Psychiatric Medications

• Quiz 1 covers material from Chapter 16 and includes 7 medication math questions.

Risperidone (Risperdal)

• Classified as an atypical antipsychotic.
• Released shortly after clozapine.
• Used to treat schizophrenia, including its negative symptoms.
• Has minimal extrapyramidal adverse effects at therapeutic dosages, specifically 1 to 6 mg/day.

Amitriptyline (Elavil)

• Belongs to the tricyclic antidepressant class.
• It is one of the oldest and most widely prescribed tricyclic antidepressants.
• Originally prescribed for depression.
• Now more commonly prescribed for insomnia and neuropathic pain.

Chlorpromazine (Thorazine)

• It is a conventional antipsychotic.
• Can also be labeled as a tranquilizer or neuroleptic.
• Induces tranquility and affects abnormally functioning nerves.

Lorazepam (Ativan)

• An intermediate-acting benzodiazepine.
• Prescribed to treat anxiety.
• Can be administered via PO, IVP, IV infusion, and IM routes.
• Intravenous push administration is useful for acutely agitated patients.
• It is administered as a continuous infusion for agitated patients on mechanical ventilation.
• Used to treat or prevent alcohol withdrawal.

Fluoxetine (Prozac)

• The first serotonin reuptake inhibitor to be marketed.
• Considered the prototypical SSRI.
• Initially for depression, now also indicated for bulimia, obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder.

Lithium

• A mood stabilizer used to treat bipolar illness.
• Treats mania, hypomania, and depression.
• Catecholamines like dopamine and norepinephrine have an important pathophysiologic role in the development of mania.
• Serotonin appears to be involved in mania.
• It is important to maintain a consistent sodium intake and avoid over or under hydration while taking it.
• Has a narrow therapeutic range of 0.6 to 1.2 mEq/L.
• Requires blood level monitoring.

Haloperidol (Haldol)

• A high-potency anti-psychotic neuroleptic drug.
• Has a favorable cardiovascular, anticholinergic, and sedative adverse-effect profile.
• Can cause extrapyramidal symptoms like tremors, muscle twitching, and tardive dyskinesia.
• Incidence of such symptoms is high during haloperidol therapy.
• Used primarily for the long-term treatment of psychosis.
• Low doses can be used for nausea.

Monoamine Oxidase Inhibitors (MAOIs)

• Along with TCAs, represents the first generation of antidepressant drug therapy.
• Rarely prescribed as antidepressants.
• Prescribed to treat Parkinson's disease.
• Can cause a hypertensive due to tyramine if taken with stimulants.
• Tyramine is found in aged cheeses, cured meats, and alcoholic beverages.

Antidepressants and Suicide Risk

• In 2005, the FDA issued a special "black box warning" (BBW) for antidepressants.
• Applies to both adult and pediatric patient populations.
• The FDA indicated a higher risk of suicide in patients taking antidepressants.
• Monitoring for worsening depressive symptoms is recommended for all patients, especially when starting or changing dosages.

Tricyclic Antidepressant (TCA) Overdoses

• Notoriously lethal.
• 70-80% of patients who die of TCA overdose do so before reaching the hospital, especially if taken with alcohol.
• Primarily affects the CNS and cardiovascular system.
• Death usually results from seizures or cardiac dysrhythmias.

Serotonin Syndrome

• Common symptoms include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, and coarse tremors.