DRUG STUDY

Mother Theresa’s Home Care(Mandaluyong City)

SUBMITTED BY:ARANDA, JUREENA T.BSN 211/ Group 41

SUBMITTED TO:Prof. Victoria Privado(Clinical Instructor)

NICANOR REYES STREET, SAMPALOC, MANILA

DRUG STUDYName of the

DrugDrug

InteractionAction Indications

Contraindications

Side EffectsNursing

ResponsibilityDEPAKOTE(divalproex sodium)

500MG/TAB

DOSAGE/FREQUENCY:Dosage: PO (Adults): 250 mg in 2 divided doses.

CLASSIFICATION: Valproates-

anticonvulsants Antiepileptic

Drug: Increased risk in bleeding with platelets agent, thrombolytic agents, or warfarin. Decreased metabolism of barbiturates and primidone, increasing risk of toxicity. Blood levels and toxicity may be increased by erythromycin, felbamate or cimetidine.

Increase levels of gamma-amino butyric acid(GABA), an inhibitory neurotransmitter min the CNS

Simple and complex absence seizures

Partial seizures with complex symptomatology

Manic episodes associated with bipolar disorder(manic-depressive illness)

Prevention of migraine headache

Contraindicated in hypersensitivity, hepatic impairment, some products contain tartrazine: avoid in patients with known hypersensitivity

Precautions in bleeding disorders, history of liver disease, organic brain disease, bone marrow depression, and renal impairment

CNS: confusion, dizziness, headache, sedation

EENT: visual disturbances

GI: hepatotoxicity, indigestion, nausea, vomiting, anorexia, constipation, diarrhea, hyper salivation, increased appetite, pancreatitis

Skin: rashes Hematology:

leucopenia, prolonged bleeding time, thrombocytopenia

Metabolic: hyperammonemia

Neurology: ataxia, paresthesia

Assess mood, ideation, and behavior frequently.

Single daily doses are usually administered at bedtime because of sedation.

Administer with or immediately after meals to minimize GI irritation.

Tell the patient not to break or chew them, as this will cause irritation of the mouth of throat.

Do not administer tablets with milk to prevent premature dissolution.

TRIMETAZIDINE(Vastarel)

35MG BID

DOSAGE/FREQUENCY:Dosage: Duration: 1-12 hours

Drug: Antihypertensives: May increase hypotensive effects. Monitor patient closely during initial therapy.Sildefanil,

It acts by directly counteracting all the major metabolic disorders occurring within the ischemic cell. The actions of trimetazidine

Treatment of ischemic heart disease (angina pectoris).

Treatment of dizziness and tinnitus

Long treatment of coronary

Contraindicated in patients taking MAOI’s (monoamine oxidase inhibitors).

CNS: dizziness, headache, weakness.

CV: ankle edema, fainting, flushing, orthostatic, hypotension, palpitations, tachycardia.

Use cautiously in patients with heart failure or hypertension and in elderly patients.

Assess patient’s condition before and regularly

Tablets : 10 mg, 20mgTablets (extended-release) :30mg, 60mg,120mg

CLASSIFICATION: Anti-ischemic (anti-

anginal) metabolic agent

tadalafil, vardenafil: may increase hypotensive effect. Avoid use together.

include limitation of intracellular acidosis, correction of disturbances of trans membrane ion exchanges, and prevention of excessive production of free radicals. I t decreases myocardial oxygen requirement by decreasing the heart rate, ventricular volume, blood pressure and contractility. In some cases, myocardial oxygen delivery is increased thru reversing coronary arterial spasm.

insufficiency. Diffuse

esophageal spasm with gastro esophageal reflux.

GI: nausea, vomiting

Skin: cutaneous vasodilation

Hematologic: Anemia

Others: hypersensitivity, reactions, sublingual burning.

during therapy.  Monitor blood

pressure, heart rate and rhythm and intensity and duration of drug response.

Promote proper guidance and information.

