DRUG STUDY

Name of the Patient : _______Sabrina _____________ Age : __26 y.o____ Sex : __Female__ Name of Student _________Sanguyo, Camille B. ____
Civil Status : _____ Single________Religion : _____ N/A_____ Rm/Bed No. _________________ Area : ____NCMH ___________ Level/ Block : _Level III-B______
Address : _____________________ N/A ______________________ Date Submitted : ________March 08, 2022_______________
Date of Admission : _____________________________ Diagnosis : Factitious Disorder (FD) Rating : ___________________________________________________

MEDICATION Classification/ Action Indications Contraindications Side Effects Adverse Effects Nursing Responsibilities

Generic Name:
Quetiapine
Brand Name:
---
Usual Dosage/Frequency:
Initial: 25 mg twice daily on day Antagonizes dopamine and
1. Increased by 25 to 50 twice
daily or three times a day on
days 2 and 3.
Usual: 300 to 400 mg daily by
day 4, in divided doses twice
daily or three times a day.
Increased every 2 days in
increments of 25 to 50 mg
twice daily, as needed.
Maximum: 800 mg daily
Usual Route:
Pharmacotherapeutic class:
of acute manic episodes
Dibenzodiazepine derivative
Clinical class: combination with lithium
Second-generation
(atypical) antipsychotic
Action:
serotonin
(anti-psychotic activity),
histamine (somnolence),
alpha1-adrenergic
(orthostatic hypotension)
receptors.
Therapeutic effect:
Diminishes symptoms
associated with
schizophrenia/bipolar
disorders.
Pharmacokinetics:
Absorption:
Treatment This drug is contraindicated Frequent (19%–10%): Overdose may produce: Before:
to patients with:  Dizziness  Heart block
associated with bipolar  Drowsiness  Hypotension  Verify the doctor’s order regarding
disorder (alone or in  Hypersensitivity to  Headache  Hypokalemia the medication.
quetiapine  Observe the ten rights of
 Tachycardia
or valproate). Occasional (9%–3%): medication administration.
Use cautiously in:
Treatment of acute  Constipation  Assess behavior, appearance,
depressive episodes  Orthostatic emotional status, response to
 Hepatic/renal
associated with bipolar hypotension environment, speech pattern,
impairment
disorder.  Tachycardia thought content.
 Preexisting abnormal  Dry mouth  Assess for suicidal tendencies,
lipid profile  Dyspepsia especially during early therapy.
 Rash Restrict amount of drug available
 Patients at risk for to patient.
 Asthenia
aspiration pneumonia,  Assess daily weight and BMI.
cardiovascular disease  Abdominal pain
 Obtain serum potassium, LFT,
(e.g., HF, history of MI)  Rhinitis
CBC and renal function tests.
Rare (2%):  Question for history of allergies
 Cerebrovascular
 Back pain and full medication history; screen
disease
 Fever for interactions.
 Dehydration  Educate and verify patient and
 Weight gain
SO’s understanding about the
 Hypovolemia medication.
 History of drug  Check the medication three times.
 Oral Well absorbed after oral abuse/dependence,  Obtain baseline vital signs.
administration  Obtain baseline I&O.
Drug Order:  Seizure disorder
Distribution: During:
Quetiapine 200mg three times Widely distributed in tissues;  Hypothyroidism
a day CNS concentration exceeds  Maintain patient’s comfort and
 Patients at risk for
plasma concentration suicide safety.
Drug Interactions:  Administer the drug: Quetiapine
Protein binding: 83%  Parkinson’s disease 200mg three times a day, as
 Concurrent use of
macrolide anti-infectives ordered by the physician.
Metabolism:  Decreased GI motility
(erythromycin,  May be administered without
Extensively metabolized by
clarithromycin), dofetilide,  Urinary retention regard to food. Extended-release
the liver (mostly by P450
sotalol, quinidine, tablets should be swallowed
CYP3A4 enyzme
disopyramide,  Narrow-angle whole, do not break, crush, or
system)
procainamidethioridazine, glaucoma chew.
chlorpromazine, Elimination:  If therapy is reinstituted after an
 Diabetes interval of 1 week off, follow initial
droperidol, gemifloxacin, < 1% excreted unchanged
moxifloxacin, mefloquine, in the urine titration schedule.
 Visual problems
pentamidine, arsenic  Monitor BP (sitting, standing,
trioxide, dolasetron, Half-life:  Elderly lying) and pulse before and
citalopram, 6 hours frequently during initial dose
escitalopramtacrolimus,  Patients at risk for titration. If hypotension occurs
and ziprasidone increase Pharmacodynamics: orthostatic hypotension during dose titration, return to the
