Drug Study

Drug Name Mechanism of Indication Contraindic Adverse Effect NURSING
action ation RESPONSIBILITY/

PRECAUTIONS
Generic name: Haloperidol is Psychoses, Severe Significant: Extrapyramida Patient with
Haloperidol a Schizophrenia toxic CNS l syndrome (e.g. dementia-related
butyrophenone. depression, pseudoparkinsonism, psychosis, bipolar
Brand name: Apo- It comatose akathisia, tardive disorders, seizures
Haloperidol Haldol nonselectively states, dyskinesia, dystonia), CNS or EEG abnormalities,
Haldol Decanoate inhibits Parkinson’s depression, risk of falls, risk
Haldol LA Peridol postsynaptic disease, anticholinergic effects of QT prolongation,
dopaminergic basal (e.g. constipation, risk factors for
Oral D2 receptors ganglia xerostomia, blurred stroke, severe CV
Severe tics, Tourette's in the brain. lesions, vision, urinary disease, decreased
syndrome thyrotoxico retention), esophageal gastrointestinal
Adult: 0.5-5 mg 2-3 sis, dysmotility and motility, paralytic
times daily. Maintenance significant aspiration, somnolence, ileus, urinary
dose: 4 mg once daily. cardiac orthostatic hypotension, retention, BPH,
Adjust dose according to disorders motor or sensory xerostomia, visual
response and (e.g. acute instability, problems, and narrow
tolerability. Max: 30 mg MI, hyperprolactinaemia. angle glaucoma.
daily. uncompensat Cardiac Concomitant use with
Child: 3-12 ed heart disorders: Cardiac antidepressants and
years Initially 0.25 mg failure, arrhythmia, tachycardia. anticholinergic
daily, increased to 0.5- arrhythmias Eye disorders: Visual agents. Avoid abrupt
3 mg daily. Max: 3 mg , disturbance. withdrawal. Renal and
daily; 13-17 years 0.25 clinically Gastrointestinal hepatic impairment.
mg daily, increased to significant disorders: Diarrhoea, Elderly. Children.
2-6 mg daily. Max: 6 mg bradycardia nausea, sialorrhoea, Pregnancy.
daily. , 2nd or vomiting.
3rd degree General disorders and Patient
Oral heart administration site Counseling
Mania, Psychoses, block, conditions: Injection Information
Schizophrenia uncorrected site reaction. This drug may
Adult: 0.5-5 mg 2-3 hypokalaemi Hepatobiliary cause
times daily. a). disorders: Jaundice. somnolence, if
Maintenance: 3-10 mg Lactation. Metabolism and nutrition affected, do
daily. Adjust dose disorders: Anorexia, not drive or
according to response hypoglycaemia. operate
and tolerability. Nervous system machinery.
Elderly: 0.5-2 mg 2-3 disorders: Agitation, Avoid exposure
times daily. Adjust dose restlessness, headache. to extreme
according to response Psychiatric heat. Avoid
and tolerability. Max: disorders: Confusion, strenuous
20 mg/day in divided depression, insomnia. exercise.
doses. Renal and urinary Ensure adequate
Child: Schizophrenia: 3- disorders: Urinary fluid intake to
12 years Initially 0.5 retention. prevent
mg daily, increased to Reproductive system and dehydration.
1-4 mg daily. Max: 6 mg breast disorders: Erectile Monitoring
daily; 13-17 years 0.5 dysfunction, Parameters
mg daily, increased to gynaecomastia, priapism. Monitor mental
1-6 mg daily. Max: 10 mg Respiratory, thoracic and status, CBC,
daily. mediastinal electrolytes
Adult: Initially, 2-10 disorders: Bronchospasm, balance, ECG,
mg in subsequent doses dyspnoea. liver function,
given as often as every Skin and subcutaneous serum glucose
60 minutes until tissue and HbA1c level,
symptoms are controlled, disorders: Acneiform rash, hemorrhage,
administer with a dosage maculopapular rash. abnormal
interval of 4-8 hours. Vascular involuntary
Adjust dose according to disorders: Hypotension. movements or
response and Potentially parkinsonian
tolerability. Max: 18 mg Fatal: Neuroleptic signs, visual
daily. malignant syndrome, changes.
Administration bronchopneumonia, blood
May be taken with or dyscrasias (e.g.
without food. May be leucopenia, neutropenia,
taken w/ meals to agranulocytosis), QT
minimise GI irritation. prolongation, torsade de
pointes.
ATC Classification
haloperidol ; Belongs to
the class of
butyrophenone
derivatives
antipsychotics.
typical antipsychotics
Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/
action PRECAUTIONS
Generic: Psychotropic Schizophrenia. Aripiprazole is CNS: akathisia, Examination and Evaluation
Aripiprazole activity may Acute and contraindicated confusion,
be due to maintenance in patients with depression, drowsiness,  Monitor and report signs
Brand Name: agonist therapy of documented extrapyramidal of neuroleptic malignant
Abilify activity at manic and hypersensitivity reactions, syndrome, including
dopamine mixed episodes to it or any fatigue, hostility,
Dosage: 30mg PO D2 and associated component of the insomnia, hyperthermia,
daily 3. Route serotonin 5- with bipolar dosage form. lightheadedness, manic diaphoresis, generalized
of HT1A receptors disorder (as reactions, impaired muscle rigidity, altered
and monotherapy or cognitive function,
Administration: antagonist with lithium nervousness, mental status,
PO 4. activity at or valproate). restlessness, seizures, tachycardia, changes in
the 5- Adjunct suicidal thoughts, blood pressure (BP), and
Classifications: HT2A receptor. treatment of tardive dyskinesia.
serotonin- Also has depression in Resp: dyspnea. incontinence.
dopamine alpha1- adults. CV: bradycardia, chest  Be alert for new
activity adrenergic Agitation pain, edema, seizures or increased
modulators blocking associated hypertension,
(SDAM) activity. with orthostatic hypotension, seizure activity,
Atypical schizophrenia tachycardia. especially at the onset
or bipolar EENT: blurred vision, of drug treatment.
Therapeutic: disorder. conjunctivitis, ear
antipsychotic, pain. Document the number,
mood stabilizer GI: constipation, duration, and severity
anorexia, ↑ salivation, of seizures, and report
Safe dose: PO nausea, vomiting, weight
(Adults): 15 mg loss. these findings
once daily as GU: urinary immediately to the
monotherapy or incontinence. physician.
10–15 mg once Hemat: anemia.
 Assess motor function,
daily with Derm: dry skin,
lithium or ecchymosis, and be alert for
valproate; skin ulcer, sweating. extrapyramidal symptoms.
target dose is MS: muscle cramps, neck
Report these symptoms
15 mg once pain.
immediately, especially
daily; may ↑ to Metab: hyperglycemia. tardive dyskinesia,
30 mg once Neuro: abnormal
daily, if gait, tremor. because this problem may
needed. Misc: NEUROLEPTIC be irreversible.
MALIGNANT SYNDROME, ↓  Be alert for suicidal
heat regulation.
thoughts and ideology.
Notify physician
immediately if patient
exhibits signs of
depression or other
changes in mood and
behavior such as
nervousness,
restlessness, hostility,
confusion, or manic
reactions.
 Assess levels of
drowsiness or
lightheadedness,
especially in older
adults.
 Monitor signs of anemia,
including unusual
fatigue, shortness of
breath with exertion,
bruising, and pale skin.
Assess BP, and report a
sustained increase in BP
Drug Name Mechanism of action Indication Contraindication Adverse Effect NURSING

RESPONSIBILITY/
PRECAUTIONS
Generic name: Olanzapine is an Olanzapine is Contraindicated with CNS: Somnolence, - Assess for
Olanzapine atypical also indicated in allergy to dizziness,
(secondgeneration) combination with olanzapine, nervousness, history of allergy
Brand name: antipsychotic that samidorphan for myeloproliferative headache, to olanzapine.
Zyprexa exerts its action the treatment of disorders, severe CNS akathisia, Monitor for the
primarily on bipolar I depression, comatose personality
Classification: dopamine and disorder, either states, lactation. - disorders, many possible drug
Antipsychotic serotonin as an adjunct to Use cautiously in tardive interaction. -
Atypical receptors. It works lithium or elderly or dyskinesia, Encourage patient
on dopamine D2 valproate or as debilitated patients, neuroleptic
Dosage: receptors in the monotherapy for or with CV or malignant to void before
10mg, mesolimbic pathway the acute cerebrovascular syndrome -CV: taking the drug to
as an antagonist, treatment of disease, dehydration, Orthostatic help decrease
Frequency: blocking dopamine manic or mixed seizure disorders, hypotension,
anticholinergic
1 tab from potential episodes or as Alzheimer’s disease, peripheral edema,
action at the post- maintenance prostate enlargement, tachycardia -GI: effects of urinary
Route: synaptic receptor. therapy, and for narrow-angle Constipation, retention. -Take
PO Olanzapine binds the treatment of glaucoma, history of abdominal pain -
this drug exactly
loosely to the schizophrenia in paralytic ileus. Respiratory:
receptor and adults. Cough, as prescribed; do
dissociates easily, pharyngitis - not change dose
allowing for normal Other: fever,
without consulting
dopamine development of
neurotransmission. diabetes mellitus your health care
The effect on the provider. -Urge
D2 receptors leads
the client to stop
to a decrease in
positive symptoms smoking; may
in patients, increase drug
including clearance -Urge
hallucinations,
delusions, and client to stop
disorganized drinking alcohol;
speech, thought, may increase CNS
and behavior.
effects.
action PRECAUTIONS
Generic Name: The antipsychotic For the treatment Hypersensitivity  Headachae 1. Assessed history of
Quetiapine agents block of moderate to to the drug and  Dizziness coma, depression,
serotonin severe manic its components. hypersensitivity, and
 Tiredness
Brand Name: receptors in episodes in bipolar Contraindicated assess for presence of
Seroquel, Gyrex addition to disorder -For the  Lighthead ed hyperglycemia, diabetes
to hyperglycemia GI
dopamine treatment of major and diabetes and neuroleptic
Dosage: 40 mg receptors. It depressive episodes  Nausea malignant syndrome. 2.
mellitus.
works by helping in bipolar disorder  Stomach upset Reviewed history of
Neuroleptic
Route: PO to restore the
malignant  Constipat ion medication that may
balance of certain interfere to the
syndrome. The
Frequency: 1 natural substances medication. 3. Observed
drug is not
tab once a day (neurotransmit the ten rights in
contraindicated
ters) in the brain preparing and
to the patient
Drug Class: administration of drug.
because the
Antipsychotic 4. Explained the side
patient has no
drug effects of the drug, in
hypersensitivity
ATYPICAL order for the patient
to the drugs and
not to panic if side
has no
effects occur. 5.
hyperglycemia,
Obtained baseline blood
diabetes mellitus
pressure in supine,
and has no
sitting, and standing
neuroleptic
position; record and
malignant
report significant
syndrome
lowering to the health
care provider before
administering the drug.
Health teaching 1.
Advised patient to
always take the
prescribed medication.
2. Advised patient to
seek follow – up check
– up if severe effects
of drugs occur.
action PRECAUTIONS
Generic Name: Blocks Monotherapy or Hypersensitivity to the - Headache 1. Checked Physicians
Risperidone dopamine, 5 – combination active substance or to - Insomnia order.
HT 2, alpha1 therapy with any of the excipients of - Agitation 2. Reviewed patient’s chart
Brand Name: and alpha2 lithium or this drug and its - Anxiety and medication.
Rileptid adrenergic, valproate for 3 components. Use - Tachycardia 3. Obtained BP measures as
and H1 week treatment cautiously in patients - Hypotension baseline data.
Dosage: 2 mg histaminergic of acute manic exposed to extreme heat 4. Monitored patient’s for
receptors in or mixed The patient is not occurrence of side effects.
Route: PO the brain. episodes from contraindicated to the
bipolar I drug because she has no Health Teaching
Frequency: 1 disorder. hypersensitivity. 1. Warned patient to avoid
tab once a day activities that requires
alertness and force.
Drug Class: 2. Advised patient to rise
Anti psychotic slowly and use other
drug precautions to avoid
ATYPICAL fainting.
3. Advised patient to avoid
alcohol.
Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

action RESPONSIBILITY/
PRECAUTIONS
Generic Name: May act Acute and Patient with risk Significant: CNS depression, Monitor blood
Asenapine through maintenance factors for dyslipidaemia, oesophageal electrolytes
combined treatment of seizures or dysmotility and aspiration, levels, renal or
Brand Name: antagonism of schizophrenia. conditions that dysphagia; extrapyramidal liver function,
Saphris dopaminergic Acute lower seizure symptoms (e.g. tardive TSH (annually);
(D2) and 5- treatment of threshold (e.g. dyskinesia, akathisia, CBC (as
CLASS: HT2A manic/mixed Alzheimer's hyperkinesia, dystonia, muscle clinically
antipsychotics, receptors. episodes dementia); rigidity, parkinsonism, tremor); indicated);
mood stabilizers Therapeutic associated Parkinson's increased risk of falls due to fasting plasma
Effects: with bipolar I disease; history somnolence, orthostatic glucose or HbA1c,
DOSAGE: (Adults): Decreased disorder (as of hypotension; syncope, QT lipid panel (12
Acute treatment—5 symptoms of monotherapy or cerebrovascular interval prolongation, weeks after
mg twice daily; acute with lithium or CV disease disruption of body temperature initiation or
Maintenance schizophrenia or valproate). (e.g. MI, heart regulation; weight gain; dose change then
treatment—5 mg and mania/ failure, leucopenia or neutropenia; annually
twice daily; may mixed conduction seizures; hyperprolactinaemia. thereafter);
^to 10 mg twice episodes of abnormalities, Blood and lymphatic system prolactin level
daily after 1 wk bipolar I ischaemic disorders: Anaemia. (if with
disorder. disease); risk Eye disorders: Accommodation symptoms).
ATYPICAL factors for disorder. Monitor mental
hypotension (e.g. Gastrointestinal status,
dehydration and disorders: Nausea, vomiting, adherence, and
hypovolaemia); abdominal pain, constipation, fall risk (every
congenital long diarrhoea, dyspepsia, dysgeusia, visit); vital
QT syndrome, oral mucosal lesions (e.g. signs such as
history of ulcerations, blistering, blood pressure,
cardiac inflammation), salivary temperature,
arrhythmia; hypersecretion. pulse,
diabetes; risk General disorders and orthostatics, or
factors for blood administration site signs of
dyscrasias (e.g. conditions: Fatigue, fever, infections (at
pre-existing low transdermal patch application least weekly
WBC or history of site reactions (e.g. dermatitis, during 1st 3-4
drug-induced discolouration, discomfort, weeks of
leucopenia or dryness, oedema, erythema, treatment and 4
neutropenia); exfoliation, induration, weeks after dose
conditions that irritation, pain, papules, change); BMI and
may elevate core pruritus). waist
body temperature Investigations: Increased ALT, circumference (8
(e.g. undergoing AST, GGT. and 12 weeks
strenuous Metabolism and nutrition after initiation
exercise, disorders: Increased appetite, or dose change
exposure to hyponatraemia. then quarterly);
extreme heat, Musculoskeletal and connective history of
concomitant use tissue disorders: Myalgia, metabolic
of restless legs syndrome. syndrome
anticholinergic Nervous system (annually).
agents). Avoid disorders: Dizziness, sedation, Assess for signs
abrupt dysarthria, hypoaesthesia, of extrapyramidal
withdrawal. Not paraesthesia. symptoms (using
approved for the Psychiatric disorders: Anxiety, formalised rating
treatment of altered mental status. scale at least
elderly patients Renal and urinary annually or every
with dementia- disorders: Urinary retention. 6 months for high
related Reproductive system and breast risk);
psychosis. disorders: Sexual dysfunction, neuroleptic
Moderate hepatic amenorrhoea. malignant
impairment. Potentially Fatal: Neuroleptic syndrome (e.g.
Children and the Malignant Syndrome; ketoacidosis fever, muscle
elderly. or hyperosmolar coma associated rigidity,
Pregnancy and with extreme hyperglycaemia; autonomic
lactation. serious hypersensitivity instability);
reactions (e.g. anaphylaxis, suicidal
angioedema); blood dyscrasias ideation.
(e.g. agranulocytosis).

PRECAUTIONS
Generic Name: Phenothiazine Indicated by Hypersensitivity CNS: Drowsiness,  Monitor HR and
Trifluoperazine similar to increase in to insomnia, BP. Hypotension is
Brand Name: chlorpromazine. mental and phenothiazines; dizziness, a common adverse
Novoflurazine, Solazine, Produces less physical comatose states; agitation, effect. 
Stelazine, Terfluzine sedative, activity. CNS depression; extrapyramidal Hypotension and
cardiovascular, Strong blood effects, extrapyramidal
Classifications: and antipsychotic dyscrasias; neuroleptic effects
CENTRAL NERVOUS SYSTEM anticholinergic drug with more children malignant (especially
AGENT; PSYCHOTHERAPEUTIC; effects and prolonged syndrome. Special akathisia and
ANTIPSYCHOTIC PHENOTHIAZINE more prominent pharmacologic Senses: Nasal dystonia) are most
TYPICAL antiemetic and effects than congestion, dry likely to occur in
extrapyramidal that of mouth, blurred patients receiving
Dosage: effects than chlorpromazine. vision, pigmentary high doses or
1 mg, 2 mg, 5 mg, 10 mg other retinopathy. parenteral
tablets; 10 mg/mL liquid; 2 phenothiazines. Management of Hematologic: administration and
mg/mL injection Antipsychotic manifestations Agranulocytosis. in older adults.
effects thought of psychotic Skin: Withhold drug and
Psychotic Disorders Adult: related to disorders; Photosensitivity, notify physician
PO 1–2 mg b.i.d., may blockade of "possibly skin rash, if patient has
increase up to 20 mg/d in postsynaptic effective" sweating. GI: dysphagia, neck
hospitalized patients IM 1–2 dopamine control of Constipation. CV: muscle spasm, or
mg q4–6h (max: 10 mg/d) receptors in excessive Tachycardia, if tongue
the brain. anxiety and hypotension. protrusion occurs.
Child: PO 6–12 y, 1 mg 1–2 tension Respiratory:  Monitor I&O
times/d, may increase up to associated with Depressed cough ratio and bowel
15 mg/d in hospitalized neuroses or reflex. Endocrine: elimination
patients IM 6– 12 y, 1 mg 1– somatic Gynecomastia, pattern. Check for
2 times/d, may increase up conditions. galactorrhea. abdominal
to 15 mg/d Dementia Behavior Interactions Drug: distention and
Geriatric: PO 0.5–1 mg 1–2 Alcohol and other pain. Encourage
times/d, may increase q4–7d CNS DEPRESSANTS adequate fluid
(max: 40 mg in divided add to CNS intake as
doses) IM 1 mg q4–6h (max: 6 depression. prophylaxis for
mg/d) Herbal: Kava-kava constipation and
may increase risk xerostomia. The
Administration Oral and severity of depressed patient
 Separate antacid and dystonic may not seek help
phenothiazine doses by at reactions. for either symptom
least 2 h. Pharmacokinetics or for urinary
 Dilute oral concentrate Absorption: Well retention. 
just before administration absorbed from GI Agitation,
with about 60–120 mL tract. Onset: jitteriness, and
suitable diluent (e.g., Rapid onset. Peak: sometimes insomnia
water, fruit juices, 2–3 h. Duration: may simulate
carbonated beverage, milk, Up to 12 h. original neurotic
soups, puddings). Avoid Metabolism: or psychotic
coffee or tea near time of Metabolized in symptoms. These
taking oral preparation. liver. adverse effects
Explain dosage and dilution Elimination: may disappear
Excreted in bile
to patient if drug is to be spontaneously. 
self-administered. and feces.
Expect maximum
 Crush tablet and give with therapeutic
fluid or mix with food if response within 2–
patient will not or cannot 3 wk after
swallow pill. initiation of
 Monitor ingestion of therapy
tablet to ensure that
patient does not hoard
medication.
Intramuscular
 Give IM injection deep
into upper outer quadrant of
buttock.
 Note: Slight yellow
discoloration of injectable
drug reportedly does not
alter potency. If color is
markedly changed, discard
solution.
 Wash hands if undiluted
concentrate is spilled on
skin to prevent contact
dermatosis.
 Store in light-resistant
container at 15°–30° C (59°–
86° F) unless otherwise
directed.

