ANTIPSYCHOTICS

Antipsychotic drugs are dopamine-receptor blockers used to treat disorders associated with
problems in thought processes. They are used to treat serious illnesses such as schizophrenia,
drug-induced psychoses and autism. They are also used to treat extreme mania, bipolar
disorder, depression that is resistant to other therapy, certain movement disorders like
Tourette’s syndrome. Antipsychotics have also been referred to as tranquilizers or
neuroleptics because they produce a state of tranquility and act on abnormally functioning
nerves. Major tranquilizer was the term used following the introduction of the first generation
drugs because sedation is a prominent action of them. Neuroleptic is used to denote drugs that
have effects on the nervous system, especially those that have Parkinson’s-like adverse
effects on posture and body movement. However, these are both older terms that are now less
commonly used.

There are two classes of anti psychotics which are:

1. Typical (First generation) antipsychotics. They form two subclasses: the

phenothiazines and no phenothiazines. They are effective at treating schizophrenia but
exhibit a high incidence of adverse effects.
2. Atypical (Second generation) antipsychotics. They have become the preferred drugs
for treatment of schizophrenia. They produce lower incidence of adverse effects than
the first generation drugs.

Nursing Assessment

 Perform a complete head-to-toe physical assessment and mental status examination.

 Assess the patient’s neurologic functioning, including level of consciousness, mental
alertness, as well as level of motor and cognitive functioning. Note baseline levels of
motor responses and reflexes as well as presence of any tremors, personality changes.
 Assess the cardiovascular, cerebrovascular, neurologic, gastrointestinal, genitourinary,
renal, hepatic, and hematologic functioning.
 Assess for the presence of of cold clammy hands, sweating, pallor.
 Regularly assess the patient for any suicidal ideation or tendencies with attention not
only to overt cues and behaviors but also to covert thoughts and ideation.
 Assess sleep habits and nutritional intake and weight gain.
  Assess and document vital signs before, during and after drug therapy. Take note of
postural Blood pressures because of the possible drug related adverse effects of
postural hypotension and dizziness.
 Note any drug allergies, contraindications, cautions, and potential drug interactions.
 Carefully review the results of any laboratory performed before and during drug
therapy.
 Assess the patient’s mouth and oral cavity to make sure the patient has swallowed the
entire oral dosage.
 Also assess addictive behaviors, elimination difficulties, allergic reactions and note
any new symptoms or problems.

Nursing Diagnosis

1. Impaired Urinary Elimination related to adverse effects of the psychotherapeutic

drugs as evidenced by decreased urine output.
2. Altered gastrointestinal elimination related to adverse effects of psychotherapeutic
drugs as evidenced by difficulty in
3. Risk for nutritional imbalance related to consequences of mental health disorder.
4. Deficient knowledge related to lack of information about the specific antipsychotic
drug as evidenced by patient’s communication wrong information.
5. Decreased self esteem related to sexual dysfunction associated with use of
psychotherapeutic drugs as evidenced by patient’s.
6. Risk for injury related to adverse effects of psychotherapeutic drugs on the central
nervous system.

Planning

 Patient will be encouraged to increase fluid intake and report urinary urgency,
hesitancy, retention, or discomfort in the lower abdomen. This will help to improve
patient’s elimination of urine.
 Patient will be educated on how to maintain healthy gastrointestinal elimination
patterns with an increase in fluids and dietary fiber with fruits and vegetables. This
will help prevent constipation and improve patient’s elimination.
 Patient will show improved nutritional status and healthy nutritional habits with
appropriate weight gain.
  Patient will be educated about the condition, the specific medication administered,
possible side effects, as well as the importance of compliance to medication regimen.
 Patient will be able to discuss with the nurse options for improving the sexual
functioning to assist with any altered patterns of sexual behavior.
 Patient will maintain high and positive self esteem in daily interactions while
experiencing fewer episodes of self destructive and negative behaviors.
 Patient will be educated on safety measures. At the end of the teaching, the patient
will demonstrate safety with activities of daily living and self care measures by
moving slowly, changing positions slowly, reporting excess dizziness as well as
fainting episodes.

Implementation

 Demonstrate a firm, calm, and empathic attitude with the use of therapeutic
communication skills while establishing a therapeutic relationship.
 Identify the patient’s education status, level of understanding and using an effective
teaching and learning method, provide simple explanations about the drug, it’s action,
possible side effects and length of time before therapeutic effects can be expected.
 Monitor vital signs and document findings especially during the initiation of the drug
therapy.
 Ensure the drugs are taken exactly as prescribed and at the same time every day
without failure. If there’s an omission, the patient should be instructed on how to
handle it or you contact the prescriber immediately.
 Solicit help from family members or others providing support in the care of the
patient so that there are options for assistance with drug administration. Adherence to
medication regimen is very crucial to effective management therefore the nurse
should identify and utilize all the support systems and resources to accomplish this.
 The nurse should encourage other forms of treatment therapies like intense
psychotherapy, relaxation therapy, stress reduction, and lifestyle changes.
 Encourage the patient to suck on sugar free hard candy or gum to help relieve dry
mouth.

Evaluation

 Monitor the therapeutic effects of the antipsychotic medication and patients progress
before, during and after drug therapy. Mental alertness, cognition, mood, affect,
 ability to carry out activities of daily living, appetite, sleep patterns should all be
closely monitored and documented.
 Monitor the serum levels of the drugs to identify both sub therapeutic and toxic levels.
 Monitor the patient for any side effects, adverse effects or idiosyncratic reactions.

Examples of Antipsychotics

1. Clozapine
2. Haloperidol

CLOZAPINE

Class- Atypical Antipsychotic

Group- Atypical Antipsychotic

Generic Name- Clozapine

Trade Name- Clozaril

Mechanism of Action- It selectively blocks the dopaminergic receptors in the mesolimbic

regions of the brain

Dosage, Route and Frequency- Oral, Start with 12.5-25mg daily and gradually increase to
300-450mg daily. The maximum should be 900mg daily. Larger doses are divided tds.

Indications- Schizophrenia, recurrent suicidal behavior in patients with schizophrenia or

schizoaffective disorder.

Contraindications- Known drug allergy, Myeloproliferative disorders, Severe

glanulocytopenia, CNS depression, angle-closure glaucoma.

