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Drug name Haloperidol

Classification: Antipsychotic Dopaminergic blocker

Action Mechanism not fully understood; antipsychotic block postsynaptic dopamine receptors in the brain depress the RAS, including those parts of the brain involved with wakefulness and emesis; chemically resembles the phenothiazines.

Indication/ Contraindication >Management of manifestation of psychotic disorder. >Control optics and vocalizations in Tourette syndrome in adults and children. >Behavioural problem in children with combative, explosive hyper excitability that cannot be attributed to immediate provocation. >Short-term treatment of hyperactive with excessive motor activity, mood liability. > Haloperidol deaconate: prolonged parenteral therapy of chronic schizophrenia. >Unlabeled uses: Control of nausea and vomiting, control of acute psychiatric situation ( IV use), Treatment of intractable hiccoughs, agitation, hyperkinesia, infantile autism. >Contraindicated with hypersensitivity to typical antipsychotics, coma or severe CNS depression, bone marrow depression, blood gyscrasia, circulatory collapse, subcortical brain damage, Parkinsons disease, liver damage, cerebral arteriosclerosis, coronary disease, severe hypotension or hypertension

Side/adverse effect >Autonomic: dry mouth, salivation, nasal congestion, nausea, vomiting, anorexia, fever, pallor, facial flushing, sweating, constipation, paralytic ileus, urinary retention, incontinence, polyuria, enuresis, priapism, ejaculation inhibition >CNS: drowsiness, insomnia, vertigo, headache, weakness, tremor, ataxia, slurring cerebral edema, seizure, exacerbation of psychotic symptoms, extrapyramidal syndrome-pseudo parkinsonism; dystonia; tardive dyskinesias, potentially irreversible(no known treatment), NMSextrapyramidal syndrome, hyperthermia, autonomic disturbances >CV: hypotension, orthostatic hypotension, hypertension, tachycardia, bradycardia, cardiac arrest, cardiomegaly, refractory arrhythmias, pulmonary edema >Endocrine: Lactation, breast, enlargement in females, galactorrhea; SIADH; amenorrhea, menstrual irregularities; gynecomastia in males, changes in libido; hyperglycemia or hypoglycaemia; glycosuria; hyponatremia; pituitary tumor with hyperprolactinemia; inhibition of ovulation, infertility, pseudo pregnancy >Hematologic: Eosinophilia, leukopenia, leucocytosis, anemia; thrombocytopenic purpura; pancytopenia >Hypersensitivity: Jaundice, urticaria, angioneuretic edema, laryngeal edema, photosensivity, eczema, asthma, anaphylactic reactions, exfoliative dermatitis >Respiratory: Bronchospasm, laryngospasm, dyspnea; suppression of cough reflex and potential for aspiration

Nursing Responsibility > Do not use haloperidol decanote for IV injections. >Gradually withdraw drug when patient has been on maintenance therapy to avoid withdrawal-emergent dyskinesias. > Discontinue drug if serum creatinine or BUN become abnormal or if WBC count is depressed. > Monitor elderly patient for dehydration; institute remedial measure promptly; sedation and decreased thirst related to CNS effects can lead to severe dehydration. > Take this drug exactly as prescribed. > Avoid driving or engaging in other dangerous activities if dizziness or drowsiness or vision changes occur. > Avoid prolonged exposure to sun, or use a sunscreen or covering garments. > Maintain fluid intake, and use precautions against heatstroke in hot weather. > Report sore throat, fever, unusual bleeding or bruising, rash, weakness, tremor, impaired vision, dark-colored urine (pink or reddish brown urine is to be expected), pale stools, yellowing of the skin or eyes.

Drug name Biperiden

Action Anticholinergic activity in CNS that is believed to help normalize the hypothesized imbalance of cholinergic and dopaminergic neurotransmission in the basal ganglia in the brain of a parkinsonism patient. Reduces severity of rigidity, and to a lesser extent, akinesia and tremor characterizing parkinsonism; less effective overall than levodopa; peripheral anticholinergic effect suppress secondary symptoms of parkinsonism, such as drooling.

Indication/ Contraindication >Adjunct in the therapy of parkinsonism (postencephalitic, arteriosclerotic, and idiopathic types) >relief of symptoms of extrapyramidal disorders that accompany phenothiazine therapy >Contraindicated with hypersensitivity to benzotropine; glaucoma, especially angleclosure glaucoma; pyloric and duodenal obstraction,stenosing peptic ulcers, achalasia (megaesophagus);prostatic hypertrophy or bladder neck obstructions; myasthenia gravis

Side/adverse effect >CNS: Disorientation, confusion, memory loss, hallucinations, psychoses, agitation, nervousness, delusions, delirium, paranoia, euphoria, excitement, light-headedness, dizziness, depression, drowsiness, weakness, giddiness, paraesthesia, heaviness of the limbs(centrally acting anticholinergic effects) >CV: Tachycardia, palpitations, hypotension, orthostatic hypotension (peripheral anticholinergic effects) >Dermatologic: Rash, urticaria, other dermatomes >EENT: Blurred vision, mydriasis, diplopia, increased intraocular tension, angle-closure glaucoma >GI: Dry mouth, constipation, dilatation of the colon, paralytic ileus, acute supportive parotitis, nausea, vomiting, epigastric distress >GU: Urinary retention, urinary hesitancy, dysuria, difficulty achieving or maintaining an erection >Other: flushing, decrease sweating, elevated temperature, muscular weakness, muscular cramping