action PRECAUTIONS
Generic Name: Blocks post- To treat Chlorpromazine Tardive Establish baseline BP (in
Chlorpromazine synaptic D2 certain should not be dyskinesia (on standing and recumbent
dopamine mental/mood given if there long-term positions), and pulse, before
Brand Name: receptors. It disorders is a known therapy). initiating treatment. -Monitor BP
Thorazine and is considered (such as hypersensitivity Involuntary frequently. Hypotensive
Largactil that dopamine schizophrenia, or allergy to movements of reactions, dizziness, and
receptor psychotic phenothiazines. extremities may sedation are common during early
Classification: blockade in disorders, The drug should also occur. Dry therapy, particularly in patients
Antipsychotic/ the mesolimbic manic phase of be used mouth, on high doses and in the older
antiemetic area accounts bipolar cautiously in constipation, adult receiving parenteral doses.
Phenothiazine for the disorder, patients who are urinary -Monitor cardiac status with
antipsychotics antipsychotic severe on retention, baseline ECG in patients with
effect, whilst behavioral antihypertensive mydriasis, preexisting cardiovascular
Psychosis blockade in problems in medications due agitation, disease. -Be alert for signs of
Adult: PO 10-50 the children). to the risk of insomnia, neuroleptic malignant syndrome
mg q1-4hr nigrostriatal Chlorpromazine developing depression and (see Appendix G). Report
initially then system helps you to severe convulsions; immediately. -Monitor I&O ratio
increase up to produces the think more hypotension. It postural and pattern: Urinary retention
2 g/day if extrapyramidal clearly, feel should not be hypotension, ECG due to mental depression and
necessary IM effects less nervous, administered changes. Allergic compromised renal function may
1050 mg q1-4hr, associated and take part concurrently skin reaction, occur. If serum creatinine
usual dose 300- with in everyday with drugs that amenorrhoea, becomes elevated, therapy should
800 mg/day chlorpromazine life. depress the gynaecomastia, be discontinued. -Monitor for
use. central nervous weight gain. antiemetic effect of
Geriatric: PO system or in Hyperglycaemia chlorpromazine, which may obscure
10-25 mg daily- patients with a and raised serum signs of overdosage of other
bid, increase poorly cholesterol. drugs or other causes of nausea
by 10-25 mg/day controlled and vomiting. -Be alert to
q4-7days, max seizure Potentially complaints of diminished visual
800 mg/day disorder. The Fatal: acuity, reduced night vision,
drug does not Agranulocytosis. photophobia, and a perceived
Nausea and have approval Instantaneous brownish discoloration of
vomiting Adult: for the deaths associated objects. Patient may be more
PO 10-25 mg q4- treatment of with ventricular comfortable with dark glasses. -
6hr prn; IM dementia related tachyarrhythmias. Monitor diabetics or prediabetics
12.5-25 mg q3hr psychosis. Marked elevation on longterm, high-dose therapy
prn, then 25-50 of body for reduced glucose tolerance and
mg q6-8 hr prn temperature with loss of diabetes control. -Ocular
if no heat stroke. examinations, and EEG (in
hypotension, Neuroleptic patients >50 y) are recommended
max 400 mg/day; malignant before and periodically during
IV 25-50 mg syndrome, prolonged therapy.
daily-qid extrapyramidal
dysfunction.
Route:
IM/ IV/ PO
TYPICAL

action PRECAUTIONS
Generic Name: Used for the Prolonged QT Extrapyramidal  Be alert for signs of
Pimozide The ability suppression of interval or symptoms including
of pimozide motor and family history acute dystonic neuroleptic malignant syndrome,
Brand Name: to suppress phonic tics in of congenital reactions, akathisia, including hyperthermia,
Orap motor and patients with long QT pseudoparkinsonism,
phonic tics Tourette's syndrome, tardive dyskinesia; diaphoresis, generalized muscle
in Disorder who history of venous rigidity, altered mental
Dosage: Tourette's have failed to cardiac thromboembolism, grand status, tachycardia, changes in
Adult: Disorder is respond arrhythmias, mal convulsions,
Initially, 2 thought to satisfactorily severe toxic CNS anticholinergic blood pressure (BP), and
mg once be primarily to standard depression, effects (e.g. incontinence. Symptoms
daily, a function treatment. comatose states, constipation, typically occur within 4–14
adjusted of its known xerostomia, blurred
according to dopaminergic uncorrected vision, urinary days after initiation of drug
response by blocking hypokalaemia or retention), CNS therapy, but can occur at any
increments of activity. hypomagnesaemia; depression, time during drug use. Report
2-4 mg at Pimozide treatment of oesophageal
intervals of these signs to the physician
binds and simple tics or dysmotility or
not less than inhibits the tics other than aspiration, immediately.
1 week. Usual dopamine D2 those associated hyperprolactinaemia,
dose range: receptor in with Tourette’s impaired core body  Assess heart rate, ECG, and
2-20 mg the CNS. syndrome. temperature
daily. heart sounds, especially during
Concomitant use regulation.
Elderly: Half with QTc- exercise Report any rhythm
the usual prolonging Eye disorders: disturbances or symptoms of
initial dose. agents, SSRIs, Decreased
increased arrhythmias,
Child: >12 CYP3A4 and accommodation, visual
years Same as strong CYP2D6 disturbance. including palpitations, chest
adult dose. inhibitors; discomfort, shortness of
drugs that may Gastrointestinal
breath, fainting, and
Route: oral cause motor and disorders:
phonic tics Nausea, vomiting, fatigue/weakness.
TYPICAL (e.g. pemoline, diarrhoea, salivary
methylphenidate, hypersecretion,  Assess BP periodically and
amphetamines) constipation, dry
compare to normal values.
until it is mouth.
determined if General disorders and Report low BP (hypotension),
these drugs or administration site especially if patient
Tourette conditions:
experiences dizziness, fatigue,
disorder are Hyperhidrosis, extreme
causing tics. exhaustion. or other symptoms.
Investigations: Weight
increased.  Assess motor function, and be
Metabolism and
nutrition alert for extrapyramidal
disorders: Anorexia, symptoms. Report these symptoms
hyperglycaemia, immediately, especially tardive
hyponatraemia.
Musculoskeletal and dyskinesia, because this
connective tissue problem may be irreversible.
disorders: Muscle Common extrapyramidal symptoms
spasm, muscle
rigidity. include:
Nervous system
disorders: Dizziness, o ∘ Tardive dyskinesia
somnolence, headache, (uncontrolled rhythmic
tremor, akinesia.
Psychiatric movement of mouth, face,
disorders: Depression, and extremities, lip
insomnia, agitation, smacking or puckering,
restlessness.
puffing of cheeks,
Renal and urinary
disorders: Nocturia, uncontrolled chewing,
urinary frequency. rapid or worm-like
Reproductive system
movements of tongue).
and breast
disorders: Erectile
dysfunction, o ∘ Pseudoparkinsonism
galactorrhoea, (shuffling gait, rigidity,
gynaecomastia,
tremor, pill-rolling
amenorrhoea, decreased
libido. motion, loss of balance
Skin and subcutaneous control, difficulty
tissue
speaking or swallowing,
disorders: Sebaceous
gland overactivity, mask-like face).
rash, pruritus.
o ∘ Akathisia (restlessness
or desire to keep moving).
o ∘ Other dystonias and
dyskinesias (dystonic
muscle spasms, twisting
motions, twitching,
inability to move eyes,
weakness of arms or legs).
 Monitor unusual weakness and

fatigue that might be due to
anemia, or other symptoms such
as fever, sore throat, mucosal
lesions, or signs of infection
that might be due to other
blood dyscrasias. Notify
physician if these signs occur.
 Periodically assess body weight

and other anthropometric
measures (body mass index, body
composition). Report a rapid or
unexplained weight loss or
decreased body fat.
Interventions
 Guard against falls and

trauma (hip fractures, head
injury, and so forth) caused
by drowsiness, blurred
vision, or extrapyramidal
symptoms; implement fall
prevention

action PRECAUTIONS
Generic Name: CNS - Headache - Checked Physicians
Risperidone Blocks Monotherapy or Hypersensitivity to Insomnia - order. 2. Reviewed
dopamine, 5 – combination the active Agitation - patient’s chart and
Brand Name: HT 2, alpha1 therapy with substance or to any Anxiety CV - medication. 3. Obtained
Rileptid and alpha2 lithium or of the excipients Tachycard ia - BP measures as baseline
adrenergic, valproate for 3 of this drug and Hypotensi on. data. 4. Monitored
Dosage: 2 mg and H1 week treatment its components. Use patient’s for occurrence
histaminergic of acute manic cautiously in of side effects. Health
Route: PO receptors in or mixed patients exposed to Teaching 1. Warned
the brain. episodes from extreme heat The patient to avoid
Frequency: 1 tab bipolar I patient is not activities that requires
once a day disorder. contraindicated to alertness and force. 2.
the drug because Advised patient rise
Drug Class: Anti she has no slowly and use other
psychotic drug hypersensitivity precautions to avoid
fainting. 3. Advised
ATYPICAL patient to avoid
alcohol.

action PRECAUTIONS
Generic Name: Mechanism is not Indicated only Severe CNS CV: Orthostatic -Monitor diabetics for loss
Clozapine defined. in the depression, blood hypotension, of glycemic control. -
Interferes with management of dyscrasia, history tachycardia, ECG Monitor for seizure
Brand Name: binding of severely ill of bone marrow changes, increased activity; seizure potential
Clozaril, dopamine to D1 schizophrenic depression; risk of increases at the higher
Fazaclo and D2 receptors patients who patients with myocarditis dose level. -Closely
in the limbic have failed to myeloproliferative especially during monitor for recurrence of
Dosage: 25 mg, region of brain. respond to disorders, first month of psychotic symptoms if the
100 mg tablets It binds other uncontrolled therapy, drug is being discontinued.
primarily to neuroleptic epilepsy; pericarditis, -Monitor cardiovascular and
Route: nondopaminer gic agents. clozapine-induced pericardial respiratory status,
orally sites (e.g., agranulocytosis, effusion, especially during the first
disintegrating alphaadrenergic, severe cardiomyopathy, month of therapy. Report
tablets serotonergic, granulocytosis, heart failure, MI, promptly S&S of CHF and
and cholinergic chemotherapy, mitral other potential cardiac
Classification: receptors). coma, leukemia, insufficiency. GI: problems. -Monitor for
atypical or leukopenia, Nausea, dry mouth, development of tachycardia
second- neutropenia, constipation, or hypotension, which may
generation myocarditis, hypersalivation. pose a serious risk for
antipsychotic concurrent Hematologic : patients with compromised
drug administration of Agranulocytosis. cardiovascular function. -
benzodiazepines or CNS: Seizures, Monitor daily temperature
other psychotropic transient fever, and report fever. Transient
drugs; renal sedation, elevation above 38° C
failure, dialysis, neuroleptic (100.4° F), with peak
hepatitis, malignant syndrome incidence during first 3 wk
jaundice; infants, (rare), dystonic of drug therapy, may occur.
lactation reactions (rare). AFTER: Educate the Patient
Metabolic: of the following: -
Hyperglycemia, Carefully monitor blood
diabetes mellitus. glucose levels if diabetic.
Urogenital: -Report flulike symptoms,
Urinary retention. fever, sore throat,
Other: Increased lethargy, malaise, or other
mortality from signs of infection. -Do not
severe engage in any hazardous
hematologic, activity until response to
cardiovascular, the drug is known.
and respiratory Drowsiness and sedation are
adverse effects. common adverse effects. -
Report immediately any of
the following: unexplained
fatigue, especially with
activity; shortness of
breath, sudden weight gain
or edema of the lower
extremities. -Do not use
OTC drugs or alcohol
without permission of
physician. -Do not breast
feed while taking
clozapine.

PRECAUTIONS
Generic Name: Amisulpride is Schizophrenia is a Phaeochromocytoma, Insomnia, anxiety, Take this
Amisulpride a substituted severe and chronic concomitant agitation, drowsiness, medicine by
benzamide psychiatric prolactin- wt gain, acute dystonia, mouth Swallow
Classification: atypical disorder with a dependent tumours parkinsonism, akathisia, the tablets
Atypical antipsychotic multifactorial (e.g. pituitary tardive dyskinesia, QT whole with a
antipsychotic which binds aetiology, which is gland prolongation, drink of water.
selectively w/ characterized by prolactinomas or hypotension, Do not chew
Dosage& Frequency: a high affinity hallucinations, breast cancer). bradycardia, GI your tablets
50-300 mg/day (up to human delusions, Pre-pubertal disorders (e.g. Take before a
to 300 mg dopaminergic disorganized childn. constipation, nausea, meal
amisulpride may be D2 and thinking and Combination w/ vomiting, dry mouth), If you feel the
given in 1 dose)- D3 receptor bizarre motor levodopa. hyperglycaemia; breast effect of your
mainly negative subtypes. behaviour pain, erectile medicine is too
symptoms 400-1200 (psychotic/positive Patient w/ history dysfunction, weak or too
mg/day (in 2 symptoms) as well of epilepsy; amenorrhoea, strong, do not
divided doses)- as apathy, Parkinson's gynaecomastia, change the dose
mainly positive anhedonia, disease, CV galactorrhoea. Rarely, yourself, but
symptoms asociality and disease. Avoid allergic reactions, ask your doctor
affect disturbance abrupt withdrawal. abnormal LFTs, seizures. 3 For elderly,
(deficit/negative Renal impairment. Potentially your doctor
symptoms). Elderly. Pregnancy Fatal: Neuroleptic will need to
Additionally, many and lactation. malignant syndrome. keep a close
patients also check on you as
present with you are more
cognitive symptoms likely to have
such as impaired low blood
executive function pressure or
and attention. sleepiness due
to this
medicine people
with kidney
problems, your
doctor may need
to give you a
lower dose

PRECAUTIONS
Generic Name: Potent  Dementia Known  uncontrolled muscle Report immediately
Fluphenazine phenothiazine,  Mania hypersensitivity movements in your face onset of mental
antipsychotic  Psychosis to (chewing, lip smacking, depression and
Brand Name: agent. Blocks  Schizophreni phenothiazines; frowning, tongue extrapyramidal
Phenothiazines postsynaptic a subcortical movement, blinking or symptoms Be alert for
dopamine  Bipolar brain damage, eye movement); appearance of acute
Dosage & receptors in the Disorder comatose or dystonia-can be
 extreme drowsiness or
Frequency: brain. Similar to  Alcoholic severely controlled by
light-headed feeling
Psychosis other Psychosis depressed reducing dosage/by
(like you might pass
Adult: PO 0.5– phenothiazines  Drug-Induced states, blood adding an
out);
10 mg/d in 1– with the Psychosis dyscrasias, antiparkinsonism
4 divided following  Depressive renal/hepatic  strange dreams, or if agent Be alert for
doses (max: of exceptions: more Psychosis disease. you feel restless or red, dry, hot skin;
20 mg/d) IM/SC potent per  Arterioscler Parenteral form excited; full, bounding pulse,
HCl 2.5– 10 weight, higher otic not recommended dilated pupils,
mg/d divided incidence of Dementia for children  blurred vision, tunnel dyspnea, mental
q6– 8h (max: extrapyramidal  Arterioscler vision, eye pain, or confusion, elevated
10 mg/d); complications, otic seeing halos around BP, temperature over
Decanoate and lower Dementia w/ lights; 105F Inform Extended
12.5– 25 mg frequency of Depressive  painful or difficult exposure to high
q1– 4wk; sedative, Features urination; environmental
Enanthate 25 hypotensive, and  Dementia w/ temperature, to sun's
mg q2wk antiemetic Depressive  severe constipation, rays, or to a high
Dementia effects. Features stomach pain, bloating; increases risk for
Behavior  Alcoholic  jaundice (yellowing of heat stroke. Monitor
Geriatric: PO Management of Dementia the skin or eyes); kidney/liver function
1– 2.5 mg/d, manifestations of & WBC w/diff Monitor
may increase psychotic  a seizure; or BP during early
every 4– 7 d disorders, therapy. If systolic
 low white blood cell
by 1– 2.5 mg/d effective for drop is more than 20
counts--fever, chills,
(max: 20 mg/d treatment of mouth sores, skin sores, mm Hg, inform
in 2– 3 antipsychotic sore throat, cough, physician. Monitor
divided doses) symptoms trouble breathing, I&O ratio and bowel
including feeling light-headed. elimination pattern-
schizophrenia As  drowsiness, headache, Monitor for
antineuralgia blurred vision; xerostomia and
adjunct constipation.
 problems with balance Patients on large
or muscle movement; doses who undergo
 nausea, loss of surgery and those
appetite, with cerebrovascular,
constipation; cardiac, or renal
insufficiency are
 swelling, weight especially prone to
changes; hypotensive effects
 stuffy nose, dry
mouth, or drooling;
 increased sweating or
urination;
 breast swelling or
tenderness; or
 impotence, trouble
having an orgasm.
Drug Name Mechanism of Indication Contraindication Adverse NURSING RESPONSIBILITY/

action Effect PRECAUTIONS
Brand Names: Loxapine is a Severe drug-  Difficulty  Monitor and report signs of
Adasuve, Xylac dopamine For the induced CNS with
antagonist, and management of depression, speaking neuroleptic malignant syndrome,
Generic Name: also a the coma (oral); or including hyperthermia,
Loxapine serotonin 5-HT2 manifestations current swallowing diaphoresis, generalized muscle
blocker. The of psychotic diagnosis or  lip smacking
Classification: exact mode of disorders such history of rigidity, altered mental status,
or
An antipsychotic action of as asthma, COPD, puckering tachycardia, changes in blood
TYPICAL Loxapine has schizophrenia bronchospasm, pressure (BP), and incontinence.
not been or acute resp  loss of
balance Symptoms typically occur within
established, symptoms control 4–14 days after initiation of
For oral dosage however changes (inhalation).  mask-like
form (capsules): in the level of drug therapy, but can occur at
face
excitability of any time during drug use.
subcortical  puffing of
 Adults—At
first, 20 to inhibitory the cheeks
 Watch for signs of
50 milligrams areas have been  rapid or
(mg) per day, observed in fine, agranulocytosis, including fever,
divided and several animal worm-like sore throat, mucosal lesions, and
given in two species in movements other signs of infection. Report
to four doses association of the
with such tongue these signs to the physician
per day. Your
doctor may manifestations  restlessness immediately.
increase your of or desire
dose if tranquilization to keep  Assess motor function, and be
needed. as calming moving
effects and alert for extrapyramidal
However, the
suppression of  shuffling symptoms. Report these symptoms
dose is
usually not aggressive walk
immediately, especially tardive
more than 250 behavior.  slowed
movements dyskinesia, because this problem
mg per day.
 stiffness of may be irreversible.
 Children—Use
and dose must the arms
be determined and legs  Assess heart rate, ECG, and heart
by your  trembling sounds, especially during
doctor. and exercise a rapid heart rate
shaking of
For oral dosage (tachycardia) or signs of other
the
form fingers arrhythmias, including
and hands palpitations, chest discomfort,
 Adults—At
 uncontrolled shortness of breath, fainting,
first, 10
milligrams chewing
and fatigue/weakness.
(mg) 2 times a movements
day. Some  uncontrolled
 Assess BP when patient assumes a
patients may movements
need 50 mg per of the more upright position (lying to
day. Your arms or standing, sitting to standing,
doctor may
legs lying to sitting). Document
increase your
dose if orthostatic hypotension and
needed. contact physician when systolic
However, the BP falls >20 mm Hg or diastolic
dose is
usually not BP falls >10 mm Hg.
more than 250
mg per day.  Monitor signs of allergic
 Children—Use reactions, including pulmonary
and dose must symptoms (tightness in the throat
be determined
by your and chest, wheezing, cough,
doctor. dyspnea) or skin reactions (rash,
pruritus, urticaria). Notify
physician immediately if these
reactions occur.
 Assess dizziness, drowsiness, and

ataxia that might affect gait,
balance, and other functional
activities Report balance
problems and functional
limitations to the physician and
nursing staff, and caution the
patient and family/caregivers to
guard against falls and trauma.
Drug Name Mechanism of action Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/
PRECAUTIONS
GENERIC NAME: Positioned nauseated
Prochlorperazine The mechanism of Indicated for the  Do not use in Drowsiness, patients who have
action of symptomatic received
BRAND NAME: prochlorperazine treatment of severe patients with dizziness, prochlorperazine
PCPZ-5 has not been fully nausea and known amenorrhea, carefully to prevent
determined, but may vomiting. hypersensitivity blurred vision, aspiration of vomitus;
CLASSIFICATI ON: be primarily Indicated for the to skin reactions may have depressed
Prochlorperazine related to its management of phenothiazines. and hypotension cough reflex.
may occur.
is in a class of anti-dopaminergic manifestations of  Older adult and
medications effects. psychotic Do not use in Neuroleptic
emaciated patients and
called Prochlorperazine disorders, such as comatose states Malignant
children, especially
conventional blocks the D2 schizophrenia and or in the Syndrome (NMS)
those with dehydration
antipsychotics. dopamine receptors generalized non- presence of has been
or acute illness,
TYPICAL in the brain, which psychotic anxiety. large amounts of reported in
appear to be
are somatodendritic The use of central nervous association with
particularly
Dosage: autoreceptors. prochlorperazine system antipsychotic
susceptible to
Oral:Usual dose: Inhibition of D2 for the management depressants drugs
extrapyramidal effects.
5 to 10 mg receptor signaling of generalized non- (alcohol, Be alert to onset of
orally 3 to 4 results in the psychotic anxiety barbiturates, symptoms: Early in
blockade of is typically not a narcotics, therapy watch for
times a day
postsynaptic first-line therapy etc.). pseudoparkinson's and
Maximum dose: 40 dopamine receptors and should be acute dyskinesia.
mg/day in the mesolimbic limited to doses of Do not use in  Be alert to signs of
system and an less than 20 mg per pediatric high core temperature:
Parenteral: increased dopamine day or for shorter surgery. Red, dry, hot skin;
IM:Usual dosage: turnover. Nausea than 12 weeks. full bounding pulse;
5 to 10 mg IM, and vomiting are Off-label uses Do not use in dilated pupils;
repeated every 3 proposed to arise include use in pediatric dyspnea; confusion;
to 4 hours as from peripheral or emergency settings patients under 2 temperature over 40.6°
necessary. central stimulation for adult and years of age or C (105° F); elevated
Maximum dose: 40 of serotonin type 3 pediatric under 20 lbs. Do BP. Exposure to high
mg/day (5-HT3) and migraines. The not use in environmental
dopamine type 2 American Headache children for temperature, to sun's
IV:Usual dose: receptors, the Society recommends conditions for rays, or to a high
2.5 to 10 mg predominant the use of which dosage has fever associated with
slow IV receptors expressed prochlorperazine as not been serious illness places
injection or at the the first-line established. this patient at risk
infusion at a chemoreceptor medication in this for heat stroke.
rate not trigger zone (CTZ). setting. In
 Be aware that drug
exceeding 5 Prochlorperazine pediatric
may color urine reddish
mg/min exerts antiemetic migraines, a non-
brown. It also may
Maximum dose: 10 effects and was steroidal anti- cause the sun-exposed
mg (single shown to inhibit inflammatory agent skin to turn gray-blue.
dose); 40 mg/day apomorphine-induced is often used in  Withhold dose and
vomiting by combination with report to the physician
Rectal:Usual blocking D2 dopamine antagonist if the following
dose: 25 mg dopamine receptors symptoms persist more
rectally 2 times in the CTZ than a few hours:
a day Tremor, involuntary
twitching, exaggerated
restlessness. Other
reportable symptoms
include light-colored
stools, changes in
vision, sore throat,
fever, rash.
 Do not breast feed
while taking this drug

action PRECAUTIONS
Generic Name: Xanthene Hypersensitivity CNS: Drowsiness, Monitor for therapeutic
THIOTHIXENE derivative For the to thioxanthenes insomnia, response. Although
chemically and management of and dizziness, therapeutic response can be
Brand Name: pharmacologically schizophrenia phenothiazines; cerebral edema, observed 1–6 h following IM
HYDROCHLORIDE similar to children <12 y; convulsions, injection, it may be days
Navane chlorprothixene comatose states; extrapyramidal or several weeks before
and the CNS depression; symptoms (dose there is a response with
Classifications: piperazine circulatory related), oral drug.
CENTRAL NERVOUS phenothiazines. collapse; blood paradoxical  Keep patient recumbent for
SYSTEM AGENT; Mechanism of dyscrasias exaggeration of at least 1 h following IM
PSYCHOTHERAPEUTIC; antipsychotic psychotic because of possibility of
PHENOTHIAZINE effects is History of symptoms; sudden orthostatic hypotension.
ANTIPSYCHOTIC unclear; thought convulsive death, Check BP periodically.
TYPICAL to be related to disorders; neuroleptic  Monitor BP for excessive
blockade of alcohol malignant hypotensive response when
Dosage: postsynaptic withdrawal; syndrome, tardive thiothixene is added to
1 mg, 2 mg, 5 mg, dopamine glaucoma; dyskinesia, drug regimen of patient on
10 mg, 20 mg receptors in the prostatic depressed cough hypertensive treatment
capsules; 5 mg/mL brain. hypertrophy; reflex. until therapy is
solution cardiovascular stabilized.
disease; patients GI: Xerostomia,  Monitor response when
who might be constipation. patient is changed from IM
exposed to to PO forms (capsules,
organophosphorus CV: Tachycardia, concentrate). Dosage
insecticides or orthostatic adjustment may be
to extreme heat; hypotension necessary.
concomitant use (especially with  Monitor infants delivered
of atropine or IM). from mothers who have
related drugs or received thiothixene.
ototoxic Hyperreflexia has been
medications Urogenital: reported.
(especially Impotence,
 Report extrapyramidal
ototoxic gynecomastia,
effects
antibiotics); galactorrhea,
(pseudoparkinsonism,
previously amenorrhea.
akathisia, dystonia) to
diagnosed breast
physician; dose adjustment
cancer Skin: Rash,
or short-term therapy with
contact
an antiparkinsonism agent
dermatitis,
may provide relief.
photosensitivity.
 Be alert to first symptoms
Special Senses: of tardive dyskinesia
Blurred vision,  Make position changes
pigmentary slowly, particularly from
retinopathy. lying down to upright
because of danger of light-
Metabolic: headedness; sit a few
Decreased serum minutes before walking.
uric acid levels.  Do not drive or engage in
potentially hazardous
activities until response
to drug is known.
 Avoid alcohol and other
depressants during therapy.
 Take drug as prescribed;
do not alter dosing regimen
or stop medication without
consulting physician.
Abrupt discontinuation can
cause delirium.
 Do not breast feed while
taking this drug without
consulting physician.

