MEDICATION ADMINISTRATION WORKSHEET CLIENT INITIALS: J.

M
Medication: Usual Dosage Cellular MOA Side Effects/Drug Nursing Indications for
Generic/Trade (Routes of Onset/Peak/ Interactions/ Management Use/Indication
name Administration) (Implications &
Duration Contraindications for This Patient
Specific drug Teachings)
class
Dosage/Route
/Times

Availability: MOA: Side Effects: Baseline Indications:

1. Tablet(T) Competes with Frequent: assessment: Treatment of
Diphenhydr Liquid(L) histamine for Drowsiness, Check baseline allergic reactions
amine Hcl Capsules(C) H-1 receptor site light-headedness, hydration status:including nasal
on effector cells dizziness, nausea. skin turgor, allergies;
T: 25 mg, 50 mg in GI tract, blood Occasional: mucous parkinsonism,
Generic/Tr
C: 25 mg, 50 mg vessels, Headache, dry membranes for including
ade name: L: 12.5 mg/5 ml respiratory tract. mouth. dryness, urinary drug-induced
Diphenhydr Cream: 1%, 2%. Therapeutic Rare: status. Assess extrapyramidal
amine Injection Effect: Produces Flushing, usual stool symptoms;
Solution: 50 anticholinergic, tachycardia, urinary frequency, prevention/treat
Benadryl mg/mL. antipruritic, retention, consistency. ment of nausea,
Tablets, antitussive, constipation, vomiting, or
Specific Chewable: 12.5 antiemetic, paradoxical reaction Intervention/eval vertigo due to
drug class: mg. antidyskinetic, (marked by uation: motion sickness;
Antihistamin sedative effects. restlessness, Encourage antitussive;
Dosage Range: agitation), blurred adequate fluid short-term
es
A: 25–50 mg Onset: vision. intake. Assess management of
q6–8h PO: 15-30 min bowel sounds for insomnia;
C: (6–11 yrs): IV, IM: Less than Drug Interactions: peristalsis. adjunct to
12.5–25 mg 15 minutes DRUG: Alcohol, Monitor daily epinephrine in
q4–6h other CNS pattern of bowel treatment of
C: (2–5 yrs): Peak: depressants (e.g., activity, stool anaphylaxis.
6.25 mg q4–6h PO, IV, IM: 1-4 lorazepam, consistency. Topical form
hrs morphine, Record time of used for relief of
Administration/ zolpidem): evacuation. pruritus from
handling: Duration: may increase CNS Assess for insect
IV PO, IV, IM: 4-6 depressant effects. abdominal
• May be given hrs Anticholinergics may disturbances.
undiluted. increase effects of Discontinue
• Give IV atropine. medication if
injection over at abdominal
least 1 min. distention occurs.
Maximum rate: MAOIs (e.g.,
25 mg/min. phenelzine, Patient/family
IM selegiline): teaching:
• Give deep IM may precipitate • Avoid tasks that
into large muscle hypertensive crisis. require alertness,
mass. HERBAL: motor skills until
PO None significant. response to drug
• Give with FOOD: is established.
food to decrease None known. • Avoid alcohol.
GI distress. LAB VALUES: May • Report
• Scored tablets increase serum persistent fever,
may be crushed. amylase. palpitations,
diarrhea.
Contraindications: • Report
Hypersensitivity to abdominal
diphenhydrAMINE. distention
Neonates or
premature infants,
breastfeeding.
Cautions:
Narrow-angle
glaucoma, stenotic
peptic ulcer,
prostatic
hypertrophy,
pyloroduodenal/blad
der neck
obstruction, asthma,
COPD, increased
IOP, cardiovascular
disease,
hyperthyroidism,
elderly.
2. Availability: MOA: Side Effects: Baseline Indication:
Chlorproma T: 10 mg, 25 mg, Depresses brain Frequent: assessment: Management of
zine 50 mg, 100 mg, areas that Drowsiness, blurred Avoid skin psychotic
200 mg control activity vision, hypotension, contact with disorders
Generic/Tr SR: 30 mg, 75 and aggression, color vision or night solution (contact (control of
mg, 100 mg including the vision disturbances, dermatitis). mania, treatment
ade name:
OC: 30 mg/ml, cerebral cortex, dizziness, Antiemetic: of
Chlorproma
100 mg/ml hypothalamus, decreased Assess for schizophrenia),
zine and limbic diaphoresis, dehydration (poor severe
Dosage Range: system, by an constipation, dry skin turgor, dry nausea/vomiting,
Thorazine PO: unknown mouth, nasal mucous severe
ADULTS, mechanism. congestion. membranes, behavioral
Specific ELDERLY: Prevents nausea Occasional: Urinary longitudinal disturbances in
drug class: 10–25 mg and vomiting by retention, furrows in children. Relief
Antipsychoti q4–6h. inhibiting or photosensitivity, tongue). of intractable
c/Phenothia CHILDREN: blocking rash, decreased Antipsychotic: hiccups, acute
zines 0.5–1 mg/kg dopamine sexual function, Assess behavior, intermittent
q4–6h. receptors in the swelling/pain in appearance, porphyria.
IV, IM: medullary breasts, weight gain, emotional status, Off-label:
ADULTS, chemoreceptor nausea, vomiting, response to Management of
ELDERLY: trigger zone and abdominal pain, environment, psychotic
25–50 mg q4 peripherally by tremors. speech pattern, disorders,
–6h. CHILDREN: blocking the Relative Side thought content. behavioral
0.5–1 mg/kg vagus nerve in Effect: symptoms
q6–8h. the GI tract. May • EPS – Moderate • Intervention/eval associated with
Maximum: relieve anxiety Anticholinergic – uation: dementia,
40 mg/day for by indirect Moderate Monitor B/P for agitation related
children reduction in • Sedation – High • hypotension. to Alzheimer’s
less than 5 yrs; arousal and Hypotension – High Assess for dementia.
75 mg/day for increased EPS. Monitor
children filtering of Drug Interactions: WBC, differential
5–12 yrs. internal stimuli to Drug: Rifampin may count for
the reticular decrease effects, blood dyscrasias,
activating Alcohol, CNS fine tongue
Administration/ system in the depressants may movement
Handling: brain stem. increase respiratory (may be an early
IM depression, sign of tardive
Do not give Onset: hypotensive effects. dyskinesia).
chlorproma- 30-60 mins MAOIs, tricyclic Supervise
zine by SQ route antidepressants suicidal-risk pt
(risk for severe Peak: may increase closely during
tissue sedative, early therapy (as
necrosis). depression
• Dilute solution within 2 to 4 anticholinergic lessens, energy
as prescribed hours after effects. level improves,
with administration Herbal: increasing suicide
Sodium Chloride St. John’s wort may potential). Assess
for Injection. Duration: decrease for therapeutic re-
• Slowly 4-6 hr; extended concentration; sponse (interest
inject drug deep release, 10-12 hr increase in surroundings,
into large photosensitization, improvement in
muscle, such sedative effect. self-care,
as gluteus Dong quai may increased ability
maximus rather increase to concentrate,
than lateral as- photosensitization. relaxed facial
pect of the thigh, Gotu kola, kava expres-
to minimize kava, valerian may sion).
discomfort. increase sedative Therapeutic
IV effect. Lab values: serum level: 50–
• For direct IV May produce 300 ng/ml;
injection, dilute false-positive toxic serum
with 0.9% pregnancy test, level: greater
NaCl to phenylketonuria than 750 ng/ml.
maximum (PKU) test. EKG
concentration of changes may occur, Patient/family
1 mg/ including QT-interval teaching:
ml. and T-wave • Full therapeutic
• Administer disturbances. response may
slowly: 0.5 take up to 6 wks.
mg/min in Contraindications: • Urine may
children, 1 Comatose states; darken.
mg/min in adults. hypersensitivity to • Do not abruptly
• Protect from chlorpromazine, withdraw from
light. phenothiazines, or long-term
• A slightly their com-ponents; drug therapy.
yellow solution use of large • Report visual
does not indicate amounts of CNS disturbances.
potency loss. depressants. • Avoid tasks that
• Discard require alertness,
markedly motor skills until
discolored response to drug
solutions. is established.
PO • Drowsiness
Administer with generally
food or milk to subsides with
decrease
 GI effects. continued
therapy.
• Avoid alcohol,
exposure to
sunlight.

