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Csp informed consent meds
CRISIS STABILIZATION / RESIDENTIAL DETOXIFICATION PROGRAM Informed Consent for Medication
Consumer: _____________________________ ___CSP ___ Detox ___ Dual Chart # _____________
While you are at the Crisis/Detox/Touchstone Dual Diagnosis Program for care and treatment one of the following classes of medications may be prescribed to you. The side effects and adverse reactions are listed below. Your signature gives Crisis Stabilization Unit physician/nurse practitioner permission to prescribe the medication as well as the nursing staff permission to administer the medication. * Some of the medications are monitored by required lab studies/ blood work.
Neuroleptics:
Abilify, Clozaril*, Compazine, Geodon, Haldol, Loxitane, Mellaril, Navane, Prolixin/Permitil, Risperdal, Risperdal Consta, Seroquel, Sparine, Thorazine, Trilafon, Zyprexa, Zydis. (Circle Prescribed Medication)
Side effects include: Sedation, muscle spasms, dry mouth, constipation, blurred vision, rapid heart beat, Parkinson symptoms:
tremor, muscle stiffness, shuffling walk, drooling, dizziness, low blood pressure, pacing or weight gain.
Date: __________ Consumer Signature: _______________________________ _________________________________ M.D./N.P
Antidepressant:
Asendin, Elavil, Celexa, Cymbalta, Desyrel, Effexor, Lexapro, Luvox, Norpramin, Paxil, Pamelor, Prozac, Remeron, Sinequan, Tofranil, Vivactil Zoloft, Wellbutrin. (Circle Prescribed Medication)
Side effects include: Sedation, dry mouth, constipation, blurred vision, rapid heart beat, drop in blood pressure, increase blood
pressure, weight gain, weight loss, nausea/ GI upset, restlessness, tremor, headache, fatigue, insomnia or dizziness.
Date: __________ Consumer Signature: _______________________________ __________________________________ M.D./N.P
Antimania:
Depakene*, Depakote*, Lamictal*, Lithium*, Tegretol*, Topamax*. (Circle Prescribed Medication)
Side effects include: Increased thirst, nausea, fine hand tremor, dizziness, weight gain, increased urination, stomach cramps,
sleepiness, loose stools, dry mouth, muscle weakness, restlessness, headache and serious rashes.
Date: __________ Consumer Signature: _______________________________ __________________________________ M.D./N.P
Antianxiety:
Atarax, Ativan, Buspar, Equanil, Centrax, Librium, Paxipam, Valium, Vistaril, Tranxene, Xanax (Circle Prescribed Medication)
Side effects include: Potentially addictive, sedation, fatigue, confusion, or blurred vision. Benefits:
Date: __________ Consumer Signature: _______________________________ __________________________________ M.D./N.P
Anticholinergic:
Artane, Benedryl, Cogentin. (Circle Prescribed Medication)
Side effects include: Dry mouth, constipation, blurred vision, and nausea. Benefits:
Date: __________ Consumer Signature: _______________________________ __________________________________ M.D./N.P
Anticonvulsant:
Dilantin, Tegretol, Klonopin, Dapakene, Neurontin, and Phenobarbital (Circle Prescribed Medication)
Side effects include: Drowsiness, nausea, vomiting, blurred vision, headache, sleeplessness, or sore gums. Benefits:
Date: __________ Consumer Signature: _______________________________ __________________________________ M.D./N.P CSP 14 Revised 10/09/07
515 Diurectic Study online at quizlet.com/_f18tt Aldactone 12. How does CAI brain know CO2 are high; thus signal more mountain sickness? 13. How does hypokalemia for signaling insulin release, thus increase hyperglycemia? 14. How does K- diuretics mechanism congestive heart failure, cirrhosis, renal15. How does loop diurectic cause important for signaling,
Ce questionnaire adresse davantage aux élèves scolarisés en Lycée. Vous pouvez utiliser ce document pour réaliser la visite avec vos élèves et/ou construire un questionnaire. Dans le cas où vous utilisez des questions du présent document, nous vous conseillons de photocopier le plan de l’exposition et de respecter la numérotation des éléments et des questions. De cette façon, vos