GENERIC NAME: trimipramine

BRAND NAME: Surmontil

DRUG CLASS AND MECHANISM: Trimipramine is a tricyclic antidepressant (TCA), the same family
as amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor; Aventyl), and desipramine (Norpramin).
Trimipramine works by raising the brain's level of norepinephrine (a neurotransmitter) to more normal levels. It also
has anti-cholinergic actions (opposing the effects of the neurotransmitter, acetylcholine) which cause many of its side
effects. Trimipramine also acts as a sedative. Trimipramine was approved by the FDA in June, 1979.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Trimipramine is available as 25 mg (blue and yellow), 50 mg (blue and orange), and 100mg (blue
and white) capsules.

STORAGE: Capsules should be stored at room temperature, approximately 25°C (77°F).

PRESCRIBED FOR: Trimipramine is approved to treat major depression that is not caused by other drugs, alcohol,
or emotional losses (such as a death in the family). Major depression is persistent and interferes with daily
functioning.

DOSING: The usual starting dose is 75 mg per day, split into equal, smaller doses (for example, 25 mg three times
daily). Doses often are gradually increased to 150 mg per day. Doses in long-term therapy may range from 50 to 150
milligrams daily. This total daily dosage may be taken once daily at bedtime or spread throughout the day. Beneficial
effects may not be seen until treatment at an appropriate dose is given for two to four weeks.

DRUG INTERACTIONS: Trimipramine interacts with other medications and drugs that slow the brain's processes,
such as alcohol, barbiturates, benzodiazepines, e.g.,diazepam (Valium) or lorazepam (Ativan), zolpidem (Ambien)
and narcotics. Reserpine, given to patients taking TCAs, can cause a stimulatory effect. Trimipramine and other
TCAs should not be used with monoamine oxidase inhibiting drugs e.g., isocarboxazid (Marplan), phenelzine (Nardil),
tranylcypromine (Parnate), and procarbazine (Matulane). High fever, convulsions and even death can occur when
these drugs are used together

PREGNANCY: Safe use of trimipramine during pregnancy has not been established; therefore, if it is to be
administered to pregnant patients or women of childbearing potential, the benefits must be weighed against the
potential hazards to the fetus.

NURSING MOTHERS: Safe use of trimipramine during lactation has not been established; therefore, if it is to be
administered to nursing mothers, the benefits must be weighed against the potential hazards to the child.

SIDE EFFECTS: Trimipramine may impair the mental and/or physical abilities required for the performance of
potentially hazardous tasks such as driving a car or operating machinery. The anti-cholinergic effects of trimipramine
may cause confusion, delirium, short-term memory problems, disorientation, impaired attention, dry
mouth,constipation, difficulty urinating (especially for a man with an enlarged prostate), blurred vision, decreased
sweating with increased body temperature, sexual dysfunction, and worsening of glaucoma. Older adults are
especially sensitive to the anti-cholinergic effects of trimipramine. Sucking hard candy or chewing gum can help
prevent dry mouth. Trimipramine can increase a person's sensitivity to sunlight; patient's taking trimipramine should
wear sunscreen and avoid sun exposure. Since trimipramine can impair the body's ability to sweat and adapt to hot
environments, patients should avoid saunas and excessive heat.
Reference: FDA Prescribing Information
ENERIC NAME: quetiapine

BRAND NAME: Seroquel

DRUG CLASS AND MECHANISM: Quetiapine is an oral antipsychotic drug used for
treating schizophrenia and bipolar disorder. Although the mechanism of action of quetiapine is unknown, like other
anti-psychotics, it inhibits communication between nerves of the brain. It does this by blocking receptors on the
nerves for several neurotransmitters, the chemicals that nerves use to communicate with each other. It is thought that
its beneficial effect is due to blocking of the dopamine type 2 (D2) and serotonin type 2 (5-HT2) receptors.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Tablets: 25, 50, 100, 200, 300, and 400 mg

STORAGE: Tablets should be stored at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Quetiapine is used alone or in combination with other drugs to treat schizophrenia and bipolar
disorder.

DOSING: Quetiapine usually is taken two or three times daily. The dose usually is increased slowly over several days
or weeks to achieve the desired effect. Quetiapine can be taken with or without food.

The initial dose for bipolar disorder is 50 mg twice daily (100 mg/d). The dose can be increased by 100 mg/d to a
daily dose of 400 mg/d. Most patients respond to 400-800 mg/d. Doses greater than 800 mg/d have not been studied.

