drug study

Drug Study

Generic Name: Haloperidol

Brand Name: HaldolClassification: Antipsychotics

Action:• Alters the effects of dopamine in the CNS• Also has anticholinergic and alpha-adrenergic blocking activity.• Diminished signs and symptoms of psychoses

Indication / Uses:

• Organic Psychoses• Acute psychotic symptoms• Relieve hallucinations, delusions, disorganized thinking• Severe anxiety• Seizures

Dosage, Frequency And Route: 5mg/amp BID

Common Adverse Effects:

• CNS: extrapyramidal symptom such as muscle rigidity or spasm, shuffling gait, posture leaning forward, drooling, masklike facial appearance, dysphagia, akathisia, tardive dyskinesia, headache, seizures.

• CV: tachycardia, arrhythmias, hypertension, orthostatic hypertension.

• EENT: blurred vision, glaucoma• GI: dry mouth, anorexia, nausea, vomiting, constipation, diarrhea,

weight gain.• GU: urinary frequency, urine retention, impotence, enuresis,

amenorrhea, gynecomastia• Hematologic: anemia, leukopenia, agranulocytosis• Skin: rash, dermatitis, photosensitivity

Contraindications:• Seizure disorder• Glaucoma• Elderly clients

Pharmacokinetics:

The drug is well and rapidly absorbed and has a high bioavailability. Plasma-levels reach their maximum within 20 minutes after injection. The decanoate injectable formulation is for intramuscular administration only and should never be used intravenously.

Interactions: Increases Drowsiness:• alcohol• barbiturates, eg amobarbital, phenobarbital• benzodiazepines, eg diazepam, temazepam• indometacin• MAOI antidepressants, eg phenelzine

• sedating antihistamines, eg chlorphenamine, hydroxyzine• sleeping tablets, eg zopiclone• strong opioid painkillers, eg morphine, codeine, dihydrocodeine• tricyclic antidepressants, eg amitriptyline.

Abnormal heart rhythm, seen as a 'prolonged QT interval' on an ECG:• antiarrhythmics (medicines to treat abnormal heart beats), eg

amiodarone, procainamide, disopyramide, sotalol• the antihistamines astemizole, mizolastine or terfenadine• atomoxetine• certain antidepressants, eg amitriptyline, imipramine, maprotiline• certain antimalarials, eg halofantrine, chloroquine, quinine,

mefloquine, Riamet• certain other antipsychotics, eg thioridazine, chlorpromazine,

sertindole• cisapride• intravenous erythromycin or pentamidine• moxifloxacin.

Nursing Considerations:

• Assess mental status prior to and periodically during therapy.• Monitor BP and pulse prior to and frequently during the period of

dosage adjustment. May cause QT interval changes on ECG.• Observe patient carefully when administering medication, to

ensure that medication is actually taken and not hoarded.• Monitor I&O ratios and daily eight. Assess patient for signs and

symptoms of dehydration.• Monitor for development of neuroleptic malignant syndrome

(fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control. Report symptoms immediately. May also cause leukocytosis, elevated liver function tests, elevated CPK.

• Advise patient to take medication as directed. Take missed doses as soon as remembered, witih remaining doses evenly spaced through out the day. May require several weeks to obtain desired effects. Do not increase dose or discontinue medication without consulting health care professional. Abrupt withdrawal may cause dizziness, nausea, vomiting, GI upset, trembling, or uncontrolled movements of mouth, tongue or jaw.

Generic Name: Chlorpromazine

Brand Name: ThorazineClassification: Antipsychotics, Antiemetics

Action: Chlorpromazine is a neuroleptic that acts by blocking the postsynaptic dopamine receptor in the mesolimbic dopaminergic system and inhibits

the release of hypothalamic and hypophyseal hormones. It has antiemetic, serotonin-blocking, and weak antihistaminic properties and slight ganglion-blocking activity.

Indication / Uses:

Chlorpromazine is used virtually in all types of psychoses. It can be combined with other anti-psychotics. Chlorpromazine is also used to control anxiety or agitation in certain patients, to relieve a wide range of drug or disease induced vomiting, and in severe hiccups.

