GRACE ANN ROXAS BSN-321

DRUG MECHANISM OF ADVERSE NURSING

ACTION
Generic Name:  Antagonise D2 receptors
Trifluoperazine resulting in anti-psychotic
effects, including relief
from symptoms such as
Brand Name: hallucinations, delusions or
Stelazine
abnormal
behaviour/thought
EFFECTS CONSIDERATION
 Use caution performing
 Drowsiness, dizziness, tasks that require
skin reactions, rash, alertness such as driving
dry mouth, insomnia, or operating machinery
amenorrhea, fatigue, Use of alcohol can cause
extreme drowsiness.
muscular weakness,
 Avoid alcohol use.
anorexia, lactation,
 This medication can
blurred vision and
reduce sweating making
neuromuscular you more susceptible to
(extrapyramidal) heat stroke.
reactions.  Avoid strenuous work or
exercise in hot weather.
GRACE ANN ROXAS BSN-321

DRUG MECHANISM OF SIDE EFFECTS NURSING

ACTION CONSIDERATION
Serious Side effects:
 Take drug exactly as
Generic Name:  Binds to the dopamine - twitching or
Perphenazine D1 and dopamine D2 ordered.
uncontrollable movements of
receptors and inhibits  Medication may cause
Brand Name: their activity. The your eyes, lips, tongue, face,
drowsiness. Caution
Trilafon mechanism of the anti- arms, or legs patient to avoid driving
emetic effect is due - tremor (uncontrolled or other activities
predominantly to requiring alertness until
shaking), drooling, trouble
blockage of the response to the
dopamine D2 swallowing, problems with
medication is known.
neurotransmitter balance or walking  Emphasize the
receptors in the - feeling restless, jittery, importance of routine
chemoreceptor trigger or agitated follow-up exams and
zone and vomiting continued participation
centre. Perphenazine confusion, unusual
in psychotherapy as
also binds the alpha thoughts or behavior indicated.
andrenergic receptor. - feeling like you might  Caution patient that this
This receptor's action is pass out medication decreases
mediated by association perspiration. Overheating
seizure (convulsions)
with G proteins that may occur during hot
activate a weather. Patient should
phosphatidylinositol- Less serious effects: notify health care
calcium second professional if unable to
- dizziness, drowsiness, remain indoors in an air-
messenger system.
anxiety conditioned environment
blurred vision, during hot weather
headache
- sleep problems
(insomnia), strange dreams
- constipation
- dry mouth or stuffy
GRACE ANN ROXAS BSN-321

nose

DRUG MECHANISM OF SIDE EFFECTS NURSING

ACTION
Generic Name:  Alters the effects of
Chlorpromazine dopamine in the CNS. CNS: NEUROLEPTIC
Has significant MALIGNANT
Brand Name: anticholinergic/alpha- SYNDROME, sedation,
Thorazine adrenergic blocking extrapyramidal reactions,
activity.Therapeutic tardive dyskinesia.
Effects: Diminished EENT: blurred vision, dry
signs/symptoms of eyes, lens opacities.
psychosis. Relief of CV: hypotension (increased
nausea/vomiting/intract with IM, IV), tachycardia.
able hiccups. GI: constipation, dry mouth,
Decreased symptoms anorexia, hepatitis, ileus.
of porphyria. GU: urinary retention.
Derm: photosensitivity,
pigment changes, rashes.
Endo: galactorrhea.
Hemat: AGRANULOCYTOSIS
, leukopenia.
Metab: hyperthermia.
Misc: allergic reactions.
CONSIDERATION
 Advise patient to take medication
exactly as directed and not to skip
doses or double up on missed
doses. If a dose is missed, take
within 1 hr or omit dose and return
to regular schedule. Abrupt
withdrawal may lead to gastritis,
nausea, vomiting, dizziness,
headache, tachycardia, and
insomnia.
 Inform patient of possibility of
extrapyramidal symptoms and
tardive dyskinesia. Instruct patient
to report these symptoms
immediately to health care
professional.
 Advise patient to change positions
slowly to minimize orthostatic
hypotension.
 Medication may cause
drowsiness. Caution patient to
avoid driving or other activities
requiring alertness until response
to the medication is known.
 Advise patient to use sunscreen
and protective clothing when
exposed to the sun. Exposed
GRACE ANN ROXAS BSN-321

