DRUG STUDY BSN III Center for Behavioral Sciences

Name of Drug Dose/Route Classification Mechanism of Indication Side Effect Nursing Responsibility
Action
Generic Name: Psychosis - Haloperidol Acute and Adverse effects Monitor for therapeutic
Haloperidol, adult: psychotherap blocks the chronic CNS:Extrapyramidal effectiveness. Because of long
Decanoate PO 0.25 mg eutic effects psychotic reactions: Parkinsonian half-life, therapeutic effects are
b.i.d. or t.i.d. - of dopamine and disorders symptoms, dystonia, slow to develop in early therapy
Brand Name: antipsychotic increases its including: akathisia, tardive or when established dosing
Haldol, Severe turnover rate schizophrenia, dyskinesia (after long- regimen is changed.
Peridol Psychosis manic states, term use); insomnia, Therapeutic window effect
adult: PO 35 drug-induced restlessness, anxiety, (point at which increased dose
mg b.i.d. or psychoses euphoria, agitation, or concentration actually
t.i.d., may need drowsiness, mental decreases therapeutic
up to 100 mg/d Useful in depression, lethargy, response) may occur after long
managing fatigue, weakness, period of high doses. Close
aggressive or tremor, ataxia, headache, observation is imperative when
agitated confusion, vertigo; doses are changed.
patients. neuroleptic malignant Target symptoms expected
syndrome, hyperthermia, to decrease with successful
grand mal seizures, haloperidol treatment include
exacerbation of psychotic hallucinations, insomnia,
symptoms. hostility, agitation, and
delusions.
CV:Tachycardia, ECG Monitor patients mental
changes, hypotension, status daily.
hypertension (with Monitor for neuroleptic
overdosage). malignant syndrome (NMS) ,
especially in those with
Endocrine:Menstrual hypertension or taking lithium.
irregularities, Symptoms of NMS can appear
galactorrhea, lactation, suddenly after initiation of
gynecomastia, impotence, therapy or after months or
increased libido, years of taking neuroleptic
DRUG STUDY BSN III Center for Behavioral Sciences

hyponatremia, (antipsychotic) medication.

hyperglycemia, Immediately discontinue drug if
hypoglycemia. NMS suspected.Monitor for
parkinsonism and tardive
SpecSenses:Blurred dyskinesia . Risk of tardive
vision. dyskinesia appears to be
greater in women receiving
Hematologic:Mild high doses and in older adults.
transient leukopenia, It can occur after long-term
agranulocytosis (rare). therapy and even after therapy
GI:Dry mouth, anorexia, is discontinued.
nausea, vomiting, Monitor for extrapyramidal
constipation, diarrhea, (neuromuscular) reactions that
hypersalivation. occur frequently during first few
Urogenital:Urinary days of treatment. Symptoms
retention, priapism. are usually dose related and
are controlled by dosage
Respiratory:Laryngospas reduction or concomitant
m, bronchospasm, administration of antiparkinson
increased depth of drugs.
respiration, Be alert for behavioral
bronchopneumonia, changes in patients who are
respiratory depression. concurrently receiving
antiparkinson drugs.
Skin:Diaphoresis, Monitor for exacerbation of
maculopapular and seizure activity.
acneiform rash, Observe patients closely for
photosensitivity. rapid mood shift to depression
when haloperidol is used to
other:Cholestatic control mania or cyclic
jaundice, variations in disorders. Depression may
liver function tests, represent a drug adverse effect
DRUG STUDY BSN III Center for Behavioral Sciences

decreased serum or reversion from a manic

cholesterol. state.
Lab tests: Monitor WBC
count with differential and liver
function in patients on
prolonged therapy.