3, Availability: MOA: Side effects: Baseline Indications:

Fluphenazin Elixir: 2.5 mg/5 May block Frequent: assessment: Management of
e Deconate ml. postsynaptic Hypotension, Obtain baseline psychotic
Injection dopamine dizziness, syncope CBC. Assess disturbances and
Generic/Tra (Decanoate): 25 receptor sites in (occur frequently behavior, schizophrenia.
de name: mg/ml. Injection the CNS. This after first injection, appearance, Off-label:
Fluphenazin Solution: action may occasionally after emotional status, Psychosis/agitati
e Deconate Hydrochloride depress areas of subsequent response to the on related to
2.5 mg/ml. Oral the brain that injections, rarely environment, Alzheimer’s
Prolixin Concentrate: 5 control activity with oral doses) speech pattern, dementia
mg/ml. and aggression, Occasional: thought content.
Specific Tablets: 1 mg, including the Drowsiness (during
drug class: 2.5 mg, 5 mg, 10 cerebral cortex, early therapy), dry Intervention/eval
Antipsychotic mg. hypothalamus, mouth, blurred uation:
1st gen. and limbic vision, lethargy, Monitor B/P for
/Phenothiazi system. constipation or hypotension.
ne Dosage Range: diarrhea, nasal Monitor CBC for
PO Onset: congestion, periph- blood dyscrasias.
Adults: Hydrochloride eral edema, urinary Monitor for fine
2.5–10 mg/day salt: 1hr retention. tongue
in divided doses Decanoate: Rare: movement (may
q6–8h. 24-72 hr Ocular changes, be early sign
Maintenance: altered skin of tardive
1–5 mg/ day. Peak: pigmentation dyskinesia).
Maximum: 40 Hydrochloride (with prolonged use Supervise sui-
mg/day. Elderly: salt: 2 hr of high doses). cidal-risk pt
Initially, 1–2.5 Decanoate: 8-10 closely during
mg/day. Titrate hr early therapy
gradually. Peak effect: Drug Interactions: (as depression
IM Decanoate: DRUG: lessens, energy
(Hydrochloride) 48-96 hr Alcohol, other CNS level improves,
: depressants may increasing suicide
Adults, Elderly: Duration: increase potential).
1.25 mg as Hydrochloride hypotensive, CNS, Assess for
single dose. May salt: 6-8 hr respiratory therapeutic
need 2.5–10 Decanoate: 4 depressant effects. response
mg/day in weeks EPS may (interest in
divided doses increase with surroundings,
q6–8h. medications improvement in
(Decanoate): producing EPS. self-care,
Initially, 12.5–25 Antihypertensive increased ability
mg q2–4wks. medications, to concentrate,
May increase in hypotensive agents relaxed facial
12.5-mg may worsen hypo- expression).
increments. tension.
Maximum dose: Lithium may Patient/family
100 mg. decrease absorp- teaching:
tion, produce • Full therapeutic
Administration/ adverse neurologic effect may take
Handling: effects. up to 6 wks.
PO 2-40mg/day MAOIs, tricyclic • Avoid skin
Injection: antidepressants contact with
12.5-75mg may solution (may
q2-4wks increase cause contact
• Avoid skin anticholinergic, dermatitis).
contact with sedative effects. • Urine may
fluphenazine Medications darken.
solution (may prolonging QT • Do not
cause contact interval abruptly withdraw
dermatitis). (e.g., erythromycin) from long-term
• Dilute oral may have additive drug therapy.
concentrate only effect. • Avoid tasks that
with water, milk, HERBAL: require alertness,
juice. Do not Dong quai, St. motor skills until
dilute with John’s response to
caffeine-containi wort may increase drugs are
ng beverages photosensitization. established.
(coffee, cola), Gotu kola, kava • Drowsiness
tannics (tea), or kava, St. John’s generally
pectinates (apple wort, valerian may subsides during
juice) due to increase CNS continued
potentia depression. therapy.
incompatibility. FOOD:
None known.
LAB VALUES: May
produce
false-positive
pregnancy,
phenylketonuria test
results. May
cause EKG
changes, including
Q- and T-wave
disturbances.

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
pheno thiazines,
myeloproliferative
disorders, severe
CNS depression,
severe hypertension
or hypotension,
subcortical brain
damage
4. Clozapine Availability: MOA: Side Effects: Baseline Indication:
Suspension, May produce Frequent assessment: Alert: For
Generic/Tra Oral antipsychotic (39%–14%): Obtain baseline initiation of
de name: (Versacloz): 50 effects by Drowsiness, weight, glucose, therapy, must
Clozapine mg/mL (100 mL). interfering with salivation, Hgb A1c, WBC, have WBC equal
Tablets dopamine tachycardia, absolute to or greater than
Clozaril (Clozaril): binding to dizziness, neutrophil count 3,500 mm3 and
25 mg, 50 mg, dopamine—espe constipation. (ANC) before ANC equal to or
Specific 100 mg, 200 mg. cially Occasional initiating greater than
drug class: Tablets (Orally D4—receptors in (9%–4%): treatment. 2,000 mm3. .
Atypical Disintegrating the limbic region Hypotension, Assess behavior, Management of
Antipsychotic [FazaClo]): 12.5 of the brain and headache, tremor, appearance, severely ill
mg, 25 mg, 100 by antagonizing syncope, emotional status, schizophrenic
mg, 150 mg, 200 adrenergic, diaphoresis, dry response to pts who have
mg. cholinergic, mouth, nausea, environment, failed to respond
histaminic, and visual disturbances, speech pattern, to other
Dosage Range: serotoninergic nightmares, thought content. antipsychotic
PO receptors. restlessness, therapy.
ADULTS: Therapeutic akinesia, agitation, Intervention/eval Treatment of
Initially, 12.5 mg Effect: hypertension, uation: recurrent suicidal
once or twice Diminishes abdominal Monitor B/P for behavior.
daily. May schizophrenic discomfort, hypertension/hyp Off-label:
increase by behavior. heartburn, weight otension. Assess Schizoaffective
25–50 mg/day gain. pulse for disorder, bipolar
over 2 wks until Onset: Rare: tachycardia disorder,
target dose of 15 min Rigidity, confusion, (common side childhood
300–450 mg/day fatigue, insomnia, effect). Monitor psychosis,
is achieved. May Duration: diarrhea, rash. CBC for blood obsessive-comp
further increase 4-12 hr dyscrasias. ulsive disorder,
by 50–100 Drug Interactions: Monitor ANC, agitation related
mg/day no more Peak plasma DRUG: WBC count every to Alzheimer’s
than once or time: Antihypertensive wk for first 6 mos, dementia.
twice wkly. 1.5-2.5 hr medications (e.g., then biweekly for
Range: 200–600 amLODIPine, 6 mos. If CBC
mg/day. Peak plasma lisinopril, valsartan) and ANC are
Maximum: concentration: may increase risk of normal after 12
900 mg/day. 102-771 ng/mL hypotension. mos, then
ELDERLY: Alcohol, other CNS monthly
Initially, 12.5 depressants (e.g., monitoring of
mg/day for 3 lorazepam, CBC and ANC is
days, then 25 morphine, zolpidem) recommended.
mg/day for 3 may increase CNS Supervise
days. May depressant effects. suicidal-risk pt
further increase Bone marrow closely during
in increments of depressants may early therapy (as
12.5–25 mg daily increase depression
q3days. Mean myelosuppression. lessens, energy
dose: 300 Cimetidine, level improves,
mg/day. citalopram, increasing suicide
Maximum: 700 ciprofloxacin, potential). Assess
mg/day erythromycin may for therapeutic
increase response
Administration/ concentration, risk (interest in
Handling: of adverse effects. surroundings,
PO SSRIs (e.g., improvement in
• Give without PARoxetine) may self-care,
regard to food. • increase increased ability
Suspension: Use concentration. to concentrate,
oral syringes Lithium may relaxed facial
(provided). increase risk of expression).
Shake well, confusion,
administer a dyskinesia, Patient/family
dose seizures. teaching:
immediately after Medications • Do not abruptly
preparing. prolonging QT discontinue
Suspension interval (e.g., long-term drug
stable for 100 amiodarone, therapy.
days after initial azithromycin, • Avoid tasks that
bottle opening. ciprofloxacin, require alertness,
Orally haloperidol) may motor skills until
Disintegrating increase risk of QT response to drug
Tablets prolongation. is established.
• Remove from CYP3A4 inducers • Drowsiness
foil blister; do not (e.g., phenytoin, generally
push tablet carBAMazepine, subsides during
through foil. rifAMPin) may continued
• Remove tablet decrease therapy.
with dry hands, concentration/effects • Avoid alcohol,
place in mouth. • . caffeine.
Allow to dissolve HERBAL: • Report fever,
in the mouth; St. John’s wort may sore throat,
swallow with decrease flu-like
saliva. concentration/therap symptoms.
• If the dose eutic effects. Kava
requires a kava, gotu kola,
splitting tablet, valerian, St. John’s
discard the wort may increase
unused portion. risk of CNS
depression. FOOD:
None known.
LAB VALUES: May
increase serum
glucose, cholesterol
(rare), triglycerides
(rare).

