MEDICATION ADMINISTRATION WORKSHEET CLIENT INITIALS: _J___

Medication: Usual Dosage Cellular MOA Side Effects/Drug Nursing Management Indications for
Generic/Trade name (Routes of Onset/Peak/ Interactions/ (Implications & Teachings) Use/Indication for
Specific drug class Administration) Duration Contraindications This Patient
Dosage/Route/Times

Schizophrenia, The exact Side Effects: Drowsiness, Nursing Implications Olanzapine is used
OLANZAPINE Mania: mechanism of dizziness, lightheadedness,  Monitor diabetics for to treat
Trade name: 13-17 years: action of olanzapine stomach upset, dry mouth, loss of glycemic schizophrenia and
Zyprexa, Zyprexa 2.5-5 mg/day is not known. It may constipation, increased control. bipolar I disorder.
Zydis orally, adujust work by blocking appetite, or weight gain may  Withhold drug and It’s also used with
Specific drug class: by increasing receptors for several occur. If any of these effects immediately report fluoxetine to treat
Atypical or decreasing neurotransmitters persist or worsen, tell your S&S of neuroleptic other conditions.
antipsychotics, 2nd by 2.5 – 5 mg. (chemicals that doctor or pharmacist malignant syndrome; These include
Generation; Target dose: nerves use to promptly. assess for and report depression caused by
Antimanic Agents 10mg/day; communicate with S&S of tardive bipolar I disorder as
Dosage: 2.5 mg – 20 Max: 20mg/day each other) in the Drug Interactions: A dyskinesia. well as depression
mg (oral), 10 mg (IM Bipolar brain. It binds to product that may interact  Lab tests: Periodically that can’t be
injection, short depression: 10- alpha-1, dopamine, with this drug is: monitor ALT, controlled with other
acting), 210-405 mg/ 17 years: 2.5 histamine H-1, metoclopramide. especially in those drugs.
vials (IM) mg orally in the muscarinic, and with hepatic
Route: Oral/ IM evening and serotonin type 2 (5- Tell your doctor or dysfunction or being
Times: Taken 1 time fluoxetine 20 HT2) receptors. pharmacist if you are taking treated with other
per day mg orally, other products that cause potentially hepatotoxic
every evening, The one key drowsiness such as opioid drugs. Periodic blood
dosage difference between pain or cough relievers glucose monitoring.
adjustments if IM and oral (such as codeine,  Monitor BP and HR
needed. olanzapine is rate of hydrocodone), alcohol, periodically. Monitor
absorption, which marijuana (cannabis), drugs temperature,
The oral dose influences onset of for sleep or anxiety (such as especially under
usually ranges action. IM alprazolam, lorazepam, conditions such as
from 5 mg to olanzapine zolpidem), muscle relaxants strenuous exercise,
20 mg. The generally reaches (such as carisoprodol, extreme heat, or
dose of the maximum cyclobenzaprine), or treatment with other
injection concentration in 15 antihistamines (such as anticholinergic drugs.
usually ranges to 45 minutes, cetirizine,  Monitor for seizures,
from 150 mg to compared with 4 diphenhydramine). especially in older
THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY
 405 mg. hours after an oral adults and cognitively
Olanzapine for dose. Check the labels on all your impaired persons.
Injection is Onset: 15- 45 mins medicines (such as allergy Patient & Family Education
intended for Peak: 6hr. or cough-and-cold products)
intramuscular Duration: 30hr. because they may contain  Carefully monitor
use only. Do ingredients that cause blood glucose levels if
not administer drowsiness. diabetic.
intravenously Contraindications:  Do not drive or engage
or Contraindicated in patients in potentially
subcutaneously with a known hazardous activities
. Inject slowly, hypersensitivity to the until response to drug
deep into the product. May exacerbate, is known; drug
muscle mass possibly precipitate, diabetes increases risk of
mellitus, low white blood orthostatic
cell or liver dysfunction. hypotension and
cognitive impairment.
 Learn common
adverse effects and
possible drug
interactions.
 Avoid alcohol and do
not take additional
medications without
informing physician.
 Do not become
overheated; avoid
conditions leading to
dehydration.
 Do not breast feed
while taking this drug.

