Cebu Normal University

College of Nursing
PSYCHOTROPIC DRUG STUDY IN
PSYCHIATRY AS A NURSING SPECIALTY
DRUG DATA
GENERIC NAME:
Fluoxetine HCl

CLASSIFICATION

MECHANISM OF ACTION

INDICATIONS

PHARMACOLOGIC:
Selective Serotonin
Reuptake Inhibitor
(SSRIs)

PHARMACOKINETICS:
A: Well absorbed after oral
administration
D: Crosses blood-brain
barrier
M&E: Converted by the liver
to norfluoxetine (primarily by
CYP2D6 iso-enzyme),
another antidepressant
compound; mostly
metabolized by the liver; 12%
excreted by kidneys as
unchanged , 7% as
unchanged.
Half-life: 1-3 days
Protein binding: 94.5%

GENERAL
INDICATIONS:
Major depressive
disorder. Obsessive
compulsive disorder.
Bulimia nervosa.
Panic disorder,
Depressive episodes
associated with
bipolar I disorder
(when used with
olanzapine);
treatment-resistant
depression (with
olanzapine)

TRADE NAME:
Prozac; Prozac Weekly;
Sarafem
THERAPEUTIC:
Antidepressant
PATIENTS DOSE:

MINIMUM DOSE:
10 mg/day
MAXIMUM DOSE:
60 mg/day
CONTENTS:
Fluoxetine (N-methyl3-phenyl-3-[4(trifluoromethyl)phenox
y]propan-1-amine)
Hydrochloride
AVAILABILITY &
COLOR:

PREGNANCY
CATEGORY:
C

ROUTE: PO
ONSET: 1-4 weeks
PEAK: unknown
DURATION: 2 weeks
THERAPEUTIC LEVELS:
50480 ng/mL

PATIENTS
ACTUAL
INDICATIONS:

CONTRAINDICATIONS
CONTRAINDICATIONS:
Hypersensitivity,
concurrent use or use
within 14 days of
discontinuing MAO
inhibitors; concurrent use
of pimozide, concurrent
use of thioridazine
(should be discontinued
at least 5 weeks before
therapy initiated, for all
contraindicated drugs)
PRECAUTIONS:
Severe hepatic/renal
impairment (lower/less
frequent dose may be
necessary), seizure
history, debilitated
patients, diabetes
mellitus, patients with
concurrent chronic
illness
DRUG
INTERACTIONS:
DRUG TO DRUG

SIDE EFFECT/
ADVERSE
REACTIONS
CNS: Headache,
nervousness,
insomnia,
drowsiness,
anxiety, tremor,
dizziness, lightheadedness,
agitation,
sedation,
abnormal gait,
seizures
CV: Hot flashes,
palpitations
Dermatologic:
Sweating, rash,
pruritus, acne,
alopecia, contact
dermatitis
GI: Nausea,
vomiting,
diarrhea, dry
mouth, anorexia,
dyspepsia,
constipation,
taste changes,
flatulence,
gastroenteritis,
dysphagia,
gingivitis
GU: Painful

NURSING RESPONSIBILITIES
BEFORE:
1. Read ticket, compare with doctors
order and have signed by head nurse.
2. History: Hypersensitivity to
fluoxetine, impaired hepatic or renal
function, diabetes mellitus, lactation,
pregnancy, seizures
3. Physical: Weight, skin rash, lesions;
reflexes, affect; bowel sounds, liver
evaluation, peripheral perfusion;
urinary output, LFTs, renal function
tests
4. Medical handwashing should be
done prior to patient handling and drug
administration.
5. Take baseline vital signs. (TPRBP,
Pain score if applicable)
DURING:
1. Greet pt. and SO, verify client
identity (verbal, pt. tags, bed number).
Assess baseline v/s.
2. Arrange for lower or less frequent
doses in elderly patients and patients
with hepatic or renal impairment.
3. BLACK BOX WARNING:
Establish suicide precautions for
severely depressed patients. Limit
quantity of capsules dispensed; high
risk in children and adolescents.
4. Administer drug in the morning.

