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Trifluoperazine (Stelazine)
Drug Classification: Antipsychotic/Phenothiazine
Uses: Psychotic disorders
Action: Phenothiazine; blocks postsynaptic CNS
dopaminergic receptors
Caution: [C, ?/−]
CI: h/o Blood dyscrasias; phenothiazine sensitivity
Interactions: ↑ CNS depression W/ barbiturates,
benzodiazepines, TCAs, EtOH; ↑ effects
OF antihypertensives, propranolol, ↓
effects OF anticoagulants ↓ effects W/
antacids
Labs: ↑ LFTs; ↓ WBCs
NIPE: ↑ Risk of photosensitivity—use sunblock;
urine color may change to pink to reddish-
brown; PO conc must bediluted to 60 mL
or more prior to administration; requires
several wk for onset of effects
Ziprasidone (Geodon)
Drug Classification: Antipsychotic/Piperazine
Derivative
Uses: Schizophrenia, acute agitation
Action: Atypical
Caution: [C, −] w/ ↓ Mg2+, ↓ K+
CI: QT prolongation, recent MI, uncompensated
HF, meds that ↑ QT
Interactions: ↑ Effects W/ ketoconazole; ↑ effects
OF antihypertensives; ↑ CNS depression
W/ anxiolytics, sedatives, opioids, EtOH;
TCAs, thioridazine; risk of prolonged QT
W/ cisapride, chlorpromazine,
clarithromycin, diltiazem, erythromycin,
levofloxacin, mefloquine, pentamidine,
TCAs, thioridazine; ↓ effects W/
amphetamines, carbamazepine; ↓ effects
OF levodopa
A n t i d e p r e s s a n t s
Amitriptyline (Elavil) NIPE: Do not cut/crush/chew, avoid EtOH, N D/C OF BBs, carbamazepine, CNS drugs,
Drug Classification: Antidepressant/TCA abruptly warfarin; ↓ effects W/ carbamazepine; ↓
Uses: Depression (not bipolar depression) effects OF phenytoin; may cause fatal Rxn
peripheral neuropathy, chronic pain, Bupropion Hydrochloride (Wellbutrin, Wellbutrin W/ MAOIs
tension HAs SR, Wellbutrin XL, Zyban) Labs: ↑ LFTs; May cause ↓ Na+/SIADH; NIPE: N
Action: TCA; ↓ reuptake of serotonin & Drug Classification: Aminoketone PRG, breast-feeding, use barrier
norepinephrine by presynaptic neurons WARNING: Closely monitor for worsening contraception
Caution: CV Dz, Szs [D,+/−] NAG, hepatic impair depression or emergence of suicidality,
CI: w/ MAOIs or w/in 14 d of use, during acute MI increased suicidal behavior in young adults Desipramine (Norpramin)
recovery Uses: Depression, smoking cessation adjunct, Drug Classification: Antidepressant/TCA
Interactions: ↓ Effects W/ carbamazepine, ADHD WARNING: Closely monitor for worsening
phenobarbital, rifampin, cholestyramine, Action: Weak inhibitor of neuronal uptake of depression or emergence of suicidality
colestipol, tobacco; ↑ effects W/ serotonin & norepinephrine; ↓ neuronal Uses: Endogenous depression, chronic pain,
cimetidine, quinidine, indinavir, ritonavir, dopamine reuptake peripheral neuropathy
CNS depressants, SSRIs, haloperidol, OCPs, Caution: [C, ?/−] CI: Sz disorder, h/o anorexia Action: TCA; ↑ synaptic serotonin or
BBs, phenothiazines, EtOH, evening nervosa or bulimia, MAOI, w/in 14 d, norepinephrine in CNS
primrose oil; ↑ effects OF amphetamines, abrupt D/C of EtOH or sedatives Caution: [C, ?/−] CV Dz, Sz disorder,
anticholinergics, epinephrine, Interactions: ↑ Effects W/ cimetidine, levodopa, hypothyroidism, elderly, liver impair
hypoglycemics, phenylephrine MAOIs; ↑ risk of Szs W/ EtOH, CI: MAOIs w/in 14 d; during AMI recovery phase
Labs: ↑ Glucose, false ↑ carbamazepine levels phenothiazines, antidepressants, Interactions: ↑ Effects W/ cimetidine, diltiazem,
NIPE: ↑ Photosensitivity—use sunscreen; ↑ theophylline, TCAs, or abrupt withdrawal fluoxetine, indinavir, MAOIs, paroxetine,
