Unit 15 PMHNP Portfolio for Clinical Practice. due 12-16-23. 4 references.

PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER

CLINICAL PRACTICE PORTFOLIO

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PMHNP Portfolio for Clinical Practice

Table of Contents

NU670 Psychopharmacology and Health promotion

Neurotransmitter Chart (Unit 1)

Antipsychotics Chart (Unit 2)

Antidepressants, Anxiolytics, & Mood Stabilizers Chart (Unit 3, 4, 5)

Substance Use Resources (Chart links) (Unit 6)

Additional Resources List

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PMHNP Portfolio for Clinical Practice

Neurotransmitters Chart Function

(Excitatory or

Inhibitory)

Locations Receptors Effects of Deficient

Effects of Surplus

Agonist Drug Antagonist Drug

Acetylcholine Excitatory

When activated, it causes the contraction of skeletal muscles and activates glandular functions in the endocrine system, sensory response excitatory, muscle function, learning and memory attention

Neuromuscular junctions, CNS

Nicotinic Muscarinic

Lack of muscle movement & control (paralysis) Linked to Alzheimer’s disease, impaired memory

Severe Muscle Spasms Can cause symptoms of muscarinic and nicotinic toxicity, Parkinson’s symptoms

Caffeine Nicotine, muscarine, Chantix, nerve gases (VX, Sarin), Alzheimer's drugs (Aricept, Exelon), physostigmine, Tensilon, pilocarpine

Muscarinic antagonists or nicotinic antagonist Hyoscyamine atropine propantheline BZ, atropine, scopolamine, benztropine, biperiden, curare, Botox, mecamylamine, α-bungarotoxin

Dopamine Inhibitory

Reward pathways cognition, voluntary motions – Stimulates hypothalamus

Hypothalamus D1, D2, D3, D4, D5

Substance abuse, Anhedonia, Parkinson’s disease

Schizophrenia drug addiction

Amphetamine, cocaine, Parkinson's drugs (levodopa, bromocriptine, benztropine), MAOIs, Wellbutrin, LSD

Antipsychotics (Haldol), Reserpine, Tetrabenazine, AMPT

Endorphins Inhibitory

Involved in pain perception and positive emotions Almost and like opiate family of drugs

Endorphins are released from the pituitary gland, typically in response to pain, and can act in both the central nervous system (CNS) and the peripheral nervous system (PNS).

Endorphins inhibit transmission of pain signals by binding μ- receptors of peripheral nerves, which block their release of neurotransmitte r substance P.

Chronic back pain, pain meds does not help, addiction, emotional sensitive

Feeling confident and optimistic, high self-esteem, artificial highs, inadequate responses to pain

Opiates (morphine, oxycodone, heroin)

Naltrexone a morphine antagonist seems to contribute to panic attacks and depression

GABA Inhibitory Brain Omega 1 Omega 2

Anxiety, seizures,

Sleep and eating disorders

Benzodiazepines and alcohol

Flumazenil, bicuculline, bemegride, Ro 15-4513, phaclofen

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PMHNP Portfolio for Clinical Practice

Help and aide and offset excitatory message and help regulate daily sleep wake cycles, also inhibits CNS

insomnia, tremors, and Huntington’s disease

Opiates, morphine, oxycodone, heroin Alcohol, barbiturates (phenobarbital), benzodiazepines (Valium), GHB, baclofen, neurosteroids (alphaxolone), muscimol

Glutamate Excitatory

Long term potentiation memory

CNS PNS N-methyl-D- aspartate (NMDA

Memory and learning difficulty

BP, too much of glutamate and too little GABA can be associated with overstimulation of the brain, that can cause migraines and seizures

D-cycloserine, domoic acid (shellfish)

PCP, ketamine, Namenda (for Alzheimer's), dextromethorphan (Robitussin), dizocilpine

Glycine Excitatory Inhibits signals

Spinal cord, brainstem

NMDA reduce the liver’s ability to synthesize bile, weakening immune system, which results in stress and infections; Worsening of state the hair, nails and skin are in; Delayed formation of proteins and disturbance in formation of structure of the connective tissue;

Activation of mental activity. Elimination of mental stress. Improved mood.

