dizziness,headache,insomnia,nervousness,mycolonus,fatigue, ECG

changes,

-Monitor mood and watch forsuicidal tendencies. Allowpatients to have only minimalamount of drug.

-Dont withdraw drug abruptly.Because patients usingtricyclic antidepressant maysuffer hypersentive episodesduring surgery, stop drug
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chronic pain.

-Cataplexy andrelatednarcolepsy.

acute recoveryperiod after MI. seizures.

CV: orthostatichypotension,palpitations,tachycardia.

EENT:Pharyngitis,rhinitis, visualchanges.

GI: Drymouth ,nausea,vomiting,anorexia,abdominalpain, diarrhea,constipation,increasedapetite.

gradually several days beforesurgery.

DRUG NAME MECHANISM OF

ACTION

ADMINISTRATI

ON

INDICATION CONTRAINDICATION ADVERSE

EFFECTS



27/49

Generic

Name:

Dextroamphe

tamine

Brand Name:

Adderall

Amphetamine and

dextroamphetamin

e are used in

combination to

treat attention-

deficit hyperactivity

disorder

(ADHD) and narcole

psy . Adderall

stimulates the brain

and also can

increase blood

pressure.

Adderall

tablets: 5, 7.5,

10, 12.5, 20,

and 30 mg.

Adderall XR

capsules: 5,

10, 15, 20, 25,

and 30 mg.

Adderall is used

for the treatment

of attention-

deficit

hyperactivity

disorder (ADHD)

and narcolepsy

Do not use during

or within 14 days

following the

administration of

MAO inhibitors;

hypertensive crises

may result.

Do not use in

patients with a

history of drug

abuse.

Nervousness,

restlessness,

excitability, di

zziness ,

headache,

fear,

anxiety, tremo

r, and even

hallucinations

and

convulsions

(seizures).

Mothers taking amphetamines

such as Adderall should refrain

from nursing their infants

because these drugs are

excreted in human milk and

can have undesirable effects

on the child.

Monitor blood pressure for

sudden decrease as it may

lead to shock-like symptoms.
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28/49


ACTION

ADMINISTRATI

ON


EFFECTS


Generic

Name:

Duloxetine

Brand Name:Cymbalta

Duloxetine affects

neurotransmitters,

the chemicals that

nerves within the

brain make andrelease in order to

communicate with

one another.

Neurotransmitters

either travel across

the space between

nerves and attach

to receptors on thesurface of nearby

nerves or they

attach to receptors

on the surface of

the nerves that

produced them, to

be taken up by the

nerve and releasedagain

Delayed-

release

capsules: 20,

30, and 60 mg

Duloxetine is

used for the

treatment of

depression,

generalizedanxiety disorder,

and pain

associated with

diabetic

peripheral

neuropathy or

fibromyalgia.

Duloxetine should

not be used in

combination with a

monoamine oxidase

inhibitor (MAOI)such as phenelzine

(Nardil) or within 14

days of

discontinuing the

MAOI. At least 5

days should be

allowed after

stopping duloxetinebefore starting an

MAOI. Combinations

of SNRIs and MAOIs

may lead to

serious, sometimes

fatal, reactions

including very high

body temperature,muscle rigidity,

rapid fluctuations of

heart rate and

blood pressure,

extreme agitation

progressing to

delirium,

and coma .

Nausea , dry

mouth , consti

pation , diarrhe

a , fatigue,

difficultysleeping,

and dizziness .

Increased

blood pressure

can occur and

should be

monitored. Sei

zures havebeen reported.

Sexual

dysfunction

(decreased

sex drive and

delayed

orgasm and

ejaculation)has been

associated

with

duloxetine.

Some patients

may

experience

withdrawal


to take drug when

breastfeeding as Nefazodone

may be secreted in breast

milk and may cause adverseeffects in infants.

