Psyche Medications

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TABLE OF CONTENTSI Training 9blectivesPharmacology: Basic Medication ConceptsAntipsYchotic Medications ..........................................a. Medication Names

b. Intended Effects ...........................' .................. c. Side Effects .................... ............................ d. ,Side effects !hat should be r e ~ o r t e d i m m e d i a t e J ~ e. Positive vs. Negative symptoms of Schizophrenia,f. C{ozarif - Special considerations ................................- g. How is Clozaril differenth. Tarvide D ~ s k i n e s i a i. Neurolptic Malignant Syndromej. Extrapyramidal ReactionsAnti8hoI!nergic Medications - medications used to !reat .side effects of othermedIcations ....................... .' . . . . . . . .....................a. Medication Names . . . . . . . . . . . '. : . . . . . Artane - Cogentin special considerations (Note} :'. . b. lntended Effects ........................................... . c. Side Effects .............................. '. . . . . . . . .......... d. Special ConsiderationsAnti-Anxiety Medications - medications used to treat a n ~ i e t y disorders. . . . . . .a. Medication Namesb. Intended Effects .............. ............................. c. Side Effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. Central nervous System Depressants

a.Special ConsiderationsAnti-Manic Medications - medications used to treat mood disorders . . . . . . ' ...a. Medication Namesb. Intended Effects ............................ " ................ c. Side Effects . . . . . . . . ............... . . . . . . . . . . . . . . . . . . . . . . . . d. SpeCial considerationsMood stabilizers! Anti-Consultants - medications used to treat mood disorders!seizure disorders. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- .a. MedicC!tion Namesb. Intended Effects .................................... ........ c. Side Effects ................................................ d. Side effects that should be reported immediatelye. Special considerationsAntidepressant Medication - Medication used to treat depressiona. Medication Namesb. Intended Effects ............................................. c. Side Effects . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... d. SpeCial considerations

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Ir v l ~ Y C h O stimulants - medication used to treat attention deficit/hyperactivity p. 1I Disorder ADDfADHDMedications - A listing of generic and brand name including "use" .......... p. 1. . .

II Pharmacology Vocabulary ................ ........................ p.2. . .

Examples of control substances p.2

I Psychotropic Medications: Acting on the brain/mindIIIIII,,I,


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II OBJECTIVES: At the completion of this training you will be able to:1. Explain to the consumer, their family members and/or significant others (S.O.) some ofI basic medication concepts, using this hand out as a tool.

I 2. You will be able to name 3 Antipsychotic Medications.I 3. You will be able to name 2 Medications used to treat side effects of antipsychoticmedications.4. You will be able to state the difference between administering medication and monitorinadministration of medication.I 5. You will be able to explain what is meant by ''Tardive Dvskinesia".I 6. You will be able to give examples of medication side effects to watch for in consumers wtake medications and how you may help the consumer to cope with these effects.I I PHARMACOLOGY: BASIC MEDICATION CONCEPTS

Before a consumer begins taking any medication, i t is important for the staff to kthe following information about the consumer.

1. Allergies to any medications or food.2. If the consumer is pregnant or intends to become pregnant while using the medication.intent is not to get pregnant be careful some medications interact with birth controlmedication.3. If the consumer is breast-feeding.4. If the consumer is taking any other medication. This includes prescription, over-the-coumedication and herbal tablets and drinks5. If the consumer has any other medical problems or any past history of medical problem

diabetes, high blood pressure, TB, hepatitis, prior surgery, etc., etc.B. Helpful Information that you can tell your consumers:1. Do not stop taking the medication without first checking with their doctor.2. Do not change the dose or time medication is taken, without first checking with their doc

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iI 3. Mediation will add to the effects of alcohol and other eNS depressants (medications thdown the Central Nervous System).

4. Do not wait until Friday afternoon to check if you have enough medicine for the week eI (staff should ask tool)i 5. Do not share your medicine with friends or family who seem to have the same symptom6. Keep a list of all current medications and your doctor's name in your purse or wallet. f 7. Consumers will be monitored for the development of abnormal involuntary movementsparticularly tardive dyskinesia. MR consumers will be monitored every 3 months, MHconsumers in residential units every 3 months, and MH consumers in outpatient clinicsI 6 months, children and adolescents will be monitored every 3 months in residential wnevery 6 months in outpatient clinics.I C. PHARMACOLOGY: OTHER MEDICATION CONCEPTS

