Nursing 1445: Psychiatric Medications

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Dalmane
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Benzodiazepine for sleep. Other uses anticonvulsant. Addictive potential. interfere with motor ability, attention, Judgment. Risk for falls, ataxia, and impaired reflexes.
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Restoril
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Benzodiazepine for sleep. Other uses anticonvulsant. Addictive potential. interfere with motor ability, attention, Judgment. Risk for falls, ataxia, and impaired reflexes.
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Halcion
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Benzodiazepine for sleep. Other uses anticonvulsant. Addictive potential. interfere with motor ability, attention, Judgment. Risk for falls, ataxia, and impaired reflexes.
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Ativan
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Benzodiazepine for anxiety. Other uses anticonvulsant. Addictive potential. interfere with motor ability, attention, Judgment. Risk for falls, ataxia, and impaired reflexes. Helps with agitation
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Valium
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Benzodiazepine for anxiety. Other uses anticonvulsant. Addictive potential. interfere with motor ability, attention, Judgment. Risk for falls, ataxia, and impaired reflexes.
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Xanax
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Benzodiazepine for anxiety. Other uses anticonvulsant. Addictive potential. interfere with motor ability, attention, Judgment. Risk for falls, ataxia, and impaired reflexes.
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Zolpidem (Ambien)
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Benzodiazepine/ Z-hypnotics for sleep. Quick onset, short half life, and can cause amnesia and ataxia.
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Zaleplon (Sonata)
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Benzodiazepine/ Z-hypnotics for sleep. Quick onset, short half life, and can cause amnesia and ataxia.
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Eszopiclone (Lunesta)
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Benzodiazepine/ Z-hypnotics for sleep. Quick onset, short half life, and can cause amnesia and ataxia.
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Buspar
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Reduces anxiety. No sedative hypnotic properties. No CNS depression. Not a controlled substance so reduced addiction. Takes six weeks to become effective.
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Elavil
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Tricyclic Antidepressant. Blocks reuptake of norepinephrine and serotonin. Second line antidepressant. Side effects: Blurred vision, dry mouth, tachycardia, urinary retention, constipation, drowsiness, sedation.
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Sinequan
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Tricyclic Antidepressant. Blocks reuptake of norepinephrine and serotonin. Second line antidepressant. Side effects: Blurred vision, dry mouth, tachycardia, urinary retention, constipation, drowsiness, sedation.
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Pamelor
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Tricyclic Antidepressant. Blocks reuptake of norepinephrine and serotonin. Second line antidepressant. Side effects: Blurred vision, dry mouth, tachycardia, urinary retention, constipation, drowsiness, sedation.
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Norpramin
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Tricyclic Antidepressant. Blocks reuptake of norepinephrine and serotonin. Second line antidepressant. Side effects: Blurred vision, dry mouth, tachycardia, urinary retention, constipation, drowsiness, sedation.
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Tofranil
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Tricyclic Antidepressant. Blocks reuptake of norepinephrine and serotonin. Second line antidepressant. Side effects: Blurred vision, dry mouth, tachycardia, urinary retention, constipation, drowsiness, sedation.
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Anafranil
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Tricyclic Antidepressant. Blocks reuptake of norepinephrine and serotonin. Second line antidepressant. Side effects: Blurred vision, dry mouth, tachycardia, urinary retention, constipation, drowsiness, sedation.
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Prozac
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(SSRI) Selective Serotonin Reuptake Inhibitor/ Antidepressant. First line. Only block Serotonin reuptake. Side effects: Blurred vision, dry mouth, Tachycardia, urinary retention, constipation, drowsines, sedation, nausea and vomiting, decreased orgasm/ libido. Take in morning
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Lexapro
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(SSRI) Selective Serotonin Reuptake Inhibitor/ Antidepressant. First line. Only block Serotonin reuptake. Side effects: Blurred vision, dry mouth, Tachycardia, urinary retention, constipation, drowsines, sedation, nausea and vomiting, decreased orgasm/ libido. Take in morning
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Celexa
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(SSRI) Selective Serotonin Reuptake Inhibitor/ Antidepressant. First line. Only block Serotonin reuptake. Side effects: Blurred vision, dry mouth, Tachycardia, urinary retention, constipation, drowsines, sedation, nausea and vomiting, decreased orgasm/ libido. Take in morning
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Paxil
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(SSRI) Selective Serotonin Reuptake Inhibitor/ Antidepressant. First line. Only block Serotonin reuptake. Side effects: Blurred vision, dry mouth, Tachycardia, urinary retention, constipation, drowsines, sedation, nausea and vomiting, decreased orgasm/ libido. Take in morning
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Zoloft
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(SSRI) Selective Serotonin Reuptake Inhibitor/ Antidepressant. First line. Only block Serotonin reuptake. Side effects: Blurred vision, dry mouth, Tachycardia, urinary retention, constipation, drowsines, sedation, nausea and vomiting, decreased orgasm/ libido. Take in morning
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Luvox
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(SSRI) Selective Serotonin Reuptake Inhibitor/ Antidepressant. First line. Only block Serotonin reuptake. Side effects: Blurred vision, dry mouth, Tachycardia, urinary retention, constipation, drowsines, sedation, nausea and vomiting, decreased orgasm/ libido. Take in morning
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Nardil
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(MAOI) Monoamine Oxidase Inhibitor. Antidepressant. Last line. Prevents destruction of monoamines by stopping the enzyme Tyraminase. If Tyramine-free diet is followed can cause hypertensive crisis thru vasoconstriction and death.
