DRUG STUDY (Risperidone, Lithium Carbonate, Multivitamins, Biperiden)

1. Risperidone 3 mg tab BID Classification: Atypical Antipsychotic Trade name: Risperdol Indications: To manage symptoms of psychosis including schizophrenia. Action: May act by antagonizing dopamine and serotonin in the CNS. Decreased symptoms of psychoses. Contraindications: Hypersensitivity, lactation, dysrhythmias, blood dyscrasias, liver damage Side effects/ Adverse Reactions: Sedation, weight gain, headaches, dry mouth, photosensitivity, urinary retention, sexual dysfunction, orthostatic hypotension, convulsions Nursing Considerations: 1. Direct client to avoid potentially dangerous situations, such as driving, until drug dosing has been stabilized. 2. Inform client about EPS; instruct the client to promptly report symptoms to the health care provider. 3. Instruct client to avoid direct sunlight to prevent photosensitivity and to use sunscreen and protective clothing to prevent a skin rash. 4. Advise client of orthostatic hypotension and possible dizziness. 5. Teach client who is taking aliphatic phenothiazines, such as chlorpromazine, that the urine might be pink or red brown; this discoloration is harmless. 6. Inform client that changes may occur related to sexual functioning and menstruating. 7. Suggest lozenges or hard candy if mouth dryness occur. 8. Encourage client to avoid extremes in temperatures and increased exercise. 9. Advise client to rise slowly from sitting or lying to standing to prevent a sudden decrease in blood pressure. 10. Evaluate the effectiveness of the drug and whether the client has acceptably reduced psychotic symptoms at the lowest dose possible. 2. Lithium Carbonate 450 mg 1 tab BID Classification: Mood Stabilizer Trade name: Eskalith, Lithane, Lithonate, Lithobid, Carbolith, Lithizine Indications: To treat bipolar manic-depressive psychosis, manic episodes. Action: Alteration of ion transport in muscle and nerve cells; increased receptor sensitivity to serotonin. Contraindications: Liver and renal dse., pregnancy, lactation, severe cardiovascular dse., severe dehydration, brain tumor damage, sodium depletion Side effects/ Adverse Reactions: Headache, lethargy, drowsiness, dizziness, tremors, slurred speech, dry mouth, anorexia, vomiting, diarrhea, polyuria, hypotension, abdominal pain, muscle weakness, restlessness, urinary incontinence, clonic movements, stupor, azotemia, leukocytosis, nephrotoxicity Nursing Considerations: 1. Observe client for signs and symptoms of depression: mood changes, insomia, apathy, or lack of interest in activities. 2. Record clients vital signs. Orthostatic hypotension is common. 3. Monitor for signs of lithium toxicity.

4. Monitor client for suicidal tendencies when marked depression is present. 5. Evaluate clients urine output and body weight. Fluid volume deficit may occur as a result of polyuria. 6. Observe client for fine and gross motor tremors and presence of slurred speed, which are signs of adverse reaction. 7. Check if clients cardiac status. Loss of fluids and electrolytes may cause cardiac dysrhythmias. 8. Monitor clients serum electrolytes. Report abnormal findings. 9. Emphasize the importance of adherence to the therapy, laboratory tests, and follow-up visits with the health care provider. 10. Encourage client to keep medical appointments. 3. Multivitamins 1 cap OD Classification: Vitamins Trade name: Theravim, Thera Multi Indications: Treatment and prevention of vitamin deficiencies. Action: Prevention of deficiency or replacement in patients whose nutritional status is questionable. Contraindications: Hypersensitivity to preservative, colorants or additives, including tartrazine, saccharin, and aspartame. Side effects/ Adverse Reactions: Allergic reactions to preservatives, additives, or colorants. Nursing Considerations: 1. Assess patient for signs of nutrition deficiency prior to and throughout therapy. 2. Instruct to notify side effects of medications to physician. 3. Encourage to comply on medications. 4. Encourage patient to comply with physicians recommendations. Explain that the best source of vitamins is a well balanced diet with foods from the 4 basic food groups. 5. Advise parents not to refer to chewable multivitamins for children as candy. 4. Biperiden 2 mg 1 tab TID PO Classification: Antiparkinson agent ( Anticholinergic ) Trade name: Akineton Indications: Adjunctive treatment of all forms of Parkinsons 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. 5. Clonazepam 2 mg 1 tab at HS PO Classification: Anticonvulsant (benzodiazepine) Trade name: Klonopin Indications: Prophylaxis for petit mal, petit mal variant, akinetic, myoclonic seizures, uncontrolled leg movements during sleep. Action: Prevention of seizures. Contraindications: Hypersensitivity to clonazepam or other benzodiazepines. Severe liver disease. Side effects/ Adverse Reactions: drowsiness, ataxia, behavioral changes Nursing Considerations: 1. Observe and record intensity, duration and location of seizure activity. 2. Assess patient for drowsiness, unsteadiness, and clumsiness. 3. Instruct patient to take medication exactly as directed. 4. Inform patient medication may cause drowsiness or dizziness. 5. Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication. 6. Advise patient to notify physician, dentist, or other health care provider of medication regimen prior to treatment or surgery. 7. Instruct patient and family to notify physician or other health care provider of unusual tiredness, bleeding, sore throat, fever, clay colored stools, yellowing of skin, or behavioral changes. 8. Emphasize the importance of follow-up examinations to determined effectiveness of the medication.

BIBLIOGRAPHY
Principles and Practice of Psychiatric Nursing 8th ed. By Stuart and Laraia Pharmacology ( A nursing process approach ) 5th ed. By Kee, Hayes, and McCuistion Davis Drug Guide for Nurses 5th ed. By Deglin and Vallerand