DRUG STUDY

1st Four Drugs

DRUG 1
Generic Name: Alprazolam
Brand Name: Xanax, Xanax XR, Apo-Alpraz, Apo-Alpraz TS
Classification Name:
 Therapeutic Class: Anxiolytics
 Pharmacologic Class: Benzodiazepines

Drug form and Dosage ordered:

Oral Solution: 1 mg/mL (concentrate)
Tablet, 0.25 mg, 0.5 mg, 1 mg, 2 mg
Tablets (ODTs): 0.25 mg, 0.5 mg, 1 mg, 2 mg
Tablets (extended-release): 0.5 mg, 1 mg, 2 mg, 3 mg

Timing: 0.25 mg BID, TID, or 0.5 mg Once a Day

Duration: Half-life: Immediate-release, 6.3 to 26.9 hours; Extended-release, 10.7 to
15.8 hours
Other Drug forms: Oral Solution, Tablet, Tablet (ODTs), Tablet (extended-release)

Indication:
 Anxiety
- Treatment of generalized anxiety disorder (GAD), short-term anxiety and
anxiety association with depression
 Panic disorders
- With or without agoraphobia

Pharmacodynamics:
 Unknown. Probably potentiates the effects of GABA, depresses the CNS, and
suppresses the spread of seizure activity
Side Effects and Adverse Reactions:
 CNS: insomnia, irritability, dizziness, headache, anxiety, confusion, drowsiness,
light-headedness, sedation, somnolence, difficulty speaking, impaired
coordination, memory impairment, fatigue, depression, suicide, mental
impairment, ataxia, paresthesia, dyskinesia, hypoesthesia, lethargy, vertigo,
malaise, tremor, nervousness, restlessness, agitation, nightmare, syncope,
akathisia, mania.
 CV: palpitations, chest pain, hypotension.
 EENT: blurred vision, tinnitus, allergic rhinitis, nasal congestion.
 GI: diarrhea, dry mouth, constipation, nausea, increased or decreased appetite,
anorexia, vomiting, dyspepsia, abdominal pain, increased or decreased
salivation.
 GU: dysmenorrhea, sexual dysfunction, premenstrual syndrome, difficulty
urinating.
 Metabolic: increased or decreased weight.
 Musculoskeletal: arthralgia, myalgia, arm or leg pain, back pain, muscle rigidity,
muscle cramps, muscle twitch.
 Respiratory: URI, dyspnea, hyperventilation.
 Skin: pruritus, increased sweating, dermatitis.
 Other: influenza, injury, emergence of anxiety between doses, dependence,
feeling warm, increased or decreased libido.

Contraindications:
 Hypersensitivity to alprazolam or any component of the formulation or other
benzodiazepines and in those with acute angle-closure glaucoma

Nursing Responsibilities:
 Monitor patient also taking an opioid for signs and symptoms of respiratory
depression and sedation.
- The optimum duration of therapy is unknown.
- Give smallest effective dose to prevent ataxia or oversedation, especially in
elderly or debilitated patients.
 Alert: Don't withdraw drug abruptly; withdrawal symptoms, including seizures,
may occur. Gradually reduce dosage. Abuse or addiction is possible.
 Monitor hepatic, renal, and hematopoietic function periodically in patients
receiving repeated or prolonged therapy.
 Closely monitor addiction-prone patients.
  Alert: Panic disorder is associated with major depressive disorders and increased
reports of suicide among untreated patients. Monitor patients with depression for
suicidal ideation or plans for suicide.
 Consider giving same total daily dose of immediate-release formulation in divided
doses more frequently in patients being treated for panic disorder who
experience early-morning anxiety or anxiety symptoms between doses.
Patient Teaching:

 Caution patient or caregiver of patient taking an opioid with a benzodiazepine,

CNS depressant, or alcohol to seek immediate medical attention if patient
experiences dizziness, light-headedness, extreme sleepiness, slowed or difficult
breathing, or unresponsiveness.
 Warn patient to avoid hazardous activities that require alertness and good
coordination until effects of drug are known.
 Tell patient to avoid use of alcohol while taking drug.
 Advise patient that smoking may decrease drug's effectiveness.
 Warn patient not to stop drug abruptly because withdrawal symptoms or seizures
may occur.
 Tell patient to swallow extended-release tablets whole.
 Tell patient using ODT to remove it from bottle using dry hands and to
immediately place it on the tongue, where it will dissolve and can be swallowed
with saliva.
 Tell patient taking half a scored ODT to discard the unused half.
 Advise patient to discard the cotton from the bottle of ODTs and keep it tightly
sealed to prevent moisture from dissolving the tablets.
 Warn female patient not to use drug if she is pregnant or breastfeeding and to
report pregnancy to prescriber.

