Medication Management Worksheet

Medication Management Worksheet Medication Name (Brand & Generic) Generic Name: Amitriptyline Trade Name: Vanatrip, Elavil, Endep Classification Tricyclic antidepressant (TCA) Is prescribed dose safe? A usual dose is 75 mg PO qd, but it may be increased to a total of 150 mg qd if needed. Pt’s diagnosis Depression, major depressive disorder. Unlabeled use includes: anxiety disorder, chronic pain syndromes (i.e. fibromyalgia, neuropathic pain/chronic pain, headache, low back pain), eating disorders, and (less commonly) attention deficit hyperactivity disorder and bipolar disorder. Drug Action or Purpose Potentiates the effects of serotonin and norepinephrine in the CNS. Amitriptyline has significant anticholinergic properties. Antidepressant action. Full effects seen 2-6 weeks after initiating treatment. Desired Effect (What are your patient’s target symptoms?) Relieve symptoms of depression. Less common: Increased appetite, improved energy level, improved sleep, decrease in chronic pain. Unwanted Effects (Risks and side effects)  Suicidal thoughts, especially if younger than 24 years of age, photosensitivity.  Common Side Effects: nausea, vomiting, drowsiness, weakness, dry mouth, nightmares, headaches, constipation, blurred vision, decreased libido, confusion, weight gain.  Severe Side Effects- call doctor immediately: slow or difficult speech, crushing chest pain, severe skin rash or hives, yellowing of skin or eyes, hallucinations. Key Patient Teaching Points or Instructions  The patient cannot take the medicine if they have recently had heart attack or if they have used an MAO inhibitor within the past 14 days.  The patient may have thoughts about suicide when first starting to take amitriptyline, especially if younger than 24 years of age. Furthermore, they should understand the importance of attending regular check ups with their doctor for at least the first three months of taking the medication. Make sure family members can identify symptoms of suicidal thoughts and worsening depression.  It may take up to 4 weeks before symptoms improve, so it is very important to keep taking the medication as directed in order to achieve results.  Stopping the medication suddenly may cause unpleasant withdrawal symptoms so they should consult with their doctor before discontinuing the medication.  The medication should be stored at room temperature away from moisture, heat, and light.  The effects on pregnant women are still unclear so if they become pregnant it is important for them to consult with their doctor to avoid harming the fetus. The medication can be passed through breast milk; therefore, women should not breastfeed while taking amitriptyline.  Geriatrics: increased risk for falls.  Advise patient to wear sunscreen more often due to increased photosensitivity.  Caution patient to make position changes slowly to minimize orthostatic hypotension. Medication Management Worksheet Medication Name (Brand & Generic) Generic Name: Nortriptyline Trade Name: Aventyl, Norventyl, Pamelor Classification Tricyclic antidepressant Is prescribed dose safe? Adults: 25mg PO, 3-4 times daily, up to 150 mg/day. Geriatric or Adolescents: 30-50mg/day in divided doses or as a single dose Pt’s diagnosis: Depression, major depressive disorder. Unlabeled use includes: Management of chronic neurogenic pain. Drug Action or Purpose Potentiates the effect of serotonin and norepinephrine. Medication has significant anticholinergic properties. Full effects seen 2-6 weeks after initiating treatment. Desired Effect (What are your patient’s target symptoms?) Relieve patient symptoms of depression. Less common: Increased appetite, improved energy level, improved sleep, decrease in chronic pain. Unwanted Effects (Risks and side effects)  Suicidal thoughts, photosensitivity.  Common Side Effects: Nausea, drowsiness, weakness, excitement or anxiety, nightmares, dry mouth, changes in appetite or weight, constipation, decreased libido, sexual dysfunction.  Severe Side Effects- call doctor immediately: muscle spasms, slow or difficult speech, shuffling walk, fever, difficulty breathing or swallowing, and arrhythmias. Key Patient Teaching Points or Instructions  Be cautious using the medication if patient has pre-existing cardiovascular disease, history of seizures, or a history of asthma.  Drug effectiveness may not be noticeable for at least 2 weeks. Full effectiveness in 2-6 weeks of therapy.  Since drug may cause vision disturbances or drowsiness, driving should be avoided until the patient is aware of how the drug affects them.  Abrupt discontinuation of drug may cause nausea, vomiting, diarrhea, headache, trouble sleeping/vivid dreams, and irritability.  The medication should be stored at room temperature away from moisture, heat, and light.  The medication can be passed through breast milk; therefore, women should not breastfeed while taking amitriptyline.  Geriatrics: increased risk for falls. Caution patient to make position changes slowly to minimize orthostatic hypotension.  Advise patient to wear sunscreen more often due to increased photosensitivity.  Close attention to adverse effects on mood during initial therapy. Make sure family members can identify symptoms of suicidal thoughts and worsening depression.  Instruct patient to notify health care professional if visual changes occur. They may need to undergo periodic glaucoma testing during the treatment therapy.  Alert patient that urine may turn blue-green in color.