Nursing Responsibility > Decrease dosage or discontinue temporarily if dry mouth makes swallowing or speaking difficult. > Give with meals if GI upset occurs: give before meals to patients with dry mouth; give after meals if drooling or nausea occurs. > Ensure that patient voids just before receiving each dose of drug if urinary retention is a problem. > Take this drug exactly as prescribed. >Avoid the use of alcohol, sedatives and over the counter drugs. > Report difficulty or painful urination; constipation, rapid or pounding heartbeat; confusion, eye pain, or rash.

Classification: Antiparkinsoni an

Drug name Divalproex Sodium

Classification: Aniepileptic

Action Mechanism of action not understood: Antiepileptic activity may be related to the metabolism of the inhibitory neurotransmitter, GABA; divalproex sodium is a compound containing equal proportions of valproic acid and sodium valproate

Indication/ Contraindication >Valproic acid: Sole and adjunctive therapy in simple(petit mal) and complex absence seizures; acute treatment of manic episodes associated with bipolar disorder; prophylaxis o migraine headache; adjunctive therapy for multiple seizure disorders >Depakote ER: Treatment of epilepsy in children 10 yr and older; treatment of acute manic or mixed episodes associated with bipolar disorder, with or without psychotic features >Depakote ER: Treatment of bipolar mania > Depakote, Depakote ER: Prophylaxis of migraine headaches >Divalproex, sodium valproate injection: Treatment of complex partial seizures as immunotherapy or with other antiepileptics Unlabeled uses: Adjunct in symptom management of schizophrenia, treatment of aggressive outbursts in children with ADHD, organic brain syndrome >Contraindicated with hypersensitivity to valproic acid, hepatic disease, or significant hepatic impairment.

Side/adverse effect >CNS: Sedation, tremor (may be dose related), emotional upset, depression, psychosis, aggression, hyperactivity, behavioural deterioration, weakness, suicidality >Dermatologic: Transient increases in hair loss, rash, petechiae >GI: Nausea, vomiting, indigestion, diarrhea, abdominal cramps, constipation, anorexia with weight loss, increased appetite with weight gain, life-threatening pancreatitis, hepatic failure; elevated liver enzyme, serum bilirubin >GU: Irregular menses, secondary amenorrhea >Hematologic: Altered bleeding time; thrombocytopenia; bruising; hematoma formation; frank hemorrhage; relative lymphocytosis; hypofibrinogenemia; leukopenia, eosinophilia, anemia, bone marrow suppression

Nursing Responsibility > Give drug with food if GI upset occur; substitution of the enteric-coated formulation also may be of benefit; have patient swallow ER tablet whole; do not cut, crush, or chew. > Be aware that patient may be at increased risk for suicidal ideation and suicidality; monitor accordingly. >Monitor ammonia levels, and discontinue if there is clinically significant elevation in level. > Monitor serum levels of valproic acid and other antiepileptics given concomitantly, especially during the first few weeks of therapy. Adjust dosage on the basis of these data and clinical response. > Take this drug exactly as prescribed. Do not chew tablet or capsules before swallowing them. Swallow them whole to prevent local irritation of mouth and throat. Depakote Sprinkle tablets may be opened and sprinkled on applesauce or pudding. > Do not discontinue this drug abruptly or change dosage, except on the advice of your health care provider. > Avoid alcohol and sleep-inducing and over-the-counter drugs. These could cause dangerous effects.

Drug name Chlorpromazi ne hydrochloride

Action Mechanism not fully understood; antipsychotic drugs blocks postsynaptic dopamine receptors in the brain; depress those parts of the brain involved with wakefulness and emesis; anticholinergic, antihistaminic (H1), and alpha adrenergic blocking.

Indication/ Contraindication >Management of manifestations of psychotic disorder; control of manic phase of manic depressive illness. >Relief of preoperative restlessness and apprehension. >Adjunct in treatment of tetanus. >Acute intermittent porphyria therapy. >Severe behavioural problems in children. >Therapy for combativeness, hyperactivity. >Control of nausea and vomiting and intractable hiccups. Contraindication >Contraindicated with allergy to chlorpromazine, comatose or severely depressed states, bone marrow depression, circulatory circulation, subcortical brain damaged, Parkinsons disease, liver damage, cerebral or coronary arteriosclerosis, severe hypotension or hypertension.