appetite & craving for sweets; ND/C of corticosteroids, benzodiazepines propoxyphene, quinidine, ritonavir
abruptly; may turn urine blue-green Labs: ↓ Prolactin level ranitidine, EtOH, grapefruit juice; ↑
NIPE: Drug may cause Szs; take 3–4 wk for full effects OF Li, sulfonylureas; ↓ effects W/
Bupropion Hydrobromide (Aplenzin) effect; N EtOH or CNS depressants; N barbiturates, carbamazepine rifampin,
Drug Classification: Aminoketon abrupt D/C; SR and XR do not cut/chew/ tobacco
WARNING: ↑ Suicide risk in pts <24 y w/ major crush NIPE: Full effect of drug may take 4 wk; blue-green
depressive/other psychiatric disorders; urine; risk of photosensitivity—use
not for ped use Citalopram (Celexa) sunblock & avoid sunlight
Uses: Depression Drug Classification: Antidepressant/SSRI
Action: Aminoketone, ? action WARNING: Closely monitor for worsening Desvenlafaxine (Pristiq)
Caution: [C, −] w/ Drugs that ↓ Sz threshold, ↑ w/ depression or emergence of suicidality, Drug Classification: Serotonin-Norepinephrine
CYP2D6-metabolized meds particularly in pts <24 y Reuptake Inhibitor (SNRI)
CI: Sz disorder, bulimia, anorexia nervosa, w/in 14 Uses: *Depression* WARNING: Monitor for worsening or emergence
d of MAOIs, other forms of bupropion, Action: SSRI of suicidality, particularly in ped,
abrupt D/C of EtOH, or sedatives CI: MAOI or w/in 14 d of MAOI use adolescent, and young adult pts
Interactions: ↑ effects W/ stimulants & meds Interactions: ↑ Effects W/ azole antifungals, Uses: Major depressive disorder
metabolized by CYP2D6 cimetidine, Li, macrolides, EtOH; ↑ effects
Action: Selective serotonin and norepinephrine Uses: Depression, DM peripheral neuropathic Uses: Depression, obsessive-compulsive disorder
reuptake inhibitor pain, generalized anxiety disorder (GAD) (OCD), panic disorder, bulimia (Prozac)
Caution: [C, ±/M] CI: Hypersensitivity, MAOI w/ or Action: Selective serotonin & norepinephrine *PMDD (Sarafem)*
w/in 14 d of stopping MAOI reuptake inhibitor (SSNRI) Action: SSRI
Interactions: ↑ Effects W/ CYP3A4 inhibitors; ↑ CI: MAOI use w/in 14 d, w/ thioridazine, NAG, CI: MAOI/thioridazine (wait 5 wk after D/C before
effects OF anticoagulants; ↓ effects OF hepatic Insuff MAOI)
CYP3A4 substrates Interactions: ↑ Effects OF flecainide, propafenone, Interactions: ↑ Effects W/ CNS depressants,
NIPE: Tabs should be taken whole, allow 7 d after phenothiazines, TCAs; ↑ effects W/ MAOIs, EtOH, St. John’s wort; ↑ effects
stopping before starting an MAOI; N cimetidine, fluvoxamine, quinolones; ↑ OF alprazolam, BBs, carbamazepine,
ETOH; caution with other serotonergics risk OF hypertensive crisis W/ MAOIs w/in clozapine, cardiac glycosides, diazepam,
and CNS active drugs 14 d of taking duloxetine dextromethorphan, loop diuretics,
Labs:? ↑ LFTs haloperidol, phenytoin, Li, ritonavir,
Doxepin (Adapin) NIPE: ↑ Risk of liver damage W/ EtOH use; N D/C thioridazine, tryptophan, warfarin,
Drug Classification: Antidepressant/TCA drug abruptly; swallow whole; monitor BP sympathomimetic drugs; ↓ effects W/
WARNING: Closely monitor for worsening cyproheptadine; ↓ effects OF buspirone,
depression or emergence of suicidality Escitalopram (Lexapro) statins
Uses: Depression, anxiety, chronic pain Drug Classification: Antidepressant/SSRI Labs: ↑ LFTs, BUN, Cr, urine albumin
Action: TCA; ↑ synaptic CNS serotonin or WARNING: Closely monitor for worsening NIPE: ↑ Risk of serotonin synd W/ St. John’s wort;
norepinephrine depression or emergence of suicidality, may take >4 wk for full effects
