Psych medications for Pharmocology
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| Common CONVENTIONAL Antipsychotic medication | Chlorpromazine (Thorazine)(Low potency)Fluphenazine (Prolixin)(High potency)Haloperidol (Haldol)(High potency)
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| Decanoates | Long acting injectable medications that take 5-7 days to start working. Available in Fluphenazine (Prolixin) and Haloperidol (Haldol)
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| Akathesia | motor restlessness; intolerance of inactivity; cannot stay still; jittery
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| Extra Pyramidal Symptoms (EPS) | Akathesia; Acute dystonia; Parkinsonism
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| Acute dystonia | Muscle spasm, feeling of thick tongue& stiff neck; eyes roll back, arched back, repetitive movements, increased muscular tone. Usually in males.
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| Parkinsonism | a neurological disorder in which a few but not all of the symptoms of Parkinson disease are present.
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| Symptoms of Coventional Meds | EPS, Tardive dyskinesia, Neuroleptic Maliganant Syndrome (NMS). Anticholinergic, lower seizure threshhold, dysrhythmias, blood dyscrasias, sexual, dysfunction, increase prolactin levels, sun sensitivity-> (lifetime)
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| Chlorpromzine (thorazine) | Conventional med, Low potency. very sedating, lowers seizure threshold, NMS, orthostatic hypotension, photosensitivity
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| Thioridazine (Mellaril) | Conventional med, Low potency. QT prolongation; cardiac side effects
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| Haloperidol (Haldol) | EPS early in treatment (Parkinsonism), weight gain
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| Atypical Antipsychotic Meds Advantages | *Produce far fewer EPS (if any)*May effectively treat people unresponsive to conventional antipsychotics*Minimally elevate prolactin levels*Significantly reduce negative symptoms
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| Atypical Antipsychotic Meds Disadvantages | *Weight gain*Insulin resistance- DMII can develop*Cost*Other side effects: rare EPS, parkinsonism, sedation, seizure
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| Clozaril (Atypical) Side Effects | **Agranulocytosis- drop in white blood cell count*Glucose intolerance*Weight gain*Drooling*Sedation*Orthostatic hypotension*Seizures at high doses(for +/- symptoms, works on DOP4 not DOP2 involuntary movement is not a problem)
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| Clozaril Side Effects continued | **BLACK BOX WARNING (risk of severe/life threatening side effects)1) agranulocytosis2) Myocardidtus3) Syncope- orthostatic hypotension
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| Respiridone (Atypical) | Adv: Different preparations- PO or injection, Consta, "M"= melt in your mouthDisadv: increase prolactin level, EPS (mostly akathesia)
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| Olanzapine (Zyprexa) Atypical | *Weight gain*Diabetes*Approved for use with bi-polar disorder*Zydis ("M")
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| Quetiapine (Seroquel)Atypical | *Hypotension*Dizziness*Sedation*Weight gain*Cataracts*Grapefruit juice no not take
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| Ziprasidone (Geodon) Atypical | *Lower incidence of weight gain*Lower risk of developing diabetes*Must be given with meals*IM available*May be effective in improving cognitive functioning*Start at 40 mg. BID. Starting lower increases incidence of side effects
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| Aripiprazole (Abilify) Atypical | *Dopamine system stabilizer*Aproved for Bi Polar disorder*Fewer side effects*With all the atypical antipsycotics, there is still a small risk of EPS and NMS
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| Paliperidone (Invega) Atypical | *Metabolite (remake) of Risperdal*New to the market*Invega does not elevate Prolactin level and does not cause akathesia
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| Atypical Drug Interactions | Oversedation w/ other cns depressants; alcohol cause + sensitivity to side effectsTegretol & Prilosec change rate in metabolismIncreased incidence of orthostatic hypotension with sedatives, antihypertensives, alcoholAvoid abrupt withdrawal
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| Atypical Nursing Interventions | *Medication teaching*Assess willingess to comply with medication regime*Educate about weight management, proper nutrition*Educate about the S/S of diabetes
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| Antidepressants | Treatment: Cognitive behavioral and other therapies Meds (TCA’s, SSRI’s MAOI’s, new meds, herbal) Generally used for 6-12 months after symptoms resolve. ECT, Self-care (diet, exercise, relaxation)Also used for panic disorder (1-2 mon. to fully work)
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| Tricyclic Antidepressants (TCA’s) | *Nortriptyline (Pamelor)*Imipramine (Tofranil)*Amitryptyline (Elavil)*Clomipramine (Anafranil)*Desipramine (Norpramin)
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| TCA side effects | Orthostatic hypotensionAnti-cholinergic: *Urinary retention*Weight gainCardiotoxicity (especially with OD)Lowers seizure threshholdSome low risk of NMS (Neuroleptic Malignant Syndrome)
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| SSRI's (Selective Seratonin Reuptake Inhibitors) | Treatment of depression and all types of anxiety disorders*Fluoxetine (Prozac)*Sertraline (Zoloft)*Paroxetine (Paxil)*Citalopram (Celexa)*Fluvoxamine (Luvox)
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| SSRI's Advantages | Advantages: Faster to achieve therapeutic effects (1-3 weeks), not anti-cholinergic, less sedation, no orthostatic hypotension, relatively safe with overdose
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| SSRI's Disadvantages/ side effects: | High incidence of GI upset, sexual dysfunction, weight gain, withdrawal syndrome, costSerotonin syndrome- life threatening. Can happen at beginning. lack of coordination, fever, tremor, hallucination, startling, death.
