Selective Serotonin Reuptake Inhibitors (SSRIs)
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Questions and Answers

What is the mechanism of action of Selective Serotonin Reuptake Inhibitors (SSRIs)?

  • Block the action of histamine
  • Increase the release of serotonin and norepinephrine
  • Inhibit reuptake of serotonin only (correct)
  • Inhibit reuptake of serotonin and norepinephrine

    • Which of the following antidepressants is known to cause anticholinergic effects?

  • Duloxetine (Cymbalta)
  • Escitalopram (Lexapro)
  • Sertraline (Zoloft)
  • Amitriptyline (Elavil) (correct)

    • What is the primary indication for Doxepin (Silenor)?

  • Anxiety
  • Fibromyalgia
  • Insomnia (correct)
  • Depression

    • Which of the following antidepressants is NOT a Selective Serotonin Reuptake Inhibitor (SSRI)?

    <p>Duloxetine (Cymbalta)</p> Signup and view all the answers

    What is a common side effect of Selective Serotonin Reuptake Inhibitors (SSRIs)?

    <p>Insomnia and sexual dysfunction</p> Signup and view all the answers

    Which of the following antidepressants increases the risk of suicide?

    <p>All antidepressants mentioned</p> Signup and view all the answers

    What is the primary indication for MAO Inhibitors?

    <p>Depression</p> Signup and view all the answers

    Which of the following antidepressants is also used for smoking cessation?

    <p>Bupropion (Wellbutrin)</p> Signup and view all the answers

    What is the mechanism of action of Benzodiazepines?

    <p>GABA agonist</p> Signup and view all the answers

    What is the primary indication for Lithium?

    <p>Bipolar disorder</p> Signup and view all the answers

    Which antidepressant is associated with a risk for seizures?

    <p>Bupropion (Wellbutrin)</p> Signup and view all the answers

    What is the primary mechanism of action of Valproate?

    <p>Inhibition of voltage-gated sodium channels</p> Signup and view all the answers

    What is the therapeutic range for serum Lithium levels?

    <p>0.4-1.2 mEq/L</p> Signup and view all the answers

    Which of the following medications requires serum concentration monitoring?

    <p>Lithium (Lithobid)</p> Signup and view all the answers

    What is the primary indication for Buspirone?

    <p>Anxiety</p> Signup and view all the answers

    Which of the following is a common side effect of Trazadone?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of Lamotrigine?

    <p>Prolongs sodium channel inactivation and blocks specific calcium channels</p> Signup and view all the answers

    What is the indication for Atomoxetine?

    <p>ADHD</p> Signup and view all the answers

    What is the primary indication for Modafinil?

    <p>Daytime fatigue from narcolepsy</p> Signup and view all the answers

    What is the mechanism of action of Zolpidem?

    <p>Enhances the inhibitory activity of GABA receptors</p> Signup and view all the answers

    Which of the following medications is a partial agonist and antagonist of dopamine 2 receptors?

    <p>Aripiprazole</p> Signup and view all the answers

    What is the pharmacological action of Cromolyn?

    <p>Inhibits mast cell degranulation</p> Signup and view all the answers

    What is a major side effect of first-generation antipsychotics?

    <p>Extrapyramidal symptoms (EPS)</p> Signup and view all the answers

    What is the indication for Daridorexant?

    <p>Insomnia</p> Signup and view all the answers

    What is the mechanism of action of Ramelteon?

    <p>Activates melatonin receptors</p> Signup and view all the answers

    What is a common side effect of CNS stimulants?

    <p>Weight loss</p> Signup and view all the answers

    What is the mechanism of action of Fluticasone?

    <p>Inhibits information pathways</p> Signup and view all the answers

    What is a contraindication for Oxymetazoline?

    <p>Hypertension</p> Signup and view all the answers

    What is the therapeutic use of Acetylcysteine?

    <p>Pulmonary disorders with thick tenacious mucus</p> Signup and view all the answers

    What is a side effect of Diphenhydramine?

    <p>Photosensitivity</p> Signup and view all the answers

    What is the mechanism of action of Ipratropium?

    <p>Anticholinergic bronchial dilator</p> Signup and view all the answers

    What is a contraindication for Codeine Cough Syrup?

    <p>Asthma</p> Signup and view all the answers

    What is the therapeutic use of Albuterol?

    <p>Acute bronchospasm</p> Signup and view all the answers

    What is a side effect of Dextromethorphan?

    <p>Dizziness</p> Signup and view all the answers

    What is the mechanism of action of Phenylephrine?

    <p>Stimulates alpha-1 adrenergic receptors</p> Signup and view all the answers

    What is the therapeutic use of Guaifenesin?

    <p>Productive cough and mucus clearance</p> Signup and view all the answers

    What is the pharmacological action of Montelukast?

    <p>Leukotriene receptor antagonist</p> Signup and view all the answers

    What is the therapeutic use of Cromolyn sodium?

    <p>Prophylaxis of asthma, allergy, and allergic rhinitis</p> Signup and view all the answers

    What is the unique feature of Reslizumab?

    <p>Blinds to interleukin-5 (IL-5)</p> Signup and view all the answers

    What is the black box warning associated with Isoniazid?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is the pharmacological action of Theophylline?

    <p>Not mentioned in the content</p> Signup and view all the answers

    What is the unique feature of Omalizumab?

    <p>Attachments to receptors on immunoglobulin E (IgE)</p> Signup and view all the answers

    What is the adverse effect of Rifampin?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is the nursing intervention for Montelukast?

    <p>Monitor ATL levels</p> Signup and view all the answers

    What is the pharmacological action of Theophylline?

    <p>Inhibits phosphodiesterase</p> Signup and view all the answers

    What is the unique feature of Reslizumab?

    <p>Attaches to interleukin-5 (IL-5)</p> Signup and view all the answers

    What is the black box warning associated with Isoniazid?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is the pharmacological action of Cromolyn sodium?

    <p>Stabilizes mast cells</p> Signup and view all the answers

    What is the adverse effect of Rifampin?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is the unique feature of Omalizumab?

    <p>Attaches to receptors on immunoglobin E (IgE)</p> Signup and view all the answers

    What is the off-label use of Bupropion?

    <p>ADHD</p> Signup and view all the answers

    What is the therapeutic use of Montelukast?

    <p>Prophylaxis of asthma and allergy</p> Signup and view all the answers

    What is the primary indication for Lithium?

    <p>Bipolar disorder</p> Signup and view all the answers

    What is the mechanism of action of Selective Serotonin Reuptake Inhibitors (SSRIs)?

    <p>Inhibits reuptake of serotonin to increase serotonin effects</p> Signup and view all the answers

    Which of the following medications is a GABA agonist?

    <p>Lorazepam</p> Signup and view all the answers

    What is the black box warning associated with Bupropion?

    <p>All of the above</p> Signup and view all the answers

    What is the indication for Duloxetine (Cymbalta)?

