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A n t i p s y c h o t i c s

Aripiprazole (Abilify, Abilify disulfiram, omeprazole, valproic narcotics, phenothiazine


DISCMELT) acid, ciprofloxacin, erythromycin, cimetidine, disulfiram,
Drug Classification: Antipsychotics clarithromycin, phenytoin, fluconazole, itraconazole,
Use: Treatment of schizoprenia, acute & verapamil, grapefruit juice; ↑ risk ketoconazole, OCPs, INH,
mixed episodes associated w/ OF ketoconazole, itraconazole, metoprolol, propoxyphene,
bipolar disorder. Treatment of digitalis tox, ↓ effectiveness OF propranolol, valproic acid, EtOH,
schizophrenia in adolescent 13-17 levodopa; ↓ effect W/ grapefruit juice, kava kava,
yr. Adjunctive treatment of major carbamazepine, rifampin, valerian; ↑ effects OF digoxin,
depressive disorder in adult. rifabutin, barbiturates, cigarette phenytoin; ↓ effects W/
Acute & maintenance treatment smoking. aminophylline, antacids,
of manic & mixed episodes Laboratory Values: ↑ Alk phos, may carbamazepine, theophylline,
associated w/ bipolar disorder w/ cause ↓ Hct & neutropenia rifampin, rifabutin, tobacco; ↓
or w/o psychotic features in childn Nursing Intervention/Patient Education: effects OF levodopa
10-17 yr. Monitor for resp depression; avoid Laboratory Values: ↑ LFTs, alk phos,
Action: Benzodiazepine; antianxiety abrupt D/C after prolonged use bilirubin, triglycerides; ↓
agent granulocytes
Caution: Elderly patients w/ dementia- Chlorpromazine (Thorazine, Nursing Intervention/Patient Education:
related psychosis. Increased Largactil) Do not D/C abruptly; dilute PO
suicidality in patients w/ major Drug Classification: Antipsychotic, conc in 2–4 oz of Liq; risk of
depressive disorder. Neuroleptic Antiemetic/ Phenothiazine photosensitivity—use sunscreen;
Malignant syndrome, tardive Use: The management of psychotic risk of tardive dyskinesia; take w/
dyskinesia, hyperglycemia, DM, disorders including manifestations food if GI upset; may darken urine
orthostatic hypotension, of manic depressive illness, manic
seizures/convulsions. May impair phase and severe behavioral Clozapine (Clozaril, FazaClo)
ability to drive or operate problems in children; nausea and DrugClassification:Antipsychotic/Dibenzo
machinery. vomiting due to stimulation of the diazepine Derivative
Contraindication: Elderly patients with chemoreceptor trigger zone. Use: *Refractory severe schizophrenia*;
dementia-related psychosis Action: Benzodiazepine; antianxiety childhood psychosis; obsessive-
should not receive Abilify. Do not agent compulsive disorder, bipolar
take Abilify if you are allergic to Caution: Resp depression, CNS impair, disorder
this medication or any of its h/o of drug dependence; avoid in Action: “Atypical” TCA
ingredients. hepatic impair Caution: [B, +/−] Monitor for psychosis
Interaction: ↑ CNS depression W/ EtOH, Contraindication: Preexisting CNS & cholinergic rebound
other CNS depressants, narcotics, depression Contraindication: Uncontrolled epilepsy;
MAOIs, anesthetics, Interaction: ↑ Effects W/ comatose state; WBC <3500
antihistamines, theophylline, antidepressants, antihistamines, cells/mm3 and ANC <2000
herbs: kava kava, valerian; ↑ anticonvulsants, barbiturates, cells/mm3 before Rx or <3000
effect W/ OCPs, cimetidine, INH, general anesthetics, MAOIs, cells/mm3 during Rx
Interaction: ↑ Effects W/ clarithromycin, Laboratory Values: ↑ LFTs, ↓ HMG, Hct, Lithium Carbonate (Eskalith,
cimetidine, erythromycin, plts, WBC Lithobid)
fluoxetine, paroxetine, quinidine, Nursing Intervention/Patient Education: Drug Classification: Antipsychotic
