Drug Study of schizophrenia
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Transcript of Drug Study of schizophrenia
DRUG STUDY
Generic Name: Haloperidol
Brand Name:
Aloperidin, Bioperidolo, Brotopon, Dozic, Duraperidol (Germany), Einalon S, Eukystol,
Haldol, Halosten, Keselan, Linton, Peluces, Serenace, Serenase, and Sigaperidol
Classification(s): Typical Antipsychotic
Suggested Dose:
Individualized dose depends on indication and response.
AVAILABLE FORMS:
Haloperidol: Tablets – 0.5 mg, 1 mg, 2 mg, 5mg, 10 mg, 20 mg.
Haloperidol decanoate: Injection – 50mg/ml, 100 mg/ml
Haloperidol lactate: Injection – 5mg/ml. Oral concentration: 2 mg/ml.
Ordered dose: Haloperidol 5 mg 1 amp IM now then q 12 (January 19, 2010)
Mode of Action: Unknown. A butyrophenone that probably exerts antipsychotic effects by
blocking postsynaptic dopamine receptors in the brain.
ROUTE ONSET PEAK DURATION
P.O. Unknown 3-6 hr Unknown
I.V. Unknown Unknown Unknown
I.M. Unknown 3-9 days Unknown
(decanoate)
I.M. (lactate) Unknown 10-20 min Unknown
Indications:
♂ Psychotic disorders (Adults and children older than age 12: Dosage varies for
each patient. Initially, 0.5 to 5 mg P.O. b.i.d. or t.i.d. Or, 2 to 5 mg I.M. haldol
lactate q 4 to 8 hours, although hourly administration may be needed until
control is obtained.)
♂ Chronic psychosis requiring prolong therapy (Adults: 50 to 100 mg I.M.
haloperidol decanoate q 4 weeks.)
♂ Tourette Syndrome (Adults: 0.5 to 5 mg P.O. b.i.d., t.i.d., or p.r.n.)
Contraindications:
♂ In patients hypersensitive to drug and in those with parkinsonism, coma, CNS
depression.
♂ Use cautiously in elderly and deliberated patients; in patients with history of
seizures or EEG abnormalities, severe CV disorders, allergies, glaucoma, or
urine retention; and in those and those taking anticonvulsants anticoagulants,
antiparkinsonians, or lithium.
Drug Interaction:
Drug – Drug
♂ Anticholinergics: May increase anticholinergic effect and glaucoma. Azole antifungals,
buspirone, macrolides: May increase haloperidol level. Carbamazepine: May increase
haloperidol level. CNS depressants: May increase CNS depression. Lithium: May cause
lethargy and confusion after high doses. Methyldopa: May cause dementia. Rifampin:
May decrease haloperidol level.
Drug – Lifestyle
♂ Alcohol use: May increase CNS depression.
Side Effects:
♂ CNS: severe extrapyramidal reactions, tardive dyskinesia, sedation, drowsiness, lethargy,
headache, insomnia, confusion, vertigo.
♂ CV: tachycardia, hypotension, hypertension, ECG changes
♂ EENT: blurred vision.
♂ GI: dry mouth, anorexia, constipation, diarrhea, nausea, vomiting, dyspepsia.
♂ GU: urine retention, menstrual irregularities, priapism.
♂ Hematologic: leukocytosis.
♂ Hepatic: Jaundice.
♂ Skin: rash, other skin reactions, diaphoresis.
♂ Other: gynecomastia.
Adverse Effects:
♂ CNS: seizures and neuroleptic malignant syndrome.
♂ CV: torsades de pointes, with I.V. use.
♂ Hematologic: Leukopenia
Nursing Responsibilities:
♂ Although drug is least sedating of the antipsychotics, warn patient to avoid activities that
require alertness and good coordination until effects of the drugs are known.
♂ Educate patient that drowsiness and dizziness usually subside after a few weeks.
♂ Inform patient to avoid alcohol while taking this drug.
♂ Tell patient to relieve dry mouth with sugarless gum or hard candy.
