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TYPE OF

NEUROTRANSMITTER
MECHANISM OF
ACTION
PHYSIOLOGIC EFFECTS
ACETYLCHOLINE Excitatory or
Inhibitory
Sleep and wakefulness cycle;
signals muscles to become alert
NEUROPEPTIDES Neuromodulators Enhance, prolong, inhibit, or limit
the effects of principal
neurotransmitters
GLUTAMATE Excitatory Neurotoxicity results if levels are
too high
GABA Inhibitory Modulates other neurotransmitters

GENERIC (TRADE) NAME ORAL DOSAGES
(mg)
IM / IV
DOSES
(mg)
DRUG CLASS
Lorazepam
(Ativan)
1 – 2 tid - Benzodiazepine
Procyclidine
(Kemadrin)
2.5 – 5 tid - Anticholinergic
Propranolol
(Inderal)
10 – 20 tid; up to
40 qid
- Beta-blocker
Trihexaphenidyl
(Artane)
2 – 5 tid - Anticholinergic

GENERIC (TRADE)
NAME
FORMS USUAL DAILY
DOSAGE (mg)
EXTREME DOSAGE
RANGE (mg/day)
Imipramine
(Tofranil)
T, C, INJ 150 - 200 50 - 300
Despiramine
(Nopramin)
T, C 150 - 200 50 - 300
Amitryptiline
(Elavil)
T, INJ 150 - 200 50 - 300
Nortryptiline
(Pamelor)
C, L 75 - 100 25 - 150
Doxepin
(Sinequan)
C, L 150 - 200 50 - 300
Trimipramine
(Surmontil)
C 150 - 200 50 - 300
Protriptyline
(Vivactil)
T 15 - 40 10 - 60
Maprotiline
(Ludiomil)
T 100 - 150 50 - 200
Amoxapine
(Ascendin)
T 150 - 200 50 - 250
Clomipramine
(Anafranil)
C, INJ 150 - 200 50 - 250

GENERIC
(TRADE) NAME
FORMS USUAL DAILY
DOSAGE (mg)
EXTREME DOSAGE
RANGE (mg/day)
Fluoxetine
(Prozac)
C, L 20 50 - 80
Fluvoxamine
(Luvox)
T 150 - 200 50 - 300
Paroxetine
(Paxil)
T 20 10 - 50
Sertraline
(Zoloft)
T 100 - 150 50 - 200






GENERIC (TRADE)
NAME
FORMS USUAL DAILY
DOSAGE (mg)
EXTREME DOSAGE
RANGE (mg/day)
Phenelzine
(Nardil)
T 45 – 60 15 - 90
Tranylcypromine
(Parnate)
T 30 - 50 10 - 90
Isocarboxazid
(Marplan)
T 20 - 40 10 - 60

GENERIC (TRADE)
NAME
FORMS USUAL DAILY
DOSAGE (mg)
EXTREME DOSAGE
RANGE (mg/day)
Buproprion
(Wellbutrin)
T 200 – 300 100 – 450
Venlafaxine
(Effexor)
T, C 75 – 225 75 – 375
Trazodone
(Desyrel)
T 200 – 300 100 – 600
Nefazodone
(Serzone)
T 300 – 600 100 - 600
Mirtazapine
(Remeron)
T

GENERIC
(TRADE) NAME
DAILY DOSAGE
RANGE
(mg)
HALF LIFE
(hours)
SPEED OF
ONSET
Buspirone
(BuSpar)
15 – 30 3 – 31 Very slow




GENERIC
(TRADE) NAME
DAILY DOSAGE
RANGE (mg)
HALF LIFE
(hours)
SPEED OF
ONSET
Alprazolam
(Xanax)
0.75 – 1.5 12 – 15 Intermediate
Chlordiazepoxide
(Librium)
15 – 100 50 – 100 Intermediate
Clonazepam
(Klonopin)
1.5 – 20 18 – 50 Intermediate
Chlorazepate
(Tranxene)
15 – 60 30 – 200 Fast
Diazepam
(Valium)
4 – 40 30 – 100 Very fast
Flurazepam
(Dalmane)
15 – 30 47 – 100 Fast
Lorazepam
(Ativan)
2 – 8 10 – 20 Moderately
slow
Oxazepam
(Serax)
30 – 120 3 – 21 Moderately
slow
Temazepam
(Restoril)
15 – 30 9.5 – 20 Moderately fast
Triazolam
(Halcion)
0.25 – 0.5 2 – 4 Fast








