1. Medication Name/Class

• Generic/Brand: Ziprasidone (Geodon).
• Class: Atypical Antipsychotic, Serotonin-Dopamine Antagonist (SDA).

2. Mechanism of Action

• Antagonizes dopamine D2 and serotonin 5-HT2A receptors. Modulating mesolimbic dopamine reduces positive symptoms; mesocortical serotonin modulation targets negative symptoms.

3. Expected Action/Therapeutic Effect

• Reduces positive and negative psychotic symptoms and rapidly controls acute agitation.

4. Indications

• Schizophrenia, Bipolar I (acute/maintenance), and acute agitation (IM route only).

5. Pharmacokinetics

• Absorption: PO bioavailability is ~60% but requires food to double absorption.
• Peak/Half-life: PO peaks in 6-8 hrs (half-life 7 hrs). IM peaks in ≤1 hr (half-life 2-5 hrs).
• Metabolism: Hepatic (minor CYP1A2/3A4 substrate).

6. Drug-Drug Interactions

• Has minimal CYP450 interference. Poses a high risk when combined with other CNS depressants or any QT-prolonging agents.

7. Side Effects vs Adverse Effects

• Common: Drowsiness, insomnia, weight gain, nausea, and EPS (akathisia).
• Serious: QT prolongation, Neuroleptic Malignant Syndrome (NMS), Tardive Dyskinesia, DRESS, and Stevens-Johnson syndrome.

8. Contraindications/Precautions

• Elderly: Avoid in dementia-related psychosis.
• Renal: Use IM formulations with caution due to the cyclodextrin excipient clearance.

9. Nursing Interventions

• Safety: Handle as a hazardous drug (Group 3).
• PO Admin: Administer whole; never crush or chew.
• IM Admin: Reconstitute ONLY with Sterile Water. Keep the patient recumbent for ≥30 mins post-injection to prevent severe hypotension.
• Monitor: Baseline/ongoing ECGs (QTc) and sodium levels (due to SIADH/hyponatremia risk).

10. Patient Education

• Take capsules whole, always with food, at roughly the same time daily.
• Immediately report palpitations, fainting, muscle stiffness, or rashes.

11. Black Box Warning/Antidote

• BBW: Increased mortality (typically heart failure or pneumonia) and increased stroke risk in elderly patients with dementia-related psychosis.

12. Nursing School Priority Summary

• Must Know: PO dosing strictly requires food for absorption; always monitor ECG for QT prolongation.
• Nice to Know: Ziprasidone is not removed by hemodialysis.
• Test Trap: Failing to keep IM patients flat for 30 minutes, risking orthostatic hypotension.
• Clinical Red Flag: Sudden fever, muscle rigidity (NMS), or arrhythmias.
• One-Sentence Memory Hook: "Ziprasidone zips the heart rhythm (QT risk) and needs a meal to zip through the gut."