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107 Cards in this Set
- Front
- Back
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Short-acting Benzodiazepines
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Lorazepam (Ativan); Aprazolam (Xanax); Oxazepam (Serax)
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Oxazepam (Serax)
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Short-acting benzodiazepine cleared through the kidneys; Dose mg/day = 30-60
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Aprazolam (Xanax)
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Short-acting benzodiazepine; Dose mg/day = 0.25 - 4.0
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Long-acting Benzodiazepines
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Diazepam (Valium); Chlordiazepoxide (Librium)
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Diazepam (Valium)
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Long-acting benzodiazepine; Dose mg/day = 4-30
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Chlordiazepoxide (Librium)
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Long-acting benzodiazepine; Dose mg/day = 30-60
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ETOH detox medications
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diazepam (Valium); lorazepam (Ativan); oxazepam (Serax); carbamazepine (Tegretol);Thiamine; Magnesium; Antabuse; naltrexone (Revia)
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Effects of diazepam (Valium) in ETOH detox
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raises seizure threshold; IM less effective than PO, erratic release from fat stores
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Effects of lorazepam (Ativan) in ETOH detox
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short acting, use with liver damage (because does not metabolize through the liver)
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Effects of oxazepam (Serax) in ETOH detox
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cleared through the kidneys; use with liver failure
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Effects of carbamazepine (Tegretol) in ETOH detox
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Use for hx of multiple withdrawals; prevents kindling effect in limbic system
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Effects of Thiamin in ETOH detox / dosage
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Replenish liver stores. give for 10 days, 100 mg/day
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Effects of magnesium on ETOH detox
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Low Mg will contribute to DT's; Give IM or IV for 3 days when indicated.
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Effects of Antabuse
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for chronic ETOH dependence relapse; someone else should administer; stops the breakdown of acetaldehyde: Drinking, using OTC meds or mouthwash with alcohol in them or cologne can lead to hypertensive crisis.
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Effects of naltexone (Revia) in ETOH detox
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Blocks opiate receptors and relieves craving. Discontinue before surgery or opiate analgesics won't work
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Anti-anxiety medications
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benzodiazepines; busprone (BuSpar); hydroxyzine (Vistaril); propanolol (Inderol); Antidepressants
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Uses for Busprone (BuSpar) / Dose mg/day =
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Anti-anxiety; non-addictive; for longer term use; Do not use PRN. Also used in dementia. Dose = 15-80 mg/day
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Uses for hydroxyzine (Vistaril) / Dose mg/day =
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Anti-anxiety med. Dose = 200-400 mg/day
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Uses for propanolol (Inderol); Drug class
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Anti-anxiety; Drug class beta-blocker/anti-HTN
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Uses for antidepressants in anti-anxiety tx
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used selectively to treat panic, phobias, OCD, PTSD
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Psychopharmacology for Mania; Meds =
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Lithium; Mood Stabilizers/anticonvulsants
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Lithium - description
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A naturally occurring salt used for tx of mania
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Lithium theraputic level
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0.4 - 1.0 meq/L;
Theraputic level very close to toxic level |
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Considerations when Lithium is used
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Kidney function must be normal, with fluid intake at 3 liters/day; Blood draws every 2 weeks; sx lag 2 weeks after theraputic level reached; cut dose in half during depressive episodes
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Early signs of lithium toxicity
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Nausea, vomiting, diarrhea, thirst, slurred speech, muscle weakness
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Interventions for early signs of lithium toxicity
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At less than 1.5 mEq/L, Withhold drug, draw blood level, re-evaluate dose
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Advanced signs of Lithium toxicity
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Coarse hand tremor; persistent GI upset; mental confusion; Muscle hyper-irritability; EEG changes; uncoordination