Contraindications:
Hypersensitivity to
cloZAPine. History
of cloZAPineinduced
agranulocytosis or
severe
granulocytopenia
Cautions:
History of seizures,
cardiovascular
disease,
myocarditis,
respiratory/hepatic/r
enal impairment,
alcohol withdrawal,
high risk of suicide,
paralytic ileus,
myasthenia gravis,
pts at risk for
aspiration
pneumonia, urinary
retention,
narrow-angle
glaucoma, prostatic
hypertrophy,
xerostomia, visual
disturbances,
constipation, history
of bowel obstruction,
diabetes mellitus.
History of long QT
prolongation/ventric
ular arrhythmias;
 concomitant use of
medications that
prolong QT interval;
hypokalemia,
hypomagnesemia.

5. Quetiapine Availability: MOA: Side Effects: Baseline Indication:

Tablets: 25 mg, May produce Frequent assessment: Treatment of
Generic/Tra 50 mg, 100 mg, antipsychotic (19%–10%): Assess behavior, schizophrenia.
de name: 200 mg, 300 mg, effects by Headache, appearance, Treatment of
Quetiapine 400 mg. Tablets, interfering with drowsiness, emotional status, acute manic
Extended-Relea dopamine dizziness. response to episodes
Seroquel se: 50 mg, 150 binding to Occasional (9%– environment, associated with
mg, 200 mg, 300 dopamine type 2 3%): speech pattern, bipolar disorder
Specific mg, 400 mg. (D2)-receptor Constipation, thought content. (alone or in
drug class: sites in the brain orthostatic Obtain baseline combination with
Atypical Dosage Range: and antagonizes hypotension, CBC, hepatic lithium or
Antipsychotic Schizophrenia DOPamine, tachycardia, dry enzyme levels valproate).
PO: serotonin, mouth, dyspepsia, before initiating Maintenance
(Immediate-Rel histamine, rash, asthenia, treatment and treatment of
ease): ADULTS, alpha1 abdominal pain, periodically bipolar disorder
ELDERLY: -adrenergic rhinitis. thereafter. as an adjunct to
Initially, 25 mg receptors. Rare (2%): Question medical lithium or
twice daily, then Therapeutic Back pain, fever, history as listed in
valproic acid.
increase in Effect: weight gain. Precautions. Treatment of
25–50-mg Diminishes acute depressive
increments symptoms Drug Interactions: Intervention/eval episodes
divided 2–3 associated with DRUG: Medications uation: associated with
times/day on the schizophrenia/bi prolonging QT Monitor mental bipolar disorder.
second and third polar disorders interval (e.g., status, onset of Adjunctive
days, up to amiodarone, extrapyramidal treatment to
300–400 mg/day Onset: citalopram, symptoms. Assist antidepressants
in 2–3 divided dasatinib, with ambulation if in major
doses by the haloperidol, dizziness occurs. depressive
fourth day. Peak: levoFLOXacin, Supervise disorder (MDD).
Further 1.5 hr ondansetron) may suicidal-risk pt OFF-LABEL:
adjustments of increase risk of QT closely during Delirium in
25–50 mg twice Duration: prolongation. early therapy (as critically ill pts,
daily may be Alcohol, other CNS psychosis, psychosis/agitati
made at intervals depressants depression on related to
of 2 days or (e.g.LORazepam, lessens, energy Alzheimer’s
longer. morphine, zolpidem) level improves, dementia.
Maintenance: may increase CNS increasing suicide Treatment of
150–750 mg/day depression. May potential). autism,
(adults); 50–200 increase Monitor B/P for treatment-resista
mg/day (elderly). hypotensive effects hypotension, lipid nt obsessive
(Extended-Rele of antihypertensives. profile, blood compulsive
ase): Initially, CYP3A4 inducers glucose, CBC, or disorder.
300 mg/day. May (e.g., phenytoin) worsening
increase at may increase depression,
intervals as short clearance. CYP3A4 unusual behavior.
as 1 day up to inhibitors Assess pulse for
300 mg/day. (e.g.clarithromycin, tachycardia (esp.
Range: 400–800 erythromycin, with rapid
mg/day. fluconazole, increase in
(Immediate-Rel itraconazole) may dosage). Monitor
ease): increase effects. daily pattern of
CHILDREN 13 HERBAL: bowel activity,
YRS AND St. John’s wort may stool consistency.
OLDER: Initially, decrease Assess for
25 mg twice concentration. Gotu therapeutic
daily on day 1, kola, kava kava, St. response
50 mg twice John’s wort, valerian (improved
daily on day 2, may increase CNS thought content,
then increase by depression. increased ability
100 mg/day to FOOD: to concentrate,
target dose of None known. improvement in
400 mg twice LAB VALUES: May self-care). Eye
daily on day 5. decrease total free exam to detect
May further thyroxine (T4 ) cataract
increase to 800 serum levels. May formation should
mg/day in increase serum be obtained
increments of cholesterol, q6mos during
100 mg or less triglycerides, ALT, treatment.
daily. Range: AST, WBC, GGT.
400–800 May produce Patient/family
mg/day. false-positive teaching:
Maximum: 800 pregnancy test • Avoid exposure
mg. Total dose in result. to extreme heat.
3 divided doses. • Drink fluids
(Extended-Rele Contraindications: often, esp. during
ase): Initially, 50 Hypersensitivity to physical activity.
mg once daily on QUEtiapine. • Take medication
day 1, 100 mg Cautions: as ordered; do
on day 2, until Renal/hepatic not stop taking or
400 mg once impairment, increase dosage.
daily is reached preexisting • Drowsiness
on day 5. Range: abnormal lipid generally
400–800 profile, pts at risk for subsides during
mg/day. aspiration continued
Maximum: 800 pneumonia, therapy.
mg/day. cardiovascular • Avoid tasks that
disease (e.g., HF, require alertness,
Administration/ history of MI), motor skills until
handling: cerebrovascular response to drug
PO disease, is established.
• Give dehydration, • Avoid alcohol.
immediate-relea hypovolemia, history • Slowly go from
se tablets of drug lying to standing.
without regard to abuse/dependence, • Report suicidal
food. seizure disorder, ideation, unusual
• Do not break, hypothyroidism, pts changes in
crush, dissolve, at risk for suicide, behavior.
or divide Parkinson’s disease,
extended-releas decreased GI
e tablets. motility, urinary
•Extended-releas retention,
e tablets should narrow-angle
be given without glaucoma, diabetes,
regard to food or visual problems,
with a light meal elderly, pts at risk for
in evening orthostatic
hypotension. Avoid
use in pts at risk for
torsades de pointes
(hypokalemia,
hypomagnesemia,
history of cardiac
arrhythmias,
congenital long QT
syndrome,
concurrent
medications that
prolong QT interval).
6. Availability: MOA: Side Effects: Baseline Indications:
Risperidone Injection, Selectively Frequent assessment: (Oral):
Powder for blocks serotonin (26%–13%): Renal function Treatment of
Generic/Tra Reconstitution and dopamine Agitation, anxiety, test, LFT shouldschizophrenia,
de name: (RisperDAL receptors in the insomnia, be performed irritability/aggres
Risperidone Consta): 12.5 mesocortical headache, before therapy sion associated
mg, 25 mg, 37.5 tract of the CNS constipation. begins. Assess with autistic
Risperdal mg, 50 mg. to suppress Occasional behavior, disease in
Oral Solution psychotic (10%–4%): appearance, children.
Specific (RisperDAL): 1 symptoms/May Dyspepsia, rhinitis, emotional status,
Treatment of
drug class: mg/mL. Tablets antagonize drowsiness, response to acute mania
Atipal (RisperDAL): DOPamine, dizziness, nausea, environment, associated with
Antipsychotic 0.25 mg, 0.5 mg, serotonin vomiting, rash, speech pattern, bipolar disorder
1 mg, 2 mg, 3 receptors in both abdominal pain, dry thought content,(monotherapy in
mg, 4 mg. CNS and skin, tachycardia. baseline weight.children and
Tablets (Orally periphery. Rare (3%–2%): Obtain fasting adults; in
Disintegrating Therapeutic Visual disturbances, serum glucose, combination with
[RisperDAL Effect: fever, back pain, CBC. lithium or
M-Tabs, Suppresses pharyngitis, cough, valproate in
RisperiDONE psychotic arthralgia, angina, Intervention/eval adults).
M-Tab]): 0.25 behavior. aggressive behavior,uation: (IM):
mg, 0.5 mg, 1 orthostatic Monitor B/P, heart Management of
mg, 2 mg, 3 mg, Onset: hypotension, breast rate, weight, LFT, schizophrenia,
4 mg. swelling. EKG. Monitor for maintenance
fine tongue treatment of
Dosage Range: Peak: Drug Interactions: movement (may bipolar 1
Schizophrenia Extensive DRUG: Alcohol, be first sign of disorder
PO: metabolizers: other CNS tardive (monotherapy or
ADULTS: 3hr depressants (e.g., dyskinesia, which in combination
Initially, 1 mg Poor LORazepam, may be with lithium or
twice daily. May metabolizers: 1 morphine, zolpidem) irreversible). valproate in
increase hr may increase CNS Monitor for adults).
gradually (1–2 depression. suicidal ideation. OFF-LABEL:
mg/day at Duration: CarBAMazepine Assess for Tourette’s
intervals of at may decrease therapeutic syndrome.
least 24 hrs) to concentration. May response (greater Post-traumatic
target dose of 6 decrease effects of interest in stress syndrome.
mg/day. Range: DOPamine agonists, surroundings, Major depressive
4–8 mg/day. levodopa. improved disorder.
Maintenance: PARoxetine, self-care,
Target dose of 4 FLUoxetine may increased ability
mg once daily increase to concentrate,
(range: 2–8 concentration, risk relaxed facial
mg/day). of extrapyramidal expression).
ELDERLY: symptoms (EPS). Monitor for
Initially, 0.5 mg Antihypertensives potential
twice daily. May (e.g., amLODIPine, neuroleptic
increase slowly lisinopril, valsartan), malignant
at increments of beta blockers (e.g., syndrome: fever,
no more than 0.5 carvedilol, muscle rigidity,
mg twice daily. metoprolol), calcium irregular B/P or
Range: 2–6 channel blockers pulse, altered
mg/day. (e.g., diltiaZEM, mental status.
CHILDREN verapamil), diuretics Monitor fasting
13–17 YRS: (e.g., furosemide, serum glucose
Initially, 0.5 HCTZ), doxepin, periodically
mg/day (as pramipexole, during therapy
single daily prazosin, sildenafil
dose). May may increase Patient/family
increase by hypotensive effect. teaching:
0.5–1 mg/day at HERBAL: • Avoid tasks that
intervals of Gotu kola, kava may require
greater than 24 kava, St. John’s alertness, motor
hrs to wort, valerian may skills until
recommended increase CNS response to drug
dose of 3 depression. FOOD: is established
mg/day. None known. (may cause
IM: LAB VALUES: May dizziness/drowsin
ADULTS, increase serum ess).
ELDERLY: prolactin, glucose, • Avoid alcohol.
Initially, 12.5–25 AST, ALT. May • Go from lying to
mg q2wks. cause EKG standing slowly.
Maximum: 50 changes. • Report
mg q2wks. trembling in
Dosage Contraindications: fingers, altered
adjustments Hypersensitivity to gait, unusual
should not be risperiDONE. muscular/skeletal
made more Cautions: movements,
frequently than Renal/hepatic palpitations,
every 4 wks. impairment, seizure severe
Bipolar Mania disorder, cardiac dizziness/fainting,
PO: disease, recent MI, swelling/pain in
ADULTS, breast cancer or breasts, visual
ELDERLY: other changes, rash,
Initially, 2–3 mg prolactin-dependent difficulty
as a single daily tumors, suicidal pts, breathing.
dose. May pts at risk for
increase by 1 aspiration
mg/day at 24-hr pneumonia.
intervals. Range: Parkinson’s disease,
1–6 mg/day. pts at risk for
PO: CHILDREN orthostatic
10–17 YRS: hypotension, elderly
Initially, 0.5 pts, diabetes,
mg/day. May decreased GI
increase by 0.5 motility, urinary
mg/day at retention, BPH,
intervals of xerostomia, visual
greater than 24 problems, pts
hrs to exposed to
recommended temperature
dose of 2.5 extremes,
mg/day. preexisting
IM: myelosuppression,
ADULTS, narrow-angle
ELDERLY: 25 glaucoma; pts with
mg q2wks. high risk of suicide.
Maximum: 50
mg q2wks.
Dosage
adjustments
should not be
made more
frequently than
every 4 wks.
Autism
CHILDREN 5
YRS AND
OLDER
WEIGHING
MORE THAN 19
KG: Initially, 0.5
mg/day. May
increase to 1 mg
after 4 days.
May further
increase dose by
0.5 mg/day in
greater than
2-wk intervals.
Range: 0.5–3
mg/day.
CHILDREN 5
YRS AND
OLDER
WEIGHING
15–19 KG:
Initially, 0.25
mg/day. May
increase to 0.5
mg/day after 4
days. May
further increase
dose by 0.25
mg/day in
greater than
2-wk intervals.
Range: 0.5–3
mg/day. Dosage
in
Renal/Hepatic
Impairment
Mild to
moderate
impairment: No
dose adjustment.
Severe
impairment:
Initial dosage for
adults, elderly
pts is 0.5 mg
twice daily.
Dosage is
titrated slowly to
desired effect.