    <p>Anxiety, major depression, migraine prevention, and fibromyalgia</p> Signup and view all the answers

    What is the pharmacological action of Cromolyn?

    <p>Inhibits mast cell degranulation, preventing the release of histamine</p> Signup and view all the answers

    What is the mechanism of action of Valproate?

    <p>Inhibition of voltage-gated sodium channels</p> Signup and view all the answers

    What is the side effect of Bupropion (Wellbutrin)?

    <p>Insomnia</p> Signup and view all the answers

    What is a common side effect of Diphenhydramine?

    <p>All of the above</p> Signup and view all the answers

    What is the primary indication for Buspirone?

    <p>Anxiety</p> Signup and view all the answers

    What is the adverse effect of Trazadone?

    <p>All of the above</p> Signup and view all the answers

    What is the therapeutic use of Fluticasone?

    <p>Allergic rhinitis</p> Signup and view all the answers

    What is the therapeutic range for serum Lithium levels?

    <p>0.4-1.2 mEq/L</p> Signup and view all the answers

    What is the mechanism of action of Oxymetazoline?

    <p>Sympathomimetic vasoconstriction of nasal blood vessels</p> Signup and view all the answers

    What is the contraindication for Codeine Cough Syrup?

    <p>All of the above</p> Signup and view all the answers

    What is the therapeutic use of Acetylcysteine?

    <p>Pulmonary disorders with thick tenacious mucus</p> Signup and view all the answers

    What is the mechanism of action of Ipratropium?

    <p>Anticholinergic bronchial dilator</p> Signup and view all the answers

    What is the therapeutic use of Albuterol?

    <p>Acute bronchospasm</p> Signup and view all the answers

    What is the mechanism of action of Phenylephrine?

    <p>Stimulates alpha-1 receptors, constricting nasal blood vessels</p> Signup and view all the answers

    What is the therapeutic use of Guaifenesin?

    <p>Productive cough and mucus clearance</p> Signup and view all the answers

    What is the primary indication for Lamotrigine?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of CNS Stimulants?

    <p>Cause the release of norepinephrine and dopamine</p> Signup and view all the answers

    What is the black box warning for Lamotrigine?

    <p>All of the above</p> Signup and view all the answers

    What is the primary indication for Modafinil?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of Dual Orexin receptor antagonists?

    <p>Blocks orexin A and B to suppress the wake drive</p> Signup and view all the answers

    What is the black box warning for First-generation antipsychotics?

    <p>Risk of falls, heart disease, and diabetes in dementia-related psychosis</p> Signup and view all the answers

    What is the primary indication for Aripiprazole?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of Histamine One receptor antagonists?

    <p>Decrease histamine, leading to sedation</p> Signup and view all the answers

    What is the primary indication for Ramelteon?

    <p>Insomnia</p> Signup and view all the answers

    What is the mechanism of action of Cromolyn?

    <p>Inhibits mast cell degranulation, preventing histamine release</p> Signup and view all the answers

    What is the therapeutic use of Fluticasone?

    <p>Allergic rhinitis</p> Signup and view all the answers

    What is the adverse effect of prolonged use of Oxymetazoline?

    <p>Rebound congestion</p> Signup and view all the answers

    What is the pharmacological action of Dextromethorphan?

    <p>Suppresses cough reflex in the CNS and provides analgesia</p> Signup and view all the answers

    What is the contraindication for Codeine Cough Syrup in patients with?

    <p>Asthma</p> Signup and view all the answers

    What is the therapeutic use of Acetylcysteine?

    <p>Pulmonary disorders with thick tenacious mucus</p> Signup and view all the answers

    What is the pharmacological action of Phenylephrine?

    <p>Stimulates alpha-1 receptors, constricting nasal blood vessels</p> Signup and view all the answers

    What is the contraindication for Oxymetazoline in patients with?

    <p>All of the above</p> Signup and view all the answers

    What is the therapeutic use of Albuterol?

    <p>Acute bronchospasm</p> Signup and view all the answers

    What is the side effect of Diphenhydramine?

    <p>Paradoxical excitement</p> Signup and view all the answers

    What is the mechanism of action of Ipratropium?

    <p>Anticholinergic, bronchial dilator</p> Signup and view all the answers

    What is the pharmacological action of Montelukast?

    <p>Leukotriene receptor antagonist</p> Signup and view all the answers

    What is the therapeutic use of Cromolyn sodium?

    <p>Prophylaxis of asthma, allergy, and rhinitis</p> Signup and view all the answers

    What is the unique feature of Reslizumab?

    <p>Binds to interleukin-5 (IL-5)</p> Signup and view all the answers

    What is the black box warning associated with Isoniazid?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is the pharmacological action of Theophylline?

    <p>Used for long-term oral prophylaxis of asthma</p> Signup and view all the answers

    What is the adverse effect of Rifampin?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is the unique feature of Omalizumab?

    <p>Binds to receptors on immunoglobulin E (IgE)</p> Signup and view all the answers

    What is the nursing intervention for Montelukast?

    <p>Monitor ALT levels</p> Signup and view all the answers

    What is the mechanism of action of Bupropion (Zyban)?

    <p>Inhibits reuptake of serotonin and norepinephrine</p> Signup and view all the answers

    What is a potential side effect of using Trazadone?

    <p>All of the above</p> Signup and view all the answers

    What is a major concern when using Benzodiazepines?

    <p>Risk of addiction and dependency</p> Signup and view all the answers

    What is the therapeutic range for serum Lithium levels?

    <p>0.4-1.2 mEq/L</p> Signup and view all the answers

    What is the primary indication for Valproate?

    <p>Seizure disorder</p> Signup and view all the answers

    What is a common side effect of Buspirone?

    <p>Sexual dysfunction</p> Signup and view all the answers

    What is the mechanism of action of Lithium?

    <p>Both a and b</p> Signup and view all the answers

    What is a black box warning associated with Benzodiazepines?

    <p>Risk of addiction and dependency</p> Signup and view all the answers

    Which medication is used to treat allergic rhinitis by inhibiting the release of histamine from mast cells?

    <p>Cromolyn</p> Signup and view all the answers

    What is a common side effect of Diphenhydramine?

    <p>Dry mouth</p> Signup and view all the answers

    What is the primary therapeutic use of Theophylline?

    <p>Prophylaxis of asthma</p> Signup and view all the answers

    Which medication is used to treat pulmonary disorders with thick tenacious mucus, such as cystic fibrosis?

    <p>Acetylcysteine</p> Signup and view all the answers

    What is a common side effect of Montelukast?

    <p>Headache</p> Signup and view all the answers

    What is the primary mechanism of action of Isoniazid?

    <p>Inhibits micro bacterial cell wall synthesis</p> Signup and view all the answers

    What is a contraindication for the use of Codeine Cough Syrup?

