Pharmacology - Case Study 1

A 20-year-old man, Lester Pliskin, was brought to an emergency department by several friends. He was very
agitated and said that the CIA was trying to contact him for a special mission and he must get away to meet his
contact in Paris. The examining health care provider admitted Lester to the psychiatric unit for observation. The
nurse on this unit took a medication history. Psychotropic drug treatment was started with haloperidol (Haldol)
40 mg per day by mouth. After several days of therapy, no improvement was noted in the clients behavior. In
fact, the client seemed to be even more agitated and had attacked a fellow client. The dosage of oral
haloperidol was raised to 50 mg, but still no improvement was observed.
Because his continued acting-out behavior was unresponsive to haloperidol therapy, Lesters treatment was
discussed at a staff conference. During the conference, one of the staff members noted that Lester had had
one previous admission, when he received oral clozapine (Clozaril). He did well enough on this medication to
be discharged to a supervised community residence. A decision was made to discontinue the haloperidol and
to begin clozapine 12.5 mg twice a day by mouth and increase the dose by 50-mg increments per day (over 2
weeks) until improvement in his behavior is noted. When Lesters dose reached 300 mg, the nursing staff
noted improvement in Lesters behavior, and he was granted increasing independence, culminating in his
transfer to a community residence. Lester is prescribed 300 mg clozapine by mouth daily while living in the
community residence.
1. When a client begins to take an antipsychotic agent such as haloperidol, what observations should the
nursing staff make about the clients behavior to determine the effectiveness of the medication?
The nurse should notice lessening delusions, hallucinations, improvement in positive or negative symptoms,
ability to return to normal activities of daily living, improvement in appetite and sleep patterns.
Adams,Holland, Urban, 2014, p.216.

2. What are the common adverse effects of haloperidol and clozapine?
haloperidol- sedation, transient drowsiness, extrapyramidal symptoms, tremor and orthostatic hypotension
Adams,Holland, Urban, 2014 p.215
clozapine- tachycardia, transient fever, sedation, dizziness, headache, somnolence, anxiety, nervousness,
hostility, insomnia, nausea, dry mouth, vomiting, constipation, parkinsonism, akathisia, extrapyramidal
symptoms Adams,Holland, Urban, 2014, p.219

3. Why is it important for the nurse to take a careful medication history before a client is started on
psychotropic therapy?
To be aware of possible drug interactions. Adams,Holland, Urban, 2014, p.216

4. What are the advantages of single daily bedtime doses of medication over divided doses?
1. The patient will not experience as much of the drowsiness. Adams,Holland, Urban, 2014, p.218

5. What should this client know about his medication before he is discharged to a community
residence?
Experience therapeutic effects, be free from or experience minimal adverse effects, verbalize
understanding of drugs use, adverse effects, and required precautions, demonstrate proper
self-administration of medication. Adams,Holland, Urban, 2014, p.216
Adams, M., Holland, N., Urban, C. (2014). Pharmacology for Nurses: A Pathophysiological Approach.
Columbus: Pearson Education, Inc.