Administration/
handling:
Do not
administer via IV
route.
IM
Reconstitution
• Use only
diluent and
needle supplied
in dose pack.
• Prepare
suspension
according to
manufacturer’s
directions.
• May be given
up to 6 hrs after
reconstitution,
but immediate
administration is
recommended. •
If 2 min pass
between
reconstitution
and injection,
shake upright
vial vigorously
back and forth to
resuspend
solution.
Rate of
Administration
• Inject IM into
upper outer
quadrant of
gluteus maximus
or into deltoid
muscle in upper
arm. Storage
• Store at room
temperature. PO
• Give without
regard to food. •
May mix oral
solution with
water, coffee,
orange juice,
low-fat milk. Do
not mix with
cola, tea. Orally
Disintegrating
Tablet
• Remove from
blister pack
immediately
before
administration. •
Using gloves,
place
immediately on
tongue.
• Tablet
dissolves in
seconds.
• Pt may swallow
with or without
liquid.
• Do not split or
chew
7. Availability: MOA: Side Effects: Baseline Indications:
Haloperidol Injection, Oil Competitively Frequent: Blurred assessment: Treatment of
(Decanoate): 50 blocks vision, constipation, Assess behavior, schizophrenia,
Generic/Tra mg/mL, 100 postsynaptic orthostatic appearance, Tourette’s
de name: mg/mL. DOPamine hypotension, dry emotional status, disorder
Haloperidol Injection, receptors in mouth, swelling or response to (controls tics and
Solution brain. soreness of female environment, vocal
Haldol (Lactate): May block breasts, peripheral speech pattern, utterances),
5 mg/mL. postsynaptic edema. thought content. severe
Specific Oral dopamine Occasional: Assess LOC. behavioral
drug class: Concentrate: receptors in the Allergic reaction, Screen for problems in
Antipsychotic 2 mg/mL. limbic system difficulty urinating, comorbidities as children with
1st gen. Tablets: 0.5 mg, and increase decreased thirst, listed in combative
1 mg, 2 mg, 5 brain turnover of dizziness, Precautions (esp. explosive
mg, 10 mg, 20 dopamine, diminished sexual seizure disorder, hyperexcitability
mg producing an function, long QT without
antipsychotic drowsiness, nausea, syndrome). immediate
Dosage Range: effect. vomiting, provocation.
Usual Dosage Therapeutic photosensitivity, Intervention/eval Management of
IM (Lactate): Effect: lethargy. uation: psychotic
ADULTS, Produces Monitor B/P, heart disorder,
ELDERLY: 2–5 tranquilizing Drug Interactions: rate/rhythm, QT short-term
mg q1–8 as effect. Strong DRUG: Alcohol, interval. treatment of
needed. extrapyramidal, other CNS Supervise hyperactive
CHILDREN 6– antiemetic depressants (e.g., suicidal-risk pt children.
12 YRS: 1–3 effects; weak diphenhydrAMINE, closely during OFF-LABEL:
mg/dose q4–8h anticholinergic, gabapentin, early therapy (as Treatment of
as needed. sedative effects. LORazepam, depression nonschizophreni
Maximum: 0.15 morphine) may lessens, energy c psychosis,
mg/kg/day. Onset: increase CNS level improves, alcohol
Change to PO 30-60 mins (IM, depression. increasing suicide dependence,
as soon as IV) CYP3A4 inducers potential). psychosis/agitati
possible. (e.g., Monitor for on related to
(Decanoate): Peak plasma carBAMazepine) rigidity, tremor, Alzheimer’s
ADULTS, time: may decrease mask-like facial dementia,
ELDERLY: PO: 2-6 hrs concentration. expression, fine emergency
Initially, 10–20 IM: 10-20 mins Medications tongue sedation of
times stabilized Decanoate: 6-7 prolonging QT movement. severely
oral dose. days interval (e.g., Assess for agitated/psychoti
Maximum: 100 amiodarone, therapeutic c pts.
mg. Duration: ciprofloxacin, response
Maintenance: 2-4 weeks ondansetron) may (interest in
10–15 times (decanoate) increase risk of QT surroundings,
daily oral dose or prolongation. improvement in
50–200 mg Medications self-care,
q4wks. producing increased ability
PO: extrapyramidal to concentrate,
ADULTS: 0.5–5 symptoms (EPS) relaxed facial
mg 2–3 (e.g., expression).
times/day. Usual diphenhydrAMINE, Monitor EKG and
dose: 5–20 benztropine) may QT interval.
mg/day. increase EPS. Therapeutic
Maximum: 100 HERBAL: Gotu serum level:
mg/day. kola, kava kava, St. 0.2–1 mcg/mL;
ELDERLY: 0.2–2 John’s wort, valerian toxic serum
mg/day. Usual may increase CNS level: greater
dose: 5–20 depression. than 1 mcg/mL.
mg/day. FOOD: None
Maximum: 100 known. Patient/family
mg/day. LAB VALUES: teaching:
CHILDREN None significant. • Full therapeutic
WEIGHING Therapeutic serum effect may take
MORE THAN 40 level: 0.2–1 up to 6 wks.
KG, mcg/mL; toxic • Do not abruptly
ADOLESCENTS serum level: Greater withdraw from
: 0.5–15 mg/day than 1 mcg/mL long-term drug
in 2–3 divided therapy.
doses. May Contraindications • Sugarless gum,
increase at no Hypersensitivity to sips of water may
less than 5–7 haloperidol, CNS relieve dry mouth.
days. Maximum: depression, coma, • Drowsiness
15 mg/day. Parkinson’s disease, generally
CHILDREN severe subsides during
3–12 YRS cardiac/hepatic continued
(15–40 KG): 0.5 disease. therapy.
mg/day. May Cautions: • Avoid tasks that
increase by 0.5 Renal/hepatic require alertness,
mg q5–7days. impairment, motor skills until
Range: cardiovascular response to drug
0.05–0.15 disease, history of is established.
mg/kg/day in 2–3 seizures, prolonged • Avoid alcohol.
divided doses. QT syndrome, • Report muscle
Maximum: 15 medications that stiffness.
mg/day. prolong QT interval, • Avoid exposure
Tourette’s hypothyroidism, to sunlight,
Disorder thyrotoxicosis, overheating,
PO: electrolyte dehydration
CHILDREN imbalance (e.g., (increased risk of
3–12 YRS: hypokalemia, heatstroke).
15–40 KG: hypomagnesemia),
Initially, 0.25–0.5 EEG abnormalities,
mg/day in 2–3 narrow–angle
divided doses. glaucoma, elderly,
May increase by pts at risk for
0.5 mg/day pneumonia,
every 5–7 days decreased GI
to usual dose of motility, urinary
1–4 mg/day. retention, BPH,
CHILDREN visual disturbances,
GREATER myelosuppression.
THAN 40 KG, Pts at risk for
ADOLESCENTS orthostatic
: Initially, hypotension (e.g.,
0.25–0.5 mg/day cerebrovascular
in 2–3 divided disease).
doses. May
increase as
needed every
5–7 days to
usual dose of
1–4 mg/day.
Dosage in
Renal/Hepatic
Impairment No
dose adjustment.

