Case Study #7

Leslie Wiley
The Robert B. Miller College
Jim Middleton, Professor
BSRN 340- Pharmacology
March 20, 2015

Case Study #7

AB has presented to the emergency department with stomach issues

as well as episodes of vertigo. Signs would lead to a multitude of different
diagnoses until the physician asks what medication AB is taking. That
question would possible make the situation a whole lot clearer. AB is taking
multiple antipsychotic medications including lithium, risperdal, and seroquel
XR.
Lithium levels should be kept between 0.8 and 1.4 mEq/L for initial
therapy. Once therapeutic effects have been achieved the level should be
kept between 0.4 to 1 mEq/L. These levels should be drawn in the morning
for the most accurate level. ABs lithium level was drawn after 9pm in the
evening as that is when she arrived at the emergency room. Her level may
be inaccurate as she may have just taken her evening dose and it wouldnt
have affected her levels yet. However, her level came back at 0.9 and is not
toxic. (Lehne, 2013)
Physicians suspect that AB has an upper respiratory infection. Two of
the medications that AB is taking, seroquel XR (Seroquel, 2014) and risperdal
(Drugs.com, 2014) have been known to cause a decrease in white blood
cells. White blood cells are used to fight off infection. If ABs immunity has
been compromised she could have picked up an upper respiratory infection.
Risperdal has been known to cause dizziness or a feeling of passing
out. More common side effects include upset stomach. (Drugs.com, 2014)
AB has both of these symptoms. Lithium also causes dizziness and

drowsiness. A serious side effect is swelling of the face and tongue along
with trouble breathing. (WebMD, no date) ABs speech sounds distant and
thickpossible swollen tongue? The last antipsychotic medication, seroquel
XR, which AB is taking, could cause dizziness or lightheadedness upon
standing. Also listed for side effects are upset stomach and disturbances in
speech and language. (Seroquel, 2014) All of these medications could
potentially have a role in ABs symptoms. Especially since her doses were
recently increased.
The husband is concerned with AB still taking this medication. I would
question him about her mental state. She was originally placed on these
medications two years ago following a family death. As a nurse, I want to
know are there other reasons for the medication such as bipolar disorder.
ABs primary physician has kept her on these medications for two years
which leads me to believe that the issue is a chronic issue rather than an
acute issue that was being treated. Her husband may need to be counseled
on the reasons for the medications and the importance of taking them. He
should be informed of what could possible happen she stop taking these
medications.
Antipsychotic medications, such as the drugs that AB is taking daily,
must be tapered down to safely stop the medications. The emergency
physician spoke with ABs primary physician and the decision was made to
stop all medications except for the lithium. Seroquel XR must be tapered off

for a couple of weeks to prevent side effects. Risperdal should also be

weaned off of. If not, there could be potential side effects from this. AB and
her husband should understand the importance of being compliant with
medications and the weaning process and to follow the direction of her
physician.

References
AstraZeneca. (2014, June 14). About Seroquel XR. Retrieved March 16, 2015,
from http://www.seroquelxr.com/about/side-effects.html
Lehne, R. A. (2013). Pharmacology for Nursing Care (8th ed.). St. Louis, MO:
Elsevier Saunders.
Lithium Carbonate. (n.d.). In WebMD. Retrieved March 16, 2015, from
http://www.drugs.com/pro/lithium-carbonate.html
Risperdal. (2014, June 16). In Drugs.com. Retrieved March 16, 2015, from
http://www.drugs.com/risperdal.html