DRUGS NAME Generic Name: Maprotiline hydrochloride Brand Name: Ludiomil

Classification: Antidepressa nts

MECHANISM OF ACTION The mechanism of action of Maprotiline is not precisely known. It does not act primarily by stimulation of the central nervous system and is not a monoamine oxidase inhibitor. The postulated mechanism of Maprotiline is that it acts primarily by potentiation of central adrenergic synapses by blocking reuptake of norepinephrine at nerve endings. This pharmacologic action is thought to be responsible for the drug's antidepressant and anxiolytic effects.

ADMINISTRATIO N Adult: PO 25-75 mg/day in 3 divided doses, up to 150 mg/day if needed. Severe: Up to 225 mg/day.

INDICATION Maprotiline hydrochloride tablets are indicated for the treatment of depressive illness in patients with depressive neurosis (dysthymic disorder) and manic depressive illness, depressed type (major depressive disorder). Maprotiline is also effective for the relief of anxiety associated with depression.

CONTRAINDICATION Maprotiline hydrochloride tablets are contraindicated in patients hypersensitive to Maprotiline and in patients with known or suspected seizure disorders. It should not be given concomitantly with monoamine oxidase (MAO) inhibitors. A minimum of 14 days should be allowed to elapse after discontinuation of MAO inhibitors before treatment with Maprotiline is initiated. Effects should be monitored with gradual increase in dosage until optimum response is achieved. The drug is not recommended for use during the acute phase of myocardial infarction.

ADVERSE EFFECT Dry mouth, constipation, blurred vision, drowsiness, dizziness, tremor, nervousness, anxiety, insomnia, agitation, confusion, nausea, weakness and fatigue, headache, CV disorders, altered liver function, changes in blood glucose concentrations , allergic skin manifestations . Potentially Fatal: Seizures

NURSING RESPONSIBILITIES carefully monitor patients receiving antidepressants for possible and/or persistent worsening of depression or emergent suicidality, especially at the beginning of therapy or when the dose either increases or decreases. instruct patients, their families and their caregivers to be alert for the emergence of agitation, irritability, and the other symptoms described above, as well as the emergence of suicidality and worsening depression, and to report such symptoms immediately to their health care provider. patients should be adequately screened to determine if they are at risk for bipolar disorder before initiating antidepressant treatment so that they can be appropriately monitored during treatment. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

DRUGS NAME Generic Name: selegiline Brand Name: Eldepryl, Zelapar

MECHANISM OF ACTION Selegiline hydrochloride is a levorotatory acetylenic derivative of phenethylamin e. It is commonly referred to in the clinical and pharmacologic al literature as l-deprenyl. The chemical name is: (R)(-)- N,2dimethyl- N -2propynylphenet hylamine hydrochloride. It is a white to near white crystalline powder, freely soluble in water, chloroform, and methanol, and has a molecular weight of 223.75. The molecular formula is C13H17HCl.

ADMINISTRATIO N The recommended regimen for the administration of Selegiline Hydrochloride Tablets USP is 10 mg per day administered as divided doses of 5 mg each taken at breakfast and lunch. Ther

INDICATION Indicated as an adjunct in the management of Parkinsonian patients being treated with levodopa/carbid opa who exhibit deterioration in the quality of their response to this therapy. There is no evidence from controlled studies that selegiline has any beneficial effect in the absence of concurrent levodopa therapy.

CONTRAINDICATION Selegiline is contraindicated in patients with a known hypersensitivity to this drug. Selegiline is contraindicated for use with meperidine (DEMEROL & other trade names). This contraindication is often extended to other opioids

ADVERSE EFFECT nausea, hallucinations, confusion, depression, loss of balance, insomnia, orthostatic hypotension, increased akinetic involuntary movements, agitation, arrhythmia, bradykinesia, chorea, delusions, hypertension, new or increased angina pectoris, and syncope.

NURSING RESPONSIBILITIES patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of therapy, or at times of dose changes, either increases or decreases. Selegiline transdermal system is contraindicated for use in patients with pheochromocytoma. Consideration should be given to changing the therapeutic regimen, including possible discontinuing the drug, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Families and caregivers being treated with antidepressants for MDD or other indications, both psychiatric and nonpsychiatric, should be made aware about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms

DRUGS NAME Generic name: Tranylcyprom ine sulfate Brand name: Parnate

MECHANISM OF ACTION Tranylcypromin e is a nonhydrazine monoamine oxidase inhibitor with a rapid onset of activity. It increases the concentration of epinephrine, norepinephrine , and serotonin in storage sites throughout the nervous system and, in theory, this increased concentration of monoamines in the brain stem is the basis for its antidepressant activity. When Tranylcypromin e is withdrawn, monoamine oxidase activity is recovered in 3 to 5 days, although the drug is excreted in 24 hours.

ADMINISTRATIO N Initial dose: 10 mg orally twice a day Maintenance dose: Usually 30 mg/day in divided doses is effective; however, dosage should be adjusted to individual needs

INDICATION For the treatment of Major Depressive Episode Without Melancholia. Tranylcypromin e sulfate should be used in adult patients who can be closely supervised. It should rarely be the first antidepressant drug given. Rather, the drug is suited for patients who have failed to respond to the drugs more commonly administered for depression.

CONTRAINDICATION Tranylcypromine sulfate should not be administered in combination with any of the following: MAO inhibitors or dibenzazepine derivatives; sympathomimetic s (including amphetamines); some central nervous system depressants (including narcotics and alcohol); antihypertensive, diuretic, antihistaminic, sedative, or anesthetic drugs; bupropion HCl; buspirone HCI; dextromethorpha n; cheese or other foods with a high tyramine content; or excessive quantities of caffeine.

ADVERSE EFFECT Overstimul ation which may include increased anxiety, agitation, and manic symptoms is usually evidence of excessive therapeuti c action. Dosage should be reduced, or a phenothiaz ine tranquilize r should be administer ed concomita ntly.

NURSING RESPONSIBILITIES

Take drug exactly as prescribed; do not stop taking drug (long-term therapy) without consulting health care provider.

Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, palpitations, edema of the extremities; visual changes; difficulty voiding

Patients should be adequately screened to determine if they are at risk for bipolar disorder prior to initiating therapy

Tranylcypromine is contraindicated in patients undergoing elective surgery. Elective surgery requiring general anesthesia is not recommended during treatment with tranylcypromine.

DRUGS NAME Generic name: phenelzine Brand name: Nardil Classification:

MECHANISM OF ACTION Phenelzine is a monoamine oxidase inhibitor (MAOI) that works by increasing the levels of certain chemicals in the brain. Phenelzine is used to treat symptoms of depression that may include feelings of sadness, fear, anxiety, or worry about physical health (hypochondria) . This medication is usually given after other antidepressants have been tried without successful treatment of symptoms. Phenelzine is not for treating severe depression or bipolar disorder (manic depression).

ADMINISTRATIO N Initial dose: 15 mg orally 3 times daily. Maintenance dose: Dosage should be increased to at least 60 mg daily and in some cases 90 mg daily will be required to obtain sufficient MAO inhibition. After maximum benefit has been achieved, the dose may be reduced slowly over several weeks to 15 mg daily or every other day.

