NR 326 Week 3 Pharm Phorm
Student Name
Chamberlain University
NR-326: Mental Health Nursing
Prof. Name
Date
Prototype Drug: Risperdal (risperidone)
Class
Therapeutic: Antipsychotics
Pharmacologic: Benzisoxazoles
Clinical Indications (Top Three)
Risperdal is indicated for schizophrenia, acute mania, and irritability associated with autistic disorder in children.
Mechanism of Action
It may act by antagonizing dopamine and serotonin in the central nervous system, leading to decreased symptoms of psychosis, bipolar mania, or autism.
Side and Adverse Effects
Common side effects include aggressive behavior, dizziness, headache, cough, dyspnea, constipation, diarrhea, dry mouth, nausea, and weight gain.
Adverse effects include neuroleptic malignant syndrome, suicidal thoughts, agranulocytosis, anaphylaxis, and angioedema.
Route and Dosage (Adults)
Schizophrenia – PO: 1 mg twice daily; increase by 1–2 mg/day at intervals of at least 24 hours to a maintenance dose of 4–8 mg daily
Schizophrenia – IM: 25 mg every 2 weeks; may increase to 37.5 or 50 mg every 2 weeks
Acute mania – PO: 2–3 mg/day as a single dose; increase by 1 mg/day at intervals of at least 24 hours (range 1–5 mg/day)
Bipolar I maintenance – IM: 25 mg every 2 weeks; may increase to 37.5 or 50 mg every 2 weeks
Nursing Implications (Top Three)
Monitor mental status (orientation, mood, behavior) before and during therapy.
Assess weight, BMI, and monitor for signs of hyperglycemia throughout therapy.
Monitor blood pressure and pulse, particularly during initial dose titration, and watch for prolonged QT interval, tachycardia, and orthostatic hypotension.
Patient Teaching
Take medication exactly as directed. Report extrapyramidal symptoms immediately. Change positions slowly to avoid orthostatic hypotension. Avoid driving or hazardous activities until the drug’s effects are known.
Other Considerations
Pregnancy Category: C
Half-life in extensive metabolizers – risperidone: 3 hr; 9-hydroxyrisperidone: 21 hr
Half-life in poor metabolizers – risperidone: 20 hr; 9-hydroxyrisperidone: 30 hr
Prototype Drug: Ritalin (methylphenidate hydrochloride)
Class
Therapeutic: Central nervous system stimulants
Clinical Indications (Top Three)
Ritalin is indicated for the symptomatic treatment of narcolepsy, attention deficit hyperactivity disorder (ADHD), and certain cases of refractory depression.
Mechanism of Action
Produces central nervous system and respiratory stimulation with weak sympathomimetic activity.
Side and Adverse Effects
Common side effects include aggressiveness, anxiety, insomnia, restlessness, tremor, hypertension, palpitations, tachycardia, and anorexia.
Adverse effects include sudden death, rhabdomyolysis, anaphylaxis, and angioedema.
Route and Dosage (Adults)
ADHD – PO: 5–20 mg two to three times daily as prompt release tablets
Narcolepsy – PO: 10 mg two to three times daily; maximum 60 mg/day
Nursing Implications (Top Three)
Monitor blood pressure, pulse, and respiration before and during therapy, and obtain a family history for sudden death or ventricular arrhythmia.
Observe for changes in behavior.
Monitor for signs of peripheral vasculopathy such as numbness or burning in the fingers.
Patient Teaching
Take medication as directed; avoid doubling doses. Take the last dose before 6 p.m. Monitor weight regularly. Avoid caffeine-containing beverages.
Other Considerations
Pregnancy Category: C
Schedule II controlled substance
Peak plasma concentration: 1–3 hr
Prototype Drug: Lithium (Eskalith, Lithobid)
Class
Therapeutic: Mood stabilizer
Clinical Indications (Top Three)
Used for manic episodes of bipolar I disorder, management of depression, and adjunct therapy in schizophrenia.
Mechanism of Action
Alters cation transport in nerve and muscle cells and may influence neurotransmitter reuptake.