Brand Names Treatment of Hypersensitivity dizziness, Instruct patient to take medication
Fanapt Iloperidone acute dry mouth, exactly as directed. Advise patient
is a schizophrenia. reactions, fatigue, that appearance of tablets in stool is
Generic Name
Iloperidone dopamine D2 including nasal normal and not of concern.
and 5-HT2A anaphylaxis and congestion, Inform patient of the possibility of
Initial dose: 1 receptor orthostatic extrapyramidal symptoms. Instruct
mg orally twice antagonist angioedema, hypotension, patient to report these symptoms
a day and acts as reported somnolence, immediately to health care
Maintenance a tachycardia, professional.
dose: 6 to 12 mg neuroleptic and weight Advise patient to change positions
twice a day agent. increased. slowly to minimize orthostatic
Maximum dose: 24 hypotension cause drowsiness.
mg/day Caution patient to avoid driving or
other activities requiring alertness
until response to medication is known.
Extremes in temperature should also be
avoided; this drug impairs body
temperature regulation.
Instruct patient to notify health care
professional promptly if sore throat,
fever, unusual bleeding or bruising,
rash, tremors, palpitations, fainting,
menstrual abnormalities, galactorrhea
or sexual dysfunction occur.
Advise patient and family to notify
health care professional if thoughts
about suicide or dying, attempts to
commit suicide; new or worse
depression; new or worse anxiety;
feeling very agitated or restless;
panic attacks; trouble sleeping; new
or worse irritability; acting
aggressive; being angry or violent;
acting on dangerous impulses; an
extreme increase in activity and
talking; other unusual changes in
behavior or mood occur.

action PRECAUTIONS
Generic Name: Psychotropic Brexpiprazole CNS: SEIZURES, Assess mental status
Brexpiprazole activity may Brexpiprazole is (Rexulti) is abnormal dreams, (orientation, mood,
be due to indicated as contraindicated dizziness, behavior) before and
Brand Name: partial adjunctive in patients with drowsiness, periodically during
Rexulti agonist therapy to a known headache, therapy.
activity at antidepressants hypersensitivity restlessness. EENT: Assess for suicidal
dopamine D2 for the to Brexpiprazole blurred vision. CV: tendencies, especially
Classification: and serotonin treatment of (Rexulti) or any cerebrovascular during early therapy for
ATYPICAL 5-HT1A major depressive of its adverse reactions (↑ depression.
antipsychotics, receptors and disorder in components. in elderly patients Restrict amount of drug
antidepressants antagonist adults. It is Reactions have with dementia- available to patient.
serotonindopamine activity at also indicated included rash, related psychoses), Risk may be increased in
activity the 5-HT2A for the facial swelling, orthostatic children, adolescents, and
modulators (SDAM) receptor. treatment of urticaria, and hypotension/syncope. adults ≤24 yrs.
schizophrenia in anaphylaxis. GI: abdominal pain,
Decreased patients 13 constipation, Advise patient and family
manifestations years of age and diarrhea, dry mouth, to notify health care
of older. dysphagia, excess professional if thoughts
schizophrenia Brexpiprazole is salivation, about suicide or dying,
including also indicated flatulence. attempts to commit suicide;
excitable, for the new or worse depression;
paranoic, or treatment of new or worse anxiety;
withdrawn agitation feeling very agitated or
behavior. associated with restless; panic attacks;
Improvement in dementia due to trouble sleeping; new or
symptoms of Alzheimer’s worse irritability; acting
depression disease; aggressive; being angry or
with increased however, it is violent; acting on
sense of not indicated as dangerous impulses; an
wellbeing. an as-needed extreme increase in
(“prn”) activity and talking
treatment for
this condition.
Drug Name Mechanism of Indication Contraindic Adverse Effect NURSING RESPONSIBILITY/

action ation PRECAUTIONS
Brand Names Lumateperone is History of  drowsiness,  Monitor all antidepressant-
Caplyta unique among Lumateperone hyper-  dry mouth, treated patients for any
Generic Name second generation is approved sensitivity
antipsychotics for the ; reactions  nausea, indication of clinical
Lumatepero
ne based on its treatment of have  dizziness, worsening and emergence
target profile schizophrenia included  increased creatine of suicidal thoughts and
Classification: and dopamine D2 in adults. It pruritus, phosphokinase, behaviors, especially
ATYPICAL receptor is also rash (.g,
 fatigue, during the initial few
antipsychotic occupancy. Unlike approved for allergic
other the treatment dermatitis,  vomiting, months of drug therapy,
Dosage: antipsychotics, of depressive papular  increased liver and at times of dosage
 10.5mg lumateperone has episodes rash, and transaminases, and changes; counsel family
 21mg partial agonist associated generalized  decreased appetite members or caregivers of
 42mg activity at with bipolar rash),
 feeling unsteady, patients to monitor for
presynaptic disorder (i.e. and urticar
dopamine (D2) bipolar ia  uncontrolled muscle changes in behavior and
Frequency &
Route: receptors, depression) in movements in the face to alert the healthcare
42 mg PO qDay resulting in adults, as (chewing, lip provider; consider
reduced monotherapy smacking, frowning, changing the therapeutic
presynaptic and/or
release of adjunctive tongue movement, regimen, including
dopamine, and therapy with blinking, or eye possibly discontinuing
antagonistic lithium or movement); therapy, in patients
activity at valproate.6  tightness in the neck whose depression is
postsynaptic
or throat, trouble persistently worse, or
dopamine (D2)
receptors. These swallowing; who are experiencing
characteristics  trouble breathing or suicidal thoughts or
allow speaking; behaviors
lumateperone to  high blood sugar--increased  Antipsychotics,
efficiently thirst, increased including lumateperone,
reduce dopamine
signaling. urination, dry mouth, may
Lumateperone also fruity breath odor; cause somnolence, postural
targets dopamine  low white blood cell hypotension, and motor and
(D1) receptors, counts--fever, chills, sensory instability,
and a useful
mouth sores, skin which may lead to falls
secondary result
of D1 activation sores, sore throat, cough, and, consequently,
is increased trouble breathing; or fractures and other
glutamatergic N-  severe nervous system injuries
methyl-D- reaction--very stiff
aspartate (NMDA)
(rigid) muscles, high
GluN2B receptor
phosphorylation. fever, sweating,
This is confusion, fast or
significant since uneven heartbeats,
NMDA mediated tremors, light-
glutamate
signaling appears headedness.
to be impaired in
patients who have
schizophrenia.
Drug Name Mechanism of Indication Contraindica Adverse Effect NURSING RESPONSIBILITY/

action tion PRECAUTIONS
Brand Names: Cariprazine Concomitant  extrapyramid Monitor blood pressure, vital
Vraylar potently binds to Cariprazine is use with al symptoms signs; weight, height, BMI,
both of these indicated for strong or waist circumference (baseline;
Generic Name: receptors, more the treatment moderate (muscle at 4, 8, 12 weeks after
Cariprazine preferably to D3 of schizophren CYP3A4 spasms, initiating or changing therapy
receptors with ia in adults inhibitors muscle then quarterly); CBC (frequently
Classification: higher to manage both and rigidity, tr during the 1st few months of
atypical affinity. Preclini positive and inducers. therapy in patients with pre-
emor,
antipsychotic cal studies negative existing low WBC or history of
suggest that D3 symptoms. It jerking drug-induced leucopenia or
receptor blockade is also movements), neutropenia); electrolytes and
is associated with indicated to  agitation, LFT (annually and as clinically
exerting pro- monotherapy indicated); fasting blood sugar
cognitive and for acute  indigestion, or HbA1c (baseline; 3 months
antidepressant management of  nausea, after therapy then yearly);
effects and manic or mixed  vomiting, fasting lipid panel (baseline; 3
attenuating episodes  sleepiness, months after therapy then if LDL
negative symptoms associated is normal, 2-5 years intervals
 restlessness
in with bipolar I or more frequently if
schizophrenia. Thi disorder , indicated). Monitor mental
s unique mechanism (bipolar  fatigue, status; personal or family
of action differs mania) in  constipation history of diabetes,
from that of other adults, and , dyslipidaemia, obesity,
antipsychotic acute hypertension or CV disease
 increased
agents that mostly management of (baseline and annually); changes
target D2 and 5- depressive appetite, in menstruation, libido,
HT2A receptors. episodes  dizziness, development of galactorrhoea,
associated  weight gain, erectile and ejaculatory
with bipolar I  headache, function (annually); Parkinson
disorder signs (baseline; weekly until
(bipolar and dose stabilized for at least 2
depression) in  insomnia. weeks after initiation or
adults. changes in dose), and tardive
dyskinesia.

RESPONSIBILITY/
PRECAUTIONS
Generic Name: Coma, severe CNS Orthostatic Caution patient
Molindone The exact mechanism Molindone is depression. hypotension, to avoid
has not been used for the CNS depression. tachycardia, driving or
Brand Name: established, however, management of Parkinson's disease. arrhythmia; other
Moban based on the Patients with extrapyramidal activities
electroencephalogram manifestations haemodynamic reactions, mental requiring
Classification: (EEG) studies, of psychotic instability; bone depression, altered alertness until
an antipsychotic molindone is thought disorders. marrow suppression; central temperature response to
TYPICAl to act by occupying predisposition to regulation, sedation, medication is
(antagonizing) seizures; drowsiness, known.
dopamine (D2) subcortical brain restlessness,
Dosage: receptor sites in the damage; severe anxiety, Caution patient
 Recommended reticular limbic cardiac, hepatic, hyperactivity, to avoid taking
dose: 50 to 75 systems in the brain, renal, respiratory euphoria, seizure; alcohol or
mg orally per thus decreasing disease. Breast pruritus, rash, other CNS
day, increasing dopamine activity. cancer or other photosensitivity; depressants
the dose to 100 Decreased dopamine prolactin-dependent menstrual concurrently
mg/day in 3 to activity results in tumours. May alter irregularities, with this
4 days decreased temperature oedema of breasts, medication.
physiological effects regulation or mask galactorrhoea,
 Maximum dose: normally induced by toxicity of other gynaecomastia;
225 mg/day excessive dopamine drugs. Patients at constipation,
stimulation, such as risk of orthostatic xerostomia, nausea,
those typically seen hypotension. salivation, wt
in manifestations of Decreased GI gain/loss; urinary
psychotic disorders. motility, urinary retention, priapism;
retention, benign leukopenia,
prostatic leukocytosis; blurred
hyperplasia, vision, retinal
xerostomia or visual pigmentation;
problems. May impair decreased
ability to drive or diaphoresis.
operate machinery.
Pregnancy and
lactation

PRECAUTIONS
Generic Name: May inhibit Treats *Contraindicated Somnolence, rash or *Monitor patients
Ziprasidone dopamine and Symptomatic in patients urticaria, GI disturbances, with diabetes
serotonin-2 treatment of hypersensitive dizziness, flu-like regularly.
Brand Name: receptors, schizophrenia, to drug *Those symptoms, HTN, headache, *Monitor patient
Geodon causing and Rapid with recent MI agitation, confusion, for symptoms of
reduction in control of acute or uncompensated dyspnoea, orthostatic metabolic syndrome
Classification: schizophrenia agitation in HF hypotension, increased *Closely monitor
Antipsychotics symptoms. schizophrenic *Contraindicated prolactin levels, wt gain, patients at risk
ATYPICAL patients in patients with sexual dysfunction, for suicide
history of extrapyramidal symptoms, *Monitor glucose,
Dosage & Route: prolonged QT tardive dyskinesia, lipid levels, and
*Capsules : 20 interval hyperglycaemia. Rarely, WBC labs
mg, 40 mg, 60 cholestatic jaundice, * Advise patient
mg, 80 mg *IM hepatitis, seizures, that drug can
injection: 20 leucopenia, neutropenia, cause sleepiness *
mg/mL single- thrombocytopenia, Advise patient
dose vials hyperlipidaemia. that symptoms may
Potentially Fatal: Life- not improve for 4
threatening arrhythmias e.g. to 6 weeks
torsades de pointes and *Immediately
sudden death, neuroleptic report rash to the
malignant syndrome, doctor
agranulocytosis, drug
reaction w/ eosinophilia and
systemic symptoms (DRESS).

PRECAUTIONS
Brand Names paliperidone is Hypersensitivity Significant: QT prolongation, Monitor mental
Invega, Invega Paliperidone indicated for to paliperidone extrapyramidal symptoms status; vital
Hafyera, is the major the treatment or risperidone. (including tardive signs
Xeplion active of adults and Lactation dyskinesia), dyslipidaemia, Monitor for
Generic Name metabolite of adolescents significant weight gain, signs and
Paliperidone risperidone. with hyperprolactinaemia, symptoms of
The mechanism schizophrenia orthostatic hypotension, tardive
of action of and in the syncope, leucopenia, dyskinesia,
Classification: paliperidone, treatment of neutropenia, agranulocytosis, neuroleptic
atypical as with other schizoaffective somnolence, motor and sensory malignant
antipsychotic used drugs having disorder in instability, seizures, syndrome,
in the efficacy in combination priapism, oesophageal autonomic
schizophrenia, with dysmotility/aspiration, instability
Dosage: is unknown, antidepressants hyperglycaemia, diabetes (e.g.
1.5mg but it has or mood mellitus (including tachycardia,
been proposed stabilizers. exacerbation of pre-existing cardiac
3mg that the Paliperidone is diabetes; ketoacidosis [very dysrhythmia).
drug's also available rarely], and diabetic coma Perform ocular
6mg
therapeutic in both an [rarely]), impaired core body examination
9mg activity in every-three- temperature regulation, yearly in
schizophrenia month and hypersensitivity reactions patients >40
Route: is mediated twice-yearly (including anaphylactic years or every
PO/IM through a extended- reactions and angioedema). 2 years in
combination of release Cardiac younger
central suspension for disorders: Tachycardia, patients
dopamine Type intramuscular bradycardia, atrioventricular
2 (D2) and injection for block, conduction disorder.
serotonin Type the treatment Eye disorders: Blurred vision.
2 (5HT2A) of Gastrointestinal
receptor schizophrenia. disorders: Abdominal pain or
antagonism. discomfort, nausea, vomiting,
constipation, diarrhoea,
dyspepsia, toothache, dry
mouth.
General disorders and
administration site
conditions: Pyrexia, asthenia,
fatigue; inj site reactions
(IM).
Infections and
infestations: Influenza.
Investigations: Decreased
weight, increased
transaminases.
Metabolism and nutrition
disorders: Decreased or
increased appetite.
Musculoskeletal and
connective tissue
disorders: Musculoskeletal
pain, back pain, arthralgia.
Nervous system
disorders: Sedation,
dizziness, tremor, headache.
Psychiatric
disorders: Insomnia,
agitation, anxiety,
depression, mania.
Renal and urinary
disorders: UTI.
Reproductive system and
breast disorders: Amenorrhoea,
galactorrhoea.
Respiratory, thoracic and
mediastinal disorders: Cough,
nasal congestion, upper
respiratory tract infection,
bronchitis, sinusitis,
pharyngolaryngeal pain.
Skin and subcutaneous tissue
disorders: Pruritus, rash.
Vascular
disorders: Hypertension.
Potentially Fatal: Neuroleptic
malignant syndrome (NMS).
PRECAUTIONS
Generic Name: Acepromazine acts as an Phenothiazines Agitation, Do not use in animals
Acepromazine antagonist (blocking Acepromazine was may potentiate coma, intended for human
agent) on different first used in the toxicity of convulsions, consumption.
Brand Name: postsysnaptic receptors humans in the organophosphates difficulty
Tranquilizers are potent
acetylpromazine, -on dopaminergic- 1950s as an and the activity breathing,
central nervous system
ACE, ACP, receptors (subtypes D1, antipsychotic of procaine difficulty
depressants, and they can
PromAce D2, D3 and D4 - agent. It is now hydrochloride. swallowing,
cause marked sedation
different antipsychotic rarely used in Therefore, do dry mouth,
with suppression of the
Classification: properties on humans. not use extreme
sympathetic nervous
phenothiazine productive and Acepromazine is Acepromazine sleepiness,
system. Tranquilizers can
antipsychotic unproductive symptoms), frequently used Injection fever,
produce prolonged
drug on serotonergic- in animals as a (acepromazine intestinal
depression or motor
receptors (5-HT1 and 5- sedative and maleate blockage,
restlessness when given
Dosage: HT2, with anxiolytic, antiemetic. Its injection) to irregular
in excessive amounts or
0.25 - 1.0 mg/lb antidepressive and principal value control tremors heart rate,
when given to sensitive
of body weight. antiaggressive is in quietening associated with low blood
animals. Tranquilizers
properties as well as and calming organic pressure,
are additive in action to
an attenuation of anxious animals. phosphate restlessness
the actions of other
extrapypramidal side- poisoning.
depressants and will
effects, but also
potentiate general
leading to weight gain,
anesthesia. Tranquilizers
fall in blood pressure,
should be administered in
sedation and
smaller doses and with
ejaculation
greater care during
difficulties), on
general anesthesia and
histaminergic-receptors
also to animals
(H1-receptors,
exhibiting symptoms of
sedation, antiemesis,
stress, debilitation,
vertigo, fall in blood
cardiac disease,
pressure and weight
sympathetic blockade,
gain), alpha1/alpha2-
hypovolemia or shock.
receptors
Acepromazine, like other
(antisympathomimetic
phenothiazine
properties, lowering of
derivatives, is
blood pressure, reflex
detoxified in the liver;
tachycardia, vertigo,
therefore, it should be
sedation,
used with caution on
hypersalivation and
animals with a previous
incontinence as well as
history of liver
sexual dysfunction, but
dysfunction or
may also attenuate
leukopenia.
pseudoparkinsonism -
controversial) and Epinephrine is
finally on muscarinic contraindicated for
(cholinergic) M1/M2- treatment of acute
receptors (causing hypotension produced by
anticholinergic phenothiazine-derivative
symptoms like dry tranquilizers since
mouth, blurred vision, further depression of
obstipation, blood pressure can occur.
difficulty/inability to
urinate, sinus Phenothiazines should be
tachycardia, ECG- used with caution when
changes and loss of followed by epidural
memory, but the anesthetic procedures
anticholinergic action because they may
potentiate the arterial
may attenuate
hypotensive effects of
extrapyramidal side-
local anesthetics.
effects).

action PRECAUTIONS
Generic Name: Fluoxetine For major Hypersensitivity insomnia, nausea, Be alert for new seizures
Fluoxetine exerts its depressive disorder to fluoxetine or diarrhea, or increased seizure
effects by (age eight and any component in anorexia, dry activity, especially at
Brand Name: blocking the older), its formulation mouth, headache, the onset of drug
Prozac reuptake of obsessivecompulsive Use of monoamine drowsiness, treatment. Document the
serotonin disor der (age oxidase anxiety, number, duration, and
Classification: into seven and older), inhibitors nervousness, severity of seizures, and
Selective presynaptic panic disorder, (MAOI) used to yawning, decreased report these findings
Serotonin serotonin bulimia, binge treat libido, decreased immediately to the
Reuptake neurons by eating diso rder, psychiatric arousal and physician. Be alert for
Inhibitors blocking the premenstrual dys disorders Never bruising increased depression and
(SSRIs) reuptake phoric disorder, initiate of suicidal thoughts,
transporter bipolar depressio n fluoxetine in a especially in the initial
Dosage: protein (as an adjunct with patient period of drug therapy and
 10mg located in olanzapine also receiving in children and teenagers.
 20mg the known as Symbyax), linezolid. Do Likewise, inform physician
 40mg presynaptic and not give or other mental health
terminal. treatmentresistant fluoxetine with care professional if
Fluoxetine depression when pimozide, patient demonstrates other
also has mild used in combination thioridazine, or mood changes such as
activity at with olanzapine tamoxifen. Use increased anxiety,
the 5HT2A and with caution in nervousness, or abnormal
5HT2C those with a arousal (mania). Monitor
receptors history of signs of allergic
seizures. reactions, including
pulmonary symptoms
(laryngeal edema,
wheezing, dyspnea, cough)
or skin reactions (rash,
pruritus, urticaria).
Notify physician
immediately if these
reactions occur. PROZAC
can cause sleepiness or
may affect your ability to
make decisions, think
clearly, or react quickly.
You should not drive,
operate heavy machinery,
or do other dangerous
activities until you know
how PROZAC affects you. Do
not drink alcohol while
using PROZAC.

PRECAUTIONS
Brand Names: Patient with bipolar Significant: Suicidal Monitor weight
Luvox The exact Indicated disorder; history of thinking and behaviour in and BMI; LFT at
mechanism of predominantly convulsive disorder; children, adolescent and baseline and as
Generic Name: action of for the CV disease (e.g. young adults, shift to clinically
Fluvoxamine fluvoxamine has management of recent history of MI, mania or hypomania, indicated.
not been fully depression unstable heart akathisia or psychomotor Closely monitor
Classification: determined, but and for disease), diabetes restlessness, bleeding for clinical
selective appears to be Obsessive mellitus, history of events (e.g. cutaneous or worsening,
serotonin- linked to its Compulsive mania or hypomania, mucous bleeding), CNS suicidality,
reuptake inhibition of CNS Disorder history of bleeding or depression, mild pupillary changes in
neuronal uptake of (OCD). Has other predisposing dilation, bone fractures, behaviour at
Dosage: serotonin also been conditions (e.g. impaired glucose control treatment
 25mg Fluvoxamine used in the thrombocytopenia, (e.g. hyper- or initiation and
 50mg blocks the management of coagulation hypoglycaemia, decreased during dosage
 100mg reuptake of bulimia disorders), raised glucose tolerance), sexual adjustments;
serotonin at the nervosa. intraocular pressure dysfunction, anxiety, social
serotonin reuptake or at risk of acute hyponatraemia, syndrome of functioning,
pump of the narrow-angle glaucoma, inappropriate antidiuretic mania, panic
neuronal membrane, volume depletion. hormone secretion (SIADH), attacks, or
enhancing the Smokers. Concomitant withdrawal symptoms. other unusual
actions of electroconvulsive Cardiac behavioural
serotonin on therapy. Avoid abrupt disorders: Palpitations, changes.
5HT1A autoreceptor. withdrawal. Renal and tachycardia. Monitor for
Studies have also hepatic impairment. Gastrointestinal signs and
demonstrated that Children and elderly. disorders: Nausea, symptoms of
fluvoxamine has Pregnancy. CYP2D6 poor vomiting, abdominal pain, serotonin
virtually no metabolisers. constipation, diarrhoea, syndrome and
affinity for α1- dry mouth, dyspepsia. akathisia.
or α2-adrenergic, General disorders and admin
β-adrenergic, site conditions: Asthenia,
muscarinic, malaise, ataxia.
dopamine D2, Hepatobiliary
histamine H1, disorders: Abnormal
GABA- hepatic function.
benzodiazepine, Metabolism and nutrition
opiate, 5-HT1, or disorders: Anorexia.
5-HT2 receptors, Musculoskeletal and
despite having an connective tissue
affinity for disorders: Arthralgia,
binding to σ1 myalgia.
receptors. Nervous system
disorders: Headache,
dizziness, somnolence,
tremor, extrapyramidal
disorder, convulsion.
Psychiatric
disorders: Agitation,
anxiety, nervousness,
insomnia, hallucination,
confusion, aggression.
Renal and urinary
disorders: Urinary
incontinence or retention,
enuresis, nocturia.
breast disorders: Delayed
ejaculation,
galactorrhoea.
Skin and subcutaneous
tissue
disorders: Hyperhidrosis,
sweating,
photosensitivity.
Vascular
disorders: Orthostatic
hypotension.