the risk of serious Onset: Unknown previous dose.
Peak: Unknown  Avoid use in patients at
ventricular arrhythmias  Observe patient carefully when
Duration: 12 hours risk for torsades de
and should be avoided. administering to ensure
pointes (hypokalemia,
medication is swallowed and not
hypomagnesemia,
 Increased CNS hoarded or cheeked.
history of cardiac
depression may occur with
arrhythmias, congenital After:
alcohol, antihistamines,
long QT syndrome,
opioid analgesics, and
concurrent medications  Assess for hypersensitivity
sedative/hypnotics.
that prolong QT reaction (chills, fever).
 Increased risk of interval).  Monitor CBC, LFT, hepatic
hypotension with acute enzyme levels, etc.
ingestion of alcohol or  Monitor for onset of
antihypertensives. extrapyramidal side effects
(akathisia, restlessness; dystonia,
 Phenytoin and thioridazine or pseudo-parkinsonism). Report
 increase clearance and
decrease effectiveness of
quetiapine (dose change
may be necessary);
similar effects may occur
with carbamazepine,
barbiturates, rifampin,
corcorticosteroids.
 Effects may be increased
by ketoconazole,
itraconazole, fluconazole,
protease inhibitors or
erythromycin, as well as
by other agents that inhibit
the cytochrome P450
CYP3A4 enzyme
these symptoms if present.
 Monitor for tardive dyskinesia
(involuntary rhythmic movement of
mouth, face, and extremities).
Report immediately; may be
irreversible.
 Monitor for development of
neuroleptic malignant syndrome
(fever, respiratory distress,
tachycardia, seizures, etc.). Notify
health care professional
immediately if these symptoms
occur.
 Monitor for symptoms related to
hyperprolactinemia (menstrual
abnormalities, galactorrhea,
sexual dysfunction).
 Evaluate the drug’s desired
therapeutic effect: decrease in
excited, manic, behavior, positive
and negative symptoms.
 Monitor for side/adverse effects.
 Document medication
administration properly as per
institution’s protocol.
Patient/Family Teaching:
 Instruct patient to take medication
as directed, even if feeling better.
Doses should be taken at the
same time each day. Take missed
doses as soon as remembered,
but not if almost time for next
dose. Do not double dose.
 Inform patient of the possibility of
extrapyramidal symptoms. Instruct
patient to report symptoms
 immediately to health care
professional.
 Advise patient to change positions
slowly to minimize orthostatic
hypotension.
 May cause drowsiness. Caution
patient to avoid driving or other
activities requiring alertness until
response to medication is known.
 Advise patient to avoid extremes
in temperature; this drug impairs
body temperature regulation.
 Advise patient to notify health care
professional of all Rx or OTC
medications, vitamins, or herbal
products being taken and to
consult with health care
professional before taking other
medications and alcohol,
especially other CNS depressants.
 Advise patient and family to notify
health care professional if
thoughts about suicide or dying,
attempts to commit suicide; new
or worse depression; new or
worse anxiety; feeling very
agitated or restless; panic attacks;
trouble sleeping; new or worse
irritability; acting aggressive; being
angry or violent; acting on
dangerous impulses; an extreme
increase in activity and talking,
other unusual changes in behavior
or mood occur.
 Refer patient for nutritional, weight
or medical management of
dyslipidemia as indicated.
 Advise patient to notify health care
 professional of medication
regimen before treatment or
surgery.
 Instruct patient to notify health
care professional promptly of sore
throat, fever, unusual bleeding or
bruising, or rash.
 Advise female patients to notify
health care professional if
pregnancy is planned or
suspected or if they are
breastfeeding or planning to
breastfeed.
 Emphasize importance of routine
follow-up exams to monitor side
effects and continued participation
in psychotherapy as indicated to
improve coping skills.

References:
 Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2013). Davis’s Drug Guide for Nurses (13th ed.). F.A. Davis Company. 1079-1081.
 Kizior, R. J., & Hodgson, K. J. (2020). Saunders Nursing Drug Handbook 2021 (1st ed.). Elsevier. 983-985.
 Jones & Bartlett Learning. (2015). 2021 Nurse’s Drug Handbook (14th ed.). Jones & Bartlett Learning. 1018-1020.