QUETIAPINE SEROQUEL Its actions could Side effects: Constipation, Nursing Implications This medication is
XR tablets occur from the drowsiness, upset stomach,  Monitor and used to treat certain
Specific Drug class: should be antagonism of tiredness, weight gain, immediately report mental/mood
Atypical swallowed dopamine type 2 blurred vision, or dry mouth signs of neuroleptic conditions (such as
antipsychotics Trade whole and not (D2) and serotonin may occur. malignant syndrome, schizophrenia,
name: SEROquel, split, chewed, 2A (5HT2A) Serious side effects: including bipolar disorder,
THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY
SEROquel XR or crushed. It is receptors. In bipolar restlessness/constant need to
Dosage forms: oral recommended depression and move, shakiness (tremor),
tablet (100 mg; 200 that major depression, mental/mood changes (such
mg; 25 mg; 300 mg; SEROQUEL quetiapine's actions as increased anxiety,
400 mg; 50 mg); oral XR be taken may be attributed to depression, thoughts of
tablet, extended without food or the binding of this suicide), difficulty
release (150 mg; 200 with a light drug or its swallowing, constipation
mg; 300 mg; 400 mg; meal metabolite to the with persistent abdominal
50 mg) norepinephrine pain, persistent
Route: Oral transporter. nausea/vomiting, loss of
Times: Taken one to Onset: Slow appetite, yellowing
three times a day Peak: 1.5 hr eyes/skin, interrupted
Duration: 6hr. breathing during sleep,
trouble urinating.
Drug interactions: Many
drugs besides quetiapine
may affect the heart rhythm
(QT prolongation),
including amiodarone,
moxifloxacin, procainamide,
quinidine, sotalol,
thioridazine, among others.
Other medications can affect
the removal of quetiapine
from your body, which may
affect how quetiapine
works. Examples include
azole antifungals (such as
itraconazole, ketoconazole),
rifamycins (such as
rifampin), drugs used to
treat seizures (such as
phenytoin), among others.
Tell the doctor if it causes
drowsiness such as opioid
pain or cough relievers
THAOBUNYUEN, Leya S. BSN 4
hyperthermia, sudden episodes of
diaphoresis, mania or depression
generalized muscle associated with
rigidity, decreased bipolar disorder).
cognition, tachycardia,
changes in blood
pressure (BP), and
incontinence.
Symptoms typically
occur within 4–14
days after initiation of
drug therapy, but can
occur at any time
during drug use.
 Be alert for new
seizures or increased
seizure activity,
especially at the onset
of drug treatment.
Document the number,
duration, and severity
of seizures, and report
these findings
immediately to the
physician.
 Assess motor function,
and be alert for
extrapyramidal
symptoms. Report
these symptoms
immediately,
especially tardive
dyskinesia, because
this problem may be
irreversible. Common
DRUG STUDY
 (such as codeine,
hydrocodone), alcohol,
marijuana (cannabis), drugs
for sleep or anxiety (such as
alprazolam, lorazepam,
zolpidem), muscle relaxants
(such as carisoprodol,
cyclobenzaprine), or
antihistamines (such as
cetirizine,
diphenhydramine).
Contraindications:
Hypersensitivity,
Hypokalemia,
Hypomagnesemia
THAOBUNYUEN, Leya S. BSN 4
extrapyramidal
symptoms include:
 Tardive dyskinesia
(uncontrolled
rhythmic movement of
mouth, face, and
extremities, lip
smacking or
puckering, puffing of
cheeks, uncontrolled
chewing, rapid or
worm-like movements
of tongue).
 Pseudoparkinsonism
(shuffling gait,
rigidity, tremor, pill-
rolling motion, loss of
balance control,
difficulty speaking or
swallowing, mask-like
face).
 Akathisia (restlessness
or desire to keep
moving).
 Other dystonias and
dyskinesias (dystonic
muscle spasms,
twisting motions,
twitching, inability to
move eyes, weakness
of arms or legs).
 Assess BP when
DRUG STUDY
 patient assumes a
more upright position
(lying to standing,
sitting to standing,
lying to sitting).
Document orthostatic
hypotension and
contact physician
when systolic BP falls
>20 mm Hg, or
diastolic BP falls >10
mm Hg.

 Monitor any cardiac

palpitations, prolonged
cough, or difficult,
labored breathing.
Report these
symptoms if they
become problematic.

 Assess peripheral
edema using girth
measurements, volume
displacement, and
measurement of
pitting edema (See
Appendix N). Report
increased swelling in
feet and ankles or a
sudden increase in
body weight due to
fluid retention.

 Watch for signs of

leukopenia, including
fever, sore throat,

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY

 mucosal lesions, and
other signs of
infection. Report these
signs to the physician.

