NAME OF THE PATIENT: BADILLA, MARINHEL TOLEDO

AGE: 28 YEARS OLD

GENDER: FEMALE
DIAGNOSIS: BIPOLAR I DISORDER
DATE ADMITTED: 1/5/2024

DRUG DATA MECHANISM OF INDICATION CONTRAINDICATIO SIDE EFFECT/ADVERSE NURSING

ACTION N EFFECT RESPONSIBILITIES
Generic Name: Divalproex Divalproex works by  Acute  Liver  Gastrointestin Assessment:
Sodium increasing the levels Manic Dysfunction al Effects  Patient's
of gamma- Episodes  Known  Weight Gain medical
Brand Name: aminobutyric acid  Maintena Hypersensiti  Sedation history,
Depakene, Depakote (GABA), a nce vity  Tremor including
neurotransmitter Treatment  Urea Cycle  Hair Loss any history
Patient’s Dose: that has inhibitory  Bipolar Disorders  Liver Function of liver
500 mg/tab, 1 tab in AM & effects in the brain. It Depressio  Pancreatitis Abnormalities disease,
1 tab in PM also has sodium n  Mitochondri  Pancreatitis pancreatiti
channel blocking  Combinati al Disorders  Thrombocytop s, or other
Classification: activity and may on  Thrombocyt enia contraindi
 Anticonvulsant/ affect other Therapy openia  Teratogenicity cations.
Antiepileptic Agent neurotransmitter  HIV  Hyperammon  Assess the
 Mood Stabilizer systems. Medications emia patient's
 Anti-Manic Agent  Pregnancy  Neurological current
 Prophylactic Effects mental
Migraine and
Medication physical
 GABAergic Agent health, as
well as any
allergies.
Baseline
Monitoring:
 Vital signs,
liver
function
 tests, and
platelet
counts.
Patient Education:
 Provide
comprehe
nsive
education
about
medicatio
n.
Psychosocial
Support:
 Provide
psychosoci
al support
to patient
and their
families.
Generic Name: Olanzapine is an  Acute  Hypersensiti Common Side Effects: Assessment:
Olanzapine atypical Manic vity  Weight Gain Conduct a
antipsychotic Episodes  Nervous  Sedation thorough
Brand Name: medication that is  Mixed System  Orthostatic assessment of the
Zyprexa often used in the Episodes Depression Hypotension patient's medical
treatment of Bipolar  Maintena  Concomitant  Increased history, including
Patient’s Dose: I Disorder. nce Use with Appetite any pre-existing
10 mg/tab, 1/2 tab in AM  Dopamine Treatment High-Dose  Dry Mouth conditions,
& 1 tab in PM Receptor  Combinati Fluvoxamine Adverse Effects: allergies, and
Antagonism on  Patients  Metabolic current
Classification:  Serotonin Therapy with a Effects medications.
 Antipsychotic Receptor  Rapid History of  Extrapyramida Assess the
 Dopaminergic Antagonism Cycling Myocardial l Symptoms patient's mental
blocker  Histamine Bipolar Infarction or (EPS) health status,
Receptor Disorder Unstabler  Neuroleptic including
 Antagonism  Heart Malignant symptoms and
 Alpha-1 Disease Syndrome behaviors
Adrenergic  Elderly (NMS) associated with
Receptor Patients  QT Bipolar I Disorder.
Blockade with Prolongation Baseline
 Anticholinerg Dementia-  Hyperprolacti Monitoring:
ic Effects Related nemia Establish baseline
Psychosis  Cognitive and measurements,
 Pregnancy Motor including vital
and Impairment signs, weight, and
Breastfeedin metabolic
g parameters (such
 Patients as blood glucose
with Known and lipid levels).
Hyperprolac Metabolic
tinemia Monitoring:
 Severe Renal Monitor metabolic
or Hepatic parameters,
Impairment including blood
glucose and lipid
levels. Educate the
patient on the
importance of
maintaining a
healthy lifestyle,
including diet and
exercise, to
mitigate potential
metabolic effects.
Neurological
Assessment:
Assess for
extrapyramidal
symptoms (EPS),
 including tremors
and muscle
rigidity. Monitor
for signs of
neuroleptic
malignant
syndrome (NMS).
Cardiovascular
Monitoring:
Monitor blood
pressure regularly,
especially during
the initial phase of
treatment, to
assess for
orthostatic
hypotension.
Monitoring for QT
Prolongation:
Be vigilant for
signs of QT
prolongation and
inform the
healthcare
provider if there
are any concerns.
This may involve
coordinating ECG
monitoring if
necessary.
Generic Name: Clonazepam, like Clonazepam is not  Allergy or Common Side Effects: Assessment:
Clonazepam other typically Hypersensiti  Sedation and Conduct a
benzodiazepines, considered a first- vity Drowsiness comprehensive
Brand Name: exerts its line treatment for  Acute  Dizziness assessment of the
Klonopin pharmacological Bipolar I Disorder. Narrow-  Cognitive patient's medical
effects by interacting The primary Angle Impairment history, including
Patient’s Dose: with the gamma- pharmacological Glaucoma  Muscle any allergies,
2 mg/tab, 1/2 tab in AM & aminobutyric acid treatments for  Severe Liver Weakness current
1/2 tab in PM (GABA) bipolar disorder Disease  Coordination medications, and
neurotransmitter often include  Myasthenia Difficulties past experiences
Classification: system in the central mood stabilizers, Gravis Adverse Effects: with
 Benzodiazepine nervous system. antipsychotics,  Sleep Apnea  Dependence benzodiazepines.
GABA is an inhibitory and, in some  Pregnancy and Evaluate the
neurotransmitter cases, and Withdrawal patient's mental
that plays a key role antidepressants. Breastfeedin  Respiratory health status,
in regulating However, g Depression including