1.. Intended Effect: When a drug does what it is prescribed to do, this is called the intend

i I effect. Example: R e s p ~ r i d a l is given to a consumer with a psychotic disorder with audihallucinations. (Reducing the auditory hallucinations is the intended effect) This is alsgiven to children to control behavioral problems. (Intend.ed effect is to stabilize behavi

. ~ : : ..? ...." Side Effect: When a drug causes an undesired effect leading to uncomfortable or mosevere symptoms, this: is cafled side effect or "adverse effect." The term I'adverse effei used when symptoms are more troublesome, but often people use both terms interchangeably. Side effects can be a rash, dermatitis, blurred vision, etc. See each classification.- 3. AIMS: Abnormal involuntary movement scale. A tool the doctor or.nurse uses to mea- the involuntary movements that consumers on psychotrqpic medications may develop.4. Tardive Dyskinesia: Tardive =late onset, Dyskinesia =Movement DisorderI Tardive Dyskinesia is a central nervous system disorder characterized by twitching of f

-tongue, and other muscle movements; generally results from prolonged use of someneuroleptic drugs (although TD may develop quickly in some consumers) and sometima result of poorly monitored AIMS (Abnormal InvoluntarY Movement Scale.)

5. Therapeutic Drug Levels: Lab tests which measure the amount of a drug circulatingI person's blood tells the doctor that the amount of drug needed to produce the intendedis or is not in the consumer's blood. Example: Lithium level and Tegretollevel.I 6. Placebo: Medication with no real healing agent,one's own belief thatthe medication wwork causes effect.2
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I7. Akathisia: A =Not, Kathisia ::: sitting.


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I I Antipsychotic Medication: Medications used to treat Psychotic conditions

r \ . Medications Names:II Brand NameHaldolI

Loxitane Mellaril Moban

I Navane-

Prolixin Serentil Stelazine Thorazine I Trilafon Atypical antipsychotics/New GenerationMeds (NGM)I Clozaril*

IG,eodonResperdalI 'SeroquelZyprexa. "ecanoates: Injectables,adol DecanoateI Prolixin Decanoate

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Generic NameHaloperidolLoxapineThioridazineMoJindoneThiothixeneFluphenazineMesoridazineTrifuloperazineChlorpromazinePerphenazine

Clozapine!'*: Ziprusadone RisperidoneI'QuetiaipineOlanzapineHaloperidol Fluphenzine

**This mediCation requires. a strict program of monitoring blood levels on a weekly basClozaril can cause a potentially fatal blood disorder in which white blood cell count droanextremely low level., (AgranuQcytosis) This disorder is reversible if caught early. TI why it must be monitored every week without exception Jor the first six months. After the doctor's discretion, the consumer can come in every two weeks for blood work.B.lntended Effects of Antipsychotics:

IThe intended effects of antipsychotics are to stop or reduce hallucinations, reduce deland strange ideas, and allow the individual to function more effectively and appropriatThese medications are used for psychotic states, such as schizophrenia, or other psyconditions.

2. These medications reduce paranoid or persecutory delusions, decrease aggressive oI abusive behavior, improve concentration and reasoning, increase social interaction, arelieve anxiety and agitation.I! Antipsychotic drugs are the best treatment available now, but they do not "cure". schizophrenia or ensure that there will be no further psychotic episodes.I: 4


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I4. Antipsychotic medications have also been called Major tranquilizers, Neuroleptic DrI and Psychotherapeutic Drugs.I rG:) Side Effects: Common:\,-.,..,/ Constipation Decreased sweating

Drowsiness Dry MouthI Light-headed DizzinessRestlessness (Akathisia) Muscle Stiffness or RigidiLow Blood Pressure (Orthostatic Hypotension) Increased sensitivity to suI Weight gain (from about 23 Ibs)(6) Side Effects that should be reported immediately to the doctor:I ../''"

1. Convulsions (Seizures)2. Lip smacking or puckering3. Tic-like, twitching or twisting movements4. Uncontrolled chewing and tongue or mouth movements5. Mask-like facial expression or muscle stiffness I 6. Shuffling walk or stiff arms and legs (EPS) 7. Trembling of hands8. Inability to move eyes I 9. Uncontrolled movements or weakness of arms or legs 10. Fainting or dizzy spells

