DRUG STUDY

BRAND NAME Prescribed and Mechanism

GENERIC NAME Recommended Of
CLASSIFICATION dosage, frequency, Action Indication Contraindication Adverse Reaction Nursing Responsibilities
route of
administration

CHLORPROMAZIN Psychotic Disorders, Phenothiazine To control manic phase Hypersensitivity Body as a Assessment & Drug Effects
E Agitation derivative with actions of manic-depressive to phenothiazine Whole: Idiopathic
HYDROCHLORIDE Adult: PO 25–100 mg at all levels of CNS illness, for derivatives; edema, muscle  Establish baseline BP
t.i.d. or q.i.d., may with a mechanism that symptomatic withdrawal states necrosis SLE-like and pulse, before
Chlorpromanyl , Larga need up to 1000 produces strong management of from alcohol; syndrome, sudden initiating treatment.
ctil , Novochlorpromaz mg/d. IM/IV 25–50 mg antipsychotic effects. psychotic disorders, comatose states, unexplained death.  Monitor BP frequently.
ine , Ormazine, Proma up to 600 mg q4–6h Actions on including brain damage, Hypotensive reactions,
par, Promaz, Sonazine,  hypothalamus and schizophrenia, in bone marrow CV: Orthostatic dizziness, and sedation
Thorazine, Thor-Prom Child: PO >6 mo, 0.55 reticular formation management of severe depression, Reye's hypotension, are common during
mg/kg q4–6h prn up to produce strong nausea and vomiting, syndrome; palpitation, early therapy,
Classifications:  500 mg/d PR >6 sedation, hypotension, to control excessive children <6 mo; tachycardia, ECG particularly in patients
CENTRAL mo, 1.1 mg/kg q6– and depressed anxiety and agitation pregnancy changes prolonged on high doses and in the
NERVOUS SYSTEM 8h IM/IV >6 mo, 0.55 temperature regulation. before surgery, and for (category C), QT and PR older adult receiving
AGENT; PSYCHOTH mg/kg q6–8h Directly depresses the treatment of severe lactation. intervals, blunting parenteral doses.
ERAPEUTIC; ANTIP heart; may increase behavior problems in of T waves, ST Patients usually develop
SYCHOTIC; PHENOT coronary blood flow. children, e.g., attention depression.  tolerance to these
HIAZINE; ANTIEME deficit disorder. Also adverse effects;
TIC used for treatment of GI: Dry mouth; however, lower doses or
acute intermittent constipation, adyna longer intervals between
Pregnancy Category: C porphyria, intractable mic ileus, doses may be required.
hiccups, and as adjunct cholestatic  Lab tests: Periodic CBC
in treatment of tetanus. jaundice, with differential, liver
aggravation of function tests, urinalysis,
peptic ulcer, and blood glucose.
dyspepsia,  Monitor cardiac status
increased appetite.  with baseline ECG in
patients with preexisting
cardiovascular disease.
CNS: Sedation,  Be alert for signs of
drowsiness, dizzine neuroleptic malignant
ss, syndrome Report
restlessness, neurol immediately.
eptic malignant  Observe and record
syndrome, tardive smoking since it
dyskinesias, tumor, increases metabolism of
syncope, headache, phenothiazines, resulting
weakness, in shortened half-life
insomnia, reduced and more rapid
REM sleep, bizarre clearance of drug.
dreams, cerebral Higher dosage in
edema, convulsive smokers may be
seizures, hypotherm required. Advise patient
ia, inability to to stop or at least reduce
sweat, depressed smoking, if possible.
cough  Monitor I&O ratio and
reflex, extrapyrami pattern: Urinary
dal symptoms, EEG retention due to mental
changes.  depression and
compromised renal
Respiratory: Laryn function may occur. If
gospasm. Skin: Fix serum creatinine
ed-drug eruption, becomes elevated,
urticaria, reduced therapy should be
perspiration, discontinued.
contact dermatitis,  Monitor for antiemetic
exfoliative effect of
dermatitis, chlorpromazine, which
photosensitivity, may obscure signs of
eczema, over dosage of other
drugs or other causes of
Special nausea and vomiting.
Senses: Blurred  Be alert to complaints of
vision, lenticular diminished visual acuity,
opacities, reduced night vision,
mydriasis, photophobia, and a
photophobia.  perceived brownish
discoloration of objects.
  Monitor diabetics or
prediabetics on long-
term, high-dose therapy
for reduced glucose
tolerance and loss of
diabetes control.
 Ocular examinations,
and EEG (in patients
>50 y) are recommended
before and periodically
during prolonged
therapy.

