Benedict James R.

Bermas
BSN - 3

Medication: Usual Dosage Cellular MOA Side Effects/Drug Interactions/ Nursing Management
Generic/Trade name (Routes of Onset/Peak/ Contraindications (Implications & Teachings)
Specific drug class Administratio Duration
Dosage/Route/Times n)

Chlorpromazine Film-Coated Chlorpromazine belongs to
hydrochloride (CENTRAL Tablet (Oral) = the category of typical
NERVOUS SYSTEM 10mg, 25mg, antipsychotics or
AGENT; 50mg, 100mg, neuroleptics, also known as
PSYCHOTHERAPEUTIC; 200mg first-generation
ANTIPSYCHOTIC; antipsychotics (FGAs). It
PHENOTHIAZINE; produces its antipsychotic
ANTIEMETIC) effect by the post-synaptic
blockade at the D2 receptors
in the mesolimbic pathway.
However, the blockade of D2
receptors in the nigrostriatal
pathway is responsible for its
extrapyramidal side effects.
O: 30-60 mins.
P: 2-4 hours
D: 4-6 hours; extended
release, 10-12 hours
Side effects may include: ● Monitor vital signs
● dizziness, feeling including BP for
unsteady, or having hypotension.
trouble keeping your ● Apnoea monitoring whilst
balance on medication.
● Observe for signs of
● blank facial expression
adverse effects.
● shuffling walk
● Patients should remain
● restlessness supine for 30 minutes after
● agitation IM injection, monitor BP
● nervousness (tachycardia may occur
● unusual, slowed, or with IM injection)
uncontrollable
movements of any part
of the body
● difficulty falling asleep or
staying asleep
● increased appetite
● weight gain
● breast milk production
● breast enlargement
 ● missed menstrual
periods
● decreased sexual ability
● changes in skin color
● dry mouth
● stuffy nose
● difficulty urinating
● widening or narrowing of
the pupils (black circles
in the middle of the eyes)
Interaction:
Interactions resulting in decreased
chlorpromazine levels - Food,
alcohol and benztropine can reduce
the absorption of chlorpromazine.
Antacids can slow the absorption of
chlorpromazine. Lithium and chronic
administration of barbiturates can
lead to increased clearance of
chlorpromazine.

Interactions resulting in increased

chlorpromazine levels - Tricyclic
antidepressants decrease the
clearance of chlorpromazine and
may lead to increased serum levels
 Contraindication:
● disopyramide
● eliglustat
● ibutilide
● indapamide
● metrizamide
● pentamidine
● pimozide
● procainamide
● quinidine
● sotalol

Levomepromazine Oral = 50 mg Suppresses sensory impulses in Side effects may include: ● Carefully supervise
(CENTRAL NERVOUS the CNS via various neuro- ● Drowsiness ambulation for at least 6
SYSTEM AGENT; Subcut = 200 mg transmitters. ● Dry mouth h, but preferably 12 h.
NONNARCOTIC ● Fatigue Orthostatic hypotension
ANALGESIC; O: 20-40 mins ● Restless with faintness, weakness,
PHENOTHIAZINE; P: 1-2 hours ● Unusual muscle and dizziness may occur
ANXIOLYTIC; SEDATIVE- D: 4 hours movements within 10–20 min after
HYPNOTIC) ● Uncontrollable muscle drug administration and
movements may last 4–6 h and
● Constipation occasionally as long as 12
h. Tolerance to effects
Interaction: usually develops with
Increased clinical effect/toxicity of successive doses.
some drugs (due to increased ● Excessive sedation and
blood concentrations of them) amnesia also occur
may occur with levomepromazine commonly during early
(methotrimeprazine) due to drug therapy.
 metabolising enzyme inhibition by
levomepromazine
(methotrimeprazine) e.g.
amitriptyline, codeine (decreased
morphine concentrations so
decreased clinical efficacy of
codeine), fluoxetine, nortriptyline,
oxycodone, paroxetine,
promethazine
Contraindication:
● Hepatic dysfunction
● Encephalopathy
● Parkinson’s disease
● DLB
● Assess BP and pulse
frequently until dosage
requirements and response
are stabilized. Monitor
older adult and debilitated
patients closely.
● Methotrimeprazine
injection contains a
bisulfite, an allergen for
some patients.
● Do not treat severe
hypotension with
epinephrine; it is
specifically
contraindicated.

