DRUG STUDY

NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS COMMON ADVERSE EFFECTS Autonomic: Dry mouth, salivation, nasal congestion, nausea, vomiting, anorexia, pallor, fever, sweating CNS: Drowsiness, insomnia, headache, weakness, ataxia, slurring, extrapyramidial syndromes CV: Hypotension, tachycardia, hypertension, pulmonary edema NURSING RESPONSIBILITIES
Before Administration: 1. Check the doctor s order before preparing the drug. 2. Identify the patient and confirm that the correct patient will be given the medication. 3. Inform the client about the side effects of the drug. During Administration: Administer the drug exactly as prescribed. After Administration: 1. Instruct the client to avoid driving or dangerous activities if dizziness and vision changes occur. 2.Avoid prolonged exposure to the sun. 3. Encourage client to maintain adequate fluid intake to maintain hydration. 4. Teach the client to report occurrence of sore throat, fever, unusual bleeding and other side effects. 5. Monitor serum creatinine, BUN and WBC count.

Brand Name: Haldol

Generic Name: haloperidol

Dosage: 2 mg tablet bid

Mechanism not fully Indications: understood; antipsychotics y Management of block postsynaptic dopamine manifestations of receptors in the brain, depress psychotic disorders the RAS, including those parts of the brain involved with y Control of tics and wakefulness and emesis; Tourette syndrome in chemically resembles the adults and children. phenotiazines.
y Behavioral problems in children with combative, explosive hyperexcitability that cannot be attributed to immediate provocation

Route: Oral

Contraindications:

Classification: y y Antipsychotic Dopamingergic blocker

Endocrine: Breast engorgement in females; amenorrhea, menstrual Contraindicated with hypersensitivity to typical irregularities; gynecomastia in males; changes in libido; antipsychotics, coma or glycosuria severe CNS depression,
liver damage, severe hypotension or hypertension Use cautiously with pregnancy and lactation; respiratory disorders; history of epilepsy; decreased renal function; children younger than 12 years old; allergy to aspirin if giving the 1,-2,5- and 10 mg tablets.

Hematologic: Anemia, leukocytosis, thrombocytopenic or nonthrombocytopenic purpura Hypersensitivity: Jaundice, urticaria, laryngeal edema, photosensitivity, eczema, exfoliative dermatitis

DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS COMMON ADVERSE EFFECTS
CNS: drowsiness, insomnia, vertigo, headache, weakness, tremors, slurring, extrapyramidial syndromes, neuroleptic malignant syndrome CV: Hypotension, tachycardia, bradycardia, heart failure, cardiomegaly, pulmonary edema EENT: Nasal congestion, photophobia, blurred vision, miosis, mydriasis Endocrine: Breast engorgement in females; SIADH; menstrual irregularities; gynecomastia; inhibition of ovulation; infertitlity; pseudopregnancy; reduced urinary levels of gonadotropins, estrogens, and progestins. GI: Dry mouth, salivation, nausea, vomiting, anorexia, constipation GU: Urinary retention Hypersentitivity: Jaundice, urticaria, exfoliative dermatitis Respiratory: Dyspnea, suppression of cough reflex

NURSING RESPONSIBILITIES
Before Administration: 1. Check the doctor s order before preparing the drug. 2. Identify the patient and confirm that the correct patient will be given the medication. 3. Advise patient and the guardian about the possibility of tardive dyskinesia. 4. Give slowly by deep IM injection into upper outer quadrant of the buttock. 5. Avoid skin contact with parenteral drug solutions due to possible dermatitis. During Administration: Administer the drug exactly as prescribed. After Administration: 1. Keep patient in recumbent position to avoid orthostatic hypotension. 2. Monitor renal function test. 3. Monitor CBC. 4. Consult with physician about dosage reduction or use of anticholinergic antiparkinsonian drugs if extrapyramidial effects occur.