PRECAUTIONS
Generic Name: It enhances It is used to You should not use this Allergic reaction Monitor mood and
Paroxetine serotonergic treat medicine if you are may occur such as behavior Assess
activity via depression, allergic to paroxetine, hives, difficult for suicidal
Brand names: the including major or if you are also taking breathing, swelling thoughts Monitor
Paxil, Brisdelle, inhibition depressive pimozide or thioridazine. in the face and appetite Monitor
Pexeva presynaptic disorder, panic Do not use an MAO throat, severe skin blood pressure
reuptake of disorder, inhibitor within 14 days reaction (fever, Monitor sodium
Classification: serotonin by obsessive before or 14 days after sore throat, levels Monitor for
Antidepressant - the serotonin compulsive you take paroxetine. A burning eyes, skin signs of toxicity
SSRI Selective (SERT) disorder (OCD), dangerous drug pain, red or purple Monitor sleep
Serotonin Reuptake receptor. anxiety interaction could occur. skin rash with patterns
Inhibitors This disorders, MAO inhibitors include blistering and
inhibition post-traumatic isocarboxazid, linezolid, peeling). Vision
Dosage: raises the stress disorder phenelzine, rasagiline, changes, weakness,
 10mg level of (PTSD), and selegiline, and drowsiness,
 20mg serotonin in premenstrual tranylcypromine. After dizziness,
 30mg the synaptic dysphoric you stop taking tiredness,
 40mg cleft, disorder paroxetine you must wait sweating, anxiety,
relieving (PMDD). at least 14 days before shaking, sleep
symptoms. you start taking an MAO problems
inhibitor. Notify your (insomnia), loss of
doctor if you have any of appetite, nausea,
the following: vomiting, diarrhea,
 heart disease, high constipation, dry
blood pressure, or a mouth, yawning,
stroke; infection,
 liver or kidney headache, or
disease; decreased sex
drive, impotence,
 a bleeding or blood
clotting disorder; abnormal
 seizures or epilepsy; ejaculation, or
 bipolar disorder (manic difficulty having
depression), drug an orgasm.
addiction, or suicidal
thoughts;
 sexual problems;
 narrow-angle glaucoma;
 low levels of sodium in
your blood. Be sure your
doctor knows if you also
take stimulant medicine,
opioid medicine, herbal
products, or medicine for
depression, mental
illness, Parkinson's
disease, migraine
headaches, serious
infections, or prevention
of nausea and vomiting.
These medicines may
interact with paroxetine
and cause a serious
condition called
serotonin syndrome.

PRECAUTIONS
Brand Names: Sertraline, Sertraline is Concomitant use Activation of hypomania or Monitor BMI
Zoloft a naphthale- indicated for or within 14 mania, seizures, CNS depression, (longitudinal
naminederi- the management days of QTc prolongation, Torsade de monitoring),
Generic Name: vative anti- of major discontinuation pointes, abnormal bleeding height, weight;
Sertraline depressant, depressive of MAOIs. events including cutaneous serum Na in at-
selectively disorder (MDD), Concurrent use bleeding (e.g. ecchymoses, risk patients.
Classification: inhibits post-traumatic with pimozide. purpura), bone fractures, mild Closely monitor
selective presynaptic stress disorder Concomitant use pupillary dilation, sexual mental status
serotonin serotonin (PTSD), of sertraline dysfunction, loss of glycaemic for worsening of
reuptake (5-HT) obsessive- oral concentrate control, withdrawal symptoms. depression,
inhibitor (SSRI) reuptake. It compulsive solution with Cardiac disorders: Palpitations, suicidal
has very disorder (OCD), disulfiram. chest pain. ideation or
Dosage: weak effects panic disorder Ear and labyrinth other unusual
25mg on norepi- (PD), disorders: Tinnitus. behavioural
50mg nephrine and premenstrual Eye disorders: Visual changes at the
100mg dopamine dysphoric disturbance. start of
neuronal disorder (PMDD), Gastrointestinal treatment or
uptake. and social disorders: Nausea, diarrhoea, when doses are
anxiety disorder dry mouth, dyspepsia, adjusted; signs
(SAD). Common constipation, vomiting, and symptoms of
off-label uses abdominal pain, flatulence, serotonin
for sertraline dysgeusia. syndrome and
include the General disorders and glucose
prevention of administration site fluctuations.
post stroke conditions: Fatigue, malaise,
depression, asthenia, pyrexia.
generalized Investigations: Weight
anxiety disorder increased.
(GAD), Metabolism and nutrition
fibromyalgia, disorders: Decreased or
premature increased appetite.
ejaculation, Musculoskeletal and connective
migraine tissue disorders: Back pain,
prophylaxis, arthralgia, myalgia.
diabetic Nervous system
neuropathy, and disorders: Headache, dizziness,
neurocardiogenic somnolence, paraesthesia,
syncope. tremor, extrapyramidal symptoms
(e.g. hyperkinesia, hypertonia,
dystonia, teeth grinding or gait
abnormalities), disturbance in
attention.
Psychiatric disorders: Insomnia,
anxiety, agitation, depression,
nervousness, nightmare, bruxism,
decreased libido,
depersonalisation.
Reproductive system and breast
disorders: Ejaculation failure,
erectile dysfunction, irregular
menstruation.
mediastinal disorders: Yawning,
pharyngitis, rhinitis, upper
respiratory tract infection.
disorders: Rash, hyperhidrosis.
Vascular disorders: Hot flush.
Potentially Fatal: Suicidal
thoughts and behavior, serotonin
syndrome or neuroleptic
malignant syndrome (NMS),
haemorrhage (e.g.
gastrointestinal or
gynaecological bleeding),
anaphylactoid reaction,
angioedema, Stevens-Johnson
syndrome, erythema multiforme,
vasculitis, syndrome of
inappropriate antidiuretic
hormone secretion (SIADH),
hyponatraemia.
Drug Name Mechanism Indication Contraindication Adverse Effect NURSING

of action RESPONSIBILITY/
PRECAUTIONS
Generic Name: Selectively Antidepressant- Concurrent use of sexual problems; Monitor mood
Citalopram inhibits depression MAOI's, bradycardia, changes during
the Generalized hypokalemia, dizziness, drowsiness; therapy,
Brand Name: reuptake of anxiety hypomagnesemia, Assess for
Celexa serotonin disorder History of mania; dry mouth, thirst, increased suicidal
in the CNS History of suicide sweating or urination; tendencies, Assess
Classification: attempt/ideation, for serotonin
Antidepressant history of seizure loss of appetite, nausea, syndrome (mental
disorder, severe diarrhea, constipation; changes agitation,
Dosage: renal hallucinations),
 10mg or hepatic feeling anxious, agitated, or Nausea, vomiting,
 20mg impairment shaky; diarrhea,
 40mg Monitor
feeling weak or tired, sleep electrolytes
problems (insomnia), yawning; (potassium and
magnesium)
increased muscle movement;
nosebleed, heavy menstrual

bleeding; or
cold symptoms such as stuffy

nose, sneezing, sore throat.

PRECAUTIONS
Generic Name: Paroxetine Indicated for clients should First few Serotonin
Escitalopram selectively generalized avoid alcohol, use days/weeks, nausea, syndrome usually
oxalate inhibits serotonin anxiety disorder carefully whit diaphoresis, tremor, begins 2-72
reuptake allowing (GAD) and OCD clients who fatigue, hours after
Brand Name: more serotonin to have liver and drowsiness, after 5- initiation
Lexapro stay at renal dysfunction, 6 weeks of therapy, of treatment,
the junction of seizure disorders, insomnia, this resolves
Classification: the neurons history headache, and sexual when
Antidepressant of gi bleeding dysfunction, weight medication is
change, GI discontinued,
Dosage: bleeding, report bruxism
tablet Hyponatremia, to provider,
 5mg serotonin syndrome, educate the
 10mg bruxism, client about
 20mg this
combination
oral solution avoid concurrent
 5mg/5mL Report adverse
effects, take
medication as
prescribed,
effects
should soon
subside, report
problems with
sexual function

action PRECAUTIONS
Generic Name: Imipramine Second-line Contraindicated dizziness, sedation, Guard against falls and
Imipramine blocks the treatment in confusion, delirium, trauma (hip fractures,
reuptake notably in hypersensitivity seizures, increased head injury, and so
Brand Name: of severe to the drug, appetite, weight forth),
Tricyclic norepinephrine depression with especially in gain, and implement fall
and melancholic cross-reactivity blurred vision, prevention strategies.
Classification: serotonin. It and atypical with other constipation, and To minimize orthostatic
Antidepressant also features dibenzodiazepine tachycardia hypotension, patient
blocks D-2 Adjunctive s, in acute should move slowly when
receptors as therapy in recovery from assuming a more upright
well nocturnal myocardial position.
as alpha 1 and 2 enuresis in infarction, and Periodically assess body
adrenergic and children above when used weight and other
H1 receptors. six years of age concurrently with anthropometric measures
Treatment of MOAI or within (body mass index, body
chronic 14 days of composition). Report a
neuropathic discontinuing rapid or unexplained
pain and panic either imipramine weight gain or increased
disorder or MOAI as this body fat.
may precipitate Be alert for increased
hypertensive depression and suicidal
crisis. thoughts and ideology,
especially when
initiating
drug treatment or in
children and teenagers.
Notify physician or
mental
health professional
immediately if patient
exhibits worsening
depression or other
changes in mood and
behavior

PRECAUTIONS
Generic Name: Selegiline is an Selegiline is Use of selegiline The most commonly Monitor confusion,
Selegiline irreversible used as an within ten days reported are hallucinations, and
inhibitor of adjunct treatment before elective headache, other psychologic
Brand Name: monoamine oxidase in the management surgery is dizziness, problems. Repeated or
Eldepryl, (MAO), an enzyme of patients with contraindicated insomnia, and excessive symptoms may
Emsam, Selgin that catabolizes Parkinson disease due to adverse nausea. Although require change in dose
norepinephrine, and as a effects on blood itt may also cause or medication. Advise
Classification: serotonin, and treatment for a pressure. Oral a hypertensive patient to avoid
Monoamine dopamine. The major depressive selegiline should crisis, a severe alcohol because of the
oxidase (MAO) blockage of this disorder (MDD) in not be used elevation of blood increased risk of
inhibitor enzyme prevents adults. concomitantly pressure when the sedation and adverse
the reuptake of Selegiline is with patient consumes effects. Instruct
Dosage: these also used cyclobenzaprine, the medication patient to report
tablet neurotransmitters offlabel for dextromethorpha concurrently with other troublesome side
 5mg in the CNS, early Parkinson n, St John's food, drink, or effects such as severe
capsule conferring disease and the wort, methadone, supplements that or prolonged sleep
 5mg increased levels treatment of propoxyphene, are rich in loss, vivid dreams, or
tablet of the attentiondeficit/ tramadol, and tyramine. Other GI reactions (nausea,
disintegrating biologically hyperact ivity other MAO dangerous adverse abdominal pain, dry
 1.25mg active monoamines disorder (ADHD inhibitors. effects include mouth).
at the synaptic Selegiline, in sudden sleep Implement therapeutic
cleft any form, should episodes, exercises
not be used if orthostatic (coordination
there is a hypotension, exercises, gait
previously arrhythmias, mental training,
identified status alteration, cardiovascular
hypersensitivity hallucinations, conditioning) to
to selegiline, extrapyramidal complement the effects
and all forms are symptoms, of drug therapy and
contraindicated dyskinesia, and help achieve optimal
with concomitant serotonin syndrome function.
use of the
medication
meperidine.

PRECAUTIONS
Generic Name: Swallow extended- Desipramine is A type of disorder  drowsiness -Assess for the
Desipramine or controlled- used to treat with high mentioned cautions
release tablets depression. This serotonin levels.  dizziness and
Brand Name: whole; do not chew medication may a low seizure contraindications
Norpramin or crush. Eat a improve your mood, threshold. closed  dry mouth (e.g., drug
normal diet with sleep, appetite, angle glaucoma. allergies,
Classification: normal salt and energy level heart attack  blurry vision hepatorenal
Anti- Depressants intake; maintain and may help within the last 30 diseases,
adequate fluid restore your days. Allergy to  trouble psychosis,
intake (at least interest in daily TCAs. Prevent urinating glaucoma, etc.) to
Dosage & 2.5 quarts/day). living. This severe prevent any
Frequency: Arrange for medication belongs hypersensitivity  constipation untoward
10 mg tab OD PO frequent checkups, to a class of reactions. complications. -
including blood medications called Myocardial  nausea Assess for history
tests. Keep all tricyclic infarction. Can of seizure
appointments for antidepressants. reoccur because of  vomiting disorders,
checkups to get the cardiac psychiatric
the most benefits effects of the  loss of problems, suicidal
with the least drug Myelography appetite thoughts and
toxicity within previous 24 myelography within
hours or in the  sexual the past 24 hours
next 48 hours. or in the next 48
Prevent possible problems, hours to avoid
drugdrug such as potentially
interaction with serious adverse
decreased
dyes reactions. -
libido Perform a thorough
(sexual physical
assessment to
desire), or establish baseline
erectile data before drug
therapy begins, to
dysfunction determine the
(impotence) effectiveness of
therapy, and to
 fast heart evaluate for the
occurrence of any
rate adverse effects
associated with
 high blood
drug therapy. -
pressure, or Monitor results of
low blood electrocardiogram
and laboratory
pressure tests (e.g., renal
(when you and liver function
tests) to monitor
stand after the effectiveness
sitting or of the therapy and
provide prompt
lying down)
treatment to
developing
complications.

action PRECAUTIONS
Generic Name: - Amitriptyline is Treatment Allergy to TCAs - Drowsiness, - Monitor orthostatic vital
Amitriptyline in the tricyclic of major - Children sedation signs.
antidepressant depression younger than 12 - Orthostatic - Monitor for increases in
Brand Name: (TCA) drug years hypotension depression and suicidal
Elavil classification and - Recent acute - ideation.
acts by blocking myocardial Anticholinergic - Initiate suicide precautions
Classification: the reuptake of infarction effects (dry when appropriate.
Tricyclic both serotonin and - Cardiac mouth, - Taper the drug over 2 weeks to
Antidepressants norepinephrine dysrhyth. constipation, prevent or minimize withdrawal.
neurotransmitters. - Seizure urinary - Assure that clients have no
- The three-ring disorder history retention, more than a 1-week supply of the
central structure, - Concurrent use blurred vision) drug.
along with a side with MAOIs. - Increased - For overdose, prepare for
chain, is the CAUTIONS risk for gastric lavage and administer
basic structure of - Angle closure suicide sodium bicarbonate to treat
tricyclic glaucoma (especially in dysrhythmias.
antidepressants - Prostatic children, Take at bedtime to prevent
hypertrophy adolescents) daytime drowsiness.
- History of - Withdrawal - Don't drive/perform hazardous
urinary retention symptoms with activities if drowsy
-Liver or renal abrupt - Move slowly from lying to
disorders discontinuation sitting or standing.
- Suicidal (anxiety, - Urinate before taking the
ideation headache, daily dose.
- History of muscle pain, - Increase fiber and fluids to
electroconvulsive nausea) prevent constipation.
therapy - High risk for - Chew gum, suck on hard candy,
-Schizophrenia overdose (life- or sip water to prevent dry
- Hematologic or threatening mouth.
respiratory dysrhythmias, - Report feelings of self-harm
disorders confusion, or worse depression.
- Diabetes seizures) - Do not stop taking the drug
mellitus abruptly.
- Alcohol use - Take the drug exactly as
disorder prescribed

action PRECAUTIONS
Generic Name: helps improve treat Allergy to TCAs Blurred vision, Monitor orthostatic vital
nortriptyline \ your mood by symptoms of - Children younger than 12 Dry mouth, signs.
adjusting the depression, years Nausea/Vomiting, - Monitor for increases
levels of such as - Recent acute myocardial Loss of in depression and
Brand Name: serotonin, decreased infarction - Cardiac appetite, suicidal ideation.
Pamelor norepinephrine, mood dysrhyth. Numbness in the - Initiate suicide
and other - Seizure disorder history hands or feet, precautions when
Classification: similar - Concurrent use with High blood appropriate.
Antidepressants, chemicals in MAOIs. CAUTIONS pressure, Rash, - Taper the drug over 2
TCAs your brain. - Angle closure glaucoma - Itching weeks to prevent or
Prostatic hypertrophy minimize withdrawal.
- History of urinary - Assure that clients
retention have no more than a 1-
-Liver or renal disorders week supply of the drug.
- Suicidal ideation
- History of Take at bedtime to
electroconvulsive therapy prevent daytime
-Schizophrenia drowsiness.
- Hematologic or - Don't drive/perform
respiratory disorders hazardous activities if
- Diabetes mellitus drowsy - Move slowly from
- Alcohol use disorder lying to sitting or
standing.
- Increase fiber and
fluids to prevent
constipation. –
Report feelings of self-
harm or worse depression.

PRECAUTIONS
Generic Name: Dibenzoxepin is a Psychoneurotic Prior sensitivity Anticholinergic, Monitor use of
Doxepin tricyclic anxiety or to TCAs, during drowsiness, other CNS
antidepressant. depressive acute recovery dizziness, depressants,
Brand Name: Reportedly one of reactions; mixed phase following weakness, fatigue, including alcohol.
Sinequan the most sedating symptoms of MI; glaucoma; headache, Danger of
of the TCAs. anxiety and prostatic hypomania, overdosage or
Classification: Inhibits serotonin depression; hypertrophy; confusion, suicide attempt is
Tricyclic reuptake from the anxiety or tendency for tremors, increased when
Antidepresant synaptic gap; also depression urinary retention; paresthesias, patient uses
inhibits associated with concurrent use of orthostatic excessive amounts
norepinephrine alcoholism; MAOIs, patients hypotension, of alcohol. Be
reuptake to a organic disease; receiving palpitation, alert to changes
moderate degree, psychotic Electroconvulsive hypertension, in voiding and
restores the level depressive Therapy, patients tachycardia, ECG evaluate patient
of these disorders; topical with suicidal changes. for constipation
neurotransmitters for treatment of tendency; renal, mydriasis, blurred and abdominal
(serotonin and pruritus. Peptic cardiovascular or vision, distention; drug
norepinephrine) as ulcer disease, hepatic photophobia, dry- has moderate to
the proposed neuralgia. dysfunction mouth, sour or strong
mechanism of metallic taste, anticholinergic
antidepressant epigastric effects.
actions distress,
constipation, Maintain
urinary retention, established dosage
delayed regimen and avoid
micturition, change of
urinary frequency, intervals,
increased doubling,
perspiration, reducing, or
tinnitus, weight skipping doses.
gain, Consult physician
photosensitivity about safe amount
reaction, skin of alcohol, if
rash, any, that can be
agranulocytosis, taken. The actions
burning or of both alcohol
stinging at and doxepin are
application site, potentiated when
edema. used together and
for up to 2 wk
after doxepin is
discontinued. Do
not drive or
engage in other
potentially
hazardous
activities until
response to drug
is known. Do not
breast feed while
taking this drug

action PRECAUTIONS
Generic Name: Trimipramine Recent MI, heart Significant: Anticholinergi Closely monitor for
Trimipramine is a For the block or other c effects (e.g. clinical worsening,
dibenza- treatment cardiac constipation, xerostomia, suicidality, or unusual
zepine of arrhythmias, blurred vision, urinary changes in behaviour.
Brand Name: tricyclic depression mania. Severe retention), fractures, QT Monitor for signs of
Surmontil anti- and liver interval prolongation, serotonin syndrome such
depressant depression impairment. orthostatic hypotension, as mental status
Classification: with anti- accompanied Lactation. withdrawal symptoms (e.g. changes (e.g.
tricyclic muscarinic by anxiety, Concurrent or insomnia, irritability, agitation,
antidepressant and sedative agitation within 14 days excessive perspiration), hallucinations,
properties. or sleep of MAOI therapy syndrome of inappropriate delirium, coma);
It acts by disturbance (e.g. linezolid antidiuretic hormone autonomic instability
post- or IV methylene secretion and hyponatremia (e.g. tachycardia,
synaptic blue). (elderly). labile blood pressure,
sensiti- Blood and lymphatic system diaphoresis);
sation to disorders: Rarely, bone neuromuscular changes
serotonin. marrow depression (e.g. (e.g. tremor, rigidity,
agranulocytosis, myoclonus);
eosinophilia, purpura, gastrointestinal
thrombocytopenia). symptoms (e.g. nausea,
Cardiac vomiting, diarrhoea).
disorders: Hypotension, Monitor electrolytes,
hypertension, tachycardia, LFTs, blood glucose,
palpitation, MI, weight and BMI. Monitor
arrhythmias, heart block, ECG, heart rate and
stroke, torsade de pointes. blood pressure of
Gastrointestinal patient at risk.
disorders: Nausea, vomiting,
anorexia, epigastric
distress, diarrhoea,
peculiar taste, stomatitis,
abdominal cramps, black
tongue, parotid swelling.
Hepatobiliary
disorders: Jaundice
(simulating obstructive),
altered liver function.
Nervous system
disorders: Drowsiness,
tremor, dizziness, headache.
Rarely, peripheral
neuropathy, seizure.
Psychiatric
disorders: Confusional
states (elderly) with
hallucinations,
disorientation, delusions,
anxiety, restlessness,
agitation, insomnia,
nightmares, exacerbation of
psychosis (e.g. mania or
hypomania, psychosis,
paranoid delusions).
Renal and urinary
disorders: Urinary
frequency.
breast disorders: Interfered
sexual function,
gynecomastia (male), breast
enlargement and
galactorrhoea (female),
increased or decreased
libido, impotence,
testicular swelling.

