PHINMA University of Pangasinan

College of Health Sciences

Name of Student Nurse: Clarisse B. Cerame Date: September 26, 2021

Level/block/group : C2 - 2BSN - 14 Hospital/Area: N/A Clinical Instructor: Kenneth Vince M. Cerezo

NAME OF DRUG MECHANISM OF ACTION CONTRAINDICATIONS SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME
May antagonize Dopamine, Contraindications: Frequent (26%–13%): Rare reactions include BASELINE ASSESSMENT
Risperidone Serotonin Receptors in both CNS Hypersensitivity to Agitation, anxiety, tardive dyskinesia
Renal function test, LFT should be
and periphery. All antipsychotics Risperidone. insomnia, headache, (characterized by tongue
performed before therapy begins.
BRAND NAME have some degree of antagonism constipation. protrusion, puffing of the
Assess behavior, appearance,
at D2 receptors. Cautions: Renal/hepatic cheeks, chewing or
emotional status, response to
Risperdal First-generation antipsychotics impairment, seizure Occasional (10%–4%): puckering of mouth),
environment, speech pattern,
(FGAs) produce antipsychotic disorder, cardiac Dyspepsia, rhinitis, neuroleptic malignant
thought content, baseline weight.
CLASSIFICATION effects at 60% to 80% D2 disease, recent MI, drowsiness, dizziness, syndrome (hyperpyrexia,
Obtain fasting serum glucose, CBC.
occupancy. breast cancer or other nausea, vomiting, muscle rigidity, altered
PHARMACOTHERAPEUTIC: Second-generation antipsychotics prolactin-dependent rash, abdominal pain, mental status, irregular
Benzisoxazole derivative. INTERVENTION/EVALUATION
(SGAs) like risperidone exhibit tumors, suicidal pts, pts dry-skin, tachycardia. pulse or B/P, tachycardia,
their therapeutic effects through at risk for aspiration diaphoresis, cardiac Monitor B/P, heart rate, weight, LFT,
CLINICAL: some D2 blockade, but more pneumonia. Parkinson’s arrhythmias, ECG. Monitor for fine tongue
Second-generation (atypical) from the blockade of serotonin disease, pts at risk for Rare (3%–2%): rhabdomyolysis, acute movement (may be first sign of tardive
antipsychotic. receptors like 5HT2A. SGAs have orthostatic hypotension, Visual disturbances, renal failure). dyskinesia, which may be irreversible).
Antimanic agent. loose binding to D2 receptors and elderly pts, diabetes, fever, back pain, Hyperglycemia, life- Monitor for suicidal ideation. Assess
can quickly dissociate from the decreased GI motility, pharyngitis, cough, threatening events such as for therapeutic response (greater
INDICATION receptor, potentially accounting urinary retention, BPH, arthralgia, angina, ketoacidosis and interest in surroundings, improved
for the lower likelihood of xerostomia, visual aggressive behavior, hyperosmolar coma, death self-care, increased ability to
The Food and Drug causing extrapyramidal problems, pts exposed to orthostatic have been reported. concentrate, relaxed facial
Administration (FDA)- symptoms (EPS). Moreover, SGAs temperature extremes, hypotension, breast expression). Monitor for potential
approved indications for oral have agonism at the 5HT1A pre-existing swelling. neuroleptic malignant syndrome:
