Drug Study

Generic Name: Haloperidol

Brand Name: Haldol

Classification: Antipsychotics
• Alters the effects of dopamine in the CNS
Action: • Also has anticholinergic and alpha-adrenergic blocking activity.
• Diminished signs and symptoms of psychoses
• Organic Psychoses
• Acute psychotic symptoms
Indication / Uses: • Relieve hallucinations, delusions, disorganized thinking
• Severe anxiety
• Seizures
Dosage, Frequency
5mg/amp BID
And Route:
• CNS: extrapyramidal symptom such as muscle rigidity or spasm,
shuffling gait, posture leaning forward, drooling, masklike facial
appearance, dysphagia, akathisia, tardive dyskinesia, headache,
seizures.
• CV: tachycardia, arrhythmias, hypertension, orthostatic
hypertension.
Common Adverse
• EENT: blurred vision, glaucoma
Effects:
• GI: dry mouth, anorexia, nausea, vomiting, constipation, diarrhea,
weight gain.
• GU: urinary frequency, urine retention, impotence, enuresis,
amenorrhea, gynecomastia
• Hematologic: anemia, leukopenia, agranulocytosis
• Skin: rash, dermatitis, photosensitivity
• Seizure disorder
Contraindications: • Glaucoma
• Elderly clients
The drug is well and rapidly absorbed and has a high
bioavailability. Plasma-levels reach their maximum within 20 minutes
Pharmacokinetics:
after injection. The decanoate injectable formulation is for intramuscular
administration only and should never be used intravenously.
Interactions: Increases Drowsiness:
• alcohol
• barbiturates, eg amobarbital, phenobarbital
• benzodiazepines, eg diazepam, temazepam
• indometacin
• MAOI antidepressants, eg phenelzine
 • sedating antihistamines, eg chlorphenamine, hydroxyzine
• sleeping tablets, eg zopiclone
• strong opioid painkillers, eg morphine, codeine, dihydrocodeine
• tricyclic antidepressants, eg amitriptyline.
Abnormal heart rhythm, seen as a 'prolonged QT interval' on an ECG:
• antiarrhythmics (medicines to treat abnormal heart beats), eg
amiodarone, procainamide, disopyramide, sotalol
• the antihistamines astemizole, mizolastine or terfenadine
• atomoxetine
• certain antidepressants, eg amitriptyline, imipramine, maprotiline
• certain antimalarials, eg halofantrine, chloroquine, quinine,
mefloquine, Riamet
• certain other antipsychotics, eg thioridazine, chlorpromazine,
sertindole
• cisapride
• intravenous erythromycin or pentamidine
• moxifloxacin.
• Assess mental status prior to and periodically during therapy.
• Monitor BP and pulse prior to and frequently during the period of
dosage adjustment. May cause QT interval changes on ECG.
• Observe patient carefully when administering medication, to
ensure that medication is actually taken and not hoarded.
• Monitor I&O ratios and daily eight. Assess patient for signs and
symptoms of dehydration.
• Monitor for development of neuroleptic malignant syndrome
(fever, respiratory distress, tachycardia, seizures, diaphoresis,
Nursing hypertension or hypotension, pallor, tiredness, severe muscle
Considerations: stiffness, loss of bladder control. Report symptoms immediately.
May also cause leukocytosis, elevated liver function tests,
elevated CPK.
• Advise patient to take medication as directed. Take missed doses
as soon as remembered, witih remaining doses evenly spaced
through out the day. May require several weeks to obtain desired
effects. Do not increase dose or discontinue medication without
consulting health care professional. Abrupt withdrawal may cause
dizziness, nausea, vomiting, GI upset, trembling, or uncontrolled
movements of mouth, tongue or jaw.