neuronal excitability. clonazepam may  Substance  Paradoxical symptoms related
 GABA be used in specific Use Reactions to bipolar disorder.
Receptor situations or as an Disorders  Depression of Baseline
Modulation adjunctive  Depression Blood Monitoring:
 Enhancemen treatment for or Suicidal Pressure Establish baseline
t of certain aspects of Ideation  Suicidal measurements,
GABAergic bipolar disorder. Thoughts including vital
Inhibition  Adjunctiv  Worsening of signs, mental
 Hyperpolariz e Depression status, and
ation and Treatment relevant laboratory
Reduced for values.
Neuronal Anxiety Dependence and
Excitability  Adjunctiv Withdrawal Risk:
 Anxiolytic, e Educate the
Sedative, Treatment patient about the
Anticonvulsa for Sleep risk of dependence
nt Effects Disturban and withdrawal
ces associated with
 Managem clonazepam.
ent of Emphasize the
Acute importance of
Mania or following the
Agitation prescribed dosage
and avoiding
abrupt
discontinuation.
Cognitive
Assessment:
Monitor the
patient for
cognitive
impairment,
including
difficulties with
concentration and
memory.
Respiratory
Monitoring:
Monitor
respiratory status,
especially in
individuals with
pre-existing
respiratory
conditions. Be
vigilant for signs of
respiratory
depression.
Mental Health
Assessment:
Regularly assess
the patient's
mental health
status, including
changes in mood,
anxiety levels, and
 potential
worsening of
depression or
suicidal ideation.
Generic Name: Biperiden is an Biperiden is not  Hypersensiti Common Side Effects: Assessment:
Biperiden anticholinergic typically indicated vity or  Dry Mouth Conduct a
medication primarily for the treatment Allergy  Blurred Vision thorough
Brand Name: used for the of bipolar I  Narrow-  Constipation assessment of the
Akineton treatment of disorder. Angle  Urinary patient's medical
Parkinson's disease Biperiden is Glaucoma Retention history, including
Patient’s Dose: and drug-induced primarily used in  Gastrointesti  Confusion and any allergies,
2 mg/tab 1/2 tab OD HS extrapyramidal the management nal Cognitive current
symptoms (EPS) of Parkinson's Obstruction Impairment medications, and
Classification: caused by certain disease and drug-  Urinary history of
Anticholinergic antipsychotic induced Retention psychiatric
medications. It is not extrapyramidal  Myasthenia conditions.
a typical choice for symptoms (EPS) Gravis Hydration:
the treatment of caused by certain  Severe Encourage
bipolar I disorder. antipsychotic Ulcerative adequate fluid
The primary medications. Its Colitis intake to address
mechanism of action antimuscarinic  Pregnancy potential dry
of biperiden is properties help and mouth and reduce
related to its alleviate Breastfeedin the risk of
antimuscarinic symptoms such as g constipation.
properties. tremors, rigidity,  Central Assessment for
 Antagonism and bradykinesia Nervous EPS:
of associated with System If biperiden is used
Muscarinic Parkinson's  Depression to manage drug-
Acetylcholin disease, as well as induced EPS,
e Receptors symptoms of EPS, monitor the
 Central which can include patient for
Nervous muscle stiffness improvement in
System and involuntary extrapyramidal
Effects movements symptoms, such as
  Impact on caused by tremors and
Extrapyramid antipsychotic muscle stiffness.
al System medications.
 Reduction of
Tremors and The primary
Rigidity treatments for
bipolar I disorder
usually involve
mood stabilizers,
antipsychotic
medications, and,
in some cases,
antidepressants.
Biperiden does
not have specific
indications for
addressing the
mood swings,
mania, or
depressive
episodes
characteristic of
bipolar disorder.
Generic Name: Folic acid, also  Adjunctiv  Allergies or Common Side Effects: Assessment:
Folic Acid known as vitamin B9, e Hypersensiti  Nausea Conduct a
is a water-soluble B Treatment vity  Bloating thorough
Brand Name: vitamin that plays a  Mood  Interaction  Gas assessment of the
Folvite crucial role in various Stabilizati with  Loss of patient's medical
physiological on Medications appetite history, including
Patient’s Dose: processes in the  Reduction  Vitamin B12  Irritability any known
500 mg/tab; 1 tab OD body. While folic acid of Deficiency Adverse Effects: allergies,
is important for Homocyst  Other  Allergic medications, and
Classification: overall health, its eine Medical Reactions pre-existing
 Vitamin specific role in the Levels Conditions  Interaction medical
 Supplement treatment of bipolar  Support with conditions.
 Water-soluble B I disorder is not a for Medications Assess the
primary mood- Medicatio  High Doses patient's overall
stabilizing agent. n and Cancer nutritional status
However, it may be Response Risk and the need for
used as an folic acid
adjunctive therapy or supplementation.
as part of a Dose and
comprehensive Administration:
treatment plan for Ensure that the
individuals with patient
bipolar disorder. understands when
Related to its and how to take
involvement in the supplement.
neurotransmitter
synthesis,
particularly in the
production of
serotonin,
dopamine, and
norepinephrine.
 Neurotransm
itter
Synthesis
 Homocystein
e
Metabolism
 DNA
Synthesis
and Repair
 Methylation
Processes