 Be alert for signs of

hyperglycemia,
including confusion,
drowsiness,
flushed/dry skin, fruit-
like breath odor,
rapid/deep breathing,
polyuria, loss of
appetite, and unusual
thirst. Patients with
diabetes mellitus
should check blood
glucose levels
frequently.
RISPERIDONE Schizophrenia The primary action Side effects: Risperidone Nursing Implications Schizophrenia
Specific Drug Class: : of risperidone is to oral tablet may cause  Monitor and report This is a mental
Antipsychotics, 2nd Adult decrease drowsiness and the feeling signs of neuroleptic health disorder that
generation, Antimanic RISPERDAL® dopaminergic and of being unstable. malignant syndrome, causes changes in
Agents can be serotonergic Parkinsonism (trouble including thinking or
Brand name: administered pathway activity in moving) hyperthermia, perception. People
Risperdal, Risperdal once or twice the brain, therefore Akathisia (restlessness and diaphoresis, with this condition
Consta, and Risperdal daily. Initial decreasing urge to move) generalized muscle may hallucinate (see
M-Tab. dosing is 2 mg symptoms of dystonia (muscle rigidity, altered mental or hear things that
Dosage: 0.25mg -4mg per day. May schizophrenia and contractions that cause status, tachycardia, aren’t there) or have
(tablet), 0.5mg- 4mg increase the mood disorders. twisting and repetitive changes in blood delusions (false
(orally disintegrating), dose at Risperidone has a movements that you can’t pressure (BP), and beliefs about
0.5mg, 1mg, 2mg, intervals of 24 high binding control) incontinence. reality).
3mg, 4mg; orally- hours or affinity for Tremors (uncontrollable Symptoms typically Acute manic or
disintegrating tabs, greater, in serotonergic 5- rhythmic movement in one occur within 4–14 mixed episodes
1mg/Ml (Oral increments of 1 HT2A receptors part of your body) days after initiation of caused by bipolar I
solution) to 2 mg per when compared to Sleepiness and fatigue drug therapy, but can disorder. This drug
Routes: oral tablet, an day, as dopaminergic D2 Dizziness occur at any time may be given alone

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY

orally disintegrating tolerated, to a receptors in the Anxiety during drug use. or with the drugs
tablet, and an oral recommended brain. Blurred vision lithium or
solution dose of 4 to 8 Onset: 1hr. Drug interactions: The  Assess motor function, divalproex. People
Times: taken 1 or 2 mg per day. In Peak: 3 hr. dose of RISPERDAL® and be alert for with bipolar disorder
times per day some patients, should be adjusted when extrapyramidal have intense mood
slower titration used in combination with symptoms. episodes. These may
may be CYP2D6 enzyme inhibitors include mania (an
appropriate. (e.g., fluoxetine, and  Assess BP when overly joyful or
Efficacy has paroxetine) and enzyme patient assumes a excited state),
been inducers (e.g., more upright position depression, or a
demonstrated carbamazepine). (lying to standing, mixture of both.
in a range of 4 Dose adjustment is not sitting to standing, Irritability
mg to 16 mg recommended for lying to sitting). associated with
per day. RISPERDAL® when co- Document orthostatic autism. Autism
Adolescents administered with ranitidine, hypotension and affects how a person
The initial dose cimetidine, amitriptyline, or contact physician acts, interacts with
is 0.5 mg once erythromycin when systolic BP falls others, learns, and
daily, Contraindications: >20 mm Hg or communicates.
administered as RISPERDAL® is diastolic BP falls >10 Symptoms of
a single-daily contraindicated in patients mm Hg. irritability may
dose in the with a known include aggression
morning or hypersensitivity to either  Report any toward others,
evening. The risperidone or paliperidone, troublesome thoughts of self-
dose may be or to any of the excipients in respiratory problems, harm, strong
adjusted at the RISPERDAL® including severe or expressions of
intervals of 24 formulation. prolonged cough, frustration or anger,
hours or Hypersensitivity reactions, nasopharyngeal and mood shifts.
greater, in including anaphylactic irritation, or
increments of reactions and angioedema, difficult/labored
0.5 mg or 1 mg have been reported in breathing.
per day, as patients treated with
tolerated, to a risperidone and in patients  Be alert for signs of
recommended treated with paliperidone. hyperglycemia,
dose of 3 mg Paliperidone is a metabolite including confusion,
per day. of risperidone. drowsiness,
flushed/dry skin, fruit-
Bipolar Mania like breath odor,
Usual Dose
THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY
 Adults rapid/deep breathing,
polyuria, loss of
The initial dose appetite, and unusual
range is 2 mg thirst.
to 3 mg per
day.
Adolescents
The initial dose
is 0.5 mg once
daily,
administered as
a single-daily
dose in the
morning or
evening.
CHLORPROMAZI PO: 30-75 Blockade of Side effects: Drowsiness, Nursing Implications This medication is
NE mg/day divided dopamine 2 dizziness, lightheadedness,  Monitor vital signs used to treat certain
Specific Drug Class: q6-12hr receptors (D2) is dry mouth, blurred vision, including BP for mental/mood
Phenothiazine initially; responsible for tiredness, nausea, hypotension. disorders (such as
antipsychotics maintenance: reducing the constipation, weight gain, or  Apnoea monitoring schizophrenia,
Brand name: usually 200 positive signs of trouble sleeping may occur. whilst on medication. psychotic disorders,
Thorazine mg/day (up to pyschosis & Drug interactions: Some  Observe for signs of manic phase of
Dosage: 10mg, 25mg, 800 mg/day in improving other products that may interact adverse effects. bipolar disorder,
50mg, 100mg, 200mg some patients; behaviors. The with this drug are: drugs that  Patients should remain severe behavioral
(oral), 25mg/ml (IM) some patients combined effect to increase the amount of supine for 30 minutes problems in
Routes: oral tablet, may require 1-2 block D2, histamine dopamine in your body after IM injection, children). It may
and IM g/day) H1 & muscarinic (such as cabergoline, monitor BP also help to decrease
Times: taken 1 or 2 M1 receptors in the levodopa, pergolide, (tachycardia may hallucinations
times per day IV/IM: 25 mg vomiting center is ropinirole), lithium, occur with IM (hearing/seeing
initially, postulated to reduce tretinoin. injection) things that are not
followed PRN nausea & vomiting. there).
with 25-50 mg Onset: 30-60 min Many drugs besides
after 1-4 hours, Duration: 4-6 hr; chlorpromazine may affect
then increased extended release, the heart rhythm (QT
to maximum of 10-12 hr prolongation), such as
400 mg q4-6hr amiodarone, dofetilide,
until patient is pimozide, procainamide,
controlled; quinidine, sotalol, macrolide
THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY
 usual dosage antibiotics (such as
300-800 erythromycin), among
mg/day others.
Contraindications: Coma.
CNS or bone marrow
depression. Reye's
syndrome.