risperidone (tablets, oral receptor. Serotonin and myelosuppression, fever, muscle rigidity, irregular B/P or
solution, and M-TABs) include norepinephrine reuptake narrow-angle glaucoma; pulse, altered mental status. Monitor
the treatment of: inhibition are potential pts with high risk of fasting serum glucose periodically
mechanisms by which risperidone suicide. during therapy.
 Schizophrenia (in adults and is postulated to produce
children aged 13 and up) antidepressant effects. The PATIENT/FAMILY TEACHING
improvement of positive • Avoid tasks that may require
 Bipolar I acute manic or symptoms is thought to be alertness, motor skills until response
mixed episodes as accomplished through the
 monotherapy (in adults and blockade of D2 receptors, to drug is established (may cause
children aged 10 and up). specifically in the mesolimbic dizziness/drowsiness).
pathway. The ability of • Avoid alcohol.
 Bipolar I acute manic or antipsychotics to block D2 • Go from lying to standing slowly.
mixed episodes adjunctive receptors in the prefrontal cortex • Report trembling in fingers, altered
with lithium or valproate (in and nucleus accumbens is gait, unusual muscular/
adults). important in improving certain skeletal movements, palpitations,
psychiatric symptoms. Of note, severe dizziness/fainting,
 Autism-associated irritability risperidone does not cause swelling/pain in breasts, visual
(in children aged 5 and up). anticholinergic effects, which changes, rash, difficulty breathing.
may benefit patients in certain
DOSAGE & FREQUENCY populations, including the elderly
with dementia.
Schizophrenia
PO: ADULTS: Initially, 1–2 Therapeutic Effect:
mg/day as single or 2 divided Suppresses psychotic behavior.
doses. May increase gradually
(1–2 mg/day at intervals of at
least 24 hrs). Usual dosage
range: 2–6 mg/ day.
ELDERLY: Initially, 0.5 mg
twice daily. May increase
slowly at increments of no
more than 0.5 mg twice daily.
Range: 2–6 mg/day.
CHILDREN 13–17 YRS: Initially,
0.5 mg/day (as single daily
dose). May increase by 0.5–1
mg/day at intervals of greater
than 24 hrs to recommended
dose of 3 mg/day.
IM: ADULTS, ELDERLY:
Initially, 12.5–25mg q2wks.
Maximum: 50 mg q2wks.
Dosage adjustments should
not be made more frequently
than every 4 wks.
SQ: ADULTS, ELDERLY: 90–120
mg once monthly.
 Bipolar Mania
PO: ADULTS: Initially, 1–3 mg
in 1 or 2 divided doses. May
increase by 1 mg/day at 24-hr
intervals. Usual dose: 4–6
mg/day.
ELDERLY: Initially, 0.5 mg
twice daily. Titrate slowly.
PO: CHILDREN 10–17 YRS:
Initially, 0.5mg/day. May
increase by 0.5–1 mg/day at
intervals of greater than 24 hrs
to recommended dose of 2.5
mg/day.
IM: ADULTS, ELDERLY: 25 mg
q2wks. May increase dose
in increments of 12.5 mg no
sooner than 4 wks.
Maximum: 50 mg q2wks.
Autism
CHILDREN 5 YRS AND OLDER
WEIGHING MORE THAN 19
KG: Initially, 0.5 mg/day. May
increase to 1 mg after 4 days.
May furtherincrease dose by
0.5 mg/day in greater than 2-
wk intervals. Range: 0.5–3
mg/day.
CHILDREN 5 YRS AND OLDER
WEIGHING 15–19 KG: Initially,
0.25 mg/day. May increase
to 0.5 mg/day after 4 days.
May further increase dose by
0.25 mg/day in greater
than 2-wk intervals. Range:
0.5–3 mg/day.

