Name of Drug Mechanism of Action
Diazepam is a long-acting - Short term management
benzodiazepine that exerts
Generic Name: anxiolytic, sedative,
Diazepam anticonvulsant, muscle relaxant
and amnestic effect. It binds to
stereospecific benzodiazepine
receptors on the postsynaptic
Classification: Benzodiazepine gamma-aminobutyric acid
derivatives anxiolytics (GABA) neuron in different
regions of the central nervous
system, e.g. brain and spinal cord
Dosage: 5mg thereby, increasing the inhibitory
effects of GABA which is involved
in sleep induction, control of
Frequency: PRN hypnosis, memory, anxiety,
epilepsy and neuronal excitability.
Route: PO
Indication
Withdrawal symptoms (e.g.
of anxiety
- Insomnia associated with
anxiety
- Sleepwalking
- Night terrors
- Adjunct in the
management of seizures
- Muscle spasms
- Acute symptoms of
alcohol withdrawal
Contraindications
- Acute or chronic severe
respiratory insufficiency
- Respiratory depression
- Myasthenia gravis
- Sleep apnoea
- Severe hepatic
insufficiency
- acute narrow-angle
glaucoma
- phobic or obsessional
states
- chronic psychosis,
hyperkinesis,
- acute porphyria.
Side Effects Nursing Consideration
Before
rebound insomnia and anxiety,
panic, palpitations, sweating,
paranoid psychosis, epileptic
attacks, delirium), anterograde
amnesia, paradoxical reactions
(e.g. restlessness, agitation,
irritability, aggressiveness,
delusion, rages, nightmares,
psychoses), habituation, drug
dependence.
Adverse Effects
Diplopia,constipation, nausea,
gastrointestinal disturbances,
altered salivation, fatigue, ataxia,
local reactions at the injection site
e.g. thrombophlebitis and venous
thrombosis, elevated
transaminases and alkaline
phospahatase.
Impaired motor ability, tremor,
headache, vertigo Confusion,
depression, slurred speech.
- Discuss risk of fetal
abnormalities with patients
desiring to become pregnant.
- Instruct about side effects of
drug: Drowsiness, dizziness, GI
upset, dreams, difficulty
concentrating, fatigue,
nervousness, crying.
- Assess for hypersensitivity.
- Reduce dose of opioid
analgesics with IV diazepam;
dose should be reduced by at
least one-third or eliminated.
- Instruct not to stop taking the
drug without consulting the health
care provider.
- Observe the 15 rights of drug
administration.
During
- Do not administer intrarterially;
may produce arteriospasm,
gangrene.
- Carefully monitor P. BP,
respiration during IV
administration.
- Change from IV therapy to oral
therapy as soon as possible.
Urinary incontinence, urinary - Do not use small veins for IV
retention, change in libido injection.
hypotension. - Instruct to take drug exactly as
prescribed.

After
- Maintain patients receiving
parenteral benzodiazepines in
bed for 3 hours.
- Do not permit ambulatory
patients to operate a vehicle
following an injection.
- Instruct patient to report
adverse reactions.
- Monitor EEG in patients treated
for status epilepticus, seizures
may recur after initial control.
- Monitor liver and renal function,
CBC during long term therapy.
- Taper dosage gradually after
long-term therapy.
- Document that drug has been
given.
 Name of Drug Mechanism of Action
Risperidone is a second-
generation antipsychotic that has
Generic Name: an affinity for D2, 5-HT2A, alpha
Risperidone 1, alpha 2 and H1 receptors. The
mechanism of action of
risperidone is not fully
Classification: Anti-psychotic understood, current theories
focus mainly on its ability to block
D2 and 5-HT2A receptors.
Dosage: 2mg
Frequency: ½ tab am; 1 tab pm
(BID)
Route: PO
Indication
- Schizophrenia. Moderate to
severe manic episodes in bipolar
disorder. Short-term treatment of
persistent aggression in patients
with moderate to severe
Alzheimer's dementia
unresponsive to non-
pharmacological approaches and
where there is a risk of harm to
self or others. Short-term
treatment of persistent
aggression in conduct disorder in
children with sub-average
intellectual functioning or mental
retardation
Contraindications
Contraindicated in patients
hypersensitive to drug and in
breast-feeding women.
Use cautiously in patients with
prolonged QT interval, CV
disease, cerebrovascular
disease, dehaydration,
hypovolemia, history of seizures,
or conditions that could affect
metabolism or hemodynamic
responses.
Side Effects
CNS: Akathisia, somnolence,
dystonia, headache, insomnia,
agitation, anxiety, pain,
parkinsonism, neuroleptic
malignant syndrome, suicide
attempt, dizziness, fever,
hallucination, mania, impaired
concentration.
CV: tachycardia, chest pain,
orthostatic hypotension,
peripheral edema, syncope,
hypertension.
EENT: rhinitis, sinusitis,
pharyngitis, abnormal vision, ear
disorder.
GI: constipation, nausea,
vomiting, dyspepsia, abdominal
pain.
Adverse Effects
 Confusion
 dizziness
 drowsiness
 extreme thirst
Nursing Consideration
 Monitor patient for
tardive dyskinesia, which
may occur after
prolonged use. It may not
appear until months or
years later and may
disappear spontaneously
or persist for life, despite
stopping drug.
 Life-threatening
hyperglycemia may
occur in patients taking
atypical antipsychotics.
Monitor patients with
diabetes regularly.
 Periodically reevaluate
drug’s risks and benefits,
especially during
prolonged use.
 Monitor patient for weight
gain.
