DrUG STUDY PSYCHE

PUROC, LIZA M.
DRUG STUDY
1. Antipsychotic drugs
a. Typical
b. Atypical
c. New generation antipsychotics
2. Anti-depressant drugs
a. Tricyclic antidepressants (TCA)
b. Selective serotonin reuptake inhibitors (SSRI)
c. Monoamine oxidase inhibitors (MAOI)
3. Anti-anxiety drugs (anxiolytics)

PUROC, LIZA M.
1. Antipsychotic drugs
a. Typical Drugs
DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

ACTION ONS EFFECTS RESPONSIBILITY/
PRECAUTIONS
 Generic Competitively blocks Haloperidol is Narrow-angle Extrapyramidal  Assess behavior,
name postsynaptic indicated for a number glaucoma, CNS symptoms (EPS) appearance,
Haloperidol dopamine receptors, of conditions including depression, coma, appear to be dose emotional status,
interrupts nerve for the treatment of myelosuppression, related and typically response to
 Brand name impulse movement, schizophrenia Parkinson’s disease, occur in first few environment, speech
Haldol increases turnover of severe days of therapy. pattern, thought
dopamine in brain. cardiac/hepatic Marked content
 Classificatio disease. drowsiness/lethargy  Monitor B/P, heart
n Therapeutic Effect: , excessive rate. Supervise
Antipsycholytic Produces Cautions: Renal/ salivation, fixed suicidal-risk pt closely
tranquilizing effect. hepatic impairment, stare may be mild during early therapy
 Dosage/ Strong cardiovascular to severe in (as depression
Route/frequen extrapyramidal, disease, history of intensity. lessens, energy level
cy antiemetic effects; seizures, prolonged Less frequently improves, increasing
Injection, Oil weak anticholinergic, QT syndrome, noted are severe suicide potential).
(Decanoate sedative effects. medications that akathisia (motor  Monitor for rigidity,
[Haldol prolong QT interval, restlessness), acute tremor, mask-like
Decanoate]): hypothyroidism, dystonias: torticollis facial expression, fine
50 mg/ml, 100 thyrotoxicosis, (neck muscle tongue movement.
mg/ml. electrolyte imbalance spasm),  Assess for therapeutic
Injection, (e.g., hypokalemia, opisthotonos response (interest in
Solution hypomagnesemia), (rigidity of back surroundings,
(Lactate EEG abnormalities, muscles), improvement in
[Haldol]): 5 elderly, pts at risk for oculogyric crisis selfcare, increased
mg/ml. Oral pneumonia, (rolling back of ability to concentrate,
Concentrate: 2 decreased GI eyes). relaxed facial
mg/ml. Tablets motility, urinary Tardive dyskinesia expression).
(Haldol): 0.5 retention, BPH, visual (tongue protrusion,  Monitor EKG and QT
mg, 1 mg, 2 mg, disturbances, puffing of cheeks, interval.
5 mg, 10 mg, 20 myasthenia gravis chewing/puckering
mg. of the mouth
PUROC, LIZA M.

PRECAUTIONS
 Generic Loxapine is a For the management Asthma, COPD, May produce  Assess all pts for
name dopamine antagonist, of the manifestations previous history of hypotension (3% of signs/symptoms of
Loxapine and also a serotonin of psychotic disorders bronchospasm pts), orthostatic bronchospasm after
5-HT2 blocker. The such as schizophrenia following loxapine hypotension, administration.
 Brand name exact mode of action treatment, acute syncope. If  Monitor respiratory
Loxitane of Loxapine has not The efficacy of respiratory distress, vasopressor status every 15 min
been established, LOXITANE in any medications therapy required, for 1 hr. If
 Classificatio however changes in schizophrenia was treating restrictive use only bronchospasm
n the level of established in clinical airway disease. norepinephrine, suspected, initiate
Antipsycholytic excitability of studies which enrolled phenylephrine rapid response
subcortical inhibitory newly hospitalized and Cautions: (epinephrine may  Assess need for
 Dosage/ areas have been chronically hospitalized Cardiovascular, worsen hypotension intubation,
Route/frequen observed in several acutely ill cerebrovascular due to beta- mechanical
cy animal species in schizophrenic patients disease, history of stimulation with ventilation.
powder for Oral association with such as subjects. seizure or conditions drug-induced partial  Monitor B/P, pulse for
Inhalation: 10- manifestations of lowering seizure alphablockade). hypotension,
mg singleuse tranquilization as threshold, elderly pts May increase arrhythmia.
inhaler calming effects and with dementia- seizure activity  Assess pt’s behavior,
Oral inhalation suppression of related psychosis related to appearance,
OD aggressive behavior. decreased seizure emotional status,
threshold. Elderly response to
pts with dementia- environment, speech
related psychosis pattern, thought
are at increased content
risk for CVA, TIA,  Immediately report
sudden death. May any difficulty
cause neuroleptic breathing, wheezing,
malignant chest tightness,
syndrome (NMS) cough, muscle
manifested by rigidity, fever,
malignant palpitation, sweating,
hyperthermia, altered mentation.
muscle rigidity,  Do not breast-feed.
altered mental  Avoid pregnancy.
status, arrhythmia,  Avoid tasks that
labile B/P, require alertness,
diaphoresis, motor skills until
rhabdomyolysis, response to drug is
PUROC, LIZA M.
renal failure. established.
 Change position
slowly to avoid
orthostatic
hypotension.

PRECAUTIONS
 Generic Depresses areas of To treat schizophrenia Contraindications: Prolonged QT  Be aware that high
name the brain that control in patients Angle-closure interval may doses and large
Thioridazine activity and unresponsive to other glaucoma, blood produce torsade de dosage changes in
aggression, including antipsychotic drugs dyscrasias, severe pointes, a form of patient with a seizure
 Brand name the cerebral cortex, cardiac/ hepatic ventricular disorder may lower
Mellaril hypothalamus, and impairment, tachycardia, sudden seizure threshold
limbic system by concurrent use of death.  Frequently monitor
 Classificatio blocking postsynaptic drugs that prolong Generally well blood pressure and
n dopamine 2 QT interval, severe tolerated with only assess for chest pain
Antipsychotic receptors. Drug may CNS depression; pts mild, transient side in patients with heart
relieve anxiety by known to have effects. Occasional: disease
 Dosage/ indiretctly reducing genetic defect Drowsiness during  Administer drug with
Route/frequen arousal and leading to reduced early therapy, dry food, milk, or full of
cy increasing filtration levels of activity of mouth, blurred glass of water to
Tablets: 10 mg, of internal stimuli to CYP2D6. vision, lethargy, minimize GI distress
25 mg, 50 mg, the brain stem constipation,  Instruct patient to
100 mg reticular activating Cautions: Seizures, diarrhea, nasal notify prescriber
Initially, 25–100 system decreased GI congestion, immediately if she
mg 3 times motility, urinary peripheral edema, develops unusual
daily; dosage retention, benign urinary retention. symptoms
increased prostatic Rare: Ocular
gradually. PO hypertrophy, visual changes, altered
problems, skin pigmentation
Parkinson’s disease, (in those taking
renal impairment, pts high doses for
at risk for pneumonia prolonged periods),
photosensitivity,
darkening of urine.
PUROC, LIZA M.

PRECAUTIONS
 Generic Occupies dopamine MOBAN is indicated for Hypersensitivity to dizziness, feeling  Assess patients fr
name receptor sites in the the management molindone, its unsteady, or having signs and symptoms
Molindone reticular activating of schizophrenia. The componenets or trouble keeping of neurologic
and limbic systems in efficacy of MOBAN in other antipsychotic your balance malignant syndrome
the CNS by blocking schizophrenia was drugs including dry mouth  Instruct the patient to
 Brand name dopamine activity in established in clinical haloperidol, loxapine, blurred vision follow treatment
Moban these areas, studies which enrolled phenothiazines and increased saliva regimen and to notify
molindone reduces newly hospitalized and thioxanthenes nausea prescriber before
 Classificatio the symptoms of chronically constipation discontinuing drug
n psychosis, helping hospitalized, acutely difficulty urinating because gradual
Antipsychotic the patient to think ill, schizophrenic blank facial dosage reduction may
and behave more patients as subjects. expression be needed
 Dosage/ coherently shuffling walk
Route/frequen unusual, slowed, or
cy uncontrollable
50-75 mg movements of any
50-75 mg/day part of the body
PO restlessness
excitement or
increased activity
depression
inappropriate
happiness
breast enlargement
breast milk
production
menstrual period
changes (missed
periods or heavy
bleeding)
changes in sex
drive
PUROC, LIZA M.

PRECAUTIONS
PUROC, LIZA M.
 Generic Increases dopiamine To treat psychotic Contraindications: Most common  Administer medication
name turnover by blocking disorders, such as Blood dyscrasias, extrapyramidal with food or milk if
Thiothixene postsynaptic acute psychosis, circulatory collapse, reaction is needed to minimize
dopamine receptors psychotic depression CNS depression, akathisia, GI distress
in the mesolimbic and schizophrenia coma. Cautions: characterized by  Don’t give drug within
 Brand name system. Eventually, Seizures, motor restlessness, 1 hour of an antacid
Navane dopamine cardiovascular anxiety. Akinesia,  Urge patients to avoid
neurotransmission disease, pts at risk marked by rigidity, smoking to begin a
 Classificatio decreases, resulting for pneumonia, tremor, increased smoking cessation
n in antipsychotic cerebrovascular salivation, mask- program while taking
Antipsychotic effects disease, narrow- like facial thiothexene
angle glaucoma, expression, reduced  Encourage patient to
 Dosage/Rou renal/hepatic voluntary avoid extreme
te / Frequency impairment, movements, occurs temperature changes
Mild to myasthenia gravis, less frequently. during dug therapy
Moderate Parkinson’s disease, Dystonias, including  Monitor B/P for
Psychosis PO: seizure disorder, pts torticollis (neck hypotension.
ADULTS, with underlying QT muscle spasm),  Assess for peripheral
ELDERLY, prolongation, opisthotonos edema. Monitor daily
CHILDREN 12 decreased GI (rigidity of back pattern of bowel
YRS AND motility, paralytic muscles), activity, stool
OLDER: 2 mg 3 ileus, urinary oculogyric crisis consistency.
times daily up to retention, BPH, visual (rolling back of  Prevent constipation.
20–30 mg/day. problems. eyes), occur rarely.  Observe for
Tardive dyskinesia, extrapyramidal
Severe characterized by symptoms (EPS),
Psychosis PO: tongue protrusion, tardive dyskinesia;
ADULTS, puffing of cheeks,  monitor for potentially
ELDERLY, chewing/puckering fatal, rare neuroleptic
CHILDREN 12 of mouth, occurs malignant syndrome.
YRS AND rarely but may be  Assess for therapeutic
OLDER: Initially, irreversible. Elderly response (interest in
5 mg twice daily. female pts have surroundings,
May increase greater risk of improvement in self-
gradually up to developing this care, increased ability
60 mg/day. reaction. Grand mal to concentrate,
seizures may occur relaxed facial expres
in epileptic pts.
PUROC, LIZA M.
PRECAUTIONS
 Generic May block To control psychotic Contraindications: EPS appear dose  Use cautiously in
name postsynaptic disorder Myelosuppression, related (particularly patients with a history
Fluphenazine dopamine receptor coma, severe CNS high dosage), of glaucoma or renal
sites in the CNS. This depression, receiving divided into 3 impairment
 Brand name action may depress large doses of categories:  Monitor temperature,
Prolixin arear of the brain hypnotics, hepatic akathisia (inability a significant,
that control activity disease, subcortical to sit still, tapping unexplained rise can
 Classificatio and aggression, brain damage. of feet, urge to indicate intolerance
n including the cerebral Cautions: Elderly, move around), and a need to
Antipsychotic cortex, hypothalamus seizures, Parkinson’s parkinsonian discontinue the drug.
and limbic system disease, severe symptoms Notify prescriber
 Dosage/ cardiac disease, renal (hypersalivation, immediately if this
Route/frequen impairment, pts at mask-like facial occurs
cy risk for pneumonia, expression,  Watch signs for
Psychosis PO: those at risk for shuffling gait, hepatic failure, such
ADULTS: 2.5–10 hypotension, tremors), acute as jaundice
mg/day in decreased GI dystonias (torticollis  Advise patient not to
divided doses motility, urinary [neck muscle mix oral solution with
q6–8h. retention, BPH, spasm], beverages that
Maintenance: 1– narrow-angle opisthotonos contain caffeine,
5 mg/day. glaucoma, [rigidity of back tannins, or pectins
Maximum: 40 myasthenia gravis, muscles],  Caution patient about
mg/day. visual problems. oculogyric crisis possible dizziness or
ELDERLY: [rolling back of light headedness
Initially, 1–2.5 eyes]). Dystonic
mg/day. Titrate reaction may
gradually. IM produce
(Hydrochloride): diaphoresis, pallor.
ADULTS, Tardive dyskinesia
ELDERLY: 1.25 (tongue protrusion,
mg as single puffing of cheeks,
dose. May need chewing/puckering
2.5– 10 mg/day of the mouth)
in divided doses occurs rarely but
q6–8h. may be irreversible.
(Decanoate): Abrupt withdrawal
Initially, 12.5–25 after longterm
mg q2–4wks. therapy may
May increase in precipitate
12.5-mg dizziness, gastritis,
PUROC, LIZA M.
increments. nausea, vomiting,
Maximum dose: tremors. Blood
100 mg.c dyscrasias,
particularly
agranulocytosis,
mild leukopenia,
may occur