Patient & Family Education

 Take medication as
prescribed and keep
appointments for follow-
up evaluation of dosage
regimen. Improvement
may not be experienced
until 7 or 8 wk into
therapy.
 Do not alter dosing
regimen, and do not give
the drug to another
person.
 May cause pink to red-
brown discoloration of
urine.
 Wear protective clothing
and sunscreen lotion
with SPF above 12 when
outdoors, even on dark
days. Photosensitivity
associated with
chlorpromazine therapy
is a phototoxic reaction.
 Severity of response
depends on amount of
exposure and drug dose.
Exposed skin areas have
appearance of an
exaggerated sunburn. If
reaction occurs, report to
physician.
 Practice meticulous oral
hygiene. Oral
candidiasis occurs
frequently in patients
receiving
phenothiazines.
 Report extrapyramidal
symptoms that occur
most often in patients on
high dosage, the
pediatric patient with
severe dehydration and
acute infection, the older
adult, and women.
 Avoid driving a car or
undertaking activities
requiring precision and
mental alertness until
drug response is known.
 Do not abruptly stop this
drug. Abrupt withdrawal
of drug or deliberate
dose skipping, especially
after prolonged therapy
with large doses, can
cause onset of
extrapyramidal
symptoms.
 Do not breast feed while
 taking this drug.

DRUG STUDY

BRAND NAME Prescribed and Mechanism

GENERIC NAME Recommended Of
CLASSIFICATION dosage, frequency, Action Indication Contraindication Adverse Reaction Nursing Responsibilities
route of
administration

Clozaril, Fazaclo Adult: PO >16 Mechanism is not Indicated only in the Severe CNS CV: Orthostatic Assessment & Drug Effects
y: Initiate at 25–50 defined. Interferes with management of depression, blood hypotension, tachyc
Classifications: CENT mg/d and titrate to a binding of dopamine to severely ill dyscrasia, history ardia, ECG  Lab tests: Baseline
RAL NERVOUS target dose of 350–450 D1 and D2 receptors in schizophrenic patients of bone marrow changes, increased WBC and absolute
SYSTEM (CNS) mg/d in 3 divided the limbic region of who have failed to depression; risk of myocarditis neutrophil count must be
AGENT; PSYCHOTH doses at 2 wk intervals, brain. It binds respond to other patients with especially during made before initial
ERAPEUTIC further increases can be primarily to neuroleptic agents. myeloproliferative first month of treatment, every week
AGENT; ANTIPSYC made if necessary, max nondopaminergic sites. disorders, therapy, for first 6 mo, then every
HOTIC; ATYPICAL of 900 mg/d uncontrolled pericarditis, 2 wk for next 6 mo, then
epilepsy; pericardial effusion, every 4 wk, and weekly
Pregnancy Category: B clozapine-induced cardiomyopathy, for 4 wk after the drug is
agranulocytosis, heart failure, MI, discontinued.
severe mitral Periodically monitor
granulocytosis, insufficiency.  blood glucose.
chemotherapy,  Monitor diabetics for
coma, leukemia, GI: Nausea, dry loss of glycemic control.
leukopenia, mouth,  Monitor for seizure
neutropenia, constipation, activity; seizure
myocarditis, hypersalivation. He potential increases at the
concurrent matologic : Agranul higher dose level.
administration of ocytosis.  Closely monitor for
benzodiazepines recurrence of psychotic
or other CNS: Seizures, tran symptoms if the drug is
psychotropic sient being discontinued.
drugs; renal fever, sedation, neu  Monitor cardiovascular
failure, dialysis, roleptic malignant and respiratory status,
hepatitis, syndrome (rare), especially during the
jaundice; infants, dystonic reactions first month of therapy.
lactation. (rare). Metabolic: H Report promptly S&S of
yperglycemia, CHF and other potential
diabetes cardiac problems.
mellitus. Urogenital  Monitor for
: Urinary retention.  development of
tachycardia or
Other: Increased hypotension, which may
mortality from pose a serious risk for
severe hematologic, patients with
cardiovascular, and compromised
respiratory adverse cardiovascular function.
effects.  Monitor daily
temperature and report
fever. Transient
elevation above 38° C
(100.4° F), with peak
incidence during first 3
wk of drug therapy, may
occur.