Haloperidol (CENTRAL Tablet Haloperidol is a first- Side effects may include: ● Monitor for therapeutic
NERVOUS SYSTEM generation (typical ● dry mouth effectiveness. Because of
AGENT; ● 0.5mg antipsychotic) which exerts long half-life, therapeutic
● increased saliva
PSYCHOTHERAPEUTIC; ● 1mg its antipsychotic action by effects are slow to
● blurred vision
ANTIPSYCHOTIC; ● 2mg blocking dopamine D2 develop in early therapy
● loss of appetite
BUTYROPHENONE) ● 5mg receptors in the brain. When or when established
● 10mg ● constipation
72% of dopamine receptors dosing regimen is
● 20mg ● diarrhea
are blocked, this drug changed. "Therapeutic
oral concentrate achieves its maximal effect. ● heartburn window" effect (point at
● nausea which increased dose or
● 2mg/mL O: 30-45 mins. ● vomiting concentration actually
P: 2-6 hours ● difficulty falling asleep or decreases therapeutic
injectable solution, D: Unknown staying asleep
lactate ● blank facial expression
● uncontrollable eye
● 5mg/mL
movements
injectable solution,
● unusual, slowed, or
decanoate
uncontrollable
● 50mg/mL movements of any part
● 100mg/mL of the body
● restlessness
● agitation
● nervousness
● mood changes
● dizziness, feeling
unsteady, or having
trouble keeping your
balance
● headache
● breast enlargement or
pain
● breast milk production
● missed menstrual
periods
● decreased sexual ability
in men
● increased sexual desire
● difficulty urinating
response) may occur after
long period of high doses.
Close observation is
imperative when doses
are changed.
● Target symptoms expected
to decrease with successful
haloperidol treatment
include hallucinations,
insomnia, hostility,
agitation, and delusions.
● Monitor patient's mental
status daily.
● Monitor for neuroleptic
malignant syndrome (NMS)
(see Appendix F), especially
in those with hypertension
or taking lithium.
Symptoms of NMS can
appear suddenly after
initiation of therapy or
after months or years of
taking neuroleptic
(antipsychotic) medication.
Immediately discontinue
drug if NMS suspected.
● Monitor for parkinsonism
and tardive dyskinesia (see
Appendix F). Risk of tardive

Interaction:
Drug: CNS DEPRESSANTS, OPIATES,
alcohol increase CNS depression;
may antagonize activity of ORAL
ANTICOAGULANTS;
ANTICHOLINERGICS may increase
intraocular pressure; methyldopa
may precipitate dementia.
Contraindication:
Parkinson's disease, parkinsonism,
seizure disorders, coma;
alcoholism; severe mental
depression, CNS depression;
thyrotoxicosis. Safe use during
pregnancy (category C), lactation,
or in children <3 y is not
established.
dyskinesia appears to be
greater in women receiving
high doses and in older
adults. It can occur after
long-term therapy and
even after therapy is
discontinued.
● Monitor for extrapyramidal
(neuromuscular) reactions
that occur frequently
during first few days of
treatment. Symptoms are
usually dose related and
are controlled by dosage
reduction or concomitant
administration of
antiparkinson drugs.
● Be alert for behavioral
changes in patients who
are concurrently receiving
antiparkinson drugs.
● Monitor for exacerbation
of seizure activity.
● Observe patients closely
for rapid mood shift to
depression when
haloperidol is used to
control mania or cyclic
disorders. Depression may
 represent a drug adverse
effect or reversion from a
manic state.
● Lab tests: Monitor WBC
count with differential and
liver function in patients on
prolonged therapy.

