PSYC ·

MEDS

SSRIs – Selective Serotonin Re-Uptake

1
Inhibitors
USES IN Major depression, OCD, Panic disorder, premature ejaculation, premenstrual dysphoric disorder, chronic pain,
MENTAL HEALTH bulimia, alcoholism, ADHD, bipolar depression (3rd line), migraines, Tourette’s, obesity

Decreases the reuptake of serotonin at selected nerve terminals in the CNS.

THERAPEUTIC • Have a weak effect on the reuptake of norepinephrine and dopamine
ACTIONS • Comparable efficacy while not eliciting the anti-cholinergic and sedating side effects that often limit
client compliance

Nausea, insomnia, weight gain, hyponatremia, increased risk of GI bleed

COMMON SIDE
Sexual dysfunction: decreased libido, impotence, delayed ejaculation, delayed or absent orgasm
EFFECTS
Serotonin Syndrome: agitation, confusion, disorientation, hallucinations **What is the cause of SS?

Treatment of depression places the client at an increased risk for suicide; monitor client for mood changes
Mental status: mood, sensorium, affect, suicidal tendencies, increase in psychiatric symptoms, depression, panic
INTERVENTIONS
Weigh every week; SSRIs can increase or decrease appetite
SSRIs should not be used during pregnancy; advise client to contact healthcare provider if she might be pregnant.

• May take 4-6 weeks for therapeutic effect

• May cause sexual dysfunction or lack of sex drive; inform nurse or physician if symptoms are present
• May cause drug interactions; inform physician of other medications or herbal supplements (digoxin,
warfarin); SSRIs should not be taken within 14 days of the last MAOI; do not take OTC drugs without first
notifying physician
• Potential for drowsiness and dizziness; do not drive or operate machinery until these SE are ruled out
• Alcohol should be avoided
• Liver & renal function tests should be performed; blood counts should be checked periodically

PATIENT/FAMILY
• Meds should not be D/Ced abruptly. If side effects become bothersome, ask physician about changing to
TEACHING a different drug. Abrupt cessation can lead to Serotonin Withdrawal. What is this? Why does it happen?

The following symptoms should be reported to a physician immediately: What are these signs of???
o Increase in depression or suicidal thoughts
o Rash, hives
o Rapid heartbeat
o Sore throat
o Difficulty urinating
o Fever, malaise
o Anorexia and weight loss
o Unusual bleeding
o Initiation of hyperactive behavior
o Severe headache

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

1. Escitalopram (Lexapro) 10-20mg daily Tx MDD, general anxiety disorders

2. Citalopram (Celexa) 20-40mg Tx: depression

20mg daily
3. Fluoxetine (Prozac) Tx: depression, bulimia, premenstrual dysphoric disorder
up to 80 mg daily

4. Paroxetine (Paxil) 20-60mg daily Tx: depression, panic disorder, OCD, social anxiety disorder

PAGE 1
 PSYC ·
MEDS

5. Sertraline (Zoloft) 50-200mg daily Tx: depression, panic disorder, OCD

6. Fluvoxamine (Luvox) 50-300mg daily OCD

2 Atypical Antidepressants
Chronic depression, ADHD, chronic fatigue syndrome, rapid cycling bipolar II disorder, anxiety disorders, nicotine
USES IN
addiction, sleep disturbance, poor appetite, pain, and major depression.
MENTAL HEALTH
These medications may be tried when other antidepressants are not effective or have problematic side effects.

The core symptoms and quality of life measures improve with antidepressant therapy.
THERAPEUTIC
Antidepressants can positively alter poor self-concept, degree or withdrawal, vegetative signs of depression and
ACTIONS
activity level.

Nausea, dry mouth, constipation, increased appetite/weight gain, dizziness, and sedation.
COMMON SIDE
BLACK BOX WARNING FOR SUICIDAL THOUGHTS AND/OR ACTIONS IN CHILDREN & ADULTS
EFFECTS
All work, but choice of what to use is based on SE, pt hx, cost, target symptoms, and family hx.