LEVOMEPROMAZ Analgesia, Act as an antagonist Side effects: Dizziness, Nursing Implications Levomepromazine
INE Sedation for a variety of lightheadedness, drowsiness,  Carefully supervise (also known as
Specific Drug Class: Adult: IM 10– receptors in the constipation, dry mouth, ambulation for at least methotrimeprazine)
phenothiazine 20 mg q4–6h central nervous blurred vision, difficulty 6 h, but preferably 12 is used to treat
antipsychotics system (CNS), urinating, and weight gain h. Orthostatic certain mental/mood
Brand name: Levomepromaz including may occur. hypotension with disorders (such as
Nozinan ine Injection adrenergic, Drug Interaction: A faintness, weakness, schizophrenia,
Dosage: may be dopamine, product that may interact and dizziness may bipolar disorder). It
10mg,12.5mg,50mg,7 administered histamine, with this drug is: occur within 10–20 works by helping to
5mg,100mg by cholinergic and levodopa min after drug restore certain
Routes: oral tablet, intramuscular serotonin (5- Many drugs besides administration and natural substances in
and IM injection or hydroxytryptamine; levomepromazine may may last 4–6 h and the brain.
Times: every 6 to 8 intravenous 5-HT) receptors. affect the heart rhythm (QT occasionally as long as
hours injection after Onset: 30 min. prolongation), including 12 h. Tolerance to
dilution with an Duration: 8hr. dronedarone, pimozide, effects usually
equal volume among others. develops with
of normal Contraindications: successive doses.
saline, or by Comatose state, severe CNS  Excessive sedation
continuous depression, and amnesia also
subcutaneous phaeochromocytoma, blood occur commonly
infusion with dyscrasia. during early drug
an appropriate therapy.
volume of  Assess BP and pulse
normal saline. frequently until dosage
requirements and
response are

