Psych pharm test

False

True

False

True

True

True - Typical - delusion, hallucination, formal thought disorder, bizarre behavior

False - Atypical - effective flattening, apathy, asociality, attention impairment

• Typical - Haldol, Thorazine
• Atypical - Geodon, Ativan

This is above maintenance level.

From 2 - 3.5 - increased tremors, muscular irritability, psychomotor retardation, mental confusion, giddiness, excessive output of dilute urine

From 3.5 - above - potentially life threatening, arrhythmia, MI, cardiovascular collapse, impaired consciousness, nystagmus, seizures, oliguria, aneuria

Headache, insomnnia, sexual dysfunction, GI upset, weight changes, anxiety

Positive: lower incidence of anticholinergic SE, less cardio-toxicity, faster onset of action than TCAs, effective antidepression with anxious features, clients with psychomotor agitation, less dangerous when OD.

• Rare: Serotonin Syndrome - overreaction of Central Serotonin receptor
• abdominal pain, diarrhea, sweating, fever, tachycardia, increased BP, delirium, myodonis, increased motor activity, hyperpyrexia, irritability, hostility, moood changes, shock, death.

overreaction of Central Serotonin receptorabdominal pain, diarrhea, sweating, fever, tachycardia, increased BP, delirium, myodonis, increased motor activity, hyperpyrexia, irritability, hostility, moood changes, shock, death.

Xanax, Ativan, Librium, Serax, Klonopin, Tranxene, Valium

Prozac, Zoloft, Celexa, Luvox, Paxil, Lexapro

Klonopin, Xanax, Librium, Tranxene, Valium, Ativan, Serax, Atarax

Cogentin, Artane, Akineton, Parsidol, Kemadrin, Benadryl, Symmetrel, Parlode

Elavil, Tofranil, Anafranil, Norpramin, Sinequan, Pamelor, Aventyl

SSRIs with MAOIs

Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, Abilify, Invega, Consta-Risperdal LA.

MAOIs with decongestant/cold remedies

Prolixin, Haldol, Stelazine, Navane, Thorazine, Mellaril, Loxitane

Lithium, Depakote, Tegretol, Klonopin, Depakene, Lamictal, Neurontin, Trileptal, Topamax, Symax, Calan

False

False - DC all drugs

True

True

True - deladly if taken in OD

late onset movement disorder - facial grimaces, abnormal tongue movements, finger movements

Severe tremor, N/V, ataxia, severe diarrhea, confusion, tinnitus

An EPS that causes motor restlessness

Occipital headache, stiff neck, flushing, palpitations

High fever, lead pipe rigidity, diaphoresis, elevated CPK

Zoloft, Paxil, Luvox

Tegretol, Neurontin, Depakote

Dry mouth, urinary retention, constipation, blurred vision

Common SE of traditional antipsychotic medications - outside the voluntary tract

Parnate, Nardil, Marplan, EMSAM (MAOIs)

Libriu, Serax

Ritalin, Cylert, Adderall, Concerta, Vyvanse

Cogentin, Akineton, Parsidol, Kemadrin, Artane, Benadryl, Symmetrel, Parlode

Valiu, Ativan, Klonopin, Xanax

Clozaril, Risperdal, Zyprexa, Seroquel

Antipsychotic, Atypical Antipsychotic

Antidepressant, SSRI

Antidepressant, Tricyclic

Antiparkinsonian, Anticholinergic

CNS stimulant

Anticonvulsant, Mood stabilizer, Antimanic

benzodiazepine, anticonvulsant, antianxiety

atypical antipsychotic

antidepressant

antianxiety

antidepressant, SSRI

anticonvulsant, mood stabilizer, antimanic

antipsychotic, typical antipsychotic

typical antipsychotic

MAOI, antidepressant

atypical antipsychotic

Benzodiazepine, antianxiety

MAOI, antidepressant

antimanic

anticholinergic, antiparkinsonian

Benzodiazepine, antianxiety

SSRI, antidepressant

Atypical antispychotic

Atypical antispychotic

antidemntia

Tricyclic antidepressant

Atypical antipsychotic

Atypical antipsychotic

Benzodiazepine, antianxiety

SSRI antidepressant

MAOI, antidepressant

antiparkinsonian, antipsychotic

atypical antipsychotic

antidemntia

antidepressant

block reuptake of neurotransmitters - serotonin, norepinephrine, dopamine - which increases levels

• Serotonin syndrome, anticholinergic crisis
• sudden lift in mood - suicide intention

1-4 weeks

Elavil, Tofranil, anafranil, Norpramin, Sinequan, Pamelor, Aventyl

Nardil, Parnate, Marplan, EMSAM

Prozac, Luvox, Paxil, Zoloft, Celexa, Lexapro

Cymbalta, Effexor, Pristiq

Wellbutrin, Remeron, Desyrel

• Constipation - high fiber diet, increase exercise, monitor fluid and food intake
• Orthostatic hypotension - rise slowly, avoid hot showers and tub baths
• tachycardia, arrhythmias - monitor BP, P, R
• Photosensitivity - sunscreen
• Dry mouth - ice chips, water, hard candy
• Lowered seizure threshold

Hypertensive Crisis

Severe occipital headache, palpitations, N/V, fever, increased BP, chest pain and coma.