INDICATION NARDIL (phenelzine) has been found to be effective in depressed patients clinically characterized as atypical, nonendogenou s, or neurotic. These patients often have mixed anxiety a nd depression a nd phobic or hypochondriacal features. There is less conclusive evidence of its usefulness with severely depressed patients with endogenou s features. NARDIL (phenelzine) should rarely be the first antidepress ant drug used. Rather, it is more suitable for use with patients who have failed to respond to the drugs more commonly used

CONTRAINDICATION should not be used in patients who are hypersensitive to the drug or its ingredients, with pheochromocyto ma, congestive heart failure, severe renal imp airment or renal disease, a history of liver disease, or abnormal liver function tests.

ADVERSE EFFECT

NURSING RESPONSIBILITIES Blood pressure should be monitored regularly to detect changes in pressor response, if hypertensive crisis occurs therapy should be discontinued immediately. If palpitations or frequent headaches occur during therapy, phenelzine should be discontinued immediately. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. The risk of suicidality appears to be greatest during the first few months of treatment, or when there is a dosage change. Families and caregivers should be advised to closely observe the patient and to communicate with the prescriber.

-sudden and severe headache, rapid heartbeat, stiffness in your neck, nausea, vomiting, cold sweat, sweating, vision problems, sensitivity to light; -chest pain, fast or slow heart rate; -swelling, rapid weight gain; -agitation, unusual thoughts or behavior; or -feeling lightheaded, fainting.

Safety and efficacy in children younger than 16 years old have not been established.

Drug Name

Mechanism of actions Unknown. A tricylic antidepressant that increases the amount of norepinephrine, serotonin or both in the CNS by blocking their reuptake by the presynaptic neurons.

Administratio n

Indication

Contraindication

Brand Name: Elavil Generic Name: Amitriptyline

Injection: 10mg/ml Tablets:10mg, 25mg, 50mg, 75mg, 100mg, 150mg.

-Depression Adults: Initially 50-100mg P.O. hs, increasing to 150mg daily. Maximum 300mg daily, if needed. Maintenance 50-100mg daily. Or 20-30mg I.M. qid Elderly patient and adolescents: 10mg P.O. t.i.d. and 20mg h.s daily.

Contraindicated with patients hypersensitive to drug and in those who have received an MAO inhibitor within the past 14 days. -Contraindicated during acute recovery phase of MI.

Adverse Effect CNS: ataxia, tremor, peripheral neurophaty, anxiety, insomnia, restlessness, drowsiness, dizziness, weakness, fatigue, headache, extrapyramida l reactions, coma, seizures, stroke, hallucination, delusion, disorientation. EENT: blurred vision, tinnitus, mydriasis, increase intraocular pressure. GI: Dry mouth , nausea, vomiting, anorexia, epigastric pain, diarrhea, constipation, paralytic ileus.

Nursing Responsibility -Alert:Parenteral form of drug is for I.M. administration only. Drug shouldnt be given I.V. -Amitriptyline has strong anticholinergic effect and is one of the most sedating tricyclic antidepressants. -if signs and symptoms of psychosis occur or increase, expect prescriber to reduce dosage. Record mood changes. Monitor patients to suicidal tendencies and allow only minimum supply of drug.

Drug Name

Mechanism of Action CLASSIFICAT ION Antipsychotics

Administration Dosage: -0.5mg/day, 1mg/day, 2mg/day, 5mg/day, 10mg/day Route: - Oral Frequency: -Once a day

Indication Organic Psychoses acute psychotic symptoms Relieve hallucinations, delusions, disorganized thinking severe anxiety seizures

Contraindication seizure disorder glaucoma elderly clients

Adverse Effect CNS: extrapyramida l symptom such as muscle rigidity or spasm, shuffling gait, posture leaning forward, drooling, masklike facial appearance, dysphagia, akathisia, tardive dyskinesia, headache, seizures. CV: tachycardia, arrhythmias, hypertension, orthostatic hypertension. EENT: blurred vision, glaucoma GI: dry mouth, anorexia, nausea, vomiting, constipation, diarrhea,

Nursing Responsibilities Assess mental status prior to and periodically during therapy. Monitor BP and pulse prior to and frequently during the period of dosage adjustment. Observe patient carefully when administering medication, to ensure that medication is actually taken and not hoarded. Monitor I&O ratios and daily eight. Assess patient for signs and symptoms of dehydration.

Generic name: Haloperidol Brand name: Haldol

ACTION: Alters the effects of dopamine in the CNS Also has anticholinergic and alphaadrenergic blocking activity. Diminished sig ns and symptoms of psychoses

weight gain. GU: urinary frequency, urine retention, impotence, enuresis, amenorrhea, gynecomastia Hematologic: anemia, leucopenia, agranulocytosi s Skin: rash, dermatitis

Drug Name

Mechanism of Action

Administration

Indication

Contraindication

Adverse Effect

Nursing Responsibilities Assess mental status prior to and periodically during therapy. Monitor BP and pulse prior to and frequently during the period of dosage adjustment. Observe patient carefully when administering medication, to ensure that medication is actually taken and not hoarded.

Generic name: Molindone

CLASSIFICAT ION Antipsychotics ACTION: MOBAN (molindone hydrochloride) is a dihydroindolo ne compound which is not structurally related to the phenothiazine s, the butyrophenon es or the thioxanthenes .

Brand name: Moban

Dosage: 1. Mild-5 mg-15 mg three or four times a day. 2. Moderate-10 mg-25 mg three or four times a day. 3. Severe-225 mg/day may be required. Route: - Oral Frequency: -Mild and Moderate- three or four times a day - Severe- Once a day

MOBAN is indicated for the management of schizophrenia. The efficacy of MOBAN in schizophrenia was established in clinical studies which enrolled newly hospitalized and chronically hospitalized, acutely ill, schizophrenic patients as subjects.

MOBAN is contraindicated in severe central nervous system depression (alcohol, barbiturates, narcotics, etc.) or comatose states, and in patients with known hypersensitivity to the drug.

Constipation; drowsiness; dry mouth; increased saliva production; nausea; restlessness.

Drug Name

Mechanism of Action CLASSIFICAT ION Antipsychotic ACTION: Loxapine is a tranquilizer f or which the exact mode of action has not been established. However, changes in the level of excitability of subcortical inhibitory areas have been observed in several animal species in association with such manifestations of tranquilization as calming effects and suppression of aggressive behavior.

Administration Dosage: -10 mg, 15 mg, 25 mg, 50 mg Route: -Oral Frequency: -twice a day

Indication Loxitane(loxapin e) is indicated for the management of the manifestations of psychotic disorders. The antipsychoti c efficacy of Loxiyane (loxapine) was established in clinical studies which enrolled newly hospitalized and chronically hospitalized acutely ill schizophrenic patients as subjects.

Contraindication Loxitane (loxapine) is contraindicated in comatose or severe drug-induced depressed states (alcohol, barbiturates, narcotics, etc.). Loxitane (loxapine) is contraindicated in individuals with known hypersensitivity to dibenzoxazepines.