Name of Drug Dose/Route Classification Mechanism of Indication Side Effect Nursing Responsibility
Action
Generic name: Mania Antimanic alters sodium tra indicated in the Monitor response to drug.
Lithium adult: PO nsport in nerve treatment of CNS:Dizziness, Usual lag of 12 wk precedes
Carbonate Loading Dose and muscle cells manic episodes headache, lethargy, response to lithium therapy.
600 mg t.i.d. or and inhibits of Bipolar drowsiness, fatigue, Keep physician informed of
Brand Name: 900 mg release of Disorder. slurred speech, progress.
Eskalith, sustained- norepinephrine Bipolar psychomotor retardation, Monitor lithium level:
Eskalith CR, release b.i.d. or and dopamine Disorder, Manic giddiness, incontinence, Generally dosage regimen is
Lithane, 30 mL (48 mEq) but not (DSM-III) is restlessness, seizures, designed to maintain serum
Lithobid, of solution t.i.d. serotonin. equivalent to confusion, blackout spells, lithium levels of 1.01.5 mEq/L
Lithonate, Manic disorientation, recent in acute mania and 0.61.6
Lithotabs PO Depressive memory loss, stupor, mEq/L during maintenance
Maintenance illness coma, EEG changes. treatment; blood sample to
Dose CV:Arrhythmias, determine serum lithium level is
300 mg t.i.d. or indicated as a hypotension, vasculitis, drawn prior to next dose (812
q.i.d. or 1520 maintenance peripheral circulatory h after last dose) when lithium
mL (2432 treatment for collapse, ECG changes. level is fairly stable.
mEq) solution in individuals with SpecSenses:Impaired Monitor for S&S of lithium
24 divided a diagnosis of vision, transient toxicity, often when lithium
doses (max: 2.4 Bipolar scotomas, tinnitus. levels are 1.52.0 mEq/L (e.g.,
g/d) Disorder. Endocrine:Diffuse thyroid vomiting, diarrhea, lack of
child:PO 15 enlargement, coordination, drowsiness,
60 mg/kg/d in hypothyroidism, muscular weakness, slurred
DRUG STUDY BSN III Center for Behavioral Sciences

divided doses speech). Withhold one dose

nephrogenic diabetes and call physician. Drug should
Azministration insipidus, transient not be stopped abruptly.
Oral hyperglycemia, When lithium levels are
Give glycosuria, hyponatremia. above 2.0 mEq/L, symptoms
with meals. GI:Nausea, vomiting, may include ataxia, blurred
Ensure anorexia, abdominal pain, vision, giddiness, tinnitus,
that diarrhea, dry mouth, muscle twitching or coarse
sustained metallic taste. tremors, and a large output of
release Musculoskeletal:Fine dilute urine.
tablets are hand tremors, coarse Weigh patient daily; check
not chewed tremors, choreoathetotic ankles, tibiae, and wrists for
or crushed; movements; edema. Report changes in I&O
must be fasciculations, clonic ratio, sudden weight gain, or
swallowed movements, edema.
whole. incoordination including Polydipsia and polyuria,
Protect ataxia, muscle weakness, apparently not dose-related,
from light hyperreflexia, are common early adverse
and encephalopathic effects, particularly in older
moisture. syndrome (weakness, adults. Symptoms may lessen
lethargy, fever, tremors, but reappear after several
confusion, extrapyramidal months or even years of
symptoms). maintenance.
Skin:Thought to be Report early signs of
toxicity rather than allergy: extrapyramidal reactions
Pruritus, maculopapular promptly to physician. The
rash, hyperkeratosis, encephalopathic syndrome
chronic folliculitis, may be induced when lithium is
transient acneiform given concomitantly with
papules (face, neck, haloperidol or with other
intertriginous areas), antipsychotic medication,
anesthesia of skin, particularly in older adults.
DRUG STUDY BSN III Center for Behavioral Sciences
cutaneous ulcers, drying
and thinning of hair,
allergic vasculitis.
Hematologic:Reversible
leukocytosis (14,000 to
18,000/mm3).
Urogenital:Albuminuria,
oliguria, urinary
incontinence, polyuria,
polydipsia, increased uric
acid excretion.
BodyWhole:Edema,
weight gain (common) or
loss, exacerbation of
psoriasis; flu-like
symptoms.
Keep physician informed of
all presenting S&S. The fine
tremor of hand or jaw, polyuria,
mild thirst, transient mild
nausea, and general discomfort
that may occur in early
treatment of mania sometimes
persist throughout therapy.
Usually, however, symptoms
subside with temporary
reduction of dose. If symptoms
persist, drug is withdrawn.
Monitor thyroid function
periodically. Be alert to and
report symptoms of
hypothyroidism.
Neonates born of mothers
who took lithium during
pregnancy may have high
serum lithium level manifested
by flaccidity, poor reflexes,
cardiac dysrhythmia, and
chronic twitching.
Lithane contains tartrazine,
which may cause an allergic-
type reaction in susceptible
patients.
Monitor older adults carefully
to prevent toxicity, which may
occur at serum levels ordinarily
tolerated by other patients.
DRUG STUDY BSN III Center for Behavioral Sciences

Name of Drug Dose/Route Classification Mechanism of Indication Side Effect Nursing Responsibility
Action
DRUG STUDY BSN III Center for Behavioral Sciences