Stop drug immediately, monitor VS, give short acting antihypertensive, use cooling measures. Teach patient to avoid foods high in typramine.

Mania

Lithium takes 1-3 weeks to work. It is given as maintenance or prophylaxis, antipsychotics will start to work on current behaviors immediately.

• Acute - 1.0 - 1.5 mEq/L
• Maintenance - 0.6-1.2 mEq/L

blurred vision, ataxia, tinnitus, persistent N/V, severe diarrhea, severe tremor

• Dry mouth - ice chips, water, hard candy
• Headache - analgesics
• GI problems - give with food
• Monitor VS 2-3times/day
• Monitor I&O
• Need water intake of 2500-3000 ml/d
• Reduced calorie diety
• Advice to avoid activities requiring alertness
• check lithium level
• inadequate sodium can cause toxicity

Depress subcortical levels of CNS - particularly limbic system and reticular formation - CNS depression

Benzodiazepines

Klonopin, Librium, Xanax, Tranxene, Valium, Ativan, Serax, Atarax

drowsiness, confusion, lethargy

Do not abruptly DC - can cause psychosis.

Block post-synaptic receptors in the basal ganglia, hypothalamus, limbic system, brainstem and medulla

Clozaril, Risperdal, Zyprexa, Seroquel, Geodon, Abilify, Invega

Prolixin, Haldol, Stelazine, Navane, Thorazine, Mellaril, Loxitane

• decreased libido
• retrograde ejaculation
• gynecomastia
• amenorrhea
• weight gain

sore throat, fever, malaise

Severe parkinsonian muscle rigidity, lead pipe rigidity, hyperpyrexia, tachycardia, increase in CPK, tachpnea, BP fluctuations, diaphoresis, rpaid deterioration of mental status to stupor and coma.

• Pseudoparkinsonism - shuffling gate, drooling, tremor, masklike face, blunted affect, stooped and stiff posture, akinesia, bradykinesia.
• Akathisia - continued restlessness
• Dystonia - involuntary muscular movements of face, arms, legs
• Oculogyric crisis - uncontrolled rolling back of eyes
• Tardive dyskinesia - bizarre facial and tongue movements

Antiparkinsonian - anticholinergic - Cogentin, Artane

• suicidal idealation, increased dreaming, psychotic behavior.
• Ritalin, Concerta, Adderall, Cylert, Vyvanse

Namenda, Reminyl, Exelon, Aricept

• Anticholinergic effects
• Blurred vision - should subside in a few weeks
• Constipation - high fiber diet, monitor fluid and food intake; increase exercise
• Urinary retention - report hesitancy or inability to urinate, monitor I&O
• Orthostatic hypotension, dizziness - rise slowly, monitor BP, avoid hot showers
• Tachycardia, arrhythmias - monitor BP, P, R&R,
• Decreased seizure threshold - institute precautions if needed
• Esophageal reflux
• Photosensitivity - wear sunscreen
• Weight gain - encourage activity, reduced calorie diet

• anticholinergic effects
• insomnia, agitation - take early in day, avoid caffeine
• headache - analgesics
• weight loss - give caloric intake, weigh daily
• sexual dysfunction - switch to another antidepressant if necessary
• dizziness - do not participate in activities that require alertness
• GI upset - give with food

• anticholinergic effects
• Hypotension - monitor BP, have pt. rise slowly
• CNS hyperstimulation - reassure pt; assess for psychosis, hypomania or seizures
• Hepatic and hematologic dysfunction - CBC and liver function tests

priapism

• MAOIs
• S&S: severe occipital headache, palpitations, N/V, fever, increased BP, chest pain, coma

Stop drug immediately, give short-acting antihypertensive, use cooling measures. Teach patient to avoid foods high in tyramine.

S&S: purposeless overactivity, agitation, confusion, disorientation, dysarthria, dry, flushed skin, tachycardia, sluggish and dilated pupils, change in LOC.

DC drug and notify doctor. Related to effects of anticholinergic drugs. Cumulative effects of too much anticholiergic effects.

