ANTI-DEPRESSANTS

1. Sertraline (Zoloft)
DRUGS
Generic name:
Sertraline

Brand name:
Zoloft

Classification:
Antidepressants

Dosage:
50mg

INDICATION

Symptoms of
depression in
patients with
or
without
history
of
mania.
Obsessivecompulsive
disorders.

MODE OF ACTION

Inhibits
serotonin
reuptake in CNS,
thus increasing
in
action
of
serotonin, does
not
affect
dopamine,
norepinephrine.

SIDE/ADVERSE
EFFECTS
Nausea,
loose
stools,
dyspepsia,
tremor,
dizziness,
insomnia,
somnolence, dry
mouth,
increased
sweating
and
male
sexual
dysfunction
(ejaculatory
delay)

NURSING
CONSIDERATION
1. Assess
other
medications
patient may be
taking
for
effectiveness and
interactions.
2. Asses
mental
status
for
worsening
of
depression,
suicidal ideation,
anxiety,
social
functioning,
,ania, or panic
attack (especially
during initiation
of therapy and
when dosage is
changed)
3. Taper
dosage
slowly
whe
discontinuing.
4. Assess
knowledge/ teach
patient
appropriate use ,
interventions to

PATIENT TEACHING
1. Take
in
the
morning
to
reduce risk of
anemia.
2. Maintain
adequate
hydration
(2-3
L/day of fluids)
unless
instructed
to
restrain
fluid
intake.
3. Report
persistent
insomnia
or
daytime
sedation,
agitation,
nervousness,
fatigue; muscle
crampning,
tremors,
weakness
or
change in gait;
chest
pain,
palpitations, or
swelling
of

reduce
effects,
adverse
symptoms
report.

2.

side
and

extremities;
vision changes
or
eye
pain;
hearing
changes;
respiratory
difficulty
or
breathlessness;
skin
rash
or
irritation;
suicidal
ideation;
or
worsening
of
condition.

to

Flouxetine (motivest)

DRUG

Brand name:
Motivest
Generic name:
Flouxetine
Dosage:
20 mg

INDICATION

Depression;
OC
disorders;
bulimia
nervosa.

MODE OF
ACTION
Inhibits CNS
neuron
uptake
of
serotonin,
but not of
norepinephr
ine

SIDE & ADVERSE EFFECT

Hot
flashes,
palpitations,
angina,
heart block, cerebral
ischemia,
MI,
ventricular
arrhythmias, agitation,
anxiety, nervousness,
headache,
insomnia,
abnormal
dreams,
drowsiness, dizziness,

NURSING
CONSIDERATION
-

Monitor
B,
pulse every 4
hours,
if
systolic
BP
drops
20
mmhg,
hold
drug
and
notify
physician;
take VS every
4 hours in

PATIENT TEACHING

Instruct
patient to
use caution
in driving
Advise
patient to
use
sunscreen
to prevent
photosensit
ivity.

tremor,
fatigue,
decreased
libido,
decreased
concentration,
seizures,
delusions,
hallucinations, coma.

patients with
CV disease.
Monitor blood
studies.
Monitor
hepatic
studies.
Assess
ECG
flattening of T
wave, bundle
branch block,
AV
block,
dysrhythmias
in
cardiac
pattern
Monitor
urinary
retention,
constipation
Assess
appetite
in
bulimia
nervosa,
weight every
day, increase
nutritious
food in diet.

Caution
patient to
avoid
alcohol
ingestion
Instruct
patient to
increase
fluids.
Advise
patient not
to
discontinue
drugs
abruptly.

3. Mitrazapine (remerson)
DRUG

INDICATION
Relief

of

ACTION
Mechanism

SIDE/ADVERSE EFFECT

dizziness,

blurred

NURSING
CONSIDERATION
History:

PATIENT TEACHINGS

Take

this

drug

Generic Name:
Mirtazapine

Brand Name:
Remerson
Classification:
Antidepressants
Dosage:
30 mg

symptom
s
of
depressio
n
(endogen
ous
depressio
n
most
responsiv
e)

of
action
unknown;
appears
to
act similarly
to
TCAs,
which inhibit
the
presynaptic
reuptake of
the
neurotransm
itters
norepinephri
ne
and
serotonin;
anticholinerg
ic at CNS
and
peripheral
receptors;
sedating;
relation
of
these effects
to
clinical
efficacy
is
unknown.

vision,
sedation,
somnolence,
malaise/lassitude,
increased
appetite
and
subsequent
weight gain,[107] dry
mouth, constipation,
enhanced libido and
sexual function, and
vivid, bizarre, lucid
dreams
or
nightmares.