DRUG 2
Generic Name: Biperiden hydrochloride
Brand Name: Akineton, Biperid
Classification Name:
 Therapeutic Class: Muscarinic receptor antagonist
 Pharmacologic Class: Anticholinergic

Drug form and Dosage ordered:

Timing:
Duration:
Other Drug forms:

Indications:
 Used to treat parkinsonism and control extrapyramidal side effects of neuroleptic
drugs
 Adjunct in the therapy of all forms of parkinsonism and control of extrapyramidal
disorders secondary to neuroleptic drug therapy

Pharmacodynamics:
 Biperiden is a weak peripheral anticholinergic agent. It has some antisecretory
antispasmodic and mydriatic effects
 Biperiden possesses nicotinolytic activity
 The parenteral form of biperiden is an effective and reliable agent for the
treatment of acute episodes of extrapyramidal disturbances sometimes seen
during treatment with neuroleptic agents
 Akathisia, akinesia, dyskinetic tremors, rigor, oculogyric crisis, spasmodic
torticollis, and profuse sweating are markedly reduced or eliminated

Side Effects and Adverse Reactions:

 CNS: confusion, depression, dizziness, hallucinations, headache, sedation,
weakness
 EENT: blurred vision, dry eyes, mydriasis
 CV: arrhythmias, hypotension, palpitations, tachycardia
 CI: constipation, dry mouth, ileus, nausea

Contraindications:
 Hypersensitivity reactions to Biperiden
 Have narrow-angle glaucoma
 Have an obstruction in bowel or a complication of bowel disease known as
megacolon
 Have myasthenia gravis

Nursing Responsibilities:
  Monitor BP and pulse after IV administration
 Advise patient to make position changes slowly and in stages, particularly from
recumbent to upright position
 Monitor for and report immediately: mental confusion, drowsiness, dizziness,
agitation, hematuria, and decrease in urinary flow
 Assess for and report blurred vision
 Monitor I & O ratio and pattern
Patient Teaching:

 Instruct patient to report other bothersome side effects, including severe or

prolonged headache, vision problems, decreased sweating, urinary problems
(hesitancy, retention) or GI problems (nausea, constipation, dry mouth)

DRUG 3
Generic Name: Risperidone
Brand Name: Risperdal, Perseris, Risperdal Consta
Classification Name:
 Therapeutic Class: Antipsychotics
 Pharmacologic Class: Benzisoxazole derivatives

Drug form and Dosage ordered:

Injection: 12.5 mg, 25 mg, 37.5 mg, 50 mg, 90 mg, 120 mg
Oral solution: 1 mg/mL
Tablets: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
Tablets (ODTs): 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
Timing: Generally 2 mg PO Once daily or BID
Duration: Half-life: PO, 3 to 20 hours; IM, 3 to 6 days; subcut, 9 to 11 days.
Other Drug forms: Injection, Oral Solution, Tablets, Tablets (ODTs)

Indications:
 Schizophrenia
  Parenteral maintenance therapy for schizophrenia or bipolar I disorder (as
monotherapy or as combination therapy with lithium or valproate)
 Monotherapy or combination therapy with lithium or valproate for 3-week
treatment of acute manic or mixed episodes from bipolar I disorder
 Irritability, including aggression, self-injury, and temper tantrums, associated with
an autistic disorder
Pharmacodynamics:
 Blocks dopamine, 5-HT2, alpha1 and alpha2 adrenergic, and H1 histaminergic
receptors in the brain.
 Primary action is to decrease dopaminergic and serotonergic pathway activity in
the brain therefore decreasing symptoms of schizophrenia and mood disorders

Side Effects and Adverse Reactions:

 CNS: akathisia, somnolence, dystonia, headache, insomnia, agitation, anxiety,
pain, parkinsonism, NMS, dizziness, fever, hallucination, mania, impaired
concentration, abnormal thinking and dreaming, tremor, hypoesthesia, fatigue,
depression, nervousness, parkinsonism.
 CV: tachycardia, chest pain, orthostatic hypotension, peripheral edema, syncope,
HTN. EENT: rhinitis, sinusitis, pharyngitis, abnormal vision, ear disorder (IM).
 GI: constipation, nausea, vomiting, dyspepsia, abdominal pain, anorexia, dry
mouth, increased saliva, diarrhea.
 GU: urinary incontinence, increased urination, abnormal orgasm, decreased
libido, vaginal dryness, amenorrhea.
 Metabolic: weight gain or loss, hyperglycemia, gynecomastia.
 Musculoskeletal: arthralgia, back pain, leg pain, myalgia.
 Respiratory: coughing, dyspnea, URI.
 Skin: rash, dry skin, photosensitivity reactions, acne, injection-site pain (IM).
Other: toothache, injury.

Contraindications:
 Contraindicated in patients hypersensitive to drug.
 Opioids should only be prescribed with benzodiazepines or other CNS
depressants to patients for whom alternative treatment options are inadequate.
 Elderly patients with dementia-related psychosis treated with antipsychotics are
at increased risk for death. Drug isn't approved to treat elderly patients with
dementia-related psychosis.
  Use cautiously in patients with prolonged QT interval, CV disease,
cerebrovascular disease, dehydration, hypovolemia, history of seizures, or
conditions that could affect metabolism or hemodynamic responses.
 Use cautiously in patients exposed to extreme heat.
 Use caution in patients at risk for aspiration pneumonia.
 Use IM injection cautiously in those with hepatic or renal impairment.
 Somnolence, orthostatic hypotension, and motor and sensory instability have
been reported, which may lead to falls and fall-related injuries.

