NS3P2 Psych Meds

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NS3P2 Psych Meds
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2015-10-18 17:50:11
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Math Psych NS3 NS3P2 Dalila
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Psych Meds a. Haloperidol (Haldol) b. Tranylcypromine (Parnate) c. Benztropine (Cogentin) d. Paroxetine (Paxil) e. Diazepam (Valium) f. Busprione (BuSpar) g. Alprazolam (Xanax) h. Lorazepam (Ativan) i. Clozapine (Clozaril) j. Ziprasidone (Geodon) k. Chlorpromazine (Thorazine) l. Fluphenazine (Prolixin) m. Methylphenidate (Ritalin) n. Amphetamine (Adderal) o. Atomoxetine (Strattera) p. Pemoline (Cyclert) q. Buproprion (Wellbutrin) r. Valproic Acid (Depakote) s. Lithium
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  1.  Define:  Extrapyramidal symptoms  (associated with Typical anti-psychotic)
    serious neurologic symptoms, are the major sideeffects of antipsychotic drugs. They include acute dystonia,pseudoparkinsonism, and akathisia. Although oftencollectively referred to as EPS, each of these reactions hasdistinct features.

    -Therapies for acute dystonia, pseudoparkinsonism, andakathisia are similar and include lowering the dosage ofthe antipsychotic, changing to a different antipsychotic, oradministering anticholinergic medication

    -Acute dystonia includes acute muscular rigidity andcramping, a stiff or thick tongue with difficulty swallowing,and, in severe cases, laryngospasm and respiratory difficulties.Dystonia is most likely to occur in the first weekof treatment, in clients younger than 40 years, in males,and in those receiving high-potency drugs such as haloperidoland thiothixene. Spasms or stiffness in musclegroups can produce torticollis (twisted head and neck),opisthotonus (tightness in the entire body with the headback and an arched neck), or oculogyric crisis (eyes rolledback in a locked position). Acute dystonic reactions can bepainful and frightening for the client. Immediate treatmentwith anticholinergic drugs, such as intramuscular benztropinemesylate (Cogentin) or intramuscular or intravenousdiphenhydramine (Benadryl), usually brings rapid relief.

    -Drug-induced parkinsonism, or pseudoparkinsonism, is often referred to by the generic label of EPS. Symptomsresemble those of Parkinson’s disease and include a stiff,stooped posture; mask-like facies; decreased arm swing; ashuffling, festinating gait (with small steps); cogwheel rigidity(ratchet-like movements of joints); drooling; tremor;bradycardia; and coarse pill-rolling movements of thethumb and fingers while at rest. Parkinsonism is treated bychanging to an antipsychotic medication that has a lowerincidence of EPS or by adding an oral anticholinergic agentor amantadine, which is a dopamine agonist that increasestransmission of dopamine blocked by the antipsychoticdrug.



    Akathisia is reported by the client as an intense need tomove about. The client appears restless or anxious andagitated, often with a rigid posture or gait and a lack ofspontaneous gestures. This feeling of internal restlessnessand the inability to sit still or rest often leads clients todiscontinue their antipsychotic medication. Akathisia canbe treated by a change in antipsychotic medication or bythe addition of an oral agent such as a beta-blocker, anticholinergic,or benzodiazepine
  2. What are the side effects of the second generation anti-psychotic (Atypical)?
    Drugs: Clozapine, Risperiodine, Seroquel, Geodon, Abilify, Zyprexa

    • Weight
    • increases are most significant withclozapine (Clozaril) and olanzapine
    • (Zyprexa). Since2004, the FDA has made it mandatory for drug
    • manufacturersthat atypical antipsychotics carry a warning of
    • theincreased risk for hyperglycemia and diabetes. Thoughthe exact
    • mechanism of this weight gain is unknown, it isassociated with increased
    • appetite, binge eating, carbohydratecraving, food preference changes,
    • and decreasedsatiety in some clients. In addition, clients with a
    • geneticpredisposition for weight gain are at greater risk


    • The older, or
    • conventional, antipsychotic medicationsare dopamine antagonists. The
    • newer, or atypical, antipsychoticmedications are both dopamine and
    • serotonin antagonists(see Chapter 2). These medications, usual daily
    • dosages,and their common side effects are listed in Table 14.1.The
    • conventional antipsychotics target the positive signs ofschizophrenia,
    • such as delusions, hallucinations, disturbedthinking, and other
    • psychotic symptoms, but have noobservable effect on the negative signs.
    • The atypical antipsychoticsnot only diminish positive symptoms but
    • also,for many clients, lessen the negative signs of lack of volitionand
    • motivation, social withdrawal, and anhedonia.
  3. Anti-psychotic
    • => The major symptoms of NMS are rigidity; highfever; autonomic
    • instability such as unstable blood pressure,diaphoresis, and pallor;
    • delirium; and elevated levelsof enzymes, particularly creatine
    • phosphokinase. confused, mute

    => Tardive dyskinesia (TD), a syndrome of permanent involuntary movements, is most commonlycaused by the long-term use of conventional antipsychoticdrugs.include involuntary movements of the tongue,facial and neck muscles, upper and lower extremities, andtruncal musculature. Tongue thrusting and protruding, lipsmacking, blinking, grimacing, and other excessive unnecessaryfacial movements are characteristic. After it has developed,TD is irreversible, although decreasing or discontinuingantipsychotic medications can arrest its progression. Unfortunately, antipsychotic medications can mask the beginningsymptoms of TD; that is, increased dosages of the antipsychoticmedication cause the initial symptoms to disappeartemporarily. As the symptoms of TD worsen, however, they“break through” the effect of the antipsychotic drug.Preventing TD is one goal when administering antipsychotics.This can be done by keeping maintenance dosagesas low as possible, changing medications, and monitoringthe client periodically for initial signs of TD using a standardizedassessment tool such as the Abnormal InvoluntaryMovement Scale

    • => Anticholinergic side effects
    • often occur with the use of antipsychotics and includeorthostatic hypotension, dry mouth, constipation, urinaryhesitance or retention, blurred near vision, dry eyes, photophobia,nasal congestion, and decreased memory. Theseside effects usually decrease within 3 to 4 weeks but do notentirely remit. The client taking anticholinergic agents forEPS may have increased problems with anticholinergicside effects. Using calorie-free beverages or hard candymay alleviate dry mouth; stool softeners, adequate fluidintake, and the inclusion of grains and fruit in the diet mayprevent constipation.

    => also increase blood prolactin levels. Elevated prolactin may cause breastenlargement and tenderness in men and women; diminishedlibido, erectile and orgasmic dysfunction, and menstrualirregularities; and increased risk for breast cancer,and may contribute to weight gain.

