Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

quetiapine Seroquel Antipsychotic 200 mg PO Q am
400 mg PO bid
Peak Onset Duration Normal dosage range
unknown unknown 8-12 hrs 100 mg/day in two divided doses on day 1, increase dose by 100
mg/day up to 400 mg/day by day 4, then may increase in 200 mg/day
increments up to 800 mg/day on day 6 if required.
Why is your patient getting this medication For IV meds, compatibility with IV drips and/or solutions
Bipolar mania N/A
Mechanism of action and indications Nursing Implications (what to focus on)
(Why med ordered) Contraindications/warnings/interactions
Probably acts by serving as an antagonist of dopamine and Hypersensitivity. Cardiovascular disease, cerebrovascular disease,
serotonin. Also antagonizes histamine H1 receptors and alpha1- dehydration or hypovolemia (increased risk of hypotension). History
adrenergic receptors. of seizures, Alzheimer’s type dementia. Geriatric patients (may require
↓ doses; inappropriate use for dementia is associated with ↑ mortality),
hepatic impairment (dosage reduction may be necessary),
hypothyroidism (may be exacerbated).
Common side effects
NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, dizziness,
weight-gain

Seroquel (quetiapine)
Interactions with other patient drugs, OTC or herbal Lab value alterations caused by medicine
medicines (ask patient specifically) May cause asymptomatic ↑ in AST and ALT. May also cause anemia,
Lantus: The efficacy of oral hypoglycemic agents and insulin thrombocytopenia, leukocytosis, and leucopenia.
may be diminished by certain drugs, including thiazides and May cause ↑ total cholesterol and triglycerides
other diuretics, corticosteroids, estrogens, progestins, thyroid
hormones, human growth hormone, phenothiazines, atypical
antipsychotics, sympathomimetic amines, protease inhibitors,
phenytoin, clozapine, megestrol, danazol, isoniazid,
asparaginase, pegaspargase, diazoxide, temsirolimus, as well as Be sure to teach the patient the following about this medication
pharmacologic dosages of nicotinic acid and Instruct patient to take medication as directed. Inform patient of the
adrenocorticotropic agents. These drugs may interfere with possibility of extrapyramidal symptoms. Instruct patient to report
blood glucose control because they can cause hyperglycemia, symptoms immediately to health care professional. Advise patient to
glucose intolerance, new-onset diabetes mellitus, and/or change positions slowly to minimize orthostatic hypotension. May
exacerbation of preexisting diabetes. cause drowsiness. Caution patient to avoid driving or other activities
Nitroglycerin: Neuroleptic agents may potentiate the requiring alertness until response to medication is known. Advise
hypotensive effect of some medications secondary to their patient to avoid extremes in temperature; this drug impairs body
peripheral alpha-1 adrenergic blocking activity. Orthostatic temperature regulation. Caution patient to avoid concurrent use of
hypotension and syncope associated with vasodilation may alcohol, other CNS depressants, and OTC or herbal medications
occur, particularly during the initial dose titration period of without consulting health care professional. Advise patient to notify
neuroleptic therapy. health care professional of medication regimen before treatment or
Proventil, Levaquine: There is some concern that quetiapine surgery. Instruct patient to notify health care professional promptly of
may have additive adverse cardiovascular effects in sore throat, fever, unusual bleeding or bruising, or rash. Emphasize
combination with other drugs that are known to prolong the QT need for continued follow-up for psychotherapy and monitoring for
interval of the electrocardiogram. Data are conflicting. In side effects. Ophthalmologic exams should be performed before and
clinical trials, there was no statistically significant difference every 6 months during therapy.
between quetiapine and placebo in the proportions of patients
experiencing potentially important changes in ECG parameters
including QT, QTc, and PR intervals. However, QT
prolongation has been reported in quetiapine overdose and with
therapeutic use of other atypical antipsychotic agents such as
sertindole, ziprasidone, and risperidone. In one case report,
torsade de pointes arrhythmia developed in a patient treated
with low-dose quetiapine. However, the relationship to
quetiapine is uncertain, as there were multiple confounding risk
factors such as hypomagnesemia, a history of QT prolongation
(possibly prior to initiation of quetiapine), a history of
substance abuse, and uncertain medication compliance. In
general, the risk of an individual agent or a combination of
agents causing ventricular arrhythmia in association with QT
prolongation is largely unpredictable but may be increased by
certain underlying risk factors such as congenital long QT
syndrome, cardiac disease, and electrolyte disturbances (e.g.,
hypokalemia, hypomagnesemia). In addition, the extent of
drug-induced QT prolongation is dependent on the particular
drug(s) involved and dosage(s) of the drug(s).
Coreg, Demadex: Neuroleptic agents may potentiate the
hypotensive effect of some medications secondary to their
peripheral alpha-1 adrenergic blocking activity. Orthostatic
hypotension and syncope associated with vasodilation may
occur, particularly during the initial dose titration period of
neuroleptic therapy.
Gabapentin: Central nervous system- and/or respiratory-
depressant effects may be additively or synergistically
increased in patients taking multiple drugs that cause these
effects, especially in elderly or debilitated patients.
Reglan: Coadministration of metoclopramide with
phenothiazines or other neuroleptic agents may increase the
Seroquel (quetiapine)
Nursing Process- Assessment Assessment Evaluation
(Pre-administration assessment) Why would you hold or not give this med? Check after giving
Monitor mental status (mood, ideation, delusions, Monitor for development of neuroleptic Decrease in excited, manic,
hallucinations, behavior) before and periodically malignant syndrome (fever, respiratory paranoiac or withdrawn behavior.
during therapy. Monitor mood changes. Assess for distress, tachycardia, seizures, diaphoresis, Make sure patient has swallowed
suicidal tendencies, especially during early hypertension or hypotension, pallor, medication and is not “cheeking”
therapy. Restrict amount of drug available to tiredness). Notify physician or other health or holding meds.
patient. Monitor blood pressure (sitting, standing, care professional immediately if these
lying) and pulse before and frequently during symptoms occur. Hypersensitivity. Seizure.
initial dose titration. If hypotension occurs during
dose titration, return to the previous dose.
Observe patient carefully when administering to
ensure medication is swallowed and not hoarded.
Monitor for onset of extrapyramidal side effects
(akathisia--restlessness;dystonia--muscle spasms
and twisting motions; or pseudoparkinsonism--
mask-like faces, rigidity, tremors, drooling,
shuffling gait, dysphagia). Report these symptoms;
reduction of dose or discontinuation may be
necessary. Trihexyphenidyl or diphenhydramine
may be used to control these symptoms. Monitor
for tardive dyskinesia (involuntary rhythmic
movement of mouth, face, and extremities).
Report immediately; may be irreversible.

Seroquel (quetiapine)