Gradually reduce medication

not abruptly to reduce side

effects
http://www.medicinenet.com/script/main/art.asp?articlekey=85386http://www.medicinenet.com/script/main/art.asp?articlekey=85386http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=24712http://www.medicinenet.com/script/main/art.asp?articlekey=24712http://www.medicinenet.com/script/main/art.asp?articlekey=331http://www.medicinenet.com/script/main/art.asp?articlekey=331http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=97800http://www.medicinenet.com/script/main/art.asp?articlekey=97800http://www.medicinenet.com/script/main/art.asp?articlekey=43369http://www.medicinenet.com/script/main/art.asp?articlekey=43369http://www.medicinenet.com/script/main/art.asp?articlekey=43369http://www.medicinenet.com/script/main/art.asp?articlekey=299http://www.medicinenet.com/script/main/art.asp?articlekey=299http://www.medicinenet.com/script/main/art.asp?articlekey=85386http://www.medicinenet.com/script/main/art.asp?articlekey=24732http://www.medicinenet.com/script/main/art.asp?articlekey=24712http://www.medicinenet.com/script/main/art.asp?articlekey=24712http://www.medicinenet.com/script/main/art.asp?articlekey=331http://www.medicinenet.com/script/main/art.asp?articlekey=331http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=1900http://www.medicinenet.com/script/main/art.asp?articlekey=97800http://www.medicinenet.com/script/main/art.asp?articlekey=43369http://www.medicinenet.com/script/main/art.asp?articlekey=43369http://www.medicinenet.com/script/main/art.asp?articlekey=299http://www.medicinenet.com/script/main/art.asp?articlekey=299


29/49

reactions upon

stopping

duloxetine.


Administration



Brand

Name:

Tofranil

Generic

Name:

Imipramine

Unknown. A tricyclic

antidepressant that

increases

norepinephrine,

serotonin or both in

the CNS by blocking

their reuptake by

the presynaptic

neurons.

Tablets: 10mg,

25mg, 50mg.

-Depression

-Childhoodenuresis

Contraindicated

with patients

hypersensitive to

drug and in those

receiving MAO

inhibitors; also

contraindicated

during acute

recovery phase of

MI.

CNS: Stroke,

drowsiness,

dizziness,excitation,

tremor,

confusion,

hallucination,

anxiety,

ataxia,

paresthesia,

nervousness

CV: orthostatic

hypotension,

palpitations,

tachycardia,

precipitation

of heart

-Monitor patients for nausea,

headache and malaise after

abrupt withdrawal of long-term theraphy: these

symptoms dont indicate

addiction.


30/49

failure.

EENT: blurred

vision tinnitus,

mydriasis.

GI: Dry mouth,

constipation,

nausea,

vomiting,

anorexia,

abdominal

cramps.

.


ADMINISTRATION



GenericName:Methylpenidate

Brand Name:Ritalin

Methylphenidatebelongs tothe piperidine classof compounds and

increases the levelsof dopamine and norepinephrine in thebrainthrough reuptakeinhibition of the monoaminetransporters .Methylphenidate(MPH) possessesstructuralsimilarities

to amphetamine an

Tablets: 5,7.5, 10, 12.5,20, and 30mg.

Treatment of attention-deficithyperactivitydisorder , postura

l orthostatictachycardiasyndrome ,and narcolepsy . It may also beprescribedfor off-labeluse in treatment-resistant casesof lethargy , depression , neuralinsult

and obesity .

Methylphenidateshould not beprescribed topatients who suffer

fromsevere arrhythmia ,hypertension or liver damage . It shouldnot be prescribed topatients whodemonstrate drug-seeking behaviour ,pronouncedagitation ornervousness.

Abdominalpain

Akathisia

Alopecia

Angina

Appetite loss

Anxiety

Bloodpressure andpulse changes

Mothers taking drug shouldrefrain from nursing theirinfants because these drugsare excreted in human milk

and can have undesirableeffects on the child.