Patient & Family Education

 Carefully monitor blood

glucose levels if
diabetic.
 Do not engage in any
hazardous activity until
response to the drug is
known. Drowsiness and
sedation are common
adverse effects.
 Due to the risk of
agranulocytosis it is
important to comply
with blood test regimen.
Report flulike
symptoms, fever, sore
throat, lethargy, malaise,
or other signs of
infection.
 Rise slowly to avoid
orthostatic hypotension.
 Report immediately any
of the following:
unexplained fatigue,
especially with activity;
shortness of breath,
sudden weight gain or
edema of the lower
extremities.
 Take drug exactly as
ordered.
 Do not use OTC drugs
or alcohol without
permission of physician.
 Do not breast feed while
taking clozapine.
 DRUG STUDY

BRAND NAME Prescribed and Mechanism

GENERIC NAME Recommended Of
CLASSIFICATION dosage, frequency, Action Indication Contraindication Adverse Reaction Nursing Responsibilities
route of
administration

Prolixin Adult: PO 0.5–10 Potent phenothiazine, Management of Known CNS: Extrapyramid Assessment & Drug Effects
Decanoate, Modecate mg/d in 1–4 divided antipsychotic agent. manifestations of hypersensitivity to al
Decanoate  doses (max: of 20 Blocks postsynaptic psychotic disorders. phenothiazines; symptoms tardive  Report immediately
FLUPHENAZINE mg/d) IM/SC HCl 2.5– dopamine receptors in subcortical brain dyskinesia, onset of mental
ENANTHATE 10 mg/d divided q6–8h the brain. Similar to damage, comatose sedation, depression and
Moditen (max: 10 other phenothiazines or severely drowsiness, extrapyramidal
Enanthate Prolixin mg/d); Decanoate 12.5 with the following depressed states, dizziness, symptoms. Both occur
Enanthate –25 mg q1– exceptions: more blood dyscrasias, headache, mental frequently, particularly
FLUPHENAZINE 4wk; Enanthate 25 mg potent per weight, renal or hepatic depression, with long-acting forms
HYDROCHLORIDE q2wk higher incidence of disease. Safety catatonic-like (decanoate and
Moditen extrapyramidal during pregnancy state, impaired enanthate).
HCl , Permitil, Prolixin complications, and (category C) or thermoregulation,  Be alert for appearance
lower frequency of lactation is not grand mal seizures.  of acute dystonia
Classifications: CENT sedative, hypotensive, established. Symptoms can be
RAL NERVOUS and antiemetic effects. Parenteral form CV: Tachycardia, controlled by reducing
SYSTEM not recommended hypertension, dosage or by adding an
AGENT; PSYCHOTH for children <12 hypotension.  antiparkinsonism drug
ERAPEUTIC; ANTIP y. such as benztropine.
SYCHOTIC; PHENOT GI: Dry mouth,  Be alert for red, dry, hot
HIAZINE nausea, epigastric skin; full, bounding
pain, constipation, pulse, dilated pupils,
Pregnancy Category: C fecal impaction, dyspnea, mental
cholecystic confusion, elevated BP,
jaundice.  temperature over 40.6°
 C (105° F). Inform
Body as a physician and institute
Whole: Peripheral measures to reduce body
edema. Special temperature rapidly.
Senses: Nasal Extended exposure to
congestion, blurred high environmental
vision, increased temperature, to sun's
intraocular rays, or to a high fever
pressure, photosens places the patient taking
itivity. . this drug at risk for heat
stroke.
 Lab tests: Monitor
kidney function in
patients on long-term
treatment. Withhold
drug and notify
physician if BUN is
elevated (normal BUN:
10–20 mg/dL). Also
perform WBC with
differential, liver
function tests,
periodically.
 Monitor BP during early
therapy. If systolic drop
is more than 20 mm Hg,
inform physician.
 Monitor I&O ratio and
bowel elimination
pattern. Check for
abdominal distension
and pain. Monitor for
xerostomia and
constipation.
 Note: Patients on large
doses who undergo
surgery and those with
cerebrovascular, cardiac,
 or renal insufficiency are
especially prone to
hypotensive effects.