Advise patient to take drug-regularly, as prescribed and to keep it accessible at all times.

Advise patient that stopping drug abruptly causes coronary vasopasm.

Instruct patient taking p.o form to take tablet on empty stomach either 30 minutes before or 1 to 2 hours after meals and to swallow tablets whole.

Tell patient to minimize orthostatic hypotension by changing upright position slowly.

Instruct patient

to store drug in cool place in tightly closed container, away from light.

Instruct patient to avoid alcohol during therapy

METROPOLOL(Lopressor)

50MG/TAB

DOSAGE/FREQUENCY:Dosage: Tablets (extended-release): 50mg

CLASSIFICATION: Antihypertensive

Drug: May reduce metropolol effect and needs to be increase in dose. It can cause excessive bradycardia and increased depressant effect on myocardium

A selective beta blocker that selectively blocks beta1 receptors; decreases cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses renin secretion.

Hypertension Early

intervention in acute MI

Angina pectoris Stable

symptomatic heart failure

Contraindicated in patients with hypersensitivity to drug or other beta blockers.

Use cautiously in patients with heart failure, diabetes, or respiratory or hepatic disease.

Contraindicated in patients with sinus bradycardia.

CNS: dizziness, fatigue. depression

CV: hypotension, bradycardia, heart failure, AV Block, edema.

GI: nausea, diarrhea

Respiratory: dyspnea

Skin: rash

Always check patient’s apical pulse rate before giving drug. Hold if cardiac rate is <60bpm.

In diabetic patients, monitor glucose level closely because drug masks common signs and symptoms of hypoglycemia.

Monitor BP frequently; drug masks common signs and symptoms of shock.

OLANZAPINE(zyprexa, zyprexa intramuscular, zyprexa zydis)

10 MG/TAB HS

DOSAGE/FREQUENCY:

Drug: increased risk of orthostatic hypotension with antihypertensive, alcohol, benzodiazepines; avoid use of

Mechanisms of action not fully understood; blocks dopamine receptors in the brain, depresses the RA; blocks serotonin receptor sites;

Treatment of schizophrenia

Treatment of acute mixed or manic episodes associated with bipolar 1 disorder and maintenance of

Contraindicated with allergy to olanzapine, myeloproliferative disorders, severe CNS depression, comatose states, and lactation. Use cautiously in

CNS: nervousness, somnolence, anxiety, insomnia, headache, drowsiness, dizziness, personality disorders.

CV: orthostatic

Risk of death is increased when drug is used to treat elderly patients with dementia-related psychosis; drug is not approved

Dosage: 5 to 10 mg orally once a day.Maintenance dose: 10 mg orally once a day.Maximum dose: 20 mg orally once a day.

CLASSIFICATION: Antipsychotic Dopaminergic

blocker

alcohol and use caution with antihypertensive. Increased risk of seizures with anticholinergic. May increase effectiveness of levodopa, dopamine agonists. Increased toxicity with fluoxamine.

anticholinergic, antihistaminic, and alpha adrenergic blocking activity may contribute to some of its therapeutic actions; produces fewer EPS effects than most antipsychotics.

bipolar 1 disorder as monotheraphy, or combine with lithium or valproate

Treatment of agitation associated with schizophrenia and bipolar 1 mania (injection)

elderly or debilitated patients with CV or cerebrovascular disease, dehydration, seizure disorders, Alzheimer’s disease, and etc.

hypotension, peripheral edema, tachycardia.

GI: constipation, abdominal pain.

Respiratory: cough, pharyngitis

Other: fever, weight gain, joint pain, development of DM

for this use. Encourage

patient to void before taking the drug to help decrease anticholinergic effect of urinary retention.

Monitor patient for DM.

Monitor elevations of temperature.

Monitor for orthostatic hypotension and provide appropriate safety measures as needed.

Take this drug exactly as prescribed.