    TEACHING: sugar free fluids and candy for dry mouth, prevent constipation (exeercise, fluids, fiber), suncreen for photosensitivity, monitor drowsiness (avoid driving and dangerous activties)
  4. Antidepressant:
    • SSRI, MAOI, Tricyclic, Other-Antidepressant drugs are primarily used in
    • the treatmentof major depressive illness, anxiety disorders, the
    • depressedphase of bipolar disorder, and psychotic depression.-the
    • mechanism ofaction is not completely understood, antidepressantssomehow
    • interact with the two neurotransmitters, norepinephrineand serotonin,
    • that regulate mood, arousal,attention, sensory processing, and appetite.
  5. ANTIDEPRESSANTS: Tricyclic and the related cyclic antidepressants:
    • cause varying degrees of sedation,orthostatic hypotension (drop in
    • blood pressure on rising),and anticholinergic side effects. In addition,
    • cyclic antidepressantsare potentially lethal if taken in an
    • overdose.

    • => Side Effects : The cyclic antidepressants block
    • cholinergicreceptors, resulting in anticholinergic effects such as
    • drymouth, constipation, urinary hesitancy or retention, drynasal
    • passages, and blurred near vision. More severe anticholinergiceffects
    • such as agitation, delirium, and ileusmay occur, particularly in older
    • adults. Other commonside effects include orthostatic hypotension,
    • sedation,weight gain, and tachycardia. Clients may develop toleranceto
    • anticholinergic effects, but these side effects arecommon reasons that
    • clients discontinue drug therapy.
  6. ANTIDEPRESSANTS: Selective serotonin reuptake inhibitors (SSRIs):
    • first was 1987 with prozac
    • -have replaced the cyclic drugs asthe first choice in treating depression because they areequal in efficacy and
    • produce fewer troublesome sideeffects.
    • -The SSRIs and clomipramine are
    • effective in the treatment of OCD as well.
    • -Suicide is always a primary
    • consideration when treatingclients with depression. SSRIs, venlafaxine,
    • nefazodone,and bupropion are often better choices for those who
    • arepotentially suicidal or highly impulsive because they carryno risk of
    • lethal overdose, in contrast to the cyclic compoundsand the
    • MAOIs.
    • -However, SSRIs are effective onlyfor mild and moderate
    • depression. Evaluation of the riskfor suicide must continue even after
    • treatment with antidepressantsis initiated. The client may feel more
    • energizedbut still have suicidal thoughts, which increases the
    • likelihoodof a suicide attempt. Also, because it often takesweeks before
    • the medications have a full therapeutic effect,clients may become
    • discouraged and tired of waiting tofeel better, which can result in
    • suicidal behavior

    • => Mechanism of Action: The major interaction iswith
    • the monoamine neurotransmitter systems in thebrain, particularly
    • norepinephrine and serotonin. Both ofthese neurotransmitters are
    • released throughout the brainand help to regulate arousal, vigilance,
    • attention, mood,sensory processing, and appetite. Norepinephrine,
    • serotonin,and dopamine are removed from the synapses afterrelease by
    • reuptake into presynaptic neurons. Afterreuptake, these three
    • neurotransmitters are reloaded forsubsequent release or metabolized by
    • the enzyme MAO.The SSRIs block the reuptake of serotonin, the cyclic
    • antidepressantsand venlafaxine block the reuptake of
    • norepinephrineprimarily and block serotonin to some degree,and the MAOIs
    • interfere with enzyme metabolism

    • => Side effects of SSRI:
    • SSRIs have
    • fewer side effects compared with the cycliccompounds. Enhanced serotonin
    • transmission can lead toseveral common side effects such as anxiety,
    • agitation,akathisia (motor restlessness), nausea, insomnia, and
    • sexualdysfunction, specifically diminished sexual drive ordifficulty
    • achieving an erection or orgasm. In addition,weight gain is both an
    • initial and ongoing problem duringantidepressant therapy, although SSRIs
    • cause less weightgain than other antidepressants. Taking medications
    • withfood usually can minimize nausea. Akathisia usually istreated with a
    • beta-blocker such as propranolol (Inderal)or a benzodiazepine. Insomnia
    • may continue to be a problemeven if the client takes the medication in
    • the morning;a sedative-hypnotic or low-dosage trazodone may
    • beneeded.Less common side effects include sedation (particularlywith
    • paroxetine [Paxil]), sweating, diarrhea, hand tremor,and headaches.

    • => NOTE: An uncommon but potentially serious drug interaction,called
    • serotonin syndrome (or serotonergic syndrome),can result from taking an
    • MAOI and an SSRI at the same time. It also can occur if the client takes
    • one of these drugs too close to the end of therapy with the other
    • .Symptoms include agitation,sweating, fever, tachycardia, hypotension,
    • rigidity,hyperreflexia, and, in extreme reactions, even coma
    • anddeath

    • => SSRI TEACHING:
    • -first thing in the morning unlesssedation
    • is a problem; generally, paroxetine most oftencauses sedation. If the
    • client forgets a dose of an SSRI, heor she can take it up to 8 hours
    • after the missed dose. Tominimize side effects, clients generally should
    • take cycliccompounds at night in a single daily dose when possible.
  7. ANTIDEPRESSANTS: MAO inhibitors (MAOIs):
    • have a low incidence of sedation and anticholinergic  effects, they must
    • be used with extreme caution for several reasons: Hypertensisive crisis
    • if the client ingests foods containinging tyramine (aminoacid), fatall
    • drug interactions with other tricyclic antidepressants, Demerol, CNS
    • depressants and many antihypertensives or general anesthetics, MAOIs are
    • potentially lethal in overdose

    • => Side Effects: daytimesedation,
    • insomnia, weight gain, dry mouth, orthostatichypotension, and sexual
    • dysfunction. The sedation andinsomnia are difficult to treat and may
    • necessitate a changein medication. Of particular concern with MAOIs is
    • thepotential for a life-threatening hypertensive crisis if theclient
    • ingests food that contains tyramine or takessympathomimetic drugs.
    • Because the enzyme MAO isnecessary to break down the tyramine in certain
    • foods, itsinhibition results in increased serum tyramine levels,causing
    • severe hypertension, hyperpyrexia, tachycardia,diaphoresis,
    • tremulousness, and cardiac dysrhythmias.
    • -Drugs that may cause
    • potentially fatal interactions with MAOIs include SSRIs, certain cyclic
    • compounds,buspirone (BuSpar), dextromethorphan, and opiate
    • derivativessuch as meperidine.

    • - Diets high in Tyramine: Mature or aged
    • cheese, meats (pepperoin, sausage), itialian broad beans (fava), Tofu,
    • banana peels, overirpe fruits, tap beers, no more than 2 cans of beer or
    • 4 ounches of wine, Sauerkraut, soybean condiments, soysaurce, MSG,
    • Yogurt, Sourceream, peanuts.