Use cautiously in patients  fast, shallow breathing
exposed to extreme heat.  fast, weak heartbeat
 headache
 increased thirst
 lip smacking or puckering
 loss of appetite
 muscle cramps
 pale, clammy skin
 poor coordination
 prolonged, painful,
inappropriate erection of
the penis
 puffing of the cheeks
 rapid or worm-like
movements of the tongue
 shivering
 talking, feeling, and
acting with excitement
and activity that cannot
be controlled
 uncontrolled chewing
movements
 uncontrolled twisting
movements of neck,
trunk, arms, or legs
 unusual bleeding or
bruising
 unusual facial
expressions or body
positions
 Name of Drug Mechanism of Action Indication Side Effects Nursing Consideration

Divalproex sodium dissociates to
the valproate ion in the
Generic Name: gastrointestinal tract. The
Divalproex Sodium mechanisms by which valproate
exerts its therapeutic effects have
not been established. It has been
suggested that its activity
Classification: Anticonvulsant in epilepsy is related to
increased brain concentrations of
gamma-aminobutyric acid
Dosage: 500 mg (GABA).
Frequency: TID
Route: PO
- Simple and complex absence  diarrhea,
seizures, mixed seizure types  constipation,
(inc absence seizures)  upset stomach,
- Complex partial seizures  dizziness,
- Mania  drowsiness,
- To prevent migraine headache  weakness,
 hair loss,
 blurred/double vision/vision
Contraindications changes,
 changes in menstrual periods,
Hypersensitivity and in those with enlarged breasts,
hepatic disease or significant  ringing in the ears,
hepatic dysfunction, and in  shakiness (tremor),
patients with a urea cycle  unsteadiness,
disorder (UCD)  unusual or unpleasant taste in
your mouth, or
Drug interaction  weight changes.
drug to drug
Aspirin, Benzodiazepines,
Carbamazepine, Lamotrigine, Adverse Effects
Phenobarbital, Phenytoin,
Rifampin, Warfarin,
Zidovudine  signs of infection (e.g., fever,
persistent sore throat, swollen
Alcohol use: cause excessive lymph nodes),
CNS depression  chest pain,
 easy bruising or unexplained
bleeding,
 fast/slow/irregular heartbeat,
 swelling of hands or feet,
 Obtain liver function test
results, platelet count,
and PT and INR before
starting therapy, and
monitor these values
periodically
 Don’t give syrup to
clients who need sodium
restriction
 Adverse reactions may
not be caused by
valproic acid alone
because it’s usually used
with other
anticonvulsants
 Divalproex sodium has a
lower risk of adverse GI
reactions
 Never withdraw drug
suddenly because
sudden withdrawal may
worsen seizures
 Monitor drug level
 uncontrolled eye movement
(nystagmus),
 feeling cold or shivering,
 rapid breathing, or
 loss of consciousness.
 Name of Drug Mechanism of Action
Carvedilol is a non-selective β-
blocker. It reduces peripheral
Generic Name: vascular resistance by selective
Carvedilol α1 receptor blockade and
suppresses renin-angiotensin
system through non-selective β-
blockade. Carvedilol has weak
Classification: alpha and beta membrane stabilising properties
blocking agent and has no intrinsic
sympathomimetic activity.
Dosage: 6.25 mg (½ tab)
Frequency: BID
Route: PO
Indications
 Hypertension.
 HF (ischemic or
cardiomyopathic) with digoxin, disorders: Anaemia.
diuretics, and ACE inhibitors.
 Left ventricular dysfunction
after myocardial infarction
Contraindications
History of serious
 Musculoskeletal and connective
hypersensitivity reaction
(Stevens-Johnson syndrome, extremities, arthralgia.
angioedema, anaphylaxis);
 Pulmonary edema;
 Cardiogenic shock;
Side Effects
Significant: Hypotension with or 
without syncope, bradycardia.
Blood and lymphatic system
Cardiac disorders: Dyspnoea,
pulmonary oedema.
Eye disorders: Visual impairment,
eye irritation, dry eye.
Gastrointestinal
disorders: Nausea, diarrhoea,
vomiting, dyspepsia, abdominal
pain.
General disorders and admin site
conditions: Asthenia, fatigue.
Infections and
infestations: Bronchitis.
Metabolism and nutrition
disorders: Oedema,
hypervolaemia, weight gain,
hypercholesterolaemia,
hyperglycaemia, hypoglycaemia.
tissue disorders: Pain in
Nervous system
disorders: Dizziness, headache.
Psychiatric
disorders: Depression.
Renal and urinary
disorders: Micturition disorders,
Nursing Considerations
Monitor BP and pulse
frequently during dose
adjustment period and
periodically during
therapy. Assess for orthostatic
hypotension when assisting
patient up from supine
position.
 Monitor intake and output
ratios and daily weight.
Assess patient routinely for
evidence of fluid overload
(peripheral edema, dyspnea,
rales/crackles, fatigue, weight
gain, jugular venous
distention). Patients may
experience worsening of
symptoms during initiation of
therapy for HF.
 Monitor patients receiving
beta blockers for signs of
overdose (bradycardia,
severe dizziness or fainting,
severe drowsiness, dyspnea,
bluish fingernails or palms,
seizures). Notify health care
 Bradycardia, heart block or abnormal renal function, renal professional immediately if
sick sinus syndrome (unless a failure. these signs occur.
pacemaker is in place); Vascular disorders: Orthostatic
hypotension, peripheral vascular
 Uncompensated HF requiring
disease.
IV inotropic agents (wean
before starting carvedilol);
 Severe hepatic impairment;
 Asthma or other
bronchospastic disorders.