• Potentially fatal, results from combining serotonin-enhancing psychotropic drugs and MAOI.
• S&S: hyperreflexia, hyperthermia, myoclonus and other symptoms suggestive of NMS.

Antimanic may enhance reuptake of serotonin and norepinephrine, thus decreasing levels in body. Anticonvulsants and channel blockers - unclear how they work.

• Drowsiness, dizziness, headache - do not participate in activities that require alertness, give analgesics
• Dry mouth, thirst - sugarless candy, ice, water, good oral hygiene
• Fine hand tremors - report to dr - may give small doses of propranolol
• Hypotension, arrhythmias, pulse irregularities - monitor Vs 203times/day; may decrease dose
• Polyuria, dehydration - monitor daily I&O, may subside, monitor skin turgor
• Weight gain - instruct pt on reduced calorie diet; instruct about adequate Na intake, 2500cc fluid/day

• N/V - give with food
• Blood dyscrasias - regular blood tests, CBS
• Prolonged bleeding time with valproid acid - platelet count and bleeding time

• Antimanic - Lithium
• Anticonvulsants - Klonopin, tegretol, Depakene, Depakote, Lamictal, Neurontin, Trileptal, Topamax
• Combination drug - Symbax
• Calcium Channel Blockers
• Calan, Isoptin

Antimanic, anticonvulsants, Calcium Channel Blockers

• Drowsiness, dizziness - do not operate dangerous equipment until alert
• Hypotension, bradycardia - take VS before initiation of therapy and daily before administration
• Nausea, constipation - give with food, increase fluid and fiber in diet

blurred vision, ataxia, tinnitus, persistent N/V, sevre diarrhea, severe tremor

Amphetamines: Ritalin, Cylert, concerta, Adderall, Vyvanse

Non Stimulant drug - Straterra

increase levels of neurotransmitters in the CNS. The produce CNS and respiratory stimulation, dilated pupils, increased motor activity and mental alertness, diminshed sense of fatigue and brighter spirits

• Overstimulation, restlessness, insomnia - assess mental status for changes in mood, level of activity, degree of stimulation and aggressiveness. Ensure pt is protected from injury, keep stimuli low and environment as quiet as possible to discourage overstimulation; to prevent insomnia, administer last dose 6-8 hours before bedtime.
• Palpitations, tachycardia - monitor and record VS at regular intervals throughout therapy. Report significant changes to dr.
• Anorexia, weight loss - to reduce anorexia, the medication can be administered immediately after meals. Weigh pt regularly because of anorexia and temporary interruption of growth and development
• Tolerance - develops rapidly. Take drug holidays under dr. direction.
• Drug should not be DCd abruptly. To do so could initiate: N/V, abdominal cramping, HA, fatigue, weakness, mental depression, suicidal ideation and increase in dreaming and psychotic behavior.

N/V, abdominal cramping, HA, fatigue, weakness, mental depression, suicidal ideation and increase in dreaming and psychotic behavior.

Anticholinergic effects, nausea, GI upset, skin rash, ortostatic hypotension, photosensitivity, hormonal effects, weight gain, reduction of seizure threshold, salivation, EPS

• Dry mouth - give sugarless hard candy, ice, water, good oral hygiene
• Blurred vision - should subside, do not drive until vision clears
• Constipation - high fiber diet, increase fluid intake and physical activity
• Urinary retention - report any difficulty urinating, Monitor I&O

shuffling gait, drooling, tremor, maslklike face, blunted affect, stooped and stiff posture, akinesia, bradykinesia.

Akinesia - muscular weakness

Akathisia - continuous restlessness. Motor inner driven restlessness, agitation; shifting of weight from foot to foot, inability to sit still.

Dystonia - involuntary muscular movements of face, arms, legs. Spasms of major muscle groups of the neck, back, eyes. Oculogyric crisis - uncontrolled rolling back of eyes - may be mistaken for seizure activity; should be treated as emergency situation - contact dr and IV benzos (Cogentin) given. Stay with pt and reassure

This is a late onset symptom. Bizarre facial and tongue movements, stiff neck, lip smacking, tongue protrusion and thrusting, blinking, grimacing and other excessive unnecessary facial movements. All patients receiving long-term antipsychotic therapy are at risk; symptoms are potentially irreversible; assess pt frequently by doing rating scale for EPS such as AIMS.

Agranulocytosis - rare - usually occurs within three months; S&S: sore throat, fever, malaise. A CBC should be done. With Clozaril patients should have weekly blood counts for 6 mths.