FLUPHENAZINE DECANOATE

1/2ML IM Q 3 WEEKS

DOSAGE/FREQUENCY:Dosage: injection – 25mg/ml, (decanoate); 2.5mg/5ml; solution (concentrate) – 5mg/ml

CLASSIFICATION:

Alcohol and other CNS depressants may potentiate depressive effects; decreases seizure threshold, may need to adjust dosage of anticonvulsants.

Potent phenothiazine, antipsychotic agent. Blocks postsynaptic dopamine receptors in the brain. Similar to other phenothiazine with the following exceptions: more potent per

Management of manifestations of psychotic disorders; the longer acting parenteral dosage forms, fluphenazine ianathate and fluphenazine decanoate, indicated for management of patients (chronic

Known hypersensitivity to phenothiazine; subcortical brain damage, comatose or severely depressed states, blood dyscrasias, renal or hepatic disease. Safety during pregnancy (category C) or lactation is not established.

Whole Body: peripheral edemaCV: Tachycardia, hypertension, hypotension.CNS: Extrapyramidal symptoms (resembling Parkinson's disease), tardive dyskinesia, sedation, drowsiness, dizziness, headache, mental depression, catatonic-like state, impaired

Be alert for red, dry, hot skin; full, bounding pulse, dilated pupils, dyspnea, mental confusion, elevated BP, temperature over 40.6° C (105° F). Inform physician and institute measures to reduce body temperature rapidly. Extended

Antipsychotic Dopaminergic

blocker Phenothiazine

weight, higher incidence of extrapyramidal complications, and lower frequency of sedative, hypotensive, and antiemetic effects.

schizophrenia) who require prolonged parenteral therapy.

Fluphenazine decanoate: management of behavioral complications in patients with mental retardation.

Parenteral form not recommended for children <12 yr.

Special Precautions: Use cautiously With anticholinergic agents, other CNS depressants; older adults, previously diagnosed breast cancer; cardiovascular diseases; pheochromocytoma; history of convulsive disorders; patients exposed to extreme heat or phosphorous insecticides; peptic ulcer; respiratory impairment.

thermoregulation, grand mal seizures.GI: Dry mouth, nausea, epigastric pain, constipation, fecal impaction, cholecystic jaundice Hematologic: Agranulocytosis, transient leukopeniaGU: inhibition of ejaculation, Urinary retention, polyuriaSpecial Senses: Nasal congestion, blurred vision, increased intraocular pressure, photosensitivity.Skin: contact dermatitis,

exposure to high environmental temperature, to sun's rays, or to a high fever places the patient taking this drug at risk for heat stroke.

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.

Report immediately onset of mental depression and extrapyramidal symptoms. Both occur frequently, particularly with long-acting forms (decanoate and enanthate).

LITHIUM CARBONATE (Eskalith CR, Lithobid, Lithonate, Lithotabs)

250 MG/TAB PRN EPS

Drug: increased risk of toxicity with thiazide diuretics due to increase renal clearance

Mechanism for the antimanic effect of lithium is unknown; possibilitiesinclude:

Control of mania in manic-depressive clients;

Investigational: to reverse

Contraindicated if therapy can’t be closely monitor.

Use cautiously in patients

CNS: tremor, drowsiness, headache, confusion, restlessness, dizziness,

Assess patient’s condition before starting therapy and regularly thereafter to monitor the drug

DOSAGE/FREQUENCY:Dosage: Tablets: 300 Mg; Extended Release Tablets: 300 mg, 450 mg, the dosage being adjusted as needed and tolerated.

CLASSIFICATION: Antimanic

lithium – reduced lithium dosage may be needed. Increased plasma lithium levels with indomethacin and some other NSAIDs and fluoxetine, methyldopa, and metronidazole. Increased CNS toxicity with carbamazepine. Encepalophatic syndrome with irreversible brain damage when taken with haloperidol. Greater risk for hypothyroidism with iodide salts.