Fluphenazine decanoate 1 mg, 2.5 mg, 5 Potent phenothiazine, Side effects may include:
(CENTRAL NERVOUS mg, 10 mg antipsychotic agent. Blocks ● upset stomach ● Report immediately onset
SYSTEM AGENT; tablets; 2.5 mg/5 postsynaptic dopamine ● weakness or tiredness of mental depression and
PSYCHOTHERAPEUTIC; mL elixir; 5 receptors in the brain. Similar ● excitement or anxiety extrapyramidal symptoms.
ANTIPSYCHOTIC; mg/mL oral to other phenothiazines with Both occur frequently,
● insomnia
PHENOTHIAZINE) concentrate; 2.5 the following exceptions: more particularly with long-
● nightmares
mg/mL, 25 potent per weight, higher acting forms (decanoate
● dry mouth
mg/mL injection incidence of extrapyramidal and enanthate).
● skin more sensitive to ● Be alert for appearance of
complications, and lower
frequency of sedative, sunlight than usual acute dystonia (see
hypotensive, and antiemetic ● changes in appetite or Appendix F). Symptoms
effects. weight can be controlled by
reducing dosage or by
O: 1 hour Interaction: adding an antiparkinsonism
P: 1-2 hours Drug: Alcohol and other CNS drug such as benztropine.
D: 6-8 hours DEPRESSANTS may potentiate ● Be alert for red, dry, hot
depressive effects; decreases skin; full, bounding pulse,
seizure threshold, may need to dilated pupils, dyspnea,
adjust dosage of mental confusion, elevated
ANTICONVULSANTS. BP, temperature over 40.6°
Herbal: Kava-kava may increase
risk and severity of dystonic
reactions.
Contraindication:
Known hypersensitivity to
phenothiazines; subcortical brain
damage, comatose or severely
depressed states, blood dyscrasias,
renal or hepatic disease. Safety
during pregnancy (category C) or
lactation is not established.
Parenteral form not recommended
for children <12 y.
C (105° F). Inform physician
and institute measures to
reduce body temperature
rapidly. Extended exposure
to high environmental
temperature, to sun's rays,
or to a high fever places
the patient taking this drug
at risk for heat stroke.
● Lab tests: Monitor kidney
function in patients on
long-term treatment.
Withhold drug and notify
physician if BUN is elevated
(normal BUN: 10–20
mg/dL). Also perform WBC
with differential, liver
function tests, periodically.
● Monitor BP during early
therapy. If systolic drop is
more than 20 mm Hg,
inform physician.
● Monitor I&O ratio and
bowel elimination pattern.
Check for abdominal
distension and pain.
Monitor for xerostomia
and constipation.
 ● Note: Patients on large
doses who undergo surgery
and those with
cerebrovascular, cardiac, or
renal insufficiency are
especially prone to
hypotensive effects.

