Meds card

COMMONLY USED PSYCHOTROPIC DRUGS
po = by mouth; prn = as needed; qd = 1x/day; bid = 2x/day; tid = 3x/day; qid = 4x/day;
qod = every other day; qhs = at bedtime; qac = before meals; = on WalMart’s $4 Rx plan, however not al dosages may be covered
IMPORTANT CLINICAL INFORMATION
Commonly used Antidepressants and Antianxiety Medications
Start: 100mg bid titrating to 150 mg bid or tid SR or XL preparation is longer acting (bid dosing) Seizure risk ; Stimulating; not good for anxiety Less GI distress than other SSRIs; No clinical CYP 450 interactions Side effect profile like SSRIs and venlafaxine Less GI distress than other SSRIs; No clinical CYP 450 interactions 20 – 80mg qam (Start: 10 – 20mg qam) More stimulating than other SSRIs; Long half life prevents withdrawal Sedating and appetite promoting; Neutropenia risk (1 in 1000) 20 – 50mg qhs (Start: 10 – 20mg qhs) Anticholinergic, sedating, withdrawal syndrome 50 – 200mg qam (Start: 25 – 50mg qam ) 50 – 150mg qhs for sleep (Start: 25mg qhs) Commonly used as sleep aid; Priapism risk Start: 37.5 – 75mg bid with titration to 300 – 375mg daily XR preparation is longer acting (once daily dosing) Side effects like SSRIs; HTN and withdrawal risk Commonly used Antianxiety and Sleep (Hypnotic) Medications
Indicated for panic disorder and anxiety; Equivalent dose: 0.5mg Start: 0.25 – 0.5mg bid with doses up to 1 – 4mg in panic disorder and up to Indicated for panic disorder and seizure disorder; Has been effective in mania Onset: intermediate; Elimination: 18 – 50 hrs; Equivalent dose: 0.25mg Start: 2 – 10mg bid to qid with doses varying widely based on the reason for Many indications including anxiety, seizures, alcohol withdrawal, & muscle spasm Onset: fast; Elimination: 30 – 100 hrs; Equivalent dose: 5mg Start: 10mg bid or tid for anxiety. Insomnia: start with 15 mg at bedtime. Indicated for alcohol withdrawal and anxiety; Equivalent dose: 15mg Indicated for insomnia, anxiety, pre-anesthesia, and status epilepticus Safer in liver disease; Equivalent dose: 1mg Start: 1 – 2mg at bedtime titrated to 3mg Approved for long term use; no evidence of dependence over six month treatment Essentially like zolpidem; Has a very short half life of one hour. Melatonin receptor agonist; Appears safe for long term use in insomnia Commonly used Antimanic Medications (Mood Stabilizers)
Start: 150 – 300mg bid with doses up to 1200 – 1500mg daily based on renal Black box warning: toxicity and the need to check levels; Level established (0.5 - 1.2 meq/L) Start: 250mg bid with end dose of 1000 – 2000mg divided bid Black box warning: hepatotoxicity, pancreatitis, and teratogenicity; Therapeutic levels (80-120mcg/mL) Start: 25mg daily for two weeks then 50mg daily for two weeks with a final Commonly used Antipsychotic Medications
Hyperprolactinemia common; Decanoate (injection) preparation available. Start: 0.5 – 1mg qhs or bid titrating to 4 – 6mg daily or bid Orally dissolvable tablet excellent for acute agitation Start: 5 – 10mg daily titrating to 15 – 30mg daily once or divided bid Sedation, weight gain, and metabolic complications are common. Start: 20mg bid titrating to 400 – 600mg daily divided bid (max dose: Very sedating with a low incidence of extrapyramidal side effects. Start: 20mg bid titrating to 40 – 80mg bid Start:10 – 15mg daily titrating to 15 – 30mg daily May have less metabolic complications than other atypicals Also has an indication for bipolar disorder Start: 12.5 daily or bid titrating slowly to 300-450mg daily in divided doses Most effective antipsychotic for treatment refractory patients Agranulocytosis, orthostasis, tachycardia, weight gain, and drooling Classic typical, high potency neuroleptic. Causes Parkinsonian symptoms (EPS). Start: 0.5 to 5mg daily or bid titrating to 5- 20 mg daily Comes in an elixir and can be given PO, IM. Long acting (depot) form available. Start: 1mg at bedtime (titrate slowly as needed to effect) Orthostatic hypertension– Patient should move slowly from resting to standing COMMONLY USED PSYCHOTROPIC DRUGS
po = by mouth; prn = as needed; qd = 1x/day; bid = 2x/day; tid = 3x/day; qid = 4x/day;
qod = every other day; qhs = at bedtime; qac = before meals; = on WalMart’s $4 Rx plan, however not al dosages may be covered
IMPORTANT CLINICAL INFORMATION
Commonly used Antidepressants and Antianxiety Medications