SIDE EFFECTS NURSING CONSIDERATIONS
Constipation
(anticholinergic
symptom)
Increase fluid and dietary fiber intake; client may
need a stool softener if unrelieved
Blurred vision
(anticholinergic
symptom)
Assess side effect, which should improve with time;
report to physician if no improvement
Urinary Retention
(anticholinergic
symptom)
Instruct client to report any frequency or burning with
urination; report to physician if no improvement over
time
Orthostatic hypotension
(anticholinergic
symptom)
Instruct client to rise slowly from sitting or lying
position; wait to ambulate until no longer dizzy or
light-headed

GENERIC
(TRADE) NAME
DOSAGE
Methylphenidate
(Ritalin)
Adults: 20-200 mg/day, orally, in divided doses
Children: 10-60 mg/day orally, in 2-4 divided doses
Dextroamphetamine
(Dexedrine)
Adults: 20-200 mg/day, orally, in divided doses
Children: 5-40 mg/day orally, in 2-3 divided doses
Pemoline
(Cylert)
Children: 37.5-112.5 mg/day orally, given once a day in
the morning






SIGNS AND
SYMPTOMS
MILD
ANXIETY
MODERATE
ANXIETY
SEVERE
ANXIETY
PANIC
ANXIETY
PHYSICAL Increased
pulse rate,
respiratory
rate, blood
pressure
Pupillary
dilation
Sweating
Nausea
Anorexia
Vomiting
Diarrhea
Constipation
Restlessness
Signs and
symptoms
become the
focus of
attention
Signs and
symptoms of
exhaustion are
ignored
COGNITIVE Attentive and
alert patient
Narrowed
perceptual field
and selective
inattention
Perceptual field
is greatly
narrowed.
Focus of
attention is
trivial events
Personality is
disorganized
EMOTIONAL Minimal use of
defense
mechanisms
Use of any
defense
mechanism
available
Defense
mechanisms
(Amnesia,
Dissociation
operate to
prevent panic
Defense
mechanisms
fail

MANIA DEPRESSION
Treatment of
Choice
Lithium ECT
Milieu Therapy Non-stimulating Stimulating
Appropriate
Activity
Quiet Type
Avoid competitive
Monotonous activity
Example: counting
Attitude
Therapy
Matter of fact (attitude
of casualness)
Kind Firmness





SERUM
LITHIUM
LEVEL
SYMPTOMS OF LITHIUM
TOXICITY
INTERVENTIONS
1.5 – 2.0
mEq/L
Nausea and vomiting,
diarrhea, reduced
coordination, drowsiness,
slurred speech, muscle
weakness
Withhold next dose; call physician.
Serum lithium levels are ordered and
doses of lithium are usually suspended
for a few days or the dose is reduced
2.0 – 3.0
mEq/L
Ataxia, agitation, blurred vision,
tinnitus, giddiness,
choreoathetoid movements,
confusion, muscle fasciculation,
hyperreflexia, hypertonic
muscles, myoclonic twitches,
pruritus, maculopapular rash,
movement of limbs, slurred
speech, large output of dilute
urine, incontinence of bladder of
bowel, vertigo
Withhold future doses, call
physician, stat serum lithium level.
Gastric lavage may be used to
remove oral lithium; IV containing
saline and electrolytes used to
ensure fluid and electrolyte
function and maintain renal
function.
SERUM
LITHIUM
LEVEL
SYMPTOMS OF LITHIUM
TOXICITY
INTERVENTIONS
3.0
mEq/L
and
above
Cardiac arrythmia, hypotension,
peripheral vascular collapse,
focal or generalized seizures,
reduced levels of consciousness
from stupor to coma, myoclonic
jerks of muscle groups, and
spasticity of muscles
All of preceding interventions plus
lithium ion excretion is augmented
with use of aminophylline,
mannitol, or urea. Hemodialysis
may also be used to remove
lithium from the body.
Respiratory, circulatory, thyroid
and immune systems are
monitored and assisted as needed.