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY

 stabilized. Monitor
older adult and
debilitated patients
closely.
 Methotrimeprazine
injection contains a
bisulfite, an allergen
for some patients.
 Do not treat severe
hypotension with
epinephrine; it is
specifically
contraindicated.
FLUPHENAZINE Psychosis Blocking Side effects: Drowsiness, Nursing Implications: Fluphenazine is a
DECANOATE Adult: PO 0.5– postsynaptic lethargy, dizziness,  Monitor BP during phenothiazine, also
Specific Drug Class: 10 mg/d in 1–4 dopamine D2 lightheadedness, nausea, early therapy. If called a neuroleptic,
Antipsychotics, 1st divided doses receptors in the loss of appetite, sweating, systolic drop is more used to treat
Generation; (max: of 20 limbic, cortical dry mouth, blurred vision, than 20 mm Hg, symptoms of a
Antipsychotics, mg/d) IM/SC system and basal headache, constipation, and inform physician. certain type of
Phenothiazine HCl 2.5–10 ganglia. pain/redness at the injection  Monitor I&O ratio and mental/mood
Brand name: mg/d divided Onset: < 1 hr site may occur. bowel elimination condition
Prolixin, Permitil, q6–8h (max: 10 Peak: 1/2 hr Drug Interaction: There pattern. Check for (schizophrenia).
Prolixin Decanoate mg/d); may be an interaction abdominal distension
Dosage: 1mg, 2.5mg, Decanoate between fluphenazine and pain. Monitor for
5mg,10mg, 12.5–25 mg decanoate and any of the xerostomia and
2.5mg/5ml, 5mg/ml q1–4wk; following: constipation.
Routes: oral tablet, Enanthate 25 Abiraterone, aclidinium,  Note: Patients on large
and IM mg q2wk alcohol doses who undergo
Times: taken once or amphetamines, surgery and those with
twice daily Dementia antihistamines that cause cerebrovascular,
Behavior drowsiness, cardiac, or renal
Geriatric: PO antiseizure medications, insufficiency are
1–2.5 mg/d, asunaprevir especially prone to
may increase Contraindications: Known hypotensive effects.
every 4–7 d by hypersensitivity to Patient Teaching
1–2.5 mg/d phenothiazines; subcortical  Do not drive or engage
(max: 20 mg/d brain damage, comatose or in potentially
THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY
 in 2–3 divided severely depressed states, hazardous activities
doses) blood dyscrasias, renal or until response to drug
hepatic disease. Safety is known.
during pregnancy (category  Do not alter dosage
C) or lactation is not regimen or stop taking
established. Parenteral form drug abruptly. Do not
not recommended for give drug to any one
children <12 y. else.
 Seek and obtain
physician approval
before taking any
OTC drugs.
HALOPERIDOL Schizophrenia, Haloperidol is a Side effects: Dizziness, Nursing implications Haloperidol is
Specific Drug Class: mania, and tic first-generation lightheadedness, drowsiness,  Be alert for new indicated for a
Antipsychotics, 1st disorders, (typical difficulty urinating, sleep seizures or increased number of
Generation, CYP3A4 Tourette antipsychotic) disturbances, headache, and seizure activity, conditions including
Inhibitor, Moderate. syndrome: which exerts its anxiety may occur. especially at the onset for the treatment of
Brand name: 2-12 years: 25- antipsychotic action Drug interactions: Some of drug treatment. schizophrenia, for
Haldol, Haldol 50 mg/day by blocking products that may interact Document the number, the manifestations of
Decanoate, (Max. dopamine D2 with this drug include: duration, and severity psychotic disorders,
Haloperidol LA, and 10mg/day) and receptors in the anticholinergic medications of seizures, and report for the control of tics
Peridol divided into brain. (for example, these findings and vocal utterances
Dosage: 0.5mg, two or three Onset: within antispasmodics such as immediately to the of Tourette’s
1mg,2mg,5mg,10mg, doses. seconds belladonna alkaloids, physician. Disorder in children
20mg (tablet), 2mg/ml 12-18 years: Duration: 6hr scopolamine), cabergoline, and adults, for
(oral concentration), 0.5-2mg/day ketoconazole, lithium,  Monitor and report treatment of severe
5mg/ml (injectable (Max: methyldopa, drugs for signs of neuroleptic behavior problems in
solution), 60mg/day) in Parkinson's disease (such as malignant syndrome children of
50/100mg/ml divided levodopa and carbidopa, (hyperthermia, combative, explosive
(injectable soln. between 2 selegiline), paroxetine, diaphoresis, hyper excitability
decanoate) doses pergolide, quinupristin- generalized muscle (which cannot be
Routes: oral tablet, Intractable dalfopristin, rifampin, rigidity, altered mental accounted for by
IM and IV hiccup: 12-18 saquinavir. status, tachycardia, immediate
Times: 2-3times oral, years old- 1.5 Contraindications: changes in blood provocation).
4-8 hours (IM) mg TDS Contraindicated in severe pressure [BP],
For oral toxic CNS depression or incontinence).
administration, comatose states from any Symptoms typically

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY

 haloperidol is cause and in individuals occur within 4–14
available in the who are hypersensitive to days after initiation of
form of tablets this drug or have Parkinson drug therapy, but can
and oral disease. Do not use in occur at any time
concentrate. It patients with known during drug use.
is also available hypersensitivity to
as a nasal phenothiazine  Monitor signs of
spray. hypersensitivity
Haloperidol reactions, including
lactate is a pulmonary symptoms
short acting (laryngeal edema,
parenteral wheezing, dyspnea) or
solution for skin reactions (rash,
intramuscular pruritus, urticaria).
and intravenous Notify physician or
administration. nursing staff
Haloperidol immediately if these
decanoate is a reactions occur.
long‐acting
intramuscular  Assess heart rate,
preparation. ECG, and heart
sounds, especially
during exercise (see
Appendixes G, H).
Report a rapid heart
rate (tachycardia) or
signs of other
arrhythmias, including
palpitations, chest
discomfort, shortness
of breath, fainting, and
fatigue/weakness.
BIPERIDEN HCL The usual Blocks cholinergic Side effects: Common side Nursing Implications Akineton is a
Specific Drug Class: beginning dose activity in the CNS, effects include blurred  Assess patient's gait prescription
Antiparkinson agents, is one tablet which is partially vision, dry mouth, and motor function to medicine used to
Anticholinergic three or four responsible for the sleepiness, constipation, and help document treat the symptoms
Brand name: times daily. symptoms of confusion antiparkinson effects, of stiffness, tremors,

