DRUG NAME MECHANISM OF ACTION INDICATIONS/ ADVERSE EFFECTS NURSING RESPONSIBILITIES

CONTRAINDICATIONS
GENERIC: Thought to antagonize Indication: CNS: dizziness, headache, BEFORE:
Olanzapine dopamine and serotonin type 2 in weakness, Dx:
CNS. Also antagonizes muscarinic  Schizophrenia fatigue, restlessness, sedation, - Check the doctor’s order.
BRAND: receptors in respiratory tract, insomnia, mood changes, agitation,  - Assess baseline mental status.
Olazin causing Contraindications: personality disorder, impaired Tx:
cholinergic activation.  Hypersensitivity to olanzapine speech, tardive  -Prepare right amount of drug to be
CLASS dyskinesia, dystonia, tremor, administered.
THERAPEUTIC: Reference: Drug to Drug Interactions: extrapyramidal effects, neuroleptic -Ensure patient’s comfort in taking
Atypical Antipsychotic malignant syndrome, coma, post the drug such as encouraging them
McGraw Hill Nurses Drug  Alcohol, CNS depressants injection to verbalize concerns.
PHARMACOLOGIC: Handbook (e.g., Lorazepam, morphine, delirium-sedation syndrome Edx:
Atypical Antipsychotic (Mood zolpidem) = may increase  -Educate client on drug therapy to
Disorder) CNS depressant effects. CV: orthostatic hypotension, chest promote understanding and
pain, tachycardia compliance.
DOSAGE:  Anticholinergics may increase  -Educate the patient drug may cause
10mg anticholinergic effects. EENT: amblyopia, rhinitis, extrapyramidal symptoms,
pharyngitis akathisia, and
ROUTE: tardive dyskinesia leading to
 Hepatotoxic medications (e.g.,
PO GI: nausea, constipation, abdominal involuntary movements, tremors,
acetaminophen,
pain, increased salivation, dry rigidity,
simvastatin) may increase risk
mouth muscle contractions, and
of hepatotoxicity.
restlessness.
GU: urinary incontinence, urinary  -Encourage patient to verbalize
tract infection concerns.
Hematologic: leukopenia, DURING:
neutropenia, agranulocytosis Dx:
Metabolic: goiter, increased thirst,

-Monitor patient for life-threatening
hyperprolactinemia, hyperlipidemia,
adverse effects.
severe hyperglycemia

-Monitor vital signs, watch for signs
and symptoms.
Musculoskeletal: hypertonia, joint
Tx:
pain
Respiratory: cough, dyspnea  -Ensure that the patient takes the
medication once a day.
Skin: ecchymosis, photosensitivity  -Assist patient in taking the
medication.
Other: increased appetite, weight Edx:
gain or  -Encourage patient to report allergic
loss, fever, flulike symptoms, reactions.
 impaired
body temperature regulation, death AFTER
Dx:
 -Assess effectiveness of medication.
 -Assess for signs of adverse effects.
Tx:
 -Provide written instruction to the
patient and family in taking the
medication.
 -Provide comfort measures such as
instructing the patient to take the
drug with food and promote rest to
help patient tolerate drug effects.
 -Ensure that patient receives full
course of medication as prescribed.
Edx:
 -Stress importance of follow-up
visits.
 -Educate the patient that she may
take the medicine without food.
 -Educate the patient to move slowly
when sitting up or standing to avoid
dizziness.
-Advise him to dangle legs briefly
before getting out of bed.