surfaces may develop a

temporary pigment change
(ranging from yellow-brown to
grayish purple). Extremes of
temperature (exercise, hot
weather, hot baths or showers)
should also be avoided, because
this drug impairs body
temperature regulation.
 Instruct patient to use frequent
mouth rinses, good oral hygiene,
and sugarless gum or candy to
minimize dry mouth. Consult
health care professional if dry
mouth continues for >2 wk.
 Advise patient not to take
chlorpromazine within 2 hr of
antacids or antidiarrheal
medication.

 Inform patient that this

medication may turn urine a
pink-to-reddish-brown color.
 Advise patient to notify health
care professional of
medication regimen prior to
treatment or surgery.
 Instruct patient to notify health
care professional promptly if
sore throat, fever, unusual
bleeding or bruising, rash,
weakness, tremors, visual
disturbances, dark-colored
urine, or clay-colored stools
occur.
 Emphasize the importance of
GRACE ANN ROXAS BSN-321

routine follow-up exams and

continued participation in
psychotherapy as indicated.

DRUG MECHANISM OF SIDE EFFECTS NURSING

ACTION CONSIDERATION

Generic Name:  Acts indirectly on  Blurred vision  Use caution performing

Mesoridazine reticular formation,  drowsiness tasks that require
whereby neuronal  dry mouth alertness such as
Brand Name: activity into reticular  impotence driving or operating
Serentil formation is reduced  incontinence machinery Use of
without affecting its alcohol can cause
intrinsic ability to
extreme drowsiness.
activate the cerebral
 Avoid alcohol use.
cortex. In addition, the
 This medication may
phenothiazines exhibit
at least part of their increase sensitivity to
activities through sunlight.
depression of  Avoid prolonged sun
hypothalamic centers. exposure and wear a
Neurochemically, the sunscreen and
phenothiazines are protective clothing when
thought to exert their you are exposed to the
effects by a central sun.
adrenergic blocking  This medication can
action. reduce sweating making
you more susceptible to
heat stroke.
 Avoid strenuous work or
exercise in hot weather.
GRACE ANN ROXAS BSN-321

 Elderly patients are

more sensitive to the
effects of this drug.

DRUG MECHANISM OF ADVERSE EFFECTS NURSING

ACTION CONSIDERATION
GRACE ANN ROXAS BSN-321

Major Safety Concerns:  Encourage patient to take

Generic Name:  Mellaril blocks Permanent pigmentation of benztropine as directed. Take
Thioridazine  postsynaptic mesolimbic retina and potential blindness missed doses as soon as
dopaminergic D1 and D2 occurs with doses above 800 possible, up to 2 hr before the
mg/day. Life-threatening next dose.
receptors in the brain;
 Taper gradually when
Brand Name: blocks alpha-adrenergic agranulocytosisrarely occurs.
discontinuing or a withdrawal
Mellaril effect, depresses the Retrograde ejaculation and reaction may occur (anxiety,
release of hypothalamic ECG changes occur tachycardia, insomnia, return of
and hypophyseal more frequentlywith parkinsonian or extrapyramidal
hormones and is thioridazine symptoms)
believed to depress the May cause drowsiness or
reticular activating dizziness. Advise patient to
system thus affecting avoid driving or other activities
basal metabolism, body that require alertness until
temperature, response to the drug is known.
wakefulness, vasomotor  WBC monitored for 3
tone, and emesis. months. (WOF signs of
infection)
 Avoid driving & operating
machineries.

DRUG MECHANISM OF SIDE EFFECTS NURSING

ACTION CONSIDERATION
GRACE ANN ROXAS BSN-321

Generic Name: •Take drug exactly as ordered.

