NATIONAL CENTER FOR MENTAL HEALTH

Nursing Education Training and Research

nursing.training@ncmh.gov.ph

DATE SUBMITTED:

RESIDENTS NAME: Mio Franco Quilit

GRADE:

ENTRANCE TO DUTY: August 4, 2015

DRUG STUDY No. 4
NAME OF DRUG
(Generic/ Brand)
Divalproex Sodium
/ Depakote ER

INDICATION
Treatment of
primary generalized
seizures, and
notably absence
and myoclonic
seizures, and also
for partial seizures.
Also used to treat
acute manic phase
of bipolar disorders
and for the
prophylaxis of
migraine.

MODE OF ACTION
Anti-convulsant
ACTION:
Increases level of
gamma/aminobutyric in
brain, which decreases
seizure activity.

15 mg/kg daily
increased at 1wk
intervals by 5-10
mg/kg daily, po
Contraindication:
Hepatic dysfunction,
urea cycle disorder
NOTE: May use another sheet when necessary.

SIDE EFFECTS/
ADVERSE
REACTION
The most frequent
adverse effects
are GI
disturbances,
particularly in
initiation of
therapy.

NURSING CONSIDERATION
>Assess for GI complaints.
>Assess for pain.
>Assess for changes in bowel.
>Assess for EPS.
>Instruct the patient to inform
physician of transient
intestinal cramps, increased
plasma prolactin levels and
EPS occur.

NAME OF DRUG
(Generic/ Brand)
Clozapine /
Clozaril
Denazapine
Zaponex

INDICATION
Schizophrenia in
patients
unresponsive to
therapies.
Contraindication
Hypersensitivity to
drug
Uncontrolled
seizures
Severe CNS
depression or coma
Concurrent use of
drugs that can
cause
agranulocytosis or
bone marrow
depression.

MODE OF ACTION
Antipsychotic agent
Unclear. Thought to
interfere with dopamine
binding in limbic system of
CNS, with high affinity for
dopamine4 receptors. May
antagonize adrenergic ,
cholinergic , histaminerg-ic
and serotonergi-c receptor.

SIDE EFFECTS/
ADVERSE
REACTION
CNS:
Sedation,
drowsiness,
dizziness,
headache, tremor,
insomnia, slurred
speech,
restlessness,
tardive dyskenisia,
akathisia,
seizures.
CV:
Hypotension,
tachycardia, chest
pain. myocarditis.
EENT:
Blurred vision, dry
eyes, nasal
congestion, and
sinusitis.
GU:
Urinary retention,
incontinence,
frequency,
urgency and
inhibited
ejaculation.
Musculoskeletal:
Muscle spasm,
rigidity,back and
muscle pain.
Hematlogic:
Agranulocytosis,
leucopenia,
hemolytic anemia,
neutropenia,
eosinphilia.
Respiratory:

NURSING CONSIDERATION
Monitor WBC count weekly
for 6 months of therapy, If its
normal, WBC testing can be
reduced to every other week.
Notify prescriber immediately
if WBC counts decreases.
Monitor ECG and liver
function test.
If drug must be withdrawn
abruptly monitor for patient
for psychosis and cholinergic
rebound.
Continue to monitor WBC
count weekly for 4 weeks,
after therapy ands.
Tell patient to allow orally
disintegrating tablet to
dissolve in mouth.
Advice patient to
immediately report new onset
of lethargy,
Weakness, fever, sore throat,
malaise, mucus membrane
ulcers, flulike symptoms of
infection.

Dyspnea,
respiratory arrest.
Skin:
Rash, sweating,
Steven_johnson
Syndrome.
Other:
Weigth gain,
Fever.