Nursing Responsibilities:
 Alert: Obtain baseline BP measurements before starting therapy and monitor BP
regularly. Watch for orthostatic hypotension, especially during first dosage
adjustment.
 Elderly patients with dementia-related psychosis treated with antipsychotics are
at increased risk for death. Drug isn't approved to treat elderly patients with
dementia-related psychosis.
 Monitor patient for tardive dyskinesia, which may occur after prolonged use. It
may not appear until months or years later and may disappear spontaneously or
persist for life, despite stopping drug.
 Alert: Watch for evidence of NMS (extrapyramidal effects, hyperthermia,
autonomic disturbance), which is rare but can be fatal.
 Life-threatening hyperglycemia may occur in patients taking atypical
antipsychotics. Monitor patients with diabetes regularly
 Alert: Monitor patient for symptoms of metabolic syndrome (significant weight
gain and increased BMI, HTN, hyperglycemia, hypercholesterolemia, and
hypertriglyceridemia).
 Periodically reevaluate drug's risks and benefits, especially during prolonged use.
 Patients experiencing persistent somnolence may benefit from administering half
the daily PO dose b.i.d.
 Monitor patient for weight gain.
 Complete fall risk assessments when initiating treatment and recurrently for
patients on long-term therapy, especially for elderly patients and patients with
diseases, conditions, or who are taking other drugs that could increase fall risk

Patient Teaching:
 Warn patient to avoid activities that require alertness until effects of drug are
known.
 Caution patient or caregiver of patient taking an opioid with a benzodiazepine,
CNS depressant, or alcohol to seek immediate medical attention for dizziness,
 light-headedness, extreme sleepiness, slowed or difficult breathing, or
unresponsiveness.
 Warn patient to rise slowly, and use other precautions to avoid fainting when
starting therapy.
 Advise patient that drug may increase fall risk due to somnolence, orthostatic
hypotension, and motor and sensory instability.
 Advise patient to use caution in hot weather to prevent heatstroke.
 Tell patient to take drug with or without food.
 Instruct patient to keep the ODT in the blister pack until just before taking it. After
opening the pack, patient should dissolve the tablet on the tongue without cutting
or chewing. Tell patient to use dry hands to peel apart the foil to expose the
tablet. Patient shouldn't attempt to push tablet through the foil.
 Advise female patient not to become pregnant or to breastfeed for 12 weeks after
final IM injection.
 Advise patient to avoid alcohol during therapy.

DRUG 4
Generic Name: Lithium carbonate
Brand Name: Carbolith, Lithane, Lithmax, Lithoboid
Classification Name:
 Therapeutic Class:
 Pharmacologic Class:

Drug form and Dosage ordered:

Timing:
Duration:
Other Drug forms:

Indications:
 Monotherapy for treatment of acute manic and mixed episodes associated with
bipolar 1 disorder
Pharmacodynamics:
 Mechanism of action is still unknown
  Therapeutic action may be due to a number of effects, ranging from inhibition of
enzymes such as glycogen synthase kinase, inositol phosphates, or modulation
of glutamate receptors

Side Effects and Adverse Reactions:

 Feeling sick (nausea)
 Diarrhea
 Dry mouth or a metallic taste in the mouth
 Feeling thirsty and needing to drink more and pee more than usual
 Mild tremor or Slight shaking of the hands
 Feeling tired or sleepy
 Weight gain (likely very gradual)
 Drowsiness, dizziness
 GI upset
 Fever

Contraindications:
 Hypersensitivity reactions to lithium carbonate
 Patients with renal failure, cardiovascular insufficiency, Addison’s disease and
untreated hypothyroidism
 For patients with less severe renal impairment, careful consideration of the risks
and benefits of lithium treatment is required

Nursing Responsibilities:
 Assess patient’s mental statis initially and periodically; if indicated, initiate suicide
preventions
 Monitor intake and output and report any drastic changes
 Patient should be drinking at least 2000 – 3000 mL a day
 Patient’s weight should be taken every 3 months
 Monitor renal and thyroid function
 Test patient’s glucose levels
 Monitor serum lithium levels twice a week during chronic therapy
 Assess patient for signs and symptoms of lithium toxicity

Patient Teaching:
 Teach patient to take this drug exactly as prescribed, after meals or with food or
milk
 Teach patient to swallow extended- or controlled release tablets whole and do
not chew or crush
 Eat a normal diet with normal salt intake; maintain adequate fluid intake at least
2.5 quarts/day
 Arrange for frequent checkups, including blood tests. Keep all appointments for
checkups to get the most benefits with the least toxicity
 Use contraception to avoid pregnancy.
 If client wishes to become pregnant or is pregnant, let her consult her health care
provider
 Let patient discontinue drug and notify health care provider if toxicity occurs such
as diarrhea, vomiting, drowsiness, and other side effects.
 If GI is upset, eat frequent small meals