DRUG STUDY

CLINICAL MANIFESTATIONS OF PATIENT N.R.M.: HALLUCINATIONS FLIGHT OF IDEAS DELUSIONS NEOLOGISM THOUGHT INSERTION HIGH BLOOD PRESSURE DRUGS ORDERED DRUGS ORDERED DOSAGE FREQUENCY CHLORPROMAZINE 50 mg At hours of sleep FLUPHENAZINE DECANOATE .5 cc AKINETON 2mg Once a Day METROPOLOL 50 mg Twice a Day

ROUTE Per Orem Intramuscular Per Orem Per Orem

BRAND NAME:Akineton GENERIC NAME: Biperiden Hydrochloride CATEGORY:Antidyskinetic DOSAGE: 2 mg (1/2 tablet) FREQUENCY: once a day ROUTE:per orem INDICATIONS AND DOSAGES: As an adjunct to treat all forms of Parkinsons disease MECHANISM OF ACTION: Blocks acetylcholines action at cholinergic receptor sites. This action restores the brains normal dopamine and acetylcholine balance, which relaxes muscle movement and decreases rigidity and tremors. Biperiden also may inhibit dopamine reuptake and storage which prolongs dopamines action. CONTRAINDICATIONS: Angle-closure glaucoma, achalasia, bladder neck obstruction, duodenal or pyloric obstruction, hypersensitivity to biperiden, myasthenia gravis, prostatic hyperplasia, stenosing peptic ulcer, toxic megacolon INTERACTIONS: Drugs Amantadine: Possibly increased adversed anticholinergic effects Digoxin: Possibly increased blood digoxin level Haloperidol: Possibly increased schizophrenic signs and symptoms, decreased serum haloperidol level, development of tardive dyskinesia Levodopa: Possibly decreased effectiveness of Levodopa Phenothiazines: possibly reduced phenothiazine effects, increased psychiatric signs and symptoms ADVERSE REACTIONS: CNS: Agitation, confusion, delirium, delusions, depression, disorientation, dizziness, drowsiness, euphoria, excitement, fever, hallucinations, headache, lightheadedness, listlessness, memory loss, nervousness, paranoia, psychosis, weakness CV: Hypotension, mild bradycardia, orthostathic hypotension, palpitations, tachycardia EENT: Angle-closure glaucoma, blurred vision, diplopia, dry mouth, increased intraocular pressure, mydriasis, suppurative parotitis GI: Constipation, duodenal ulcer, epigastric distress, ileus, nausea, vomiting GU: Dysuria, urinary hesitancy, urine retention MS: Muscle spasms, muscle weakness SKIN: Decreased sweating, dermatosis, flushing,rash, urticaria NURSING CONSIDERATIONS: Expect to administer IV or IM biperiden when patient has needs more rapid response than oral drug can provide. Assess muscle rigidity and tremor as baseline. Caution patient to avoid activities that require alertness until she knows how the drug affects her. Because biperiden decreases sweating, urge patient to avoid extremely hot and humid conditions to reduce risk of heatstroke and severe hyperthermia. Stress need for periodic eye examinations and intraocular pressure measurements.

CLINICAL MANIFESTATIONS:INABILITY TO SLEEP, HALLUCINATIONS, DELUSIONS, FLIGHT OF IDEAS, THOUGHT INSERTION, NEOLOGISMS DRUG ORDERED:Chlorpromazine(Generic) BRAND NAME: Laractyl CLASS AND CATEGORY:Antipsychotic drug, tranquilizer DOSAGE:50 mg FREQUENCY: at hours of sleep ROUTE:per orem INDICATIONS AND DOSAGES: To manage symptoms of psychotic disorders or control manic manifestations of manic-depression in outpatients To control acutely disturbed or manic hospitalized patient To treat severe behavioral problems in children To treat nausea and vomiting To treat intractable hiccups To provide preoperative relaxation To treat tetanus MECHANISM OF ACTION: Depresses areas of the brain that control activity and aggression, including the cerebral cortex, hypothalamus, and limbic system, by an unknown mechanism. It may relieve anxiety by causing indirect reduction in arousal and increased filtering of internal stimuli to the reticular activating system in brain stem. CONTRAINDICATIONS: Comatose states; hypersensitivity to chlorpromazine, phenothiazines, or their components; use large amounts of CNS depressants INTERACTIONS: Drugs CNS depressant: Prolonged and intensified effect of CNS depression ADVERSE REACTIONS: CNS: Drowsiness, extrapyramidal signs and symptoms, neuroleptic malignant syndrome, seizures CV: ECG changes; orthostatic hypotension; tachycardia EENT: Blurred vision, dry mouth, nasal congestion, ocular changes with long term therapy ENDO: Gynecomastia, hyperglycemia, hypoglycemia, lactation, moderate breast engorgement GI: Constipation, ileus, nausea GU: Amenorrhea, ejaculation disorders, impotence, priapism, urine retention HEME: Agranulocytosis, aplastic anemia, eosinophilia,hemolytic anemia, leucopenia, pancytopenia, thromcytopenic purpura SKIN: Exfoliative dermatitis, jaundice, photosensitivity, tissue necrosis, urticaria NURSING CONSIDERATIONS: Assess for mental status. Check for swallowing of oral medication. Check for hoarding or giving of medication to other patients. Monitor input-output ratio; palpate bladder if low urinary output occurs, especially in elderly. Urinalysis recommended before, during, prolonged therapy. Monitor blood pressure with patient sitting, standing, and lying. Take pulse and respirations every 4 hours during initial treatment. Check for dizziness, faintness, palpitations, tachycardia on rising. Identify for neuroleptic malignant syndrome; hyperpyrexia, muscle rigidity; increased CPK, altered mental status: should discontinue drug. Assess for EPS. Assess for constipation, urinary retention daily. Dont open or crush. Use cautiously in patients with acute or chronic respiratory problems.