PRECAUTIONS
 Generic Mesoridazine, as with Used in the treatment Do not take an allergic reaction  Monitor serum
name other phenothiazines, of schizophrenia, mesoridazine if you (difficulty potassium level
Mesoridazine acts indirectly on organic brain have any of the breathing; closing before and during
reticular formation, disorders, alcoholism following conditions of your throat; therapy and
 Brand name whereby neuronal and psychoneuroses. or a history of these swelling of your administer potassium
Serentil activity into reticular conditions: heart lips, tongue, or supplement as
formation is reduced disease; an irregular face; or hives); prescribed
 Classificatio without affecting its heartbeat or a uncontrollable  Monitor patient for
n intrinsic ability to history of irregular movements of the neuroleptic malignant
Antipsychotic activate the cerebral heartbeats; a history mouth, tongue, syndrome
cortex. In addition, of prolonged QT cheeks, jaw, arms,  Assess patient for
 Dosage the phenothiazines intervals; a family or legs; signs of blood
 Route/frequ exhibit at least part history of congenital fever; dyscrasias, including
ency of their activities long QT syndrome; muscle rigidity; cellulitis, fever and
Intramuscular through depression hypokalemia (low muscle spasms of pharyngitis
Adult: Initially, of hypothalamic levels of potassium in the face or neck;  Advise patient to
25 mg. Repeat centers. your blood); slow sweating; change position slowly
after 30-60 min Neurochemically, the heartbeats that irregular pulse; to minimize
if necessary; up phenothiazines are require treatment; or fast or irregular orthostatic
to 200 mg daily thought to exert their other heartbeat heartbeats. hypotension
has been given effects by a central disturbances. These severe restlessness
Oral adrenergic blocking conditions may or tremor;
Adult: Initially, action. increase the risk of severe drowsiness;
25-50 mg tid. irregular heartbeats, blurred vision;
heart attack, and dizziness or
death while taking fainting; or a rash.
mesoridazine.
PUROC, LIZA M.
PRECAUTIONS
 Generic Inhibits dopamine D2 For the management A known Drowsiness,  Use trifluoperazine
name receptors in the of schizophrenia. hypersensitivity to dizziness, skin cautiously in patients
Stelazine brain. It has weak Stelazine phenothiazines, reactions, rash, dry with glaucoma
anticholinergic and (trifluoperazine HCl) is comatose or greatly mouth, insomnia, a because of drugs
 Brand name sedative effects but effective for the short- depressed states due menorrhea, fatigue, anticholinergic effect
Trifluoperazine strong extrapyrmidal term treatment of to central nervous muscular weakness,  Advise patient to take
and antiemetic generalized non- system depressants anorexia, lactation, drug with food
 Classificatio effects. It controls psychotic anxiety. and, in cases of blurred  Instruct the patient to
n severely disturbed, However, Stelazine existing blood vision and neuromu notify prescriber
Antianxiety, agitated or violent (trifluoperazine) is not dyscrasias, bone scular (extrapyrami immediately if she
Antipsychotic behavior but may the first drug to be marrow depression dal) reactions. experiences difficulty
also be used for used in therapy for and pre-existing liver swallowing or
 Dosage nonpsychotic anxiety most patients with damage. speaking
 Route/frequ non-psychotic anxiety
ency because certain risks
Oral: Usual associated with its use
starting dosage are not shared by
is 2 mg to 5 mg common alternative
b.i.d. (Small or treatments
emaciated (i.e., benzodiazepines)
patients should .
always be
started on the
lower dosage.)

PRECAUTIONS
 Generic Depresses areas of Perphenazine Perphenazine Tardive dyskinesia,  Shouldn’t be used to
name the brain that control (perphenazine) is (perphenazine) a movement treat dementia related
Trilafon activity and indicated for use in the products are disorder, Severe psychosis in the
aggression, including treatment contraindicated in muscle stiffness elderly
 Brand name cerebral cortex, of schizophrenia and comatose or Fever  Use catiously in
Perphenazine hypothalamus and for the control of greatly obtunded pati Unusual tiredness patients with
limbic system by an severe nausea and ents and in patients or weakness depression or hepatic,
 Classificatio unknown mechanism vomiting in adults. receiving large doses Fast heartbeat pulmonary or renal
n Also prevents nausea of central nervous Difficult or fast dysfunction and in
Antiemetic, and vomiting by system depressants breathing elderly patients
PUROC, LIZA M.
antipsychotic inhibiting or blocking (barbiturates, Increased sweating  Monitor temperature
dopamine receptors alcohol, narcotics, Loss of bladder frequently and notify
 Dosage/ in medullary analgesics, control prescriber if it rises
Route/frequen chemoreceptor or antihistamines); in Seizures  Monitor blood
cy trigger zone and the presence of Decreased thirst pressure of patient
4 to 8 mg t.i.d. peripherally by existing blood Confusion who takes large doses
initially; reduce blocking vagus nerve dyscrasias, bone Eye pain especially if surgery is
as soon as in the GI tract marrow depression, Fast heartbeat or indicated, because of
possible to or liver damage; and irregular pulse the increased risk of
minimum in patients who have Rash or hives hypotension
effective dosage. shown High or low blood
hypersensitivity to pressure
perphenazine Tight throat
(perphenazine) Vision loss
tablets, their Swelling in your
components, or eyes, face, mouth,
related compounds. lips, tongue, throat,
arms, hands, feet,
ankles or lower legs
Itching
Unusually pale skin
Unusual tiredness
or weakness

PRECAUTIONS
 Generic Depresses brain For the treatment Do not use in Uncontrolled muscle  Don’t open or crush
name areas that control of schizophrenia. patients with known movements in your ER capsules
Thorazine activity and hypersensitivity to face, stiffness in  Chlorpromazine
aggression, including phenothiazines. your neck, tightness shouldn’t be used to
 Brand name the cerebral cortex, Do not use in in your throat, treat dementia-
Chlorpromazine hypothalamus and comatose states or in trouble breathing or related psychosis in
limbic system by an the presence of large swallowing, the elderly because of
 Classificatio unknown mechanism amounts of central lightheadedness, an increased risk of
n nervous system confusion, death
Antiemetic, depressants (alcohol, agitation,  Protect concentrate
antipsychotic, barbiturates, feeling jittery, from light
tranquilizer narcotics, etc.). trouble sleeping,  Use cautiously in
weakness, breast patients with
 Dosage/ swelling cardiovascular,
PUROC, LIZA M.
Route/frequen or discharge, hepatic, or renal
cy convulsions disease because of
I.M.: 25 mg (1 (seizure), increased risk of
mL). yellowing of the developing
skin or eyes hypotension, heart
(jaundice), failure and arrythmias
fever, chills, mouth
sores, skin sores,
sore throat, cough,
very stiff (rigid)
muscles, high fever,
sweating,
confusion,
fast or uneven
heartbeats, and
tremors
b. Typical Drugs:

PRECAUTIONS
 Generic Blocks dopamine Primary indications for Contraindications: Seizures occur  Monitor B/P for
name receptors in the clozapine Concurrent use of occasionally . hypertension/hypoten
Clozapine brain, depresses the include schizophrenia other drugs that may Overdose produces sion. Assess pulse for
RAS; or schizoaffective suppress bone CNS depression tachycardia (common
 Brand name anticholinergic, disorder partially or marrow function, (sedation, delirium, side effect). Monitor
Clozaril antihistaminic, and fully resistant history of clozapine- coma), respiratory CBC for blood
alpha-adrenergic to treatment with induced depression, dyscrasias.
 Classificatio blocking activity other antipsychotic agranulocytosis or hypersalivation.  Supervise suicidal-risk
n may contribute to drugs, severe Blood dyscrasias, pt closely during early
Antipsychotic some of its or schizophrenia/schiz granulocytopenia, particularly therapy (as
therapeutic (and oaffective myeloproliferative agranulocytosis, depression lessens,
 Dosage/ adverse) actions. accompanied by disorders, paralytic mild leukopenia, energy level
Route/frequenc Clozapine produces persistent suicidal or ileus, uncontrolled may occur. improves, increasing
y fewer extrapyramidal self-injurious behavio seizures, severe CNS suicide potential).
PO: ADULTS: effects than other depression, coma.  Assess for therapeutic
Initially, 12.5 mg antipsychotics. response (interest in
once or twice a Blocks dopamine surroundings,
day. May increase receptors in the improvement in self-
by 25–50 mg/ brain, depresses the care, increased ability
RAS;
PUROC, LIZA M.
day over 2 wks anticholinergic, to concentrate,
until dosage of antihistaminic, and relaxed facial
300–450 mg/day alpha-adrenergic expression).
is achieved. blocking activity  Do not abruptly
may contribute to discontinue long-term
some of its drug therapy.
therapeutic (and Drowsiness generally
adverse) actions. subsides during
Clozapine produces continued therapy.
fewer extrapyramidal  Avoid tasks that
effects than other require alertness,
antipsychotics. motor skills until
Interferes with response to drug is
binding of dopamine established.
at dopamine receptor  Avoid alcohol,
sites; binds primarily caffeine. Report fever,
at nondopamine sore throat, flu-like
receptor sites. symptoms.