β-Alanine D-Alanine D-Serine Glycine Hypotaurine L-Alanine L-Proline L-Serine Milacemide Quisqualamine Sarcosine Taurine

Strychnine hydrochloride

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PMHNP Portfolio for Clinical Practice

Norepinephrin e

Excitatory

Fight or flight responses, modulation of mood, plays a role in learning and memory retrieval, can also increase HR, glucose in and oxygen to brain and muscles

Adrenal medulla alpha 1, alpha 2

beta 1, beta 2

Mental disorders in depression

Increase anxiety Adderall Methamphetamine Cocaine and speed Amphetamine, cocaine, SNRIs (Effexor, Cymbalta), tricyclic antidepressants, MAOIs, Wellbutrin, LSD, pseudoephedrine (Sudafed), albuterol, pyridostigmine

Propranolol, clonidine, phentolamine, reserpine, AMPT

Serotonin Inhibitory

Mood and emotional states of being, regulation of sleep, hunger, and wakefulness, arousal

Gut CNS 5HT1A, 5HT1C, 5HT1D, 5HT2, 5HT3

Mood disorders and depression, OCD, anxiety, Schizophrenia

Autism Mania Hallucination

Selective Serotonin Reuptake Inhibitors (SSRIs) Amphetamine, cocaine, LSD, psychedelics (mushrooms, mescaline), SSRIs (Prozac, Zoloft), tricyclic antidepressants, MAOIs, BuSpar, triptans (sumatriptan, for migraines)

Atypical antipsychotics (Risperdal, Seroquel), Zofran, reserpine, TPH inhibitors, tryptophan- depleted drink

Notes: If the drug decreases the effect of a neurotransmitter, then it is an antagonist

If a drug increases the effect of a neurotransmitter, it is an agonist

Glycine - There are no drugs utilized in clinical practice that are known to block glycine transporters

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PMHNP Portfolio for Clinical Practice

Antipsychotics First Generation

11 drugs Side Effects (L= low) (M= Moderate) (H=High) (* weight gain)

Generic Name Trade Name

Route(s) of Administrati

on

LAI Long Acting

Injectable option

Starting Dose

Half Life

Indications (s/sx & diagnosis) M

O A

(n eu

ro tr

an sm

it te

r ef

fe ct

s)

E P

S

H yp

er li

p id

em ia

T 2D

M

W ei

gh t

G ai

n

C og

n it

iv e

Is su

e Other SE Costs

Chlorpromazine Thorazine oral n/a 10mg -200mg

24 Bipolar mania, schizophrenia

dopamine M H L * L CNS neuroleptic malignant syndrome orthostatic

hypotension blurred vision

$37.12 - $161.83

Fluphenazine Prolixin oral/IM Decanoate 25/ml

1mg – 10mg

18hr Psychotic disorders

H L L extrapyramidal symptoms (e.g., pseudoparkinsonism

dystonia, dyskinesia).

$55.92 – 211.21

Perphenazine Trilafon oral n/a 2mg – 16mg

12hrs Schizophrenia N/V

dopamine H L * L Parkinson-like symptoms, dystonia, akathisia, tardive

dyskinesia

$34.71- $149.76

Prochlorperazine Compazine Oral & rectal

suppository

n/a 5mg -10mg

Oral 5hr

6.9hr I/v

Schizophrenia, Non-psychotic anxiety

dopamine M L * Hematologic Drowsiness, dyskinesia, akathisia,

parkinsonism, tremor/tremulousness

$10.00 - $26.12

Thioridazine Mellaril Oral n/a 10mg -100mg

24hr Schizophrenia for those that do not have an acceptable response to other antipsychotic therapy

dopamine L L * rash; hives; itching; red, swollen, blistered, or peeling skin with or

