SANCHEZ, SARAH GRACE T.

BSN 209/GROUP 35B

Generic and Brand Name Generic name: CLOZAPINE Brand name: CLOZARIL Indication and Dosage Indication: - Management of severely ill schizophrenics who are unresponsive to antipsychotic drugs. - Reduction of the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder(not orally disintegrating tablet). Dosage: 50mg BID Action Mechanism not fully understood: Blocks dopamine receptors in the brain, depresses the RAS; ant cholinergic, antihistaminic, and alpha-adrenergic blocking activity may contribute to some of its therapeutic(and adverse) actions. Clozapine produces fewer extra pyramidal effects than other antipsychotic. Side Effects Drowsiness, sedation, seizures, dizziness, syncope, headache, tremor, distributed sleep, nightmares, restlessness, agitation, increased salivation, sweating, tardive dykinesia, neuroleptic malignant syndrome. Contraindication - Contraindicated with allergy to clozapine, myeloproliferative disorders, history of clozapine-induced agranulocytosis or severe granulocytopenia, severe CNS depression, comatose states, history of seizure disorders, lactation, therapy with other drugs that cause bone marrow suppression. - Use cautiously with CV disease, narrow-angle glaucoma, pregnancy. Nursing Consideration - Use only when unresponsive to conventional antipsychotic drugs, risk of serious CV and respiratory effects. - Monitor WBC count weekly during treatment and for 4 week thereafter. Dosage must be adjusted based on WBC count. Potentially fatal agranulocytosis has been reported. - Monitor for seizures; with history of seizures, risk increases as dose increases.

SANCHEZ, SARAH GRACE T. BSN 209/GROUP 35B

Generic and Brand Name Generic name: BIPERIDEN HYDROCHLORIDE Brand name: AKINETON Indication and Dosage Indication: - Adjunct in the therapy of parkinsonism(post-enceph alitic, arteriosclerotic, and idiopathic types). - Relief of symptoms of extra pyramidal disorders that accompany phenothiazine therapy. Dosage: 2mg PO TID Action Anticholinergic activity in the 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, kinesis and tremor characterizing parkinsonism; less effective overall than levodopa; peripheral anticholinergic effects suppress secondary symptoms of parkinsonism, such as drooling. Side Effects Disorientation, confusion, memory loss, hallucinations, psychoses, agitation, nervousness, delusions, delirium, paranoia, euphoria, excitement, light-headedness, dizziness, depression, drowsiness, weakness, giddiness, paresthesia, heaviness of the limbs(central acting anticholinergic effects). Contraindication - Contraindicated with hypersensitivity to benzotropine; glaucoma, especially angle-closure glaucoma; pyloric or duodenal obstruction, stenosing peptic ulcers, achalasia(mega-esophagu s); prostatic hypertrophy or bladder neck obstructions; myasthenia gravis. - Use cautiously with tachycardia, cardiac arrythmias, hypertension, hypotension, hepatic or renal impairment, alcoholism, chronic illness, people who work in a hot environment; hot weather; lactation; Alzheimers disease, pregnancy. Nursing Consideration - 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 and nausea occurs. - Ensure that patient voids just before receiving each dose of drug if urinary retention is a problem.