    <p>Asthma</p> Signup and view all the answers

    Which medication is a selective beta-2 adrenergic agonist used to treat acute bronchospasm?

    <p>Albuterol</p> Signup and view all the answers

    What is the primary indication for Rifampin?

    <p>Tuberculosis</p> Signup and view all the answers

    What is the primary mechanism of action of Selective Serotonin Reuptake Inhibitors (SSRIs)?

    <p>Inhibits reuptake of serotonin to increase serotonin effects</p> Signup and view all the answers

    What is a side effect of Dextromethorphan?

    <p>All of the above</p> Signup and view all the answers

    Which medication is used to increase respiratory tract fluid and reduce the viscosity of mucus?

    <p>Guaifenesin</p> Signup and view all the answers

    What is the primary therapeutic use of Cromolyn sodium?

    <p>Prophylaxis of asthma</p> Signup and view all the answers

    What is a contraindication for the use of Oxymetazoline?

    <p>All of the above</p> Signup and view all the answers

    What is a rare but serious adverse effect of Rifampin?

    <p>Hepatotoxicity</p> Signup and view all the answers

    Which medication stimulates alpha-1 receptors, constricting nasal blood vessels to treat nasal congestion?

    <p>Phenylephrine</p> Signup and view all the answers

    What is the primary mechanism of action of Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)?

    <p>Inhibits reuptake of serotonin and norepinephrine to increase effects</p> Signup and view all the answers

    Which of the following medications is indicated for seizure disorder, migraines, and bipolar disorder?

    <p>Lamotrigine</p> Signup and view all the answers

    What is the primary therapeutic use of Reslizumab?

    <p>Prophylaxis of asthma</p> Signup and view all the answers

    What is the therapeutic use of Fluticasone?

    <p>All of the above</p> Signup and view all the answers

    What is a black box warning associated with Isoniazid?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is the mechanism of action of Zolpidem?

    <p>Enhances the inhibitory activity of GABA receptors</p> Signup and view all the answers

    Which of the following antipsychotics is a partial agonist and antagonist of dopamine 2 receptors?

    <p>Aripiprazole</p> Signup and view all the answers

    What is the primary indication for Modafinil?

    <p>Daytime fatigue from narcolepsy</p> Signup and view all the answers

    What is the mechanism of action of Lamotrigine?

    <p>Prolongs sodium channel inactivation, blocks specific calcium channels, and blocks glutamate</p> Signup and view all the answers

    Which of the following medications is a controlled substance?

    <p>Modafinil</p> Signup and view all the answers

    What is the primary indication for Daridorexant?

    <p>Insomnia</p> Signup and view all the answers

    Which of the following antidepressants is associated with a risk for seizures?

    <p>Lamotrigine</p> Signup and view all the answers

    What is the primary indication for Doxylamine?

    <p>Insomnia</p> Signup and view all the answers

    Which of the following medications is associated with a black box warning for abuse and dependence?

    <p>Methylphenidate</p> Signup and view all the answers

    Which of the following medications is contraindicated in patients with narrow angle glaucoma?

    <p>Diphenhydramine</p> Signup and view all the answers

    What is the therapeutic use of Dextromethorphan?

    <p>Cough suppression and analgesia</p> Signup and view all the answers

    What is the mechanism of action of Phenylephrine?

    <p>Stimulates alpha-1 adrenergic receptors</p> Signup and view all the answers

    What is the adverse effect of Fluticasone with prolonged use?

    <p>Systemic effects</p> Signup and view all the answers

    What is the unique feature of Oxymetazoline?

    <p>It is a sympathomimetic</p> Signup and view all the answers

    What is the nursing intervention for Oxymetazoline?

    <p>Limit use to 3-4 consecutive days to prevent rebound congestion</p> Signup and view all the answers

    What is the therapeutic use of Acetylcysteine?

    <p>Pulmonary disorders with thick tenacious mucus</p> Signup and view all the answers

    What is the mechanism of action of Ipratropium?

    <p>Blocks the effects of acetylcholine</p> Signup and view all the answers

    What is the therapeutic use of Guaifenesin?

    <p>Productive cough and mucus clearance</p> Signup and view all the answers

    What is the side effect of Diphenhydramine?

    <p>Photosensitivity</p> Signup and view all the answers

    What is the pharmacological action of Montelukast?

    <p>Leukotriene receptor antagonist</p> Signup and view all the answers

    What is a common side effect of Cromolyn sodium?

    <p>Stinging and burning of nasal mucosa</p> Signup and view all the answers

    What is the therapeutic use of Reslizumab?

    <p>Attaches to interleukin-5 (IL-5) to reduce allergy symptoms</p> Signup and view all the answers

    What is the unique feature of Omalizumab?

    <p>Attaches to receptors on immunoglobin E (IgE)</p> Signup and view all the answers

    What is the black box warning associated with Isoniazid?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is the pharmacological action of Theophylline?

    <p>Mast cell stabilizer</p> Signup and view all the answers

    What is the adverse effect of Rifampin?

    <p>Hepatotoxicity</p> Signup and view all the answers

    What is the nursing intervention for Montelukast?

    <p>Monitor ATL levels</p> Signup and view all the answers

    What is the primary mechanism of action of Valproate?

    <p>Inhibition of voltage-gated sodium channels</p> Signup and view all the answers

    What is the therapeutic range for serum Lithium levels?

    <p>0.4-1.2 mEq/L</p> Signup and view all the answers

    Which of the following side effects is commonly associated with Lithium therapy?

    <p>Weight gain</p> Signup and view all the answers

    Why is it important for patients taking Lithium to drink adequate fluids?

    <p>To interfere with antidiuretic hormone (ADH) function</p> Signup and view all the answers

    What is the primary indication for Valproate?

    <p>Seizure disorders</p> Signup and view all the answers

    What is the primary role of Flumazenil in the management of Benzodiazepine overdose?

    <p>To counteract CNS depression</p> Signup and view all the answers

    Why is Lithium therapy typically monitored through serum concentration monitoring?

    <p>Due to its narrow therapeutic index</p> Signup and view all the answers

    What is a potential complication of Lithium therapy?

    <p>Renal toxicity</p> Signup and view all the answers

    What should patients taking St. John's Wort for mental health be cautioned about?

    <p>It may lead to serotonin syndrome</p> Signup and view all the answers

    What type of medications may take several weeks to work?

    <p>Meds for mental health</p> Signup and view all the answers

    Why is it important to taper off certain medications?

    <p>To avoid withdrawal symptoms</p> Signup and view all the answers

    What type of therapy is often used in conjunction with medications for mental health?

    <p>All of the above</p> Signup and view all the answers

    What is a common warning given to patients and their family members about certain medications?

    <p>Increased risk of suicide</p> Signup and view all the answers

    What should patients be cautioned about when taking medications for mental health and also drinking alcohol?