(a) decrease in catecholamine neurotransmitter levels caused by lithium effect onNa+-K+ ATPase to improve transneuronal membrane transport of sodium ion; (b) decrease in cyclic AMP levels caused by lithium which decreases sensitivity ofhormonal-sensitive adenyl cyclase receptors: Affects the distribution of calcium, Mg, andsodium ions and affects glucose metabolism

neutropenia induced by cancer chemotherapy, in children with chronic neutropenia, and in AIDS clients receiving ziduvudine;

To prevent/control acute manic or mixed episodes in patients with bipolar disorder.

Major depression, schizoaffective disorder, schizophrenic disorder, alcohol dependence.

Apparent mixed bipolar disorder in children.

receiving neuroleptics, neuromuscular blockers, or diuretics, in debilitated patients, and in patients with thyroid disease, seizure disorder, renal or CV disease, severe debilitation or dehydration or sodium depletion.

Cardiovascular or renal disease; brain damage; dehydration, sodium depletion, clients receiving diuretics; lactation

.

psychomotor retardation, stupor, lethargy, coma, syncope, epileptiform seizures, EEG changes, worsened organic mental syndrome, impaired speech, ataxia, weakness, incoordination.

CV: reversible ECG changes, arrhythmias, hypotension, ankle and wrist edema.

EENT: tinnitus ,blurred vision

GI: dry mouth, metallic taste, nausea and vomiting, anorexia, diarrhea, thirst, abdominal pain, flatulence, indigestion.

GU: polyuria, glycosuria, renal toxicity, albuminuria

Hematologic: reversible leukocytosis.

Metabolic: goiter, hypothyroidism, hyponatremia,

effectiveness .Expect delay of 1 to 3 weeks before drugs beneficial effects are noticed.

Give with plenty of waters and after meals to minimize GI reactions.

take withfood or immediately after meals; avoid caffeinated drinks/foods (may aggravate mania)

report persistent diarrhea; the client may need supplemental fluids or salts

transient hyperglycemia.

RISPERIDONE (risperdal)

2 MG/TAB HS

DOSAGE/FREQUENCY:Dosage: Adult: 1mg P.O. B.I.D., increased by 1mg B.I.D. as tolerated on 2nd

and 3rd day, up to a target dosage of 3 mg B.I.D. by day 3. May adjust in increments or decrements of 1mg B.I.D. at weekly intervals; usual dosage range is 4-8mg/day.

CLASSIFICATION: Antipsychotic Benzisoxazole

Drug: increased therapeutic and toxic effects with clozapine. Decreased therapeutic effect with carbamazepine. Decreased effectiveness of levodopa.

Mechanisms of action not fully understood: Blocks dopamine and serotonin receptors in the brain, depresses the RAS; anticholinergic, antihistaminic, and alpha-adrenergic blocking activity may contribute to some of its therapeutic and adverse reactions.

treatment of schizophrenia in adults

treatment of schizophrenia in adolescents aged 13-17 years

acute manic or mixed episodes associated with Bipolar I Disorder in adults, children and adolescents aged 10-17 years

treatment of irritability associated with autistic disorder in children and young adults

It has also been used as a control drug for people with tourette syndrome and other tic disorders.

treatment of major depression with psychotic features

cure persistent

Contraindicated during lactation. Use with caution in individuals with cardiovascular and cerebrovascular disease.

CNS: aggressive behavior, dizziness, drowsiness, extrapyramidal reactions, headache, increased dreams, longer sleep periods, insomnia, sedation, fatigue, nervousness, agitation, anxiety, hyperkinesia

CV: orthostatic hypotension, chest pain, tachycardia, arrhythmias

Musculoskeletal:Joint or back pain

Respiratory: cough, dyspnea, URTI

Skin: pruritus, diaphoresis, rash, dry skin, increased pigmentation, photosensitivity

Obtain baseline blood pressure measurements before starting therapy

Watch for orthostatic hypotension especially during first dosage

Monitor patient for tardive dyskinesia

Monitor patient for weight gain

Potentially severe or fatal hyperglycemia may occur in patients taking atypical antipsychotics

or intractable hiccups

LEVOMEPRAZONE(nozinan)

50MG/TAB HS

DOSAGE/FREQUENCY:Dosage: Administered in the form of an oral tablet. When use in the treatment of the terminally ill, patients using oral versions of the medication usually take 12.5 to 50 mg every four to eight hours.

