Pocket Psych Drugs: Point-of-Care Clinical Guide

234 Pages·2018·5.815 MB·English

by  Darlene D. Pedersen

Point-of-Care Clinical Guide
SECOND EDITION
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Legend/Explanation for Drugs A-Z/Alert
Following are explanations of information used throughout and applies to all
psychotropic drugs A-Z:
In the Alphabetical Psychotropic Drug Tabs, each drug’s half lifeis noted by T1/;
2
Canadian drug tradenamesare listed initalics;most frequent side effectsare
underlined; and LIFE-THREATENING side effects are listed as ALL CAPS. In the avail-
abilitysection, all Canadian doses will have Canadian noted just before each and
every dose.
Legend for DRUG COSTS (based on 30-day supply)
$ =$0–$50 per month; $$ =$50–$100 per month; $$$ =$100–$200 per month;
$$$$ =more than $200 per month.
TALL MAN LETTERING: The FDA has asked manufacturers to update 33 look-alike
generic drug names. If a psychotropic drug uses tall man lettering, it will be used in
the psychotropic alphabetical sections, such as chlorproMAZINE (as compared with
chlorproPAMIDE). (US FDA Center for Drug and Research; www.fda.gov/cder/
index/html)
ALERT: Refer to the Physicians Desk Reference or product insert (prescribing
information) for complete and current drug information (dosages, warnings,
indications, adverse effects, interactions, etc.) needed to make appropriate choices
in the treatment of clients before administering any medications. Although every
effort in this volume has been made to provide key information about medications
and classes of drugs, such information is not and cannot be all-inclusive in a
reference of this nature, and this information should not be used for prescribing or
administering medications. Professional judgment, training, supervision, relevant
references, and “current” drug information is critical to the appropriate selection,
evaluation, and use of drugs, as well as the monitoring and management of clients
and their medications.
Pocket Psych Drugsis dedicated to my son, Jorgen David, to Jessica, Isaac, and Miles.
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Darlene D. Pedersen, MSN, APRN, PMHCNS
Purchase additional copies of this book at your health science bookstore or directly from
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Consultant to the First Edition:Thanks to Laura G. Leahy, MSN, APN, CNS, FNP, BC for her consultation
on pediatric drugs in the first edition.
First Edition Reviewers:Lois Angelo, APRN, MSN; Laura Aromando, ARNP, MSN; Barbara Braverman,
MSN, CRNP, BC-CNS; Arleen F. Briggs, RN, MSN, RNC, APRN; Barbara Chamberlain, PhD, APRN, CCRN,
WCC; Perri-Anne Concialdi, RN, MSN, CNS; Karen I. Curlis, PMHCNS-BC; Margie Eckroth-Bucher, PhD,
RN, PMHCNS-BC; Kathryn Farwell, PhD, RN; Elizabeth A. Favreau, MSN, RN, CNE; Linda S. Forte; Carlie
Frederick, ARPN, PMH-BC, CPNP; Melissa Garno, EdD; Sheila Hart, MSN, RN; Joan Hoover, RN, BSN,
MSEd; Dottie Irvin, DNS, APRN, BC; Florence Keane, DNSc, MBA, ARNP-ANP-C; Michelle Link, RN, MSN;
Angela Luciani, RN, BScN, MN; Robin Murray, RN, MSN; Ketankumar V. Patel, MD; Catherine Ann Weitzel,
RN, MSN, ARNP
As new scientific information becomes available through basic and clinical research, recommended
treatments and drug therapies undergo changes. The author(s) and publisher have done everything
possible to make this book accurate, up to date, and in accord with accepted standards at the time of
publication. The author(s), editors, and publisher are not responsible for errors or omissions or for conse-
quences from application of the book, and make no warranty, expressed or implied, in regard to the con-
tents of the book. Any practice described in this book should be applied by the reader in accordance
with professional standards of care used in regard to the unique circumstances that may apply in each
situation. The reader is advised always to check product information (package inserts) for changes and
new information regarding dose and contraindications before administering any drug. Caution is espe-
cially urged when using new or infrequently ordered drugs.