without fever; wheezing; tightness in the chest or

throat; trouble breathing, swallowing, or talking

$25.03 – 71.40

Trifluoperazine Stelazine Oral n/a 1mg -10mg

18hr Schizophrenia nonpsychotic anxiety

dopamine H L * H Parkinson-like symptoms, dystonia, akathisia), drowsiness, fatigue, muscular weakness,

insomnia, blurred vision, skin reactions or rash, anorexia, dry mouth,

hypotension, amenorrhea, galactorrhea

$15.57 - $35.74

Thiothixene Navane Oral n/a 1mg -10mg

n/a Schizophrenia dopamine H L * Cough difficulty with swallowing

dizziness fast heartbeat

hives itching

puffiness or swelling of the eyelids or around the eyes,

face, lips, or tongue shortness of breath

$34.06 - $132.17

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PMHNP Portfolio for Clinical Practice

skin rash tightness in the chest unusual tiredness or

weakness wheezing

Incidence n Haloperidol Haldol Oral & Im Haldol

Deaconate Oral

0.5mg- 20mg

Dec 50/ml

Oral 18hr

Dec 3 wks.

Psychotic disorders Tourette’s disorder Pediatric behavior with problems with hyperactivity

Dopamine and

serotonin

H H Cardiac NMS

leukopenia/neutropenia include pre-existing low white blood cell count

(WBC)

$14.16 - $27.27

Pimozide Orap oral n/a 1mg – 2mg

Tourette’s syndrome

dopamine H * Leukopenia, Neutropenia and Agranulocytosis

$33.88 - $142.95

Loxapine Loxitane Oral/IM n/a 5mg – 50mg

IM 25mg/ml – 50m/ml

8hr Schizophrenia dopamine M * Leukopenia, Neutropenia and Agranulocytosis

NMS 18.37 - $72.86

Molindone Moban Oral and IM 5mg - 100mg

IM 20mg/ml

Schizophrenia dopamine L L M Akathisia/motor restlessness occurred early

in treatment.

$33.61 - $205.50

Second Generation

12 drugs Generic Name Trade

Name Route(s) of

Administrat ion

LAI Long

Acting Injectabl

e option

Starting Dose

Half Life

Indications (s/sx &

diagnosis)

M O

A (n

eu ro

tr an

sm it

te r

ef fe

ct s)

E P

S

H yp

er li

p id

em ia

T 2D

M

W ei

gh t

G ai

n

C og

ni ti

ve I

ss ue

Other SE Costs

Aripiprazole Abilify ORAL n/a 10MG -15MG

unkno wn

Schizophrenia Bipolar disorder

Serotonin and

dopamine

L * hives; difficult breathing; swelling of your face, lips,

tongue, or throat.

$12.10 - $667.58

Asenapine Saphris S/L n/a 5mg -10 mg

24 hr schizophrenia in adults, and bipolar I disorder in adults and children who are at least 10 years old.

serotonin, dopamine, and alpha- adrenergic receptors.

L H liver disease long QT syndrome hives; fast

heartbeats, feeling light- headed; wheezing, difficult breathing; swelling of your

face, lips, tongue, or throat. .

$600.63 - $724.15

Clozapine Clozaril Oral n/a 12.5mg – 200mg

8hr single dose 12 hr

at stead

y

Treatment resistant schizophrenia and recurrent suicidal behaviors

dopamine serotonin norepinep

hrine receptors, acetylchol

ine.

L H H H Clozaril affects your immune system. You may get infections more easily,

even serious, or fatal infections. Clozaril can

cause serious heart problems

$32.64 – 248.27

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PMHNP Portfolio for Clinical Practice

state

Iloperidone Fanapt Oral n/a 1mg - 12mg

18-33 hrs.

Schizophrenia – approved for use in psychotic conditions related to dementia

Dopamine and

seratonine

M M This drug must be titrated slowly to avoid orthostatic

hypotension. hives; difficult breathing;

swelling of your face, lips, tongue, or throat.