    • => MAOI TEACHING: need to be aware that a
    • lifethreateninghyperadrenergic crisis can occur if they do notobserve
    • certain dietary restrictions. They should receive awritten list of foods
    • to avoid while taking MAOIs. Thenurse should make clients aware of the
    • risk for serious oreven fatal drug interactions when taking MAOIs
    • andinstruct them not to take any additional medication,including
    • over-the-counter preparations, without checkingwith the physician or
    • pharmacist.
  8. Other antidepressants such as venlafaxine desvenlafaxine(Pristiq) (Effexor), bupropion (Wellbutrin), duloxetine(Cymbalta), trazodone (Desyrel), and nefazodone (Serzone).
    • => SE: Both nefazodone and trazodone commonly causeheadaches.
    • Nefazodone also can cause dry mouth and nausea.Bupropion and venlafaxine
    • desvenlafaxine may causeloss of appetite, nausea, agitation, and
    • insomnia. Venlafaxinealso may cause dizziness, sweating, or sedation.
    • Sexualdysfunction is much less common with the novel
    • antidepressants,with one notable exception: Trazodone can causepriapism
    • (a sustained and painful erection that necessitatesimmediate treatment
    • and discontinuation of the drug).Priapism also may result in impotence.
  9. Mood Stabilizers:  Lithium, Depakote, Tegretol (s/s of  toxicity, therapeutic level)
    • -Mood-stabilizing drugs are used to treat bipolar disorderby stabilizing
    • the client’s mood, preventing or minimizingthe highs and lows that
    • characterize bipolar illness, andtreating acute episodes of mania.

    • => Lithium is considered afirst-line agent in the treatment of bipolar
    • disorder-more importantly, the serum lithiumlevel should be about 1.0
    • mEq/L. Serum lithium levels ofless than 0.5 mEq/L are rarely
    • therapeutic, and levels ofmore than 1.5 mEq/L are usually considered
    • toxic; level should be monitored every 2 to 3 days while the therapeutic
    • dosage is being determined; then, it should be monitored weekly. When
    • the client’s condition is stable,the level may need to be checked once a
    • month or less frequently.
    • =SE: mild nauseaor diarrhea, anorexia, fine
    • hand tremor, polydipsia,polyuria, a metallic taste in the mouth, and
    • fatigue or lethargy.Weight gain and acne are side effects that occur
    • laterin lithium therapy; both are distressing for clients. Takingthe
    • medication with food may help with nausea, and theuse of propranolol
    • often improves the fine tremor. Lethargyand weight gain are difficult to
    • manage or minimizeand frequently lead to noncompliance.
    • =Toxicity:
    • severe diarrhea, vomiting,drowsiness, muscle weakness, and lack of
    • coordination. If lithium levelsexceed 3.0 mEq/L, dialysis may be
    • indicated.

    • => Valproic acid and topiramate are known to increase
    • levelsof the inhibitory neurotransmitter GABA. Both valproicacid and
    • carbamazepine are thought to stabilize mood byinhibiting the kindling
    • process. This can be described asthe snowball-like effect seen when
    • minor seizure activityseems to build up into more frequent and severe
    • seizures.In seizure management, anticonvulsants raise the level ofthe
    • threshold to prevent these minor seizures. It is suspectedthat this same
    • kindling process also may occur inthe development of full-blown mania
    • with stimulation bymore frequent, minor episodes. This may explain why
    • anticonvulsantsare effective in the treatment and prevention ofmania as
    • well.
    • =SE: drowsiness, sedation, dry mouth, and blurred vision. Warning:
    • LIVER FAILURE and fatality. life threatnening pancreatitis and
    • teratogenic effects: neural tube defects (spina bifida)
  10. **Anti-anxiety
    • =used totreat anxiety and anxiety disorders, insomnia, OCD,depression,
    • posttraumatic stress disorder, and alcoholwithdrawal. Antianxiety drugs
    • are among the most widelyprescribed medications today

    • ==> Benzodiazepines :
    • have proved to bethe most effective in relieving
    • anxiety and are the drugsmost frequently prescribed. Benzodiazepines
    • also may beprescribed for their anticonvulsant and muscle
    • relaxanteffects
    • .MOA: mediate the actions of the amino acidGABA, the
    • major inhibitory neurotransmitter in the brain.
    • -note: Drugs with a
    • longer half-life require less frequent dosingand produce fewer rebound
    • effects between doses; however,they can accumulate in the body and
    • produce “nextdaysedation” effects. Conversely, drugs with a
    • shorterhalf-life do not accumulate in the body or cause
    • next-daysedation, but they do have rebound effects and requiremore
    • frequent dosing.
    • -Temazepam (Restoril), triazolam (Halcion), and
    • flurazepam(Dalmane) are most often prescribed for sleep rather than for
    • relief of anxiety.
    • -Diazepam (Valium),chlordiazepoxide (Librium), and
    • clonazepam often areused to manage alcohol withdrawal as well as to
    • relieveanxiety.
    • --SE: tendency to cause physical dependence.
    • Psychological dependence on benzodiazepines iscommon: Clients fear the
    • return of anxiety symptoms orbelieve they are incapable of handling
    • anxiety withoutthe drugs. This can lead to overuse or abuse of
    • thesedrugs. Buspirone does not cause this type of physicaldependence.
    • The side effects most commonly reported with benzodiazepinesare those
    • associated with CNS depression, suchas drowsiness, sedation, poor
    • coordination, and impairedmemory or clouded sensorium. When used for
    • sleep, clientsmay complain of next-day sedation or a
    • hangovereffect.Elderly clients may have more difficulty managing
    • theeffects of CNS depression. They may be more prone to fallsfrom the
    • effects on coordination and sedation. They alsomay have more pronounced
    • memory deficits and may haveproblems with urinary incontinence,
    • particularly at night.

    • => BENZO TEACHING: antianxiety agents are aimed
    • atrelieving symptoms such as anxiety or insomnia but do nottreat the
    • underlying problems that cause the anxietyBenzodiazepinesstrongly
    • potentiate the effects of alcohol: Onedrink may have the effect of three
    • drinks. Therefore, clientsshould not drink alcohol while taking
    • benzodiazepines.Benzodiazepine withdrawal can be fatal. After the
    • clienthas started a course of therapy, he or she should neverdiscontinue
    • benzodiazepines abruptly or without thesupervision of the physician
  11. **Anti-EPS-Extrapyramidal symptoms(EPS)
    • , serious neurologic symptoms, are the major sideeffects of
    • antipsychotic drugs. They include acute dystonia,pseudoparkinsonism, and
    • akathisia. Although oftencollectively referred to as EPS, each of these
    • reactions hasdistinct features.
  12. **Stimulants
    • CNS like amphetamine, in past: treated depression and
    • obesity
    • Dextroamphetamie has been widely abused to produce a high or  remain awake for long periiods of time

    • TODAY: used for ADHD and
    • narcolepsy

    • => Amphetamines: Potential for abuse is high.
    • Administration for prolonged periods may lead to drug dependence.The
    • primary stimulant drugs used to treat ADHD aremethylphenidate (Ritalin),
    • amphetamine (Adderall), anddextroamphetamine (Dexedrine). Pemoline
    • (Cylert) isinfrequently used for ADHD because of the potential forliver
    • problems.