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Contents
Tab 1:Basics of (cid:129)Side Effects Associated With
Psychopharmacology/ Therapeutic Classes 12
Biology and Drug (cid:129)Black Box Warnings 13
Classes 1
Tab 2:Psychotropic
(cid:129)Pharmacokinetics/
Drugs A–C 15
Pharmacodynamics 1
(cid:129)ALPRAZolam 15
(cid:129)The Limbic System (Figure) 2
(cid:129)Amitriptyline 17
(cid:129)Synapse Transmission (Figure) 3
(cid:129)Amphetamine Mixtures 19
(cid:129)Autonomic Nervous System:
(cid:129)ARIPiprazole 21
Sympathetic and
(cid:129)Atomoxetine 24
Parasympathetic Effects 3
(cid:129)Benztropine 26
(cid:129)Neurotransmitters 4
(cid:129)Brexpiprazole 28
(cid:129)Medication and the Elderly 4
(cid:129)BuPROPion HCl 31
(cid:129)Pharmacokinetics in the
(cid:129)BusPIRone 34
Elderly 5
(cid:129)CarBAMazepine 35
(cid:129)Medications and Children 6
(cid:129)Cariprazine 39
(cid:129)Indications/Off-Label Uses 6
(cid:129)ChlordiazePOXIDE 41
(cid:129)Pediatric Dosing 7
(cid:129)ChlorproMAZINE 43
(cid:129)Psychotropic Adverse Effects 7
(cid:129)Citalopram 46
(cid:129)Extrapyramidal Symptoms
(cid:129)ClomiPRAMINE 48
(EPS) 7
(cid:129)ClonazePAM 50
(cid:129)Tardive Dyskinesia 8
(cid:129)CloZAPine 52
(cid:129)Neuroleptic Malignant
Syndrome (NMS) 8 Tab 3:Psychotropic
(cid:129)Serotonin Syndrome 8 Drugs D–G 55
(cid:129)Treatment-Emergent (cid:129)Desipramine 55
Diabetes 9 (cid:129)Desvenlafaxine 57
(cid:129)Antiparkinsonian Agents 9 (cid:129)Dextroamphetamine 59
(cid:129)Drug-Herbal Interactions 10 (cid:129)Diazepam 61
(cid:129)Therapeutic Drug Classes 10 (cid:129)Donepezil 63
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(cid:129)Doxepin 65 (cid:129)Oxazepam 126
(cid:129)DULoxetine 68 (cid:129)Paliperidone 128
(cid:129)Escitalopram 70 (cid:129)Paroxetine HCl 131
(cid:129)Eszopiclone 72 (cid:129)Perphenazine 135
(cid:129)FLUoxetine 73 (cid:129)Phenelzine 137
(cid:129)FluPHENAZine 76 (cid:129)Pimozide 139
(cid:129)Flurazepam 79 (cid:129)Propranolol 142
(cid:129)FluvoxaMINE 81 (cid:129)QUEtiapine 144
(cid:129)Gabapentin 83
Tab 6:Psychotropic
(cid:129)Galantamine 85
Drugs R–Z 147
Tab 4:Psychotropic (cid:129)Ramelteon 147
Drugs H–M 87 (cid:129)Risperidone 148
(cid:129)Haloperidol 87 (cid:129)Rivastigmine 151
(cid:129)HydrOXYzine 89 (cid:129)Selegiline Transdermal 153
(cid:129)Imipramine 91 (cid:129)Sertraline 155
(cid:129)Isocarboxazid 94 (cid:129)Temazepam 160
(cid:129)LamoTRIgine 96 (cid:129)Thiamine [Vitamin] 162
(cid:129)Levomilnacipran 99 (cid:129)Thioridazine 164
(cid:129)Lisdexamfetamine 101 (cid:129)Thiothixene 166
(cid:129)Lithium 103 (cid:129)Topiramate 168
(cid:129)LORazepam 106 (cid:129)Tranylcypromine 170
(cid:129)Loxapine 108 (cid:129)Trazodone 172
(cid:129)Lurasidone 110 (cid:129)Triazolam 174
(cid:129)Memantine 112 (cid:129)Trihexyphenidyl 176
(cid:129)Methylphenidate 114 (cid:129)Valbenazine 178
(cid:129)Mirtazapine 117 (cid:129)Valproates 179
(cid:129)Molindone 119 (cid:129)Venlafaxine 182
(cid:129)Vortioxetine 185
Tab 5:Psychotropic
(cid:129)Zaleplon 187
Drugs N–Q 121
(cid:129)Ziprasidone 189
(cid:129)Nortriptyline 121
(cid:129)Zolpidem 191
(cid:129)Olanzapine (with fluoxetine) 123
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Tab 7:Labs/Protocols 195 Tab 8:Tools 203