Assess mental status: mood, sensorium, affect, suicidal tendencies, and increase in psychiatric symptoms.
INTERVENTIONS
Observe for mania; antidepressants can induce mania in patients with bipolar disorder.

Teach that therapeutic effects may take 2-4 weeks.

PATIENT/FAMILY Drowsiness, dizziness: Use caution when driving or other activities requiring alertness.
TEACHING Avoid alcohol ingestion.
Suicidal ideas or behaviors may occur in children or young adults.

2. Desvenlafaxine
GENERIC & 1. Bupropion 3. Venlafaxine 4. Mirtazapine 5. Trazodone 6. Duloxetine
TRADE NAMES (Wellbutrin) (Effexor) (Remeron) (Desyrel) (Cymbalta)
(Pristiq)

150-400 mg
DOSAGE 200-400 mg daily 50 mg daily 25-375 mg daily 15-45 mg daily 20-60 mg bid
daily
Used for
Unlabeled use
neuropathic
Monitor B/P & for alcoholism,
pain associated
Tx: depression, pulse; may cause anxiety, panic
Unlabeled use for with diabetic
smoking new or worsened disorder, and
(unlabeled: resting neuropathy,
cessation, ADHD HTN. insomnia. May
OCD, PMDD, & tremors/benign generalized
(unlabeled) cause sedation.
PTSD) familial anxiety
May cause
tremor/levodopa- disorder, and
Increased risk of abnormal Not a 1st line
DISTINGUISING/ Risk for HTN induced fibromyalgia.
SEIZURES if bleeding/bruising, chose for
CRITICAL and weight gain. dyskinesias.
dose is over glaucoma, antidepressant
INFORMATION There are
300mg or if elevated treatment, but
TO NOTE Effexor XR used Monitor for associated
patient has cholesterol & often given along
for social anxiety dizziness/drowsin sexual side
seizure disorder. triclyceride levels. with another
disorder. ess. effects.
agent because
No weight gain or Taper off med of somnolence,
Taper off slowly. Monitor for urinary Monitor liver
sexual side slowly to avoid one of its side
retention. enzymes
effects. Discontinuation effects (helps
Syndrome. with sleep
Photosensitivity
disturbance)
may occur.

PAGE 2
 PSYC ·
MEDS

3 TCAs – Tricyclic Antidepressants

USES IN
Depression, anxiety, OCD, panic disorder, and neurogenic pain
MENTAL HEALTH

THERAPEUTIC
Decrease in depression, anxiety, pain, or other disorders, absence of suicidal thoughts
ACTIONS

Drowsiness, dizziness, disorientation/confusion, weakness, blurred vision, dry mouth, constipation, urinary
COMMON SIDE
retention, headache, nausea, increased appetite  weight gain, impaired sexual functioning, sensitivity to light,
EFFECTS
increased heart rate, low blood pressure, increase in suicidal thoughts & actions, EPS primarily in geriatric patients

Observe for orthostatic hypotension. Stopping treatment abruptly can cause withdrawal symptoms. Assist with
INTERVENTIONS
ambulation during beginning therapy. Give gum, hard surgarless candy, or frequent sips of water for dry mouth.

Therapeutic effects may take 2-6 weeks. Avoid alcohol.

Do not quickly discontinue medication after long-term use.
PATIENT/FAMILY Drowsiness/dizziness: Use caution in driving and other activities requiring alertness.
TEACHING Wear sunscreen or covering when in sunlight because of photosensitivity.
Contraceptive is recommended during treatment because of birth defects. (Pregnancy Category C)
Change positions and rise slowly to prevent orthostatic hypotension.

