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Generic Name aripiprazole

Trade Name Abilify

Classification Atypical antipsychotic

Dose 10mg

Route tab

Time/frequency Morning

Peak 35 h.

Onset 3 hr

Duration 75 h (94 h for metabolite); 146 h (poor metabolizers)

Normal dosage range Schizophrenia Adult: PO 1015 mg once daily, may increase at 2wk intervals to max of 30 mg/day if needed Adolescent/Child (at least 10 y old): PO 2 mg daily, increase to 5 mg after 2 days, increase to 10 mg after 2 more days. Can increase up to 30 mg. Bipolar Mania Adult: PO 1530 mg once daily Adolescent/Child (at least 10 y old): PO 2 mg daily, increase to 5 mg after 2 days, increase to 10 mg after 2 more days. Can increase up to 30 mg. Agitation Associated with Schizophrenia/Bipolar Adult: IM 9.75 mg (range: 5.2515 mg) Adjunct in Major Depression Adult: PO 25 mg daily Pharmacogentic Dosage Adjustment Reduced CYP2D6 expression (i.e., poor metabolizers): Give 70% of normal starting dose For IV meds, compatibility with IV drips and/or solutions N/A

Why is your patient getting this medication Major Depressive Disorder

Mechanism of action and indications (Why would this med be ordered) . Efficacy of aripiprazole may be mediated through a combination of partial agonist activity at D2 and 5-HT1A receptors and antagonist activity at 5-HT2A receptors. Partial dopaminergic agonist property of aripiprazole accounts for antipsychotic treatment of schizophrenic and bipolar individuals.

Nursing Implications (what to focus on) Contraindications/warnings/interactions Assessment & Drug Effects Monitor diabetics for loss of glycemic control. Monitor cardiovascular status. Assess for and report orthostatic hypotension. Take BP supine then in sitting position. Report systolic drop of greater than 1520 mm Hg. Patients at increased risk are those who are dehydrated, hypovolemic, or receiving concurrent antihypertensive therapy. Monitor body temperature in situations likely to elevate core temperature (e.g., exercising strenuously, exposure to extreme heat, receiving drugs with anticholinergic activity, or being subject to dehydration). Monitor for and report signs of tardive dyskinesia. Monitor for and immediately report S&S of neuroleptic malignant syndrome (NMS) that include: Hyperpyrexia, muscle rigidity, altered mental status, irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia. Withhold drug if NMS is suspected. Lab tests: Monitor periodically Hct and Hgb. Monitor periodically blood glucose. Monitor for elevated CPK and myoglobinuria if NMS is suspected. Common side effects Body as a Whole: Headache, asthenia, fever, flu-like symptoms, peripheral edema, chest pain, neck pain, neck rigidity. CNS: Anxiety, insomnia, lightheadedness, somnolence, akathisia, tremor, extrapyramidal symptoms, depression, nervousness, increased salivation, hostility, suicidal thought, manic reaction, abnormal gait, confusion, cogwheel rigidity. CV: Hypertension, tachycardia, hypotension, bradycardia. Risk of

stroke in elderly with dementia-related psychosis. GI: Nausea, vomiting, constipation, anorexia. Hematologic: Ecchymosis, anemia. Metabolic: Weight gain, weight loss, hyperglycemia, diabetes mellitus, increased creatine kinase. Musculoskeletal: Muscle cramp. Respiratory: Rhinitis, cough. Skin: Rash. Special Senses: Blurred vision.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Drug: CYP3A4 inducers ( carbamazepine, phenytoin, etc.) will decrease aripiprazole levels (may need to double aripiprazole dose); use with CYP2D6 or CYP3A4 inhibitors ( ketoconazole, quinidine, fluoxetine, paroxetine, etc.) may increase aripiprazole levels (reduce dose by ); may cause additive sedation with other SEDATIVES (alcohol, tramadol, BARBITURATES, etc.); may enhance effects of ANTIHYPERTENSIVE AGENTS.

Lab value alterations caused by medicine Lab tests: Monitor periodically Hct and Hgb. Monitor periodically blood glucose. Monitor for elevated CPK and myoglobinuria if NMS is suspected.

Be sure to teach the patient the following about this medication Carefully monitor blood glucose levels if diabetic. Do not drive or engage in other potentially hazardous activities until reaction to drug is known. Avoid situations where you are likely to become overheated or Herbal: St. John's wort may decrease aripiprazole levels. dehydrated. Notify physician if you become pregnant or intend to become pregnant Food: High fat meals may delay time to peak plasma levels. while taking this drug. Nursing Process- Assessment Assessment Evaluation (Pre-administration assessment) Why would you hold or not give this med? Check after giving Monitor diabetics for loss of glycemic Monitor periodically Hct and CONTRAINDICATIONS Hypersensitivity to aripiprazole; dementia in control. Hgb. Monitor periodically blood elderly; QT prolongation; lactation. Monitor cardiovascular status. Assess for glucose. Monitor for elevated and report orthostatic hypotension. CPK and myoglobinuria if NMS Take BP supine then in sitting is suspected. position. Report systolic drop of greater than 1520 mm Hg. Patients at increased risk are those who are dehydrated, hypovolemic, or receiving concurrent antihypertensive therapy. Monitor body temperature in situations likely to elevate core temperature (e.g., exercising strenuously, exposure to extreme heat, receiving drugs with anticholinergic activity, or being subject to dehydration). Monitor for and report signs of tardive dyskinesia. Monitor for and immediately report S&S of neuroleptic malignant syndrome (NMS) that include: Hyperpyrexia, muscle rigidity, altered mental status, irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia. Withhold drug if NMS is suspected.