Side Effects- Sedation, Headache, Agranulocytosis, Confusion

Nursing Assessment

 Perform a thorough mental status examination, and document findings prior to

initiation of treatment.
  Assess musculoskeletal functioning and monitor for any extrapyramidal reaction.
 Monitor liver ad renal function, complete blood count, and urinalysis before and
during the therapy.
 Make sure to document blood pressure readings with close attention to postural
readings.
 Carefully monitor heart sounds, and observe for any abnormal heart rhythms.

Patient/Family Teaching

 Educate patient on the importance of taking medication as prescribed.

 Educate patient in possible adverse effects stating that it’s important to watch for any
changes in mood or behavior, as clozapine can cause serious side effects like suicidal
thoughts or actions.
 Instruct patient to report lethargy, weakness, fever, sore throat, malaise, mouth ulcers,
and flulike symptoms.

HALOPERIDOL

Class- Typical Antipsychotics, Dopamine receptor antagonist

Group- Butyrophenone

Generic Name- Haloperidol

Trade Name- Haldol

Mechanism of Action- It depresses the cerebral cortex, hypothalamus, and limbic system. It
also blocks neurotransmission at postsynaptic dopamine receptors and exhibits alpha-
adrenergic blocking and anticholinergic effects.

Dosage, Routes and Frequency- PO, IM, IV. 0.5-5mg b.d or t.d.s.

Indications- Schizophrenia, Tourette’s syndrome, severe refractory behavioral problems or

hyperactivity, Nausea (low doses).

Contraindications- Parkinson’s disease, seizure disorders, coma, alcoholism, severe mental

depression, CNS depression, lactation.
Side Effects- Drowsiness, EPS, Tardive dyskinesia, NMS, Agranulocytosis, Respiratory
depression, Laryngospasm.

Nursing Assessment

 Assess the therapeutic effects of the drug. Also assess for adverse effects.
 Assessment of baseline motor, sensory, and neurologic functioning.
 Monitor for extrapyramidal reactions that occur frequently during first few days of
treatment.
 Monitor WBC count with differential and liver function in patients on prolonged
therapy.

Patient/Family Teaching

 Instruct patient to take oral dose with a full glass (240 mL) of water or with food or
milk.
 Instruct patient to avoid use of alcohol during therapy.
 Educate patient on the dangers of driving or engaging in other potentially hazardous
activities until response to drug is known.
 Instruct patient to avoid overexposure to sun or sunlamp and use a sunscreen; drug
can cause a photosensitivity reaction.


ANTIDYSRHYTHMIC

The therapeutic goals of antidysrhythmics are to terminate existing dysrhythmias or to

prevent abnormal rhythms for the purpose of reducing the risks of sudden death, stroke or
other complications resulting from the condition. These drugs act by altering specific
electrophysiologic properties of the heart. They do this through two basic mechanisms:
blocking flow through ion channels (conduction) or altering autonomic activity
(automaticity). These drugs are classified using Vaughan Williams classification. There are
four major classes of drugs: I (including Ia, Ib, and I), II, III, and IV.

Class Ia: they increase blockade of sodium channel, delay polarization, increase action
potential duration. They are Quinidine, Disopyramide, Procainamide.

Class Ib: they increase blockade of sodium channel, accelerate repolarization, can increase or
decrease action potential. Examples are Lidocaine, Phenytoin.
Class Ic: increase blockade of sodium channel, increase or decrease repolarization; also
suppress reentry. Examples are Flecainide, Propafenone.

Class II: beta-blocking drugs. Slows conduction velocity, decreases automaticity; prolongs
refractory period. Examples are Acebutolol, Esmolol, Propranolol.

Class III: drugs wise principal effect on the cardiac tissue is to increase action potential
duration. Slows repolarization and prolongs refractory period. Examples are Amioradone,
Dronedarone, Sotalol, Ibutilide, Dofetilide.

Class IV: calcium channel blockers. Slows conduction velocity, decreases contractility;
prolongs refractory period. Examples are Verapamil, Diltiazem.

It’s important to note that there are antidysrhythmic drugs that have the properties of several
classes a d therefore cannot be placed in one particular class. Examples are Digoxin,
Adenosine.

Nursing Assessment

 Perform a head-to-toe physical assessment, collect medical history and medication

profile. Also pay attention to the patient’s gender and race-ethnicity.
 Review any baseline ECGs and interpretation. Also check vital signs with attention to
blood pressures, postural blood pressures, heart sounds and pulse.
 Assess for signs and symptoms associated with decreased cardiac functioning.
 Assess baseline levels of alertness and any increase in anxiety levels, restlessness.
They can indicate hypoxia.
 Assess for contraindications, cautions and drug-food interactions.
 Monitor periodic electrolyte levels, especially potassium, calcium and magnesium;
renal function laboratory values; and drug levels as needed.

Nursing Diagnosis

1. Decreased cardiac output related to cardiac effects of the drug as evidenced by weak
pulse and cool extremities.
2. Ineffective peripheral tissues perfusion related to decreased blood flow to different
body parts as evidenced by slow capillary refill and cyanosis.
3. Altered sensory perception related to effects of the drug on the central nervous system
as evidenced by confusion or patient.
 4. Risk for injury related to weakness and dizziness

Planning

 Patient will have an increase in the cardiac output with control of dysrhythmia.
 Patient will experience improved peripheral perfusion with strong, regular bilateral
peripheral pulses and warm, pink extremities.
 Patient will demonstrate adequate knowledge about the therapeutic effects and
adverse effects of medication therapy.

Implementation

 Monitor the vital signs especially pulse rate and blood pressure.
 Closely monitor the ECG because of possible prolongation of the patient’s QT
interval by more than 50%.
 If not contraindicated, advise the patient that oral dosage forms are better tolerated if
taken with food and fluids to minimize gastrointestinal upset.
 An infusion pump should be used for intravenous dosing of any of the classes of
antidysrhythmics with use if proper solution and dilution. Titrate the dose to the
smallest amount enough to manage arrhythmia to decrease the risk of drug toxicity.
 When administering lidocaine, it is important to check the vial carefully to be sure if
it’s for cardiac use. They are usually labeled as either for “cardiac” or “not for
cardiac” use.
 Continue to monitor periodic electrolyte levels, especially potassium, calcium and
magnesium; renal function laboratory values; and drug levels as needed.
 Discuss with the patient the rationale for the drug therapy, desired therapeutic
outcomes, possible adverse effects and any necessary monitoring or precautions.
 Provide comfort and safety measures (e.g. raising side rails, adequate room lighting,
noise control) to help patient tolerate drug effects.

Evaluation

 Monitor closely for the therapeutic effects as well as adverse effects and toxicities.
  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.