CLASSIFICATION: Antipsychotic Antiemetic Analgesic Sedative

Drug: Increased risk of extrapyramidal effects with metoclopramide, acetyl cholinesterase inhibitors. Additive hypotensive effects with antihypertensive agents, trazodone. Additive sedative effects with CNS depressants. May alter level/effects of CYP2D6 substrates. Reduced pressor effects of epinephrine. Reduced effects of bromocriptine, guanethidine, and levodopa.

Thought to improve psychotic conditions by blocking postsynaptic  dopamine D 2 receptors in the mesolimbic area of the brain and by producing alpha-adrenergic blockade {68-

Phenothiazine’s act centrally to inhibit or block the dopamine D 2 receptors in the medullary chemoreceptor trigger zone (CTZ) and peripherally by blocking the vagus nerve in the gastrointestinal tract.

Used at lower dosage for the treatment of nausea and vomiting.

Management of manifestations of psychotic conditions.

They are clearly effective in schizophrenia, and produce a quieting effect in hyperactive or excited psychotic patients.

Used in elderly patients for the management of psychosis associated with dementia.

Indicated in the management of manifestations of the manic phase of manic-depressive illness.

Contraindicated in patients hypersensitive to levomepromazine

Cardiovascular disease, severe hypertension or hypotension or CNS depression- 

Comatose states History of

cardiac arrhythmias

Pheochromocytoma, blood dyscrasias

Akathisia  (restlessness or need to keep moving) 

blurred vision associated with anticholinergic effect   

dystonic extrapyramidal effects  (muscle spasms of face, neck, body, arms, or legs, causing unusual postures or expressions on face; sticking out of tongue; tic-like or twitching movements; trouble in breathing, speaking, or swallowing; twisting movements of body; inability to move eyes),

tardive dyskinesia  Hypotension, Orthostatic

hypotension, tachycardia, QT prolongation, weight gain, disorders of

menstruation

For oral dosage forms: Taking with food, milk, or water to reduce stomach irritation

Diluting each dose of medication that comes in dropper bottle with a recommended beverage immediately prior to use

Avoiding use of antacids or antidiarrheal medication within 2 hours of taking phenothiazine

Avoiding use of alcoholic beverages or other CNS depressants during therapy

Avoiding the use of over-the-counter medications for colds or allergies to prevent increased

anticholinergic effects and risk of developing heatstroke

FLUOXETINE HCL(Prozac)

20 MG/TAB BID

DOSAGE/FREQUENCY:Dosage: Tablets – 10, 15, 20 mg; capsules – 10, 20, 40 mg; liquid – 20 mg/ml; DR capsules – 90 mg.

CLASSIFICATION: Antidepressant SSRI

Drug: possible fatal reactions with MAOIs; do not administer together, 2 wks. washout period needed. Increased therapeutic and toxic effects of TCA’s. Do not use with thioridazine. Decreased effectiveness if taken while smoking. Increased toxicity with lithium. Avoid serotonergic drugs.

Acts as an antidepressant by inhibiting CNS neuronal uptake of serotonin; blocks uptake of serotonin with little effect on norepinephrine; little affinity for muscarinic, histaminergic, and alpha1-adrenergic receptors.

Depression, obsessive-compulsive disorder

Depression in elderly patients

Maintenance therapy for depression in stabilized patients (not for newly diagnosed depression)

Short-term and long-term treatment of bulimia nervosa

Short-term treatment of panic disorder with or without agoraphobia

Anorexia nervosa in weight –restored patients

Depression caused by bipolar disorder

Cataplexy Alcohol

dependence Premenstrual

Contraindicated in patients hypersensitive to drug and in those taking MAO inhibitors within 14 days of starting therapy. MAO inhibitors shouldn’t be started within 5 weeks of stopping fluoxetine. Use cautiously in patients at high risk for suicide and in those with history of diabetes mellitus, seizures, mania, or hepatic, renal, or CV disease. Use in third trimester pregnancy may be associated with neonatal complications at birth. Consider the risk versus benefit of treatment during this time.