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| Monoamine Oxidase Inhibitors (MAOI’s) | Marplan, Nardil, ParnateFor ppl not responsive to other agentsSide effects: sedation, anti-cholinergic, toxicity, hyperstensive crisisMust wait 2 weeks after discontinuing an SSRI or TCA to start MAOI’s!
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| Foods to Avoid with MAOI's | Hypertensive crisis with foods that contain tyramine can be life threatening: Chinese food, soy sauce, aged cheese, wine, beer, liver, bananas, avocados, chocolate, yeast extract, meat tenderizers
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| Considerations in medication selection | *Prior positive response*Response of family member*Side effects*Interactions with other medications*Patient preference*Patient age*Cost/insurance*Concurrent medical disorders
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| Mood stabilizers: Lithium | Excreated by Kidneys: Low sodium, increased lithium; Dehydration, increased lithium. short half life, Narrow therapeutic window 0.8-1.4 mEq/L. Levels drwan in am b4 morning dose
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| Lithium side effects | *Nausea, diarrhea*Fatigue, muscle weakness*Headache, confusion*Polyuria, increased thirst (flushed out med)*Mild hand tremor*Renal toxicity*Hypothyroidism and goiter* Can be cardiotoxic
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| Lithium Toxicity | ***Vomiting, diarrhea, hyperactivity of muscles, ataxia, seizures, dysrhythmias, gate changes, EKG changes, confusion. Death can result from pulmonary complicationsCause of toxicity: diarrhea, dehydration, over dose
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| Mood stabilizers: Valproic Acid | 1st line choiceDepakote, Depakene*Advantages: works faster than Lithium, fewer side effects*Target plasma leves 50-125 mg/ ml*Adverse reactions: thrombocytopenia, pancreatitis, liver failureNO ALCOHOL
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| Other anticonvulsants used as mood stabilizers | Carbamazine (Tegretol, Carbitrol)-many drug to drug interactions. Blood dysgracia, bone marrow suppressionLamotrigine (Lamictal)- look 4 rash: Steven Johnson Syndrom- promote weight loss, treat migraineGabapentin (Neurontin)Topiramate (Topamax)
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| Anxiolytics | Decreases anxietyDiazepam (Valium)Lorazepam (Ativan)Alprazolam (Xanax)Clonazepam (Klonopin)Chlordiazepoxide (Librium)
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| Benzodiazepines | 1st line 4 anxiety; r meant 4 short term All about the same, differ in onset & duration of actionDiazepam= muscle spasmLorazepam= elders Relatively safe in overdose situationFlumazenil, given IV, can be used with ODGood for sleep problemst. rx
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| Benzodiazepine side effects | Hypotentsion Drowsiness Anterograde amnesia Paradoxical effects- agitated instead of relaxDependence/abuseAvoid alcohol/caffeine bc they stimulate CNS instead of suppress.Sudden stop= seizure/agitationCombining other opioids may cause death
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| Busperone (Buspar)(Not CNS depressant) | Advantages: lower abuse potential, no sedation, does not potentiate other cns depressantsDisadvantages: effects develop slowly, cannot be used as prnGenerally well-tolerated. Erythromycin and grapefruit juice will potentiate actions
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| Barbiturates | High abuse/ dependence potentialVery seldom used except; Anti-seizure, Severe insomnia, induction of anesthesiaOverdose picture: respiratory depression, coma, PINPOINT PUPILS, hypotension, hypothermiatreatment for OD is treating symptoms
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| Sleep Aids | Not for long term; interrups REM Sleep*Zolpidem (Ambien)*Zoleplon (Sonata)*Lunesta*Ramelteon (Rozeram)
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| CNS Stimulants | MOA: paradoxical methodIndicated for ADHD/ ADD and narcolepsyMethylphenidate (Ritalin)Amphetamine/dextroamphetamine: Adderall
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| CNS Stimulants side effects | Side effects: cns stimulation, restlessness, insomnia, dysrythmias, hypertension, appetite suppression, in excessive amounts- psychosisAbuse potential
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| CNS Preparations | Short Duration: Ritalin, Adderall Intermediate duration: Ritalin SR,Long duration: Ritalin LA, Adderall XR, Concerta
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| Provigil: CNS stimulant used for narcolepsy | Side effects: Headache, nausea, diarrheaDoes not disrupt night time sleepUsual dose 200 mg. in a.m.Schedule IV
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