1. 2. 3. 4. 5. 6. 7.
GENERIC &
amitriptyline clomipramine desipramine imipramine protriptyline nortriptyline doxepin
TRADE NAMES
(Elavil) (Anafranil) (Norpramin) (Tofranil) (Vivactil) (Pamelor) (Sinaquan)

DOSAGE

*exception:
Category D
Caution if
EPS may patient is
Caution if
Pregnancy occur; undergoing
patient is
Category C primarily in ECT or
DISTINGUISING/ undergoing CV monitoring
(ALL) geri pts elective EPS may
CRITICAL ECT or for elderly if
surgery occur,
INFORMATION elective dose >20
Cigraretts Therapeutic primarily in
TO NOTE surgery mg/day
decrease effect may EPS may geri pts.
serum level take 2-3 occur,
EPS may
weeks primarily in
occur,
geri pts.
primarily in
geri pts.

TCAs: NOTES:
•Generic names: trip, -ine

PAGE 3
 PSYC ·
MEDS

4 MAOIs – Monamine Oxidase Inhibitors

Depression, adjunct management of Parkinson’s disease
USES IN
Unlabeled Uses: bulimia, cocaine addiction, migraines, seasonal affective disorder, panic disorder, Alzheimer’s
MENTAL HEALTH
disease

THERAPEUTIC Decrease in depression, akathisia *definition??

ACTIONS Improved mood

GI: constipation, nausea, diarrhea, somach upset, dry mouth, increase in appetite, weight gain
Neuro: dizziness, drowsiness, fatigue, sleep disturbances, blurred vision, headache, weakness
COMMON SIDE Fluid: low BP, lightheadedness, decreased urine output, increased sweating
EFFECTS Reproductive: decreased sexual function
EPS primarily in geriatric patients
Increase in suicidal thoughts and actions

Assist with ambulation @ beginning of therapy. Observe for orthostatic hypotension.

INTERVENTIONS DO NOT TAKE WITH SSRIs  can lead to serotonin syndrome …* which is what??
Abruptly cessation of drugs can cause withdrawal symptoms.

Therapeutic effects may take up to 3 weeks. Change positions and rise slowly to prevent orthostatic hypotension.
Tyramine: Avoid foods with cheese, chocolate, pickled products, wine, beer, fermented soy (@ Asian restaurants)
PATIENT/FAMILY and large amounts of caffeine  can cause BP to become dangerously high
TEACHING Do not d/c quickly after long-term use.
Caution with driving and other activities requiring alertness (b/c of SE of drowsiness/dizziness)
Contraceptives recommended (risk of birth defects?)

GENERIC & TRADE

tranylcypromine (Parnate) selegiline (EMSAM – patch)
NAMES

Adult = 10mg BID; may increase to 30 mg/day after 2 Adult = 6mg/24 hr initially; increase by 3mg/24hr after 2
DOSAGE
weeks, max 60mg/day weeks, max 12 mg/24hr
Pregancy Category C

Apply to dru, intact skin on upper torso, upper thigh, or

DISTINGUISING/ Only used for depression when uncontrolled by other outer surface of arm q12hr
CRITICAL means (last resort!)
INFORMATION TO Avoid foods in tyramine (cheese, chocolate, pickled
NOTE Caution with patients undergoing elective surgery. products, wine, beer, caffeine, fermented soy 
dangerously high BP)

Avoid OTC cold/flu/cough meds

PAGE 4
 PSYC ·
MEDS

Benzodiazepines, Non-benzodiazepine
5 Anxiolytics
Acute mania, psychotic illnesses, anxiety associated w/ depression, impulse control disorders, alcohol withdrawal,
USES IN and catonia (not common)
MENTAL HEALTH
**HIGHLY ADDICTIVE; benzos treat anxiety, affect GABA (increase or decrease?)

THERAPEUTIC Relief from anxiety, seizure prophylaxis (Atavan), alcohol withdrawal, relief from irritability, anticonvulsant, skeletal
ACTIONS muscle relaxation (Valium), insomnia

COMMON SIDE
Dizziness, drowsiness, confusion, fatigue (CNS), orthostatic hypotension (CV), constipation (GI)
EFFECTS

Monitor VS, especially BP, RR, and if CV patient, orthostatic hypotension.