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY

Akineton The dosage Parkinson's disease. Drug interactions: The
Dosage: 2mg should be Restores the natural central anticholinergic
Routes: oral individualized balance of syndrome can occur when
Times: one to three with the 2mg neurotransmitters in anticholinergic agents such
times daily dose titrated the CNS. as AKINETON (biperiden)
upward to a are administered
maximum of 8 concomitantly with drugs
tablets (16 mg) that have secondary
per 24 hours. anticholinergic actions, e.g.,
certain narcotic analgesics
such as meperidine, the
phenothiazines and other
antipsychotics, tricyclic
antidepressants, certain
antiarrhythmics such as the
quinidine salts, and
antihistamines.
Contraindications:
Untreated narrow-angle
glaucoma, mechanical
stenoses in the GI tract,
paralytic ileus, megacolon,
prostatic adenoma and
diseases that can lead to
perilous tachycardia.
THAOBUNYUEN, Leya S. BSN 4
especially when spasms, and poor
starting drug therapy, muscle control of
or during dosing Parkinson’s disease.
changes or addition of Akineton may be
other antiparkinson used alone or with
drugs. Motor function other medications.
should be assessed at
different times of the
day, such as when
drugs are reaching
therapeutic levels (i.e.,
1–2 hr after oral dose),
as well as when drug
effects are minimal
(just before the next
dose).
 Assess blood pressure
(BP) periodically and
compare to normal
values (See Appendix
F). Report low BP
(hypotension),
especially if patient
experiences dizziness,
fatigue, or other
symptoms.
 Assess dizziness and
drowsiness that might
affect gait, balance,
and other functional
activities (See
Appendix C). Report
balance problems and
functional limitations
to the physician and
nursing staff, and
DRUG STUDY
 caution the patient and
family/caregivers to
guard against falls and
trauma.

 Monitor confusion,
hallucinations,
depression, and other
psychologic problems.
Repeated or excessive
symptoms may require
change in dose or
medication.

 Instruct patient to
report other
bothersome side
effects, including
severe or prolonged
headache, vision
problems, decreased
sweating, urinary
problems (hesitancy,
retention), or GI
problems (nausea,
constipation, dry
mouth).
CLONAZEPAM Panic Disorder Clonazepam Side effects: Drowsiness, Nursing Implications Clonazepam is used
Specific Drug Class: 0.25 mg PO enhances the dizziness, tiredness, loss of  Monitor addiction- to prevent and
Benzodiazepines q12hr initially; activity of the coordination, or increased prone patients control seizures.
Brand name: may increase to inhibitory saliva production may carefully because of This medication is
Klonopin 1 mg/day after neurotransmitter occur. their predisposition to known as an
Dosage: tablet 3 days (up to 4 Gamma- Drug interaction: Some habituation and drug anticonvulsant or
dispersible: Schedule mg/day in some Aminobutyric acid products that may interact dependence. antiepileptic drug. It
IV patients) (GABA) in the with this drug include: is also used to treat
0.125mg, 0.25mg, central nervous orlistat, sodium oxybate.  · Monitor liver panic attacks
0.5mg, 1mg, 2mg Seizure system to give its Contraindications: function and blood

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY

tablet: Schedule IV Disorders anticonvulsant, Clonazepam should not be counts periodically in
0.5mg, 1mg, 2mg 1.5 mg/day PO skeletal muscle used in patients with a patients on long-term
Routes: oral, IV divided q8hr; relaxant, and history of sensitivity to therapy.
Times: 2-3 times a increase by 0.5- anxiolytic effects. benzodiazepines or clinical
day 1 mg q3Days Onset: 20-60mins or biochemical evidence of  Take drug exactly as
until desired Peak: 1-4hr. significant liver disease. It is prescribed; do not stop
effect achieved; contraindicated in acute taking drug (long-term
not to exceed glaucoma. therapy) without
20 mg/day consulting health care
provider.
Maintenance:
2-8 mg PO; not  Avoid alcohol, sleep-
to exceed 20 inducing, or OTC
mg/day drugs.

 Avoid pregnancy;
serious adverse effects
can occur. Use of
barrier contraceptives
is advised while taking
this drug.

 Drowsiness, dizziness
(may become less
pronounced; avoid
driving or engaging in
other dangerous
activities); GI upset
(take drug with food);
fatigue; dreams;
crying; nervousness;
depression, emotional
changes; bed-wetting,
urinary incontinence.