Examples of Antidysrhythmics

1. Lidocaine
2. Amioradone

LIDOCAINE

Class- Ib Antidysrhythmics

Group- Sodium Channel blockers

Generic Name- Lidocaine

Trade Name- Xylocaine

Mechanism of action- They block sodium channels, accelerate repolarization and decrease
the action potential duration.

Dosage, Routes and Frequency- IV: 1-4mg/min infusion (max: 3mg/kg per 5-10min). Max
dose of 300mg total bolus in 1hr.

Indications- Life-threatening ventricular dysrhythmias

Contraindications- Hypersensitivity to it, severe SA or AV intraventricular block, Stokes-

Adams, Wolff-Parkinson-White syndrome.

Adverse Effects- Bradycardia, Hypotension, Anxiety, Metallic taste, Dysrhythmia, Nausea,

Vomiting, Drowsiness, Dizziness, Lethargy.

Nursing Assessments

 Assess the cardiovascular system with attention to heart rate and blood pressure.
 Check the ECG and stop infusion immediately if it indicates excessive cardiac
depression.
 Check the vial carefully to be sure if it’s for cardiac use. They are usually labeled as
either for “cardiac” or “not for cardiac” use. Lidocaine is also an anesthetic so the
 concentration of the drug should be double-checked if not triple-checked. Solutions
with epinephrine must never be used intravenously but only ad topical anesthetic.
 Assess for neurotoxic effects (e.g., drowsiness, dizziness, confusion, paresthesia,
visual disturbances, excitement, behavioral changes) in patients receiving IV infusions
or with high lidocaine blood levels.

Patient/Family Teaching

 Oral topical anesthetics (e.g., Xylocaine Viscous) may interfere with swallowing
reflex. Do NOT ingest food within 60 min after drug application; especially pediatric,
geriatric, or debilitated patients.
 Do not chew gum while buccal and throat membranes are anesthetized to prevent
biting trauma.

AMIORADONE

Class- Class III Antidysrhythmics

Group- Potassium channel blocker

Generic Name- Amioradone

Trade Name- Cordarone

Mechanism of action- They increase the action potential by prolonging repolarization in

phase 3. The refractory period is prolonged and automaticity is reduced.

Dosage, Route and Frequency- IV: 150mg over 10min, then 360mg over 6hr, then 540mg
over 18hrs, then decrease to 0.5mg/min. PO: usual maintenance dose of 200-600mg daily.

Indications- Life-threatening ventricular tachycardia of fibrillation, atrial fibrillation

resistant to other drug therapy.

Contraindications- Hypersensitivity, severe sinus bradycardia, second or third degree heart

block.
Adverse Effects- Pulmonary toxicity, Thyroid disorders, bradycardia, hypotension, AV block,
SA node dysfunction, ataxia, hypoglycemia or hyperglycemia, visual disturbances, vasculitis,
epidermal necrolysis, Hepatotoxicity.

Nursing Assessment

 Assess for photosensitivity and photophobia in the patient.

 Assess for respiratory, thyroid, hepatic, dermatologic, or hypertensive conditions.
 Assess baseline and periodic serum electrolytes (including magnesium), periodic
CBC, and routine blood chemistry.
 Assess for drug interactions, contraindications and cautions.

Patient/Family Teaching

 Advise patient to avoid taking grapefruit juice while taking the medication because it
inhibits metabolism of hepatic enzymes thereby leading to an increased risk for
toxicity.
 Recommend the consumption of a high fiber diet and increase fluid intake of up to 8-
10 glasses of water per day to minimize constipation unless contraindicated.
 Emphasize the need for protection of eyes by wearing sunglasses or tinted contact
lenses. Also advise the patient to avoid sun exposure by wearing sun-protective
clothing.
 Recommend taking the drug with food or snack to reduce gastrointestinal upset.
 Instruct patient to immediately report any blue-gray discoloration of the skin (usually
after a year) as well as any jaundice, unusual skin rash, reactions, nausea, vomiting ,
dizziness.

ANXIOLYTICS

An anxiolytic is any drug that has the ability to relieve anxiety. Primary anxiolytics include
the benzodiazepine drug class and the miscellaneous drug buspirone.

The benzodiazepines which include alprazolam, diazepam, and lorazepam are commonly
used in the first line drug therapy for both acute and chronic anxiety disorders.

Nursing Assessment
  Assess and document the vital signs paying attention to the blood pressure reading
especially because of drug-related postural hypotension.
 Assess alertness, orientation, sensory/motor functioning, as well as any complaints of
ataxia, headache or other neurologic abnormalities.
 Closely observe and assess older adult patients for over sedation and/or profound
CNS depression during drug therapy.
 Conduct a baseline visual testing using a Snellen chart.
 Assess for suicidal in the patients.
 Assess for drug interactions, contraindications, and cautions.

Nursing Diagnosis

1. Risk for Falls related to CNS depressant effects.

2. Disturbed Sleep Pattern related to sedative effects of anxiolytics as evidenced by
changes in duration and quality of sleep
3. Deficient knowledge related to lack of enough understanding of when and how to take
prescribed medication as evidenced by patient’s demonstration of confusion about the
prescribed medication regimen.
4. Risk for Suicidal Ideation related to paradoxical reactions from anxiolytics.

Planning

1. Aim to reduce risk for falls by:

 Teaching and assisting patient with safety precautions like bed in low position,
call light in reach.
 Enrolling patient in balance/ambulation program to improve strength and stability
 Ensuring adequate nonskid footwear and mobility aids are in use.
2. Improve the sleep patterns of the patient by:
 Assessing the current sleeping pattern, duration and quality.
 Identifying factors that contribute to sleep disturbance.
 Developing a consistent sleep routine with the patient.
 Consider scheduling anxiolytics to avoid initial sedation during sleep.
 Teaching proper sleep hygiene like cool, dark and quiet environment.
  Recommend the use of blackout curtains, earplugs, or other aids to create a conducive
sleep environment.
 Regularly reassess the effectiveness of the sleep interventions and adjust the plan as
needed.
3. Improve the Knowledge of the patient by:
 Assessing the current knowledge of the patient to identify areas of confusion or
deficiency.
 Teaching the indications, dosage, frequency and purpose of each medication.
 Discussing the common side effects, explaining when it’s imperative to contact
the physician.
 Ask patient to demonstrate proper administration technique with medication.
 Schedule regular follow-up to assess the patient’s understanding of anxiolytic
therapy and adjust education strategies as needed based on the patient’s responses
and feedback.
4. Reduce the risk for suicide and suicidal ideas by:
 Frequently assessing the mood, suicidal thoughts and behaviors.
 Establishing safety plan for coping strategies and close monitoring when
needed.
 Actively listen and provide supportive counseling and coping techniques.
 Refer to a mental health specialist for further suicide risk evaluation.

