UNIVERSITY OF CEBU – BANILAD

COLLEGE OF NURSING

ACTIVITY 4:
DRUG
STUDY

Submitted by:
Vinz Alyssa Mae T. Ono
BSN III – A

Submitted to:
Barlutch T. Centillas MAN, RN, LPT
Clinical Instructor
 UNIVERSITY OF CEBU – BANILAD
COLLEGE OF NURSING

DRUG STUDY
Patient: J. A. M. Age: 38 Hospital No. 2628634 Room No. A4

Impression/Diagnosis: : Paranoid Schizophrenia

Allergy to:

ANTIPSYCHOTIC DRUGS:

Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Avoid tasks that may require
Risperidone Dosage alertness, motor skills until
Ordered: Treatment of schizophrenia (in Agitation, anxiety, Renal function test, LFT should be response to drug is established
adults and children aged 13 and insomnia, headache, performed before therapy begins. (may cause dizziness/drowsiness).
Tablet up), bipolar I acute manic or mixed constipation, dyspepsia, Assess behavior, appearance, • Avoid alcohol.
2 grams episodes as monotherapy (in adults rhinitis, drowsiness, emotional status, response to • Go from lying to standing
Brand Name: and children aged 10 and up), dizziness, nausea, environment, speech pattern, slowly.
Timing: bipolar I acute manic or mixed vomiting, rash, abdominal thought content, baseline weight. • Report trembling in fingers,
Risperdal episodes adjunctive with lithium or pain, dry skin, Obtain fasting serum glucose, altered gait, unusual
Once a day valproate (in adults), and autism- tachycardia, visual CBC. muscular/skeletal movements,
associated irritability (in children disturbances, fever, back (Kizior & Hodgson, 2019) palpitations, severe
 Classification Duration: aged 5 and up).
Name: (McNeil, Gibbons, & Cogburn,
Second-generation 3 days 2021)
(atypical)
antipsychotic; Other Drug Pharmacodynamics:
Benzisoxazole Forms:
derivative Second-generation antipsychotics
Injection, (SGAs) like risperidone exhibit
powder for their therapeutic effects through
reconstitution some D2 blockade, but more from
Oral Solution the blockade of serotonin receptors
like 5HT2A. The improvement of
positive symptoms is thought to be
accomplished through the blockade
of D2 receptors, specifically in the
mesolimbic pathway. The ability
of antipsychotics to block D2
receptors in the prefrontal cortex
and nucleus accumbens is
important in improving certain
psychiatric symptoms. Of note,
risperidone does not cause
anticholinergic effects, which may
benefit patients in certain
populations, including the elderly
with dementia.
(McNeil, Gibbons, & Cogburn,
2021)
pain, pharyngitis, cough, dizziness/fainting, swelling/pain
arthralgia, angina, in breasts, visual changes,
aggressive Planning: rash, difficulty breathing.
behavior, orthostatic (Kizior & Hodgson, 2019)
hypotension, breast The client will:
swelling -Adhere to recommended
(Kizior & Hodgson, 2019) treatment regimen.
-Report a reduction of psychotic
symptoms, including delusions,
paranoia, irrational behavior, and
Adverse Reactions: hallucinations.
-Demonstrate an understanding of
Rare reactions include the drug’s actions by accurately
tardive dyskinesia describing drug side effects and
(characterized by tongue precautions.
protrusion, puffing of the
cheeks, chewing, or Implementation:
puckering of mouth),
neuroleptic malignant Monitor B/P, heart rate, weight,
syndrome (hyperpyrexia, LFT, EKG. Monitor for fine
muscle rigidity, altered tongue movement (may be first
mental status, irregular sign of tardive dyskinesia, which
pulse or B/P, tachycardia, may be irreversible). Monitor for
diaphoresis, cardiac suicidal ideation. Assess for
arrhythmias, therapeutic response (greater
rhabdomyolysis, acute interest in surroundings, improved
renal failure). self-care, increased ability to
Hyperglycemia, life- concentrate, relaxed facial
threatening events such as expression). Monitor for potential
ketoacidosis and neuroleptic malignant syndrome:
hyperosmolar coma, death fever, muscle rigidity, irregular
have been reported. B/P or pulse, altered mental status.
(Kizior & Hodgson, 2019) Monitor fasting serum glucose
periodically during therapy.
Contraindications: (Kizior & Hodgson, 2019)
Hypersensitivity to
risperidone. Cautions may Evaluation:
include: Renal/hepatic
impairment, seizure Advise patient to take medication
 disorder, cardiac disease, as directed. Take missed doses as
recent MI, breast cancer soon as remembered; with
or other prolactin remaining doses evenly spaced
dependent tumors, throughout the day. Monitor
suicidal pts, pts at risk for temperature. If fever occurs, rule
aspiration pneumonia. out underlying infection, and
Parkinson’s disease, pts at consult physician for appropriate
risk for orthostatic comfort measures.
hypotension, elderly pts, (Kizior & Hodgson, 2019)
diabetes, decreased GI
motility, urinary retention,
BPH, xerostomia, visual
problems, pts exposed to
temperature extremes,
preexisting
myelosuppression, narrow
angle glaucoma, pts with
high risk of suicide.
(Kizior & Hodgson, 2019)

Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Avoid exposure to extreme heat.
Dosage • Drink fluids often, esp. during
Quetiapine Ordered: Treatment of schizophrenia. Headache, drowsiness, Assess behavior, appearance, physical activity.
Treatment of acute manic episodes dizziness, constipation, emotional status, response to • Take medication as ordered; do
Tablet associated with bipolar disorder orthostatic hypotension, environment, speech pattern, not stop taking or increase
Brand Name: 25mg (alone or in combination with tachycardia, dry mouth, thought content. Obtain baseline dosage.
lithium or valproate). dyspepsia, rash, asthenia, CBC, hepatic enzyme levels before • Drowsiness generally subsides
 Seroquel Timing: Maintenance treatment of bipolar
disorder as an adjunct to lithium or
Once a day valproic acid. Treatment of acute
Classification depressive episodes associated
Name: Duration: with bipolar disorder. Adjunctive
Second-generation treatment to antidepressants in
(atypical) 8-12 hours major depressive disorder (MDD).
antipsychotic; (Kizior & Hodgson, 2019)
Dibenzapine Other Drug
derivative Forms: Pharmacodynamics:
Extended- Quetiapine has a strong affinity for
Release the 5-HT2 receptor. Although
quetiapine has a multitude of
complex mechanisms; it mediates
its pharmacological effect mainly
via its 5HT2 antagonistic action. It
also acts on dopaminergic D1 and
D2 receptors. Quetiapine is an
antagonist for D2 receptors and 5-
HT2 receptors.[10] It is also
suggested that the anxiolytic and
antidepressant properties of both
quetiapine and its active metabolite
norquetiapine are due to the
norepinephrine transporter (NET)
inhibitory potential and partial
agonist activity at 5 HT1A
receptor, respectively.[11]
Blocking of the D2 receptor in
mesocortical and mesolimbic
pathways is indicated in the
treatment of schizophrenia for
negative and positive symptoms,
respectively. Increased dopamine
in these pathways has shown to be
associated with schizophrenia.
(Maan, et al., 2020)
abdominal pain, rhinitis,
back pain, fever, and
weight gain.
(Kizior & Hodgson, 2019)
Adverse Reactions:
Overdose may produce
heart block, hypotension,
hypokalemia, tachycardia.
(Kizior & Hodgson, 2019)
Contraindications:
Hypersensitivity to
Quetiapine. Cautions may
include renal/hepatic
impairment, preexisting
abnormal lipid profile, pts
at risk for aspiration
pneumonia,
cardiovascular disease
(e.g., HF, history of MI),
cerebrovascular disease,
dehydration,
hypovolemia, history of
drug abuse/dependence,
seizure disorder,
hypothyroidism, pts at
risk for suicide,
Parkinson’s disease,
decreased GI motility,
urinary retention, narrow-
angle glaucoma, diabetes,
visual problems, elderly,
pts at risk for orthostatic
hypotension. Avoid use in
pts at risk for torsade de
pointes (hypokalemia,
initiating treatment and during continued therapy.
periodically thereafter. Question • Avoid tasks that require
medical history as listed in alertness, motor skills until
Precautions. response to drug is
established.
Planning: • Avoid alcohol.
• Slowly go from lying to
After 8 hours of nursing standing.
interventions, the patient will have • Report suicidal ideation, unusual
a decrease in excited, manic, changes in behavior.
paranoiac, or withdrawn behavior. (Kizior & Hodgson, 2019)
Implementation:
Monitor mental status, onset of
extrapyramidal symptoms. Assist
with ambulation if dizziness
occurs. Supervise suicidal risk pt.
closely during early therapy (as
psychosis, depression lessens,
energy level improves, increasing
suicide potential). Monitor B/P for
hypotension, lipid profile, blood
glucose, CBC, or worsening
depression, unusual behavior.
Assess pulse for tachycardia (esp.
with rapid increase in dosage).
Monitor daily pattern of bowel
activity, stool consistency. Assess
for therapeutic response (improved
thought content, increased ability
to concentrate, improvement in
self-care). Eye exam to detect
cataract formation should be
obtained q6mos during treatment.
(Kizior & Hodgson, 2019)
 hypomagnesemia, history Evaluation:
of cardiac arrhythmias,
congenital long QT Decrease in excited, manic,
syndrome, concurrent paranoiac, or withdrawn behavior.
medications that prolong Make sure patient has swallowed
QT interval). medication and is not “checking”
(Kizior & Hodgson, 2019) or holding meds.

Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Avoid dehydration, particularly
Dosage during exercise, exposure to
Ordered: Management of manifestations of Drowsiness, agitation, Obtain baseline LFT, serum extreme heat,
Brand Name: schizophrenia. Treatment of acute insomnia, headache, glucose, weight, lipid profile concurrent use of medication
Tablet mania associated with bipolar nervousness, hostility, before initiating treatment. Assess causing dry mouth, other drying
Zyprexa 5mg disorder as monotherapy or in dizziness, rhinitis, behavior, appearance, emotional effects.
combination with lithium or anxiety, constipation, status, response to environment, • Sugarless gum, sips of water
Classification Timing: valproate. In combination with nonaggressive atypical speech pattern, thought content. may relieve dry mouth.
Name: Fluoxetine: treatment of depressive behavior, dry mouth, • Report suspected pregnancy.
Second-generation Twice a day episodes associated with bipolar I weight gain, orthostatic Planning: • Take medication as prescribed;
(atypical) disorder and treatment of hypotension, fever, do not stop taking or increase
antipsychotic Duration: treatment-resistant bipolar arthralgia, restlessness, After 8 hours of nursing dosage.
depression. IM: Zyprexa cough, pharyngitis, visual intervention, the patient will have • Slowly go from lying to
1 week Intramuscular: Controls acute changes (dim vision), an improvement in self-care, standing.
agitation in schizophrenia and tachycardia; back, chest, increased ability to concentrate, • Avoid alcohol.
Other Drug bipolar mania. Relprevv: Long- abdominal, or extremity and relaxed facial expressions. • Avoid tasks that require
Forms: acting antipsychotic for IM pain; tremor. alertness, motor skills until
injection for treatment of (Kizior & Hodgson, 2019) Implementation: response to drug is
Injection, schizophrenia. OFF-LABEL: established.
Powder for Prevention of chemotherapy- Adverse Reactions: Monitor B/P, serum glucose, • Monitor diet, exercise program
reconstitution induced nausea/vomiting. Acute
treatment.
(Kizior & Hodgson, 2019)
Pharmacodynamics:
Antagonizes alpha1-adrenergic,
Dopamine, histamine, muscarinic,
serotonin receptors. Produces
anticholinergic, histaminic, CNS
depressant effects.
Therapeutic Effect: Diminishes
psychotic symptoms.
(Kizior & Hodgson, 2019)
lipids, LFT. Assess for tremors, to prevent weight gain.
Rare reactions include changes in gait, abnormal muscular (Kizior & Hodgson, 2019)
seizures, neuroleptic movements, behavior. Supervise
malignant syndrome, a suicidal risk pt. closely during
potentially fatal syndrome early therapy (as depression
characterized by lessens, energy level improves,
hyperpyrexia, muscle increasing suicide potential).
rigidity, irregular pulse or (Kizior & Hodgson, 2019)
B/P, tachycardia,
diaphoresis, cardiac Evaluation:
arrhythmias.
Extrapyramidal symptoms Assess for therapeutic response
(EPS), dysphagia may (interest in surroundings,
occur. Overdose (300 mg) improvement in self-care,
produces drowsiness, increased ability to concentrate,
slurred speech. relaxed facial expression). Assist
(Kizior & Hodgson, 2019) with ambulation if dizziness
occurs. Assess sleep pattern.
Contraindications: Notify physician if extrapyramidal
symptoms (EPS) occur.
Hypersensitivity to
Olanzapine. Cautions:
Disorders in which CNS
depression is prominent;
cardiac disease,
hemodynamic instability,
prior MI, ischemic heart
disease; hyperlipidemia,
pts at risk for aspiration
pneumonia, decreased GI
motility, urinary retention,
BPH, narrow-angle
glaucoma, diabetes,
elderly, pts at risk for
suicide, Parkinson’s
disease, severe
renal/hepatic impairment,
predisposition to seizures.
(Kizior & Hodgson, 2019)
 Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Avoid tasks that require alertness,
Dosage motor skills until response to drug
Ziprasidone Ordered: Treatment of schizophrenia, acute Headache, drowsiness, Assess pt.’s behavior, appearance, is established.
agitation in pts with schizophrenia. dizziness, rash, orthostatic emotional status, response to • Avoid alcohol.
Brand Name: Capsule Treatment of acute mania or mixed hypotension, weight gain, environment, speech pattern, • Report chest pain, shortness of
40mg episodes associated with bipolar restlessness, constipation, thought content. EKG should be breathing, irregular heartbeats,
Geodone Timing: disorder with or without psychosis. dyspepsia, and obtained to assess for QT fainting,
Maintenance treatment of bipolar hyperglycemia, priapism. prolongation before instituting palpitations.
Classification Once a day disorder as adjunct to lithium or medication. Blood chemistry for
Name: valproic acid. Major depressive Adverse Reactions: serum magnesium, potassium
Second-generation Duration: disorder (adjunct to should be obtained before
(atypical) antidepressants). Prolongation of QT beginning therapy and
antipsychotic; Not specified (Kizior & Hodgson, 2019) interval (as seen on EKG) routinely thereafter.
Antipsychotic may produce torsades de (Kizior & Hodgson, 2019)
Other Drug Pharmacodynamics: pointes, a form of
Forms: ventricular tachycardia. Planning:
Exact mechanism unknown. Pts with bradycardia,
Injection Antagonizes alpha-adrenergic, hypokalemia, The client will:
Powder for Dopamine, histamine, serotonin hypomagnesemia is at -Adhere to recommended
reconstitution receptors; inhibits reuptake of increased risk. treatment regimen.
serotonin, norepinephrine. -Report a reduction of psychotic
Therapeutic Effect: Diminishes Contraindications: symptoms, including delusions,
symptoms of schizophrenia, paranoia, irrational behavior, and
depression. Hypersensitivity to hallucinations.
(Kizior & Hodgson, 2019) ziprasidone. Conditions -Demonstrate an understanding of
associated with risk of the drug’s actions by accurately
prolonged QT interval, describing drug side effects and
congenital long QT precautions.
syndrome, concurrent use
of other QT-prolongation
medications (e.g.,
amiodarone,
moxifloxacin, tacrolimus,
thioridazine).
Uncompensated HF.
Recent MI. Cautions: Pts
with bradycardia,
hypokalemia,
hypomagnesemia may be
at greater risk for torsades
de pointes. History of MI
or unstable heart disease,
seizures, cardiac
arrhythmias, disorders
in which CNS depression
is a feature, pts at risk for
aspiration pneumonia,
hypotension, suicide;
elderly, diabetes, hepatic
impairment, Parkinson’s
disease, pts with breast
cancer or other prolactin-
dependent tumors.
Implementation:
Assess for therapeutic response
(greater interest in surroundings,
improved selfcare, increased
ability to concentrate, relaxed
facial expression). Monitor weight.
(Kizior & Hodgson, 2019)
Evaluation:
Immediate documentation after
medication administration.
Monitor patient closely for
anaphylaxis. Assess cardiac
rhythm in patients with
hypokalemia or hypomagnesemia.
Immediately report evidence of
neuroleptic malignant syndrome, a
rare but potentially fatal adverse
reaction including hyperpyrexia,
muscle rigidity, altered mental
status, irregular pulse, blood
pressure changes, tachycardia,
diaphoresis, arrhythmia,
myoglobinuria. Monitor patient
closely for suicidal tendencies.
(Donnelly, S., 2011)
 Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Do not abruptly discontinue long-
Dosage term drug therapy.
Clozapine Ordered: Management of severely ill Drowsiness, salivation, Obtain baseline weight, glucose, • Avoid tasks that require
schizophrenic pts who have failed tachycardia, dizziness, Hgb A1c, WBC, absolute alertness, motor skills until
Tablet to respond to other antipsychotic Constipation, neutrophil count (ANC) before response to drug is
Brand Name: 100mg therapy. Treatment of recurrent hypotension, headache, initiating treatment. Assess established.
suicidal behavior in schizophrenia tremor, syncope, behavior, appearance, emotional • Drowsiness generally subsides
Clozaril Timing: or schizoaffective disorder. diaphoresis, dry mouth, status, response to environment, during continued therapy.
Schizoaffective disorder, bipolar nausea, visual speech pattern, thought content. • Avoid alcohol, caffeine.
Once a day disorder, childhood psychosis, disturbances, nightmares, • Report fever, sore throat, flu-
Classification obsessive-compulsive disorder, restlessness, Planning: like symptoms.
Name: Duration: agitation related to Alzheimer’s akinesia, agitation, (Kizior & Hodgson, 2019)
Second-generation dementia. hypertension, abdominal The patient will have an interest in
(atypical) Not specified (Kizior & Hodgson, 2019) discomfort, heartburn, the surroundings, improvement of
antipsychotic; weight gain, rigidity, oneself in terms of self-care, and
Antipsychotic Other Drug Pharmacodynamics: confusion, fatigue, ability o concentrate.
Forms: insomnia, diarrhea, rash.
Interferes with binding of (Kizior & Hodgson, 2019) Implementation:
Suspension, Dopamine and serotonin receptor
Oral sites. Therapeutic Effect: Adverse Reactions: Monitor B/P for
Disintegrating Diminishes schizophrenic hypertension/hypotension. Assess
behavior. Seizures occur pulse for tachycardia (common
(Kizior & Hodgson, 2019) occasionally (3% of pts). side effect). Monitor CBC for
Overdose produces CNS blood dyscrasias. Monitor ANC,
depression (sedation, WBC count every week for first 6
delirium, coma), months, then biweekly for 6 mos.
respiratory depression, If CBC and ANC are
hypersalivation. Blood normal after 12 months, then
dyscrasias, particularly monthly monitoring of CBC and
agranulocytosis, mild ANC is recommended. Supervise
leukopenia, may occur. suicidal risk pt. closely during
 (Kizior & Hodgson, 2019) early therapy (as depression
lessens, energy level improves,
Contraindications: increasing suicide potential).
(Kizior & Hodgson, 2019)
Hypersensitivity to
clozapine. History of Evaluation:
clozapine induced
agranulocytosis or severe Assess for therapeutic response
granulocytopenia. (interest in surroundings,
Cautions: History of improvement in self-care,
seizures, cardiovascular increased ability to concentrate,
disease, myocarditis, relaxed facial expression). Follow
respiratory/hepatic/renal guidelines for discontinuation or
impairment, alcohol reinstitution of the drug. Educate
withdrawal, high risk of patient on seriousness of potential
suicide, paralytic ileus, agranulocytosis.
myasthenia gravis, pts at (Kizior & Hodgson, 2019)
risk for aspiration
pneumonia, urinary
retention, narrow-angle
glaucoma, prostatic
hypertrophy, xerostomia,
visual disturbances,
constipation, history of
bowel obstruction,
diabetes mellitus. History
of long QT
prolongation/ventricular
arrhythmias; concomitant
use of medications that
prolong QT interval;
hypokalemia,
hypomagnesemia.
(Kizior & Hodgson, 2019)

