DRUG STUDY

Neuralgia: Avoid triggering tic douloureux (draft, talking,

CARBAMAZEPINE washing face, jarring bed, hot/warm/cold food or liquids).
Brand Name
Bipolar: Monitor for suicidal ideation, behavioral changes.
Carbatrol, Epitol, Equetro, TEGretol, TEGretol XR
Observe for excessive sedation.
Generic Name
Carbamazeprine SODIUM VALPROATE
Brand Name
Drug Classification Valpo
Anti-convulsant
Generic Name
Mechanism of Action Sodium Valproate
Decreases sodium ion influx into neuronal membranes (may
depress activity in thalamus, decreasing synaptic transmission Drug Classification
or decreasing temporal stimulation, leading to neural Anticonvulsants
discharge).
Mechanism of Action
Indication Sodium valproate is thought to reduce or prevent manic
Carbatrol, Epitol, Tegretol, Tegretol XR: Treatment of partial episodes by increasing the amount of a chemical called
seizures with complex symptomatology, generalized tonic- gamma-aminobutyric acid (GABA) in the brain. GABA blocks
clonic seizures, mixed seizure patterns, pain relief of trigeminal, transmission across nerves in the brain and has a calming
glossopharyngeal neuralgia. effect.

Equetro: Acute manic and mixed episodes associated with Indication

bipolar disorder. Used to treat epilepsy and bipolar disorder. It's occasionally
used to prevent migraine headaches.
Contraindication
Hypersensitivity to carbamazepine, tricyclic antidepressant
Contraindication
Dosage Contraindicated in patients with hepatic disorders,
200mg tablet significant hepatic impairment, hypersensitivity to
components of the drug and class of drug, urea cycle
Side Effect disorders, mitochondrial disorders, or suspected disorders in
Vertigo, somnolence, ataxia, fatigue, leukopenia, rash, patients <2-year-old, and pregnancy (for migraine headache
urticaria, nausea, vomiting prophylaxis use of valproic acid).