♂ Always remember, don’t give deconate form IV.
♂ Monitor the client for signs of tardive dyskinesia which may occur after prolonged use. It
may not appear until months or years later and may disappear spontaneously or persist for
life, despite ending drug.
♂ Watch out for signs and symptoms of neuroleptic malignant syndrome, which is rare but
fatal.
♂ Inform patient to do not withdraw the drug abruptly unless required by severe adverse re-
actions.
♂ Remind patient to always protect the drug from light. Slight yellowing injection or con-
centrate is common and doesn’t affect potency. Discard the drug if there is a markedly
discolorations in the solutions.
♂ Stop taking haloperidol and check the patient with their doctor right away if they have
any of the following symptoms while using haloperidol: convulsions (seizures); difficulty
with breathing; a fast heartbeat; a high fever; high or low blood pressure; increased
sweating; loss of bladder control; severe muscle stiffness; unusually pale skin; or tired-
ness. These could be symptoms of a serious condition called neuroleptic malignant syn-
drome (NMS).
BIBLIOGRAPHY: 26th Edition Nursing 2006 Drug Handbook by Lippincott
Williams and Wilkins; Phil. Pharmaceutical Directory Review, 7th edition.
Generic Name: Flupentixol
Brand Name: Fluanxol; Depixol; Depixol Low Volume; Depixol-Conc
Classification(s): Typical Antipsychotics
Ordered dose: Flupentixol decanoate 20 mg 1 amp now then q monthly (January
19, 2010)
Mode of Action: Flupenthixol is a type of thioxanthene drug and acts by antagonism of D1
and D2 dopamine receptors (as well as serotonin). Side effects are similar
to many other typical antipsychotics, namely extrapyramidal symptoms
of akathisia, parkinsonian tremor and rigidity. However, anticholinergic
adverse effects are low.
The typical antipsychotics are less commonly used now that
the atypical antipsychotics are available (with less side effects).
Indications:
♂ Schizophrenia and other psychoses
Dose: oral (rarely used) - initially 3-9mg twice daily, max. dose 18mg/day
Depot antipsychotic (Depixol) (brand name: Fluanxol Depot in Australia)
o test dose of 20mg IM,
o if tolerated, further dose of 20-40mg after 7 days,
o usual interval 2-4 weeks between doses,
o usual maintenance dose between 50mg every 4 weeks and 300mg every 2 weeks,
o max. 400mg IM weekly.
♂ Depression
Dose:
o initially 1mg/day, increased after 1 week to 2mg/day,
o use half above doses in the elderly,
o max 3mg/day (2mg in the elderly),
o doses above 2mg (1mg in the elderly) should be gived as divided doses.
Contraindications:
♂ If patient is allergic to flupentixol or any other medicine of this class.
♂ If patient is allergic to any other medicine including preservative and dyes.
♂ Elderly people should be prescribed flupentixol with caution.
♂ If patient has history of kidney problem, liver problem or epilepsy.
♂ If patient has a problem of heart disease, high blood pressure or diabetes.
♂ If patient has a problem of enlarged prostate, thyroid problem or Parkinson’s disease.
♂ If two drugs are taken together, they may interact with each other. If patient is taking
any prescribed or non-prescribed, food supplements or herbal medicine.
♂ If patient is pregnant, or plan to become pregnant.
Drug Interaction:
♂ Prescription and nonprescription medications, especially those that may cause
drowsiness such as: sedatives, narcotic pain relievers (e.g., codeine), anti-anxiety
agents (e.g., diazepam), antidepressants or other psychiatric medicine, dopamine-type
drugs (e.g., cabergoline, pergolide, bromocriptine, pramipexole), muscle relaxants
(e.g., cyclobenzaprine), drowsiness-causing antihistamines (e.g., diphenhydramine),
atropine-like drugs, anti- seizure drugs.
♂ Many cough-and-cold products contain ingredients that may add a drowsiness effect.