Side and Adverse Effects
Common side effects include fatigue, headache, impaired memory, ECG changes, diarrhea, nausea, muscle weakness, and tremors.
Adverse effects include seizures and arrhythmias.
Route and Dosage (Adults)
Tablets or capsules – 300 to 600 mg three times daily initially
Maintenance – 300 mg three to four times daily
Nursing Implications (Top Three)
Assess mental status regularly; initiate suicide precautions if indicated.
Monitor for signs of lithium toxicity, including vomiting, diarrhea, slurred speech, decreased coordination, drowsiness, muscle weakness, or twitching.
Monitor serum lithium levels twice weekly during initiation and every two months during maintenance.
Patient Teaching
Take medication as prescribed, even when feeling well. Maintain consistent sodium and fluid intake. Avoid hazardous activities until effects are known.
Other Considerations
Pregnancy Category: D
Half-life: 20–27 hr
Onset: 5–7 days; Peak: 10–21 days
Therapeutic range: 0.5–1.5 mEq/L for acute mania, 0.6–1.2 mEq/L for maintenance; should not exceed 2.0 mEq/L
Prototype Drug: Depakote (divalproex sodium)
Class
Therapeutic: Anticonvulsants, vascular headache suppressants
Pharmacologic: Valproates
Clinical Indications (Top Three)
Indicated for absence seizures, complex partial seizures, and as adjunctive therapy for multiple seizure types. Also used for manic episodes in bipolar disorder and migraine prevention.
Mechanism of Action
Increases levels of GABA, an inhibitory neurotransmitter, in the central nervous system.
Side and Adverse Effects
Common side effects include agitation, dizziness, headache, insomnia, sedation, visual disturbance, abdominal pain, anorexia, diarrhea, indigestion, nausea, vomiting, and tremor.
Adverse effects include suicidal thoughts, hepatotoxicity, pancreatitis, hyperammonemia, and hypothermia.
Route and Dosage (Adults)
Single agent therapy – initial dose of 10–15 mg/kg/day in one to four divided doses; increase by 5–10 mg/kg/day weekly until therapeutic response is achieved
Nursing Implications (Top Three)
Assess seizure activity and initiate seizure precautions.
Monitor mood, ideation, and behavior.
Assess suicidal tendencies, especially early in therapy.
Patient Teaching
Take medication as prescribed. Avoid hazardous activities until effects are known. Inform healthcare provider about all concurrent medications before starting new ones.
Other Considerations
Pregnancy Category: D
Half-life: 9–16 hr
Peak: 1–4 hr
Therapeutic range: 50–100 mcg/mL for seizures, 50–125 mcg/mL for mania
Prototype Drug: Methadone (Dolophine)
Class
Therapeutic: Opioid analgesics
Pharmacologic: Opioid agonist
Clinical Indications (Top Three)
Used for moderate to severe chronic pain, detoxification and maintenance therapy for opioid dependence, and neonatal abstinence syndrome.
Mechanism of Action
Binds to opiate receptors in the central nervous system, producing analgesia and suppressing withdrawal symptoms.
Side and Adverse Effects
Common side effects include confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, and unusual dreams.
Adverse effects include hypotension, bradycardia, QT prolongation, constipation, urinary retention, and respiratory depression.
Route and Dosage (Adults)
Moderate to severe pain – PO: 2.5 mg every 8–12 hr
Moderate to severe pain – IV, IM, Subcutaneous: 10 mg every 6–8 hr
Nursing Implications (Top Three)
Notify provider if patient is unconscious or difficult to arouse.
Assess for constipation.
Use pain scales to evaluate treatment effectiveness.
Patient Teaching
Take medication exactly as prescribed. Avoid alcohol and CNS depressants. Change positions slowly to prevent dizziness. Avoid hazardous activities until effects are known.
Other Considerations
Use with caution in structural heart disease
Onset: 30–60 min
Peak: 90–120 min
Half-life: 15–25 hr (increases with chronic use)
References
Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). Davis’s drug guide for nurses. Philadelphia, PA: F.A. Davis Company.