Conduct a scholarly search for several options of a “antidepressants and anxiolytics” – Psychiatric Mental Health Nurse Practitioner Clinical Practice Portfolio.
Instructions
Conduct a scholarly search for several options of a “antidepressants and anxiolytics”. You will then complete the template to add to your program portfolio for entry clinical practice.
Use PMPNP Portfolio for Clinical Practice Template here for the Antipsychotics chart completion.
Solution
Psychiatric Mental Health Nurse Practitioner Clinical Practice Portfolio
| Neurotransmitters Chart | ||||||||||
| Function (Excitatory or Inhibitory) | Locations | Receptors | Effects of Deficient | Effects of Surplus | Agonist Drug | Antagonist Drug | ||||
| Acetylcholine | Inhibitory | Several different locations of the brain including striatal complex, the basal forebrain and the medulla | Acetylcholine receptors either nicotinic and muscarinic subunits | Memory impairment and brain disorders | Having excess acetylcholine accumulated at the synapses and neuromuscular junctions triggers symptoms of muscarinic and nicotinic toxicity. These symptoms include cramps, lacrimation, and blurry vision amongst others. | Include nicotine, choline, epibatidine,obeline, varenicline and cysteine mimic the action of acetylcholine | Compete with actions of acetylcholine for example atropine competes for a common binding site on all muscarinic receptors | |||
| Dopamine | Both excitatory and inhibitory | Located in the mid brain at the substania nigra and ventra tegmental area. Also found in hypothalamus and arcuate nucleus | There are five types of dopamine receptors with each having a specific function or functions. They are D1, D2, D3, D4, and D5. The functions of D1 include memory, attention, locomotion, regulation of renal function and impulse control. | Aches and pains, tremors, spasms, tremors, muscle cramps and muscle stiffness | One becomes aggressive, competitive, and have poor impulse control. It can lead to gambling, addiction, binge eating and ADHD. | Include Bromocriptine, cabergoline, Rotigitine and Apomorphine. | Clozepine, Chlorpromazine, promethazine and risperidone. | |||
| Endorphins | Inhibitory | Are released from the pituitary gland in response to pain and can act in both the central nervous system and the peripheral nervous system. | Bind with μ-receptors of peripheral nerves thus inhibiting the transmission of pain signals | Leads to depression and headaches | Besides decreased feelings of pain, secretion of endorphins leads to feelings of euphoria, modulation of appetite, release of sex hormones, and enhancement of the immune response. | .methadone and buprenorphine intramuscular heroin | Naloxone and naltrexone used in opioid antagonists drugs and as competitive antagonists bind to the opioid receptors without activating the receptors. | |||
| GABA inhibitory The Limbic system where personal feelings and emotional memories are generated and stored. | There are two classes of GABA receptors namely ionotropic receptors( GABAA) and metabotropic receptors(GABAB | Lower than normal levels of GABA in the brain is associate with sleep disorders, anxiety. Depression and schizophrenia | Causes hypersomnia or daytime sleepiness. | GABA (a) receptor agonists are like alcohol, barbiturates and benzodiazepine. GABA(b) receptor agonists include propofol, sodium oxybate and Baclofen. GABA analogs are like gabapentin, pregabalin and Valproic acid | Include bicuculline, securinine and metrazol Conventionally, these drugs generate a stimulant and convulsant effects hence their use to counter overdose of sedative drugs. | |||||
