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Drug Study

Generic Name Brand Name Action Indication Contraindicatio Adverse and Side Nursing
n Effect Considerations
Divalproex Sodium Depakote Increases level of Treatment of Pregnancy The most frequent - Monitor blood
gamma- primary (Category D). adverse effects are studies: Hct,
aminobutyric generalized Patients with gastro-intestinal Hgh, RBC,
acid(GABA) in seizures, and known disturbances, serum folate,
brain, which notably absence hypersensitivity particularly on platelets, Pro-
decreases seizure and myoclonic to the drug. initiation of time, vit D if
activity. seizures, and also Patients with pre- theraphy. on long term
for partial seizures. existing liver theraphy.
Also used to treat disease or a Less common: - Monitor liver
acute manic phase family history of Increased appetite function
of bipolar disorders severe hepatic and weight gain, studies: AST,
(manic depression) dysfunction. edema, headache, ALT, bilirubin,
and for the Patients with reversible creatinine,
prophylaxis of known urea cycle prolongation of failure
migraine. disorders. bleeding time, and - Monitor blood
thrombocytopenia. levels:
therapeutic
Neurologic: level 50-100
Ataxia, tremor, mcg/mL
sedation, lethargy, - Assess
confusion and mentral
more rarely status: mood,
encephalopathy sensorium,
and coma. affect,
memory
Aggression, (long, short)
hyperactivity, - Assess
behavioural respiratory
disturbances, dysfunction:
transient hair loss, respiratory
sometimes with depression,
regrowth of curly character,
hair, amenorrhea, rate, rhythm;
gynecomastia, hold drug if
hepatic failure and respirations
pancreatitis. are<12/min or
if pupils are
dilated.
- Warn patient
not to stop the
drug abruptly.
- Instruct
patient to
avoid driving
or activities
that require
alertness.
- Advise patient
to report
visual
disturbance,
rash,
diarrhea,
light-colored
stools,
jaundice,
protracted
vomiting to
physician.
Generic Name Brand Name Action Indication Contraindication Adverse and Side Nursing
Effect Considerations
Carbamazepine Tegretol Exact mechanism Epilepsy, acute Pregnancy Mild, mostly -Assess for
unknown; appears mania: (Category D). transient and dose seizures.
to decrease maintenance of Hypersensitivity. dependent. -Monitor liver
polysynaptic bipolar affective Severe hemic Dizziness, ataxia, function tests and
responses and disorders. Alcohol disorders. Severe allergic skin urine function test.
block posttetanic withdrawal bradycardia (less reactions, -Caution patient to
potentiation. disorder. than 50 times/ leukopenia, avoid activities that
min). vomiting, require alertness.
accommodation -Advise patient to
disorders. Diplopia, use sunscreen to
liver enzyme prevent
elevations, SLE- photosensitivity.
like syndromes: -Advise patient not
peripheral neuritis, to discontinue
hallucinations, medication quickly
agitation, after long term use.
depression. -Teach patient to
report immediately
to physician if with
following reactions:
chills, rash, light-
colored stools, drak
urine, yellowing of
skin/eyes,
abdominal pain,
sore throat, mouth
ulcers, bruising,
blurred vision,
dizziness.
Generic Name Brand Action Indication Contraindication Adverse and Nursing
Name Side Effect Considerations
Olanzapine Zyprexia Unknown: may Acute and Known hypersensitivity -Headache -Allergy to olanzapine.
mediate maintenance to the drug. -Dizziness
antipsychotic treatment of -Somnolence -Assess mental status.
activity by both schizophrenia and Pregnancy (Category C). -Agitation
dopamine and other psychoses May induce orthostatic -Postural -Do not withdraw drug
serotonin type 2 where positive hypotension associated Hypotension abruptly.
(5- symptoms and/or with dizziness, -Intramuscular
hydroxytryptamin negative symptoms tachycardia and in some injection site -Advise patient to avoid
e [HT]2) are prominent. patients, syncope. discomfort hot tubs.
antagonism; also, -Postural
may antagonize As monotheraphy or Patients with a history of Hypotension -Advise patient not to do
muscarinic in combination with seizures or with -Hypotension hazardous activities.
receptors, lithium or valproate conditions that lower the -Bradycardia with
histaminic (H1)- for acute manic or seizures or with or without -Give decreased dose in
and alpha- mixed episodes in conditions that hypotension or elderly.
adrenergic. bipolar disorder with potentially lower the syncope Provide supervised
or without psychotic seizure threshold. -Tachycardia ambulation until
features and with or Alzheimer’s dementia. stabilized on
without repid cycling medication.
course. Avoid driving/operating
machineries. -Provide decreased
Rapid control of Hypotension, stimuli by dimming light,
agitation and bradyarrythmia, acute avoiding loud noises.
disturbed MI, unstable angina
behaviours in pectoris, sick sinus -assess for neuroleptic
patients with syndrome, heart malignant syndrome:
schizophrenia or surgery. hyperpyrexia, muscle
manic episodes rigidity etc.
when oral theraphy
is not appropriate.
Generic Brand Name Action Indication Contraindication Adverse and Side NursingConsiderations
Name Effect

