EMERGENCY PSYCHIATRIC MEDICATIONS – PO MEDS Drug Name Dosing (per FDA) Tmax/Bioavailability Half-life (T1/2) Comments Aripiprazole (Abilify®) can cause akathisia Chlorpromazine (Thorazine®)
Poor bioavailability; useful if patient also with nausea (IM preferred) Haloperidol (Haldol®) Olanzapine (Zyprexa®) Olanzapine (Zyprexa Zydis®)
Same as IM; Zydis tablets are bioequivalent to Zyprexa tablets (No faster onset) Quetiapine (Seroquel®)
Sedation; orthostasis, low Risperidone (Risperdal®)
Orthostasis, doses > 6mg daily associated with inc EPS, drug intxn (strong 2D6 inhib - avoid Paxil/Prozac) Risperidone (Risperdal M- Ziprasidone (Geodon®)
QTc prolongation, caution in pt with cocaine history, take with food, non- sedating Diazepam (Valium®) active metabolite, AMS Lorazepam (Ativan®) Benztropine (Cogentin®) Anticholinergic SE, caution in patients with tachycardia, hypertension Diphenhydramine (Benadryl®) Less anticholinergic SE Divalproex ER (Depakote® ER)
Can be given twice daily if not tolerated QD, clearance reduced in cirrhotics, GI upset, sedation EMERGENCY PSYCHIATRIC MEDICATIONS – IM MEDS Drug Name Dosing (per FDA) Half-life (T1/2) Comments Aripiprazole
9.75 mg IM as a single dose (range: 5.25-
Can cause akathisia, may (Abilify®) decrease effect of other antipsych Chlorpromazine Compatible in same syringe (Thorazine®) with Benadryl; orthostasis, QTc changes (caution in pt with cocaine history) Fluphenazine HCL 1.25mg – 10mg IM as single dose, pt 4mg IM = 10mg PO (Prolixin) Compatible in same syringe as Benadryl, Cogentin, and hydroxyzine Haloperidol (Haldol®)
Pros: Can be dose repeatedly Cons: EPS, excessive sedation
Olanzapine (Zyprexa®)
after the 2nd dose. Do not exceed 30mg in
Avoid in combination with IM lorazepam (inc CV depression, resp depression) Ziprasidone
10 mg IM every 2 hours or 20 mg every 4 (Geodon®)
caution in patients with cocaine history, Don’t mix in same syringe as lorazepam Droperidol Black Box warning for sudden death, QTc prolongation Benztropine (Cogentin) Diphenhydramine (Benadryl®)
patients, sedation, somnolence, less expensive than cogentin Lorazepam (Ativan®)
depression, avoid use with olanzapine IM, do not mix with ziprasidone syringe.
REFLEXIONES SOBRE LA ARCHIVÍSTICA ECLESIÁSTICA por Fernando J. de Lasala, S. J. Lo que expongo a continuación no pretende ser un artículo, nisiquiera una nota, sino unos simples apuntes con finalidad pedagógica. Tomo como punto de partida una nota de Eutimio Sastre Santos1, y tengo en cuenta mis lecciones de Diplomática Eclesiástica en la Universidad Católica Portuguesa (10-15