Name of the Drug

Mechanism of Action

Indication Management of severely ill schizophrenics who are unresponsive to standard antipsychotic drugs Reduction of the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder (not orally disintegrating tablet)

Contraindication

Adverse effects Drowsiness, dizziness, headache; nausea, vomiting, constipation, anxiety, confusion, fatigue, transient fever. Rarely, dysphagia, acute pancreatitis, cholestic jaundice; orthostatic hypotention, tachycardia; seizures; hypersalivation.
Potentially Fatal:

Nursing Implication Weekly monitoring of WBC during treatment and for 4 wk thereafter. Dosage may be adjusted base on the WBC count. Potentially fatal agranulocytosis has been reported. Monitor Temperature. If fever occurs, rule out underlying infection, and consult physician for comfort measures. Monitor seizures; with history of seizures, risk increases as dose increases. Monitor elderly patients for dehydration. Institute remedial measures promptly; sedation and decreased thirst related to CNS effects can lead to dehydration. Monitor patient regularly for signs and symptoms of diabetes Mellitus. Encourage voiding before taking drug to decrease anticholinergic

Generic Name: Clozapine

Clozapine has relatively weak dopamine receptorblocking activity at Brand Name: D1, D2, D3 and D5 receptors but has high Clozaril affinity for the D4 receptor. It has also Dosage: blocking effects on very low dose serotonin, a-adrenergic usually 12.5 mg histamine H1 and once or twice on cholinergic receptors. the first day and increased slowly until a therapeutic dose is Classification: Antipsychotic, Dopaminergic blocker

History of bone marrow disorders including agranulocytosis, circulatory collapse, alcoholic or toxic psychosis, drug intoxication, uncontrolled epilepsy, severe renal, hepatic or cardiac disease; paralytic ileus. Pregnancy and lactation.

Rarely, thromboembolism. Reversible neutropenia which may progress to a potentially fatal agranulocytosis. Fatal myocarditis.

Name of the Drug

Mechanism of Action

Indication treatment of depression; most effective in patients with major depressive disorder Treatment of OCD treatment of bulimia treatment of panic disorder with or without agoraphobia Unlabeled use: treatment of obesity, alcoholism, numerous psychiatric disorders, chronic pain, various neuropathies.

Contraindication contraindicated with hypersensitivity to fluoxetine, pregnancy Use cautiously with impaired hepatic or renal function, diabetes mellitus, lactation, seizures, history of suicide attemps. .

Adverse effects

Nursing consideration Establish suicide precautions for severely depressed patients. Limit quantity of capsules dispensed; high risk in children and adolescents. Monitor patient for response to therapy for up to 4 wk before increasing dose. Switch to once a week therapy by starting weekly dose 7 days after last 20 mg/day dose. If response is not satisfactory, reconsider daily dosing. Report rash, mania, seizures, severe weight loss. Do not take this drug during pregnancy. If you think that you are pregnant or wish to become pregnant, consult your health care provider.

Generic Name: Fluoxetine Brand name: Prozac Dosage: 20mg/day PO in the morning. If no clinical improvement is seen, increase dose after several weeks. Administer doses > 20 mg/day on a bid schedule. Do not exceed 80 mg/day.

Acts as an antidepressant by inhibiting CNS neuronal uptake of serotonin; blocks uptake of serotonin with little effect on norepinephrine; little affinity for muscarinic, histaminergic, and alpha1- adrenergic receptors.

Classification: Antidepressant, SSRI

CNS: headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, light- headedness, agitation, sedation, abnormal gait, seizures CV: hot flashes, palpitations Dermatologic: sweating, rash, pruritus, acne, alopecia, contact dermatitis GI: nausea, vomiting, diarrhea, dry mouth, anorexia, dyspepsia, constipation, taste changes, flatulence, gastroenteritis, dysphagia, gingivitis GU: painful menstruation, sexual dysfunction, frequency, cystitis, impotence, urgency, vaginitis Respiratory: URIs, pharyngitis, cough, dyspnea, bronchitis, rhinitis Other: weight changes, asthenia, fever

Name of the Drug Generic name: Alprazolam Brand name: Xanax Dosage: Initially, 0.250.5 mg PO tid; adjust to maximum daily dose of 4 mg/day in divided doses or extended-release form once per day in theAM once dosage is established (immediate release, intensol solution). Classification:

Mechanism of action Exact mechanisms of action not understood; main sites of action may be the limbic system and reticular formation; increases the effects of GABA, an inhibitory neurotransmitter; anxiety blocking effects occur at doses well below those necessary to cause sedation, ataxia.