PHINMA University of Pangasinan

 College of Health Sciences

Name of Student Nurse: Clarisse B. Cerame Date: September 26, 2021

Level/block/group : C2 - 2BSN - 14 Hospital/Area: N/A Clinical Instructor: Kenneth Vince M. Cerezo

NAME OF DRUG MECHANISM OF ACTION CONTRAINDICATIONS SIDE EFFECTS ADVERSE EFFECTS NURSING RESPONSIBILITIES
GENERIC NAME
Amitriptyline is in the tricyclic Contraindications: Frequent: Dizziness, Overdose may produce BASELINE ASSESSMENT
Amitriptyline antidepressant (TCA) drug Hypersensitivity to drowsiness, dry confusion, seizures, severe Observe and record behavior. Assess
classification and acts by blocking amitriptyline. Acute mouth, orthostatic drowsiness, changes in psychological status, thought content,
BRAND NAME the reuptake of both serotonin recovery period after MI, hypotension, cardiac conduction, fever, suicidal ideation, sleep patterns,
and norepinephrine co-administered headache, increased hallucinations, agitation, appearance, interest in environment.
Elavil neurotransmitters. The three-ring with or within 14 days of appetite, weight dyspnea, vomiting, unusual For pts on long-term therapy,
central structure, along with a MAOIs. gain, nausea, unusual fatigue, weakness. Abrupt hepatic/renal function tests, blood
CLASSIFICATION side chain, is the basic structure fatigue, unpleasant withdrawal after prolonged counts should be performed
of tricyclic antidepressants.Cautions: taste. therapy may produce periodically.
PHARMACOTHERAPEUTIC: Amitriptyline is a tertiary amine Prostatic hypertrophy, headache, malaise, nausea,
Tricyclic and has strong binding affinities history of Occasional: Blurred vomiting, vivid dreams. INTERVENTION/EVALUATION
for alpha-adrenergic, histamine urinary retention or vision, confusion, Blood dyscrasias, cholestatic Supervise suicidal-risk pt closely
CLINICAL: Antidepressant (H1), and muscarinic (M1) obstruction, narrow- constipation, jaundice occur rarely during early therapy (as depression
receptors.[3] angle glaucoma, hallucinations, lessens, energy level improves,
INDICATION diabetes, seizures, delayed micturition, increasing suicide potential). Assess
Amitriptyline increases hyperthyroidism, eye pain, appearance, behavior, speech pattern,
noradrenergic or serotonergic cardiac/hepatic/renal arrhythmias, fine level of interest, mood. Monitor B/P
Amitriptyline is FDA approved neurotransmission by blocking disease, schizophrenia, muscle tremors, for hypotension, pulse, arrhythmias.
medication to treat major the norepinephrine or serotonin xerostomia, visual parkinsonian Therapeutic serum level: Peak: 120–
depressive disorder (MDD) in transporter (NET or SERT) at problems, constipation syndrome, anxiety, 250 ng/mL; toxic serum level: greater
adults. presynaptic terminals. Chronic or bowel obstruction, diarrhea, diaphoresis, than 500 ng/mL.
treatment with amitriptyline elderly, increased heartburn, insomnia.
The non-FDA-approved desensitizes presynaptic intraocular pressure PATIENT/FAMILY TEACHING
indications are anxiety, post- autoreceptors and (IOP), hiatal hernia, Rare: • Go slowly from lying to standing. •
traumatic stress disorder, heteroreceptors, producing long- suicidal ideation. Hypersensitivity, Tolerance to postural hypotension,
insomnia, chronic pain lasting changes in monoaminergic alopecia, tinnitus, sedative and anticholinergic effects
(diabetic neuropathy, neurotransmission.[4] It is more breast enlargement, usually develops during early therapy.
fibromyalgia), irritable bowel sedating and has increased photosensitivity. • Maximum therapeutic effect may be
syndrome, interstitial cystitis anticholinergic properties noted in 2–4 wks.
(bladder pain syndrome), compared to other TCAs. Like • Sensitivity to sun may occur.
migraine prophylaxis, other antidepressants, the onset • Report visual disturbances.
postherpetic neuralgia, and
sialorrhea. of therapeutic action typically
begins at approximately 2 to 4
weeks.
Therapeutic Effect:
Antidepressant effect.
DOSAGE & FREQUENCY
• Do not abruptly discontinue
medication.
• Avoid tasks that require alertness,
motor skills until response to drug is
established.
• Avoid alcohol.
• Sips of water may relieve dry mouth.

Depression
PO: ADULTS: Initially, 25–50
mg/day as a single dose at
bedtime, or in divided doses.
May gradually increase up to
100–300 mg/day. Titrate to
lowest effective dosage.
ELDERLY: 10 mg 3 times/day
and 20 mg at bedtime.
ADOLESCENTS: 10 mg 3
times/day and 20 mg at
bedtime.
Pain Management
PO: ADULTS, ELDERLY: 25–50
mg at bedtime. May increase
to 150 mg/day. CHILDREN:
Initially, 0.1 mg/kg. May
increase over 2 wks to 0.5–2
mg/kg at bedtime.