Antidepressants And Antipsychotic

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• Give with a full glass (240 mL) of water or with food or milk.
• Taper dosing regimen when discontinuing therapy. Abrupt termination can initiate extrapyramidal symptoms.

.decrease hallucinations, insomnia, hostility, agitation, and delusions.
•*******Monitor for neuroleptic malignant syndrome (NMS) (fatal complication: hyperrexia, altered mental status, muscle rigidity irregular, irregular pulse, fluctuating BP, diaphresis & tachtcardia), especially in those with hypertension or taking lithium. Symptoms of NMS can appear suddenly after initiation of therapy or after months or years of taking neuroleptic (antipsychotic) medication. Immediately discontinue drug if NMS suspected.
• Monitor for parkinsonism and tardive dyskinesia (extrapyramidal symptom manifested by involunary rhythmic, bizzrre movement of face, jaw, mouth, tongue, & sometimes extremities.). Risk of tardive dyskinesia appears to be greater in women receiving high doses and in older adults. It can occur after long-term therapy and even after therapy is discontinued.
•***** Monitor for extrapyramidal (neuromuscular) reactions that occur frequently during first few days of treatment. Symptoms are usually dose related and are controlled by dosage reduction or concomitant administration of antiparkinson drugs.
• Be alert for behavioral changes in patients who are concurrently receiving antiparkinson drugs.
• Monitor for exacerbation of seizure activity.
• Observe patients closely for rapid mood shift to depression when haloperidol is used to control mania or cyclic disorders. Depression may represent a drug adverse effect or reversion from a manic state.
• Lab tests: Monitor WBC count with differential and liver function in patients on prolonged therapy.
Patient & Family Education
• Avoid use of alcohol during therapy.
• Do not drive or engage in other potentially hazardous activities until response to drug is known.
• Discuss oral hygiene with health care provider; dry mouth may promote dental problems. Drink adequate fluids.
• Avoid overexposure to sun or sunlamp and use a sunscreen; drug can cause a photosensitivity reaction.

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Haloeridol(Haldol)

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• Give with or immediately after food to reduce possibility of GI irritation. Tablet may be crushed if patient is unable to take it whole; administer with food or fluid.
• Give increased doses preferably in late afternoon or at bedtime due to sedative action that precedes antidepressant effect.
• Give as single dose at bedtime to promote sleep or for patients with dizziness or when daytime sedation interferes with work productivity.
• Note that dose is usually tapered over 2 wk at discontinuation to prevent withdrawal symptoms (headache, nausea, malaise, musculoskeletal pain, panic attack, weakness).

• Monitor therapeutic effectiveness. It may take 1–6 wk to reduce attacks when used for migraine prophylaxis.
• Monitor for S&S of drowsiness and dizziness (initial stages of therapy); institute measures to prevent falling. Also monitor for overdose or suicide ideation in patients who use excessive amounts of alcohol.
• Lab tests: Baseline and periodic leukocyte and differential counts; renal and hepatic function tests; eye examinations (including glaucoma testing); recommended particularly for older adults, adolescents, and patients receiving high doses/prolonged therapy.
• Monitor BP and pulse rate in patients with preexisting cardiovascular disease. Assess for orthostatic hypotension especially in older adults. Withhold drug if there is a rise or fall in systolic BP (by 10–20 mm Hg), or a sudden increase or a significant change in pulse rate or rhythm. Notify physician.
• Monitor I&O, including bowel elimination pattern.
Patient & Family Education
• Monitor weight; drug may increase appetite or a craving for sweets.
• Understand that tolerance/adaptation to anticholinergic actions (see Appendix F) usually develops with maintenance regimen. Keep physician informed.
• Relieve dry mouth by taking frequent sips of water and increasing total fluid intake.
• Make position change slowly and in stages to prevent dizziness.
• Do not drive or engage in potentially hazardous activities until response to drug is known.
• Do not use OTC drugs without consulting physician while on TCA therapy; many preparations contain sympathomimetic amines.
• Note: it may turn urine blue-green.

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(Tricyclic Antidepressants)
Amitriptyline HCL (Elavil)

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• Give as a single dose in morning. Give in two divided doses; one in a.m. and one at noon to prevent insomnia, when more than 20 mg/d prescribed.
- may cause sexual dysfunction.
• Provide suicidal or potentially suicidal patient with small quantities of prescription medication.
• Monitor for worsening of depression or expression of suicidal ideations.
• Use with caution in the older adult patient or patient with impaired renal or hepatic function (may need lower dose).
• Use with caution in anorexic patient, since weight loss is a possible side effect.
• Monitor for S&S of anaphylactoid reaction (excessive allergic response : wheezing, chills, generalized pruritic urticaria, diaphoresis, sense of uneasy agitation, flushing, palpitations, coughing, difficulty breathing, cardiovascular collapse.).
- should not admit with MAOI med.
• Lab tests: Periodic serum electrolytes; monitor closely plasma glucose in diabetes.
• Monitor serum sodium level for development of hyponatremia, especially in patients who are taking diuretics or are otherwise hypovolemic.
• Monitor diabetics for loss of glycemic control; hypoglycemia has occurred during initiation of therapy, and hyperglycemia during drug withdrawal.
• Monitor for S&S of improved affect. Requires approximately 2–3 wk for therapeutic effects to be felt.
• Weigh weekly to monitor weight loss, particularly in the older adult or nutritionally compromised patient. Report significant weight loss to physician.
• Observe for and promptly report rash or urticaria and S&S of fever, leukocytosis, arthralgias(pain in 1 or more joints), carpal tunnel syndrome, edema, respiratory distress, and proteinuria. Drug may have to be discontinued or adjunctive therapy instituted with steroids or antihistamines.
• Observe for dizziness and drowsiness and employ safety measures (up with assistance, side rails, etc.) as indicated.
• Monitor for and report increased anxiety, nervousness, or insomnia; may need modification of drug dose.
• Monitor for seizures in patients with a history of seizures. Use appropriate safety precautions.
• Supervise patients closely who are high suicide risks; especially during initial therapy.
• Monitor patients with hepatic or renal impairment carefully for S&S of toxicity (e.g., agitation, restlessness, nausea, vomiting, seizures).
Patient & Family Education
• Notify physician of intent to become pregnant.
• Notify physician of any rash; possible sign of a serious group of adverse effects.
• Do not drive or engage in potentially hazardous activities until response to drug is known; especially if dizziness noted.
• Monitor blood glucose for loss of glycemic control if diabetic.
• Note: Drug may increase seizure activity in those with history of seizure.

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Selective Serotonin Reuptake inhibitor (SSRI antidepressant)
Fluoxetine Hydrochloride (Prozac)