Adverse Effect Constipation (severe) Difficult urination Inability to move eyes Muscle spasms especially of the neck and back Skin rash Sore Throat and fever Increased spasms of the eyelids

Nursing Responsibilities Monitor BP and pulse prior to and frequently during the period of dosage adjustment. Assess mental status prior to and periodically during therapy. Monitor I&O ratios and daily eight. Assess patient for signs and symptoms of dehydration.

Generic name: Loxapine

Brand name: Loxitane

Drug Name

Mechanism of Action CLASSIFICATION: Antipsychotic

Administratio n Dosage: 1.Mild- 2 mg three times daily 2.Severe- 5 mg twice daily Route: Oral

Indication Navane (thiothixene hcl) is effective in the management of schizophrenia. Navane (thiothixene hcl) has not been evaluated in the management of behavioral complications in patients with mental retardation.

Contraindication Navane (thiothixene hcl) is contraindicated in patients with circulatory collapse, comatose states, central nervous system depression due to any cause, and blood dyscrasias. It is also contraindicated in individuals who have shown hypersensitivity to the drug. It is not known whether there is a cross sensitivity between the thioxanthenes and the phenothiazine derivatives, but this possibility should be considered.

Adverse Effect -very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, feeling like you might pass out -restless muscle movements in your eyes, tongue, jaw, or neck -tremor (uncontrolled shaking) -difficulty in swallowing

Nursing Responsibilities Monitor BP and pulse prior to and frequently during the period of dosage adjustment. Assess mental status prior to and periodically during therapy. Monitor I&O ratios and daily eight. Assess patient for signs and symptoms of dehydration.

Generic name: Thiothixene

Brand name: Navane

ACTION: Navane (thiothixene hcl) is an antipsychotic of the thioxanthene series. Navane (thiothixene hcl) possesses certain chemical and pharmacological similarities to the piperazine phenothiazines and differences from the aliphatic group of phenothiazines.

Frequency: 1.Mild- three times daily 2.Severetwice daily

Drug Name

Mechanism of Action CLASSIFICATION: Antipsychotic

Administratio n Dosage: -8 to 16 mg Route: -Oral Frequency: -Three to four times a day

Indication Perphenazine is indicated for use in the treatment of schizophrenia; and for the control of severe nausea and vomiting in adults.

Contraindication Perphenazine products are contraindicated in comatose or greatly obtunded patients and in patients receiving large doses of central nervous system depressants (barbiturates, alcohol, narcotics, analgesics, or antihistamines); in the presence of existing blood dyscrasias, bone marrow depression, or liver damage; and in patients who have shown hypersensitivity to perphenazine tablets, their components, or related compounds.

Generic name: Perphenazine

Brand name: Trilafon

ACTION: Perphenazine has actions at all levels of the central nervous system, particularly the hypothalamus. However, the site and mechanism of action of therapeutic effect are not known.

Adverse Effect Appetite loss; blurred vision; confusion; constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; nasal congestion; nausea; sleeplessness ; tired feeling; vomiting.

Nursing Responsibilities Assess mental status prior to and periodically during therapy. Monitor BP and pulse prior to and frequently during the period of dosage adjustment. Observe patient carefully when administering medication, to ensure that medication is actually taken and not hoarded. Monitor I&O ratios and daily eight. Assess patient for signs and symptoms of dehydration.

DRUG NAME GENERIC NAME: Aripiprazole BRAND NAME: Abilify

MECHANISM OF ACTION Antipsychotic Partial agonist at dopamine D2 and serotonin 5-HT 1A receptors, and antagonist at serotonin 5-HT 2A receptor

ADMINISTRAT ION Dose: 10 or 15 mg Route: PO Frequency OD

INDICATION Treatment of schizophrenia; treatment of acute manic and mixed episodes associated with bipolar disorder.

CONTRAINDICATION C/I in: Hypersensitivity OB: lactation Use cautiously in: -known cardiovascular or cerebrovascular disease -Conditions which cause hypotension (dehydration, treatment with antihypertensives or diuretics)

ADVERSE EFFECT CV: HPN, tachycardia, hypotension, bradycardia CNS: Headache, anxiety, agitation, insomnia, akathisia, somnolence, lightheadedn ess GI: constipation

NURSING RESPONSIBILITIES -Assess patients mental status before and periodically during therapy. -Monitor blood pressure (sitting, standing, lying), pulse, and respiratory rate before and periodically during therapy -Monitor for development of neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status, respiratory distress, tachycardia, seizures, diaphoresis, HPN or hypotension, pallor, tiredness, loss of bladder control). Notify physician immediately if these symptoms occur. -Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face and extremities; lim smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid

of=r worm-like movements of tongue). Notify physician if these symptoms occur, as these side effects may be irreversible.

DRUG NAME Generic Name: Clozapine Brand Name: Clozaril

MECHANISM OF ACTION Antipsychotic

ADMINISTRAT ION Dose: 300 900 mg. Route: PO Frequency: OD

INDICATION Management of severely and chronically mentally ill schizophrenic patients who have not responded to or cannot tolerate standard antipsychotic drug treatment; to reduce risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective

CONTRAINDICATION History of clozapine- induced agranulocytosis or severe granulocytopenia; myeloproliferative disorders; simultaneous administration with other agents known to cause bone marrow suppression; severe CNS depression or comatose states; uncontrolled epilepsy; hypersensitivity to

ADVERSE EFFECT CNS: neuroleptic malignant syndrome, seizures, dizzinss, sedation. CV: myocarditis, hypotension, tachycardia GI: constipation Hemat: agranulocytosi s, leukopenia.

NURSING RESPONSIBILITIES -Monitot patients mental status (delusions, hallucinations, and behavior) before and periodically during therapy. -Monitor for signs of myocarditis(unexplained fatigue, dyspnea, tachypnea, fever, chest pain, palpitations, other signs and symptoms of heart failure, ECG changes, such as ST-T wave abnormalities, arrhythmias, or tachycardia during the first month of therapy). If these occur, clozapine should be discontinued and not restarted.

Interferes with dopamine binding at D1, D2, D3 and D5 receptors in CNS; antagonizes adrenergic, cholinergic, histaminergic, and serotonergic neurotransmission.

disorder who are judged to be at chronic risk for re-experiencing suicidal behavior (except orally disintegrating tablets). DRUG NAME GENERIC NAME: Risperidone BRAND NAME: Risperdal MECHANISM OF ACTION Antipsychotic ADMINISTRAT ION Dose: 2-8 mg Route: PO Frequency: BID INDICATION Treatment of schizophrenia; short term treatment of acute manic or mixed episodes associated with bipolar disorder (oral only) as either monotherapy or adjunct therapy to lithium or valproate.

product.

-clozapine lowers the seizure threshold. Institute seizure precautions for patients with history of seizure disorder.

CONTRAINDICATION Hypersensitivity Use cautiously in Geriatric or debilitated patients, underlying cardiovascular disease, history of seizures, diabetes or risk factors for diabetes, pregnancy, lactation, or children.

