Our Lady of the Pillar College-Cauayan
COLLEGE OF NURSING AND MIDWIFERY
DRUG STUDY
Submitted by: Regine L. Mey-ang
NAME OF DRUGS
Generic Name: Clozapine
Brand Name: Clozaril
Classifications:
CNS agent,
Psychotherapeutic,
neuroleptic agent,
dopamine reuptake
inhibitor
FREQUENCY,
ROUTE, DOSE
50-100 mg BID
MODE OF ACTION
Mechanism is not
defined.
Interferences with
binding of
dopamine to D1
and D2 receptors
in the limbic
region of brain. It
binds primarily to
nondopaminergic
sites
INDICATION&
NURSING RESPONSIBILITIES
CONTRAINDICATION
Indication: indicated only in
the management of severely
ill schizophrenic patients who
have failed to respond to other
neuroleptic agents.
Contraindicated in: severe
CNS depression, blood
dyscrasia, history of bone
marrow depression; patients
with myeloproliferative
disorders, uncontrolled
epilepsy, clozapine induced
agranulocytosis, severe
granulocytosis, concurrent
administration of
benzodiazepines or other
psychotropic drugs;
pregnancy lactation
1. Check the doctors order.
2. Because of risk of agranulocytosis a
baseline white blood count and
differential count must be made before
initial treatment, every week for 6
months, then every 2 weeks for next 6
months and 4 weeks after the drug is
discontinued.
3. Monitor for seizure activity
4. If the drug is being discontinued,
closely monitor for recurrent psychotic
symptoms.
5. Monitor for development of
tachycardia or hypotension, which may
pose a serious risk for patients with
compromised cardiovascular function.
6. Monitor daily temperature and report
fever. Transient elevation above 38C,
with peak incidence during first 3 weeks
of drug therapy, may occur.
7. Advise patient not to engage in any
hazardous activity until response to the
drug is known. Drowsiness and sedation
are common side effects.
8. Instruct patient to rise slowly to avoid
orthostatic hypotension.
9. Instruct patient that drug should be
taken exactly as ordered.
NAME OF DRUGS
FREQUENCY,
ROUTE, DOSE
Generic Name: Quetiapine 100 mg tab OD
Fumarate
Brand Name: Seroquel
Classifications:
CNS agent,
Psychotherapeutic,
serotonin and dopamine
reuptake inhibitor
MODE OF ACTION
Quetiapine
fumarate
antagonizes
multiple
neurotransmitter
receptors in the
brain including
serotonin as well
as dopamine D1
and D2 reeptors.
Its mechanism of
action is unknown.
However, it is
thought that
quetiapine
fumarates
antagonism of
dopamine and
serotonin
receptors is
responsible for
itsantipsychotic
properties
INDICATION&
NURSING RESPONSIBILITIES
CONTRAINDICATION
Indication: management of
psychotic disorder
Contraindicated in:
hypersensitivity to quetiapine;
lactation; alcohol use.
1. Check the doctors order.
2. Therapeutic effectiveness is indicated
by a reduction in psychotic behavior.
Periodically reassess need for continued
treatment.
3. Withhold the drug and immediately
report S&S of tardive dyskinesia or
neuroleptic malignant syndrome.
4. Lab tests: periodically monitor liver
functions, lipid profile, thyroid function,
blood glucose, CBC with differential.
5. Exercise caution with potentially
dangerous activities requiring alertness,
especially during the first week of drug
therapy or during dose increments.
6. Make position changes slowly,
especially when changing from lying or
sitting to standing to avoid dizziness,
palpitations, and fainting.
7. Avoid alcohol consumption and
activities that may cause overheating and
dehydration.
NAME OF DRUGS
Generic Name: Biperiden
hydrochloride
Brand Name: Akineton
Classifications:
Autonomic nervous system
agent, anticholinergic
(parasympatholytic),
antiparkinsonism agent
FREQUENCY,
ROUTE, DOSE
2 mg tab OD
MODE OF ACTION
Synthetic tertiary
amine,
antimuscarinic. In
common with
other
Parkinsonism
drugs has
atropinelike
(anticholinergic)
actions.
