Seroquel (quetiapine)

Clinical Medications Worksheets Generic Name quetiapine

Trade Name Seroquel

Peak unknown

Onset unknown

Classification Antipsychotic Duration 8-12 hrs

Why is your patient getting this medication Bipolar mania Mechanism of action and indications (Why med ordered) Probably acts by serving as an antagonist of dopamine and serotonin. Also antagonizes histamine H1 receptors and alpha1adrenergic receptors.

Seroquel (quetiapine)

Dose Route Time/frequency 200 mg PO Q am 400 mg PO bid Normal dosage range 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. For IV meds, compatibility with IV drips and/or solutions N/A Nursing Implications (what to focus on) Contraindications/warnings/interactions Hypersensitivity. Cardiovascular disease, cerebrovascular disease, dehydration or hypovolemia (increased risk of hypotension). History 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

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Lantus: The efficacy of oral hypoglycemic agents and insulin may be diminished by certain drugs, including thiazides and 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 pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes. Nitroglycerin: 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. Proventil, Levaquine: There is some concern that quetiapine may have additive adverse cardiovascular effects in combination with other drugs that are known to prolong the QT interval of the electrocardiogram. Data are conflicting. In clinical trials, there was no statistically significant difference 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 respiratorydepressant 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)

Lab value alterations caused by medicine May cause asymptomatic ↑ in AST and ALT. May also cause anemia, thrombocytopenia, leukocytosis, and leucopenia. May cause ↑ total cholesterol and triglycerides

Be sure to teach the patient the following about this medication Instruct patient to take medication as directed. Inform patient of the possibility of extrapyramidal symptoms. Instruct patient to report symptoms immediately to health care professional. Advise patient to change positions slowly to minimize orthostatic hypotension. May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Advise patient to avoid extremes in temperature; this drug impairs body temperature regulation. Caution patient to avoid concurrent use of alcohol, other CNS depressants, and OTC or herbal medications without consulting health care professional. Advise patient to notify health care professional of medication regimen before treatment or surgery. Instruct patient to notify health care professional promptly of sore throat, fever, unusual bleeding or bruising, or rash. Emphasize need for continued follow-up for psychotherapy and monitoring for side effects. Ophthalmologic exams should be performed before and every 6 months during therapy.

Nursing Process- Assessment (Pre-administration assessment) Monitor mental status (mood, ideation, delusions, hallucinations, behavior) before and periodically during therapy. Monitor mood changes. Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Monitor blood pressure (sitting, standing, lying) and pulse before and frequently during 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)

Assessment Why would you hold or not give this med? Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness). Notify physician or other health care professional immediately if these symptoms occur. Hypersensitivity. Seizure.

Evaluation Check after giving Decrease in excited, manic, paranoiac or withdrawn behavior. Make sure patient has swallowed medication and is not “cheeking” or holding meds.