Caution: [C, ?/−] w/ EtOH abuse, elderly, w/ MAOI particularly in ped pts
CI: NAG, urinary retention, MAOI use w/in 14 d, in Uses: Depression, anxiety Fluvoxamine (Luvox)
recovery phase of MI Action: SSRI Dose: Drug Classification: Antidepressant/SSRI
Interactions: ↑ Effects W/ fluoxetine, MAOIs, Caution: [C, +/−] Serotonin synd use w/ WARNING: Closely monitor for worsening
albuterol, CNS depressants, escitalopram, NSAID, ASA or other drugs depression or emergence of suicidality,
nticholinergics, propoxyphene, quinidine, affecting coagulation associated w/ ↑ particularly in ped pts
EtOH, grapefruit juice; ↑ effects OF bleeding risk Uses: *Obsessive-compulsive disorder (OCD)*
carbamazepine, anticoagulants, CI: w/ or w/in 14 d of MAOI Disp: Tabs 5, 10, 20 Action: SSRI
amphetamines, thyroid drugs, mg; soln 1 mg/mL Caution: [C, ?/−]
sympathomimetics; effects W/ ascorbic Interactions: ↑ Risk of serotonin synd W/ Interactions (MAOIs, phenothiazines, SSRIs,
acid, cholestyramine, tobacco; ↓ effects linezolid; ↑ risk of bleeding W/ serotonin agonists, others)
OF bretylium, guanethidine, levodopa anticoagulants, ASA, NSAIDs; may ↑ CNS CI: MAOI w/in 14 d
Labs: ↑ Serum bilirubin, alk phos, glucose effects W/ CNS depressants Interactions: ↑ Effects W/ melatonin, MAOIs; ↑
NIPE: Risk of photosensitivity—use sunblock, urine NIPE: N D/C abruptly; full effects may take 3 wk; effects OF BBs, benzodiazepines,
may turn blue-green, may take 4–6 wk for take w/o regard to food; may cause ↑ methadone, carbamazepine, haloperidol,
full effect appetite & wgt gain Li, phenytoin, TCAs, theophylline,
warfarin, St. John’s wort; ↑ risks of
Duloxetine (Cymbalta) Fluoxetine (Prozac, Sarafem) serotonin synd W/ buspirone,
Drug Classification: Antidepressant/SSNRI Drug Classification: Antidepressant/SSRI dexfenfluramine, fenfluramine, tramadol,
WARNING: Antidepressants may ↑ risk of WARNING: Closely monitor for worsening nefazodone, sibutramine, tryptophan; ↓
suicidality; consider risks/benefits of use. depression or emergence of suicidality, effects W/ buspirone, cyproheptadine,
Closely monitor for clinical worsening, particularly in ped pts tobacco; ↓ effects OF buspirone, HMG-
suicidality, or behavior changes CoA reductase inhibitors
NIPE: N MAOIs for 14 d before start of drug; N Caution: [C, ?] Has anticholesterol effects, w/ Sz, observe all pts for clinical symptoms; not
EtOH clonidine, CNS depressant use, CYP1A2, for ped use
CYP3A4 inducers/inhibitors Uses: *Endogenous depression*
CI: MAOIs w/in 14 d Action: TCA; ↑ synaptic CNS levels of serotonin
Interactions: ↑ Effects W/ CNS depressants, and/or norepinephrine
Imipramine (Tofranil) fluvoxamine; ↑ risk of HTN crisis W/ CI: TCA allergy, use w/ MAOI
Drug Classification: Antidepressant/TCA MAOIs Interactions: ↑ Effects W/ antihistamines, CNS
WARNING: Close observation for suicidal thinking Labs: ↑ ALT, cholesterol, triglycerides depressants, cimetidine, fluoxetine, OCP,
or unusual changes in behavior NIPE: Handle rapid tabs w/ dry hands, do not cut phenothiazine, quinidine, EtOH; ↑ effects
Uses: *Depression, enuresis*, panic attack, chronic or chew; do not ↑ dose at intervals of less OF anticoagulants; ↑ risk of HTN W/
pain than 1–2 wk clonidine, levodopa, sympathomimetics;
Action: TCA; ↑ CNS synaptic serotonin or ↓ effects W/ barbiturates,
norepinephrine Nefazodone carbamazepine, rifampin
Caution: [D, ?/−] CI: Use w/ MAOIs, NAG, acute Drug Classification: Antidepressant/Serotonin Labs: ↑ Serum bilirubin, alk phos
