Drug Name Mechanism of Action Indication Contraindication Adverse/ Side Effects Nursing Responsibility

Divalproex The drug's • Complex partial • Contraindicated with CNS: Sedation, tremor 1. Take this drug exactly
anticonvulsant activity seizures hypersensitivity to (may be dose-related), as prescribed. Do not
Dose: 250mg/tab may be related to • Simple and complex valproic acid, hepatic emotional upset, chew tablets or
increased brain absence seizures disease or significant depression, psychosis, capsules before
Twice a day concentrations of • Mania hepatic impairment. aggression, swallowing them.
gamma-aminobutyric • Migraine Prophylaxis • Use cautiously with hyperactivity, Swallow them whole to
acid (GABA), an children < 18 mo; behavioral prevent local irritation
inhibitory children < 2 yr, deterioration, weakness of mouth and throat.
neurotransmitter in the especially with multiple Dermatologic: Transient Sprinkle tablets may be
CNS, by inhibiting antiepileptics, increases in hair loss, opened and sprinkled
enzymes that catabolize congenital metabolic rash, petechiae on applesauce or
GABA or block the disorders, severe GI: Nausea, vomiting, pudding.
reuptake of GABA into seizures accompanied indigestion, diarrhea, 2. Do not discontinue
glia and nerve endings. by severe mental abdominal cramps, this drug abruptly or
Valproic Acid may also retardation, organic constipation, anorexia change dosage, except
work by suppressing brain disorders (higher with weight loss, on the advice of your
repetitive neuronal risk of developing fatal increased appetite with health care provider.
firing through inhibition hepatotoxicity); weight gain, life- 3. Avoid alcohol and
of voltage-sensitive pregnancy (fetal neural threatening sleep-inducing and
sodium channels. It is tube defects; do not pancreatitis, hepatic over-the-counter drugs.
also a histone discontinue to prevent failure These could cause
deacetylase inhibitor major seizures; GU: Irregular menses, dangerous effects.
discontinuing such secondary amenorrhea 4. You may experience
medication is likely to Hematologic: Slight these side effects:
precipitate status elevations in AST, ALT, Drowsiness (avoid
epilepticus, hypoxia and LDH; increases in serum driving or performing
risk to both mother and bilirubin, abnormal other tasks requiring
fetus); lactation. changes in other LFTs, alertness; take at
` altered bleeding time; bedtime); GI upset (take
thrombocytopenia; with food or milk, eat
bruising; hematoma frequent small meals; if
formation; frank problem persists,
hemorrhage; relative substitute enteric-
lymphocytosis; coated drug); transient
hypofibrinogenemia; increase in hair loss.
leukopenia, 5. Report bruising, pink
eosinophilia, anemia, stain on the toothbrush,
bone marrow yellowing of the skin or
suppression eyes, pale feces, rash,
pregnancy; abdominal
pain with nausea,
vomiting, anorexia.
 Drug Name Mechanism of Action Indication Contraindication Adverse/ Side Effects Nursing Responsibility

Clozapine The mechanism by Clozapine is indicated Contraindications: Clozapine’s side effect 1. Carefully monitor
which clozapine exerts for the treatment of Clozapine is profile ranges from mild blood glucose levels if
Dose: 1/2 tab its effects involves the severely ill patients with contraindicated in symptoms (i.e. hyper- diabetic.
blocking of 5-HT2A/5- schizophrenia who fail patients with a previous salivation and an 2. Do not engage in any
Twice a day HT2C serotonin to respond adequately hypersensitivity to increased appetite) to hazardous activity until
receptors and the D1-4 to standard anti- clozapine or any other more life-threatening response to the drug is
dopamine receptors, psychotic treatment. component of this drug, conditions like known. Drowsiness and
with the highest affinity Because of the risks of in patients with agranulocytosis and sedation are common
for the D4 dopamine severe neutropenia and myeloproliferative myocarditis. In addition adverse effects.
receptor. As a of seizure associated disorders, uncontrolled to the common adverse 3. Due to the risk of
serotonin and with its use, Clozapine epilepsy, paralytic ileus, effects of atypical anti- agranulocytosis (see
D4 dopamine should be used only in or a history of psychotics, clozapine Appendix F) it is
antagonist, clozapine is patients who have clozapine-induced can cause tachycardia important to comply
able to elicit its anti- failed to respond agranulocytosis or and constipation. Rarer with blood test
psychotic effects adequately to standard severe side effects include regimen. Report flulike
without inducing many anti-psychotic granulocytopenia. As dystonia, neuroleptic symptoms, fever, sore
of the extra-pyramidal treatment. with more typical anti- malignant syndrome, throat, lethargy,
motor effects psychotic drugs, and seizures. malaise, or other signs
associated with contraindicated in of infection.
D2 dopamine receptor severe central nervous 4. Rise slowly to avoid
antagonists.[ system depression or orthostatic
comatose states. Should hypotension.
not be used 5. Report immediately
simultaneously with any of the following:
other agents having a unexplained fatigue,
well-known potential to especially with activity;
cause agranulocytosis shortness of breath,
or otherwise suppress sudden weight gain or
bone marrow function. edema of the lower
The mechanism of extremities.
clozapine-induced 6. Take drug exactly as
agranulocytosis is ordered.
unknown; nonetheless, 7. Do not use OTC drugs
it is possible that or alcohol without
causative factors may permission of physician.
interact synergistically
to increase the risk
and/or severity of bone
marrow suppression
 Drug Name Mechanism of Action Indication Contraindication Adverse/ Side Effects Nursing Responsibility

Ascorbic Acid Necessary for collagen • Prevention and Hypersensitivity to Flushing, fainting, 1. High doses of vitamin
C are not recommended
formation and tissue treatment of scurvy ascorbic acid or any dizziness, headache,
during pregnancy.
Dose: 500 mg/ tab repair in the body; • Increase iron component fatigue. nausea, 2. Take large doses of
vitamin C in divided
involved in some excretion during vomiting, diarrhea,
amounts because the
Once a day oxidation-reduction as deferoxamine heartburn, diarrhea, body uses only what is
needed at a particular
well as many other administration hyperoxaluria
time and excretes the
petabolic reactions. thalassemia patients, it rest in urine.
3. Megadoses can
may increase the iron
interfere with
overload state. absorption of vitamin
B12.
4. Note: Vitamin C
increases the
absorption of iron when
taken at the same time
as iron-rich foods.
5. Do not breast feed
while taking this drug
without consulting
physician.