Hypersensitivity to
any
antidepresssant;
concomitant
therapy with MAOI;
recent
MI;
myelography within
previous 24 hr or
scheduled within 48
hr; lactation; ECT;
preexisting
CV
disorders;
angleclosure glaucoma;
increased
IOP,
urinary
retention,
ureteral or urethral
spasm;
seizure
disorders;
hyperthyroidism;
impaired
hepatic,
renal
function;
psychiatric
problems;
manicdepressive patients;
elective
surgery;
pregnancy,
lactation

Rarer side effects:

agitation/restlessnes
s,
irritability,
aggression,
apathy
and/or
anhedonia
(emotional blunting),
excessive
mellowness
or
calmness,
difficulty
swallowing, shallow
breathing, decreased
body
temperature,
miosis,
nocturnal
emissions,
spontaneous orgasm,
loss of balance, and
restless
legs
syndrome.

Physical:
Body
weight;
T;
skin
color,
lesions;
orientation, affect,

exactly
as
prescribed; do not
stop taking the
drug abruptly or
without
consulting
your
health
care
provider.

Place
orally
disintegrating
tablet on tongue;
it
can
be
swallowed
without
water.
Open blister pack
with dry hands
and use tablet
immediately; do
not cut or break
tablet.

Avoid
using
alcohol,
other
sleep-inducing
drugs, or OTC
drugs while using
this drug.

Avoid prolonged
exposure
to

reflexes, vision and

hearing;
P,
BP,
orthostatic
BP,
perfusion;
bowel
sounds,
normal
output,
liver
evaluation;
urine
flow, normal output;
usual
sexual
function, frequency
of menses, breast
and
scrotal
examination; liver
function
tests,
urinalysis,
CBC,
ECG

You may experience

these side effects:
Headache,
dizziness,
drowsiness,
weakness, blurred
vision
(reversible;
avoid driving or
performing
tasks
that
require
alertness); nausea,
vomiting, loss of
appetite, dry mouth
(eat frequent small

sunlight
or
sunlamps; use a
sunscreen
or
protective
garments if long
exposure
to
sunlight
is
unavoidable.

meals; use frequent

mouth care, suck
on
sugarless
candies);
nightmares,
inability
to
concentrate,
confusion; changes
in sexual function.

Report fever, flulike

illness,
any
infection,
dry
mouth,
difficulty
urinating, excessive
sedation.

ANTI-EXPRAPYRAMIDAL SYNDROME
1.

Biperiden HCL (akineton)

DRUGS

INDICATION

Generic name:
Biperiden

Parkinsonian
syndrome
especially
counteract

to

MODE OF
ACTION
Synthetic
anticholinergic
drug,
block

SIDE/ADVERSE
EFFECTS

CNS: confusion,
anxiety,
restlessness,

NURSING
CONSIDERATION
5. Document
indication
for
therapy, onset of
signs
and

PATIENT
TEACHING
4. Instruct
patient
that
doses should
not be dpuble,

HCL

Brand name:
Akineton

muscle rigidity
and
tremor;
extrapyramidal
symptoms

cholinergic
responses in
the CNS

irritability.
Delusions,
hallucinations,
headache,
sedation,
depression,
incoherence,
dizziness,
euphoria, tremors,
memory loss

Classification:
Anti-parkinson
agent, anticholinergic

Dosage:
2mg

CV:
palpitations,
tachycardia,
postural
hypotension,
bradycardia
EENT: blurred
vision,
photophobia,
dilated pupils,
difficulty
swallowing,
mydriasis,
increased
intraocular
tension, angleclosure
glaucoma
GI: dryness of

6.

7.

8.