DRUG NAME MECHANISM OF ACTION INDICATIONS/ ADVERSE EFFECTS NURSING RESPONSIBILITIES

CONTRAINDICATIONS
GENERIC: Increases level of gamma- Indication: CNS: confusion, dizziness, BEFORE:
Valproic Acid aminobutyric acid in brain, reducing headache, Dx:
seizure  Mania associated with sedation, ataxia, paresthesia,  -Check the doctor’s order.
BRAND: activity bipolar asthenia,  -Assess baseline mental status.
Valpros disorder tremor, drowsiness, emotional Tx:
Reference: Contraindications: lability,  -Prepare right amount of drug to be
CLASS abnormal thinking, amnesia, administered.
THERAPEUTIC: McGraw Hill Nurses Drug  Hypersensitivity to drug or hyperammonemic  -Ensure patient’s comfort in taking
Mood stabilizer Handbook tartrazine encephalopathy, suicidal behavior the drug such as encouraging them
(some products) or ideation to verbalize concerns.
PHARMACOLOGIC:  Hepatic impairment Edx:
Carboxylic acid derivative  Urea cycle disorders EENT: amblyopia, blurred vision,  -Educate client on drug therapy to
nystagmus, tinnitus, pharyngitis promote understanding and
DOSAGE: Interactions compliance.
250 mg Drug-drug. GI: nausea, vomiting, diarrhea,  -Encourage patient to verbalize
Activated charcoal, cholestyramine: abdominal pain, dyspepsia, concerns.
ROUTE: decreased valproate absorption anorexia,  -Educate patient to immediately
PO pancreatitis report signs and symptoms of liver
Antiplatelet agents (including dysfunction (such as malaise,
abciximab, aspirin and other Hematologic: leukopenia, weakness,
nonsteroidal anti-inflammatory thrombocytopenia lethargy, appetite loss, vomiting, or
drugs, eptifibatide, tirofiban), yellowing of skin or eyes), signs
cefamandole, cefoperazone, Hepatic: hepatotoxicity and symptoms of pancreatitis (such
cefotetan, heparin, thrombolytics, as abdominal
warfarin: increased risk of bleeding Metabolic: hyperammonemia pain, nausea, vomiting, loss of
appetite),
Barbiturates, primidone: decreased Musculoskeletal: back pain or suicidal behavior or ideation.
metabolism and greater risk of
toxicity Respiratory: dyspnea
of these drugs, decreased valproate
efficacy Skin: rash, alopecia, bruising
DURING:
Carbamazepine: increased Other: abnormal taste, increased Dx:
carbamazepine blood level, appetite, weight gain, flulike  -Monitor patient for life-threatening
decreased valproate symptoms, infection, infusion site adverse effects.
blood level, poor seizure control pain and  -Monitor vital signs, watch for signs
reaction, multiorgan and symptoms.
Chlorpromazine: decreased hypersensitivity Tx:
valproate clearance and increased reaction  -Ensure that the patient takes the
trough level medication once a day.
 -Assist patient in taking the
Cimetidine: decreased valproate medication.
clearance Edx:
 -Encourage patient to report allergic
Clonazepam: absence seizures in
reactions.
patients with history of these
seizures CNS depressants (such as
AFTER
antihistamines and antidepressants,
Dx:
MAO
 -Assess effectiveness of medication.
inhibitors, opioid analgesics,
sedativehypnotics): additive CNS  -Assess for signs of adverse effects.
depression Tx:
 -Provide written instruction to the
 Diazepam: displacement of patient and family in taking the
diazepam from binding site, medication.
inhibited diazepam  -Provide comfort measures such as
metabolism instructing the patient to take the
drug with food and promote rest to
Erythromycin, felbamate: increased help patient tolerate drug effects.
valproate blood level, greater risk of  -Ensure that patient receives full
toxicity course of medication as prescribed.
Edx:
Ethosuximide: inhibited  -Stress importance of follow-up
ethosuximide metabolism visits.
Lamotrigine: decreased valproate  -Educate the patient that she should
blood take the medicine with food to
level, increased lamotrigine blood prevent GI upset.
level  -Instruct patient to avoid alcohol.
 -Educate patient not to stop therapy
Phenytoin: increased phenytoin abruptly.
effects
and risk of toxicity, decreased
valproate effects

Salicylates (large doses in children):

