MECHANISM OF INDICATION /

DRUG NAME ADVERSE EFFECT NURSING RESPONSIBILITIES

ACTION CONTRAINDICATION

GENERIC NAME: Antagonizes alpha1- INDICATIONS: CNS: dizziness, headache, Dx:

OLANZAPINE adrenergic, dopamine,  Schizophrenia weakness, fatigue,  Obtain baseline LFT, serum
histamine, muscarinic,  Bipolar I disorder (manic or restlessness, sedation, glucose, weight, lipid profile
BRAND NAME: serotonin mixed episodes) insomnia, mood changes, before initiating treatment.
ZYPREXA receptors. Produces  Agitation associated with agitation, personality  Assess behavior, appearance,
anticholinergic, histaminic, schizophrenia and bipolar I disorder, impaired speech, emotional status, response to
CLASSIFICATION: CNS depressant effects. mania tardive dyskinesia, environment, speech pattern,
 Pharmacologic  Depressive episodes dystonia, tremor, thought content.
Thienobenzodiazepin  THERAPEUTIC associated with bipolar I extrapyramidal effects,
e EFFECT: disorder neuroleptic malignant Tx:
- Diminishes  Treatment-resistant syndrome, coma,  Monitor B/P, serum glucose,
 Therapeutic psychotic depression postinjection delirium- lipids, LFT.
Antipsychotic symptoms. sedation syndrome  Assess for tremors, changes in
CONTRAINDICATIONS: gait, abnormal muscular
DOSAGE:  None CV: orthostatic movements, behavior.
 Injection powder for hypotension, chest pain,  Supervise suicidal-risk pt
suspension (extended- DRUG INTERACTIONS: tachycardia closely during early therapy (as
release): 210 mg/vial,  Drug-to-Drug: depression lessens, energy level
 300 mg/vial, 405  Alcohol, CNS depressants EENT: amblyopia, improves, increasing suicide
mg/vial may increase CNS rhinitis, pharyngitis potential).
 Solution for injection: depressant effects.  Assess for therapeutic response
10-mg vials  Anticholinergics may GI: nausea, constipation, (interest in surroundings,
 Tablets: 2.5 mg, 5 mg, increase anticholinergic abdominal pain, increased improvement in self-care,
7.5 mg, 10 mg, 15 mg, effects. salivation, dry mouth increased ability to concentrate,
20 mg  Hepatotoxic medications relaxed facial expression).
 Tablets (orally may increase risk of GU: urinary incontinence,  Assist with ambulation if
disintegrating): 5 mg, 10 hepatotoxicity. urinary tract infection dizziness occurs. Assess sleep
mg, 15 mg, 20 mg pattern.
 Drug-to-Food: Hematologic:  Notify physician if
ROUTE:  None known leukopenia, neutropenia, extrapyramidal symptoms
P.O. agranulocytosis (EPS) occur.
IM
Metabolic: goiter, EDx:
increased thirst,  Avoid dehydration, particularly
hyperprolactinemia, during exercise, exposure to
hyperlipidemia, severe extreme heat, concurrent use of
hyperglycemia medication causing dry mouth,
other drying effects. 
Musculoskeletal:  Sugarless gum, sips of water
hypertonia, joint pain may relieve dry mouth. 
 Respiratory: cough,  Report suspected pregnancy. 
dyspnea  Take medication as prescribed;
Skin: ecchymosis, do not stop taking or increase
photosensitivity dosage. 
Other: increased appetite,  Slowly go from lying to
weight gain or loss, fever, standing. 
flulike symptoms,  Avoid alcohol. 
impaired body  Avoid tasks that require
temperature regulation, alertness, motor skills until
death response to drug is
established. 
 Monitor diet, exercise program
to prevent weight gain.

INDICATION / NURSING
DRUG NAME MECHANISM OF ACTION ADVERSE EFFECT
CONTRAINDICATION RESPONSIBILITIES

GENERIC NAME: Directly increases concentration INDICATIONS: CNS: confusion, dizziness, Dx:
VALPROIC ACID of inhibitory neurotransmitter  Complex partial seizures headache, sedation, ataxia,  Review history of
gamma-aminobutyric acid  Simple or complex absence paresthesia, asthenia, tremor, seizure disorder
BRAND NAME: (GABA). seizures drowsiness, emotional lability, (intensity, frequency,
DEPAKOTE  Mania associated with abnormal thinking, amnesia, duration, level of
 THERAPEUTIC bipolar disorder hyperammonemic consciousness).
CLASSIFICATION: EFFECT:  To prevent migraine encephalopathy, suicidal  Initiate safety
 Pharmacologic - Produces behavior or ideation measures, quiet dark
Carboxylic acid anticonvulsant effect, CONTRAINDICATIONS: environment. CBC
derivative stabilizes mood,  Hypersensitivity to drug or EENT: amblyopia, blurred should be performed
prevents migraine head tartrazine (some products) vision, nystagmus, tinnitus, before and 2 wks after
 Therapeutic ache.  Hepatic impairment pharyngitis therapy begins, then 2
Anticonvulsant, mood  Urea cycle disorders wks following
stabilizer, antimigraine GI: nausea, vomiting, maintenance dose.
agent DRUG INTERACTIONS: diarrhea, abdominal pain,  Obtain baseline hepatic
 Drug-to-Drug: dyspepsia, anorexia, function tests.
DOSAGE:  Carbapenems (e.g., pancreatitis
 Tablets, Delayed-Release meropenem), CYP3A4 Tx:
(Depakote): 125 mg, 250 inducers (e.g., Hematologic: leukopenia,  Monitor serum LFT,
mg, 500 mg. carbamazepine, thrombocytopenia ammonia, CBC.
 Tablets, ExtendedRelease phenytoin) may decrease  Observe frequently for
(Depakote ER): 250 mg, concentration/effects. Hepatic: hepatotoxicity recurrence of seizure
500 mg  May alter effect of activity.
warfarin. Metabolic:  Monitor serum hepatic
ROUTE:  May increase concentration hyperammonemia function tests, CBC.
P.O. of lamotrigine.  Assess skin for
 Topiramate may increase Musculoskeletal: back pain ecchymoses, petechiae.
risk of elevated serum  Monitor for clinical
ammonia levels. Respiratory: dyspnea improvement (decrease
in intensity/frequency of
 Drug-to-Food: Skin: rash, alopecia, bruising seizures).
 None known
Other: abnormal taste, EDx:
increased appetite, weight  Do not abruptly
gain, flulike symptoms, discontinue medication
infection, infusion site pain after long-term use (may
and precipitate seizures).
reaction, multiorgan  Strict maintenance of
hypersensitivity reaction drug therapy is essential
for seizure control. 
 Avoid tasks that require
alertness, motor skills
until response to drug is
established.
 Drowsiness usually
disappears during
continued therapy.
 Avoid alcohol.
 Carry identification card,
bracelet that notes
anticonvulsant therapy.
 Report nausea, vomiting,
lethargy, altered mental
status, weakness, loss of
appetite, abdominal pain,
yellowing of skin,
unusual
bruising/bleeding.
 Report if seizure control
worsens, suicidal
ideation (depression,
unusual changes in
behavior, suicidal
thoughts) occurs.