PRECAUTIONS
Generic Name Hypersensitivity anxiety, blood disorders, Monitor patient
Protriptyline Protriptyline For the to clomipramine confusion, decreased with history of
acts by treatment or excipients, libido, dizziness, CVD (including
Brand Name: decreasing the of cross- flushing, headache, previous
Vivacil reuptake of depression sensitivity to impotence, insomnia, low MI, stroke,
norepinephrine tricyclic blood pressure, tachycardia, or
Classification: and serotonin (5- antidepressants nightmares, rapid or conduction
tricyclic HT). of the irregular heartbeat, rash, abnormalities.
antidepressant dibenzazepine seizures, sensitivity to -monitor BP, pulse
group. sunlight, stomach and every 4hrs; if
Hypersensitivity intestinal discomfort, systolic
to drug Recovery sedation, hypotension, BP drops 20mmHg
phase of blurred vision, dry mouth, hold drug, notify
myocardial constipation, urinary physician.
infarction (MI) retention, postural -monitor blood
MAO inhibitor hypotension, tachycardia, studies.
use within past hypertension, ECG changes, assess mental
14 days heart failure, impaired status.
memory and delirium, and
precipitation of hypomanic
or manic episodes in
bipolar depression.
Withdrawal symptoms
include gastrointestinal
disturbances, anxiety, and
insomnia.

PRECAUTIONS
Generic Name Maprotiline, a Seizure Significant: Suicidality, Monitor for
Maprotiline tetracyclic For treatment disorders. clinical worsening, unusual symptoms of
antidepressant of Concomitant use behavioural changes, anxiety, clinical
Brand Name: and non- depression, during or w/in agitation, panic attacks, worsening,
Ludiomil selective including the 14 days of MAOI insomnia, irritability, unusual changes
monoamine depressed use. hostility, aggressiveness, in behaviour and
Classification: reuptake phase of impulsivity, akathisia, emergence of
tetracyclic inhibitor, bipolar seizures, mild pupillary suicidality esp
antidepressant also inhibits depression, dilation. Rarely, hypomanic or during
norepinephrine psychotic manic episodes, neutrophil initiation or
reuptake in depression, depression. dosage
the and Nervous: Drowsiness, dizziness, adjustment.
presynaptic involutional nervousness, headache, tremor.
neuronal melancholia, CV: Sinus tachycardia,
membrane. It and may also palpitations, flushing,
alleviates the be helpful in orthostatic hypotension.
mood, anxiety, treating GI: Dry mouth, constipation,
agitation and certain nausea, vomiting, abdominal
psychomotor patients disorders, increased appetite.
retardation. suffering Genitourinary: Erectile
severe dysfunction, micturition
depressive disorder.
neurosis. Endocrine: Hot flush, abnormal
wt gain.
Musculoskeletal: Muscular
weakness.
Ophthalmologic: Blurred vision,
accommodation disorder.
Dermatologic: Rash, urticaria,
photosensitivity, hyperhidrosis.
Others: Fatigue, pyrexia.

PRECAUTIONS
Generic Name: Anti-depressants  Concomitant or Suicidal thoughts Monitor closely
Mirtazapine potentiates the This drug is within 14 days of  Drowsiness for changes in
effects of no indicated for the discontinuing  have normal behavior that
Brand Name: epinephrine and treatment of major MAOIs including dreams could indicate the
Remeron Soltab, serotonin.  depressive linezolid and IV emergence or
 agitation
Remeron RD Antidepressant disorder and its methylene blue. worsening of
associated  confusion suicidal thoughts
action, which may dizziness
Classification: develop only after symptoms. or behavior
tetracyclic Mirtazapine has  weakness depression.
several weeks.
antidepressant been used off-  sinusitis  Caution patient
label for a  dyspnea to change position
 15mg once daily variety of  cough slowly to minimize
at bedtime conditions  Constipation orthostatic
including panic hypotension.
 dry mouth
 PO disorder,  Instruct
generalized  increased
appetite patients to notify
anxiety disorder,
 Safe dose: 15mg  Anorexia
HCP of signs and
dysthymia, tension symptoms of
once daily; may
headaches, hot  nausea serotonin syndrome
increase every 1-2
weeks up to
flushes, post-  vomiting (mental status
45mg/day. traumatic stress  edema changes:
disorder (PTSD),  hypotension Agitation,
sleep disorders, hallucinations,
 vasodilation
substance abuse coma; autonomic
disorders, and  increased thirst instability;
sexual disorders,  weight gain Tachycardia
among others.9,13  increase hyperthermia)
triglycerides Geri: increased
 back pain sensitivity to CNS
 twitching effects and
oversedation.
Begin at lower
doses and titrate
carefully.

PRECAUTIONS
Generic Name: Amoxapine, a For the Acute recovery Drowsiness, dry mouth, Monitor closely
Amoxapine dibenzoxazepine relief of phase following constipation, blurred vision; for clinical
TCA, is the N- symptoms of MI. Concomitant anxiety, insomnia, worsening,
Brand Name: desmethyl depression or w/in 14 days restlessness, nervousness, suicidality or
Asendin derivative of in patients of MAOI use. palpitations, tremors, unusual
loxapine w/ with confusion, excitement, behavioural
Classification: actions similar neurotic or nightmares, ataxia, alteration changes. Monitor
tricyclic to reactive in EEG pattern, paraesthesia, heart rate, BP,
antidepressant amitriptyline. depressive tinnitus, disorientation, and ECG esp in
It reduces the disorders as seizure, hypomania, numbness, older adults and
reuptake of well as incoordination, disturbed patient w/ pre-
norepinephrine endogenous concentration, hyperthermia; existing cardiac
and serotonin, and oedema, skin rash, drug fever, disease. Measure
and psychotic urticaria, photosensitisation, wt, BMI, and
significantly depressions. pruritus, vasculitis, blood glucose.
blocks dopamine May also be hepatitis; prolactin level
receptor used to elevation; nausea, epigastric
activity. treat distress, vomiting, flatulence,
depression abdominal pain, peculiar taste,
accompanied diarrhoea; dizziness, headache,
by anxiety fatigue, weakness, excessive
or appetite, increased
agitation. perspiration; disturbance of
accommodation, mydriasis,
delayed micturition, urinary
retention, nasal stuffiness;
hypotension, HTN, syncope,
tachycardia; leucopenia,
agranulocytosis;
increased/decreased libido,
impotence, menstrual
irregularity, breast
enlargement, galactorrhoea (in
females), syndrome of
inappropriate antidiuretic
hormone secretion; lacrimation,
wt gain/loss, altered liver
function, painful ejaculation.
Rarely, tardive dyskinesia.

PRECAUTIONS
Brand Names: May be used to Acute recovery Suicidal ideation and Monitor blood
Anafranil Clomipramine treat obsessive- phase of MI, behaviour, activation of pressure and
is a strong, compulsive recent MI, psychosis and hypomanic or pulse rate
Generic Name: but not disorder and history of QTc manic episodes, seizures, QTc prior to and
Clomipramine completely disorders with interval prolongation, torsades de during
selective an obsessive- prolongation, pointes, anticholinergic treatment; ECG,
Classification: serotonin compulsive narrow-angle effects (e.g. constipation, cardiac status,
tricyclic reuptake component (e.g. glaucoma, paralytic ileus, xerostomia, serum Na
antidepressant inhibitor depression, urinary blurred vision, urinary levels, renal
(SRI), as the schizophrenia, retention, retention), CNS depression, function and
active main Tourette’s mania. Severe bone fractures, dental caries, LFTs in at-risk
metabolite disorder). hepatic mild pupillary dilation, patients
desmethy- Unlabeled impairment. orthostatic hypotension, periodically
clomipramine indications Concomitant use hypertensive crises, male during
acts include: with selective sexual dysfunction, syndrome treatment and
preferably as depression, MAO-A inhibitors of inappropriate antidiuretic as clinically
an inhibitor panic disorder, (e.g. hormone secretion (SIADH), indicated.
of chronic pain moclobemide), hyponatraemia, weight gain, Closely monitor
noradrenaline (e.g. central linezolid, IV increased ALT/AST, withdrawal for signs of
reuptake. α1- pain, idiopathic methylene blue; or discontinuation syndrome. serotonin
receptor pain disorder, with or within Rarely, bone marrow syndrome, and
blockage and tension 21 days of suppression, drug rash with suicidal
β-down- headache, initiating or eosinophilia and systemic ideation or
regulation diabetic discontinuing syndrome (DRESS). unusual
have been peripheral treatment with Blood and lymphatic system behaviour
noted and most neuropathy, MAOIs intended disorders: Leucopenia, changes
likely play a neuropathic to treat agranulocytosis, especially
role in the pain), cataplexy psychiatric thrombocytopenia. during initial
short term and associated disorders. Cardiac disorders: Sinus months of
effects of narcolepsy tachycardia, palpitation, ECG treatment or at
clomipramine. (limited changes (e.g. ST and T times of dose
A blockade of evidence), changes). changes.
sodium- autistic Ear and labyrinth
channels and disorder disorders: Tinnitus.
NDMA-receptors (limited Eye disorders: Accommodation
might, as with evidence), disorder.
other trichotillomania Gastrointestinal
tricyclics, (limited disorders: Nausea, vomiting,
account for evidence), diarrhoea, dyspepsia.
its effect in onchophagia Metabolism and nutrition
chronic pain, (limited disorders: Increased or
in particular evidence), decreased appetite.
the stuttering Musculoskeletal and connective
neuropathic (limited tissue disorders: Muscle
type. evidence), weakness, hypertonia, myalgia.
premature Nervous system
ejaculation, and disorders: Dizziness,
premenstrual headache, somnolence, tremor,
syndrome. myoclonus, speech disorder,
paraesthesia, dysgeusia,
memory impairment, attention
disturbance.
Psychiatric
disorders: Restlessness,
confusional state, insomnia,
delirium, aggression, anxiety,
agitation, disorientation,
hallucinations, nightmares.

PRECAUTIONS
Brand Names: Bupropion is a Bupropion is Current or Headache, dry mouth, Monitor BP and
Aplenzin, relatively indicated for the history of nausea, insomnia, LFT before and
Auvelity, weak inhibitor treatment of major seizure dizziness, pharyngitis, during
Budeprion, of the depressive disorder disorder, eating constipation, agitation, treatment;
Contrave, neuronal (MDD), seasonal disorders (e.g. anxiety, abdominal pain, monitor wkly if
Forfivo, uptake of affective disorder bulimia or tinnitus, tremor, used with
Wellbutrin, Zyban norepinephrine (SAD), and as an aid anorexia nervousness, somnolence, nicotine
and dopamine, to smoking cessation. nervosa); CNS irritability, vasodilation, products.
Generic Name: w/ minimal tumour, photosensitivity, Monitor for
Bupropion effect on When used in epilepsy; hypertonia, suicidal worsening and
serotonin combination history of ideation, emotional emergence of
Classification: reuptake. The with naltrexone as bipolar disorder lability, hostility, suicidal
norepinephrine mechanism by the marketed product (when used as an palpitation, myalgia, thoughts and
and dopamine which it aids ContraveⓇ, bupropion aid in smoking twitch, sweating, rash, behaviours.
reuptake in smoking is indicated as an cessation). nausea, migraine, insomnia,
inhibitor cessation is adjunct to a reduced- Abrupt pharyngitis, urinary
presumed to be calorie diet and withdrawal of frequency or retention, hot
mediated by increased physical alcohol, flushes, dysphagia,
its activity for chronic benzodiazepines, flushing, anorexia, chills,
noradrenergic weight management in barbiturates, facial eodema,
and/or adults with an antiepileptic photosensitivity,
dopaminergic initial body mass drugs. Severe hypotension, stroke,
actions. index (BMI) of: 30 hepatic tachycardia, gastric
kg/m^2 or greater cirrhosis. reflux, gingivitis,
(obese) or 27 kg/m^2 Concomitant increased salivation,
or greater admin or w/in 14 jaundice, mouth ulcers,
(overweight) in the days of MAOIs stomatitis, thirst,
presence of at least withdrawal. ecchymosis, leg cramps,
one weight-related decreased libido,
comorbid condition depersonalisation,
(e.g., hypertension, dysphoria, vertigo,
type 2 diabetes phlebitis, pulmonary
mellitus, or embolism, colitis,
dyslipidemia). aesophagitis, GI
Bupropion is also hemorrhage, hepatitis,
used off-label as a intestinal perforation,
first-line treatment pancreatitis, stomach
in patients with ADHD ulcer, hyperglycaemia,
and comorbid bipolar hypoglycaemia, anaemia,
disorder when used as muscle weakness, fever,
an adjunct to mood rhabdomyolysis, euphoria,
stabilizers. delirium, pneumonia,
Stevens-Johnson syndrome,
mydriasis, deafness,
increased intraocular
pressure, abnormal
ejaculation, cystitis.

action PRECAUTIONS
Generic Name: Inhibits Decrease in : Hypersensitivity; CNS: NEUROLEPTIC • Assess mental status
venlafaxine serotonin and depressive Concurrent use of MALIGNANT SYNDROME, and mood changes. Inform
norepinephrine symptomatology, MAO inhibitors or SEIZURES, SUICIDAL health care professional
Brand Name: reuptake in the with fewer MAO-like drugs THOUGHTS, abnormal if patient demonstrates
Effexor CNS. relapses/ (linezolid or dreams, anxiety, significant increase in
recurrences. methylene blue). Use dizziness, anxiety, nervousness, or
Classification: Decreased Cautiously in: headache, insomnia, insomnia. • Assess
Antidepressants, anxiety. Cardiovascular nervousness, suicidal tendencies,
antianxiety Decrease in disease, including weakness, abnormal especially in early
agents Pharma: panic attacks. hypertension; thinking, therapy. Restrict amount
SSRI/SNRI Hepatic agitation, of drug available to
Pregnancy impairment/Impaired confusion, patient. Risk may be
Category C renal function (↓ depersonalization, increased in children,
dose rec); History drowsiness, adolescents, and adults
Major Depressive of seizures or neuro emotional lability, ≤24 yr. • Monitor BP
Disorder PO impairment; Hx of worsening before and periodically
(Adults): mania, drug abuse, depression. EENT: during therapy.
Tablets—75 Angle-closure rhinitis, visual Sustained hypertension
mg/day in 2–3 glaucoma; OB: Use disturbances, may be dose-related;
divided doses; only if clearly epistaxis, decrease dose or
may ↑ by up to required, weighing tinnitus. CV: chest discontinue therapy if
75 mg/day every benefit to mother vs pain, hypertension, this occurs. • Monitor
4 days, up to potential harm to palpitations, appetite and nutritional
225 mg/day (not fetus Lactation: tachycardia. GI: intake. Weigh weekly.
to exceed 375 Potential for abdominal pain, Report continued weight
mg/day in 3 serious adverse altered taste, loss. Adjust diet as
divided doses); reactions in infant; anorexia, tolerated to support
Extended-release discontinue drug or constipation, nutritional status. •
(XR) capsules—75 discontinue breast diarrhea, dry Assess for serotonin
mg once daily feeding; Pedi: ↑ mouth, dyspepsia, syndrome (mental changes
(some patients risk of suicidal nausea, vomiting, [agitation,
may be started thinking and weight loss. GU: hallucinations, coma],
at 37.5 mg once behavior sexual dysfunction, autonomic instability
daily) for 4–7 (suicidality) in urinary frequency, [tachycardia, labile BP,
days; may ↑ by children and urinary retention. hyperthermia],
up to 75 mg/day adolescents with Derm: ecchymoses, neuromuscular
at intervals of major depressive itching, aberrations [hyper-
not less than 4 disorder and other photosensitivity, reflexia,
days (not to psychiatric skin rash. Neuro: incoordination], and/or
exceed 225 disorders. Observe paresthesia, GI symptoms [nausea,
mg/day). General closely for twitching. Misc: vomiting, diarrhea]),
Anxiety Disorder suicidality and SEROTONIN SYNDROME, especially in patients
PO (Adults): behavior changes chills, bleeding, taking other
Extended-release yawning serotonergic drugs
(XR) capsules—75 (SSRIs, SNRIs,
mg once daily triptans). • Lab Test
(some patients Considerations: Monitor
may be started CBC with differential
at 37.5 mg once and platelet count
daily) for 4–7 periodically during
days; may ↑ by therapy. May cause
up to 75 mg/day anemia, leukocytosis,
at intervals of leukopenia,
not less than 4 thrombocytopenia,
days (not to basophilia, and
exceed 225 eosinophilia. • May
mg/day). Social cause an ↑ in serum
Anxiety Disorder alkaline phosphatase,
PO (Adults): bilirubin, AST, ALT,
Extended-release BUN, and creatinine. •
(XR) capsules—75 May also cause ↑ serum
mg once daily. cholesterol. • May cause
Panic Disorder electrolyte
PO (Adults): abnormalities
Extended-release (hyperglycemia or
(XR) capsules— hypoglycemia,
37.5 mg once hyperkalemia or
dailyfor 7 days; hypokalemia,
may then ↑ to 75 hyperuricemia,
mg once daily; hyperphosphatemia or
may then ↑ by 75 hypophosphatemia, and
mg/day every 7 hyponatremia). • May
days (not to cause false-positive
exceed 225 immunoassay screening
mg/day). tests for phencyclidine
(PCP) and amphetamine

RESPONSIBILITY/
PRECAUTIONS
Brand Names: The exact mechanism of Desvenlafaxine is Hypersensitivity Headache, Assess mental
Pristiq the antidepressant indicated for the to desvenlafaxine nausea, status and mood
action of treatment of major succinate, vomiting, changes,
Generic Name; desvenlafaxine is depressive disorder in venlafaxine diarrhea, especially
Desvenlafaxine unknown but is thought adults. It has also hydrochloride or constipation, during initial
to be related to the been used off-label to to any excipients dry mouth, few months of
Dosage: potentiation of treat hot flashes in in the increased therapy and
50 mg: Each serotonin and menopausal women. desvenlafaxine sweating, during dose
extended-release norepinephrine in the formulation. decreased changes. Assess
tablets contains central nervous system, Desvenlafaxine is appetite, suicidal
75.87 mg of through inhibition of an inhibitor of tremor, feeling tendencies,
desvenlafaxine their both nervous, especially in
succinate reuptake. Particularly, norepinephrine restless, early therapy.
equivalent to 50 desvenlafaxine has been and serotonin fatigue, or Monitor BP
mg found to inhibit the reuptake. having trouble before and
desvenlafaxine. serotonin, Desvenlafaxine sleeping periodically
100 mg: Each norepinephrine, and succinate must (insomnia). during therapy.
extended-release dopamine transporters not be used in These will Monitor appetite
tablets contains with varying degrees of combination with often improve and nutritional
151.77 mg of affinity. a monoamine over the first intake; weigh
desvenlafaxine Desvenlafaxine inhibits oxidase inhibitor week or two as weekly
succinate serotonin transporters (MAOI), or within you continue to
equivalent to with 10 times the at least 14 days take the
100 mg affinity of of discontinuing medication
desvenlafaxine. norepinephrine treatment with an
transporters, and MAOI. Based on
Classification: dopamine transporters the half-life of
antidepressant with the lowest desvenlafaxine
agent and SNRI affinity. succinate, at
least 7 days
should be allowed
after stopping
desvenlafaxine
succinate before
starting an MAOI.
Starting
desvenlafaxine
succinate in a
patient who is
being treated
with a reversible
MAOI such as
linezolid or in
whom intravenous
methylene blue
has been
administered is
also
contraindicated
because of an
increased risk of
serotonin
syndrome
RESPONSIBILITY/
PRECAUTIONS
Brand Names: The mechanism of action of Concomitant use Most common -Monitor
Desyrel, Oleptro trazodone is not fully Trazodone is of monoamine adverse patient with
understood, however, it is indicated for oxidase reactions history of CVD
Generic Name: known to inhibit the the treatment of inhibitors (incidence ≥ 5% (including
Trazodone reuptake of serotonin and major depressive (MAOIs), or use and twice that previous MI,
block both histamine and disorder within 14 days of placebo) stroke,
Classification: alpha-1-adrenergic (MDD). It has of stopping are: edema, tachycardia, or
serotonin uptake receptors. Despite the fact been used off- MAOIs. blurred vision, conduction
inhibitor that trazodone is frequently label for syncope, abnormalities.
considered a selective adjunct therapy drowsiness, -monitor BP,
serotonin reuptake in alcohol fatigue, pulse every
inhibitor, several reports dependence, and diarrhea, nasal 4hrs; if
have shown that other off-label to congestion, systolic BP
mechanisms including treat anxiety weight loss. drops 20mmHg
antagonism at serotonin 5- and insomnia. It hold drug,
HT1a, 5-HT1c, and 5-HT2 may also be used notify
receptor subtypes may occur. off-label to physician. -
The strongest antagonism of treat symptoms monitor blood
trazodone is reported to of dementia, studies. -
occur at the serotonin 5- Alzheimer’s assess mental
HT21c receptors, preventing disease, status.
serotonin uptake. In schizophrenia,
addition to acting on eating
serotonin receptors, disorders, and
trazodone has been shown to fibromyalgia due
inhibit serotonin to its effects
transporters. The on various
antidepressant effects of neurotransmitter
trazodone result from the receptors.
inhibition of receptor
uptake, which normally
decreases circulating
neurotransmitters,
contributing to depressive
symptoms

RESPONSIBILITY/
PRECAUTIONS
Generic Name Within the For the Liver injury due Increased risk of suicidal Screen patients
Nefazodone serotonergic treatment to previous thinking and behaviour; for bipolar
system, nefazodone of therapy with anticholinergic effects (e.g. disorder before
Brand Name: acts as an depression. nefazodone; xerostomia, constipation, urinary starting
Serzone antagonist at type active liver retention); bone fractures, mild treatment
2 serotonin (5-HT2) disease or pupillary dilation and other (including
Classification: post-synaptic elevated visual disturbances (e.g. blurred detailed
antidepressant receptors and, like baseline serum vision, scotoma, visual trails), psychiatric
fluoxetine-type transaminases. orthostatic hypotension. Rarely, history).
antidepressants, Concomitant priapism, convulsions. Obtain LFTs at
inhibits pre- administration Cardiac disorders: Sinus baseline and
synaptic serotonin with bradycardia. periodically.
(5-HT) reuptake. carbamazepine, Gastrointestinal Closely monitor
These mechanisms astemizole, disorders: Nausea, dyspepsia, for signs of
increase the amount cisapride, diarrhoea, vomiting. clinical
of serotonin pimozide, General disorders and worsening,
available to terfenadine, administration site suicidal
interact with 5-HT triazolam. conditions: Weakness, peripheral ideation, and
receptors. Within Concurrent use oedema. unusual
the noradrenergic with or within Infections and behavioural
system, nefazodone 14 days of infestations: Infection. changes,
inhibits discontinuing Metabolism and nutrition especially at
norepinephrine MAOIs disorders: Increased appetite. the start of
uptake minimally. Nervous system therapy or when
Nefazodone also disorders: Drowsiness, dizziness, doses are
antagonizes headache, agitation, memory increased or
alpha(1)-adrenergic impairment, paraesthesia, ataxia. decreased.
receptors, Psychiatric disorders: Insomnia,
producing sedation, confusion, abnormal dreams.
muscle relaxation, Respiratory, thoracic and
and a variety of mediastinal
cardiovascular disorders: Pharyngitis, increased
effects. cough.
disorders: Rash, pruritus.
Vascular disorders: Hypotension.