Brand Name: NovoChlorpromazine

Generic Name: chlorpromazine hydrochloride Dosage: 25 mg (IM) / 2550mg tablet tid

Mechanism of action not fully Indications: understood; antipsychotic y Management of drugs block postsynaptic manifestations of dopamine receptors in the psychotic disorders; brain; depress those parts of control of manic phase of the brain involved with manic-depressive illness wakefulness and emesis; anticholinergic; antihistaminic; y Severe behavioural and alpha-adrenergic blocking. problems in children
y Therapy for combativeness, hyperactivity

Route: Intramascular/ Oral

Classification:
y

y y y y

Antipsychotic Anxiolytic Dopaminergic blocker Phenothiazine

Control of nausea and vomiting and intractable hiccups

Contraindications: y Contraindicated with allergy to chlorpromazine, liver damage, coma or severely depressed states, severe hypotension or hypertension Use cautiously with respiratory disorders; epilepsy; exposure to heat.

DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS COMMON ADVERSE EFFECTS
CNS: Insomnia, anxiety, agitation, headache, somnolence, aggression, dizziness, tardive dyskinesia CV: Orthostatic hypotension, arrhythmias EENT: Nasal congestion, photophobia, blurred vision, miosis, mydriasis Dermatologic: Rash, dry skin, seborrhoea, photosensitivity GI: Dry mouth, nausea, vomiting, increased saliva, constipation, abdominal discomfort Respiratory: Rhinitis, coughing, sinusitis, pharyngitis, dyspnea Other: Chest pain, arthralgia, back pain, fever, diabetes mellitus, hyperglycemia

NURSING RESPONSIBILITIES
Before Administration: 1. Check the doctor s order before preparing the drug. 2. Identify the patient and confirm that the correct patient will be given the medication. 3. Inform the client about the side effects of the drug. 4. Maintain seizure precaution when initiating therapy and increasing dosage. 5. Instruct patient to remove orally disintegrating tablet with dry hands; immediately put on tongue; do not chew; and once disintegrated, swallow. During Administration: Administer the drug exactly as prescribed. After Administration: 1. Monitor temperature. 2. Advise patient to use contraception during therapy. 3. Instruct patient to report any signs of adverse effects such as lethargy, weakness, fever, sore throat, malaise, mouth ulcer.

Brand Name: Risperdal

Generic Name: risperidone

Dosage: 3 mg tablet bid

Route: Oral

Classification: y Antipsychotic

Mechanism of action not fully Indications: understood; blocks dopamine and serotonin receptors in the y Treatment of brain; depress the RAS; schizophrenia anticholinergic; antihistaminic; and alpha-adrenergic blocking y Delaying the relapse in activity may contribute to long-term treatment of some of its therapeutic and schizophrenia adverse actions. y Short-term treatment of acute manic or mixed episodes associated with bipolar 1 disorder y Treatment of irritability temper associated with autistic disorders in children and adolescents

Contraindicatios: y Contraindicated with hypersensitivity to risperidone Use caustiously with CV disease, renal or hepatic impairment, hypotension.

DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS COMMON ADVERSE EFFECTS CNS: Nervousness, anxiety, agitation, headache, insomnia, light-headedness, abnormal gait, seizures CV: Hot flashes, palpitations, chest pain Dermatologic: Swelling, rash, pruritus, acne, contact dermatitis GI: Dry mouth, nausea, vomiting, anorexia, constipation, dyspepsia, taste changes, gastroenteritis, gingivits NURSING RESPONSIBILITIES
Before Administration: 1. Check the doctor s order before preparing the drug. 2. Identify the patient and confirm that the correct patient will be given the medication. 3. Inform the client about the side effects of the drug. 4. Establish suicide precaution for severely depressed patients. 5. Counsel patient to use nonhormonal contraceptives. During Administration: Administer the drug exactly as prescribed. At the same time, morning or evening.

Brand Name: Zoloft

Generic Name: sertraline hydrochloride

Acts as an antidepressant by Indications: inhibiting CNS neuronal uptake of serotonin; blocks uptake of y Treatment of major serotonin with little effect on depressive disorder norepinephrine, muscarinic, y Treatment of OCD histaminergic, and alpha1adrenergic receptors. or dopaminergic y Treatment of panic disorder with or without agoraphobia Treatment of Post Traumatic Stress Disorder Treatment of social anxiety disorder

Dosage: 50 mg talet OD

Route: Oral y Classification: y y Antidepressant Selective Serotonin Reuptake Inhibitors y

Contraindications: y Contraindicated with hypersensitivity to setraline. Use cautiously with impaired hepatic or renal function.

