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Generic Name Divalproex Sodium
Brand Name Depakote
Action Increases level of gammaaminobutyric acid(GABA) in brain, which decreases seizure activity.
Indication Treatment of primary generalized seizures, and notably absence and myoclonic seizures, and also for partial seizures. Also used to treat acute manic phase of bipolar disorders (manic depression) and for the prophylaxis of migraine.
Contraindicatio n Pregnancy (Category D). Patients with known hypersensitivity to the drug. Patients with preexisting liver disease or a family history of severe hepatic dysfunction. Patients with known urea cycle disorders.
Adverse and Side Effect The most frequent adverse effects are gastro-intestinal disturbances, particularly on initiation of theraphy. Less common: Increased appetite and weight gain, edema, headache, reversible prolongation of bleeding time, and thrombocytopenia. Neurologic: Ataxia, tremor, sedation, lethargy, confusion and more rarely encephalopathy and coma. Aggression, hyperactivity, behavioural
Nursing Considerations - Monitor blood studies: Hct, Hgh, RBC, serum folate, platelets, Protime, vit D if on long term theraphy. - Monitor liver function studies: AST, ALT, bilirubin, creatinine, failure - Monitor blood levels: therapeutic level 50-100 mcg/mL - Assess mentral status: mood, sensorium, affect, memory (long, short) - Assess respiratory
Instruct patient to avoid driving or activities that require alertness. jaundice. transient hair loss. rash. gynecomastia. hold drug if respirations are<12/min or if pupils are dilated. protracted vomiting to physician. rhythm. hepatic failure and pancreatitis. character. Warn patient not to stop the drug abruptly. amenorrhea. sometimes with regrowth of curly hair. light-colored stools.disturbances. Advise patient to report visual disturbance. rate. - - dysfunction: respiratory depression. diarrhea. .
drak urine. blurred vision. liver enzyme elevations. -Advise patient to use sunscreen to prevent photosensitivity. Contraindication Pregnancy (Category D). -Teach patient to report immediately to physician if with following reactions: chills. accommodation disorders. Diplopia. -Advise patient not to discontinue medication quickly after long term use. bruising. Nursing Considerations -Assess for seizures. hallucinations. Alcohol withdrawal disorder. leukopenia.Generic Name Carbamazepine Brand Name Tegretol Action Exact mechanism unknown. vomiting. Adverse and Side Effect Mild. dizziness. agitation. yellowing of skin/eyes. Indication Epilepsy. Severe hemic disorders. mostly transient and dose dependent. allergic skin reactions. Severe bradycardia (less than 50 times/ min). ataxia. acute mania: maintenance of bipolar affective disorders. mouth ulcers. lightcolored stools. SLElike syndromes: peripheral neuritis. Hypersensitivity. depression. . sore throat. appears to decrease polysynaptic responses and block posttetanic potentiation. rash. -Caution patient to avoid activities that require alertness. -Monitor liver function tests and urine function test. Dizziness. abdominal pain.
unstable angina pectoris. Contraindication Nursing Considerations -Allergy to olanzapine. -Intramuscular tachycardia and in some injection site patients. -Tachycardia Alzheimer’s dementia. -Advise patient not to do hazardous activities. -Agitation May induce orthostatic -Postural hypotension associated Hypotension with dizziness. -assess for neuroleptic malignant syndrome: hyperpyrexia. Hypotension. may antagonize muscarinic receptors. histaminic (H1)and alphaadrenergic. -Advise patient to avoid hot tubs. -Provide decreased stimuli by dimming light. muscle rigidity etc. -Do not withdraw drug abruptly. acute MI. sick sinus syndrome. Provide supervised ambulation until stabilized on medication. Rapid control of agitation and disturbed behaviours in patients with schizophrenia or manic episodes when oral theraphy is not appropriate. As monotheraphy or in combination with lithium or valproate for acute manic or mixed episodes in bipolar disorder with or without psychotic features and with or without repid cycling course. -Give decreased dose in elderly.Generic Name Olanzapine Brand Name Zyprexia Action Unknown: may mediate antipsychotic activity by both dopamine and serotonin type 2 (5hydroxytryptamin e [HT]2) antagonism. -Assess mental status. avoiding loud noises. also. Indication Acute and maintenance treatment of schizophrenia and other psychoses where positive symptoms and/or negative symptoms are prominent. discomfort -Postural Patients with a history of Hypotension seizures or with -Hypotension conditions that lower the -Bradycardia with seizures or with or without conditions that hypotension or potentially lower the syncope seizure threshold. heart surgery. syncope. -Dizziness -Somnolence Pregnancy (Category C). Avoid driving/operating machineries. bradyarrythmia. . Adverse and Side Effect Known hypersensitivity -Headache to the drug.