$202.00

Lurasidone Latuda oral 40mg * 160mg

schizophrenia in adults and teenagers who are at least 13 years old.

Dopamine serotonin)

and noradrena

line.

L M mood or behavior changes, anxiety, panic attacks,

trouble sleeping, or if you feel impulsive, irritable,

agitated, hostile, aggressive, restless,

hyperactive (mentally or physically), more depressed, or have

thoughts about suicide or hurting yourself.

$1620

Olanzapine Zyprexa Oral

intramuscular powder for

solution

intramuscular powder for suspension extended release

n/a 2.5mg - 20mg

21-54 hrs.

Schizophrenia Bipolar disorder Acute agitation associated with schizophrenia and mania

Dopamine and

serotonin

L H Bloating or swelling of the face, arms, hands, lower

legs, or feet blurred vision

change in vision change in walking and

balance clumsiness or unsteadiness

difficulty with speaking difficulty with swallowing

drooling impaired vision

inability to sit still loss of balance control

$4.50 - $159.72

Paliperidone Invega Oral IM Sustenna

Oral 1.5mg -

9mg

Sustenna 39mg/ml

to 234mg/ml

Oral 23hrs IM

Suste nna

25-49 days IM

Tinza 84- 139 days

Schizophrenia Schizoaffective disorder

Dopamine and

serotonin

L L You should not use Invega if you are allergic to

paliperidone or risperidone (Risperdal).

heart problems, or a heart attack.

long QT syndrome (in you or a family member).

high or low blood pressure, or fainting spells;

$112.14 – 825.73

Quetiapine Seroquel oral n/a 25mg - 400mg

XR 50mg – 400mg

6 hrs. Schizophrenia Acute manic episodes

Major depression adjunctive therapy

Obsessive compulsive disorders

5-HT2A serotonin

L H H H liver or kidney disease.

heart disease, heart rhythm problems, a history of heart attack or stroke.

high or low blood pressure.

a history of low white blood cell (WBC) counts.

abnormal thyroid tests or

$3.00 - $87.05

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PMHNP Portfolio for Clinical Practice

prolactin levels.

seizures or epilepsy

Risperidone Risperidone Oral n/a 0.25mg – 4mg

3-20 hrs.

includ ing

metab olite

Bipolar mania Schizophrenia Irritability associated with autistic disorder

Unlabeled uses: Obsessive compulsive disorder

Dopamine and

serotonin

L M N M May contain phenylalanine. Tell your

doctor if you have phenylketonuria (PKU). may temporarily affect fertility (ability to have

children) in women. Risperidone can pass into breast milk and may cause

side effects in the baby

$1.50 - $59.56

Ziprasidone Geodon Oral/IM n/a Oral 20mg – 80mg

Powder for IM 20/vial

7hrs oral

Im 2- 5 hrs.

Schizophrenia Bipolar mania Acute agitation in schizophrenia

(IMF)

serotonin dopamine,

and histamine

L M N M Do not take Geodon with these meds anagrelide,

methadone. tacrolimus;

$12.93 - $154.09

Brexpiprazole Rexulti Oral n/a 1mg - 4mg

86hrs - 91 hrs.

Time to

stead y-

state: withi n 10 to 12 days of

dosin g

Adjunctive treatment of

major depressive disorder (MDD)

serotonin, dopamine,

and norepinep

hrine

L L L L thoughts about suicide or dying

new or worsening depression

feeling very agitated or restless

panic attacks new or worsening

irritability an extreme increase in

activity or talking (mania)

$1157.45 - $1411.85

Cariprazine Vraylar Oral n/a 1.5mg -6mg

1 week

schizophrenia dopamine and

acetylchol ine

L L heart disease, high blood pressure.

a stroke or blood clot.

high cholesterol or triglycerides (a type of fat

in the blood).

liver or kidney disease.

diabetes; or

if you are dehydrated.