Neuroleptic Malignant Syndrome - rare, but potentially fatal. S&S: severe parkinsonian muscle rigidity, lead pipe rigidity, hyperpyrexia, tachycardia, increase in CPK, tachpnea, fluctuations in BP, diaphoresis, rapid deterioration of mental status to stupor and coma. Routine assessments of temp and observe for parkinsonian symptoms. Stop drug immediately, monitor VS, degree of muscle rigidity, I&O, LOC

• Anticholinergics:
• Cogentin, Akineton, Parsidol, Kemadrin, Artane

• Antihistamines:
• Benadryl

• Dopaminergic agonists:
• Symmetrel, Parlode

To restore the natural balance of two major neurotransmitters in CNS - acetylcholine and dopamine

• Anticholinergic effects
• Paralytic ileus - rare - monitor for abdominal distention, absent bowel sounds, N/V, epigastric pain, report to dr.
• urinary retention - tell pt to report difficulty, monitor I&O
• tachycardia, decreased sweating, increased temperature - assess VS each shift; report any changes
• Nausea, GI upset - give with food
• Sedation, drowsiness, dizziness - give at bedtime, tell pt. not to drive
• Exacerbation of psychoses - assess for signs of loss of contact with reality; intervene during hallucinations; talk about real events; orient to reality; stay with patient during agitation and delirium; remain calm
• orthostatic hypotension

Antihistamines - hydroxyzine

• Benzodiazepines:
• Klonopin
• Xanax
• Librium
• Tranxene
• Valium
• Ativan
• Serax

It does not depress CNS. It is beleied to produce desired effects through interactions with serotonin, dopamine and other neurotransmitter receptors.

• drowsiness, confusion, lethargy (most common)
• Tolerance - instruct patient not to dc abruptly.
• Ability to potentiate effects of other CNS depressants - instruct not to drink alcohol or take other medications that depress CNS
• Possibility of aggravating other depressive symptoms - assess patients mood daily; take necessary precations
• orthostatic hypotension
• paradoxical excitement - symptoms opposite of desired effect - stop taking drug, notify dr.
• dry mouth
• N/V

• lag time of 10 days to 2 weeks between onset of therapy and subsiding of anxiety.
• No evidence that BuSpar creates tolerance or dependence

• Blood dyscrasias - sore throat, fever, malaise, easy bruising, unusual bleeding
• Abrupt withdrawal can be life threatening because of withdrawal symptoms.

nausea, vomiting, malaise, weakness, tachycardia, sweating, anxiety, orthostatic hypotension, tremor, insomnia, seizures

Namenda, Reminyl, Exelon, Aricept, Cognex

• normalizes levels of glutamate which in excess quantities contributes to neurodegeneration
• Treatment of moderate to severe Alzheimers meds. No evidence that it modifies underlying disease, slows down functional decline.

S&S: monitor for hypertension - headache, vomiting, constipation, fatigue

prevents the breakdown of acetylcholamine and increase the availability at cholinergic synapses. Moderately improves cognition, behavior, function. Slows disease progression.

Reminyl - monitor for N/V, loss of appetite, dizziness, syncope

Exelon - monitor for N/V, abdominal pain, loss of appetite, upset stomach, muscle weakness

Aricept - monitor for nausea, diarrhea, insomnia, test stools periodically for GI bleeding

• Dry mouth
• Sedation
• Nausea

Purposeless overactivity, agistation, confusion, disorientation, dysarthuria, dry flushed skin, tachycardia, sluggish and dilated pupils, change in location.

DC drug and notify dr.

Retlated to the effects of anticholinergic drugs. cumulative effects of too much anticholinergic effects = anticholinergic intoxicity.

Potentially fatal - results from combining serotonin enhancing psychotropic drugs. Causes dangerously high serotonin levels in brain.

Hyperreflexia, hyperthermia, myoclonus and other symptoms suggestive of NMS.

twitching or clonic spasm of muscle/groups

difficult and defective speech due to impairment in tongue or other muscles.

• insomnia/agitation - early in day
• headache - analgesics or change drug
• weight loss - watch caloric intake
• sexual dysfunction - change antidepressants if intolerable
• dizziness - do not participate in activities requiring allertness
• GI upset - give with food

seizures, suicidal thoughts, anxiety, headaches, drowsiness, insomnia nervousness, diarrhea, sexual dysfunction, sweating, pruritis, tremor.

assess for suicidal tendencies, weigh weekly.

Avoid alcohol, change position slowly, causes phtosensitivity.

Suicidal thoughts, dizziness, drowsiness, headaches, insomnia, nervousness, weakness, constipation, diarrhea, dry mouth, dyspepsia, nausea, serotonin syndrome.

taper off, assess for suicidal tendencies, serotonin syndrome, weigh weekly.