| Glutamate | Excitatory | Occurs in protein- containing foods like cheese milk and mushrooms but is also produced by the human body.in the CNS | Glutamate receptors are found on the dendrites of postsynaptic cells and bind with glutamate released in into the synaptic cleft by presynaptic cells | Causes insomnia, mental exhaustion and difficulties in concentration. | Increase cellular activity, leading to over excitation on nerve cells which eventually causes cell death. | Cycloutylene AP5 and DCG IV Kainic acid and Quisqualic acidAmantadine,Glycine inhibitory In the brain stem and spinal cord. | Glycine receptors have the function of fast inhibitory transmission in the CNS. Suppress neural firing through hyper polarization that occurs when glycine activates anion channels. Means the body produces less glutathione that negatively impacts on how one body handles oxidative stress over time. | Elevated glycine levels within the brain and cerebrospinal fluid cause’s seizures, breathing difficulties, movement disorders and intellectual disability. | D- Alanine L- Serine | Can either be selective like Brucine, Tutin and Strychnine or non-selective like Pitrazepin, Caffeine, Pictrotoxin and Bicuculine |
| Glutamate | excitatory | Occurs in protein- containing foods like cheese milk and mushrooms but is also produced by the human body.in the CNS | Glutamate receptors are found on the dendrites of postsynaptic cells and bind with glutamate released in into the synaptic cleft by presynaptic cells | Causes insomnia, mental exhaustion and difficulties in concentration. | Increase cellular activity, leading to over excitation on nerve cells which eventually causes cell death. | Cycloutylene AP5 and DCG IV Kainic acid and Quisqualic acid | Amantadine, | |||
| Norepinephrine | Excitatory | Produced in the inner part of the adrenal glands called the adrenal medulla | Norepinephrine binds to alpha- and beta-adrenergic receptors or adrenoceptors in different tissues. For example in the blood vessels it triggers vasoconstrictive thus increasing blood pressure. | Low levels of Norepinephrine is associated with ADHD, lack of concentration, lethargy and even depression. | Can lead to panic attacks, elevated blood pressure, euphoria ,and general hyperactivityEpinephrineTricyclic antidepressant, beta blockers and antipsychoticsSerotonin inhibitory Primarily found in the enteric nervous system whose location is within the gastrointestinal tract though its production occurs in the CNS. | Serotonin membrane depolarization occurs after fast mediation and excitatory responses by 5-HT3 receptors located on neurons in both PNS and CNS. | Serotonin Levels below normal are associated with depression, anxiety and sleep | Excessive levels of Serotonin causes mild shivering and diarrhea to severe muscle rigidity , fever, and seizures | Serotonin 5-HT-Receptor Agonists Addyi.almotriptan.Amerge.Axert.eletriptan.flibanserin.Frova.frovatriptan. | 5-HT3 antagonists include Dolasetron. Granisetron. Ondansetron. Palonosetron. |
Notes:
| AntipsychoticsFirst Generation Side Effects (L=Low, M=Moderate, H=High) Generic NameTrade NameRoute(s) of AdministrationLAI(Long acting injectable) option (with starting dose in mgStarting Dose(mg /day)Half Life In hoursIndications (s/sx & diagnosis) Signs/ symptoms and diagnosisMOA (neurotransmitter effects)EPSHyperlipidemiaT2DMWeight GainCognitive IssueOther SE (side effects)CostsChlorpromazineThorazinePO 100mg30hrsSchizophrenia, bipolar disorder and hyperactivityAn antagonist that prevent dopamine from accessing the receptor thus blocking signal transmission. | L | M | L | H | L | Skin discoloration, Eye vision changes | 10mg (100): $20.79; 25mg (100): $27.03; 50mg (100): $38.24 | ||||||||
| Fluphenazine | Prolixin | IM | Yes, 12.5 | 2mg | 17-112days | Schizophrenia, psychotic disorders, Tourette syndrome | Fluphenazine is an antagonist that blocks postsynaptic dopamine D1a receptors and D2 receptors in the limbic, contical system and basal ganglia | H | M | H | H | H | Joint pain, seizures | 1mg (90): $17.99; 2.5mg (60): $15.99; 5mg (60): $18.99; 10mg (60): $24.99 | |
| Perphenazine | Trilafon | PO, IM/IV | 10mg | 9-12hrs | Schizophrenia | Perphenazine is a dopamine antagonist and a phenothiazine derivative that blocks post synaptic D2 receptors in the mesolimbic and medullary chemoreceptor trigger zone leading to prevention of excessive dopamine in the brain. | H | L | L | H | M | Dizziness and light headedness | 2mg (60): $51.99; 4mg (60): $69.99; 8mg (60): $76.99; 16mg (60): $107.99 | ||