Special precaution isrecommended in individualswith epilepsy with additionalcaution in individuals withuncontrolled epilepsy due tothe potential formethylphenidate to lower theseizure threshold.
http://en.wikipedia.org/wiki/Piperidinehttp://en.wikipedia.org/wiki/Dopaminehttp://en.wikipedia.org/wiki/Norepinephrinehttp://en.wikipedia.org/wiki/Norepinephrinehttp://en.wikipedia.org/wiki/Reuptake_inhibitorhttp://en.wikipedia.org/wiki/Reuptake_inhibitorhttp://en.wikipedia.org/wiki/Reuptake_inhibitorhttp://en.wikipedia.org/wiki/Monoamine_transporterhttp://en.wikipedia.org/wiki/Monoamine_transporterhttp://en.wikipedia.org/wiki/Amphetaminehttp://en.wikipedia.org/wiki/Therapyhttp://en.wikipedia.org/wiki/Therapyhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndromehttp://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndromehttp://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndromehttp://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndromehttp://en.wikipedia.org/wiki/Narcolepsyhttp://en.wikipedia.org/wiki/Narcolepsyhttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Lethargyhttp://en.wikipedia.org/wiki/Lethargyhttp://en.wikipedia.org/wiki/Depression_(mood)http://en.wikipedia.org/wiki/Depression_(mood)http://en.wikipedia.org/wiki/Depression_(mood)http://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Arterial_hypertensionhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Drug_addiction#Behaviorhttp://en.wikipedia.org/wiki/Drug_addiction#Behaviorhttp://en.wikipedia.org/wiki/Abdominal_painhttp://en.wikipedia.org/wiki/Abdominal_painhttp://en.wikipedia.org/wiki/Akathisiahttp://en.wikipedia.org/wiki/Alopeciahttp://en.wikipedia.org/wiki/Anginahttp://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Anxietyhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Pulsehttp://en.wikipedia.org/wiki/Piperidinehttp://en.wikipedia.org/wiki/Dopaminehttp://en.wikipedia.org/wiki/Norepinephrinehttp://en.wikipedia.org/wiki/Norepinephrinehttp://en.wikipedia.org/wiki/Reuptake_inhibitorhttp://en.wikipedia.org/wiki/Reuptake_inhibitorhttp://en.wikipedia.org/wiki/Monoamine_transporterhttp://en.wikipedia.org/wiki/Monoamine_transporterhttp://en.wikipedia.org/wiki/Amphetaminehttp://en.wikipedia.org/wiki/Therapyhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndromehttp://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndromehttp://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndromehttp://en.wikipedia.org/wiki/Narcolepsyhttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Lethargyhttp://en.wikipedia.org/wiki/Depression_(mood)http://en.wikipedia.org/wiki/Depression_(mood)http://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Arrhythmiahttp://en.wikipedia.org/wiki/Arterial_hypertensionhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Drug_addiction#Behaviorhttp://en.wikipedia.org/wiki/Drug_addiction#Behaviorhttp://en.wikipedia.org/wiki/Abdominal_painhttp://en.wikipedia.org/wiki/Abdominal_painhttp://en.wikipedia.org/wiki/Akathisiahttp://en.wikipedia.org/wiki/Alopeciahttp://en.wikipedia.org/wiki/Anginahttp://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Anxietyhttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Blood_pressurehttp://en.wikipedia.org/wiki/Pulse


31/49

d itspharmacologicaleffects are moresimilar to thoseof cocaine , thoughMPH is less potentand longer induration of action.

(both up anddown)

Cardiacarrhythmia

Diaphoresis (s

weating)

Dizziness

Dyskinesia

Dysphoria orEuphoria

Headaches


Administration Indication Contraindication Adverse Effect Nursing Responsibility

Brand

Name:

Remeron

Generic

Name:

Thought to be

caused by

enhancement of

central

noradrenergic and

serotonergic

activity.

Tablets: 15mg,

30mg, 45mg.

Tablets: (orally

disintegrating)

15mg, 30mg,

45mg.

-Depression

Adults: Initially,

15mg P.O. h.s.

maintenance

dose ranges

from 15 5o 45mg

Contraindicated

with patients

hypersensitive to

drug within 14 days

of MAO inhibitor

therapy.

CNS:

Somnolence,

dizziness,

asthenia,

abnormal

dreams.

Abnormal

-Dont use within 14 days of

MAO inhibitor therapy.

- Record mood changes.

Watch for suicidal tendencies.