Avoid alcohol and caffeine

suicidal thoughts, anxiety, dizziness, drowsiness, headaches, insomnia, weakness, constipation, diarrhea, dry mouth, nausea, ejaculatory disturbance, sweating, serotonin syndrome.

Taper off, do not crush, assess for suicidal tendencies, serotonin syndrome, OCD, PTSD, PMD, SAD, Panic Attacks

suicidal thoughts, dizziness, drowsiness, fatigue, headache, insomnia, diarrhea, dry mouth, nausea, sexual dysfunction, sweating, tremor, serotonin syndrome

• Assess for suicidal tendencies, serotonin syndrome.
• Avoid alcohol, caffeine, use sunscreen.

suicidal thoughts, apathy, confusion, drowsiness, insomnia, weakness, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, increased saliva, nausea, sweating, tremor, serotonin syndrome

• Assess for serotonin syndrome
• Causes photosensitivity, avoid alcohol and caffeine, change positions slowly

Suicidal thoughts, insomnia, diarrhea, nausea, serotonin syndrome.

assess for serotonin syndrome; taper off during 3rd semester; avoid alcohol and caffeine

• Prozac
• Luvox
• Paxil
• Zoloft
• Celexa
• Lexapro

• Elavil
• Tofranil
• anafranil
• Norpramin
• Sinequan
• Pamelor, Aventyl

• Blurred vision - should subside in a few weeks; do not drive until clears
• Constipation - increased fiber diet; monitor fluids and food intacke; increase exercise
• Urinary retention - report hesitancy or inability; monitor I&O, see dr.
• Orthostatic hypotension - change position slowly; monitor BP; avoid hot showers and tub baths

suicidal thoughts, lethargy, sedation, blurred vision, dry eyes, dry mouth, arrhythmia, hypotension, constipation

Dose titration is a slow process, taper off; give with or immediately after meal to avoid gastric upset; tablet may be crushed; patients taking high doses need ECG

drowsiness, fatigue, blurred vision, dry eyes, arrhythmias, hypotension, constipation, dry mouth. SE may not be noticed for 2 weeks

• dose titration is a slow process; taper off; monitor baseline and periodic ECG
• Monitor BP and pulse; assess sexual libido

seizures, lethargy, sedation, weakness, blurred vision, dry eyes, dry mouth, arrhythmias, consipation, N/V, male sexual dysfunction

• give at bedtime
• higher doses do ECGs

drowsiness, fatigue, blurred vision, dry eyes, dry mouth, arrhythmia, hypotension, constipation

• High doses need ECG
• side effects may not be noticed for 2 weeks

fatigue, sedation, blurred vision, hypotension, constipation, dry mouth

• Increase dose at bedtime, slow titration; taper off; administer with food; do not mix oral concentrates with carbonated drinks or grape juice
• Monitor BP, assess weight

drowsiness, fatigue, lethargy, blurred vision, dry eyes, dry mouth, arrhythmia, hypotension, constipation

Give with food, give at bedtime; monitor ECG

Nardil, Parnate, Marplan, EMSAM

• Anticholinergic effects - blurred vision, dry mouth, constipation, urinary retention
• Hypotension - monitor BP, have patient rise slowly
• CNS hyperstimulation - reassure patient, assess for psychosis, hypomania or seizures, may need to stop drug
• Hepatic and hematologic dysfunction - blood cell counts, liver function tests, if dysfunction - DC

seizures, dizziness, drowsiness, headaches, hyperreflexia, insomnia, tremor, twitching, weakness, hypertensive crisis, edema, orthostatic hypotension, constipation, dry mouth

• may be crushed, mixed with food
• monitor BP and pulse
• avoid alcohol, CNS depressants, drugs, food containing tyramine, excessive caffeine

blurred vision, dry mouth, constipation, urinary retention, hypotension, CNS hyperstimulation, hepatic and hematologic dysfunction, hypertensive crisis, seizures, agranulocytosis

do not give in evening - insomnia; monitor BP, assess for psychosis, hypomania, seizures, CBC, liver function test; assess mental status, mood changes, monitor pulse rate, I&Os, avoid tyramine rich foods - hypertensive crisis; do ot DC abruptly, avoid alcohol, change position slowly, avoid caffeine

blurred vision, dry mouth, constipation, urinary retention, hypotension, CNS hyperstimulation, hepatic and hematologic dysfunction, seizures, dizziness, headaches, hypertensive crisis, nausea

do not give in pm - insomnia; assess mental status, mood changes; monitor BP and pulse rate; I&O, liver function; avoid tyramine, tryptophan, tyrosine; avoid alcohol, caffeine, CNS depressants; don't DC abruptly; change position slowly

blurred vision, dry mouth, constipation, urinary retention, hypotension, CNS hyperstimulation, hepatic and hematologic dysfunction, insomnia, hypertensive crisis, diarrhea, application site reaction, seizures

monitor BP, pulse rate, assess for psychosis, hypomania, CBC, liver function; apply to dry intact skin; change position slowly; avoid alcohol; avoid tyramine; CNS stimulants; avoid exposing to direct heat

