Depakote
Valproate ( Depacon), Valproic acid ( Depakene, Stavzor), divalproex sodium ( Depakote), headache suppressant 
Reason/reasons why the medication is prescribed for this client. 
Bipolar disorder
Uses: 
Simple (petit mal), Complex (petit mal), absence,  mixed manic episodes associated with bipolar disorder, prophylaxis of migraine, migraines, adjunct in schizophrenia, tardive dyskinsia, aggression in children with ADHD, tonic- clonic (grand mal)
Dosage/Route: 
PO 750 mg/day in divided doses  
Recommended Dosage 
750 mg/day for an adult in divided doses for treatment of mania
½ life 6-16 hr		
Recommended Client Age
 Not recommended for children unless prescribed for the use of epilepsy due to possible suicidal ideations
Pertinent assessments to make before and after giving this medication: 
Assess respirations 
Parameters to consider: 
Black box warning: 
Pregnancy (D), hepatic disease, pancreatitis (may be fatal), children < 2 yr
Any reason to hold this medication: 
Hold if respirations are < 12/min or if pupils are dilated 
Pertinent labs and interventions for the medication:
 Blood studies: Hct, Hgb, RBC, serum folate, PT/PTT, serum ammonia, platelets, vit D if long term therpy, Hepatic studies: AST, ALT, bilirubin; heptatic failure has occurred
Changes recommended in dosage for physiologic reasons (renal/hepatic, etc.) 
Desired action “how” it works
 Increases the levels of GABA in the brain which decreases seizure activity (suppresses CNS)
Common Adverse Affects :
  CNS: Coma, Suicidal ideation, GI: hepatic failure, pancreatitis, toxic hepatitis, HEMA: blood  dyscrasias (thrombocytopenia, leucopenia, lymphocytosis)
INTERVENTIONS FOR EACH ADVERESE EFFECT:
  Monitor blood studies: Hct, Hgb, RBC, serum folate, PT/PTT, serum ammonia, platelets,observe for signs and symptoms of blood dyscrasias, such as bruising, assess base line liver function, monitor liver function regularly labs to pay attention to AST, ALT, bilirubin,, avoid use in children younger than 2yr , administer lowest effective dose, advise to use birth control and avoid use in pregnancy 
Expected therapeutic effects for this client: 
Prevention of mania and depressive episodes
Evaluate the effects experienced by this client:
 Patient was admitted because she stopped taking her medications but effectiveness maybe evidence by relief of acute manic symptoms or depressive, verbalization of improved mood, ability to perform ADLs, improved sleep and eating habits

Side effects: 
CNS: sedation, drowsiness, dizziness, headache, incoordination, depression, hallucinations, behavioral changes, tremors, weakness
EENT: Visual disturbances, taste perversion
GI: Nausea, vomiting, constipation, diarrhea, dyspepsia, anorexia, cramps, weight gain
HEMA: bruising
INTEG: rash, alopecia, photosensitivity, dry skin
NURSING INTERVENTIONS FOR EACH SIDE EFFECTS: 
Advise the patient that many of the symptoms are generally self –limiting, teach to use cautiously when driving, or performing other activities requiring alertness because of drowsiness, dizziness, blurred vision, monitor for changes in behavior and affect, dim the lights and try to eliminate any extra noise if headache occurs, inform them to wear sunscreen because photosensitivity may occur, increase fluids and fiber if patient becomes constipated, Give with food or milk to decrease GI symptoms such as nausea, switch to enteric-coated formulation, if bruising occurs check blood studies and teach them about safety such as playing contact sports.

Possible drug/drug interactions: 
Increases valproic acid level: erythromycin, felbamate
Increases CNS depression: alcohol, opioids, barbiturates, antihistamines, MAOIs, sedative/hypnotics
Increases toxicity of valproic acid slicylates
Increases action of phenytonin, tricyclics, carbamazepine, ethosuximide, barbiturates, zidovudine, lorazepam, rufinamide
Increases bleeding – antiplatelets, NSAIDs, tirofiban, eptifibatide, abciximab, cefoperazone, cefotatan, heparin, thrombolytics
Increases toxicity of carbamazepine, ethosuximide, lamotrigine, zidovudine, 
Decreases metabolism of valproic acid cimetidine
Drug/ lab test: 
false positive: Ketones, urine
Possible drug/food interactions
Possible drug/environment interactions: 
Photosensitivity 
Pertinent info to document