ADVERSE EFFECT CNS: neuroleptic malignant syndrome, aggressive behavior, dizziness, extrapyramida l reactions, headache, increased dreams, increased sleep duration, insomnia, sedation. EENT: pharyngitis, rhinitis, visual disturbances. RESPI: cough GI: constipation, diarrhea, dry mouth, nausea

NURSING RESPONSIBILITIES --Monitot patients mental status (delusions, hallucinations, and behavior) before and periodically during therapy. -Monitor mood changes.Suicidal tendencies - Monitor for development of neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status, respiratory distress, tachycardia, seizures, diaphoresis, HPN or hypotension, pallor, tiredness, loss of bladder control). Notify physician immediately if these symptoms occur. -Advise patient to change positions slowly to minimize orthostatic hypotension.

Has antipsychotic effect, apparently caused by dopamine and serotonin receptor blocking in CNS

DRUG NAME

MECHANISM OF

ADMINISTRAT

INDICATION

CONTRAINDICATION

ADVERSE

NURSING RESPONSIBILITIES

ACTION GENERIC NAME: Olanzapine BRAND NAME: Zyprexa Antipsychotic

ION Dose: 5-15 mg Route: PO Frequency: OD Treatment of schizophrenia(or al); short-term treatment of acute mixed or manic episodes with bipolar disorder(oral); in combination with lithium or valproate for short-term treatment of acute episodes associated with bipolar disorder(oral); agitation associated with schizophrenia and bipolar I mania (IM). Hypersensitivity Lactation Use cautiously in: Patients with hepatic impairment, geriatric patients, cardiovascular or cerebrovascular disease

EFFECT CNS: neuroleptic malignant syndrome, seizures, agitation, dizziness, headache, restlessness, sedation, weakness CV: orthostatic hypotension, tachycardia GI: constipation, dry mouth Metab: wt. gain Neuro: tremor --Monitot patients mental status (delusions, hallucinations, and behavior) before and periodically during therapy. -Monitor BP, ECG, pulse and RR before and frequently during dose adjustment. -Assess fluid intake and bowel function. Increased bulk and fluids in the diet may help minimize constipation. -Monitor patient for onset of akathisia(restlessness or desire to keep moving) and estrapyramidal side effects (parkinsonian- difficulty speaking or swallowing, loss of balance, pill rolling, mask-like face, shuffling gait, rigidity, tremors) -Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face and extremities; lim smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid of=r worm-like movements of tongue). Notify physician if these symptoms occur, as these side effects may be irreversible.

Antagonizes dopamine and serotonin type 2 in the CNS.

DRUG NAME GENERIC NAME: Quetiapine Fumarate BRAND NAME: Seroquel

MECHANISM OF ACTION Antipsychotic

ADMINISTRAT ION Dose: 150-750 mg. Route: PO Frequency: Bid in divided doses

INDICATION

CONTRAINDICATION

ADVERSE EFFECT CNS: neuroleptic malignant syndrome, seizures, dizziness Metab: weight gain

NURSING RESPONSIBILITIES

Has antipsychotic effects, apparently caused by dopamine and receptor receptor blockade in the CNS

Treatment of schizoprhrenia; short-term treatment of acute manic episodes associated with bipolar disorder, as either monotherapy or adjunct therapy to lithium or divalproex

C/I in: Hypersensitivity Lactation Use cautiously in: -CVD, dehydration or hypovolemia -Hx of seizures, Alzheimers dementia or age >65 y/o -hepatic impairment -hypothyroidism (may be exacerbated) -Hx of suicide attempt -pregnancy or children

-Monitot patients mental status (delusions, hallucinations, and behavior) before and periodically during therapy. -Monitor BP(sitting, standing, lying) and pulse before and frequently during initial dose titration. -Monitor for development of neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status, respiratory distress, tachycardia, seizures, diaphoresis, HPN or hypotension, pallor, tiredness, loss of bladder control). Notify physician immediately if these symptoms occur. -Advise patient to change postions slowly to minimize orthostatic hypotension. -Advise patient to avoid extremes in temperature; this drug impairs body temp. regulation. -Assess fluid intake and bowel function. Increased bulk and fluids in the diet may help minimize constipation.

DRUG NAME GENERIC NAME: Ziprasidon e HCL BRAND NAME: Geodon

MECHANISM OF ACTION Antipsychotic Effects probably mediated by antagonism of dopamine type 2 (D2) and serotonin type 2 (5-Ht2). Also antagonizes alpha2 adrenergic receptors.

ADMINISTRATI ON Dose: 40-160 mg Route: PO Frequency: OD

INDICATION Treatment of schizophrenia; treatment of acute manic or mixed episodes associated with bipolar disorder; treatment of acute agitation in schizophrenic patients

CONTRAINDICATION -recent acute MI; uncompensated heart failure; known hypersensitivity to the product.

ADVERSE EFFECT CNS: neuroleptic malignant syndrome, dizziness, drowsiness, restlessness. CV: prolonged QT interval GI: constipation, diarrhea, nausea

NURSING RESPONSIBILITIES -Monitot patients mental status (delusions, hallucinations, and behavior) before and periodically during therapy. --Monitor BP(sitting, standing, lying) and pulse before and frequently during initial dose titration. -Patients who experience dizziness, palpitations, or syncope may require further evaluation. -Monitor patient for onset of akathisia(restlessness or desire to keep moving) and estrapyramidal side effects (parkinsonian- difficulty speaking or swallowing, loss of balance, pill rolling, mask-like face, shuffling gait, rigidity, tremors) -Monitor for development of neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status, respiratory distress, tachycardia, seizures, diaphoresis, HPN or hypotension, pallor, tiredness, loss of bladder control). Notify physician immediately if these symptoms occur.

DRUG NAME GENERIC NAME: Chlorprom azine BRAND NAME: Thyrazine

MECHANISM OF ACTION Antipsychotic -Alters the effects of dopamine in the CNS -Has significant anticholinergic / alphaadrenergic blocking activity

ADMINISTRATI ON Dose: 10-25 mg Route: PO Frequency: 2-4x daily

INDICATION -Acute chronic psychoses, particularly when accompanied by increased psychomotor activity -Nausea and vomiting -Intractable hiccups -Preoperative sedation -Treatment of acute intermittent porphyria.

CONTRAINDICATION -Hypersensitivity -Hypersensitivity to sulfites(injectables) or benzyl alcohol. -Cross-sensitivity with other phenothiazines may occur -Narrow-angle glaucoma -Bone marrow depression -Severe liver / cardiovascular disease

ADVERSE EFFECT CNS: neuroleptic malignant syndrome, sedation. EENT: blurred vision, dry eyes. CV: hypotension GI: constipation, dry mouth DERM: photosensitivit y Hemat: agranulocytosi s.

NURSING RESPONSIBILITIES -Monitot patients mental status (delusions, hallucinations, and behavior) before and periodically during therapy. -Monitor BP(sitting, standing, lying) and pulse before and frequently during initial dose titration. -Assess fluid intake and bowel function. Increased bulk and fluids in the diet may help minimize constipation. -Monitor patient for onset of akathisia(restlessness or desire to keep moving) and estrapyramidal side effects (parkinsonian- difficulty speaking or swallowing, loss of balance, pill rolling, mask-like face, shuffling gait, rigidity, tremors) -Monitor for development of neuroleptic malignant syndrome (fever, muscle rigidity, altered mental status, respiratory distress, tachycardia, seizures, diaphoresis, HPN or hypotension, pallor, tiredness, loss of bladder control). Notify physician immediately if these symptoms occur.