INTERVENTIONS
Monitor for changes in mental status; mood, affect, sleeping pattern, drowsiness, dizziness, & suicidal tendencies.

Contraindications: pregnancy, breastfeeding, hx of drug abuse; sleep apnea, caution w/ sedation

PATIENT/FAMILY Do not take w/ alcohol, driving, operating heavy machinery, certain herbs (ex. Catnip)
TEACHING These drugs has highly addictive qualities!
Alcohol, barbiturates, opiates, antidepressnts

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

2-6 mg/day in divided Off label use: seizure prophylaxis
1. lorazepam (Ativan)
doses; max 10 mg/day Contraindicated w/ naoxybate (CNS & respiration depression)
1.5 mg/day, tid, PO;
2. clonazepam (Klonopin) Eye problems: needed for ophthalmic exam during,
Max 20 mg/day
2-10 mg bid-qid, PO, IM, IV
3. diazepam (Valium) Off label use: benzodiazepine withdrawal
2-10mg q 3-4 hr
Serious reactions: syncope, tachycardia, seizures, coma, suicidal ideation,
4. alprozolam (Xanax) 0.25-0.5 mg tid PO
unsafe if pregnant
5. chlordiazepoxi??
5-10 mg tid-qid Serious reactions: agranulocytosis, Pregnancy Category D
(Librium)
10-30 mg tid-qid; Decrease effects of oral contraceptives; BP if drops 20 mmHg, hold product &
6. oxazepam (Serax)
max 120 mg/day notify prescriber; suicidal tendencies
5 mg tid; may increase by 5
7. buspirone (BuSpar) mg/day q 2-3 days; max 60 Not addictive, but takes days to kick in.
mg/day

PAGE 5
 PSYC ·
MEDS

6 Traditional Antipsychotics
Acutely agitated or potentially violent patient

VOCAB: S&S? why? related tx?

USES IN •EPS
MENTAL HEALTH •TD
•NMS
•Anticholinergic effects

THERAPEUTIC
Tranquilizing or sedative effect, decrease agitation, aggressiveness, delusion
ACTIONS

•EPS, Extrapyramidal symptoms – rigidity, tremor, bradykinesia (slow movement), & bradyphrenia (slow
thought)

•Pseudoparkinsonism – EPS similar to Parkinson’s disease: akathisia (distressing motor restlessness) and
COMMON SIDE acute dystonia (painful muscle spasms)
EFFECTS

•CNS effects – drowsiness, neuroleptic malignant syndrome (NMS), extrapyramidal symptoms (EPS), and tardive
dyskinesia (TD).
o NMS, neuroleptic malignant syndrome – potentially life-threatening adverse effect: high
fever, unstable BP, and myoglobinemia

INTERVENTIONS Agranulocytosis: Check WBC

NMS, Neuroleptic Malignant Syndrome – medical emergency!  decreased LOC, increase muscle…*spasms?,
PATIENT/FAMILY diaphoresis, chills
TEACHING Hypotension – get up slowly (orthostatic hypotension?)
Anticholinergic – laxitive for constipation, photosensitivity = sunscreen, hat & sunglasses

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

1. haloperidol (Haldol) 1-100 mg *Long acting! Low sedative property; High incident of EPS; Appropriate for elderly
2. chlorpromazine (Thorazine) 25-2000 Photosensitivity; highest sedative and hypotensive effect
NOT recommended as first-line antipsychotic 
3. thioridazine (Mellaril) 40-800
ECG changes, may cause sudden DEATH
4. perphenazine (Trilafon) 8-48 Can help control severe vomiting
5. trifluoperazine (Stelazine) 2-80 Low sedative effect; withdrawal or paranoia
6. fluphenazine (Prolixin) 1-60 Among least sedating

PAGE 6
 PSYC ·
MEDS

7 Atypical Antispychotics
Treats the positive AND negative symptoms of schizophrenia
USES IN Prevents relapse of schizophrenia
MENTAL HEALTH Helps with symptoms of anxiety and depression, decreases suicidal behavior, and increases neurocognitive
function