Dosage, Frequency And Route: 200 mg/Tab, ½ tab in a.m.; 1 tab HS


Tardive dyskinesia (on long-term therapy). Involuntary movements of extremities may also occur. Dry mouth, constipation, urinary retention, mydriasis, agitation, insomnia, depression and convulsions; postural hypotension, ECG changes. Allergic skin reaction, amenorrhoea, gynaecomastia, weight gain. Hyperglycaemia and raised serum cholesterol.Potentially Fatal: Agranulocytosis. Instantaneous deaths associated with ventricular tachyarrhythmias. Marked elevation of body temperature with heat stroke. Neuroleptic malignant syndrome, extrapyramidal dysfunction

• CNS: neuroleptic malignant syndrome, sedation, extrapyramidal reactions, tardive dyskinesia

• CV: hypotension (increased with IM, IV)• EENT: blurred vision, dry eyes, lens opacities• GI: constipation, dry mouth, anorexia, hepatitis, ileus• GU: urinary retention• Hematologic: agranulocytosis, leukopenia• Skin: photosensitivity, pigment changes, rashes

Contraindications:

• Hypersensitivity. • Cross-sensitivity may exist among phenothiazines. Should not

be used in narrow-angle glaucoma. • Should not be used in patients who have CNS depression. • Coma • Bone-marrow suppression • Phaeochromocytoma • Lactation.

Pharmacokinetics:

Onset: 15 min (IM); 30-60 min (oral). Absorption: Readily but sometimes erratically absorbed from the GI tract (oral); peak plasma concentrations after 2-4 hr. Distribution: Widely distributed; crosses the blood-brain barrier and placenta; enters breast milk. Metabolism: Extensively hepatic by hydroxylation and conjugation with glucuronic acid, N-oxidation, oxidation of a sulfur atom and dealkylation. Excretion: Urine and faeces (as active and inactive metabolites); 30 hr (elimination half- life).

Interactions: None


1. Assess mental status prior to and periodically during therapy.® So that the nurse can determine major or minor changes after

drug has been taken.2. Monitor BP and pulse prior to and frequently during the period of dosage adjustment.May cause QT interval changes on ECG.

® To observe for any changes relevant.3. The drug may be taken with or without food.

® May be taken w/ meals to reduce GI discomfort.4. Observe patient carefully when administering medication.

® To ensure that medication is actually taken and not hoarded.5. Monitor I&O ratios and daily weight.

® Assess patient for signs and symptoms of dehydration.6. Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control. Report symptoms immediately. May also cause leukocytosis, elevated liver function tests, elevated CPK.

® To be able to watch out for any changes, and report to physician these changes

7. Advise patient to take medication as directed. Take missed doses as soon as remembered, with remaining doses evenly spaced through out the day.

® Missed doses may require several weeks to obtain desired effects.

8. Do not increase dose or discontinue medication without consulting health care professional.

® Abrupt withdrawal may cause dizziness, nausea, vomiting, GI upset, trembling, or uncontrolled movements of mouth, tongue or jaw.

9. Instruct patient to report significant changes in neurological status, such as seizures, extreme lethargy, slurred speech, disorientation or ataxia.

® To report to the physician and to be able to do some precautions.

10. Monitor kidney and liver function of the patient.® Observe for signs of hepatic toxicity. Monitor laboratory blood

work such as platelets, PT, PTT, and liver enzymes11. Monitor cardiovascular status of the patient.

• To be able to observe for hypertensive crisis and signs of impending stroke or M.I.: severe headache, dizziness, paresthesias,bradycardia, tachycardia, nausea/vomiting, diaphoresis.

12. Watch out for somnolence, coma, hypotension and extrapyramidal symptoms, agitation and restlessness, convulsions, fever, autonomic reactions such as dry mouth and ileus, EKG changes and cardiac arrhythmias.

Generic Name: Lithium Carbonate

Brand Name: Eskalith CRClassification: Mood Stabilizer

Action:

Preclinical studies have shown that lithium alters sodium transport in nerve and muscle cells and effects a shift toward intraneuronal metabolism of catecholamines, but the specific biochemical mechanism of lithium action in mania is unknown.