Generic Name: Chlorpromazine

Brand Name: Thorazine

Classification: Antipsychotics, Antiemetics
Action: Chlorpromazine is a neuroleptic that acts by blocking the postsynaptic
dopamine receptor in the mesolimbic dopaminergic system and inhibits
 the release of hypothalamic and hypophyseal hormones. It has
antiemetic, serotonin-blocking, and weak antihistaminic properties and
slight ganglion-blocking activity.
Chlorpromazine is used virtually in all types of psychoses. It can be
combined with other anti-psychotics. Chlorpromazine is also used to
Indication / Uses:
control anxiety or agitation in certain patients, to relieve a wide range
of drug or disease induced vomiting, and in severe hiccups.
Dosage, Frequency
200 mg/Tab, ½ tab in a.m.; 1 tab HS
And Route:
Tardive dyskinesia (on long-term therapy). Involuntary movements of
extremities may also occur. Dry mouth, constipation, urinary retention,
mydriasis, agitation, insomnia, depression and convulsions; postural
hypotension, ECG changes. Allergic skin reaction, amenorrhoea,
gynaecomastia, weight gain. Hyperglycaemia and raised serum
cholesterol.
Potentially Fatal: Agranulocytosis. Instantaneous deaths associated
with ventricular tachyarrhythmias. Marked elevation of body
Common Adverse temperature with heat stroke. Neuroleptic malignant syndrome,
Effects: extrapyramidal dysfunction
• CNS: neuroleptic malignant syndrome, sedation,
extrapyramidal reactions, tardive dyskinesia
• CV: hypotension (increased with IM, IV)
• EENT: blurred vision, dry eyes, lens opacities
• GI: constipation, dry mouth, anorexia, hepatitis, ileus
• GU: urinary retention
• Hematologic: agranulocytosis, leukopenia
• Skin: photosensitivity, pigment changes, rashes
• Hypersensitivity.
• Cross-sensitivity may exist among phenothiazines. Should not
be used in narrow-angle glaucoma.
• Should not be used in patients who have CNS depression.
Contraindications:
• Coma
• Bone-marrow suppression
• Phaeochromocytoma
• Lactation.
Onset: 15 min (IM); 30-60 min (oral).
Absorption: Readily but sometimes erratically absorbed from the GI
tract (oral); peak plasma concentrations after 2-4 hr.
Distribution: Widely distributed; crosses the blood-brain barrier and
placenta; enters breast milk.
Pharmacokinetics:
Metabolism: Extensively hepatic by hydroxylation and conjugation
with glucuronic acid, N-oxidation, oxidation of a sulfur atom and
dealkylation.
Excretion: Urine and faeces (as active and inactive metabolites); 30 hr
(elimination half- life).
Interactions: None
 1. Assess mental status prior to and periodically during therapy.
® So that the nurse can determine major or minor changes after
drug has been taken.
2. Monitor BP and pulse prior to and frequently during the period of
dosage adjustment.May cause QT interval changes on ECG.
® To observe for any changes relevant.
3. The drug may be taken with or without food.
® May be taken w/ meals to reduce GI discomfort.
4. Observe patient carefully when administering medication.
® To ensure that medication is actually taken and not hoarded.
5. Monitor I&O ratios and daily weight.
® Assess patient for signs and symptoms of dehydration.
6. Monitor for development of neuroleptic malignant syndrome (fever,
respiratory distress, tachycardia, seizures, diaphoresis, hypertension or
hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder
control. Report symptoms immediately. May also cause leukocytosis,
elevated liver function tests, elevated CPK.
® To be able to watch out for any changes, and report to physician
these changes
7. Advise patient to take medication as directed. Take missed doses as
soon as remembered, with remaining doses evenly spaced through out
the day.
Nursing ® Missed doses may require several weeks to obtain desired
Considerations: effects.
8. Do not increase dose or discontinue medication without consulting
health care professional.
® Abrupt withdrawal may cause dizziness, nausea, vomiting, GI
upset, trembling, or uncontrolled movements of mouth, tongue
or jaw.
9. Instruct patient to report significant changes in neurological status,
such as seizures, extreme lethargy, slurred speech, disorientation or
ataxia.
® To report to the physician and to be able to do some
precautions.
10. Monitor kidney and liver function of the patient.
® Observe for signs of hepatic toxicity. Monitor laboratory blood
work such as platelets, PT, PTT, and liver enzymes
11. Monitor cardiovascular status of the patient.
• To be able to observe for hypertensive crisis and signs of
impending stroke or M.I.: severe headache, dizziness,
paresthesias,bradycardia, tachycardia, nausea/vomiting,
diaphoresis.
12. Watch out for somnolence, coma, hypotension and extrapyramidal
symptoms, agitation and restlessness, convulsions, fever, autonomic
reactions such as dry mouth and ileus, EKG changes and cardiac
arrhythmias.
 Generic Name: Lithium Carbonate

