Name
Chamberlain University
NR-326: Mental Health Nursing
Prof. Name
Date
Therapeutic: Antipsychotics
Pharmacologic: Benzisoxazoles
Risperdal is indicated for schizophrenia, acute mania, and irritability associated with autistic disorder in children.
Risperdal acts by antagonizing dopamine and serotonin receptors in the central nervous system, leading to decreased symptoms of psychosis, bipolar mania, or autism.
Common: Aggressive behavior, dizziness, headache, cough, dyspnea, constipation, diarrhea, dry mouth, nausea, and weight gain
Adverse: Neuroleptic malignant syndrome, suicidal thoughts, agranulocytosis, anaphylaxis, and angioedema
| 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 |
Monitor mental status (orientation, mood, behavior) before and during therapy.
Assess weight, BMI, and monitor for hyperglycemia.
Monitor blood pressure and pulse, especially during dose titration, and assess for prolonged QT interval, tachycardia, and orthostatic hypotension.
Patients should take Risperdal exactly as prescribed. They must report extrapyramidal symptoms immediately, change positions slowly to avoid orthostatic hypotension, and avoid hazardous activities until drug effects are known.
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
Therapeutic: Central nervous system stimulants
Ritalin is prescribed for narcolepsy, attention deficit hyperactivity disorder (ADHD), and certain cases of refractory depression.
Ritalin produces central nervous system and respiratory stimulation with weak sympathomimetic activity.
Common: Aggressiveness, anxiety, insomnia, restlessness, tremor, hypertension, palpitations, tachycardia, and anorexia
Adverse: Sudden death, rhabdomyolysis, anaphylaxis, and angioedema
| Condition | Route | Dosage |
|---|---|---|
| ADHD | PO | 5–20 mg two to three times daily (prompt release) |
| Narcolepsy | PO | 10 mg two to three times daily; max 60 mg/day |
Monitor blood pressure, pulse, and respiration; obtain family history of sudden death or arrhythmias.
Observe for behavioral changes.
Monitor for peripheral vasculopathy (numbness, burning in fingers).
Patients should take Ritalin as prescribed without doubling doses, take the last dose before 6 p.m., monitor weight, and avoid caffeine-containing beverages.
Pregnancy Category: C
Schedule: II controlled substance
Peak Plasma Concentration: 1–3 hr
Therapeutic: Mood stabilizer
Lithium is indicated for manic episodes of bipolar I disorder, depression management, and as adjunct therapy in schizophrenia.
Lithium alters cation transport in nerve and muscle cells and may affect neurotransmitter reuptake.
Common: Fatigue, headache, impaired memory, ECG changes, diarrhea, nausea, muscle weakness, tremors
Adverse: Seizures and arrhythmias
| Formulation | Dosage |
|---|---|
| Tablets/Capsules (Initial) | 300–600 mg three times daily |
| Maintenance | 300 mg three to four times daily |
Assess mental status and initiate suicide precautions when indicated.
Monitor for lithium toxicity (vomiting, diarrhea, slurred speech, drowsiness, muscle weakness).
Monitor serum lithium levels twice weekly during initiation and every 2 months for maintenance.
Patients should take lithium consistently, maintain sodium and fluid intake, and avoid hazardous activities until effects are established.
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); should not exceed 2.0 mEq/L
Therapeutic: Anticonvulsants, vascular headache suppressants
Pharmacologic: Valproates
Depakote is prescribed for absence seizures, complex partial seizures, and as adjunct therapy for multiple seizure types. It is also used for manic episodes in bipolar disorder and migraine prevention.
Depakote increases GABA levels in the central nervous system, enhancing inhibitory neurotransmission.
Common: Agitation, dizziness, headache, insomnia, sedation, visual disturbances, abdominal pain, anorexia, diarrhea, indigestion, nausea, vomiting, tremor
Adverse: Suicidal thoughts, hepatotoxicity, pancreatitis, hyperammonemia, hypothermia
| 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 |
Assess seizure activity and implement seizure precautions.
Monitor mood, ideation, and behavior.
Evaluate for suicidal tendencies, particularly in early therapy.
Patients must take Depakote as prescribed, avoid hazardous activities until effects are known, and inform healthcare providers about all concurrent medications.
Pregnancy Category: D
Half-life: 9–16 hr
Peak: 1–4 hr
Therapeutic range: 50–100 mcg/mL (seizures), 50–125 mcg/mL (mania)
Therapeutic: Opioid analgesics
Pharmacologic: Opioid agonist
Methadone is used for moderate to severe chronic pain, detoxification and maintenance therapy in opioid dependence, and neonatal abstinence syndrome.
Methadone binds to opioid receptors in the CNS, producing analgesia and suppressing withdrawal symptoms.
Common: Confusion, sedation, dizziness, dysphoria, euphoria, hallucinations, headache, unusual dreams
Adverse: Hypotension, bradycardia, QT prolongation, constipation, urinary retention, respiratory depression
| 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 |
Notify provider if the patient is unconscious or difficult to arouse.
Monitor and manage constipation.
Use pain scales to assess treatment effectiveness.
Patients should take methadone exactly as prescribed, avoid alcohol and CNS depressants, rise slowly to prevent dizziness, and avoid hazardous activities until drug effects are known.
Caution: Use in structural heart disease
Onset: 30–60 min
Peak: 90–120 min
Half-life: 15–25 hr (longer with chronic use)
Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). Davis’s drug guide for nurses. Philadelphia, PA: F.A. Davis Company.
