DRUG STUDY

NAME OF DRUG GENERIC NAME: Haloperidol BRAND NAME: Haldol CLASSIFICATION Anti-psychotic ACTION May block postsynaptic dopamine receptors in the limbic system and increase brain turnover of dopamine, producing an antipsychotic effect. INDICATION Management of manifestations of psychotic disorders and for control of tics and vocal utterances of Gilles de la Tourettes syndrome; for treatment of agitated states in acute and chronic psychoses. Used for short-term treatment of hyperactive children and for severe behavior problems in children of combative, explosive hyperexcitability. CONTRAINDICATION Parkinsons disease, parkinsonism, seizure disorders, coma; alcoholism; severe mental depression, CNS depression; thyrotoxicosis. ADVERSE EFFECTS CNS:Extrapyramidal reactions: Parkinsonian symptoms, dystonia, akathisia, tardive dyskinesia (after longterm use); insomnia, restlessness, anxiety, euphoria, agitation, drowsiness, mental depression, lethargy, fatigue, weakness, tremor, ataxia, headache, confusion, vertigo; neuroleptic malignant syndrome, hyperthermia, grand mal seizures, exacerbation of psychotic symptoms. CV:Tachycardia, ECG changes, hypotension, hypertension (with overdosage). Endocrine:Menstrual irregularities, galactorrhea, lactation, NURSING CONSIDERATIONS

Monitor patients mental status daily. Monitor for neuroleptic malignant syndrome (NMS) , especially in those with hypertension or taking lithium. Symptoms of NMS can appear suddenly after initiation of therapy or after months or years of taking neuroleptic (antipsychotic) medication. Immediately discontinue drug if NMS suspected.Monit or for parkinsonism and tardive dyskinesia . Risk of tardive

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gynecomastia, impotence, increased libido, hyponatremia, hyperglycemia, hypoglycemia. Senses:Blurred vision. Hematologic:Mild transient leukopenia, agranulocytosis (rare). GI:Dry mouth, anorexia, nausea, vomiting, constipation, diarrhea, hypersalivation. Urogenital:Urinary retention, priapism. Respiratory:Laryngospasm, bronchospasm, increased depth of respiration, bronchopneumonia, respiratory depression. Skin:Diaphoresis, maculopapular and acneiform rash, dyskinesia appears to be greater in women receiving high doses and in older adults. It can occur after long-term therapy and even after therapy is discontinued. Monitor for extrapyramidal (neuromuscular) reactions that occur frequently during first few days of treatment. Symptoms are usually dose related and are controlled by dosage reduction or concomitant administration of antiparkinson drugs. Be alert for behavioral changes in

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photosensitivity. Other:Cholestatic jaundice, variations in liver function tests, decreased serum cholesterol. patients who are concurrently receiving antiparkinson drugs. Monitor for exacerbation of seizure activity. Observe patients closely for rapid mood shift to depression when haloperidol is used to control mania or cyclic disorders. Depression may represent a drug adverse effect or reversion from a manic state.

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NAME OF DRUG GENERIC NAME: Chlorpromazine BRAND NAME: Thorazine CLASSIFICATION Anti-psychotic ACTION Chlorpromazine is a neuroleptic that acts by blocking the postsynaptic dopamine receptor in the mesolimbic dopaminergic system and inhibits the release of hypothalamic and hypophyseal hormones. It has antiemetic, serotonin-blocking, and weak antihistaminic properties and slight ganglion-blocking activity. INDICATION Acute and chronic psychoses, particularly when accompanied by increased psychomotor activity, nausea and vomiting. Also used in the treatment of intractable hiccups. CONTRAINDICATION Cross-sensitivity may exist among phenothiazines, and should not be used in narrow-angle glaucoma and in patients who have CNS depression. ADVERSE EFFECTS CNS: neuroleptic malignant syndrome, sedation, extrapyramidal reactions, tardive dyskinesia CV: hypotension (increased with IM, IV) EENT: blurred vision, dry eyes, lens opacities

NURSING CONSIDERATIONS

GI: constipation, dry mouth, anorexia, hepatitis, ileus GU: urinary retention Hematologic: agranulocytosis, leukopenia Skin: photosensitivity, pigment changes, rashes

Assess mental status prior to and periodically during therapy. Monitor BP and pulse prior to and frequently during the period of dosage adjustment. May cause QT interval changes on ECG. Observe patient carefully when administering medication, to ensure that medication is actually taken and not hoarded. Monitor I&O ratios and daily eight. Assess patient for signs and symptoms of dehydration. Monitor for development of

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neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control. Report symptoms immediately. May also cause leukocytosis, elevated liver function tests, elevated CPK. Advise patient to take medication as directed.

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NAME OF DRUG GENERIC NAME: Biperidine Hydrochloride BRAND NAME: Akineton CLASSIFICATION Anti- cholinergic Anti- parkinsonism ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS CNS: Agitation, confusion, delirium, delusions, depression, disorientation, dizziness, drowsiness, euphoria, excitement, fever, hallucinations, headache, lightheadedness, listlessness, memory loss, nervousness, paranoia, psychosis, weakness CV: Hypotension, mild bradycardia, orthostatic hypotension, palpitations, tachycardia EENT: Blurred vision, diplopia, dry mouth, increased intraocular pressure, mydriasis, narrow-angle glaucoma, suppurative parotitis NURSING CONSIDERATIONS Expect to give I.V. or I.M. biperiden when patient needs more rapid response than oral drug can provide. Assess muscle rigidity and tremor as baseline. Then check them often for improvement indicating biperidens effectiveness. Caution patient to avoid driving and other activities that require alertness until biperidens CNS effects are known. Emphasize the need for periodic eye examinations

Blocks acetylcholines As adjunct to treat all Achalasia, bladder action at cholinergic forms of neck obstruction, receptor sites. This Parkinsons disease hypersensitivity action restores the to biperiden, brains normal myasthenia gravis, dopamine and narrow-angle acetylcholine balance, glaucoma, prostatic which relaxes muscle hypertrophy, movement pyloric or duodenal and decreases rigidity obstruction, and tremors. stenosing peptic ulcer, Biperiden also may toxic megacolon inhibit dopamine reuptake and storage, which prolongs dopamines action.

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GI: Constipation, duodenal ulcer, epigastric distress, ileus, nausea, vomiting GU: Dysuria, urinary hesitancy, urine Retention MS: Muscle spasms, muscle weakness SKIN: Decreased sweating, dermatosis, flushing, rash, urticaria and intraocular pressure measurement because biperiden may cause narrowangle glaucoma and increases intraocular pressure.