Download The document is for psych case study. and more Study Guides, Projects, Research Psychiatry in PDF only on Docsity!
VII. Medical Management Generic Name General Classification Indications Mechanism of Action Side Effects Nursing Responsibility Sodium Valproate Anticonvulsant/an ti-epileptic •Epilepsy: absence. •Seizures •Myoclonic seizures •Complex partial seizures.
PHARMACOD
YNAMIC:
Sodium valproate increases the brain's concentration of gamma- aminobutyric acid (GABA), which is an inhibitory neurotransmitter
. It is thought to exert its anticonvulsant effects by enhancing GABA- mediated inhibition and suppressing excessive neuronal activity. PHARMACOK INETICS: Absorption: Sodium valproate is well absorbed after oral administration. Distribution: It is widely distributed throughout the body, including the brain. Metabolism: Sodium valproate undergoes hepatic metabolism, primarily by glucuronidation. Elimination: It is eliminated mainly through - drowsiness - dizziness •gastrointestina l disturbances (nausea, vomiting), weight gain, hair loss, and tremor. Less common side effects include liver dysfunction, pancreatitis, and blood disorders. Before Administration: 1.Before administration: - Assess the patient's medical history, including any history of liver disease or hypersensitivity reactions. During Administration: 1. Administer the medication orally as prescribed, ensuring the correct dose and route. - Monitor the patient closely for any signs of adverse effects or allergic reactions during administration. After Administration: 1. Monitor the patient for the desired therapeutic response. 2. Assess the patient for any side effects or adverse reactions. 3. Perform regular monitoring of liver function tests and blood counts, especially during long-term therapy. 4. Provide patient education regarding the importance of compliance with the medication regimen/ 5. Educate the patient about potential side effects to report to the healthcare provider. Brand Name Contraindicati ons Usual Dose Valpros 1.Hypersensitiv ity. 2.Liver disease: •hepatic impairment •significant hepatic disease. The dosing regimen may vary depending on the condition being treated, the patient's age, and individual factors. It is important to follow the prescribed dose and consult with a healthcare professional for specific dosage instructions. Date Ordered Actual Dose June 27, 2023 500 mg 1 TAB q 6 hours
urine as metabolites. Generic Name General Classification Indications Mechanism of Action Side Effects Nursing Responsibility Levetiracetam Anticonvulsant/an ti-epileptic Epilepsy: Levetiracetam as adjunctive theraphy treatment of partial-onset seizures, myoclonic seizures, and generalized tonic-clonic seizures in adults and children.
PHARMACOD
YNAMIC:
The exact mechanism of action of levetiracetam is not fully understood. It is believed to modulate neurotransmitter release by binding to a synaptic vesicle protein, which may reduce neuronal excitability and inhibit seizures. PHARMACOK INETICS: Absorption: Levetiracetam is rapidly and almost completely absorbed after oral administration. Distribution: It has a moderate distribution in the body and readily crosses the blood-brain barrier. Metabolism: Levetiracetam undergoes minimal metabolism in the liver. Elimination: It is primarily eliminated unchanged in the urine. Common side effects may include;
- Drowsiness •dizziness •weakness •headache •behavioral changes (agitation, irritability).
- Other side effects may include gastrointestinal disturbances (nausea, vomiting), coordination difficulties, and mood changes. Before Administration:
- Assess the patient's medical history, including any history of hypersensitivity reactions.
- Review the patient's current medications for potential drug interactions or contraindications.
- Perform baseline assessments, including vital signs and neurological status. During Administration:
- Administer the medication orally or intravenously as prescribed, ensuring the correct dose and route.
- Monitor the patient closely for any signs of adverse effects or allergic reactions during administration.
- Maintain aseptic technique when administering the intravenous formulation. After Administration:
- Monitor the patient for the desired therapeutic response and assess for any side effects or adverse reactions.
- Provide comfort measures for any discomfort experienced by the patient.
Brand Name Contraindicati ons Usual Dose Keppra Hypersensitivit y ● The dosing regimen of levetiraceta m may vary depending on the patient's age, weight, and individual factors. It is important to follow the prescribed dose and consult with a healthcare professional for specific dosage instructions. Date Ordered Actual Dose June 27, 2023 10 mg IV STAT for seizure
June 27, 2023 Abrupt discontinuation after prolonged use should be avoided to prevent withdrawal symptoms. Diazepam is available in various formulations, including oral tablets, oral solutions, injectable solutions, and rectal gels. When taken orally, diazepam is well absorbed from the gastrointestinal tract. Distribution: Diazepam has a high lipid solubility, which allows it to rapidly cross the blood-brain barrier and distribute widely throughout the body. The drug is extensively bound to plasma proteins, primarily albumin, with approximately 98% protein binding. Metabolism: Diazepam undergoes extensive metabolism in the liver by hepatic enzymes. The major active metabolite of diazepam is desmethyldiaze pam (also known as nordazepam), which has a longer half-life than diazepam. Elimination: The elimination half-life of diazepam is 10 mg IV STAT for seizure and any required administration devices (e.g., syringe, measuring cup). Verify the integrity and expiration date of the medication. During Administration:
- Educate the patient: Explain the purpose of diazepam, its potential effects and side effects, and any specific instructions (e.g., taking with or without food). Address any questions or concerns the patient may have.