Risperidone tablet (Oral) Risperidone is a second- Side effects may include ● Check patient’s history of
(Central Nervous ● 0.25mg generation antipsychotic that ● nausea. allergy to Risperidone
System(CNS)atypical ● 0.5mg has an affinity for D2, 5-HT2A, ● vomiting. ● Check patient’s VS and
antipsychotics) ● 1mg alpha 1, alpha 2 and H1 ● diarrhea. Monitor patient regularly
● 2mg receptors. The mechanism of ● constipation. for signs and symptoms
● 3mg action of risperidone is not ● heartburn. of diabetes mellitus.
● 4mg fully understood, current ● dry mouth. ● Advise patient to rise
tablet, orally theories focus mainly on its ● increased saliva. slowly from a recumbent
disintegrating ability to block D2 and 5- ● increased appetite. or seated position to
● 0.5mg HT2A receptors. Interaction minimize light-
● 1mg Risperidone/Duloxetine; headedness.
● 2mg O: Unknown ● Warn patient not to
Fluoxetine; Paroxetine
● 3mg
P: 1hour Interactions operate hazardous
● 4mg
D: Unknown ● The amount of risperidone machinery, including
Oral Solution
● 1mg/ml in the blood may increase. driving a car, until effects
This may cause the patient of drug are known.
to have more side effects ● Tell patient to call before
from the medicine. taking new drugs,
Cabergoline/Selected Dopamine including OTC drugs,
Blockers because of potential for
● The effectiveness of the interactions.
 cabergoline, antipsychotic
or anti-nausea medicine
may be decreased.
Sibutramine/Antipsychotics
● Both sibutramine and
Antipsychotic drugs can
affect the patient’s central
nervous system, this might
cause more side effects
than normal.
Contraindication
● Patient hypersensitive to
drug and in breast-feeding
women.
● Use cautiously in patients
with prolonged QT
interval, CV disease,
cerebrovascular disease,
dehydration, hypovolemia,
history of seizures, or
exposure to extreme heat
or conditions that could
affect metabolism or
hemodynamic responses

Quetiapine fumarate For Quetiapine is a second- Side effects may include:

(Central Nervous schizophrenia: generation antipsychotic that ● Mood and behavior ● Monitor diabetics for loss
System(CNS)atypical ● IR: 150 to has affinity for D2, 5-HT2A, changes of glycemic control.
antipsychotics) 750 mg daily H1, alpha 1 and 5-HT1A ● Constipation ● Reassess need for
 in two or receptors. Its precise ● Stomach pain continued treatment
three mechanism of action is ● Upset stomach periodically.
divided unknown, but according to ● Nausea ● Withhold the drug and
doses the dopamine theory of ● Vomiting immediately report S&S of
● ER: 400 to schizophrenia, antipsychotic ● Drowsiness tardive dyskinesia or
800 mg each effects might be related to ● Dizziness neuroleptic malignant
evening; the drug’s ability to reduce ● Lightheadedness syndrome (see Appendix
start with dopaminergic Interaction: F).
300 mg daily neurotransmission in the Paintkillers ● Lab tests: Periodically
with up to mesolimbic pathway. ● It's fine to take paracetamol, monitor liver function, lipid
300 mg O: 4 - 6 hours aspirin or ibuprofen with profile, thyroid function,
increases P: 1.5 hours quetiapine, assuming these blood glucose, CBC with
daily/as D: 3 hours are appropriate for you. If differential.
needed. you find quetiapine makes ● Monitor ECG periodically,
For bipolar I you drowsy or constipated, especially in those with
disorder it's best to avoid taking co- known cardiovascular
(manic): codamol, because this disease.
● IR: 200 to painkiller could make these ● Perform baseline cataract
400 mg problems worse. exam when therapy is
twice daily ● Drug: BARBITURATES, started and at 6 mo
For bipolar I carbamazepine, phenytoin, intervals thereafter.
disorder rifampin, thioridazine may
● Monitor patients with a
(manic/mixed): increase clearance of
history of seizures for
● ER: 400 to quetiapine. Quetiapine may
lowering of the seizure
800 mg each potentiate the cognitive and
threshold.
evening. motor effects of alcohol,
● Carefully monitor blood
For acute enhance the effects of
glucose levels if diabetic.
depressive ANTIHYPERTENSIVE
● Exercise caution with
bipolar disorder: AGENTS, antagonize the
potentially dangerous
● IR: 300 mg effects of levodopa and
daily at DOPAMINE AGONISTS.
bedtime Ketoconazole, itraconazole,
● ER: 300 at fluconazole, erythromycin
bedtime may decrease clearance of
quetiapine. Herbal: St.
John's wort may cause
serotonin syndrome
(headache, dizziness,
sweating, agitation).
Contraindication:
● There are currently no
known FDA
contraindications of
quetiapine. However,
there are several
precautions to be
considered when
administering this drug. As
mentioned before,
quetiapine, along with
other atypical
antipsychotics, is
associated with an
increased risk of death in
elderly patients with
dementia-related
activities requiring
alertness, especially during
the first week of drug
therapy or during dose
increments.
● Make position changes
slowly, especially when
changing from lying or
sitting to standing to avoid
dizziness, palpitations, and
fainting.
● Avoid alcohol consumption
and activities that may
cause overheating and
dehydration.
● Inform the physician
immediately if you become
pregnant.
● Do not breastfeed while
taking this drug.
psychosis. Also, precaution
is a consideration with
drugs that increase QT
interval and patients with
prolonged QT intervals.
Drugs include Class I and
Class III antiarrhythmics,
antipsychotics, macrolides,
fluoroquinolone,
pentamidine,
levomethadyl acetate,
methadone, first-, and
second-generation
antipsychotics, tricyclic
antidepressants, quinine,
halofantrine, and
albendazole. These
combinations put the
patient at risk for torsades
de pointes. Precautions
are also necessary for
patients with a history of
cardiac arrhythmia,
hypokalemia, and
hypomagnesemia
Clozapine 25 mg, 100 mg Mechanism is not defined. Side effect may include:
(Central Nervous tablets and Interferes with binding of ● weight gain;
System(CNS); orally dopamine to D1 and D2 ● dizziness, tremor;
psychotherapeutic disintegrating receptors in the limbic region
● fast heart rate;
agents tablets of the brain. It binds primarily
● headache, drowsiness;
atypical;antipsychotic) to nondopaminergic sites
● nausea, constipation;
O: 2–4 weeks
● dry mouth, or increased
P: 2.5 hours
salivation;
D: 4–6 hours
● vision problems; or.
● fever, increased sweating.
Interaction:
Alcohol and other CNS
DEPRESSANTS compound
depressant effects;
ANTICHOLINERGIC AGENTS
potentiate anticholinergic effects;
ANTIHYPERTENSIVE AGENTS may
potentiate hypotension.
Contraindication:
Severe CNS depression, blood
dyscrasia, history of bone marrow
depression; patients with
myeloproliferative disorders,
uncontrolled epilepsy; clozapine-
● Lab tests: Baseline WBC and
absolute neutrophil count must
be made before initial
treatment, every week for first
6 mo, then every 2 wk for next
6 mo, then every 4 wk, and
weekly for 4 wk after the drug
is discontinued. Periodically
monitor blood glucose.
● Monitor diabetics for loss of
glycemic control.
● Monitor for seizure activity;
seizure potential increases at
the higher dose level.
● Closely monitor for recurrence
of psychotic symptoms if the
drug is being discontinued.
● Monitor cardiovascular and
respiratory status, especially
during the first month of
therapy. Report promptly S&S
of CHF and other potential
cardiac problems.
● Monitor for development of
tachycardia or hypotension,
which may pose a serious risk
for patients with compromised
cardiovascular function.
 ● Monitor daily temperature and
induced agranulocytosis, severe report fever. Transient
granulocytosis, chemotherapy, elevation above 38° C (100.4°
coma, leukemia, leukopenia, F), with peak incidence during
neutropenia, myocarditis, first 3 wk of drug therapy, may
concurrent administration of occur.
benzodiazepines or other
psychotropic drugs; renal failure,
dialysis, hepatitis, jaundice; infants,
lactation.