-Although agranulocytosis
http://en.wikipedia.org/wiki/Cocainehttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Diaphoresishttp://en.wikipedia.org/wiki/Dizzinesshttp://en.wikipedia.org/wiki/Dyskinesiahttp://en.wikipedia.org/wiki/Dysphoriahttp://en.wikipedia.org/wiki/Dysphoriahttp://en.wikipedia.org/wiki/Euphoriahttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Cocainehttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Diaphoresishttp://en.wikipedia.org/wiki/Dizzinesshttp://en.wikipedia.org/wiki/Dyskinesiahttp://en.wikipedia.org/wiki/Dysphoriahttp://en.wikipedia.org/wiki/Euphoriahttp://en.wikipedia.org/wiki/Headache


32/49

Mirtazapinedaily. Adjust

dosage at

intervals of at

least 1 week.

-Use cautiously in

patients with CV or

cerebrovascular

disease, seizure

disorder, suicidal

thoughts, hepatic or

renal impairment or

history or mania or

hypomania.

thinking,

tremors,

confusion,

suicidal

behaviors.

CV: edema,

peripheral

edema.

GI: nausea,

increased

apetite, dry

mouth,

constipation.

GU: urinary

freaquency.

Megain.tabolic

: weight

Respiratory:dyspnea.

occurs rarely, stop drug and

monitor patients closely if he

develops a sore throat, fever,

stomatitis or other signs and

symptoms of infection with a

low WBC count.


ACTION

ADMINISTRATI

ON


EFFECTS



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34/49


Administration Indication Contraindication AdverseEffect


Brand Name:

Desyrel

Generic

Name:

trazodone

Unknown. Inhibits

CNS neuronal

uptake of serotonin;

not a tricyclic

derivates.

Tablets: 50mg,

100mg,

150mg,300mg.

-Depression

Adults: Initially,150mg P.O. daily

in divided doses;

then increased

by 50mg daily q

3 to 4 days p.r.n

.Doses ranges

from 150 to

400mg daily.Maximum

600mg daily for

inpatients and

400mg daily for

outpatient.

-Contraindicated

with patients

hypersensitive to

drug

-Use cautiously in

patients with cardiac

disease or in the

initial recovery

phase of MI and in

patients at risk for

suicide.

CNS:

Drowsiness,

dizziness,nervousness,

fatigue,

confusion,

tremor,

weakness,

vivid dreams,

hostility,

anger,nightmares,

headache,

insomnia,

syncope.

CV:

Orthostatic

hypotension,

-Give drug after meals or a

light snack for optimal

absorption and to decreasedrisk of dizziness.

-Record mood changes.

Monitor patients for suicidal

tendencies and allow only

minimum supply of drugs.


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tachycardia,

hypertension,

shortness of

breath, ECG

changes.

GI: nausea,

vomiting , dry

mouth,

anorexia,

constipation.

Skin: rash,

urticaria,

diaphoresis


ADMINISTRATION



Generic

Name:

Venlafaxine

Brand Name:

Effexor

Classification:

Anti-depressant

Mode of action:

Venlafaxine is in a

new class of anti-

depressant

Tablets of 25,

37.5, 50, 75,

and 100 mg.

Effexor XR is

available in

capsules of

Treatment of

depression,

depression with

associated

symptoms of

anxiety,

generalized

Contraindicated to

patients

hypertensive to

venlafaxine.

Nausea,

headaches,

anxiety,

insomnia,

drowsiness,

and loss of

appetite.

Monitor blood pressure.

Therapy should not be

stopped abruptly but gradually


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medications that

affects chemical

messengers within

the brain. These

chemical

messengers are

calledneurotransmitters,

and some examples

are serotonin,

dopamine, and

norepinephrine.

37.5, 75, and

150 mg.

anxiety disorder,

and social

anxiety disorder.

increased

blood

pressure


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38/49


ACTION

ADMINISTRATI

ON


EFFECTS


Generic

Name:

Zolpidem

Brand Name:

Ambien

Zolpidem belongs

to a class of drugs

called sedatives or

hypnotics.

Zolpidem shares

some

characteristics of a

family of sedatives

called benzodiazepi

nes .

Benzodiazepines

cause sedation,

muscle relaxation,

act as anti-

convulsants (anti-

seizure

medications), and

reduce anxiety .

