Key Counseling Points - Neuro/Psych Flashcards
Benztropine counseling points
Drug may impair heat regulation. Advise patient to use caution with activities leading to an increased core temperature, such as strenuous exercise, exposure to extreme heat, or dehydration. Patient should avoid activities requiring mental alertness or coordination until drug effects are realized. Instruct patient to report sudden muscle weakness or stiffness, and signs/symptoms of tardive dyskinesia (tongue thrusting, facial grimacing/tics, random movements of extremities). Patient should not drink alcohol while taking this drug.
Carbamazepine counseling points
May decrease effectiveness of oral contraceptives; use an alternative form of birth control. Avoid activities requiring mental alertness or coordination until drug effects are realized. Take with food, but not alcohol, grapefruit, or grapefruit juice. Avoid abrupt discontinuation.
Carbidopa/Levodopa counseling points
If you are using the oral disintegrating tablets, place on top of the tongue; does not require water or swallowing.
Dexmethylphenidate counseling points
Avoid late evening doses due to resulting insomnia. If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of soft food such as applesauce. Stir this mixture well and swallow it without chewing. Seek medical attention if chest pain, seizures, heart palpitations, change in behavior or personality, or hostility.
Divalproex counseling points
Avoid activities requiring mental alertness until drug effects are realized; drug may cause somnolence or dizziness. Seek medical attention for signs and symptoms of liver dysfunction (eg, dark-colored urine, light-colored stools, yellowing of skin or eyes, etc), especially during first 6 mo of therapy. Take with food to avoid GI irritation. Do not discontinue drug abruptly, as this may precipitate seizures. Avoid alcohol. Sprinkle capsules can be swallowed whole or opened and sprinkled onto soft food; do not chew.
Donepezil counseling points
Take at bedtime, with or without food. Allow disintegrating tablet to dissolve on tongue and follow with a glass of water. Adverse effects may be more frequent at dose escalation and tend to resolve with continued use. Report signs/symptoms of GI bleeding.
Eletriptan counseling points
Should avoid activities requiring mental alertness or coordination until drug effects are realized, as this drug may cause dizziness or somnolence.
Eszopiclone counseling points
Take immediately before bedtime and do not take with heavy/high-fat meal. Severe anaphylactic/anaphylactoid reactions, some fatal, have been reported. Be aware of the risk of “sleep-driving” and other complex behaviors (eg, preparing and eating food, making phone calls) when the patient is not fully awake. Risk is increased when drug is combined with alcohol or other CNS depressants. Avoid activities requiring mental alertness or coordination until drug effects are realized. Report insomnia that worsens or persists longer than 7-10 d. Report abnormal thoughts or behavior (confusion, agitation, hallucinations, suicidal thoughts, new or worsening depression), memory loss, or anxiety. Take drug only when experiencing insomnia. This drug should not be taken on a regular schedule when insomnia is not present. Do not drink alcohol while taking this drug.
Gabapentin counseling points
First dose on 1st day should be taken at bedtime. ER formulation should be taken with the evening meal. Patient should avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness and somnolence. Report worsening depression, suicidal ideation, or unusual changes in behavior. Avoid sudden discontinuation of drug, as this may precipitate status epilepticus. Wait 2 h after antacid before taking medication.
Guanfacine counseling points
Avoid alcohol, CNS depressants. Caution with driving and other tasks requiring alertness. Swallow extended-release tablet whole, may be taken with or without food. Report signs/symptoms of hypotension, exacerbation of angina peripheral edema, fatigue, hypotension, or hepatic dysfunction with initial dosing and dose changes. Avoid abrupt discontinuation to avoid rebound HTN.
Lacosamide counseling points
May be taken without regard to food but at same time of day. Take with food if GI distress. For the oral solution, measure carefully with oral syringe. Seek medical attention if seizure frequency increases or seizures worsen, abnormal heartbeat, or extreme dizziness.
Lamotrigine counseling points
Seek medical attention if blistering rash develops or if yellowing of skin or eyes, unusual bruising or bleeding, shortness of breath, or suicidal thoughts occur. Slow titration necessary to minimize side effects. Avoid alcohol. Consult HCP if become or planning to become pregnant. Review driving restrictions for patients with seizures. Place oral disintegrating tablet formulation on tongue and allow to dissolve.