Generic Name: Involve the blockade  Acute  Known Common Side Effects: Assessment:
Haloperidol of dopamine Mania Hypersensiti  Extrapyramida Conduct a
receptors in the  Mixed vity l Symptoms thorough
Brand Name: brain. Episodes  Parkinson's (EPS) assessment of the
Haldol  Dopamine  Psychotic Disease  Sedation patient's mental
Receptor Features  Central  Orthostatic and physical
Patient’s Dose: Antagonism  Agitation Nervous Hypotension health, including a
5 mg/tab +  Blockade of and System  Anticholinergi baseline
Diphenhydramine 50 D2 Receptors Aggressio Depression c Effects assessment of
mg/ml for disruptive  Reduction of n  Coma and  Weight Gain symptoms, vital
behavior Dopaminergi  Short- Severe CNS Adverse Effects: signs, weight, and
c Term Depression  Tardive any pre-existing
Classification: Transmission Treatment  Severe Dyskinesia medical
Antipsychotic  Stabilization Cardiovascul (TD) conditions.
of Dopamine ar Disease Neurological
 Hyperprolacti
Activity  Blood Assessment:
nemia
 Impact on Dyscrasias: Monitor for EPS,
 Seizures
Other  Pheochromo which may include
 Cognitive
Neurotransm cytoma tremors, rigidity,
Impairment bradykinesia, and
itters  Hyperprolac
tardive dyskinesia.
tinemia
Assessment of
 Elderly
Mental Status:
Individuals Monitor the
with patient's mental
Dementia- status, including
Related mood, behavior,
Psychosis and cognitive
function.
Orthostatic Blood
Pressure
Measurement:
Check blood
pressure in
different positions
 (lying, sitting, and
standing) to assess
for orthostatic
hypotension.
Educate the
patient about the
importance of
changing positions
slowly to prevent
dizziness or
fainting.
Generic Name: Involve complex  Manic  Renal Common Side Assessment:
Lithium Carbonate interactions with Episodes Impairment Effects: Conduct a
neurotransmitters,  Preventio  Cardiovascular  Polyuria and thorough
Brand Name: second messenger n of Manic Disease Polydipsia assessment of the
Eskalith systems, and Episodes:  Dehydration  Hand patient's medical
various cellular Bipolar  Sodium Tremors: history.
Patient’s Dose: processes. Lithium Maintena Depletion  Weight Gain Assess the patient's
450 mg/tab 1 tab in AM; 1 is a mood- nce  Bradyarrhythmi  Thyroid baseline mental
tab in PM stabilizing Therapy as Dysfunction health status,
medication  Augmenta  Myasthenia mood symptoms,
Classification: commonly used in tion Gravis Adverse Effects: and overall physical
CNS agent; the management Therapy  Pregnancy and  Renal health.
Psychotherapeutic agent; of bipolar disorder,  Rapid Breastfeeding Dysfunction Monitoring
Antimanic particularly for Cycling  Hypersensitivit  Cardiovascul Lithium Levels:
preventing manic Bipolar y ar Effects Regularly monitor
episodes. Disorder  Hyperparath lithium levels in the
 Inhibition yroidism blood to ensure
of Inositol  Dermatologic they are within the
Phosphata al Effects therapeutic range.
se  Neurological Renal Function
 Second Effects Monitoring:
Messenger  Toxicity Monitor renal
Systems function through
 Neurotrans regular
mitter assessments of
Release kidney function
 Neuroprot tests.
ective Thyroid Function
Effects Monitoring:
 Impact on Regularly assess
GABAergic thyroid function
Transmissi through thyroid
on function tests, as
 Cellular lithium can affect
Homeostas thyroid function
is and may lead to
 Gene hypothyroidism.
Expression Vital Signs
Monitoring:
Monitor vital signs
regularly.
Cognitive Function
Monitoring:
Assess cognitive
function regularly,
including
concentration and
memory.
Hydration
Monitoring:
Encourage and
monitor adequate
fluid intake to
prevent
dehydration, which
can affect lithium
levels.
Dietary
Considerations:
Discuss dietary
considerations,
including the
impact of salt
intake on lithium
levels.