Zolpidem has

selectivity in that it

has little of the

muscle relaxant

and anti-seizure

effects and more of

the sedative effect.

Therefore, it is used

primarily as a

medication for

sleep.

Tablets: 5 and

10 mg.

Tablet

(extended

release): 6.25

mg and 12.5

mg.

Oral spray: 5

mg/spray

Insomnia

associated with

difficulty falling

asleep or staying

asleep

Ambien is

contraindicated in

patients with known

hypersensitivity to

zolpidem tartrate or

to any of the

inactive ingredients

in the formulation

Drowsiness, di

zziness ,

confusion ,

insomnia,

euphoria,

ataxia and

visual

changes.

Zolpidem can

cause

withdrawal

symptoms

(muscle

cramps,

sweats,

shaking,

and seizures )

when the

drug is

abruptly

discontinued.

Instruct patient not to drink

alcoholic beverages as it may

alter the effect of the drug


to take drug as it is known

that the drug will be excreted

in milk.

Caution not to combine with

other sedative drugs as it may

increase adverse effects.
http://www.medicinenet.com/script/main/art.asp?articlekey=45293http://www.medicinenet.com/script/main/art.asp?articlekey=45293http://www.medicinenet.com/script/main/art.asp?articlekey=45293http://www.medicinenet.com/script/main/art.asp?articlekey=24696http://www.medicinenet.com/script/main/art.asp?articlekey=24780http://www.medicinenet.com/script/main/art.asp?articlekey=24780http://www.medicinenet.com/script/main/art.asp?articlekey=63314http://www.medicinenet.com/script/main/art.asp?articlekey=472http://www.medicinenet.com/script/main/art.asp?articlekey=45293http://www.medicinenet.com/script/main/art.asp?articlekey=45293http://www.medicinenet.com/script/main/art.asp?articlekey=24696http://www.medicinenet.com/script/main/art.asp?articlekey=24780http://www.medicinenet.com/script/main/art.asp?articlekey=24780http://www.medicinenet.com/script/main/art.asp?articlekey=63314http://www.medicinenet.com/script/main/art.asp?articlekey=472


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ADMINISTRATION

INDICATION CONTRAINDICATION

ADVERSEEFFECTS


Generic

Name:

Palperidone

Brand Name:

Invega

Extended

release

Antipsychotic

Chemically,

paliperidone is one

of many

active metabolites

of the older atypical

antipsychotic risperi

done (paliperidone

is 9-

hydroxyrisperidone,

i.e. risperidone with

an

extra hydroxyl grou

p).

Dose:

6 mg

Route:

PO

Frequency:

OD

Acute and

maintenance

treatment of

schizophrenia;

acute treatment

of schizoaffective

disorder as

monotherapy or

as an adjunct to

mood stabilizers

and/or

antidepressants

(oral only)

Hypersensitivity to

risperidone,

paliperidone, or

any component of

the product.

Most common:

* Tardive

dyskinesia

*High blood

sugar

and diabetes

*Hyperprolactin

emia

*Fainting or

lightheadednes

s when

standing up or

sitting up too

quickly.

*Impairment of

alertness and

driving ability

*Risk in people

Advise patient that drug

may cause drowsiness

or impaired judgment or

thinking skills, and to

use caution while

driving, riding a bike, or

performing other tasks

requiring mental

alertness until tolerance

is determined.

Advise patient to get up

slowly from a lying or

sitting position and to

avoid sudden position

changes to prevent

postural hypotension.

Advise patient to avoid

alcohol while taking

paliperidone.

Advise patient to avoid

strenuous activity
http://en.wikipedia.org/wiki/Metabolitehttp://en.wikipedia.org/wiki/Risperidonehttp://en.wikipedia.org/wiki/Risperidonehttp://en.wikipedia.org/wiki/Risperidonehttp://en.wikipedia.org/wiki/Hydroxylhttp://en.wikipedia.org/wiki/Tardive_dyskinesiahttp://en.wikipedia.org/wiki/Tardive_dyskinesiahttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Hyperprolactinemiahttp://en.wikipedia.org/wiki/Hyperprolactinemiahttp://en.wikipedia.org/wiki/Metabolitehttp://en.wikipedia.org/wiki/Risperidonehttp://en.wikipedia.org/wiki/Risperidonehttp://en.wikipedia.org/wiki/Risperidonehttp://en.wikipedia.org/wiki/Hydroxylhttp://en.wikipedia.org/wiki/Tardive_dyskinesiahttp://en.wikipedia.org/wiki/Tardive_dyskinesiahttp://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Hyperprolactinemiahttp://en.wikipedia.org/wiki/Hyperprolactinemia