RESPONSIBILITY/
PRECAUTIONS
Brand Names Uncontrolled Suicidal thoughts and Screen patients
Cymbalta, Duloxetine is a Indicated for: hypertension. behaviour (particularly in for personal or
Drizalma, potent inhibitor of 1) Management of Hepatic and children and young family history
Irenka, neuronal serotonin Major Depressive severe renal adults), activation of of bipolar
Yentreve and norepinephrine Disorder. (CrCl <30 mania or hypomania, disorder, mania,
Generic Name reuptake and a less 2) Management of mL/min) mydriasis, increase in or hypomania
Duloxetine potent inhibitor of Generalized impairment. blood pressure and before
dopamine Anxiety Concomitant use clinically significant treatment.
Classification: reuptake. Duloxetine Disorder. with or within hypertension, bleeding Monitor blood
serotonin has no significant 3) Management of 14 days of abnormalities (e.g. pressure (at
norepinephrine affinity for diabetic discontinuing ecchymoses, purpura, baseline and
reuptake dopaminergic, peripheral nonselective, gastrointestinal periodically
inhibitor adrenergic, neuropathy. irreversible haemorrhage), during
cholinergic, 4) Management of MAOIs. hyponatraemia, akathisia, treatment),
histaminergic, fibromyalgia. Concomitant use increased liver enzymes, hepatic and
opioid, glutamate, 5) Management of with linezolid, hepatitis, jaundice, renal functions;
and GABA receptors. chronic IV withdrawal symptoms blood glucose
musculoskeletal methylthioninium (particularly upon abrupt and HbA1c in
The mechanisms pain. chloride (also discontinuation), diabetic
involved in 6) Management of known as increased fasting blood patients (at
duloxetine's osteoarthritis methylene blue), glucose and HbA1c, baseline and as
benefits in of the knee in thioridazine, orthostatic hypotension, clinically
depression and adults. and potent syncope, falls, acute indicated).
anxiety have not 7) Management of CYP1A2 angle-closure glaucoma, Closely monitor
been fully chronic lower inhibitors (e.g. urinary hesitation and for clinical
elucidated. back pain in fluvoxamine, retention; decreased worsening,
Dysfunctional adults. ciprofloxacin, libido, erectile suicidality, or
serotonin and 8) Management of enoxacin). dysfunction, ejaculatory unusual changes
norepinephrine stress urinary delay or failure (male), in behaviour
signaling are incontinence in delayed or absent orgasm (particularly
thought to be adult women (female); severe skin during the
involved and reactions (e.g. erythema initial 1-2
increases in the multiforme, Stevens- months of
availability of Johnson syndrome). Rarely, therapy or
these hypertensive crisis. during periods
neurotransmitters at Cardiac of dosage
the synaptic cleft disorders: Palpitations. adjustments).
thought to mediate a Ear and labyrinth Monitor for
therapeutic effect. disorders: Tinnitus, signs and
It is postulated vertigo. symptoms of
that the involvement Eye disorders: Blurred serotonin
of serotonin and vision. syndrome (e.g.
norepinephrine in Gastrointestinal mental status
area responsible for disorders: Dry mouth, changes,
emotional modulation nausea, vomiting, seizures,
such as the limbic constipation, diarrhoea, tachycardia,
system contributes abdominal pain, dyspepsia, hyperthermia,
to the effects in flatulence. diaphoresis,
mood disorders General disorders and tremor,
specifically but administration site rigidity).
this has yet to be conditions: Fatigue,
confirmed. asthenia, chills.
Investigations: Decreased
weight.
Metabolism and nutrition
disorders: Decreased
appetite.
Musculoskeletal and
connective tissue
disorders: Musculoskeletal
pain, muscle spasm.
Nervous system
disorders: Headache,
somnolence, dizziness,
tremor, paraesthesia,
lethargy.
Psychiatric
agitation, anxiety,
abnormal dreams, sleep
disorder.
Renal and urinary
disorders: Dysuria,
pollakiuria.
mediastinal
disorders: Yawning.
tissue
disorders: Hyperhidrosis,
rash.
Vascular
disorders: Flushing.

PRECAUTIONS
Brand Names Vilazodone Concomitant or Worsening of Monitor for
Viibryd selectively Vilazodone is within 14 days of depression, mania or clinical
Generic Name inhibits approved for discontinuing MAOI hypomania, angle- worsening,
Vilazodone serotonin treatment of therapy (e.g. closure glaucoma, emergence of
reuptake in the major depressive linezolid, IV seizures, fractures, suicidal thoughts
Classification: central nervous disorder. methylene blue). hyponatraemia. or behaviours and
antidepressant system as well as Gastrointestinal unusual changes
agent acting as a disorders: Nausea, in behaviour.
partial agonist diarrhoea, Monitor for signs
of 5HT-1A constipation, and symptoms of
receptors The vomiting, flatulence, serotonin
exact mechanism dry mouth. syndrome and
for how these Nervous system hyponatraemia.
effects translate disorders: Dizziness.
to its Psychiatric
antidepressant disorders: Abnormal
effects are not dreams.
known, though Skin and
there is an subcutaneous tissue
association disorders: Pruritus.
between these
effects and
antidepressive
activity

PRECAUTIONS
Brand Names Phenelzine is Cerebrovascular Suicidality, CNS Monitor blood
Nardil The basic indicated for disease, depression, postural pressure, blood
Generic Name mechanism of the treatment of phaeochromocytoma, hypotension, shift to glucose, heart
Phenelzine action of nonendogenous, abnormal LFTs or hypomania or mania, rate, renal
phenelzine acts neurotic or history of hepatic intracranial bleeding, function and
Classification: as an inhibitor atypical disease. Hepatic sensitisation to insulin, LFT. Monitor for
a monoamine and substrate of depression for and severe renal pyridoxine deficiency, mental status,
oxidase monoamine oxidase patients that do impairment. Within withdrawal syndrome. worsening of
inhibitor which not tolerate 10 days of use Blood and lymphatic depression,
subsequently other forms of with general system disorders: Blood suicidality, and
causes an therapy. anaesthesia for dyscrasias. unusual changes
elevation in elective surgery. Cardiac in behaviour
brain levels of Concomitant or disorders: Arrhythmias. prior to
catecholamines within 14 days of Eye disorders: Blurred initiation of
and serotonin. It discontinuing vision, nystagmus, therapy and
also presents a treatment with glaucoma. every dose
similar structure MAOIs, bupropion, Gastrointestinal titration.
to amphetamine and SSRIs. disorders: Nausea,
which explains Concomitant use vomiting, dry mouth,
the effect on the with constipation.
uptake and dextromethorphan, General disorders and
release of CNS depressants administration site
dopamine, (e.g. alcohol, conditions: Weakness,
noradrenaline, pethidine), fatigue, oedema,
and serotonin. guanethidine. sweating.
Phenelzine has Tyramine-rich Investigations: Elevated
been reported to food. serum transaminases,
inhibit tyrosine increased weight.
aminotransferase, Metabolism and nutrition
aromatic amino disorders: Hypermetabolic
acid syndrome,
decarboxylase, hypo/hypernatraemia,
and dopamine B- increased appetite.
hydroxylase.7 Musculoskeletal and
connective tissue
disorders: Twitching,
muscle tremor, lupus-like
illness.
Nervous system
disorders: Dizziness,
drowsiness, myoclonic
movement, hyperreflexia,
headache, paraesthesia,
peripheral neuritis,
convulsions, palilalia.
Psychiatric
nervousness, euphoria,
behavioural changes,
jitteriness, confusion,
hallucinations.
Renal and urinary
disorders: Difficulty in
micturition.
breast
disorders: Impotence,
delayed ejaculation.
tissue disorders: Rash,
pruritus, purpura.

PRECAUTIONS
Brand Names Tranylcypromine Porphyria, actual or Insomnia, Monitor blood
Parnate increases For the suspected cerebrovascular postural HTN, glucose, BP,
Generic Name epinephrine, treatment of disease, severe CV disease, drowsiness, renal and hepatic
Tranylcypromine norepinephrine major actual or suspected dizziness, function, heart
and serotonin depressive phaeochromocytoma, fatigue, dry rate, mental
Classification: concentration episode hyperthyroidism, blood mouth, blurred status.
monoamine in storage without dyscrasias, liver damage. vision,
oxidase sites melancholia. Concomitant use w/ indirectly headache, May impair
inhibitor throughout the acting sympathomimetic amines diarrhoea, ability to drive
nervous system or similar anti-obesity nausea, or operate
through agents, ephedrine or vomiting, sleep machinery.
inhibition of phenylpropanolamine, levodopa disturbance,
the enzyme, or dopamine, pethidine and rash,
monoamine closely related narcotic overstimulation
oxidase. analgesics, nefopam, (e.g. agitation
dextromethorphan, buspirone, and anxiety,
bupropion, fluvoxamine, TCAs, developing
SSRIs, selective rarely into
norepinephrine reuptake hypomanias).
inhibitors (SNRIs) and other Rarely,
MAOIs and cheese or other hepatocellular
foods w/ high-tyramine damage,
content (w/in 2 wk after jaundice,
stopping treatment); hallucinations,
meperidine (w/in 2 or 3 wk blood
after stopping treatment). dyscrasias.

action RESPONSIBI
LITY/
PRECAUTION
S
Brand Names Isocarboxazid Known or suspected Orthostatic hypotension, Monitor
Marplan Isocarboxazid is indicated cerebrovascular hepatic complications, renal
works by for the disorders, CV disease, jaundice, suicidal thoughts, function
Generic Name: irreversibly treatment of hypertension or history self-harm, suicide-related and liver
Isocarboxazid blocking the the enduring of headache, known or events, increase or decrease function
action of and suspected in frequency of seizures; at
Classification: monoamine debilitating phaeochromocytoma. excessive excitement (in baseline
monoamine oxidases symptoms of Hepatic impairment restless or agitated and as
oxidase (MAO) in the depression (including history of patients); shift to mania or necessary;
inhibitor nervous that have not liver disease or abnormal hypomania (in patients with blood
system. MAO responded to LFTs) and severe renal bipolar disorder). pressure,
subtypes A other impairment. Concomitant Cardiac heart
and B are antidepressant use with or within 14 disorders: Palpitations. rate.
involved in drugs. Depress days of stopping SSRIs or Eye disorders: Blurred Assess for
the ion is a other MAOIs; indirectly- vision. changes in
metabolism of common but acting sympathomimetic Gastrointestinal mood,
serotonin and serious mood agents (e.g. disorders: Dryness of mouth, signs and
catecholamine disorder. amphetamines, nausea, vomiting, symptoms
neurotransmit metaraminol, constipation. of
ters such as fenfluramine, anorectic General disorders and suicidal
epinephrine, agents, ephedrine, administration site ideation
norepinephrin phenylpropanolamine, conditions: Peripheral (particula
e, and dopamine, levodopa), oedema, weakness, fatigue. rly at the
dopamine. pethidine, certain CNS Nervous system start of
Isocarboxazid depressants (including disorders: Dizziness, therapy
, as a narcotics), drowsiness, headache, tremor, and when
nonselective antihypertensives, myoclonic jerks, doses are
MAO diuretic, antihistamines, paraesthesia. adjusted).
inhibitor, sedatives or anaesthetic Psychiatric
binds drugs, bupropion, disorders: Insomnia.
irreversibly buspirone, Renal and urinary
to monoamine dextromethorphan, disorders: Impotence, urinary
oxidase-A dibenzazepine frequency, urinary hesitancy.
(MAO-A) and derivatives, general Skin and subcutaneous tissue
monoamine anaesthesia used during disorders: Diaphoresis.
oxidase-B elective surgery.
(MAO-B).

RESPONSIBILITY/
PRECAUTIONS
Generic Name This medication Dyspnoea or Bradycardia, Monitor vital
Amobarbital Amobarbital (like all is a barbiturate airway syncope, signs during and
barbiturates) works by derivative, obstruction, hypotension; after admin.
Brand Name: binding to the GABAA prescribed for porphyria, sleep apnoea,
Amytal Sodium or receptor at either the anxiety, apnoea, pre- atelectasis (post-
Tuinal alpha or the beta sub insomnia and existing CNS op),
unit. These are binding induction of depression or hypoventilation;
Classification: sites that are distinct preanesthetic coma. Severe agitation,
barbiturate from GABA itself and sedation. It hepatic anxiety, ataxia,
also distinct from the alters impairment. confusion, CNS
benzodiazepine binding cerebellar depression,
site. Like function and dizziness, fever,
benzodiazepines, produces hallucinations,
barbiturates potentiate drowsiness, headache,
the effect of GABA at sedation and insomnia,
this receptor. This hypnosis nightmares,
GABAA receptor binding nervousness,
decreases input psychiatric
resistance, depresses disturbances,
burst and tonic firing, somnolence,
especially in abnormal thinking;
ventrobasal and hyperkinesias;
intralaminar neurons, nausea, vomiting,
while at the same time constipation;
increasing burst liver damage;
duration and mean megaloblastic
conductance at anaemia (following
individual chloride chronic
channels; this phenobarbital
increases both the use); angioedema,
amplitude and decay rash; inj site
time of inhibitory reaction.
postsynaptic currents.
In addition to this
GABA-ergic effect,
barbiturates also block
the AMPA receptor, a
subtype of glutamate
receptor. Glutamate is
the principal
excitatory
neurotransmitter in the
mammalian CNS.
Amobarbital also
appears to bind
neuronal nicotinic
acetylcholine
receptors.

PRECAUTIONS
Brand Names For the short- Acute Respiratory depression Pregnancy test
Nembutal Pentobarbital term treatment intermittent (particularly IV use), may be
Generic Name binds at a of insomnia. porphyria or suicidal ideation and considered in
Pentobarbital distinct binding history of behaviour; paradoxical women of
site associated manifest or responses (including childbearing
Classification: with a Cl- latent agitation, hyperactivity); potential to
barbiturate ionopore at the porphyria; drug dependence, decreased rule out
drug GABAA receptor, severe BMD, increased risk of pregnancy before
increasing the respiratory fractures (prolonged use). initiating
duration of time depression. IV: Blood and lymphatic system treatment.
for which the Cl- History of disorders: Agranulocytosis, Monitor serum
ionopore is open. sedative- megaloblastic anaemia, phenobarbital
The post-synaptic hypnotic thrombocytopenia. concentration
inhibitory effect substance use Cardiac (if clinically
of GABA in the disorder; disorders: Bradycardia. indicated);
thalamus is, nephritic Gastrointestinal LFTs, CBC with
therefore, patients (large disorders: Nausea, differential,
prolonged. All of doses). Severe vomiting. and renal
these effects are renal and General disorders and function
associated with hepatic administration site (periodically).
marked decreases impairment. conditions: Lethargy, Observe for
in GABA-sensitive hangover effect; inj site signs and
neuronal calcium reactions (IV/IM). symptoms of
conductance (gCa). Hepatobiliary suicidality or
The net result of disorders: Hepatitis, unusual changes
barbiturate action cholestasis. in behaviour.
is acute Musculoskeletal and Assess for
potentiation of connective tissue history of
inhibitory disorders: Dupuytren's addiction or
GABAergic tone. contracture, arthralgia, suicidal
Barbiturates also frozen shoulder, ideation; CNS
act through potent osteomalacia, rickets; status and
(if less well osteopenia, osteoporosis seizure
characterized) and (prolonged use). activity. For IV
direct inhibition Nervous system inj: Monitor
of excitatory disorders: Drowsiness, blood pressure,
AMPA-type ataxia, nystagmus. heart and
glutamate Psychiatric respiratory
receptors, disorders: Mental rate, and
resulting in a depression, hallucination; administration
profound confusion, restlessness (in site.
suppression of elderly); memory and
glutamatergic cognitive impairment;
neurotransmission. behavioural disturbances
(in children).
tissue
disorders: Maculopapular,
morbilliform or
scarlatiniform rashes.
Vascular
disorders: Hypotension,
syncope.

PRECAUTIONS
Generic Name: Depresses sensory Sedation and Sensitivity to Hangover, Monitor vitals
phenobarbital – cortex, decreases anticonvulsant barbiturates, delirium, frequently in IV
motor activity and activity. severe respiratory depression, doses. Seizures:
Brand Name: alters cerebellar For the treatment disease with drowsiness, assess location,
Barbital, Luminal, function. Raises of all types of dyspnea or excitation, duration and
Solfoton seizure threshold seizures except obstruction, lethargy, vertigo, characteristics of
and inhibits absence seizures. uncontrolled respiratory seizure activity.
transmission in severe pain, depression, Sedation: Assess
Classifciation: the nervous manifest hepatic Laryngospasm, LOC and anxiety
Barbiturate, system. or familial bronchospasm, when used
Anticonvulsant, history of hypotension, preoperative
Sedative/hypnotic porphyria; severe constipation, sedation. LABS:
kidney disease; diarrhea, nausea, CBC, hepatic and
history of vomiting, renal function
previous addiction photosensitivity, periodically,
to sedative rashes, urticaria, serum folate.
hypnotics; phlebitis at IV Instruct to take
uncontrolled pain; site, arthralgia, medication as
pregnancy myalgia, directed, do not
(particularly neuralgia, abruptly stop
early pregnancy) hypersensitivity medication,
(category D), reactions contact PCP if
lactation; including signs/symptoms of
sustained release angioedema and angioedema, fever,
formulation for serum sickness, sore throat, mouth
children physical sores, unusual
dependence, bleeding/bruising,
psychological nosebleeds or
dependence. petechiae
PRECAUTIONS
Generic Name Barbiturates like Children, young Drowsiness, Instruct patient to take
Butabarbital butabarbital Butabarbital is adults, elderly ataxia, medication exactly as
potentiate GABA-A indicated for and debilitated paradoxical directed. Do not increase
Classification: receptors and use as a patients. excitement, dose because of the habit-
barbiturate inhibit receptors sedative or Patients with confusion, forming potential of
for neuronal hypnotic. depression or headache and butalbital. If medication
acetylcholine, and Butabarbital with a history CNS depression; appears less effective after
kainate. GABA-A should not be of drug or respiratory a few weeks, consult health
receptors are used to treat alcohol abuse or depression; GI care professional. Dose of
predominantly on insomnia for addiction. disorders; acetaminophen should not
the post-synaptic longer than 2 Insomnia caused hepatitis: exceed maximum recommended
membrane, and upon weeks by pain. Acute fever; daily dose of 4 g/day.
activation, open porphyria. megaloblastic Chronic excessive use of >4
chloride channels Severe hepatic anaemia. g/day (2 g in chronic
to hyperpolarize impairment. Potentially alcoholism) may lead to
the neuron and History of CNS Fatal: Erythema hepatotoxicity, renal or
decreased firing depression or multiforme; cardiac damage. Discontinue
rate. Potentiation coma, pulmonary exfoliative gradually to prevent
of GABAergic insufficiency dermatitis. withdrawal symptoms (anxiety,
neurons produces and sleep diaphoresis, disturbed sleep,
sedation. apnoea. nausea/vomiting,
Inhibition of Pregnancy & restlessness, seizures,
neuronal lactation. worsened headache).
acetylcholine Advise patients with tension
receptors and headaches to take medication
glutamate receptors at first sign of headache.
of the kainate Lying down in a quiet, dark
subtype desensitize room may also be helpful.
their respective Medications taken for
neurons, producing prophylaxis should be
sedation continued.
May cause drowsiness or
dizziness. Advise patient to
avoid driving and other
activities requiring
alertness until response to
medication is known.
Instruct patient to notify
health care professional of
all Rx or OTC medications,
vitamins, or herbal products
being taken and consult
health care professional
before taking any new
medications.
Caution patient to avoid
concurrent use of alcohol or
other CNS depressants, may
cause overdose.
Rep: Advise females of
reproductive potential notify
health care professional if
pregnancy is planned or
suspected and to avoid
breastfeeding during therapy.
Advise patient to use an
additional nonhormonal method
of contraception while taking
butalbital compound.

RESPONSIBILITY/
PRECAUTIONS
Generic Name Methylphenobarbital Caution should be drowsiness, Monitor patient
Methylphenobarbital binds at a distinct For the relief exercised in lethargy, responses, blood
binding site of anxiety, patients with vertigo, levels (as
Classification: associated with a tension, and history of kidney headache, severe appropriate) if
GABA Modulators Cl- ionopore at the apprehension, or liver CNS depression, any interacting
GABAA receptor, also used as an problems, mental drugs listed
increasing the anticonvulsant suicidal depression, and above are given
duration of time for the thoughts, lung myalgic, with
for which the treatment of disease, heart neuralgic, or phenobarbital;
Cl- ionopore is epilepsy. disease, arthralgic pain. suggest
open. The post- depression, who Residual alternative means
synaptic inhibitory are taking other sedation or of contraception
effect of GABA in medications, any "hangover" to women using
the thalamus is, allergy, during occurs hormonal
therefore, pregnancy and frequently contraceptives.
prolonged. breastfeeding. following WARNING: Do not
hypnotic doses, give intra-
and subtle arterially; may
distortion of produce
mood, impaired arteriospasm,
judgment, and thrombosis,
impaired motor gangrene.
skills may Administer IV
persist for many doses slowly.
hours. Some Administer IM
patients, doses deep in a
particularly large muscle mass
those with (gluteus maximus,
severe pain, vastus lateralis)
experience or other areas
paradoxical where there is
excitement little risk of
and/or euphoria, encountering a
restlessness, or nerve trunk or
delirium, and, major artery.
therefore, WARNING: Monitor
barbiturates injection sites
should not be carefully for
administered in irritation,
the presence of extravasation (IV
uncontrolled use). Solutions
pain. are alkaline and
very irritating
to the tissues.
Monitor P, BP,
respiration
carefully during
IV
administration.
Arrange for
periodic lab
tests of
hematopoietic,
renal, and
hepatic systems
during long-term
therapy.
WARNING: Taper
dosage gradually
after repeated
use, especially
in patients with
epilepsy. When
changing from one
antiepileptic
drug to another,
taper dosage of
the drug being
discontinued
while increasing
the dosage of the
replacement drug.