    • => MOA: Amphetamines and methylphenidate are often
    • termedindirectly acting amines because they act by causing releaseof the
    • neurotransmitters (norepinephrine, dopamine, andserotonin) from
    • presynaptic nerve terminals as opposed tohaving direct agonist effects
    • on the postsynaptic receptors.They also block the reuptake of these
    • neurotransmitters.
    • -the inhibitory centers in the brain are stimulated,
    • so the childhas greater abilities to filter out distractions and
    • managehis or her own behavior

    • => SE: The most common side effects of
    • stimulants are anorexia,weight loss, nausea, and irritability. The
    • client should avoidcaffeine, sugar, and chocolate, which may worsen
    • thesesymptoms. Less common side effects include dizziness, drymouth,
    • blurred vision, and palpitations. The most commonlong-term problem with
    • stimulants is the growth andweight suppression that occurs in some
    • children. This canusually be prevented by taking “drug holidays” on
    • weekendsand holidays or during summer vacation, which helps torestore
    • normal eating and growth patterns.

    • => TEACHING: The potential for
    • abuse exists with stimulants, but this isseldom a problem in children.
    • Taking doses of stimulantsafter meals may minimize anorexia and nausea.
    • Caffeine-freebeverages are suggested; clients should avoid chocolate
    • andexcessive sugar. Most important is to keep the medicationout of the
    • child
  13. Haloperidol (Haldol)
    Class: Antipsychotic

    • For: Schizo, manic states, Tourette’s, second line
    • treatment for atypical antipsychotic

    • Alters the effects of dopamine in the CNS.Also has anticholinergic and alpha-adrenergic blocking
    • activity.
    • Therapeutic Effect(s):Diminished signs and symptoms of
    • psychoses.
    • Improved behavior in children with Tourette's syndrome or
    • other behavioral problems.

    • Side Effect: Seizures, Extra pyramidal
    • reaction, confusion, hypotension, tachycardia, constipation, dry mouth,
    • anorexia, impotence, diaphoresis, Agranulocytosis, anemia, leukopenia,
    • Neuroleptic Malignant Syndrome

    • NC: Ortho BP, I/O (constipation), onset of
    • akathisia (restlessness) & Observe closely for extrapyramidal side
    • effects (parkinsonian– difficulty speaking or swallowing, loss of
    • balance control, pill rolling of hands, mask-like face, shuffling gait,
    • rigidity, tremors; and dystonic– muscle spasms, twisting motions,
    • twitching, inability to move eyes, weakness of arms or legs).

    • LAB: CBC
    • Differential, prolactin (can increase)

    • Patient teaching:  Take with food
    • (GI irritation), don’t miss, EPS warning, Ortho hypotension, avoid
    • alchohol and other CNS depressants, SUNSCREEN, use mouth
    • rinses/sugarless gum candy-has a duration of 4 weeks. After the client’s
    • condition is stabilized with oral doses of these medications,
    • administrationby depot injection is required every 2 to 4 weeks to
    • maintainthe therapeutic effect
  14. Tranylcypromine (Parnate)
    Class: Antidepressant (MAOI)

    • For Depression,
    • Inhibits the enzyme
    • monoamine oxidase, resulting in an accumulation of various
    • neurotransmitters (dopamine, epinephrine, norepinephrine, and serotonin)
    • in the body.

    • Therapeutic Effect(s):Improved mood in depressed
    • patients.

    • Side Effect: SEIZURES, confusion, dizziness, drowsiness,
    • headache, insomnia, restlessness, tremor, paresthesia, weakness,
    • HYPERTENSIVE CRISIS, AGRANULOCYTOSIS, leukopenia, thrombocytopenia,
    • Ortho hypotension, dry mouth, abdominal pain, anorexia, constipation,
    • diarrhea, dry mouth, hepatitis, nausea

    • NC: Monitor BP, Pulse, mental
    • status, I/O, Edema and urinary retention

    • Labs: Hepatic function, glucose
    • (causes hypoglycemia in diabetics)

    • TOXICITY: Concurrent ingestion of
    • tyramine-rich foods and many medications may result in a
    • life-threatening hypertensive crisis. Signs and symptoms of hypertensive
    • crisis include chest pain, tachycardia or bradycardia, severe headache,
    • nausea, vomiting, photosensitivity, neck stiffness, sweating, and
    • enlarged pupils. Treatment includes IV phentolamine, gastric lavage,
    • induced vomiting.

    • Patient teaching: Don’t mix with other antidepressants!
    • Tyramine rich foods must be avoided,  Don’t take in evening
    • (insominia), avoid alcohol, CNS depressants,  excess caffeine (even 2
    • weeks after therapy is over),  Orthostatic hypotension,  sugar free gum
    • for dry mouth
  15. Benztropine (Cogentin)
    Class: Antiparkinson/Anticholinergics

    • For: Parkinson’s adjunct including
    • EPS effects and acute dystonic rxnsBlocks cholinergic activity in the
    • CNS, which is partially responsible for the symptoms of Parkinson's
    • disease.Restores the natural balance of neurotransmitters in the
    • CNS.

    Therapeutic Effect(s):Reduction of rigidity and tremors.

    • Side Effect:
    • CNS: confusion, depression, dizziness, hallucinations, headache,
    • sedation, weakness blurred vision, dry eyes, mydriasis, CV: arrhythmias,
    • hypotension, palpitations, tachycardia, GI: constipation, dry mouth,
    • ileus, nausea, GU: hesitancy, urinary retention, Misc: decreased
    • sweating

    • NC: Assess EPS, parkinsonian symptoms, bowel function
    • (constipation), I/O (urinary retention), ortho BP for IV/IM

    Labs: None

    • Patient teaching: drowsyiness, dizziness, rinsing mouth, change
    • positions slowly, decreased sweating can lead to overheating (AC
    • inside), avoid antacids within 1-2 hours of meds
  16. Paroxetine (Paxil)
    Class: Antianxiety agent, Antidepresessants (SSRI)

    • FOR: Major depressive
    • disorder, panic disorder, Social Anxiety Disorder

    • Inhibits neuronal
    • reuptake of serotonin in the CNS, thus potentiating the activity of
    • serotonin; has little effect on norepinephrine or dopamine; mechanism
    • for benefit in treating vasomotor symptoms unknown.

    • Therapeutic
    • Effect(s):Antidepressant action.Decreased frequency of panic attacks,
    • OCD, or anxiety.Improvement in manifestations of post-traumatic stress
    • disorder.Decreased dysphoria prior to menses.