40/49

with a seizure

disorder or a

history or

health

conditions that

make seizures

more likely*Extrapyramida

l effects --

persistent

movement

disorders or

muscle

disturbances,

such asrestlessness,

tremors, and

muscle

stiffness

during periods of high

temperature or

humidity and to avoid

overheating and

dehydration.


ADMINISTRATION


ADVERSEEFFECTS


GenericName:Pemoline

Brand Name:Cylert

Pemoline andmethylphenidateboth have theability to stimulatethe brain, probablyby affectingneurotransmitters,the chemicals in thebrain that nervesuse tocommunicate with

Tablets: 18.75mg, 37.5 mgand 75 mg.

Chewabletablet: 37.5mg.

Is used as part of a treatmentprogram forchildren withADHD.

Contraindicated topatientshypertensive topemoline andmethylpehenidateor any of itscomponents.

Insomnia,anorexia,tachycardia,rash aplasticanemia,abdominaldiscomfort,nausea andvomiting,

Pemoline may cause seriousliver toxicity and/or failure.Blood tests should be donebefore and during treatmentto monitor for liver toxicity

Instruct nursing mothers notto take drug as it is not knownif the drug passes throughbreast milk and its effects
http://en.wikipedia.org/wiki/Seizure_disorderhttp://en.wikipedia.org/wiki/Seizure_disorderhttp://en.wikipedia.org/wiki/Extrapyramidal_effectshttp://en.wikipedia.org/wiki/Extrapyramidal_effectshttp://en.wikipedia.org/wiki/Seizure_disorderhttp://en.wikipedia.org/wiki/Seizure_disorderhttp://en.wikipedia.org/wiki/Extrapyramidal_effectshttp://en.wikipedia.org/wiki/Extrapyramidal_effects


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each other.Although bothdrugs areconsideredstimulants, theyhave differenteffects onneurotransmittersin the brain.


ADMINISTRATION


ADVERSEEFFECTS


GenericName:Fluephenazi ne

Brand Name:

Prolixin

12.5 mg of fluphenazinedecanoate isroughlyequivalent to100 mgof zuclopenthixol decanoateor 20 mgof flupentixol decanoate.

PROLIXIN isindicated in themanagement of manifestations of psychoticdisorders.

Contraindication:

o Pregnancyo Nursingmotherso Hypersensitivityo Myastheniagravis,o PreexistingCNS depressionor comao respiratorydepression;o acutepulmonaryinsufficiencyo sleepapnoeasyndrome;o severehepaticimpairment;o acutenarrow angle

glaucoma;

Mostcommon:

o Drowsinesso Fatigueo ataxia(loss of balance).o Seizureo Coma

RareO MusclespasmO ConfusionO DepressionO SpeechproblemsO Doublevision

Advise patient, family, orcaregiver to notify health careprovider of the following:excessive drowsiness,increased agitation or anxiety,involuntary body or facialmovements.

Advise patient to avoidstrenuous activity duringperiods of high temperature orhumidity

Instruct patient to get upslowly from a lying or sittingposition and to avoid suddenposition changes to preventpostural hypotension. Advisepatient to report dizziness withposition changes to healthcare provider. Caution patientthat hot tubs and hot showersor baths may make dizzinessworse.
http://en.wikipedia.org/wiki/Zuclopenthixolhttp://en.wikipedia.org/wiki/Zuclopenthixolhttp://en.wikipedia.org/wiki/Flupentixolhttp://en.wikipedia.org/wiki/Zuclopenthixolhttp://en.wikipedia.org/wiki/Zuclopenthixolhttp://en.wikipedia.org/wiki/Flupentixol


42/49

children 450msec), includingcongenitalprolongation;history of arrhythmias.Lactation .