Patient & Family Education

 Do not drive or engage

in potentially hazardous
activities until response
to drug is known.
 Do not alter dosage
regimen or stop taking
drug abruptly. Do not
give drug to anyone else.
 Seek and obtain
physician approval
before taking any OTC
drugs.
 Be alert for adverse
effects, early detection is
critical because both
decanoate and enanthate
have a long duration of
action. Inform physician
promptly if following
symptoms appear: Light-
colored stools, changes
in vision, sore throat,
fever, cellulitis, rash,
any interference with
your willful (volitional)
movements.
 Make sure to eat and
drink adequately in
order to prevent
constipation and dry
mouth.
 Be aware that it may be
 difficult for you to adjust
to extremes in
temperature. Use caution
because of this possible
impaired
thermoregulation.
 Avoid exposure to sun;
wear protective clothing
and cover exposed skin
surfaces with sun screen
lotion (SPF above 12).
 Avoid alcohol while on
fluphenazine therapy.
 Note: Fluphenazine may
discolor urine pink to
red or reddish brown.
 Do not breast feed while
taking this drug without
consulting physician.
 Periodic ophthalmologic
exams are
recommended.
 DRUG STUDY

BRAND NAME Prescribed and Mechanism

GENERIC NAME Recommended Of
CLASSIFICATION dosage, frequency, Action Indication Contraindication Adverse Reaction Nursing Responsibilities
route of
administration

HALOPERIDOL  Psychosis Potent, long-acting Management of Parkinson's CNS: Extrapyramid Assessment & Drug Effects
(ha-loe-per'i-dole) Adult: PO 0.2–5 mg butyrophenone manifestations of disease, al
Haldol, Peridol  b.i.d. or t.i.d. IM 2–5 derivative with psychotic disorders and parkinsonism, reactions: Parkinso  Monitor for therapeutic
HALOPERIDOL mg repeated q4h prn; pharmacologic actions for control of tics and seizure disorders, nian symptoms, effectiveness. Because
DECANOATE Decanoate: 50–100 mg similar to those of vocal utterances of coma; alcoholism; dystonia, of long half-life,
Haldol q4wk piperazine Gilles de la Tourette's severe mental akathisia, tardive therapeutic effects are
phenothiazines but syndrome; for depression, CNS dyskinesia; slow to develop in early
Classifications: CENT Child: PO 0.5 mg/d in with higher incidence treatment of agitated depression; insomnia, therapy or when
RAL NERVOUS 2–3 divided doses, may of extrapyramidal states in acute and thyrotoxicosis. restlessness, established dosing
SYSTEM be increased by 0.5 mg effects and less chronic psychoses. Safe use during anxiety, euphoria, regimen is changed.
AGENT; PSYCHOTH q5–7d to 0.05–0.15 hypotensive and Used for short-term pregnancy agitation, "Therapeutic window"
ERAPEUTIC; ANTIP mg/kg/d relatively low sedative treatment of (category C), drowsiness, mental effect may occur after
SYCHOTIC; BUTYR activity. hyperactive children lactation, or in depression, long period of high
OPHENONE Severe Psychosis and for severe behavior children <3 y is lethargy, fatigue, doses. Close observation
Adult: PO 3–5 mg problems in children of not established. weakness, tremor, is imperative when
Pregnancy Category: C b.i.d. or t.i.d., may combative, explosive ataxia, headache, doses are changed.
need up to 100 hyperexcitability. confusion,  Target symptoms
mg/d IM 2–5 mg, may vertigo; neuroleptic expected to decrease
repeat q.h. prn; malignant with successful
Decanoate: 50–100 mg syndrome, haloperidol treatment
q4wk hyperthermia, include hallucinations,
grand mal seizures, insomnia, hostility,
Child: PO 0.05–0.15 exacerbation of agitation, and delusions.
mg/kg/d in 2–3 divided psychotic  Monitor patient's mental
doses symptoms.  status daily.
 Monitor for neuroleptic
Dementia CV: Tachycardia, malignant syndrome
Geriatric: PO 0.25– ECG changes,
0.5 mg 1–2 times daily, hypotension, (NMS), especially in
may increase every 4–7 hypertension (with those with hypertension
d (max: 4 mg/d in 2–3 overdosage).  or taking lithium.
divided doses) Symptoms of NMS can
Endocrine: Menstr appear suddenly after
ual irregularities, initiation of therapy or
galactorrhea, after months or years of
lactation, taking neuroleptic
gynecomastia, (antipsychotic)
impotence, medication. Immediately
increased libido, discontinue drug if NMS
hyponatremia, suspected.
hyperglycemia,  Monitor for
hypoglycemia. Spe parkinsonism and
cial Senses: Blurred tardive dyskinesia. Risk
vision. Hematologi of tardive dyskinesia
c: Mild transient appears to be greater in
leukopenia, agranul women receiving high
ocytosis (rare).  doses and in older
adults. It can occur after
GI: Dry mouth, long-term therapy and
anorexia, nausea, even after therapy is
vomiting, discontinued.
constipation,  Monitor for
diarrhea, extrapyramidal
hypersalivation.  (neuromuscular)
reactions that occur
Respiratory: Laryn frequently during first
gospasm, few days of treatment.
bronchospasm, Symptoms are usually
increased depth of dose related and are
respiration, controlled by dosage
bronchopneumonia,  reduction or concomitant
respiratory administration of
depression.  antiparkinson drugs.
 Be alert for behavioral
Skin: Diaphoresis, changes in patients who
maculopapular and are concurrently
acneiform rash,
photosensitivity.  receiving antiparkinson
drugs.
Other: Cholestatic  Observe patients closely
jaundice, variations for rapid mood shift to
in liver function depression when
tests, decreased haloperidol is used to
serum cholesterol. control mania or cyclic
disorders. Depression
may represent a drug
adverse effect or
reversion from a manic
state.
 Lab tests: Monitor WBC
count with differential
and liver function in
patients on prolonged
therapy.