Side/adverse effect >CNS: Drowsiness, insomnia, vertigo, headache, weakness, tremor, ataxia, slurring, cerebral edema, seizures, exacerbation of psychotic symptoms, extrapyramidal syndromes, neuroleptic malignant syndrome, tardive dyskinesia >CV: Hypotension, orthostatic hypotension, hypertension, tachycardia, bradycardia, cardiac arrest, heart failure, cardiomegaly, refractory arrhythmias, pulmonary edema. >EENT: Nasal congestion, glaucoma, photophobia, blurred vision, meiosis, mydriasis, deposits in the cornea and lens, pigmentary retinopathy. >Endocrine: Lactation; breast engorgement in females; galactorrhea; SIADH; amenorrhea; menstrual irregularities; gynecomastia; changes in libido; hyperglycaemia; inhibition of ovulation; infertility; pseudo pregnancy; reduced urinary levels of gonadotropins, estrogens, and prostaglandin. >GI: Dry mouth, salivation, nausea, vomiting, anorexia, constipation, paralytic ileus, incontinence >GU: Urinary retention, polyuria, incontinence, priapism, ejaculation inhibition, male impotence, urine discoloured pink to red-brown. >Hematologic: Eosinophilia, leukopenia, leucocytosis, anemia, aplastic anemia, haemolytic anemis, thrombocytopenic or nonthrombocytopenic purpura, pancytopenia, elevated serum cholesterol. >Hypersensitivity: Jaundice, urticaria, angioneurotic edema, laryngeal edema, photosensitivity, eczema, asthma, anaphylactic reaction, exfoliative dermatitis, contact dermatitis.

Nursing Responsibility >Do not give by subcutaneous injection; give slowly by deep IM injection into upper outer quadrant of buttocks. >Keep patient recumbent 30 min after injection to avoid orthostatic hypotension. >If giving drug via continuous infusion for intractable hiccups, keep patient flat in bed during infusion and monitor BP >Avoid skin contact with parenteral drug solution due to possible contact dermatitis. >Patient or the patients guardian should be advised about the possibility of tardive dyskinesias. >Monitor renal function tests; discontinue if serum creatine or BUN becomes abnormal. >Monitor CBC; discontinue if WBC count is depressed. >Withdraw drug gradually after high-dose therapy; possible gastritis, nausea, dizziness, headache, tachycardia, insomnia after abrupt withdrawal. >Take the drug exactly as prescribed. Avoid over-the-counter drug and alcohol unless you have consulted your health care provider. >Use caution in hot weather; risk of heatstroke; keep up fluid intake, and do not over exercise in a hot climate.

Drug classification Antiemetic Antipsychotic Anxiolytics Dopaminergic blocker Phenothiazine

>Respiratory: Bronchospasm, laryngospasm, dyspnea, suppression of cough reflex and potential aspiration. >Other: Fever, heatstroke, pallor, flushed faces, sweating, photosensitivity.

Drug name Fludac

Action Acts as an antidepressant by inhibiting CNS neuronal uptake of serotonin; blocks uptake of serotonin with Drug little effect on classification norepinephrine; little affinity for muscarinic, Antidepressant histaminergic, and alpha 1adrenergic receptors. Selective serotonin reuptake inhibitor (SSRI)

Indication/ Contraindication Treatment of depression; most effective in patients with major depressive disorder Treatment of obsessive-compulsive disorder Treatment of bulimia Treatment of PMDD (pre-menstrual dysphoric disorder) ( Sarafem) Treatment of panic disorder with or without agoraphobia ( Prozac) Unlabelled use: treatment of obesity, alcoholism, numerous psychiatric disorders, chronic pain, various neuropathies Contraindicated with hypersensitivity to fluoxetine; pregnancy. Use cautiously with impaired hepatic or renal function, diabetes mellitus, lactation.

Side/adverse effect CNS: Headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, lightheadedness, agitation, sedation, abnormal gait, convulsions CV: Hot flashes, palpitations Dermatologic: Sweating, rash, pruritus, acne, alopecia, contact dermatitis GI: Nausea, vomiting, diarrhea, dry mouth, anorexia, dyspepsia, constipation, taste changes, flatulence, gastroenteritis, dysphagia, gingivitis GU: Painful menstruation, sexual dysfunction, frequency, cystitis, impotence, urgency, vaginitis Respiratory: Upper respiratory infections, pharyngitis, cough, dyspnea, bronchitis, rhinitis Other: Weight loss, asthenia, fever

Nursing Responsibility Arrange for lower or less frequent doses in elderly patients and patients with hepatic or renal impairment. Establish suicide precautions for severely depressed patients. Limit quantity of capsules dispensed. Administer drug in the morning. If dose of > 20 mg/day is needed, administer in divided doses. Monitor patient for response to therapy for up to 4 wk before increasing dose. Switch to once a week therapy by starting weekly dose 7 days after last 20 mg/day dose. If response is not satisfactory, reconsider daily dosing. It may take up to 4 week before the full effect occurs. Take in the morning (or in divided doses if necessary). If you are taking the once weekly capsule, mark calendar with reminders of drug day. Report rash, mania, seizures, severe weight loss. Do not take this drug during pregnancy. If you think that you are pregnant or wish to become pregnant, consult with your physician.

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