| Trifluoperazine | Stelazine | PO , IM | 5mg | 22hrs | Generalized nonpsychotic anxiety | Trifluoperazine is a dopamine antagonist and a phenothiazine derivative of phenothiazine with antipsychotic and antiemetic activities. It blocks central dopamine receptors to prevent effects like delusions and hallucinations that result from excesive dopamine Acts as a calmodulin inhibitor causing cystolic calicium elevation. | HLMHMSevere muscle spasms, Mask like expression of the face2mg (60): $36.99; 5mg (60): $35.99; 10mg (60): $55.99ThioridazineMellariPO 100mg21-24hrsSchizophreniaThioridazine blocks DA-2 receptors within the mesolimbic pathway decreasing positive symptomsLLHLLVision changes or loss Jerking movements while walking10mg (90): $23.99; 25mg (90): $28.99; 50mg (90): $35.99; 100mg (90): $34.99HaloperidolHaldolPO, IMYes, 503mg21-24hrsSevere childhood behavioral problems, HyperactivityHaloperido exerts its antipsychotic action by blocking the brains dopamine D2 receptorsHLLMLErectile dysfunction Muscle twitching, uncontrollable shaking0.5mg (90): $16.99; 1mg (90): $19.99; 2mg (90): $20.99; 5mg (90): $25.99;ThiothixeneNavanePO 4mg24hrs Decreases dopamine activity causing decreased stimulation of psychotic effects by blocking post synaptic dopamine receptors in the mesolimbic system and medullary chemoreceptor trigger zone. | H | L | L | L | H | Severe muscle spasms Trouble when swallowing | 1mg (90): $22.99; 2mg (90): $29.69; 5mg (90): $37.99 | |
| Loxapine | Loxitane | PO | 10mg | 4-7.61hrs | Schizophrenia | Loxapine efficacy is believed to be mediated by high- affinity antagonism of postsynaptic D2 receptors and serotonin 5-HT2A receptors | M | L | M | H | H | Depression Suicidal ideation | 5mg (30): $28.99; 50mg (30): $39.99 | ||
| Pimozide | Orap | PO | 2mg | 55-150hrs | Schizophrenia Tourette syndrome | Selectively inhibits type 2 dopaminergic receptors in the CNS. This decreases dopamine neurotransmission and diminishes the occurrence of motor and vocal tics. It also antagonizes alpha-adrenergic and 5-HT2 receptors | H | L | L | L | H | Mask-like face expression, eyes rolling up | 1mg (60): $85.99; 2mg (60): $109.99 | ||
| Molindone | Moban | PO | 10mg | 1.5 hrs | Schizophrenia | Thought to exert its effect by blocking dopamine receptors most likely D2 and D3 that are found in the reticular activating and limbic systems thus lowering excess dopamine in the brain. | M | L | L | L | L | May cause tardive dyskinesia, unusual uncontrolled movements | around $99.35, 74% off the average retail price of $382.42 | ||
| Zuclopenthixol | Clopixol | IM | Yes,100 | 25mg | 24hrs | Schizophrenia and other psychoses | Zuclopenthixol is an antagonist at D1 and D2 dopamine receptors.It also has a high affinity for alpha 1-adrenergic and 5-HT2 receptors | H | M | H | H | M | Fast heartbeat, stomach upsets | 200mg/mL $0.54 to 2.18 | |
| Second Generation | |||||||||||||||
| Aripiprazole | Abilify | PO | Yes 300-400mg IM every 4 weeks | 10-15 mg/d | 75-146 hours | Schizophrenia Bipolar 1 disorder | Partial against at D2 receptors. Lowers dopaminergic neurotransmission in the mesolimbic pathway | L | M | L | L | L | Seizures suicidal ideation | Oral tablet 5mg is about $12 for 30 tablets | |
| Clozapine | Clorazil | PO | 25 mg | 6-26 hours | Schizoaffective disorder partially or fully resistant to treatment with other antipsychotic drugs | Blocks 5-HT2A / 5-HT2c serotonin receptors and the D1-4 dopamine receptors | Clinically insignificant | L | M | M | L | Seizures leukopenia | Oral tablet 100mg is about $88 for 100 tablets | ||
| Olanzapine | Zyprexa | PO | Yes 150-405 mg every 2 or 4 weeks | 5-10 mg/d | 31-52 hours | SChizophrenia | MOA of Olanzapine is unknown but it is believed its efficacy in schizophrenia is mediated through a antagonism of both dopamine and serotonin type 2((5HT2) | L | M | H | H | M | Acute haemorrhagic pancrealitis, status epilipticus | Oral tablet 15 mg is about $14 for a supply of 30 tablets | |