Tablets10, 20 mg
Capsules10, 20, 40
mg
Liquid20 mg/5 Ml
DR capsules90 mg
ROUTE/S OF
ADMINISTRATION:
po

WARNING:
Possible fatal
reactions with
MAOIs; do not
administer together;
2-wk washout period
needed.
Increased
therapeutic and toxic
effects of TCAs. Do
not use with
thioridazine
(increased levels of
thioridazine)
Decreased
effectiveness if taken
while smoking
Increased toxicity of
lithium; avoid this
combination
Additive CNS
effects if combined
with
benzodiazepines,
alcohol; avoid these
combinations
Avoid administration
with other
serotonergic drugs;
may lead to
serotonin syndrome

FOOD TO DRUG
Increased risk of
serotonin syndrome
with St. Johns wort
and SAMe.

menstruation,
sexual
dysfunction,
frequency,
cystitis,
impotence,
urgency,
vaginitis
Respiratory:
URIs,
pharyngitis,
cough, dyspnea,
bronchitis,
rhinitis
Other: weight
changes,
asthenia, fever

5. Monitor patient for response to

therapy for up to 4 wk before
increasing dose.
6. Switch to once a week therapy by
starting weekly dose 7 days after last 20
mg/day dose. If response is not
satisfactory, reconsider daily dosing.
AFTER:
1. Monitor mood changes. Let SO
inform nurse if pt. demonstrates
significant increase in anxiety,
nervousness or insomnia.
2. Assess for any sexual side effects
after administration (erectile
dysfunction, decreased libido)
3. Assess for sensitivity reactions after
administration.
4. DOCUMENT hour, amount,
medication and drug reaction (if any)
5. Monitor appetite and nutritional
intake. Weigh weekly, note continued
weight loss. Adjust diet as tolerated to
support nutritional status.
6. Continually observe pt. response to
drug therapy (v/s, lab exams) and
serotonin syndrome

Source: Deglin, J. H.,

& Vallerand, A. H.
(2011). Davis's drug
guide for nurses.
Philadelphia, Penn:
F.A. Davis. (pp 597600)

DRUG DATA
GENERIC NAME:
Duloxetine

Source: Deglin, J. H., &

Vallerand, A. H. (2011).
Davis's drug guide for
nurses. Philadelphia,
Penn: F.A. Davis. (pp
597-600)

MINIMUM DOSE:
20 mg/day
MAXIMUM DOSE:
60 mg/day
CONTENTS:
Duloxetine (N-Methyl3-(naphthalen-1-yloxy)3-(thiophen-2yl)propan-1-amine)

Source: Deglin, J.
H., & Vallerand, A.
H. (2011). Davis's
drug guide for
nurses.
Philadelphia, Penn:
F.A. Davis. (pp
597-600)

Source: Deglin, J. H., &

Vallerand, A. H. (2011).
Davis's drug guide for
nurses. Philadelphia,
Penn: F.A. Davis. (pp
597-600)

CONTRAINDICATIONS

CLASSIFICATION

MECHANISM OF ACTION

INDICATIONS

PHARMACOLOGIC:
Selective Serotonin
Reuptake Inhibitor
(SSRIs)

PHARMACOKINETICS:
A: Well absorbed after oral
administration
D: Unknown
M&E: Mostly metabolized
primarily by CYP2D6 and
CYP1A2 enzyme pathways
Half-life: 12 Highly (>90%)
protein bound

GENERAL
INDICATIONS:
Major depressive
disorder. Diabetic
peripheral
neuropathic pain.
Generalized anxiety
disorder.
Fibromyalgia.
(Unlabeled: Stress,
urinary
incontinence)

TRADE NAME:
Cymbalta
PATIENTS DOSE:

Source: Deglin, J. H., &

Vallerand, A. H. (2011).
Davis's drug guide for nurses.
Philadelphia, Penn: F.A.
Davis. (pp 597-600)

THERAPEUTIC:
Antidepressant

PREGNANCY
CATEGORY:
C

ROUTE: PO
ONSET: unknown
PEAK: 6 hours
DURATION: 12 hours
THERAPEUTIC LEVELS:
20-80 ng/mL