Adverse Reactions Dosage

Toxic reactions appear as blood dyscrasias (aplastic anemia,
agranulocytosis, thrombocytopenia, leukopenia, leukocytosis,
eosinophilia), cardiovascular disturbances (HF,
hypotension/hypertension, thrombophlebitis, arrhythmias),
dermatologic effects (rash, urticaria, pruritus,
photosensitivity). Abrupt withdrawal may precipitate status
epilepticus.
Drug Interaction
CYP3A4 inhibitors (e.g., cimetidine, clarithromycin, azole
antifungals, protease inhibitors) may increase concentration.
CYP3A4 inducers (e.g., rifampin, phenytoin) may decrease
concentration/ effects. May decrease concentration/ effects of
hormonal contraceptives, warfarin, trazodone. May decrease
concentration/effects of abemaciclib, apixaban, axitinib,
bosutinib, brigatinib, dronedarone, nifedipine, ranolazine,
regorafenib, vorapaxar, voriconazole. May decrease
therapeutic effect of BCG (intravesical).
Nursing Responsibilities
Seizures: Observe frequently for recurrence of seizure activity.
Monitor therapeutic levels. Assess for clinical improvement
(decrease in intensity, frequency of seizures). Assess for clinical
evidence of early toxicity (fever, sore throat, mouth
ulcerations, unusual bruising/bleeding, joint pain).
500mg tablet
Side Effects
Stomach pain, feeling or being sick, diarrhea, dry or sore
mouth, or swollen gums, shakes (tremors) in a part of your
body, or unusual eye movements, feeling tired or sleepy,
headache, weight gain, thinning hair, or changes to the
colour or texture of your hair, irregular or delayed periods
Adverse Reactions
nausea, upper abdominal cramps, abnormal liver function,
weight gain, and diarrhea.
Drug Interaction
Cholestyramine, rifampin may decrease
concentration/effect. May increase adverse effects of
lamotrigine, Lorazepam.
Nursing Responsibilities
Monitor CBC, LFT, serum ammonia. Anticonvulsant: Observe
frequently for recurrence of seizure activity. Assess skin for
ecchymoses, petechiae. Monitor for clinical improvement
(decrease in intensity/ frequency of seizures).
Antimanic: Question for suicidal ideation. Assess for
therapeutic
 DRUG STUDY
response (interest in surroundings, increased ability to
concentrate, relaxed facial expression).
Antimigraine: Evaluate for relief of migraine headache and
resulting photophobia, phonophobia, nausea, vomiting.
CHLORPROMAZINE
Brand Name
Thorazine and largactil
Generic Name
Chlorpromazine
Drug Classification
Phenothiazine antipsychotic
Mechanism of Action
Chlorpromazine acts as an antagonist (blocking agent) on
different postsysnaptic receptors -on dopaminergic-receptors
(subtypes D1, D2, D3 and D4 - different antipsychotic
properties on productive and unproductive symptoms), on
serotonergic-receptors (5-HT1 and 5-HT2, with anxiolytic,
antidepressive and antiaggressive properties as well as an
attenuation of extrapypramidal side-effects, but also leading to
weight gain, fall in blood pressure, sedation and ejaculation
difficulties), on histaminergic-receptors (H1-receptors,
sedation, antiemesis, vertigo, fall in blood pressure and weight
gain), alpha1/alpha2-receptors (antisympathomimetic
properties, lowering of blood pressure, reflex tachycardia,
vertigo, sedation, hypersalivation and incontinence as well as
sexual dysfunction, but may also attenuate
pseudoparkinsonism - controversial) and finally on muscarinic
(cholinergic) M1/M2-receptors (causing anticholinergic
symptoms like dry mouth, blurred vision, obstipation,
difficulty/inability to urinate, sinus tachycardia, ECG-changes
and loss of memory, but the anticholinergic action may
attenuate extrapyramidal side-effects).
Indication
used to treat nausea, vomiting, preoperative anxiety,
schizophrenia, bipolar disorder, and severe behavioral
problems in children.
Contraindication
Hypersensitivity to phenothiazines, Coma, severe hypotension,
severe central nervous system (CNS) depression, concurrent
administration of large amounts of CNS depressants,
subcortical brain damage, poorly controlled seizure disorder,
Severe cardiovascular disease, Lactation.
Dosage
100mg tablet
Side Effects
drowsiness, dry mouth, stuffy nose, blurred vision,
constipation, impotence, and trouble having an orgasm
Adverse Reactions
increased likelihood of sedation, sexual dysfunction, postural
hypotension, cardiac arrhythmia, and sudden cardiac death.
Drug Interaction
Drugs that increase the amount of dopamine in the body
(such as cabergoline, levodopa, pergolide, ropinirole),
lithium, tretinoin.
Nursing Responsibilities
Assess mental status prior to and during treatment. Monitor
blood pressure. Ensure patient is taking medication. Monitor
CBC and liver function tests. Instruct patient not to skip doses
or double dose.
HALOPERIDOL
Brand Name
Haldol, Haldol Decanoate, Novo-Peridol
Generic Name
Haloperidol
Drug Classification
Antipsychotic
Mechanism of Action
Nonselectively blocks postsynaptic Dopamine receptors in
brain
Indication
Treatment of schizophrenia, Tourette’s disorder (controls
tics and vocal utterances), severe behavioral problems in
children with combative explosive hyperexcitability without
immediate provocation. Management of psychotic disorder,
short-term treatment of hyperactive children.
Contraindication
Hypersensitivity to haloperidol, CNS depression, coma,
Parkinson’s disease.
Dosage
5mg tablet
Side Effects
Blurred vision, constipation, orthostatic hypotension, dry
mouth, swelling or soreness of female breasts, peripheral
edema.
Adverse Reactions
Extrapyramidal symptoms (EPS) appear to be dose related
and typically occur in first few days of therapy. Marked
drowsiness/ lethargy, excessive salivation, fixed stare may be
mild to severe in intensity. Less frequently noted are severe
akathisia (motor restlessness), acute dystonias: torticollis
(neck muscle spasm), opisthotonos (rigidity of back muscles),
oculogyric crisis (rolling back of eyes). Tardive dyskinesia