Levetiracetam counseling points
Swallow extended-release tablet whole; do not chew, break, or crush. Avoid activities requiring mental alertness or coordination until drug effects are realized. Report mood swings, agitation, hostile behavior, suicidal ideation, or unusual changes in behavior. Avoid sudden discontinuation of drug; may increase seizure activity.
Lisdexamfetamine counseling points
Take dose in the morning with or without food. If capsule opened for administration, drug should be dissolved in water, yogurt, or orange juice and consumed immediately. Monitor growth rate and weight in children. Report new or worsened psychiatric problems (behavior and thought problems, bipolar illness, aggressive behavior or hostility). Also report chest pain, palpitations, dyspnea, or signs/symptoms of cardiac dysrhythmia, AMI, or cerebrovascular accident.
Memantine counseling points
May be taken with or without food. The oral solution is packaged with a dosing device that should be used to administer the medication.
Metaxalone counseling points
Patients should avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects.
Methylphenidate counseling points
Avoid late evening doses due to resulting insomnia. Swallow the extended-release capsule whole. Do not crush, break, or chew it. If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of soft food such as pudding, yogurt, or applesauce. Stir this mixture well and swallow it without chewing. Avoid abrupt discontinuation. For the patch, apply same time each day, alternating hips. Remove after 9 h.
Modafinil counseling points
This drug may decrease effectiveness of hormonal or IUD contraception. Recommend additional form of birth control during therapy and 1 mo after last dose. Avoid activities requiring mental alertness or coordination until drug effects are realized. If using drug for daytime wakefulness, take in the morning; if using to maintain wakefulness during shift work, take drug 1 h prior to working. Do not drink alcohol while taking this drug. Practice good sleep hygiene. Does not replace need for CPAP machines in patients with obstructive sleep apnea.
Oxcarbazepine counseling points
Suspension should be shaken well and dose prepared immediately using oral dosing syringe. Suspension can be mixed in a small glass of water just prior to administration or may be swallowed directly from the syringe. Avoid activities requiring mental alertness or coordination until drug effects are realized. Advise patient to report signs/symptoms of serious dermatologic reactions, myelosuppression, or hepatotoxicity. Take with food, but not alcohol, grapefruit, or grapefruit juice. Avoid abrupt discontinuation to avoid risk of seizure.
Phenobarbital counseling points
Avoid activities requiring mental alertness or coordination until drug effects are realized, as drug may cause dizziness, light-headedness, or somnolence. Advise patient against sudden discontinuation of drug. Do not drink alcohol or use other CNS depressant drugs while taking phenobarbital. Many drug interactions; check with HCP when starting new medications or OTC products.
Phentermine counseling points
May impair ability to engage in potentially hazardous activities such as operating machinery or driving a motor vehicle; avoid. Take during day to avoid insomnia.
Phenytoin counseling points
Suspension requires extensive shaking before administration. Do not crush extended-release capsules. Avoid activities requiring mental alertness or coordination until drug effects are realized. Report signs/symptoms of pancytopenia, hepatotoxicity, systemic lupus erythematosus, or severe skin reaction. Do not drink alcohol while taking this drug. Many drug interactions; check with HCP when starting new medications or OTC products.
Pramipexole counseling points
Take with food if nausea occurs. Avoid activities requiring mental alertness or coordination until drug effects are realized. Rise slowly from a sitting/lying-down position. Report new or increased gambling urges, sexual urges, compulsive eating or buying, as well as new-onset or worsening dyskinesia. Do not discontinue abruptly, as this may cause emergent hyperpyrexia and confusion. Do not drink alcohol, and avoid concomitant use of other CNS depressants.
Pregabalin counseling points
Solution must be used within 45 d of first opening the bottle. Avoid activities requiring mental alertness or coordination until drug effects are realized. Avoid sudden discontinuation of drug due to risk of withdrawal, including increased seizure frequency. Avoid concurrent use of CNS depressants, such as alcohol.
Rizatriptan counseling points
Avoid alcohol, CNS depressants. Caution with driving and other tasks requiring alertness. Allow disintegrating tablet to dissolve on tongue and then swallow, do not chew.
Ropinirole counseling points
Take with food to reduce nausea. Avoid driving and other activities requiring mental alertness or coordination until drug effects are realized. Rise slowly from sitting/lying-down position. Report new onset or exacerbation of dyskinesia, changes in BP, fainting, or unusual urges. Avoid sudden discontinuation of drug; it increases risk of neuroleptic malignancy syndrome. Do not drink alcohol or take other CNS depressants while using this drug.