PATIENTS
ACTUAL
INDICATIONS:

http://nurseslabs.com/flu
oxentine-hcl/

CONTRAINDICATIONS:
Hypersensitivity,
concurrent use of MAO
inhibitors; uncontrolled
angle-closure glaucoma,
end-stage renal disease;
chronic hepatic
impairment or substantial
alcohol use (increased
hepatitis risk), lactation
PRECAUTIONS:
History of suicide
attempt or ideation,
mania history, concurrent
use of other centrally
acting drugs which may
increase adverse
reactions risk, seizure
disorder history,
controlled angle-closure
glaucoma, diabetic
patients and those with
renal impairment

Source:
Deglin, J. H.,
& Vallerand,
A. H. (2011).
Davis's drug
guide for
nurses.
Philadelphia,
Penn: F.A.
Davis. (pp 597600)

Source: Deglin, J. H., & Vallerand, A.

H. (2011). Davis's drug guide for
nurses. Philadelphia, Penn: F.A.
Davis. (pp 597-600)

SIDE EFFECT/
ADVERSE
REACTIONS
CNS: Neuroleptic
malignant
syndrome,
seizures, suicide
thoughts, fatigue,
drowsiness,
insomnia, mania
activation,
dizziness,
nightmares
EENT: Blurred
vision, increased
IOP
CV: Hypertension
GI:
Hepatotoxicity,
decreased
appetite,
constipation, dry
mouth, nausea,
diarrhea, gastritis,
vomiting
F&E:
Hyponatremia
GU: Dysuria,
abnormal orgasm,

NURSING RESPONSIBILITIES

http://nurseslabs.com/fluoxentine-hcl/

BEFORE:
1. Read ticket, compare with doctors
order and have signed by head nurse.
2. History: Hypersensitivity to
fluoxetine, impaired hepatic or renal
function, diabetes mellitus, lactation,
pregnancy, seizures
3. Physical: Weight, skin rash, lesions;
reflexes, affect; bowel sounds, liver
evaluation, peripheral perfusion;
urinary output, LFTs, renal function
tests
4. Medical handwashing should be
done prior to patient handling and
drug administration.
5. Take baseline vital signs. (TPRBP,
Pain score if applicable)
DURING:
1. Greet pt. and SO, verify client
identity (verbal, pt. tags, bed number).
Assess baseline v/s.
2. May be administered without regard
to meals. Do not chew, crush or open
and sprinkle contents on food or
liquids.

AVAILABILITY &
COLOR:
Capsules: 20, 30, 60 mg
(blue and yellow
colored)

DRUG
INTERACTIONS:
DRUG TO DRUG

ROUTE/S OF
ADMINISTRATION:
po

Concurrent use with

MAO inhibitors may
result in serious
potentially fatal
reactions.
Lineazolid, tramadol
and triptans increase
risk of serotonin
syndrome
Fluvoxamine and
fluoroquinolones
increase serum
levels, should not be
taken together
Increased risk of
bleeding with
aspirins, NSAIDs or
warfarin
Avoid administration
with other
serotonergic drugs;
may lead to
serotonin syndrome

FOOD TO DRUG
Increased risk of
serotonin syndrome
with St. Johns wort
and SAMe.

ED, Decreased
libido, urinary
retention
Derm:
Diaphoresis,
pruritus, rash
Neuro: tremors
Misc.:
SEROTONIN
SYNDROME

3. BLACK BOX WARNING:

Establish suicide precautions for
severely depressed patients. Limit
quantity of capsules dispensed; high
risk in children and adolescents.
4. Administer drug in the morning.
5. Monitor patient for response to
therapy for up to 4 wks before
increasing dose.
6. Instruct SOs to inform nurse for any
signs of anaphylaxis or adverse drug
effects.
AFTER:
1. Assess mental status. Let SO inform
nurse if pt. demonstrates significant
increase in anxiety, nervousness or
insomnia.
2. Assess for any sexual side effects
after administration (erectile
dysfunction, decreased libido)
3. Assess for sensitivity reactions after
administration.
4. DOCUMENT hour, amount,
medication and drug reaction (if any)
5. Monitor appetite and nutritional
intake. Weigh weekly, note continued
weight loss. Adjust diet as tolerated to
support nutritional status.
6. Continually observe pt. response to
drug therapy (v/s, lab exams) and
serotonin syndrome