• Cymbalta
• Effexor
• Pristiq

Neuroleptic Malignant Syndrome; seizures, suicidal thoughts, fatigue, drowsiness, insomnia, hepatotoxicity, decreased appetite, constipation, dry mouth, nausea, dysuria, increased sweating, serotonin syndrome, increased risk of bleeding with aspirin, warfarin

give without regard to meals, assess for ED, monitor BP, appetite, changes in behavior, suicidal tendencies; DC gradually, watch for anxiety, agitation, watch for serotonin syndrome; avoid alcohol

Neuroleptic malignant syndrome, seizures, suicidal thoughts, abnormal dreams, anxiety, dizziness, headache, insomnia, nervousness, weakness, rhinitis, visual disturbances, abdominal pain, altered taste, anorexia, constipation, diarrhea, dry mouth, dyspepsia, N/V, weight loss, sexual dysfunction, ecchymosis, paresthesia, serotonin syndrome, chills

Give with food; assess mental status, mood changes, suicidal tendencies; BP; avoid alcohol

NMS, seizures, suicidal thoughts, anxiety, dizziness, drowsiness, insomnia, decreased appetite, nausea, constipation, male sex dysfunction, sweating, serotonin syndrome

Give at the same time; assess mental status and mood change, suicidal tendencies; monitor BP, appetite; avoid alcohol.

• Wellbutrin
• Wellbutrin Sr
• Desyrel
• Remeron

Seizures, suicidal thoughts/behavior, agitation, headaches, dry mouth, N/V, tremor

• CP in history of bulimia, increased risk of bleeding with warfarin, nicotine may cause hypertension
• may be used with sedatives for first week, avoid bedtime doses, give with food, for SAD give in fall, taper in early spring, assess mood change and mental status, restrict amount available to patient, may require 4 weeks, may impair judgment, watch for suicidality, avoid alcohol, unused shell may appear in stool, use sunscreen, cease smoking during 2nd week

*Priapism*, suicidal thoughts, drowsiness, hypotension, dry mouth

May increase digoxin, increase CNS depression with other CNS depressants, may increase PT with warfarin; administer with meals monitor BP, P; assess mental status, suicidal tendencies; assess CBC, renal and hepatic function

Change position slowly, avoid alcohol and CNS depressants

no sexual disturbances, drowsiness, constipation, dry mouth, increased appetite, agranulocytosis, weight gain

may give at bedtime to decrease drowsiness, assmental status and suicidal tendencies, take BP and P, weight, seizure activity, CBC, hepatic function

Change position slowly, avoid alcohol and CNS depressants; notify dr. if dry mouth urinary retention or constipation; monitor dietary intake

Antimanic - Lithium Carbonate

Anticonvulsants - Klonopin, Tegretol Depakene, Depakote, Lamictal, Neurontin, Trileptal, Topamax

Combo - Symbax

Calcium Channel Blockers - Verapamil

• Acute - 1.0 - 1.5 mEq/L
• Maintenance - 0.6 - 1.2 mEq/L

Enhance the reuptake of serotonin, norepinephrine; decrease levels in body

Fatigue, seizures, impaired memory, anorexia, abdominal pain, bloating, hypothyroid, drowsiness, dizziness, headache, dry mouth, thirst, GI upset, N/V, fine hand tremors, hypotension, arrhythmias, pulse irregularities, polyuria, dehydration, weight gain

blurred vision, ataxia, tinnitus, severe N/V, severe diarrhea, severe tremor - stop drug notify dr.

Give with food or milk; monitor VS 2-3 times/day; monitor I&O, turgur; doctor may give propranolol for tremors; assess mental status; monitor lithium levels; draw blood samples in a.m.

Drink 2000-3000 ml/day; consistent and moderate sodium intake, avoid excessive amount of caffeine; avoid activities cause increased sodium loss; notify doctor of diarrhea, vomiting; ECG evaluated if histor of CVD or older than 40; notify dr of irregular pulse, SOB

• Klonopin
• Tegretol
• Depakene
• Depakote
• Lamictal
• neurontin
• Trileptal
• Topamax

suicidal thoughts, behavioral changes, drowsiness, ataxia

Interaction with alcohol, antidepressants, antihistamines, benzodiazepines; seizure precautions; give with food; taper off; assess degree and manifestation of anxiety and mental status; assess for drowsiness, unsteadiness, clumsiness; monitor CBC and liver function.

