Psych

Rapid Review

• Mechanism of Action: Antipsychotic, Antiemetic; antagonizes dopamine and alpha adrenergic receptors. 
• Indications: Agitation, nausea/vomiting, headache, pain (as adjunct w/ opiate) 
• Contraindications: Allergy to drug/class, known or suspected prolonged QT
• Dosage:
  • Acute agitation: 5-10mg (IV) or 10 mg (IM)
  • Nausea/vomiting: 0.625 – 2.5 mg (IV)
• Onset: 5-10 minutes
• Duration: 2-4 hours
• Adverse Reactions: QT prolongation, extrapyramidal side effects

Pearls

Deep Dive

• Droperidol Use in the Emergency Department (emDocs)

Rapid Review

• Mechanism of Action: Antipsychotic; blocks dopaminergic receptors in the brain, depressing reticular activating system.
• Indications: Acute agitation, psychosis
• Contraindications: Allergy to drug, Parkinson’s disease. Caution in QT prolongation.
• Dosage: 5-10 mg PO/IM/IV q2hrs (Max 100mg/day)
• Onset: 10-20 minutes
• Duration: 4-6 hours (IV)
• Adverse Reactions: Drowsiness, extrapyramidal symptoms, tardive dyskinesia
• Special Considerations: May increase liver function test values

Pearls

Deep Dive

• Understanding Haloperidol (EP Monthly)

Rapid Review

• Mechanism of Action: Atypical antipsychotic; binds to dopamine, histamine, alpha1, and 5HT2 receptors. 
• Indications: Acute agitation, schizophrenia, bipolar disorder
• Contraindications: Allergy to drug/class. Should not be given for dementia-related psychosis, NMS
• Dosage: 5-10 mg IM/ODT (max 30mg/day)
• Onset: 15-45 minutes
• Duration: Half life of 30 hours for most adults
• Adverse Reactions: Orthostatic hypotension (3-20%), Neuroleptic malignant syndrome, extrapyramidal side effects
• Special Considerations: N/A

Pearls

Deep Dive

• Adverse Events from IV Olanzapine for Agitation in the ED (ALiEM)

Rapid Review

• Mechanism of Action: Antipsychotic; D2 and 5HT2 antagonist. Strong alpha 1 blocker and histamine-1 antagonist.
• Indications: Acute agitation, psychosis.
• Contraindications: QT prolongation, allergy to drug, decompensated heart failure
• Dosage: 10-20mg IM q2-4 hrs (Max: 40 mg/day)
• Onset: 
• Duration: Half life 2-7 hrs.
• Adverse Reactions: Prolonged QT, torsades, neuroleptic malignant syndrome, extrapyramidal side effects, dizziness
• Special Considerations: None 

Pearls

Deep Dive

• Comparison of IM Midazolam, Olanzapine, Ziprasidone, and Haloperidol for Behavioral Control (REBEL EM)