DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES

ACTION
DIVALPROEX The drug's anticonvulsant  Treatment of Contraindicated in patients Adverse effects: Before Administration
SODIUM activity may be related to acute manic or hypersensitive to drug and Sedation, tremor, emotional upset,  Check doctor’s order including the right
(ANTIEPILEPTIC) increased brain mixed episodes in those with hepatic depression, psychosis, aggression, medication (name and form) and right
500 mg 1 tab BID concentrations of gamma- associated with disease or significant hyperactivity, behavioural dosage.
aminobutyric acid bipolar disorder hepatic dysfunction, and in deterioration, weakness,  Prepare medication as indicated
(GABA), an inhibitory
with or without patients with a urea cycle suicidality, rash, petechiae,  Obtain liver function test results, platelet
neurotransmitter in the
CNS, by inhibiting psychotic disorder (UCD). pancreatitis, hemorrhage, bone count, and PT and INR before starting
enzymes that catabolize features marrow suppression, therapy, and monitor these values
GABA or block the  Treatment of thrombocytopenia, hepatotoxicity, periodically.
reuptake of GABA into bipolar mania erythema multiforme, Stevens-  Don't give syrup to patients who need
glia and nerve endings.  Prophylaxis of Johnson syndrome, sodium restriction. Check with
migraine hypersensitivity reactions prescriber.
headache During Administration
Side effects:  Verify patient’s identity
Drowsiness, GI upset, transient  Inform patient not to chew tablets or
increase in hair loss. capsules before swallowing them.
Swallow them whole to prevent local
irritation of mouth and throat.
 Administer the right drug with the right
dose at the right time
 State importance and purpose of the drug
to the patient

After Administration
 Adverse reactions may not be caused by
valproic acid alone because it's usually
used with other anticonvulsants.
 Divalproex sodium has a lower risk of
adverse GI reactions.
 Never withdraw drug suddenly because
sudden withdrawal may worsen seizures.
Call prescriber at once if adverse
reactions develop.
 Notify prescriber if tremors occur; a
dosage reduction may be needed.
 Monitor drug level. Therapeutic level is
 50 to 100 mcg/ml.
 When converting patients from a brand-
name drug to a generic drug, use caution
because breakthrough seizures may occur
DRUG MECHANISM OF INDICATION
ACTION
FLUPHENAZINE May block postsynaptic
DECANOATE dopamine receptor sites
(ANTIPSYCHOTIC in the CNS. This action
) may depress areas of
500 mg 1 tab BID the brain that control
activity and aggression,
including the cerebral
cortex, hypothalamus,
and limbic system.
CONTRAINDICATION ADVERSE EFFECT
 Treatment of  Contraindications CNS: Ataxia, cerebral edema,
acute or chronic dizziness,
psychosis Blood dyscrasias, bone drowsiness, headache, insomnia,
marrow depression, lightheadedness,
cerebral arteriosclerosis, nervousness, seizures, slurred
coma, concomitant use of speech, syncope, worsening
psychotic
large amounts of another
symptoms
CNS depressant, coronary CV: AV conduction disorders,
artery disease, hepatic bradycardia,
dysfunction, cardiac arrest,
hypersensitivity to hypercholesterolemia,
phenothiazines, hypertension,
myeloproliferative orthostatic hypotension, QT-
interval
disorders, severe
prolongation, shock, ST-segment
CNS depression, severe depression, tachycardia
EENT: Blurred vision, dry
hypertension or
mouth, glaucoma,
hypotension, subcortical increased salivation, laryngeal
brain damage edema,
laryngospasm, miosis, mydriasis,
nasal congestion,
papillary hypertrophy of the
 Precautions tongue, parotid gland
enlargement, photophobia,
Cardiovascular diseases,
pigmentary retinopathy, ptosis
Parkinson’s disease, angle- ENDO: Breast engorgement
closure glaucoma, (females),
myasthenia gravis, galactorrhea, hyperglycemia,
prostatic hyperplasia; hypoglycemia,
seizure disorders; OB, mastalgia, syndrome of
Lactation: safety not inappropriate ADH
secretion
established; enters breat
GI: Anorexia, constipation,
milk, not recommended; diarrhea, fecal
Geri: dosage reduction impaction, ileus, increased
NURSING RESPONSIBILITIES
Before Administration
1. Monitor patient’s blood pressure routinely.
2. Assess mental status (mood, behavior,
orientation).
3. Assess weight and BMI.
4. Assess positive and negative symptoms of
schizophrenia.
5. Assess fluid intake and bowel function
6. Prepare drug aseptically and verify the right
dose. Render health teaching as appropriate.
During Administration
1. Verify patient’s identity using the chart and
other patient and nurse’s confirmation.
2. Administer oral doses with food, milk, or a full
glass of water.
3. For I.M. and subcutaneous injection, use at least
a 21G needle.
4. To prevent contact dermatitis, avoid getting
solution ion hands.
5. Advise patient not to mix oral solution
with beverages that contain caffeine (coffee, cola),
tannins (tea), or pectins (apple juice).
6. Observe patient carefully when administering
medication to ensure that medication is taken not
hoarded or cheeked.
After Administration
1. Document medication given.
2. Don’t let patient sit or stand up until
blood pressure and heart rate have
returned to baseline.
appetite, nausea, 3. Notify prescriber if patient develops tardive
vomiting dyskinesia or urinary incontinence.
GU: Amenorrhea, bladder 4. Instruct to frequently do good oral hygiene.
paralysis, 5. Be alert for and immediately report signs of
decreased libido, enuresis,
neuroleptic malignant syndrome.
menstrual irregularities,
6. Notify prescriber about worsening psychotic
polyuria, urinary frequency,
urinary symptoms: agitation, catatonic
incontinence, urine retention state, confusion, depression, hallucinations,
HEME: Anemia, aplastic anemia, lethargy, paranoid reactions.
eosinophilia, leukopenia, 7. Monitor temperature; a significant, unexplained
thrombocytopenia, rise can indicate intolerance and a need to
thrombocytopenic or discontinue drug. Notify prescriber immediately if
nonthrombocytopenic this occur
purpura
RESP: Bronchospasm, dyspnea,
increased
respiratory depth
SKIN: Contact dermatitis, dry
skin, eczema,
erythema, jaundice,
photosensitivity, pruritus,
seborrhea
Other: Heatstroke, hyponatremia,
lupuslike symptoms, weight gain.