Escitopram 5 mg, 10 mg, 20 Selective serotonin reuptake Side effect

(Central Nervous mg tablets; inhibitor (SSRI) in the CNS. ● dizziness, drowsiness, ● Monitor for therapeutic
System(CNS)Agent; 5 mg/5 mL Antidepressant effect is weakness; effectiveness: Indicated by
psychotherapeutic agent liquid presumed to be linked to its ● sweating, feeling shaky or elevation of mood; 1–4 wk
; selective serotonin; Orally inhibition of CNS presynaptic anxious; may be needed before
reuptake neuronal uptake of serotonin ● sleep problems (insomnia); improvement is noted.
inhibitor;antidepressant which results in ● dry mouth, loss of appetite; ● Closely observe for worsening
s) antidepressant activity. Does ● nausea, constipation; of depression or emergence of
not produce any ● yawning; suicidality.
sympathomimetic response ● weight changes; or. ● Lab tests: Monitor periodically
or anticholinergic activity. ● decreased sex drive, hepatic functions, CBC, serum
O: Approx. 1 week impotence, or difficulty having sodium, and lithium levels
P: 3 hours an orgasm. when the two drugs are given
D: 12 hours 30 minutes concurrently.
Interaction:
● Monitor periodically HR and
BP, and carefully monitor
Combination with MAOI could result complete cardiac status in
in hypertensive crisis, hyperthermia, person with known or
 rigidity, myoclonus, autonomic
instability; cimetidine may increase
escitalopram levels; linezolid may
cause serotonin syndrome.
Contraindication:
Hypersensitivity to citalopram;
concurrent use of MAOIS or use
within 14 d of discontinuing MAOIS;
pregnancy (category C); volume
depleted; lactation; children <18 y.
suspected cardiac disease.
● Monitor closely older adult
patients for adverse effects,
especially with doses >20
mg/d.
● Do not engage in hazardous
activities until reaction to this
drug is known.
● Avoid using alcohol while
taking escitalopram.
● Inform physician of commonly
used OTC drugs as there is
potential for drug
interactions.
● Report distressing adverse
effects including any changes
in sexual functioning or
response.
● Periodic ophthalmology
exams are advised with long-
term treatment.
● Do not breastfeed while
taking this drug.