Implementation

 Frequent monitoring of vital signs with special attention to blood pressure and
postural blood pressure readings.
 Perform the three checks properly to ensure the right medication is administered to
prevent medication errors because of existence of sound-alike or look-alike drugs.
 Encourage the use of elastic compression stockings and changing positions slowly to
minimize dizziness and falls from orthostatic hypotension.
 Create a therapeutic environment for open communication to encourage patient’s
verbalization of all disturbing thoughts, including those of suicide.
 Check the patient’s oral cavities for hoarding or checking of drugs.
  Administer intramuscular dosage forms in a large muscular mass and only as
prescribed.
 Ensure fall precautions like nonskid socks and clearing the environment.

Evaluation

 Monitor the therapeutic effects of the drugs administered. They are evidenced by
improved mental alertness, cognition, and mood; less anxiety and panic attacks;
improved sleep patterns and appetite; more interest in self and others; less tension and
irritability; and fewer feeling of fear, impending doom and stress.
 Assess for adverse effects of hypotension, lethargy, fatigue, drowsiness, and
confusion.
 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.

Examples of Anxiolytics

1. Lorazepam
2. Buspirone

LORAZEPAM

Class- Anxiolytic

Group- Benzodiazepines

Generic Name- Lorazepam

Trade Name- Ativan

Mechanism of action- It potentiates the actions of GABA, thereby causing all levels of CNS
depression, from simple relaxation, to the induction of sleep, to coma.

Dosage, Routes and Frequency- PO, IM, IV. PO: 2-6mg daily divided in two to three doses
(max: 10mg daily)

Indications- Anxiety, alcohol withdrawal, agitation.

Contraindications- Drug allergy, narrow-angle glaucoma, pregnancy.

Adverse Effects- Drowsiness, dizziness, ataxia, blurred vision, vertigo, sedation, confusion,
anaphylaxis, constipation, dry mouth, anorexia, orthostatic hypotension.

Nursing Assessment

 Assess and monitor the patient for suicidal attempts because it use may be associated
with it.
 Assess for sleep patterns, mood changes, mental alertness, irritability, appetite.
 Assess for adverse effects of the drug as well as toxic reactions.

Patient/Family Teaching

 Educate patient on the importance of taking medication exactly as prescribed.

 Instruct patient not to stop medication abruptly.
 Educate patient on the potential adverse effects and when to contact the prescriber.
 Educate patient on the effects of drinking alcohol or smoking while taking the drug.
 Educate patient on the dangers of driving or engaging in any activity that requires
alertness.

BUSPIRONE

Class- Anxiolytic

Group- Nonbenzodiazepine Anxiolytic.

Generic Name- Buspirone

Trade Name- BuSpar

Mechanism of action- It enhances dopamine receptors and suppresses serotonin receptors in

the brain.

Dosage, Routes and Frequency- PO:

Indications- Anxiety

Contraindications- Drug allergy

Adverse Effects- Paradoxical anxiety, dizziness blurred vision, headache, nausea

Nursing Assessment
  Assess for therapeutic effects of the drug. Desired response may begin within 7–10
days. However, optimal results take 3–4 weeks.
 Assess for drug interactions, cautions and contraindications.
 Assess for sleep patterns, mood changes, mental alertness, irritability, appetite.
 Observe for and report swollen ankles, decreased urinary output, changes in voiding
pattern, jaundice, itching, nausea, or vomiting.

Patient/Family Teaching

 Instruct patient to take exactly as prescribed: Specifically, do not omit, skip, increase
or decrease doses without advice of the physician.
 Instruct patient not to take it with grapefruit juice as it can increase the effects of the
drug.
 Instruct patient not to take over the counter drugs without first consulting the
physician.

CNS DEPRESSANTS

Sedatives and Hypnotics are drugs that have a calming effect or that depress the central
nervous system (CNS).

Sedatives reduce nervousness, excitability and irritability without causing sleep, but a
sedative can become an hypnotic if it is given in large enough doses.

Hypnotics induce sleep and have much more potent effect on the CNS than sedatives do.

Sedatives-hypnotics can be classified chemically into three main groups: barbiturates,

benzodiazepines, and miscellaneous drugs.

Nursing Assessment

 Assess for insomnia, paying attention to the inset, duration, frequency, and
pharmacologic as well as non-pharmacologic measures taken.
 Assess for sleep disorders, sleep patterns, difficulty in sleeping or frequent
awakenings.
 Assess for time taken to fall asleep as well as energy level upon awakening.
 Assess vital signs thoroughly and presence of pain.
 Perform a thorough physical examination for baseline comparisons.
  Assess the mental status, memory cognitive abilities, alertness, level of orientation,
mood changes, depression or other mental disorders, changes in sensations, anxiety
and panic attacks.
 Assess for any allergies, use of alcohol, smoking history, caffeine intake, past and
current medication profile.
 Assess for general health status, weight, nutrition, exercise, life stressors and general
lifestyle.

Nursing Diagnosis

1. Risk for injury related to CNS depression effects of the medication.

2. Ineffective airway clearance related to depressed gag reflex as evidenced by
accumulation of pulmonary secretions.
3. Risk for Impaired gas exchange related respiratory depression as evidenced.
4. Risk for constipation related decreased gastrointestinal motility from anticholinergic
effects of the medication.

Planning

1. Reduce risk for injury by:

 Encouraging the use of assistive devices and precautions.
 Ensuring patient rooms and hall ways remain obstacles free.
 Ensuring call light and personal items are within reach.
2. Ensure there’s an improved airway clearance by:
 Teaching cough and deep breathing exercises.
 Identifying appropriate suctioning equipment when needed.
 Ensuring patient remains in upright, forward position to facilitate breathing.
3. Manage respiratory depression and reduce risk for Impaired gas exchange by:
 Frequently assessing respiratory rate, effort, oxygen saturation level.
 Monitoring for increased work of breathing or use of accessory muscles
 Teaching pursed lip breathing and cough/deep breathing techniques
 Maintaining clear airway and proper body alignment for breathing
 Preventing fatigue and pain which can contribute to shallow breathing.
4. Reducing the risk for constipation by:
 Establishing bowel regimen and promoting early ambulation.
  Reviewing dietary approaches such as high fiber foods.
 Reviewing the timing of medication administration that contribute to constipation.