Source: Deglin, J. H.,

& Vallerand, A. H.
(2011). Davis's drug
guide for nurses.
Philadelphia, Penn:
F.A. Davis. (pp 490492)

Source: Deglin, J. H.,

& Vallerand, A. H.
(2011). Davis's drug
guide for nurses.
Philadelphia, Penn:
F.A. Davis. (pp 490492)

DRUG DATA

CLASSIFICATION
PHARMACOLOGIC:
Selective Serotonin
Reuptake Inhibitor
(SSRIs)

GENERIC NAME:
Sertraline
TRADE NAME:
Zoloft
PATIENTS DOSE:

MINIMUM DOSE:
25 mg/day
MAXIMUM DOSE:
200 mg/day

THERAPEUTIC:
Antidepressant

PREGNANCY
CATEGORY:
C

Source: Deglin, J. H., &

Vallerand, A. H. (2011).
Davis's drug guide for
nurses. Philadelphia, Penn:
F.A. Davis. (pp 490-492)

Source: Deglin, J.
H., & Vallerand, A.
H. (2011). Davis's
drug guide for
nurses.
Philadelphia, Penn:
F.A. Davis. (pp
490-492)

Source: Deglin, J. H., &

Vallerand, A. H. (2011).
Davis's drug guide for
nurses. Philadelphia,
Penn: F.A. Davis. (pp
490-492)

MECHANISM OF ACTION

INDICATIONS

CONTRAINDICATIONS

PHARMACOKINETICS:
A: Appears to be well
absorbed after oral
administration
D: Extensively distributed
throughout body tissues
M&E: Extensively
metabolized by the liver, one
metabolite has some antidepressant activity; 14%
excreted unchanged in feces
Half-life: 24 hours

GENERAL
INDICATIONS:
Major depressive
disorder. Panic
disorder. Obsessive
compulsive disorder.
Post-traumatic stress
disorder. Social
anxiety disorder.
Premenstrual
dysphoric disorder.
Unlabeled: General
anxiety disorder.

http://reference.medscape.co
m/drug/cymbalta-duloxetine342960

ROUTE: PO
ONSET: within 2-4 weeks
PEAK: unknown
DURATION: unknown
THERAPEUTIC LEVELS:
9.5 to 56 ng/ml

CONTENTS:
Sertraline ((1S,4S)-4(3,4-dichlorophenyl)-Nmethyl-1,2,3,4tetrahydronaphthalen-1amine)

PATIENTS
ACTUAL
INDICATIONS:

CONTRAINDICATIONS:
Hypersensitivity,
concurrent use of MAO
inhibitors; uncontrolled
angle-closure glaucoma,
end-stage renal disease;
chronic hepatic
impairment or substantial
alcohol use (increased
hepatitis risk), lactation
PRECAUTIONS:
History of suicide
attempt or ideation,
mania history, concurrent
use of other centrally
acting drugs which may
increase adverse
reactions risk, seizure
disorder history,
controlled angle-closure
glaucoma, diabetic
patients and those with
renal impairment
DRUG

Source: Deglin,
J. H., &
Vallerand, A. H.
(2011). Davis's
drug guide for
nurses.
Philadelphia,
Penn: F.A.
Davis. (pp 490492)

SIDE EFFECT/
ADVERSE
REACTIONS
CNS: Neuroleptic
malignant
syndrome,
seizures, suicide
thoughts, fatigue,
drowsiness,
insomnia, mania
activation,
dizziness,
nightmares
EENT: Blurred
vision, increased
IOP
CV: Hypertension
GI:
Hepatotoxicity,
decreased
appetite,
constipation, dry
mouth, nausea,
diarrhea, gastritis,
vomiting
F&E:
Hyponatremia
GU: Dysuria,
abnormal orgasm,
ED, Decreased

Source: Deglin, J. H., & Vallerand,

A. H. (2011). Davis's drug guide for
nurses. Philadelphia, Penn: F.A.
Davis. (pp 490-492)
http://reference.medscape.com/drug/
cymbalta-duloxetine-342960