Mostcommon:

drowsin

ess

dry

mouth

nausea

vomitin

g

diarrhea

constipa

tion

restless

ness

headach

e

weight

gain

-Monitor orthostatic bloodpressure 3-5 days afterinitiation of therapy.

-Monitor tremors and gaitchanges.

-Monitor Vital Signs

-Monitor lipid profile andfasting blood glucose.

-monitor target behaviors forwhich the agent is given;monitor hepatic function


43/49


ADMINISTRATION


ADVERSEEFFECTS


GenericName:

Trifluoperazine

Brand Name:

Blocks postsynapticmesolimbicdopaminergic D1and D2 receptors inthe brain;depresses therelease of hypothalamic.

Dose:2-5 mg

Route:PO

Frequency:BID

Indicated toAnxiety states: it

controlsexcessiveanxiety, tensionand agitationseen in neurosesor associatedwith somaticconditions.he treatment orprevention of nausea andvomiting of various causes. Themanagement of psychoticdisorders, suchas acute orchroniccatatonic,hebephrenic andparanoidschizophrenia;psychosis due toorganic brain

Trifluoperazine iscontraindicatedin CNSdepression , coma, and blooddyscrasias.

Trifluoperazineshould be usedwith caution inpatients sufferingfrom renal orhepatic impairmen

Mostcommon:

drowsin

ess

dry

mouth

sedation

postural

hypotension

akathisi

a

fatigue

increase

d

prolacti

-Monitor the urine output of the patient.

-Monitor tremors and gaitchanges.

-Monitor Vital Signs

-Monitor hypersens Tivity of the patient.
http://www.mims.com/USA/drug/info/trifluoperazine?type=full&mtype=generic#Overdosagehttp://www.mims.com/USA/drug/info/trifluoperazine?type=full&mtype=generic#Overdosagehttp://en.wikipedia.org/wiki/CNS_depressionhttp://en.wikipedia.org/wiki/CNS_depressionhttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Blood_dyscrasiahttp://en.wikipedia.org/wiki/Blood_dyscrasiahttp://www.mims.com/USA/drug/info/trifluoperazine?type=full&mtype=generic#Overdosagehttp://www.mims.com/USA/drug/info/trifluoperazine?type=full&mtype=generic#Overdosagehttp://en.wikipedia.org/wiki/CNS_depressionhttp://en.wikipedia.org/wiki/CNS_depressionhttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Blood_dyscrasiahttp://en.wikipedia.org/wiki/Blood_dyscrasia


44/49

damage, toxicpsychosis, andthe manic phaseof manic-depressiveillness.

n levels.

restless

ness

dizzines

s

blurred

vision


ADMINISTRATION


ADVERSEEFFECTS


Genericname:

-citalopramhydrobomide

Brandname:

-celexa

Classification:

-antidepressant-SSRI

Mode of action:

-potentiatesserotonergicactivity in the CNSby inhibiting neural

reuptake of

Dosage:

Adult:20ml/day POincrease 40ml/day lessthan 1 weekinterval

Route:

-oral

-Treatment of depression,particularly

effective in majordepressivedisorders

-unlabeled uses:OCD, panicdisorder, PMDD,social phobiatrichotillomani,PTSD

-contraindicatedwith MAOI use;allergy to drug or

any component of the drug or othersSSRI ; concomitantuse of pimozide.

-Use cautiouslywith renal orhepaticimpairment ,

pregnancy, and

CNS:somnolence,dizziness

insomnia ,tremor ,nervousness,headache ,anxiety,paresthesia ,blurred vision

-CV:palpitation,vasodilation ,

orthostatic

-Administer once a day , inthe morning :may be takenwith food if desired .

-instruct patient using orallydisintegrating

-encourage patient to continueuse for 4 6wk as desired.

Establish appropriate safetyprecaution if patientexperiences adverse CNSeffect.