Implementation

 Administer intravenous diuretics slowly because rapid administration may cause

cardiac problems.
 Ensure that safety precautions are taken such as use of side rails or bed alarms. Ensure
ambulation occurs safely and with assistance when patients are sedated or are
experiencing adverse effects of the drug.
 Administer drug to patient prior to meals for faster onset of action. If GIT upset is
imminent, they can be taken with light meals or snacks.
 Observe and document the patient’s level of consciousness or sedation; orientation to
person, place and time; respiratory rate; oxygen saturation; and other vital signs.
 Monitor the patient’s red blood cell count and hemoglobin and hematocrit levels. Also
monitor the therapeutic blood levels of the drug.
 Intravenous barbiturates should be diluted with normal saline or other recommended
solutions.
 When giving intramuscular injection, give the solution deep into the large muscle
mass to prevent tissue sloughing; however avoid this route and use only when
absolutely necessary.

Evaluation

 Assess for therapeutic effect of the drug. This includes: increased ability to sleep at
night, fewer awakenings, shorter sleep induction time, few adverse effects such as
hangover effects, and an improved senses of well-being because of improved sleep.
 Constantly observe and document the occurrence of any adverse effects of
barbiturates, benzodiazepines.
 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.

Examples of CNS Depressants

1. Diazepam
 2. Zolpidem

DIAZEPAM

Class- Anxiolytic, Antiepileptic

Group- Long Acting Benzodiazepines

Generic Name- Diazepam

Trade Name- Valium

Mechanism of action- It depresses the GABA receptors in the brain thereby inhibiting
stimulation

Dosage, Routes and Frequency- PO: 2-10mg three to four times daily; IV: 2-10mg

Indications- Muscle relaxation, preprocedure sedation, status epilepticus, acute

anxiety/agitation.

Contraindications- Drug allergy,

Adverse Effects- Drowsiness, Paradoxical excitement, dizziness, vertigo, lethargy, cognitive

impairment.

Nursing Assessment

 Identify disorders or conditions that represent cautions or contraindications to it use.

Also assess for drug interactions.
 Assess the patient for signs of anemia, suicidal behaviors or history of drug abuse,
alcohol and other related substances.
 Assess renal function by reviewing laboratory results on renal and hepatic function to
rule out organ impairment and prevent potential toxicity or complications resulting
from decreased excretion and/or metabolism.
 Assess for concurrent use of other CNS depressants because this may lead to severe
decrease in blood pressure, respiratory rate, reflexes, and level of consciousness.

Patient/Family Teaching
  Advise the patient to take the drug in empty stomach or with light meal or snacks so
as to aid fast onset of action.
 Educate patient about the REM interference and rebound insomnia that may occur
with just a 3- to 4- week regimen of drug therapy.
 Educate patient about the effect of grapefruit juice on benzodiazepines.
 Instruct patient to avoid driving or participating in any activity that require mental
alertness while taking the drug.
 Instruct patient not to discontinue medication abruptly.
 Educate the patient on safety with these drugs such as avoiding smoking in bed or
when lounging.
 Educate the patient on the drug/drug and drug/food interactions.

ZOLPIDEM

Class- Hypnotics

Group- Short-acting Nonbenzodiazepine hypnotic

Generic Name- Zolpidem

Trade Name- Ambien

Mechanism of action- It binds the (BZ1) receptor specifically with a potent affinity for the
alpha 1/alpha 5 subunits (in vitro)

Dosage, Routes and Frequency- PO: 5-10mg at bedtime.

Indications- Sleep induction.

Contraindications- Drug allergy

Adverse Effects- Temporary memory loss,

Nursing Assessment

 Perform a head-to-toe physical assessment and a thorough medication history with

measurement of vital signs.
 Assess and document for allergies to the drugs and to aspirin.
 Assess for any confusion, lightheadedness, especially in older adults.
Patient/Family Teaching

 Emphasize that medications are to be taken only as prescribed. The patient should not
double up on dosage if one dose does not work unless otherwise prescribed.
 Advise the patient to take Zolpidem at bedtime on an empty stomach with no
crushing, chewing, or breaking if the oral dosage form. The medication should be
taken before midnight to prevent difficulty waking in the morning.
 Instruct patient not to discontinue medication abruptly.
 Educate the patient on safety with these drugs such as avoiding smoking in bed or
when lounging.
 Educate the patient on the drug/drug and drug/food interactions.

CNS STIMULANTS

These are a broad class of drugs that stimulate specific areas if the brain or spinal cord. CNS
stimulation results from either excessive stimulation of excitatory neurons or blockade of
inhibitory neurons. However, most stimulants act by stimulating the excitatory neurons in the
brain. All CNS stimulants have the common action on raising the general alertness level of
the brain. Mood is often elevated, and the individual may temporarily become unaware it
physical fatigue.

CNS stimulants are classified in three ways. The first is based on chemical structural
similarities. Major chemical classes of CNS stimulants includes amphetamines, serotonin
antagonists, sympathomimetics, and xanthines.

Secondly, they can be classified according to their site of action.

Finally, they can be classified according to their therapeutic uses and these include anti-
attention deficit, antinarcoleptic, anorexiant, antimigraine, and analeptic drugs.

Nursing Assessment

Collect a thorough medical history with attention to preexisting diseases or conditions,

especially those impacting the cardiovascular, cerebrovascular, neurologic, renal, and liver
systems.
Collect past and current history of addictive or substance abuse behaviors

Collect a complete medication profile with a listing if prescription, OTC, and herbal drugs
and any use of alcohol, nicotine, and/or social or illegal drugs

Take a complete nutritional and dietary history, lifestyle, exercise, stress levels.

Assess baseline weight, height and dietary intake.

Assess vital signs with attention to blood pressure and pulse rate.

Assess for contraindications, cautions and drug interactions.

Nursing Diagnosis

1. Risk for Ineffective Coping related to feelings of anxiety from CNS stimulant use.
2. Risk for Impaired Cardiovascular Function related to sympathomimetic effects of
CNS stimulants.
3. Disturbed Thought Processes related to potential agitation, hostility, mania from CNS
stimulant use as evidenced by pressured speech, illogical thoughts, paranoia.
4. Risk for Trauma related to tremors, uncoordinated movements from CNS stimulant
use.

