Name: R.P.

Diagnosis: Undifferentiated Schizophrenia Generic/Brand Name Chlorpromazine Dosage 100mg HS Classification Antipsychotic Mode of Action Mechanisms not fully understood; antipsychotic drugs block postsynaptic dopamine receptors in the brain; depress those parts in the brain involved with wakefulness and emesis; anticholinergic, antihistamine (H1), and alpha adrenergic blocking. Indication Acute and chronic psychoses, particularly when accompanied by increase psychomotor activity. Nausea and vomiting. Intractable hiccups. Preoperative sedation. Treatment of acute intermittent porphyria. Unlabeled uses: vascular headache. Contraindicat ion Hypersensitivi ty, previous resistance, Use cautiously in : Infection. Other chronic debilitating diseases. Geriatric patients. Side Effects CNS: drowsiness, insomnia, vertigo, headache, weakness, tremors, ataxia, slurring, cerebral edema, seizures, exacerbation of psychotic symptoms, extrapyramidal syndromes, neuroleptic malignant syndrome, tardive dyskinesia CV: orthostatic hypotension, hypertension, bradycardia, tachycardia, cardiac arrest, heart failure, cardiomegaly, refractory arrhythmias, pulmonary edema EENT: nasal congestion, glaucoma, photophobia, Nursing Responsibilities - Assess allergy in chlorpromazine; comatose or severely depressed state; bone marrow depression; circulatory collapsed; Parkinsons disease - Check weight, temp.; skin color, turgor; reflexes, orientation, IOP, ophthalmic examination - protect oral concentrate from light - patient or the relative of the client should be advisedabout the possibility of tardive dyskinesia - Be alert to potential for aspirationbecause of suppressed cough reflex

blurred vision, miosis, mydriasis, deposits in the cornea and lens, pigmentary retinopathy Ascorbic Acid 500mg Vitamin C Essential for the stimulation of the production of collagen-which is the most abundant protein covering and protecting all mucosal linings and tissues necessary in maintaining all organs chiefly the heart and blood vessels . Being a potent anti-oxidant, if effectively fights against free radicals and its harmful effects in the body. For prevention and treatment of Vitamin C deficiency. It hastens wound healing and increase body resistance from infectious disease. For healthy gums, teeth and bones and other connective tissues. Contraindicat ed in those persons who have shown hypersensitivi ty to any component of this preparation. CNS: drowsiness, fatigue, headache, insomnia GI: cramps, diarrhea, nausea and vomiting GU: kidney stones DERM: flushing HEMAT: Sickle cell crisis Should be given with care to patients with hyperoxaluria. Tolerance maybe included in patients taking high doses.

Name: S.L. Diagnosis: Undifferentiated Schizophrenia Generic/Brand Name Chlorpromazine Dosage 150mg HS Classification Antipsychotic Mode of Action Mechanisms not fully understood; antipsychotic drugs block postsynaptic dopamine receptors in the brain; depress those parts in the brain involved with wakefulness and emesis; anticholinergic, antihistamine (H1), and alpha adrenergic blocking. Indication Acute and chronic psychoses, particularly when accompanied by increase psychomotor activity. Nausea and vomiting. Intractable hiccups. Preoperative sedation. Treatment of acute intermittent porphyria. Unlabeled uses: vascular headache. Contraindicat ion Hypersensitivi ty, previous resistance, Use cautiously in : Infection. Other chronic debilitating diseases. Geriatric patients. Side Effects CNS: drowsiness, insomnia, vertigo, headache, weakness, tremors, ataxia, slurring, cerebral edema, seizures, exacerbation of psychotic symptoms, extrapyramidal syndromes, neuroleptic malignant syndrome, tardive dyskinesia CV: orthostatic hypotension, hypertension, bradycardia, tachycardia, cardiac arrest, heart failure, cardiomegaly, refractory arrhythmias, pulmonary edema EENT: nasal congestion, glaucoma, photophobia, Nursing Responsibilities -Assess allergy in chlorpromazine; comatose or severely depressed state; bone marrow depression; circulatory collapsed; Parkinsons disease - Check weight, temp.; skin color, turgor; reflexes, orientation, IOP, ophthalmic examination - protect oral concentrate from light - patient or the relative of the client should be advisedabout the possibility of tardive dyskinesia - Be alert to potential for aspirationbecause of suppressed cough reflex