sertraline; ↑ depressant effects Photosensitivity—use sunblock; Use: Manic episodes of bipolar Dz*,
W/ CNS depressants, EtOH; ↑ urine may turn pink or red, ↑ risk augment antidepressants,
effects OF digoxin, warfarin; ↓ of heatstroke in hot weather; less aggression, posttraumatic stress
effects W/ carbamazepine, sedative/hypotensive than disorder
phenytoin, primidone, chlorpromazine Action: Effects shift toward intraneuronal
phenobarbital, valproic acid, St. metabolism of catecholamines
John’s Wort, nutmeg, caffeine; ↓ Haloperidol (Haldol) Caution: [D, −] Many drug interactions;
effects OF phenytoin Drug Classification: avoid ACE inhibitor or diuretics;
Laboratory Values: Monitor WBCs; Antipsychotic/Butyrophenone thyroid Dz
weekly CBC mandatory 1st 6 mo, Use: Psychotic disorders, agitation, Contraindication: Severe renal impair or
then qowk Tourette disorders, hyperactivity CV Dz, lactation
Nursing Intervention/Patient Education: in children Interaction: ↑
↑ Risk of developing Action: Butyrophenone; antipsychotic, Effects OF TCA; ↑ effects W/ ACEIs,
agranulocytosis; avoid activities neuroleptic bumetanide, carbamazepine,
where sudden loss of Caution: ↑ Effects w/ SSRIs, CNS ethacrynic acid, fluoxetine,
consciousness could cause harm; depressants, TCA, indomethacin, furosemide, methyldopa, NSAIDs,
benign temperature ↑ may occur metoclopramide; avoid levodopa phenytoin, phenothiazine,
during the 1st 3 wk of Rx (↓ antiparkinsonian effects) probenecid, tetracyclines, thiazide
Contraindication: NAG, severe CNS diuretics, dandelion, juniper; ↓
Fluphenazine (Prolixin, Permitil) depression, coma, Parkinson Dz, effects W/ acetazolamide,
Drug Classification: BM suppression, severe antacids, mannitol, theophylline,
Antipsychotic/Phenothiazine cardiac/hepatic Dz urea, verapamil, caffeine
Use: Schizophrenia Interaction: ↑ Effects W/ CNS Laboratory Values: ↑ Serum glucose, I-
Action: Phenothiazine antipsychotic; depressants, quinidine, EtOH; ↑ 131 uptake, WBC; ↓ uric acid, T3,
blocks postsynaptic mesolimbic hypotension W/ antihypertensives, T4
dopaminergic brain receptors nitrates; ↑ anticholinergic effects Nursing Intervention/Patient Education:
Caution: W/ antihistamines, Several wk before full effects of
Contraindication: Severe CNS antidepressants, atropine, med, ↑ fluid intake to 2–3 L/d
depression, coma, subcortical phenothiazine, quinidine,
brain damage, blood dyscrasias, disopyramide; ↓ effects W/ Molindone (Moban)
hepatic Dz, w/ caffeine, tannic antacids, carbamazepine, Li, Drug Classification: Antipsychotic
acid, or pectin-containing nutmeg, tobacco; ↓ effects OF Use: Schizophrenia
products anticoagulants, levodopa, Action: Piperazine phenothiazine
Interaction: ↑ Effects W/ antimalarials, guanethidine Caution: [C, ?] NAG
BBs, CNS depressants, EtOH, kava Laboratory Values: ↑ LFTs Contraindication: Drug/EtOH CNS
kava; ↑ effects OF Nursing Intervention/Patient Education: depression, coma
anticholinergics, BBs, nitrates; ↓ ↑ Risk of photosensitivity—use Interaction: ↑ Effects W/
effects W/ antacids, caffeine, sunblock; do not give decanoate antihypertensives; ↑
tobacco; ↓ effects OF IV; dilute PO conc liq w/ H2O/juice; hyperkalemia W/ K-sparing
anticonvulsants, guanethidine, monitor for EPS; ECG monitoring diuretics, K supls, salt substitutes,
levodopa, sympathomimetics w/ off-label IV use
trimethoprim; ↑ effects OF insulin, Contraindication: Risperidone Prochlorperazine (Compazine)
Li; ↓ effects W/ ASA, NSAIDs hypersensitivity, w/ Drug Classification: Antiemetic,
Laboratory Values: ( Lipid profile, phenothiazines, ranolazine, Antipsychotic/ Phenothiazine
fasting glucose, HgA1c; may ↑ ziprasidone, prolonged QT, h/o Use: N/V, agitation, & psychotic