Avoid alcohol, CNS depressants; notify dr. of unusual tiredness, bleeding, sore throat, fever, clay color stools, yellow skin, behavior changes, suicidality, aggression, violence or other behavior changes

Suicidal thoughts, ataxia, drowsiness, Stevens-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, thrombocytopenia

CP in bone marrow suppression; seizure precautions, give with food, give at bedtime, do not give suspension with other liquid meds - becomes orange rubbery mass, monitor for behavior changes, monitor for changes in skin condition, monitor CBC, platelet, reticulocyte, serum, iron; perform genetic testing in patient of Asian ancestory; DC if bone marrow depression

Notify dr if behavior changes; skin rash, fever, sore throat, mouth ulcers, bruising, abdominal pain, chills, pale stool, dark urine, jaundice, avoid alcohol and grapefruit juice; use sunscreen and nonhormonal contraception

Suicidal thoughts; agitation, dizziness, headaches, insomnia, sedation, visual disturbances, hepatotoxicity, pancreatitis, abdominal pain, N/V, anorexia, diarrhea, indigestion, hyperammonemia; hypothermia; tremor

Give with food; give at bedtime; assess for seizures; assess for suicidality, hepatic function; may interfere with accuracy of thyroid funciton test; false positive urine ketone tests;

do not drive until dr clears; avoid alcohol and CNS depressants; watch for behavior changes, suicidality, and panic attacks; carry ID describing regimen; notify dr if anorexia, abdominal pain, severe N/V, facial edema, lethargy, bleeding, bruising; pregnant pts enroll in NAAED pregnancy registry

suicidal thoughts, agitation, dizziness, headache, insomnia, sedation, visual disturbances, hepatotoxicity, pancreatitis, abdominal pain, anorexia, diarrhea, indigestion, N/V, hyperammonemia; hypothermia; tremor

increased bleeding with warfarin; toxicity increased by aspirin and carbamazepine; give with meals; do not give with milk or carbonation; assess seizures, suicidality, mood; monitor CBC, plateletes, bleed time, hepatic function; may interfere with accuracy of thyroid function; false positive urine ketone tests;

do not DC abruptly; no driving til cleared by dr; avoid alcohol and CNS depressants; monitor mood, behavior changes, suicidality; pregnant pts - register with NAAED pregnancy registry; carry ID, drug regimen; call dr if anorexia, abdominal pain, jaundice, severe N/V, easy bleeding, bruising

suicidal thoughts, ataxia, dizziness, headache, N/V, photosensitivity, rash, stevens-johnson syndrome

DC gradually, monitor for behavior chagnes, suicidal thoughts, skin rash

Wear sunscreen, notify dr if rash, do not drive without dr ok; watch for suicidality, carry ID and medication regimen

suicidal thoughts, confusion, depression , drowsiness, ataxia,

antacids may decrease absorption, morphine increases levels; do not DC abruptly, monitor closely for behavior changes, assess seizures, may cause false positive urine protein test

do not take within 2 hours of antacis, do not drive until ok'd, notify dr if behavior changes, suicidality, or before surgery. Carry ID and drug regimen

suicidal thoughts, dizziness, vertigo, drowsiness, fatigue, headache, abnormal vision, diplopia, nystagmus, abdominal pain, N/V, ataxia, gait disturbances, tremor

may alter effects of drugs, may decrease effectiveness of hormonal BC; implement seizure precautions; monitor ECG and electrolytes; may cause hyponatremia; may require fluid restrictions and DC of med; gradually DC, avoid alcohol and CNS depressants; no driving until okayed by dr; use alternate forms of BC; notify dr of behavior changes, suicidality; carry ID and med regimen

increased seizures, suicidal thoughts, dizziness, drowsiness, fatigue, impaired concentration/memory, nervousness, psychomotor slowing, speech problems, sedation, abnormal vision, diplopia, nystagmus, nasea, weight loss, ataxia, paresthesia

monitor for behavior changes and suicidality; monitor CBC and platelets; may cause anemia and metabolic acidosis;

if more than one dose missed, gradually DC; may cause decreased sweating and increased body temp; hydrate well in heat; 2000-3000 ml/day to prevent stones; avoid driving until response known; avoid alcohol and CNS depressants; use nonhormonal BC; use sunscreen; carry ID, notify dr if behavior changes, eye problems or before surgery

Symbax - zyprexia and fluoxetine

NMS, seizures, suicidality, agitation, dizziness, headache, restlessness, sedation, weakness, amblyopia, rhinitis, constipation, dry mouth, weight changes, tremor, agranulocytosis, insomnia, anxiety, nervousness, diarrhea, sexual dysfunction, increased sweating, pruritus