The initial dose for schizophrenia is 25 mg twice daily (50 mg/d). The dose can be increased by 25-50 mg two or
three times daily. The target dose is 300-400 mg/d in two or three doses. Patients respond to 150-750 mg/d, and
doses greater than 800 mg/d have not been evaluated.

DRUG INTERACTIONS: Phenytoin (Dilantin) and thioridazine (Mellaril) markedly decrease the amount of quetiapine
that is absorbed from the intestine and thereby reduces its effectiveness. Therefore, patients taking phenytoin or
thioridazine may require higher doses of quetiapine.

Quetiapine can cause hypotension (low blood pressure) and therefore increase the blood pressure lowering effects of
antihypertensive drugs.

Quetiapine can increase the sedating effects of other drugs that sedate. Such drugs include narcotic pain relievers
[for example, oxycodone and acetaminophen (Percocet, Roxicet, Tylox, Endocet)], barbiturates, sedatives such
as alprazolam (Xanax) andclonazepam (Klonopin), ethanol, and blood pressure drugs that can cause orthostatic
hypotension, such as prazosin (Minipress) and terazosin (Hytrin).

Quetiapine is eliminated from the body by an enzyme in the liver called cytochrome P450 3A. There is a concern that
drugs that strongly interfere with the enzyme, for
example,ketoconazole (Nizoral), itraconazole (Sporanox), fluconazole (Diflucan),
and erythromycin,clarithromycin (Biaxin), nefazodone (Serzone), verapamil (Calan, Isoptin, Verelan),
ordiltiazem (Cardizem, Tiazac, Dilacor) may cause elevated and toxic levels of quetiapine.

PREGNANCY: There are no adequate studies of quetiapine in pregnant women. Studies in animals are inconsistent.
Some studies suggest effects on the fetus and others show no effects. Quetiapine should only be used in pregnancy
if the physician feels that it is absolutely necessary and that the potential benefits justify the unknown risks.
NURSING MOTHERS: Quetiapine is excreted in the milk of animals during lactation. Although it is not known if it is
excreted in human milk, it is recommended that women taking quetiapine not breast feed.

SIDE EFFECTS: Frequent adverse effects include headache, agitation, dizziness, drowsiness, weight gain and
stomach upset. Quetiapine can cause orthostatic hypotension (a drop in blood pressure upon standing that can lead
to dizziness orfainting) especially during the first 3-5 day period of treatment, when it is restarted after temporary
discontinuation, and after an increase in the dose. The risk of orthostatic hypotension is about 1 in 100 (one of every
hundred patients who takes quetiapine). Quetiapine frequently causes tiredness (1 in 5 patients), especially during
the first 3-5 days of treatment. Because of this tiredness, care should be exercised in any activity requiring mental
alertness such as operating a motor vehicle or hazardous machinery. Less common side effects include seizures (1
in 125 patients) and hypothyroidism (1 in 250 patients).

As with other antipsychotics, long-term use of quetiapine may lead to irreversible tardive dyskinesia, a neurologic
disease which consists of involuntary movements of the jaw, lips, and tongue.

A potentially fatal complex referred to as neuroleptic malignant syndrome (NMS) has been reported with antipsychotic
drugs. Patients who develop NMS may have high fevers, muscle rigidity, altered mental status, irregular pulse or
blood pressure, rapid heart rate, excessive sweating, and heart arrhythmias.

In animals, quetiapine has been associated with the development of cataracts, and cataracts have been reported in
patients using quetiapine for prolonged periods. Although it is not clear if quetiapine is responsible for the cataracts
seen in humans, eye examinations by slit-lamp (to identify cataracts before they impair vision) are recommended at
the beginning of treatment and every six months during treatment. If cataracts form, treatment should be
discontinued.
Quetiapine may increase blood concentrations of cholesterol and triglycerides by 11% and 17%, respectively.

There is an increased risk of hyperglycemia (high blood glucose) and related events in patients taking atypical
antipsychotics, including quetiapine. Patients should be tested during treatment for elevated blood-sugars.
Additionally, persons with risk factors fordiabetes, including obesity or a family history of diabetes, should have their
fasting levels of blood sugar tested before starting treatment and periodically throughout treatment to detect the onset
of diabetes. Any patient developing symptoms that suggest diabetes during treatment should be tested for diabetes.

4. Biperiden 2 mg 1 tab TID PO

Classification: Antiparkinson agent ( Anticholinergic )

Trade name: Akineton

Indications: Adjunctive treatment of all forms of Parkinson’s disease, including drug

induced extrapyramidal effects and acute dystonic reactions.