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Signs of severe lithium toxicity
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Ataxia; blurred vision; oliguria; severe hypotension; seizures; stupor; coma to cardiac arrhythmia; circulatory collapse; death
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Interventions for severe lithium toxicity / Blood level
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Blood level 2.0 or higher
No know antidote. Hemodialysis may be necessary |
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Uses for carbamazepine (Tegretol)
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Anticonvulsant effective in tx of mania and aggression
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Considerations when using carbamazepine (Tegretol)
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Monitor blood levels first 8 weeks
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Side effects of carbamazepine (Tegretol)
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Sedation; diplopia; uncoordination; agranulocytosis; aplastic anemia
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Uses for valporic acid (Depakote)
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Anticonvulsant effective in mania and aggression
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Considerations when using valporic acid (Depakote)
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Monitor liver functions
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Side effects of valporic acid (Depakote)
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Tremors; GI upset; wt. gain; alopecia; hepatitis
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Tricyclic antidepressants (TCA)
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Amitryptyline (Elavil); Doxepine (Sinequan)
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Second Generation (Atypical) antidepressants
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Maprotyline (Ludiomil); Desyrel (Trazadone)
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SSRI: Selective Serotonin Re-uptake Inhibitors
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Fluoxetine (Prozac); Sertraline (Zoloft)
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Important drug interaction consideration with SSRI's and SSNRI's
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FATAL W/ MAOI'S
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SSNRI: Selective Serotonin/Norepinephrine Re-uptake Inhibitors
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Venlafixine (Effexor)
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Side-effects for amitryptyline (Elavil) / Sedation; cardiac conduction abnormalities; 3;Anticholenergic; Orthostatic hypotension = rated from 0-3; 1=low, 2=moderate, 3=high
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sedation = 3; cardiac conduction abnormalities = 3; anticholinergic = 3; orthostatic hypotension = 2
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Side-effects for doxepine (Sinequan) / Sedation; cardiac conduction abnormalities;Anticholinergic; Orthostatic hypotension = rated from 0-3; 1=low, 2=moderate, 3=high
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sedation = 2; cardiac conduction abnormalities = 0;anticholinergic = 1; orthostatic hypotension = 1
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Side-effects for maprotyline (Ludiomil) / Sedation; cardiac conduction abnormalities;Anticholinergic; Orthostatic hypotension = rated from 0-3; 1=low, 2=moderate, 3=high
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sedation = 2; cardiac conduction abnormalities = 2;anticholinergic = 3; orthostatic hypotension = 1
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Side-effects for desyrel (Trazadone) / Sedation; cardiac conduction abnormalities;Anticholinergic; Orthostatic hypotension = rated from 0-3; 1=low, 2=moderate, 3=high
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sedation = 3; cardiac conduction abnormalities = 0;anticholinergic = 0; orthostatic hypotension = 2
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Side-effects for fluoxetine (Prozac) / Sedation; cardiac conduction abnormalities;Anticholinergic; Orthostatic hypotension = rated from 0-3; 1=low, 2=moderate, 3=high
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sedation = 0; cardiac conduction abnormalities = 0;anticholinergic = 1; orthostatic hypotension = 1
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Side-effects for sertraline (Zoloft) / Sedation; cardiac conduction abnormalities;Anticholinergic; Orthostatic hypotension = rated from 0-3; 1=low, 2=moderate, 3=high
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Sedation = 0;cardiac conduction abnormalities = 1; Anticholinergic = 1 ;Orthostatic hypotension = 1
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Side-effects for venlafixine (Effexor) / Sedation; cardiac conduction abnormalities;Anticholinergic; Orthostatic hypotension = rated from 0-3; 1=low, 2=moderate, 3=high
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Sedation = 1; cardiac conduction abnormalities = 0;Anticholinergic = 1 ;Orthostatic hypotension = 0
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Considerations for maprotyline (Ludiomil)
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Toxic in OD
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Considerations for doxepine (Sinequan)
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Toxic in OD; anxiety and depression
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Considerations for sertraline (Zoloft)
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+ insomnia
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Considerations for venlafixine (Effexor)
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MAOI- fatal rx