| Quetiapine | Seroquel | PO | 25mg/d | 7-12 hours | Mania episodes, depressive episodes | Thought to involve rapid dissociation from D2 receptors | L | L | M | M | L | Anaphylaxis, seizures, suicidal ideation | Oral tablet 25mg is about $190 is approximately $190 for a supply of 30 tablets | ||
| Risperodone | Risperdal | PO | Yes 12.5 -1550 mg every 2 weeks | 1mg twice daily | 3-20 hours | Schizophrenia and long term treatment of bipolar 1 disorder | The dopamine theory of schizophrenia contends that risperidone’s MOA most likely involves a decrease in the dopaminergic transmission in the mesolimbic pathway | L | L | L | L | L | Hypothermia, neutropenia | Oral tablet 1mg is about $17 for 30 tablets | |
| Ziprasidone | Geodon | PO | 20 mg twice daily | 2-5 hours | Acute agitation in schizophrenia | Functioned as an agonist at the 5HT1A receptor and as an antagonist at the D2, 5HT2A and 5HT1D receptors. It inhibits synaptic reuptake of serotonin and norepinephrine. | L | L | H | H | L | Bone marrow suppression, priapism | Oral capsule 20mg is about $103 for a supply of 40 tablets | ||
| Paliperadone | Invega Susdtenna | IM | Yes39 -234 mg every 4 weeks | 3mg once daily | 24-49 days | Schizophrenia. Adjunct to mood stabilizers, or antidepressants | Attributed to antagonism of brain dopamine D2 and serotonin 5-HT2A receptors | L | L | L | L | M | Insomnia, CPK elevation | Oral tablet 3mg is about $318 for 30 tablets supply | |
| MElperone | Buronil | PO, IM | 25 mg and increase to 75 mg according to tolerability | 3-4 hours –oral 6 hours-IM | Schizophrenia, L-DOPA and other forms of psychoses in Parkinson disease | Exhibits antagonist activity at D2dopaminergic and 5HT2A serotonergic receptors | L | L | M | M | L | Neutropenia and leukopenia | 10 mg/$81 | ||
| Sertindole | Serdolect | PO | 4 mg/d once daily increased gradually in increments of 4 mg every 4-5 days | 72 hours | SChizophrenia | Sertindole is an antipsychotic drug with affinity for dopamine D2, serotonin 5-HT2A and 5-HT2C, and alpha1-adrenoreceptors. | Clinically insignificant | L | H | H | L | Clinically insignificant | 4 mg $38 for 30 tablets | ||
| Sulpiride | Dogmatil | PO. IM | 200-400 mg twice daily | 6-8hrs | Schizophrenia | Is a selective dopamine receptor antagonist within the brain | L | M | L | L | L | jaundice | 25mg $98.10 |
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Notes:
| Antidepressants, Anxiolytics & Mood StabilizersAntidepressants Side Effects (L=Low, M=Moderate, H=High) Generic NameTrade NameRoute(s) of AdministrationLAI optionStarting DoseHalf LifeIndications (s/sx & diagnosis)MOA (neurotransmitter effects)EPSHyperlipidemiaT2DMWeight GainCognitive IssueOther SECostsSSRIs CitalopramCelexaBy mouth(PO) 20mg once daily with or without food27-32 hrsMajor depressive Disorder-MDD-(DSM-IV dysphoric mood lasting 14 days or more Excessive anxiety and worry last six months or more mind going blank-Generalized Anxiety disorder-GAD- (DSM-IV) and major depressive disorderLinked to potentiation of serotonergic activity in the CNS resulting from its inhibition of CNS neuronal reuptake of serotonin(5-HT)Acute dystoniaLMMLInsomnia, nausea , ejaculation disorders, increasing fatigue$ 268 for 30 tablets of 20mgEscitalopramLexaproPOYES10mg/day27-32 hoursSymptoms of MDD and GADBinds to the serotonin transporter protein and inhibit reuptake of serotonin by the presynaptic neuronReversible or irreversible motor disturbancesHLLHBlurred vision, racing thought, headache, confusion$18.56 for 30 day supplyFluxetineProzacPOYes20mg/day in the morning4-16 daysMDD ,acute and maintenance treatment of obsessions and compulsions with OCD, Binge eating and panic disorderProzac MOA is not known but is believed to be presumed to be linked to its inhibition of CNS neuronal uptake of serotonindizzinessLHHLUnusual dreams, sexual dysfunction, weight change, urinating more often$ 166.25 for 30 capsules of 40 mgParoxetinePaxilPO 20 