Action: Reduction of rigidity and tremors.

Contraindications: Hypersensitivity, narrow angle glaucoma, bowel obstruction,

megacolon, tardive dyskinesia
Side effects/ Adverse Reactions: dry eyes, blurred vision, constipation, dry mouth,
urinary retention

Nursing Considerations:

1. Assess Parkinson and extrapyramidal symptoms ( restlessness or desire to keep

moving, rigidity, tremors, pill rolling, masklike face, shuffling gait, muscle

spasms, twisting motions, difficulty speaking or swallowing, loss of balance control)

prior to and throughout course of therapy.

2. Assess bowel function daily. Monitoring for constipation, abdominal pain,

distention, or the absence of bowel sounds.

3. Monitor intake and output ratios and assess patient for urinary retention.

4. Advise patient to make position changes slowly to minimize orthostatic

hypotension.

5. Withhold drug and notify physician or other health care provider if significant
behavioral changes occur.

6. Administer with food or immediately after meals to minimize gastric irritation.

7. Advise patient to take medication as directed.

8. Advise patient that frequent mouth rinses, good oral hygiene, and sugarless gum
or candy may decrease dry mouth.

9. Caution patient that this medication decreases perspiration.

10. Emphasize the importance of routine follow-up examinations.

Serenace
Contents:
Haloperidol

Indication:
• Psychotic orders
• Tourette syndrome
•Del i ri um
• severe behaviour problem in children
• short term treatment of hyperactive children who show excessive motor activity

Action:
• Blocks dopamine receptors in the tuberoinfundibular system to cause sedation. Also
causes alpha-adrenergic blockade, decreases release of growth hormone, and increases
prolactin release by pituitary.

Contraindication:

• Contraindicated in lactating women and in client’s with Parkinsonism

Special Precaution:

• PO dosage has not been determined in children, older adult or debilitated patient

• Glaucoma

Side effects/Adverse reactions:

• Side effects: Drowsiness, dizziness, blurred vision,
GI upset, salivation, dry mouth
• Adverse Reaction: Seizures, tardive dyskinesia

Dosage and availability:

•Dosage: (Adults) 0.5-2 mg 2-3 times per day
for severe symptoms
(Children 3-12 years or 15-40 kg) 0.05-0.075 mg/kd/day

• Available forms: Tablets: 0.5 mg, 1 mg, 2 mg,

5 mg, 10 mg, 20 mg

Nursing Responsibilities:
•Store tablets from 15-30 ˚C (59-86 ˚F).
•Assess CBC, electrolytes, liver and renal function.
•Instruct client or family to avoid alcohol and activities that require mental alertness until
drug effects realized.

Chlorpromazine
Thorazine, Largactil
Antipsychotic, Antiemetic

Indication:
•Preanesthetic to relieve restlessness & apprehension
•Adjunct to treat tetanus
•severe behavioural problem in children 1-12 years old marked by combativeness and

or explosive hyper-excitable behaviour

Action:

•May block postsynaptic dopamine receptors in brain and inhibit medullary

chemoreceptor trigger stone.

Contraindication:

•Contraindicated in patients hypersensitive to drug and in patients with CNS

depressions, bone marrow suppression, subcortical damage and coma.

Special precaution:

•Use cautiously in debilitated patients and in those with hepatic or renal disease,

severe CV disease.

•In acutely ill or dehydrated children and elderly , use cautiously

Side effects/Adverse reactions:

•Side effects: Constipation, drowsiness, blurred vision, decreased sweating, difficulty

urinating, dark urine, swollen breasts

•Adverse Reaction: tremor, seizures, neuroleptic malignant syndrome,

thrombocytopenia

Dosage and availability:

•Dosage: (Adults) 10 mg3-4 times a day or 25 mg 2-3 times a day

(Children) 1 mg/kg (0.5mg/lb) q 6-8 hours as needed

•Available forms: Injection: 25 mg/ml

Oral concentrate: 100 mg/ml

Suppository, rectal: 100mg

Syrup: 10mg/5ml

Tablets: 10 mg, 25 mg, 50 mg, 100mg, 200 mg

Nursing Responsibilities:

•The maximum daily P.O. and parenteral dose for adults and adolescents should be 1
gram of the base.
•Solutions may cause contact dermatitis: avoid contact with hands or clothing.
•The oral concentrate is light sensitive: protect from light and dispense in amber
glass bottle.