Indication / Uses: Used in treating bipolar manic-depressive psychosis, manic episodesDosage, Frequency

And Route: 450 mg/tab, 1 tab BID


Headache, lethargy, drowsiness, dizziness, tremors, slurred speech, dry mouth, anorexia, vomiting, diarrhea, polyuria, hypotension, abdominal pain, muscle weakness, restlessness, urinary incontinence, clonic movements, stupor, azotemia, leukocytosis, nephrotoxicity,

Contraindications: Liver and renal disease, pregnancy, lactation, sever cardiovascular disease, sever dehydration, brain tumor/damage, sodium depletion

Pharmacokinetics:

An ordinary and a sustained-release lithium carbonate preparation were administered acutely at equivalent dosage (1.80 g=24.3 mmol) in a crossover fashion to manic patients. Serum lithium levels were determined by atomic absorption spectroscopy and pharmacokinetic parameters were calculated. Maximum mean serum levels of 1.13 mmol/l and 0.78 mmol/l were achieved at 6 h and 12 h respectively with the ordinary and sustained-release forms. The mean half-lives of absorption, redistribution and elimination were 0.78 h±0.05 (SE), 5.06 h±0.23, 26.8 h±4.5 and 3.73 h±0.37 (SE), 4.42 h±0.28 and 25.6 h±5.5 for the ordinary and sustained-release forms respectively. In healthy volunteers the ordinary preparation was completely absorbed but only 85% of the sustained-release form was absorbed in the manic subjects. Lithium ion distributed into two kinetic compartments and the final compartment appeared to correspond to total body water.

Interactions:

• Indomethacin and piroxicam have been reported to increase significantly, steady state plasma lithium levels

• There is evidence that angiotensin-converting enzyme inhibitors, such as enalapril and captopril, may substantially increase steady-state plasma lithium levels, sometimes resulting in lithium toxicity.


• Observe client for signs and symptoms of depression: mood changes, insomnia, apathy, or lack of interest in activities,

• Record client’s vital signs. Orthostatic hypotension is common• Monitor signs of lithium toxicity.

• Monitor client for suicidal tendencies when marked depression is present.

• Evaluate client’s urine output and body weight. Fluid volume deficit may occur as a result of polyuria

• Observe client for fine and gross motor tremors and presence of slurred speech, which are signs of adverse reaction

• Check client’s cardiac. Loss of fluids and electrolytes may cause cardiac dysrhythmias

• Monitor client’s serum electrolytes. Report abnormal findings• Emphasize the importance of adherence to therapy, laboratory

tests, and follow-up visits with the health care provider• Encourage client to keep medical appointments.

Generic Name: Lamotrigine

Brand Name: LamticalClassification: Anitconvulsants

Action: Stabilizes electrical activity in the brain

Indication / Uses:

• Epilepsy. Lamotrigine is used to treat generalised tonic-clonic seizures (grand mal epilepsy) and partial seizures.

• Type of severe childhood epilepsy (Lennox-Gastaut syndrome).• Mood stabilizer in bipolar affective disorder (unlicensed use).• Trigeminal neuralgia, which is severe pain in the lips, gums,

cheek, chin or eye caused by a disorder of the nerves in the face (unlicensed use).

Dosage, Frequency And Route: 50 mg/tab, 1 tab OD

Common Adverse Effects: Ataxia, dizziness, headache, nausea, vomiting, photosensitivity, rash

Contraindications: Hypersensitivity and impaired cardiac function

Pharmacokinetics:Peak: 1.4-4.8 hrsOnset: unknownDuration: unknown

Interactions: • Valproate (as sodium valproate, valproate semisodium or valproic acid) increases the blood level of lamotrigine.

• Hormonal contraceptives (eg the pill) can reduce the amount of lamotrigine in the blood and make it less effective at controlling seizures.

• The following medicines may also reduce the blood level of lamotrigine:

carbamazepinephenobarbital

phenytoinprimidonerifampicin


• Assess patient for skin rash frequently during therapy. Discontinue lamotrigine at first sign of rash; may be life threatening. Steven-Johnson syndrome or toxic epidermal necrolysis may develop. Rash usually occurs during the initial 2-8 weeks of therapy and is more frequent in patients taking multiply antiepileptic agents, especially valproic acid. Assess location, duration and characteristics of seizure activity. Assess mood, ideation and behaviours frequently. Initiate suicide precautions if indicated

• Do not discontinue abruptly; may cause increase in frequency of seizures

Generic Name: Flupenthixol

Brand Name: Depixol,FluanxolClassification: Antipsychotic

Action:

Its effects resemble those of the phenothiazine, fluphenazine, in that it belongs among the antipsychotic drugs which are less likely to cause sedation and hypotension, but have greater propensity for producing extrapyramidal reactions.