Administration/
handling:
IV
Only haloperidol
lactate is given
IV.
Note: For IV
administration,
ECG monitoring
for QT
prolongation/arrh
ythmias is
recommended.
Reconstitution
• May give
undiluted.
• May add to
50–100 mL of
D5W. Rate of
Administration
• Give IV push at
rate of 5 mg/min.
• Infuse IV
piggyback over
30 min.
• For IV infusion,
up to 25 mg/hr
has been used
(titrated to pt
response).
Storage
• Discard if
precipitate
forms,
discoloration
occurs.
• Store at room
temperature; do
not freeze.
• Protect from
light.
IM
Parenteral
Administration
• Pt should
remain
recumbent for
30–60 min to
minimize
hypotensive
effect.
• Prepare
Decanoate IM
injection using
21-gauge
needle.
• Do not exceed
maximum
volume of 3 mL
per IM injection
site.
• Inject slow,
deep IM into
upper outer
quadrant of
gluteus
maximus.
PO
• Give without
regard to meals.
• Scored tablets
may be crushed.
• Dilute oral
concentrate with
water or juice.
• Avoid skin
contact with oral
concentrate;
may cause
contact
dermatitis.
8. Sertraline Availability: MOA: Side Effects: Baseline Indications:
Oral Blocks reuptake Frequent assessment: Treatment of
Generic/Tra Concentrate: 20 of the (26%–12%): Assess major depressive
de name: mg/mL. Tablets: neurotransmitter Headache, nausea, appearance, disorders, panic
Sertraline 25 mg, 50 mg, serotonin at diarrhea, insomnia, behavior, speech disorder,
100 mg. CNS neuronal drowsiness, patterns, level of obsessive-comp
Zoloft presynaptic dizziness, fatigue, interest, mood. ulsive disorder
Dosage Range: membranes, rash, dry mouth. For pts on (OCD),
Specific Depression PO: increasing Occasional long-term post-traumatic
drug class: ADULTS: availability at (6%–4%): therapy, CBC, stress disorder
Antidepressa Initially, 50 postsynaptic Anxiety, renal function, (PTSD),
nt/Selective mg/day. May receptor sites. nervousness, LFT should be premenstrual
Serotonin increase by 50 Therapeutic agitation, tremor, performed dysphoric
Reuptake mg/day at 7-day Effect: dyspepsia, periodically. disorder
Inhibitors intervals up to Relieves diaphoresis, (PMDD), social
(SSRIs) 200 mg/day. depression, vomiting, Intervention/eval anxiety disorder.
ELDERLY: reduces constipation, sexual uation: OFF-LABEL:
Initially, 25 obsessive-comp dysfunction, visual Assess mental Eating disorders,
mg/day. May ulsive behavior, disturbances, status for bulimia nervosa,
increase by decreases altered taste. depression, generalized
25–50 mg/day at anxiety. Rare (Less Than suicidal ideation anxiety disorder
7-day intervals 3%): (esp. at beginning (GAD).
up to 200 Onset: Flatulence, urinary of therapy or
mg/day. after 4-6 weeks frequency, change in
Obsessive-Com paresthesia, hot dosage), anxiety,
pulsive Peak plasma flashes, chills social function,
Disorder (OCD) time: panic attack.
PO: 4.5-8.4 hr Drug Interactions: Monitor daily
ADULTS, DRUG: pattern of bowel
CHILDREN Duration: Anticoagulants activity, stool
13–17 YRS: 7 days (e.g., heparin, consistency.
Initially, 50 rivaroxaban, Assist with
mg/day with warfarin), ambulation if
morning or antiplatelets (e.g., dizziness occurs.
evening meal. aspirin,
May increase by clopidogrel), Patient/family
50 mg/day at NSAIDs (e.g., teaching:
7-day intervals ibuprofen, • Dry mouth may
up to 200 ketorolac, be relieved by
mg/day. naproxen), sugarless gum,
ELDERLY, thrombolytics sips of water.
CHILDREN (e.g., alteplase) • Report
6–12 YRS: may increase risk of headache,
Initially, 25 bleeding. May fatigue, tremor,
mg/day. May increase sexual
increase by 25– concentration, risk dysfunction.
50 mg/day at of toxicity of highly • Avoid tasks that
7-day intervals. protein-bound require alertness,
Maximum: 200 medications (e.g., motor skills until
mg/day. digoxin, warfarin). response to drug
Panic Disorder, MAOIs (e.g., is established
Post-Traumatic phenelzine, (may cause
Stress Disorder selegiline) may dizziness,
(PTSD), Social cause neuroleptic drowsiness).
Anxiety malignant • Take with food if
Disorder (SAD) syndrome, serotonin nausea occurs.
PO: syndrome. • Inform physician
ADULTS, Concomitant use of if pregnancy
ELDERLY: other serotonergic occurs.
Initially, 25 drugs (e.g., • Avoid alcohol.
mg/day. May buspirone, • Do not take
increase by 50 carBAMazepine, OTC medications
mg/day at 7-day fentanyl, linezolid, without consulting
intervals. Range: SNRIs [e.g., physician.
50–200 mg/day. duloxetine, • Report
Maximum: 200 venlafaxine], worsening of
mg/day. triptans [e.g., depression,
Premenstrual sumatriptan]) may suicidal ideation.
Dysphoric cause serotonin
Disorder syndrome. May
(PMDD) increase
PO: concentration,
ADULTS: toxicity of tricyclic
Initially, 50 antidepressants
mg/day either (e.g., amitriptyline,
daily throughout doxepin).
menstrual cycle HERBAL:
or limited to Gotu kola, kava
luteal phase of kava, St. John’s
menstrual cycle. wort, valerian may
May increase up increase CNS
to 150 mg/day depression. St.
per menstrual John’s wort may
cycle in 50-mg increase risk of
increments when serotonin syndrome.
dosing
throughout FOOD: None
menstrual cycle known.
or 100 mg/day LAB VALUES: May
when dosing increase total serum
during luteal cholesterol,
phase only. triglycerides, ALT,
Dosage in Renal AST. May decrease
Impairment No serum uric acid.
dose adjustment.
Dosage in Contraindications
Hepatic Hypersensitivity to
Impairment Use sertraline. MAOI use
caution. within 14 days
(concurrently or
Administration/ within 14 days of
handling: stopping an MAOI or
PO sertraline).
• Give with food, Concurrent use of
milk if GI distress oral concentrate
occurs. • Oral (contains alcohol)
concentrate with disulfiram.
must be diluted Concurrent use with
before pimozide; initiation
administration. in pts treated with
Mix with 4 oz linezolid or
water, ginger ale, methylene blue.
lemon/lime soda, Cautions:
or orange juice Seizure disorder,
only. Give hepatic impairment,
immediately after pts at risk for uric
mixing. acid nephropathy,
elderly pts, pts in
third trimester of
pregnancy, pts at
high risk for suicide,
family history of
bipolar disorder or
mania, pts with risk
factors for QT
prolongation (e.g.,
hypokalemia,
hypomagnesemia),
alcoholism. Pts in
 whom weight loss is
undesirable.