- Administer the medication: Follow the prescribed route of administration (e.g., oral, intravenous, intramuscular) and use the appropriate technique. Ensure proper hand hygiene and adhere to infection control practices.
- Monitor the patient: Observe the patient closely during and after administration for any immediate adverse reactions or changes in vital signs. Monitor respiratory status, level of consciousness, and any signs of sedation or oversedation. After Administration:
- Document the administration: Record the medication administration details, including the medication name, dose, route, time, and any relevant
approximately 20 to 50 hours, but its metabolites, such as desmethyldiaze pam, have longer elimination half-lives. The prolonged half- life of diazepam and its metabolites allows for once- daily dosing. observations or patient responses.
- Provide patient education: Reinforce any instructions related to diazepam, such as adherence to the prescribed schedule, potential side effects to watch for, and any precautions or safety measures. Encourage the patient to report any adverse effects promptly.
- Monitor and evaluate the patient's response: Continuously assess the patient's condition and response to diazepam over time. Observe for therapeutic effects and monitor for any potential adverse effects.
- Collaborate with the healthcare team: Maintain open communication with other healthcare providers involved in the patient's care. Generic Name General Classification Indications Mechanism of Action Side Effects Nursing Responsibility Mannitol Diuretics, Osmotic Agents. Used for the promotion of diuresis before irreversible renal failure becomes established, the reduction of intracranial pressure, the treatment of cerebral edema, and the promotion of urinary excretion of toxic substances. Pharmacodyn amics: Mannitol is an osmotic diuretic that is metabolically inert in humans and occurs naturally, as a sugar or sugar alcohol, in fruits and vegetables. Mannitol elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, ● Slow/shallo w increased urination; ● Nausea, vomiting; ● Fever, chills, headache, runny nose; ● Chest pain; ● Rash; or dizziness, blurred vision. Before Administration:
- Check the medication order
- Check the vital signs
- Prepare the exact dosage
- Identify the patient
- Explain the purpose of taking the medication.
throughout the extracellular fluid compartment. Distribution: Mannitol has a relatively small volume of distribution, primarily limited to the extracellular fluid compartment. It does not readily cross cell membranes or the blood-brain barrier, which is why it remains primarily in the extracellular space. Metabolism: Mannitol is not metabolized in the body. It is a sugar alcohol that undergoes minimal biotransformati on. Elimination: Mannitol is excreted unchanged by the kidneys through glomerular filtration. It is not reabsorbed by the renal tubules, leading to a high urinary clearance. Mannitol has a relatively short elimination half-life of approximately 1.5 to 2 hours in adults. Generic Name General Classification Indications Mechanism of Action Side Effects Nursing Responsibility Dexamethasone Corticosteroid (Glucocorticoid) It is employed in the Pharmacodyna mics: ● Upset stomach Before Administration:
treatment of cerebral edema associated with brain tumors, head injury, or neurosurgical procedures. Dexamethasone acts by binding to cytoplasmic glucocorticoid receptors, leading to the formation of a receptor-ligand complex. This complex then translocates into the nucleus, where it regulates gene transcription. Dexamethasone has a high affinity for glucocorticoid receptors and exerts its effects by modulating the expression of various genes involved in inflammation and immune response. It suppresses the production of pro- inflammatory cytokines, inhibits the migration of inflammatory cells, and reduces the permeability of blood vessels, resulting in potent anti- inflammatory effects. Pharmacokineti cs: Absorption: Dexamethasone is available in various formulations, including oral tablets, intravenous injection, and topical preparations. When taken orally, dexamethasone ● Stomach irritation ● Vomiting ● Headache ● Dizziness ● Insomnia ● Restlessness ● Depression ● Anxiety ● Acne
- Review the medication order: Confirm the correct medication, dose, route, and frequency prescribed for the patient.
- Verify patient information: Identify the patient using two unique identifiers, such as their name and date of birth, to ensure you have the right patient.
- Assess the patient: Perform a comprehensive assessment, including vital signs, relevant laboratory values, and any signs or symptoms related to the condition being treated.
- Gather necessary supplies: Prepare the appropriate dosage form of dexamethasone, such as tablets or liquid, along with any required administration devices (e.g., syringe, measuring cup). During Administration:
- Educate the patient: Explain the purpose of dexamethasone, its potential side effects, and any specific instructions (e.g., taking with food). Address any questions or concerns the patient may have.
- Administer the medication: Follow the prescribed route of administration (e.g., oral, intravenous, intramuscular) and ensure proper technique. Adhere to infection control practices and Brand Name Contraindicat ions Usual Dose Dexpak/ Decadron Dexamethason e is contraindicate d in patients with known hypersensitivit y to the drug or any components of the formulation. It should be used with caution in patients with systemic fungal infections, active untreated infections, or impaired liver or kidney function. Long-term or high-dose use of dexamethason e requires careful monitoring due to the potential for adverse effects such as adrenal suppression, osteoporosis, glucose intolerance, and increased susceptibility to infections. 4 to 20 mg/day given in a single daily dose or in 2 to 4 divided doses Date Ordered Actual Dose June 29, 2023 4g IV q 8 x 3 doses
depending on the route of administration. Intravenous dexamethasone has a relatively short elimination half-life of approximately 3 to 4 hours, while oral dexamethasone has a longer elimination half-life of approximately 36 to 54 hours. plan, including medication adjustments or discontinuation if necessary.