prolactin; ↑ Serum K+, BUN, Cr arrhythmia disorders
Nursing Intervention/Patient Education: Interaction: ↑ Risk of prolongation of QT Action: Phenothiazine; blocks
Take w/o food; monitor for interval W/ class 1A & class III postsynaptic dopaminergic CNS
persistent cough antiarrhythmics, chlorpromazine, receptors
thioridazine, gatifloxacin, Caution: [C, +/−] NAG, severe
Olanzapine (Zyprexa, Zyprexa moxifloxacin, EtOH; ↓ effects OF liver/cardiac Dz
Zydis) levodopa & other dopamine Contraindication: Phenothiazine
Drug Classification: Antipsychotic/ agonists sensitivity, BM suppression; age
Thienobenzodiazepine Laboratory Values: ↑ Serum glucose, <2 y or wgt <9 kg
Use: Bipolar mania, schizophrenia, LFTs Interaction: ↑ Effects W/ chloroquine,
psychotic disorders, acute Nursing Intervention/Patient Education: indomethacin, narcotics,
agitation in schizophrenia Do not chew/cut/crush pill; procarbazine, SSRIs,
Action: Dopamine & serotonin antagonist monitor for orthostatic effects & pyrimethamine; ↑ effect OF
Caution: [C, −] renal Fxn esp in elderly antidepressants, BBs, EtOH; ↓
Interaction: ↑ Effects W/ fluvoxamine; ↑ effects W/ antacids,
sedation W/ CNS depressants, Perphenazine (Trilafon) anticholinergics, barbiturates,
EtOH; ↑ Szs W/ anticholinergics, Drug Classification: Antipsychotic, tobacco; ↓ effects OF
CNS depressants; ↑ hypotension Antiemetic/Phenothiazine guanethidine, levodopa, Li
W/ antihypertensives, diazepam; Use: Psychotic disorders, severe N, Laboratory Values: False(+) urine
↓ effects W/ activated charcoal, intractable hiccups bilirubin, amylase,
carbamazepine, omeprazole, Action: Phenothiazine, blocks brain phenylketonuria, ↑ serum
rifampin, St. John’s wort, tobacco; dopaminergic receptors prolactin
↓ effects OF dopamine agonists, Caution: [C, ?/−] NAG, severe ↑/↓BP Nursing Intervention/Patient Education:
levodopa Contraindication: henothiazine N D/C abruptly; risk of
Laboratory Values: ↑ LFTs sensitivity, BM depression, severe photosensitivity—use sunblock;
Nursing Intervention/Patient Education: liver or cardiac Dz urine may turn pink/red
↑ Risk of tardive dyskinesia, Interaction: ↑ Effects W/
photosensitivity—use sunscreen, antidepressants; ↑ effects OF Quetiapine (Seroquel, Seroquel
body temp impairment; takes anticholinergics, antidepressants, XR)
weeks to titrate dose; smoking ↓ propranolol, phenytoin; ↑ CNS Drug Classification : Antipsychotic
levels; may be confused w/ Zyrtec effects W/ CNS depressants, EtOH; Uses: Acute exacerbations of
↓ effects W/ antacids, Li, schizophrenia
Paliperidone (Invega) phenobarbital, caffeine, tobacco; Action: Serotonin & dopamine
Drug Classification: ↓ effects OF levodopa, Li antagonism
Use: Schizophrenia Laboratory Values: ↑ Serum cholesterol, Caution: [C, −] CI: Component allergy
Action: Risperidone metabolite, glucose, LFTs; ↓ HMG, plts, WBCs Interactions: ↑ Effects W/ azole
antagonizes dopamine & Nursing Intervention/Patient Education: antifungals, cimetidine,
serotonin receptors Take oral dose w/ food; risk of macrolides, EtOH; ↑ effects OF
Caution: [C; ?/−] w/ Bradycardia, ↓ photosensitivity—use sunblock antihypertensives, lorazepam; ↓
K+/Mg2+, renal/hepatic impair effects W/ barbiturates,
carbamazepine, glucocorticoids, ↓ effects W/ barbiturates, Li, Action: Phenothiazine; blocks
phenytoin, rifampin, thioridazine; tobacco; ↓ effects OF levodopa postsynaptic CNS dopaminergic
↓ effects OF dopamine Labs: ↑ Serum LFTs; ↓ HMG, Hct, plts, receptors
antagonists, levodopa WBC Caution: [C, ?/−]
Labs: ↑ LFTs, cholesterol, triglycerides NIPE: ↑ Risk of photosensitivity—use CI: h/o Blood dyscrasias; phenothiazine