mg/day24 hours- 4.4 daysTreats panic attacks, anxiety disorders, OCD and post traumatic stressEnhances serotonergic activity through inhibition of presynaptic reuptake of serotonin by the serotonin receptor. The inhibition increases the level of serotonin in the synaptic cleft thereby reliving the symptomsminimalLLLLDizziness, nausea, drowsiness, yawning$229 for 40 mg 30 day supplySertalineZoloftPOYES50mg /qday24hrs-4.4 daysMDD, OCD, Panic disorder, Social anxiety disorder(SAD) Post traumatic stress disorder, premenstrual dysphoric disorderThought to be linked to its inhibition of CNS neuronal uptake of serotonin (5HT)Neurological side effectsLMLLNausea, ejaculation disorder, drowsiness, fatigue$393,84 for 30 day supply SNRIs DesvenlafaxinePristiqPO 50 mg once daily with or without food12hours -2.5daysMDDThought to work by affecting the patient’s levels of serotonin and norepinephrinedizzinessLLLLHeadache, nausea, diarrhea, constipation, , insomnia$ 217 for 14 tablets supplyDuloxetineCymbaltaPO swallow whole do not crush, or chew and do not open the delayed release capsule 40 mg/day(20mg twice daily8-17 hoursGAD diabetic peripheral neuropathic pain, fibromyalgiaThe exact MOA of antidepressants, central inhibitory and anxiolytic of Cymbalta is not known but these actions are thought to be connected to its potentiation of serotonergic and noradrenergic activity within the CNSHLLLLLiver damage(itching, right upper arm abdominal pain, dark urine) changes in blood pressure, serotonin syndrome$14 for 30 capsulesVenlafaxine XREffexor XRPO 75 mg/day divided in two or 3 doses dose with food either in the morning or evening and swallowed whole3-13 hoursMDDIn humans believed to be linked to its potentiation of neurotransmitter activity in the CNS. Together with its active metabolite O- desmethyvenlafaxine are potential inhibitors of neuronal serotonin and norepinephrine reuptake | Muscle spasms | H | L | L | H | Suicidal thoughts, serotonin syndrome, changes in blood pressure Changes in weight, manic hypomanic episodes | $230 for 15 capsules | ||||||||
| Milnacipran | Savella | PO | 100 mg/day(adminsistered twice/day | 6-8 hours | Fibromyalgia not approved for pediatric patients | In humans, the exact MOA of the central pain inhibitory action and its ability to improve fibromyalgia symptoms is unknown. Sudies have demonstrated it is potent inhibitor of neuronal norepinephrineand serotonin reuptake. | Dizziness | H | L | L | L | Headache, constipation , nausea, hypertension | $412 for 55 tablets | ||
| Levomilnacipran | Fetzima | PO | 40- 120 mg taken once daily | 12 hours | MDD | MOA is currently unkown but is connected to the potentiation of serotonic and norephinephrine in the CNS through inhibition of reuptake at transporters of serotonin and norepinephrine | constipation | M | L | L | L | Constipation excessive sweating , decreased appetite and tachrdia | $701.08 for a 30 day supply | ||
| TCAs | |||||||||||||||
| Amitriptyline | Elavil | PO, IM | 75mg/day in divided doses | 20 hurs | Depression | Elavil MOA is not known it is not a monoamine oxidase inhibitor neither does it act on through CNS stimulation. However it inhibits the membrane pump mechanism responsible for serotonin and norepinephrine uptake in adrenergic and serotonergicrons | dizziness | L | H | H | M | Weight gain, constipation blurred vision, dizziness , dry mouth and drowsiness | $13 for 20 tablets | ||
| DEsipramine | Norpramin | PO | 100-200 mg/day in single dose or divided dose | 12-54 hours | Depression mood disorders, sleeplessness, poor appetite | A TCA that selectively blocks reuptake of norapinephrine( noradrenaline from the neuronal synapse. Inhibits reuptake of serotoninheadacheLMMLChanges in weight and appetite, dry mouth , nightmares, constipation, drowsiness$175 for 30 Day supplyDoxepineSinequanmPO, IV, IM, topical 75 mg/day 15-31 hoursPsychoneuroticc patients with depression and /or anxiety, psychotic depressive disorders, MDD, involution depressionAS a TCA its MOA works by increasing the