Drug Name Brand Name: Wellbutrin Generic Name: Bupropion

Mechanism of actions Unknown. Drug doesnt inhibit Mao but weakly inhibits norepinephrine , dopamine, serotonin reuptake. Noradrenergic or dopaminergic mechanism, or both may cause drugs effect.

Administrati on

Indication

Contraindication

Adverse Effect

Nursing Responsibility

Tablets (extendedrelease): 150mg, 300mg. Tablets (immediaterelease): 7mg, 100mg. Tablets (sustainedrelease): 100mg, 150mg, 200mg.

-Depression Adults: For immediaterelease initially 100mg P.O. b.i.d. increases after 3 days to 100mg P.O. b.i.d. if needed. if patient doesnt improve after several weeks of therapy, increase dosage to 15mg t.i.d. No single dose should exceed 150mg. Allow atleast 6 hours between successive doses. .

Contraindicated with patients hypersensitive to drug and in those who have received an MAO inhibitor within the past 14 days and in those with seizure disorders or history of bulimia or anorexia nervosa because of a higher risk of seizure. -Dont use with Zyban or other drugs containing bupropion that are used for smoking cessation. -contraindicated in patients abruptly stopping use of alcohol or sedatives (including benzodiazepines).

CNS: fever, headache,seiz ure, anxiety, confusion, delusions, euphoria, hostility, impaired sleep quality, insomnia, sedation, tremor, akinesia, agitation, dizziness, fatigue, syncope, suicidal behaviors. CV: hypertension, hypotension, palpitations, tachycardia, arrhythmias, chest pain. EENT: auditory disturbances, blurred vision, epistaxis,

-In switching patients from regular or sustained- release tablets to extended-release tablets, give the same total daily dose ( when possible) as the once-daily dosage provided. -Closely monitor patients with history of bipolar disorder. Antidepressants can cause manic episodes during the depressed phase of bipolar disorder. This may be less likely to occur with buprprion than with other antidepressant.

pharyngitis, sinusitis. Other:fever and chills.

DRUG NAME Generic Name: Buspirone

MECHANISM OF ACTION Classification: Anti-anxiety Mode of Action:

ADMINISTRATI ON Dosage: 5, 10, 15, and 30 mg

INDICATION Management of anxiety disorders or for the shortterm relief of the symptoms of anxiety Generalized anxiety of a limited or moderate degree

CONTRAINDICATION Contraindicated to patients hypertensive to Buspirone Contraindicated in patients with severe hepatic or severe renal impairment

ADVERSE EFFECTS Dizziness, nau sea, headache , nervousness, lightheadedne ss, excitement, and insomnia. Less frequent side effects include unsteady gait,diarrhea, excitement, w eakness,

NURSING RESPONSIBILITIES Monitor blood pressure as it may increase when interacting with other drugs. Instruct nursing mothers not to take drug as it is not known if the drug will be excreted in milk.

Brand Name: Buspar

Its mechanism of action is not clearly understood but may involve effects on neurotransmitters, chemicals that nerves use to communicate with one another.

Form: Tablet

Serotonin and dopamine are two of these neurotransmitters. Buspirone may work by stimulating serotonin type 1A receptors on nerves

hostility, skin rash, and tremors.

Drug Name

Mechanism of actions Unknown. A tricyclic antidepressant that inhibits reuptake of serotonin, and noepinephrine at the presynaptic neuron.

Administrati on

Indication

Contraindication

Adverse Effect

Nursing Responsibility

Brand Name: Anafranil Generic Name: clomipramine

Capsule:25mg, 50mg, 75mg.

-Obsessive compulsive disorder. -To manage panic disorder with orwitgout agoraphobia. -Depression,

Contraindicated with patients hypersensitive to drug or oyher tricyclic antidepressants, in those who have taken MAO inhibitors within previous 14 days and in patients in

CNS: Somnolence, tremor, dizziness, headache, insomnia, nervousness, mycolonus, fatigue, ECG changes,

-Monitor mood and watch for suicidal tendencies. Allow patients to have only minimal amount of drug. -Dont withdraw drug abruptly. Because patients using tricyclic antidepressant may suffer hypersentive episodes during surgery, stop drug

chronic pain. -Cataplexy and related narcolepsy.

acute recovery period after MI.

seizures. CV: orthostatic hypotension, palpitations, tachycardia. EENT: Pharyngitis, rhinitis, visual changes. GI: Dry mouth , nausea, vomiting, anorexia, abdominal pain, diarrhea, constipation, increased apetite.

gradually several days before surgery.

DRUG NAME

MECHANISM OF ACTION

ADMINISTRATI ON

INDICATION

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ADVERSE EFFECTS

NURSING RESPONSIBILITIES

Generic Name: Dextroamphe tamine Brand Name: Adderall

Amphetamine and dextroamphetamin e are used in combination to treat attentiondeficit hyperactivity disorder (ADHD) and narcole psy. Adderall stimulates the brain and also can increase blood pressure.

Adderall tablets: 5, 7.5, 10, 12.5, 20, and 30 mg. Adderall XR capsules: 5, 10, 15, 20, 25, and 30 mg.

Adderall is used for the treatment of attentiondeficit hyperactivity disorder (ADHD) and narcolepsy

Do not use during or within 14 days following the administration of MAO inhibitors; hypertensive crises may result. Do not use in patients with a history of drug abuse.

Nervousness, restlessness, excitability, di zziness, headache, fear, anxiety, tremo r, and even hallucinations and convulsions (seizures).

Mothers taking amphetamines such as Adderall should refrain from nursing their infants because these drugs are excreted in human milk and can have undesirable effects on the child. Monitor blood pressure for sudden decrease as it may lead to shock-like symptoms.

DRUG NAME Generic Name: Duloxetine Brand Name: Cymbalta

MECHANISM OF ACTION Duloxetine affects neurotransmitters, the chemicals that nerves within the brain make and release in order to communicate with one another. Neurotransmitters either travel across the space between nerves and attach to receptors on the surface of nearby nerves or they attach to receptors on the surface of the nerves that produced them, to be taken up by the nerve and released again

ADMINISTRATI ON Delayedrelease capsules: 20, 30, and 60 mg

INDICATION Duloxetine is used for the treatment of depression, generalized anxiety disorder, and pain associated with diabetic peripheral neuropathy or fibromyalgia.

CONTRAINDICATION Duloxetine should not be used in combination with a monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil) or within 14 days of discontinuing the MAOI. At least 5 days should be allowed after stopping duloxetine before starting an MAOI. Combinations of SNRIs and MAOIs may lead to serious, sometimes fatal, reactions including very high body temperature, muscle rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium, and coma.