Side Effects:
Nausea, drowsiness, dizziness, diarrhea, constipation, blurred vision, insomnia, urine
problem, tremor, weakness, vomiting, and difficulty in breathing, slow heart rate, ir-
regular blood pressure and convulsions.
Less common side effects of flupentixol include skin rashes, muscle problem, dizzi-
ness while rising from bed, sore throat, dark urine, increased sweating, yellowness of
skin and eyes, decreased sex drive and painful erection, chest pain and muscle
spasms.
Nursing Responsibilities:
♂ Educate patient that Flupentixol can cause drowsiness, dizziness and blurred vision.
♂ Remind client that alcohol will increase feelings of drowsiness.
♂ Remind patient that before having any surgery, including dental or emergency treat-
ment, tell the surgeon, doctor or dentist that you are taking flupentixol.
♂ Inform client that Flupentixol can occasionally cause a dry mouth. If patient experi-
ences 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 acci-
dent 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, drowsi-
ness, 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.
BIBLIOGRAPHY: 26th Edition Nursing 2006 Drug Handbook by Lippincott
Williams and Wilkins; Phil. Pharmaceutical Directory Review, 7th edition.
Generic Name: Biperiden
Brand Name: Akineton, Benzum 2, Berofin, Biperen, Bipiden, Desiperiden
Classification(s): Anti-Parkinson's Agent, Anticholinergic
Suggested Dose:
Adults:
Parkinsonism: 2 mg 3-4 times/day
Extrapyramidal: 2 mg 1-3 times/day
Elderly: Initial: 2 mg 1-2 times/day
Ordered dose: Biperiden Hcl 2 mg / tab 1 tab B.I.D. prn for EPS (January 19,
2010)
Mode of Action: Biperiden is a weak peripheral anticholinergic agent with nicotinolytic
activity. The beneficial effects in Parkinson's disease and neuroleptic-
induced extrapyramidal symptoms are believed to be due to the inhibition
of striatal cholinergic receptors.
Indications:
♂ Adjunctive treatment of all forms of Parkinson's disease (postencephalitic, idiopathic, and
arteriosclerotic).
♂ Improve parkinsonian signs and symptoms related to antipsychotic drug therapy.
♂ Relieves muscle rigidity, reduces abnormal sweating and salivation, improves abnormal
gait, and to lesser extent, tremor.
Contraindications:
♂ Hypersensitivity to biperiden or any component of the formulation
♂ Narrow-angle glaucoma
♂ Bowel obstruction, megacolon
♂ 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.
Drug Interaction:
Drug – Drug
♂ 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 (espe-
cially 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.
♂ 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.
Side Effects:
♂ CNS : Drowsiness, vertigo, headache, and dizziness are frequent. With high doses
nervousness, agitation, anxiety, delirium, and confusion. Biperiden may lower the
seizure-threshold.
♂ Peripheral side effects : Blurred vision, dry mouth, impaired sweating, abdominal dis-
comfort, and obstipation are frequent. Tachycardia may be noted. Allergic skin reactions
may occur.
♂ Eyes : Biperiden causes mydriasis with or without photophobia. It may precipitate narrow
angle glaucoma.
Adverse Effects:
♂ Cardiovascular: Orthostatic hypotension, bradycardia
♂ Central nervous system: Drowsiness, euphoria, disorientation, agitation, sleep disorder
(decreased REM sleep and increased REM latency)
♂ Gastrointestinal: Constipation, xerostomia, dry throat, nasal dryness
♂ Genitourinary: Urinary retention
♂ Neuromuscular & skeletal: Choreic movements
♂ Ocular: Blurred vision
Nursing Responsibilities:
♂ Instruct patient to use caution when driving, operating machinery, 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 2006 Drug Handbook by Lippincott
Williams and Wilkins; Phil. Pharmaceutical Directory Review, 7th edition
Generic Name: Chlorpromazine Hydrochloride
Brand Name: Chlorpromanyl, Largactil, Novo-Chlorpromazin, Thorazine
Classification(s): Typical Antipsychotic
Suggested Dose:
Individualized dose depends on indication and response.