Patient: L.K.N Age: 24 Hospital No. 12345678 Room No. B6

 Impression/Diagnosis: : Major Depressive Disorder

Allergy to:

ANTIDPRESSANTS

Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Do not stop taking medication or
Dosage increase dosage.
Citalopram Ordered: Treatment of depression. OFF- Nausea, dry mouth, Hepatic/renal function tests, blood • Avoid alcohol.
LABEL: Treatment of alcohol drowsiness, insomnia, counts should be performed • Avoid tasks that require
Brand Name: Tablet abuse, diabetic neuropathy, diaphoresis, tremor, periodically for alertness, motor skills until
20 mg obsessive-compulsive disorder, diarrhea, abnormal pts on long-term therapy. Observe, response to drug is
Celexa smoking cessation, GAD, panic ejaculation, dyspepsia, record behavior. Assess established.
Timing: disorder. fatigue, anxiety, vomiting, psychological status, • Report worsening depression,
Classification anorexia, sinusitis, sexual thought content, sleep pattern, suicidal ideation, unusual changes
Name: Once a day Pharmacodynamics: dysfunction, menstrual appearance, interest in in behavior.
disorder, abdominal pain, environment. Screen for (Kizior & Hodgson, 2019)
Serotonin Reuptake Duration: Inhibits CNS neuron uptake of agitation, decreased bipolar disorder.
inhibitor; serotonin but not of libido. (Kizior & Hodgson, 2019)
Antidepressant 1 week norepinephrine; weak inhibitor of (Kizior & Hodgson, 2019)
CYP450 enzyme system, thus Planning:
Other Drug making it more appealing than Adverse Reactions:
Forms: other products. -Report mood elevation (may use
Overdose manifested as short objective tool, such as the
Oral Solution dizziness, drowsiness, Beck Depression Tool).
tachycardia, confusion, -Remain safe from self-harm or
seizures, torsade’s de harm directed toward others.
pointes, ventricular -Actively engage in self-care
tachycardia, sudden death. activities.
Serotonin syndrome -Report ability to fall asleep and
or neuroleptic malignant stay asleep as was able to do
syndrome (NMS)–like before depression.
reactions have been -Demonstrate an understanding of
reported. the drug’s action by accurately
(Kizior & Hodgson, 2019) describing drug side effects and
precautions.
Contraindications:
Implementation:
Hypersensitivity to
citalopram, use of MAOIs -Arrange for lower dose in elderly
intended to treat patients and in those with renal or
psychiatric disorders hepatic impairment because of the
(concurrently or within 14 potential for severe adverse effects.
days of discontinuing -Limit drug access if patient is
either citalopram or suicidal to decrease the risk of
MAOI), initiation in pts overdose to cause harm.
receiving linezolid or -Monitor patient for 4 weeks to
methylene blue. ascertain onset of full therapeutic
Concurrent use with effect.
pimozide. Cautions: -Establish suicide precautions for
Elderly, hepatic/renal severely depressed patients to
impairment, seizure decrease the risk of overdose to
disorder. Not cause harm.
recommended in pts with -Administer drug once a day in the
congenital long QT morning to achieve optimal
syndrome, bradycardia, therapeutic effects.
recent MI, -Suggest that the patient use barrier
uncompensated HF, contraceptives to prevent
hypokalemia, or pregnancy while taking this drug
hypomagnesemia, pts at because serious fetal abnormalities
high risk of suicide. can occur.
(Kizior & Hodgson, 2019) -Provide comfort measures (e.g.
taking food with the drug) to help
patient tolerate drug effects.
-Provide safety measures (e.g.
adequate lighting, raised side rails,
etc.) to prevent injuries.
-Educate client on drug therapy to
promote compliance.
(Tabangcora, I.D., 2021)

Evaluation:

-Monitor patient response to

therapy (e.g., alleviation of signs
and symptoms of depression).
-Monitor for adverse effects (e.g.,
sedation, dizziness, respiratory
dysfunctions, GU problems, etc.).
-Evaluate patient understanding on
drug therapy by asking patient to
name the drug, its indication, and
adverse effects to watch for.
-Monitor patient compliance to
drug therapy.
(Tabangcora, I.D., 2021)
 Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Maximum therapeutic response
Dosage may require 4 or more weeks of
Fluoxetine Ordered: Treatment of major depressive Headache, asthenia, Assess appearance, behavior, therapy.
disorder (MDD), obsessive insomnia, anxiety, mood, suicidal tendencies. For pts • Do not abruptly discontinue
Brand Name: Oral Solution compulsive disorder drowsiness, nausea, on long-term therapy, baseline medication.
20mg/5mL (OCD), binge-eating and vomiting diarrhea, decreased renal function, LFT, blood counts • Avoid tasks that require
Prozac in moderate to severe bulimia appetite, dizziness, should be performed at baseline alertness, motor skills until
Timing: nervosa, premenstrual dysphoric tremor, fatigue, vomiting, and periodically thereafter. response to drug is
Classification disorder (PMDD), panic disorder constipation, dry mouth, (Kizior & Hodgson, 2019) established.
Name: Once a day with or without agoraphobia. abdominal pain, • Avoid alcohol.
Treatment of resistant or bipolar 1 nasal congestion, Planning: • To avoid insomnia, take last
Serotonin Reuptake Duration: depression (with Olanzapine). diaphoresis, rash, flushed dose of drug before 4 PM.
inhibitor; OFF-LABEL: Treatment of skin, lightheadedness, and -Report mood elevation (may use (Kizior & Hodgson, 2019)
Antidepressant, anti- 2 weeks fibromyalgia, post-traumatic stress impaired concentration. short objective tool, such as the
obsessional agent, disorder (Kizior & Hodgson, 2019) Beck Depression Tool).
antibulimic Other Drug (PTSD), Raynaud’s phenomena, -Remain safe from self-harm or
Forms: social anxiety disorder, selective harm directed toward others.
mutism. Adverse Reactions: -Actively engage in self-care
Capsules, (Kizior & Hodgson, 2019) activities.
Tablets May increase risk of -Report ability to fall asleep and
Pharmacodynamics: suicide. Agitation, coma, stay asleep as was able to do
diarrhea, delirium, before depression.
Selectively inhibits serotonin hallucinations, -Demonstrate an understanding of
uptake in CNS, enhancing hyperreflexia, the drug’s action by accurately
serotonergic function. hyperthermia, describing drug side effects and
Therapeutic Effect: Relieves tachycardia, seizures may precautions.
depression; reduces obsessive- indicate life-threatening
compulsive, bulimic behavior. serotonin syndrome. Implementation:
(Kizior & Hodgson, 2019) (Kizior & Hodgson, 2019)

Contraindications:
Hypersensitivity to
Fluoxetine. Use of
MAOIs within 5
weeks of discontinuing
Fluoxetine or within 14
days of discontinuing
MAOIs. Initiation in pts
receiving linezolid or
methylene blue. Use with
pimozide or thioridazine.
Note: Do not initiate
thioridazine until 5 weeks
after discontinuing
fluoxetine. Cautions:
Seizure disorder, cardiac
dysfunction (e.g., history
of MI), diabetes, pts with
risk factors for QT
prolongation, concurrent
use of medication that
increases QT interval,
renal/hepatic impairment,
pts at high risk for
suicide, in pts. where
weight loss is undesirable,
elderly. Pts at risk of
acute narrow angle
glaucoma or with
increased intraocular
pressure.
(Kizior & Hodgson, 2019)
Supervise suicidal risk pt. closely
during early therapy (as depression
lessens, energy level improves,
increasing suicide potential).
Monitor mental status, anxiety,
social functioning, appetite,
nutritional intake. Monitor daily
pattern of bowel activity, stool
consistency. Assess skin for rash.
Monitor serum LFT, glucose,
sodium, weight.
(Kizior & Hodgson, 2019)
Evaluation:
-Monitor patient response to
therapy (e.g., alleviation of signs
and symptoms of depression).
-Monitor for adverse effects (e.g.,
sedation, dizziness, respiratory
dysfunctions, GU problems, etc.).
-Evaluate patient understanding on
drug therapy by asking patient to
name the drug, its indication, and
adverse effects to watch for.
-Monitor patient compliance to
drug therapy.
(Tabangcora, I.D., 2021)
 Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: May cause dry mouth,
Dosage constipation, blurred vision.
Clomipramine Ordered: Treatment of obsessive- Ejaculatory failure, dry -Assess for the mentioned cautions Avoid tasks that require alertness,
compulsive disorder, and mouth, somnolence, and contraindications (e.g., drug motor skills until response to drug
Brand Name: Capsule depression, panic tremors, dizziness, allergies, hepatorenal diseases, is established.
50mg attacks. headache, constipation, psychosis, glaucoma, etc.) to • Tolerance to postural
Anafranil (Kizior & Hodgson, 2019) fatigue, nausea. prevent any untoward hypotension, sedative,
Timing: Occasional (14%–5%): complications. anticholinergic effects usually
Classification Pharmacodynamics: Impotence, diaphoresis, -Assess for history of seizure develop during early therapy.
Name: Once a day dyspepsia, sexual disorders, psychiatric problems, • Maximum therapeutic effect
Blocks reuptake of dysfunction, suicidal thoughts and myelography may be noted in 2–4 wks.
Tricyclic; Duration: neurotransmitters (norepinephrine, dysmenorrhea, within the past 24 hours or in the • Do not abruptly discontinue
Antidepressant serotonin) at CNS presynaptic nervousness, weight gain, next 48 hours to avoid potentially medication.
5 days membranes, increasing availability pharyngitis. Rare (less serious adverse reactions.
at postsynaptic receptor sites. than 5%): Diarrhea, -Perform a thorough physical
Other Drug Therapeutic Effect: Reduces myalgia, rhinitis, assessment to establish baseline
Forms: obsessive-compulsive behavior. increased appetite, data before drug therapy begins, to
(Kizior & Hodgson, 2019) paresthesia, memory determine the effectiveness of
None impairment, anxiety, rash, therapy, and to evaluate for the
pruritus, anorexia, occurrence of any adverse effects
abdominal pain, vomiting, associated with drug therapy.
flatulence, flushing, UTI, -Monitor results of
back pain. electrocardiogram and laboratory
(Kizior & Hodgson, 2019) tests (e.g., renal and liver function
tests) to monitor the effectiveness
of the therapy and provide prompt
treatment to developing
Adverse Reactions: complications.
(Tabangcora, I.D., 2021)
Overdose may produce
seizures, cardiovascular Planning:
effects (severe orthostatic
hypotension, dizziness,
tachycardia, palpitations,
arrhythmias), altered
temperature regulation
(hyperpyrexia,
hypothermia). Abrupt
discontinuation
after prolonged therapy
may produce headache,
malaise, nausea,
vomiting, vivid dreams.
Anemia, agranulocytosis
has been noted.
(Kizior & Hodgson, 2019)
Contraindications:
Hypersensitivity to
Clomipramine, other
tricyclic agents. Acute
recovery period after MI,
use of MAOIs intended
for psychiatric disorders
(concurrently or within 14
days of discontinuing
either clomipramine or
MAOI). Initiation in pts
receiving linezolid or
methylene blue. Cautions:
Pts at high risk for
suicide, prostatic
hypertrophy, history of
urinary
retention/obstruction,
narrow-angle glaucoma,
seizures,
cardiovascular/hepatic/ren
al disease,
hyperthyroidism,
-Report mood elevation (may use
short objective tool, such as the
Beck Depression Tool).
-Remain safe from self-harm or
harm directed toward others.
-Actively engage in self-care
activities.
-Report ability to fall asleep and
stay asleep as was able to do
before depression.
-Demonstrate an understanding of
the drug’s action by accurately
describing drug side effects and
precautions.
Implementation:
Supervise suicidal risk pt. closely
during early therapy (as depression
lessens, energy level improves,
increasing suicide potential).
Assess appearance, behavior,
speech pattern, level of interest,
mood.
(Kizior & Hodgson, 2019)
Evaluation:
-Monitor patient response to
therapy (e.g., alleviation of signs
and symptoms of depression).
-Monitor for adverse effects (e.g.,
hypotension, suicidal thoughts,
cardiac arrhythmias, etc.).
-Evaluate patient understanding on
drug therapy by asking the patient
to name the drug, its indication,
and adverse effects to watch for.
-Monitor patient compliance to
 alcoholism, xerostomia, drug therapy.
visual problems, elderly, (Tabangcora, I.D., 2021)
constipation, history of
bowel obstruction.
Tumors of the adrenal
medulla (e.g.,
pheochromocytoma).
(Kizior & Hodgson, 2019)

Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Do not discontinue abruptly.
Dosage • Change positions slowly to
Doxepin Ordered: Treatment of depression and/or Orthostatic hypotension, Assess B/P, pulse, EKG (those avoid dizziness.
anxiety. Silenor (only): Treatment drowsiness, dry mouth, with history of cardiovascular • Avoid tasks that require
Brand Name: Capsule of insomnia in pts. with difficulty headache, increased disease). Perform alertness, motor skills until
25mg staying asleep. Topical: Treatment appetite, weight gain, CBC, serum electrolyte tests response to drug is established.
Sinequan of pruritus associated with atopic nausea, unusual fatigue, before long-term therapy. Assess • Do not cover affected area with
Timing: dermatitis. OFF-LABEL: unpleasant taste. pt.’s appearance, occlusive dressing after applying
Classification Treatment of neurogenic pain, Topical: Edema, behavior, level of interest, mood, cream.
Name: Once a day treatment of anxiety. increased pruritus, suicidal ideation, sleep pattern. • May cause dry mouth.
(Kizior & Hodgson, 2019) eczema, burning, tingling, (Kizior & Hodgson, 2019) • Avoid alcohol, limit caffeine.
Tricyclic; Duration: stinging at application • May increase appetite.
Antidepressant, site, altered taste, • Avoid exposure to
antianxiety, 1 week dizziness, drowsiness, dry sunlight/artificial light source.
antineuralgic, Pharmacodynamics: skin, dry mouth, fatigue, Planning: • Therapeutic effect may be noted
antipruritic Other Drug headache, thirst. within 2–5 days, maximum effect
Forms: work by increasing the Occasional: PO: Blurred -Report mood elevation (may use within 2–3 wks.
concentration of the vision, confusion, short objective tool, such as the • Report worsening depression,
Tablets, Oral neurotransmitter’s serotonin (5- constipation, Beck Depression Tool). suicidal ideation, unusual changes
Concentrate, HT) and norepinephrine (NE) in
Cream the brain. This action prolongs the
availability of the
neurotransmitters (5-HT and NE)
within the synaptic cleft and
enhances their neurotransmission
by preventing their reuptake back
into the presynaptic terminal.
Doxepin also displays antagonistic
properties in the central nervous
system by blocking the following
receptors: histamine (H1), alpha-1
adrenergic, and muscarinic. It also
inhibits sodium and potassium
channels in cardiomyocytes.
(Almasi & Meza, 2020)
hallucinations, difficult -Remain safe from self-harm or in behavior (esp. at initiation of
urination, eye pain, harm directed toward others. therapy or with changes in
irregular heartbeat, fine -Actively engage in self-care dosage).
muscle tremors, activities. (Kizior & Hodgson, 2019)
nervousness, impaired -Report ability to fall asleep and
sexual function, diarrhea, stay asleep as was able to do
diaphoresis, heartburn, before depression.
insomnia. Silenor: -Demonstrate an understanding of
Nausea, upper respiratory the drug’s action by accurately
infection. Topical: describing drug side effects and
Anxiety, skin precautions.
irritation/cracking,
nausea. Rare: PO: Implementation:
Allergic reaction,
alopecia, tinnitus, Monitor B/P, pulse, weight.
breast enlargement. Perform CBC, serum electrolyte
Topical: Fever, tests periodically to assess
photosensitivity. renal/hepatic function. Monitor
(Kizior & Hodgson, 2019) mental status, suicidal ideation.
Supervise suicidal risk pt. closely
Adverse Reactions: during early therapy (as depression
lessens, energy level improves,
Abrupt or too-rapid increasing suicide potential).
withdrawal may result in Assess appearance, behavior,
headache, malaise, speech pattern, level of interest,
nausea, vomiting, vivid mood. Therapeutic serum level:
dreams. Overdose may 110–250 ng/mL; toxic serum level:
produce confusion, severe greater than 300 ng/mL.
drowsiness, agitation, (Kizior & Hodgson, 2019)
tachycardia, arrhythmias,
shortness of breath, Evaluation:
vomiting.
(Kizior & Hodgson, 2019) -Monitor patient response to
therapy (e.g., alleviation of signs
Contraindications: and symptoms of depression).
-Monitor for adverse effects (e.g.,
Hypersensitivity to hypotension, suicidal thoughts,
doxepin. Glaucoma, cardiac arrhythmias, etc.).
hypersensitivity to -Evaluate patient understanding on
other tricyclic drug therapy by asking the patient
 antidepressants, urinary to name the drug, its indication,
retention, use of MAOIs and adverse effects to watch for.
within 14 days. Cautions: -Monitor patient compliance to
Cardiac/hepatic/renal drug therapy.
disease, pts at risk for (Tabangcora, I.D., 2021)
suicidal ideation,
respiratory compromise,
sleep apnea, history of
bowel obstruction,
increased IOP, glaucoma,
history of seizures, history
of urinary
retention/obstruction,
hyperthyroidism, prostatic
hypertrophy, hiatal hernia,
elderly.
(Kizior & Hodgson, 2019)

Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: • Slowly go from lying to
Dosage standing to avoid hypotensive
Nortriptyline Ordered: Treatment of symptoms of Drowsiness, fatigue, dry Assess for suicidal effect; tolerance to postural
depression. OFF-LABEL: mouth, blurred vision, ideation/tendencies, behavior, hypotension, sedative,
Brand Name: Capsule Adjunctive therapy for constipation, delayed thought content, appearance. anticholinergic effects usually
10 mg smoking cessation, myofascial micturition, orthostatic Obtain baseline glucose, develop during early therapy.
Pamelor pain, postherpetic pain, orofacial hypotension, diaphoresis, cholesterol levels. For pts on long- • Avoid alcohol.
Timing: pain, chronic pain, irritable bowel impaired concentration, term therapy, hepatic/renal • Avoid tasks that require
Classification syndrome. increased appetite, urinary function tests, blood counts should alertness, motor skills until
Name: Once a day (Kizior & Hodgson, 2019) retention. Occasional: GI be performed periodically. response to drug is established.