PRECAUTIONS
 Generic Risperidone is an RISPERDAL(risperidon Contraindications: Rare reactions  Monitor B/P, heart
name SGA with a high 5- e) is indicated for the None known. include tardive rate, weight, hepatic
Risperidone HT2A/D2 ratio (it has treatment of Cautions: dyskinesia function tests, EKG.
a higher affinity for schizophrenia Renal/hepatic (characterized by  Monitor for fine
 Brand name 5-HT2A receptors RISPERDAL is impairment, seizure tongue protrusion, tongue movement
Risperdal than for D2 indicated for the disorders, cardiac puffing of the (may be first sign of
receptors). According treatment of acute disease, recent MI, cheeks, chewing or tardive dyskinesia,
 Classificatio to the dopamine manic or mixed breast cancer or puckering of which may be
n theory of episodes associated other prolactin- mouth), neuroleptic irreversible).
Antipsychotic schizophrenia, with Bipolar dependent tumors, malignant  Monitor for suicidal
the mechanism of I Disorder. suicidal pts, those at syndrome (marked ideation.
 Dosage/Rou action of risperidone risk for aspiration by hyperpyrexia,  Assess for therapeutic
te/frequency might involve a pneumonia. May muscle rigidity, response (greater
Injection, reduction of increase risk of altered mental interest in
Powder for dopaminergic stroke in pts with status, irregular surroundings,
Reconstitution neurotransmission in dementia. May pulse or B/P, improved self-care,
(Risperdal the mesolimbic increase risk of tachycardia, increased ability to
Consta): 12.5 pathway hyperglycemia, diaphoresis, cardiac concentrate, relaxed
mg, 25 mg, 37.5 cerebrovascular arrhythmias, facial expression).
PUROC, LIZA M.
mg, 50 mg. Oral disease, dehydration, rhabdomyolysis,  Monitor for potential
Solution hypovolemia. acute renal failure). neuroleptic malignant
(Risperdal): 1 Hyperglycemia, in syndrome: fever,
mg/ ml. Tablets some cases muscle rigidity,
(Risperdal): 0.25 extreme and irregular B/P or pulse,
mg, 0.5 mg, 1 associated with altered mental status.
mg, 2 mg, 3 mg, ketoacidosis,  Monitor fasting serum
4 mg hyperosmolar glucose periodically
coma, death, has during therapy.
been reported.  Avoid tasks that may
require alertness,
motor skills until
response to drug is
established (may
cause
dizziness/drowsiness

PRECAUTIONS
 Generic The mechanism of Olanzapine is used to Contraindications: Rare reactions  Monitor B/P, glucose,
name action of olanzapine, treat certain None known. include seizures, lipids, hepatic
Olanzapine as with other drugs mental/mood Cautions: Pts with neuroleptic function tests.
having efficacy in conditions (such benign prostatic malignant  Assess for tremors,
 Brand name schizophrenia, is as schizophrenia, bipol hyperplasia, suidal syndrome, a changes in gait,
Zyprexa unknown. However, ar disorder). It may pts, decrease GI potentially fatal abnormal muscular
it has been proposed also be motility, paralytic syndrome movements, behavior.
 Classificatio that this drug's used in combination ileus, urinary characterized by  Supervise suicidal-risk
n efficacy in with retention, glaucoma, hyperpyrexia, pt closely during early
Antipsychotics, schizophrenia is other medication to myasthenia gravis, muscle rigidity, therapy (as
2nd Generation; mediated through a treat depression breast cancer or irregular pulse or depression lessens,
Antimanic combination of history of breast B/P, tachycardia, energy level
Agents dopamine and cancer, hepatic diaphoresis, cardiac improves, increasing
serotonin type 2 impairment, elderly, arrhythmias. suicide potential).
 Dosage/ (5HT2) antagonism. concurrent use of Extrapyramidal  Assess for therapeutic
Route/frequen The mechanism of potentially symptoms (EPS), response (interest in
cy action of olanzapine hepatotoxic drugs, dysphagia may surroundings,
Taken orally in the treatment of dose escalation, occur. Overdose improvement in self-
5-10 mg per day acute manic or mixed known cardiovascular (300 mg) produces care, increased ability
initially; if episodes associated disease (history of drowsiness, slurred to concentrate,
necessary, may with bipolar I MI, ischemia, heart speech. relaxed facial
PUROC, LIZA M.
be titrated disorder is unknown. failure, conduction expression).
upward in abnormalities),  Assist with
increments of 5 cerebrovascular ambulation if
mg per day at disease, conditions dizziness occurs.
intervals greater predisposing pts to  Assess sleep pattern.
than 1 week hypotension Notify physician if
(dehydration, extrapyramidal
hypovolemia, symptoms (EPS)
hypertensive occur.
medications), history  Avoid dehydration,
of seizures, particularly during
conditions lowering exercise, exposure to
seizure threshold extreme heat,
(e.g., Alzheimer’s concurrent use of
dementia), those at medication causing
risk for aspiration dry mouth, other
pneumonia drying effects.
 Sugarless gum, sips
of tepid water may
relieve dry mouth.
Notify physician if
pregnancy occurs or if
there is intention to
become pregnant
during olanzapine
therapy.
 Take medication as
ordered; do not stop
taking or increase
dosage.
 Rise slowly from
sitting/lying position.
Avoid tasks that
require alertness,
motor skills until
response to drug is
established.
 Monitor diet, exercise
program to prevent
weight gain.

PUROC, LIZA M.
PRECAUTIONS
 Generic Quetiapine Treatment of Contraindications: Headache,  Monitor mental
name mechanism of schizophrenia. None known. drowsiness, status, onset of
Quetiapine action might involve Treatment of acute dizziness. extrapyramidal
rapid dissociation manic episodes with Cautions: Alzheimer’s Constipation, symptoms.
 Brand name from D2 receptors. bipolar disorder (alone dementia, history of orthostatic  Assist with
Seroquel [/caption] PET or in combination with breast cancer, hypotension, ambulation if
studies show that lithium or valproate). cardiovascular tachycardia, dry dizziness occurs.
 Classificatio there is a relationship Maintenance disease (e.g., CHF, mouth, dyspepsia Supervisidal-risk pt
n between D2 receptor treatment of bipolar history of MI), (heartburn, closely during early
Antipsychotic occupancy and disorder. Treatment of cerebrovascular indigestion, therapy (as psychosis,
antipsychotic effects acute depressive disease, hepatic epigastric pain), depression lessens,
 Dosage [1]. D2 receptor episodes associated impairment, rash, asthenia (loss energy level
 Route/frequ occupancy in the with bipolar disorder. dehydration, of strength, improves, increasing
ency ranges of 60 % to Adjunctive treatment hypovolemia, history energy), abdominal suicide
PO: ADULTS, 75% is associated in major depressive of drug pain, rhinitis.Back potential).Monitor B/P
ELDERLY: with antipsychotic disorder (MDD). abuse/dependence, pain, fever, weight for hypotension, lipid
Initially, 25 mg efficacy seizures, gain. verdose may profile, blood glucose,
twice a day, then hypothyroidism, pts produce heart CBC, or worsening
25–50 mg 2–3 at risk for suicide, block, hypotension, depression, unusual
times a day on Parkinson’s disease, hypokalemia, behavior.
the second and decreased GI tachycardia.  Assess pulse for
third days, up to motility, urinary tachycardia (esp. with
300–400 mg/day retention, narrow- rapid increase in
in divided doses angle glaucoma, dosage). Assess
diabetes, visual bowel activity for
problems. evidence of
constipation. Assess
for therapeutic
response (improved
thought content,
increased ability to
concentrate,
improvement in self-
care). Eye exam to
detect cataract
formation should be
obtained q6mos
during treatment.
 Avoid exposure to
extreme heat.
 Drink fluids often,
PUROC, LIZA M.
esp. during physical
activity.
 Take medication as
ordered; do not stop
taking or increase
dosage.
 Avoid tasks that
require alertness,
motor skills until
response to drug is
established.

PRECAUTIONS
 Generic Selectively blocks To treat schizophrenia, Contraindications: Headache,  Assess for therapeutic
name serotonin and acute manic or mixed Conditions associated drowsiness, response (greater
Ziprasidone dopamine receptors episodes of bipolar with risk of prolonged dizziness. interest in
in the mesocortical disorder Occasional: Rash, surroundings,
QT interval,
 Brand name tract of the CNS, orthostatic improved selfcare,
thereby suppressing congenital long QT hypotension, weight
Geodon increased ability to
psychotic symptoms syndrome, gain, restlessness, concentrate, relaxed
 Classificatio concurrent use of constipation, facial expression).
n other QT dyspepsia Monitor weight.
Antipsychotic prolongation (heartburn,  Avoid tasks that
medications. indigestion, require alertness,
 Dosage/ epigastric pain). motor skills until
Uncompensated
Route/frequen Rare: response to drug is
cy heart failure. Recent Hyperglycemia, established.
10 mg/day IM MI. priapism.  Avoid alcohol.
PO rolongation of QT
interval (as seen on
EKG) may produce
torsade de pointes,
a form of
ventricular
tachycardia. Pts
with bradycardia,
hypokalemia,
hypomagnesemia
are at increased
PUROC, LIZA M.
risk.

PRECAUTIONS
 Generic The antipsychotic Indicated for the Contraindications: Weight gain,  Periodically monitor
name action of aripiprazole treatment of: None known. headache, weight.
Aripiprazole is likely due to the Cautions: Concurrent insomnia, vomiting.  Monitor for
agonism of D2 and 5- Schizophrenia use of CNS Light-headedness, extrapyramidal
 Brand name HT1A receptors Acute depressants nausea, akathisia, symptoms (abnormal
Abilify though the exact Treatment of Manic (including alcohol), drowsiness movement), tardive
mechanism has not and Mixed Episodes cardiovascular or Blurred vision, dyskinesia (protrusion
 Classificatio been defined associated with Bipolar cerebrovascular constipation, of tongue, puffing of
n I Disorder diseases (may induce asthenia (loss of cheeks,
Adjunctive hypotension), strength, energy), chewing/puckering of
 Dosage/ Treatment of Major Parkinson’s disease anxiety, fever, rash, the mouth).
Route/frequen Depressive Disorder (potential for cough, rhinitis,  Periodically monitor
cy exacerbation), orthostatic B/P, pulse
The history of seizures or hypotension. (particularly in those
recommended conditions that may Extrapyramidal with preexisting
starting and lower seizure symptoms, cardiovascular
target dose for threshold neuroleptic disease).
ABILIFY is 10 or (Alzheimer’s malignant  Assess for therapeutic
15 mg/day disease), diabetes syndrome occur response (greater
administered on mellitus. Pts at risk rarely. Prolonged interest in
a once-a-day for pneumonia. QT interval occurs surroundings,
schedule without rarely. May cause improved self-care,
regard to meals leukopenia, increased ability to
PO neutropenia, concentrate, relaxed
agranulocytosis. facial expression)
 Avoid alcohol.
require alertness,
motor skills until
response to drug is
established.
 Report worsening
depression, suicidal
ideation, unusual
changes in behavior,
extrapyramidal
PUROC, LIZA M.
effects.
c. New generation antipsychotics ( Mostly are included in typical and atypical drugs)

PRECAUTIONS
 Generic Amilsulpride is a Indicated for the Hypersensitivity to Difficulty sleeping  Take this medicine by
name substituted treatment of acute and the active ingredient (insomnia) or mouth
Amisulpride benzamide atypical chronic schizophrenic or to other feeling anxious or  Swallow the tablets
antipsychotic which disorders, ingredients of the agitated. whole with a drink of
 Brand name binds selectively with characterized by medicinal product. Feeling drowsy or water. Do not chew
Solian a high affinity to positive symptoms Concomitant sleepy. your tablets
human dopaminergic with delusions, prolactin-dependent Constipation,  Take before a meal
 Classificatio D2 and D3 receptor hallucinations, thought tumours e.g. feeling or being  Instruct patient to
n subtypes disorders, hostility and pituitary gland sick, dry mouth. notify health care
Antipsychotic suspicious behavior; or prolactinomas and Putting on weight. professional
primarily negative breast cancer Unusual production immediately if they
 Dosage/ symptoms (deficit Phaeochromocytoma. of breast milk in perceive a change in
Route/frequen syndrome) with Children before the women and heart rate, feel
cy blunted affect, onset of puberty. men, breast pain. lightheaded, or faint.
200 mg BID PO emotional and social Combination with Menstrual period  Instruct patient to
withdrawal. levodopa stops. notify health care
Breast professional of all Rx
enlargement in or OTC medications,
men. vitamins, or herbal
products being taken
and to consult with
health care
professional before
taking other
medications.
 Instruct patient to
notify health care
professional if
pregnancy is planned
or suspected. Advise
breastfeeding patients
to consider
interrupting
breastfeeding and
PUROC, LIZA M.
pumping and discard
breast milk for 48 hr
after administration to
minimize exposure to
infant.