    <p>It decreases the effect of the medication</p> Signup and view all the answers

    What is the primary indication for Valproate?

    <p>Bipolar disorder</p> Signup and view all the answers

    Which of the following is an indication for Lamotrigine?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of CNS stimulants?

    <p>Causes release of norepinephrine and dopamine</p> Signup and view all the answers

    What is a first-line treatment for ADHD?

    <p>CNS stimulants</p> Signup and view all the answers

    What is a common side effect of Lithium therapy?

    <p>Diabetes insipidus</p> Signup and view all the answers

    What is the therapeutic range for serum Lithium levels?

    <p>0.6-1.2 mmol/L</p> Signup and view all the answers

    Which of the following medications is used to treat bipolar disorder?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of CNS stimulants in ADHD?

    <p>Causes the release of norepinephrine and dopamine</p> Signup and view all the answers

    What is the indication for Modafinil?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a common side effect of CNS stimulants?

    <p>Insomnia</p> Signup and view all the answers

    Study Notes

    Antidepressants

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    • Examples: Sertraline (Zoloft), Fluoxetine (Prozac), Escitalopram (Lexapro), Citalopram (Celexa), Paroxetine (Paxil)
    • Mechanism of Action (MOA): inhibits reuptake of serotonin to increase serotonin effects
    • Indications: depression, anxiety, obsessive compulsive disorder
    • Off-label use: premature ejaculation
    • Side Effects/Adverse Effects: insomnia, sexual dysfunction, increased risk of suicide
    • First-line treatment for depression and anxiety
    • Relatively safe in pregnancy

    Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

    • Examples: Duloxetine (Cymbalta), Venlafaxine (Effexor)
    • MOA: inhibits reuptake of serotonin and norepinephrine to increase effects
    • Indications: anxiety, major depression, migraine prevention, fibromyalgia
    • Side Effects/Adverse Effects: sexual dysfunction, insomnia, hypertension, orthostatic hypotension, hepatotoxicity, increased risk of suicide

    Tricyclic Antidepressants (TCAs)

    • Examples: Amitriptyline (Elavil), Nortriptyline, Imipramine (Tofranil)
    • MOA: inhibits reuptake of serotonin and norepinephrine
    • Indications: depression
    • Off-label use: fibromyalgia, IBS, migraines, anxiety, and withdrawal syndrome
    • Side Effects/Adverse Effects: anticholinergic effects, ECG changes, CNS depression, orthostatic hypotension, sedation, weight gain, urinary retention, blurred vision, increased risk of suicide
    • Not first-line treatment due to delayed onset of action

    Monoamine Oxidase Inhibitors (MAOIs)

    • Example: Phenelzine (Nardil)
    • MOA: inhibits monoamine oxidase, increasing amount of neurotransmitters
    • Indications: depression
    • Off-label use: anxiety
    • Side Effects/Adverse Effects: orthostatic hypotension, hypertension when interacting with tyramine foods, insomnia, anticholinergic effects, increased risk of suicide
    • Interacts with many medications, requires avoidance of tyramine foods

    Bupropion (Wellbutrin)

    • MOA: inhibits uptake of norepinephrine and dopamine
    • Indications: depression, smoking cessation (Zyban)
    • Off-label use: ADHD, bipolar
    • Side Effects/Adverse Effects: risk of seizures, insomnia, increased risk of suicide and neuropsychiatric events

    Mood Stabilizers

    Lithium (Lithobid)

    • MOA: reduces excitatory neurotransmitters, increases inhibitory neurotransmitters
    • Indications: bipolar disorder
    • Off-label use: depression
    • Side Effects/Adverse Effects: cardiac/renal/CNS effects, polyuria, polydipsia, bradycardia, weight gain, toxic above 1.5 mEq/L
    • Requires serum concentration monitoring

    Valproate (Depakote)

    • MOA: inhibits voltage-gated sodium channels, enhancing GABA synthesis
    • Indications: seizure disorder, migraines, bipolar disorder
    • Side Effects/Adverse Effects: hepatotoxicity, teratogenic, pancreatitis, thrombocytopenia, bleeding, inhibits platelets
    • Contraindications: liver disease, pregnancy

    Lamotrigine (Lamictal)

    • MOA: prolongs sodium channel inactivation, blocks specific calcium channels, blocks glutamate
    • Indications: seizure disorder, bipolar disorder
    • Off-label use: panic disorder, anxiety, migraines, headaches, binge eating disorder, borderline personality disorder, PTSD
    • Side Effects/Adverse Effects: Stevens-Johnson syndrome, hemophagocytic lymphohistiocytosis, angioedema, toxic epidermal necrolysis

    CNS Stimulants

    Methylphenidate (Ritalin), Amphetamine (Adderall), Dextroamphetamine (Dexedrine)

    • MOA: releases norepinephrine and dopamine
    • Indications: ADHD, narcolepsy
    • Side Effects/Adverse Effects: weight loss, insomnia
    • Contraindications: substance abuse history

    Atomoxetine (Strattera)

    • MOA: blocks reuptake of norepinephrine
    • Indications: ADHD
    • Side Effects/Adverse Effects: weight loss, insomnia
    • Not a controlled substance

    Modafinil (Provigil)

    • MOA: inhibits reuptake of dopamine
    • Indications: daytime fatigue from narcolepsy, ADHD, obstructive sleep apnea, shift work sleep disorder
    • Off-label use: depression, fatigue
    • Contraindications: substance abuse history

    Dual Orexin Receptor Antagonists (DORAs)

    Daridorexant (Quviviq), Suvorexant (Belsomra)

    • MOA: blocks orexin A and B, suppressing wake drive
    • Indications: insomnia
    • Side Effects/Adverse Effects: none listed
    • Contraindications: substance abuse history

    Histamine One Receptor Antagonists (Antihistamines)

    Doxylamine (Unisom), Hydroxyzine (Vistaril)

    • MOA: decreases histamine, leading to sedation
    • Indications: insomnia, nausea in pregnancy, anxiety, allergies
    • Side Effects/Adverse Effects: sedation, respiratory depression

    Benzodiazepine Receptor Agonists (BZRAs)

    Zolpidem (Ambien), Eszopiclone (Lunesta)

    • MOA: enhances GABA receptors, inducing sleep
    • Indications: insomnia
    • Side Effects/Adverse Effects: dizziness, drowsiness, falls, abuse and dependence
    • Contraindications: substance abuse history

    Melatonin Receptor Agonists

    Ramelteon (Rozerem)

    • MOA: activates melatonin receptors, controlling circadian rhythm and sleep/wakefulness
    • Indications: insomnia
    • Side Effects/Adverse Effects: none listed
    • Relatively safe for long-term use

    Antipsychotics

    First Generation Antipsychotics (Typical)

    Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol)

