Psych medication resources

  1. I recently accepted a new role in community mental health with an organization that does homeless outreach. We primarily focus on homeless individuals who have severe mental health issues. As you can imagine, there are A LOT of new medications I am trying to learn. Does anyone have any good resources that can breakdown all the different psych meds/anti-psychotics? Especially in which cases you would use which medications?
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    About CommunityOB

    Joined: Aug '14; Posts: 19; Likes: 10
    from WA , US

    9 Comments

  3. by   BeenThere2012
    I would like the same information...Anyone out there?
  4. by   Heylove
    Great questions! One thing that I've noticed is that certain doctors have their preference for what they prescribe for the same diagnosis. I'll look around to see what I have, or a good reference.

    Thank you for what you do, by the way. It is a very important component to mental health. My son experienced homelessness with subsequent hospitalizations and I appreciated his nurses working with me to get him some real help.
  5. by   Heylove
  6. by   InquisitiveAPN
    Are you looking for handouts for the clients or education?

    If the latter, get Stahl's books. His prescriber's guide lists approved and off label uses, augmentation strategies, etc. The essentials books does a fun job explaining how most psych meds work.

    Subscribe to Psychiatic Times (free) and read the emails.

    A considerable amount of meds in psych are off label so you're standard nurse book will be useless.

    Most all of us pick our preferred meds and stick to those. Out of 40-50 psych meds I may consider using in practice, I generally stick to about ten them. Psych meds aren't really great either. Some days I find myself really tired of med mgmt.

    Briefly:

    All of the SSRIs, excluding paroxetine, are generally safe in pregnancy and lactation and can treat, depressive, anxiety, trauma, obsessive-compulsive, and eating disorders. The side effects might be leveraged.

    bupropion may be used for depression, ^ executive function, wakefulness, appetite reduction >wt loss, smoking cessation and suppress drug and maybe gambling cravings, libido increase

    mirtazapine - depression, sometimes anxiety, sleep, appetite < wt gain

    antiepileptics for impulse control, anger, anxiety, mood stabization, seizures, migraine, antipsychotic augmentation; notably here valproic acid formulations, carbamazepine, oxcarbazepine, gabapentin

    differentiate between first and second generation antipsychotics. Potential uses might be psychosis, bipolarity, depression, insomnia, trauma, anxiety, appetite increase, OCD augmentation, et Al

    Not many people use MAO inhibitors, but when I do they work well

    tricyclic antidepressants - depression, sleep, anxiety, chronic pain, HA, appetite/weight

    stimulants - ADHD, executive function increase whether ADHD or not, refractory depression, wakefulness, appetite suppression and weight loss

    SNRIs - can be dose dependent, depression, anxiety, trauma, pain

    buspirone - anxiety, little else

    trazodone and nefazodone depression, insomnia

    lithium - mood stability, depression, suicide protective, antipsychotic augmentation


    benzodiazepines - anxiety, panic, ocd, trauma (contraindicated in many studies), sleep, psychosis, agitation, IED; z- drugs

    Other drugs you may find floating around:

    beta blockers, almost always propranolol for anxiety or tremor, HA,
    alpha 1 blockers - anxiety, sweating, nightmares and sleep (prazosin)
    alpha 2 agonists - clonidine and guanfacine; anxiety, ADHD, kids with what presents as ADHD, agitation, sleep

    desmopressin - enuresis
    cyproheptadine - appetite/wt, sexual dysfunction, several uses
    ropinirole, et al
    benztropine
    trihexyphendyl
    amantadine
    dextromethopram
    melatonin and melatonin agonists
    hydroxyzine pamoate (capsule) or hydrochloride (tablet) - anxiety, agitation, sleep

    Read about EPS and how to treat it, serotonin syndrome, serotonin discontinuation syndrome, neuroleptic malignant syndrome, akithisia (which I spell differently every time I write it),
  7. by   BeenThere2012
    THANK YOU SO MUCH! You gave me great information and I appreciate that you took the time to post all that.

    Where I work, I see a lot of the following prescribed in addition to what you mentioned and have wondered how the docs decide amongst the following:

    Zyprexa
    Risperidone
    Invega and Invega Systena
    Clozaril
  8. by   BeenThere2012
    And I'll look into the references you mentioned.
    Thank you, again!
  9. by   InquisitiveAPN
    Quote from BeenThere2012
    THANK YOU SO MUCH! You gave me great information and I appreciate that you took the time to post all that.