Treatment of Positive Symptoms – decreased hallucination and delusions

THERAPEUTIC Treatment of Negative Symptoms – decreased feelings of lonliness, better self-esteem, more communicative, less
ACTIONS preoccupied with own thoughts, increased energy and increased motivation

Other – decreased anxiety & depression; decreased suicidal behavior; lower relapse rates

Weight gain (ALL except Geodone and Abilify)  diminished self-esteem r/t weight gain 
COMMON SIDE Glucose dysregulation
EFFECTS Hypercholesterolemia
Hypertension

INTERVENTIONS Agranulocytosis – monitor WBC for possible agranulocytosis when taking Clozaril

PATIENT/FAMILY
Usually takes 3-6 weeks for antipsychotics to work
TEACHING

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

VERY high weight gain
Agranulocytosis (WBC)
1. clozapine (Clozaril) 76-700 mg/day
Increased rate of seizures
Excessive salivation
Moderate weight gain
Hypotension; Insomnia
2. risperidone (Risperdal) 1-16 mg/day
Sedation; Sexual dysfunction
Rare NMS (neuromalignant syndrome), TD (tardive diskinesia)
Hight weight gain
Drowsiness
3. olanzapine (Zyprexa) 3-40 mg/day Insomnia
Agitation and restlessness
Akathisia or pseudoparkinsonism
Moderate weight gain
4. quetiapine (Seroquel) 100-1000 mg/day Drowsiness
Headache

5. ziprasidone NO weight gain 

20-160 mg/day
(Geodone/Zeldox) Treats depressive symptoms

6. aripiprazole (Abilify) 10-30 mg/day NO weight gain 

Seizures
7. paliperidone (Invega) 6 mg/day NMS (neuromalignant syndrome)
Tachycardia

PAGE 7
 PSYC ·
MEDS

8 Anti-Manic and Mood Stabilizing Drugs

Help control mood swings, prevent recurrences, and reduce the risk of suicide.
USES IN
Considered lifetime maintenance therapy for bipolar clients.
MENTAL HEALTH
Lithium treats acute mania and prevents both manic and depressive episodes in bipolar clients.

Lithium: reduces elation, grandiosity, expansiveness, flight of ideas, irritability, manipulations and anxiety.
THERAPEUTIC AEDs (antieliptic drugs=divalproex, lamotrigine, carbamazepine): continuously cycling clients, dampening
ACTIONS affective swings in schizoaffective clients, diminish impulsive & aggressive behavior, and controlling mania and
depression w/in 2-3 weeks.

COMMON SIDE Nausea and vomiting; trembling of hands and arms; blurred vision or double vision; dizziness; drowsiness; dry
EFFECTS mouth; weight gain

Assess kidney & liver function. Assess blood count (esp. WBC and platelet count b/c of agranulocytosis)
VERY Low therapeutic index; constant monitoring & shouldn’t exceed 1.5 mEq/L:
INTERVENTIONS
•S&S of Lithium Toxicity: Nausea & vomiting, slight tremors  coarse tremors
•Similar SE when first starting Lithium, but are signs of TOXICITY later on in tx!

Lithium treats current problem and prevents relapse; continue taking drug even after episode.
•Electrolytes: monitor & maintain electrolyte balance if you sweat a lot (ex. extreme sports); increase fluid, but
PATIENT/FAMILY maintain salt intake. *the body regards lithium as a salt.
TEACHING
Check kidney and thyroids periodically, esp. if taking lithium long term.
Support groups available for bipolar clients.