Brand Name: Eskalith CR

Classification: Mood Stabilizer
Preclinical studies have shown that lithium alters sodium transport in
nerve and muscle cells and effects a shift toward intraneuronal
Action:
metabolism of catecholamines, but the specific biochemical mechanism
of lithium action in mania is unknown.
Indication / Uses: Used in treating bipolar manic-depressive psychosis, manic episodes
Dosage, Frequency
450 mg/tab, 1 tab BID
And Route:
Headache, lethargy, drowsiness, dizziness, tremors, slurred speech, dry
Common Adverse mouth, anorexia, vomiting, diarrhea, polyuria, hypotension, abdominal
Effects: pain, muscle weakness, restlessness, urinary incontinence, clonic
movements, stupor, azotemia, leukocytosis, nephrotoxicity,
Liver and renal disease, pregnancy, lactation, sever cardiovascular
Contraindications:
disease, sever dehydration, brain tumor/damage, sodium depletion
An ordinary and a sustained-release lithium carbonate preparation
were administered acutely at equivalent dosage (1.80 g=24.3 mmol) in a
crossover fashion to manic patients. Serum lithium levels were
determined by atomic absorption spectroscopy and pharmacokinetic
parameters were calculated. Maximum mean serum levels of 1.13 mmol/l
and 0.78 mmol/l were achieved at 6 h and 12 h respectively with the
ordinary and sustained-release forms. The mean half-lives of absorption,
Pharmacokinetics:
redistribution and elimination were 0.78 h±0.05 (SE), 5.06 h±0.23, 26.8
h±4.5 and 3.73 h±0.37 (SE), 4.42 h±0.28 and 25.6 h±5.5 for the ordinary
and sustained-release forms respectively. In healthy volunteers the
ordinary preparation was completely absorbed but only 85% of the
sustained-release form was absorbed in the manic subjects. Lithium ion
distributed into two kinetic compartments and the final compartment
appeared to correspond to total body water.
• Indomethacin and piroxicam have been reported to increase
significantly, steady state plasma lithium levels
• There is evidence that angiotensin-converting enzyme inhibitors,
Interactions:
such as enalapril and captopril, may substantially increase steady-
state plasma lithium levels, sometimes resulting in lithium
toxicity.
Nursing • Observe client for signs and symptoms of depression: mood
Considerations: changes, insomnia, apathy, or lack of interest in activities,
• Record client’s vital signs. Orthostatic hypotension is common
• Monitor signs of lithium toxicity.
 • Monitor client for suicidal tendencies when marked depression is
present.
• Evaluate client’s urine output and body weight. Fluid volume
deficit may occur as a result of polyuria
• Observe client for fine and gross motor tremors and presence of
slurred speech, which are signs of adverse reaction
• Check client’s cardiac. Loss of fluids and electrolytes may cause
cardiac dysrhythmias
• Monitor client’s serum electrolytes. Report abnormal findings
• Emphasize the importance of adherence to therapy, laboratory
tests, and follow-up visits with the health care provider
• Encourage client to keep medical appointments.

Generic Name: Lamotrigine

Brand Name: Lamtical

Classification: Anitconvulsants
Action: Stabilizes electrical activity in the brain
• Epilepsy. Lamotrigine is used to treat generalised tonic-clonic
seizures (grand mal epilepsy) and partial seizures.
• Type of severe childhood epilepsy (Lennox-Gastaut syndrome).
Indication / Uses: • Mood stabilizer in bipolar affective disorder (unlicensed use).
• Trigeminal neuralgia, which is severe pain in the lips, gums,
cheek, chin or eye caused by a disorder of the nerves in the face
(unlicensed use).
Dosage, Frequency
50 mg/tab, 1 tab OD
And Route:
Common Adverse
Ataxia, dizziness, headache, nausea, vomiting, photosensitivity, rash
Effects:
Contraindications: Hypersensitivity and impaired cardiac function
Peak: 1.4-4.8 hrs
Pharmacokinetics: Onset: unknown
Duration: unknown
Interactions: • Valproate (as sodium valproate, valproate semisodium or valproic
acid) increases the blood level of lamotrigine.
• Hormonal contraceptives (eg the pill) can reduce the amount of
lamotrigine in the blood and make it less effective at controlling
seizures.
• The following medicines may also reduce the blood level of
lamotrigine:

carbamazepine
phenobarbital
 phenytoin
primidone
rifampicin
• Assess patient for skin rash frequently during therapy.
Discontinue lamotrigine at first sign of rash; may be life
threatening. Steven-Johnson syndrome or toxic epidermal
necrolysis may develop. Rash usually occurs during the initial 2-8
weeks of therapy and is more frequent in patients taking multiply
Nursing
antiepileptic agents, especially valproic acid. Assess location,
Considerations:
duration and characteristics of seizure activity. Assess mood,
ideation and behaviours frequently. Initiate suicide precautions if
indicated
• Do not discontinue abruptly; may cause increase in frequency of
seizures