NIPE: ↑ Risk of cataract formation, sunblock, take w/ food; N D/C sensitivity
tardive dyskinesia; take w/o abruptly; ↓ temp regulation; urine Interactions: ↑ CNS depression W/
regard to food; ↓ body temp color change to reddish brown; barbiturates, benzodiazepines,
regulation avoid EtOH, dilute PO conc in 2–4 TCAs, EtOH; ↑ effects OF
oz Liq antihypertensives, propranolol, ↓
Risperidone, Oral (Risperdal, effects OF anticoagulants ↓
Risperdal M-Tab) Thiothixene (Navane) effects W/ antacids
Drug Classification: Antipsychotic Drug Classification: Labs: ↑ LFTs; ↓ WBCs
Uses: Psychotic disorders Antipsychotic/Thioxanthene NIPE: ↑ Risk of photosensitivity—use
(schizophrenia), dementia of the Uses: Psychosis sunblock; urine color may change
elderly, bipolar disorder, mania, Action: Antagonizes dopamine receptors to pink to reddish-brown; PO conc
Tourette disorder, autism Caution: [C, ?] Avoid w/ ↑ QT interval or must bediluted to 60 mL or more
Action: Benzisoxazole antipsychotic meds that can ↑ QT prior to administration; requires
Caution: [C, −], ↑ BP w/ CI: Phenothiazine sensitivity Drowsiness, several wk for onset of effects
antihypertensives, clozapine EPS most common; ↓ BP,
CI: Component allergy dizziness, drowsiness, neuroleptic Ziprasidone (Geodon)
Interactions: ↑ Effects W/ clozapine, CNS malignant synd, Szs, skin Drug Classification:
depressants, EtOH; ↑ effects OF discoloration, photosensitivity, Antipsychotic/Piperazine
antihypertensives; ↑ effects W/ constipation, sexual dysfunction, Derivative
carbamazepine; ↓ effects OF blood dyscrasias, pigmentary Uses: Schizophrenia, acute agitation
levodopa retinopathy, hepatic impair Action: Atypical
Labs: ↑ LFTs, serum prolactin Interactions: ↑ Effects W/ BBs; ↑ effects Caution: [C, −] w/ ↓ Mg2+, ↓ K+
NIPE: ↑ Risk photosensitivity—use OF anticholinergics, CI: QT prolongation, recent MI,
sunblock, extrapyramidal effects; antihistamines, antihypertensives, uncompensated HF, meds that ↑
may alter body temp regulation; CNS depressants, nitrates, EtOH; QT
several wks to see effect ↓ effects W/ barbiturates, Li, Interactions: ↑ Effects W/ ketoconazole;
tobacco, caffeine; ↓ effects OF ↑ effects OF antihypertensives; ↑
Thioridazine (Mellaril) levodopa CNS depression W/ anxiolytics,
Drug Classification : Labs: ↑ LFTs sedatives, opioids, EtOH; TCAs,
Antipsychotic/Phenothiazine NIPE: ↑ Risk of photosensitivity—use thioridazine; risk of prolonged QT
Action: Phenothiazine antipsychotic sunblock; take w/ food; N D/C W/ cisapride, chlorpromazine,
Caution:[C, ?] Phenothiazines, QTc- abruptly; ↓ temp regulation; clarithromycin, diltiazem,
prolonging agents, Al CI: darkens urine color; dilute PO erythromycin, levofloxacin,
Phenothiazine sensitivity conc immediately before use mefloquine, pentamidine, TCAs,
Interactions: ↑ Effects W/ BBs; ↑ effects thioridazine; ↓ effects W/
OF anticholinergics, Trifluoperazine (Stelazine) amphetamines, carbamazepine; ↓
antihypertensives, antihistamines, Drug Classification: effects OF levodopa
CNS depressants, nitrates, EtOH; Antipsychotic/Phenothiazine Labs: ↑ Glucose; monitor electrolytes
Uses: Psychotic disorders
NIPE: May take weeks before full effects,
take w/ food, ↑ risk of tardive
dyskinesia

A n t i d e p r e s s a n t s

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

Republic of the Philippines


UNIVERSITY OF NORTHERN PHILIPPINES
Heritage City of Vigan

COLLEGE OF NURSING

Central Nervous System


Agents
In Partial Fulfillment of the Requirements
of the Subject
Seminar in Nursing
Submitted to:
RHENE A. GAZMEN, RN
Instructor

Submitted by:
MA. LORRAINE B. ENCARNACION
BSN IV – E

December 16, 2010