Clozapine  Multiple receptor  Orthostatic •Meds take 6 wks or longer to
antagonism: hypotension (high),
serotonin 5HT2A sedation achieve full clinical effect.
receptor,dopamine (high),anticholinergic •WBC monitored for 3 months.
Brand Name: D1, D2, and D4 (high), extrapyramidal
Clozaril receptors symptoms (absent). (WOF signs of infection)
Most common:sedation,
•Avoid driving & operating
dizziness, hypotension,
tachycardia, machineries.
constipation,
hyperthermia,hypersaliv •Avoid direct sunlight.
ation. Hypersalivation •Avoid extremes in temperatures &
can be treated with
anticholinergic agents. increased exercise.
•Change positions slowly.
•Alipathic phenothiazines pink-red
brown urine.
•Suggest lozenges, hard candy for
dry mouth.
•Changes to sexual functioning &
menstruation

MECHANISM OF SIDE EFFECTS NURSING CONSIDERATION

ACTION
GRACE ANN ROXAS BSN-321

 Encourage patient to take benztropine as directed.

Take missed doses as soon as possible, up to 2 hr
Generic Name:  Benztropine  Blurred vision; before the next dose.
benztropine antagonizes the constipation;  Taper gradually when discontinuing or a withdrawal
effect of depression; reaction may occur (anxiety, tachycardia, insomnia,
return of parkinsonian or extrapyramidal symptoms)
acetylcholine. This dilated pupils;
May cause drowsiness or dizziness. Advise patient to
Brand Name: decreases the disorientation; avoid driving or other activities that require alertness
Cogentin imbalance dizziness; until response to the drug is known
between the drowsiness; dry  Instruct patient that frequent rinsing of mouth, good
neurotransmitters, mouth; fast oral hygiene, and sugarless gum or candy may
acetylcholine and heartbeat; decrease dry mouth. Patient should notify health care
dopamine, which hallucinations; professional if dryness persists (saliva substitutes
may improve the headache; heat may be used). Also, notify the dentist if dryness
symptoms of early stroke; impaired interferes with use of dentures
Parkinson's memory;  Caution patient to change positions slowly to
disease. Benztropi increased minimize orthostatic hypotension
ne is a synthetic sensitivity of eyes  Instruct patient to notify health care professional if
difficulty with urination, constipation, abdominal
compound to light; lack of
discomfort, rapid or pounding heartbeat, confusion,
resulting from the drive; eye pain, or rash occurs
combination of the lightheadedness;  Advise patient to confer with health care professional
active portions of loss of appetite; before taking OTC medications, especially cold
atropine and nausea; remedies, or drinking alcoholic beverages
diphenhydramine. nervousness;  Caution patient that this medication decreases
numbness of perspiration. Overheating may occur during hot
fingers; weather. Patient should notify health care
sleeplessness; professional if unable to remain indoors in an air-
stomach upset; conditioned environment during hot weather
trembling of  Advise patient to avoid taking antacids or
hands; urinary antidiarrheals within 1–2 hr of this medication
retention; weak or Emphasize the importance of routine follow-up
exams.
stiff muscles.

DRUG MECHANISM OF SIDE EFFECTS NURSING CONSIDERATION

ACTION
GRACE ANN ROXAS BSN-321

 Instruct patient to take drug exactly

as prescribed, not to double dose to
Generic Name:  Competitively blocks Cardiovascular Effects compensate for missed ones and to
Haldol dopamine receptors to avoid abrupt withdrawal of this drug
cause sedation and  Tachycardia, to minimize risk of EPS.
Brand Name: also causes alpha- hypotension,  Instruct patient to take antacids 2
Haloperidol adrenergic and and hypertension  hrs before or after this drug.
anticholinergic  Advice patient to avoid hazardous
blockade. It CNS Effects activities until drug response is
depresses cerebral determined because dizziness and
cortex, hypothalamus  Extrapyramidal blurred vision are common. Remind
and limbic system, Symptoms (EPS)
patient to avoid OTC preparations
which control activity  Parkinson-like because serious drug interactions
and aggression but symptoms, akathisia, may occur; avoid also the use of
also cause significant or dystonia (includingopi alcohol and other CNS depressants
extrapyramidal sthotonos and since increased drowsiness may
effects. The oculogyric crisis). occur.
mechanism for  Advice patient to shift position
antipsychotic effects slowly because orthostatic
are unclear. hypotension, tell patient to avoid hot
tubs, hot showers, tub baths and to
take extra precautions during hot
weather to prevent heat stroke.
 Tell patient to report sore throat,
malaise, fever, bleeding, mouth
sores and other adverse reations.
GRACE ANN ROXAS BSN-321