9.

symptoms
and
other
agents
tried
and
outcome
of
therapy.
Assess
for
Parkinsonism,
EPS:
shuffling
gait,
rigidity,
involuntary
movements, pill
rolling,
muscle
spasms, drooling
before
and
during
treatment.
Assess
for
mental
status:
affect,
mood,
CNS depression,
worsening
of
mental
symptoms during
early therapy.
Assess
patient
response
if
anticholinergics
are given.
Monitor
for
constipation,
cramping pain in
abdomen
and

but
missed
dosemay
be
taken up to
2hrs
before
next dose.
5. Tell patient not
to discontinue
this
drug
abruptly, taper
off
over
a
week
to
prevent
withdrawal
symptoms.
6. Avoid activities
that
require
alertness, may
cause
dizziness,
drowsiness
and blurring of
vision.
7. Teach patient
toavid
OTC
coughand cold
preparations
with
alcohol
and
antihistamines
,
increased
CNS
depression

mouth,
constipation,
nausea,
vomiting,
abdominal
distress, paral
ytic ileus

GU: hesitancy,
retention,
dysuria

Integ: rash,
urticaria,
dermatoses

Misc: increased
temp, flushing,
decreased
sweating,
hyperthermia,
heat stroke,
numbness of
fingers

MS: weakness,
cramping

abdominal
distention.
Increase
fluids;
add fiber to diet
and exercise if
these occurs.
10. Assess
for
tolerance
over
long-term
therapy, dosage
may have to be
increased
or
changed.

may occur.
8. Caution
patient to rise
slowly
from
sitting
or
recumbent
positions
to
minimize
prthostatis
hypotension.

2. Benadryl
DRUGS
Brand name:
Benadryl
Generic
name:
Diphenhydra
mide
Classification:
Antimuscarini
c

ACTION

Acts on blood
vessels,
Gi,
respiratory
system
by
antagonizing
the effects of
histamine for
H1-receptor
site; decreases
allergic
response
by
bloking
histamine
;
causes
decrease heart
rate
,
vasodilatation,
secretions;
significant CNS

INDICATIONS

Is used for
its
antimusca
rinic
properties
in
the
control of
Parkinsoni
sm
and
druginduced
extrapyra
midal
disorders.

SIDE /ADVERSE
EFFECTS
Orthostatic
hypotension,
palpitations;
bradycardia;
tachycardia;
reflex
tachycardia;
extrasystoles;
faintness.
Drowsiness;
sedation;
dizziness;
disturbed
coordination;
Epigastric
distress; nausea;
vomiting;
diarrhea;
constipation;

NURSING
CNSIDERATION
1. Assess respiratory
status:
rate,
rhythm,
and
increase
in
bronchial
secretions,
wheezing
and
chest
tightness;
provide fluids to
2L
day
to
decrease
chest
secretions
2. Monitor input and
ouput ratio: be
alert for urinary
retention,
frequency,
dysuria, especially
elderly:
drug

PATIENT TEACHINGS
1. . Tell the patient
that false-negative
result,ay occur with
skin testing;; these
procedure
should
not be scheduled
until 3 days after
discontinuing use.
2. Caution patient to
avoid
hazardous
activities
and
activities requiring
alertness,
since
dizziness
may
occur,;
instruct
patient to request
assistance
with
ambulation.
3. Teach all aspects of

depressant
and
anticholinergic
properties.

change in bowel
habits. Hemolytic
anemia;
thrombocytopeni
a;
aggranulocytosis.
Increases
appetite, weight
gain. Thickening
of
bronchial
secretions; chest
tightness;
wheezing;
respiratory
depression.
Hypersensensitivi
ty
reactions;
photosensitivity.

3.

4.

5.
6.

7.