Vortioxetine Oral (Film- Vortioxetine hydrobromide Side Effects ● Assess for the mentioned
hydrobromide coated Tablets) belongs to a class of drugs ● nausea, cautions and
(Antidepressants; (Once a day) called Antidepressants. This ● diarrhea, contraindications (e.g. drug
selective serotonin 5mg medication is used to treat ● constipation, allergies, hepatorenal
reuptake inhibitor; 10mg depression. It works by ● vomiting, diseases, psychosis,
serotonin receptor 15mg helping to restore the
modulator.) 20mg balance of a certain natural
substance (serotonin) in the
brain. Vortioxetine is an SSRI
(selective serotonin reuptake
inhibitor) and serotonin
receptor modulator. This
medication may improve
your mood, sleep, appetite,
contraindicated for people who
and energy level and may
help restore your interest in
daily living.
O: Unknown
P: 7 to 11 hours
D: 66 hours
● sexual dysfunction,
● dry mouth,
● gas,
● dizziness,
● abnormal dreams, and
● itching.
Contraindication
This medication is
have:
● A disorder with excess
antidiuretic hormone called
syndrome of inappropriate
antidiuretic hormone
● A low amount of sodium in
the blood
● manic behavior
● A form of mania that has a
lower severity of symptoms
● manic-depression
● suicidal thoughts
● serotonin syndrome, a type
of disorder with high
serotonin levels
● closed angle glaucoma
● bleeding from stomach,
esophagus or duodenum
● CYP2D6 poor metabolizer
● A risk of angle-closure
glaucoma due to narrow
angle of anterior chamber of
eye
glaucoma, etc.) to prevent
any untoward
complications.
● Assess for history of seizure
disorders, psychiatric
problems, suicidal thoughts
and myelography within the
past 24 hours or in the next
48 hours to avoid
potentially serious adverse
reactions.
● Perform a thorough physical
assessment to establish
baseline data before drug
therapy begins, to
determine the effectiveness
of therapy, and to evaluate
for the occurrence of any
adverse effects associated
with drug therapy.
● Monitor results of
electrocardiogram and
laboratory tests (e.g. renal
and liver function tests) to
monitor the effectiveness of
the therapy and provide
prompt treatment to
developing complications.
 Drug Interaction
Aspirin can increase the risk of
bleeding when used with this
medication.
Taking MAO inhibitors with this
medication may cause a serious
(possibly fatal) drug interaction. Do
not take any MAO inhibitors
(isocarboxazid, linezolid, methylene
blue, moclobemide, phenelzine,
procarbazine, rasagiline, safinamide,
selegiline, tranylcypromine) during
treatment with this medication.
Most MAO inhibitors should also
not be taken for 2 weeks before and
21 days after treatment with this
medication.
The risk of serotonin
syndrome/toxicity increases if you
are also taking other drugs that
increase serotonin. Examples
include street drugs such as
MDMA/"ecstasy," St. John's wort,
certain antidepressants (including
other SSRIs such as
fluoxetine/paroxetine, SNRIs such as
duloxetine/venlafaxine), among
others. The risk of serotonin
syndrome/toxicity may be more
likely when you start or increase the
dose of these drugs.
Biperiden hcl Oral Biperiden HCL belongs to a class Side Effects ● Monitor BP and pulse after
(AUTONOMIC NERVOUS 2mg 1-3 times a of drugs called Anticholinergic. It ● dry mouth, nose or throat, IV administration. Advise
AGENT; day is used to treat the symptoms of patient to make position
ANTICHOLINERGIC(PARA stiffness, tremors, spasms, and
● blurred vision,
changes slowly and in
SYMPATHOLYTIC); poor muscle control of ● drowsiness, stages, particularly from
ANTIPARKINSONISM Parkinson’s disease by ● euphoria, recumbent to upright
AGENT) improving muscle control and ● disorientation, position.
reducing stiffness, biperiden ● urinary retention, ● Monitor for and report
allows more normal movements ● dizziness, immediately: Mental
of the body as the disease
● constipation, confusion, drowsiness,
symptoms are reduced. It may dizziness, agitation,
be used alone or with other ● nausea,
hematuria, and decrease in
medications. ● vomiting, urinary flow.
● agitation, ● Assess for and report
O: Unknown ● disturbed behavior, blurred vision.
P: 1.5 hours ● decreased sweating, ● Monitor I&O ratio and
D: 18 hours ● difficult or painful urination, pattern.
● involuntary movements, ● Note: Biperiden usually
● slow heart rate, and reduces muscle rigidity. In
patients with severe
● reduction in rapid eye
parkinsonism, tremors may
movement (REM) sleep
increase as spasticity is
Contraindication relieved.
This medication is contraindicated
for people who:
Are Hypersensitivity to biperiden
Have Narrow angle glaucoma
Have Bowel obstruction have a
Megacolon
Drug Interaction
Alcohol and other CNS
DEPRESSANTS INCREASE SEDATION;
haloperidol, PHENOTHIAZINES,
 OPIATES, TRICYCLIC
ANTIDEPRESSANTS, quinidine
increase risk of anticholinergic side
effects.