Tricyclic compound, Duration: Pharmacodynamics:
Antidepressant
5 days Blocks reuptake of
neurotransmitters (norepinephrine,
Other Drug serotonin) at neuronal
Forms: presynaptic membranes, increasing
their availability at postsynaptic
Oral Solution receptor sites. Therapeutic Effect:
Relieves depression, anxiety
disorders, nocturnal enuresis.
(Kizior & Hodgson, 2019)
disturbances (nausea, GI
distress, metallic taste),
photosensitivity. Rare:
Paradoxical reactions
(agitation, restlessness,
nightmares, insomnia),
extrapyramidal symptoms
(particularly fine hand
tremor).
(Kizior & Hodgson, 2019)
Adverse Reactions:
High dosage may produce
cardiovascular effects
(severe orthostatic
hypotension,
dizziness, tachycardia,
palpitations, arrhythmias),
altered temperature
regulation (hyperpyrexia,
hypothermia). Abrupt
discontinuation from
prolonged therapy
may produce headache,
malaise, nausea,
vomiting, vivid dreams.
(Kizior & Hodgson, 2019)
Contraindications:
Hypersensitivity to
nortriptyline. Use during
acute recovery period
after MI. Use of MAOI
intended to treat
psychiatric disorders
(concurrently or within 14
days of discontinuing
either nortriptyline or
(Kizior & Hodgson, 2019) • Therapeutic effect may be noted
in 2 weeks or longer.
Planning: • Photosensitivity to sun may
occur; use sunscreen, protective
-Report mood elevation (may use clothing.
short objective tool, such as the • Dry mouth may be relieved by
Beck Depression Tool). sugarless gum, sips of water.
-Remain safe from self-harm or • Report visual disturbances,
harm directed toward others. worsening depression, suicidal
-Actively engage in self-care ideation, unusual changes in
activities. behavior (esp. at initiation of
-Report ability to fall asleep and therapy or with changes in
stay asleep as was able to do dosage).
before depression. • Do not abruptly discontinue
-Demonstrate an understanding of medication.
the drug’s action by accurately (Kizior & Hodgson, 2019)
describing drug side effects and
precautions.
Implementation:
Supervise suicidal risk pt. closely
during early therapy (as depression
lessens, energy level improves,
increasing suicide potential).
Assess appearance, behavior,
speech pattern, level of interest,
mood. Monitor daily pattern of
bowel activity, stool consistency.
Avoid constipation with increased
fluids, bulky foods.
Monitor B/P, pulse for
hypotension, arrhythmias, weight.
Assess for urinary retention.
Therapeutic peak serum level: 6–
10 mcg/mL; trough serum level:
0.5–2 mcg/mL. Toxic peak serum
level: greater than 12 mcg/mL;
toxic trough: greater than 2
mcg/mL.
 MAOI). Initiation of
nortriptyline in pt.
receiving linezolid or
methylene blue. Cautions:
Prostatic hyperplasia,
history of urinary
retention/obstruction,
narrow-angle glaucoma,
diabetes, history of
seizures, hyperthyroidism,
cardiac/hepatic/renal
disease, psychosis,
increased intraocular
pressure, pts at high risk
for suicide, elderly pts.
(Kizior & Hodgson, 2019)
Patient: H.G.B Age:
Impression/Diagnosis: : Generalized Anxiety Disorder
Allergy to:
ANTIANXIETY
(Kizior & Hodgson, 2019)
Evaluation:
-Monitor patient response to
therapy (e.g., alleviation of signs
and symptoms of depression).
-Monitor for adverse effects (e.g.,
hypotension, suicidal thoughts,
cardiac arrhythmias, etc.).
-Evaluate patient understanding on
drug therapy by asking the patient
to name the drug, its indication,
and adverse effects to watch for.
-Monitor patient compliance to
drug therapy.
(Tabangcora, I.D., 2021)
30 Hospital No. 87654321 Room No. C8
 Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Drowsiness usually disappears
Dosage during continued therapy.
Alprazolam Ordered: Management of generalized Ataxia, light-headedness, Assess degree of anxiety; assess • If dizziness occurs, change
anxiety disorders (GAD). Short- drowsiness, slurred for drowsiness, dizziness, light- positions slowly from recumbent
Brand Name: Tablet term relief of symptoms of anxiety, speech (particularly in headedness. to sitting position before standing.
(Immediate- panic disorder, with or without elderly or debilitated pts), Assess motor responses (agitation, • Avoid tasks that require
Xanax Release) agoraphobia. Anxiety associated confusion, trembling, tension), autonomic alertness, motor skills until
0.5 mg with depression. OFF-LABEL: depression, blurred vision, responses (cold/clammy hands, response to drug is established.
Classification Timing: Anxiety in children. Preoperative constipation, diarrhea, dry diaphoresis). Initiate fall • Smoking reduces drug
Name: anxiety mouth, headache, nausea, precautions. effectiveness.
Twice a day (Kizior & Hodgson, 2019) problems such as anger, (Kizior & Hodgson, 2019) • Sour hard candy, gum, sips of
Benzodiazepine, impaired memory; water may relieve dry mouth.
Antianxiety Duration: Pharmacodynamics: paradoxical reactions Planning: • Do not abruptly withdraw
(insomnia, nervousness, medication after long-term
1 week Enhances the inhibitory effects of irritability). The client will: therapy.
the neurotransmitter gamma- (Kizior & Hodgson, 2019) -Report absence or decrease (use • Avoid alcohol.
aminobutyric acid in the brain. scale) of physical and behavioral • Do not take other medications
Other Drug Therapeutic Effect: Produces manifestations of anxiety. without consulting physician.
Forms: anxiolytic effect due to CNS -Demonstrate an understanding of (Kizior & Hodgson, 2019)
depressant action. Adverse Reactions: the drug’s action by accurately
Oral Solution (Kizior & Hodgson, 2019) describing drug side effects and
Orally Abrupt or too-rapid precautions.
Disintegrating withdrawal may result in -Verbalize the need to discuss with
tablets restlessness, irritability, the healthcare provider any
Extended- insomnia, intention to discontinue the drug
Release tablets hand tremors, and the importance of not
abdominal/muscle withdrawing the drug abruptly.
cramps, diaphoresis, -Report ability to tolerate usual
vomiting, seizures. activities of daily living without
Overdose results in
drowsiness, confusion,
diminished reflexes,
coma. Blood
dyscrasias noted rarely.
(Kizior & Hodgson, 2019)
Contraindications:
Hypersensitivity to
Alprazolam. Acute
narrow angle closure
glaucoma, concurrent use
with ketoconazole or
itraconazole or other
potent CYP3A4
inhibitors. Cautions:
Renal/hepatic impairment,
predisposition to urate
nephropathy, obese pts.
Concurrent use of
CYP3A4
inhibitors/inducers
and major CYP3A4
substrates; debilitated pts,
respiratory disease,
depression (esp. suicidal
risk), elderly (increased
risk of severe toxicity).
History of substance
abuse.
(Kizior & Hodgson, 2019)
excessive drowsiness and fatigue.
(Prenhall, 2020)
Implementation:
-Monitor vital signs. Observe
respiratory patterns, especially
during sleep, for evidence of apnea
or shallow breathing.
(Benzodiazepines can reduce the
respiratory drive-in susceptible
clients.)
-Monitor neurological status,
especially level of consciousness.
(Confusion or lack of response
may indicate overmedication.)
-Ensure client safety. (Drug may
cause excessive drowsiness and
increase risk for injury.)
-Monitor the client’s intake of
stimulants, including caffeine (in
beverages such as coffee, tea, cola
and other soft drinks, and OTC
analgesics such as Excedrin),
and nicotine from tobacco products
and nicotine patches. (These
products can reduce the drug’s
effectiveness.)
-Monitor affect and emotional
status. (Drug may increase risk of
mental depression, especially in
clients with suicidal tendencies.)
-Avoid abrupt discontinuation of
therapy. (Withdrawal symptoms,
including rebound anxiety and
sleeplessness, are possible with
abrupt discontinuation after long-
term use.)
-Assess prior methods of stress
reduction. Reinforce previously
used effective methods and teach
new coping skills. (This will assist
client to use medications for the
shortest time possible and build
self-confidence.)
(Prenhall, 2020)

Evaluation:

-The client reports a decrease in

physical and behavioral
manifestations of anxiety.
-The client demonstrates an
understanding of the drug’s actions
by accurately describing drug side
effects and precautions.
-The client verbalizes the
importance of not discontinuing
the drug abruptly.
-The client reports the ability to
tolerate usual activities of daily
living without excessive
drowsiness and fatigue.
(Prenhall, 2020)
 Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Avoid tasks that require alertness,
Dosage motor skills until response to drug
Clonazepam Ordered: Adjunct in treatment of Lennox- Frequent (37%–11%): Mild, transient drowsiness; ataxia, is established.
Gastaut syndrome (petit mal Mild, transient behavioral disturbances • Do not abruptly discontinue
Brand Name: Tablet variant epilepsy); akinetic, drowsiness; ataxia, (aggression, irritability, agitation), medication after long-term
1 mg myoclonic seizures; absence behavioral disturbances esp. in children. Occasional therapy.
Klonopin seizures (petit mal) unresponsive (aggression, irritability, (10%–5%): Dizziness, ataxia, URI, • Strict maintenance of drug
Timing: to agitation), esp. in fatigue. Rare (4% or less): therapy is essential for seizure
Classification succinimides. Treatment of panic children. Occasional Impaired memory, dysarthria, control.
Name: Once a day disorder. OFF-LABEL: Burning (10%–5%): Dizziness, nervousness, sinusitis, rhinitis, • Avoid alcohol.
mouth syndrome, REM sleep ataxia, URI, fatigue. Rare constipation, allergic reaction. • Report depression, thoughts of
Benzodiazepine, Duration: behavior disorder, essential tremor. (4% or less): Impaired (Kizior & Hodgson, 2019) suicide/self-harm, excessive
Anticonvulsant, (Kizior & Hodgson, 2019) memory, dysarthria, drowsiness, GI symptoms,
Antianxiety 1 week nervousness, sinusitis, Planning: worsening or loss of seizure
Pharmacodynamics: rhinitis, constipation, control.
Other Drug allergic reaction. The client will: (Kizior & Hodgson, 2019)
Forms: Depresses all levels of CNS; (Kizior & Hodgson, 2019) -Report absence or decrease (use
depresses nerve impulse scale) of physical and behavioral
None transmission in motor cortex. Adverse Reactions: manifestations of anxiety.
Suppresses abnormal discharge in -Demonstrate an understanding of
petit mal seizures. Therapeutic Abrupt withdrawal may the drug’s action by accurately
Effect: Produces anxiolytic, result in pronounced describing drug side effects and
anticonvulsant effects. restlessness, irritability, precautions.
(Kizior & Hodgson, 2019) insomnia, hand tremors, -Verbalize the need to discuss with
abdominal/muscle the healthcare provider any
cramps, diaphoresis, intention to discontinue the drug
vomiting, status and the importance of not
epilepticus. Overdose withdrawing the drug abruptly.
results in drowsiness, -Report ability to tolerate usual
confusion, diminished activities of daily living without
reflexes, coma. Antidote: excessive drowsiness and fatigue.
Flumazenil (Prenhall, 2020)
(Kizior & Hodgson, 2019)
Implementation:
Contraindications:

Hypersensitivity to
clonazepam. Active
narrow-angle glaucoma,
severe hepatic disease,
pregnancy. Cautions:
Renal/hepatic
impairment, impaired gag
reflex, chronic respiratory
disease, elderly,
debilitated pts.,
depression, pts at risk of
suicide or drug
dependence, concomitant
use of other CNS
depressants.
(Kizior & Hodgson, 2019)
-Observe for excess sedation,
respiratory depression, suicidal
ideation. Assess children, elderly
for paradoxical reaction,
particularly during early therapy.
-Initiate seizure precautions,
observe frequently for recurrence
of seizure activity.
-Assist with ambulation if
drowsiness, ataxia occur. For pts
on long-term therapy,
CBC, BMP, LFT should be
performed periodically. Evaluate
for therapeutic response: decreased
intensity and frequency of seizures
or, if used in panic attack, calm
facial expression, decreased
restlessness.
(Kizior & Hodgson, 2019)
Evaluation:
-The client reports a decrease in
physical and behavioral
manifestations of anxiety.
-The client demonstrates an
understanding of the drug’s actions
by accurately describing drug side
effects and precautions.
-The client verbalizes the
importance of not discontinuing
the drug abruptly.
-The client reports the ability to
tolerate usual activities of daily
living without excessive
drowsiness and fatigue.
(Prenhall, 2020)
 Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: • Avoid alcohol.
Dosage • Limit caffeine.
Diazepam Ordered: Short-term relief of anxiety Frequent: Pain with IM -Assess B/P, pulse, respirations • May cause drowsiness; avoid
symptoms, relief of acute alcohol injection, drowsiness, immediately before administration. tasks that require alertness, motor
Brand Name: Tablet withdrawal. fatigue, ataxia. Anxiety: skills until response to drug is
5 mg Adjunct for relief of acute Occasional: Slurred -Assess autonomic response (cold, established.
Valium musculoskeletal conditions, speech, orthostatic clammy hands; diaphoresis), motor • May be habit forming.
Timing: treatment of seizures (IV hypotension, headache, response (agitation, trembling, • Avoid abrupt discontinuation
Classification route used for termination of status hypoactivity, tension). Musculoskeletal spasm: after prolonged use.
Name: Once a day epilepticus). Gel: Control of constipation, nausea, ---Record onset, type, location, (Kizior & Hodgson, 2019)
increased seizure activity in blurred vision. Rare: duration of pain. Check for
Benzodiazepine, Duration: refractory epilepsy in pts on stable Paradoxical CNS immobility, stiffness, swelling.
Antianxiety, Skeletal regimens. OFF-LABEL: reactions Seizures:
muscle relaxant, 1 week Treatment of panic disorder. Short- (hyperactivity/nervousnes -Review history of seizure disorder
angiconvulsant term treatment of spasticity in s in children, (length, intensity, frequency,
Other Drug children with cerebral palsy. excitement/restlessness in duration, LOC).
Forms: Sedation for mechanically vented elderly/debilitated pts) -Observe frequently for recurrence
pts in ICU. generally noted during of seizure activity.
Injection (Kizior & Hodgson, 2019) first 2 weeks of therapy, (Kizior & Hodgson, 2019)
Solution, Oral particularly in presence of
concentrate, Pharmacodynamics: uncontrolled pain. Planning:
Oral solution, (Kizior & Hodgson, 2019)
Rectal gel Depresses all levels of CNS by The client will:
enhancing action of gamma- Adverse Reactions: -Report absence or decrease (use
aminobutyric acid (GABA), a scale) of physical and behavioral
major inhibitory neurotransmitter
in the brain. Therapeutic Effect:
Produces anxiolytic effect, elevates
seizure threshold, produces
skeletal muscle relaxation.
(Kizior & Hodgson, 2019)
IV route may produce manifestations of anxiety.
pain, swelling, -Demonstrate an understanding of
thrombophlebitis, carpal the drug’s action by accurately
tunnel syndrome. describing drug side effects and
Abrupt or too-rapid precautions.
withdrawal may result in -Verbalize the need to discuss with
pronounced restlessness, the healthcare provider any
irritability, insomnia, intention to discontinue the drug
hand tremor, and the importance of not
abdominal/muscle withdrawing the drug abruptly.
cramps, diaphoresis, -Report ability to tolerate usual
vomiting, seizures. activities of daily living without
Abrupt withdrawal in pts excessive drowsiness and fatigue.
with epilepsy may (Prenhall, 2020)
produce increase in
frequency/severity of Implementation:
seizures. Overdose results
in drowsiness, confusion, Monitor heart rate, respiratory rate,
diminished reflexes, CNS B/P, mental status. Assess
depression, coma. children, elderly for paradoxical
Antidote: Flumazenil reaction, particularly during early
(Kizior & Hodgson, 2019) therapy. Evaluate for therapeutic
response (decrease in
Contraindications: intensity/frequency of seizures;
calm facial expression, decreased
Hypersensitivity to restlessness; decreased intensity of
diazepam. Acute narrow- skeletal muscle pain).
angle glaucoma, untreated Therapeutic serum level: 0.5–2
open-angle glaucoma, mcg/mL; toxic serum level: greater
severe respiratory than 3 mcg/mL.
depression, severe (Kizior & Hodgson, 2019)
hepatic insufficiency,
sleep apnea syndrome, Evaluation:
myasthenia gravis.
Children younger than 6 -The client reports a decrease in
mos. (oral). Cautions: Pts physical and behavioral
receiving other CNS manifestations of anxiety.
depressants or -The client demonstrates an
psychoactive agents, understanding of the drug’s actions
depression, history of by accurately describing drug side
 drug and alcohol abuse, effects and precautions.
renal/hepatic impairment, -The client verbalizes the
respiratory disease, importance of not discontinuing
impaired gag reflex, the drug abruptly.
concurrent use of strong -The client reports the ability to
CYP3A4 inhibitors or tolerate usual activities of daily
inducers. living without excessive
(Kizior & Hodgson, 2019) drowsiness and fatigue.
(Prenhall, 2020)

Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: • Drowsiness usually subsides
Dosage during continued therapy.
Lorazepam Ordered: Management of anxiety disorders, Frequent (16%–7%): Offer emotional support to anxious • Avoid tasks that require
short-term relief of symptoms of Drowsiness, dizziness. pt. Pt must remain recumbent alertness, motor skills until
Brand Name: Tablet anxiety, anxiety associated with Rare (less than 4%): following parenteral administration response to drug is established.
2 mg depressive symptoms. Insomnia Weakness, ataxia, to reduce hypotensive effect. • Smoking reduces drug
Ativan due to anxiety or transient stress. headache, hypotension, Assess motor responses (agitation, effectiveness.
Timing: IV: Status epilepticus, nausea, vomiting, trembling, tension), autonomic • Do not abruptly discontinue
Classification preanesthesia for amnesia, confusion, injection site responses (cold or clammy hands, medication after long-term
Name: Twice a day sedation. reaction. diaphoresis). therapy.
OFF-LABEL: Treatment of (Kizior & Hodgson, 2019) (Kizior & Hodgson, 2019) • Do not use alcohol, CNS
Benzodiazepine, Duration: alcohol withdrawal, psychogenic depressants.
Antianxiety, catatonia, partial complex seizures, Adverse Reactions: Planning: • Contraception recommended for
sedative-hypnotic, 1 week agitation (IV administration only), The client will: long-term therapy.
antiemetic, skeletal antiemetic for chemotherapy; rapid Abrupt or too-rapid -Report absence or decrease (use • Immediately report suspected
muscle relaxant, Other Drug tranquilization of agitated pt., withdrawal may result in scale) of physical and behavioral pregnancy.
 amnesiac, Forms: status epilepticus in children
anticonvulsant, (Kizior & Hodgson, 2019)
antitremor. Inject
Solution, Pharmacodynamics:
Oral Solution
Enhances action of inhibitory
neurotransmitter gamma-
aminobutyric acid (GABA) in
CNS, affecting memory, motor,
sensory, cognitive function.
Therapeutic Effect: Produces
anxiolytic, anticonvulsant,
sedative, muscle relaxant,
antiemetic effects.
(Kizior & Hodgson, 2019)
pronounced restlessness, manifestations of anxiety. (Kizior & Hodgson, 2019)
irritability, insomnia, -Demonstrate an understanding of
hand tremor, abdominal the drug’s action by accurately
cramping, muscle cramps, describing drug side effects and
diaphoresis, vomiting, precautions.
seizures. Overdose results -Verbalize the need to discuss with
in drowsiness, confusion, the healthcare provider any
diminished reflexes, intention to discontinue the drug
coma. Antidote: and the importance of not
Flumazenil withdrawing the drug abruptly.
(Kizior & Hodgson, 2019) -Report ability to tolerate usual
activities of daily living without
excessive drowsiness and fatigue.
Contraindications: (Prenhall, 2020)
Hypersensitivity to Implementation:
Lorazepam, other
benzodiazepines. Monitor B/P, respiratory rate, heart
Acute narrow-angle rate. For those on long-term
glaucoma, IV therapy, hepatic/renal function
administration in pts with tests, CBC should be performed
sleep apnea, severe periodically. Assess for
respiratory depression paradoxical reaction, particularly
(except during mechanical during early therapy. Evaluate for
ventilation). Cautions: therapeutic response: calm facial
Neonates, renal/hepatic expression, decreased restlessness,
impairment, compromised insomnia, decrease in seizure-
pulmonary function, related symptoms. Therapeutic
concomitant CNS serum level: 50–240 ng/mL; toxic
depressant use, serum level: N/A.
depression, history of (Kizior & Hodgson, 2019)
drug dependence,
alcohol abuse, or Evaluation:
significant personality
disorder, pts at risk for -The client reports a decrease in
suicide. physical and behavioral
(Kizior & Hodgson, 2019) manifestations of anxiety.
-The client demonstrates an
understanding of the drug’s actions
by accurately describing drug side
 effects and precautions.
-The client verbalizes the
importance of not discontinuing
the drug abruptly.
-The client reports the ability to
tolerate usual activities of daily
living without excessive
drowsiness and fatigue.
(Prenhall, 2020)

Generic / Dosage, Indication/Pharmacodynamics of Side Effects / Adverse Nursing Responsibilities Patient Teaching
Brand Name & Timing Drug Reaction / (Nursing Process Approach) (20%)
Classification & Duration (20%) Contraindication (40%)
(5%) (5%) (10%)

Generic Name: Drug Form & Indications: Side Effects: Assessment: Improvement may be noted in 7–
Dosage 10 days, but optimum therapeutic
 Buspirone Ordered: Short-term management (up to 4 Frequent (12%–6%):
weeks) of generalized anxiety Dizziness, drowsiness,
Brand Name: Tablet disorder (GAD). nausea, headache.
7.5 mg OFF-LABEL: Augmenting Occasional
Buspar medication for antidepressants. (5%–2%): Nervousness,
Timing: (Kizior & Hodgson, 2019) fatigue, insomnia, dry
Classification mouth, light-headedness,
Name: Twice a day Pharmacodynamics: mood swings, blurred
vision, poor
Nonbarbiturate, Duration: Exact mechanism of action concentration, diarrhea,
Antianxiety unknown. Binds to serotonin, paresthesia. Rare: Muscle
3 days Dopamine at presynaptic pain/stiffness, nightmares,
neurotransmitter receptors in CNS. chest pain, involuntary
Other Drug Therapeutic Effect: Produces movements.
Forms: anxiolytic effect. (Kizior & Hodgson, 2019)
(Kizior & Hodgson, 2019)
None Adverse Reactions:
No evidence of drug
tolerance, psychological
or physical dependence,
withdrawal syndrome.
Overdose may produce
severe nausea, vomiting,
dizziness, drowsiness,
abdominal distention,
excessive pupil
constriction.
(Kizior & Hodgson, 2019)
Contraindications:
Hypersensitivity to
buspirone. Cautions:
Concurrent use of
MAOIs, severe
hepatic/renal impairment
(not recommended).
(Kizior & Hodgson, 2019)
Assess degree/manifestations of effect generally takes 3–4 wks.
anxiety. Offer emotional support. • Drowsiness usually disappears
Assess motor responses (agitation, during continued therapy.
trembling, tension), autonomic • If dizziness occurs, slowly go
responses (cold, clammy from lying to standing.
hands; diaphoresis). • Avoid tasks that require
(Kizior & Hodgson, 2019) alertness, motor skills until
response to drug is established.
Planning: • Avoid alcohol, grapefruit
products.
The client will: • Be consistent in taking
-Report absence or decrease (use regarding food.
scale) of physical and behavioral (Kizior & Hodgson, 2019)
manifestations of anxiety.
-Demonstrate an understanding of
the drug’s action by accurately
describing drug side effects and
precautions.
-Verbalize the need to discuss with
the healthcare provider any
intention to discontinue the drug
and the importance of not
withdrawing the drug abruptly.
-Report ability to tolerate usual
activities of daily living without
excessive drowsiness and fatigue.
(Prenhall, 2020)
Implementation:
For pts on long-term therapy,
CBC, LFT, renal function tests
should be performed periodically.
Assist with ambulation if
drowsiness, dizziness occurs.
Evaluate for therapeutic response:
calm facial expression, decreased
restlessness,
lessened insomnia, mental status.
(Kizior & Hodgson, 2019)
 Evaluation:

-The client reports a decrease in

physical and behavioral
manifestations of anxiety.
-The client demonstrates an
understanding of the drug’s actions
by accurately describing drug side
effects and precautions.
-The client verbalizes the
importance of not discontinuing
the drug abruptly.
-The client reports the ability to
tolerate usual activities of daily
living without excessive
drowsiness and fatigue.
(Prenhall, 2020)

References:

Almasi, A., & Meza, C.E. (2020). Doxepin. StatPearls. https://libguides.csudh.edu/citation/apa-7.

Kizior, R.J., & Hodgson, K.J. (2019). Saunders nursing drug handbook 2019. Elsevier.
McNeil, S.E., Gibbons, J.R., & Cogburn, M. (2021). Risperidone. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459313/.
Prenhall. (n.d.). Nursing process focus: Clients receiving atypical antipsychotic therapy.
https://wps.prenhall.com/wps/media/objects/3775/3866436/npf_charts/ch17/Atypical%20Antipsychotic.pdf
Prenhall. (n.d.). Nursing process focus: Clients receiving benzodiazepine and nonbenzodiazepine antianxiety therapy.
https://wps.prenhall.com/wps/media/objects/3775/3866436/npf_charts/ch14/Benzodiazepine.pdf
Tabangcora, I.D. (2021, April 22). Antidepressants. https://nurseslabs.com/antidepressants/#nursing_considerations