Generic Name: Flupenthixol

Brand Name: Depixol,Fluanxol

Classification: Antipsychotic
Its effects resemble those of the phenothiazine, fluphenazine, in that it
belongs among the antipsychotic drugs which are less likely to cause
Action:
sedation and hypotension, but have greater propensity for producing
extrapyramidal reactions.
The maintenance therapy of chronic schizophrenic patients whose main
Indication / Uses:
manifestations do not include excitement, agitation or hyperactivity
Dosage, Frequency
20mg/amp q monthly give 1 dose prior to discharge
And Route:
• drowsiness
• dizziness
• headaches
• dry mouth
• weight changes
Common Adverse • constipation
Effects: • blurred vision
• shakiness
• restlessness
• irregular periods or breast changes in women
• sexual problems
 • tendency to get sunburn
Contraindications: In patients with known hypersensitivity to the thioxanthenes. The
possibility of cross-sensitivity between the thioxanthenes and
 phenothiazine derivatives should be considered.
Flupenthixol is also contraindicated in the presence of CNS depression
due to any cause, comatose states, suspected or established subcortical
brain damage, blood dyscrasias, pheochromocytoma, liver damage,
cerebrovascular or renal insufficiency, and severe cardiovascular
disorders. It is not indicated for the management of severely agitated
psychotic patients, psychoneurotic patients or geriatric patients with
confusion and/or agitation. As with phenothiazines, flupenthixol should
not be used concomitantly with large doses of hypnotics due to the
possibility of potentiation.
Pregnancy and Lactation: Safety in pregnancy has not been established.
Therefore, it should not be administered to women of childbearing
potential or during lactation, unless, in the opinion of the physician, the
expected benefit to the patient outweighs the potential risk to the fetus or
child.
Children: Safety and efficacy in children have not been established, and
its use is not recommended in the pediatric age group
Peak concentrations of the drug were found between days 4 and 7,
following i.m. injections of 40 mg of flupenthixol 2% or 10%. It could
still be detected in the blood 3 weeks after injection. The metabolites of
Pharmacokinetics: flupenthixol appear to be inactive. Flupenthixol dihydrochloride is well
absorbed from the gastrointestinal tract reaching maximum serum
concentrations within 3 to 8 hours. Flupenthixol is excreted mainly in the
feces, with some excretion also occurring in the urine
Dopamine (concurrent use may antagonize peripheral vasoconstriction
produced by high doses of dopamine, because of the alpha-adrenergic
blocking action of thioxanthenes)
Ephedrine (alpha-adrenergic blocking action of thioxanthenes may
decrease the pressor response to ephedrine when it is used concurrently
with thioxanthenes
Metaraminol (concurrent use usually decreases, but does not reverse
Interactions: or completely block, the pressor response to metaraminol, because of the
alpha-adrenergic blocking action of thioxanthenes)
Methoxamine (prior administration of thioxanthenes may decrease the
pressor effect and duration of action of methoxamine because of the
alpha-adrenergic blocking action of thioxanthenes)
Phenylephrine (prior administration of thioxanthenes may decrease the
pressor response to phenylephrine because of the alpha-adrenergic
blocking action of thioxanthenes)
Nursing • Remind patient that before having any surgery, including dental
Considerations: or emergency treatment, tell the surgeon, doctor or dentist that
you are taking flupentixol.
• Inform client that Flupentixol can occasionally cause a dry mouth.
If patient experiences this, try chewing sugar-free gum, sucking
sugar-free sweets or pieces of ice.
• Flupentixol can cause some people's skin to become more
 sensitive to sunlight than it usually is. Avoid strong sunlight and
sunbeds until you know how your skin reacts and use a suncream
higher than factor 15.
• If client experience 'flu like' symptoms such as stiffness, high
temperature, abnormal paleness, leaking bladder and a racing
heartbeat contact their doctor or go to the accident and emergency
department of your local hospital immediately.
• Educate the patient that the symptoms of overdose may include
seizers, muscle spasms, weakness, fast heartbeat, fever, difficult
breathing, severe dizziness, drowsiness, convulsions, irregular
heartbeat, disturbed concentration, constipation and coma.
• Inform patient to take the medicine with a full glass of water.
• Remind the patient that the medicine can be taken with or without
food.
• Instruct to the patient that he can swallow the medicine as whole.
Don’t cut or chew the medicine.