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Parnate
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(MAOI) Monoamine Oxidase Inhibitor. Antidepressant. Last line. Prevents destruction of monoamines by stopping the enzyme Tyraminase. If Tyramine-free diet is followed can cause hypertensive crisis thru vasoconstriction and death.
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EMSAM
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(MAOI) Monoamine Oxidase Inhibitor. Antidepressant. Last line. Prevents destruction of monoamines by stopping the enzyme Tyraminase. If Tyramine-free diet is followed can cause hypertensive crisis thru vasoconstriction and death. Comes in a patch form.
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Effexor
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(SSNRI) Serotonin Norepinephrine Reuptake Inhibitor. Antidepressant. Increases Serotonin and Norepinephrine. Good for neuropathic pain
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Cymbalta
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(SSNRI) Serotonin Norepinephrine Reuptake Inhibitor. Antidepressant. Increases Serotonin and Norepinephrine. Good for neuropathic pain
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Remeron
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(SND) Serotonin Norepinephrine Disinhibitor. Antidepressant. Minimal sexual dysfunction, weight gain, and sedation.
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Wellbutrin
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(DNRI) Dopamine Norepinephrine reuptake inhibitor. Antidepressant. NO Sexual side effects! Can cause decreased appetite, and lowers seizure threshold. Can also be used in quiting smoking!
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Zyban
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(DNRI) Dopamine Norepinephrine reuptake inhibitor. Antidepressant. NO Sexual side effects! Can cause decreased appetite, and lowers seizure threshold. Can also be used in quiting smoking! Half the dose of Wellbutrin.
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Desyrel
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(DNRI) Dopamine Norepinephrine reuptake inhibitor. Antidepressant. NO Sexual side effects! Can cause decreased appetite, and lowers seizure threshold. Need very high doses for antidepressant effects. Can cause Priapism (Errection lasting over 4 hours!)
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Lithium
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Drug of choice used for mood stabilization. Antipsychotic. Affects electrical conductivity in neurons. Weight gain, Polyuria, Tremors, Nausea, Vomiting, Convulsions, Arrthymias, Goiter, Hypothyroidism. Needs blood monitoring. Dosages of 300 to 600mg TID. Not given if under 12 years of age.
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Theraputic level of Lithium discovered in the blood stream should be?
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0.4 to 1.3 mEq/L (maintenance level)
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Adult mania levels of Lithium discovered in the blood stream should be?
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1.0 to 1.5 mEq/L (serum levels)
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Elderly mania levels of Lithium discovered in the blood stream should be?
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0.3 to 0.8 mEq/L (serum levels)
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A physical work up is necessary for a patient to go on Lithium; what do they need?
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*Physical *Kidney function test *Thyroid function test *Pregnancy test *EKG test *Na+ levels if dehydration or electrolyte imbalances are a concern.
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Lithium adverse reactions are associated with a serum level of?
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2.0 mEq/L or above. Very bad.
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Blood levels are drawn on Lithium patients weekly or biweekly until the therapeutic level is reached. After that, levels are checked how frequently?
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Every 3 months after stability is reached. Blood levels are drawn 8 to 12 hours from last dose.
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Early signs of Lithium Toxicity should look like?
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<1.5 mEq/L Nausea, Diarrhea, Thirst, Polyuria, Lethargy, Slurred speech, Muscle weakness, fine tremors Nursing action: Hold medications, measure blood, fix dehydration.
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Advanced signs of Lithium Toxicity should look like?
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1.5 to 2 mEq/L Coarse hand tremor, presistent gastrointestinal upset, confusion, muscle hyperirritable, Mental status change, incoordination, and sedation.. Nursing action: Hold med, assess vs, measure blood levels, fix dehydration.