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

- Cardiac dysrhythmias, convulsions; fluid balance & distribution (because it’s a salt)
- Lowest therapeutic index of ALL psychiatric drugs; toxicity can occur even within
Maintenance blood
1. lithium carbonate therapeutic range  requires constant monitoring & should not exceed 1.5 mEq/L
level range b/t
(Lithane Lithobid, Eskalith) - Long-term risks: hypothyroidism & impairment of kidney’s ability to concentrate
0.4 and 1.3 mEq/L
urine  assess renal fx and thyroid status)
- Elderly: “Start low & go slow”

2. divalproex PO: 750 mg/day Monitor liver fx and platelet count periodically.
(Depakote) (max 3000 mg/day) Do not discontinue quickly because it may result in convulsions.

3. lamotrigine Rash: potentially life threatening! (Rare, but serious)

100-200 mg/day
(Lamictal) Teach: seek medical attention if rash appears, but most are likely to be benign.
Agranulocytosis: monitor WBC
4. carbamazepine
800-1200 mg/day Works better on patients who have rapid cycling, severely paranoid, angry mania.
(Tegretol)
Also, dysphoric manic clients.
5. oxcarbazepine Maintenance:
Similar to carbamazepine, except it doesn’t decrease WBC 
(Trileptal) 1200 mg/day

6. olanzapine/fluoxetine HCl olanzapine: 3-12 mg Antipsychotic w/ mood stabilizer (combination drug)

(Symbyax) fluoxetine: 25-50 mg Fluoxetine HCl is a SSRI.

PAGE 8
 PSYC ·
MEDS

9 Alzheimer’s Disease Treatments

USES IN
Cholinergic drugs that increase acetylcholine concentrations in the brain (Cholinergic Carla: Rest & digest)
MENTAL HEALTH

THERAPEUTIC Treatment aims to increase quality of life because there is no cure for Alzheimer’s.
ACTIONS Decrease the symptom of dementia.

Cardiovascular: bradycardia, hypotension, conduction abnormalities

CNS: headache, dizziness, convulsions
COMMON SIDE
GI: abdominal cramps, increased secretions, nausea & vomiting
EFFECTS
Respiratory: increased bronchiole secretions bronchospasms
Other: lacrimation, sweating, salivation, miosis
Mental status: affect, mood, behavioral changes, hallucinations, confusion
GI: increase fluids for constipation
GU: expect urinary frequency  make bathroom accessible
INTERVENTIONS Toxicity Symptoms: “cholinergic crisis”
Early symptoms: abdominal cramps, salivation, flushing of the skin, n/v
Later manifestations: hypotension, bloody diarrhea, shock, cardiac arrest
Provide support, therapy groups

PATIENT/FAMILY Report side effects: restlessness, psychosis, visual hallucinations, stupor, LOC
TEACHING Patient/family must understand that medications are NOT a cure. 

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

1. mementine
Dizziness & confusion are common SE
(Namenda)
2. galantamine
Must take with meals
(Razadyne)
3. donepezil Do not take with anticholinergics; to take between meals, but can take with
(Aricept) meals to reduce GI symptoms
4. rivastigmine
Comes in an oral agent or in a transdermal patch
(Exelon)
5. tacrine Must have LFT; to take between meals, but can take with meals to reduce GI
(Cognex) symptoms

PAGE 9
 PSYC ·
MEDS

10 Central NS Stimulants, ADHD tx

USES IN
Narcolepsy (1930s); Depression (1950s); ADHD (1980s)
MENTAL HEALTH

THERAPEUTIC Feelings of euphoria, relief from fatigue, improved performance on selected tasks, increased activity, appetite
ACTIONS suppression, wakefulness, increased concentration

Growth retardation in children  assess height & weight

COMMON SIDE CNS: restlessness, irritability, dysphoria, dizziness, tremors, aggressive behavior, toxicity
EFFECTS Cardio: increased BP, headaches, pallor
GI: nausea, vomiting, dry mouth, abdominal pain

Assess height & weight changes.