(tongue protrusion, puffing of cheeks, chewing/puckering of
the mouth) may occur during long-term therapy or after drug
discontinuance and may be irreversible. Elderly female pts
have greater risk of developing this reaction. May increase
risk of QT interval prolongation, cardiac arrhythmias.
 DRUG STUDY
Drug Interaction
Alcohol, other CNS depressants (e.g., diphenhydramine,
gabapentin, Lorazepam, morphine) may increase CNS
depression. CYP3A4 inducers (e.g., carbamazepine, phenytoin,
rifampin) may decrease concentration. Medications prolonging
QT interval (e.g., amiodarone, ciprofloxacin, ondansetron) may
increase risk of QT prolongation. Aclidinium, ipratropium,
tiotropium, umeclidinium may increase anticholinergic effect.
Metoclopramide may increase adverse effects.
Nursing Responsibilities
Monitor B/P, heart rate/rhythm. Monitor ECG, QT interval.
Supervise suicidal-risk pts closely during early therapy (as
depression lessens, energy level improves, increasing suicide
potential). Monitor for rigidity, tremor, mask-like facial
expression, fine tongue movement. Assess for therapeutic
response (interest in surroundings, improvement in self-care,
increased ability to concentrate, relaxed facial expression).
CLOZAPINE
Brand Name
Clozaril, Fazaclo, Versacloz
Generic Name
Clozapine
Drug Classification
Antipsychotic
Mechanism of Action
Interferes with binding of Dopamine and serotonin receptor
sites.
Indication
Management of severely ill schizophrenic pts who have failed
to respond to other antipsychotic therapy. Treatment of
recurrent suicidal behavior in schizophrenia or schizoaffective
disorder
Contraindication
Hypersensitivity to clozapine. History of clozapine-induced
agranulocytosis or severe granulocytopenia
Dosage
100mg tablet
Side Effects
Drowsiness, salivation, tachycardia, dizziness, constipation.
Adverse Reactions
Seizures occur occasionally (3% of pts). Overdose produces CNS
depression (sedation, delirium, coma), respiratory depression,
hypersalivation. Blood dyscrasias, particularly agranulocytosis,
mild leukopenia, may occur
Drug Interaction
CNS depressants (e.g., alcohol, morphine, oxycodone,
zolpidem) may increase CNS depression. Anticholinergics (e.g.,
aclidinium, ipratropium, umeclidinium) may increase
anticholinergic effect. Strong CYP3A4 inhibitors (e.g.,
clarithromycin, ketoconazole, ritonavir) may increase
concentration/effect. Strong CYP3A4 inducers (e.g.,
carbamazepine, phenytoin, rifampin) may decrease
concentration/effect. Metoclopramide may increase adverse
effects
Nursing Responsibilities
Monitor B/P for hypertension/hypotension. Assess pulse for
tachycardia (common side effect). Monitor CBC for blood
dyscrasias. Monitor ANC, WBC count every wk for first 6 mos,
then biweekly for 6 mos. If CBC and ANC are normal after 12
mos, then monthly monitoring of CBC and ANC is
recommended. Supervise suicidal-risk pt closely during early
therapy (as depression lessens, energy level improves,
increasing suicide potential). Assess for therapeutic response
(interest in surroundings, improvement in self-care,
increased ability to concentrate, relaxed facial expression).
OLANZAPINE
Brand Name
Apo-olanzapine, zyprexia, zyprexa relprevv, Zyprexa zydis
Generic Name
Olanzapine
Drug Classification
Antipsychotic
Mechanism of Action
Antagonizes alpha1-adrenergic, Dopamine, histamine,
muscarinic, serotonin receptors. Produces anticholinergic,
histaminic, CNS depressant effect
Indication
PO: Management of manifestations of schizophrenia.
Treatment of acute mania associated with bipolar I disorder
as monotherapy or in combination with lithium or valproate.
In combination with Fluoxetine: treatment of depressive
episodes associated with bipolar I disorder and treatment of
treatment-resistant bipolar depression. Maintenance
treatment of bipolar I disorder
Contraindication
Hypersensitivity to Olanzapine.
Dosage
10mg tablet
Side Effects
Drowsiness, agitation, insomnia, headache, nervousness,
hostility, dizziness, rhinitis.
Adverse Reactions
Rare reactions include seizures, neuroleptic malignant
syndrome, a potentially fatal syndrome characterized by
hyperpyrexia, muscle rigidity, irregular pulse or B/P,
tachycardia, diaphoresis, cardiac arrhythmias.
Extrapyramidal symptoms (EPS), dysphagia may occur.
Overdose (300 mg) produces drowsiness, slurred speech.
 DRUG STUDY
Drug Interaction
Alcohol, CNS depressants (e.g., Lorazepam, morphine,
zolpidem) may increase CNS depressant effects.
Anticholinergics (e.g., aclidinium, ipratropium, tiotropium,
umeclidinium) may increase anticholinergic effect. QT-
prolonging agents (e.g., amiodarone, haloperidol,
moxifloxacin, sotalol) may cause QT interval prolongation.
Nursing Responsibilities
Monitor B/P, serum glucose, lipids, LFT. Assess for tremors,
changes in gait, abnormal muscular movements, behavior.
Supervise suicidal-risk pt closely during early therapy (as
depression lessens, energy level improves, increasing suicide
potential). Assess for therapeutic response (interest in
surroundings, improvement in self-care, increased ability to
concentrate, relaxed facial expression). Assist with ambulation
if dizziness occurs. Assess sleep pattern. Notify physician if
extrapyramidal symptoms (EPS) occur
to severe paradoxical reactions (hallucinations, tremors,
seizures). Children, infants, neonates may experience
paradoxical reactions (restlessness, insomnia, euphoria,
nervousness, tremors). Overdosage in children may result in
hallucinations, seizures, death.
Drug Interaction
Alcohol, other CNS depressants (e.g., Lorazepam, morphine,
zolpidem) may increase CNS depressant effects.
Anticholinergics (e.g., aclidinium, ipratropium, tiotropium,
umeclidinium) may increase anticholinergic effects
Nursing Responsibilities
Monitor B/P, esp. in elderly (increased risk of hypotension).
Monitor children closely for paradoxical reaction. Monitor
for sedation.

