HALOPERIDOL

50mg/mL ampule

NAME OF DRUG Brand Name: Haldol, Haldol Decanoate

Therapeutic class: Antipsychotics

Pharmacologic class: Butyrophenone derivatives

Treatment of schizophrenia, Tourette’s disorder (controls tics

and vocal utterances), severe behavioral problems in children
INDICATION with combative explosive hyperexcitability without immediate
provocation. Management of psychotic disorder, short-term
treatment of hyperactive children

Competitively blocks postsynaptic dopamine receptors in brain.

MECHANISM OF
Therapeutic Effect: Produces tranquilizing effect. Strong
ACTION
extrapyramidal, antiemetic effects; weak anticholinergic,
sedative effects.

Frequent: Blurred vision, constipation, orthostatic hypotension,

dry mouth,swelling or soreness of female breasts, peripheral
edema
SIDE EFFECTS
Occasional: Allergic reaction, difficulty urinating, decreased
thirst, dizziness, diminished sexual
function, drowsiness, nausea, vomiting, photosensitivity,
lethargy

 extrapyramidal symptoms
 marked drowsiness/lethargy
 excessive salivation
ADVERSE  fixed stare
REACTION  severe akathisia (motor restlessness)
 acute dystonias
 tardive dyskinesia (tongue protrusion, puffing of cheeks,
chewing/puckering of the mouth)

NURSING
CONSIDERATIONS  Monitor patient for tardive dyskinesia, which may occur
after prolonged use. It may not appear until months or
years later and may disappear spontaneously or persist
for life, despite ending drug.

Alert: Watch for signs and symptoms of NMS (extrapyramidal

effects, hyperthermia, autonomic disturbance), which is rare
but commonly fatal.

Alert: Monitor ECG when drug is given in high doses or when

patient is taking other QT interval–prolonging drugs because of
 the increased risk of QT-interval prolongation and torsades de
pointes.

Black Box Warning: Elderly patients with dementia-related

psychosis treated with atypical or conventional antipsychotics
are at increased risk for death. Antipsychotics aren't approved
for the treatment of dementia-related psychosis.

 Don't withdraw drug abruptly unless required by severe

adverse reactions.
 Complete fall risk assessments at start of antipsychotic
treatment and recurrently for patients on long-term
therapy, especially those at increased risk for falls.
 Esophageal dysmotility and aspiration can occur. Use
cautiously in patients at risk for aspiration (those with
pneumonia, Alzheimer disease).

Look alike–sound alike: Don't confuse Haldol with Halcion or

Halog.

DRUG-DRUG
INTERACTION Anticholinergics: May increase anticholinergic effects and
glaucoma. Use together cautiously.

Antiparkinsonian drugs (dopamine agonist): May diminish

therapeutic effect of both haloperidol and antiparkinsonian drug
(dopamine agonist). Avoid using together. If used together
can't be avoided, monitor patient for decreased effects of both
agents.

Azole antifungals, buspirone, macrolides: May increase

haloperidol level. Monitor patient for increased adverse
reactions; haloperidol dose may need to be adjusted.

Beta blockers: May cause an unexpected severe hypotensive

reaction. If this occurs, provide supportive treatment.

Carbamazepine: May decrease haloperidol level. Monitor

patient.

CNS depressants: May increase CNS depression. Use

together cautiously.

Lithium: May cause lethargy and confusion after high doses.

Monitor patient.

Black Box Warning - Opioid class warning: May cause slow

or difficult breathing, sedation, and death. Avoid use together.
If use together is necessary, limit dosage and duration of each
drug to minimum necessary for desired effect.

QT-interval-prolonging drugs: May prolong QT interval.

Monitor ECG.

Rifampin: May decrease haloperidol level. Monitor patient for

 clinical effect.

Alcohol can worsen the side effects of haloperidol. Drowsiness,

dizziness, confusion mood changes, and difficulty in
concentration can occur while taking alcohol with haloperidol.
DRUG-FOOD
You can take haloperidol 2-3 times a day with food or on an
INTERACTION
empty stomach as directed by the doctor. Do not exceed the
recommended dose. Dilute the liquid form with water, or
orange, apple or tomato juice and take immediately after
mixing.

Since there is no specific antidote, supportive treatment is

the mainstay for haloperidol toxicity. If a patient develops signs
ANTIDOTE FOR
and symptoms of toxicities, the clinician should consider
TOXICITY
gastric lavage or induction of emesis as soon as possible,
followed by the administration activated charcoal.

References:
Comerford, K. C., & Durkin, M. T. (2021). Nursing 2021 Drug Handbook. 41st edition.
Philadelphia, Wolters Kluwer.