DRUG MECHANISM OF SIDE EFFECTS NURSING CONSIDERATION

ACTION
 Advise patient to take medication as
 Drowsiness, directed and not to skip doses or double
Generic Name:   Prolixin blocks lethargy, dizziness, up on missed doses. If a dose is missed,
fluphenazine postsynaptic nausea, loss of appetite, take within 1 hr or skip dose and return to
hydrochloride regular schedule if taking more than 1
mesolimbic sweating, dry mouth,
dose/day; take as soon as possible
dopaminergic D1 blurred vision, headache, unless almost time for next dose if taking
Brand Name: and D2 receptors or constipation may 1 dose/day. Abrupt withdrawal may lead
Prolixin in the brain; occur. to gastritis, nausea, vomiting, dizziness,
depresses the  CNS: NEUROLEPTIC headache, tachycardia, and insomnia
release of MALIGNANT  Inform patient of possibility of
hypothalamic and SYNDROME, extrapyra extrapyramidal symptoms and tardive
hypophyseal midal reactions, dyskinesia. Caution patient to report these
hormones and is sedation, tardive symptoms immediately to health care
believed to dyskinesia. EENT: blurre professional
depress the d vision, dry  Advise patient to change positions slowly
to minimize orthostatic hypotension
reticular activating eyes. CV: hypertension,
Medication may cause drowsiness.
system thus hypotension, Caution patient to avoid driving or other
affecting basal tachycardia. GI: anorexia activities requiring alertness until
metabolism, body , constipation, drug- response to medication is known
temperature, induced hepatitis, dry  Caution patient to avoid taking alcohol or
wakefulness, mouth, ileus, nausea, other CNS depressants concurrently with
vasomotor tone, weight gain. GU: urinary this medication
and emesis retention. Derm: photose  Advise patient to use sunscreen and
nsitivity, pigment protective clothing when exposed to the
changes, sun. Exposed surfaces may develop a
rashes. Endo:galactorrhe blue-gray pigmentation, which may fade
after discontinuation of the medication.
a. Hemat: AGRANULOC
Extremes of temperature should also be
YTOSIS, leukopenia, avoided because this drug impairs body
thrombocytopenia. Misc:  temperature regulation
allergic reactions.

DRUG MECHANISM OF SIDE EFFECTS NURSING

GRACE ANN ROXAS BSN-321

ACTION CONSIDERATION
 Instruct patient to take this drug
exactly as directed. If a dose is
 Inhibits the action of  CNS: dizziness, nervousnes missed, take as soon as remembered,
Generic Name: acetylcholine, s, confusion, drowsiness, unless next scheduled dose is within
trihexyphenidyl 2 hr; do not double doses.
resulting in: headache, psychoses,  Medication should be tapered
Decreased sweating weakness. gradually when discontinuing or a
Brand Names: and salivation, EENT: blurred withdrawal reaction may occur
Artane, Trihexane Mydriasis (pupillary vision, mydriasis. (anxiety, tachycardia, insomnia, return
dilation), Increased CV: orthostatic hypotension, of parkinsonian or extrapyramidal
heart rate. Also has tachycardia. symptoms).
spasmolytic action GI: dry mouth, nausea,  May cause drowsiness or dizziness.
on smooth muscle. constipation, Advise patient to avoid driving or
Inhibits cerebral vomiting. GU: urinary other activities that require alertness
until response to medication is known.
motor centers and hesitancy, urinary retention.
 Caution patient to change positions
blocks efferent slowly to minimize orthostatic
impulses hypotension.
 Instruct patient that frequent rinsing of
mouth, good oral hygiene, and
sugarless gum or candy may
decrease dry mouth. Patient should
notify health care professional if
dryness persists (saliva substitutes
may be used). Also, notify the dentist
if dryness interferes with use of
dentures.
 Advise patient to confer with health
care professional prior to taking OTC
medications, especially cold
remedies, or drinking alcoholic
beverages.
GRACE ANN ROXAS BSN-321