GENERIC (TRADE)
NAME OF
ANTICONVULSANT
SIDE EFFECTS NURSING IMPLICATIONS
Carbamazepine (Tegretol) Dizziness, hypotension,
ataxia, sedation, blurred
vision, leukopenia, rashes
Assist client to rise slowly from
sitting position
Monitor gait and assist as
necessary
Report rashes to physician
Divalproex (Depakote) Ataxia, drowsiness,
weakness, fatigue,
menstrual changes,
dyspepsia, nausea,
vomiting, weight gain, hair
loss
Monitor gait and assist as
necessary
Provide rest periods
Give with food
Establish balanced nutrition
.Gabapentin (Neurontin) Dizziness, hypotension,
ataxia, coordination,
sedation, headache,
fatigue, nystagmus,
nausea, vomiting
Assist client to rise slowly from
sitting position
Provide rest periods
Give with food
Lamotrigine (Lamictal) Dizziness, hypotension,
ataxia, coordination,
sedation, headache,
weakness, fatigue,
menstrual changes, sore
throat
Assist client to rise slowly from
sitting position
Monitor gait and assist as
necessary
Provide rest periods
Topiramate (Topamax) Dizziness, hypotension,
anxiety, ataxia,
incoordination, confusion,
sedation, slurred speech,
tremor, weakness
Assist client to rise slowly from
sitting position
Monitor gait and assist as
necessary
Orient client
Oxcarbazepine (Trileptal) Dizziness, fatigue, ataxia,
confusion, nausea,
vomiting, anorexia,
headache, tremor,
confusion
Assist client to rise slowly from
sitting position
Monitor gait and assist as
necessary
Orient client



INDICATOR DELIRIUM DEMENTIA
Onset Rapid Gradual and insidious
Duration Brief (hours to days) Progressive deterioration
Level of
Consciousness
Impaired, fluctuates Not affected
Memory Short-term memory
impaired
Short-term then Long-term memory
impaired, eventually destroyed
Speech May be
slurred,rambling,
pressured, irrelevant
Normal in early stage, progressive aphasia in
later stage
Thought
Processes
Temporarily
disorganized
Impaired thinking, eventual loss of thinking
abilities
Perception Visual or tactile
hallucinations,
delusions
Often absent, but can have paranoia,
hallucinations, illusions
Mood Anxious, fearful if
hallucinating;
weeping, irritable
Depressed and anxious in early stage, labile
mood , restless pacing, angry out-bursts in
later stages

NAME OF
CHOLINESTERASE
INHIBITOR
DOSAGE RANGE
AND ROUTE
NURSING CONSIDERATIONS
Tacrine (Cognex) 40 – 160 mg orally
per day divided into
4 doses
Monitor liver enzymes for
hepatotoxic effects
Monitor for flu-like symptoms
Donepezil (Aricept) 5 – 10 mg orally
per day
Monitor for nausea, diarrhea, and
insomnia
Test stools periodically for GI
bleeding
Rivastigmine (Exelon) 3 – 12 mg orally
per day divided into
2 doses
Monitor for nausea, vomiting,
abdominal pain, and loss of appetite
Galantamine (Reminyl) 16 – 32 mg orally
per day divided into
2 doses
Monitor for nausea, vomiting, loss of
appetite, dizziness and syncope

SYNDROME CAUSE ONSET ESSENTIAL
FEATURE
OTHER SIGNS
AND SYMPTOMS
DELIRIUM
TREMENS
Faulty
metabolism of
alcohol
Acute Delirium Increased vital signs
Visual and tactile
hallucinations
Coarse tremors
KORSAKOFF’S
PSYCHOSIS
Thiamine and
Niacin
deficiency
Chronic Memory
Disturbances
Retrograde amnesia
Anterograde
amnesia
Confabulation
WERNICKES
PSYCHOSIS
Thiamine
deficiency
Chronic Confusion
Opthalmoplegia
Ataxia

LEVEL OF MR

INTELLIGENCE
QUOTIENT (IQ)
WHAT CAN
BE DONE
MILD / MORON 50 / 55 TO 70 EDUCABLE
MODERATE /
IMBECILE
35 / 40 TO 50 / 55 TRAINABLE
SEVERE / IDIOT 20 / 25 TO 35 / 40 NEEDS CLOSE
SUPERVISION
PROFOUND BELOW 20 / 25 NEEDS CUSTODIAL
CARE