MEDICATIONS USED TO TREAT BEHAVIOURS Depression, Psychosis, Schizophrenia, Anxiety Target Symptoms ANTIPSYCHOTICS (Neuroleptics) p. 257; also p.

26 & p. 30 Class Generic Trade

Older Typical High Potency Dopamine Antagonists Haloperidol Fluphenazine Haldol ** IM Prolixin ** IM Agitation Hallucinations Delusions
Lower doses Nausea

Major Side Effects

Extra Pyramidal Symptoms Orthostatic hypotension Sedation Anticholinergic (ortho BP, dry mouth, blurred vision, constipation, urinary retention)
Note: high potency has more symptoms from top of 4

Low potency has more symptoms from bottom of 4

Med. Potency Low Potency New Generation (Atypical) Dopamine & Serotonin Antagonists

Loxapine Perphenazine Chlopromazine Thioriidazine Risperidone Olanzepine Clozapine Quetiapine Ziprasidone Paliperadone Aripiprazole

Loxapac Trilafon Largactal Mellaril Risperdal **IM Zyprexa Clozaril Seroquel Geodon Invega **IM Abilify

Agitation Hallucinations Delusions Same as above

May be used in nausea & for hiccups

Same Same Inc. appetite Same as above Less side effects Photosensitity Weight gain Seizures

Agitation Hallucinations Delusions

Treating EPS
Acute dystonia Pseudoparkinsonism Akathisia **************** TD; or change med Maybe irreversible

*Clozaril-agranulocytosis ____________________ **IM depot long-acting (4) meds -Haldol deconate Q 4 wks -Prolixin deconateQ2-4 wks -Risperdal Consta Q2 wks -Invega Sustenna Q 4 wks Anticholinergics (*Cogentin, Artane, Kemadrin, *Akineton), Antihistamine (*benedryl) Dopaminergic agonist-symmetrel Benzodiazepine (ativan, *valium), B-blocker (inderal) *IM/IV emergency p. 258 may also lower the dose antipsychotic or change meds

ANXIOLYTICS
Benzodiazepine *sedativehypnotics, anxiolytics; Loraxepam Oxazepam Clonazepam Diazepam Ativan Serax Rivotril Valium Anxiety Phobias Agitation Aggressiveness Sleeplessness Insomnia CNS depression; sedation physical dependence. orth BP; morning hangover; wean gradually; some long many half-lives (valium) 20100hrs, rebound REM next day

HYPNOTICS
Hypnotics Temaxepam Fluraepam Nitrazepam Restoril Dalmane Mogadon Less hangover effects

ANTIDEPRESSANTS p. 286-88
Tricyclics TCAs Amitripyline Desipramine Amoxapine Doxepin Imipramine Nortriptyline Paroxetine Fluoxetine Citaloprim Escitalopram Sertraline Fluvoxamine Elavil Norpramin Ascendin Sinequan Tofranil Pamelor Paxil Prozac Celexa Lexapro Zoloft Luvox Depression & Assosicated Agitation or Aggression
(may also be used for neuralgia)

Anticholinergic Orthostatic BPs Sedation ++ wt gain; rashes, suicidal gestures No cardiovasc. or anticholingergic effects; Headache, agitation, nausea, diarrhea, sweating, insomnia, wt gain, sexual dysfunction, Some wt. loss (Prozac), suicidal; ideation (After 7d-insomnia & GI upset subside, energy) CNS stimulation-dizzy, vertigo, headache, tremors, twitching, wt gain, anticholinergic HYPERTENSIVE CRISIS Avoid tyramine foods wine, aged cheese, pickled meats, caffeine, ripe bananas, soy Sedation, dizziness, nausea,wt gain, some seizure, sexual dysfunction

SSRIs
(Selective Serotonin Reuptake Inhibitors) Ist choice

Depression & Assosicated Agitation or Aggression

MAOIs

Nardil Parnate Marplan NPM Not popular meds

Other Atypical anitdepressants

Trazodone Bupropion Venlafaxine Desvenlafaxine Nefazodone Duloxetine

Dysyrel Wellbutrin Effexor Pristiq Serzone Cymbalta

Same as above

MOOD STABILIZERS p. 302

Antiepileptics as mood stabilizers 2 nd choice after lithium

*Carbamazepine

Tegretol

Agitation Aggressiveness Emotional Liability When sensitive or unresponsive to anti -psychotics

(also used for neuralgia)

Rash, drowsiness, ataxia, confusion, hyponatremia, neutropenia, anemia; agranulocytosis; weight gain; monitor levels; monitor CBC

*Valproic Acid Gabapentin Lamotrigine Topiramate Oxcarbazepine Other Lithium *first choice for acute mania and/or bipolar Benzodiazepine

Epival Depakane Neurontin Lamictal Topamax Trileptal Klonopin

Same as above

Rash, drowsiness, ataxia, confusion, weight gain, nv; liver function Dizziness, hyotension, Sedation, headache, nv Dizzy, hypotension, sedation, nausea, nv, vision blur Dizziness, hypotension, visual blur, nv Dizziness, nv, headache CNS depression, dependence Common side effects: nausea, diarrhea, anorexia, fine hand tremors, polydipsia, polyuria, (initially )metallic taste in mouth, fatigue, lethargy, memory problems, wt gain, acne, hypothyroid, edema, alopecia GI upset, polyuria, thirstinitally resolve orin 6 wks Early S&S resemble toxicity Toxic: severe diarrhea, vomiting, drowsy, muscle twitching, lack of coordination Health Teaching; Blood lithium levels; renal and thyroid studies. Need 2L fluid; adequate Na diet; if fluid losses toxicity risk