Classification Indications Prefix/Suffix Meds – Generic (Brand) lorazepam (Ativan) clonazepam (Klonopin) diazepam (Valium) Side Effects CNS Depressant (Decreases vitals: increase falls risk) It basically relaxes you. HR decreases, breathing decreases Nursing Implications Asses vitals Pre and Post admin Can be drying Educate about -Falls (benzos makes you dizzy, drowsy) / tolerance/ short term use High potential for abuse Benzodiazepines Acute anxiety/ ETOH withdrawal chlordiazepoxide (Librium) …pam …lam Always check/do a set of vitals before giving benzos and after giving it (an hour later) because they decreases vitals signs such as respirations SHORT TERM (Not long time because it builds tolerance, just like alcohol) Same ^^ alprazolam (Xanax) But higher risk of withdrawal seizures Don’t admin with another CNS depressant Address drying Side Effects: Offer water frequently, offer Sugar free candy, Ice chips Can cause seizure in withdrawal Monitor for abuse Same ^^ + High risk for seizure with withdrawal** flunitrazepam (Rohypnol) - Illegal, known as “Date rape drug”, “roofies” Anxiolytic Anxiety buspirone (Buspar) Few side effects Can cause mild restlessness Mild GI upset No tolerance issues Educate it takes 2 weeks to start working Use benzo in the first two weeks for anxiety until full effect Alcohol antagonist Adverse reaction when mixed with ETOH ETOH Long term treatment disulfiram (Antabuse) acamprosate (Campral) Opioid Antagonist Opiate OD Tx naloxone (Narcan) buprenorphine, buprenorphine/naloxone (Suboxone) Opioid Partial Agonist Synthetic Narcotic opioid Opioid receptor Antagonist First Generation Anti-psychotics (Typical) Opiate maintenance, decrease opiate cravings Nal… …one Little Induce opiate withdrawal Used in emergency situations If a patient has a history of substance abuse, we have to make sure (monitor) for med seeking behavior CNS depressant (decreases vitals: increase falls risk) High potential for abuse Educate Avoid all ETOH products as it will result in severe GI upset/illness (5-10 min after ETOH ingested). Educate: let med dissolve fully under tongue for full effect Asses prep and post administration vitals signs Don’t admin with another CNS depressant methadone (Dolophine) Educate about Falls/tolerance/short term use ETOH and opiate relapse naltrexone (ReVia - PO), (Vivitrol - monthly IM Injec) Schizophrenia Psychosis …azine Mania haloperidol (Haldol) haloperidol decanoate (LAI) chlorpromazine (Thorazine) fluphenazine (Prolixin) fluphenazine decanoate (LAI) EPS TD Sedating Drying Monitor for abuse If substance is used while on this med, the client will not feel the effects of it, but can still overdose Monitor for abnormal movements/perform AIMs as needed Second Generation AntiPsychotics (Atypical) Schizophrenia …idone Psychosis …apine Mania risperidone (Risperdal) Risperdal Consta (LAI) paliperidone (Invega) Invega Sustenna (LAI) ziprasidone (Geodon) olanzapine (Zyprexa) Zyprexa Relprevv (LAI) quetiapine (Seroquel) asenapine (Saphris) Can cause NMS (Neuroleptic malignant syndrome) Educate about possibility of abnormal movements/to seek help If they develop symptoms at home (they should not contact healthcare provider at home because this is an emergency, and it can be deadly Educate about falls Metabolic syndrome NMS/EPS/TD possible but less likely Educate/monitor for S&S of NMS. If develops at home-911 or go to the hospital right Educate: Modifiable risk factors: (long term) diet, exercise, smoking cessation Educate this med can cause weight gain Monitor: BMI, Fasting, triglycerides, fasting glucose, BP iloperidone (Fanapt) Agranulocytosis clozapine (Clozaril) Educate/address drying Offer water frequently, offer