GU: Painful menstruation, After Administration: sexual dysfunction, impotence, vaginitis 1. Inform patient that it may take Respiratory: URIs, pharyngitis, rhinitis, bronchitis, dyspnea
4-6 weeks to see improvement. 2. Instruct client to report rash, mania, seizurs, edema, difficulty of breathing, increased depression and thoughts of suicide.

DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS COMMON ADVERSE EFFECTS CNS: Nervousness, anxiety, agitation, headache, insomnia, light-headedness, blurred vision, seizures, akathisia, dizziness, restlessness CV: Orthostatic hypotension Dermatologic: Rash GI: Nausea, vomiting, abdominal pain, constipation, diarrhea, esophageal dysmotility Respiratory: Rhinitis, cough Other: Fever, neuroleptic malignant syndrome, increased suicide risk, development of diabetes mellitus NURSING RESPONSIBILITIES
Before Administration: 1. Advise women of childbearing age to use contraceptives while using this drug. 2. Establish baseline orientation and affect before beginning therapy. 3. Establish appropriate safety precautions if patient experiences adverse CNS effects. 4. Instruct patient to take the drug once daily. If a dose is forgotten, instruct to take the next dose as soon as remembered and then resume taking the drug the next day. During Administration: Administer the drug exactly as prescribed without regard to food. After Administration: 1. Protect patient from extremes of heat; monitor BP. 2. Ensure that patient is wellhydrated while taking the drug. 3. Teach the patient not to take the medication with alcohol.

Brand Name: Abilify

Generic Name: aripiprazole

Dosage: 30 mg tablet OD

Route: Oral

Acts against an agonist at Indications: y Treatment of dopamine and serotonin sites schizophrenia in patient s and antagonist at other 13 years and older. serotonin receptor sites; this combination of actions is y Treatment of major thought to be responsible for depressive disorder as the drug s effectiveness in adjunct to antidepressant treating schizophrenia, though therepy the mechanism of action is not understood. y Treatment and
maintenance of acute manic and mixed episodes associated with bipolar disorders in patients 10 years and older y Treatment of agitation associated with schizophrenia or bipolar disorder

Classification: y Atypical antipsychotic y Dopamine, serotonin agonist and antagonist y Psychotropic drug

Contraindications: y Contraindicated with allergy to aripiprazole. y Use cautiously with suicidal ideation, pregnancy, hypotension, exposure to extreme heat, dysphagia, elderly patiesnts with dementiarelated psychosis

DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS COMMON ADVERSE EFFECTS
Less than 15 mEq/L CNS: Lethargy, slurred speech, muscle weakness, fine brand tremor GI: Nausea, vomiting diarrhea, thirst GU: Polyuria 1.5-2 mEq/L (mild to moderate toxic reactions) CNS: Coarse hand tremor, confusion, hyperirritability, incoordination, drowsiness CV: ECG changes GI: Persistent GI upset, excessive salivation, indigestion 2-2.5 mEg/L (moderate to severe toxic reactions) CNS: Ataxia, tinnitus, blurred vision, stupor, coma CV: Severe hypotension with cardiac arrhythmias GU: Larga output of dilute urine Respiratory: Fatalities secondary to pulmonary complications Greater than 2.5 mEa/L (life threatening toxicity) General: Complex involvement of multiple organ systems, including seizures, arrhythmias, CV collapse, stupor, coma

NURSING RESPONSIBILITIES
Before Administration: 1. Check the doctor s order before preparing the drug. 2. Identify the patient and confirm that the correct patient will be given the medication. 3. Inform the client about the different adverse effects of the drug. 4. Teach the client to eat a normal diet with normal salt intake and maintain adequate fluid intake. 5. Counsel patient to use barrier contraceptives. During Administration: Administer the drug exactly as prescribed, after meals with food or milk. After Administration: 1. Instruct the client to arrange for frequent checkups, including blood tests. 2. Inform the client to discontinue drug and notify the health care provider if toxicity occurs. 3. Report diarrhea or fever.

