DRUG STUDY: BIPOLAR I DISORDER
I. LURASIDONE
Date and Time Ordered: August 2, 2021 at 8:00 AM
Generic Name: Lurasidone
Brand Name: Latuda
Drug Classification: Antidepressant
Dosage, Route, Frequency: Lurasidone 20 mg P.O. OD
Mechanism of Action: Atypical antipsychotics block both dopamine and serotonin
receptors. This dual action may help to alleviate some of the unpleasant neurological
effects and depression associated with the typical antipsychotics.
Desired Effect: This drug was given to treat episodes of depression
Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order For verification and to avoid errors
2. Explain the drug to the client and to To gain cooperation and promote compliance
significant others
3. Observe the 12 Rs in drug administration. To prevent error in drug administration
4. Assess for the cautions, contraindications, To prevent any untoward complications.
and adverse effects of the drug.
5. Do not allow patient to crush or chew It will speed up their absorption and may
sustained release capsules cause toxicity
6. Consider warning the patient/significant So they are prepared for that neurological
others about the risk of development of change
tardive dyskinesias with continued use
7. Monitor CBC To arrange to discontinue the drug at signs of
bone marrow suppression
8. Provide positioning of legs and arms To decrease the discomfort of dyskinesias
9. Provide sugarless candy and ice chips as To increase secretions and to prevent dry
well as frequent mouth care mouth from becoming a problem
10. Provide safety measures such as raising the To prevent injuries
side rails and assistance with ambulation if
CNS effects, or orthostatic hypotension
occurs
11. Provide for vision examinations To determine ocular changes and arrange
appropriate dose change
12. Document relevant data. To prevent errors or duplication of drug
administration
II. OLANZAPINE
Date and Time Ordered: August 2, 2021 at 8:00 AM
Generic Name: Olanzapine
Brand Name: Zyprexa
Drug Classification: Atypical Antipsychotic
Dosage, Route, Frequency: Olanzapine 5-10 mg PO BID
Mechanism of Action: This drug produces antipsychotic effect by interfering with the
binding of dopamine at D1, D2, D3 and D5 receptors, and has a high affinity for the D4
receptor in the limbic region of the brain. It also acts as an antagonist at α-adrenergic,
histamine H1, cholinergic and other dopaminergic and serotonergic (5-HT2A) receptors.
It produces fewer extrapyramidal reactions and less tardive dyskinesia than standard anti
psychotics. It is believed that many psychotic illnesses are caused by abnormal
communication among nerves in the brain and that by altering communication through
neurotransmitters, thus can alter the psychotic state.
Desired Effect: It helps to decrease hallucinations and help to think more clearly and
positively self, feel less agitated, and take a more active part in everyday life and to
restore the balance of certain natural substances in the brain.
Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Check and verify the doctor’s order. To prevent errors in administering the
medication to the patient.
2. Observe the 10 rights in medication To ensure safety and prevent committing
administration. mistakes.
3. Obtain the patient’s history about To determine if it’s contraindicated to the
allergies and if she experienced a medication.
severe infection.
4. Explain the action of the drug in a To gain cooperation and compliance in
simple manner based on the ability of taking the drug.
the patient to comprehend.
5. Provide diversional activities such as To divert the client’s attention and to
engaging the client to different potentiate the action of the drug.
therapies.
6. Monitor for the adverse and side
effects of the drug as to:
increase body temperature A transient increase above 100.4° F (38 °C)
may occur, most often within the first 3 weeks
of therapy.
tachycardia Tachycardia may also be a side effect of the
drug.
weight gain To check for a sudden increase in body weight.
dizziness To prevent injury and falls
7. Document the procedure done. For legal purposes and to provide information
that the procedure has been rendered to the
patient.
III. RISPERIDONE
Date and Time Ordered: August 2, 2021 at 8:00 AM
Generic Name: Risperidone
Brand Name: Risperdal
Drug Classification: Atypical Antipsychotic ; Mood Stabilizers
Dosage, Route, Frequency: Risperidone 5-10 mg PO BID
Mechanism of Action: It blocks the dopamine and 5HT2 receptors in the brain.
Specifically, it inhibits dopaminergic dopamine receptors and serotonergic receptors in
the brain. It may also block histamine receptors, and other neural receptors to improve
bipolar disorder.
Desired Effect: This drug was given to decrease or reduce symptoms of auditory
hallucination. It promotes emotional quieting, produces calmness and improves alteration
in thought to maintain the stability of the client. It also suppresses psychotic behavior and
to decrease it symptoms.