9. Fluoxetine Availability: MOA: Side Effects: Baseline Indications:

Capsules: Selectively Frequent (greater assessment: Treatment of
Generic/Tra 10 mg, 20 mg, inhibits serotonin than 10%): Assess major depressive
de name: 40 mg. uptake in CNS, Headache, asthenia, appearance, disorder (MDD),
Fluoxetine Oral Solution: enhancing insomnia, anxiety, behavior, mood, obsessive-comp
20 mg/5 mL. serotonergic drowsiness, nausea, suicidal ulsive disorder
Prozac Tablets: 10 mg, function. diarrhea, decreased tendencies. For (OCD),
20 mg, 60 mg. Therapeutic appetite. pts on long-term binge-eating and
Specific Capsules Effect: Relieves Occasional therapy, baseline vomiting in
drug class: (Delayed-Relea depression; (9%–2%): renal function, moderate to
Antidepressa se): 90 mg. reduces Dizziness, tremor, LFT, blood counts severe bulimia
nt/SSRIs obsessive-comp fatigue, vomiting, should be nervosa,
Dosage Range: ulsive, bulimic constipation, dry performed at premenstrual
Use lower or behavior. mouth, abdominal baseline and dysphoric
less frequent pain, nasal periodically disorder
doses in pts with Onset: congestion, thereafter. (PMDD), panic
renal/hepatic 2–4 weeks of diaphoresis, rash. disorder with or
impairment, pts beginning treat- Rare (less than Intervention/eval without
with concurrent ment, with about 2%): uation: agoraphobia.
disease or 10% of the Flushed skin, Supervise Treatment of
multiple eventual lightheadedness, suicidal-risk pt resistant or
medications, the responders impaired closely during bipolar 1
elderly. starting to feel concentration. early therapy (as depression (with
Depression better after 6 depression OLANZapine).
PO: weeks in an Drug Interactions: lessens, energy OFF-LABEL:
ADULTS, 8-week trial DRUG:NSAIDs level improves, Treatment of
ELDERLY: (e.g., ibuprofen, increasing suicide fibromyalgia,
Initially, 5–20 mg Peak: ketorolac, potential). post-traumatic
each morning. 6-8 hr naproxen), Monitor mental stress disorder
May increase antiplatelets (e.g., status, anxiety, (PTSD),
after several wks Duration: clopidogrel), social functioning, Raynaud’s
by 20 mg/day. anticoagulants (e.g., appetite, phenomena,
Maximum: 80 warfarin) may nutritional intake. social anxiety
mg/day as single increase risk of Monitor daily disorder,
or 2 divided bleeding. Alcohol, pattern of bowel selective mutism.
doses. PROzac other CNS activity, stool
Weekly: 90 depressants (e.g., consistency.
mg/wk, begin 7 lorazepam, Assess skin for
days after last morphine, zolpidem) rash. Monitor
dose of 20 mg in may increase CNS serum LFT,
pts maintained depression. MAOIs glucose, sodium;
on 20 mg/day. (e.g., phenelzine, weight
CHILDREN selegiline) may
8–18 YRS: produce serotonin Patient/family
Initially, 10–20 syndrome and teaching:
mg/day. neuroleptic • Maximum
Lower-weight malignant therapeutic
children may be syndrome. May response may
started at 10 increase require 4 or more
mg/day and concentration/toxicit wks of therapy.
increased to 20 y of phenytoin, • Do not abruptly
mg/day after 1 tricyclic discontinue
wk if needed. antidepressants medication.
Panic Disorder (e.g., amitriptyline, • Avoid tasks that
PO: doxepin, require alertness,
ADULTS, nortriptyline). motor skills until
ELDERLY: HERBAL:Gotu kola, response to drug
Initially, 10 kava kava, St. is established.
mg/day. May John’s wort, valerian • Avoid alcohol.
increase to 20 may increase CNS • To avoid
mg/day after 1 depression. St. insomnia, take
wk. May further John’s wort may last dose of drug
increase dose increase effects, risk before 4 PM.
after several of serotonin
weeks. syndrome.
Maximum: 60 FOOD: None
mg/day. known.
Bulimia LAB VALUES: May
Nervosa decrease serum
PO: sodium. May
ADULTS: 60 mg increase serum ALT,
each morning. AST
May titrate to 60
mg over several Contraindications
days. Hypersensitivity to
Obsessive-Com FLUoxetine. Use of
pulsive MAOIs within 5
Disorder (OCD) weeks of
PO: discontinuing
ADULTS, FLUoxetine or within
ELDERLY: 14 days of
Initially, 20 discontinuing
mg/day. May MAOIs. Initiation in
increase after pts receiving
several wks. linezolid or
Usual dose: methylene blue. Use
20–60 mg/day. with pimozide or
Maximum: 80 thioridazine. Note:
mg/day. Do not initiate
CHILDREN thioridazine until 5
7–18 YRS: weeks after
Initially, 10 discontinuing
mg/day. May fluoxetine.
increase to 20 Cautions: Seizure
mg/day after 2 disorder, cardiac
wks. Range: dysfunction (e.g.,
20–60 mg/day. history of MI),
Depression diabetes, pts with
Associated with risk factors for QT
Bipolar prolongation,
Disorder concurrent use of
PO: medication that
ADULTS, increases QT
ELDERLY, interval,
CHILDREN renal/hepatic
10–17 YRS: impairment, pts at
(with high risk for suicide,
OLANZapine):In in pts where weight
itially, 20 mg/day. loss is undesirable,
May increase elderly. Pts at risk of
after several acute narrow-angle
wks. Range: 20– glaucoma or with
50 mg/day. increased
Premenstrual intraocular pressure.
Dysphoric
Disorder
(PMDD)
(Sarafem)
PO:
ADULTS: 20
mg/day
continuously or
20 mg/day
beginning 14
days prior to
menstruation
and continuing
through first full
day of menses
(repeated with
each cycle).
Dosage in
Renal/Hepatic
Impairment Use
caution.