PRECAUTIONS
 Generic Zotepine is a Zotepine, like other Severe CNS Headache, asthenia,  Elderly patients
name dopamine antagonist atypical depression. Personal hypotension, should monitor blood
Zotepine that has a high antipsychotics, is or family history of tachycardia, pressure before
affinity for D1- and considered as the first- epilepsy. Acute gout, elevated LFT, starting zotepine
 Brand name D2-like receptors. It line treatment in newly history of increased prolactin treatment and for the
Sirilept presents a strong diagnosed nephrolithiasis. levels, wt gain, first few weeks of
antagonism for schizophrenia. It is Patients with constipation, treatment
 Classificatio several serotonin usually thought to be preexisting QT agitation, anxiety,  ECG, electrolyte
n receptors, such as 5- an option of choice for prolongation. dizziness, insomnia, levels, CBC and liver
Antipsychotic HT2a, 5-HT2c, 5-HT6 managing acute Treatment of somnolence, function test have to
and 5-HT7. Zotepine schizophrenic episodes behaviour problems sweating, blurring be monitored at
 Dosage activities are also when discussion with in elderly with of vision. regular intervals
 Route/frequ related to the the patient is not dementia. Lactation. Extrapyramidal  Rapid discontinuation
ency inhibition of possible symptoms and of zotepine is not
Adult: Initially, noradrenaline tardive dyskinesia advised as it leads to
25 mg tid, reuptake and with prolonged rebound psychosis
increased at 4- serotonergic activity. treatment. GI and hence the drug
day interval if All these effects allow disturbances, blood requires gradual
necessary. Max: zotepine to improve dyscrasias, decreasing of dose
100 mg tid. the negative and photosensitisation.
Elderly: Initially cognitive symptoms Potentially
, 25 mg bid, of schizophrenia Fatal: Neuroleptic
increased malignant
gradually. Max: syndrome.
75 mg bid.
PUROC, LIZA M.
PRECAUTIONS
 Generic Sulpiride is a Sulpiride is indicated Hypersensitivity to Dizziness  Increased motor
name selective dopamine for the treatment of sulpiride. Headache agitation has been
Sulpiride D2 and D3 receptor acute and chronic Pre-existing breast Extrapyramidal side reported at high
antagonist.6,7,8 In schizophrenia cancer or other effects dosage in a small
 Brand name silico studies show prolactin-dependent - Tremor number of patients: in
Dogmatil that sulpiride may tumors. - Dystonia aggressive, agitated
interact with the Asp- Phaeochromocytoma. - Akathisia — a or excited phases of
 Classificatio 119 and Phe-417 Intoxication with sense of inner the disease process,
n amino acid residues other centrally-active restlessness that low doses of sulpiride
Antipsychotic of these drugs. presents itself with may aggravate
receptors.8 It is Concomitant use of the inability to stay symptoms. Care
 Dosage/ estimated that D2 levodopa. still should be exercised
Route/frequen receptors should be Acute porphyria. - Parkinsonism where mania or
cy 65-80% occupied for Comatose state or Somnolence (not a hypomania is present.
2oo mg OD PO optimal treatment CNS depression. very prominent  Extrapyramidal
and minimal adverse Bone-marrow adverse effect reactions, principally
effects suppression. considering its lack akathisia have been
Cautions[1] of α1 adrenergic, reported in a small
Pre-existing Parkinso histamine and number of cases. If
n's disease muscarinic warranted, reduction
Patients under 18 acetylcholine in dosage or anti-
years of age receptor affinity) parkinsonian
(insufficient clinical Insomnia medication may be
data) Weight gain or loss necessary.
Pre-existing severe Hyperprolactinemia  As with other
heart (elevated plasma neuroleptics,
disease/bradycardia, levels of the neuroleptic malignant
or hypokalemia (pred hormone, prolactin syndrome, a
isposing to long QT which can, in turn potentially fatal
syndrome and lead to sexual complication, which is
severe arrhythmias) dysfunction, galacto characterised by
Patients with pre- rrhea, amenorrhea, hyperthermia, muscle
existing epilepsy. Ant gynecomastia, etc.) rigidity, autonomic
iconvulsant therapy Nausea instability, altered
should be maintained Vomiting consciousness and
Lithium use — Nasal congestion elevated CPK levels,
increased risk of Anticholinergic adve has been reported. In
neurological side rse effects such as: such an event, or in
effects of both drugs - Dry mouth the event of
- Constipation hyperthermia of
PUROC, LIZA M.
- Blurred vision undiagnosed origin,
Impaired all antipsychotic
concentration drugs, including
sulpiride, should be
discontinued.
 Elderly patients are
more susceptible to
postural hypotension,
sedation and
extrapyramidal
effects.
 In patients with
aggressive behaviour
or agitation with
impulsiveness,
sulpiride could be
given with a sedative.
2. Anti-depressant drugs
a. Tricyclic antidepressants (TCA)
PRECAUTIONS
 Generic Blocks reuptake of Clomipramine is used Contraindications: Ejaculatory failure,  Assess psychological
name neurotransmitters off-label to treat Acute recovery dry mouth, status, thought
Clomipramine (norepinephrine, patients with period after MI, use somnolence, content, level of
serotonin) at CNS depression, anxiety, within 14 days of tremors, dizziness, interest, mood,
 Brand name presynaptic treatment-resistant MAOIs. headache, behavior, suicidal
Anafranil membranes, depression, cataplexy Cautions: Pts at high constipation, ideation
increasing availability syndrome, insomnia, risk for suicide, fatigue, nausea.  Supervise suicidal-risk
 Classificatio at postsynaptic neuropathic pain, prostatic Impotence, pt closely during early
n receptor si chronic pain, body hypertrophy, history diaphoresis, therapy (as
Antidepressant dysmorphic disorder, of urinary dyspepsia, sexual depression lessens,
panic disorder, retention/obstruction dysfunction, energy level
 Dosage premature ejaculation, , narrow-angle dysmenorrhea, improves, increasing
 Route/frequ pediatric nocturnal glaucoma, seizures, nervousness, suicide potential).
ency enuresis, and hepatic/renal weight gain,  Assess appearance,
100-200 mg/day trichotillomania disease, alcoholism, pharyngitis behavior, speech
PO xerostomia, visual Diarrhea, myalgia, pattern, level of
problems, elderly, rhinitis, increased interest, mood.
constipation, history appetite,  May cause dry mouth,
PUROC, LIZA M.
of bowel obstruction paresthesia, constipation, blurred
memory vision.
impairment,  Tolerance to postural
anxiety, rash, hypotension,
pruritus, anorexia, sedative,
abdominal pain, anticholinergic effects
vomiting, usually develop
flatulence, flushing, during early therapy.
UTI, back pain  Maximum therapeutic
effect may be noted
in 2–4 wks.
 Do not abruptly
discontinue
medication.
require alertness,
motor skills until
response to drug is
established.
 Daily dose may be
given at bedtime to
minimize daytime
sedation.
 Avoid alcohol.
 Report worsening
depression, suicidal
ideation, change in
behavior

PRECAUTIONS
 Generic Desipramine enhance For depression Hypersensitivity Blurred vision  Assess for the
name s monoamine Severe cardiovascula Constipation mentioned cautions
Desipramine neurotransmission in r disorder Drowsiness and contraindications
certain areas of the Narrow Dry mouth (e.g. drug allergies,
 Brand name brain by inhibiting angle glaucoma Fatigue hepatorenal diseases,
Norpramine the re-uptake of Any drugs or Lethargy psychosis, glaucoma,
noradrenaline and conditions that Sedation etc.) to prevent any
 Classificatio serotonin at the prolong QT interval Weakness untoward
n noradrenergic and Acute recovery post- Agitation complications.
PUROC, LIZA M.
Antidepressant serotoninergic nerve heart Anxiety  Assess for history
endings, attack (myocardial Headache of seizure disorders,
 Dosage/ respectively. It also infarction [MI]) Nausea psychiatric problems,
Route/frequen induces sedation Coadministration Sweating suicidal thoughts and
cy through histamine 1 with serotonergic Trouble sleeping myelography within
75-300 mg/day receptor blockage drugs (insomnia) the past 24 hours or
PO and hypotension Vomiting in the next 48 hours
through beta- Breast swelling (in to avoid potentially
adrenergic blockage. men or women) serious adverse
Confusion reactions.
Diarrhea  Perform a thorough
Dizziness physical assessment
Dizziness on to establish baseline
standing data before drug
ECG changes therapy begins, to
Elevated liver functi determine the
on tests effectiveness of
Extrapyramidal therapy, and to
symptoms evaluate for the
(muscle spasms, occurrence of any
restlessness, adverse effects
muscle rigidity, associated with drug
slowness of therapy.
movement, tremor,  Monitor results of
and jerky electrocardiogram and
movements) laboratory tests (e.g.
Fast heart rate renal and liver
Increased appetite function tests) to
Lack of coordination monitor the
Nervousness effectiveness of the
Numbness and therapy and provide
tingling prompt treatment to
developing
complications.
PUROC, LIZA M.
PRECAUTIONS
 Generic Doxepin exact This medication is CNS: Drowsiness, diz Dry mouth, blurred  Monitor use of other
name mechanism of action used to treat ziness, weakness, vision, constipation, CNS depressants,
Doxepin is not very clear. mental/mood fatigue, headache, and urinary including alcohol.
However, doxepin is problems such hypomania, retention have been Danger of overdosage
 Brand name known to be a as depression and anxi confusion, tremors, reported. If they do or suicide attempt is
Adapin selective histamine ety. It may help paresthesias. not subside with increased when
H1 receptor improve mood and CV: Orthostatic continued therapy, patient uses excessive
 Classificatio blocker.1 This effect feelings of well-being, hypotension, palpitati or become severe, amounts of alcohol.
n on histamine relieve anxiety and on, hypertension, it may be necessary  Be alert to changes in
Antidepressant receptors indicates tension, help tachycardia, ECG to reduce the voiding and evaluate
effectiveness in skin you sleep better, and changes. dosage. patient for
 Dosage/ conditions increase your energy Special Drowsiness is the constipation and
Route/frequen level Senses: Mydriasis, most commonly abdominal distention;
cy blurred vision, noticed side effect. drug has moderate to
PO 30–150 mg/d photophobia. GI: Dry This tends to strong anticholinergic
h.s. or in divided -mouth, sour or disappear as effects.
doses, may metallic taste, therapy is  Maintain established
gradually epigastric distress, continued. Other dosage regimen and
increase to 300 constipation. infrequently avoid change of
mg/d (use lower Urogenital: Urinary reported CNS side intervals, doubling,
doses in older retention, delayed effects are reducing, or skipping
adult patients) micturition, urinary confusion, doses.
frequency. disorientation,  Consult physician
Other: Increased hallucinations, about safe amount of
perspiration, tinnitus, numbness, alcohol, if any, that
weight gain, paresthesias, ataxia can be taken. The
photosensitivity , extrapyramidal actions of both
reaction, skin rash, symptoms, alcohol and doxepin
agranulocytosis, burn seizures, tardive are potentiated when
ing or stinging at dyskinesia, used together and for
application and tremor. up to 2 wk after
site, edema. doxepin is
discontinued.
 Do not drive or
engage in other
potentially hazardous
activities until
response to drug is
known.
PUROC, LIZA M.
 Do not breast feed
while taking this drug
without consulting
physician.

