This program will look at adverse reactions to specific psychotropic drugs. Antipsychotic medications include typical and atypical agents.
Typical Agents (01:03)
Typical antipsychotic agents include haloperidol (Haldol), thioridazine (Mellaril), thiothixene (Navane), fluphenazine (Prolixin), and chlorpromazine (Thorazine). Major side effects include movement disorders.
Atypical Agents (02:35)
Atypical antipsychotic agents include aripiprazole (Abilify), clozapine (Clozaril), ziprasidone (Geodon), risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa). Side effects include hyperglycemia and diabetes; blood sugar levels are monitored. Agranulocytosis is common with clozapine; white blood cell and neutrophil counts are monitored.
Typical and Atypical Agents (01:07)
Antipsychotic classes can cause electrocardiogram changes, and should be used with caution in arrhythmia patients. The FDA no longer approves them for dementia-related psychosis, due to an increase in cardiovascular and infection fatality risk in elderly patients.
Antidepressant classes include tricyclic (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and dual mechanism antidepressants.
Tricyclic antidepressants include clomipramine (Anafranil), amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), and protriptyline (Vivactil). Side effects include atropinic overload—resulting in redness, dry mouth and psychotic symptoms. Antihistamines, neuroleptic agents and antiparkinson agents can also cause atropinic overload.
Monoamine Oxidase Inhibitors (02:42)
MOAI antidepressants include phenelzine (Nardil) and tranylcypromine (Parnate). These have serious drug-food and drug-drug interactions, including hypertensive crisis. Patients should avoid foods containing tyamine, decongestants, stimulants, Dextromethorphan, appetite suppressants, carbamazepine (Tegretol), and other antidepressants.
Selective Serotonin Reuptake Inhibitors and Serotonin–Norepinephrine Reuptake Inhibitors (04:54)
SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft). SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq). Serotonin syndrome usually occurs with drug interactions. Treatment includes benzodiazepines, IV fluids, and medication withdrawal.
Discontinuation Syndrome (00:44)
Antidepressants should be tapered gradually. SSRI withdrawal symptoms include nausea, dizziness, lethargy, and headache. Tricyclic symptoms cause hypomania, akathisia, cardiac arrhythmias, gastrointestinal upset, and panic attacks. MAOI symptoms include flu-like symptoms, confusion, hypomania, and worsening depression.
Miscellaneous Side Effects (00:51)
Priapism is associated with trazodone (Desyrel). Liver failure has been reported with nefazodone (Serzone).
Mood Stabilizing Agents (03:37)
Lithium remains the most common drug for bipolar disorder. Toxicity can occur with drug interactions or overdose; hear symptoms. Blood levels greater than 1.5 millimoles per liter can become life-threatening. Serum levels and urine output should be monitored.
Valproic acid (Depakote) can prolong bleeding time. Topiramate (Topamax) can decrease oral contraceptive effects. Antiepileptic drugs increase suicide risk.
Antianxiety Agents (02:08)
Benzodiazepines, including clonazepam (Klonopin), lorazepam (Ativan), and alprazolam (Xanax) are short term anxiety treatments. Clonazepam can increase suicide risk. Buspirone (Buspar) takes two weeks to take effect. These drugs can cause paradoxical excitement; CNS depressants should be avoided.
Psychotropic Medication Side Effects Summary (00:41)
Caregivers should be attentive, recognize any unusual symptoms, and take action to remedy them.
Credits: Medication Specific Reactions (01:02)
Credits: Medication Specific Reactions
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