ANTI CONVULSIVE DRUGS

1. Carbamezipine (fegretol)

should
be
discontinued
if
these occur.
Asses
type
of
involuntary
movements
and
evaluate response
to
this
medication.
Assess movement
disorder
before
and
after
administration.
Assess
sleep
patterns.
Assess
nausea,
vomiting , bowel
sounds
and
abdominal pain.
Asses degree of
itching,
skin
rashand
inflammation.

drug uses; to notify

physician
if
confusion,
sedation,
hypotension occur,
to avoid driving and
other
hazardous
activity
if
drowsiness occurs;
to avoid alcohol or
other
CNS
depressants
that
may
potentiate
effect.
4. Inform patient that
drug may cause dry
mouth:
frequent
oral rinses, good
oral hygiene, and
sugarless gum or
candy
may
minimize the effect

DRUG

INDICATION

ACTION

SIDE/ADVERSE
EFFECT

Generic Name:
carbamazepin
e

Acute
mania,
maintenance for
bipolar affective
disorders.

Exact
mechanism
unknown,
appears
to
decrease
polysynaptic
responses and
block
posttetanic
potentiation.

Dizziness,
ataxia,
allergic
skin
reactions,
leukopenia,
vomiting
and
accommodation
disorders.

Brand Name:
Tegretol
Classification:
Central
nervous
system drugs

NURSING
CONSIDERATION

Assess for seizures,

character,
location,
duration,
intensity,
character,
activity
that stimulates pain.
Asses for trigeminal
neuralgia: facial pain
including
location,
duration,
intensity,
character,
activity
that stimulates pain.
Monitor
liver
functions test.
Check
for
water
retention,
with
decreased osmolality
and concentration of
sodium in plasma,
especially in elderly
patients with cardiac
disease.
Check blood levels
during treatment or
when changing dose.

PATIENT
TEACHINGS

Advise patient to
take medications
as directed
caution
patient
to
avoid
activities
that
require alertness.
Teach patient to
report
immediately
tp
physician if with
following
reactions: chills,
rash,
llightcolored
stools,
dark
urine,
yellowing
of
skin/eyes,
abdominal pain,
sore
throat,
mouth
ulcers,
bruising, blurred
vision, dizziness.
Advise
the
patient not to
discontinue
medication
quickly after a
long term

2. (Depakote) Divalproex sodium

DRUG

Generic
name: divalproex
sodium

Brand
name:
Depakote

Classification:
Anticonvulsant/mo
od stabilizer

INDICATION

MODE OF ACTION

For treatment and

management of
seizure disorders,
mania, and
prophylactic
treatment of
migraine headache

Divalproex binds to
and inhibits GABA
transaminase. The
drug's
anticonvulsant
activity may be
related to
increased brain
concentrations of
gammaaminobutyric acid
(GABA), an
inhibitory
neurotransmitter in
the CNS, by
inhibiting enzymes
that catabolize
GABA or block the
reuptake of GABA
into glia and nerve
endings.
Divalproex may
also work by
suppressing
repetitive neuronal

SIDE &
ADVERSE
EFFECTS
The most
common side
effects from
Depakote are
sedation,
tiredness, and
gastrointestinal
symptoms,
including
nausea,
cramping, and
diarrhea.
Shifting all or
most of the
dosage close to
bedtime may
decrease
daytime
sedation

NURSING
CONSIDERATION

PATIENT
TEACHING

Give drug with food if GI

upset occurs;
substitution of the
enteric-coated
formulation also may
be of benefit; have
patient swallow SR
tablet whole; do not
cut, crush, or chew.
WARNING: Reduce
dosage, discontinue,
or substitute other
antiepileptics
gradually; abrupt
discontinuation of all
antiepileptics may
precipitate absence
seizures.
WARNING: Arrange for
frequent liver function
tests; discontinue
drug immediately
with significant
hepatic dysfunction,
suspected or
apparent; hepatic
dysfunction has
progressed in spite of
drug discontinuation.

If you miss a
dose, take it as
soon as
possible, within
23 hours of
the scheduled
dosing. If it is
close to your
next scheduled
dose, skip the
missed dose
and continue
on your regular
dosing
schedule, but
do not take
double doses.
Depakote, the
extendedrelease form, is
intended for
once-a-day
dosing. Swallow
the tablets
whole

firing through
inhibition of
voltage-sensitive
sodium channels.

