Emergency Psychiatric Medications

[edie1]

Could someone tell me the most common medications used for psychiatric emergencies? I am guessing most of them are IM but the information I have found has been from a drug company or wikipedia and not sure I can entirely trust these sources. Thank you.

edie

[Mandychelle79, ASN, RN]

If it is our normal psych doctor giving the orders, Haldol and Ativan most of the time. If we called a violent code, depends on what the doctor orders when they get there ( hospitalist)

[Abug]

OK, great info. Has anyone but me seen Geodon used in emergent situations? It can be helpful but must be given with food. That can be tricky with a paranoid person. But if the person's willing to take a po it seems to be quite effective and sure doesn't have the SEs of vitamin H.

[TerpGal02, ASN]

We use Geodon in emergencies, never PO though, always IM. Then ya get around the take with food thing lol. That seems to be our go to IM these days. It works but takes forEVER to mix.

[rferrenlpt]

Geodon IM is used but its more likely the patient will calm down by the time its reconstituted

[VivaLasViejas, ASN, RN]

PO Geodon works well if a patient is willing and able to eat a generously-spread peanut butter sandwich along with it---the peanut butter provides the fat needed for best absorption of the drug. Just a suggestion from someone who actually takes ziprasidone regularly and has learned a few tricks that promote its bioavailability while avoiding weight gain!

[TerpGal02, ASN]

Only problem with long term Geodon therapy is the whole long QT thing. I have seen it a few times. Our docs always get a baseline ecg when starting it, and then a repeat a few days later.

[Jules A, MSN]

Most commonly used on my unit is Haldol 5mg with Ativan 2mg. IM along with Cogentin 1mg IM for EPS

I usually do 5mg or 10mg of Haldol with 1mg Ativan and definitely prefer to use Benadryl rather than Cogentin because you get the protection from EPS but a little extra sedating bang for your buck.

[Jules A, MSN]

We don't use IM Zyprexa within an hour of IM Ativan.

Concomitant use of benzodiazepines and other medicinal

products

Special caution is necessary in patients who have received treatment with

other medicinal products having haemodynamic properties similar to those of

intramuscular olanzapine including other antipsychotics (oral and/or

intramuscular) and benzodiazepines (see section 4.5). Temporal association of

treatment with IM olanzapine with hypotension, bradycardia, respiratory

depression and death has been very rarely (

patients who have received benzodiazepines and/or other antipsychotics (see

section 4.8).

Simultaneous injection of intramuscular olanzapine and parenteral

benzodiazepine is not recommended due to the potential for excessive sedation,

cardiorespiratory depression and in very rare cases, death (see sections 4.5 and

6.2). If the patient is considered to need parenteral benzodiazepine treatment,

this should not be given until at least one hour after IM olanzapine

administration. If the patient has received parenteral benzodiazepine, IM

olanzapine administration should only be considered after careful evaluation of

clinical status, and the patient should be closely monitored for excessive

sedation and cardiorespiratory depression.

Zyprexa Powder for Solution for Injection - Summary of Product Characteristics (SPC) - (eMC)

[electricblack]

Code Whites (always prep meds and have someone call security so its handled smoothly).

We use either Zyprexa 5-10 or cocktail of Haldol (2.5-5mg), Ativan (1-2mg), and Cogentin (2mg). Always offer PO, usually the presence of security gets them to take it, sometimes having too much ppl can escalate them even more, always support em cuz it can be a very scary and traumatic experience to some).

The med usually works very quickly and I usually encourage em to stay in a quiet environment like their room to let the med work.

They either sleep, calm down, or it doesn't touch them in which case you need a security around or you a close observation (locked room or restraints... But make sure theyre deemed involuntary before all of this, and close obs for patient safety).

Be careful of the elderly as well... It can affect your choice of medication.

[SouthernPsy]

And on the 8th day, God created zyprexa, ativan, and haldol...

[NurseJamie8]

On my unit we use Haldol, Ativan, and Zyprexa as emergency IM meds. Never Benadryl because it actually makes dementia patients more agitated.

[TerpGal02, ASN]

I've never seen PO Geodon used is an emergency. Lots of patients take PO Geodon as a regular scheduled med. Its a great mood stabilizer, weight neutral but yeah the prolonged QT thing. If we start it in the hospital, we get a baseline ECG then another one a few days later. I think outpatient, any psych that knows what they are doing will send patients for routine ECGs. We just had to take a patient OFF Geodon because of that.