CNS: nervousness, somnolence, anxiety, insomnia, headache, drowsiness, tremor, dizziness, asthenia, suicidal behavior, fatigue, and fever.

CV: palpitations, hot flashes

EENT: nasal congestion, pharyngitis, sinusitis

GI: Diarrheas, nausea, dry mouth, anorexia, dyspepsia, constipation, abdominal pain, vomiting, flatulence, increased appetite.

GU: sexual dysfunction

Metabolic: weight loss

Musculoskeletal: muscle pain

Respiratory: upper respiratory tract infection,

Use antihistamines or topical corticosteroids to treat rashes or pruritus.

Watch for weight change during therapy, particularly in underweight or bulimic patients.

Record mood changes

Watch for suicidal tendencies

Drug may increase the risk of suicidal thinking and behavior in children and adolescents with major depressive disorder or other psychiatric disorder.

Drug has a long-life; monitor patient for adverse effects for up to 2 weeks after drug is

dysphonic disorder

cough, respiratory distress

Skin: rash, pruritus, diaphoresis Other: flulike syndrome

stopped.

BIPERIDEN HCL(akineton)

2 MG/TAB PRN ẋ EPS

DOSAGE/FREQUENCY:Dosage: Adjust dosage carefully according to individual requirements and response. Oral: Initially, 2 mg 3–4 times daily; if tolerance develops, or dosage is inadequate, titrate dose to maximum of 16 mg daily in 3–4 divided doses.

Drug-Induced Extrapyramidal Reactions

CLASSIFICATION: Anti Parkinsons Synthetic

anticholinergic

Drug: Additive anticholinergic effects with drugs sharing anticholinergic properties such as antihistamines, quinidine, phenothiazines and tricyclic antidepressant. Counteracts the cholinergic effects of bethanechol. Antacids or antidiarrheals may decrease absorption

Blocks cholinergic activity of the CNS, which is responsible for the symptoms of Parkinson’s disease-Restores the natural balance of neurotransmitters in the CNS.-Reduction of rigidity and tremors

Adjunctive treatment of all forms of Parkinson’s disease, including drug-induced extrapyramidal effects and acute dystonic reactions.

Control of extrapyramidal disorders secondary to neuroleptic drug therapy (e.g., phenothiazines).

Contraindicated with hypersensitivity to benztropine; glaucoma, especially angle-closure glaucoma; pyloric or duodenal obstruction, stenosing peptic ulcers, achalasia (mega esophagus); prostatic hypertrophy or bladder neck obstructions; myasthenia gravis.

 Use cautiously with tachycardia, cardiac arrhythmias, hypertension, hypotension, hepatic or renal dysfunction, alcoholism,

CNS: confusion, depression, dizziness, hallucinations, headache, sedation, weakness

EENT: blurred vision, dry eyes, mydriasis

CV: arrhythmias, hypotension, palpitations, tachycardia

GI: constipation, dry mouth, ileus, nausea

GU: hesitancy, urinary retentionMisc: decreased sweating

Note indications for therapy, characteristics of symptoms, other agents trailed and outcome.

List age; older clients should receive lower doses of biperiden.

Take after meals to avoid gastric irritation. Do not stop abruptly.

Record stools; increase intake of fluids, fruit juices, and fiber to avoid constipation.

Avoid overheating, drug reduces perspiration.

Ensure that patient voids just before receiving each dose of drug if urinary retention is a

chronic illness, people who work in hot environment; hot weather; lactation.

Hypersensitivity to biperiden,

Narrow angle glaucoma,

Bowel obstruction,

Mega colon

problem.