WARNING: Arrange for

patient to have
platelet counts,
bleeding time
determination before
therapy, periodically
during therapy, and
prior to surgery.
Monitor patient
carefully for clotting
defects (bruising,
blood-tinged
toothbrush).
Discontinue if there is
evidence of
hemorrhage, bruising,
or disorder of
hemostasis.
Monitor ammonia
levels, and
discontinue if there is
clinically significant
elevation in level.
Monitor serum levels of
valproic acid and
other antiepileptic
drugs given
concomitantly,
especially during the
first few weeks of
therapy. Adjust
dosage on the basis
of these data and
clinical response.
Arrange for counseling
for women of

and do not
crush or chew
them. If
stomach upset
occurs, take
Depakote after
meals or with
food.
Contact your
physician if you
have persistent
abdominal
symptoms,
including pain,
loss of
appetite,
nausea,
vomiting, and
jaundice.
Depakote
may cause
sedation and
drowsiness,
especially
during initiation
of therapy, and
impair your
alertness.
Use caution
when driving or
performing
tasks that

childbearing age who

wish to become
pregnant.
WARNING: Discontinue
drug at any sign of
pancreatitis.
WARNING: Evaluate
for therapeutic serum
levelsusually 50
100 mcg/mL.

require
alertness.
Store the
medication in
its originally
labeled, lightresistant
container, away
from heat and
moisture. Heat
and moisture
may precipitate
breakdown of
your
medication.

3. Epicval

DRUG
Generic Name:
Valproic Acid
Brand Name:
Epival
Classification:
Antiepileptic
Dosage/Route:
250mg/Oral

INDICATION

Treatment of
acute manic
or
mixed
episodes
associated
with bipolar
disorder, with
or
without
psychotic
features.

ACTION

SIDE/ADVERS
E EFFECTS

NURSING
CONSIDERATION

Mechanism
of
action
not
understood.
Antiepileptic
activity may be
related to the
metabolism
of
the
inhibitory
neurotransmitte
r,
GABA;
divalproex

CNS:
Sedation, tremor
(may
be
dose
related),
emotional upset,
depression,
psychosis,
aggression,
hyperactivity,
behavioral
deterioration,

Nursing Consideration:
- Give drug with food if
GI
upset
occurs;
substitution
of
the
enteric-coated
formulation also may
be benefit; hve patient
swallow
SR
tablet
whole; do not cut of
crush, or chew.
- Black box warning

PATIENT
TEACHING
-

Do not d/c this

drug abruptly or
change dosage,
except on the
advice of your
health
care
provider.
Have
frequent
check-ups,
including blood

Adjunct
in
symptom
management
of
schizophrenia
.

sodium
is
a
compound
containing equal
proportions
of
valproic
acid
and
sodium
valproate.

weakness
Dermatologic:
Transient
increases in hair
loss,
rash,
petechiae
GI:
Nausea, vomiting,
indigestion,
diarrhea,
abdominal
cramps,
constipation,
anorexia
with
weight
loss,
increased appetite
with weight gain,
life-threatening
pancreatitis,
hepatic failure

ANTI-MANIC DRUGS
1. Lithium carbonate

Arrange for frequent

LFTs; discontinue drug
immediately
with
suspected or apparent
significant
hepatic
impairment; continue
LFTs to determine if
hepatic
impairment
progresses in spite of
drug discontinuation
Arrange for patients to
have platelet counts,
bleeding
time
determination before
therapy,
periodically
during therapy, and
prior
to
surgery.
Monitor
patient
carefully for clotting
defects. D/c if there is
evidence
of
hemorrhage, bruising,
or
disorder
of
hemostasis.

tests to monitor
your
drug
response. Keep
all appointments
for check-ups.
You
may
experience these
s/e: Drowsiness,
GI
upset,
transient
increase in hair
loss.
Report bruising,
pink stain on the
toothbrush,
yellowing of the
the
skin/eyes,
pale
feces,
preganancy,
abdominal pain
with N/V and
anorexia.