    • Side Effect: CNS:
    • NEUROLEPTIC MALIGNANT SYNDROME, SUICIDAL THOUGHTS, anxiety, dizziness,
    • drowsiness, headache, insomnia, weakness, agitation, amnesia, confusion,
    • emotional lability, hangover, impaired concentration, malaise, mental
    • depression, syncope EENT: blurred vision, rhinitis Resp: cough,
    • pharyngitis, respiratory disorders, yawning CV: chest pain, edema,
    • hypertension, palpitations, postural hypotension, tachycardia,
    • vasodilation GI: constipation, diarrhea, dry mouth, nausea, abdominal
    • pain, ↓/↑ appetite, dyspepsia, flatulence, taste disturbances,
    • vomitingGU: ejaculatory disturbance, ↓ libido, genital disorders,
    • infertility, urinary disorders, urinary frequency Derm: STEVENS-JOHNSON
    • SYNDROME, sweating, photosensitivity, pruritus, rash F and E:
    • hyponatremia Metabolic: weight gain/loss MS: back pain, bone fracture,
    • myalgia, myopathy Neuro: paresthesia, tremor Misc: SEROTONIN SYNDROME,
    • chills, fever

    • Labs: Monitor CBC and differential periodically during
    • therapy. Report leukopenia or anemia.

    • NC: Don’t use with MAOI, Assess
    • appetite, mental status, suicidal tendencies, serotonin syndrome (mental
    • changes [agitation, hallucinations, coma], autonomic instability
    • [tachycardia, labile BP, hyperthermia], neuromuscular aberations [hyper
    • reflexia, incoordination], and/or GI symptoms [nausea, vomiting,
    • diarrhea]), especially in patients taking other serotonergic drugs
    • (SSRIs, SNRIs, triptans).Monitor for development of neuroleptic
    • malignant syndrome (fever, respiratory distress, tachycardia, seizures,
    • diaphoresis, hypertension or hypotension, pallor, tiredness).

    • Patient
    • teaching:  Dizziness and drowsiness, assess for suicidality, dry mouth
    • precuations,
  17. Diazepam (Valium)
    • Class:  Antianxiety, anticonvulsant, sedative/hypnotic
    • (BENZODIAZEPINE)

    • For: Adjunct in Anxiety, Athetosis, Prior anxiety to
    • cardioversion, Preop sedation, conscious sedation, seizures, decrease
    • muscle spasms and tremors of alc withdrawal

    • Depresses the CNS, probably
    • by potentiating GABA, an inhibitory neurotransmitter.Produces skeletal
    • muscle relaxation by inhibiting spinal polysynaptic afferent
    • pathways.Has anticonvulsant properties due to enhanced presynaptic
    • inhibition.

    • Therapeutic Effect(s):Relief of
    • anxiety.Sedation.Amnesia.Skeletal muscle relaxation.Decreased seizure
    • activity.

    • Side Effect: dizziness, drowsiness, lethargy, depression,
    • hangover, ataxia, slurred speech, headache, paradoxical excitationEENT:
    • blurred visionResp: RESPIRATORY DEPRESSIONCV: hypotension (IV only)GI:
    • constipation, diarrhea (may be caused by propylene glycol content in
    • oral solution), nausea, vomiting, weight gainDerm: rashesLocal: pain
    • (IM), phlebitis (IV), venous thrombosisMisc: physical dependence,
    • psychological dependence, tolerance

    • Labs: Liver, Kidney and CBC
    • functioning (increase AST and ALT)

    • NC: Monitor BP, pulse, Respirations,
    • Fall risks, mental status, seizure, alcohol withdrawal (tremors,
    • agitation, hallucinations)

    • Patient teaching: Causes drowsiness, fall risk
    • for elderly
  18. Busprione (BuSpar)
    Class: Antianxiety

    • Binds to serotonin and dopamine receptors in the
    • brain. Increases norepinephrine metabolism in the brain.

    • Therapeutic
    • Effect(s): Relief of anxiety.

    • Side Effect: dizziness, drowsiness,
    • excitement, fatigue, headache, insomnia, nervousness, weakness,
    • personality changesEENT: blurred vision, nasal congestion, sore throat,
    • tinnitus, altered taste or smell, conjunctivitisResp: chest congestion,
    • hyperventilation, shortness of breathCV: chest pain, palpitations,
    • tachycardia, hypertension, hypotension, syncopeGI: nausea, abdominal
    • pain, constipation, diarrhea, dry mouth, vomitingGU: changes in libido,
    • dysuria, urinary frequency, urinary hesitancyDerm: rashes, alopecia,
    • blisters, dry skin, easy bruising, edema, flushing, pruritusEndo:
    • irregular mensesMS: myalgiaNeuro: incoordination, numbness, paresthesia,
    • tremorMisc: clamminess, sweating, fever

    Labs: NONE


    • NC: assess anxiety
    • degree

    • Patient teaching: Avoid grapefruit juice, doesn’t cause physical
    • or psychological dependence or tolerance. With meals for GI irritation,
    • causes dizziness and drowsiess, avoid alchol and other CNS depressants
  19. Alprazolam (Xanax)
    Class: Antianxiety/ BENZODIAZEPINE

    • For: Generalized Anxiety Order, Panic
    • disorder, Anxiety associated with depression, also..Insomnia, IBS, acute
    • mania

    • Acts at many levels in the CNS to produce anxiolytic effect. May
    • produce CNS depression. Effects may be mediated by GABA, an inhibitory
    • neurotransmitter.

    • Therapeutic Effect(s): Relief of anxiety.Side Effect:
    • CNS: dizziness, drowsiness, lethargy, confusion, hangover, headache,
    • mental depression, paradoxical excitationEENT: blurred visionGI:
    • constipation, diarrhea, nausea, vomiting, weight gainDerm: rashMisc:
    • physical dependence, psychological dependence, tolerance

    • Labs: CBC,
    • Liver, Renal, may decrease hematocrit and cause neutropenia

    • NC: assess
    • anxiety, drowsiness, Risk for falls in elderly
    • ANTIDOTE: Flumenazil for
    • toxcity

    • Patient teaching: Drowsy/Dizzy, avoid grapefruit, alcohol (and
    • other CNS depressants),
  20. Lorazepam (Ativan)
    Class: Antianxiety/BENZO

    • Depresses the CNS, probably by potentiating
    • GABA, an inhibitory neurotransmitter.

    • Therapeutic Effect(s):Sedation.
    • Decreased anxiety. Decreased seizures.

    • Side Effect: dizziness,
    • drowsiness, lethargy, hangover, headache, ataxia, slurred speech,
    • forgetfulness, confusion, mental depression, rhythmic myoclonic jerking
    • in pre-term infants, paradoxical excitationEENT: blurred visionResp:
    • respiratory depressionCV: rapid IV use only: APNEA, CARDIAC ARREST,
    • bradycardia, hypotensionGI: constipation, diarrhea, nausea, vomiting,
    • weight gain (unusual)Derm: rashesMisc: physical dependence,
    • psychological dependence, tolerance

    • Labs: Renal, Hepatic, hematological
    • functions

    • ANTIDOTE: Flumenazil (don’t use with seizure patients,
    • increases it)

    • NC: Assess for CNS depression and reactions, anxiety,
    • Status Epilepticus

    • Patient teaching: Short term only, taper dosing don’t
    • stop abruptly (causes withdrawal), drowsiness and dizziness, avoid
    • alcohol,
  21. Clozapine (Clozaril)
    Class: Antipsychotic

    • Binds to dopamine receptors in the CNS. Also has
    • anticholinergic and alpha-adrenergic blocking activity. Produces fewer
    • extrapyramidal reactions and less tardive dyskinesia than standard
    • antipsychotics but carries high risk of hematologic
    • abnormalities.