Generic Name: Individualize antiepileptic Mechanism of Epilepsy, acute -Assess for seizures.
Carbamazepine dosage; a low action not mania: Mild, mostly transient and -Monitor liver function tests and
initial dosage understood; anti maintenance of dose dependent. urine function test.
Brand Name: with gradual epileptic activity bipolar affective Dizziness, ataxia, allergic -Caut ion patient to avoid activities
Tegretol increase is may be related disorders. skin reactions, that require alertness.
advised. to its ability to Alcohol leukopenia, vomiting, -Advise patient to use sunscreen to
inhibit withdrawal accommodation prevent photosensitivity.
PO polysynaptic disorder. disorders. Diplopia, liver -Advise patient not to discontinue
responses and enzyme elevations, SLE- medication quickly after long term
block post- like syndromes: use.
tetanic potentiati peripheral neuritis, -Teach patient to report immediately
on. Drug is hallucinations, agitation, to physician if with following
chemically depression. reactions: chills, rash, light-colored
related to the stools, drak urine, yellowing of
TCAs. skin/eyes, abdominal pain, sore
throat, mouth ulcers, bruising,
blurred vision, dizziness.
DRUG STUDY BSN III Center for Behavioral Sciences

Name of Drug Dose/Route Classification Mechanism of Action Indication Side Effect Nursing
Responsibility
Chlorpromazine 100mg, OP Therapeutic: Alters the effects of This medication is Drowsiness, Assess mental
Antiemetic, dopamine in the used to treat certain dizziness, dry status( orientation
Antipychotics CNS. Has significant mental/mood mouth, blurred , mood, behavior)
Pharmacologic: anticholenergic/ disorders (such as vision, tiredness, prior to and
Phenothiazines alpha- adrenergic schizophrenia, nausea, periodically
blocking activity. psychotic disorders, constipation, weight during therapy.
Therapeutic effects: manic phase of gain, and trouble Assess weight
diminished sign and bipolar disorder, sleeping may occur. and BMI initially
symptoms of severe behavioral If any of these and throughout
psychosis. Relief of problems in effects persist or therapy.
nausea/ vomiting/ children). worsen, tell your Assess fasting
intractable hiccups. Chlorpromazine doctor or pharmacist blood glucose
Decreased helps you to think promptly. and cholesterol
symptoms of more clearly, feel levels initially and
porphyria. less nervous, and periodically
take part in everyday throughout
life. It can reduce therapy. Refer as
aggressive behavior appropriate for
and the desire to nutritional/ weight
hurt yourself/others. and medical
It may also help to management.
decrease Assess positive
hallucinations (hallucination,
(hearing/seeing delusions,
things that are not agitation) and
there). negative (social
Chlorpromazine is a withdrawal)
psychiatric symptoms of
medication that schizophrenia.
Monitor blood
DRUG STUDY BSN III Center for Behavioral Sciences

belongs to the class pressure, pulse,

of drugs called and respiration
phenothiazine rate prior to and
antipsychotics. It frequently during
works by helping to the period of dose
restore the balance adjustment.
of certain natural Observe patient
substances in the carefully when
brain. administering
Chlorpromazine is medication to
also used to control ensure
nausea/vomiting, medication is
relieve prolonged actually taken
hiccups, relieve and not hoarded.
restlessness/anxiety Assess fluid
before surgery, and intake and bowel
help treat tetanus. function.
DRUG STUDY BSN III Center for Behavioral Sciences

Name of Drug Dose,route Classification Mechanism of Indications Contraindications Side Effects Nursing
Actions Responsibility

Sodium Valproate 500 mg, OP Therapeutic: Increase level of This medication is Hypersensitivity, Diarrhea, SEIZURES
+ valproic Acid Anticonvulsants GABA, an used to treat hepatic impairment dizziness, Assess location,
inhibitory seizure disorders, drowsiness, hair duration, and
neurotransmitter mental/mood loss, characteristic of
in the CNS. conditions (such blurred/double seizure activity.
as manic phase of vision, change in Institute seizure
bipolar disorder), menstrual precautions.
and to prevent periods, ringing in
migraine the ears, BIPOLAR
headaches. It shakiness DISORDER
works by restoring (tremor), Assess mood,
the balance of unsteadiness, idealation, and
certain natural weight changes behavior
substances may occur. If any frequency.
(neurotransmitters of these effects
) in the brain. persist or worsen,
tell your doctor or
pharmacist
promptly.