increased valproate effects

Topiramate: increased risk of

hyperammonemia with and without
encephalopathy and hypothermia

Tricyclic antidepressants: increased

blood levels of these drugs, greater
risk
of adverse reactions

Zidovudine: decreased zidovudine

clearance in patients with human
immunodeficiency virus

DRUG NAME MECHANISM OF ACTION INDICATIONS/ ADVERSE EFFECTS NURSING RESPONSIBILITIES

CONTRAINDICATIONS
GENERIC: Thought to depress CNS at Indication: CNS: amnesia, agitation, ataxia, BEFORE:
Lorazepam limbic system and disrupt depression, disorientation, dizziness, Dx:
 neurotransmission in reticular  For the management of drowsiness, headache,  -Check the doctor’s order.
BRAND: activating system. anxiety disorders or for the incoordination,  Assess baseline mental status.
Ativan short-term relief of the asthenia Tx:
Reference: symptoms of anxiety or  -Prepare right amount of drug to be
CLASS anxiety associated with CV (with too rapid I.V. administered.
THERAPEUTIC: McGraw Hill Nurses Drug depressive symptoms. administration): hypotension,  -Ensure patient’s comfort in taking
Anxiolytic Handbook bradycardia, tachycardia, apnea, the drug such as encouraging them
cardiac arrest, cardiovascular to verbalize concerns.
PHARMACOLOGIC: collapse
Benzodiazepine
Contraindications: EENT: blurred vision, diplopia, Edx:
DOSAGE: nystagmus  -Educate client on drug therapy to
2 mg ● Hypersensitivity to drug, other promote understanding and
benzodiazepines, polyethylene or GI: nausea, abdominal discomfort compliance.
ROUTE: propylene glycol, or benzyl alcohol  -Encourage patient to verbalize
PO ● Acute angle-closure glaucoma Other: increased or decreased concerns.
● Coma or CNS depression appetite
 -Educate patient to avoid alcohol,
● Hepatic or renal failure because it increases drowsiness and
other CNS effects.
Interactions
Drug-drug. CNS depressants
(including DURING:
antidepressants, antihistamines, Dx:
benzodiazepines, sedative-
 -Monitor patient for life-threatening
hypnotics): additive
adverse effects.
CNS depression
 -Monitor vital signs, watch for signs
Hormonal contraceptives: increased
and symptoms.
lorazepam clearance
Tx:
Drug-herbs. Chamomile, hops,  -Ensure that the patient takes the
kava, medication once a day.
skullcap, valerian: increased CNS  -Assist patient in taking the -
depression medication.
Edx:
Drug-behaviors. Alcohol use:  -Encourage patient to report allergic
increased reactions.
CNS depression
Smoking: increased metabolism and AFTER
decreased efficacy of lorazepam Dx:
 -Assess effectiveness of medication.
 -Assess for signs of adverse effects.
Tx:
  -Provide written instruction to the
patient and family in taking the
medication.
 -Provide comfort measures such as
instructing the patient to take the
drug with food and promote rest to
help patient tolerate drug effects.
 -Ensure that patient receives full
course of medication as prescribed.
Edx:
 -Stress importance of follow-up
visits.
 -Educate patient not to stop therapy
abruptly.
 -Educate to the patient that with
long-term use, drug must be
discontinued slowly (typically
over 8 to 12 weeks).
 -Educate patient to avoid smoking,
because it speeds drug breakdown
in
body

DRUG NAME MECHANISM OF ACTION INDICATIONS/ ADVERSE EFFECTS NURSING RESPONSIBILITIES

CONTRAINDICATIONS
GENERIC: Inhibits neuronal uptake of Indication: CNS: dizziness, drowsiness, BEFORE:
Setraline Hydrochloride serotonin fatigue, Dx:
in CNS, potentiating serotonin  Used as a first-line headache, insomnia, agitation,  -Check the doctor’s order.
BRAND: activity; treatment of major anxiety,  Assess baseline mental status.
Zoloft has little effect on norepinephrine or depressive disorder confusion, emotional lability, poor Tx:
dopamine uptake  Used to treat OCD, Panic concentration, mania, nervousness,  -Prepare right amount of drug to be
CLASS disorder, PTSD, SAD, and weakness, yawning, tremor, administered.
THERAPEUTIC: Reference: Premenstrual dysphoric hypertonia, hypoesthesia,  -Ensure patient’s comfort in taking
Selective Serotonin Reuptake disorder. paresthesia, suicidal the drug such as encouraging them
Inhibitor McGraw Hill Nurses Drug behavior or ideation (especially in to verbalize concerns.
Handbook child or adolescent), neuroleptic
malignant syndrome–like
PHARMACOLOGIC: reactions Edx:
Antidepressant Contraindications:  -Educate client on drug therapy to
CV: chest pain, palpitations promote understanding and
 Patients who have
DOSAGE: syndrome of inappropriate EENT: vision abnormalities, compliance.
50 mg antidiuretic hormone. tinnitus,  -Encourage patient to verbalize
 Who has low amount of rhinitis, pharyngitis concerns.
ROUTE: sodium in the blood.  - Educate patient to take once a day,
PO  Manic Behavior. GI: nausea, vomiting, diarrhea, either in morning or night, with or
 Manic-depression. constipation, dyspepsia, flatulence, without food.
abdominal pain, dry mouth,
Interactions anorexia
Drug-drug: DURING:
GU: urinary frequency, urinary Dx:
Adrenergics: increased disorders,  -Monitor patient for life-threatening
adrenergic sensitivity, increased risk sexual dysfunction, menstrual adverse effects.
of disorders  -Monitor vital signs, watch for signs
serotonin syndrome and symptoms.
Musculoskeletal: back pain, Tx:
Cimetidine: increased sertraline myalgia  -Ensure that the patient takes the
blood medication once a day.
level and effects Skin: diaphoresis, rash  -Assist patient in taking the -
Clozapine, most benzodiazepines, medication.
phenytoin, tricyclic antidepressants, Other: altered taste, increased Edx:
tolbutamide, warfarin: increased appetite,
 -Encourage patient to report allergic
blood fever, thirst, hot flashes, serotonin
reactions.
levels and effects of these drugs syndrome
AFTER
Disulfiram: disulfiram reaction, Dx:
indicated by nausea, vomiting,  -Assess effectiveness of medication.
flushing,  -Assess for signs of adverse effects.
throbbing headache, diaphoresis, Tx:
cardiovascular and respiratory
 -Provide written instruction to the
reactions (with sertraline oral
patient and family in taking the
concentrate)
medication.
 -Provide comfort measures such as
Drugs affecting serotonergic system
instructing the patient to take the
(selective serotonin reuptake
drug with food and promote rest to
inhibitors,
help patient tolerate drug effects.
selective norepinephrine reuptake
inhibitors), linezolid, lithium,  -Ensure that patient receives full
tramadol, course of medication as prescribed.
triptans, tryptophan: increased risk Edx:
of  -Stress importance of follow-up
serotonin syndrome visits.
 -Educate patient not to stop therapy
 Drugs metabolized by CYP450- abruptly.
2DC or  - Educate the patient that If evening
CYP450-3A4: increased blood dose causes insomnia, recommend
levels of switching to morning dose.
these drugs 