II 11. Painful, inappropriate penile erection (continuing) 12. Fast or irregular heartbeat13. Extreme restlessness and inability to sit sUII" (Akathisia)E. Positive versus Negative Symptoms ofSchizoRhrenia: .1. Positive Symptoms include hallucinations, delusions,' marked positive formal thoughtdisorder (manifested by markedincoherenoo, derailment, tangentiality, or ilfogicality), abizarre or disorganized behavior.I 2. Negative Symptoms include marked poverty of speech or poverty of cohtent of speecaffective flattening, and inability to experience pleasure, few social contacts, emotionalwithdrawal and lack of concern with self-care.' .F. With al l Antipsychotics:

-a. Increased fluid intake may help the side effects of dry mouth, nasal stuffiness, aconstipation. Frequent rinsing of the mouth, hard candy and sugarless gum willhelp.b. Increased f1.uid and high fiber will help relieve constipation,i 5


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Ic. Advise consumers that care should be taken not to get up too suddenly. GettinI suddenly can cause dizziness in someone who does not take medications, so imagine what kind of dizziness it can cause with our consumers. Advise the coto sit on the side of the bed in the morning when they wake up and dangle theiI a minute or two before they get up.

I d. Wear sunscreen, protective clothing; hats and sunglasses; especially in the suDo not become overheated during exercise or hot weather, since overheating mresult in heat stroke.I e. Antipsychotic drugs do not control a person's thoughts; instead, they often helpconsumer- to tell the difference between psychotic symptoms and the "real worlI G. Clozaril Special Considerations:I a. Increased constipation can be a major problem. Encourage diet with lots of fruvegetables, and whole grains. Encourage fluids. Ask doctor about use of fiber

additivesie: Metamud!.

II b. Nocturnal Salivation (nighttime drooling}, happens in almost everyone on Clozacan last a long time, but it usually goes away by Itself after 8 to 12 months on thmedication. It can reoccur i f the dose is increased, but will again eventually go

c. Orthostatic Hypotension or Postural Hypotension, (low blood pressure) happenabout 50% of consumers on this medication. It usually disappears in about 2 toI weeks. Caution consumer to get up especially from lying down, slowly and in srise up on elbow, sit (slowly) at edge, then rise to standing slowly. Move slowlyI d. it may cause temporary drowsiness or blurred Vision. (AVOid driving if this shouoccur.)I

H. How is ClozarH different from other antipsychotic medication?I a. Clozaril therapy offers new hope for many patients because it often works whenantipsychotics have not. It has helped some seriously ill patients improve enouI be able to return to normal family life, school or work.b. Clozaril differs from other antipsychotics in terms of side effects. It has fewer nI and muscle-related side effects common to mostantipsychotics, such as feelingrestlessness, stiffness, shaking and muscle cramps.

iI: c. Tardive Dyskinesia, movements such asgrimacing,sucking, and smacking of tand spastic movements of the arms, legs, head and neck, over which the consuhas no control have not been proven to occur as a result of Clozaril therapy. InClozaril has even improved the symptoms of tardive dyskinesia in some patientdeveloped this side effect while taking other a n t i p s y c h o ~ i c s . 6

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Id. About one or two people out of every 100 who take Clozaril will develop

II agranulocytosis. With this condition, the body's ability to make white blood cellseverely reduce the body's ability to fight infection. If there is a decrease, evensomething as minor as a sore throat can rapidly become a life-threatening situaTherefore, weekly bl.ood tests are essential for ttie first six months. After six mothe doctor can authorize the consumer to come every two weeks after.I Tarvide Dvskinesia:II 1. A central nervous system disorder characterized by involuntary movements most oftenaffecting the mouth, lips, and tongue, and sometimes the trunk or other parts of the bogenerally occurs in about 15 to 20% of consumers who, have been receiving antipsychI drugs for many years, but TO can occur in consumers who have been treated with thedrugs fo r shorter periods of time. In most cases, the symptoms of TO are mild, and thconsumer may be unaware of the movements. Often these will disappear if the mediccan be stopped.I 2. Tardive means "late onset". Dyskinesia means "movement disorder".

3. Remember, AIMS (Abnormal Involuntary Movement Scale) needs to be done routinelyII doctor or nurse to assess the consumer for abnormal involuntary movements. Anytim,\ observe abnormal involuntary movements in our consumers, document what you obseand report your observations to the unit nurse or the doctor.I J. Neuroleptic Malignant Syndrome:I; 1. A rare and potentially fatal syndrome, also called NMS.. Ifs clinical manifestations are increased muscle tone (muscle rigidity), decreased leVEn of consciousness, hyperpyrex(increase in body temperature to over 101F). altered mental status, irregular pulse andI pressure, tachycardia, (abnormally rapid heart rate), profuse sweating: '1

2. This condition is very hard for the physiCian to diagnose because it is easily confused other serious medication conditions.