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Severe signs of Lithium Toxicity should look like?
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Ataxic gait, confusion, large output of urine followed by oliguria, mental status changes, blurred vision, clonic movements, seizures, stupor, hypotension, coma, pulmonary complications, finally…… DEATH!!! Nursing action: hospitalizations, medication stopped, excretion (Emetic, Aminophylline, peritoneal dialysis.)
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Top six causes of Lithium Toxicity
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1. Decreased sodium intake 2. Diuretic therapy 3. Decreased kidney function. 4. fluid/ electrolyte losses via fever, sweating, or vomit 5. Medical Illness 6. Lithium OD (intentional/unintentional)
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Depakote (Valproic Acid)
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Anticonvulsant/ Mood stabilizer. Used to treat Bipolar disorder. Therapeutic level: 50-125 mcg/mL. Fatal at 800-1000 mcg/mL. Causes Respiratory depression (Hold if Resp.Rate is <12). Side effects: weight gain, mild alopecia, and possible THROMBOCYTOPENIA. Check platelets levels and Liver function test. Also used for migraine headache prevention.
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Tegretol (Carbazemepine)
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Anticonvulsant/ Mood stabilizer. Used to treat Bipolar Disorder. Drowsiness is common, Orthostatic hypotension, Bone Marrow suppression, sore throats, malaise, mouth ulcers, easy bruising or bleeding. Can cause AGRANULOCYTOSIS/ THROMBOCYTOPENIA. Therapeutic leves 4 to 12 mcg/mL. Toxicity usually in children under 18 years old.
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Tegretol (Carbazemepine) Toxicity signs should appear?
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Nystagmus(eye twitching), Dystonia, Respiratory depression. Usually under 18 years old.
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Lamictal
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Anticonvulsant/ mood stabilizer. Maintenance therapy in bipolar clients. Not effective in mania. Risk for STEVEN JOHNSON RASH. No blood monitoring needed.
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Trileptal
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Anticonvulsant/ mood stabilizer. Relatively safe, no blood monitoring required.
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Neurontin
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Anticonvulsant/ mood stabilizer. Relatively safe, no blood monitoring required.
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TopoMax
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Anticonvulsant/ mood stabilizer. Relatively safe, no blood monitoring required.
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Haldol
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Antipsychotic/ Conventional Antipsychotic. Blocks attachment of Dopamine to receptors. Treats the positive sx of schizophrenia. Side effects are: Psuedoparkinsonism, Akathisia, Dystonia, Tardive Dyskinesia, Amenorrhea, Glactorrhea in women, Gynecomastia in men, memory loss, blurred vision, dry mouth, constipation, urine retention, Orthostatic Hypotension, failure to ejaculate, sedation, substantial weight gain. Usually used for PRN for psychiatric emergencies.
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Navane
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Antipsychotic/ Conventional Antipsychotic. Blocks attachment of Dopamine to receptors. Treats the positive sx of schizophrenia. Side effects are: Psuedoparkinsonism, Akathisia, Dystonia, Tardive Dyskinesia, Amenorrhea, Glactorrhea in women, Gynecomastia in men, memory loss, blurred vision, dry mouth, constipation, urine retention, Orthostatic Hypotension, failure to ejaculate, sedation, substantial weight gain. Usually used for PRN for psychiatric emergencies.
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Thorazine
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Antipsychotic/ Conventional Antipsychotic. Blocks attachment of Dopamine to receptors. Treats the positive sx of schizophrenia. Side effects are: Psuedoparkinsonism, Akathisia, Dystonia, Tardive Dyskinesia, Amenorrhea, Glactorrhea in women, Gynecomastia in men, memory loss, blurred vision, dry mouth, constipation, urine retention, Orthostatic Hypotension, failure to ejaculate, sedation, substantial weight gain. Usually used for PRN for psychiatric emergencies.
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Prolixin
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Antipsychotic/ Conventional Antipsychotic. Blocks attachment of Dopamine to receptors. Treats the positive sx of schizophrenia. Side effects are: Psuedoparkinsonism, Akathisia, Dystonia, Tardive Dyskinesia, Amenorrhea, Glactorrhea in women, Gynecomastia in men, memory loss, blurred vision, dry mouth, constipation, urine retention, Orthostatic Hypotension, failure to ejaculate, sedation, substantial weight gain. Usually used for PRN for psychiatric emergencies.
