Post by jasim on Feb 20, 2015 5:36:58 GMT
Risperidone
By Jasim Ahmed
Generic name: Risperidone
Brand name: Risperdal, Ozidal, Rispa, Resdone, Risperdal Quicklet, Rixadone
Mechanism: Risperidone is a second generation atypical antipsychotic monoaminergic antagonist. This drug acts as an antagonism of dopamine receptors and is effective at decreasing both positive and negative symptoms of psychosis.
Indications: This drug is used for schizophrenia, schizopherniform disorder, schizoaffective disorder, delusional disorder, bipolar disorder, drug-induced psychosis, organic psychosis, management of acute mania associated with bipolar disorder and treatment of behavioural disturbances.
Dose: For schizophrenia initially 1 mg orally twice daily, increased to 2 mg twice daily then increasing gradually if needed. For mania associated with bipolar initially 2 mg orally daily, increasing by 1 mg increments at daily intervals if needed. For behavioural disturbances with dementia initially 0.25 mg orally twice daily, increasing dose by 0.25 mg increments every second day if needed.
Contraindications: Drugs which prolong the QT interval, including sotalol, amiodarone, erythromycin, pentamidine, disopyramide, any agents which cause hypokalaemia or hypomagnemia. Patients with prolactin dependant tumours, phaechromocytoma (adrenal tumour), liver impairment, severe CNS depression, coma, Parkinson’s disease, circulatory collapse, long QT interval, bradycaedia or arrhythmias.
Adverse reactions: Parkinsonism’s, dystonias (repetitive twisting or abnormal posturing), akathisia (restlessness), tardive dyskinesia (repetitive facial grimacing), metabolic dysregulation, hyperprolactinaemia and cardiac side effects. Can also manifest as transient leucopania, agranulocytosis, thrombocytopenia, oral thrush, dry mouth, thirst, blurred vision, urinary retention, constipation, tachycardia, palpitations, photophobia, QT prolongation, postural hypotension, gynaecomastia, amenorrhoea, erectile dysfunction, nausea, vomiting, headache, increased body weight, worsening of diabetes, hyperglycaemia, dysphagia. Neuroleptic malignant syndrome is a potentially life threatening condition, most common in the young and elderly. Hyperthermia, muscle rigidity, altered conscious state, tachycardia, profuse sweating and arrhythmias.
Care considerations: Initial stabilisation should be done under medical supervision as adverse effect can be unpredictable. Improvement may take days to weeks to achieve and patients should be closely monitored during this time. Before starting therapy, patient should be thoroughly medically assessed. It can cause an antiemetic effect, care should be taken as this may mask symptoms of overdose. If the patient presents with neuroleptic malignant syndrome, the drug should be stopped immediately. Patient may experience an increase in temperature during the first 4 weeks of therapy and this must be carefully evaluated and distinguished from neuroleptic malignant syndrome. There could be inherent risk of suicide, therefore patients should be closely observed especially at the start of the therapy. Patient should be observed carefully so that a distinction may be made between return of psychotic behaviour and the onset of extrapyramidal reactions. Caution if used in those with a history of liver impairment, seizures or epilepsy
Patient education: Patient should be educated regarding postural hypotension. Patient should avoid alcohol. This drug should not be suddenly ceased. It may take several weeks to improve the symptoms. Therapy should be slowly discontinued over 1 to 2 weeks under supervision. Should avoid driving a vehicle or operating machinery if drowsy or dizzy especially in the first few weeks of therapy. Instruct patient to avoid overheating including strenuous exercise, exposure to extreme temperatures and dehydration as this drug may disrupt the ability to reduce temperature. Family members and carers should be instructed to monitor patient closely for any agitation, irritability, change in behaviour or any sign of depression such as sadness, withdrawal from friends or previously pleasurable activities or any attempt of self-harm.
Reference: Tiziani, A. (2013). Havard’s nursing guide to drugs (9th ed.). Chatswood, NSW: Elsevier.