Valproic Acid Depacon Anticonvulsant Treatment of Pregnancy - Hemorrhage - Assess mental


activity may be generalized (Category D). status.
by increasing convulsive Hepatic disease or - Bruising
levels of y- seizures, tonic- significant - Assess hepatic and
- Coagulation disorders hematologic status.
aminobutyric clonic(grand dysfunction.
(GABA) in brain, mal), absence - Hyperammonemia - Advise patient to
which decreases (petit mal), report drug induced
- Sedation
seizure activity. partial (focal adverse reactions.
Other and motor). - Transient alopecia
possibilities - Advise patient not to
include acting on - Nausea discontinue quickly
the postsynaptic after long-term use.
- Vomiting
receptor sites to
- Instruct patient to
mimic or - Indigestion
avoid activities that
enhance the
- Increased appetite requires mental
inhibitory effect
alertness.
of GABA. - Thrombocytopenia
- Instruct patient not to
- Anemia chew or crush
extended tablets.
- Bone marrow
suppression - Tell patient that syrup
should not be mixed
with carbonated
drinks.
- Advise patient that
drug may be taken
with food or milk to
reduce GI effects.
Generic Brand Action Indication Contraindication Adverse and Side Effect Nursing
Name Name Considerations

Lithium Eskalith, Alters cation Manic Contraindicated CNS: SEIZURES, fatigue, heada -Assess mental status
Carbonate Lithobid transport in nerve episodes of in: Hypersensitivity che, impaired memory, ataxia, (orientation, mood,
and muscle. manic Severe cardiovascular sedation, confusion, dizziness, behavior) initially and
depressive or renal disease drowsiness, psychomotor
periodically. Assess
May also illness Dehydrated or retardation, restlessness, stupor.
influence (treatment, debilitated patients EENT: aphasia, blurred vision, manic symptoms with
reuptake of maintenance, Should be used only dysarthria, tinnitus. Young Mania Rating
neurotransmitters. prophylaxis). where therapy, CV: ARRHYTHMIAS,ECG Scale (YMRS) at
including blood levels, changes, edema, hypotension. baseline and
Therapeutic may be closely GI: abdominal periodically through
Effects: Prevents/ monitored pain, anorexia, bloating, diarrhea, treatment in patients
decreases Some products contain nausea, dry mouth, metallic
with mania. Initiate
incidence of acute alcohol or tartrazine taste.
manic episodes and should be avoided GU: polyuria, glycosuria, suicide precautions if
in patients with known nephrogenic diabetes insipidus, indicated.
hypersensitivity or renal toxicity.
intolerance Derm: acneiform - Toxicity and
Use Cautiously in: Any eruption, folliculitis,alopecia, Overdose: Monitor
degree of cardiac, diminished sensation, pruritus. serum lithium levels
renal, or thyroid disease Endo: hypothyroidism, goiter, twice weekly during
Diabetes mellitus hyperglycemia, hyperthyroidism. initiation of therapy and
Pregnancy/LactationSaf F and E:hyponatremia. every 2–3 mo during
ety not established Hemat: leukocytosis. chronic therapy. Draw
Geri: Initial dosage Metab: weight gain. blood samples in the
reduction MS: muscle weakness, morning immediately
recommended hyperirritability, rigidity. before next dose.
Neuro:tremors. Therapeutic levels
range from 0.5 to 1.5
mEq/L.

- Assess patient for


signs and symptoms of
lithium toxicity (vomiting,
diarrhea, slurred
speech, decreased
coordination,
drowsiness, muscle
weakness, or twitching).
If these occur, report
before administering
next dose.

-Explain to patients with


cardiovascular disease
or over 40 yr of age the
need for ECG
evaluation before and
periodically during
therapy. Patient should
inform health care
professional if fainting,
irregular pulse, or
difficulty breathing
occurs.

- Advise patient that


weight gain may occur.