AVAILABLE FORMS:
Capsules (extended release): 200 mg, 300 mg.
Injections: 25 mg/ml
Oral concentrate: 30 mg/ml, 100 mg/ml
Suppositories: 25 mg, 100 mg
Syrup: 10 mg/5ml
Tablets: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg
Ordered dose: Chlorpromazine 200g/tab (January 20, 2010)
Mode of Action: Unknown. A piperidine phenothiazine that probably blocks postsynaptic
dopamine receptors in the brain.
ROUTE ONSET PEAK DURATION
P.O. 30-60min Unknown 4-6hr
I.M., I.V. Unknown Unknown Unknown
P.R. >1hr Unknown 3-4 hr
Indications:
♂ Psychosis, mania (Adults: for hospitalized patients with acute disease, 25 mg
I.M.)
♂ Nausea and vomiting (Adults: 10 to 25 mg PO q 4 to 6 hours, p.r.n. Or, 25 mg
IM initially.)
♂ Acute intermittent porphyria, intractable hiccups (Adults: 25 to 50 mg PO
t.i.d. or q.i.d.)
♂ Tetanus (Adults: 25 to 50 mg IV or IM t.i.d. or q.i.d.)
Contraindications:
♂ In patients hypersensitive to drug; in those with CNS depression, bone mar-
row suppression, or subcortical damage, and in those in coma.
♂ Use cautiously in elderly and deliberated patients and in patients with hepatic
or renal disease, severe CV disease, respiratory disorders, hypocalcemia, glau-
coma, pr prostatic hyperplasia.
♂ Use cautiously in acutely ill or dehydrated children.
Drug Interaction:
Drug – Drug
♂ Antacids: May inhibit absorption of oral phenothiazines. Anticholinergics such as
tricyclic antidepressants, antiparkinsonians: May increase anticholinergic activity,
aggravated parkinsonian symptoms. Anticonvulsants: May lower seizure threshold.
Barbiturates, lithium: May decrease phenothiazine effect. Centrally acting anthypertensives:
May decrease antihypertensive effect. CSN depressants: May increase CNS depression.
Electroconvulsive therapy, insulin: may cause severe reactions. Lithium: May increase
neurologic effects. Meperidine: May cause excessive sedation and hypotension. Propanolol:
May increase levels of both propanolol and chlorpromazine. Warfarin: May decrease effect
of oral anticoagulants.
Drug – Lifestyle
♂ Alcohol use: May increase CNS depression, particularly psychomotor skills.
Side Effects:
♂ CNS: extra pyramidal reactions, sedation, tardive dyskinesia, pseudoparkinsonism.
♂ CV: orthostatic hypotension
♂ GI: dry mouth, constipation
♂ GU: urine retention
♂ Skin: mild photosensitivity reactions, pain at IM injection site
Adverse Effects:
♂ CNS: Seizures and neuroleptic malignant syndrome.
♂ Hematologic: Leukopenia, agranulocytosis, aplastic anemia, thrombocytopenia
Nursing Responsibilities:
♂ Obtain baseline blood pressure measurements before starting therapy, and monitor
regularly. Watch client for orthostatic hypotension.
♂ Monitor client for tardive dyskinesia, which may occur after prolonged use.
♂ Warn patient to avoid activities that require alertness or good coordination until effects of
drug are known.
♂ Remind client that drowsiness and dizziness usually subside after a few weeks.
♂ Advise patient not to crush, chew, or break extended release capsule form before
swallowing.
♂ Educate patient to avoid alcohol while taking the drug.
♂ Have the patient to report signs of urine retention or constipation.
♂ Remind patient to use sunblock and to wear protective clothing to avoid oversensitivity to
the sun.
♂ Advise client to relieve dry mouth with sugarless gum or hard candy.
♂ Withhold dose and notify prescriber if jaundice, symptoms of blood dyscrasia, or
persistent extrapyramidal reactions develop.