By Jasim Ahmed
Generic name: Risperidone
Brand name: Risperdal, Ozidal, Rispa, Resdone, Risperdal Quicklet, Rixadone
Mechanism: Risperidone is a second generation atypical antipsychotic monoaminergic antagonist. This drug acts as an antagonism of dopamine receptors and is effective at decreasing both positive and negative symptoms of psychosis.
Indications: This drug is used for schizophrenia, schizopherniform disorder, schizoaffective disorder, delusional disorder, bipolar disorder, drug-induced psychosis, organic psychosis, management of acute mania associated with bipolar disorder and treatment of behavioural disturbances.
Dose: For schizophrenia initially 1 mg orally twice daily, increased to 2 mg twice daily then increasing gradually if needed. For mania associated with bipolar initially 2 mg orally daily, increasing by 1 mg increments at daily intervals if needed. For behavioural disturbances with dementia initially 0.25 mg orally twice daily, increasing dose by 0.25 mg increments every second day if needed.
Contraindications: Drugs which prolong the QT interval, including sotalol, amiodarone, erythromycin, pentamidine, disopyramide, any agents which cause hypokalaemia or hypomagnemia. Patients with prolactin dependant tumours, phaechromocytoma (adrenal tumour), liver impairment, severe CNS depression, coma, Parkinson’s disease, circulatory collapse, long QT interval, bradycaedia or arrhythmias.
Adverse reactions: Parkinsonism’s, dystonias (repetitive twisting or abnormal posturing), akathisia (restlessness), tardive dyskinesia (repetitive facial grimacing), metabolic dysregulation, hyperprolactinaemia and cardiac side effects. Can also manifest as transient leucopania, agranulocytosis, thrombocytopenia, oral thrush, dry mouth, thirst, blurred vision, urinary retention, constipation, tachycardia, palpitations, photophobia, QT prolongation, postural hypotension, gynaecomastia, amenorrhoea, erectile dysfunction, nausea, vomiting, headache, increased body weight, worsening of diabetes, hyperglycaemia, dysphagia. Neuroleptic malignant syndrome is a potentially life threatening condition, most common in the young and elderly. Hyperthermia, muscle rigidity, altered conscious state, tachycardia, profuse sweating and arrhythmias.
Care considerations: Initial stabilisation should be done under medical supervision as adverse effect can be unpredictable. Improvement may take days to weeks to achieve and patients should be closely monitored during this time. Before starting therapy, patient should be thoroughly medically assessed. It can cause an antiemetic effect, care should be taken as this may mask symptoms of overdose. If the patient presents with neuroleptic malignant syndrome, the drug should be stopped immediately. Patient may experience an increase in temperature during the first 4 weeks of therapy and this must be carefully evaluated and distinguished from neuroleptic malignant syndrome. There could be inherent risk of suicide, therefore patients should be closely observed especially at the start of the therapy. Patient should be observed carefully so that a distinction may be made between return of psychotic behaviour and the onset of extrapyramidal reactions. Caution if used in those with a history of liver impairment, seizures or epilepsy
Patient education: Patient should be educated regarding postural hypotension. Patient should avoid alcohol. This drug should not be suddenly ceased. It may take several weeks to improve the symptoms. Therapy should be slowly discontinued over 1 to 2 weeks under supervision. Should avoid driving a vehicle or operating machinery if drowsy or dizzy especially in the first few weeks of therapy. Instruct patient to avoid overheating including strenuous exercise, exposure to extreme temperatures and dehydration as this drug may disrupt the ability to reduce temperature. Family members and carers should be instructed to monitor patient closely for any agitation, irritability, change in behaviour or any sign of depression such as sadness, withdrawal from friends or previously pleasurable activities or any attempt of self-harm.
Reference: Tiziani, A. (2013). Havard’s nursing guide to drugs (9th ed.). Chatswood, NSW: Elsevier.