 Report severe
dizziness, weakness,

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY

 drowsiness that
persists, rash or skin
lesions, difficulty
voiding, palpitations,
swelling in the
extremities.
DIVALPROEX The The drug's Side effects: Diarrhea, Nursing Implications Divalproex sodium
SODIUM recommended anticonvulsant dizziness, drowsiness, hair  Monitor for is a stable
Specific Drug Class: initial dose is activity may be loss, blurred/double vision, therapeutic coordination
Anti-epileptics, 750 mg daily in related to increased change in menstrual periods, effectiveness achieved compound
Anticonvulsants divided doses. brain concentrations ringing in the ears, shakiness with serum levels of comprised of sodium
Brand name: Depakote of gamma- (tremor), unsteadiness, valproic acid at 50– valproate and
Depakote, Depakote tablets are aminobutyric acid weight changes may occur. 100 mcg/mL. valproic acid used to
ER, and Depakote administered (GABA), an Drug interaction: Some  Monitor patient treat manic episodes
Sprinkles orally. inhibitory products that may interact alertness especially associated with
Dosage: tablet, neurotransmitter in with this drug include: with multiple drug bipolar disorder,
delayed-release Mania the CNS, by certain antidepressants (e.g., therapy for seizure epilepsy, and
(Depakote): 125mg, Depakote inhibiting enzymes amitriptyline, nortriptyline, control. Evaluate migraine headaches.
250mg, 500mg initial dose: that catabolize phenelzine), certain plasma levels of the
tablet, extended- 750 mg/day GABA or block the antibiotics (carbapenems adjunctive
release (Depakote orally in reuptake of GABA such as doripenem, anticonvulsants
ER): 250mg, 500mg divided doses into glia and nerve imipenem), irinotecan, periodically as
capsule (Depakote endings. mefloquine, orlistat, other indicators for possible
Sprinkles): 125mg Depakote ER Peak: 1- 5 hr. medications for seizure neurologic toxicity.
Routes: oral initial dose: 25 (e.g., ethosuximide,  Monitor patient
Times: 2 times a day mg/kg orally lamotrigine, phenytoin, carefully during dose
once daily rufinamide adjustments and
Not to exceed promptly report
60 mg/kg/day Contraindications: presence of adverse
 Depakote should not effects. Increased
Epilepsy be administered to dosage is associated
Adult: 10-15 patients with hepatic with frequency of
mg/kg/day disease or significant adverse effects.
orally initially; hepatic dysfunction  Lab tests: Perform
may increase  Depakote is baseline platelet
by 5-10 contraindicated in counts, bleeding time,
mg/kg/week to patients with known and serum ammonia,
achieve optimal
THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY
 clinical hypersensitivity to then repeat at least
response; not to the drug q2mo, especially
exceed 60  Depakote is during the first 6 mo
mg/kg/day contraindicated in of therapy.
patients with known Patient Teaching
Depakote: If urea cycle disorders  Do not discontinue
daily dose  For use in therapy abruptly; such
greater than prophylaxis of action could result in
250 mg, give as migraine headaches: loss of seizure control.
divided dose Depakote is Consult physician
contraindicated in before you stop or
Pediatric: 10- women who are alter dosage regimen.
15 mg/kg/day pregnant and in  Note to diabetic
orally initially; women of patients: Drug may
may increase childbearing cause a false-positive
by 5-10 potential who are not test for urine ketones.
mg/kg/week to using effective Notify physician if
achieve optimal contraception this occurs; a
clinical differential diagnostic
response; not to blood test may be
exceed 60 indicated.
mg/kg/day  Notify physician
promptly if
spontaneous bleeding
or bruising occurs
(e.g., petechiae,
ecchymotic areas,
otorrhagia, epistaxis,
melena).
 Withhold dose and
notify physician for
following symptoms:
visual disturbances,
rash, jaundice, light-
colored stools,
protracted vomiting,
diarrhea. Fatal liver