Kizior, R., & Hodgson, K. (2018, April 13). Saunders Nursing Drug Handbook 2019 (1st
ed.). Saunders.
 FUROSEMIDE
20mg/2mL ampule

NAME OF DRUG Brand Name: Lasix

Therapeutic class: Antihypertensives

Pharmacologic class: Loop diuretics

Treatment of edema associated with HF and renal/hepatic

INDICATION disease; acute pulmonary edema. Treatment of hypertension
(not recommended as initial treatment).

Enhances excretion of sodium, chloride, potassium by direct

MECHANISM OF action at ascending limb of loop of Henle.
ACTION
Therapeutic Effect: Produces diuresis, lowers B/P.

Expected: Increased urinary frequency/volume.

Frequent: Nausea, dyspepsia, abdominal cramps, diarrhea or

constipation, electrolyte disturbances.
SIDE EFFECTS
Occasional: Dizziness, light-headedness, headache, blurred
vision, paresthesia, photosensitivity, rash, fatigue, bladder
spasm, restlessness, diaphoresis.

Rare: Flank pain.

 profound water loss/electrolyte depletion

ADVERSE
 hypokalemia, hyponatremia, dehydration
REACTION
 thrombosis, circulatory collapse, sudden death

NURSING
CONSIDERATIONS Alert: Monitor weight, BP, and pulse rate routinely with long-
term use.

Black Box Warning: Drug is potent diuretic and can cause

severe diuresis with water and electrolyte depletion. Monitor
patient closely and adjust dose carefully.

 If oliguria or azotemia develops or increases, drug may

need to be stopped.

 Monitor fluid intake and output and electrolyte, BUN,

and carbon dioxide levels frequently.

 Watch for signs of hypokalemia, such as muscle

weakness and cramps.
  Consult prescriber and dietitian about a high-potassium
diet or potassium supplements.

 Monitor glucose level in diabetic patients.

 Drug may not be well absorbed orally in patient with

severe HF. Drug may need to be given IV even if patient
is taking other oral drugs.

 Monitor uric acid level, especially in patients with a

history of gout.

 Monitor elderly patients, who are especially susceptible

to excessive diuresis, because circulatory collapse and
thromboembolic complications are possible.

 Monitor patients with severe symptoms of urine

retention due to bladder emptying disorders, prostate
enlargement, or urethral narrowing or worsening of
symptoms, especially during initial treatment.

 Drug may increase fetal birth weight. Monitor fetal

growth during pregnancy.

Look alike–sound alike: Don't confuse furosemide with

torsemide. Don't confuse Lasix with Lonox, Lidex, or Luvox.

DRUG-DRUG
INTERACTION Aminoglycoside antibiotics, cisplatin: May increase
ototoxicity. Use together cautiously.

Amphotericin B, corticosteroids, corticotropin,

metolazone: May increase risk of hypokalemia. Monitor
potassium level closely.

Antidiabetics: May decrease hypoglycemic effects. Monitor

glucose level.

Antihypertensives: May increase risk of hypotension. Use

together cautiously. Decrease antihypertensive dose if needed.

Cardiac glycosides, neuromuscular blockers: May increase

toxicity of these drugs from furosemide-induced hypokalemia.
Monitor potassium level.

Chlorothiazide, chlorthalidone, hydrochlorothiazide,

indapamide metolazone: May cause excessive diuretic
response, causing serious electrolyte abnormalities or
dehydration. Adjust doses carefully, and monitor patient closely
for signs and symptoms of excessive diuretic response.

Ethacrynic acid: May increase risk of ototoxicity. Avoid using

together.
 Lithium: May decrease lithium excretion, resulting in lithium
toxicity. Monitor lithium level.

NSAIDs: May inhibit diuretic response. Use together

cautiously.

Phenytoin: May decrease diuretic effects of furosemide. Use

together cautiously.

Propranolol: May increase propranolol level. Monitor patient

closely.

Salicylates: May cause salicylate toxicity. Use together

cautiously.

Sucralfate: May reduce diuretic and antihypertensive effect.

Separate doses by 2 hours.

DRUG-FOOD Any food: May decrease furosemide serum level. Don't give
INTERACTION with food.

No antidote to furosemide is known. If overdose during

ANTIDOTE FOR parenteral treatment has taken place, in principle, the
TOXICITY treatments consists on follow up and supportive therapy.
Haemodialysis does not accelerate furosemide elimination.

References:
Comerford, K. C., & Durkin, M. T. (2021). Nursing 2021 Drug Handbook. 41st edition.
Philadelphia, Wolters Kluwer.

Kizior, R., & Hodgson, K. (2018, April 13). Saunders Nursing Drug Handbook 2019 (1st
ed.). Saunders.