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Clozaril
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Antipsychotic/ Atypical Antipsychotic. First line. Target of positive and negative sx of schizophrenia. No movement disorders. Side effects: Sedation, hypersalivation, tachycardia, constipation, Suppress Bone Marrow, AGRANULOCYTOSIS (must monitor White blood cells), increased weight, increased triglycerides, increased blood sugars, can cause Metabolic syndrome.
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Zyprexa
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Antipsychotic/ Atypical Antipsychotic. First line. Target of positive and negative sx of schizophrenia. No movement disorders. Side effects: Sedation, hypersalivation, tachycardia, constipation, Suppress Bone Marrow, AGRANULOCYTOSIS (must monitor White blood cells), increased weight, increased triglycerides, increased blood sugars, can cause Metabolic syndrome.
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Risperdal
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Antipsychotic/ Atypical Antipsychotic. HIGHEST RISK for motor disorders (EPS) of any atypical antipsychotic. Long acting injectable form is CONSTA. Not to be used in dementia clients can cause stroke.
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Seroquel
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Antipsychotic/ Atypical Antipsychotic. High sedation, weight gain, Orthostatic hypotension, low risk for (EPS)
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Geodon
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Antipsychotic/ Atypical Antipsychotic. Cardiac side effects.
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Abilify
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Antipsychotic/ Atypical Antipsychotic. side effects: akathesia and insomnia (dancing in place)
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Invega:
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Antipsychotic/ Atypical Antipsychotic. Consistant release (OROS) similar to Risperdal. RISK for motor disorders (EPS). Not to be used in dementia clients can cause stroke.
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Ritalin
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Psychostimulant. Used to treat ADHD and Melancholic Depression. Blocks Norepinephrine reuptake, blocks dopamine reuptake, mimicks Norepinephrine and Dopamine.
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Adderall
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Psychostimulant. Used to treat ADHD and Melancholic Depression. Blocks Norepinephrine reuptake, blocks dopamine reuptake, mimicks Norepinephrine and Dopamine.
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Straterra
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Psychostimulant. Nonstimulant.
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Intuniv
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Psychostimulant. Nonstimulant.
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Aricept
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Anticholinesterase Inhibitors. Used to maintain normal brain function for as long as possible in Alzheimers patients. DOES NOT prevent or slow structural degeneration.
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Reminyl
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Anticholinesterase Inhibitors. Used to maintain normal brain function for as long as possible in Alzheimers patients. DOES NOT prevent or slow structural degeneration.
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Excelon
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Anticholinesterase Inhibitors. Used to maintain normal brain function for as long as possible in Alzheimers patients. DOES NOT prevent or slow structural degeneration.
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Namenda
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Anticholinesterase Inhibitors. Used to maintain normal brain function for as long as possible in Alzheimers patients. DOES NOT prevent or slow structural degeneration. Reduces degeneration from calcium leaving the cells.
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Patient is currently taking Clozaril and is starting to experience fever, sore throat, and flu like symptoms. This means……?
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Agranulocytosis and need to monitor CBC weekly.
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Your patient is starting to experience extrapyramidal effects of antipsychotic meds, such as dystonia, akathisia, or pseudoparkinsonism. Next step would be to?
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Consult with physician to prescribe an antiparkinsonian drug such as Artane, Cogentin, or Benadryl. Plus lower the dose of the antipsychotic. This lowers EPS.
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True or False? Tardive Dyskinesia can be cured?
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No cure for TD exists. FALSE!
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Does Thorazine have a high or low sedation/ side effect?
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High
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Does Haldol have a High or low sedation/ side effect?
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Low
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Long Acting Antipsychotics/ Depot injects involve which drugs?
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Traditional: Prolixin D Haldol D Atypical: Consta
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Neuroleptic Malignant Syndrome
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Potentially fatal, occurs in less than 1% of those taking antipsychotics. Symptoms include: Lowered level of consciousness, increased muscle tone, and autonomic dysfunction. FEVER, HYPERTENSION, TACHYCARDIA, TACHYPNEA, DIAPHORESIS, AND DROOLING!
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Layngeal Dystonia aka Haldol neck
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Rare, but threatens airway. Administer Artane, cogentin, or benedryl results in minutes, monitor airway.
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Anticholinergic Toxicity
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Dry mouth, decreased peristalsis, mydriasis (or prolonged pupil dilation), non reactive pupils, hot dry skin, hyperpyrexia without sweat, tachycardia, agitation, unstable vital signs, delirium, seizure, repetitive motor movements. Hold meds, emergency cooling, medical transfer, consult prescriber!
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What other mental health meds can be used as adjuncts to antipsychotic drugs?
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Antidepressants, Anticonvulsants(suppressing violence), Benzodiazepines can be used during acute phase to reduce agitation.

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