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY

 failure has occurred in
patients receiving this
drug.
 Avoid alcohol and
self-medication with
other depressants
during therapy.
Lithium Carbonate Administered Lithium acutely Side Effects: Drowsiness, Nursing Implications This medication is
Specific Drug Class: orally stimulates the dizziness, tiredness,  Monitor response to used to treat manic-
Bipolar Disorder NMDA receptor, increased thirst, increased drug. Usual lag of 1–2 depressive disorder
Agents Mania increasing frequency of urination, wk precedes response (bipolar disorder). It
Brand name: Adult: PO glutamate weight gain, and mildly to lithium therapy. works to stabilize
Lithium Carbonate Loading Dose availability in the shaking hands (fine tremor) Keep physician the mood and reduce
Tablets 600 mg t.i.d. or postsynaptic may occur. informed of progress. extremes in behavior
Dosage: tablet, 900 mg neuron. After Drug Interaction: Other  Lab test: Periodic by restoring the
extended release: sustained- chronic medications can affect the lithium levels (draw balance of certain
300mg, 450mg release b.i.d. or administration, removal of lithium from blood sample prior to natural substances
Tablet: 300mg 30 mL (48 lithium induces your body, which may affect next dose or 8–12 h (neurotransmitters)
Capsule: 150mg, mEq) of NMDA how lithium works. after last dose); in the brain
300mg, 600mg solution t.i.d. downregulation, this Examples include ACE periodic thyroid
Solution: 8mEq/5mL PO way lithium inhibitors (such as captopril, function tests.
Routes: oral Maintenance modulates enalapril), ARBs (such as  Monitor older adults
Times: 3-4 times a Dose 300 mg glutamate losartan, valsartan), NSAIDs carefully to prevent
day (adult), 2-3 times t.i.d. or q.i.d. or neurotransmission. (such as celecoxib, toxicity, which may
a day (children) 15–20 mL (24– Peak: ½ to 3 hr. ibuprofen), "water pills" occur at serum levels
32 mEq) (diuretics such as ordinarily tolerated by
solution in 2–4 hydrochlorothiazide, other patients.
divided doses furosemide), other drugs for  Be alert to and report
(max: 2.4 g/d) mental/mood conditions symptoms of
Child: PO 15– (such as chlorpromazine, hypothyroidism
60 mg/kg/d in haloperidol, thiothixene), Patient Teaching
divided doses among others.  Be alert to increased
output of dilute urine
Contraindications: and persistent thirst.
• Patients with significant Dose reduction may
cardiovascular disease be indicated.
• Patients with significant  Contact physician if
THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY
 renal disease diarrhea or fever
• Untreated hypothyroidism develops. Avoid
• Conditions associated with practices that may
hyponatremia, for example: encourage
Addison's disease, dehydration: hot
dehydrated or environment,
severely debilitated patients, excessive caffeine
patients on low sodium diets beverages (diuresis).
• Diuretics should not be  Drink plenty of liquids
used during lithium therapy (2–3 L/d) during
without appropriate dosage stabilization period
adjustment and at least 1–1½ L/d
• Hypersensitivity to lithium during ongoing
or any of the excipients therapy.
contained in the capsule  Avoid self-prescribed
• Breastfeeding low-salt regimen, self-
dosing with antacids
containing sodium,
and high-sodium
foods (e.g., prepared
meats and diet soda).
FLUOXETINE Depression, Blocking the Side Effects: Common side Nursing Implications Fluoxetine is a
Specific Drug Class: Obsessive- reuptake of effects include feeling sick  Use with caution in prescription
Bipolar Disorder Compulsive serotonin into (nausea), headaches and the older adult patient medicine used to
Agents Disorder presynaptic trouble sleeping. or patient with treat major
Brand name: Adult: PO 20 serotonin neurons Drug Interaction: The impaired renal or depressive disorder,
Prozac, Sarafem, mg/d in a.m., by blocking the major fluoxetine-drug hepatic function (may bulimia nervosa (an
Rapiflux, Selfemra may increase reuptake transporter interactions involve the need lower dose). eating disorder),
Dosage: 10mg, 20mg, by 20 mg/d at protein located in amino acids L-dopa and L- obsessive-
60mg,80,90mg weekly the presynaptic tryptophan, anorexiants,  Use with caution in compulsive disorder,
Routes: oral intervals (max: terminal. Fluoxetine anticonvulsants, anorexic patient, since panic disorder, and
Times: one or two 80 mg/d); 20 also has mild antidepressants, anxiolytics, weight loss is a premenstrual
times a day mg/d in a.m.; activity at the calcium channel blockers, possible side effect. dysphoric disorder
when stable 5HT2A and 5HT2C cyproheptadine, lithium (PMDD).
may switch to receptors. salts, and drugs of abuse.  Monitor for S&S of
90 mg Peak: 3-8hr.  Contraindication: anaphylactoid reaction Fluoxetine is
sustained- Hypersensitivity to (see Appendix F). sometimes used

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY

 release capsule fluoxetine or any  Lab tests: Periodic together with
qwk (max: 90 component in its serum electrolytes; another medication
mg/wk) formulation monitor closely called olanzapine
Child: PO > 7 y plasma glucose in (Zyprexa) to treat
10–20 mg/d in  Use of monoamine diabetes. manic depression
a.m. (max: 60 oxidase inhibitors caused by bipolar
mg/d for OCD) (MAOI) used to treat  Monitor serum sodium disorder.
Geriatric: PO psychiatric disorders level for development
Start with 10 (clinicians should of hyponatremia,
mg/d avoid initiating especially in patients
fluoxetine within who are taking
Premenstrual two weeks of diuretics or are
Dysphoric discontinuing the otherwise
Disorder MAOI) hypovolemic.
Adult: PO 10–
20 mg q.d.  Never initiate  Monitor diabetics for
(max: 60 mg/d) fluoxetine in a loss of glycemic
patient receiving control; hypoglycemia
Bulimia linezolid. Do not has occurred during
Nervosa give fluoxetine with initiation of therapy,
Adult: PO 60 pimozide, and hyperglycemia
mg q.d. thioridazine, or during drug
tamoxifen. Use this withdrawal.
agent with caution in  Monitor for S&S of
those with a history improved affect.
of seizures. Requires
approximately 2–3 wk
 Use caution when for therapeutic effects
dosing in the elderly. to be felt.
 Fluoxetine is not
recommended for
use during
pregnancy. Patient Teaching

 Do not drive or engage

in potentially
hazardous activities
until response to drug
THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY
 is known; especially if
dizziness noted.

 Monitor blood glucose

for loss of glycemic
control if diabetic.

 Note: Drug may

increase seizure
activity in those with
history of seizure.

 Do not breast feed

while taking this drug
without consulting
physician.

THAOBUNYUEN, Leya S. BSN 4 DRUG STUDY