Drug Purpose Use Contradictions Interactions Side effects Nursing implicationsBenzodiazepines-pam suffixAlprazolam (Xanax)Diazepam (Valium)Lorazepam (Ativan)Anxiolytic Decreased CNS activity in brainstem & limbic systemAnxiety Other CNS depressants like alcohol/sedativesSedationHypotensionDrowsinessLoss of coordinationTreat overdose w/ Flumazenil (IM, verypainful)Habit formingbuspirone (BusPar) Unknown Chronic anxiety Grapefruit juice Paradoxical anxiety (esp. in elderly)HeadacheNauseaNever PRN- always scheduled1 week for effectivenessNon-habit forminglithium carbonate(Eskalith, Lithobid)Mood stabilizer: exact MOA unknownSerotenergic effectsBipolar depression (mania)PregnancyRenal insufficiency Low salt diet/diureticsNSAIDs (except aspirin)Toxicity: 0.6-1.2 mEq/L therapeutic range, very narrowTremorPolyuriaHypothyroidismRegular hydration and sodium intake to prevent toxicityvalproic acid (Depakote)Antiepileptic drug Bipolar depression (mania)SeizuresTricyclic Block reuptake of 2nd line treatment Cardiac MAOIs Sedation (give at Several weeks forantidepressants:Amitriptyline (Elavil)norepinephrine andserotoninfor depressionOCDAdjunct for paindysrhythmiaSeizures(Anticholinergic precautions):GlaucomaConstipationUrinary blockageAnesthetics used in surgerybedtime)DysrhythmiaOrthostatic hypotensionImpotenceAnticholinergic effects (dry)therapeutic effectTaper off gradually to discontinueWean off before surgery over severalweeksMAOIs:Phenelzine (Nardil)Isocarboxazid (Marplan)Amines are not broken down, higher levels in brain2nd line treatment for depression after careful consideration of risksTyramine foods-> HTN crisisSSRIsTricyclics Sympathomimetic Orthostatic hypotensionTachycardiaDizzinessInsomniaSuicidal ideationTaper down slowly to discontinueSSRIfluoxetine (Prozac)sertraline (Zoloft)escitalopram (Lexapro)Selective serotonin reuptake inhibitor; makes serotonin stay at receptors longer1st line depression treatment Bipolar (depression)PTSDPanic disordersEating disorders MAOI, other SS/SNRI, other serontenergic actingdrugs risk for Serotonin Syndrome (delirium,agitation, tachycardia) within 2 weeks Sexual dysfunctionRisk of suicideWeight loss/gainTaper over 2-4 weeks to discontinueTake early in day to prevent insomniaSNRIvelafaxine (Effexor)duloxetine (Cymbalta)desvenlafaxine (Pristiq)Serotonin-norepinephrine reuptake inhibitor; both neurotransmitters more available at receptors “” “” “”Bupropion (Wellbutrin, Zyban)Block dopamine uptake, make it available at receptor longerDepressionSubstance abuseSmoking cessation (Zyban formulation)Eating disordersSuicidal ideationChildren under 18MAOIsAntiepileptic drugs (Dilantin): seizure riskN/V/DSeizure riskDelusions of grandeur, psychosisSuicidal ideationTypical antipsychoticschlorpromazine (Thorazine)haloperidol (Haldol)Block dopamine receptors in brainTranquilizes patients PsychosisSchizophreniaAdjunct for bipolar Behavioral disordersExtrapyramidal symptoms (EPS)Tardive dyskinesia (TD)Neuroleptic malignant syndrome (NMS) mostly with HaldolAnticholinergic effectsphotosensitivityNMS life threatening: report fever, BP ASAPAtypical antipsychoticsRisperidone (Risperdal)Airprazole (Abilify)Olanzapine (Zyprexa)Block dopamine-2 (D2) and serotonin2 (5-HT2) receptors specifically PsychosisSchizophreniaSedationPhotosensitivityDry mouth, constipationGalactorrheaWeight gainImproved efficacy and safety over typicals Fewer EPS than typicalsSt. John’s Wort (herb)DepressionSleep disordersNervousnessAnxietySSRIs- serotonin syndromeMAOIsMany other drugsTyramine-containing foodsGI upsetFatigueDizzinessConfusionDry