Valproic acid (CENTRAL (Oral) Valproic acid is used to treat Side Effects ● Monitor for therapeutic
NERCOUS SYSTEM 250 mg certain types of seizures ● stomach pain, feeling or effectiveness achieved with
AGENT; capsules; 125 (epilepsy). This medicine is an being sick (nausea or serum levels of valproic
ANTICONVULSANT mg sprinkle anticonvulsant that works in the vomiting) acid at 50–100 mcg/mL.
GABA INHIBITOR) capsules; 125 brain tissue to stop seizures. ● diarrhoea ● Monitor patient alertness
mg, 250 mg, Valproic acid is also used to treat ● dry or sore mouth, or especially with multiple
500 mg the manic phase of bipolar swollen gums drug therapy for seizure
delayed-release disorder (manic-depressive ● shakes (tremors) in a part of control. Evaluate plasma
tablets; 500 mg illness), and helps prevent your body, or unusual eye levels of the adjunctive
sustained- migraine headaches. movements anticonvulsants
release tablets; O: Unknown ● feeling tired or sleepy periodically as indicators
250 mg/5 mL P: 1 to 4 hours ● headache for possible neurologic
syrup D: 5 to 20 hours ● weight gain toxicity.
(IV) ● thinning hair, or changes to ● Monitor patient carefully
100 mg/mL the colour or texture of your during dose adjustments
injection hair and promptly report
● irregular or delayed periods presence of adverse
Contraindication effects. Increased dosage is
This medication is associated with frequency
contraindicated for people who: of adverse effects.
Are Hypersensitivity to valproate ● Lab tests: Perform baseline
sodium platelet counts, bleeding
Have thrombocytopenia time, and serum ammonia,
Have bleeding disorders or liver then repeat at least q2mo,
dysfunction or disease especially during the first 6
have cirrhosi mo of therapy.
have pancreatitis
● Multiple drugs for seizure
 Have congenital metabolic control increase the risk of
disorders hyperammonemia, marked
have severe seizures, or on by lethargy, anorexia,
multiple anticonvulsant drugs; asterixis, increased seizure
Have AIDS frequency, and vomiting.
Are for treatment of mania with Report such symptoms
ages lower than 18. promptly to the physician.
Drug Interaction If they persist with
Alcohol and other CNS decreased dosage, the drug
DEPRESSANTS potentiate will be discontinued.
depressant effects
ANTICONVULSANTS,
BARBITURATES increase or
decrease anticonvulsant and
BARBITURATE levels;
haloperidol, loxapine,
maprotiline, MAOIs,
PHENOTHIAZINES,
THIOXANTHENES, TRICYCLIC
ANTIDEPRESSANTS can increase
CNS depression or lower seizure
threshold; aspirin, dipyridamole,
warfarin increase risk of
spontaneous bleeding and
decrease clotting; clonazepam
may precipitate absence
seizures; SALICYLATES,
cimetidine may increase valproic
acid levels and toxicity.
Mefloquine can decrease valproic
acid levels; isoniazid may
increase valproic acid levels and
hepatotoxicity; meropenem may
 decrease valproic acid levels;
cholestyramine may decrease
absorption.

Diphenhydramine hcl (Oral) Diphenhydramine is an Side Effects ● Monitor cardiovascular

(ANTIHISTAMINE; H1- 25 mg, 50 mg antihistamine that reduces ● dry mouth, nose, and status especially with pre-
RECEPTOR capsules, the effects of natural throat existing cardiovascular
ANTAGONIST) tablets; 6.25 chemical histamine in the ● drowsiness disease.
mg/5 mL, 12.5 body. Histamine can produce ● dizziness ● Monitor for adverse effects
mg/5 mL syrup symptoms of sneezing, ● nausea especially in children and
(PO/IM/IV) itching, watery eyes, and ● vomiting the older adult.
50 mg/mL runny nose. ● loss of appetite ● Supervise ambulation and
injection Diphenhydramine is also used ● constipation use side-rails as necessary.
to treat motion sickness, to ● increased chest Drowsiness is most
induce sleep, and to treat congestion prominent during the first
certain symptoms of ● headache few days of therapy and
Parkinson's disease. ● muscle weakness often disappears with
O: 15 to 30 mins ● excitement (especially in continued therapy. Older
P: 1 to 4 hours children) adults are especially likely
D: 4 to 7 hours ● nervousness to manifest dizziness,
● vision problems sedation, and hypotension.
● difficulty urinating or
painful urination
Contraindication
This medication is
contraindicated for people who:
Are Hypersensitivity to
antihistamines of similar
structure
Have lower respiratory tract
symptoms (including acute
asthma)
Have narrow-angle glaucoma
have prostatic hypertrophy,
 bladder neck obstruction
have GI obstruction or stenosis
Drug Interaction
Alcohol and other CNS
DEPRESSANTS, MAO INHIBITORS
compound CNS depression.