3. Should the consumer have any of the above signs and symptoms, you should call thedoctor immediately!4. 60% of affected patients are men.I. Extrapyramidal Reactions:

The extrapyramidal system is the portion of the central nervous system responsible focoordinating and integrating various aspects of motor or body movements. 1. Extrapyramidal syndrome is a variety of signs and symptoms, including muscular rigiditremors, drooling, shuffling gait (parkinsonism); restlessness (akathisia); peculiar invol

postures (dystonia); motor inertia (akinesia) and many other neurologic disturbances.z


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I'I 2. Oculogyric Crisis may occur, where the eyes are elevated and "locked" in this positionThese reactions are TERRI FYI NG to the consumer who has no prior experience withproblems or knowledge of this type of side effect.. Administration of an anticholinergicI necessary at this point and provides rapid treatment of this acute dystonic reaction.3. Parkinsonian Syndrome has many features of Parkinson's Disease, such as: diminis

I Irange of facial expression (masked facial features), cogwheel rigidity, slowed movemdrooling, small handwriting and "pillrolling" tremor. The onset of this side effect is graand may not a p p e a ~ for weeks after the meds have been administered.

I' )1 Antichofinergics: Medications used to treat side effects of Antjpsychotics: Medication names: t" I f' A\Brand Name Generic NameI Akineton Biperiden

Artane* Trihexphenidyl Benadryl DiphenhydramineII Cogentin Benztropine SymmetreJ Amantidine It Note* Artane, is potentially abused. It is known to create a feeling of a "high" obeing in some .people, so if you have a consumer who is always "running out" 'II "losing" or "missing" their Artane, you may want.to talk to the doctor and monitomore closely. Cogentin has also been abuse in this way.Ii

- ~ ~ -" B. Intended Effect:

II The intended effect of this medication class is to reduce or eliminate the side effects tconsumer may get from taking antipsychotic drugs.Examples of the side effects this medication class helps to alleviate include:, a. Restlessnessb, Involuntary movementsc. Muscle rigidity or stiffnessd. TwitchingI e. Tongue or mouth movements I c. Side Effects: 1. Like all other medications, these medicines can also cause unwanted side effects., 2. Some side effects you will see with these drugs are:a. Drowsiness, b. Dry mouthc. Constipationd. Urinary retentione. Decreased or possibly increased sweating

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I, D. Special Considerations:, Remember, this medication is given to relieve or diminish the side effects of antipsychdrugs which already cause dry mouth. Taking anticholinergics increases dry mouth.Frequent rinsing, sugarless gum, hard candy can help. Encourage the person to drinkof fluids, especial ly water. Good oral hygiene also help's - frequent tooth brushing., 2. This medication can cause increased sleepiness, constipation, and low blood pressurthese problems already exist, you should be even more diligent in monitoring the cons, ::!v. This medication decreases sweating. This can be a real problem in the EI Paso climaSweating is the body's way of cooling the body. Talk to consumer about avoiding spetoo much time in the sun and avoiding overheating. Always encourage plenty of fluids4. This medication can cause urinal}' retention which can lead to frequent urinary tract

II-- infections. Urinary retention means that the bladder does not quite empty when you usome urine stays in the bladder. This leads (or may lead to) bacterial contamination ainfection.v. Consumers should be aware of symptoms of urinary tr(:lct infection., These include:&I a. frequent urination, and the feeling that you still need to urinate just after urinatin

b. Burning, itching or painful urinationc. You should also watch for dark. concentrated, foul sme.iling urine.Educate your consumers about the need forgocid personal hygiene and daily b (For the female front to back cleaning when using the toilet.) Contact the doctor or nurse as soon as possible;, should consumers have any oabove symptoms. '

lL A n f i ~ A n x i e t y Medications: Anxiolytics: Medications; used to treatanxiety " .', Some' anti-anxiety medications.are' "controlled" drugs. Benzodiazepinesare controlle1. They must be kept under lock and key.II 2.: They must be accounted for carefully, which may' nclude "signing out" on an insheet.II Medication Names: Benzod iazepines: II

Brand Name Generic NameAtivan LorazepamDoral QuazepamHalcion TriazolamI Librium ChlordiazepoxideSerax OxazepamTranxene Chlorazepate-Valium Diazepam:I Xanax Alprazolam9