Patient & Family Education

 Avoid use of alcohol

during therapy.
 Do not drive or engage
in other potentially
hazardous activities until
response to drug is
known.
 Discuss oral hygiene
with health care
provider; dry mouth may
promote dental
problems. Drink
adequate fluids.
 Avoid overexposure to
sun or sunlamp and use
a sunscreen; drug can
cause a photosensitivity
reaction.
  Do not breast feed while
taking this drug without
consulting physician.

DRUG STUDY

BRAND NAME Prescribed and Mechanism

GENERIC NAME Recommended Of
CLASSIFICATION dosage, frequency, Action Indication Contraindication Adverse Reaction Nursing Responsibilities
route of
administration

RISPERIDONE Psychosis Mechanism is not well Reduction or Hypersensitivity Body as a Assessment & Drug Effects
(ris-per'i-done) Adult: PO 1–6 mg understood. Interferes elimination of to risperidone; Whole: Orthostatic
Risperdal, Risperdal b.i.d., start with 1 mg with binding of psychotic symptoms in elderly with hypotension with  Monitor diabetics for
M-TAB, Risperdal b.i.d., increase by 1 mg dopamine to D2- schizophrenia and dementia-related initial doses, loss of glycemic control.
Consta b.i.d. daily to an initial
interlimbic region of related psychoses; psychosis; QT sweating,  Reassess patients
target dose of 3 mg the brain, serotonin (5- treatment of bipolar prolongation, weakness, fatigue.  periodically and
Classifications: CENT b.i.d. (max: 8
HT2) receptors, and disorder. Seems to Reye's syndrome, maintain on the lowest
RAL NERVOUS mg/d) IM 25 mg once alpha-adrenergic improve negative brain tumor, CNS: Sedation, effective drug dose.
SYSTEM (CNS) q2wk (max: 50 mg) receptors in the symptoms such as severe CNS drowsiness,  Monitor closely
AGENT; ANTIPSYC Geriatric: PO Start occipital cortex. It has apathy, blunted affect, depression, head headache, transient neurologic status of
HOTIC; ATYPICAL with 0.5 mg b.i.d. and low to moderate and emotional trauma; suicidal blurred older adults.
Prototype: Clozapine increase by 0.5 mg affinity for the other withdrawal. ideation, tardive vision, insomnia, di  Monitor cardiovascular
b.i.d. daily to an initial
serotonin (5-HT) dyskinesia; sinhibition, agitatio status closely; assess for
Pregnancy Category: C target of 1.5 mg b.i.d. receptors and no sunlight (UV) n, anxiety, orthostatic hypotension,
affinity to exposure, tanning increased dream especially during initial
Bipolar Disorder nondopaminergic sites beds; pregnancy activity, dizziness, dosage titration.
Adult: PO 2–3 mg (category C), catatonia, extrapyra  Monitor closely those at
once daily for up to 3 lactation, children midal symptoms, risk for seizures.
wk <15 y. especially with  Assess degree of
Geriatric: PO Start doses >10 cognitive and motor
with 0.5 mg b.i.d. and mg/d, neuroleptic impairment, and assess
increase by 0.5 mg malignant for environmental
b.i.d. daily to an initial syndrome (rare), hazards.
target of 1.5 mg b.i.d. increased risk of  Lab tests: Monitor
(max: 4 mg/d). May stroke in elderly.  periodically blood
convert to once daily glucose, serum
dosing after stabilized CV: Prolonged electrolytes, liver
in b.i.d. 2–3 d QTc interval, function, and complete