    Where I work, I see a lot of the following prescribed in addition to what you mentioned and have wondered how the docs decide amongst the following:

    Zyprexa
    Risperidone
    Invega and Invega Systena
    Clozaril
    It's not so much a matter of XYZ drug for ABC disorder. Zyprexa is relatively cheap and generally does a good job of shutting people down in an inpatient environment be it psychosis, mania, aggression. There's also Zyprexa Zydis which is SL administration and isn't cheap! Makes people fat quick.

    Risperidone is cheap. At higher doses it's more like a first generation or typical antipsychotic so chance of EPS is greater. Also can cause weight gain, lactation, man boobs, etc. Can be a reasonably good drug.

    I don't use Invega. It's too expensive so I don't make drug formularies fund it. The IM is helpful for people who aren't med compliant. I have very little anecdotal experience with it.

    Clozaril is a very unique antipsychotic usually reserved for people unresponsive to other drugs or who have a lot of EPS with other drugs. Requires granulocyte monitoring and recording in the REMS database. You have to be registered to use it. I am. There's some other benefit as well and IP is the best place to start it rather than OP, IMHO.
  10. by   BeenThere2012
    Quote from InquisitiveAPN
    It's not so much a matter of XYZ drug for ABC disorder. Zyprexa is relatively cheap and generally does a good job of shutting people down in an inpatient environment be it psychosis, mania, aggression. There's also Zyprexa Zydis which is SL administration and isn't cheap! Makes people fat quick.

    Risperidone is cheap. At higher doses it's more like a first generation or typical antipsychotic so chance of EPS is greater. Also can cause weight gain, lactation, man boobs, etc. Can be a reasonably good drug.

    I don't use Invega. It's too expensive so I don't make drug formularies fund it. The IM is helpful for people who aren't med compliant. I have very little anecdotal experience with it.

    Clozaril is a very unique antipsychotic usually reserved for people unresponsive to other drugs or who have a lot of EPS with other drugs. Requires granulocyte monitoring and recording in the REMS database. You have to be registered to use it. I am. There's some other benefit as well and IP is the best place to start it rather than OP, IMHO.
    Yes...I work in IP. Thank you again. Good info.
    We have many revolving door patients who are not med compliant.

    I've noticed zyprexa used rather frequently as an ER med along with Diphenhydramine, Haldol, sometimes Thorazine. Or some combination of these.

    I know Clozaril is used when nothing else is working and understand the possible SE's.

    I'm learning...!
  11. by   FolksBtrippin
    I work in the community also, in a similar program to you, OP. Inquisitive APN made a great post. I just have a little to add. In the community you will be using a lot of long term injectables, called IM depot. The reason is that it will be hard to find your patients, and hard for them to stay compliant with oral meds for many reasons. Homeless are the most difficult.

    Here are the IM depot drugs we use, they are always for psychosis or mania. Never for depression:


    Invega Sustena: you give 234 mg IM, then 8 days later 156 mg IM. That is the loading dose. After that it is monthly 234 mg IM. Deltoid or Gluteal. Once the patient has gotten 4 sustennas, they can get trinza, which is the 3 month version.

    Risperidal Consta: this is every 2 weeks and has to be refrigerated. Also, has a higher risk of man boobs and lactation than the Invega Sustena, which is chemically almost identical. So not as good as Invega, but some of our pts just tolerate it better for some reason. comes in 12.5 mg, 25 mg, 50 mg and most of our pts get 50 mg. Deltoid or glute.

    Abilify maintenna: Monthly. Less effective than the Invega and risperidal, less side effects. Also good for bipolar mania. 400 mg IM delt or glute. There is also a 300 mg version that one of our pts is on. You have to keep your folks on the oral version for a while first though which can be a problem.

    Aristada: Same chemical as abilify, but longer acting. Once every 3 months. Also, there is an option of doing 2 injections as a loading dose rather than doing oral meds to start.

    Haldol dec: Cheap. Given every 2, 3 or 4 weeks. Draw up the dose yourself rather than a prefab box. Very effective, but strong risk of EPS and parkinsonism.

    Prolixin dec: Cheap. We don't have anyone on this right now.

    Before we get our folks on medicaid or medicare we get these drugs as samples from the reps, who are very good to us and give us whatever we need. With the exception of haldol dec and prolixin which are just too old to still be peddled by reps.

    Your job will be about building rapport and trust. Simple is best. Bring food and drinks for every visit in the community. Hopefully your agency gives you some petty cash. Don't boss your patients, freedom is key for this population in general and the homeless are even more about their freedom. Before you leave any engagement, find out what they need for the next one. I end every engagement with "What do you want me to report back to the team?" and then "What do you want us to bring you next time we come out?" Write it down and then make it happen. This is how you create trust. They get in the habit of looking forward to seeing you.

    This is really the best work ever.

    PM me if you want

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