DRUG MECHANISM OF SIDE EFFECTS NURSING CONSIDERATION

ACTION
 Take exactly as directed (may be
prescribed in conjunction with
Generic Name:  Parlodel is a dopamine  Nausea, constipation, levodopa/carbidopa); do not change
bromocriptine  agonist. It works by dizziness, dosage or discontinue this medicine
blocking the release of drowsiness, loss of without consulting prescriber.
Brand Names: prolactin from the appetite, vomiting,  Therapeutic effects may take
Parlodel pituitary gland and diarrhea, and several weeks or months to achieve
lowering growth headache may occur. and you may need frequent
hormone levels (in monitoring during first weeks of
patients with therapy.
acromegaly). In  Take with meals if GI upset occurs,
Parkinson disease, before meals if dry mouth occurs, or
Parlodel works by after eating if drooling or if nausea
stimulating dopamine occurs. Take at the same time each
receptors in certain day.
parts of the brain  Maintain adequate hydration unless
instructed to restrict fluid intake;
void before taking medication. Do
not use alcohol, prescription or OTC
sedatives, or CNS depressants
without consulting prescriber. Urine
or perspiration may appear darker.
GRACE ANN ROXAS BSN-321

DRUG MECHANISM OF SIDE EFFECTS NURSING

ACTION CONSIDERATION

 Assess for Parkinsonism, EPS.

Generic Name:  Synthetic  Assess for mental status.
Biperiden anticholinergic  CNS and peripheral  Assess patient response if
drug, blocks effects, skin rashes, anticholinergics are given.
cholinergic dyskinesia, ataxia,  Assess for tolerance over long
Brand Names: responses in the twitching, impaired term therapy, dosage may have to
Akineton CNS. speech, micturition be increased or changed.
difficulties. Fatigue,  Avoid activities that require
dizziness, at higher alertness, may cause dizziness,
doses, restlessness, drowsiness and
agitation, anxiety, blurring of vision.
confusion.  Avoid abrupt discontinuation,
increased sensitivity to side
effects especially elderly; enhance
risk of cerebral seizures in
predisposed persons, abuse, and
impaired ability to drive or operate
machinery.

DRUG MECHANISM OF SIDE EFFECTS NURSING

ACTION CONSIDERATION
GRACE ANN ROXAS BSN-321

 Caution the client that the

Generic Name:  Antagonizes the effect
diphenhydramine of histamine at H1
receptor sites; does not
bind or inactivate
Brand Names: histamine
Benadryl
medication may cause drowsiness,
 CNS: headache, creating difficulties or hazards or
fatigue, anxiety, other activities that require
tremors, vertigo, alertness.
confusion, depression,
seizures, hallucinations  Tell the client to take the
•CV: tachycardia, medication with food to decrease
palpitations, orthostaic GI upset.
hypotension, heart Explain to the client that arising
failure quickly form a lying or
•EENT: blurred vision sitting position may cause
• GI: dry mouth, orthostatic hypotension.
nausea, vomiting,
constipation, flatulence  When taking these medications,
• GU: urinary hesitancy the client needs to have blood cells
or frequency, urine counts, renal function, hepatic
retention function, and blood pressure
• Hematologic: monitored.
leukopenia
• Skin: photosensitivity,  Adverse effects of these drugs
dermatitis occur more commonly in elderly
clients.