tachycardia.  blood counts.
GI: Dry mouth,
dyspepsia, nausea, Patient & Family Education
vomiting, diarrhea,
constipation,  Carefully monitor blood
abdominal pain, glucose levels if
elevated liver diabetic.
function tests (AST,  Do not engage in
ALT).  potentially hazardous
activities until the
Respiratory: Rhini response to drug is
tis, cough, known.
dyspnea. Skin: Phot  Be aware of the risk of
osensitivity.  orthostatic hypotension.
 Learn adverse effects
Urogenital: Urinar and report to physician
y retention, those that are
menorrhagia, bothersome.
decreased sexual  Wear sunscreen and
desire, erectile protective clothing to
dysfunction, sexual avoid photosensitivity.
dysfunction male
 Notify physician if you
and female.
intend to or become
pregnant.
 Do not breast feed while
taking this drug.
 DRUG STUDY

BRAND NAME Prescribed and Mechanism

GENERIC NAME Recommended Of
CLASSIFICATION dosage, frequency, Action Indication Contraindication Adverse Reaction Nursing Responsibilities
route of
administration

QUETIAPINE Adult: PO Initiate with Antagonizes multiple Management of Hypersensitivity Body as a Assessment & Drug Effects
FUMARATE 25 mg b.i.d., may neurotransmitter psychotic disorders, to quetiapine; Whole: Asthenia,
(Ce-ti-a'peen) increase by 25–50 mg receptors in the brain management of bipolar pregnancy fever, hypertonia,  Monitor diabetics for
Seroquel b.i.d. to t.i.d. on the including serotonin (5- disorder. (category C), dysarthria, flu loss of glycemic control.
second or third day as HT1A and 5-HT2) as lactation; alcohol syndrome, weight  Reassess need for
Classifications: CENT tolerated to a target well as dopamine use. Safety and gain, peripheral continued treatment
RAL NERVOUS dose of 300–400 mg/d D1 and D2 receptors. efficacy in edema.  periodically.
SYSTEM (CNS) divided b.i.d. to t.i.d., Mechanism of action is children have not  Withhold the drug and
AGENT; PSYCHOTH may adjust dose by 25– unknown, however, been established. CNS: Dizziness, immediately report S&S
ERAPEUTIC 50 mg b.i.d. q.d. as antipsychotic headache, of tardive dyskinesia or
AGENT; ANTIPSYC needed (max: 800 properties thought to somnolence.  neuroleptic malignant
HOTIC, ATYPICAL mg/d) be related to syndrome.
antagonized responses. CV: Postural  Lab tests: Periodically
Pregnancy Category: C Geriatric: PO Initiate Antagonizes histamine hypotension, monitor liver function,
with 25 mg b.i.d., H1 receptors resulting tachycardia, lipid profile, thyroid
titrate more slowly in possible palpitations.  function, blood glucose,
than adult patients, somnolence, and CBC with differential.
target range 150–200 adrenergic alpha1 and GI: Dry mouth,  Monitor ECG
mg/day in divided alpha2 receptors which dyspepsia, periodically, especially
doses may lead to orthostatic abdominal pain, in those with known
hypotension. constipation, cardiovascular disease.
anorexia.   Perform baseline
cataract exam when
Metabolic: hypergl therapy is started and at
ycemia, diabetes 6 mo intervals thereafter.
mellitus. 
  Monitor patients with a
Respiratory: Rhini history of seizures for
tis, pharyngitis, lowering of the seizure
cough, dyspnea. threshold.
 