Antiparkinsonism
activity is thought
to be by reducing
central excitatory
action of
acetylcholine on
cholinergic
receptors in the
extrapyramidal
system. This
action helps to
establish some
balance between
INDICATION&
NURSING RESPONSIBILITIES
CONTRAINDICATION
Indication: adjunct in all
forms of parkinsonism,
particularly postencephalitic
and idiopathic parkinsonism
(appears to be less effective in
arteriosclerotic type). Also
used to control drug-induced
parkinsonism (extrapyramidal
symptoms) associated with
reserpine and phenothiazine
therapy.
Contraindicated in: narrow
angle glaucoma; GI or GU
obstruction, megacolon;
tardive dyskinesia. Safe use
during pregnancy in nursing
women, and in children
established.
1. Check the doctors order.
2. Advise patient to make position
changes slowly and in stages, particularly
from recumbent to upright position.
3. It is reported that certain susceptible
patients may manifest mental confusion,
drowsiness, dizziness, agitation,
hematuria, and decrease in urinary flow.
Report these symptoms immediately.
4. Slight dryness of mouth and blurred
vision are common dose-related side
effects and may relieve or eliminated by
dosage reduction.
5. Monitor I & O ratio and pattern. If
constipation is a problem, increase in
dietary fiber and fluid intake may help.
6. Biperiden usually reduces sweating,
drooling, excessive oiliness of skin, and
muscle rigidity. In patients with severe
parkinsonism, tremors may increase as
spasticity is relieved.
cholinergic and
dopaminergic
activity in the
basal ganglia.
NAME OF DRUGS
Generic Name:
Fluphenazine Decanoate
Brand Name: Prolixin
decanoate, Modecate
decanoate
Classifications:
CNS agent,
psychotherapeutic,
antipsychotic,
phenothiazine
FREQUENCY,
ROUTE, DOSE
0.5 mg IM
MODE OF ACTION
Potent
phenothiazine.
Blocks post
synaptic dopamine
receptors in the
brain. Similar to
other
phenothiazines
with the following
expectations: more
potent per weight,
higher incidence
of extrapyramidal
complications, and
lower frequency
of sedative and
hypotensive
effects.
INDICATION&
NURSING RESPONSIBILITIES
CONTRAINDICATION
Indication: Management of
manifestations of psychotic
disorders
Contraindicated in: known
hypersensitivity to
phenothiazines; subcortical
brain damage, comatose or
severly depressed stats, blood
dyscrasias, renal or hepatic
disease. Safe use during
pregnancy (category c) or in
nursing women not
established. Parenteral form
not recommended for children
< 12y.
1. Check the doctors order.
2. Report immediately the onset of metal
depression and extrapyramidal symptoms.
They occur frequently, particularly with
long acting forms. Be alert for appearance
of acute dystonia. Symptoms can be
controlled by reducing fluphenazine
dosage or by adding an anti-parkinsonism
drug such as benztropine.
3. Extended exposure to high
environmental temperature, to suns rays,
or to a high fever associated with serious
illness places this patient at risk for heat
stroke. Be alert to red, dry, hot sin; full,
bounding pulse, dilated pupils, dyspnea,
mental confusion, elevated BP,
temperature over 40.6C.
4. Renal function should be monitored in
patients on long term treatment. The drug
should be discontinue if BUN is elevated.
5. Monitor BP during early therapy, if
systolic drop is more than 20 mmHg
inform physician.
6. Monitor I & O ratio and bowel
elimination pattern. Check for abdominal
distention and pain.
7. Encourage adequate food and fluid
intake as prophylaxis for constipation and
for xerostomia.
8. Warn patient to avoid exposure to sun,
to wear protective clothing and cover
exposed skin surfaces with sun screen
lotion.
9. Alcohol should be avoided while
patient is on fluphenazine therapy.
10. Inform patient that fluphenazine may
discolor urine pink to red or reddish
brown.