    • MOA: blocks dopamine 2 receptors
    • Indications: schizophrenia
    • Off-label use: bipolar disorder, nausea
    • Side Effects/Adverse Effects: drowsiness, anticholinergic effects, sexual dysfunction, orthostatic hypotension, extrapyramidal symptoms (EPS), neuroleptic malignant syndrome (NMS)
    • Contraindications: dementia-related psychosis

    Second Generation Antipsychotics (Atypical)

    Lurasidone (Latuda), Olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone (Risperdal), Ziprasidone (Geodon)

    • MOA: blocks dopamine 2 and serotonin receptors
    • Indications: bipolar disorder, depression, schizophrenia
    • Off-label use: delusional disorder, obsessive-compulsive disorder
    • Side Effects/Adverse Effects: weight gain, hyperglycemia, dyslipidemia, EPS, NMS, orthostatic hypotension
    • Contraindications: dementia-related psychosis

    Third Generation Antipsychotics (Atypical)

    Aripiprazole (Abilify)

    • MOA: partial agonist and antagonist of dopamine 2 receptors
    • Indications: bipolar I disorder, irritability associated with autism spectrum disorder, schizophrenia, Tourette's disorder
    • Side Effects/Adverse Effects: skin rash, angioedema, hyperglycemia, NMS, EPS, seizures, priapism, stroke, impulsive behaviors
    • Contraindications: dementia-related psychosis

    Respiratory Medications

    • Cromolyn (mast cell receptor stabilizer): inhibits mast cell degranulation, preventing release of histamine; instruct patient on proper inhaler or nasal spray technique and use prior to exposure
    • Diphenhydramine (H1 Receptor Agonist) - Benadryl:
      • Pharmacological action: blocks the effects of histamine at H1 receptors, resulting in antihistamine effects
      • Adverse effects: photosensitivity, paradoxical excitement (especially in children), anticholinergic effects, dry mouth, tachycardia, hypertension
      • Contraindications: hypersensitivity, narrow angle glaucoma, BPH, G.I. obstruction
    • Fluticasone (intranasal corticosteroid):
      • Therapeutic use: allergic rhinitis
      • Mechanism of action: inhibits inflammation pathways
      • Side effects: nasal irritation, epistaxis (nose bleeds)
      • Adverse effects: systemic effects with prolonged use (especially with oral steroids)
      • Contraindications: hypersensitivity; masks effects of infection, so do not use if patient has a known infection
    • Oxymetazoline (decongestant):
      • Pharmacological action: sympathomimetic vasoconstriction of nasal blood vessels
      • Mechanism of action: stimulates alpha-adrenergic receptors
      • Side effects: rebound congestion with prolonged use, nasal irritation, minor stinging or dryness
      • Nursing interventions: limit use to 3-4 consecutive days to prevent rebound congestion
      • Contraindications: hypertension, diabetes, thyroid disorder, heart disease

    Cough Medications

    • Dextromethorphan (antitussive):
      • Pharmacological action: suppresses cough reflex in CNS and provides analgesia
      • Side effects: dizziness, drowsiness, nausea
      • Adverse effects: rare, but can cause slurred speech, ataxia, hyperexcitability, stupor, respiratory depression, seizures, coma, and toxic psychosis
      • Contraindications: concurrent use of MAOIs
    • Codeine cough syrup:
      • Pharmacological action: suppresses cough reflex in CNS and provides analgesia
      • Side effects: sedation, constipation, respiratory depression
      • Nursing interventions: monitor for respiratory depression, assess for pain relief; be careful in patients with asthma as bronchoconstriction can occur

    Mucolytic Agents

    • Acetylcysteine (mucolytic):
      • Pharmacological action: breaks down bonds in mucus, reducing its viscosity
      • Therapeutic use: pulmonary disorders with thick, tenacious mucus (e.g., cystic fibrosis, chronic bronchitis)
      • Side effects: smells like rotten eggs

    Bronchodilators

    • Albuterol (beta-2 adrenergic agonist):
      • Pharmacological action: selective beta-2 adrenergic agonist, bronchial dilator
      • Therapeutic use: acute bronchospasm
      • Adverse effects: palpitations, headaches, tremors, restlessness, nervousness, tachycardia
      • Contraindications: hypersensitivity, cardiovascular effects
      • Interactions: concurrent use of beta blockers will inhibit the bronchodilation effects of albuterol; patients should avoid MAOIs within 14 days of beginning therapy
    • Ipratropium (anticholinergic):
      • Pharmacological action: anticholinergic, bronchial dilator
      • Therapeutic use: COPD, asthma exacerbations
      • Adverse effects: upper respiratory tract irritation, cough, dry nasal mucosa, hoarseness, sis
      • Contraindications: hypersensitivity to soybeans and peanuts

    Antihistamines

    • Diphenhydramine (H1 Receptor Agonist) - Benadryl:
      • Pharmacological action: blocks the effects of histamine at H1 receptors, resulting in antihistamine effects
      • Adverse effects: photosensitivity, paradoxical excitement (especially in children), anticholinergic effects, dry mouth, tachycardia, hypertension
      • Contraindications: hypersensitivity, narrow angle glaucoma, BPH, G.I. obstruction

    Antidepressants

    • Selective Serotonin Reuptake Inhibitors (SSRIs):
      • Mechanism of action: inhibit reuptake of serotonin to increase serotonin effects
      • Indications: depression, anxiety, obsessive-compulsive disorder
      • Off-label uses: premature ejaculation
      • Side effects: insomnia and sexual dysfunction
      • Black box warning: increased risk for suicide
      • First-line for depression and anxiety; relatively safe in pregnancy
    • Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):
      • Mechanism of action: inhibit reuptake of serotonin and norepinephrine to increase effects
      • Indications: anxiety, major depression, migraine prevention, fibromyalgia
      • Side effects: sexual dysfunction, insomnia, hypertension, orthostatic hypotension, hepatotoxicity
      • Black box warning: increased risk for suicide
    • Tricyclic Antidepressants (TCAs):
      • Mechanism of action: inhibit reuptake of serotonin and norepinephrine
      • Indications: depression
      • Off-label uses: fibromyalgia, IBS, migraines, anxiety, and withdrawal syndrome
      • Side effects: anticholinergic effects, ECG changes like tachycardia, CNS depression, orthostatic hypotension, sedation, weight gain, urinary retention, blurred vision
      • Black box warning: increased risk for suicide
      • Not first-line treatment, as it takes many weeks to work

    Mood Stabilizers

    • Lithium (Lithobid):

      • Mechanism of action: reduces excitatory neurotransmission and increases inhibitory neurotransmission
      • Indication: bipolar disorder
      • Off-label uses: depression
      • Side effects: cardiac/renal/CNS effects, polyuria, polydipsia, bradycardia, weight gain
      • Black box warning: monitor lithium levels for toxicity
      • Patient education: requires lab monitoring, due to interfering with antidiuretic hormone (ADH); patient must drink adequate fluids