    • Therapeutic Effect(s): Diminished schizophrenic behavior.
    • Diminished suicidal behavior.

    • Side Effect: CNS: NEUROLEPTIC MALIGNANT
    • SYNDROME, SEIZURES, dizziness, sedationEENT: visual disturbancesCV:
    • CARDIAC ARREST, DEEP VEIN THROMBOSIS, MYOCARDITIS, TORSADE DE POINTES,
    • VENTRICULAR ARRHYTHMIAS, hypotension, tachycardia, bradycardia, ECG
    • changes, hypertension, syncope, QT interval prolongationGI:
    • constipation, abdominal discomfort, dry mouth, ↑ salivation, nausea,
    • vomiting, weight gainGU: nocturnal enuresisDerm: rash, sweatingEndo:
    • hyperglycemia, hyperlipidemia, weight gainHemat: AGRANULOCYTOSIS,
    • LEUKOPENIANeuro: extrapyramidal reactionsResp: PULMONARY EMBOLISMMisc:
    • fever

    Labs: WBC, Neutrophils (Important)

    • Toxicity overdose: TREATED with
    • Charcoal and supported measures

    • NC: Monitor mental status, Ortho BP,
    • pulse rate, Weight, extrapyrimidial side effects, tardive dyskinesia,
    • seizure precautions (lowers seizure threshold!), monitor for Neuroleptic
    • Malignant syndrome, assess respiratory status

    • Patient teaching: Teach
    • EPS, quit smoking, ortho hypotension, seizures, drowsiness, dry  mouth
    • precautions,

    • -potentially fatal side effect of agranulocytosis. This
    • develops  suddenly andis characterized by fever, malaise, ulcerative
    • sore throat,and leukopenia. This side effect may not be
    • manifestedimmediately and can occur up to 24 weeks after the
    • initiationof therapy. Initially, clients needed to have a weeklywhite
    • blood cell count (WBC) above 3,500 per mm3to obtain the next week’s
    • supply of clozapine. Currently,all clients must have weekly WBCs drawn
    • for the first6 months. If the WBC is 3,500 per mm3 and the
    • absoluteneutrophil count (ANC) is 2,000 per mm3, the client mayhave
    • these labs monitored every 2 weeks for 6 months,and then every 4 weeks.
    • This decreased monitoring isdependent on continuous therapy with
    • clozapine. Anyinterruption in therapy requires a return to more
    • frequentmonitoring for a specified period of time.

    • After clozapinehas
    • been discontinued, weekly monitoring of the WBCand ANC is required for 4
    • weeks.WARNING Droperidol, Thioridazine, MesoridazineMay lengthen the QT
    • interval, leading to potentiallylife-threatening cardiac dysrhythmias
    • or cardiacarrest.WARNING ClozapineMay cause agranulocytosis, a
    • potentially life-threateningevent. Clients who are being treated with
    • clozapinemust have a baseline WBC count and differential
    • beforeinitiation of treatment and a WBC count every weekthroughout
    • treatment and for 4 weeks after discontinuationof clozapine
  22. Ziprasidone (Geodon)
    Class: Antipsychotic, Mood stabilizer

    • For: Schnzio, Bipolar
    • disorders
    • Effects probably mediated by antagonism of dopamine type 2 (D2)
    • and serotonin type 2 (5-HT2). Also antagonizes α2 adrenergic
    • receptors.

    Therapeutic Effect(s): Diminished schizophrenic behavior.

    • Side
    • Effect: CNS: NEUROLEPTIC MALIGNANT SYNDROME, seizures, dizziness,
    • drowsiness, restlessness, extrapyramidal reactions, syncope, tardive
    • dyskinesiaResp: cough/runny noseCV: PROLONGED QT INTERVAL, orthostatic
    • hypotensionGI: constipation, diarrhea, nausea, dysphagiaGU: amenorrhea,
    • impotenceHemat: AGRANULOCYTOSIS, leukopenia, neutropeniaEndo:
    • galactorrhea, hyperglycemia, hyperlipidemia, weight gainDerm: rash,
    • urticaria

    • Labs: Serum potassium, magnesium, blood glucose, cholesterol,
    • CBC diff, Prolactin levels (increases with this med)

    • NC: Assess mental
    • status, weight, BMI, BP, observe for  akathis, cheeking of meds, EPS,
    • seizure precuations (lowers seizure threshold), Monitor for development
    • of neuroleptic malignant syndrome (fever, respiratory distress,
    • tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor,
    • tiredness).

    • Patient teaching: Seizures, drowsiness, EPS, ortho
    • hypotension, Advise patient of need for continued medical follow-up for
    • psychotherapy, eye exams, and laboratory tests.

    • => Contraindicated in
    • patients with a known history of QT prolongation, recent myocardial
    • infarction, oruncompensated heart failure, it should not be usedwith
    • other QT-prolonging drugs.
  23. Chlorpromazine (Thorazine)
    Class: Antipsychotic (Phenothiazines)

    • For Schnizophrenia, psychoses after
    • failure with atypical antipsychotics, N/V, intractable hiccups, Bipolar
    • Disorder

    • Alters the effects of dopamine in the CNS.Has significant
    • anticholinergic/alpha-adrenergic blocking activity. 

    • Side Effect: CNS:
    • NEUROLEPTIC MALIGNANT SYNDROME, sedation, extrapyramidal reactions,
    • tardive dyskinesiaEENT: blurred vision, dry eyes, lens opacitiesCV:
    • hypotension (↑ with IM, IV), tachycardiaGI: constipation, dry mouth,
    • anorexia, hepatitis, ileus, priapismGU: urinary retentionDerm:
    • photosensitivity, pigment changes, rashEndo: galactorrhea,
    • amenorrheaHemat: AGRANULOCYTOSIS, leukopeniaMetabolic: hyperthermiaMisc:
    • allergic reactions

    • Labs: CBC, liver, ocular exams, H&H, decreased
    • leukocytes, granulocytes, platelets. Increased Bilirubin, liver enzymes,
    • blood glucose and cholesterol levels periodically. Serum prolactin
    • levels increased.

    • NC: Assess mental status, weight, Positive and
    • negative symptoms of schizo, akathisia, EPS, tardive dyskinesia,
    • Neuroleptic malignant syndrome, hyperprolactinemia

    • Patient teaching: EPS,
    • Ortho hypotension, drowsiness, avoid alc, Sunscreen,  avoid extremes of
    • temp, frequent oral hygiene and dray mouth, no antacids within 2 hours
    • of med, notify of unusual bleeding, tremors, visual disturbances
    • -Turns
    • urine pink to reddish brown
  24. Fluphenazine (Prolixin)
    Class: Antipsychotic (Phenothiazines)

    • Alters the effects of dopamine in
    • the CNS. Has anticholinergic and alpha-adrenergic blocking
    • activity.