Indication / Uses: The maintenance therapy of chronic schizophrenic patients whose main manifestations do not include excitement, agitation or hyperactivity

Dosage, Frequency And Route: 20mg/amp q monthly give 1 dose prior to discharge


• drowsiness • dizziness • headaches • dry mouth • weight changes • constipation • blurred vision • shakiness • restlessness • irregular periods or breast changes in women • sexual problems • tendency to get sunburn

Contraindications: In patients with known hypersensitivity to the thioxanthenes. The possibility of cross-sensitivity between the thioxanthenes and

phenothiazine derivatives should be considered.Flupenthixol is also contraindicated in the presence of CNS depression due to any cause, comatose states, suspected or established subcortical brain damage, blood dyscrasias, pheochromocytoma, liver damage, cerebrovascular or renal insufficiency, and severe cardiovascular disorders. It is not indicated for the management of severely agitated psychotic patients, psychoneurotic patients or geriatric patients with confusion and/or agitation. As with phenothiazines, flupenthixol should not be used concomitantly with large doses of hypnotics due to the possibility of potentiation.Pregnancy and Lactation: Safety in pregnancy has not been established. Therefore, it should not be administered to women of childbearing potential or during lactation, unless, in the opinion of the physician, the expected benefit to the patient outweighs the potential risk to the fetus or child.Children: Safety and efficacy in children have not been established, and its use is not recommended in the pediatric age group

Pharmacokinetics:

Peak concentrations of the drug were found between days 4 and 7, following i.m. injections of 40 mg of flupenthixol 2% or 10%. It could still be detected in the blood 3 weeks after injection. The metabolites of flupenthixol appear to be inactive. Flupenthixol dihydrochloride is well absorbed from the gastrointestinal tract reaching maximum serum concentrations within 3 to 8 hours. Flupenthixol is excreted mainly in the feces, with some excretion also occurring in the urine

Interactions:

Dopamine (concurrent use may antagonize peripheral vasoconstriction produced by high doses of dopamine, because of the alpha-adrenergic blocking action of thioxanthenes)Ephedrine (alpha-adrenergic blocking action of thioxanthenes may decrease the pressor response to ephedrine when it is used concurrently with thioxanthenesMetaraminol (concurrent use usually decreases, but does not reverse or completely block, the pressor response to metaraminol, because of the alpha-adrenergic blocking action of thioxanthenes)Methoxamine (prior administration of thioxanthenes may decrease the pressor effect and duration of action of methoxamine because of the alpha-adrenergic blocking action of thioxanthenes)Phenylephrine (prior administration of thioxanthenes may decrease the pressor response to phenylephrine because of the alpha-adrenergic blocking action of thioxanthenes)


• Remind patient that before having any surgery, including dental or emergency treatment, tell the surgeon, doctor or dentist that you are taking flupentixol.

• Inform client that Flupentixol can occasionally cause a dry mouth. If patient experiences this, try chewing sugar-free gum, sucking sugar-free sweets or pieces of ice.

• Flupentixol can cause some people's skin to become more

sensitive to sunlight than it usually is. Avoid strong sunlight and sunbeds until you know how your skin reacts and use a suncream higher than factor 15.

• If client experience 'flu like' symptoms such as stiffness, high temperature, abnormal paleness, leaking bladder and a racing heartbeat contact their doctor or go to the accident and emergency department of your local hospital immediately.

• Educate the patient that the symptoms of overdose may include seizers, muscle spasms, weakness, fast heartbeat, fever, difficult breathing, severe dizziness, drowsiness, convulsions, irregular heartbeat, disturbed concentration, constipation and coma.

• Inform patient to take the medicine with a full glass of water.• Remind the patient that the medicine can be taken with or without

food.• Instruct to the patient that he can swallow the medicine as whole.

Don’t cut or chew the medicine.