PRECAUTIONS
 Generic Tricyclic Treatment of major Contraindications CNS: Seizures,  Assess vital signs (BP
name antidepressant (TCA) depression. Prostatic tremor, and pulse rate) during
Trimipramine pharmacologically hypertrophy; during confusion, sedation. adjustment period of
similar to recovery period after Special tricyclic
 Brand name imipramine. MI. Safety during Senses: Blurred antidepressant (TCA)
Surmontil Moderate pregnancy (category vision. CV: Tachyca therapy. If BP falls
anticholinergic and C) or lactation is not rdia, orthostatic more than 20 mm Hg
 Classificatio strong sedative established. hypotension, hypert or if there is a sudden
n effects; useful in Cautious Use ension. GI: Xerosto increase in pulse rate,
Antidepressant depression Schizophrenia, mia, withhold medication
associated with electroshock therapy, constipation, paraly and notify physician.
 Dosage/ anxiety and sleep suicidal tendency; ticileus.  Orthostatic
Route/frequen disturbances. Recent cardiovascular, liver, Urinary retention. hypotension may be
cy studies suggest thyroid, kidney Skin: Photosensitivi sufficiently severe to
PO 75–100 strong, active H2- disease ty, sweating. require protective
mg/d in divided receptor antagonism assistance when
doses, may is a characteristic of patient is ambulating.
increase TCAs. Instruct patient to
gradually up to change position from
300 mg/d if recumbency to
needed PO standing slowly and in
Maintenance stages.
Dose Usually  Report signs of liver
50–150 mg/d dysfunction: Yellow
skin and sclerae,
light-colored stools,
pruritus, abdominal
discomfort.
 Report fine tremors, a
distressing
extrapyramidal
adverse effect, to
physician.
PUROC, LIZA M.
 Monitor bowel
elimination pattern
and I&O ratio. Severe
constipation and
urinary retention are
potential problems,
especially in older
adults. Advise
increased fluid intake
to at least 1500 mL/d
(if allowed).
 Monitor patient
carefully during initial
drug therapy when
therapeutic "lag
period" may foster
noncompliance.
 Inspect oral
membranes daily with
high-dose therapy.
Urge outpatient to
report symptoms of
stomatitis or
xerostomia.
 Regulate
environmental
temperature and
patient's clothing
carefully; drug may
cause intolerance to
heat or cold.
 Excessive alcohol may
potentiate TCA effects
and increase the
danger of overdosage
or suicide attempt

PUROC, LIZA M.
PRECAUTIONS
 Generic Potent hydrazine Management of Contraindications Body as a  Drug is usually
name (monoamine endogenous Hypersensitivity to Whole: Dizziness or discontinued if no
Phenelzine oxidase) MAO depression, depressive MAO inhibitors; vertigo, therapeutic response
inhibitor. Precise phase of manic- pheochromocytoma; headache, orthostat occurs after 3 or 4
 Brand name mode of action is not depressive psychosis, hyperthyroidism; ic wk. Maximum
Nardil known. and severe exogenous CHF, cardiovascular hypotension, drowsi antidepressant effects
Antidepressant and (reactive) depression or cerebrovascular ness generally appear in 2–
 Classificatio diverse effects not responsive to disease; impaired or insomnia, weakn 6 wk and persist
n believed to be due to more commonly used kidney function, ess, fatigue, several weeks after
Antidepressants irreversible inhibition therapy. hypernatremia; edema, tremors, drug withdrawal.
of MAO, thereby atonic colitis; twitching, akathisia,  Avoid self-medication.
 Dosage/ permitting increased glaucoma; history of ataxia, OTC preparations
Route/frequen concentrations of frequent or severe hyperreflexia, containing
cy endogenous headaches; history of faintness, dextromethorphan,
PO 15 mg t.i.d., epinephrine, liver disease, hyperactivity, sympathomimetic
rapidly increase norepinephrine, abnormal liver marked agitation, agents, or
to at least 60 serotonin, and function tests; older anxiety, seizures, antihistamines (e.g.,
mg/d, may need dopamine within adult or debilitated trismus, cough, cold, and hay
up to 90 mg/d presynaptic neurons patients; paranoid opisthotonos, respir fever remedies,
and at receptor sites. schizophrenia. Safety atory depression, appetite
Also thought to during pregnancy coma. CNS: Mania, suppressants) can
inhibit hepatic (category C), hypomania, precipitate severe
microsomal drug- lactation, or in confusion, memory hypertensive
metabolizing children <6 y of age impairment, reactions if taken
enzymes; thus it may is not established. delirium, during therapy or
intensify and prolong hallucinations, within 2–3 wk after
the effects of many euphoria, acute discontinuation of an
drugs. anxiety reaction, MAO inhibitor.
toxic precipitation  Report immediately to
of schizophrenia, physician the onset of
convulsions, headache and
peripheral palpitation, prodromal
neuropathy. CV: Hy symptoms of
pertensive hypertensive crisis or
crisis (intense any other unusual
occipital headache, effects which may
palpitation, marked indicate need to
hypertension, stiff discontinue therapy.
neck, nausea,  Do not consume foods
vomiting, sweating, and beverages
fever, photophobia, containing tyramine
PUROC, LIZA M.
dilated pupils, or tryptophan or
bradycardia or drugs containing
tachycardia, pressor agent. These
constricting chest can cause severe
pain, intracranial hypertensive
bleeding), reactions. Get a list
hypotension or from your care
hypertension, circul provider.
atory  Avoid drinking
collapse. GI: Consti excessive caffeine and
pation, dry mouth, chocolate beverages
nausea, vomiting, a (e.g., coffee, tea,
norexia, weight cocoa, or cola).
gain. Hematologic:  Discuss with physician
Normocytic and wearing elastic
normochromic stockings and
anemia, elevating legs when
leukopenia. Skin: H sitting to minimize
yperhidrosis, skin hypotensive effects of
rash, drug.
photosensitivity. Sp  Make position
ecial changes slowly,
Senses: Blurred especially from
vision. recumbent to upright
posture, and dangle
legs over bed a few
minutes before rising
to walk.
 Avoid standing still for
prolonged periods.
Also avoid hot
showers and baths
(resulting
vasodilatation may
potentiate
hypotension); lie
down immediately if
feeling light-headed
or faint.
 Check weight 2 or 3
times per week and
report unusual gain.
 Report jaundice.
PUROC, LIZA M.
Hepatotoxicity is
believed to be a
hypersensitivity
reaction unrelated to
dosage or duration of
therapy.
 Avoid overexertion
while taking this drug.
MAO inhibitors may
suppress anginal pain
that would otherwise
serve as a warning
sign of myocardial
ischemia.
without consulting
physician.

PRECAUTIONS
 Generic Antidepressant with Treatment of Contraindications CNS: Somnolence,  Monitor for significant
name potent, selective, depression and Hypersensitivity to headache, nausea and vomiting,
Fluvoxamine inhibitory activity on obsessive-compulsive fluvoxamine or agitation, insomnia, especially during
neuronal (5-HT) disorders. fluoxetine; children dizziness, seizures. initial therapy.
 Brand name serotonin reuptake <8 y. CV: Orthostatic  Monitor for worsening
Luvox (SSRI); structurally Cautious Use hypotension, slight of depression or
unrelated to TCAs. Pregnancy (category bradycardia. GI: Na emergence of suicidal
 Classificatio Compared with TCAs, B), lactation, liver usea, vomiting, dry ideations.
n shows fewer disease, renal mouth,  Assess safety;
Antidepressant anticholinergenic impairment, abrupt constipation, drowsiness and
effects and no severe discontinuation; anorexia. Urogenital dizziness are common
 Dosage/ cardiovascular cardiac disease, : Sexual adverse effects.
Route/frequen effects. dehydration, dysfunction. Skin: S  Monitor PT and INR
cy hyponatremia, older tevens-Johnson carefully with
PO Start with 50 adults, ECT, seizure syndrome, toxic concurrent warfarin
mg q.d., may disorders, seizures, epidermal therapy; adjust
increase slowly suicidal ideation, necrolysis (rare). warfarin as needed.
up to 300 mg/d tobacco smoking.  Note: Nausea and
given q.h.s. or vomiting are common
divided b.i.d. in early therapy.
PUROC, LIZA M.
Notify physician if
these adverse effects
last more than a few
days.
 Exercise caution with
hazardous activity
until response to the
drug is known.
without consulting
physician.

PRECAUTIONS
 Generic Centrally acting Both inpatient and Contraindications CNS: Drowsiness, li  Monitor pulse rate
name triazolopyridine outpatient with major Initial recovery phase ght-headedness, and regularity before
Trazodon derivative depression with or of MI; ventricular tiredness, dizziness, administration if
antidepressant without prominent ectopy; electroshock insomnia, patient has
 Brand name chemically and anxiety. therapy. Safety headache, preexisting cardiac
Desyrel structurally unrelated during pregnancy agitation, impaired disease.
to tricyclic, (category C) or in memory and  Note: Adverse effects
 Classificatio tetracyclic, or other children <8 y is not speech, generally are mild and
n antidepressants. established. disorientation. CV: tend to decrease and
Antidepressant Potentiates serotonin Cautious Use Hypotension disappear after the
effects by selectively Patient with suicidal (including first few weeks of
 Dosage/ blocking its reuptake ideation; bipolar orthostatic treatment.
Route/frequen at presynaptic disorder, older hypotension), hyper  Observe patient's
cy membranes in CNS. adults; cardiac tension, syncope, level of activity. If it
PO 150 mg/d in Does not stimulate arrhythmias or shortness of breath, appears to be
divided doses, CNS and causes disease; hepatic chest pain, increasing toward
may increase by fewer anticholinergic disease, renal tachycardia, sleeplessness and
50 mg/d q3–4d genitourinary and impairment; palpitations, agitation with
(max: 400–600 neurologic effects as lactation. bradycardia, PVCs, changes in reality
mg/d) compared with other ventricular orientation, report to
antidepressants. tachycardia (short physician. Manic
Produces varying episodes of 3–4 episodes have been
degrees of sedation beats). Special reported.
in normal and Senses: Nasal and  Check patient for
mentally depressed sinus congestion, symptoms of
patient. blurred vision, eye hypotension. If
PUROC, LIZA M.
irritation, sweating orthostatic
or clamminess, hypotension is
tinnitus. GI: Dry troublesome, suggest
mouth, anorexia, measures to reduce
constipation, danger of falling and
abdominal distress, help patient to
nausea, vomiting, tolerate the effects.
dysgeusia, Discuss with
flatulence, physician; reduction
diarrhea. Urogenital of dose or
: Hematuria, discontinuation of the
increased drug may be
frequency, delayed prescribed.
urine flow, early or  Male patient should
absent menses, report inappropriate
male priapism, or prolonged penile
ejaculation erections. The drug
inhibition. Hematolo may be discontinued.
gic: Anemia. Muscul  Be aware that
oskeletal: Skeletal overdose is
aches and pains, characterized by an
muscle extension of common
twitches. Skin: Skin adverse effects:
eruptions, rash, Vomiting, lethargy,
pruritus, acne, drowsiness, and
photosensitivity. Bo exaggerated
dy as a anticholinergic effects.
Whole: Weight gain Seizures or
or loss. arrhythmias are
unusual.
 Do not alter dose or
intervals between
doses.
 Consult physician if
drowsiness becomes a
distressing adverse
effect. Dose regimen
may be changed so
that largest dose is at
bedtime.
 Limit or abstain from
alcohol use. The
depressant effects of
PUROC, LIZA M.
CNS depressants and
alcohol may be
potentiated by this
drug.
 Do not self-medicate
with OTC drugs for
colds, allergy, or
insomnia treatment
without advice of
physician. Many of
these drugs contain
CNS depressants.
b. Selective serotonin reuptake inhibitors (SSRI)