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i2. Non-Benzodiazepines - Anti-Anxiety Medications - NOT CONTROLLED DRUGSI Brand Name Generic Name Atarax Hydroxyzinej B u s ~ a r Buspirone ProchlorperzineCompazineI Vistaril Hydroxyzine Pamoater ...:8 . I ntended Effect:j 1. Reduction of tension

2. Relief of anxiety or agitationI 3. Relief of symptoms associated with alcohol withdrawal4. Relief of insomnia. _ / " - : ; : : P { ~

/ ) Side Effects -Common:j, 1. Difficulty concentrating, confusion, forgetfulness. 2. Sedation, unusual tiredness or severe weakness.3. Hypotension (low blood pressure). Dizziness or light-headedness., 4. Muscle weakness, slurred speech. 5. Unusual excitement, nervousness or irritability, difficulty sleeping6. Seizures7. Clumsiness or unsteadiness.I o. Central Nervous System D e R r ~ s s a n t s : BENZODIAZEPINES belong to the group of medicines called central Rervous, system- 1..depressants (eNS). These are medici nes that "slow down" the nervous system.

2. Some benzodiazepines are used to relieve nervousness or tension, others are used rI for insomnia. (They usually are not effective for more than a few weeks for insomnia)Note: Benzodiazepines should not be used for nervousness or tension caused by the stress of everyday life.I E. Side Effects - Rare: Report to Doctor:1. Blurred vision or other changes in vision. I 2. Changes in sexual drive or performance. 3. False sense of well being.I 4. Fast or pounding heart.5. Headache, increased sensitivity to light.6. Nausea or vomiting.I 7. Trembling, tingling, burning or prickly sensations.

F. Special Considerations:I The presence of other medical problems may affect the use of benzodiazpines. Makethat the doctor knows if the consumer has any other medical problems, especially:I 10


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IIa. Alcohol abuse (or history of) 11 b. Drug abuse or dependence c. Brain disease. CNS depression and other side effects of benzodiazepines maydevelop. .11 d. Let the doctor know if consumer has difficulty swallowing, especially if the consua child or adolescent.I e. Emphysema, asthma, bronchitis, or other chronic lung disease. f. Glaucomag. Sleep apnea-(benzodiazepines may make this worse.}h. Epilepsy-or history of seizure. Although Clonazepam and Diazepam are usedI treating seizures, starting or suddenly stopping these medications may increaseseizures. I i. Consumers with kidney or liver disease may have higher blood levels, which woincrease the side effects.

I 2. These drugs will add to the DEPRESSANT EFFECT OF ALCOHOL and other medicatsuch as cold remedies and over-the-counter sleep medicines. I

3. Some consumers have the tendency to want to increase the dose of their medication ifI. feel it is not working properly. Remind them to consult Vvith the doctor about any changNever make changes without checking with the doctor."I 4. For consumers taking this medication for insomnia: When their schedule does not perthem to get a full night's (7 to 8 hours), they may continue to feel drowsy and may expeI memory problems because the effects of the medicine has not had time to wear off. If a continuing problem, encourage them to discuss this with their doctor.I 5. If a consumer will be taking this medicine in large doses or for a long time, it is importanthey not stop taking it without first checking with the doctor. The doctor may want togradually reduce the amount they are taking and not stop suddenly. Suddenly discontithis medicine may cause withdrawal side effects.

6. OVERDOSE: If an overdose occurs, seek emergency help at once.. Taking an overdoBenzodiazepines and alcohol or other CNS depressants may lead to unconsciousnesspossibly death.

. Chordiazepoxide and Di(3zepam have been reported tq increase the chance of birth dewhen used during the first 3 months of pregnancy. Too much of these drugs duringpregnancy may cause the baby to become dependent on the medication. Use of thesemedications may cause drowsiness, slow heartbeat, shortness of breath, or troubledbreathing in the newborn infant. These medications can also pass into the breast milk.

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II 8. Use in children: Most of the side effects of these medications are likely to occur in chespecially in the very young. These patients are usually more sensitive than adults teffects of benzodiazepines. When Clonazepam is used for long periods of time in chmay cause unwanted effects in physical and mental growth. These effects may not I: noticed until many years later.9. Use in older adults: Most of the side effects of these mediCines are more likely to oc

IIelderly, who are usually more sensitive to all medicines. Taking these meds for troubsleeping may cause more daytime drowsiness in the elderly. In addition, falls and reinjuries may be more likely to occur in elderly consumers taking benzodiazepines.