    • Valproate (Valproic Acid) - Depakote:

      • Mechanism of action: inhibition of voltage-gated sodium channels, decreasing neuron excitability and firing rate
      • Indications: seizure disorder, migraines, bipolar disorder
      • Black box warning: hepatotoxicity, teratogenic, pancreatitis, thrombocytopenia, bleeding, inhibits platelets

    • Lamotrigine (Lamictal):

      • Mechanism of action: prolongs sodium channel inactivation, blocks specific calcium channels, and blocks glutamate
      • Indications: seizure and bipolar disorder
      • Off-label uses: panic disorder, anxiety, migraines, and headaches, binge eating disorder, borderline personality disorder, post-traumatic stress disorder (PTSD)
      • Black box warning: Steven-Johnson syndrome, hemophagocytic lymphohistiocytosis, angioedema, toxic epidermal necrolysis### Medications for Respiratory Issues

    • Fluticasone (Intranasal Corticosteroid): used to treat allergic rhinitis, inhibits inflammation pathways, side effects include nasal irritation and epistaxis, contraindications include hypersensitivity and masking effects of infection.

    • Oxymetazoline (Decongestant): sympathomimetic vasoconstriction of nasal blood vessels, stimulates alpha adrenergic receptors, side effects include rebound congestion, nasal irritation, and minor stinging or dryness, contraindications include hypertension, diabetes, thyroid disorder, and heart disease.

    • Dextromethorphan (Antitussive): suppresses cough reflex in the CNS and provides analgesia, side effects include dizziness, drowsiness, and nausea, adverse effects include rare cases of slurred speech, ataxia, hyperexcitability, stupor, respiratory depression, seizures, coma, and toxic psychosis, contraindications include concurrent use of MAOIs.

    Cough Medications

    • Codeine Cough Syrup: suppresses cough reflex via the CNS and provides analgesia, side effects include sedation, constipation, and respiratory depression, nursing interventions include monitoring for respiratory depression and assessing for pain relief, careful use in patients with asthma due to bronchoconstriction.

    • Guaifenesin (Expectorant): increases respiratory tract fluid, reducing viscosity of mucus, therapeutic use is for productive cough and mucus clearance, contraindications include hypersensitivity and use in children under six.

    • Acetylcysteine (Mucolytic): breaks down bonds in mucus, reducing its viscosity, therapeutic use is for pulmonary disorders with thick tenacious mucus, cystic fibrosis, and chronic bronchitis, has a strong rotten egg smell.

    Bronchodilators

    • Albuterol (Beta-Adrenergic Agonist): selective beta-2 adrenergic agonist, therapeutic use is for acute bronchospasm, adverse effects include palpitations, headaches, and tachycardia, contraindications include hypersensitivity and cardiovascular effects.

    • Ipratropium (Anticholinergic): anticholinergic bronchial dilator, therapeutic use is for COPD and asthma exacerbations, adverse effects include upper respiratory tract irritation, cough, dry nasal mucus, and hoarseness, contraindications include hypersensitivity to soybeans and peanuts.

    Other Medications

    • Phenylephrine (Alpha-Adrenergic Agonist): stimulates alpha-1 receptors, constricting nasal blood vessels, therapeutic use is for nasal congestion, adverse effects include increased blood pressure and rebound congestion, contraindications include acute pancreatitis, heart disease, and narrowing angle glaucoma.

    • Methylxanthines (Caffeine, Theophylline): bronchial dilators, therapeutic use is for asthma, medication administration is oral or intravenously, contraindications include narrow safety margin with long-term use, patient interactions include numerous drug interactions.

    • Montelukast (Leukotriene Modifiers): leukotriene receptor antagonists, side effects include headache and nausea, adverse effects include rare neuropsychiatric events, contraindications include hepatic impairment.

    • Cromolyn sodium (Mast Cell Stabilizer): therapeutic uses include prophylaxis of asthma, allergy, and allergic rhinitis, adverse effects include bronchospasms, anaphylaxis, and stinging and burning of nasal mucosa.

    • Monoclonal Antibodies (Various): designed to attach to information mediators that reduce allergy symptoms, examples include Reslizumab and Omalizumab.

    • Isoniazid (Anti-Tubercular Drug): inhibits micro-bacterial cell wall synthesis, therapeutic use is for tuberculosis, adverse effects include neurotoxicity, paresthesia, and black box warning for hepatotoxicity.

    • Rifampin (Anti-Tubercular Drug): inhibits DNA-dependent RNA polymers in mycobacterial, side effects include orange discoloration of bodily fluids and gastrointestinal upset, adverse effects include hepatotoxicity.

    Respiratory Medications

    • Cromolyn (mast cell receptor stabilizer): inhibits mast cell degranulation, preventing release of histamine; instruct patient on proper inhaler or nasal spray technique and use prior to exposure
    • Diphenhydramine (H1 Receptor Agonist) - Benadryl:
      • Pharmacological action: blocks the effects of histamine at H1 receptors, resulting in antihistamine effects
      • Adverse effects: photosensitivity, paradoxical excitement (especially in children), anticholinergic effects, dry mouth, tachycardia, hypertension
      • Contraindications: hypersensitivity, narrow angle glaucoma, BPH, G.I. obstruction
    • Fluticasone (intranasal corticosteroid):
      • Therapeutic use: allergic rhinitis
      • Mechanism of action: inhibits inflammation pathways
      • Side effects: nasal irritation, epistaxis (nose bleeds)
      • Adverse effects: systemic effects with prolonged use (especially with oral steroids)
      • Contraindications: hypersensitivity; masks effects of infection, so do not use if patient has a known infection
    • Oxymetazoline (decongestant):
      • Pharmacological action: sympathomimetic vasoconstriction of nasal blood vessels
      • Mechanism of action: stimulates alpha-adrenergic receptors
      • Side effects: rebound congestion with prolonged use, nasal irritation, minor stinging or dryness
      • Nursing interventions: limit use to 3-4 consecutive days to prevent rebound congestion
      • Contraindications: hypertension, diabetes, thyroid disorder, heart disease

    Cough Medications

    • Dextromethorphan (antitussive):
      • Pharmacological action: suppresses cough reflex in CNS and provides analgesia
      • Side effects: dizziness, drowsiness, nausea
      • Adverse effects: rare, but can cause slurred speech, ataxia, hyperexcitability, stupor, respiratory depression, seizures, coma, and toxic psychosis
      • Contraindications: concurrent use of MAOIs
    • Codeine cough syrup:
      • Pharmacological action: suppresses cough reflex in CNS and provides analgesia
      • Side effects: sedation, constipation, respiratory depression
      • Nursing interventions: monitor for respiratory depression, assess for pain relief; be careful in patients with asthma as bronchoconstriction can occur