Generic Name: Biperiden

Brand Name: Akineton, Benzum 2, Berofin, Biperen, Bipiden, DesiperidenClassification: Anticholinergic

Action:

Biperiden is a weak peripheral anticholinergic agent with nicotinolytic activity. The beneficial effects in Parkinson's disease and neuroleptic-induced extrapyramidal symptoms are believed to be due to the inhibition of striatal cholinergic receptors.

Indication / Uses:

• Adjunctive treatment of all forms of Parkinson's disease (postencephalitic, idiopathic, and arteriosclerotic).

• Improve parkinsonian signs and symptoms related to antipsychotic drug therapy.

• Relieves muscle rigidity, reduces abnormal sweating and salivation, improves abnormal gait, and to lesser extent, tremor.

Dosage, Frequency And Route: 2 mg/tab 1 tab BID for EPS


• Cardiovascular: Orthostatic hypotension, bradycardia • Central nervous system: Drowsiness, euphoria, disorientation,

agitation, sleep disorder (decreased REM sleep and increased REM latency) Gastrointestinal: Constipation, xerostomia, dry throat, nasal dryness

• Genitourinary: Urinary retention• Neuromuscular & skeletal: Choreic movements• Ocular: Blurred vision

Contraindications:

• Hypersensitivity to biperiden or any component of the formulation

• Narrow-angle glaucoma• Bowel obstruction, megacolon• Myasthenia gravis• Caution in patients with obstructive diseases of the urogenital

tract, patients with a known history of seizures and those with potentially dangerous tachycardia

Pharmacokinetics:

Peak plasma concentrations following a single oral 4 mg immediate-release dose are reached after 1.5 hours. The elimination half-life has been determined as 18.4 hours, and may be prolonged in geriatric patients. After a 4 mg intravenous dose, the elimination half-life is approximately 24 hours

Interactions:

• Amantadine, rimantadine: Central and/or peripheral anticholinergic syndrome can occur when administered with amantadine or rimantadine.

• Anticholinergic agents: Central and/or peripheral anticholinergic syndrome can occur when administered with opioid analgesics, phenothiazines and other antipsychotics (especially with high anticholinergic activity), tricyclic antidepressants, quinidine and some other antiarrhythmics, and antihistamines.

• Atenolol: Anticholinergics may increase the bioavailability of atenolol (and possibly other beta-blockers); monitor for increased effect.

• Cholinergic agents: Anticholinergics may antagonize the therapeutic effect of cholinergic agents; includes tacrine and donepezil.

• Digoxin: Anticholinergics may decrease gastric degradation and increase the amount of digoxin absorbed by delaying gastric emptying.

• Levodopa: Anticholinergics may increase gastric degradation and decrease the amount of levodopa absorbed by delaying gastric emptying.

• Neuroleptics: Anticholinergics may antagonize the therapeutic effects of neuroleptics.


• Instruct patient to use caution when driving, operating machinery, or performing other hazardous activities. Biperiden may cause dizziness or blurred vision. If patient experience dizziness or blurred vision, avoid these activities.

• Remind patient to use alcohol cautiously. Alcohol may increase drowsiness and dizziness while client is taking biperiden.

• Remind client to avoid becoming overheated. Biperiden may cause decreased sweating. This could lead to heat stroke in hot weather or with vigorous exercise.

• Educate client to take each dose with a full glass of water.• Educate patient to take biperiden after a meal if it upsets his

stomach.• Remind the patient to store biperiden at room temperature away

from moisture and heat.• This medication decreases saliva production, an effect that can

increase gum and tooth problems (e.g., cavities, gum disease). Instruct client to take special care with their dental hygiene (e.g., brushing, flossing) and have regular dental check-ups

• If client experiences signs of hyperthermia such as mental/mood changes, headache, or dizziness, promptly seek cool or air-conditioned shelter and/or stop exercising, and seek immediate medical attention.

• Remind patient to not share the medication to others. • If patient misses a dose, remind them to take it as soon as they

remember. If it is near the time of the next dose, skip the missed dose and resume their usual dosing schedule. Do not double the dose to catch up.

BIBLIOGRAPHY: 26th Edition Nursing 2007 Drug Handbook by Lippincott Williams and Wilkins; Phil. Pharmaceutical Directory Review, 7th edition.

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