Instruct the patient to swallow the whole tablet. Allow him to take drug with food or a full glass of milk and water. Tell patient to avoid alcohol. Advise patient, especially if elderly, to rise slowly from a supine or seated position. Explain that drug may reduce body response to heat and cold. Inform patient that drug increases sensitivity to sunlight. If patient reports dry mouth, suggest sugarless chewing gum, hard candy, and fluids. Urge patient to report if suddenly experiences sore throat or other signs and symptoms of infection.

CLINICAL MANIFESTATION:HALLUCINATIONS, DELUSION, FLIGHT OF IDEAS, NEOLOGISMS AND THOUGHT INSERTION DRUG ORDERED: Fluphenazine Decanoate (Generic) CATEGORY:Antipsychotic drug DOSAGE: .5 cc FREQUENCY: Once a month ROUTE: Intramuscular INDICATIONS AND DOSAGES: To control psychotic disorders MECHANISM OF ACTION: May block postsynaptic dopamine2 (D2) receptors in the CNS. This action may depress areas of the brain that control activity and aggression, including the cerebral cortex, hypothalamus and limbic system. CONTRAINDICATIONS: Blood dyscrasias, bone marrow depression, cerebral arteriosclerosis, coma, concomitant use of large amounts of another CNS depressant, coronary artery disease, hepatic dysfunction, hypersensitivity to phenothiazines, myeloproliferative disorders, severe CNS depression, severe hypertension or hypotension, subcortical brain damage INTERACTIONS: Drugs Antihypertensives: Possibly severe hypotension ADVERSE REACTIONS: CNS: Ataxia, cerebral edema, dizziness, drowsiness, headache, insomnia, lightheadedness, nervousness, seizures, slurred speech, syncope, worsening psychotic signs and symptoms CV: AV conduction disorders, bradycardia, cardiac arrest, hypercholesterolemia, hypertension, orthostatic hypotension, prolonged QT interval, shock, ST-segment depression, tachycardia EENT: Blurred vision, dry mouth, glaucoma, increased salivation, laryngeal edema, laryngospasm, miosis, mydriasis, nasal congestion, papillary hypertrophy of the tongue, parotid gland enlargement, photophobia, pigmentary retinopathy, ptosis ENDO: Breast engorgement(females), galactorrhea, hyperglycemia, hypoglycemia, mastalgia,

syndrome of inappropriate ADH secretion

GI: anorexia, constipation, diarrhea, fecal impaction, ileus, increased appetite, nausea, vomiting GU: amenorrhea, bladder paralysis, decreased libido, enuresis, menstrual irregularities, polyuria, urinary frequency, urinary incontinence, urine retention HEME: anemia, aplastic anemia, eosinophilia, leucopenia, thrombocytopenia, thrombocytopenic or nonthrombocytopenic purpura RESP: Bronchospasm, dyspnea, increased respiratory depth SKIN: Contact dermatitis, dry skin, eczema, erythema, jaundice, photosensitivity, pruritus, seborrhea OTHER: Heatstroke, hyponatremia, lupuslike signs and symptoms,weight gain NURSING CONSIDERATIONS: Use fluphenazine cautiously in patients with a history of glaucoma or renal impairment. Monitor temperature. Assess patients for signs of hepatic failure. Notify prescriber about the worsening of psychotic symptoms. Advise patient not to mix oral solution with beverages that contain caffeine, pectins, or tannins. Warn patient that he may become dizzy or lightheaded. Teach how patient to prevent heatstroke, orthostatic hypotension, and photosensitivity reactions. Warn patient not to stop taking fluphenazine abruptly.

CLINICAL MANIFESTATION: INCREASED BLOOD PRESSURE DRUG ORDERED :Metropolol (Generic Name) CATEGORY:Antipsychotic drug DOSAGE:50 mg FREQUENCY:twice a day ROUTE: per orem INDICATIONS AND DOSAGES: Hypertension Early intervention in acute MI MECHANISM OF ACTION: Unknown. A selective beta blocker that selectively blocks beta1 adrenergic receptors; decreases cardiac output, peripheral resistance, and cardiac oxygen consumption; depresses rennin secretions. CONTRAINDICATIONS: Hypersensisitivity to drug or other beta-blocers, sinus bradycardia ADVERSE REACTIONS: CNS: fatigue, dizziness, depression CV: bradycardia, hypotension,heart failure, AV block GI: diarrhea, nausea RESP: dyspnea SKIN: rash NURSING CONSIDERATIONS: Use cautiously in patients with heart failure, diabetes, or respiratory or hepatic disease. Always check patients apical pulse rate before giving the drug. Monitor glucose levels in diabetic patient. Monitor blood pressure regularly. When therapy is discontinued, reduce dose gradually over 1 to 2 weeks. Instruct patient to take drug with meals. Caution patient to avoid driving and other tasks requiring mental alertness until response to therapy is established. Tell patient to alert prescriber if shortness of breath occurs.