Indication Management of anxiety disorders, short-term relief of symptoms of anxiety; anxiety associated with depression. Treatment of panic attacks with or without agoraphobia Unlabeled uses: Social phobia, premenstrual syndrome, depression

Contraindication Hypersensitivity to benzodiazepines, psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with depression of vital signs, pregnancy (crosses the placenta; risk of congenital malformations, neonatal withdrawal syndrome), labor and delivery (floppy infant syndrome), lactation (secreted in breast milk; infants become lethargic and lose weight). Use cautiously with impaired liver or kidney function, debilitation.

Adverse Effect CNS: Transient, mild drowsiness initially; sedation, depression, lethargy, apathy, fatigue, light-headedness, disorientation, anger, restlessness, confusion, crying, delirium, headache, slurred speech, dysar CV: Bradycardia, tachycardia, CV collapse, hypertension, hypotension, palpitations, edema EENT: Visual and auditory disturbances, diplopia, depressed hearing, nasal congestion GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, hepatic impairment

Nursing Consideration Do not administer with grapefruit juice. Do not stop taking drug (in long-term therapy) without consulting health care provider; drug should not be stopped suddenly. Avoid alcohol, sleepinducing, or over-thecounter drugs. You may experience these side effects: Drowsiness, dizziness, fatigue; depression; dreams; crying; nervousness. Report severe dizziness, weakness, drowsiness that persists, rash or skin lesions, difficulty voiding, palpitations, swelling in the extremities.

Benzodiazepine, Anxiolytic

Name of the Drug Generic Name:

Mechanism of Action

The mechanism of action for methylphenidate, like Methylphenidate other stimulants used in ADHD, is not well Brand Name: understood. It is believed that methylphenidate Ritalin activates the brain stem arousal system and cortex. Dosage: Structurally, Children 6 y/o and overmethylphenidate acts as a small doses, (e.g. 5 to 10 dopamine and mg 3 times daily) with norepinephrine reuptake weekly increments of 5 to inhibitor, resulting in a 10 mg in the daily dosage prolongation of dopamine Administer in divided doses receptor effects.[1-4] 2 or 3 times daily, preferably 30 to 40 minutes before meals. Average daily dosage is 20 to 30 mg. Classification: CNS stimulant

Indication Methylphenidate is indicated as an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate-to-severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity. The diagnosis of this syndrome should not be made with finality when these symptoms are only of comparatively recent origin. Non-localizing (soft) neurological signs, learning disability, and abnormal EEG may or may not be present, and a diagnosis of CNS dysfunction may or may not be warranted.

Contraindication Anxiety, tension, agitation, thyrotoxicosis, tachyarrhythmias, severe angina pectoris and glaucoma. Hypersensitivity to methylphenidate. Also contraindicated in patients with motor tics or with a family history or diagnosis of Tourette's syndrome.

Adverse Effects Central and Peripheral Nervous System: Dizziness, drowsiness, headache, and dyskinesia may occur. Isolated cases of the following have been reported: hyperactivity, convulsions, muscle cramps, choreo-athetoid movements, tics, or exacerbation of pre-existing tics, Tourette's syndrome, and psychotic episodes including hallucinations which subsided when methylphenidate was discontinued. Psychic dependence in emotionally unstable persons has occurred rarely with chronic treatment. Although a definite causal relationship has not been established, isolated cases of transient depressed mood have been reported. Symptoms of visual disturbances have been encountered in rare cases. Difficulties with accommodation and blurring of vision have

Nursing Consideration Monitor growth of children on long-term methylphenidate therapy. Ensure that all timedrelease tablets and capsules are swallowed whole, not chewed or crushed. Dispense the least feasible dose to minimize risk of overdose. Give before 6 PM to prevent insomnia. Monitor CBC and platelet counts periodically in patients on long-term therapy. Monitor BP frequently early in treatment. Take this drug exactly as prescribed. Timed-release tablets and capsules must be swallowed whole, not chewed or crushed. Metadate CD capsules may be opened and entire contents sprinkled on soft fooddo not chew or crush granules. Avoid alcohol and OTC drugs, including nose drops, cold remedies; some OTC drugs could cause dangerous effects. Report

been reported. Gastrointestinal: Nausea and abdominal pain may occur at the start of treatment and may be alleviated if taken with food. Cardiovascular: Palpitations, blood pressure and pulse changes (both up and down), tachycardia, angina and cardiac arrhythmias. Skin and/or Hypersensitivity: Rash, pruritus, urticaria, fever, arthralgia, and alopecia. Isolated cases of exfoliative dermatitis, erythema multiforme with histopathological findings of necrotizing vasculitis, and thrombocytopenic purpura.

nervousness, insomnia, palpitations, vomiting, rash, fever.