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serotonin, resultingin antidepressanteffect, with littleeffect innorepinephrine ordopamine reuptake

Frequency:

-4 6 wks

lactation and inpatient who areelderly or suicidal.

hypotension,hypertension

-DERM:sweating , rash, redness

-GI: nausea ,

dry mouth,constipationdiarrhea,anorexia,flatulence ,vomiting

-GU:ejaculatorydisoder


ADMINISTRATION


ADVERSEEFFECTS


Genericname:

-escitalopram

Classification:


Dosage:

-10 mg

-treatment of major depressivedisorder

contraindicatedwithMAOI,pimozideuse; with allergy to

-somolence,dizziness,insomnia

-give once a day in themorning or in the evening-encourage to continue use for4 -6wks , as directed to ensure


46/49

oxalate

Brandname:

-lexapro

Mode of action:

-potentiatesserotonergic activity in the CNS byinhibiting reaptakeof serotoninresulting in antidepressant effectwith little effect onnorepinephrine ordopamine ; aninsomer of

citalopram

Route:

-oral

-maintenancetreatment fopatient withmajordepressivedisorder

-treatment of

generalizedanxiety disorder

-unlabled use;panic disorder.

drug or tocitalopram or anycomponent of thedrug, -usecautiously in theelderly and withrenal or hepaticimpairment ,illnesses of metabolism orhemodynamicresponse,pregnancy,lactation , suicidalpatient , patientswith mania orseizure disorders.

,fatigue ,complex sleepdisorderserotoninsyndrome .

, adequate level to affectdepression.

-advice patient to avoid theuse of alcohol while beingtreated with antidepressantdrugs.

- establish appropriate safetyprecaution if the patientexperience s adverse CNSeffect.

DRUG NAME MECHANISM OF ADMINISTRATI INDICATION CONTRAINDICATIO ADVERSE NURSING RESPONSIBILITIES


47/49

ACTION ON N EFFECTS

Genericname:

-fluoxetinehydrochloride

Brandname:

-prozac

Classification:


Mode of action:

-act as an

antidepressant byinhibiting CNSneural uptake toserotonin; blocksuptake of serotoninwith little effectwith norepinephrine; little affinity formuscarinic ,histaminergic , andalpha , adrenergicreceptors.

Dosage :

-20 mg

Route:

-oral

-treatment of depression; mosteffective inpatient withmajor depressivedisorder

-treatment of OCD

-treatment of bulimia-treatment of PMDD ( sarafem)-treatment of panic disorderwith or without

agoraphobia

-unlabled use;raynaudsphenomenon,borderlinepersonalitydisorder.

-containdicatedwithhypersensitivity tofluoxetine ,pregnancy

-us cautiously withimpaired hepaticor renal function,diabetes mellitus ,lactation seizure ,history of suicideattempts.

-CNS:headache,nervousness ,insomnia,drowsinessanxiety ,

tremor,dizziness,light-headedness,agitation,sedationabnormalgait ,seizure

-Arrange the lower of lessfrequent does in elderlypatient and patient withhepatic impairment .

-administered drug in the

morning .monitor patient for responseto therapy for up to 4 wksbefore increasing dose .


48/49


ADMINISTRATION


ADVERSEEFFECTS


Genericname:

-paroxetinemesylate

Brandname:

-paxil

Classification:

-antidepres-sant

Mode of action:

-potentiatesserotonegic activityin the CNS,resulting inantidepressanteffect .

Dosage:

-20 mg

Route:

-oral

-treatment of major depressivedisorder

-treatment oCOD

-treatment of panic disorder

-treatment of

social anxietydisorder andgeneralizeanxiety disorder

-treatment of PTSD

-treatment of PMDD

-treatment of hotflushes , diabeticneuropathy.

contraindicatedwith use MAOI orthioridazine,

- use cautiously inelderly patientwith renal ohepaticimpairment,pregnancy,lactation suicidalpatient s.

-somnolence,dizziness,insomnia ,tremors ,nervousness ,headache,anxiety,paresthesia ,blurred vision.

-administer once a day in themorning

-shake suspension well beforeusing

-ensure that patient swallowsCR tablets whole; do not cutcrush or chew.

-limit amount of drug given

potentially suicidal patients .

-abruptly discontinuing thedrug may result indiscontinuation symptoms(agitations, palpitations);consider tapering.


49/49

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Edited Psyche Drugs