(cid:129)Therapeutic Plasma Levels: (cid:129)Trade Names to Generic
Mood Stabilizers 195 Names (Drugs A–Z) 203
(cid:129)Plasma Levels/Laboratory (cid:129)Abbreviations 204
Test Monitoring 195 (cid:129)Psychotropic Approximate
(cid:129)Disorders and Labs/Tests Dose Equivalences 207
Performed 195 (cid:129)Pregnancy Categories and
(cid:129)Clozapine Risk Evaluation Controlled Substances
and Mitigation Strategy Schedules 209
(REMS) Program 197 (cid:129)BMI/Metabolic Syndrome 211
(cid:129)Common Laboratory Values 197 (cid:129)MAOI Diet (Tyramine)
(cid:129)General Chemistry 197 Restrictions 213
(cid:129)Hematology 199 (cid:129)Nonpharmacological
(cid:129)Treatment Algorithms in Treatments of Depression/
Psychopharmacology 200 Other Disorders 214
(cid:129)IPAP Schizophrenia (cid:129)References 215
Algorithm 201 (cid:129)Index 218
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Pharmacokinetics/Pharmacodynamics 1
Basics of Psychopharmacology/Biology
and Drug Classes
Pharmacokinetics/Pharmacodynamics
Pharmacokinetics (PK)can be defined as “how the body processes a drug” result-
ing in a drug’s concentration in the body. This is done through absorption, distribu-
tion, metabolism, and excretion (ADME).
Absorption: Describes the drug’s movement from point of administration (oral,
injection, skin) until it reaches the bloodstream. In oral administration, first-pass
metabolismrefers to how much of the drug is metabolized by the liver and there-
fore is not available to the bloodstream (bioavailability of drug). This determines the
dose needed for oral administration or the need for an alternative route of entry (such
as parenteral).
Distribution: Movement of drug from the bloodstream to the rest of the body.
Concerned with movement over the blood-brain barrier (may affect the brain) or
crossing the placenta (may affect the fetus). Also concerns highly protein-bound
drugs that may cause drug interactions.
Metabolism and Excretion:The primary organ of metabolism is the liver, and excre-
tion of drugs takes place through the kidneys. Dosing considerations are based on
how well the liver and kidneys are functioning. Half-life is also a factor as drugs with
long half-lives may accumulate, resulting in overdose or toxicity.
Half-lifeis the time (hours) that it takes for 50% of a drug to be eliminated from the
body. Time to total elimination involves halving the remaining 50%, and so forth,
until total elimination. Half-life is considered in determining dosing frequency and
in determining time to steady state. The rule of thumb for steady state(stable
concentration/manufacture effect) attainmentis 4–5 half-lives.Because of fluox-
etine’s long half-life, a 5-week washout is recommended after stopping fluoxetine
and before starting an MAOI to avoid a serious and possibly fatal reaction.
Protein Bindingis the amount of drug that binds to the blood’s plasma proteins; the
remainder circulates unbound. It is important to understand this concept when pre-
scribing two or more highly protein-bound drugs as one drug may be displaced,
causing increased blood levels and adverse effects.
Pharmacodynamicsis usually defined as “what the drug does to the body” and
therefore the effect the drug has on the body (positive effects and side effects).
BASICS