seizure, anxiety, depression, sedative, antipsychotic, BPD, antiepileptic, stimulants ADHD

Phenytoin (Dilantin)

Decreases Na+ influx.

Indications: Partial/tonic-clonic seizures, post-neurosurgery, off-label arrhythmias, severe preeclampsia.

AE: Nystagmus, ataxia, slurred speech, tremor, confusion, hirsutism, gingival hyperplasia, ↑BG, teratogenic, purple glove syndrome.

NC: Therapeutic 10–20 mcg/mL; adjust q5–7 days; taper; take with food.;

Carbamazepine (Tegretol)

Delays sodium channel recovery.

Indications: DOC focal & tonic-clonic seizures, bipolar disorder, neuropathic pain.

AE: Nystagmus, ataxia, leukopenia, anemia, thrombocytopenia, rash, photosensitivity.

NC: Monitor CBC/platelets; avoid grapefruit juice; multiple drug interactions.;

Valproate / Divalproex (Depakote)

Increases GABA availability.

Indications: All seizures, migraines, bipolar disorder.

AE: GI upset, fatal hepatotoxicity, pancreatitis, teratogenicity.

NC: BLACK BOX warnings; avoid liver disease; pregnancy tests; monitor for pancreatitis.;

Oxcarbazepine (Trileptal)

Blocks Na+ entry. Indications: Focal seizures.

AE: Dizziness, drowsy, diplopia, nystagmus, hyponatremia, hypothyroidism, SJS.

NC: Monitor renal function, sodium, drug interactions, contraception effectiveness.;

Topiramate (Topamax)

Blocks Na/Ca/Glutamate; enhances GABA.

Indications: Focal & tonic-clonic seizures, Lennox-Gastaut, migraine prophylaxis, neuropathic pain.

AE: Suicidal ideation, dizziness, cognitive slowing, weight loss, metabolic acidosis, kidney stones.

NC: Assess suicide risk, avoid keto diet, monitor weight.;

Gabapentin (Neurontin)

Enhances GABA release.

Indications: Focal seizures; off-label neuropathic pain, fibromyalgia, migraines, hot flashes.

AE: Somnolence, dizziness, ataxia, fatigue, nystagmus, edema.

NC: Do not crush XR; take at bedtime; taper slowly.;

Levetiracetam (Keppra)

Unknown mechanism.

Indications: Myoclonic, focal, generalized tonic-clonic seizures.

AE: Drowsiness, asthenia, agitation, depression, anxiety, hallucinations.

NC: Monitor CBC & renal/LFTs; IV infusion 15 min.;

Paroxetine (Paxil)

SSRI; inhibits serotonin reuptake.

Indications: GAD, OCD, depression.

AE: NMS, suicidal thoughts, SJS, dry mouth, sweating.

NC: Monitor for serotonin syndrome & NMS; treat dry mouth; report symptoms.;

Buspirone (Buspar)

Non-benzo; serotonin receptor affinity.

Indications: Anxiety; safe in substance abuse.

AE: Dizziness, nausea, headache, excitement, tinnitus.

NC: Avoid MAOIs & grapefruit; avoid alcohol; may cause palpitations.;

Diazepam (Valium)

Benzodiazepine; enhances GABA.

Indications: Anxiety, sedation, muscle relaxation, seizures, status epilepticus. AE: Dizziness, depression, N/V, sexual dysfunction; toxicity.

NC: Flumazenil antidote; taper; avoid driving; avoid caffeine; increase fluids.;

Fluoxetine (Prozac)

SSRI; blocks serotonin reuptake.

Indications: Depression, bipolar, OCD, panic disorder.

AE: Weight gain, nausea, insomnia, sexual dysfunction, suicidality.

NC: Takes 4 weeks; assess serotonin syndrome; avoid MAOI + St John’s wort.;

Venlafaxine (Effexor XR)

SNRI; blocks serotonin & norepi reuptake.

Indications: GAD, depression, social anxiety.

AE: N/V, HTN, HA, insomnia.

NC: Taper 2 wks; risk serotonin syndrome.;

Imipramine (Tofranil)

Tricyclic; blocks serotonin & norepi reuptake.

Indications: Depression, bipolar, fibromyalgia.