Monitory any change in mental status (speech, irritability, talkativeness.)
INTERVENTIONS
Monitor VS, esp. BP
Insulin may need to be adjusted in diabetics due to decreased appetite

Abuse: these drugs have addictive qualities, so monitor for signs of abuse
PATIENT/FAMILY
Caffeine: decrease amount of caffeine and chocolate b/c this increases irritability
TEACHING
Alcohol: avoid alcohol to decrease synergist effects

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

1. methylphenidate
60mg/day Seizure & dysrhythmias
(Ritalin)

2. dextroamphetamine Could show as signs of schizophrenia if it reaches toxic amounts (b/c of

40mg/day
(Dexedrin) dopamine)

40mg/day
3. dextroampetamine
(rare to have higher Cardiomyopathy, myocardial infarction, and sudden death in chronic use
(Adderall)
doses than this)
4. methylphenidate Incrases insomnia
18-72mg/day
(Concerta) Weight loss common  assess weight

5. atomoxetive
100mg/day Risk for thoughts of suicide and mania
(Strattera)

6. lisdexamfetamine
70mg/day Severe allergic reaction to Stevens-Johnsons Syndrome
dimeslate (Vyvanse)

7. dexmethylphenidate
20mg/day Potential for dyskanisia symptoms and some reports of Tourette’s syndrome
hydrochloride (Focalin)

8. methylphenidate
Allergy: erythema is not an indicator of allergy alone; must be accompanied with
transdermal patch 30mg/day
edema, papules, & vesicles
(Daytrana Patch)

PAGE 10
 PSYC ·
MEDS

11 Extrapyramidal Side Effect agents

USES IN
Treatment of extrapyramidal side effects (4): acute dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia
MENTAL HEALTH

Reduction in EPS:
•Acute dystonia – fewer muscle cramps in the head & neck
THERAPEUTIC •Akathisia – decreased internal & internal restlessness, pacing and fidgeting
ACTIONS
•Pseudoparkinsonism – decreased stiffening of muscular activity
•TD, tardive dyskinesia – snake-like tongue, tongue out

COMMON SIDE
Urinary retention, constipation, blurred vision, cognitive impairment, and delerium
EFFECTS

Monitor WBC levels for agranulocytosis & leukopenia (defn)

INTERVENTIONS •Agranulocytosis
•Leukopenia

Photosensitivity: sunglasses to protect the eyes; sunblock to protect the skin

PATIENT/FAMILY
Dry mouth: perform oral hygiene
TEACHING
Constipation: fiber, laxatives

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

1. trihexyphenidyl Paralytic ileus
5-15 mg/day
(Artane) Contraindication: angle-closure glaucoma; myasthenia gravis

2. diphenhydramine Not to exceed 400

Seizure; thrombocytopenia; agranulocytosis; hemolytic anemia; anaphylaxis
(Benadryl) mg/day

Do not d/c abruptly; withdrawal symptoms will occur

3. benztropine mesylate
0.5-6 mg/day Paralytic ileus  listen to BS
(Cogentin)
Hyperthermia

4. amantadine
200-400 mg/day Agranulocytosis; leukopenia
(Symmetrel)

5. biperiden
6-8 mg/day Contraindication: angle-closure glaucoma; myasthenia gravis
(Akineton)

AIMS Test (long-term evaluation for Tardive Dyskinesia)

•A – abnormal
•I – involuntary
•M – movement
•S – scale
o Stick tongue out, tremors

PAGE 11
 PSYC ·
MEDS

12 Herbals
USES IN St. John’s Wort – mild to moderate depression and anti-anxiety
MENTAL HEALTH Valerian – sedative that causes sleep; anxiolytic or antidepressant effects

THERAPEUTIC St. John’s Wort – corrects imbalances with serotonin, norepinephrine and dopamine
ACTIONS Valerian – affinity for GABA receptors, releases GABA and inhibits its uptake

St. John’s Wort – sensitizes skin, makes skin more susceptible to sunburn. Inhibits monoamine oxidase, so caution
with MAOIs. Mild nausea, headache & sleepiness. Adverse effects: photodermatitis, delayed hypersensitivity, GI
upset, dizziness, dry mouth, restlessness, & constipation
COMMON SIDE
EFFECTS
Valerian – serious allergic reaction = difficulty breathing, closing of throat, swelling of lips/tongue/face; hives.
Long term users: may experience headache, excitability, restlessness, uneasiness, sleeplessness, dilated pupils,
irregular heartbeats or other heart problems