recovery from MI, PRG, CHF, angina, CV Modulator NIPE: Concurrent use W/ MAOIs have resulted in
Dz, arrhythmias WARNING: Fatal hep & liver failure possible, D/C if HTN, Szs, death; ↑ risk of photosensitivity
Interactions: ↑ Effects W/ amiodarone, LFTs >3× ULN, do not retreat; closely —use sunscreen; max effect may take >2–
anticholinergics, BBs, cimetidine, monitor for worsening depression or 3 wk
diltiazem, Li, OCPs, quinidine, suicidality, particularly in ped pts
phenothiazine, ritonavir, verapamil, EtOH, Uses: *Depression* Paroxetine (Paxil, Paxil CR, Pexeva)
evening primrose oil; ↑ effects OF CNS Action: ↓ Neuronal uptake of serotonin & Drug Classification: Antidepressant/SSRI
depressants, hypoglycemics, warfarin; ↑ norepinephrine WARNING: Closely monitor for worsening
risk of serotonin synd W/ MAOIs; ↓ Caution: [C, M] depression or emergence of suicidality,
effects W/ tobacco; ↓ effects OF clonidine CI: w/ MAOIs, pimozide, carbamazepine, particularly in children, adolescents, &
Labs: ↑ Serum glucose, LFTs alprazolam; active liver Dz young adults; not for use in peds
NIPE: D/C 48 h before surgery; D/C MAOIs 2 wk Interactions: ↑ Risk of hypotension W/ Uses: *Depression, obsessive-compulsive disorder,
before admin this drug; 4–6 wk for full antihypertensives, nitrates; ↑ effects OF panic disorder, social anxiety disorder*,
effects; take w/ food; less sedation than alprazolam, CCB, digoxin, HMG-CoA PMDD
amitriptyline reductase inhibitors, triazolam; ↑ risk of Action: SSRI
QT prolongation W/ astemizole, cisapride, Caution: [D, ?/] ↑ Bleeding risk
Mirtazapine (Remeron, Remeron SolTab) pimozide; ↑ risk of serious and/or fatal CI: w/ MAOI, thioridazine, pimozide
Drug Classification: Tetracyclic Antidepressant Rxn W/ MAOIs; ↓ effects OF propranolol Interactions: ↑ Risk of QT prolongation W/
WARNING: ↑ Risk of suicidal thinking and Labs: ↑ LFTs, cholesterol; ↓ Hct pimozide, thioridazine; ↑ effects W/
behavior in children, adolescents, and NIPE: Take w/o food; may take 2–4 wk for full cimetidine; ↑ effects OF BBs,
young adults w/ major depression and therapeutic effects; monitor HR, BP dexfenfluramine, dextromethorphan,
other psychological disorders. Not for fenfluramine, haloperidol, MAOIs,
peds Nortriptyline (Pamelor) theophylline, TCAs, warfarin, St. John’s
Uses: *Depression* Drug Classification: Antidepressant/TCA wort, EtOH; ↓ effects W/ cyproheptadine,
Action: α2-Antagonist antidepressant, ↑ WARNING: ↑ Suicide risk in pts <24 y w/ major phenobarbital, phenytoin; ↓ effects OF
norepinephrine & 5-HT depressive/other psychological disorders digoxin, phenytoin Labs: ↑ Alk phos,
esp during 1st mo of Tx; risk ↓ pts >65 y; bilirubin, glucose
NIPE: Take w/o regard to food; may take up to 4 venlafaxine; ↑ risk of hypertension W/ N, xerostomia, syncope, confusion, tremor, hep,
wk for full effect; N D/C Abruptly dextroamphetamine, levodopa, EPS
methylphenidate, SSRIs, tyramine- Interactions: ↑ Effects W/ fluoxetine,
Phenelzine (Nardil) containing foods, EtOH, ephedra, ginseng, phenothiazines; ↑ risk of serotonin synd
Drug Classification: Antidepressant/MAOI ma-huang, St. John’s wort W/ MAOIs, SSRIs, venlafaxine, St. John’s
WARNING: Antidepressants increase the risk of NIPE: N EtOH & tyramine-containing foods; rotate wort; ↑ CNS depression W/ barbiturates,
suicidal thinking & behavior in children & site; see oral form CNS depressants, opioids, sedatives, EtOH;
adolescents w/ major depressive disorder ↑ hypotension W/ antihypertensive,
