NR 326 Week 3 Pharm Phorm

Student Name

Chamberlain University

NR-326: Mental Health Nursing

Prof. Name

Date

NR 326 Week 3 Pharm Phorm

Prototype Drug: Risperdal (Risperidone)

Class

Therapeutic: Antipsychotics
Pharmacologic: Benzisoxazoles

Clinical Indications (Top Three)
Risperdal is primarily prescribed for managing schizophrenia, acute mania episodes, and irritability associated with autistic disorder in pediatric populations. It effectively alleviates symptoms related to psychosis and mood dysregulation.

Mechanism of Action
Risperdal functions by antagonizing dopamine D2 and serotonin 5-HT2A receptors in the central nervous system. This dual receptor blockade reduces psychotic symptoms, controls manic episodes, and moderates irritability in autism spectrum disorders.

Side and Adverse Effects

Type	Effects
Common	Aggressive behavior, dizziness, headache, cough, dyspnea, constipation, diarrhea, dry mouth, nausea, weight gain
Adverse	Neuroleptic malignant syndrome, suicidal thoughts, agranulocytosis, anaphylaxis, angioedema

Route and Dosage (Adults)

Condition	Route	Dosage
Schizophrenia	PO	1 mg twice daily; increase by 1–2 mg/day every ≥24 hr to maintenance 4–8 mg/day
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 every ≥24 hr (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)

Continuously assess the patient’s mental status, including mood, orientation, and behavior.
Monitor weight, BMI, and blood glucose levels to detect metabolic changes early.
Track blood pressure and pulse, particularly during dose titration, and watch for cardiac irregularities like prolonged QT interval or orthostatic hypotension.

Patient Teaching
Patients should take Risperdal exactly as prescribed. Report any involuntary movements, changes in mood, or other extrapyramidal symptoms. Patients should rise slowly to minimize dizziness and avoid activities requiring alertness until 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 commonly used to treat attention deficit hyperactivity disorder (ADHD), narcolepsy, and treatment-resistant depression. Its stimulatory effects improve attention, wakefulness, and executive functioning.

Mechanism of Action
Ritalin enhances central nervous system activity and respiratory function while exhibiting weak sympathomimetic properties, facilitating improved focus and energy regulation.

Side and Adverse Effects

Type	Effects
Common	Aggressiveness, anxiety, insomnia, restlessness, tremor, hypertension, palpitations, tachycardia, anorexia
Adverse	Sudden death, rhabdomyolysis, anaphylaxis, angioedema

Route and Dosage (Adults)

Condition	Route	Dosage
ADHD	PO	5–20 mg two to three times daily (prompt release)
Narcolepsy	PO	10 mg two to three times daily; maximum 60 mg/day

Nursing Implications (Top Three)

Monitor vital signs, including blood pressure, pulse, and respiration; review family history for cardiac events.
Observe behavioral changes, including mood swings or agitation.
Assess for peripheral vascular symptoms like numbness or tingling in extremities.

Patient Teaching
Patients should follow the prescribed schedule, avoid doubling doses, and take the last dose before 6 p.m. to prevent insomnia. Regular weight monitoring and limiting caffeine intake are recommended.

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)
Lithium is effective for managing manic episodes in bipolar I disorder, depressive symptoms, and as adjunct therapy in schizophrenia.

Mechanism of Action
Lithium alters cation transport across nerve and muscle cells and may influence neurotransmitter reuptake, stabilizing mood and reducing mania.

Side and Adverse Effects

Type	Effects
Common	Fatigue, headache, impaired memory, ECG changes, diarrhea, nausea, muscle weakness, tremors
Adverse	Seizures, arrhythmias

Route and Dosage (Adults)

Formulation	Dosage
Tablets/Capsules (Initial)	300–600 mg three times daily
Maintenance	300 mg three to four times daily

Nursing Implications (Top Three)

Assess mental status and implement suicide precautions when necessary.
Monitor for lithium toxicity, including gastrointestinal upset, slurred speech, or drowsiness.
Check serum lithium levels biweekly during initiation and every 2 months during maintenance.

Patient Teaching
Patients should maintain consistent lithium intake, preserve adequate sodium and fluid consumption, and avoid driving until therapeutic effects are established.

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 (acute mania), 0.6–1.2 mEq/L (maintenance); avoid exceeding 2.0 mEq/L

Prototype Drug: Depakote (Divalproex Sodium)

Class

Therapeutic: Anticonvulsants, vascular headache suppressants
Pharmacologic: Valproates

Clinical Indications (Top Three)
Depakote is prescribed for absence seizures, complex partial seizures, manic episodes of bipolar disorder, and migraine prophylaxis.

Mechanism of Action
Depakote enhances gamma-aminobutyric acid (GABA) activity in the CNS, promoting inhibitory neurotransmission to stabilize mood and prevent seizure activity.

Side and Adverse Effects

Type	Effects
Common	Agitation, dizziness, headache, insomnia, sedation, visual disturbances, abdominal pain, anorexia, diarrhea, nausea, vomiting, tremor
Adverse	Suicidal thoughts, hepatotoxicity, pancreatitis, hyperammonemia, hypothermia

Route and Dosage (Adults)

Therapy	Dosage
Single-agent therapy	10–15 mg/kg/day in 1–4 divided doses; increase by 5–10 mg/kg/day weekly until therapeutic response achieved

Nursing Implications (Top Three)

Assess seizure activity and implement safety precautions.
Monitor mood, behavioral changes, and suicidal ideation.
Evaluate early therapy for adverse effects or toxicity.

Patient Teaching
Patients must adhere to the prescribed schedule, avoid hazardous activities until effects are known, and notify providers of all medications being taken.

Other Considerations

Pregnancy Category: D
Half-life: 9–16 hr
Peak: 1–4 hr
Therapeutic range: 50–100 mcg/mL (seizures), 50–125 mcg/mL (mania)

Prototype Drug: Methadone (Dolophine)

Class

Therapeutic: Opioid analgesics
Pharmacologic: Opioid agonist

Clinical Indications (Top Three)
Methadone is indicated for moderate-to-severe chronic pain, detoxification and maintenance in opioid dependence, and management of neonatal abstinence syndrome.

Mechanism of Action
Methadone binds to opioid receptors in the CNS, providing analgesia and suppressing withdrawal symptoms.

Side and Adverse Effects

Type	Effects
Common	Confusion, sedation, dizziness, dysphoria, euphoria, hallucinations, headache, unusual dreams
Adverse	Hypotension, bradycardia, QT prolongation, constipation, urinary retention, respiratory depression

Route and Dosage (Adults)

Condition	Route	Dosage
Moderate–severe pain	PO	2.5 mg every 8–12 hr
Moderate–severe pain	IV/IM/Subcutaneous	10 mg every 6–8 hr

Nursing Implications (Top Three)

Notify the provider if the patient becomes unconscious or difficult to arouse.
Monitor and manage constipation proactively.
Utilize pain scales to assess therapeutic effectiveness.

Patient Teaching
Take methadone as prescribed, avoid alcohol and CNS depressants, rise slowly to prevent dizziness, and avoid activities requiring alertness until effects are known.

Other Considerations

Use with caution in patients with structural heart disease
Onset: 30–60 min; Peak: 90–120 min
Half-life: 15–25 hr (may increase 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.