brains concentration of neurotransmitter’s serotonin(5-HT and norepinephrinedizzenessLLLHConfusion, blurred vision, anxiety, dizziness and agrunulocytosis$17 for 30 day supply ImipramineTofranilPO 30-40 mg/day19 hoursDepresion, nocturnal enuresis, neuopathic pain, hyperactivityA TCA that inhibits the reuptake of norepineohrine and serotonin thereby increasing the brain levels of these transmittersinsignificantHLLHHalucinations, confusion, seizures, pounding heartbeats$649.68NotriptylinePamelorPO 25 mg 3 or 4 times/day36 hoursMajor depresion, SAD, postherptic neuralgia, nocturnal enuresis, prementrual dysphoric disorder(PMDD)Inhibits reuptake of norepinephrine and serotonin by the presynaptic neuronal membrane thus elevating their levels in the synapse. | Not pronouncedLHHLWeight gain or loss, dizziness, urinary retention, constipation, dizziness when standing$16.11 for 30 tabletsMAOIs PhenelzineNardilPO 15 mg 3 times a day11.6 hoursTreatment resistant depression, SAD , panic disorderAn inhibitor and substrate of monoamine oxidase leading to elevation in brain levels of serotonin and catecholamines and serotonidizzinessLHHLWeight gain, decreased sexual activity, constipation, dry mouth and dizziness$162 for 60 tabletsSelegilineEmsamOn dry, intact skin on the upper torso(below the neck and above the waste 6mg every 24 hours18-25 hoursMDDNot fully understood but is believed to be connected to potentiation of monoamine neurotransmitter activity in the CNS leading to inhibition of MAO activityheadachesLLLMDiarrhea, drowsiness, dizziness, insomnia$20 per patch or $600 per monthTranylcypromineParnatePO 30mg/day in divided doses2.5 hoursMDDA non –hydrazine monoamine oxidase inhibitor with a rapid onset of activityinsomniaLLLLVision problem, frequent headache, sensitivity to light , nausea drowsiness$854 for supply of 100 tablets Atypical BupropionWEllbutrinPO and swallowed hole with or without food 200 mg/day given 100mg twice daily3-4 hoursMajor depression., MDD, SADWhile its MOA is not clearly understood at the present, Wellbutrin]n is known to enhance both noradrenergic and dopaminergic neurotransmission through reuptake of dopamine transporter and norepinephrineDifficulty sleepingHLLLFast heartbeat, weight loss, constipation, dry mouth$86.62 for 30MirtazapineRemeronPO 15mg/day in a single dose20-40 hrsInsomnia, depression, post-traumatic stress disorderHas a dual mode of action as a noradrenergic and specific serotonergic antidepressant (NaSSA) that acts by antagonizing the adrenergic alpha 2- auto receptors and alpha-2 auto receptors. It also blocks 5-HT2 and 5-HT3 receptors | Akathisia( feeling restless | M | H | H | L | Weight gain, dry mouth, lack of energy, increased appetite | $55.99 for 30 tablets | |
| Nefazodone | Serzone | PO | 200mg /day divided in two doses | 2.5- 4 hours | Depression | In the serotonergic system nefazodone acts as an antagonist at type 2 serotonin(5HT2) post –synaptic receptors inhibits presynaptic serotonin (5-HT) reuptake. These mechanisms elevate the serotonin amount available for interaction with 5_HT receptorsTardive dyskinesiaHLLHNausea, confusion, jaundice, seizures, painful penis erection that lasts 4 hours or more$338 for 100 tabletsAnxiolytics Benzodiazepines AlprazolamXanaxPO 0.25- 2 mg 3 times a day11.2 hoursPanic disorder, anxiety associate to depressionBeing a benzodiazepine, it produces several therapeutic and adverse effects by binding to the GABAa benzodiazepine receptor site and modulating this action, ParkinsonismLLLHMemory problem, slurred speech, poor balance coordination , trouble concentrating$11 for 6 tabletsChlordiazepoxideLibriumPO 50- 100 mg/day24-48 hoursAnxiety withdrawal symptoms of acute alcoholismPrecise mechanism is unknown but it blocks EEG arousal by stimulating the brain’s stem reticular formationTardive dyskinesiaLLLLBlurred vision, headache trouble walking, changes in sexual interest$10 for 3 capsules ofClobazepamOnfiPO 5 mg administered two times a day20-80 hoursSeizures associate with Lennox- Gastaut