    • Therapeutic Effect(s):Diminished signs and symptoms of
    • psychoses.

    • Side Effect: CNS: NEUROLEPTIC MALIGNANT SYNDROME,
    • extrapyramidal reactions, sedation, tardive dyskinesiaEENT: blurred
    • vision, dry eyesCV: hypertension, hypotension, tachycardiaGI: anorexia,
    • constipation, drug-induced hepatitis, dry mouth, ileus, nausea, weight
    • gainGU: urinary retentionDerm: photosensitivity, pigment changes,
    • rashesEndo: galactorrheaHemat: AGRANULOCYTOSIS, leukopenia,
    • thrombocytopeniaMisc: allergic reactions

    • Labs: CBC, liver (increased
    • enzymes), ocular, H/H, Leukocytes, platelets,

    • NC: Assess mental sttus,
    • BP, ECG, Pulse, Resporatory rate, no cheeking, onset of EPS, Neruoleptic
    • Malingnant syndrope,

    • Patient teaching: Don’t mix with caffeine, EPS,
    • Ortho hypotension, drowsiness, avoid alc, Sunscreen,  avoid extremes of
    • temp, frequent oral hygiene and dray mouth, no antacids within 2 hours
    • of med, notify of unusual bleeding, tremors, visual disturbances
  25. Methylphenidate (Ritalin)
    Class: CNS Stimulant

    • For: ADHD and narcolepsyProduces CNS and
    • respiratory stimulation with weak sympathomimetic activity.Therapeutic
    • Effect(s):Increased attention span in ADHD.Increased motor activity,
    • mental alertness, and diminished fatigue in narcoleptic patients.

    • Side Effect:CNS: hyperactivity, insomnia, restlessness, tremor, behavioral
    • disturbances, dizziness, hallucinations, headache, irritability, mania,
    • thought disorder
    • EENT: blurred vision, teeth grindingCV: SUDDEN DEATH,
    • hypertension, palpitations, tachycardia, hypotension, peripheral
    • vasculopathyGI: anorexia, constipation, cramps, diarrhea, dry mouth,
    • metallic taste, nausea, vomitingDerm: contact sensitization (erythema,
    • edema, papules, vesicles) (transdermal), erythema, rashesMetabolic:
    • growth suppression, weight loss (may occur with prolonged use)Neuro:
    • akathisia, dyskinesia, ticsMisc: ANAPHYLAXIS, ANGIOEDEMA, fever,
    • physical dependence, psychological dependence, tolerance

    Labs: Monitor BP, pulse, Respirations,

    • NC: Use with MAO inhibitors or vasopressors may
    • result in hypertensive crisis (concurrent use or use within 14 days of
    • MAO inhibitors is contraindicated).

    • Patient teaching: dizzy, blurred
    • vision, avoid caffeine beverages concrurrently,  emphasize importance of
    • follow up examsMethylphenidate produces milder CNS stimulation
    • thanamphetamines;


    • => Use with caution in emotionally unstable clients such asthose with alcohol or drug dependence because theymay increase the dosage on their own. Chronic abusecan lead to marked tolerance and
    • psychic dependence.
  26. Amphetamine (Adderal)
    Class: CNS Stimulant

    • For ADHD and Narcolepsy; Causes release of
    • norepinephrine from nerve endings. Pharmacologic effects are: CNS and
    • respiratory stimulation, Vasoconstriction, Mydriasis (pupillary
    • dilation).

    • Therapeutic Effect(s):Increased motor activity, mental
    • alertness, and decreased fatigue in narcoleptic patients.Increased
    • attention span in ADHD.

    • Side Effect:CNS: hyperactivity, insomnia,
    • restlessness, tremor, aggression, anger, behavioral disturbances,
    • dizziness, hallucinations, headache, mania, irritability, skin picking,
    • talkativeness, thought disorder, ticsEENT: blurred vision, mydriasisCV:
    • SUDDEN DEATH, palpitations, tachycardia, cardiomyopathy (increased with
    • prolonged use, high doses), hypertension, hypotension, peripheral
    • vasculopathyGI: anorexia, constipation, cramps, diarrhea, dry mouth,
    • metallic taste, nausea, vomitingGU: erectile dysfunction, ↑ libidoDerm:
    • alopecia, urticariaEndo: growth inhibition (with long term use in
    • children)Neuro: paresthesiaMisc: psychological dependence

    • Labs:
    • Corticosteroid concentrations    

    • NC: Assess BP, pulse, respirations
    • periodically. Observe for rebound depression (false sense of euphoria),
    • monitor for high dependence, weight

    • Patient teaching: Take 6 hours before
    • bedtime, limit caffeine, may impair judgement, inform patients starting
    • therapy of risk of peripheral vasculopathy. Instruct patients to notify
    • health care professional of any new numbness; pain; skin color change
    • from pale, to blue, to red; or coolness or sensitivity to temperature in
    • fingers or toes,
  27. Atomoxetine (Strattera)
    Class: selective norepinephrine reuptake inhibitors

    FOR ADHD

    • Selectively
    • inhibits the presynaptic transporter of norepinephrine.

    • Therapeutic
    • Effect(s): Increased attention span.

    • Side Effect: CNS: SUICIDAL THOUGHTS,
    • dizziness, fatigue, mood swings, behavioral disturbances,
    • hallucinations, hostility, mania, thought disorderAdults: insomniaCV:
    • hypertension, orthostatic hypotension, QT interval prolongation,
    • syncope, tachycardiaGI: HEPATOTOXICITY, dyspepsia, nausea,
    • vomitingAdults: dry mouth, constipationDerm: rash, urticariaGU: Adults:
    • dysmenorrhea, ejaculatory problems, ↓ libido, erectile dysfunction,
    • urinary hesitation, urinary retentionMetabolic: ↓ appetite,
    • weight/growth lossNeuro: Adults: paresthesiaMisc: ALLERGIC REACTIONS
    • INCLUDING ANGIONEUROTIC EDEMA AND ANAPHYLAXIS


    Labs: Liver Funct

    • NC: Assess
    • attention span, impulse control, and interactions with others.Monitor
    • BP and pulse periodically during therapy, Assess weight, signs of liver
    • injury (pruritus, dark urine, jaundice, right upper quadrant tenderness,
    • unexplained "flu-like" symptoms)

    • Patient teaching: Liver injury signs,
    • dizzineeess, don’t miss doses, suicidal tendencies
  28. Pemoline (Cyclert)
    Class:  central nervous system stimulants

    • Produces CNS stimulation, which
    • may be mediated by dopamine.Causes increased motor activity and mental
    • alertness, decreased fatigue, mild euphoria, and decreased
    • appetite.

    • Therapeutic Effect(s): Increased attention span in children
    • with ADHD.