DIPHENHYDRAMINE
Brand Name
Allerdryl, Banophen, Benadryl, Benadryl Children’s Allergy,
Diphen, Diphensit, Genahist, Nytol

Generic Name
Diphenhydramine

Drug Classification
Antihistamine, anticholinergic, antipruritic, antitussive,
antiemetic, antidyskinetic

Mechanism of Action
Competes with histamine for H-1 receptor site on effector cells
in GI tract, blood vessels, respiratory tract.

Indication
Treatment of allergic reactions, including nasal allergies and
allergic dermatoses; parkinsonism, including drug-induced
extrapyramidal symptoms; prevention/ treatment of nausea,
vomiting, or vertigo due to motion sickness; antitussive; short-
term management of insomnia; adjunct to Epinephrine in
treatment of anaphylaxis. Topical form used for relief of
pruritus from insect bites, skin irritations

Contraindication
Hypersensitivity to diphenhydramine. Neonates or premature
infants, breastfeeding.

Dosage
50mg capsule

Side Effects
Drowsiness, dizziness, muscle weakness, hypotension, urinary
retention, thickening of bronchial secretions, dry mouth, nose,
throat, lips; in elderly: sedation, dizziness, hypotension.
Adverse reactions: Hypersensitivity reactions (eczema,
pruritus, rash, cardiac disturbances, photosensitivity) may
occur. Overdose symptoms may vary from CNS depression
(sedation, apnea, hypotension, cardiovascular collapse, death)