Planning

1. Improve patient’s coping by:

 Assessing current coping methods and provide counseling .
 Teaching stress management and relaxation techniques.
 Encourage verbalization of worries and listen actively.
2. Reducing risk for improving cardiovascular functions by:
 Obtaining baseline vital signs and cardiac status
 Monitoring for chest pain, irregular heart rhythms
 Encourage patient to quickly report any adverse medication reaction.
3. Risk for Disturbed Thought Processes
 Frequently assess mental status and cognitions
 Validate patient’s perceptions and provide reassurance
 Reduce environmental stimuli that trigger paranoia
 4. Risk for Trauma
 Advise patient to avoid tasks that require motor control skills.
 Provide safety education to prevent household accidents
 Encourage use of assistive devices for stability .

Implementation

 For drugs used in the treatment of Attention Deficit Hyperactivity Disorder, dosing
should be individualized and based on the patient’s needs at different times during the
school day. There should be well planned scheduling of the medication and effective
communication among the school teachers, school nurse, and the student and family
to ensure successful treatment.
 The last dose should be taken about 4 to 6 hours prior to bedtime, as ordered so as to
decrease the occurrence of insomnia.
 Monitor the patient’s growth with specific attention to the height and weight.
 For anorexiant, medication should be taken first thing in the morning to minimize
interference with sleep. Recommend that the drugs should not be taken within 4 to 6
hours of bedtime.
 Assess patient’s weight weekly ad ordered.
 Encourage the patient to keep a record of food intake, as well as responses to drug
regimen, any adverse effects, socialization, exercise and notes about how they feel
day to day.
 Assess for tolerance to the anorexiant drug during course of treatment and it should be
reported if it occurs.
 Ergot Alkaloids should be taken exactly as prescribed. They work best when taken at
exactly the first sign of a migraine.
 Encourage the patient to report any unusual headaches, as well as any persistent
headache, worsening of headaches, severe nausea, vomiting, dizziness, restlessness.
 The medications should not be taken with triptans.
 An analeptic, doxapram should be administered intravenously and at different dosages
depending on the indication.
 Doxapram infusions should be given using intravenous pump, and the patient is
closely monitored.
 Place the patient in Sims or Semi-fowler’s position to prevent aspiration.
Evaluation

 Assess for therapeutic responses to the medications administered.

 Assess for adverse effects of the medications administered.
 Assess for any increased irritability and withdrawal symptoms.
 Assess the patient for decreased levels of fat-soluble vitamins.
 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.

Examples of CNS Stimulants

1. Atomoxetine
2. Sumatriptan

ATOMOXETINE

Class- Anti-ADHD

Group- Selective norepinephrine re-uptake inhibitor.

Generic Name- Atomoxetine

Trade Name- Strattera

Mechanism of action- It allows for increased concentration of the norepinephrine

neurotransmitter in the prefrontal cortex.

Dosage, Routes and Frequency- In Pediatric (less than 70kg), PO: 0.5-1.2mg/kg/day
divided once or twice daily.

In adults (70kg or more), PO: 40-100 mg/day divided once or twice daily.

Indications- Attention Deficit Hyperactivity Disorder.

Contraindications- Closed-angle glaucoma, current use of monoamine oxidase inhibitor,
Jaundice

Adverse Effects- Xerostomia, headache, decreased appetite, insomnia, mood swings,

irritability, agitation, orthostatic hypotension, tachycardia

Nursing Assessment

 Obtain baseline weight, height, growth and development patterns, vital signs,
complete blood cells count (if ordered) and subsequently.
 Assess the cardiac function, emotional)mental status, sleep habits or patterns.
 Assess for atypical behaviors, loss of attention span, history of social problems or
problems at school (in pediatrics)
 Assess nutritional and dietary status and document the daily dietary intake before and
during the drug therapy.
 Assess for contraindications, cautions and drug interactions.
 Note patient’s use of any other the counter drugs, prescription drugs or herbal
preparations specifically ginseng and caffeine.

Patient/Family Teaching

 Recommend that’s medications be taken on an empty stomach 30 to 45 minutes

before eating for maximal drug effects.
 Recommend that the last dose should be taken about 4 to 6 hours prior to bedtime, as
ordered so as to decrease the occurrence of insomnia.
 Encourage keeping all follow-up appointment to monitor drug therapy.
 Instruct patient and family not to increase or decrease dosage amounts to prevent
complications.
 Encourage family to ensure patient takes extended release preparations in their
original dosage form without altering it in any way.

SUMATRIPTAN

Class- Antimigraines

Group- Serotonin receptor agonist

Generic Name- Sumatriptan

Trade Name- Imitrex

Mechanism of action- It activates the 5-HT1 serotonin receptors on intracranial and extra
cerebral blood vessels, resulting in vasoconstriction and reduced transmission in trigeminal
pain pathways.

Dosage, Routes and Frequency- PO: 25-100mg, can be repeated after 2hrs (max
200mg/day); SC: 4-6mg, can be repeated after 1hr (max 2 injections/day); Nasal spray: 5-
20mg, can repeat after 2hrs ( max 40mg/day)

Indications- Acute migraines

Contraindications- Coronary artery disease, cerebrovascular disease, peripheral vascular

disease, Chronic Kidney Disease, Hepatic impairment.

Adverse Effects- Paresthesia, tingling, dry mouth, warming sensation, dizziness, vertigo.

Nursing Assessment

 Obtain a complete health history and medication history including allergies. This
should include a thorough cardiac history.
 Assess the level of pain and vital signs paying close attention to the blood pressure
and pulse.
 Assess for drug interactions, cautions and contraindications.
 Assess for desired therapeutic effects and also for adverse effects.

Patient/Family Teaching

 Teach the patient that the goal of the therapy is pain relief rather than control.
 Encourage the patient to take the drug before an headache becomes severe and to take
it as prescribed.
 Encourage the patient to avoid foods or beverages that are known triggers of the
migraine e.g. pickled foods, beer, wine, cheese.
 Before using a nasal spray dosage form, instruct the patient to first gently blow the
nose to clear the nasal passages. Teach patient how to use the nasal spray.
 Advise patient to avoid things that require alertness and rapid skilled movements until
migraine is relieved. It can be helpful to keep the room dark and minimize noise.
 Advise patient to keep a record about the experience ma of headaches,
precipitators/relievers, and the rating of the scale.
  Instruct the patient to contact the prescriber immediately if the are any problems like
palpitations, chest pain, or pain of the extremities.

ANTIDEPRESSANTS

These are drugs used to enhance or elevate mood. They are used to treat all symptoms of
major depressive disorders as sell as the depressive phases of bipolar disorder. They act by
restoring normal neurotransmitter balances in a specific regions of the brain. They increase
the levels of neurotransmitters concentration in the CNS.