PRECAUTIONS
Brand Names Secobarbital For the Short- Seconal Sodium  drowsines Guard against falls
Seconal binds at a term treatment of (secobarbital sodium s and trauma (hip
Sodium distinct binding intractable capsules) is fractures, head
site associated insomnia for contraindicated in  headache injury, and so forth),
Generic Name
Secobarbital with a patients patients who are  fatigue especially if
Cl- ionopore at habituated to hypersensitive to  dizziness drowsiness and vertigo
Classification: the barbiturates barbiturates. It is  dry mouth carry over into the
barbiturate GABAA receptor, also contraindicated daytime. Implement
 upset
increasing the in patients with a fall prevention
duration of time history of manifest stomach strategies, especially
for which the or latent porphyria,  You may if balance is impaired
Cl- ionopore is marked impairment of still (See Appendix E).
open. The post- liver function, or feel
synaptic respiratory disease Causes
drowsy
inhibitory effect in which dyspnea or photosensitivity; use
of GABA in the obstruction is the next care if administering
thalamus is, evident. day after UV treatments. Advise
therefore, taking patient to avoid
prolonged. the direct sunlight and
use sunscreens and
SEDATIVE- protective clothing.
HYPNOTIC.
Help patient explore
nonpharmacologic
methods to induce
sleep, such as
relaxation techniques,
reduced caffeine
intake, and so forth.
action PRECAUTIONS
Generic Name: Exact mechanisms Management Contraindicated CNS: Transient, mild Arrange to taper dosage
alprazolam of action not of anxiety with drowsiness initially; gradually after long-
understood; main disorders, hypersensitivity sedation, depression, term therapy, especially
Brand Name: sites of action short-term to lethargy, apathy, in epileptic patients.
Alprazolam may be the limbic relief of benzodiazepines, fatigue, light-  Do not administer
Intensol, system and symptoms of psychoses, acute headedness, with grapefruit juice.
ApoAlpraz (CAN), reticular anxiety; narrow-angle disorientation, anger,  Taper drug slowly;
Niravam, Novo- formation; anxiety glaucoma, shock, hostility, episodes of decrease by no more than
Alprazol (CAN), increases the associated coma, acute mania and hypomania, 0.5 mg every 3 days.
Nu-Alpraz (CAN), effects of GABA, with alcoholic restlessness, Take this drug exactly
Xanax, Xanax TS an inhibitory depression. intoxication confusion, crying, as prescribed; take
(CAN), Xanax XR neurotransmitter;  Treatment with depression delirium, headache, extended-release form
anxiety blocking of panic of vital signs, slurred speech, once a day in the
Classification: effects occur at attacks with pregnancy dysarthria, stupor, morning; place rapidly
Benzodiazepine, doses well below or without (crosses the rigidity, tremor, disintegrating tablet on
Anxiolytic those necessary agoraphobia placenta; risk dystonia, vertigo, top of tongue, where it
to cause  Unlabeled of congenital euphoria, nervousness, will disintegrate and
sedation, ataxia. uses: Social malformations, difficulty in can be swallowed with
phobia, neonatal concentration, vivid saliva.
withdrawal dreams, psychomotor
premenstrual  Do not drink
syndrome, syndrome), labor retardation,
grapefruit juice while
depression and delivery extrapyramidal
on this drug.
(“floppy infant” symptoms; mild
syndrome), paradoxical excitatory  Do not stop taking
lactation reactions during first drug (in long-term
therapy) without
(secreted in 2 wk of treatment 
breast milk; consulting health care
CV: Bradycardia,
infants become provider; drug should
tachycardia, CV
lethargic and not be stopped suddenly.
collapse,
lose weight). hypertension,  Avoid alcohol, sleep-
 Use cautiously hypotension, inducing, or over-the-
counter drugs.
with impaired palpitations, edema 
liver or kidney Dermatologic:  You may experience
function, Urticaria, pruritus, these side effects:
debilitation. Drowsiness, dizziness
rash, dermatitis 
(these effects will be
EENT: Visual and
less pronounced after a
auditory disturbances,
diplopia, nystagmus, few days, avoid driving
depressed hearing, a car or engaging in
nasal congestion  GI: other dangerous
Constipation, activities if these
diarrhea, dry mouth, occur); GI upset (take
salivation, nausea, drug with food);
anorexia, vomiting, fatigue; depression;
difficulty in dreams; crying;
swallowing, gastric nervousness
disorders, hepatic
impairment
 GU: Incontinence,
changes in libido,
urinary retention,
menstrual
irregularities 
Hematologic:
Elevations of blood
enzymes—LDH, alkaline
phosphatase, AST, ALT;
blood dyscrasias—
agranulocytosis,
leukopenia
 Other: Hiccups,
fever, diaphoresis,
paresthesias, muscular
disturbances,
gynecomastia. Drug
dependence with
withdrawal syndrome
when drug is
discontinued; more
common with abrupt
discontinuation of
higher dosage used for
longer than 4 mo

PRECAUTIONS
Generic Name: Clonazepam is an Used alone or as Hypersensitivity Drowsiness, Monitor addiction-
clonazepam effective adjunct in to fatigue, muscular prone patients
anticonvulsant. It treatment of benzodiazepines, hypotonia, carefully because
Brand Name: Apo- raises the Lennox-Gastaut acute pulmonary coordination of their
Clonazepam (CAN), threshold for syndrome (petit insufficiency, disturbances, predisposition to
GenClonazepam propagation of mal variant), acute narrow angle dizziness, habituation and
(CAN), Klonopin, seizure activity akinetic and glaucoma vertigo, anorexia, drug dependence.
Klonopin Wafers, and prevents myoclonic visual  Monitor liver
Nu-Clonazepam generalization of seizures; may be disturbances, function and blood
(CAN), Rivotril focal or local useful in patients libido changes. counts
(CAN) activity. with absence  Potentially periodically in
Clinically, it (petit mal) Fatal: Salivary or patients on
Classification: improves focal seizures who have bronchial longterm therapy.
Benzodiazepine, epilepsy and not responded to hypersecretion  WARNING: Taper
Antiepilepti c generalized succinimides; up leading to dosage gradually
seizures. It is to 30% of patients respiratory after long-term
also believed to show loss of problems therapy,
enhance the effectiveness of (children). May especially in
activity of GABA, drug, often within produce diminished patients with
and acts as 3 mo of therapy reflexes or coma. epilepsy;
anxiolytic. (may respond to Rarely, blood substitute another
dosage dyscrasias. antiepileptic.
adjustment);
 Monitor patient
treatment of panic
for therapeutic
disorder with or
drug levels: 20–80
without
ng/mL.
agoraphobia
 If the patient
 Unlabeled uses:
has epilepsy,
Periodic leg
arrange for
movements during
patient to wear
sleep; hypokinetic
medical alert
dysarthria, acute
identification
manic episodes,
indicating patient
multifocal tic
has epilepsy and
disorders,
is receiving drug
neuralgias
therapy
PRECAUTIONS
Generic Name: Depresses the CNS, Lorazepam is FDA- Lorazepam is CNS: Dizziness, Assess respiration
lorazepam probably by approved for contraindicated drowsiness, after rapid IV
potentiating short-term (4 in patients with lethargy, administration. Notify
Brand Name: gammaaminobutyric months) relief of hypersensitivity hangover, physician immediately
ApoLorazepam, acid (GABA), an anxiety symptoms to headache, ataxia, if patient exhibits
Ativan, inhibitory related to anxiety benzodiazepines slurred speech, any interruption in
NovoLorazem, neurotransmitter. disorders, or to any forgetfulness, respiratory rate
NuLoraz anxiety-associated components of confusion, mental (apnea) or signs of
insomnia, the formulation, depression, respiratory
anesthesia in acute narrow- rhythmic myoclonic depression.
Classification: premedication in angle glaucoma, jerking in preterm Continually monitor
analgesic adults to relieve pre-existing CNS infants, for signs of cardiac
adjuncts, anxiety or to depression, paradoxical arrest, especially
antianxiety produce coma, acute excitation. EENT: after rapid IV
agents, sedation/amnesia, pulmonary Blurred vision. administration. Assess
sedative/hypnotics and treatment of insufficiency or Resp: respiratory blood pressure
Pharmacologic status sleep apnea. depression. CV: periodically and
class: epilepticus. Rapid IV use only: compare to normal
benzodiazepines APNEA, CARDIA values Assess heart
CARREST, rate, ECG, and heart
Dosage: bradycardia, sounds, especially
If seizure hypotension. GI: during exercise.
persists after 5- Constipation, Report any behavioral
10 min, Usual 4 diarrhea, nausea, or personality changes
mg/dose slow IV at vomiting, weight such as confusion,
2 mg/min If gain (unusual). forgetfulness, slurred
seizure persists speech, decreased
after 5-10 min, mental acuity, or
administer 4 mg IV excessive excitation.
again

action PRECAUTIONS
Generic Name: Depresses all Anxiety - Acute narrow- IV route may BASELINE ASSESSMENT -
Diazepam levels of CNS by Skeletal Muscle angle glaucoma, produce pain, Assess B/P, pulse,
enhancing action Relaxation - severe swelling, respirations
Brand Name: Apo- of gamma- Alcohol respiratory thrombophlebitis, immediately before
Diazepam Diastat aminobutyric Withdrawal - depression, carpal tunnel administration. -
Diazepam Intensol acid, a major Status severe hepatic syndrome. Abrupt Anxiety: Assess
Novo-Dipam Valium inhibitory Epilepticus - insufficiency, or too-rapid autonomic response
neurotransmitter Control of sleep apnea withdrawal may (cold, clammy hands,
Dosage/Route/Fre in the brain. Increased syndrome, result in diaphoresis), motor
quency: Anxiety PO: Therapeutic Seizure myasthenia pronounced response (agitation,
ADULTS: 2–10 mg 2–4 Effect: Produces Activity gravis. Children restlessness, trembling, tension). -
times a day. ELDERLY: anxiolytic (Breakthrough less than 6 irritability, Musculoskeletal spasm:
Initially, 1–2 mg 1–2 effect, elevates Seizures) in months of age. insomnia, hand Record onset, type,
times a day. seizure Pts with Cautions: Pts tremor, location, duration of
CHILDREN: 0.12–0.8 threshold, Refractory receiving other abdominal/muscle pain. Check for
mg/kg/day in divided produces Epilepsy Who CNS depressants cramps, immobility, stiffness,
doses q6–8h. IV, IM: skeletal muscle Are on Stable or psychoactive diaphoresis, swelling. - Seizures:
ADULTS: 2–10 mg; may relaxation. Regimens of agents, vomiting, Review history of
repeat in 3–4 hrs if Anticonvulsants depression, seizures. Abrupt seizure disorder
needed. CHILDREN: - Dosage in history of drug withdrawal in pts (length, intensity,
0.04–0.3 mg/kg/dose Renal and alcohol with epilepsy may frequency, duration,
q2–4h. Maximum: 0.6 Impairment - abuse, produce increase LOC). - Observe
mg/kg within 8-hr Dosage in renal/hepatic in frequently for
period. Skeletal Hepatic impairment, frequency/severity recurrence of seizure
Muscle Relaxation PO: Impairment respiratory of seizures. activity. - Initiate
ADULTS: 2–10 mg 2–4 disease, Overdose results seizure precautions.
times a day. ELDERLY: impaired gag in drowsiness, INTERVENTION/EVALUATION
Initially, 1–2 mg 1–2 reflex, confusion, - Monitor heart rate,
times a day. concurrent use diminished respiratory rate, B/P,
CHILDREN: 0.12–0.8 of strong CYP3A4 reflexes, CNS mental status. - Assess
mg/kg/day in divided inhibitors or depression, coma. children, elderly for
doses q6–8h. Alcohol inducers. Antidote: paradoxical reaction,
Withdrawal PO: Flumazenil (see particularly during
ADULTS, ELDERLY: 10 Appendix K for early therapy. -
mg 3–4 times during dosage) Evaluate for
first 24 hrs, then therapeutic response
reduced to 5 mg 3–4 (decrease in
times a day as intensity/frequency of
needed. Status seizures; calm facial
Epilepticus IV: expression, decreased
ADULTS, ELDERLY: 5–10 restlessness; decreased
mg q5–10min. Maximum: intensity of skeletal
30 mg. INFANTS, muscle pain). -
CHILDREN: 0.1–0.3 Therapeutic serum
mg/kg over 5 min or level: 0.5–2 mcg/ml;
less; may repeat toxic serum level:
after 5–10 min. greater than 3 mcg/ml.
Maximum: 10 mg/dose. PATIENT/FAMILY TEACHING
Control of Increased - Avoid alcohol. -
Seizure Activity Limit caffeine. - May
(Breakthrough cause drowsiness, avoid
Seizures) in Pts with tasks that require
Refractory Epilepsy alertness, motor skills
Who Are on Stable until response to drug
Regimens of is established. - May
Anticonvulsants be habit forming. -
Rectal Gel: ADULTS, Avoid abrupt
CHILDREN 12 YRS AND discontinuation after
OLDER: 0.2 mg/kg; may prolonged use.
be repeated in 4–12
hrs. CHILDREN 6–11
YRS: 0.3 mg/kg; may
hrs . CHILDREN 2–5
YRS: 0.5 mg/kg; may
hrs.
PHARMACOTHERAPEU TIC:
Benzodiazepine
(Schedule IV).
CLINICAL:
Antianxiety, skeletal
muscle relaxant,
anticonvulsant.
PRECAUTIONS
Generic Name: Acts at many Sedation and Hypersensitivity Dizziness, Assess for anxiety
chlordiazepoxide levels of the CNS relief of anxiety ● Cross- drowsiness and level of
to produce sensitivity with sedation Assess
Classification: anxiolytic effect other risk for falls For
benzodiazepines Depresses the CNS, benzodiazepines alcohol withdrawal
probably by ● Uncontrolled assess for
PO (adults): potentiating GABA, severe pain tremors,
● Alcohol an inhibitory ● Pulmonary agitation,
withdrawal: 50-100 neurotransmitter disease delirium, and
mg until agitation ● Angle-closure hallucinations
is controlled up glaucoma
to 400 mg/day ● Pregnancy Use Instruct patients
● Anxiety: 5-25 mg cautiously: to take medication
3-4 times a day PO ● Hepatic as directed.
(geriatric or dysfunction Medication is less
debilitated ● Severe renal effective after a
patients): impairment few weeks. May
● Anxiety: 5 mg 2- ● History of cause drowsiness
4 times daily suicide attempt or or dizziness. Use
increase as needed substance abuse caution when
PO (children): ● Lactation driving or doing
Anxiety: 5 mg 2-4 other activities.
times daily up to Avoid use of
10 mg 2-3 times alcohol or other
daily CNS depressants

GENERIC NAME Temazepam is a Short-term •low amount of •Muscle It is the nurse's responsibility to
Temazepam type of management albumin proteins cramps continuously assess and optimize
Benzodiazepines of in the blood •seizures safety measures or dependence,
BRAND NAME that work by insomnia •suicidal •shakiness in tolerance precautions such as the use
Restoril enhancing a very (trouble thoughts the of side rails or bed alarms. •Observe
important with •alcohol extremities. the S&S of overdose: weakness,
DOSAGE neurotransmitter sleeping). intoxication •stomach bradycardia, somnolence, confusion,
Older adults: 7.5 called GABA •drug abuse cramps slurred speech, ataxia, coma with
mg; may adjust (gammaamino •depression •sweating reduced or absent reflexes,
dose if needed butyric acid) at •asthma •trembling or hypertension, and respiratory
Adult: 7.5-30mg the GABA A •worsening of shaking of depression. AFTER: •When a patient is
Children (4-11yrs receptor. This debilitating the hands or ambulating, it is the nurse's
old) : 0.5 mg/kg results in the chronic lung feet responsibility to ensure they are
sedative, disease called •vomiting kept safe and with assistance,
FREQUENCY every hypnotic COPD •decreased especially when most of the patients
night at bedtime (sleepinducing), lung function are sedated or are experiencing side
anxiolytic •liver problems effects of these drugs. •Educate
ROUTE Oral route (antianxiety), •memory loss patients about REM interference and
SUPPLIED anticonvulsant, •sleep apnea rebound insomnia that they may occur
Temazepam is and muscle •pregnancy just a 3-4 weeks regimen of drug
supplied both by relaxant •chronic therapy. •Examine the client for the
a tablet and a properties for obstructive hangover effect, which is common with
capsule with which the drugs pulmonary many CNS depressants, and assess for
7.5mg,15mg are prescribed. disease •complex potential dependence on drugs abused.
22.5mg,30mg sleep behaviors •Report any behavioral or personality
available doses like eating or changes such as excessive excitement,
driving while hallucinations, or expression of
Classification: asleep abnormal thoughts. •Advise patient to
Sedatives, avoid alcohol and other CNS
Anxiolytics, depressants because of the increased
Benzodiazepin risk of sedation and adverse effects.
•Caution the patient and significant
others to guard against complex motor
behaviors that can occur while
asleep, including driving a car.
•Instruct patient to report other
bothersome side effects including
severe or prolonged blurred vision,
skin rash, or GI problems (nausea,
vomiting, constipation, diarrhea)
•Instruct patient to consult
physician if insomnia continues in
spite of medication.
Drug Name Mechanism of Indication Contraindicatio Adverse Effect NURSING

action n RESPONSIBILITY
/
PRECAUTIONS
Brand Names Midazolam has different Acute narrow- Anterograde amnesia, Monitor the
Buccolam, The actions of indications depending on angle glaucoma, CNS depression, level of
Busulfex, benzodiazepines its formulation by the severe hypotension, sedation,
Nayzilam, such as midazolam FDA. respiratory paradoxical reactions respiratory
Seizalam are mediated insufficiency, (e.g. hyperactive or rate, heart
Generic Name through the Nasal severe aggressive behaviour), rate, blood
Midazolam inhibitory For the nasal spray respiratory suicidal ideation, pressure,
neurotransmitter formulation, midazolam failure, acute withdrawal symptoms. oxygen
Classification: gamma- is indicated for the respiratory Cardiac saturation
Short-acting aminobutyric acid acute treatment of depression, disorders: Bradycardia (e.g. pulse
benzodiazepine (GABA), which is intermittent, myasthenia , tachycardia. oximetry),
with rapid one of the major stereotypic episodes of gravis, sleep Gastrointestinal vital signs.
onset inhibitory frequent seizure apnoea disorders: Nausea,
neurotransmitters activity (i.e., seizure syndrome; vomiting,
in the central clusters, acute severe hepatic constipation, dry
nervous system. repetitive seizures) impairment mouth, hiccups.
Benzodiazepines that are distinct from a (oral). General disorders and
increase the patient’s usual seizure Concomitant use administration site
activity of GABA, pattern in patients with with CYP3A4 conditions: Fatigue,
thereby producing epilepsy 12 years of age inhibitors. inj site reactions
a sedating and older. (e.g. erythema, pain,
effect, relaxing Intravenous phlebitis,
skeletal muscles, For the intravenous thrombosis).
and inducing injection formulation, Injury, poisoning and
sleep, midazolam is indicated procedural
anesthesia, and as an agent for complications: Falls,
amnesia. sedation/anxiolysis/amne fractures.
Benzodiazepines sia and prior to or Musculoskeletal and
bind to the during diagnostic, connective tissue
benzodiazepine therapeutic or disorders: Muscle
site on GABA-A endoscopic procedures, weakness.
receptors, which such as bronchoscopy, Nervous system
potentiates the gastroscopy, cystoscopy, disorders: Sedation
effects of GABA coronary angiography, (prolonged and post-
by increasing the cardiac catheterization, operative), decreased
frequency of oncology procedures, alertness, somnolence,
chloride channel radiologic procedures, headache, dizziness,
opening suture of lacerations drowsiness, ataxia.
and other procedures Psychiatric
either alone or in disorders: Confusion,
combination with other euphoric mood,
CNS depressants. The depression,
sedative, anxiolytic and hallucinations,
amnestic use of physical drug
midazolam can also be dependence, withdrawal
employed pre- syndrome.
operatively. It can also Respiratory, thoracic
be indicated for and mediastinal
induction of general disorders: Dyspnoea,
anesthesia, before laryngospasm,
administration of other bronchospasm, cough.
anesthetic agents or as Skin and subcutaneous
a component of tissue
intravenous disorders: Rash,
supplementation of urticaria, pruritus.
nitrous oxide and oxygen
for a balanced
anesthesia. A relatively
narrower dose range of
midazolam and a shorter
period of induction can
be achieved if midazolam
is combined with
narcotic premedication.
Intramuscular
For the intramusuclar
injection formulation,
midazolam is indicated
for preoperative
sedation/anxiolysis/amne
sia or for treatment of
status epilepticus in
adults.
Oral
Midazolam syrup is
indicated for use in
pediatric patients for
sedation, anxiolysis and
amnesia prior to
diagnostic, therapeutic
or endoscopic procedures
or before induction of
anesthesia. It is only
approved in monitored
settings only and not
for chronic or home use.