Brand Name: Duralith

Generic Name: lithium carbonate

Dosage: 300 mg tablet tid

Route: Oral

Classification: y Antimanic Drug

Mechanism is not known; Indications: alters sodium transport in nerve and muscle cells; y Treatment of manic inhibits release of episodes of bipolar norepinephrine and dopamine; disorder, maintenance but not serotonin, from therapy to prevent or stimulated neurons; slightly diminish frequence and increases intraneuronal stores intensity of subsequent of catecholamines; decreases manic episodes. in intraneuronal content of second messengers and may Contraindications: thereby selectively modulate the responsiveness of y Contraindicated with hyperactive neruons that hypersensitivity to might contribute to the manic tartrazine; significant state. renal or CV disease, severe debilitation, dehydration; sodium depletion, patients on diuretic; use of ACE inhibitors y Use cautiously with protracted seating and diarrhea; suicidal or impulsive patients; intermittent fever

DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS COMMON ADVERSE EFFECTS CNS: Nervousness, hallucinations, agitation, headache, memory loss, lightheadedness, confusion, paranoia, dizziness, excitement CV: Tachycardia, palpitations, orthostatic hypotension Dermatologic: Rash, urticaria GI: Dry mouth, nausea, vomiting, paralytic ileus, constipation, epigastric distress EENT: Blurred vision, mydriasis, increased intraocular tension, angleclosure glaucoma GU: Urinary retention, urinary hesitancy, difficulty achieving and maintaining an erection Others: Flushing, decreased seating, elevated temperature, muscular weakness and cramping NURSING RESPONSIBILITIES
Before Administration: 1. Check the doctor s order before preparing the drug. 2. Identify the patient and confirm that the correct patient will be given the medication. 3. Inform the client about the different adverse effects of the drug. 4. Give with caution during hot weather. 5. Ensure that patient voids just before receiving each dose of drug if urinary retention is a problem. During Administration: Administer the drug exactly as prescribed. After Administration: 1. Instruct the client to arrange for frequent checkups, including blood tests. 2. Inform the client to report painful urination; constipation; rapid or pounding heart; confusion; eye pain or rash.

Brand Name: Akineton

Generic Name: biperiden

Dosage: 2 mg tablet tid

Route: Oral

Classification: y Antiparkinsonian

Anticholinergic activity in the Indications: CNS that is believed to help normalize the hypothesized y Adjunct in the therapy imbalance of cholinergic and of parkinsonism dopaminergic neurotransmission in the basal y Relief of symptoms of ganglia in the brain of a extrapyramidial parkinsonism patient. Reduces disorders that severity of rigidity, and to a accompany lesser extent, akinesia and phenothiazine therapy tremor characterizing parkinsonism; less effective Contraindications: overall than levodopa; peripheral anticholinergic y Contraindicated with effects suppress secondary hypersensitivity to symptoms of parkinsonism, benztropine; glaucoma; such as drooling. peptic ulcers, achalasia; bladder neck obstructions y Use cautiously with tachycardia, cardiac arrhythmias, hypertension, people who work in hot environment; hot weather; lactation

DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS COMMON ADVERSE EFFECTS CNS: Sedation, tremor, emotional upset, depression, hyperactivity, behavioural deterioration Dermatologic: Transient increases in hair loss, rash, petichiae GI: Dry mouth, nausea, vomiting, constipation, diarrhea, anorexia with weight loss GU: Irregular menses Hematologic: Slight elevation in AST, ALT, LDH; increases in serum bilirubin; thrombocytopenia, frank hemorrhage; anemia; bone marrow suppression NURSING RESPONSIBILITIES
Before Administration: 1. Check the doctor s order before preparing the drug. 2. Identify the patient and confirm that the correct patient will be given the medication. 3. Inform the client about the different adverse effects of the drug. 4. Instruct the client to practice contraception at all times. During Administration: 1. Administer the drug exactly as prescribed. Do not chew or crush. 2. Give drug with food if GI upset occur.

Brand Name: Depakene

Generic Name: valproic acid

Mechanism of action not Indications: understood; Antiepileptic y Sole and adjunctive activity may be related to the therapy in in somple and metabolism of the inhibitory complex seizuresl acute neurotransmitter, GABA; treatment of manic
episodes associated with bipolar disorder; prophylaxis of migraine headaches; adjunctive therapy for multiple seizure disorders. y Unlabeled uses: Adjunct in symptom management of schizophrenia. Treatment of aggressive outbursts in children with ADHD, organic brain syndrome

Dosage: 250 mg capsule tid

Route: Oral

Classification: y Antiepileptic

Contraindications: y Contraindicated with hypersensitivity to valproic acid, hepatic disease, or significant hepatic impairment Use cautiously with pregnancy; lactation; discontinuing such medication is likely to precipitate status epilepticus

After Administration: 1. Instruct the client to arrange for frequent checkups, including blood tests. 2. Tell the client to avoid alcohol and sleep-inducing and over-thecounter drugs.

DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS Indications: y Treatment of schizophrenia in patients older than 18 years Short-term treatment of acute manic or depressive episodes associated with bipolar I disorder, as monotherapy or in combination with lithium or divalproex COMMON ADVERSE EFFECTS Autonomic: Dry mouth, salivation, nasal congestion, nausea, vomiting, anorexia, fever, pallor, flushed faces, sweating, constipation CNS: Drowsiness, insomnia, vertigo, headache, tremor, tardive dyskinesia CV: Hypotension, orthostatic hypotension, syncope Hematologic: Increases ALT, total cholesterol and triglycerides NURSING RESPONSIBILITIES
Before Administration: 1. Check the doctor s order before preparing the drug. 2. Identify the patient and confirm that the correct patient will be given the medication. 3. Inform the client about the different adverse effects of the drug. 4. Maintain suicide precaution. During Administration: Administer the drug exactly as prescribed. After Administration:

Brand Name: Seroquel

Generic Name: quetiapine fumerate

Mechanism of action not fully understood; blocks dopamine and serotonin receptors in the brain; also acts as a receptor antagonist at histamine and adrenergic receptor sites

Dosage: 25 mg tablet bid

Route: Oral

Classification: y Antipsychotic

Contraindications: y Contraindicated with coma or severs CNS depression, allergy to quetiapine, lactation. Use cautiously with CV disease, hypotension, hepatic impairment, seizures, exposure to extreme heat, tardive dyskinesia, dehydration; pregnance

Other: Risk of development of 1. Instruct the client to arrange diabetes mellitus for frequent checkups, including
blood tests and assess for signs and symptoms of diabetes mellitus. 2. Maintain adequate hydration and use precaution against heat stroke. 3.Consult physician about dosage reduction and use of anticholinergic antiparkinsonians if extrapyramidial effects occur

DRUG STUDY
NAME OF DRUG MECHANISM OF ACTION INDICATIONS AND CONTRAINDICATIONS Indications: y Management of manifestations of psychotic disorders; the longer the acting parenteral dosage are indicated for management of patients who require prolong parenteral therapy COMMON ADVERSE EFFECTS Autonomic: Dry mouth, salivation, nasal congestion, nausea, vomiting, anorexia, fever, pallor, flushed faces, sweating, urinary retention, male impotence CNS: Drowsiness, insomnia, vertigo, headache, tremor, ataxia, slurring, seizures; dystonias; akathisia CV: Hypotension, orthostatic hypotension, tachycardia, bradycardia, refractory arrhythmias Endocrine: Breast engorgement in females; SIADH, amenorrhea, hyperglycemia, hypoglycemia Hematologic: Eosinophilia, leukopenia, anemia; aplastic anemia Respiratory: Bronchospasm, dyspnea; suppression of cough reflex. NURSING RESPONSIBILITIES
Before Administration: 1. Check the doctor s order before preparing the drug. 2. Identify the patient and confirm that the correct patient will be given the medication. 3. Inform the client about the different adverse effects of the drug. During Administration: Administer the drug exactly as prescribed. After Administration: 1. Instruct client to avoid prolonged exposure to sun and use a sunscreen or cover skin if exposure is unavoidable. 2. Emphasize the importance of being hydrated and use precautions against heatstroke. 3. Tell the client to avoid driving or engaging in other dangerous activities if drowsiness, weakness, tremor, extrapyramidial symptoms occur.

Brand Name: Modecate Concentrate

Generic Name: fluphenazine

Dosage: 25 mg (timing based on patient s response)

Mechanism of action not fully understood; blocks dopamine and serotonin receptors in the brain; depress the RAS; anticholinergic; antihistaminic; and alpha-adrenergic blocking activity may contribute to some of its therapeutic and adverse actions.

Route: Intramascular

Contraindications: Classification: y y y Antipsychotic Dopaminergic blocker Contraindicated with hypersensitivity to fluphenazine and other phenothiazines and aspirin; bone marrow depression; ;over da,age; severe hypotension Use cautiously with respiratory disorders; glaucoma; epilepsy; decreased renal function; pregnancy; lactation