Start: 100mg bid titrating to 150 mg bid or tid SR or XL preparation is longer acting (bid dosing) Seizure risk ; Stimulating; not good for anxiety Less GI distress than other SSRIs; No clinical CYP 450 interactions Side effect profile like SSRIs and venlafaxine Less GI distress than other SSRIs; No clinical CYP 450 interactions 20 – 80mg qam (Start: 10 – 20mg qam) More stimulating than other SSRIs; Long half life prevents withdrawal Sedating and appetite promoting; Neutropenia risk (1 in 1000) 20 – 50mg qhs (Start: 10 – 20mg qhs) Anticholinergic, sedating, withdrawal syndrome 50 – 200mg qam (Start: 25 – 50mg qam ) 50 – 150mg qhs for sleep (Start: 25mg qhs) Commonly used as sleep aid; Priapism risk Start: 37.5 – 75mg bid with titration to 300 – 375mg daily XR preparation is longer acting (once daily dosing) Side effects like SSRIs; HTN and withdrawal risk Commonly used Antianxiety and Sleep (Hypnotic) Medications
Indicated for panic disorder and anxiety; Equivalent dose: 0.5mg Start: 0.25 – 0.5mg bid with doses up to 1 – 4mg in panic disorder and up to Indicated for panic disorder and seizure disorder; Has been effective in mania Onset: intermediate; Elimination: 18 – 50 hrs; Equivalent dose: 0.25mg Start: 2 – 10mg bid to qid with doses varying widely based on the reason for Many indications including anxiety, seizures, alcohol withdrawal, & muscle spasm Onset: fast; Elimination: 30 – 100 hrs; Equivalent dose: 5mg Start: 10mg bid or tid for anxiety. Insomnia: start with 15 mg at bedtime. Indicated for alcohol withdrawal and anxiety; Equivalent dose: 15mg Indicated for insomnia, anxiety, pre-anesthesia, and status epilepticus Safer in liver disease; Equivalent dose: 1mg Start: 1 – 2mg at bedtime titrated to 3mg Approved for long term use; no evidence of dependence over six month treatment Essentially like zolpidem; Has a very short half life of one hour. Melatonin receptor agonist; Appears safe for long term use in insomnia Commonly used Antimanic Medications (Mood Stabilizers)
Start: 150 – 300mg bid with doses up to 1200 – 1500mg daily based on renal Black box warning: toxicity and the need to check levels; Level established (0.5 - 1.2 meq/L) Start: 250mg bid with end dose of 1000 – 2000mg divided bid Black box warning: hepatotoxicity, pancreatitis, and teratogenicity; Therapeutic levels (80-120mcg/mL) Start: 25mg daily for two weeks then 50mg daily for two weeks with a final Commonly used Antipsychotic Medications
Hyperprolactinemia common; Decanoate (injection) preparation available. Start: 0.5 – 1mg qhs or bid titrating to 4 – 6mg daily or bid Orally dissolvable tablet excellent for acute agitation Start: 5 – 10mg daily titrating to 15 – 30mg daily once or divided bid Sedation, weight gain, and metabolic complications are common. Start: 20mg bid titrating to 400 – 600mg daily divided bid (max dose: Very sedating with a low incidence of extrapyramidal side effects. Start: 20mg bid titrating to 40 – 80mg bid Start:10 – 15mg daily titrating to 15 – 30mg daily May have less metabolic complications than other atypicals Also has an indication for bipolar disorder Start: 12.5 daily or bid titrating slowly to 300-450mg daily in divided doses Most effective antipsychotic for treatment refractory patients Agranulocytosis, orthostasis, tachycardia, weight gain, and drooling Classic typical, high potency neuroleptic. Causes Parkinsonian symptoms (EPS). Start: 0.5 to 5mg daily or bid titrating to 5- 20 mg daily Comes in an elixir and can be given PO, IM. Long acting (depot) form available. Start: 1mg at bedtime (titrate slowly as needed to effect) Orthostatic hypertension– Patient should move slowly from resting to standing Provide d by Mental H ealth Infrastructure a nd Train ing (MHIT) Project an d REACH NOLA (w ww.reac hno la.org) MAXIMUM THERAPEUTIC DOSES (mg PER DAY) OF (Medication "failures" are often due to inadequate dosing*) *Treat at the maximum tolerated therapeutic dose for 6 to 8 weeks before switching. • Dangerous interactions with other necessary medications • It was never "indicated" to begin with (wrong diagnosis or wrong medicine for diagnosis) • It has been at the maximum therapeutic dose for 6 to 8 weeks with no results Originally created by Alex Thompson, MD, MPH, MBA and Stephen Thielke, MD, MPH MAXIMUM THERAPEUTIC DOSES (mg PER DAY) OF (Medication "failures" are often due to inadequate dosing*) *Treat at the maximum tolerated therapeutic dose for 6 to 8 weeks before switching. • Dangerous interactions with other necessary medications • It was never "indicated" to begin with (wrong diagnosis or wrong medicine for diagnosis) • It has been at the maximum therapeutic dose for 6 to 8 weeks with no results Originally created by Alex Thompson, MD, MPH, MBA and Stephen Thielke, MD, MPH Provide d by Mental H ealth Infrastructure a nd Train ing (MHIT) Project an d REACH NOLA (w ww.reac hno la.org)

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