NAME OF
DRUG

INDICATION

Generic
name:
Lithium
Carbonate

Brand

name:
Quilonium-R

Classificatio
n:
Antidepress
ant

MODES OF ACTION

Treatment
of Neurotransmitters:
acute episodes
-Adrenergic:
of mania &
Lithium increases
hypomania.
the proportion of
low-affinity
receptors thereby
Acute depressions.
reducing
receptor
function.
Acute or chronic
cluster
2-Adrenergic:
headaches.
Lithium
induces
subsensitivity
of
Prophylaxis
of
2-receptors
recurrent manic
thereby increasing
depressive
the release of NE.
illness
Serotonergic:
Lithium
downEndogenous
regulates
some
depression.
serotonergic
receptor subtypes
and
increases
serotonin turnover.
This
reduces
negative
feedback, thereby
increasing
the
release
of
serotonin.
Dopaminergic:
Lithium blocks the
up-regulation
of
receptors
when
given concurrently
with neuroleptics
and
increases
dopamine
concentrations
and turnover. This
prevents
the
release
of
NE,
prevents
D2
dopamine receptor
up-regulation and
augments
the
effects of indirect
agonists.

SIDE/ADVERSE EFFECTS

Initial Therapy: Fine hand

tremor, polyuria, thirst and
nausea

Blood and Lymphatic System

Disorders: Leukocytosis.

Endocrine

Disorders:
Euthyroid
goitre,
hypothyroidism,
hyperthyroidism,
hyperparathyroidism.

Metabolism

and
Nutrition
Disorders: Hyperglycemia,
hypercalcemia, weight gain,
anorexia.

Psychiatric

Disorders:
Hallucinations, somnolence,
memory loss.

Nervous System Disorders:

Tremor,
fasciculations/twitching,
clonic
movements
of
extremities,
ataxia,
choreoathetoid movements,
impaired nerve conduction,
hyperactive deep tendon
reflexes,
extrapyramidal
symptoms, seizures, slurred
speech, dizziness, vertigo,
nystagmus, stupor, coma,
pseudomotor
cerebri,
headache,
dysgeusia,
myasthenia gravis.

Eye

Disorders:
blurred vision.

Scotomata,

NURSING
CONSIDERATI
ONS
1.
Observe
client for signs
and symptoms
of depression,
mood changes,
insomnia,
apathy or lack
of interest in
activities.
2. Check for
signs of lithium
toxicity.
3.
Monitor
client
for
suicidal
tendencies
4.
Check
clients
urine
output
and
body weight.
5. Observe for
and signs of
side/adverse
effects.
6.
Check
clients cardiac
status.
7.
Monitor
patients
electrolytes.

PATIENT
TEACHINGS

1. Tell patient to
take the drug as
prescribed even
if
they
feel
better.
2. Teach patient
the signs and
symptoms
of
lithium
toxicity
and tell them to
report it to the
doctor if any of it
is observed.
3. Tell the patient
that there is a
need
for
an
adequate
and
constant salt and
water intake.
4. Tell patient
that they must
discontinue
lithium therapy
and contact the
physician
immediately
if
they experience
polydypsia,
polyurea or such
clinical signs of
lithium toxicity.
5. Tell patient to
take the drug
with food.

MINOR TRANQUILIZERS
1. Alprazolam (xapor)

DRUG

Generic Name:
Alprazolam

Brand Name:
Apo-Alpraz
(CAN), NovoAlprazol (CAN),
Nu-Alpraz
(CAN), Xanax,
Xanax TS (CAN),
Xanax XR

Drug class:
Benzodiazepine
Anxiolytic

INDICATION

ACTION

Management
of anxiety
disorders, shortterm relief of
symptoms of
anxiety; anxiety
associated with
depression.
Treatment of
panic attacks
with or without
agoraphobia
Unlabeled
uses: Social
phobia,
premenstrual
syndrome,
depression

Exact
mechanisms of
action not
understood;
main sites of
action may be
the limbic
system and
reticular
formation;
increases the
effects of
gammaaminobutyrate,
an inhibitory
neurotransmitte
r; anxiety
blocking effects
occur at doses
well below
those necessary
to cause
sedation,
ataxia.

SIDE/ADVERSE
EFFECT

CNS: dizziness,
drowsiness,
lethargy, confusion,
hangover,
headache, mental
depression,
paradoxical
excitation.
EENT: blurred
vision.
GI: constipation,
diarrhea, nausea,
vomiting, weight
gain.

NURSING
CONSIDERATION

Nursing
Consideration:
- Use cautiously
with impaired liver
or kidney function,
debilitation.