Skin: Rash, Patient & Family Education
sweating. 
 Carefully monitor blood
Hematologic: Leuk glucose levels if
openia. diabetic.
 Exercise caution with
potentially dangerous
activities requiring
alertness, especially
during the first week of
drug therapy or during
dose increments.
 Make position changes
slowly, especially when
changing from lying or
sitting to standing to
avoid dizziness,
palpitations, and
fainting.
 Avoid alcohol
consumption and
activities that may cause
overheating and
dehydration.
 Inform physician
immediately if you
become pregnant.
 Do not breast feed while
taking this drug.
 DRUG STUDY

BRAND NAME Prescribed and Mechanism

GENERIC NAME Recommended Of
CLASSIFICATION dosage, frequency, Action Indication Contraindication Adverse Reaction Nursing Responsibilities
route of
administration

OLANZAPINE Psychotic Disorders Antipsychotic activity Management of Hypersensitivity Body as a Assessment & Drug Effects
(o-lan'za-peen) Adult: PO Start with is thought to be due to psychotic disorders, to olanzapine; Whole: Weight
Zyprexa, Zyprexa 5–10 mg once/d, may antagonism for both treatment of bipolar abrupt gain, fever, back  Monitor diabetics for
Zydis, Zyprexa increase by 2.5–5 mg q serotonin disorder, acute discontinuation, and chest pain, loss of glycemic control.
IntraMuscular wk until desired 5HT2A/2C and agitation (IM). coma, severe CNS peripheral and  Withhold drug and
response (usual range dopamine D1– depression, lower extremity immediately report S&S
Classifications: CENT 10–15 mg/d, max: 20 4 receptors. May subcutaneous or edema, joint pain, of neuroleptic malignant
RAL NERVOUS mg/d) inhibit the CNS intramuscular twitching, syndrome (see Appendix
SYSTEM (CNS) presynaptic neuronal injection of premenstrual F); assess for and report
AGENT; PSYCHOTH Geriatric: PO Start reuptake of serotonin olanzapine; syndrome.  S&S of tardive
ERAPEUTIC with 5 mg once/d and dopamine. tardive dyskinesia.
AGENT; ANTIPSYC Antagonism of alfa- dyskinesia; CNS: Somnolence,  Lab tests: Periodically
HOTIC Bipolar Mania adrenergic receptors infants, pregnancy dizziness, monitor ALT, especially
AGENT; ATYPICAL;  Adult: PO Start with results in the adverse (category C), headache, agitation, in those with hepatic
SELECTIVE 10–15 mg once/d, may effect of orthostatic lactation. insomnia, dysfunction or being
SEROTONIN increase by 5 mg q24h hypotension. nervousness, treated with other
REUPTAKE if needed hostility, anxiety, potentially hepatotoxic
INHIBITOR; DOPAM personality drugs. Periodic blood
INE-REUPTAKE disorder, akathisia, glucose monitoring.
INHIBITOR hypertonia, tremor  Monitor BP and HR
amnesia, euphoria, periodically. Monitor
Pregnancy Category: C stuttering, temperature, especially
extrapyramidal under conditions such as
symptoms (dystonic strenuous exercise,
events, parkinsonis extreme heat, or
m, akathisia), treatment with other
tardive dyskinesia.  anticholinergic drugs.
 Monitor for seizures,
CV: Postural especially in older adults
hypotension, and cognitively impaired
hypotension, persons.
tachycardia. 
GI: Abdominal Patient & Family Education
pain, constipation,
dry mouth,  Carefully monitor blood
increased appetite, glucose levels if
increased diabetic.
salivation, nausea,  Do not drive or engage
vomiting, elevated in potentially hazardous
liver function tests.  activities until response
to drug is known; drug
Metabolic: Hyperg increases risk of
lycemia, diabetes orthostatic hypotension
mellitus.  and cognitive
impairment.
Urogenital: Preme  Learn common adverse
nstrual syndrome, effects and possible drug
hematuria, urinary interactions.
incontinence,  Avoid alcohol and do
metrorrhagia.  not take additional
medications without
Respiratory: Rhini informing physician.
tis, cough,  Do not become
pharyngitis, overheated; avoid
dyspnea.  conditions leading to
dehydration.
 Do not breast feed while
taking this drug.
 DRUG STUDY