PRECAUTIONS
 Generic Selective serotonin Depression. Contraindications Body as a  Watch closely for
name reuptake inhibitor Hypersensitivity to Whole: Asthenia, worsening of
Citalopram (SSRI) in the CNS. citalopram; fatigue, fever, depression or
Antidepressant effect concurrent use of arthralgia, emergence of
 Brand name is presumed to be MAOIs or use within myalgia. CV: Tachy suicidal ideations.
Celexa linked to its inhibition 14 d of discontinuing cardia, postural  Monitor for
of CNS presynaptic MAOIs; pregnancy hypotension, therapeutic
 Classification neuronal uptake of (category C); volume hypotension. GI: Na effectiveness:
SELECTIVE serotonin which depleted; lactation; usea, vomiting, Indicated by
SEROTONIN- results in children <18 y. diarrhea, dyspepsia, elevation of mood;
REUPTAKE antidepressant Cautious Use abdominal pain, dry 1–4 wk may be
INHIBITOR activity. Does not Hypersensitivity to mouth, anorexia, needed before
(SSRI) produce any other SSRIs; renal or flatulence. CNS: Diz improvement is
sympathomimetic hepatic insufficiency; ziness, insomnia, noted.
 Dosage/ response or older adults; somnolence, agitati  Lab tests: Monitor
Route/frequen anticholinergic concurrent use of on, tremor, anxiety, periodically hepatic
cy activity. diuretics, paresthesia, functions, CBC,
PO Start at 20 dehydration, renal migraine. Respirato serum sodium, and
mg q.d., may impairment or renal ry: URI, rhinitis, lithium levels when
increase to 40 failure, sinusitis. Skin: Incr the two drugs are
mg q.d. if cardiovascular eased given concurrently.
needed disease (e.g., sweating. Urogenita  Monitor periodically
dysrhythmias, l: Dysmenorrhea, HR and BP, and
PUROC, LIZA M.
conduction defects, decreased libido, carefully monitor
myocardial ejaculation complete cardiac
ischemia); history of disorder, status in person with
seizure disorders or impotence. known or suspected
suicidal tendencies; cardiac disease.
ECT treatments.  Monitor closely older
adult patients for
adverse effects
especially with doses
>20 mg/d.
 Do not engage in
hazardous activities
until reaction to this
drug is known.

PRECAUTIONS
 Generic Selective serotonin Depression, Contraindications Body as a  Monitor for
name reuptake inhibitor generalized anxiety Hypersensitivity to Whole: Fatigue, therapeutic
Escitalopram (SSRI) in the CNS. disorder. citalopram; fever, arthralgia, effectiveness:
Antidepressant effect concurrent use myalgia. CV: Palpita Indicated by elevation
 Brand name is presumed to be of MAOIS or use tion, hypertension. of mood; 1–4 wk may
Lexapro linked to its inhibition within 14 d of GI: Nausea, diarrhe be needed before
of CNS presynaptic discontinuing MAOIS; a, dyspepsia, improvement is
 Classificatio neuronal uptake of pregnancy (category abdominal pain, dry noted.
n serotonin which C); volume depleted; mouth, vomiting,  Closely observe for
SELECTIVE results in lactation; children flatulence, worsening of
SEROTONIN- antidepressant <18 y. reflux. CNS: Dizzine depression or
REUPTAKE activity. Does not Cautious Use ss, insomnia, emergence of
INHIBITOR produce any Hypersensitivity to somnolence, parest suicidality.
(SSRI) sympathomimetic other SSRIs; suicidal hesia, migraine,  Lab tests: Monitor
response or ideations, tremor, periodically hepatic
 Dosage/ anticholinergic depression, mania, vertigo. Metabolic: I functions, CBC, serum
Route/frequen activity. hyponatremia, ncreased or sodium, and lithium
cy ethanol intoxication, decreased levels when the two
PO 10 q.d., may ECT, dehydration, weight. Respiratory drugs are given
increase to 20 renal or hepatic : URI, rhinitis, concurrently.
mg q.d. if insufficiency; older sinusitis. Skin: Incr  Monitor periodically
needed after 1 adults; concurrent eased HR and BP, and
wk use of diuretics, sweating. Urogenita carefully monitor
cardiovascular l: Dysmenorrhea, complete cardiac
PUROC, LIZA M.
disease (e.g., decreased libido, status in person with
dysrhythmias, ejaculation known or suspected
conduction defects, disorder, cardiac disease.
myocardial impotence,  Monitor closely older
ischemia); history of menstrual cramps. adult patients for
seizure disorders or adverse effects,
suicidal tendencies. especially with doses
>20 mg/d.
 Do not engage in
until reaction to this
drug is known.

PRECAUTIONS
 Generic Fluoxetine is a potent Treatment of Severe renal or Nervousness,  Arrange for lower or
name and highly selective depression; most hepatic failure; insomnia, anxiety, less frequent doses in
Fluoxetine inhibitor of serotonin effective in patients hypersensitivity; headache, tremor, elderly patients and
(5-HT) re-uptake. No with major depressive lactation; drowsiness, dry patients with hepatic
 Brand name affinity for disorder concomitant MAOIs mouth, nausea, or renal impairment.
Prozac adrenoceptors or Treatment of OCD or within 2 wk of vomiting, sweating,  BLACK BOX
histamine, GABA-B, Treatment of bulimia MAOI withdrawal. diarrhoea. Seizures, WARNING: Establish
 Classificatio or muscarinic Treatment of PMDD mania, hypomania suicide precautions
n receptors. (Sarafem) or mixed manic for severely
Antidepressant Treatment of panic states reported. depressed patients.
disorder with or Hyponatraemia; Limit quantity of
 Dosage/ without agoraphobia elevation of hepatic capsules dispensed;
Route/frequen Unlabeled use: enzymes. high risk in children
cy Treatment of obesity, Potentially Fatal: and adolescents.
20 mg/day PO in alcoholism, numerous Rarely, systemic  Administer drug in the
the morning psychiatric disorders, events possibly morning.
chronic pain, various related to vasculitis  Monitor patient for
neuropathies have been reported response to therapy
in patients with for up to 4 wk before
rash but may be increasing dose.
serious involving  Switch to once a week
lungs, kidney and therapy by starting
liver. weekly dose 7 days
after last 20 mg/day
dose. If response is
not satisfactory,
PUROC, LIZA M.
reconsider daily
dosing
 You may experience
these side effects:
Dizziness, drowsiness,
nervousness,
insomnia (avoid
driving or performing
hazardous tasks);
nausea, vomiting,
weight loss (eat small
frequent meals;
monitor your weight
loss); sexual
dysfunction; flulike
symptoms.
 Report rash, mania,
seizures, severe
weight loss.

PRECAUTIONS
 Generic Antidepressant Treatment of major Hypersensitivity to Somnolence,  BLACK BOX
name structurally unrelated depressive disorder paroxetine; insomnia, WARNING: Be alert
Paroxetine to other serotonin Treatment of OCD concomitant use of headache, for increased
reuptake inhibitors. Treatment of panic MAO inhibitors, dizziness; suicidality in children
 Brand name Potent and highly disorders pregnancy (category decreased libido; and adolescents.
Paxil selective inhibitor of Treatment of social D); alcohol; children nausea, xerostomia,  Administer once a day
serotonin reuptake anxiety disorder or adolescents with constipation, in the morning.
 Classificatio by neurons in CNS. (social phobia) major depressive diarrhoea;  Shake suspension well
n Treatment of disorder. ejaculatory before using.
Antidepressant generalized anxiety disturbances;  Ensure that patient
disorder weakness, tremor, swallows CR tablets
 Dosage/ Treatment of diaphoresis; whole; do not cut,
Route/frequen posttraumatic stress vasodilation, chest crush, or chew.
cy disorder pain, palpitation,  Limit amount of drug
20 mg/day PO as hypertension, given to potentially
a single daily tachycardia, suicidal patients.
dose. Range, nervousness,  Abruptly discontinuing
20–50 mg/day. anxiety , agitation, the drug may result in
PUROC, LIZA M.
Or 25–62.5 abnormal dreams, discontinuation
mg/day CR impaired symptoms (agitation,
tablet. concentration, palpitations); consider
yawning, tapering.
depersonalisation,  Advise patient to
amnesia, emotional avoid using if
lability, vertigo, pregnant or lactating.
confusion, chills;
rash, pruritus;
orgasmic
disturbance,
dysmenorrhoea;
anorexia, decreased
appetite, dyspepsia,
flatulence,
abdominal pain,
appetite increased,
vomiting, taste
perversion, weight
gain; impotence,
genital disorder,
urinary frequency,
UTI; paresthesia,
myalgia, back pain,
myoclonus,
myopathy,
myasthenia,
arthralgia; blurred
vision, abnormal
vision; tinnitus;
respiratory
disorder,
pharyngitis,
sinusitis, rhinitis;
infection.

PRECAUTIONS
 Generic Potent inhibitor of Major depression, Patients CV: Palpitations,  Supervise patients at
PUROC, LIZA M.
name serotonin (5HT) obsessive-compulsive taking MAO inhibitors chest pain, risk for suicide closely
Sertraline reuptake in the disorder, panic or within 14 d of hypertension, during initial therapy.
brain, and chemically disorder, social anxiety discontinuing MAO in hypotension,  Monitor for worsening
 Brand name unrelated to TCA, disorder, premenstrual hibitor; antabuse; edema, syncope, of depression or
Zoloft tetracyclic or other dysphoric disorder, suicidal ideation, tachycardia. CNS: A emergence of suicidal
available generalized anxiety, hyponatremia; mania gitation, insomnia, ideation.
 Classificatio antidepressants. post-traumatic stress or hypomania, headache,  Monitor older adults
n Chronic disorder. pregnancy (category dizziness, for fluid and sodium
Antidepressant administration of C); third trimester of somnolence, imbalances.
sertraline results in pregnancy. fatigue, ataxia,  Monitor patients with
down regulation of incoordination, a history of a seizure
 Dosage/ norepinephrine, a vertigo, abnormal disorder closely.
Route/frequen reaction found with dreams, aggressive  Lab tests: Monitor PT
cy other effective behavior, delusions, and INR with patients
PO Begin with 50 antidepressants. hallucinations, receiving concurrent
mg/d, gradually Sertraline does not emotional lability, warfarin therapy.
increase every inhibit MAO. paranoia, suicidal  Report diarrhea,
few weeks ideation, nausea, dyspepsia,
according to depersonalization. E insomnia, drowsiness,
response (range: ndocrine: Gynecom dizziness, or
50–200 mg) astia, male sexual persistent headache
dysfunction. GI: Na to physician.
usea, vomiting,  Report signs of
diarrhea, bleeding promptly to
constipation, physician when taking
indigestion, concomitant warfarin.
anorexia,  Do not breast feed
flatulence, while taking this drug
abdominal pain, dry without consulting
mouth. Special physician.
Senses: Exophthal
mos, blurred vision,
dry eyes, diplopia,
photophobia,
tearing,
conjunctivitis,
mydriasis. Skin: Ra
sh, urticaria, acne,
alopecia. Respirator
y: Rhinitis,
pharyngitis, cough,
dyspnea,
bronchospasm. Bod
PUROC, LIZA M.
y as a
Whole: Myalgia,
arthralgia, muscle
weakness. Metaboli
c: Hyponatremia in
older adults.
c. Monoamine oxidase inhibitors (MAOI)