MAO inhibitors: potentially fatal

reactions (hyperthermia, rigidity,
myoclonus, autonomic instability)

Pimozide: increased pimozide blood

level

Sumatriptan: weakness,
hyperreflexia,
incoordination

DRUG NAME MECHANISM OF ACTION INDICATIONS/ ADVERSE EFFECTS NURSING RESPONSIBILITIES

CONTRAINDICATIONS
GENERIC: Thought to potentiate serotonergic Indication: CNS: apathy, confusion, BEFORE:
Citalopram Hydrobromide activity in CNS by inhibiting drowsiness, Dx:
neuronal uptake of serotonin  It is used to treat depression, insomnia, migraine, weakness,  -Check the doctor’s order.
BRAND: including major depressive agitation, amnesia, anxiety,  Assess baseline mental status.
Celexa Reference: disorder (MDD). dizziness, Tx:
fatigue, poor concentration, tremor,  -Prepare right amount of drug to be
CLASS McGraw Hill Nurses Drug paresthesia, deepening of administered.
THERAPEUTIC: Handbook depression,  -Ensure patient’s comfort in taking
Antidepressant Contraindications: suicide attempt, neuroleptic the drug such as encouraging them
malignant syndrome-like to verbalize concerns.
 of inappropriate antidiuretic reactions
PHARMACOLOGIC: hormone.
Selective Serotonin Reuptake  Low amount of magnesium, CV: orthostatic hypotension, Edx:
Inhibitor sodium, and potassium in tachycardia, ECG changes
 the blood.  -Educate client on drug therapy to
 Manic-depression. Metabolic: hyponatremia promote understanding and
DOSAGE: compliance.
20 mg Interactions EENT: abnormal visual  -Encourage patient to verbalize
Drug-drug: accommodation concerns.
ROUTE:  - Instruct patient to take drug with
PO 5-hydroxytryptamine1 receptor GI: nausea, vomiting, diarrhea, full
agonists abdominal pain, dyspepsia, glass of water with or without food
(such as sumatriptan, zolmitriptan):flatulence, at
increased risk of adverse reactions increased saliva, dry mouth, same time every day.
increased
Lithium: potentiation of appetite, anorexia DURING:
serotonergic Dx:
effects GU: polyuria, amenorrhea,  -Monitor patient for life-threatening
dysmenorrhea, ejaculatory delay, adverse effects.
MAO inhibitors: life-threatening erectile dysfunction, decreased  -Monitor vital signs, watch for signs
reactions libido and symptoms.
Tricyclic antidepressants (TCAs): Tx:
altered Musculoskeletal: joint pain,  -Ensure that the patient takes the
TCA pharmacokinetics myalgia medication once a day.
 -Assist patient in taking the -
Respiratory: cough
medication.
Edx:
Skin: rash, pruritus, diaphoresis,
 -Encourage patient to report allergic
photosensitivity
reactions.
Other: altered taste, fever, yawning, - Instruct patient to immediately
weight changes, serotonin report irregular or rapid heartbeats,
syndromelike reactions dizziness, fainting, palpitations,
agitation, hallucinations,
incoordination, nausea, vomiting,
diarrhea, fever, muscle rigidity,
altered mental status (including
catatonic signs), excessive
sweating, headache, difficulty
concentrating, memory impairment,
confusion, weakness, and
unsteadiness

AFTER
Dx:
 -Assess effectiveness of medication.
 -Assess for signs of adverse effects.
Tx:
 -Provide written instruction to the
patient and family in taking the
medication.
 -Provide comfort measures such as
instructing the patient to take the
drug with food and promote rest to
help patient tolerate drug effects.
 -Ensure that patient receives full
course of medication as prescribed.
Edx:
 -Stress importance of follow-up
visits.
 -Educate patient not to stop therapy
abruptly.
 - Instruct patient to move slowly
when
sitting up or standing, to avoid
dizziness or light-headedness
caused by sudden blood pressure
decrease.
 - Educate the patient several weeks
may pass before he starts to feel
better.