ADVERSE EFFECTS Nausea, dry mouth, consti pation, diarrhe a, fatigue, difficulty sleeping, anddizziness. Increased blood pressure can occur and should be monitored.Sei zures have been reported. Sexual dysfunction (decreased sex drive and delayed orgasm and ejaculation) has been associated with duloxetine. Some patients may experience withdrawal

NURSING RESPONSIBILITIES Instruct nursing mothers not to take drug when breastfeeding as Nefazodone may be secreted in breast milk and may cause adverse effects in infants. Gradually reduce medication not abruptly to reduce side effects

reactions upon stopping duloxetine.

Drug Name

Mechanism of actions

Administrati on

Indication

Contraindication

Adverse Effect

Nursing Responsibility

Brand Name: Tofranil

Unknown. A tricyclic antidepressant that increases norepinephrine, serotonin or both in

Tablets: 10mg, 25mg, 50mg.

-Depression -Childhood enuresis

Contraindicated with patients hypersensitive to drug and in those receiving MAO inhibitors; also contraindicated during acute recovery phase of MI.

CNS: Stroke, drowsiness, dizziness, excitation, tremor, confusion, hallucination, anxiety, ataxia, paresthesia, nervousness CV: orthostatic hypotension, palpitations, tachycardia, precipitation of heart

-Monitor patients for nausea, headache and malaise after abrupt withdrawal of longterm theraphy: these symptoms dont indicate addiction.

Generic Name: Imipramine

the CNS by blocking their reuptake by the presynaptic neurons.

failure. EENT: blurred vision tinnitus, mydriasis. GI: Dry mouth, constipation, nausea, vomiting, anorexia, abdominal cramps. .

DRUG NAME Generic Name: Methylpenida te Brand Name: Ritalin

MECHANISM OF ACTION Methylphenidate belongs to the piperidine class of compounds and increases the levels of dopamine and no repinephrine in the brain through reuptake inhibition of the monoamine transporters. Methylphenidate (MPH) possesses structural similarities to amphetamine an

ADMINISTRATI ON Tablets: 5, 7.5, 10, 12.5, 20, and 30 mg.

INDICATION Treatment of att ention-deficit hyperactivity disorder, postura l orthostatic tachycardia syndrome, and narcolepsy. It may also be prescribed for off-label use in treatmentresistant cases of lethargy, depr ession, neural insult andobesity.

CONTRAINDICATION Methylphenidate should not be prescribed to patients who suffer from severe arrhythmia, hypertension or live r damage. It should not be prescribed to patients who demonstrate drugseeking behaviour, pronounced agitation or nervousness.

ADVERSE EFFECTS Abdominal pain Akathisia Alopecia Angina Appetite loss Anxiety Blood pressure and pulse changes

NURSING RESPONSIBILITIES Mothers taking drug should refrain from nursing their infants because these drugs are excreted in human milk and can have undesirable effects on the child. Special precaution is recommended in individuals with epilepsy with additional caution in individuals with uncontrolled epilepsy due to the potential for methylphenidate to lower the seizure threshold.

d its pharmacological effects are more similar to those of cocaine, though MPH is less potent and longer in duration of action.

(both up and down) Cardiac arrhythmia Diaphoresis (s weating) Dizziness Dyskinesia Dysphoria or Euphoria Headaches

Drug Name

Mechanism of actions

Administration

Indication

Contraindication

Adverse Effect

Nursing Responsibility

Brand Name: Remeron

Thought to be caused by enhancement of central noradrenergic and

Tablets: 15mg, 30mg, 45mg.

-Depression Adults: Initially,

Contraindicated with patients hypersensitive to drug within 14 days of MAO inhibitor therapy.

CNS: Somnolence, dizziness, asthenia, abnormal dreams. Abnormal

-Dont use within 14 days of MAO inhibitor therapy. - Record mood changes. Watch for suicidal tendencies. -Although agranulocytosis

Tablets: (orally disintegrating) 15mg, 30mg, 45mg.

15mg P.O. h.s. maintenance dose ranges from 15 5o 45mg

Generic Name:

serotonergic activity.

Mirtazapine daily. Adjust dosage at intervals of at least 1 week.

-Use cautiously in patients with CV or cerebrovascular disease, seizure disorder, suicidal thoughts, hepatic or renal impairment or history or mania or hypomania. thinking, tremors, confusion, suicidal behaviors. CV: edema, peripheral edema. GI: nausea, increased apetite, dry mouth, constipation. GU: urinary freaquency. Megain.tabolic : weight Respiratory: dyspnea. occurs rarely, stop drug and monitor patients closely if he develops a sore throat, fever, stomatitis or other signs and symptoms of infection with a low WBC count.

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MECHANISM OF ACTION

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INDICATION

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Generic Name: Nefadozone

Classification: Anti-depressant Mode of action:

Tablets: 50, 100, 150, 200, and 250 mg.

Nefazodone is used for the treatment of depression.

All antidepressants whose actions include increasing brain concentrations of serotonin, including nefazodone, should not be taken with any of the MAO (monoamine oxidase) inhibitor class of antidepressants, for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), procarbazine (Matulane), and selegiline (Eldepryl). Such combinations may lead to confusion, high blood pressure,tremor, and increased activity.

Nausea, dizzi ness, insomni a, agitation, tiredness, dry mouth,consti pation lightheadedn ess, blurred vision, and confusion.

Instruct nursing mothers not to take drug when breastfeeding as Nefazodone may be secreted in breast milk and may cause adverse effects in the nursing infan

Brand Name: Serzone

Nefazodone is an oral antidepressant drug that affects chemicals in the brain that nerves use to send messages to one another, The neurotransmitters that are released by nerves are taken up again by the nerves that release them for reuse.

Drug Name

Mechanism of actions

Administration

Indication

Contraindication

Adverse Effect

Nursing Responsibility

Brand Name: Desyrel

Unknown. Inhibits CNS neuronal uptake of serotonin; not a tricyclic

Tablets: 50mg, 100mg, 150mg, 300mg.

-Depression Adults: Initially, 150mg P.O. daily in divided doses; then increased by 50mg daily q 3 to 4 days p.r.n .Doses ranges from 150 to 400mg daily. Maximum 600mg daily for inpatients and 400mg daily for outpatient.

-Contraindicated with patients hypersensitive to drug -Use cautiously in patients with cardiac disease or in the initial recovery phase of MI and in patients at risk for suicide.

CNS: Drowsiness, dizziness, nervousness, fatigue, confusion, tremor, weakness, vivid dreams, hostility, anger, nightmares, headache, insomnia, syncope. CV: Orthostatic hypotension,

-Give drug after meals or a light snack for optimal absorption and to decreased risk of dizziness. -Record mood changes. Monitor patients for suicidal tendencies and allow only minimum supply of drugs.

Generic Name: trazodone

derivates.

tachycardia, hypertension, shortness of breath, ECG changes. GI: nausea, vomiting , dry mouth, anorexia, constipation. Skin: rash, urticaria, diaphoresis

DRUG NAME Generic Name: Venlafaxine

MECHANISM OF ACTION Classification: Anti-depressant Mode of action:

ADMINISTRATI ON Tablets of 25, 37.5, 50, 75, and 100 mg.