Topiramate counseling points
Avoid activities requiring mental alertness and coordination until drug effects are realized. Drug may cause dizziness and somnolence, especially if taken with alcohol or other CNS depressants. May cause diplopia, nervousness, confusion, and many other CNS effects. Do not discontinue drug abruptly, as this may cause increased seizure activity. Seek medical attention for new eye problems or high body temperature. May decrease sweating; avoid hot temperatures (including hot tubs and saunas). Maintain adequate fluid intake to minimize the risk of kidney stones. Instruct females on estrogen-progestin contraceptives to use an additional form of contraception due to decreased effectiveness of oral contraceptives. Take a missed dose as soon as possible, if more than 1 dose is missed, consult HCP.
Trazodone counseling points
Avoid driving and other activities requiring mental alertness or coordination until drug effects are realized, as this medicine may cause dizziness or somnolence. Report signs/symptoms of priapism immediately. Avoid use of MAOI within the past 14 d. Avoid sudden discontinuation of drug. Do not drink alcohol, or use barbiturates or other CNS depressants while taking this drug.
Varenicline counseling points
Take drug after eating and with a full glass (240 mL) of water. If you experience sleepwalking, seizures signs of hypersensitivity (shortness of breath), mental status changes or suicidal ideation, stop taking and contact HCP. May be used with other nicotine replacement products to help alleviate withdrawal from nicotine. Limit alcohol use.
Zolpidem counseling points
Take on an empty stomach. May cause daytime drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol. Take immediately prior to bedtime. There is risk of “sleep-driving” and other complex behaviors (eg, preparing and eating food, making phone calls) when not fully awake, zolpidem should be discontinued if this occurs. Risk is increased when drug is combined with alcohol or other CNS depressants. Bed partner should monitor for irregular respiration.
Sumatriptan counseling points
Avoid activities requiring mental alertness or coordination until drug effects are realized, as this drug may cause dizziness or somnolence.
Amitriptyline counseling points
Avoid activities requiring mental alertness, alcohol, and other CNS depressants. Symptomatic improvement may not be seen for a few weeks. Avoid sudden discontinuation of drug. Do not use alcohol.
Aripiprazole counseling points
Avoid activities requiring mental alertness or coordination until drug effects are realized. Drug may impair heat regulation. Drug may also lower seizure threshold. Patients with history of seizures or conditions that lower seizure threshold should report increased seizure activity. Report worsening depression, suicidal ideation, or unusual changes in behavior, especially at initiation of therapy or with dose changes. Children, adolescents, and young adults are at higher risk for these effects during the first few months of therapy. Report signs/symptoms of hyperglycemia, extrapyramidal effects, and neuroleptic malignant syndrome. Avoid sudden discontinuation. Avoid alcohol.
Atomoxetine counseling points
Avoid activities requiring mental alertness or coordination until drug effects are realized. Growth rate and weight may need to be monitored more frequently in children. Report new or worsened psychiatric problems, chest pain, palpitations, dyspnea, or signs/symptoms of cardiac dysrhythmias, MI, or cerebrovascular accident. Do not open capsules as atomoxetine is an ocular irritant.
Buspirone counseling points
Patient should avoid activities requiring mental alertness or coordination until drug effects are realized. Advise patient that symptomatic improvement may not be seen for a few weeks. Advise patient against sudden discontinuation of drug. Patient may take with or without food, but should always take drug consistently. Patient should not drink alcohol or large amounts of grapefruit juice while taking this drug. Avoid concomitant use with MAOI.
Bupropion counseling points
Avoid alcohol, CNS depressants, and activities requiring mental alertness. Take at the same time each day and at bedtime if possible. If taking the extended-release tablet, the tablet shell may remain intact and be visible in the stool.
Citalopram counseling points
Avoid activities requiring mental alertness or coordination until drug effects are realized. Symptomatic improvement may not be seen for several weeks. Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding. Avoid abrupt discontinuation, may precipitate withdrawal symptoms. Do not drink alcohol or use NSAIDs or aspirin while taking this drug.
Clonazepam counseling points
May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol. Allow orally disintegrating tablet to dissolve on your tongue.