Administration/
handling:
PO
• Give without
regard to food,
but give with
food, milk if GI
distress occurs. •
Bipolar disorder:
Give once daily
in evening.
• Depression,
OCD: Give once
daily in morning
or twice daily
(morning and
noon).
• Bulimia: Give
once daily in
morning.
10. Lithium Availability: MOA: Side Effects: Baseline Indications:
Carbonate Capsules: Changes cation Side effects are assessment: Management of
150 mg, 300 mg, transport across dose related and Question history bipolar disorder.
Generic/Tra 600 mg. cell membrane seldom occur at of cardiac/thyroid Treatment of
de name: Oral Solution: in nerve/muscle lithium serum levels disease, renal mania in pts with
Lithium 300 mg/5 mL. cells; influences less than 1.5 mEq/L. impairment. bipolar disorder.
Carbonate Tablets: reuptake of Occasional: Fine Assess hydration OFF-LABEL:
300 mg. serotonin/norepi hand tremor, status. Assess Augmenting
Lithobid Tablets nephrine. polydipsia, polyuria, mental status agent for
(Extended-Rele Therapeutic mild nausea. (e.g., mood, depression
Specific ase): Effect: Stabilizes Rare: Weight gain, behavior). Serum
drug class: 300 mg, 450 mg. mood, reducing bradycardia, lithium levels
Bipolar episodes of tachycardia, acne, should be tested
Disorder Dosage Range: mania. rash, muscle q3–4days during
Agent During acute twitching, peripheral initial phase of
phase, a Onset: cyanosis, therapy, q1–2mos
therapeutic serum pseudotumor cerebri thereafter, and
lithium (eye pain, wkly if there is no
concentration of
Peak: headache, tinnitus, improvement of
0.6–1.2 mEq/L is
vision disturbances). disorder or
required. For
long-term control, adverse effects
desired level is Duration: Drug Interactions: occur.
0.8–1 mEq/L. DRUG: Diuretics
Monitor serum (e.g., furosemide), Intervention/eval
drug NSAIDs, uation:
concentration, metroNIDAZOLE, Clinical
clinical response ACE inhibitors (e.g., assessment of
to determine enalapril, lisinopril), therapeutic effect,
proper dosage.
angiotensin II tolerance to drug
Usual Dosage
antagonists, SSRIs effect is
PO:
(e.g., escitalopram, necessary for
ADULTS,
paroxetine, correct
ELDERLY,
sertraline), calcium dosing-level
CHILDREN
channel blockers management.
OLDER THAN
(e.g., losartan, Assess behavior,
12 YRS:
valsartan) may appearance,
(Immediate-Rel
increase lithium emotional status,
ease): 300 mg
concentration, risk response to
3–4 times/day.
of toxicity. HERBAL: environment,
Gradually
None significant. speech pattern,
increase based
FOOD: None thought content.
on
known. Monitor serum
response/tolerab
lithium
ility.
(Extended-Rele LAB VALUES: May concentrations,
ase): 450 mg increase serum CBC with
twice daily. glucose, differential,
Gradually immunoreactive urinalysis,
increase based parathyroid creatinine
on hormone, calcium. clearance.
response/tolerab Therapeutic serum Monitor renal,
ility. Usual level: 0.6–1.2 hepatic, thyroid,
dose:(Immediat mEq/L; toxic serum cardiovascular
e-Release): level: greater than function; serum
900– 1,800 1.5 mEq/L. electrolytes.
mg/day in 3–4 Assess for
divided doses. Contraindications increased urinary
(Extended-Rele Hypersensitivity to output, persistent
ase): 900–1,800 lithium. Severely thirst. Report
mg in 2 divided debilitated pts, polyuria,
doses. severe prolonged
CHILDREN cardiovascular vomiting,
6–12 YRS: disease, concurrent diarrhea, fever to
(Immediate-Rel use with diuretics, physician (may
ease): 15–60 severe dehydration, need to
mg/kg/day in 3–4 severe renal temporarily
divided doses disease, severe reduce or
not to exceed sodium depletion or discontinue
usual adult dose. dehydration. dosage). Monitor
Cautions: for signs of
Administration/ Mild to moderate lithium toxicity.
handling: cardiovascular Assess for
PO disease, thyroid therapeutic
• Administer with disease, elderly, response
meals, milk to mild to moderate (interest in
decrease GI renal impairment, surroundings,
upset. medications altering improvement in
• Do not break, sodium excretion, self-care,
crush, dissolve, pregnancy, pts at increased ability
or divide risk for suicide, pts to concentrate,
extended-releas with significant fluid relaxed facial
e tablets. loss, pts receiving expression).
neuromuscular Monitor lithium
blocking agents. levels q3–4days
at initiation of
therapy (then
q1–2mos). Obtain
lithium levels
8–12 hrs
postdose.
Therapeutic
serum level:
0.6–1.2 mEq/L;
toxic serum
level: greater
than 1.5 mEq/L.