action PRECAUTIONS
Generic Name: Acts at many Short-term Hypersensitivity; abnormal thinking, Supervise ambulation and
triazolam levels in the CNS, management Cross-sensitivity behavior changes, transfer of patients
producing of with other dizziness, following
Trade Name: generalized insomnia. benzodiazepines excessive sedation, administration. Remove
Halcoin depression. may occur;Pre- hangover, headache, cigarettes. Side rails
Effects may be existing CNS anterograde should be raised and
mediated by GABA, depression; amnesia, confusion, call bell within reach
Dosage/ Route/ an inhibitory Uncontrolled hallucinations, at all times. PO
Frequency: neurotransmitter. severe pain; sleep-driving, Administer right before
Concomitant use of lethargy, mental going to bed. Do not
PO (Adults): potent CYP3A4 depression, take with or right after
0.125–0.25 mg (up inhibitors; OB: paradoxical a meal.
to 0.5 mg) at May cause fetal excitation EENT:
bedtime. PO harm; Lactation: blurred visionGI: instruct patient to take
(Geriatric Use not constipation, triazolam as directed.
Patients or recommended while diarrhea, nausea, Discuss the importance
Debilitated vomiting Derm: of preparing environment
Patients): 0.125 rashes Misc: for sleep (dark room,
mg at bedtime physical quiet, avoidance of
initially; may be dependence, nicotine and caffeine).
↑ as needed. psychological If less effective after
dependence, a few weeks, consult
Classificatoin: tolerance. health care
benzodiazepines professional; do not
increase dose. Advise
patient to avoid
grapefruit and
grapefruit juice during
therapy.May cause
daytime drowsiness or
dizziness. Caution
patient to avoid driving
or other activities
requiring alertness
until response to
medication is known.
Instruct patient and
family how to reduce
falls risk at home

action PRECAUTIONS
Generic Name: Enhances GABA Used for short- Known Relaxes patient: Instruct the patient
Flurazepam: effects term treatment hypersensitivity daytime sedation, that they may have a
(inhibits of insomnia. to drug dizziness, hangover feeling the
Classification: overstimulation confusion. next day, use with
Hypnotic CNS of CNS). caution in older adults,
depressant (long- tell patient to avoid
acting alcohol and other CNS
benzodiazepine) depressants;
Drug Name Mechanism Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

of action PRECAUTIONS
Generic Name: Oxazepam Oxazepam Narrow-angle Epilepsy, Monitor for adverse reactions.
Oxazepam affects is used to glaucoma, CNS psychoses, mental Most are dose related. Physician
chemicals treat depression, depression; will rely on accurate observation
Brand Name: in the anxiety pregnancy, myasthenia gravis; and reports of patient response to
Serax brain that disorders breastfeeding, impaired hepatic or the drug to determine lowest
may be or alcohol severe, renal function; effective maintenance dose.Monitor
unbalanced withdrawal uncontrolled pain, drug abuse, for therapeutic
Classification: in people symptoms. sleep addiction-prone effectiveness.Maximum effect may
Benzodiazepine with apnea.Precautions: individuals. require 1–2 wk; patient tolerance
anxiety Mental impairment, Injectable diazepam to therapeutic effects may develop
Dosage: pts with drug used with extreme after 4 wk of treatment.Observe
Anxiety: Adult - dependence caution in older necessary preventive precautions
PO 10-15 mg max potential adults, the very for suicidal tendencies that may
120mg/day, Geri - ill, and patients be present in anxiety states
PO 10 mg max with COPD accompanied by depression.
60mg/dayAlcohol
Withdrawal - 15-
30 mg

action PRECAUTIONS
Brand Names quazepam likely Documented  daytime  Use caution
Doral exerts its Quazepam is hypersensitivity drowsiness, in COPD, sleep apnea,
Generic Name effects by indicated
potentiating for the Acute alcohol  headache, renal/hepatic disease,
Quazepam
the effect of treatment intoxication  dizziness, impaired gag reflex,
gamma- of insomnia  tiredness, respiratory
aminobutyric characteriz Myasthenia gravis  upset disease, open-angle
Classification: acid (GABA) on ed by
long-acting stomach, and glaucoma (questionable),
GABA(A) difficulty Narrow-angle glauco
benzodiazep receptors, the falling ma  dry mouth depression, suicide
ine main inhibitory asleep,  hives, ideation
neurotransmitte frequent Severe respiratory  difficulty  Anterograde amnesia repor
Adult dosage r receptors in nocturnal depression breathing, ted with benzodiazepine
Tablet: Schedule the mammalian awakenings,
 swelling of use
brain. GABA(A) and/or Depressed neuroses,
IV receptors are a early psychotic reactions the face,  May impair the ability to
component of morning lips, perform hazardous tasks
 7.5 mg GABA-gated awakenings. tongue, or  Patients particularly the
 15 mg ionotropic IV use in shock, throat, elderly, are at higher
chloride coma,
 nausea, risk of falls; therapy
channels that depressed respirati
produce on, patients who  vomiting, can cause drowsiness and
inhibitory recently received  snoring, decrease the level of
postsynaptic other respiratory  confusion, consciousness
potentials - depressants
 agitation,  Paradoxical reactions,
following  hallucinatio including hyperactive or
activation by ns, aggressive behavior,
GABA, the
channel  unusual reported
undergoes a thoughts or  Sleep-related activities,
conformational behavior, including sleep-driving,
change that  suicidal cooking and eating, and
allows the
thoughts, making phone calls while
passage of
chloride ions  driving, asleep may occur;
through the eating, discontinue therapy in
channel. The making phone these patients
inhibitory calls or  Use caution in patients
potentials
having sex with a history of drug
produced by
GABA and later abuse or
neurotransmissi having no acute alcoholism;
on play an memory of tolerance, psychological
integral role the and physical dependence
in the
suppression and activity, may occur with prolonged
control of and use
epileptiform  worsening  Observational studies
nerve firing depression have demonstrated that
such as that
concomitant use
seen in
epilepsy, which of opioid analgesics
makes the GABA and benzodiazepines incre
system a ases the risk of drug-
desirable related mortality
target in the
compared to the use of
treatment of
epilepsy. opioids alone
 If a decision is made to
prescribe a
benzodiazepine
concomitantly with
opioids, prescribe the
lowest effective dosages
and minimum durations of
concomitant use, and
follow patients closely
for signs and symptoms of
respiratory depression
and sedation; in patients
already receiving an
opioid analgesic,
prescribe a lower initial
dose than indicated in
the absence of an opioid
and titrate based on
clinical response
 If an opioid is initiated
in a patient already
taking a benzodiazepine,
prescribe a lower initial
dose of the opioid and
titrate based on clinical
response

Generic Name: Exact mechanisms Management of Contraindicated Drowsiness, WARNING: Taper dosage gradually
clorazepate not understood; anxiety with muscular after long-term therapy,
dipotassium benzodiazepines disorders or hypersensitivity hypotonia, especially in epileptics.
potentiate the for short- to anterograde  Arrange for patients with
Brand Name: Apo- effects of GABA, term relief benzodiazepines; amnesia, epilepsy to wear medical alert
Clorazepate (CAN), an inhibitory of symptoms psychoses; acute tremor, GI identification, indicating
Novo-Clopate neurotransmitter; of anxiety narrow-angle upsets. disease and medication usage.
(CAN), Tranxene- anxiolytic  Symptomatic glaucoma; shock; Teaching points
SD, TranxeneSD effects occur at relief of coma; acute  Take drug exactly as
Half Strength, doses well below acute alcohol alcoholic prescribed; do not stop taking
Tranxene-T-tab those necessary withdrawal intoxication drug (long-term therapy) without
to cause  Adjunctive with depression consulting your health care
Classification: sedation, ataxia. therapy for of vital signs; provider.
Benzodiazepine, partial pregnancy (risk  Avoid alcohol, sleep-inducing,
Anxiolytic, seizures of congenital or over-the-counter drugs.
Antiepileptic malformations,  Avoid pregnancy while taking
neonatal this drug; using barrier
withdrawal contraceptives is advised. If you
syndrome); labor become pregnant, do not stop the
and delivery drug; contact your health care
(“floppy infant” provider.
syndrome);
 You may experience these side
lactation
effects: Drowsiness, dizziness
(infants tend to
(may be transient; avoid driving
become lethargic
a car or engaging in other
and lose
dangerous activities); GI upset
weight).
(take with food); fatigue;
 Use depression; dreams; crying;
cautiously with nervousness; depression,
impaired liver emotional changes; bed-wetting,
or renal urinary incontinence.
function,
 Report severe dizziness,
debilitation;
weakness, drowsiness that
elderly
persists, rash or skin lesions,
patients.
difficulty voiding, palpitations,
swelling in the extremities.
Drug Name Mechanism of action Indication Contraindication Adverse Effect PRECAUTIONS

Brand Names remimazolam exerts its  Severe  lightheadednes Clinically
Byfavo therapeutic effects by Remimazolam hypersensit s, notable hypoxia, brad
Generic Name potentiating the effect is indicated ycardia,
of gamma-aminobutyric for the ivity  shallow and hypotension obser
Remimazolam
acid (GABA) on GABA(A) induction reaction to breathing, and ved in clinical
Dosage receptors, the main and dextran 40  changes in trials; continuously
form: intravenous inhibitory maintenance blood pressure monitor vital signs
powder for neurotransmitter of during sedation and
injection (20 mg) receptors in the procedural through the recovery
mammalian sedation in  hives, period
Classification brain.2 GABA(A) adults Contains dextran 40,
ultra short- receptors are a undergoing which can cause
 difficulty
acting component of GABA-gated procedures hypersensitivity
benzodiazepi ionotropic chloride lasting 30 breathing, reactions, including
ne channels that produce minutes or  swelling of rash, urticaria, prur
inhibitory postsynaptic less. the face, itus, and anaphylaxis
potentials - following lips, tongue, Benzodiazepine use in
activation by GABA, the late-stage pregnancy
or throat,
channel undergoes a can result in
conformational change  weak or sedation in
that allows the passage shallow the neonate; observe
of chloride ions through breathing, newborns for signs or
the channel. The  confusion, sedation and manage
inhibitory potentials accordingly
 slow
produced by GABA Pediatric
neurotransmission play heartbeats, neurotoxicity
an integral role in the  lightheadednes
suppression and control s,
of epileptiform nerve  drowsiness,
firing such as that seen
in epilepsy, which makes and
the GABA system a  dizziness
desirable target in the
treatment of epilepsy.

PRECAUTIONS
Generic Name: Diphenhydramine is Indication for the Contraindicated to drowsiness, 1. Assess and
Diphenhydramine widely used in blocks effects of a pregnant patient dizziness, accurately record
pregnancy as a histamine and With muscle maternal vital signs.
Brand Name: sedative, an initiation hypersensitivity weakness, 2. Monitor patient’s
Benadryl antihistamine, and relaxation and to to the drug and urinary mental alertness. 3.
an anti-nausea fall asleep prior its components as retention, dry Explain to the patient
Dosage: 1 ampule drug, confirm its to blood well. mouth, nose the side effects that
Route: IVF via IM safety during transfusion due to Contraindicated to and throat, may occur prior in
Frequency: 30 pregnancy. The excessive blood breastfeeding flushing, taking the medication.
minutes Pregnancy drug have loss during mothers Pregnancy epigastric 4. If patient is
category: B Drug oxytocin-like removal of Category B - used distress having acute allergic
Class: effects. placental only if clearly reaction, obtain
Antihistamine/ fragments left on needed. history of recently
Antiemetic the mother’s ingested foods and
stomach after drugs because it may
Classification: delivery. cause contradict to
first-generation the medication. 5.
antihistamine that Assess for tolerance
is used in a to antihistamine
variety of effect. 6. Instruct
conditions to patient to avoid task
treat and prevent that require alertness
dystonias, motor skills until
insomnia, response to drug is
pruritis, establish. 7. Explain
urticaria, to the patient that
vertigo, and dry mouth, drowsiness
motion sickness. and dizziness may be
an expected response
to the drug. 8. If
drug causes severe
allergic reaction then
terminate the use of
drug and notify the
physician for further
intervention.
Drug Name Mechanism Indication Contraindication Adverse Effect PRECAUTIONS

of action
Summary The Sodium combination •CNS depression  Sodium Oxybate can slow or stop
Sodium physiologic oxybate is with •Abuse and your breathing, even at regular
oxybate is al actions a central sedative Misuse [see
a central of sodium nervous hypnotics Warnings and doses or if you are also taking
nervous oxybate are system Precautions stimulant medicines.
system mediated by depressant •combination with •Respiratory  Fatal side effects can occur if
depressant gamma- indicated alcohol Depression and you use this medicine with
used to hydroxybuty for the • Sleep-Disordered
alcohol, or with other drugs
treat rate (GHB), treatment patients with Breathing [see that cause drowsiness or slow
cataplexy its active of succinic Warnings and your breathing.
and compound. cataplexy semialdehyde Precautions
excessive While the or dehydrogenase •Depression and  Avoid taking other medicines
daytime exact excessive deficiency Suicidality that make you sleepy or slow
sleepiness mechanism daytime •Other your breathing. This includes
(EDS) of action sleepiness Behavioral or cold
associated of GHB in (EDS) in Psychiatric
or allergy medicine, opioid pain
with narcolepsy patients Adverse
narcolepsy. is not with Reactions medicine, sedatives, muscle
Brand Names fully narcolepsy Parasomnias relaxants, seizure medicine, or
Lumryz, understood, In the US Use in Patients medicine for depression,
Xyrem, it is and in Sensitive to anxiety, or mental illness. Your
Xywav suggested Europe, the High Sodium
doctor may need to change your
Generic Name that GHB drug is Intake [see
has approved Warnings and treatment plan if you need to
Sodium
oxybate multiple for use in Precautions use any of these other
immediate- modes of patients 7 medicines.
releaase oral action. years of  Misuse of sodium Oxybate can
solution Sodium age and
Oxybate older cause breathing problems,
(Xyrem),
Schedule III Oral while in seizures, loss of consciousness,
 500mg/mL Solution is Canada, it or death. Sodium Oxybate is
powder or oral a CNS is not available only from a certified
extended-release depressant recommended
pharmacy. Do not allow anyone
suspension in children
under the else to use your medication.
(Lumryz),
age of 18,  Do not drink alcohol or take
Schedule III
 4.5 unless other sleep medicines together
g/packet clearly with sodium Oxybate. Dangerous
 6 needed
side effects or death could
g/packet
occur.
 7.5
g/packet  Do not give sodium Oxybate to
 9 anyone who has a rare metabolic
g/packet disorder called succinic
semialdehyde dehydrogenase
deficiency (which can cause
mental or physical impairment).
 It is dangerous to purchase
sodium Oxybate on the Internet
or outside the United States.
The sale and distribution of
medicines outside the U.S. does
not comply with safe-use
regulations of the Food and Drug
Administration (FDA). These
medications may contain
dangerous ingredients, or may
not be distributed by a licensed
pharmacy.
 Do not drink alcohol. Dangerous
side effects or death could
occur.

PRECAUTIONS
Generic Name: Buspirone exerts Management of Hypersensitivity. Dizziness, nausea, Provide sugarless
buspirone anxiolytic anxiety disorders Epilepsy; severe headache, lozenges or ice
hydrochloride activity through or short-term renal or hepatic nervousness, chips if dry mouth
high affinity for relief of symptoms impairment; lightheadedness, or altered taste
Brand Name: BuSpar serotonin 5-HT1A of anxiety children excitement, occurs.
and 5-HT2  Unlabeled use: paresthesia, sleep  Arrange for
Classification: receptors. It has Decreasing the disturbances, analgesic for
Anxiolytic moderate affinity symptoms (aches, chest pain, headache or
for dopamine D2- pains, fatigue, tinnitus, nasal musculoskeletal
Dosage: receptors but no cramps, congestion, sore aches. *Teaching
Oral affinity for GABA irritability) of throat. Less points
 Short-term receptors. PMS sedation and lower  Take this drug
management of potential for exactly as
anxiety dependence prescribed.
 Adult: compared to other  Avoid the use of
Initially, 5 mg anxiolytics. alcohol, sleep-
bid/tid increased inducing, or over-
by 5-mg increments the-counter drugs
at intervals of 2- and grapefruit
3 days. Max: 45 mg juice; these could
daily in divided cause dangerous
doses. effects.
 Max Dosage: 45  You may
mg daily in experience these
divided doses. side effects:
Drowsiness,
dizziness, light-
headedness (avoid
driving or
operating complex
machinery); GI
upset (eat
frequent small
meals); dry mouth
(suck ice chips or
sugarless
candies); dreams,
nightmares,
difficulty
concentrating or
sleeping,
confusion,
excitement
(reversible; will
stop when the drug
is discontinued).
 Report abnormal
involuntary
movements of
facial or neck
muscles, motor
restlessness; sore
or cramped
muscles; abnormal
posture; yellowing
of the skin or
eyes.

PRECAUTIONS
Generic Name: Produces CNS Insomnia with Hypersensitivity; blurred vision, CNS depression may ↑
zolpidem depression by difficulties in History of double visionGI: with
binding to GABA sleep initiation experiencing diarrhea, nausea, sedatives/hypnotics,
Trade receptors.Has no complex sleep vomiting Neuro: alcohol,
Name: Ambien analgesic behaviors with COMPLEX SLEEP phenothiazines,
properties. zolpidem; Sleep BEHAVIORS tricyclic
apnea; Severe (including sleep antidepressants,
PO SL (Adults): hepatic impairment driving, sleep opioid analgesics,
Tablets, spray, or (↑ risk of hepatic walking, or or antihistamines.
SL tablets encephalopathy). engaging in other Concurrent use of
(Edluar)– 5 mg activities while CYP3A4 inducers,
(for women) and 5– sleeping), daytime including rifampin ,
10 mg (for men) at drowsiness, may ↓ levels.
bedtime; may ↑ to dizziness, Concurrent use of
10 mg at bedtime abnormal thinking, CYP3A4 inhibitors,
if 5–mg dose not agitation, including
effective; SL amnesia, behavior ketoconazole , may ↑
tablets (generic)– changes, levels; consider ↓
1.75 mg (for hallucinations, zolpidem dose.
women) or 3.5 mg prolonged reaction Concomitant use of
(for men) once time Misc: kava-kava, valerian,
upon awakening in HYPERSENSITIVITY or chamomile can ↑
the middle-of-the- REACTIONS CNS depression. St.
night; (including John's wort may ↓
Extendedrelease anaphylaxis), levels; avoid
tablets– 6.25 mg physical concurrent use. Food
(for women) and dependence, ↓ and delays
6.25–12.5 mg (for psychological absorption.
men) at bedtime; dependence,
may ↑ to 12.5 mg tolerance
at bedtime if
6.25–mg dose not
effective.

Classification: Hydroxyzine and Hydroxyzine may be Hypersensitivity Drowsiness The nurse instructs
Antiemetic, other effective in to Confusion patients to take
Antihistamine, antihistamines are treating nausea hydroxyzine, Dizziness medication as directed
Anxiolytic thought to relieve and vomiting and cetirizine & other Dry mouth and to enhance safety
nausea and preventing and piperazine Urinary precautions due to
Generic Name: vomiting by treating motion derivatives, retention adverse effects.
Hydroxyzine HCl blocking the sickness. aminophylline or Thickened  Adverse effects may
action of  Hydroxyzine is ethylenediamine. respiratory impair thinking or
acetylcholine in also used as a Porphyria; secretions reactions, so operating
Usual Dose: IM 25– the brain. This sedative to treat preexisting a motor vehicle should
100 mg every 4–6 h drug works to stop anxiety. prolonged QT be avoided.
as needed Usual nausea and  Additionally, interval.  Try to identify the
routes: IM vomiting by the drug is given Pregnancy & circumstances that cause
stopping the in combination lactation. or aggravate nausea and
release and action with other vomiting and avoid them
of acetylcholine medications during when possible.
(a hormone from anesthesia.  Drugs are more
the
effective in preventing
parasympathetic
nausea and vomiting than
nervous system)
in stopping them. Thus,
which gets the GI
they should be taken
system moving
before the causative
while the rest of
event when possible.
the body is at
rest.  Do not eat, drink, or
take oral medications
during acute vomiting
episodes, to avoid
aggravating the stomach
upset.
 Lying down may help
nausea and vomiting to
subside; activity tends
to increase stomach
upset.
 After your stomach has
settled down, try to
take enough fluids to
prevent dehydration and
potentially serious
problems. Tea, broth,
and gelatins are usually
tolerated.
 Do not drive an
automobile or operate
dangerous machinery if
drowsy from antiemetic
drugs, to avoid injury.

PRECAUTIONS
Generic Name: Dibenzoxepin is a Psychoneurotic Prior sensitivity Anticholinergic, Monitor use of
Doxepin tricyclic anxiety or to TCAs, during drowsiness, other CNS
antidepressant. depressive acute recovery dizziness, depressants,
Classification: Reportedly one of reactions; mixed phase following weakness, fatigue, including alcohol.
Tricyclic the most sedating symptoms of MI; glaucoma; headache, Danger of
Antidepressant of the TCAs. anxiety and prostatic hypomania, overdosage or
Inhibits serotonin depression; hypertrophy; confusion, tremors, suicide attempt is
Adult: PO 30– 150 reuptake from the anxiety or tendency for paresthesias, increased when
mg/d h.s. or in synaptic gap; also depression urinary orthostatic patient uses
divided doses, may inhibits associated with retention; hypotension, excessive amounts
gradually increase norepinephrine alcoholism; concurrent use of palpitation, of alcohol. Be
to 300 mg/d (use reuptake to a organic disease; MAOIs, patients hypertension, alert to changes
lower doses in moderate degree, psychotic receiving tachycardia, ECG in voiding and
older adult restores the level depressive Electroconvulsive changes. mydriasis, evaluate patient
patients) of these disorders; topical Therapy, patients blurred vision, for constipation
Geriatric: PO 10– neurotransmitters for treatment of with suicidal photophobia, dry- and abdominal
25 mg h.s., may (serotonin and pruritus. Peptic tendency; renal, mouth, sour or distention; drug
gradually increase norepinephrine) as ulcer disease, cardiovascular or metallic taste, has moderate to
to 75 mg/d Child: the proposed neuralgia. hepatic epigastric strong
PO 1– 3 mg/kg/d in mechanism of dysfunction distress, anticholinergic
single or divided antidepressant constipation, effects.
doses Pruritus actions urinary retention,
Adult: Topical delayed
apply a thin film micturition,
q.i.d. with at urinary frequency,
least 3– 4 h increased
between perspiration,
applications, may tinnitus, weight
use up to 8 d gain,
photosensitivity
reaction, skin
rash,
agranulocytosis,
burning or stinging
at application
site, edema.

RESPONSIBILITY/
PRECAUTIONS
Brand Names Tryptophan  feeling  unusual  Instruct
Aminosyn A number of important may be drowsy or tiredness; patient to
free, side reactions occur useful in light-headed;  severe muscle take as
Aminosyn during the catabolism of increasing  dry mouth, pain (most directed; do
Clinimix tryptophan on the serotonin heartburn, often in the not take more
Clinisol pathway to acetoacetate. production, burping, gas; shoulders, than directed.
Freamine The first enzyme of the promoting  stomach pain, back, or  Advise patient
Freamine catabolic pathway is an healthy nausea, legs); to notify
Hepatamine iron porphyrin oxygenase sleep, vomiting,  weakness, health care
Nephramine, that opens the indole managing diarrhea; numbness, professional
Olimel, ring. The latter enzyme depression  weakness, tingling, or of symptoms of
Periolimel, is highly inducible, its by lack of burning pain esosinophilia-
Plenamine, concentration rising enhancing coordination; (especially myalgia
Premasol, almost 10-fold on a diet mental and  blurred at night); sydrome occur.
Primene, high in tryptophan. emotional vision;  tremors or  Advise female
Procalamine Kynurenine is the first well-being,  headache; or twitching patient to
Prosol, key branch point managing  sexual muscle notify health
Travasol, intermediate in the pain problems. movements; care
Trophamine, pathway. Kynurenine tolerance,  swelling in professional
Tryptan undergoes deamniation in and any part of if pregnancy
a standard managing your body; is planned or
Generic Name transamination reaction weight.  skin changes suspected or
Tryptophan yielding kynurenic acid. (dryness, if
Kynurenic acid and yellowing, breastfeeding.
metabolites have been hardening,
shown to act as rash, hair
antiexcitotoxics and loss);
anticonvulsives. A  breathing
second side branch difficulty;
reaction produces or
anthranilic acid plus  uneven
alanine. Another heartbeat.
equivalent of alanine is  feeling
produced further along drowsy or
the main catabolic light-headed;
pathway, and it is the  dry mouth,
production of these heartburn,
alanine residues that burping, gas;
allows tryptophan to be  stomach pain,
classified among the nausea,
glucogenic and ketogenic vomiting,
amino acids. The second diarrhea;
important branch point  weakness,
converts kynurenine into lack of
2-amino-3-carboxymuconic coordination;
semialdehyde, which has  blurred
two fates. The main flow vision;
of carbon elements from  headache; or
this intermediate is to  sexual
glutarate. problems.

Drug Study

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Drug Study

Uploaded by

Copyright:

Available Formats

Drug Name Mechanism of Indication Contraindic Adverse Effect NURSING

action ation RESPONSIBILITY/

Drug Name Mechanism of action Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

 Monitor unusual weakness and

 Periodically assess body weight

 Guard against falls and

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse NURSING RESPONSIBILITY/

 Assess dizziness, drowsiness, and

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindic Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindica Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of action Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism Indication Contraindication Adverse Effect NURSING

nosebleed, heavy menstrual

cold symptoms such as stuffy

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of action Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of action Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of action Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of action Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of action Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindicatio Adverse Effect NURSING

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/

Drug Name Mechanism of Indication Contraindication Adverse Effect NURSING RESPONSIBILITY/