When administered at therapeutic doses, all antidepressants have similar effectiveness

therefore, the choice if treatment is not usually based on this factor. The treatment is however
individualized and patients who are unresponsive to one class of medications may respond
favorably to drugs from a different class. The four primary classes of antidepressants are:

1. Selective serotonin re-uptake inhibitors (SSRIs)

2. Atypical antidepressants
3. Tricyclic antidepressants (TCAs)
4. Monoamine oxidase inhibitors (MAOIs)

The SSRIs are the preferred drugs for treating depression due to their low incidence of
serious adverse effects.

Nursing Assessment

 Perform a complete head-to-toe physical assessment and mental status examination.

 Regularly assess the patient for any suicidal ideation or tendencies with attention not
only to overt cues and behaviors but also to covert thoughts and ideation.
 Assess the patient’s neurologic functioning, including level of consciousness, mental
alertness, as well as level of motor and cognitive functioning. Note baseline levels of
motor responses and reflexes as well as presence of any tremors, personality changes.
 Assess sleep habits and nutritional intake and weight gain/loss.
 Assess and document vital signs before, during and after drug therapy. Take note of
postural Blood pressures because of the possible drug related adverse effects of
postural hypotension and dizziness.
  Note any drug allergies, contraindications, cautions, and potential drug interactions.
 Carefully review the results of any laboratory performed before and during drug
therapy.
 Assess the patient’s mouth and oral cavity to make sure the patient has swallowed the
entire oral dosage.

Nursing Diagnosis

1. Acute pain related to effects on CNS as evidenced by patient’s verbalization of pain.

2. Decreased cardiac output related to effects on cardiovascular system as evidenced by
3. Disturbed thought processes and sensory perception related to CNS effects
4. Risk for injury related to CNS effects

Planning

1. Acute Pain
 Perform comprehensive pain assessment including location, severity (1-10 scale),
quality, duration, alleviating/aggravating factors
 Assess nonverbal cues such as facial grimacing, guarding, rubbing of painful areas
 Review current analgesic regimen and clarify last time/dose of pain medication
 Provide analgesic per recommended schedule and evaluate efficacy
 Teach non-pharmacologic pain relief measures like relaxation, distraction,
positioning
 Monitor for adverse effects of pain regimens like over sedation
2. Decreased cardiac output
 Obtain baseline and ongoing heart rate, blood pressure, and cardiovascular
assessment
 Monitor for symptoms like chest pain, palpitations, dizziness, syncope
 Educate patient on action of antidepressant medication and importance of
reporting adverse reactions
 Assess patient’s fluid and nutritional intake and need for interventions
 Assist with activity intolerance and institute fall precautions if indicated.
 Evaluate need for dosage change or alternate antidepressant medication.
 Prepare emergency equipment in the event of significant hypotensive episode.
3. Disturbed Thought Processes
  Frequently assess mental status and cognitions
 Validate patient’s perceptions and provide reassurance
 Reduce environmental stimuli that trigger paranoia.
4. Reduce risk for injury by:
 Encouraging the use of assistive devices and precautions.
 Ensuring patient rooms and hall ways remain obstacles free.
 Ensuring call light and personal items are within reach.

Implementation

 Administer all antidepressants carefully and exactly as ordered.

 Carefully monitor the patient, be readily available and provide supportive care during
this time.
 Advise the patient to take the drug with food or enough fluid.
 Assist with ambulation and other activities if patient is weak, an older adult or dizzy.
 Counsel patient about the potential sexual dysfunction and ask patient to discuss
possible options with the prescriber.
 Do not withdraw the medications abruptly.
 Advise the patient to report symptoms like blurred vision, excessive drowsiness,
sleepiness, urinary retention, constipation and cognitive impairment.

Evaluation

 Monitor the therapeutic effects of the antidepressants and patients progress before,
during and after drug therapy.
 Monitor the patient for symptoms of serotonin syndrome such as agitation,
tachycardia, hyperreflexia, and tremors.
 Monitor the serum levels of the drugs to identify both sub therapeutic and toxic levels.

Examples of Antidepressants

1. Amitriptyline
2. Fluoxetine

AMITRIPTYLINE
Class- Antidepressant

Group- Tricyclic Antidepressants

Generic Name- Amitriptyline

Trade Name- Elavil

Mechanism of action- It blocks the reuptake of norepinephrine and serotonin into

presynaptic nerve terminals. This results in an increased action if both neurotransmitters in
neurons.

Dosage, Routes and Frequency- PO: 10-300 mg/day

Indications- Depression, Insomnia, Neuropathic pain

Contraindications- Drug allergy, pregnancy, myocardial infarction.

Adverse Effects- Dry mouth, constipation, blurred vision, urinary retention, dysrhythmias.

Nursing Assessment

 Monitor the patient for adverse effects.

 Assess for cautions, contraindications and drug interactions.

Patient/Family Teaching

 Educate patient on the adverse effects and drug/food interactions.

 Emphasize the importance of keeping a list of all medications on them at all times.
 Advise patient to report signs like blurred vision, excessive drowsiness, sleepiness,
urinary retention, constipation and cognitive impairment.
 Explain to patient that discoloration of urine is normal when taking amitriptyline.

FLUOXETINE

Class- Antidepressant

Group- Selective serotonin reuptake inhibitor

Generic Name- Fluoxetine

Trade Name- Prozac

Mechanism of action- It selectively blocks the reuptake of serotonin neurotransmitter at the
neuronal presynaptic membrane.

Dosage, Routes and Frequency- PO: 10-30mg/day; higher up to 80mg/day divided bid.

Indications- Depression, Obsessive compulsive disorder, Bulimia Nervosa, panic disorder,

premenstrual dysphoric disorder

Contraindications- Drug allergy, concurrent MAOI therapy.

Adverse Effects- Anxiety, dizziness, drowsiness, insomnia.

Nursing Assessment

 Assess and document findings associated with the neuromuscular and gastrointestinal
systems.
 Assess patient for symptoms of serotonin syndrome.
 Assess for significant drug interactions.
 Periodic serum electrolytes; monitor closely plasma glucose in diabetes.
 Weigh weekly to monitor weight loss, particularly in the older adult or nutritionally
compromised patient. Report significant weight loss to physician.
 Assess patients for suicidal behaviors.