INDICATION Treatment of depression, depression with associated symptoms of anxiety, generalized

CONTRAINDICATION Contraindicated to patients hypertensive to venlafaxine.

ADVERSE EFFECTS Nausea, headaches, anxiety, insomnia, drowsiness, and loss of appetite.

NURSING RESPONSIBILITIES Monitor blood pressure. Therapy should not be stopped abruptly but gradually

Brand Name: Effexor

Venlafaxine is in a new class of antidepressant

Effexor XR is available in capsules of

medications that affects chemical messengers within the brain. These chemical messengers are called neurotransmitters, and some examples are serotonin, dopamine, and norepinephrine.

37.5, 75, and 150 mg.

anxiety disorder, and social anxiety disorder.

increased blood pressure

DRUG NAME Generic Name: Zolpidem Brand Name: Ambien

MECHANISM OF ACTION Zolpidem belongs to a class of drugs called sedatives or hypnotics. Zolpidem shares some characteristics of a family of sedatives called benzodiazepi nes. Benzodiazepines cause sedation, muscle relaxation, act as anticonvulsants (antiseizure medications), and reduce anxiety. Zolpidem has selectivity in that it has little of the muscle relaxant and anti-seizure effects and more of the sedative effect. Therefore, it is used primarily as a medication for sleep.

ADMINISTRATI ON Tablets: 5 and 10 mg.

INDICATION Insomnia associated with difficulty falling asleep or staying asleep

CONTRAINDICATION Ambien is contraindicated in patients with known hypersensitivity to zolpidem tartrate or to any of the inactive ingredients in the formulation

ADVERSE EFFECTS Drowsiness,di zziness, confusion, insomnia, euphoria, ataxia and visual changes. Zolpidem can cause withdrawal symptoms (muscle cramps, sweats, shaking, and seizures) when the drug is abruptly discontinued.

NURSING RESPONSIBILITIES Instruct patient not to drink alcoholic beverages as it may alter the effect of the drug Instruct nursing mothers not to take drug as it is known that the drug will be excreted in milk. Caution not to combine with other sedative drugs as it may increase adverse effects.

Tablet (extended release): 6.25 mg and 12.5 mg. Oral spray: 5 mg/spray

DRUG NAME Generic Name: Palperidone

MECHANISM OF ACTION Antipsychotic

ADMINISTRATI ON Dose: 6 mg Route:

INDICATION Acute and maintenance treatment of schizophrenia; acute treatment of schizoaffective disorder as monotherapy or as an adjunct to mood stabilizers and/or antidepressants (oral only)

CONTRAINDICATIO N Hypersensitivity to risperidone, paliperidone, or any component of the product.

ADVERSE EFFECTS Most common: *Tardive dyskinesia *High blood sugar and diabetes *Hyperprolactin emia *Fainting or lightheadednes s when standing up or sitting up too quickly.

NURSING RESPONSIBILITIES

Advise patient that drug may cause drowsiness or impaired judgment or thinking skills, and to use caution while driving, riding a bike, or performing other tasks requiring mental alertness until tolerance is determined.

Brand Name: Invega Extended release

Chemically, paliperidone is one of many active metabolites of the older atypical antipsychotic risperi done(paliperidone is 9hydroxyrisperidone, i.e. risperidone with an extra hydroxyl grou p).

PO Frequency: OD

Advise patient to get up slowly from a lying or sitting position and to avoid sudden position changes to prevent postural hypotension.

*Impairment of alertness and driving ability *Risk in people

Advise patient to avoid alcohol while taking paliperidone.

Advise patient to avoid strenuous activity

with a seizure disorder or a history or health conditions that make seizures more likely *Extrapyramida l effects -persistent movement disorders or muscle disturbances, such as restlessness, tremors, and muscle stiffness DRUG NAME Generic Name: Pemoline Brand Name: Cylert MECHANISM OF ACTION Pemoline and methylphenidate both have the ability to stimulate the brain, probably by affecting neurotransmitters, the chemicals in the brain that nerves use to communicate with ADMINISTRATI ON Tablets: 18.75 mg, 37.5 mg and 75 mg. Chewable tablet: 37.5 mg. INDICATION Is used as part of a treatment program for children with ADHD. CONTRAINDICATIO N Contraindicated to patients hypertensive to pemoline and methylpehenidate or any of its components. ADVERSE EFFECTS Insomnia, anorexia, tachycardia, rash aplastic anemia, abdominal discomfort, nausea and vomiting,

during periods of high temperature or humidity and to avoid overheating and dehydration.

NURSING RESPONSIBILITIES Pemoline may cause serious liver toxicity and/or failure. Blood tests should be done before and during treatment to monitor for liver toxicity Instruct nursing mothers not to take drug as it is not known if the drug passes through breast milk and its effects

each other. Although both drugs are considered stimulants, they have different effects on neurotransmitters in the brain. DRUG NAME Generic Name: Fluephenazi ne Brand Name: Prolixin MECHANISM OF ACTION ADMINISTRATI ON 12.5 mg of fluphenazine decanoate is roughly equivalent to 100 mg of zuclopenthi xol decanoate or 20 mg of flupentixol decanoate. INDICATION CONTRAINDICATIO N Contraindication : o Pregnancy o Nursing mothers o Hypersensit ivity o Myasthenia gravis, o Preexisting CNS depression or coma o respiratory depression; o acute pulmonary insufficiency o sleep apnoea syndrome; o severe hepatic impairment; o acute narrow angle glaucoma; ADVERSE EFFECTS Most common: o Drowsin ess o Fatigue o ataxia (loss of balance). o Seizure o Coma Rare O Muscle spasm O Confusi on O Depress ion O Speech problems O Double vision NURSING RESPONSIBILITIES

PROLIXIN is indicated in the management of manifestations of psychotic disorders.

Advise patient, family, or caregiver to notify health care provider of the following: excessive drowsiness, increased agitation or anxiety, involuntary body or facial movements. Advise patient to avoid strenuous activity during periods of high temperature or humidity Instruct patient to get up slowly from a lying or sitting position and to avoid sudden position changes to prevent postural hypotension. Advise patient to report dizziness with position changes to health care provider. Caution patient that hot tubs and hot showers or baths may make dizziness worse.

children <6 mth (oral)

DRUG NAME Generic Name: Mesoridazin e BESYLATE Brand Name: Serentil

MECHANISM OF ACTION Mesoridazine is a phenothiazine antipsychotic. It has a piperidine sidechain and is a metabolite of thioridazine. It acts by blocking postsynaptic CNS dopamine receptors.

ADMINISTRATI ON Adult: Initially, 25-50 mg tid. May adjust dose to 100400 mg according to response.

INDICATION Indicated to the management of schizophrenic patients who fail to respond adequately to treatment with other antipsychotic drugs. Due to the risk of significant potentially life threatening, proarrhytmic effects with Serentil treatment, Serentil should be used only in patients only who have failed to respond adequately to treatment with appropriate causes antipsychotic drugs.

CONTRAINDICATIO N Severe CNS depression and coma; prolonged QT interval (>450 msec), including congenital prolongation; history of arrhythmias. Lactation.