Lithium
Lithium carbonate ( Lithane, Eskalith, Lithobid) 
Mood stabilizer, antimanic, antipsychotic
Reason/reasons why the medication is prescribed for this client: 
 Bipolar disorder
Uses:
 Bipolar disorders (manic phase), prevention of bipolar manic-depressive psychosis, alcoholism, bulimia, schizophrenia
Dosage/Route:  Pt. 
PO 300 mg tid	
Recommended Dosage  
adult PO 300 – 600 mg tid 
½ life : 
18-36 hrs depending on age   
Recommended Client Age: 
Adult
Pertinent assessments to make before and after giving this medication 
Parameters to consider
Black box warning: 
Lithium level > 1.5
Any reason to hold this medication 
Pertinent labs and interventions for the medication 

Changes recommended in dosage for physiologic reasons (renal/hepatic, etc.)  
Renal dose (Adult) PO CCR 10-50 ml/min 50%- 75% of dose; CCr < 10 ml/min 25%-50% of dose , reduce dose to geriatric patients 
Desired action “how” it works:  
May alter sodium, potassium ion transport across cell membrane in nerve, muscle cells; may balance biogenic amines of norepinephrine, serotonin in CNS areas involved in emotional responses 
Common Adverse Affects: 
CNS: Seizures
 CV: dysrhythmias, circulatory collapse
 GU: polyuria, glycosuria, proteinuria, albuminuria, renal toxicity 
 HEMA: leukocytosis
INTERVENTIONS FOR EACH ADVERESE EFFECT: 
 Check urine for albuminuria, glycosuria, uric acid during beginning treatment, q2mo thereafter, monitor the I&o, keep dosage at the lowest level necessary, assess baseline BUN and creatinine, and monitor kidney function periodically, monitor ECG 
Expected therapeutic effects for this client:  
Prevent return of mania or depression and decrease desire of suicide 
Evaluate the effects experienced by this client
Side effects: 
CNS: headache, drowsiness, dizziness, tremors, twitching, slurred speech, restlessness, confusion, stupor, memory loss, clonic movements, fatigue 
CV: hypotension, ECG changes, edema
EENT: tinnitus, blurred vision
ENDO: hyponatremia, goiter, hyperglycemia, hypo/hyperthyroidism
GI: dry mouth, anorexia, nausea, vomiting, diarrhea, incontinence, abdominal pain, metallic taste
INTEG: drying of hair, alopecia, rash, pruritus
MS: muscle weakness
NURSING INTERVENTIONS FOR EACH SIDE EFFECTS:  
CNS: fine hand tremors that can interfere with purposeful motor skills can be exacerbated by factors such as stress and caffeine, administer beta- adrenergic blocking agents such as propanolol (Inderal), adjust dose to be as low as possible, give in divded doses, or use long –acting formulations, advise the patient to report an increase in tremors, which could be a sign of lithium toxicity
ENDO: goiter and hypothyroidism may occur with long-term use, obtain baseline T3, T4 and TSH levels prior to starting treatment and an annually thereafter, advise the patient to monitor for signs of hypothyroidism( cold, dry skin, decreased heart rate, weight gain), Levothyroxine (synthroid) maybe given to manage hyperthyroidism,
GI: advise the patient that symptoms are usually transient, administer medication with meals or milk, for dry mouth give hard candy or gum and encourage liquids  
Possible drug/drug interactions: 
 Diuretics: sodium is excreted with the use of diuretics; with decreased serum sodium, lithium excretion is decreased, which can lead to toxicity
NSAIDs(ibuprofen [Motrin] and celecoxib [ celebrex] ): - concurrent use will increase renal reabsprption of lithium, leading to toxicity
Anticholinergics ( antihistamines, trcyclic antidepressants)_- abdominal discomfort can result from anticholinergic- induced urinary retention and polyuria   
Increases effects of neuromuscular blocking agents, phenothiazines
Increases renal clearance- sodium bicarbonate, acetazolamide, mannitol, aminophylline
Increases lithium effect/toxicity- carbamazepine, fluoxetine, methyldopa
Decreases lithium effects- theophyllines, urea, urinary alkalinizers  
Possible drug/food interactions 
Decreases lithium levels black/green tea and coffee
Sodium intake will significantly alter lithium excretion 
Drug/ Lab Test: 
Increases potassium excretion, urine glucose, blood glucose, protein, BUN
Decreases VMA, T3, T4
Possible drug/environment interactions 
Pertinent info to document