--,rlV> Lithium: A n t i ~ m a n i c Medication/Drug Used to Treat Mood Disorders:I ',A.' MediCLilJion Names: Brand Name Generic Name'"'I Eskalith Lithium Carbonate, Eskalith CR (slow release) Lithium Carbonate CR

B. Intended Effect :I The reduction of symptoms of mania, such as hyperactivity, loss of inhibitions, restleexaggeration,grandiose thinking. Mood disorders are also known as Manic-DeprI illness or Bipolar Disorders.I .... Side Effects that shoutdbe reported immediately to your doctor= ,

1. Nausea and vomiting or diarrhea

I 2. Shakiness or bothersome tremor3. Swelling of hands and feet4. Mental confusion, slurred speechI 5. Lack of coordination6. Increased drowsiness or weakness7. Slurred speech, confusion, ringing in the ears, or involuntary movementsI D. Side Effects: Common:I 1. Increased thirst2. Increased urinationI 3. Dry mouth4. Skin rash is less common, but tell the doctor if this occurs.I E. Special Considerations:1. It is best to take lithium with meals to reduce upset stomach.I May experience muscle weakness, fatigue or shaking. These effects are temporary should go away after 2 or3 weeks, but should be reported to the doctor.I 12


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I3. It is important to maintain proper water and salt intake when taking lithium. 6 to 8 glass, water should be consumed every day and table salt should be added to food especiallythere is profuse diaphoresis or diarrhea.

I 4. Lithium may not work as well as it should if large amounts of caffeine are present: coffeteas and colas should be avoided. f 5. Never double up on medicine if a dose is missed.6. Lithium blood levels may be monitored on a regular basis, usually every 3 months. Thef doctor will schedule. It is important to know if the correct amount of the drug is circulatithe blood and that possible side effects are avoided by levels not being too high. "I 7. Extra care must be taken in hot weather and during activities that cause one to sweat hsuch as hot baths, saunas or exercising. The loss of too much water and salt from the could lead to serious side effects.

Mood Stablizers/Anticonvulsants: Drugs used to treat /mood/seizure disorders:Medication Names.Brand NameCerebyx (IMinjectables)I Depakene DepakoteI Dilantin Felbatol* LamictalI Luminal I Neurotin (not proven to work as mood)PrimidoneTegretoITopamaxI Zarontin

Generic NameFosphenvtoinValproicAcidDivalproex SodiumPhenytoinFelbamate*LamotriQinePhenobarbitalGabapentinMyosinCarbamazepineTopiramateEthosuximide*Used in special cases of consumers with chronic Epilepsy

r - T ) u l ~ . p J 4B. Intended Effects:This medication is used to treat seizure disorders.c. Side Effects:

DrowsinessBlurred visionItching


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II..., 9.10.11.-12.

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Special Considerations:Inform the doctor if consumer has liver disease, bleeding disorder, kidney disease,'gllung disease or breathing disorders or any allergies. Inform the doctor if consumer is taking any of the following: a. Medications for depressionb. Medications for colds, allergies; insomnia; muscle re.laxants; pain medicine or sedLimit or eliminate alcohol consumption. Alcohol can add to the sedation caused by thmedication.Advise any health care provider that consumer takes this medicine before having anycare procedure. . Vallproic acid can cause false results for ketones in urine tests. Inform doctor if consumer is pregnant or becomes pregnant after this medication hasinitiated. Inform the doctor of all meds the consumer is taking, to include over-the-counter medespecially blood thinners, Coumadin, Tagamet, Antabuse, Theophyliine, etc. It is recommended that consumer wear or carry medication identification indicating thtake anticonvulsants. Store this medication out of reach of children, away from moisture and sunlight. Do nin the bathroom. Do not crush this medication. It must be swallowed whole.

."Take this medication as prescribed. Do not suddenly stop this drug without consultingdoctor as seizures may occur. If there is a history of seizure disordersIt is important to take this medication on time to keep the level of medication in the bloconstant.Clonazepam may also be used in the treatment of panic attacks and movement disorMaintain good oral hygiene with regular brushing, flossing and massaging of the gumespecially those who take Dilantin as it can cause hyperplasia in long term use.For information on enrollment in Med Alert - call: Medic Alert 1-800-854-1166.

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f'-,f / r " Antidepressants: Medications used to treat depression:

. . ..- Medication Names:I Brand NameAnafranilAsendin

II Desyrel Effexor Elavil LexaproLimbitrolI LudiomilLuvoxNardiJ

II Norpramin Pamelor Parnate Paxil ProzacI RemeronI

SerzoneSinequanVivactilWellbutrinZoloft(_07

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Psyche Medications