St. John’s Wort – monitor for possible drug rx

INTERVENTIONS
Valerian – assess for possible SE of long-term use

St. John’s Wort – teach: wear sunscreen on a daily basis. Should NOT be used during pregnancy.
PATIENT/FAMILY
Valerian – use caution w/ activities that require alertness (driving, operating machinery or other hazardous
TEACHING
activities); alcohol may increase drowsiness when taken together; FDA has NOT approved this drug.

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

Hypericum perforatum L. Pill: 300-900 mg
Treats mild to moderate depression
(St. John’s Wort) Liquid: 2-4 mL TID
270-1215 mg
Valariana officinalis
Therapeutic over 2-4 Sedative and anxiolytic activity; “nature’s sandman”
(Valerian)
weeks of treatment

Kava Kava

Ginko Biloba

PAGE 12
 PSYC ·
MEDS

13 Substance Abuse Related

USES IN
Maintenance of substance abstinence and maintenance of withdrawal symptoms
MENTAL HEALTH

THERAPEUTIC
Affects brain chemistry and lessens symptoms of withdrawal – tremors, n/v/d, etc.  thus encouraging abstinence!
ACTIONS

COMMON SIDE
Stimulation, N/V/D, headache, hypotension
EFFECTS

Assess baseline LOC/mental status

Assess which substance is being abused, how much & for how long (months, yrs?) and when the patient last
INTERVENTIONS
used the substance
Provide ample opportunity for support group/therapy for pt & family

Can cause thoughts of suicide and depression, so family must keep a close eye on the patient
PATIENT/FAMILY Cannot drive or operate machinery till therapeutic dose has been reached and mental status is stabilized
TEACHING Medication is a tool to help; however, patient must have will and support from friends and family
“Meds are a tool, not a cure!”

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

Treats alcohol withdrawal.
NEVER administer until the patient has abstained for at least 12 hours.
Not for patients who have acute alchohol intoxication, psychoses or CV disease
1. disulfiram (Antabuse)
Deter! Combining Antabuse with ANYTHING containing alcohol will create very
unpleasant side effects.
VS q3-5 min with initial administration.
2. naltrexone (Revia) Contraindicated with opioid dependence; opioid antagonist.
Monitor for hepatotoxicity

3. buprenorphine HCl Treats opioid dependency

(Suboxone) Causes orthostatic hypotension

Treatment with Campral should be initiated as soon as possible after the period
4. acamprosate calcium of alcohol withdrawal
(Campral) Patient must have already undergone detoxification & achieved abstinence
Not for patients with compromised renal function

PAGE 13
 PSYC ·
MEDS

NURS 3581 – Psychoactive Drug Classifications

SSRIs – Selective Serotonin Re-Uptake Inhibitors

1
Atypical Antidepresants (new generation)
2
TCAs – Tricyclic Antidepressants
3
MAOIs - Monamine Oxidase Inhibitors
4
Benzodiazepines & Non-Benzodiazepine Anxiolytics
5
Traditional Antipsychotics
6
Atypical Antipsychotics
7
Anti-Manic & Mood Stabilizing Drugs
8
Alzheimer’s Disease Treatments
9
1 CNS Stimulants & ADHD Treatment

0
Extrapyramidal Side Effect Treatment Agents
11
Herbals
12
Substance Abuse Related
13
PAGE 14
 PSYC ·
MEDS

SAMPLE CHART.

# classification
USES IN
MENTAL HEALTH

THERAPEUTIC
ACTIONS

COMMON SIDE
EFFECTS

INTERVENTIONS

PATIENT/FAMILY
TEACHING

GENERIC & TRADE NAMES DOSAGE DISTINGUISING/CRITICAL INFORMATION TO NOTE

PAGE 15