Trazodone
Trazode ( aleptro) 
Antidepressant
Reason/reasons why the med. Is prescribed for this client.
Depression, anxiety
Dosage/Route:  Pt. 
PO 150 mg 
Recommended Dosage
150 mg
½ life
 4.4- 7.5 hr
Recommended Client Age
Adult
Unlabeled children as young as 6 but not recommend  
Pertinent assessments to make before and after giving this medication 
Parameters to consider
Any reason to hold this medication 
Pertinent labs and interventions for the medication 
Changes recommended in dosage for physiologic reasons (renal/hepatic, etc.) 
Desired action “how” it works
Selectively inhibits serotonin uptake by the brain
Common Adverse Affects 
Suicidal ideations, acute renal failure, paralytic ileus, blood dyscrasias
INTERVENTIONS FOR EACH ADVERESE EFFECT
Hepatic studies: AST, ALT, bilirubin, BUN, and creatinine
Blood studies: CBC, leukocytes, monitor for bruising and bleeding of the gums
Expected therapeutic effects for this client
Decreased depression
Evaluate the effects experienced by this client
Side effects
CNS: dizziness, drowsiness, confusion, headache, nightmares 
EENT: blurred vision
GI: constipation  
INTEG: Photosensitivity 
NURSING INTERVENTIONS FOR EACH SIDE EFFECTS 
CNS & EENT: Teach to use in cautiously during activities that require alertness (i.e. driving) because of drowsiness, dizziness and blurred vision
INTEG: wear sun block
GI: Increase fluids and bulk in diet, encourage pt to ambulate to help facilitate peristalsis, stool softeners may be given as well
Possible drug/drug interactions
SSRIs increase toxicity (serotonin syndrome) 
Increases digoxin
Herbal 
St. John’s wort increases toxicity (serotonin syndrome)
Possible drug/food interactions
Possible drug/environment interactions 
Photosensitivity 
Pertinent info to document

Carbamazepine
Carbamazepine ( tegretol)
Mood stabilizing antiepileptic 
Reason/reasons why the med. Is prescribed for this client.
Bipolar disorder
Dosage/Route:  Pt. 
PO 200mg bid
Recommended Dosage
Adult 200mg 
½ life 
18-65 hrs then 8-29 after 1 mnth
Recommended Client Age
Adult
Pertinent assessments to make before and after giving this medication
Parameters to consider
Any reason to hold this medication 
Pertinent labs and interventions for the medication
Changes recommended in dosage for physiologic reasons (renal/hepatic, etc.)
Desired action “how” it works
Inhibits GABA as well as glutamate

Common Adverse Effects 
Bone marrow depression, blood dyscasias ( leucopenia, anemia, thrombocytopenia), teratogenesis, Steven Johnson syndrome 
INTERVENTIONS FOR EACH ADVERESE EFFECTS
Blood dyscrasias: baseline CBC and platelets, perform ongoing monitoring/ observer for bruising and bleeding of gums
Teach to avoid use during pregnancy 
If Steven Johnson syndrome occurs discontinue use and notify the provider 
Expected therapeutic effects for this client
Prevent relapse of mania and depressive episodes
Evaluate the effects experienced by this client
Effectiveness may be evidenced by relief of acute manic symptoms or depressive symptoms, verbalization of improvement in mood ability to perform ADLs, improved sleep, and eating habits
Side effects
 Nystagmus, double vision, vertigo, staggering gate, hypo-osmolarity, decreased urine output, and hypertension
NURSING INTERVENTIONS FOR EACH SIDE EFFECT
Gradually increase the does and establish, administer at bedtime, monitor serum sodium, and monitor edema
Possible drug/drug interactions 
Decreases effects of oral contraceptives, warfarin (Coumadin) 

Possible drug/food interactions 
Grapefruit juice (p450 pathway) 
Possible drug/environment interactions 
Pertinent info to document

Clonazepam 
Clonazepam
Anticonvulsant, benzodiazepine derived 
Reason/reasons why the med. Is prescribed for this client 
Anxiety 
Dosage/Route:  
PO 1 mg tid
Recommended Dosage 
1.5 mg/day tid
½ life 
18-50 hr, duration 6- 12 hr
Recommended Client Age 
< 10 yr or < 30 kg 
Pertinent assessments to make before and after giving this medication
Parameters to consider
Any reason to hold this medication
Pertinent labs and interventions for the medication
Changes recommended in dosage for physiologic reasons (renal/hepatic, etc.) 
Desired action “how” it works
Inhibits spike, wave formation in absence seizures, decreases amplitude, frequency, duration, spread of discharge in minor motor seizures