PRECAUTIONS
 Generic Thought to increase Initial monotherapy for Concurrent use with CNS: headache,  Assess signs and
name dopaminergic activity idiopathic Parkinson's cyclobenzaprine, vertigo, dizziness, symptoms of
Rasagiline by irreversibly disease dextromethorphan, agitation, anxiety, Parkinson's disease
inhibiting MAO type B methadone, somnolence, (tremor, muscle
 Brand name in nerve cells, propoxyphene, amnesia, confusion, weakness and rigidity,
Azilect increasing dopamine tramadol, and St. dystonia, ataxic gait) prior to
availability to brain John's wort hypertonia, and during therapy.
 Classificatio cells abnormal gait,  Monitor BP
n ataxia, dyskinesia, periodically during
MAO inhibitor hyperkinesia, therapy.
Antiparkinsonian paresthesia,  Assess skin for
agent, neuropathy, tremor, melanomas
antidyskinetic depression, periodically during
malaise, abnormal therapy.
 Dosage/ dreams, asthenia,  Stay alert for
Route/frequen myasthenia, hypertensive crisis in
cy hallucinations, strok patients using
1 mg P.O. daily e concurrent drugs that
CV: orthostatic may cause this
hypotension, serious interaction.
syncope,  Be alert for
angina, bundle- dopaminergic adverse
branch block effects and
EENT: conjunctivitis exacerbation of
, epistaxis, rhinitis preexisting
GI: abdominal pain, dyskinesias when
dyspepsia, rasagiline is used as
indigestion, nausea, adjunct to levodopa.
vomiting, diarrhea, Levodopa dosage may
constipation, need to be reduced.
PUROC, LIZA M.
dysphagia,  Monitor for orthostatic
gastroenteritis, dry hypotension during
mouth, gingivitis, first 2 months of
anorexia, GI therapy, especially
hemorrhage when drug is used as
GU: hematuria, adjunct to levodopa
urinary  Inspect patient
incontinence, frequently for signs of
erectile dysfunction, melanoma.
decreased libido  In patient with
Hematologic: leuko hepatic insufficiency,
penia, obtain periodic liver
anemia, hemorrhag function tests.
e
Musculoskeletal: art
hralgia, arthritis,
neck pain,
tenosynovitis,
bursitis, leg cramps
Respiratory: asthm
a, dyspnea,
increased cough
Skin: alopecia, skin
cancer, rash,
sweating, pruritus,
skin ulcer,
ecchymosis,
photosensitivity
reaction

PRECAUTIONS
 Generic Mechanism of action Adjunctive therapy of Hypersensitivity to CNS: Sleep  Monitor vital signs,
name is not fully Parkinson's disease for selegiline; disturbances, particularly during
Selegiline understood. Increase patients being treated concomitant use with psychosis, period of dosage
in dopaminergic with levodopa and meperidine and other agitation, adjustment. Report
 Brand name activity is thought to carbidopa who exhibit opioids; lactation. confusion, alterations in BP or
Zelapar be primarily due to deterioration in the dyskinesia, pulse. Indications for
selective inhibition of quality of their dizziness, discontinuation of the
 Classificatio MAO type B activity. response to therapy. hallucinations, drug include
n Although MAOs are dystonia, orthostatic
PUROC, LIZA M.
MAO inhibitor widely distributed akathisia. CV: Hypo hypotension,
throughout the body, tension. GI: Anorex hypertension, and
 Dosage/ most of the MAO in ia, nausea, vomitin arrhythmias.
Route/frequen the brain is type B. g, abdominal pain,  Monitor all patients
cy constipation, closely for behavior
PO 5 mg b.i.d. diarrhea. changes (e.g.,
with breakfast hallucinations,
and lunch (doses confusion, depression,
>10 mg/d are delusions).
associated with  Do not exceed the
increased risk of prescribed drug dose.
toxicity due  Report symptoms
to MAO inhibition of MAO inhibitor-
) induced hypertension
(e.g., severe
headache,
palpitations, neck
stiffness, nausea,
vomiting)
immediately to
physician.
 Do not drive or
engage in potentially
until response to drug
is known.
 Make positional
changes slowly and in
stages. Orthostatic
hypotension is
possible as well as
dizziness, light-
headedness, and
fainting.
without consulting
physician.

PRECAUTIONS
PUROC, LIZA M.
 Generic MAO INHIBITOR of Symptomatic Hypersensitivity CNS: Dizziness,  Monitor for
name the hydrazine group. treatment of to MAO INHIBITORs; light-headedness, therapeutic
Isocaboxazid Inhibits monoamine depressed patients pheochromocytoma; tiredness, effectiveness: May be
oxidase, the enzyme refractory to or CHF; children (<16 weakness, drowsine apparent within 1 wk
 Brand name involved in the intolerant of TCAs or y); older adults (>60 ss, vertigo, or less, but in some
Marplan catabolism of electroconvulsive y) or debilitated headache, overactiv patients there may be
catecholamine therapy. patients; severe ity, hyperreflexia, a time lag of 3–4 wk
 Classificatio neurotransmitters renal or hepatic muscle twitching, before improvement
n and serotonin. impairment. Safe use tremors, mania occurs.
ANTIDEPRESSAN during pregnancy hypomania, insomni  Monitor BP. Monitor
T; MONOAMINE (category C) or a, confusion, for orthostatic
OXIDASE (MAO) lactation is not memory hypotension by
INHIBITOR established. impairment. CV: Or evaluating BP with
thostatic patient recumbent
 Dosage/ hypotension, parad and standing.
Route/frequen oxical hypertension,  Check for peripheral
cy palpitation, edema daily and
PO 10–30 mg/d tachycardia, other monitor weight
in 1–3 divided arrhythmias. Specia several times weekly.
doses (max: 30 l Senses: Blurred  Note: Toxic symptoms
mg/d) vision, nystagmus, from overdosage or
glaucoma. GI: Incre from ingestion of
ased appetite, contraindicated
weight substances (e.g.,
gain, nausea, diarrh foods high in
ea, constipation, tyramine) may occur
anorexia, black within hours.
tongue, dry  Monitor I&O and
mouth, abdominal bowel elimination
pain. Urogenital: Dy patterns.
suria, urinary
retention, incontine
nce, sexual
disturbances. Body
as a
Whole: Peripheral
edema, excessive
sweating, chills,
skin rash, hepatitis,
jaundice.

PUROC, LIZA M.
PRECAUTIONS
 Generic Potent hydrazine Management of Hypersensitivity to Body as a  Evaluate patient's BP
name (monoamine endogenous MAO inhibitors; Whole: Dizziness or in standing and
Phenelzine oxidase) MAO depression, depressive pheochromocytoma; vertigo, recumbent positions.
inhibitor. Precise phase of manic- hyperthyroidism; headache, orthostat Prior to initiation of
 Brand name mode of action is not depressive psychosis, CHF, cardiovascular ic treatment.
Nardil known. and severe exogenous or cerebrovascular hypotension, drowsi  Lab tests: Perform
Antidepressant and (reactive) depression disease; impaired ness baseline CBC and liver
 Classificatio diverse effects not responsive to kidney function, or insomnia, weakn function tests. Also
n believed to be due to more commonly used hypernatremia; ess, fatigue, perform periodic CBC
ANTIDEPRESSAN irreversible inhibition therapy. atonic colitis; edema, tremors, and liver function
T; MONOAMINE of MAO, thereby glaucoma; history of twitching, akathisia, tests during
OXIDASE (MAO) permitting increased frequent or severe ataxia, prolonged or high-
INHIBITOR concentrations of headaches; history of hyperreflexia, dose therapy.
endogenous liver disease, faintness,  Monitor BP and pulse
 Dosage/ epinephrine, abnormal liver hyperactivity, between doses when
Route/frequen norepinephrine, function tests; older marked agitation, titrating initial
cy serotonin, and adult or debilitated anxiety, seizures, dosages. Observe
PO 15 mg t.i.d., dopamine within patients; paranoid trismus, closely for evidence of
rapidly increase presynaptic neurons schizophrenia. Safety opisthotonos, respir adverse drug effects.
to at least 60 and at receptor sites. during pregnancy atory depression, Thereafter, monitor at
mg/d, may need Also thought to (category C), coma. CNS: Mania, regular intervals
up to 90 mg/d inhibit hepatic lactation, or in hypomania, throughout therapy.
microsomal drug- children <6 y of age confusion, memory  Report immediately if
metabolizing is not established. impairment, hypomania
enzymes; thus it may delirium, (exaggeration of
intensify and prolong hallucinations, motility, feelings, and
the effects of many euphoria, acute ideas) occurs as
drugs. anxiety reaction, depression improves.
toxic precipitation This reaction may also
of schizophrenia, appear at higher than
convulsions, recommended doses
peripheral or with long-term
neuropathy. CV: Hy therapy.
pertensive  Observe for and
crisis (intense report therapeutic
occipital headache, effectiveness of drug:
palpitation, marked Improvement in sleep
hypertension, stiff pattern, appetite,
neck, nausea, physical activity,
vomiting, sweating, interest in self and
fever, photophobia, surroundings, as well
PUROC, LIZA M.
dilated pupils, as lessening of
bradycardia or anxiety and bodily
tachycardia, complaints.
constricting chest  Observe patient with
pain, intracranial diabetes closely for
bleeding), S&S of hypoglycemia
hypotension or (see Appendix F).
hypertension, circul Patients on prolonged
atory therapy should be
collapse. GI: Consti checked periodically
pation, dry mouth, for altered color
nausea, vomiting, a perception, changes
norexia, weight in fundi or visual
gain. Hematologic: fields. Changes in
Normocytic and red-green vision may
normochromic be the first indication
anemia, of eye damage.
leukopenia. Skin: H
yperhidrosis, skin
rash,
photosensitivity. Sp
ecial
Senses: Blurred
vision.

PRECAUTIONS
 Generic Potent nonhydrazine Severe depression. Pregnancy (category CNS: Vertigo,  Do not eat tyramine-
name MAO inhibitor C); patients >60 y; dizziness, tremors, containing foods
Tranylcypromine structurally similar to confirmed or muscle twitching,  Be aware that
amphetamine. suspected headache, blurred excessive use of
 Brand name Actions and toxicity cerebrovascular vision. CV: Orthosta caffeine-containing
Parnate similar to those of defect, tic beverages (chocolate,
hydrazine MAO cardiovascular hypotension, arrhyt coffee, tea, cola) can
 Classificatio inhibitors but also disease, hmias, hypertensive contribute to
n has rapid and direct hypertension, crisis. GI: Dry development of rapid
ANTIDEPRESSAN amphetamine-like pheochromocytoma, mouth, anorexia, heartbeat,
T; MAO CNS stimulatory history of severe or constipation, arrhythmias, and
INHIBITOR action, is less likely recurrent headaches; diarrhea, abdominal hypertension.
to cause lactation. discomfort. Skin: R  Make position
 Dosage/ hepatotoxicity and ash. Urogenital: Im changes slowly,
PUROC, LIZA M.
Route/frequen does not produce potence. Body as a particularly from
cy prolonged MAO Whole: Peripheral recumbent to upright
PO 30 mg/d in 2 inhibition (reversible edema, sweating. posture.
divided doses binding).  Avoid potentially
(20 mg in a.m., hazardous activities
10 mg in p.m.), until response to drug
may increase by is known.
10 mg/d at 3 wk  Avoid alcohol or other
intervals (max: CNS depressants
60 mg/d) because of their
possible additive
effects.
3. Anti-anxiety drugs (anxiolytics)

PRECAUTIONS
 Generic Exact mechanisms of Management of Contraindicated with CNS: Drowsiness,  Note: Adverse
name action not anxiety disorders, hypersensitivity to sedation, light- reactions that may
Alprazolam understood; main short-term relief of benzodiazepines, headedness, occur during early
sites of action may symptoms of anxiety; psychoses, acute dizziness, syncope, high-dose therapy.
 Brand name be the limbic system anxiety associated narrow-angle depression, These usually
Xanax and reticular with depression. glaucoma, shock, headache, disappear with
formation; increases Treatment of panic coma, acute alcoholic confusion, continuing therapy,
 Classificatio the effects of GABA, attacks with or without intoxication with insomnia, but dosage
n, Anxiolytic an inhibitory agoraphobia depression of vital nervousness, adjustments may be
neurotransmitter; Unlabeled uses: Social signs, pregnancy fatigue, clumsiness, indicated.
 Dosage/ anxiety blocking phobia, premenstrual (crosses the unsteadiness,  Make position
Route/frequen effects occur at doses syndrome, depression placenta; risk of rigidity, tremor, changes slowly and in
cy well below those congenital restlessness, stages to prevent
0.25–0.5 mg PO necessary to cause malformations, paradoxical dizziness.
tid sedation, ataxia. neonatal withdrawal excitement,  Do not use alcohol,
syndrome), labor and hallucinations. CV: other CNS
delivery (“floppy Tachycardia, depressants, or OTC
infant” syndrome), hypotension, ECG medications
lactation (secreted in changes. Special containing
breast milk; infants Senses: Blurred antihistamines (e.g.,
become lethargic and vision. Respiratory: sleep aids, cold, hay
PUROC, LIZA M.
lose weight). Dyspnea. fever, or allergy
remedies) without
consulting physician.
 Do not drive or
engage in potentially
until response to drug
is known.
 Taper dosage
following continuous
use; abrupt
discontinuation of
drug may cause
withdrawal
symptoms: nausea,
vomiting, abdominal
and muscle cramps,
sweating, confusion,
tremors, convulsions.