Nursing Responsibilities:
Nursing Responsibilities Rationale
Check and verify the doctor’s order. To make sure thus, avoiding mistakes on giving
medication to the patient.
Observe the 10 rights in medication To ensure safety and prevent committing
administration. mistakes.
Observe patient when administering medication. To ensure that the medication is swallowed and
not hoarded or cheeked.
Assist patient to change positions slowly or get To minimize orthostatic hypotension
up from sitting/laying position to standing
position
Monitor patient’s mental status (orientation, For notable changes in behavior that could
mood, and behavior) and mood before and indicate the emergence or worsening of suicidal
periodically during the therapy. thoughts or behavior or depression, especially
during the therapy.
Monitor and observe the possible side effects of To be able to address the side effects
the drug such as drowsiness, dizziness, light- immediately and prevent worsening of the
headedness, drooling, nausea, weight gain, condition.
tiredness, or hypotension
Monitor patient for onset of extrapyramidal side To be able to refer to the physician immediately
effects (akathisia-restlessness; dystonia-muscle thus action required like reduction of dose or
spasms and twisting motions; pseudo discontinuation may be necessary as ordered and
parkinsonism-mask-like face, rigidity, tremors, to prevent further complications.
drooling, shuffling gait, dysphagia; or
Neuroleptic Malignant Syndrome- fever,
respiratory distress, tachycardia, seizures,
diaphoresis, hypertension).
Document the procedure done. For legal purposes and to provide information
that the procedure has been rendered to the
patient.
IV. LORAZEPAM
Date and Time Ordered: August 2, 2021 at 8:00 AM
Generic Name: Lorazepam
Brand Name: Ativan
Drug Classification: Benzodiazepines
Dosage, Route, Frequency: Lorazepam 2 mg Sublingual OD
Mechanism of Action: Lorazepam binds to benzodiazepine receptors on the
postsynaptic GABA-A ligand-gated chloride channel neuron at several sites within the
central nervous system (CNS). It enhances the inhibitory effects of GABA, which
increases the conductance of chloride ions into the cell.
Desired Effect: This drug was given to manage anxiety.
Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order For verification and to avoid errors
2. Explain the drug to the client and to To gain cooperation and promote compliance
significant others
3. Observe the 12 Rs in drug administration. To prevent error in drug administration
4. Assess for the cautions, contraindications, To prevent any untoward complications.
and adverse effects of the drug.
5. Monitor hepatic and renal function, as well To detect dysfunction and to arrange to taper
as CBC, during long-term therapy and discontinue the drug if dysfunction
occurs.
6. Provide comfort measures such as having To help patient tolerate drug effects
them void before dosing, instituting a
bowel program as needed, giving food
with the drug if GI upset is severe.
Providing environmental control such as
lightning, temperature, and stimulation
7. Provide safety precautions such as raise To prevent injury
side rails and assistance with ambulation
8. Offer support and encouragement To help the patient cope with the diagnosis
and the drug regimen.
9. Document relevant data. To prevent errors or duplication of drug
administration
V. LITHIUM
Date and Time Ordered: August 2, 2021 at 8:00 AM
Generic Name: Lithium
Brand Name: Lithobid
Drug Classification: Antimanic Agents
Dosage, Route, Frequency: Lithium 600 mg PO BID
Mechanism of Action: Mechanism of lithium is not known; alters sodium transport
in nerve and muscle cells; inhibits release of norepinephrine and dopamine, but not
serotonin, from stimulated neurons; slightly increases intraneuronal stores
of catecholamines; decreases intraneuronal content of second messengers and may
thereby selectively modulate the responsiveness of hyperactive neurons that might
contribute to the manic state.
Desired Effect: This drug was given to prevent or diminish frequency and intensity of
subsequent manic episodes.
Nursing Responsibilities:
Nursing Responsibilities Rationale
1. Verify doctor’s order For verification and to avoid errors
2. Explain the drug to the client and to To gain cooperation and promote compliance
significant others
3. Observe the 12 Rs in drug administration. To prevent error in drug administration
4. Assess for the cautions, contraindications, To prevent any untoward complications.
and adverse effects of the drug.
5. Give drug with food or milk or after meals. To reduce side effects of stomach irritation
6. Observe client for signs and symptoms of To determine possible treatment options
depression and mood changes.
7. Monitor signs of lithium toxicity To prevent further complications that causes
toxicity
8. Provide safety precautions such as raise To prevent injury
side rails and assistance with ambulation
9. Offer support and encouragement To help the patient cope with the diagnosis
and the drug regimen.
10. Document relevant data. To prevent errors or duplication of drug
administration