Common Adverse Affects 
CNS: suicidal tendencies
HEMA: thrombocytopenia, leukocytosis, and eosinophilia
RESP: respiratory depression
INTERVENTIONS FOR EACH ADVERESE EFFECTS
HEMA: blood studies
RESP: Use cautiously with other medication that cause respiratory depression such as opoids
Expected therapeutic effects for this client
Decreased level of anxiety 
Evaluate the effects experienced by this client
Side effects
CNS:  Drowsiness, dizziness, confusion, behavioral changes, tremors, insomnia, headache, and slurred speech
CV: Palpitations, bradycardia, tachycardia
EENT: Increased salivation, nystagmus, diplopia (double vision), abnormal eye movements
GI: nausea, constipation, polyphagia, anorexia, xerostomia, diarrhea, gastritis, and sore gums
GU: dysuria, enuresis, noctoria, retention, libido changes 
INTEG: rash, alopecia, hirsutism
RESP: dyspnea, congestion
NURSING INTERVENTIONS FOR EACH SIDE EFFECT
GI: administer with food or milk for GI upset, administer a stool softener for constipation, increase fiber/bulk to help with constipation, and encourage pt to ambulate to help increase peristalsis
CNS & EENT: advise pt to not drive if vision problems occur, and avoid other actives that require alertness due decreased CNS
Possible drug/drug interactions 
Increases clonazepam effects:
Azoles, cimetidine, clarithromycin, diltiazem, erythromycin, fluoxetine, and oral contraceptives
Increases CNS depression:
Alcohol, barbiturates, opiates, antidepressants, other anticonvulsants, general anesthetics, hypnotics, sedatives
Decreases clonazepam effect:
Carbamazepine, Phenobarbital, phenytoin
Herbals
Decreases clonazepam effect:
Ginseng, St. John’s Wort
Increases CNS depression:
Ginkgo, melatonin 
 Drug/ Lab Test
Increases:
AST, alk phos, bilirubin
Possible drug/food interactions 
Possible drug/environment interactions
Pertinent info to document

Saphris
Asenapine ( saphris)
Atypical antipsychotic, benzisoxazole derivative
Reason/reasons why the med. Is prescribed for this client
Schizoaffective 
Dosage/Route:
Sublingually 10 mg BID  
Recommended Dosage
Schizophrenia sublingually 5 mg bid, max 20 mg/day
Bipolar 1 disorder sublingually 10mg bid, may decrease to 5mg bid as needed, max 20 mg/day
½ life 
Terminal ½ life 24 hr
Recommended Client Age
Adult 
Pertinent assessments to make before and after giving this medication
Mental status before administration asses for suicidal thoughts behaviors 
Affect, orientation LOC, reflexes, gait, coordination, sleep  pattern disturbances
B/P standing and laying; also pulse, respirations; establish baseline before starting treatment; report a drop of 30mm Hg watch for ECG changes; prolonged QT may occur 
Parameters to consider
Any reason to hold this medication 
Pertinent labs and interventions for the medication
Changes recommended in dosage for physiologic reasons (renal/hepatic, etc.)
Administer in lower doses for geriatric pt
Desired action “how” it works
Action unknown, may be mediated through both dopamine type 2 (D2) and serotonin type antagonism 
Common Adverse Affects 
CNS: seizures, neuroleptic malignant syndrome 
CV: sinus tachycardia; heart failure, QT prolongation, stroke, bundle branch block
HEMA: thrombocytopenia, 
Expected therapeutic effects for this client
Improved mood/ affect 
Evaluate the effects experienced by this client
Side effects
CNS: EPS, pseudoparkinsomism, akathisia, dystonia, tardive dyskinesia; drowsiness, insomnia, agitation, anxiety and headache
CV: orthostatic hypotension
GI: nausea, vomiting , constipastion, weight gain, increases appetite
GU: hyperprolactinemia, hyperglycemia, and hyponatremia
NURSING INTERVENTIONS FOR EACH SIDE EFFECT
CNS: avoid in use with other CNS depressants, teach to avoid hazardous activities if drowsy or dizzy, avoid OTC preparations ( cough, hay fever, cold) unless approved by provider, avoid use of alcohol because may increase drowsiness, and supervised ambulation until pt is stabilized on medication do not involve in strenuous exercise because fainting is possible
CV: raise slowly from sitting or lying postions gradually because orthostatic hypotension may occur
GI: Increase fluids because constipation may occur 
Possible drug/drug interactions
Increases sedation:
When taken with other CNS depressants, alcohol
Increases EPS:
SSRIs
Increases asenapine excretion:
Carbamazepine
Drug/Lab Test
Increases prolactin levels
Possible drug/food interactions 
Possible drug/environment interactions
Pertinent info to document