Patient/Family Teaching

 Teach patients that consumption of fiber supplements must occur at least 2 hours
before or after the dosing of medication to avoid interference with drug absorption.
 Encourage the patient to openly discuss any concerns about adverse effects like sexual
dysfunction, gastrointestinal upset or tremors.
 Educate patients is the drug/drug interactions of the medication.
 Encourage patient to report any increase in suicidal thoughts or extreme changes in
mood.
 Emphasize that follow-up visits must be kept and prescriber contacted if there are any
concerns.

MOOD STABILIZING DRUGS

These are drugs that are used to treat bipolar illness. They have the ability to moderate
extreme shifts in emotion and relieve symptoms of mania and depression during acute
episodes.

Nursing Assessment

 Perform a thorough neurologic examination, including baseline levels of

consciousness and alertness, gait and mobility levels and overall motor functioning.
 Assess vital signs, hydration status, dietary intake, skin tone, and presence of edema.
 Assess for cautions and contraindications (e.g. drug allergies, renal or CV diseases,
suicidal or impulsive patients with severe depression, dehydration and sodium
depletion, etc.) to prevent any untoward complications.
 Check laboratory results for serum sodium, albumin, and uric acid levels.

Nursing Diagnosis

1. Imbalanced nutrition related to medication-induced appetite changes as evidenced by

weight loss and nutritional deficits.
2. Disturbed sleep pattern related to side effects of medication on sleep-wake cycle as
evidenced by changes in patient’s sleep duration and quality.
3. Risk for injury related to adverse effects of the medication on CNS.
4. Risk for constipation related to decreased gastrointestinal motility.

Planning

1. Imbalanced Nutrition
 Conduct a comprehensive nutritional assessment to identify specific dietary
concerns.
 Recommend small frequent meals to stimulate appetite.
 Monitor weight changes and adjust interventions as required.
2. Disturbed Sleep Pattern
 Provide education on sleep hygiene practices.
 Teach relaxation techniques that can be used before bedtime.
 Establish a consistent sleep routine including a regular bedtime and wake-up time.
 Coordinate the administration of mood stabilizing drugs with bedtime.
3. Risk for Injury
 Assess gait/balance and encourage assistive devices
  Ensure the floor surfaces are clutter-free, visualize environment.
 Encourage use of non-skid floor mats, pads
 Reinforce calling for help with transfers/ambulation
4. Risk for Constipation
 Assess bowel function and establish bowel regimen
 Increase dietary fiber, fluid intake, physical activity
 Consider timing of constipating medications
 Educate on bowel stimulation techniques

Implementation

 Ensure there’s adequate hydration and electrolyte status before administering

medication.
 Administer drug cautiously and monitor serum lithium levels daily to monitor for
toxic levels and to arrange for appropriate drug dose adjustment.
 Administer drug with food or milk to reduce GI discomfort if present.
 Arrange to decrease dose after acute manic episodes because lithium tolerance is
greatest during acute episodes and decreases when the acute episode is over.
 Provide comfort measures (e.g. sugarless lozenges and frequent mouth care, etc.) to
help patient tolerate drug effects.
 Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent
injuries

Evaluation

 Assess for therapeutic effects of the medication such as decreased mania and
stabilization of the patient’s mood.
 Assess for adverse reactions like dysrhythmias, hypotension, sedation, slurred speech,
slower motor abilities, and weight gain.
 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.
Example of Mood Stabilizing Drugs

1. Lithium Carbonate
2. Valproic Acid

LITHIUM CARBONATE

Class- Antimanic

Group- Alkali metal ion salt

Generic Name- Lithium Carbonate

Trade Name- Lithobid

Mechanism of action- It acts by changing neurotransmitter balance in specific brain regions.

It increases the synthesis of serotonin.

Dosage, Routes and Frequency- PO: 600-1800mg/day divided into two or three times.

Indications- Acute mania, prevention of mania

Contraindications- Serious cardiovascular impairment, chronic kidney disease, severe

dehydration.

Adverse Effects- Gastrointestinal discomfort, tremor, confusion, sedation, seizures, cardiac

dysrhythmias, slurred speech, weight gain, hypotension.

Nursing Assessment

 Perform a thorough neurologic examination, including baseline levels of

consciousness and alertness, gait and mobility levels and overall motor functioning.
 Assess vital signs, hydration status, dietary intake, skin tone, and presence of edema.
 Check laboratory results for serum sodium, albumin, and uric acid levels.
 Periodic lithium levels (draw blood sample prior to next dose or 8–12 h after last
dose); periodic thyroid function tests.
 Weigh patient daily; check ankles, tibiae, and wrists for edema. Report early signs of
extrapyramidal reactions to the physician.

Patient/Family Teaching

 Educate patient that the effects of the drug make take 2 to 3 weeks or more to appear.
  Encourage patient to return regularly for follow-up and also to check and record
weight weekly.
 Instruct patient to maintain a normal sodium diet and fluid intake and avoid caffeine
and alcohol.
 Contact physician if diarrhea or fever develops. Avoid practices that may encourage
dehydration: hot environment, excessive caffeine beverages (diuresis).
 Instruct patient to report excessive thirst, urination, dizziness, muscle weakness,
tachycardia, palpitations, or confusion promptly.
 Instruct to not abruptly discontinue the drug.

VALPROIC ACID

Class- Antiepileptic, Antimanic.

Group- GABA agonist

Generic Name- Valproic Acid

Trade Name- Depakene, Depacon, Depakote.

Mechanism of action- It increases the concentrations of inhibitory neurotransmitter GABA

in the brain. Abnormal discharge of neuron are suppressed.

Dosage, Routes and Frequency- PO: 10-15mg/kg/day gradually increased to 60mg/kg/day.

Indications- Generalized seizures, partial seizures, mania associated with bipolar disorder.

Contraindications- Hypersensitivity reaction, significant hepatic impairment, bleeding

disorders, cirrhosis, congenital metabolic disorders, autoimmune deficiency syndrome

Adverse Effects- Dizziness, drowsiness, GI upset, weight gain, Hepatotoxicity, pancreatitis,

ataxia, unusual eye movements.

Nursing Assessment

 Gather and document information about the patient’s medical history, medication
profile, neurologic system.
 Assess for allergies, cautions, contraindications and drug interactions.
 Assess for history of pancreatitis, baseline weight and liver function studies.
Patient/Family Teaching

 Instruct patient not to take drug with carbonated beverages.

 Recommend taking the drug with enough water, food or snack to minimize
gastrointestinal upset.
 Instruct patient to avoid taking caffeine and alcohol.
 Educate patient about the adverse effects, drug interactions.