ADVERSE EFFECTS Most common: drowsin ess dry mouth nausea vomitin g diarrhea constipa tion restless ness headach e weight gain

NURSING RESPONSIBILITIES -Monitor orthostatic blood pressure 3-5 days after initiation of therapy. -Monitor tremors and gait changes. -Monitor Vital Signs -Monitor lipid profile and fasting blood glucose. -monitor target behaviors for which the agent is given; monitor hepatic function

DRUG NAME Generic Name: Trifluoperaz ine Brand Name:

MECHANISM OF ACTION Blocks postsynaptic mesolimbic dopaminergic D1 and D2 receptors in the brain; depresses the release of hypothalamic.

ADMINISTRATI ON Dose: 2-5 mg Route: PO Frequency: BID

INDICATION Indicated to Anxiety states: it controls excessive anxiety, tension and agitation seen in neuroses or associated with somatic conditions. he treatment or prevention of nausea and vomiting of various causes. The management of psychotic disorders, such as acute or chronic catatonic, hebephrenic and paranoid schizophrenia; psychosis due to organic brain

CONTRAINDICATIO N Trifluoperazine is contraindicated in CNS depression, coma, and blood dyscrasias. Trifluoperazine should be used with caution in patients suffering from renal or hepatic impairmen

ADVERSE EFFECTS Most common: drowsin ess dry mouth sedation postural hypoten sion akathisi a fatigue increase d prolacti

NURSING RESPONSIBILITIES -Monitor the urine output of the patient. -Monitor tremors and gait changes. -Monitor Vital Signs -Monitor hypersens Tivity of the patient.

damage, toxic psychosis, and the manic phase of manicdepressive illness.

n levels. restless ness dizzines s blurred vision

DRUG NAME Generic name: -citalopram hydrobomide

MECHANISM OF ACTION Classification: -antidepressant -SSRI

ADMINISTRATI ON Dosage: Adult:20 ml/day PO increase 40 ml/day less than 1 week interval

INDICATION -Treatment of depression, particularly effective in major depressive disorders -unlabeled uses: OCD, panic disorder, PMDD, social phobia trichotillomani, PTSD

CONTRAINDICATIO N -contraindicated with MAOI use; allergy to drug or any component of the drug or others SSRI ; concomitant use of pimozide.

ADVERSE EFFECTS CNS :somnolence ,dizziness insomnia , tremor , nervousness, headache , anxiety ,paresthesia , blurred vision CV:palpitation, vasodilation , orthostatic

NURSING RESPONSIBILITIES -Administer once a day , in the morning :may be taken with food if desired . -instruct patient using orally disintegrating -encourage patient to continue use for 4 6wk as desired. Establish appropriate safety precaution if patient experiences adverse CNS effect.

Brand name: -celexa

Mode of action: -potentiates serotonergic activity in the CNS by inhibiting neural reuptake of Route: -oral

-Use cautiously with renal or hepatic impairment , pregnancy, and

serotonin, resulting in antidepressant effect, with little effect in norepinephrine or dopamine reuptake

Frequency: -4 6 wks

lactation and in patient who are elderly or suicidal.

hypotension ,hypertension -DERM: sweating , rash , redness -GI: nausea , dry mouth, constipation diarrhea ,anorexia, flatulence , vomiting -GU :ejaculatory disoder

DRUG NAME Generic name: -escitalopram

MECHANISM OF ACTION Classification: -antidepressant -SSRI

ADMINISTRATI ON Dosage: -10 mg

INDICATION -treatment of major depressive disorder

CONTRAINDICATIO N contraindicated with MAOI,pimozide use; with allergy to

ADVERSE EFFECTS -somolence, dizziness ,insomnia

NURSING RESPONSIBILITIES -give once a day in the morning or in the evening -encourage to continue use for 4 -6wks , as directed to ensure

oxalate

Mode of action: Brand name: -lexapro -potentiates serotonergic act ivity in the CNS by inhibiting reaptake of serotonin resulting in anti depressant effect with little effect on norepinephrine or dopamine ; an insomer of citalopram Route: -oral

-maintenance treatment fo patient with major depressive disorder -treatment of generalized anxiety disorder -unlabled use; panic disorder.

drug or to citalopram or any component of the drug, -use cautiously in the elderly and with renal or hepatic impairment , illnesses of metabolism or hemodynamic response ,pregnancy ,lactation , suicidal patient , patients with mania or seizure disorders.

,fatigue , complex sleep disorder serotonin syndrome .

, adequate level to affect depression. -advice patient to avoid the use of alcohol while being treated with antidepressant drugs. - establish appropriate safety precaution if the patient experience s adverse CNS effect.

DRUG NAME

MECHANISM OF

ADMINISTRATI

INDICATION

CONTRAINDICATIO

ADVERSE

NURSING RESPONSIBILITIES

ACTION Generic name: -fluoxetine hydrochloride Classification: -antidepressant -SSRI

ON Dosage : -20 mg -treatment of depression; most effective in patient with major depressive disorder -treatment of OCD Route: -oral -treatment of bulimia -treatment of PMDD ( sarafem) -treatment of panic disorder with or without agoraphobia -unlabled use; raynauds phenomenon, borderline personality disorder.

N -containdicated with hypersensitivity to fluoxetine , pregnancy

EFFECTS -CNS: headache, nervousness , insomnia, drowsiness anxiety , tremor ,dizziness ,lightheadedness ,agitation, sedation abnormal gait ,seizure -Arrange the lower of less frequent does in elderly patient and patient with hepatic impairment . -administered drug in the morning . monitor patient for response to therapy for up to 4 wks before increasing dose .

Mode of action: -act as an antidepressant by inhibiting CNS neural uptake to serotonin; blocks uptake of serotonin with little effect with norepinephrine ; little affinity for muscarinic , histaminergic , and alpha , adrenergic receptors.

-us cautiously with impaired hepatic or renal function, diabetes mellitus , lactation seizure , history of suicide attempts.

Brand name: -prozac

DRUG NAME Generic name: -paroxetine mesylate

MECHANISM OF ACTION Classification: -antidepres-sant

ADMINISTRATI ON Dosage: -20 mg

INDICATION -treatment of major depressive disorder -treatment o COD -treatment of panic disorder -treatment of social anxiety disorder and generalize anxiety disorder -treatment of PTSD -treatment of PMDD -treatment of hot flushes , diabetic neuropathy.

CONTRAINDICATIO N contraindicated with use MAOI or thioridazine, - use cautiously in elderly patient with renal o hepatic impairment ,pregnancy ,lactation suicidal patient s.

ADVERSE EFFECTS -somnolence ,dizziness ,insomnia , tremors , nervousness , headache, anxiety, paresthesia , blurred vision.

NURSING RESPONSIBILITIES -administer once a day in the morning -shake suspension well before using -ensure that patient swallows CR tablets whole; do not cut crush or chew. -limit amount of drug given potentially suicidal patients . -abruptly discontinuing the drug may result in discontinuation symptoms (agitations, palpitations) ;consider tapering.

Route: Mode of action: Brand name: -paxil -potentiates serotonegic activity in the CNS, resulting in antidepressant effect . -oral