AE: Sedation, orthostatic hypotension, anticholinergic symptoms, cardiac toxicity.

NC: Lethal in overdose, gastric lavage/charcoal; small Rx amount for suicidal pts.;

Phenelzine (Nardil)

MAOI; ↑ norepi, serotonin, tyramine.

Indications: Depression, bulimia, PTSD, panic disorder.

AE: Orthostatic hypotension, hypertensive crisis w/ tyramine foods.

NC: Avoid tyramine foods (wine, cheese, soy sauce, pickled/processed meats).;

Bupropion (Wellbutrin)

Inhibits dopamine/norepi reuptake.

Indications: Depression, SAD prevention, ADHD, smoking cessation.

AE: Agitation, HA, dry mouth, weight loss, tachycardia, seizures.

NC: Ask about seizures/head trauma; no sexual dysfunction.;

Alprazolam (Xanax)

Benzodiazepine; potentiates GABA.

Indications: Anxiety, vertigo (off-label).

AE: CNS/resp depression, amnesia, paradoxical excitement.

NC: Monitor CNS depression; flumazenil antidote.;

Zolpidem (Ambien)

Sedative-hypnotic; GABA agonist.

Indications: Insomnia.

AE: CNS depression, next-day drowsiness, complex sleep behaviors, hallucinations, withdrawal.

NC: Rapid onset; use only if severe insomnia.;

Haloperidol

1st gen antipsychotic; dopamine blocker.

Indications: Schizophrenia, psychosis, Tourette’s.

AE: EPS (dystonia/parkinsonism/akathisia), QT prolongation, NMS.

NC: Monitor EKG; stop if NMS; high potency.;

Clozapine (Clozaril)

2nd gen antipsychotic; blocks dopamine & serotonin.

Indications: Schizophrenia.

AE: Sedation, weight gain, metabolic syndrome, agranulocytosis.

NC: Monitor CBC, metabolic panel, mental status.;

Ziprasidone (Geodon)

D2 & 5HT2 antagonist; also α2 blockade.

Indications: Schizophrenia, bipolar mania; IM for agitation.

AE: NMS, seizures, EPS, QT prolongation, GI effects, rash.

NC: Monitor EKG, motor symptoms, use IM w/ assistance.;

Lithium (Lithobid)

Unknown; affects serotonin & glutamate; neuroprotective.

Indications: Acute mania, bipolar prophylaxis.

AE: GI upset, tremors, polyuria, weakness.

NC: Therapeutic 0.4–1; monitor levels q2–3 days; hydrate; monitor renal/thyroid/Na; hemodialysis if >2.5.;

Divalproex (Valproate)

Valproic acid + sodium salts.

Indications: BPD, acute mania prevention.

AE: Thrombocytopenia, pancreatitis, liver failure.

NC: Start 250mg TID; monitor levels 50–120; monitor platelets.;

Carbamazepine (Tegretol) (BPD use)

Reduces manic symptoms.

Indications: BPD episodes.

AE: Neurologic effects, thrombocytopenia, pancreatitis.

NC: Monitor CBC, LFTs.;

Lamotrigine (Lamictal)

Blocks Na channels; ↓ glutamate.

Indications: Bipolar maintenance.

AE: HA, dizziness, diplopia, SJS.

NC: Can be combined with others; monitor rash.;

Amphetamine/Dextroamphetamine (Adderall)

Increases release of dopamine & NE.

Indications: ADHD, narcolepsy.

AE: Dependence, insomnia, weight loss, tachycardia, HTN, psychosis.

NC: Take AM; avoid MAOI/CNS stimulants; withdrawal education.;

Modafinil (Provigil)

Non-amphetamine stimulant; reduces sleep-promoting neurons.

Indications: Narcolepsy, OSA, shift-work disorder.

AE: HA, N/V, tachycardia, HTN.

NC: Take AM; monitor VS & breathing.;

Methylphenidate (Ritalin)

Increases NE & dopamine; inhibits reuptake.

Indications: ADHD, narcolepsy.

AE: Insomnia, ↓ appetite, emotional lability, abuse risk.

NC: Take AM; avoid MAOI/CNS stimulants; withdrawal caution.;