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Dose ranges for amitryptyline (Elavil)
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50 - 150 mg per day; max dose 300 mg/day
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Dose ranges for doxepine (Sinequan)
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50-150 mg/day; max dose 100-200 mg/day
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Dose ranges for maprotyline (Ludiomil)
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50-150 mg/day; max dose 225 mg/day
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Dose ranges for desyrel (Trazadone)
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150 mg/day; max dose 400-600 mg/day
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Dose ranges for fluoxetine (Prozac)
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20 mg/day; max dose 80 mg/day
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Dose ranges for sertraline (Zoloft)
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50 mg/day; max dose 200 mg/day
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dose ranges for venlafixine (Effexor)
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75 mg/day; max dose 375 mg/day
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3 antipsychotic classes
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Phenothiazines; Butyrophenones; Atypical Antipsychotics
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Phenothiazines
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Chlorpromazine (Thorazine); Thioridazine (Mellaril); Fluphenazine (Prolixin)
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Butyrophenones
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Haloperidol (Halidol);
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Atypical Antipsychotics
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Clozapine (Clozaril); Respiridone (Resperidal); Olanzapine (Zyprexia)
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dosage for chlorpromazine (thorazine) ~ acute/maintainence
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Acute = 200-1600 mg/day; Maintenence = 50-800 mg/day
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dosage for thioridazine (Mellaril) ~ acute/maintainence ~
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Acute = 200-600 mg/day; Maintenence = 50-800 mg/day ~
Route = PO |
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dosage for Fluphenazine (Prolixin) ~ acute/maintainence ~
Route |
Acute = 2.5 - 20 mg/day; Maintenence = 2-40 mg/day
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Butyrophenones
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Haloperidol (Halidol);
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Atypical Antipsychotics
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Clozapine (Clozaril); Respiridone (Resperidal); Olanzapine (Zyprexia)
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dosage for chlorpromazine (thorazine) ~ acute/maintainence
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Acute = 200-1600 mg/day; Maintenence = 50-800 mg/day
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dosage for thioridazine (Mellaril) ~ acute/maintainence ~
Route |
Acute = 200-600 mg/day; Maintenence = 50-800 mg/day ~
Route = PO |
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dosage for Fluphenazine (Prolixin) ~ acute/maintainence ~
Route |
Acute = 2.5 - 20 mg/day; Maintenence = 2-40 mg/day
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dosage for haloperidol(Halidol) ~ acute/maintainence ~
Route |
Acute dose = 5-50 mg/day; maintenance = 1-15 mg/day;
route = PO; IM; Decanoate, 25 mg z-track IM q 4 weeks |
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dosage for respiridone (Resperidal) ~ acute/maintainence ~
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Acute dose = (not given) mg/day; maintenance = 4-6 mg/day;
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dosage for clozapine (Clozaril) ~ acute/maintainence ~
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Acute dose = 300-900 mg/day; maintenance = 200-400 mg/day;
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dosage for Olanzapine (Zyprexia) ~ acute/maintainence ~
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Acute dose = 10-20 mg/day; maintenance = 12.5 - 29 mg/day;
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Indications and side effect for chlorpromazine (Thorazine)
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Lowers seizure threshold; Photosensitivity; stopping suddenly and restarting can cause "thorazine shuffle" which is permanent
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Side effect of thioridazine (Mellaril)
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may lengthen QT interval; Possible torsades de pontes
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what medications are long-acting in oil
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Decanoates ~ specifically fluphenazine (Prolixin) and haloperidol (Halidol)
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Side effects of clozapine (Clozaril)
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Agranulocytosis; Seizures; blood dyscrasias
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Side effects of respiridone (Respiridal)
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Insomnia; agitation; wt. gain
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Side effects of olanzapine (Zyprexia)
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Agitation; insomnia; interacts w/ antidepressants
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Phenothiazines used to treat...
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positive sx; lower dose in elderly
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Atypical antipsychotics used to treat...