Generic Name: Biperiden

Brand Name: Akineton, Benzum 2, Berofin, Biperen, Bipiden, Desiperiden

Classification: Anticholinergic
Biperiden is a weak peripheral anticholinergic agent with nicotinolytic
activity. The beneficial effects in Parkinson's disease and neuroleptic-
Action:
induced extrapyramidal symptoms are believed to be due to the inhibition
of striatal cholinergic receptors.
• Adjunctive treatment of all forms of Parkinson's disease
(postencephalitic, idiopathic, and arteriosclerotic).
• Improve parkinsonian signs and symptoms related to
Indication / Uses:
antipsychotic drug therapy.
• Relieves muscle rigidity, reduces abnormal sweating and
salivation, improves abnormal gait, and to lesser extent, tremor.
Dosage, Frequency
2 mg/tab 1 tab BID for EPS
And Route:
• Cardiovascular: Orthostatic hypotension, bradycardia
• Central nervous system: Drowsiness, euphoria, disorientation,
agitation, sleep disorder (decreased REM sleep and increased
Common Adverse REM latency) Gastrointestinal: Constipation, xerostomia, dry
Effects: throat, nasal dryness
• Genitourinary: Urinary retention
• Neuromuscular & skeletal: Choreic movements
• Ocular: Blurred vision
 • Hypersensitivity to biperiden or any component of the
formulation
• Narrow-angle glaucoma
• Bowel obstruction, megacolon
Contraindications:
• Myasthenia gravis
• Caution in patients with obstructive diseases of the urogenital
tract, patients with a known history of seizures and those with
potentially dangerous tachycardia
Peak plasma concentrations following a single oral 4 mg immediate-
release dose are reached after 1.5 hours. The elimination half-life has
Pharmacokinetics: been determined as 18.4 hours, and may be prolonged in geriatric
patients. After a 4 mg intravenous dose, the elimination half-life is
approximately 24 hours
• Amantadine, rimantadine: Central and/or peripheral
anticholinergic syndrome can occur when administered with
amantadine or rimantadine.
• Anticholinergic agents: Central and/or peripheral anticholinergic
syndrome can occur when administered with opioid analgesics,
phenothiazines and other antipsychotics (especially with high
anticholinergic activity), tricyclic antidepressants, quinidine and
some other antiarrhythmics, and antihistamines.
• Atenolol: Anticholinergics may increase the bioavailability of
atenolol (and possibly other beta-blockers); monitor for increased
effect.
Interactions:
• Cholinergic agents: Anticholinergics may antagonize the
therapeutic effect of cholinergic agents; includes tacrine and
donepezil.
• Digoxin: Anticholinergics may decrease gastric degradation and
increase the amount of digoxin absorbed by delaying gastric
emptying.
• Levodopa: Anticholinergics may increase gastric degradation and
decrease the amount of levodopa absorbed by delaying gastric
emptying.
• Neuroleptics: Anticholinergics may antagonize the therapeutic
effects of neuroleptics.
Nursing • Instruct patient to use caution when driving, operating machinery,
Considerations: or performing other hazardous activities. Biperiden may cause
dizziness or blurred vision. If patient experience dizziness or
blurred vision, avoid these activities.
• Remind patient to use alcohol cautiously. Alcohol may increase
drowsiness and dizziness while client is taking biperiden.
• Remind client to avoid becoming overheated. Biperiden may
cause decreased sweating. This could lead to heat stroke in hot
weather or with vigorous exercise.
• Educate client to take each dose with a full glass of water.
• Educate patient to take biperiden after a meal if it upsets his
 stomach.
• Remind the patient to store biperiden at room temperature away
from moisture and heat.
• This medication decreases saliva production, an effect that can
increase gum and tooth problems (e.g., cavities, gum disease).
Instruct client to take special care with their dental hygiene (e.g.,
brushing, flossing) and have regular dental check-ups
• If client experiences signs of hyperthermia such as mental/mood
changes, headache, or dizziness, promptly seek cool or air-
conditioned shelter and/or stop exercising, and seek immediate
medical attention.
• Remind patient to not share the medication to others.
• If patient misses a dose, remind them to take it as soon as they
remember. If it is near the time of the next dose, skip the missed
dose and resume their usual dosing schedule. Do not double the
dose to catch up.

BIBLIOGRAPHY: 26th Edition Nursing 2007 Drug Handbook by Lippincott Williams and
Wilkins; Phil. Pharmaceutical Directory Review, 7th edition.