& other psychological disorders; not for Sertraline (Zoloft) neuroleptics; nitrates, EtOH; ↑ effects OF
peds use Drug Classification: Antidepressant/SSRI clonidine, digoxin, phenytoin; ↓ effects
Uses: *Depression*, bulimia WARNING: Closely monitor pts for worsening W/ potent CYP3A4 inducers
Action: MAOI depression or emergence of suicidality, (carbamazepine); CYP3A4 inhibitors to ↑
Caution: [C, −] Interacts w/ SSRI, ergots, triptans particularly in ped pts trazodone concentrations (nefazodone,
CI: CHF, h/o liver Dz, pheochromocytoma Uses: *Depression, panic disorders, obsessive– ritonavir, indinavir, ketoconazole,
Interactions: ↑ HTN Rxn W/ amphetamines, compulsive disorder (OCD), posttraumatic itraconazole)
fluoxetine, levodopa, metaraminol, stress disorder (PTSD)*, social anxiety NIPE: Take w/ food; ↑ fluids to 2–3 L/d; N D/C
phenylephrine, phenylpropanolamine, disorder, eating disorders, premenstrual abruptly; ↑ risk of priapism; takes 1–2 wk
pseudoephedrine, reserpine, sertraline, disorders for symptom improvement
tyramine, EtOH, foods W/ tyramine, Action: ↓ Neuronal uptake of serotonin
caffeine, tryptophan; ↑ effects OF Caution: [C, ?/−] w/ Haloperidol (serotonin synd), Venlafaxine (Effexor, Effexor XR)
barbiturates, narcotics, sedatives, sumatriptan, linezolid, hepatic impair Drug Classification: Antidepressant/Serotonin,
sumatriptan, TCAs, ephedra, ginseng CI: MAOI use w/in 14 d; concomitant pimozide Norepinephrine, & Dopamine Reuptake
Labs: ↓ Glucose, false(+) ↑ in bilirubin & uric acid Interactions: ↑ Effects W/ cimetidine, tryptophan, Inhibitor
NIPE: 2–4 wk for effect; avoid tyramine-containing St. John’s wort; ↑ effects OF WARNING: Monitor for worsening depression or
foods (eg, cheeses) benzodiazepines, phenytoin, TCAs, emergence of suicidality, particularly in
warfarin, EtOH; ↑ risk of serotonin synd ped pts
Selegiline, Transdermal (Emsam) W/ MAOIs Uses: *Depression, generalized anxiety*, social
Drug Classification: Anti-Parkinson Agent/MAO B Labs: ↑ LFTs, triglycerides, ↓ uric acid anxiety disorder; panic disorder*,
Inhibitor NIPE: N D/C abruptly; take w/o regard to food obsessive-compulsive disorder, chronic
WARNING: May ↑ risk of suicidal thinking & fatigue synd, ADHD, autism
behavior in children & adolescents w/ Trazodone (Desyrel) Action: Potentiation of CNS neurotransmitter
major depression disorder Drug Classification: Antidepressant activity
Uses: *Depression* WARNING: Closely monitor for worsening Caution: [C, ?/−]
Action: MAOI depression or emergence of suicidality, CI: MAOIs
CI: Tyramine-containing foods w/ 9- or 12-mg particularly in pts <24 y Interactions: ↑ Effects W/ cimetidine,
doses; serotonin-sparing agents Uses: *Depression*, hypnotic, augment other desipramine, haloperidol, MAOIs; ↑ risk
Caution: [C, −] ↑ Carbamazepine & oxcarbazepine antidepressants of serotonin synd W/ sumatriptan,
levels Action: Antidepressant; ↓ reuptake of serotonin & trazodone, St. John’s wort
Interactions: ↑ Risk of serotonin synd W/ norepinephrine NIPE: XR caps swallow whole—N chew; take w/
dextroamphetamine, dextromethorphan, Caution: [C, ?/−] food; N use EtOH; N D/C abruptly; D/C
fenfluramine, meperidine, CI: Component allergy Disp: Tabs 50, 100, 150, 300 MAOI 14 d before start of this drug; ↑
methylphenidate, sibutramine, mg SE: Dizziness, HA, sedation,
fluids to 2–3 L/d; may take 2–3 wk for full
effects; frequent edema & wgt gain
COLLEGE OF NURSING
Submitted to:
RHENE A. GAZMEN, RN
Instructor
Submitted by:
MA. LORRAINE B. ENCARNACION
BSN IV – E
December 16, 2010