NURSING RESPONSIBILITIES
BEFORE:
1. Read ticket, compare with doctors
order and have signed by head nurse.
2. History: Hypersensitivity to
fluoxetine, impaired hepatic or renal
function, diabetes mellitus, lactation,
pregnancy, seizures
3. Physical: Weight, skin rash, lesions;
reflexes, affect; bowel sounds, liver
evaluation, peripheral perfusion;
urinary output, LFTs, renal function
tests
4. Medical handwashing should be
done prior to patient handling and
drug administration.
5. Take baseline vital signs. (TPRBP,
Pain score if applicable)
DURING:
1. Greet pt. and SO, verify client
identity (verbal, pt. tags, bed number).
Assess baseline v/s.
2. May be administered without regard
to meals. Do not chew, crush or open
and sprinkle contents on food or
liquids.
3. BLACK BOX WARNING:

AVAILABILITY &
COLOR:
Tablets: 25, 50, 100 mg
Capsules: 50, 100 mg
Oral concentrate: 20
mg/mL in 60 mL bottles
ROUTE/S OF
ADMINISTRATION:
po

INTERACTIONS:
DRUG TO DRUG

Concurrent use with

MAO inhibitors may
result in serious
potentially fatal
reactions.
Lineazolid, tramadol
and triptans increase
risk of serotonin
syndrome
Fluvoxamine and
fluoroquinolones
increase serum
levels, should not be
taken together
Increased risk of
bleeding with
aspirins, NSAIDs or
warfarin
Avoid administration
with other
serotonergic drugs;
may lead to
serotonin syndrome

FOOD TO DRUG
Increased risk of
serotonin syndrome
with St. Johns wort
and SAMe.

libido, urinary
retention
Derm:
Diaphoresis,
pruritus, rash
Neuro: tremors
Misc.:
SEROTONIN
SYNDROME

Establish suicide precautions for

severely depressed patients. Limit
quantity of capsules dispensed; high
risk in children and adolescents.
4. Administer drug in the morning.
5. Monitor patient for response to
therapy for up to 4 wks before
increasing dose.
6. Instruct SOs to inform nurse for any
signs of anaphylaxis or adverse drug
effects
AFTER:
1. Assess mental status. Let SO inform
nurse if pt. demonstrates significant
increase in anxiety, nervousness or
insomnia.
2. Assess for any sexual side effects
after administration (erectile
dysfunction, decreased libido)
3. Assess for sensitivity reactions after
administration.
4. DOCUMENT hour, amount,
medication and drug reaction (if any)
5. Monitor appetite and nutritional
intake. Weigh weekly, note continued
weight loss. Adjust diet as tolerated to
support nutritional status.
6. Continually observe pt. response to
drug therapy (v/s, lab exams), assess
for serotonin syndrome

Source: Deglin, J. H.,

& Vallerand, A. H.
(2011). Davis's drug
guide for nurses.
Philadelphia, Penn:
F.A. Davis. (pp 11471149)

Source: Deglin, J. H.,

& Vallerand, A. H.
(2011). Davis's drug
guide for nurses.
Philadelphia, Penn:
F.A. Davis. (pp 11471149)

Source: Deglin, J. H., &

Vallerand, A. H. (2011).
Davis's drug guide for
nurses. Philadelphia, Penn:
F.A. Davis. (pp 1147-1149)

Source: Deglin, J.
H., & Vallerand, A.
H. (2011). Davis's
drug guide for
nurses.
Philadelphia, Penn:
F.A. Davis. (pp
1147-1149)

Source: Deglin, J. H., &

Vallerand, A. H. (2011).
Davis's drug guide for
nurses. Philadelphia,
Penn: F.A. Davis. (pp
1147-1149)

Source: Deglin,
J. H., &
Vallerand, A. H.
(2011). Davis's
drug guide for
nurses.
Philadelphia,
Penn: F.A.
Davis. (pp 11471149)

Source: Deglin, J. H., & Vallerand,

A. H. (2011). Davis's drug guide for
nurses. Philadelphia, Penn: F.A.
Davis. (pp 1147-1149)