Nursing Pharmacology- Psyche

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MAOI's
(monoamine oxidase inhibitors)

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The first type of antidepressant developed.
They have been replaced by antidepressants that are safer and cause fewer side effects.
MAOIs generally require diet restrictions because they can cause dangerously high blood pressure when taken with certain foods. In spite of side effects, these medications are still a good option for some people. In certain cases, they relieve depression when other treatments have failed.

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Common MAOI's

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Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam, Eldepryl, Zelapar)
Tranylcypromine (Parnate)

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Side Effects of MAOI's

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Daytime sleepiness
Dizziness or lightheadedness
Low blood pressure
Diarrhea
Dry mouth
Altered sense of taste
Nervousness
Muscle aches
Insomnia
Weight gain
Reduced sexual desire or difficulty reaching orgasm
Inability to maintain an erection (erectile dysfunction)
Difficulty urinating
Prickling or tingling sensation in the skin (paresthesia)

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SSRI's
(selective seratonin reuptake inhibitors)

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The most commonly prescribed antidepressants. They can ease symptoms of moderate to severe depression, are relatively safe and generally cause fewer side effects than other types of antidepressants.

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How SSRI's Work

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SSRIs ease depression by affecting chemical messengers (neurotransmitters) used to communicate between brain cells. Most antidepressants work by changing the levels of one or more of these naturally occurring brain chemicals.

SSRIs block the reabsorption (reuptake) of the neurotransmitter serotonin (ser-oh-TOE-nin) in the brain. Changing the balance of serotonin seems to help brain cells send and receive chemical messages, which in turn boosts mood. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters.

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Common SSRI's

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Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac, Prozac Weekly, Sarafem)
Paroxetine (Paxil, Paxil CR, Pexeva)
Sertraline (Zoloft)
Fluoxetine combined with the atypical antipsychotic olanzapine (Symbyax)

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Side Effects of SSRI's

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Nausea
Dry mouth
Headache
Diarrhea
Nervousness, agitation or restlessness
Reduced sexual desire or difficulty reaching orgasm
Inability to maintain an erection (erectile dysfunction)
Rash
Increased sweating
Weight gain
Drowsiness
Insomnia

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Clozapine
(Clozaril, Fazacio ODT)

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Clozapine is an anti-psychotic medication that works by blocking receptors in the brain for several neurotransmitters (chemicals that nerves use to communicate with each other)

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Clozapine is precribed for?

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Clozapine is use in the management of psychotic disorders including schizophrenia. Because of concern for the side effect of agranulocytosis (see side effects), clozapine should be reserved for patients who have failed to respond to other standard medications or who are at risk for recurring suicidal behavior.

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Clozapine Information

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DOSING: Clozapine is given once, twice, or three times daily. The dose often is increased slowly until the optimal dose is found. The full effects of clozapine may not be seen until several weeks after treatment is begun.

DRUG INTERACTIONS: Risperidone (Risperdal) may cause an increase in the amount of clozapine in the blood. This could lead to an increased risk of side effects from clozapine.

SIDE EFFECTS: Clozapine may cause a severe reduction in white blood cell count, a condition known as agranulocytosis, in approximately 1 in 100 patients who take it for at least one year. White blood cells fight infections, and a severe reduction in white blood cells can result in severe infections. If not caught early, agranulocytosis can be fatal. Therefore, the white blood cell count should be measured (with a blood test) prior to starting treatment and regularly (weekly) while patients receive this medication, and for 4 weeks after it is stopped.

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Haloperidol
(Haldol)

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Haloperidol is an antipsychotic medication. It also is used to control tics and vocal utterances that are part of Tourette's syndrome. Haloperidol interferes with the effects of neurotransmitters in the brain which are the chemical messengers that nerves manufacture and release to communicate with one another. Haloperidol blocks receptors for the neurotransmitters (specifically the dopamine and serotonin type 2 receptors) on the nerves. As a result, the nerves are not "activated" by the neurotransmitters released by other nerves. Haloperidol was approved by the FDA in 1967.

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Haloperidol Information

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PRESCRIBED FOR: Haloperidol is used for treating schizophrenia, acute psychosis, and for tics and vocal utterances of Tourette's syndrome.

DRUG INTERACTIONS: Haloperidol causes sedation, and sedation may be greater if haloperidol is taken with alcohol and other drugs than can cause sedation such as the benzodiazepine class of anti-anxiety drugs

SIDE EFFECTS: The most common side effects associated with haloperidol are extrapyramidal effects (sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes), dizziness, hyperactivity, tiredness, and nausea. Sedation, weight gain, erectile dysfunction, menstrual irregularities, insomnia, gynecomastia, dry mouth, nausea, vomiting, and constipation are also common.

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Tamezapam
(Restoril)

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Restoril belongs to a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). It affects chemicals in the brain that may become unbalanced and cause sleep problems (insomnia).
Restoril is used to treat insomnia symptoms, such as trouble falling or staying asleep.

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Tamezapam Side Effects

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weak or shallow breathing;fast or pounding heartbeats;confusion, slurred speech, unusual thoughts or behavior; hallucinations, agitation, aggression; thoughts of suicide or hurting yourself;restless muscle movements in your eyes, tongue, jaw, or neck.

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Gabapentin (neurontin)

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Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy.

Side Effects:
Clumsiness or unsteadiness
Continuous, uncontrolled, back-and-forth, or rolling eye movements