Question

I would like all students to review and analyze psychiatric medications in the following categories:

1. Stimulants

2. Antidepressants

3. Antipsycotics

4. Mood Stabilizers

5. Antianxiety

Please research names of agents, uses, contraindications, complications, dosing and what you as an RN would assess for with patients who are on these medications. This is not a graded activity, but will be used to assess attendance and involvement.

Answer 1

1) STIMULANT

• Adderall (amphetamine & dextroamphetamine) and Ritalin (methylphenidate).
• Methamphetamine (including crystal meth).
• Cocaine (including crack cocaine).

USE:treatment-resistant depression and attention deficit (hyperactivity) disorder

CONTRAINDICATION:contraindicated in individuals with advanced arteriosclerosis (hardening of the arteries), glaucoma (increased eye pressure), hyperthyroidism (excessive production of thyroid hormone), or moderate to severe hypertension.

COMPLICATION:

• Increased heart rate.
• Heightened blood pressure.
• Very high body temperature.
• Muscle shakes or tremors.
• Agitation.

Usual Adult Dose for Attention Deficit Disorder(amphetamine)

ORAL DISINTEGRATING TABLETS (ODT) and ORAL SUSPENSION (Adzenys ER 1.25 mg/mL): 12.5 mg orally once a day in the morning

ORAL SUSPENSION (Dyanavel XR 2.5 mg/mL):
Initial Dose: 2.5 or 5 mg orally once a day in the morning
-Increase in increments of 2.5 to 10 mg per day every 4 to 7 days until optimal response is obtained.
Maximum Dose: 20 mg orally per day.

ANTIDIPRESSANTS

• Amitriptyline
• Amoxapine
• Desipramine (Norpramin)
• Doxepin
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)
• Protriptyline
• Trimipramine

USE:depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia, or mild chronic depression

COMPLICATION

• Drowsiness
• Blurred vision
• Constipation
• Dry mouth
• Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
• Urine retention

CONTRAINDICATION:acute recovery period after a myocardial infarction, or history of drug hypersensitivity

Usual Adult Dose for Depression

OUTPATIENTS:
-Initial dose: 75 mg orally per day in divided doses; this may be increased to 150 mg/day (if needed)
-Maintenance dose: 40 to 100 mg orally per day
-Maximum dose: 150 mg/day

ANTIPSYCOTICS

isperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), ziprasidone (Zeldox), paliperidone (Invega), aripiprazole (Abilify) and clozapine (Clozaril).

USE:psychosis, principally in schizophrenia and bipolar disorder.

CONTRAINDIACTION

• History of severe allergy.
• Use of central nervous system (CNS) depressants like barbiturates, benzodiazepines, opioids.
• With anticholinergic medication like scopolamine or use of phencyclidine.
• Severe cardiac abnormalities

COMPLICATION

• Blurred vision.
• Dry mouth.
• Drowsiness.
• Muscle spasms or tremors.
• Weight gain.

Usual Adult Dose for:

• Schizophrenia

Additional dosage information:

Usual Adult Dose for Schizophrenia (CLOZAPINE)

Initial dose: 12.5 mg orally once or twice a day
Titration and Maintenance dose: May increase total daily dose in increments of 25 mg to 50 mg per day to a target dose of 300 mg to 450 mg per day (administered in divided doses) by the end of week 2. Subsequent dose increases can be in increments of up to 100 mg once or twice weekly.
Maximum dose: 900 mg per day

MOOD STABILIZERS

• lithium (Camcolit, Liskonum, Priadel, Lithonate, Litarex, Li-liquid)
• carbamazepine (Tegretol)
• lamotrigine (Lamictal)
• valproate (Depakote, Epilim)
• asenapine (Sycrest)

USE :bipolar mood disorder and sometimes people with schizoaffective disorder and borderline personality disorder

CONTRAINDICATION: significant renal or cardiovascular disease. severe debilitation or dehydration. sodium depletion.

COMPLICATION:

• Nausea.
• Tremors.
• Hair loss.
• Sexual problems.
• Weight gain.
• Liver damage.
• Kidney damage.
• Diarrhea

SODIUM VALPROATE Iis given intravenously and dose depend on the age.

ANTI ANXIETY DRUGS

alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan)

USE : ANXIETY

CONTRAINDICATION:

• overweight.
• suicidal thoughts.
• alcohol intoxication.
• drug abuse.
• depression.
• wide-angle glaucoma.
• closed angle glaucoma.
• decreased lung function.

COMPLICATION

• Depression.
• Insomnia.
• Alcohol withdrawal symptoms.
• Seizures.
• Panic disorder.
• Itching.
• Nausea.
• Vomiting.

Usual Adult Dose for Anxiety

Immediate-release tablets/orally disintegrating tablets (ODT): 0.25 to 0.5 mg orally administered 3 times a day
-Maximum dose: 4 mg/day