blurred vision, miosis, mydriasis, deposits in the cornea and lens, pigmentary retinopathy Biperiden HCl 2mg PRN for EPS Antiparkinsonis m Biperiden is a tertiary amine antimuscarinic with central and peripheral actions. It stimulates and then depresses the CNS, it also has antispasmodic actions on smooth muscle and reduces secretions, esp salivary and bronchial secretions. Absorption: Readily absorbed from the GI tract. Bioavailability: about 30%. Metabolism: Extensive firstpass effect. Excretion: Elimination halflife: about 20 hr. This medication is an anticholinergic agent, prescribed for Parkinson disease and involuntary muscle movement due to neuroleptic drug therapy. Closed-angle glaucoma or narrow angle between iris and cornea; prostatic hyperplasia; myasthenia gravis except to reduce adverse muscarinic effects of an anticholinergi c; hypersensitivi ty; bowel obstruction; megacolon. Dryness of the mouth with difficulty in swallowing and talking, thirst, reduced bronchial secretions, mydriasis with cycloplegia and photophobia, flushing and dryness of the skin, transient bradycardia followed by tachycardia with palpitations and arrhythmias, difficulty in micturition, constipation and drowsiness. Slight transient hypotension followed by IV/IM admin. Assess for EPS, Parkinsonism. - Assess for mental status. - Assess patient response if anticholinergics are given. - Assess for tolerance over long term therapy, dosage may have to be increased or changed. - Avoid activities that require alertness, may cause dizziness, drowsiness and blurring of vision.

Fluphenazine Decanoate

1 cc IM

Antipsychotic

The basic effects of fluphenazine decanoate appear to be no different from those of fluphenazine hydrochloride, with the exception of duration of action. The esterification of fluphenazine markedly prolongs the drug's duration of effect without unduly attenuating its beneficial action. Prolixin Decanoate has activity at all levels of the central nervous system as well as on multiple organ systems. The mechanism whereby its therapeutic action is exerted is unknown. Fluphenazine differs from other

Fluphenazine Decanoate Injection is a long-acting parenteral antipsychotic drug intended for use in the management of patients requiring prolonged parenteral neuroleptic therapy (e.g., chronic schizophrenics ).

Allergy to any phenothiazine ; comatose or severely depressed states; concurrent use of large doses of other CNS depressants; bone marrow depression or blood dyscrasias; liver damage; cerebral arteriosclerosi s; coronary artery disease; severe hypotension or hypertension; subcortical brain damage; children younger than 12 years of age (decanoate).

Drowsiness, lethargy, dizzine ss, nausea, loss of appetite, sweating, dry mouth, blurred vision, headache, or constipation may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Arrange for discontinuation of drug if serum creatinine, BUN becomes abnormal or if WBC count is depressed. - Monitor elderly patients for dehydration, institute remedial measures promptly. Sedation and decreased sensation of thirst related to CNS effects can lead to severe dehydration. Consult physician regarding appropriate warning of patient or patient's guardian about tardive dyskinesias. - Consult physician about dosage reduction, use of anticholinergic antiparkinsonian drugs (controversial) if extrapyramidal effects occur. - Take drug exactly as prescribed. - Avoid driving or engaging in other dangerous activities if CNS, vision changes occur. - Avoid prolonged exposure to sun; use a sunscreen or covering garments if exposure is unavoidable. - Maintain fluid intake, and use precautions

phenothiazine derivatives in several respects: it is more potent on a milligram basis, it has less potentiating effect on central nervous system depressants and anesthetics than do some of the phenothiazines and appears to be less sedating, and it is less likely than some of the older phenothiazines to produce hypotension

against heatstroke in hot weather. - Report sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors, impaired vision, dark urine (pink or reddish brown urine is expected), pale stools, yellowing of skin or eyes.

Name: E.M. Diagnosis: Paranoid Schizophrenia Generic/Brand Name Clozapine Dosage 100mg HS Classification Antipsychotic Mode of Action Clozapine has relatively weak dopamine receptorblocking activity at D1, D2, D3 and D5 receptors but has high affinity for the D4 receptor. It has also blocking effects on serotonin, adrenergic histamine H1 and cholinergic receptors. Absorption: Absorbed well from the GI tract (oral); peak plasma concentrations after 2.5 hr. Distribution: Protein-binding: 95%. Metabolism: Hepatic; Ndemethylation and N-oxidation by cytochrome P-450 isoenzyme CYP1A2. Indication This medication is an antipsychotic, prescribed for schizophrenia. It changes the activity of certain natural substances in the brain. Contraindicat ion History of bone marrow disorders including agranulocytos is, circulatory collapse, alcoholic or toxic psychosis, drug intoxication, uncontrolled epilepsy, severe renal, hepatic or cardiac disease; paralytic ileus. Pregnancy and lactation. Side Effects Drowsiness, dizziness, headache; nausea, vomiting, constipation; anxiety, confusion, fatigue, transient fever. Rarely, dysphagia, acute pancreatitis, cholestatic jaundice; orthostatic hypotension, tachycardia; seizures; hypersalivation. Potentially Fatal: Rarely, thromboembolis m. Reversible neutropenia which may progress to a potentially fatal agranulocytosis. Fatal myocarditis. Nursing Responsibilities Differential blood counts must be normal on commencement and monitored regularly. - Due to potential for myocarditis and cardiomyopathy, patients should have: Full physical examination and medical history; - Specialist examination if there are any cardiac problems; Investigations for myocarditis or cardiomyopathy in the presence of tachycardia. Stop taking if cardiomyopathy or myocarditis is suspected. - Use with caution in conjunction with drugs causing constipation. - Withdraw drug over 14 days to prevent rebound psychosis. Patient teaching Patients must immediately report symptoms of infection, especially - Avoid hot baths or showers as hypotension