sugar free-candy/ ice chips Orthostatic hypotension Educate/monitor for S&S of NMS. If develops at home-911 -Monitor WBC/ANC (acute neutrophil count) & signs of infection -Educate about falls Antihistamine Anticholinergics diphenhydramine (Benadryl) benztropine (Cogentin) Treats EPS trihexyphenidyl (Artane) Drying (Can’t see, can’t pee, can’t spit, can’t __) Educate/address drying SE Offer water frequently, offer sugar-free candy/ Ice chips Drowsiness Educate about falls vesicular monoamine transporter 2 (VMAT2) inhibitors valbenazine (Ingrezza) Treats TD …benazine deutetrabenazine (Austedo, Teva) Hepatotoxicity valproic acid (Depakote) Anticonvulsants Mood stabilizer/ Bipolar D/O carbamazepine (Tegretol) Can cause liver inflammation, leukopenia, and plastic anemia Stevens-Johnson Syndrome lamotrigine (Lamictal) Onset 5-14 days (usually supplement w/atypical in this lag time if manic) Lithium Toxicity Mood Stabilizer Bipolar D/O lithium carbonate Renal issues Thyroid issues CV issues (Cardiovascular) Monitor liver function (BMP) Titrate up Obtain serum levels Monitor liver enzymes weekly for first 8 weeks Monitor CBC Educate if any rash occurs, hold medication, notify physician Monitor -Labs: renal function (BMP), thyroid (thyroxine & TSH) Daily weights -input and output: (take in at least 2L/day -Lithium level at least 5 days after start and after any dosage change fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) citalopram (Celexa) SSRIs Depressive & Anxiety D/Os On set 1-3 weeks Weight gain Sexual side effects GI distress Serotonin syndrome …etine …pram escitalopram (Lexapro) BBW*** Can increase risk for suicide (black box warning) If out of level if high, hold med, assess and call provider Educate: -When effects will start -SEs lessen over time (6 weeks) -don’t stop abruptly - if increase suicidal thoughts call 911/seek immediate attention/ go to hospital or call suicide hotline -if causes GI upset, take with food desvenlafaxine (Pristiq) duloxetine (Cymbalta) SNRIs Depressive & Anxiety D/Os …tine …xine venlafaxine (Effexor) ...yline …pine atomoxetine (Strattera) amoxapine (Ascendin) doxepin (Sinequan) nortriptyline (Pamelor) amitriptyline (Elavil) ADHD Tricyclics Depressive & Anxiety D/Os Possible Serotonin syndrome - Monitor/educate about serotonin syndrome -Monitor/educate about serotonin syndrome BBW*** Can increase risk for suicide (black box warning) -monitor/educate about increased suicidality Onset 4-8 weeks (long) Educate/address drying SE: offer water frequently, offer sugar-free candy/ ice Very dying/similar to anticholinergic effects Educate about falls imipramine (Tofranil) -orthostatic hypotension Monitor/educate about increased suicidality Sedating Lethal in OD phenelzine (Nardil) tranylcypromine (Parnate) BBW*** Can increase risk for suicide Multiple drug/food interactions: can lead to HTN crisis (hypertensive) BBW*** Can increase risk for suicide Educate to avoid: (pg 31 box 2.1) -Food contain tyramide: age-meats, aged-cheeses, wine/beer, soy products -OTC decongenstans such as Allegra, claritin MAOIs Depressive & Anxiety D/Os -Stimulants isocarboxazid (Marplan) -Monitor BP & HR for first 6 weeks -Educate about HTN crisis -Monitor/educate about increased suicidality Atypical Antidepressants Stimulants Depressive & Anxiety D/Os ADHD & ADD bupropion (Wellbutrin) trazodone (Desyrel) mirtazapine (Remeron) methylphenidate (Ritalin) …amphetamine dextroamphetamine (Dexedrine) amphetamine (Adderall) LAI- Long acting injectable BBW*** Can increase risk for suicide CNS Stimulants -Monitor/educate about increased suicidality -Monitor vitals Pre and Post admin & long term Addicting -Educate about possible dependance