    • Side Effect: CNS: SEIZURES, insomnia, dizziness, dyskinetic
    • movements, headache, irritability, mental depression, nervousness
    • (increased doses)CV: tachycardia (increased doses)GI: HEPATIC FAILURE,
    • anorexia, drug-induced hepatitisDerm: rash, sweatingMetabolic: weight
    • lossMisc: fever

    • Labs: Serum ALT every 2 eeks, LDH, AST, Alkaline
    • Phosphatase

    • Patient teaching: Instruct patient to take medication in
    • morning to avoid sleep disturbances. If a dose is missed, take as soon
    • as remembered. Causes dizziness, avoid intake of large amounts of
    • caffeine, how to assess for liver failure (sign a consent), Importance
    • of follow up exams-pemoline primarily affects dopamine and therefore has
    • less effect on the sympathetic nervous system.

    • -Can cause
    • life-threatening liver failure, which can result in death or require
    • liver transplantation in 4 weeks from the onset of symptoms. The
    • physician should obtain written consent before the initiation of this
    • drug.
  29. Bupropion (Wellbutrin)
    Class: Antidepressant/ Smoking Deterrant

    • Decreases neuronal reuptake of
    • dopamine in the CNS. Diminished neuronal uptake of serotonin and
    • norepinephrine (less than tricyclic antidepressants).

    • Therapeutic
    • Effect(s): Diminished depression. Decreased craving for cigarettes.

    • Side Effect:    CNS: SEIZURES, SUICIDAL THOUGHTS/BEHAVIOR, agitation,
    • headache, aggression, anxiety, delusions, depression, hallucinations,
    • hostility, insomnia, mania, panic, paranoia, psychosesGI: dry mouth,
    • nausea, vomiting, change in appetite, weight gain, weight lossDerm:
    • photosensitivityEndo: hyperglycemia, hypoglycemia, syndrome of
    • inappropriate ADH secretionNeuro: tremor

    • Labs: Hepatic and renal function
    • closely to prevent elevated serum and tissue bupropion
    • concentrations

    NC: Monitor mood changes, mental status

    • Patient teaching: 
    • Can impair judgement, good oral/dry mouth care, importance of follow up
    • exams


    • => Can cause seizures at a rate four times that of
    • otherantidepressants. The risk for seizures increases whendoses exceed
    • 450 mg/day (400 mg SR); dose increasesare sudden or in large increments;
    • the client has ahistory of seizures, cranial trauma, excessive use ofor
    • withdrawal from alcohol, or addiction to opiates,cocaine, or
    • stimulants; the client uses OTC stimulantsor anorectics; or the client
    • has diabetes being treatedwith oral hypoglycemics or insulin.
  30. Valproic Acid (Depakote)
    Class: Anticonvulsant

    • Increase levels of GABA, an inhibitory
    • neurotransmitter in the CNS.

    • Therapeutic Effect(s):Suppression of seizure
    • activity.Decreased manic episodes.Decreased frequency of migraine
    • headaches.

    • Side Effect:CNS: SUICIDAL THOUGHTS, agitation, dizziness,
    • headache, insomnia, sedation, confusion, depressionCV: peripheral
    • edemaEENT: visual disturbancesGI: HEPATOTOXICITY, PANCREATITIS,
    • abdominal pain, anorexia, diarrhea, indigestion, nausea, vomiting,
    • constipation, ↑ appetiteDerm: alopecia, rashesEndo: weight gainHemat:
    • leukopenia, thrombocytopeniaMetabolic: HYPERAMMONEMIANeuro: HYPOTHERMIA,
    • tremor, ataxia

    • Labs: CBC, platelets, bleeding time, hepatic function,
    • serum ammonia and monitor for hepatotoxicity

    • Toxicity Overdose:
    • Therapeutic serum levels range from 50–100 mcg/mL (start monitoring at
    • 60 mg –max recommended amount)

    • NC: assess seizures
    • IV: over 60 min

    • Patient
    • teaching: Drowsy, Dizziness, Hepatoxicity, Teratogenic effects

    • => Can
    • cause hepatic failure, resulting in fatality. Liverfunction tests should
    • be performed before therapyand at frequent intervals thereafter,
    • especially for thefi rst 6 months. Can produce teratogenic effects
    • suchas neural tube defects (e.g., spina bifi da). Can
    • causelife-threatening pancreatitis in both children and adults. Can occur
    • shortly after initiation or after years of therapy.
  31. Lithium
    Class: Mood Stabalizer

    • Alters cation transport in nerve and muscle.May
    • also influence reuptake of neurotransmitters.

    • Therapeutic Effect(s):
    • Prevents/decreases incidence of acute manic episodes.

    • Side Effect:CNS:
    • SEIZURES, fatigue, headache, impaired memory, ataxia, sedation,
    • confusion, dizziness, drowsiness, psychomotor retardation, restlessness,
    • stuporEENT: aphasia, blurred vision, dysarthria, tinnitusCV: ECG
    • changes, arrhythmias, edema, hypotension, unmasking of Brugada
    • syndromeGI: abdominal pain, anorexia, bloating, diarrhea, nausea, dry
    • mouth, metallic tasteGU: polyuria, glycosuria, nephrogenic diabetes
    • insipidus, renal toxicityDerm: acneiform eruption, folliculitis,
    • alopecia, diminished sensation, pruritusEndo: hypothyroidism, goiter,
    • hyperglycemia, hyperthyroidismF and E: hyponatremiaHemat:
    • leukocytosisMetabolic: weight gainMS: muscle weakness,
    • hyperirritability, rigidityNeuro: tremors

    • Labs: Renal, Thyroid, WBC with
    • differential, serum electrolytes and glucose periodically
    • Toxicity
    • Overdose: Monitor serum lithium levels twice weekly during initiation of
    • therapy and every 2 mo during chronic therapy. Draw blood samples in
    • the morning immediately before next dose. Therapeutic levels range from
    • 0.5 to 1.5 mEq/L for acute mania and 0.6–1.2 mEq/L for long term
    • control. Serum concentrations should not exceed 2.0 mEq/L.Assess patient
    • for signs and symptoms of lithium toxicity (vomiting, diarrhea, slurred
    • speech, decreased coordination, drowsiness, muscle weakness, or
    • twitching). If these occur, report before administering next dose.

    • NC:
    • Mental, Weight, I/O

    • Patient teaching: Dizzy, ddrowsiness, Low sodium
    • predisposes to toxicit, advicse patient to drink 2-3L day, low calorie
    • diet because of weight gainLithium is a salt, maintain hydration and
    • sodium intake.Hand tremors and metallic taste are an expected S/E

    • =>monitoring blood levels periodically is important. The time ofthe last
    • dose must be accurate so that plasma levels can bechecked 12 hours after
    • the last dose has been taken. Takingthese medications with meals
    • minimizes nausea. Theclient should not attempt to drive until dizziness,
    • lethargy,fatigue, or blurred vision has subsided.

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