PATIENT TEACHINGS

- Instruct patient to take

medication exactly as
directed; do not skip or
double up on missed
doses. If a dose is missed,
take within 1 hr;
otherwise, skip the dose
and return to regular
schedule. If medication is
less effective after a few
weeks, check with health
care professional; do not
increase dose. Abrupt
withdrawal may cause
sweating, vomiting,
muscle cramps, tremors,
and seizures

Derm: rashes.
Misc: physical
dependence,
psychological
dependence,
tolerance.

May cause drowsiness

or dizziness. Caution
patient to avoid driving
and other activities
requiring alertness until
response to the
medication is known.
Geri: Instruct patient and
family how to reduce falls
risk at home
Advise patient to avoid
drinking grapefruit juice
during therapy
Advise patient to avoid
the use of alcohol or
other CNS depressants
concurrently with
alprazolam. Instruct
patient to consult health
care professional before
taking Rx, OTC, or herbal

2. Zolpidem (adormix)
Drug

Generic Name:
Zolpidem
Brand Name:
Adormix
Classification:
Sedative-hypnotic

Dosage and route:

1 tab, 10 mg

Indication

Zolpidem is approved
for
the
short-term
(usually about two to
six weeks) treatment
of insomnia, and it has
been
studied
for
nightly use up to six
months in a singleblind trial published in
1991, an open-label
study lasting 180 days
published in 1992 (with
continued efficacy in
patients who had kept
taking it as of 180 days
after the end of the
trial), and in an openlabel trial lasting 179
days
published
in
1993. Zolpidem has
not proven effective in

Action

Side Effects and

Adverse
Reactions

Produces
CNS headache,
lethargy,
depression
at
drowsiness.
limbic,
thalamic,
Daytime
hypothalamic
sedation,
levels of CNS; may
dizziness,
be mediated by
confusion, lightneurotransmitter
headedness,
y-aminobutyric
anxiety,
irritability,
acid
(GABA);
amnesia, poor
results
are
coordination,
sedation,
complex sleep
hypnosis, skeletal
related
muscle
relaxant,
reactions: sleep
anticonvulsant
driving, sleep
activity, anxiolytic
eating
action
CV: chest pain,
palpitation
GI: nausea,
vomiting,
diarrhea,
heartburn,

Nursing
Responsibilty

Blood studies:
Hct, Hgb, RBC,
if
blood
dyscrasias are
suspected
(rare)
Hepatic
studies:
AST,
ALT, bilirubin if
hepatic
damage
has
occurred
Mental status:
mood,
sensorium,
affect, memory
(long, short)
Blood
dyscrasias:
fever,
sore
throat,
bruising, rash,
jaundice,

Patient teaching

That
dependence is
possible
after
long-term use
To avoid driving
or
other
activities
requiring
alertness until
drug
is
stabilized
To avoid alcohol
ingestion
That
effects
may
take
2
nights
for
benefits to be
noticed
Alternative
measures
to
improve sleep:
reading,
exercise

maintaining sleep and

is more used for sleep
initiation problems.

abdominal pain,
constipation
HEMA: luekopenia,
granulocytopeni
a (rare)
SYST: severe
allergic reactions

epistaxis (rare)
Type of sleep
problem: falling
asleep, staying
asleep

several
hours
before bedtime,
warm
bath,
warm milk, TV,
self
hypnosis,
deep breathing

3. Clorazepam
DRUG

INDICATION

Brand Name:

-Lennox-

Ritrovil

Gaustat
syndrome,
atypical
absence
seizures,
akinetic
and
mycolonic
seizures.
-Panic disorder
-Acute manic
episodes
of
bipolar
disorder

Generic Name:
Clorazepam

Classification:
Minor Tranquilizer

ACTION

SIDE/ADVERSE EFFECTS

NURSING
CONSIDERATI
ON

-Probably
facilitates
the
effects of the
inhibitory
neurotransmitt
er GABA.

CNS: Transient mild drowsiness,

depression, lethargy, apathy,
fatigue, light headedness, anger,
restlessness, confusion, delirium,
headache

Watch
for
behavioral
disturbances
especially
in
children.