    Mucolytic Agents

    • Acetylcysteine (mucolytic):
      • Pharmacological action: breaks down bonds in mucus, reducing its viscosity
      • Therapeutic use: pulmonary disorders with thick, tenacious mucus (e.g., cystic fibrosis, chronic bronchitis)
      • Side effects: smells like rotten eggs

    Bronchodilators

    • Albuterol (beta-2 adrenergic agonist):
      • Pharmacological action: selective beta-2 adrenergic agonist, bronchial dilator
      • Therapeutic use: acute bronchospasm
      • Adverse effects: palpitations, headaches, tremors, restlessness, nervousness, tachycardia
      • Contraindications: hypersensitivity, cardiovascular effects
      • Interactions: concurrent use of beta blockers will inhibit the bronchodilation effects of albuterol; patients should avoid MAOIs within 14 days of beginning therapy
    • Ipratropium (anticholinergic):
      • Pharmacological action: anticholinergic, bronchial dilator
      • Therapeutic use: COPD, asthma exacerbations
      • Adverse effects: upper respiratory tract irritation, cough, dry nasal mucosa, hoarseness, sis
      • Contraindications: hypersensitivity to soybeans and peanuts

    Antihistamines

    • Diphenhydramine (H1 Receptor Agonist) - Benadryl:
      • Pharmacological action: blocks the effects of histamine at H1 receptors, resulting in antihistamine effects
      • Adverse effects: photosensitivity, paradoxical excitement (especially in children), anticholinergic effects, dry mouth, tachycardia, hypertension
      • Contraindications: hypersensitivity, narrow angle glaucoma, BPH, G.I. obstruction

    Antidepressants

    • Selective Serotonin Reuptake Inhibitors (SSRIs):
      • Mechanism of action: inhibit reuptake of serotonin to increase serotonin effects
      • Indications: depression, anxiety, obsessive-compulsive disorder
      • Off-label uses: premature ejaculation
      • Side effects: insomnia and sexual dysfunction
      • Black box warning: increased risk for suicide
      • First-line for depression and anxiety; relatively safe in pregnancy
    • Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):
      • Mechanism of action: inhibit reuptake of serotonin and norepinephrine to increase effects
      • Indications: anxiety, major depression, migraine prevention, fibromyalgia
      • Side effects: sexual dysfunction, insomnia, hypertension, orthostatic hypotension, hepatotoxicity
      • Black box warning: increased risk for suicide
    • Tricyclic Antidepressants (TCAs):
      • Mechanism of action: inhibit reuptake of serotonin and norepinephrine
      • Indications: depression
      • Off-label uses: fibromyalgia, IBS, migraines, anxiety, and withdrawal syndrome
      • Side effects: anticholinergic effects, ECG changes like tachycardia, CNS depression, orthostatic hypotension, sedation, weight gain, urinary retention, blurred vision
      • Black box warning: increased risk for suicide
      • Not first-line treatment, as it takes many weeks to work

    Mood Stabilizers

    • Lithium (Lithobid):

      • Mechanism of action: reduces excitatory neurotransmission and increases inhibitory neurotransmission
      • Indication: bipolar disorder
      • Off-label uses: depression
      • Side effects: cardiac/renal/CNS effects, polyuria, polydipsia, bradycardia, weight gain
      • Black box warning: monitor lithium levels for toxicity
      • Patient education: requires lab monitoring, due to interfering with antidiuretic hormone (ADH); patient must drink adequate fluids

    • Valproate (Valproic Acid) - Depakote:

      • Mechanism of action: inhibition of voltage-gated sodium channels, decreasing neuron excitability and firing rate
      • Indications: seizure disorder, migraines, bipolar disorder
      • Black box warning: hepatotoxicity, teratogenic, pancreatitis, thrombocytopenia, bleeding, inhibits platelets

    • Lamotrigine (Lamictal):

      • Mechanism of action: prolongs sodium channel inactivation, blocks specific calcium channels, and blocks glutamate
      • Indications: seizure and bipolar disorder
      • Off-label uses: panic disorder, anxiety, migraines, and headaches, binge eating disorder, borderline personality disorder, post-traumatic stress disorder (PTSD)
      • Black box warning: Steven-Johnson syndrome, hemophagocytic lymphohistiocytosis, angioedema, toxic epidermal necrolysis### Medications for Respiratory Issues

    • Fluticasone (Intranasal Corticosteroid): used to treat allergic rhinitis, inhibits inflammation pathways, side effects include nasal irritation and epistaxis, contraindications include hypersensitivity and masking effects of infection.

    • Oxymetazoline (Decongestant): sympathomimetic vasoconstriction of nasal blood vessels, stimulates alpha adrenergic receptors, side effects include rebound congestion, nasal irritation, and minor stinging or dryness, contraindications include hypertension, diabetes, thyroid disorder, and heart disease.

    • Dextromethorphan (Antitussive): suppresses cough reflex in the CNS and provides analgesia, side effects include dizziness, drowsiness, and nausea, adverse effects include rare cases of slurred speech, ataxia, hyperexcitability, stupor, respiratory depression, seizures, coma, and toxic psychosis, contraindications include concurrent use of MAOIs.

    Cough Medications

    • Codeine Cough Syrup: suppresses cough reflex via the CNS and provides analgesia, side effects include sedation, constipation, and respiratory depression, nursing interventions include monitoring for respiratory depression and assessing for pain relief, careful use in patients with asthma due to bronchoconstriction.

    • Guaifenesin (Expectorant): increases respiratory tract fluid, reducing viscosity of mucus, therapeutic use is for productive cough and mucus clearance, contraindications include hypersensitivity and use in children under six.

    • Acetylcysteine (Mucolytic): breaks down bonds in mucus, reducing its viscosity, therapeutic use is for pulmonary disorders with thick tenacious mucus, cystic fibrosis, and chronic bronchitis, has a strong rotten egg smell.

    Bronchodilators

    • Albuterol (Beta-Adrenergic Agonist): selective beta-2 adrenergic agonist, therapeutic use is for acute bronchospasm, adverse effects include palpitations, headaches, and tachycardia, contraindications include hypersensitivity and cardiovascular effects.

    • Ipratropium (Anticholinergic): anticholinergic bronchial dilator, therapeutic use is for COPD and asthma exacerbations, adverse effects include upper respiratory tract irritation, cough, dry nasal mucus, and hoarseness, contraindications include hypersensitivity to soybeans and peanuts.

    Other Medications

    • Phenylephrine (Alpha-Adrenergic Agonist): stimulates alpha-1 receptors, constricting nasal blood vessels, therapeutic use is for nasal congestion, adverse effects include increased blood pressure and rebound congestion, contraindications include acute pancreatitis, heart disease, and narrowing angle glaucoma.

    • Methylxanthines (Caffeine, Theophylline): bronchial dilators, therapeutic use is for asthma, medication administration is oral or intravenously, contraindications include narrow safety margin with long-term use, patient interactions include numerous drug interactions.

