DRUG STUDY Patient; __________________________________________________________Age: __________Hospital No._____________ Room No.

____________ Impression Diagnosis: ______________________________________________ Attending Physician: _________________________________________ Allergy to: _______________________________________________________ Indication/ Mechanism of Drug Action Generic/ Name & Classification Generic : Valproate sodium Timing: Brand: Depacon Duration: * As adjunct to treat simple or complex absence seizures, complex partial seizures, myoclonic seizures and generalized tonic-clonic seizures * To treat acute manic phase of bipolar disorder Classification: Other Form: Chemical Class: Carboxylic acid derivative Therapeutic Class: Anticonvulsant * To prevent migraine headache Dose, Strenght & Formulation Ordered: Indications: * To treat simple or complex seizures,, complex partial seizures, myoclonic seizures and generalized tonic-clonic seizures as monotherapy. CNS: Agitation, ataxia, confusion, depression, dizziness, drowsiness, euphoria, hallucinations, headache, hyperesthesia, hupothermia, lethargy, loss of zeizure control, sedation, suicidal ideation, tremor, vertigo, weakness EENT: diplopia, nytgamus, pharyngitis, spots before eyes ENDO: galactorrhea, hyperglycemia Gi: abdominal pain, anorexia, constipation, diarrhea, elevated liver function test results, hepatotoxicty, increased appetite, indigestion, nausea, vomiting Adverse/ Side Effects Drug Interaction Nursing Responsibilities 1. Urge patient to avoid alcohol during therapy 2. Urge woman to notify prescriber at once about suspected or known pregnancy 3. Urge family or caregiver to watch for closely for suicidal tendencies, especially when therapy starts or dosage changes. 4. Rationale Client Teaching

1. Give valproate sodium with food. 2. Watch patient closely for suicidal tendencies, particularly when therapy starts and dosage changes. 3. Monitor patient drug level as ordered, especially early in therapy and if patient takes other drugs 4. Advise patient to avoid hazardous activities during therapy 5. Instruct patient to swallow capsules whole

- to minimize GI irritation - depression may worsen temporarily during these times, possibly leading to suicidal ideation - interactions can alter the blood level

- drug may affect mental and motor performance - to prevent irritation to mouth and throat

Indication/ Mechanism of Drug Action Generic/ Name & Classification Dose, Strenght & Formulation Mechanism of Action: May decrease seizure activity by blocking reuptake of gammaaminobutyric acid (GABA), the most common inhibitory neurotransmitter in the brain. GABA suppresses the rapid firing of neurons by inhibiting voltage-sensitive sodium channels.

Adverse/ Side Effects Drug Interaction Nursing Responsibilities

Rationale

Client Teaching

GU: menstrual irregularities HEME: eosinophilia, hematoma, leukopenia, prolonged bleeding time, thrombocytopenia, dysarthria SKIN: alopeica, diaphoresis, erythema, jaundice, petechiae, photosensitivity, pruritus, SJS

Indication/ Mechanism of Drug Action Generic/ Name & Classification Dose, Strenght & Formulation

Adverse/ Side Effects Drug Interaction Nursing Responsibilities

Rationale

Client Teaching

Indication/ Mechanism of Drug Action Generic/ Name & Classification Generic : lithium carbonate Brand: Carbolith Mechanism of Action: May increase presynaptic degredation of the cathecolamine neurotransmitters serotonin, dopamine and norepinephrine; inhibit their release at neural synapses; and decrease postsynaptic receptor sensitivity. These actions may correct overactive cathecolamine systems in patients with mania Dose, Strenght & Formulation Indications: To treat recurrent bipolar affective disorder, to prevent bipolar disorder depression

Adverse/ Side Effects Drug Interaction Nursing Responsibilities CNS: ataxia, coma, confusion, depression, dizziness, drowsiness, headache, lethargy, seizures,, syncope CV: arrythmias, ECG changes, edema EENT: dental caries, dry mouth, exopthalmus ENDO: diabetes insipidus, euthyroid goiter, hypothyroidism, myxedema GI: adbominal distention and pain, anorexia, diarrhea, nausea, thirst GU: stress incontennce, urinaryfrequency HEME: leukocytosis MS: muscle twitching and weakness RESP: dyspnea SKIN: ance, alopecia, thin hair 1. Administer lithium after meals 2. Be aware that lithium affects intracellular and extracellular potassium ion shift, which can cause ECG changes such as flattened or inverted T waves 3. Weigh patient daily

Rationale

Client Teaching

- to slow absorption from GI tract and reduce adverse reaction - it can increase the risk of cardiac arrest

1. Advise patient to take lithium with or after meals to minimize adverse reactions 2. Inform patient that frequent urination, nausea, and thirst may occur during the first few days of treatment 3. Caution patient not to stop taking lithium or adjust dosage without first consulting prescriber 4. Instruct patient to report signs of toxicity such as diarrhea, drowsiness, muscle weakness and tremor

- to detect sudden weight changes - lithium alters blood glucose tolerance - to detect enlargement because drug may cause goiter

Classification: Chemical Class: Alkaline metal Therapeutic Class: Antidepressant, antimanic

4. Monitor blood glucose level often in diabetic patient 5. Palpate thyroid gland

Indication/ Mechanism of Drug Action Generic/ Name & Classification Dose, Strenght & Formulation

Adverse/ Side Effects Drug Interaction Nursing Responsibilities

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Client Teaching

5. Urge patient to avoid hazardous activities until drug CNS effects are known 6. Advise patient to maintain normal fluid and sodium intake 7. Emphasize the importance of complying with scheduled check ups and laboratory test