BRAND NAME Prescribed and Mechanism

GENERIC NAME Recommended Of
CLASSIFICATION dosage, frequency, Action Indication Contraindication Adverse Reaction Nursing Responsibilities
route of
administration

TRIHEXYPHENIDYL Parkinsonism Synthetic tertiary Symptomatic treatment Narrow-angle GI: Dry mouth, Assessment & Drug Effects
HYDROCHLORIDE Adult: PO 1 mg day 1, amine anticholinergic of all forms of glaucoma. Safety nausea, constipatio
(trye-hex-ee-fen'i-dill) 2 mg day 2, then agent similar to parkinsonism during pregnancy n.   Be aware that incidence
Aparkane, Apo-Trihex,  increase by 2 mg q3– atropine. Thought to (arteriosclerotic, (category C), and severity of adverse
Novohexidyl, Trihexy 5d up to 6–10 mg/d in act by blocking excess idiopathic, lactation, or in Special effects are usually dose
3 or more divided of acetylcholine at postencephalitic). Also children is not Senses: Blurred related and may be
Classifications: AUTO doses (max: 15 mg/d) certain cerebral to prevent or control established. vision, mydriasis, minimized by dosage
NOMIC NERVOUS synaptic sites. Relaxes drug-induced photophobia, angle- reduction. Older adults
SYSTEM smooth muscle by extrapyramidal closure glaucoma. appear more sensitive to
AGENT; ANTICHOLI direct effect and by disorders. usual adult doses.
NERGIC atropinelike blocking Urogenital: Urinar  Monitor vital signs.
(PARASYMPATHOL action on the y hesitancy or Pulse is a particularly
YTIC); ANTIPARKIN parasympathetic retention.  sensitive indicator of
SONISM nervous system. response to drug. Report
AGENT; ANTI- CNS: Dizziness, tachycardia, palpitations,
MUSCARINIC; ANTI nervousness, insom paradoxical bradycardia,
SPASMODIC nia, drowsiness, or fall in BP.
confusion,  Assess for and report
Pregnancy Category: C agitation, delirium, severe CNS stimulation
psychotic that occurs with high
manifestations, doses, and in patients
euphoria.  with arteriosclerosis, or
those with history of
CV: Tachycardia, hypersensitivity to other
palpitations, drugs.
hypotension,  In patients with severe
orthostatic rigidity, tremors may
hypotension.  appear to be accentuated
during therapy as
rigidity diminishes.
 Monitor daily I&O if
patient develops urinary
hesitancy or retention.
Voiding before taking
drug may relieve
problem.
 Check for abdominal
distention and bowel
sounds if constipation is
a problem.
 Monitor intraocular
pressure at regular
intervals.
 Provide close follow-up
care. Tolerance may
develop, necessitating
dosage adjustment or
use of combination
therapy. Patients  60 y
frequently develop
sensitivity to drug
action.

Patient & Family Education

 Learn measures to
relieve drug-induced dry
mouth; rinse mouth
frequently with water
and suck ice chips,
sugarless gum, or hard
candy. Maintain
 adequate total daily fluid
intake.
 Avoid excessive heat
because drug suppresses
perspiration and,
therefore, heat loss.
 Do not to engage in
potentially hazardous
activities requiring
alertness and skill. Drug
causes dizziness,
drowsiness, and blurred
vision. Help walking
may be indicated.
 Do not breast feed while
taking this drug without
consulting physician.