CV: Bradycardia, tachycardia, CV

Collapse,
hypertension
and
hypotension, palpitation, edama

-Assess elderly
patients
response
closely.

DERMATOLOGIC:
pruritus, rash, edema
EENT:
Visual
disturbance,

and

Urticaria,

auditory
diplopia,

-Monitor

PATIENT
TEACHING

-Dont
stop
drug
abruptly
because
this
may
worsen
seizures.
Call
prescriber
at
once
if
adverse
reactions
develop

Dosage:
2mg

-Adjunct
treatment for
schizophrenia

nystagmus, depressed hearing,

nasal congestion
GI: Constipation, diarrhea, dry
mouth,
salvation,
nausea,
anorexia,
vomiting,
difficulty
swallowing
GU:
Incontinence,
urinary
retention, changes in libido,
menstrual irregularities

patient
for
oversedation
-Withdrawal
symptoms
are
similar
to
those
of
barbiturates.

INJECTABLES
1. Fluphenazine decanoate

NAME OF
DRUG

INDICATION

MODE OF ACTION

Generic
Management
of Fluphenazine
name:
schizophrenia,
decanoate blocks
Fluphenazin
mania & other
postsynaptic
e decanoate
psychoses.
dopamine D1 and
D2 receptors in the
Brand
mesolimbic
name:
system
and
Modezine
decreases
the
release
of
hypothalamic and
hypophyseal
hormones.
It
reduces
Classificatio
aggressiveness
n:
with
Antipsychoti
disappearance of
cs
hallucinations and
delusions.or
increase in adenyl
cyclase
function
depending on the
proportion
of
regional
Gproteins.

SIDE/ADVERSE
EFFECTS

Tardive
dyskinesia
Sedation
Mental confusion
Hypotension
Hyperprolactinae
mia leading to
galactorrhoea
and
amenorrhoea in
women
Loss of libido
Impotence and
sterility in males.
Allergic reactions
Cholestatic
jaundice
orneal and lens
deposits
Skin
pigmentation.
Potentially
Fatal:
Agranulocytosis;
neuroleptic
malignant
syndrome.

NURSING
CONSIDERATIONS

PATIENT
TEACHINGS

1. Check if patient
has
any
extrapyramidal
symptoms (dystonic
reactions & akathisia
are
common).
Occasionally,
galactorrhea,
augmentation
of
epilepsy,
epigastric
pain or jaundice. May
release
catecholamines, use
w/
caution
in
pheochromocytoma.

1. Tell patient to
avoid direct sunlight
exposure.

2. Check for
history
hypersensitivity
the drug
3. Rotate
sites

any
of
to

injection

4. Check patients
prolactin
levels
(which may persist
after chronic admin.)

2. Tell patient to
have regular eye
examinations
if
receiving long term
therapy.
3. Tell patient that
drug may be taken
with or without food.
4. Tell patient to
report any observed
adverse reaction to
the
health
care
team.

2. Haloperidol
DRUG

Generic Name:
Haloperidol
Brand Name:
Haldol
Classification:
CNS drugs

INDICATION

ACTION

SIDE/ADVERSE
EFFECT

NURSING
CONSIDERATIO
N

PATIENT
TEACHINGS

Management of
Tourette
disorders, control
for adults. Longterm
antipsychotic
therapy.

Competitively
blocks dopamine
receptors to
cause sedation
and also causes
alpha adrenergic
and anticholinergic
blockade. It
depresses
cerebral cortex,
hypothalamus
and limbic
system that
control activity
and aggression.

Blurred
vision;
changes
in
menstrual
period;
constipation;
dryness
of
mouth; swelling
or pain in breasts
(in
females);
unusual
secretion of milk;
weight gain

-assess patients
disorder and
mental status
before drug
therapy.
-Monitor for
possible adverse
reactions (severe
extrapyramidal
reactions).
Monitor
swallowing of

-Instruct patient
to
take
drug
exactly
as
prescribed.
- advise patient
to
avoid
hazardous
activities
until
the
drug
response
is
determined
because
dizziness
and
blurred vision are
common.

-management of
severe
behavioural
problems in
children.