Antipsychotics: 1st Gen Typical / Conventional Chlorpromazine Haloperidol Fluphenazine Loxapine Thorazine Haldol Prolixin Loxitane Thioridazine Thiothixene Perphenazine Trifluoperazine Side Effects EPS Akathisia Parkinsonism Acute Dystonia Tardive Dyskinesia Ortho. Hypotension Anticholinergic effects Sexual dysfunction Weight gain Sedation Seizures Skin effects Contraindications Important Info Liver issues Parkinson’s disease Severe hypotension Dementia Benztropine (Cogentin) Diphenhydramine (Benadryl) These block dopamine NMS: Very serious! Hyperpyrexia BP fluctuations Tachycardia Tachypnea Decreased LOC Avoid OTC meds that can cause anticholinergic = = Treats EPS! Treats EPS! Antipsychotics: 2nd Gen Atypical / Unconventional Risperidone Clozapine Olanzapine Quetiapine Aripiprazole Risperdal Clozaril Zyprexa Seroquel Abilify (3rd gen) Iloperidone Lurasidone Paliperidone Ziprasidone Side Effects Fewer/mild EPS Ortho. Hypotension Anticholinergic effects Sleep disturbances Sexual dysfunction Weight gain Contraindications Risperidone preg riskC Dementia Diabetes mellitus Benztropine (Cogentin) Diphenhydramine (Benadryl) Important Info Clozapine Agranulocytosis NMS: Very serious! Hyperpyrexia BP fluctuations Tachycardia Tachypnea Decreased LOC = = Treats EPS! Treats EPS! Antidepressants: SSRI’s Fluoxetine Paroxetine Sertraline Citalopram Escitalopram Prozac Paxil Zoloft Celexa Lexapro Vilazodone Viibryd Side Effects Weight changes Early weight loss Late weight gain Sexual dysfunction Serotonin syndrome Confusion Agitation / anxiety Fever / sweating Hallucinations Diarrhea Tremors CNS stimulation Insomnia Agitation Anxiety Contraindications Fluoxetine Preg risk C Not advisable to take with: MAOI’s TCA’s St. John’s wort Lithium NSAIDs Use cautiously with patients with liver/renal dysfunction, cardiac disease, seizure disorders, diabetes, ulcers, GI bleeding Important Info When DC’ing, taper off to avoid withdrawal syndrome Antidepressants: TCA’s Amitriptyline Nortriptyline Imipramine Trimipramine Elavil Aventyl Tofranil Surmontil Desipramine Clomipramine Doxepin Amoxapine Side Effects Ortho. Hypotension Anticholinergic SE Dry mouth Urinary retention Constipation Blurred vision Photophobia Tachycardia Sedation Silenor Contraindications Amitriptyline is preg C Important Info Paradoxical side effect Can increase SI Seizures Use cautiously with CAD, diabetes, liver/kidney/respiratory issues, urinary retention or obstruction Caution with MAOI, can cause bad HTN Avoid use with other anticholinergic meds Antidepressants: MAOI’s Selegiline Phenelzine Isocarboxazid Tranylcypromine Side Effects CNS simulation Anxiety Hypomania, mania Ortho. Hypotension Hypertensive crisis Headache, N/V Tachycardia, HTN Sweating Altered LOC Contraindications Phenelzine is preg C Caution with TCA or SSRI, can cause serotonin syndrome Not with ephedrine or amphetamines, can cause HTN crisis Emsam Nardil Marplan Parnate Important Info Diet: NO TYRAMINE Diet: NO TYRAMINE Diet: NO TYRAMINE Use with BP meds can cause dangerous hypotension Reduce caffeine to avoid HTN Mood Stabilizer: Lithium 0.8-1.4 mEq/L: Therapeutic level for patient in a manic episode 0.6-1.2 mEq/L: Therapeutic maintenance level (not currently manic) Less than 1.5 mEq/L: common adverse effects NVD, thirst, polyuria Lethargy, slurred speech Fine hand tremors, muscle weakness 1.5-2.0 mEq/L: early indications Worsening NVD Stupor, mental confusion Coarse hand tremors, poor coordination 2.0-2.5 mEq/L: advanced indications Extreme polyuria of dilute urine, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension, stupor/coma, possible death from respiratory complications 2.5+ mEq/L: Severe toxicity = Coma, death Contraindications Pregnancy Risk D, discourage breastfeeding. liver/kidney disease, cardiac disease, hypovolemia, schizophrenia NSAIDS can cause toxicity, but aspirin is ok Teachings Drink 1.5-3 L of water daily; don’t take diuretics Maintain normal sodium diet 2-3 grams Take with food or milk to decrease GI upset Blood levels need to be drawn frequently at first, then every few months Two major long-term risks are hypothyroidism and impairment of kidney’s ability to concentrate urine Anticonvulsants / Antiepileptic Valproate/Valproic Acid Carbamazepine Lamotrigine Side Effects CSN effects Nystagmus Double vision Vertigo Staggering gait Headache Contraindications Pregnancy risk D Blood disorders Bone marrow disorders Depakote Tegretol Lamictal Important Info Therapeutic Valproate Level = 50-125 ug/mL Carbamazepine report blood issues: Leukopenia Anemia Thrombocytopenia NO grapefruit for carbamazepine Watch for hepatotoxicity Benzodiazepines Alprazolam Diazepam Lorazepam Chlordiazepoxide Xanax Valium Ativan Librium Clonazepam Oxazepam Clorazepate Klonopin Serax Tranxene Side Effects Contraindications Important Info Drowsiness Pregnancy risk D Dry mouth Sleep apnea Respiratory depression They are generally Glaucoma used short term. Hx of sub abuse Withdrawal symptoms Anxiety, insomnia, diaphoresis, tremors, delirium, seizures Acute toxicity Confusion Resp. depression Hypotension Anterograde amnesia Paradoxical response Anxiety, insomnia Very addictive! Can cause dependence. Non-Benzodiazepines for Anxiety Buspirone (Buspar) - Not addictive Preg B, not while breastfeeding NO Grapefruit, St. John’s wort, erythromycin, MAOI Diphenhydramine (Benadryl) - Not addictive May cause anticholinergic symptoms High doses = sleeepy CNS Stimulants (Treats ADHD) Methylphenidate Amphetamine mixture Dextroamphetamine Side Effects Insomnia Restlessness Weight loss Appetite suppression Cardio effects Dysrhythmias Chest pain High BP Possible psychosis Hallucinations Paranoia Contraindications Sub use disorder Cardiovascular issues Severe anxiety Psychosis Preg risk C MAOIs Caffeine Other CNS stimulants Ritalin Adderall Focalin Important Info Don’t crush/chew sustained release tabs Given 30-45 mins before meals, last dose given by 4pm Full response can take up to 6 weeks Avoid caffeine Cholinesterase inhibitors (Treats Alzheimer’s Disease) Donepezil Rivastigmine Galantamine Side Effects GI upset NVD Bradycardia Syncope Aricept Exelon Razadyne Contraindications Important Info Asthama/COPD (can cause bronchoconstriction) Start low and go slow NSAIDS (can cause GI bleed) Ok with or without food Antihistamines TCA’s Antipsychotics When DC’ing, taper off Donepezil qHS, do not crush!