    • Montelukast (Leukotriene Modifiers): leukotriene receptor antagonists, side effects include headache and nausea, adverse effects include rare neuropsychiatric events, contraindications include hepatic impairment.

    • Cromolyn sodium (Mast Cell Stabilizer): therapeutic uses include prophylaxis of asthma, allergy, and allergic rhinitis, adverse effects include bronchospasms, anaphylaxis, and stinging and burning of nasal mucosa.

    • Monoclonal Antibodies (Various): designed to attach to information mediators that reduce allergy symptoms, examples include Reslizumab and Omalizumab.

    • Isoniazid (Anti-Tubercular Drug): inhibits micro-bacterial cell wall synthesis, therapeutic use is for tuberculosis, adverse effects include neurotoxicity, paresthesia, and black box warning for hepatotoxicity.

    • Rifampin (Anti-Tubercular Drug): inhibits DNA-dependent RNA polymers in mycobacterial, side effects include orange discoloration of bodily fluids and gastrointestinal upset, adverse effects include hepatotoxicity.

    CNS Depressants

    • Can cause addiction and dependency
    • First line for cessation of acute generalized seizures
    • Patient education: do not mix with alcohol or other CNS depressants
    • Treatment for overdose: Flumazenil

    Mood Stabilizers

    • Lithium (Lithobid)
      • MOA: reduces excitatory neurotransmission (dopamine and glutamate) but increases inhibitory neurotransmission (GABA)
      • Indication: bipolar disorder
      • Off label: depression
      • Requires serum concentration monitoring as narrow therapeutic index
      • Therapeutic response: 0.4-1.2 mEq/L, toxic usually above 1.5 mEq/L
      • Side effects/adverse effects: cardiac/renal/CNS effects, polyuria, polydipsia, bradycardia, weight gain
      • Patient education: requires lab monitoring, due to interfering with antidiuretic hormone (ADH) pt must drink adequate fluids
    • Valproic Acid (Depakote)
      • MOA: inhibition of voltage-gated sodium channels, decrease neuron excitability and firing rate
      • Indications: seizure disorder, migraines, bipolar disorder
      • Side effects/adverse effects: hepatoxicity, teratogenic, pancreatitis, thrombocytopenia, bleeding, inhibits platelets
    • Lamotrigine (Lamictal)
      • MOA: prolongs sodium channel inactivation, blocks specific calcium channels and blocks glutamate
      • Indications: seizure and bipolar disorder
      • Off label: panic disorder, anxiety, migraines, binge eating disorder, borderline personality disorder, posttraumatic stress disorder (PTSD)
      • Side effects/adverse effects: steven johnson syndrome, hemophagocytic lymphohistiocytosis, angioedema, toxic epidermal necrolysis

    CNS Stimulants

    • Methylphenidate (Ritalin), Amphetamine (Adderall), Dextroamphetamine (Dexedrine)
      • MOA: cause release of norepinephrine and dopamine
      • Indications: ADHD and narcolepsy
      • Side effects/adverse effects: weight loss and insomnia
      • Black box warning: abuse and dependence
      • Controlled substance
      • First line for ADHD
      • May recommend a “drug holiday” during the summer for kids
    • Atomoxetine (Strattera)
      • MOA: blocks reuptake of norepinephrine to increase its effects
      • Indication: ADHD
      • Less effective than CNS stimulants, so second line
      • Not a controlled substance
    • Modafinil (Provigil)
      • MOA: inhibits reuptake of dopamine to increase levels
      • Indications: daytime fatigue from narcolepsy, ADHD, obstructive sleep apnea, shift work sleep disorder
      • Off label: depression and fatigue
      • Controlled substance

    Dual Orexin Receptor Antagonist (DORA)

    • Daridorexant (Quviviq), Suvorexant (Belsomra)
      • MOA: blocks orexin A and B, which suppress the wake drive
      • Indication: insomnia
      • Not for long-term use
      • Controlled substance
      • Monitor for safety at night

    Histamine One Receptor Antagonist (Antihistamine)

    • Doxylamine (Unisom), Hydroxyzine (Vistaril)
      • MOA: decreases histamine, leading to sedation
      • Indications: insomnia, nausea in pregnancy, anxiety, allergies

    Benzodiazepine Receptor Agonist (BZRA)

    • Zolpidem (Ambien), Eszopiclone (Lunesta)
      • MOA: enhances the inhibitory activity of GABA receptors to suppress neural transmission in the brain and induce sleep
      • Indication: insomnia
      • Not for long-term use
      • Controlled substance
      • Side effects/adverse effects: dizziness, drowsiness, falls
      • Black box warning: abuse and dependence
      • Goal is to reduce the number of times you wake up at night
      • Monitor for safety at night

    Melatonin Receptor Agonist

    • Ramelteon (Rozerem)
      • MOA: activates melatonin receptors, which control circadian rhythm and sleep/wakefulness
      • Indication: insomnia
      • Not a controlled substance
      • Relatively safe for long-term use

    First Generation Antipsychotics

    • Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol)
      • MOA: blocks dopamine 2 receptors
      • Indication: schizophrenia
      • Off label: bipolar disorder and nausea
      • Side effects/adverse effects: drowsiness, anticholinergic effects, sexual dysfunction, ortho hypotension
      • Associated with extrapyramidal symptoms (EPS; CNS system affected) and neuroleptic malignant syndrome (NMS; rigidity, high fever)
      • Black box warning: not for use in dementia-related psychosis (inc risk for falls, heart dx, and DM)
      • Patient education: med compliance and can take many weeks to work

    Second Generation Antipsychotics

    • Lurasidone (Latuda), Olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone (Risperdal), Ziprasidone (Geodon)
      • MOA: blocks dopamine 2 and serotonin receptors
      • Indications: bipolar disorder, depression, and schizophrenia
      • Off label: delusional disorder and obsessive-compulsive disorder
      • Side effects/adverse effects: weight gain, hyperglycemia, dyslipidemia, Central Nervous System effects or EPS (less likely than first gen), NMS, ortho hypotension
      • Ziprasidone used for acute psychosis
      • Black box warning: not for use in dementia-related psychosis (inc risk for falls, heart dx, and DM)
      • Patient education: pt compliance

    Third Generation Antipsychotics

    • Aripiprazole (Abilify)
      • MOA: partial agonist and antagonist of dopamine 2 receptors
      • Indications: bipolar I disorder, irritability associated with autism spectrum disorder, schizophrenia, and Tourette's disorder
      • Side effects/adverse effects: skin rash, angioedema, hyperglycemia, NMS, EPS, seizures, priapism, stroke, impulsive behaviors
      • Black box warning: inc risk for suicide, not for use in dementia-related psychosis

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    Learn about SSRIs, their mechanism of action, indications, side effects, and risks. Understand their role in treating depression, anxiety, and other conditions.

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