$1216.57 – $1469.87

Notes:

EPS: (L= low) (M= Moderate) (H=High) (* weight gain)

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PMHNP Portfolio for Clinical Practice

Weight gain with second generation 1= very low, 2=low, 3=moderate, 4= high, 5= very high

Side Effects (L=Low, M=Moderate, H=High)

Costs: the cost of drugs were obtained from Goodrx.com with prescription discount and coupons (https://www.goodrx.com)

Last updated: 10/2020 nw

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PMHNP Portfolio for Clinical Practice

Last updated: 10/2020 nw

Antidepressants, Anxiolytics & Mood Stabilizers Antidepressants Side Effects (L=Low, M=Moderate, H=High)

Generic Name Trade Name

Route(s) of Administratio

n

LAI option

Starting Dose

Half Life Indications (s/sx &

diagnosis)

M O

A (n

eu ro

tr an

sm it

te r

ef fe

ct s)

E P

S

H yp

er li

pi de

m ia

T 2D

M

W ei

gh t

G ai

n

C og

n it

iv e

Is su

e Other Side Effects possible Anticholinergic side effect (ACH- effects dry mouth, constipation, difficulty in urinating and burry

Costs

SSRIs

Citalopram Celexa Oral n/a 10 mg 35hrs Depression Serotonin increase in blood pressure. Low ACH

$3.00- $16.00

Escitalopram Lexapro Oral n/a 5mg 27-32hrs MDD 5HT1A M H Nausea, dry mouth, trouble sleeping, constipation, tiredness, drowsiness, dizziness, and increased sweating

$3.00 - $68.42

Fluoxetine Prozac Oral n/a 10mg 1-16 days Depression Serotonin M H Nausea, drowsiness, dizziness, anxiety, trouble sleeping, loss of appetite, tiredness, sweating, or yawning

$3.00 - $20.65

Fluvoxamine Luvox Oral n/a 25mg 13.6- 15.6 hrs.

OCD social anxiety disorder

Norepinephrine Low ACH Headache, nausea, diarrhea, dry mouth, increased sweating, feeling nervous, restless, fatigued, sleepy or insomnia

$30.81-$165.71

Paroxetine Paxil Oral n/a 10mg 21 hrs MDD panic disorder

Serotonin H Low ACH $31.28-$142.46

Sertraline Zoloft Oral n/a 25mg 26-104 hrs MDD/ OCD Serotonin M H Nausea, dizziness, drowsiness, dry mouth, loss of appetite, increased sweating, diarrhea, upset stomach

$32.99

Vilazodone Viibryd Oral n/a 10mg 25hrs MDD Serotonin diarrhea, nausea, vomiting

$358.00

Vortioxetine Trintellix Oral n/a 5mg 66hrs MDD Serotonin Low ACH nausea. diarrhea. dry mouth. constipation. vomiting. gas. dizziness. abnormal dreams.

$486.00

Generic Name Trade Name

Route(s) of Administratio n

LAI option

Starting Dose

Half Life Indications (s/sx & diagnosis)

M O

A (n

eu ro

tr an

sm it

te r

ef fe

ct s)

E P

S

H yp

er lip

id em

ia

T 2D

M

W ei

gh t

G ai

n

C og

n it

iv e

Is su

e Other Side Effects possible Anticholinergic side effect (ACH- effects dry mouth,

Costs

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PMHNP Portfolio for Clinical Practice

Notes: MDD – Major depressive disorder

Costs: the cost of drugs were obtained from Goodrx.com with prescription discount and coupons (https://www.goodrx.com)

Substance Use Resources

Commonly Used Drugs and Treatment Information Charts:

https://www.drugabuse.gov/sites/default/files/Commonly-Used-Drugs-Charts_final_June_2020_optimized.pdf

https://www.drugabuse.gov/sites/default/files/nida_commonlyuseddrugs_final_printready.pdf

Withdrawal Sx Chart https://www.drugabuse.gov/sites/default/files/nida_commonlyabused_withdrawalsymptoms_10062017-508-1.pdf

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