 Explain to the client that use of

these drugs in warm weather may
increase the likelihood of
heatstroke.
GRACE ANN ROXAS BSN-321

DRUG MECHANISM OF SIDE EFFECTS NURSING

ACTION CONSIDERATION

Generic Name:  Increases the  Dyskinesia, GI  Do not take levodopa if you have
Levodopa production of dopamine upset, taken a monoamine oxidase
levels hallucinations, inhibitor (MAOI) such as
Brand Name: confusion, isocarboxazid (Marplan),
Sinemet psychological tranylcypromine (Parnate), or
disturbances, phenelzine (Nardil) in the past 2
weeks.
depression,
dizziness,
headache, dream
abnormalities,
dystonia, cardiac  Antacids may increase the
arrhythmias, effectiveness of levodopa and
hypotension, lead to side effects. Ask your
dyspnea, on-off doctor about the use of
phenomenon, back antacids
pain,
blepharospasm
(may indicate  Tell your doctor if you are taking
excess dosage), a medicine to treat high blood
hypertension, pressure (hypertension). Drugs
anticholinergic taken to treat high blood pressure
effects, anorexia, may be more effective when
insomnia, taken with levodopa, and very
leukopenia, renal low blood pressure could result.
and liver function
disorders, seizures,
neuroleptic
malignant
syndrome.
DRUG MECHANISM OF SIDE EFFECTS NURSING
GRACE ANN ROXAS BSN-321
ACTION
 Although the
Generic Name: mechanisms for
SELEGILINE selegiline's beneficial
action in the treatment of
Brand Names: Parkinson's disease are
Eldepryl not fully understood, the
inhibition of monoamine
oxidase type B (MAO B)
is thought to be of
primary importance.
MAO B is involved in the
oxidative deamination of
dopamine in the brain.
Eldepryl is best known as
an irreversible inhibitor of
MAO. MAO's activity is
inhibited when selegiline
binds to the isoalloxazine
flavin adenine
dinucleotide (FAD) at its
active center. In addition,
there is evidence that
selegiline may increase
dopaminergic activity
through other
mechanisms
CONSIDERATION
 sudden and severe  Caution the client that the
headache, confusion, medication may cause
blurred vision, drowsiness, creating difficulties
problems with speech or hazards or other activities that
or balance, nausea, require alertness.
vomiting, chest pain,
seizure (convulsions),  Tell the client to take the
and sudden numbness medication with food to decrease
or weakness GI upset.
(especially on one side Explain to the client that arising
of the body); feeling quickly form a lying or
light-headed, fainting; sitting position may cause
hallucinations; feeling orthostatic hypotension.
restless, agitated, or
irritable; twitching  When taking these medications,
muscle movements; or the client needs to have blood
painful or difficult cells counts, renal function,
urination. hepatic function, and blood
pressure monitored.
 Adverse effects of these drugs
occur more commonly in elderly
clients.
GRACE ANN ROXAS BSN-321

DRUG MECHANISM OF SIDE EFFECTS NURSING CONSIDERATION

ACTION

 Antiviral activity  CNS: nclude  Assess for Parkinsonism, EPS.

Generic Name: involves interference nervousness, anxiety,  Assess for mental status.
Amantadine with a viral protein, agitation, insomnia,  Assess patient response if
M2 (an ion channel), difficulty in anticholinergics are given.
which is required for concentrating, and  Assess for tolerance over long term
Brand Names: the viral particle to exacerbations of pre-
Symmetrel therapy, dosage may have to be
become "uncoated" existing seizure increased or changed.
once taken inside a disorders and  Avoid activities that require alertness,
cell by endocytosis psychiatric symptoms may cause dizziness, drowsiness and
in patients with blurring of vision.
schizophrenia or  Inform patient of possibility of
Parkinson's disease. extrapyramidal symptoms and tardive
dyskinesia. Caution patient to report these
symptoms immediately to health care
professional
 Advise patient to change positions slowly
to minimize orthostatic hypotension
Medication may cause drowsiness.
Caution patient to avoid driving or other
activities requiring alertness until
response to medication is known
GRACE ANN ROXAS BSN-321