syndromeNot fully understood but believed to involve potentiation of GABAergic neurotransmission leading to binding of benzodiazepine site of the GABAA receptorParkinsonismLLLHSlow thinking, impaired motor skills, sedation, drowsiness$1333 for supply of 120 tabletsClonazepamKlonopinPO 0.25 mg/day adminstered twice20- 50 hoursPanic disorder with and without agoraphobia, insomnia and restless legs syndrome Modulates GABA function in the brain by the benzodiazepine receptor, located on GABAa receptors leading to increased GABAergic inhibition of neuronal firingParkinsonismMLLHDifficulty in thinking or remembering, unstradiness, increased saliva$12 for supply of 15 tabletsClorazepateTranxenePO 30 mg /day in divided doses48 hoursSeizures, acute alcohol withdrawal , anxietyIts action becomes manifest once it deactivates the nerous system through its potentiaon of the inhibitory effect of GABA on GABA-A receptors. They do this by binding to a site that is different from the GABA binding site. | headache | L | L | L | L | Headache, dry mouth , stomach upset consiptation | $15 for supply of 3 tablets | ||
| Diazepam | Valium | PO | 10 mg 3- 4 times on day 1 then reduce to 5 mg 3-4 times a day | 48 hours | Addiction /dependence, Anxiety/OCD, muscle spasms, seizure disorders | Exerts inhibitor anxiolytic, sedative, muscle relaxant anticonvulsant and amnestic effects by facilitating the action of GABA an inhibitor of CNS neurotransmitters | Parkinsonism | L | L | L | H | Memory problem, ataxia( balance loss) fatigue, spinning sensation | $10 for 1 tablet | ||
| Barbiturates | |||||||||||||||
| Amorbarbital | $775 for 1 powder of injection | Oral, IM. IV, Rectal 30-50 mg administered 2 or 3 times a day8-42 hoursControl seizures, insomnia, relieve pre-operative anxietyWorks by binding to the GABAA receptor at either the alpha or beta subunitParkinsonismLLLHConfusion, nervousness, sleepiness nausea$775 for 1 powder of injectionButabarbitalButisolPO 15-30 mg given 3 or times a day100 hoursDepressionPotentiates GABAergic neurons besides inhibiting neuronal acetylcholine and glutamate receptors leading to sedationConstipationLLLLLoss of appetite, excitement, headache$441 for supply of 100 tabletsPentobarbitalNembutalIM 150- 200mg15-50 hoursInsomniaWorks in the CNS in that it binds to GABA-A subtype receptorsParkinsonismLLLHNightmares, nausea vomiting, loss of coordination$1026 for 20 millimetersSecobarbitalSeconalPO 100mg at bedtime as a hypnotic28 hoursInsomnia epilepsyDecreases CNS activity by binding to barbiturate site at GABA- receptor complex increasing GABA activity and lowering reticular activity systemdizzinessLLLLNightmares, agitation, excitement, drowsiness$ 3 226.75 for 100 tabletsMood Stabilizers LithiumLithonate, Lithobid, EskalithPONo600mg 3 times a day or 900mg twice18- 36 hoursFDA approved for Bipolar Disorder Thought to be effective for depression and possibly effective for schizophrenia and attention deficit hyperactivity (ADHD)At neuronal level, lithium works by decreasing the excitatory (dopamine and glutamate while increasing inhibition (GABA) transmission). Be that as it may a complex neurotransmitters system underpins these side wide impacts as they seek to achieve homeostasis through compensatory changes | Increases EPS ratings like gait, shoulder shaking, elbow rigidity, and tremor. | H | H | H | L | Worsen skin disorders, cause thyroid gland problems | $5.49 for 300mg 90 tablets | ||||||
| Valproic acid | Depakote, Depakene | PO | No | 250mg 2 times a day | 4-16 hours | Seizure disorders manic phase of BD and prevention of migraine headaches | Acts on GABA levels within the CNS , blocks voltage-gated ion channels and inhibition of histone deacetylase | Its EPS are completely reversible and occur spontaneously. | L | M | M | L | Hair loss, ringing ears and changes in menstrual periods | $16.77 for ninety 250 mg tablets | |
