psych and behavioral medications

Question 1

diazepam ; valium

Answer 1

Classification: Benzodiazepine, anticonvulsant

MOA: depresses the CNS by potentiating GABA, an inhibitory neurotransmitter; produces skeletal muscle relaxation.

Pharmacokinetics: Onset: IV 1-5 minutes, duration IV 15-60 min

Indications: treat seizure activity including status epilepticus; can be used as skeletal muscle relaxant

AR/SE: dizziness, drowsiness, hypotension

Contraindications: known allergy; pts with severe pulmonary impairment, liver dysfunction, uncontrolled severe pain, angle-closure glaucoma, preexisting CNS depression

Dosage: 5-10 mg IV may repeat q 5-10 min up to 30 mg total

Special Considerations: (P class D) may cause respiratory arrest if given too quickly or in excess. Do not mix with other drugs, may cause precipitate.

Question 2

diphenhydramine ; benadryl

Answer 2

Class: antihistamine

MOA: antagonizes the effects of histamine at the H1 receptor site, does not bind to or inactivate histamine; has CNS and anticholinergic properties

Pharmacokinetics: well absorbed; onset: IV-rapid IM- 20-30 min; duration: 4-8 hours

Indications: relief of acute dystonic reactions

AR/SE: drowsiness, anorexia, dry mouth

Contraindications: known allergy; pts with acute
asthma attacks

Dosage: Adult: 25-50 mg IV, IM Peds: 1.25 mg/kg IV, IM

Special Considerations: (P class B)

Question 3

haloperidol ; haldol

Answer 3

Class: antipsychotic

MOA: alters the effects of dopamine in the CNS; also has anticholinergic and alpha-adrenergic blocking activity

Pharmacokinetics: well absorbed; onset: IV-minutes IM- 20-30 min; duration: 4-8 hours

Indications: acute and chronic psychotic disorders including schizophrenia, manic states, and drug-induced psychoses. Also used as chemical restraint.

AR/SE: seizures, respiratory depression, hypotension, tachycardia, extrapyramidal reactions

Contraindications: known allergy, angle-closure glaucoma, CNS depression, severe liver or cardiovascular disease, prolonged QT syndrome

Dosage: Adult: 5mg IV (10 mg IM)

Special Considerations: (P class C)

Question 4

lorazepam ; ativan

Answer 4

Classification: anticonvulsant, antianxiety

MOA: Depresses CNS by potentiating GABA and inhibitory neurotransmitter

Pharmacokinetics: Absorbed rapidly, onset 15-30 minutes IV, duration 8-12 hours

Indications: decrease anxiety and seizure activity, also can be used as premedication before cardioversion

AR/SE: Apnea and cardiac arrest (rapid IV), dizziness, drowsiness, lethargy, slurred speech

Contraindications: known allergy, pre-existing CNS depression, uncontrolled severe pain, severe hypotension, angle-closure glaucoma.

Dosage: 1-2 mg IV/IO/IM/IN, may be repeated if necessary but not to exceed 8 mg in 12 hrs.

Special considerations: (P Class D) Flush line before administration if other drugs have been given. Use caution in pts with severe liver, renal, or pulmonary impairment.

Question 5

midazolam ; versed

Answer 5

Classification: benzodiazepine, antianxiety, sedative/hypnotic

MOA: Acts on CNS to produce generalized CNS depression via GABA

Pharmacokinetics: Onset IN 5 min, IM 15 min, IV 1.5-5 min, Duration IN ½-1 hr, IM/IV 2-6 hrs

Indications: seizure activity, anxiety, premedication before painful procedures

AR/SE: Apnea, laryngospasm, respiratory depression, cardiac arrest, phlebitis, hiccups

Contraindications: known allergy, pts in shock, preexisting CNS depression, uncontrolled severe pain or angle-closure glaucoma.

Dosage: 1-2.5mg IV, 5mg IN (for sedation/induction, initial dose of 2-4 mg IV/IO followed by 3-5 mg q 15 min to maintain sedation)

Special considerations: (P Class D) monitor vital signs continuously.

Question 6

ketamine ; ketalar

Answer 6

Classification: Anesthetic; analgesic agent

MOA: blocks afferent transmission of impulses associated with pain perception; causes short-acting amnesia without muscular relaxation results is a patient who is dissociated from the environment.

Pharmacokinetics: Well absorbed, onset 30 seconds, duration 10-15 minutes

Indications: sedation, pain control, induction agent for RSI

AR/SE: Apnea, Severe Respiratory depression, hallucinations, explicit dreams

Contraindications: known allergy, hypertensive patients or patients with increased ICP

Dosage: Adult- 1mg/kg over 1 min IV (2-4 mg/kg IM)

Special considerations: (P Class C) prolonged recover time if used with other opioids or barbituates, monitor vital signs frequently