Monitor CBC - may cause leukopenia

change position slowly, extrapyramidal and dyskinsia; use sunscreen, decrease libido, notify dr if behavior changes, insomnia, headaches

Verapamil - Calan, Isoptin

drowsiness, dizziness, cypotension, bradycardia, nausea, constipation, arrhythmias, CHF, stevens-johnson syndrome

give with food or milk; patient should remain recumbent for 1 hour after IV, administer over 2 minutes; monitor BP, PR, ECG, I&O, daily weight, signs of CHF, renal and hepatic function

Avoid large amounts of grapefruit juice and caffeine; teach to take pulse; contact dr if HR<50; change position slowly; good dental hygiene; avoid alcohol, cold meds; notify dr of irregular HB or severe headache, wear sunscreen

• Ritalin
• Cylert
• Concerta
• Adderall
• Vyvanse

Increase levels of neurotransmitters in CNS; produce CNS and respiratory stimulation; dilated pupils, increased motor activity and mental alertness; decreased sense of fatigue and brighter spirits

hyperactivity, insomnia, restlessness, tremor, sudden death, hypertension, palpitation, tachycardia, anorexia

Give with water, milk, or juice; monitor BP, P, R; assess for heart disease; monitor for behavior chang; monitor height and weight

Avoid caffeine; shell may appear in stool; may need medication holidays

seizures, insomnia, hepatic failure, anorexia, additive CNS stimulants with other CNS stimulants

give in the morning; medication holidays; assess attention span; motor or vocal tics; impulse control; behavior changes; monitor height and weight; serum ALT every 2 weeks; may cause elevated LDH; alkaline phosphate, AST and ALT levels; taper off; may cause dizziness; avoid caffeine; may cause liver failure

hyperactivity, insomnia, restlessness, tremor, sudden death, hypertension, palpitations, tachycardia, anorexia

give on empty stomach, take with water milk or juice; monitor BP, P, R; monitor height and weight; may produce false sense of euphoria and well being; monitor CBC, differential and platelet count; take last dose 6 hours before bedtime; do not abruptly DC; avoid caffeine

hyperactivity, insomnia, restlessness, tremor, sudden death, palpitations, tachycardia, anorexia

Fruit juices can increase effect of amphetamine; medication free days; monitor BP, P, R; obtain family history; may produce false sense of euphoria; high dependence and abuse potential; assess height and weight; take last dose 6H before bed; avoid caffeine; may impair judgment; may cause dry mouth

behavioral disturbances, sudden death, anorexia

• administer in morning; assess attention span and impulse control; monitor BP, P, R; history of family sudden death; evaluate unexplained syncope; monitor height and weight; monitor for behvior change
• notify HCP of signs and symptoms of heart problems; check weight 2-3 times/weekly

Straterra

• Prolixin
• Haldol
• Stelazine
• Navane
• Thorazine
• Mellaril
• Loxitane

NMS; extrapyramidal reactions, photosensitivity, agranulocytosis; may increase risk of lithium toxicity; may cause Q & T wave changes

Do not mix with caffeine, tannins or pectinates; assess mental status, BP, P, R, ECG; watch that patient swallows pills; assess fluid take and bowel function; observe for akathisia, parkinsonia, dystonia; give benzos or benadryl for symptoms

Change position slowly; may cause drowsiness; use sunscreen; good oral hygiene; notify HCP of bleed, rash, hepatic or renal function

seizures, extrapyramidal reactions, blurred vision, dry eyes, constipation, dry mouth, agranulocytosis, NMS

administer with food, do not dilute with coffee or tea; assess mental status, BP, P, ECG; may cause QT interval changes; monitor I&O, weight; assess fluid intake and bowel function; monitor for akathisia, parkinsonian, dystonic - give benzos; monitor for NMS, leukocytosis; increased liver function tests; increase CPK; monitor CBC and liver function tests; do not increase or DC without dr permission; may cause drowsiness; avoid alcohol; use sunscreen; good oral hygiene

NMS, extrapyramidal reactions, sedation, constipation, photosensitivity, agranulocytosis, lithium decreases absorption

Give with food; assess mental status, weight, BMI, BP, ECG, sedation, I&O, weight; make sure pill is swallowed; monitor for akathisia, parkinsonian, dystonic - give benzos or benadryl; monitor for NMS, CBC, liver function, ocular exams; may cause false +/- pregnancy tests.

Do not abruptly DC, change position slowly; may cause drowsiness; avoid extremes in temps; avoid alcohol; may turn urine pink to reddish brown