| Lamotrigine | Lamictal | PO(orally disintegrating tablets) | No | 25mg once a day for 2 weeks | 25 hours but reaches 70 hours if patient is also taking Valproate | Prevent mood swings of. BD in adults Prevent or control seizures Not approved for use in children less than 24 months | Being a triazine, Lamotrigine selectively binds sodium channels, stabilize presynaptic neuronal membrane and inhibits the release of glutamate. However, the MOA for Lamotrigine is not fully understood. | Scarcity of literature reporting EPS for Lamotrigine exist but it has been reported to induce dystonia in BD | H | L | L | H | Trigger depression, suicidal ideation and mental /mood swings | $18 for 100 mg 30 tablets | |
| Carbamazepine | Carbatrol, Tegretol, Epitol Equetro | PO | No | 200mg per day divided in two doses | 18-65 hours | To relieve certain types of nerve pan. Reduces the spread of seizure activity | As a sodium channel blocker it binds selectively to voltage- gated sodium channels in their inactive conformation. This binding prevents repetitive and sustained firing of an action potentialAdjunctive use of Carbamazepine may increase the patient’s risk use EPS occurrence if using SGAHLLLHeadaches, liver problems, , loss of appetite, kidney problems and nystagmus( unusual eye movements$64.88 for 30 4-mg tabletsAripiprazoleAbilifyZyprexaIM use onlyYes2mg/day for 2 days then 5mg for 2 days then 10mg once per day75- 94 hoursTreat depression Dementia related behavior problemsIs both a partial agonist at dopamine D2 and the serotonin 5-HT1A receptors and an antagonist at serotonin 5-HT2A receptor. Currently as with other drugs that demonstrate efficacy in schizophrenia and BD Abilify’s MOA is unknown. | May cause restlessness, tremor and stiffness. | M | H | H | H | Depression suicidal attempts/ ideation, mask like face, trouble controlling certain urges like gambling, sex, eating, shopping | $941 for 10mg 30 tablets | |
| Olanzapine | Zyprexa | PO(ODT) | Yes | 10mg /day | 21-54 hours | Treat mood disorders triggered by Schizophrenia or BD and depression | Currently he MOA for olanzapine is unknown but is thought to work by blocking some neurotransmitters in the brain. It then binds to alpha-1, dopamine, histamine H-1, muscarinic and serotonin type 2(5-HT2) receptors | Has lower EPS symptom profile compared to other mood stabilizers like muscle spasms, muscle shaking, tremor and slurred speech | H | M | M | M | Blood sugar rise, fainting, shaking, mood changes, confusion | $14 for 15mg 30 tablets | |
| Risperadone | Risperdal | Deep IM deltoid or gluTeal injection | Yes | 2/-3 mg per day | 21-30 hours | Some mental/ mood disorders like autistic disorder, BD and schizophrenia | Primary action decreases dopaminergic and serotonergic pathway activity within the patient’s brain thus lowering schizophrenia and mood disorders symptoms. Risperidone also has a high binding affinity for serotonergic 5-HT2A receptors once it is compared to the brain’s dopaminergic D2 receptors. | Risperidone- induced EPS include acute dystonia and parkinsonism. | M | H | H | L | Difficulty swallowing, anxiety, restlessness, and interrupted breathing when sleeping | $17 for 1mg 30 tablets |
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Withdrawal Sx Chart
Community Health Promotion Essay Examples
| Capella University Health Promotion Plan And Best Practices PPT | Discussion: NURSFPX4060 Capella University Health Promotion Plan and Best Practices PPT Health Promotion Plan |
| Health Promotion Plan Presentation | Health Promotion Plan Presentation |
| Health Promotion and Community Resource Teaching Project | Identify interdisciplinary health professionals important to include in the health promotion. What is their role? Why is their involvement significant? |
| Identify a health problem or need for health promotion for a particular stage in the life span of a population | PURPOSE To apply concepts you have learned about health promotion concepts and strategies, enhance your written communication skills, and demonstrate a beginning understanding of cultural competency. |
| Pender Health Promotion Model | Pender Health Promotion Model |