PRECAUTIONS
 Generic Benzodiazepine Relief of various Hypersensitivity to Body as a  Monitor for S&S of
name derivative. Acts on anxiety and tension chlordiazepoxide and Whole: Edema, pain orthostatic
Chlordiazepoxide the limbic, thalamic, states, preoperative other in injection site, hypotension and
and hypothalamic apprehension and benzodiazepines; jaundice, tachycardia, which
 Brand name areas of the CNS. anxiety, and for narrow angle hiccups, respiratory occur more frequently
Librium Has long-acting management of glaucoma, prostatic depression. CV: Ort with parenteral
hypnotic properties. alcohol withdrawal. hypertrophy, shock, hostatic administration.
 Classificatio Causes mild comatose states, hypotension, Patient should stay
n suppression of REM primary depressive tachycardia, recumbent 2–3 h
ANXIOLYTIC; SE sleep and of deeper disorder or changes in ECG after IM or IV
DATIVE- phases, particularly psychoses, patterns seen with injection; observe
HYPNOTIC; BEN stage 4, while pregnancy (category rapid IV closely and monitor
ZODIAZEPINE increasing total sleep D), lactation, oral administration. GI: vital signs.
time. use in children <6 y, Nausea, dry mouth,  Check BP and pulse
 Dosage/ parenteral use in vomiting, before giving
Route/frequen children <12 y, acute constipation, benzodiazepine in
cy alcohol intoxication. increased early part of therapy.
PUROC, LIZA M.
PO 20–25 mg appetite. CNS: Dro If blood pressure falls
t.i.d. or wsiness, dizziness, l 20 mm Hg or more or
q.i.d. IM/IV 50– ethargy, changes in if pulse rate is above
100 mg, then EEG pattern; vivid 120 bpm, delay
25–50 mg t.i.d. dreams, medication and
or q.i.d. nightmares, consult physician.
headache, vertigo,  Lab tests: Periodic
syncope, tinnitus, blood cell counts and
confusion, liver function tests are
hallucinations, recommended during
parodoxic rage, prolonged therapy.
depression,  Monitor for S&S of
delirium, agranulocytosis: sore
ataxia. Skin: Photos throat or mouth,
ensitivity, skin upper respiratory
rash. Urogenital: Ur infection, fever, and
inary frequency. malaise. Total and
differential WBC
counts should be
ordered immediately,
and protective
isolation instituted.
 Monitor I&O until drug
dosage is stabilized.
Report changes in
I&O ratio and dysuria
to physician.
Cumulative
(overdosage) effects
can result in renal
dysfunction. Older
adults are especially
vulnerable.
 Monitor for S&S of
paradoxic reactions—
excitement,
stimulation, disturbed
sleep patterns, acute
rage—which may
occur during first few
weeks of therapy in
psychiatric patients
and in hyperactive
PUROC, LIZA M.
and aggressive
children receiving
chlordiazepoxide.
Withhold drug and
report to physician.
 Assess patient's sleep
pattern. If dreams or
nightmares interfere
with rest, notify
physician. A change in
the dosing schedule,
dose, or an alternate
drug may be
prescribed.
 Abrupt
discontinuation of
drug in patients
receiving high doses
for long periods ( 4
mo) has precipitated
withdrawal
symptoms, but not for
at least 5–7 d
because of slow
elimination.

PRECAUTIONS
 Generic Clonazepam is an Used alone or as Hypersensitivity to Drowsiness, fatigue,  Monitor addiction-
name effective adjunct in treatment benzodiazepines, muscular prone patients
Clobazepam anticonvulsant. It of Lennox-Gastaut acute pulmonary hypotonia, carefully because of
raises the threshold syndrome (petit mal insufficiency, acute coordination their predisposition to
 Brand name for propagation of variant), akinetic and narrow angle disturbances, habituation and drug
Onfi seizure activity and myoclonic seizures; glaucoma. dizziness, vertigo, dependence.
prevents may be useful in anorexia, visual  Monitor liver function
 Classificatio generalization of patients with absence disturbances, libido and blood counts
n focal or local activity. (petit mal) seizures changes. periodically in
ANTICONVULSA Clinically, it improves who have not Potentially patients on long-term
NT; BENZODIAZ focal epilepsy and responded to Fatal: Salivary or therapy.
EPINE generalized seizures. succinimides bronchial  WARNING: Taper
It is also believed to hypersecretion dosage gradually after
PUROC, LIZA M.
 Dosage/ enhance the activity leading to long-term therapy,
Route/frequen of GABA, and acts as respiratory especially in patients
cy anxiolytic. problems (children). with epilepsy;
0.01–0.03 May produce substitute another
mg/kg/day PO; diminished reflexes antiepileptic.
do not exceed or coma. Rarely,  Monitor patient for
0.05 mg/kg/day blood dyscrasias therapeutic drug
PO, given in two levels: 20–80 ng/mL.
or three doses  If the patient has
epilepsy, arrange for
patient to wear
medical alert
identification
indicating patient has
epilepsy and is
receiving drug
therapy

PRECAUTIONS
 Generic Diazepam is a long- Management of Hypersensitivity; Body as a  Monitor for adverse
name acting anxiety disorders or preexisting CNS Whole: Throat and reactions. Most are
Diazepam benzodiazepine with for short-term relief of depression or coma, chest dose related.
anticonvulsant, symptoms of anxiety respiratory pain. CNS: Drowsin Physician will rely on
 Brand name anxiolytic, sedative, depression; acute ess, fatigue, ataxia, accurate observation
Valium muscle relaxant and pulmonary confusion, and reports of patient
amnestic properties. insufficiency or sleep paradoxic rage, response to the drug
 Classificatio It increases neuronal apnoea; severe dizziness, vertigo, to determine lowest
n membrane hepatic impairment; amnesia, vivid effective maintenance
Benzodiazepine, permeability to acute narrow angle dreams, headache, dose.
Anxiolytic, Antie chloride ions by glaucoma; children < slurred speech,  Monitor for
pileptic binding to 6 mth; pregnancy tremor; EEG therapeutic
stereospecific and lactation. changes, tardive effectiveness.
 Dosage/ benzodiazepine dyskinesia. CV: Hyp Maximum effect may
Route/frequen receptors on the otension, require 1–2 wk;
cy postsynaptic GABA tachycardia, patient tolerance to
PO 2–10 mg neuron within the edema, cardiovascu therapeutic effects
b.i.d. to q.i.d. or CNS and enhancing lar collapse. Special may develop after 4
PUROC, LIZA M.
15–30 mg/d the GABA inhibitory Senses: Blurred wk of treatment.
sustained effects resulting in vision, diplopia,  Observe necessary
release IV/IM 2– hyperpolarisation and nystagmus. GI: Xer preventive
10 mg, repeat if stabilisation. ostomia, nausea, precautions for
needed in 3–4 h constipation, suicidal tendencies
hepatic that may be present
dysfunction. Urogen in anxiety states
ital: Incontinence, accompanied by
urinary retention, depression.
gynecomastia  Observe patient
(prolonged use), closely and monitor
menstrual vital signs when
irregularities, diazepam is given
ovulation parenterally;
failure. Respiratory: hypotension,
Hiccups, muscular weakness,
coughing, laryngosp tachycardia, and
asm. Other: Pain, respiratory depression
venous thrombosis, may occur.
phlebitis at injection  Lab tests: Periodic
site. CBC and liver function
tests during
prolonged therapy.
 Supervise ambulation.
Adverse reactions
such as drowsiness
and ataxia are more
likely to occur in older
adults and debilitated
or those receiving
larger doses. Dosage
adjustment may be
necessary.
 Monitor I&O ratio,
including urinary and
bowel elimination.
 Note: Smoking
increases metabolism
of diazepam; lowering
clinical effectiveness.
Heavy smokers may
need a higher dose
than the nonsmoker.
PUROC, LIZA M.
 Note: Psychic and
physical dependence
may occur in patients
on long-term high
dosage therapy, in
those with histories of
alcohol or drug
addiction, or in those
who self-medicate.

PRECAUTIONS
 Generic Benzodiazepine Hypnotic in Prolonged CNS: Residual  Monitor effectiveness.
name derivative, with management of all administration; sleep sedation, Hypnotic effect is
Flurazepam hypnotic activity kinds of insomnia apnea; intermittent drowsiness, light- apparent on second or
equal to or greater (e.g., difficulty in porphyria; acute headedness, third night of
 Brand name than that produced falling asleep, frequent narrow-angle dizziness, ataxia, consecutive use and
Dalmane by barbiturates or nocturnal awakening glaucoma; children headache, continues 1–2 nights
chloral hydrate. Mode or early morning <15 y; pregnancy nervousness, after drug is stopped
 Classificatio and site of action not awakening or both). (category X), apprehension, (drug has a long half-
n known; appears to Also for treatment of lactation. talkativeness, life).
ANXIOLYTIC; SE act at limbic and poor sleeping habits. irritability,  Supervise ambulation.
DATIVE- subcortical levels of depression, Residual sedation and
HYPNOTIC; BEN CNS to produce hallucinations, drowsiness are
ZODIAZEPINE sedation, skeletal nightmares, relatively common.
muscle relaxation, confusion, Excessive drowsiness,
 Dosage/ and anticonvulsant paradoxic reactions: ataxia, vertigo, and
Route/frequen effects. excitement, falling occur more
cy euphoria, frequently in older
PO 15 y, 15–30 hyperactivity, adults or debilitated
mg h.s. disorientation, com patients.
a (overdosage). Sp  Monitor drug
ecial ingestion if patient
Senses: Blurred has a history of drug
vision, burning abuse. Prolonged use
eyes. GI: Heartburn of large doses can
, nausea, vomiting, result in psychic and
diarrhea, abdominal physical dependence.
pain. Body as a  Lab tests: Obtain
PUROC, LIZA M.
Whole: Immediate blood counts and liver
allergic reaction, and kidney function
hypotension, with repeated use.
granulocytopenia  Be aware that
(rare), jaundice withdrawal symptoms
(rare). have occurred 3 d
after abrupt
discontinuation after
prolonged use and
include worsening of
insomnia, dizziness,
blurred vision,
anorexia, GI upset,
nasal congestion,
paresthesias.

DrUG STUDY PSYCHE

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

DrUG STUDY PSYCHE

Uploaded by

Copyright:

Available Formats

PUROC, LIZA M.

3. Anti-anxiety drugs (anxiolytics)

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

b. Selective serotonin reuptake inhibitors (SSRI)

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

c. Monoamine oxidase inhibitors (MAOI)

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

3. Anti-anxiety drugs (anxiolytics)

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

DRUG NAME MECHANISM OF INDICATIONS CONTRAINDICATI ADVERSE NURSING

You might also like