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negative and positive sx
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Monoamine Oxidase Inhibitors: MAOI's
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Marplan; phenelzine (Nardil); tranylcypromine (Parnate); St John's Wort
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Dose range for phenelazine (Nardil)
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45-90 mg/day
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Dose range for tranylcypromine (Parnate)
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30
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Side-effects for phenelzine (Nardil) / Sedation; Cardiac conduction; Anticholinergic; Orthostatic hypotension = rated from 0-3; 1=low, 2=moderate, 3=high
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Sedation = 2
Cardiac conduction = 0 Anticholinergic = 0 Orthostatic hypotension =3 |
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Side-effects for tranylcypromine (Parnate) / Sedation; Cardiac conduction; Anticholinergic; Orthostatic hypotension = rated from 0-3; 1=low, 2=moderate, 3=high
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Sedation = 0
Cardiac conduction = 0 Anticholinergic = 0 Orthostatic hypotension =3 |
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Important precaution for MAOI's
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interact with Tyramine to yield hypertensive crisis
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sx of hypertensive crisis
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sever HA, stiff/sore neck, flushed, tachycardia, nosebleed, pupils dilate, chest pains, stroke, coma, death
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tx for hypertensive crisis
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treat as an emergency with IV regitine, oral chlorpromazine (Thorazine), IV Nifedipine
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Drugs that interact with MAOI's
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OTC meds for congestion; Antidepressants; Amine precursors (levodopa, L-tryptophan); Narcotics; Anesthetics; Sedatives (incl ETOH); anti-HTNs; Stimulants
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Unsafe foods to eat with MAOI's ~ contain tyramine or other vasopressors~ (vegetable category)
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avocados, fermented bean curd, fermented soybean paste, sauerkraut
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Unsafe foods to eat with MAOI's ~ contain tyramine or other vasopressors~ (fruit category)
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figs, bananas
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Unsafe foods to eat with MAOI's ~ contain tyramine or other vasopressors~ (meat category)
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fermented, smoked, aged meats/liver
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Unsafe foods to eat with MAOI's ~ contain tyramine or other vasopressors~ (dairy category)
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practically all cheeses
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Unsafe foods to eat with MAOI's ~ contain tyramine or other vasopressors~ (yeast category)
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yeast extract, but baked goods containing yeast are ok
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Unsafe foods to eat with MAOI's ~ contain tyramine or other vasopressors~ (alcoholic beverages category)
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some imported beers, Chianti
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Unsafe foods to eat with MAOI's ~ contain tyramine or other vasopressors~ (Misc. category)
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protein supplements, soups, shrimp paste, soy sauce, chocolate, fava beans, ginsing, caffeine (in large amounts
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Antihypertensives (interact w/ MAOI's)
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Methyldopa; guanethidine; resperpine
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Important interaction warnine r/t MAOI's
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DO NOT TAKE ANTIDEPRESANTS (TCA, SSRA, SSNRI) WITHIN 14 DAYS OF STOPPING MAOI'S
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Side effects for chlorpromazine (Thorazine);
EPS; Anticholinergic; sedatation; hypotensive ~rated 1=low, 2=mod, 3=high |
EPS = 2
Anticholinergic = 2 Sedative = 3 Hypotensive = 3 |
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Side effects for thioridazine (Mellaril)
EPS; Anticholinergic; sedatation; hypotensive ~rated 1=low, 2=mod, 3=high |
EPS =
Anticholinergic = 3 Sedative = 3 Hypotensive = 3 |
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Side effects for fluphenazine (Prolixin)
EPS; Anticholinergic; sedatation; hypotensive ~rated 1=low, 2=mod, 3=high |
EPS = 3
Anticholinergic = 1 Sedative = 1 Hypotensive = 1 |
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Side effects for haloperidol (Halidol)
EPS; Anticholinergic; sedatation; hypotensive ~rated 1=low, 2=mod, 3=high |
EPS = 3
Anticholinergic = 0 Sedative = 1 Hypotensive = 1 |
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Side effects for clozapine (Clozaril);
EPS; Anticholinergic; sedatation; hypotensive ~rated 1=low, 2=mod, 3=high |
EPS = 0
Anticholinergic = 0 Sedative = 1 Hypotensive = 1 |
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Side effects for respiridone (Resperidal);
EPS; Anticholinergic; sedatation; hypotensive ~rated 1=low, 2=mod, 3=high |
EPS = 1
Anticholinergic = 1 Sedative = 1 Hypotensive = 1 |
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Side effects for olanzapine (Zyprexia);
EPS; Anticholinergic; sedatation; hypotensive ~rated 1=low, 2=mod, 3=high |
EPS = 2
Anticholinergic = 2 Sedative = 3 Hypotensive = 3 |