Biperiden HCl

2mg PRN for EPS

Antiparkinsonis m

Excretion: Via urine and faeces (as metabolites and trace amounts of unchanged drug); 12 hr (elimination half-life) Biperiden is a tertiary amine antimuscarinic with central and peripheral actions. It stimulates and then depresses the CNS, it also has antispasmodic actions on smooth muscle and reduces secretions, esp salivary and bronchial secretions. Absorption: Readily absorbed from the GI tract. Bioavailability: about 30%. Metabolism: Extensive firstpass effect. Excretion: Elimination halflife: about 20 hr.

can Oral hygiene is important to avoid oral candidiasis. - Avoid overexposure to the sun as heatstroke can occur. This medication is an anticholinergic agent, prescribed for Parkinson disease and involuntary muscle movement due to neuroleptic drug therapy. Closed-angle glaucoma or narrow angle between iris and cornea; prostatic hyperplasia; myasthenia gravis except to reduce adverse muscarinic effects of an anticholinergi c; hypersensitivi ty; bowel obstruction; megacolon. Dryness of the mouth with difficulty in swallowing and talking, thirst, reduced bronchial secretions, mydriasis with cycloplegia and photophobia, flushing and dryness of the skin, transient bradycardia followed by tachycardia with palpitations and arrhythmias, difficulty in micturition, constipation and drowsiness. Slight transient hypotension followed by IV/IM admin. Assess for EPS, Parkinsonism. - Assess for mental status. - Assess patient response if anticholinergics are given. - Assess for tolerance over long term therapy, dosage may have to be increased or changed. - Avoid activities that require alertness, may cause dizziness, drowsiness and blurring of vision.

Fluphenazine Decanoate

1 cc IM

Antipsychotic

The basic effects of fluphenazine decanoate appear to be no different from those of fluphenazine hydrochloride, with the exception of duration of action. The esterification of fluphenazine markedly prolongs the drug's duration of effect without unduly attenuating its beneficial action. Prolixin Decanoate has activity at all levels of the central nervous system as well as on multiple organ systems. The mechanism whereby its therapeutic action is exerted is unknown. Fluphenazine differs from other

Fluphenazine Decanoate Injection is a long-acting parenteral antipsychotic drug intended for use in the management of patients requiring prolonged parenteral neuroleptic therapy (e.g., chronic schizophrenics ).

Allergy to any phenothiazine ; comatose or severely depressed states; concurrent use of large doses of other CNS depressants; bone marrow depression or blood dyscrasias; liver damage; cerebral arteriosclerosi s; coronary artery disease; severe hypotension or hypertension; subcortical brain damage; children younger than 12 years of age (decanoate).

Drowsiness, lethargy, dizzine ss, nausea, loss of appetite, sweating, dry mouth, blurred vision, headache, or constipation may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Arrange for discontinuation of drug if serum creatinine, BUN becomes abnormal or if WBC count is depressed. - Monitor elderly patients for dehydration, institute remedial measures promptly. Sedation and decreased sensation of thirst related to CNS effects can lead to severe dehydration. Consult physician regarding appropriate warning of patient or patient's guardian about tardive dyskinesias. - Consult physician about dosage reduction, use of anticholinergic antiparkinsonian drugs (controversial) if extrapyramidal effects occur. - Take drug exactly as prescribed. - Avoid driving or engaging in other dangerous activities if CNS, vision changes occur. - Avoid prolonged exposure to sun; use a sunscreen or covering garments if exposure is unavoidable. - Maintain fluid intake, and use precautions

phenothiazine derivatives in several respects: it is more potent on a milligram basis, it has less potentiating effect on central nervous system depressants and anesthetics than do some of the phenothiazines and appears to be less sedating, and it is less likely than some of the older phenothiazines to produce hypotension

against heatstroke in hot weather. - Report sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors, impaired vision, dark urine (pink or reddish brown urine is expected), pale stools, yellowing of skin or eyes.