Desvenlafaxine counseling points
Take with or without food. Avoid alcohol. Symptomatic improvement may not be evident for a few weeks. Do not discontinue drug abruptly as this may precipitate withdrawal symptoms such as dysphoric mood, irritability, and agitation. Avoid activities requiring mental alertness or coordination until drug effects are realized, as this medicine may cause dizziness or somnolence.
Doxepin counseling points
Avoid activities requiring mental alertness until drug effects are realized. Symptomatic improvement in depression may not be seen for a few weeks. Avoid abrupt discontinuation of drug. Do not drink alcohol.
Duloxetine counseling points
Avoid activities requiring mental alertness or coordination until drug effects are realized. Symptomatic improvement may not be seen for 4-6 wk. Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding. Avoid abrupt discontinuation, may precipitate withdrawal symptoms. Do not drink alcohol or use NSAIDs or aspirin while taking this drug.
Escitalopram counseling points
Avoid activities requiring mental alertness or coordination until drug effects are realized. Symptomatic improvement may not be seen for 4-6 wk. Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding. Avoid abrupt discontinuation, may precipitate withdrawal symptoms. Do not drink alcohol or use NSAIDs or aspirin while taking this drug.
Fluoxetine counseling points
Take without meals and in the morning. Avoid activities requiring mental alertness or coordination until drug effects are realized. Symptomatic improvement may not be seen for several weeks, while adverse effects often present in the 1st wk of therapy. Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding. Do not drink alcohol or use NSAIDs or aspirin while taking this drug.
Lithium counseling points
An FDA-approved patient medication guide must be dispensed with this medication. Swallow extended-release tablets whole; do not crush or chew. Avoid activities requiring mental alertness or coordination until drug effects are realized. Report signs/symptoms of toxicity, which may vary depending on the degree.
What should be reported while taking Lithium?
Report signs/symptoms of toxicity, which may include diarrhea, vomiting, tremor, ataxia, drowsiness, muscle weakness, lack of coordination, giddiness, blurred vision, tinnitus, or large volumes of dilute urine.
What is important to avoid while taking Lithium?
Avoid activities requiring mental alertness or coordination until drug effects are realized. Do not drink alcohol or use NSAIDs or aspirin.
What should Lurasidone be taken with?
Take with food.
What should be reported while taking Lurasidone?
Report worsening depression, suicidal ideation, or unusual changes in behavior, especially at initiation of therapy or with dose changes.
What is the administration instruction for Mirtazapine?
Orally disintegrating tablet blister pack should be opened with dry hands and placed on tongue; no water is needed.
What should be reported while taking Mirtazapine?
Report worsening depression, suicidal ideation, or unusual changes in behavior.
What should be avoided while taking Nortriptyline?
Avoid activities requiring mental alertness or coordination until drug effects are realized.
What should be reported while taking Nortriptyline?
Report worsening depression, suicidal ideation, unusual changes in behavior, or unusual bleeding.
What should be reported while taking Olanzapine?
Report symptoms of tardive dyskinesia, neuroleptic malignant syndrome, or DRESS syndrome.
What should be avoided while taking Paroxetine?
Avoid activities requiring mental alertness or coordination until drug effects are realized.
What is the administration instruction for Quetiapine?
Take with food but avoid alcohol.
What should be reported while taking Risperidone?
Report signs/symptoms of hyperglycemia, arrhythmia, tardive dyskinesia, or neuroleptic malignant syndrome.
What should be avoided while taking Sertraline?
Avoid activities requiring mental alertness or coordination until drug effects are realized.
What is the administration instruction for Venlafaxine?
Take with food, but avoid alcohol. Extended-release capsules and tablets should be swallowed whole.
What should be reported while taking Vilazodone?
Advise patient against sudden discontinuation of drug.
What is the administration instruction for Ziprasidone?
Take with food to increase absorption, but avoid alcohol.
What should be avoided while taking Alprazolam?
Avoid alcohol and tasks requiring motor coordination.
What should be avoided while taking Diazepam?
Avoid alcohol and tasks requiring motor coordination.
What should be avoided while taking Lorazepam?
Avoid alcohol and tasks requiring motor coordination.
What is the administration instruction for Temazepam?
Take 30 min prior to bedtime.
What should be avoided while taking Triazolam?
Avoid alcohol and tasks requiring motor coordination.
What is the mechanism of action for Clobazam?
Often causes lethargy and somnolence. Avoid alcohol and opioids while using. Avoid activities requiring mental alertness. Do not discontinue abruptly.