Indication Treatment of generalized convulsive seizures. Instruct patient not to chew or crush extended tablets. Contraindication Pregnancy (Category D). absence (petit mal). partial (focal and motor). - - - - . Other possibilities include acting on the postsynaptic receptor sites to mimic or enhance the inhibitory effect of GABA. Tell patient that syrup should not be mixed with carbonated drinks. Advise patient to report drug induced adverse reactions. which decreases seizure activity.Generic Name Valproic Acid Brand Name Depacon Action Anticonvulsant activity may be by increasing levels of yaminobutyric (GABA) in brain. Hepatic disease or significant dysfunction. Instruct patient to avoid activities that requires mental alertness. - Adverse and Side Effect Hemorrhage Bruising Coagulation disorders Hyperammonemia Sedation Transient alopecia Nausea Vomiting Indigestion Increased appetite Thrombocytopenia Anemia Bone marrow suppression NursingConsiderations Assess mental status. Advise patient not to discontinue quickly after long-term use. Assess hepatic and hematologic status. tonicclonic(grand mal).
.- Advise patient that drug may be taken with food or milk to reduce GI effects.
GI: abdominal pain. GU: polyuria. Lithobid Action Alters cation transport in nerve and muscle. may be closely monitored Some products contain alcohol or tartrazine and should be avoided in patients with known hypersensitivity or intolerance Use Cautiously in: Any degree of cardiac. confusion. including blood levels. bloating.Toxicity and Overdose: Monitor serum lithium levels twice weekly during initiation of therapy and every 2–3 mo during chronic therapy.5 Manic episodes of manic depressive May also illness influence (treatment. fatigue. drowsiness. Assess manic symptoms with Young Mania Rating Scale (YMRS) at baseline and periodically through treatment in patients with mania. mood.ECG changes. neurotransmitters. dizziness. folliculitis. blurred vision. CV: ARRHYTHMIAS. renal. Hemat: leukocytosis. Nursing Considerations -Assess mental status (orientation. nephrogenic diabetes insipidus. pruritus. hyperglycemia.5 to 1. impaired memory. psychomotor retardation. hyperthyroidism. dysarthria. Initiate suicide precautions if indicated. Endo: hypothyroidism. Metab: weight gain. rigidity. Draw blood samples in the morning immediately before next dose. Derm: acneiform eruption. diarrhea. F and E:hyponatremia. reuptake of maintenance. behavior) initially and periodically. nausea. Therapeutic Effects: Prevents/ decreases incidence of acute manic episodes . edema. MS: muscle weakness. prophylaxis). hyperirritability. diminished sensation. goiter. anorexia. . Therapeutic levels range from 0.alopecia. sedation. restlessness. heada che. metallic taste. stupor. Indication Contraindication Contraindicated in: Hypersensitivity Severe cardiovascular or renal disease Dehydrated or debilitated patients Should be used only where therapy. hypotension. tinnitus. or thyroid disease Diabetes mellitus Pregnancy/LactationSaf ety not established Geri: Initial dosage reduction recommended Adverse and Side Effect CNS: SEIZURES. renal toxicity. glycosuria. ataxia. dry mouth.Generic Name Lithium Carbonate Brand Name Eskalith. EENT: aphasia. Neuro:tremors.
mEq/L. slurred speech. Patient should inform health care professional if fainting.Assess patient for signs and symptoms of lithium toxicity (vomiting. drowsiness. If these occur. . report before administering next dose.Advise patient that weight gain may occur. decreased coordination. . -Explain to patients with cardiovascular disease or over 40 yr of age the need for ECG evaluation before and periodically during therapy. . or twitching). muscle weakness. irregular pulse. or difficulty breathing occurs. diarrhea.
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