Patient/family
teaching:
• Limit alcohol,
caffeine intake.
• Avoid tasks
requiring
coordination until
CNS effects of
drug are known.
• May cause dry
mouth.
• Maintain
adequate salt,
fluid intake (avoid
dehydration).
• Report vomiting,
diarrhea, muscle
weakness,
tremors,
drowsiness,
ataxia.
• Monitoring of
serum level is
necessary to
determine proper
dose.
11. Sodium Availability: MOA: Side Effects: Baseline Indications:
Valproate Capsules Directly Frequent: assessment: Monotherapy/adj
(Depakene): increases Epilepsy: Anticonvulsant: unctive therapy
Generic/Tra 250 mg. concentration of Abdominal pain, Review history of of complex
de name: Capsules, inhibitory irregular menses, seizure disorder partial seizures,
Valproic acid Sprinkle neurotransmitter diarrhea, transient (intensity, simple and
(Depakote gammaaminobut alopecia, frequency, complex
Depakote, Sprinkle): yric acid indigestion, nausea, duration, level of absence
Depacon, 125 mg. (GABA). vomiting, tremors, consciousness). seizures.
Depakene Injection, Therapeutic fluctuations in body Initiate safety Adjunctive
Solution Effect: weight. Mania measures, quiet therapy of
Specific (Depacon): Decreases (22%–19%): dark multiple seizures
drug class: 100 mg/mL. seizure activity, Nausea, environment. including
Anticonvulsa Syrup stabilizes mood, drowsiness. CBC should be absence
nt/Antimanic (Depakene): prevents Occasional: performed before seizures.
250 mg/5 mL. migraine Epilepsy: and 2 wks after Additional uses
Tablets, headache. Constipation, therapy begins, for Depakote,
Delayed-Releas dizziness, then 2 wks Depakote ER,
e (Depakote): Onset: drowsiness, following Stavzor:
125 mg, 250 mg, headache, skin maintenance Treatment of
500 mg. Tablets, rash, unusual dose. Obtain manic episodes
Extended-Relea Peak: excitement, baseline LFT. with bipolar
se (Depakote restlessness. Antimanic: disorder,
ER): Mania (12%–6%): Assess behavior, prophylaxis of
250 mg, 500 mg. Duration: Asthenia, abdominal appearance, migraine
pain, dyspepsia, emotional status, headaches.
Dosage Range: rash. response to OFF-LABEL:
Seizures Rare: Epilepsy: environment, Refractory status
PO: Mood changes, speech pattern, epilepticus,
ADULTS, diplopia, nystagmus, thought content. diabetic
ELDERLY, spots before eyes, Antimigraine: neuropathy.
CHILDREN 10 unusual Question pt Mood stabilizer
YRS AND bleeding/bruising regarding onset, for behaviors in
OLDER: Initially, location, duration dementia.
10– 15 Drug Interactions: of migraine,
mg/kg/day in 1–3 DRUG: possible
divided doses. Carbapenems (e.g., precipitating
May increase by meropenem), symptoms.
5–10 mg/kg/day CYP3A4 inducers
at wkly intervals (e.g., Intervention/eval
up to 60 carBAMazepine, uation:
mg/kg/day. phenytoin, rifAMPin) Monitor CBC,
Usual adult may decrease LFT, serum
dosage: concentration/effects ammonia.
1,000–2,500 . May alter effect of Anticonvulsant:
mg/day. warfarin. May Observe
IV: increase frequently for
ADULTS, concentration of recurrence of
ELDERLY, lamoTRIgine. seizure activity.
CHILDREN: Topiramate may Assess skin for
Same frequency increase risk of ecchymoses,
as oral dose. elevated serum petechiae.
Manic Episodes ammonia levels. Monitor for
PO: HERBAL: clinical
(Depakote): Evening primrose improvement
ADULTS, may decrease (decrease in
ELDERLY: seizure threshold. intensity/frequenc
Initially, 750 FOOD: y of seizures).
mg/day in None known. Antimanic:
divided doses. LAB VALUES: Question for
Maximum: 60 May increase serum suicidal ideation.
mg/kg/day. LDH, bilirubin, ALT, Assess for
PO: AST. Therapeutic therapeutic
(Extended-Rele serum level: response
ase [Depakote 50–100 mcg/mL; (interest in
ER]):Initially, 25 toxic serum level: surroundings,
mg/kg/day once greater than 100 increased ability
daily. mcg/mL. to concentrate,
Maximum: 60 relaxed facial
mg/kg/day. Contraindications expression).
(Delayed-Relea Hypersensitivity to Antimigraine:
se [Stavzor]): valproic acid. Active Evaluate for relief
Initially, 750 hepatic disease, of migraine
mg/day in urea cycle headache and
divided dose. disorders, known resulting
Titrate to lowest mitochondrial photophobia,
therapeutic disorders; migraine phonophobia,
dose. prevention in nausea, vomiting.
Maximum: 60 pregnant women. Therapeutic
mg/kg/day Cautions: serum level:
Prevention of Children younger 50–100 mcg/mL;
Migraine than 2 yrs. Pts at toxic serum
Headaches risk for level: greater
PO: hepatotoxicity. than 100
(Extended-Rele History of hepatic mcg/mL.
ase [Depakote impairment,
ER]): ADULTS, bleeding Patient/family
ELDERLY: abnormalities, pts at teaching:
Initially, 500 high risk for suicide, • Do not abruptly
mg/day for 7 elderly pts. discontinue
days. May medication after
increase up to long-term use
1,000 mg/day. (may precipitate
PO: seizures). • Strict
(Delayed-Relea maintenance of
se [Depakote]): drug therapy is
ADULTS, essential for
ELDERLY, seizure control.
CHILDREN 16 • Avoid tasks that
YRS AND require alertness,
OLDER: Initially, motor skills until
250 mg twice response to drug
daily. May is established.
increase up to • Drowsiness
1,000 mg/day. usually
ADULTS, disappears during
ELDERLY, continued
CHILDREN 12 therapy.
YRS AND • Avoid alcohol.
OLDER: • Report liver
(Stavzor):250 problems such as
mg twice daily. nausea, vomiting,
May increase to lethargy, altered
1,000 mg/day. mental status,
Dosage in weakness, loss of
Renal appetite,
Impairment abdominal pain,
No dose yellowing of skin,
adjustment. unusual
Dosage in bruising/bleeding.
Hepatic • Report if seizure
Impairment control worsens,
Mild to moderate suicidal ideation
impairment: Not (depression,
recommended. unusual changes
Severe in behavior,
impairment: suicidal thoughts)
Contraindicated. occurs.
Administration/
handling:
IV
Reconstitution •
Dilute each
single dose with
at least 50 mL
D5W, 0.9%
NaCl, or lactated
Ringer’s.
Rate of
Administration
• Infuse over 60
min at rate of 20
mg/min or less. •
Alternatively,
single doses of
up to 45 mg/kg
given over 5–10
min (1.5–6
mg/kg/min).
Storage
• Store vials at
room
temperature.
• Diluted
solutions stable
for 24 hrs.
• Discard unused
portion. PO
• May give
without regard to
food. Do not mix
oral solution with
carbonated
beverages (may
cause
mouth/throat
irritation).
• May sprinkle
capsule
(Depakote
Sprinkle)
contents on
applesauce and
give immediately
(do not chew
sprinkle beads).
• Give
delayed-release/
extended-releas
e tablets whole.
Do not crush,
break, open
delayed-release
capsule
(Stavzor).
•Regular-release
and
delayed-release
formulations
usually given in
2–4 divided
doses/day.
Extended-releas
e formulation
(Depakote ER)
usually given
once daily.
12. Biperiden Availability: MOA: Side Effects: • Expect to give Indications:
Hcl Biperiden HCl Blocks CNS: I.V. or I.M. As adjunct to
(Akidin) 2 mg acetylcholine’s Agitation, confusion, biperiden when treat all forms of
Generic/Tra tablet action at delirium, delusions, patient needs Parkinson’s
de name: cholinergic depression, more rapid disease. To
Biperiden Hcl Dosage Range: receptor sites. disorientation, response than control
Adults: The initial This action dizziness, oral drug can extrapyramidal
Akidin dose is 1 mg restores the drowsiness, provide. symptoms
(1/2 tablet) in brain’s normal euphoria, •Assess muscle (except tardive
Specific two divided dopamine and excitement, fever, rigidity and dyskinesia)
drug class: dose. The dose acetylcholine hallucinations, tremor as caused by
Anticholinergi may be adjusted balance, which headache, baseline. Then phenothiazines
c to 2 mg (1 tablet) relaxes muscle lightheadedness, check them often and other
daily up hc movement and listlessness, for improvement, neuroleptic drugs
maximum dose decreases memory loss, indicating
al 16 mg (8 rigidity and nervousness, biperiden’s
tablets) daily. tremors. paranoia, psychosis, effectiveness.
The total daily Biperiden also weakness WARNING:
dose must be may inhibit CV: When giving
given evenly dopamine Hypotension, mild biperiden to
throughout the reuptake and bradycardia, patient with
day. storage, which orthostatic drug-induced
Drug-Induced prolongs hypotension, extrapyramidal
Extrapyramidal dopamine’s palpitations, reactions, be alert
Symptoms action. tachycardia for worsening of
Adults-. 1 to 4 EENT: psychiatric
mg may be given Onset: Blurred vision, symptoms.
to patient in one diplopia, dry mouth, patient teaching
to four divided increased
doses Peak: intraocular pressure,
concomitantly 1.5 hrs mydriasis, Patient/family
given with narrow-angle teaching:
neuroleptics Duration: glaucoma, • Caution patient
depending a the suppurative parotitis to avoid driving
severity ol the GI: and other
symptoms. Constipation, activities that
Children 3 —15 duodenal ulcer, require alertness
years of age: 1 epigastric distress, until biperiden’s
to 2 mg may be ileus, nausea, CNS effects are
given to patient vomiting known.
in one to three GU: WARNING:
divided doses. Because
biperiden
Or as prescribed Dysuria, urinary decreases
by a physician. hesitancy, urine sweating, urge
retention patient to avoid
Administration/ MS: extremely hot and
handling: Muscle spasms, humid conditions
Treatment of muscle weakness to reduce risk of
Biperiden HCI SKIN: heatstroke and
(Akidin) is Decreased severe
usually given sweating, hyperthermia.
with small dermatosis, flushing, This is especially
incremental rash, urticaria important for
doses, elderly patients
depending on Drug Interactions: and those who
the therapeutic DRUGS: abuse alcohol or
effect a side amantadine: have chronic
effects. Cautious Possibly increased illness or CNS
dosing is adverse disease.
necessary in anticholinergic •Emphasize the
elderly patients, effects need for periodic
especially those digoxin: eye examinations
with symptoms Possibly increased and intraocular
of organic brain serum digoxin level pressure
disease. ThE haloperidol: measurement
have been Possibly increased because
limited schizo phrenic biperiden may
experience in symptoms, cause
pediatric use of decreased serum narrow-angle
the drug product. haloperidol level, glaucoma and
and development of increase
tardive dyskinesia intraocular
bisoprolol fumarate pressure.
151 B
levodopa:
Possibly decreased
levodopa
effectiveness
phenothiazines:
Possibly reduced
phenothiazine
effects and
increased
psychiatric
symptoms
Contraindications:
Achalasia, bladder
neck obstruction,
hypersensitivity to
biperiden,
myasthenia gravis,
narrow-angle
glaucoma, prostatic
hypertrophy, pyloric
or duodenal
obstruction,
stenosing peptic
ulcer, toxic
megacolon