CNS Stimulants

Ritalin: Short acting

Daytrana: (transdermal) Long acting
PURPOSE: ADHD
Conduct Disorder
SE: CNS Stimulation (Insomnia, Restlessness)
Weight Loss
Cardiovascular Effect
Development of psychotic symptoms such as hallucination and paranoid.
Withdrawal reaction
Hypersensitivity skin
CONTRAINDICATED: History of drug abuse, cardiovascular disease
severe anxiety and psychosis
INTERACTIONS: MAOI can cause hypertensive crisis, OTC cold and decongestant
can increase
CNS.
NURSING INTERVENTIONS: Do not crush or chew take whole tablet.
Take daily
Place patch on hip daily in morning and don't leave
longer than 9 hours, alternate hip.
Controlled by Federal law, refill require handwritten
RX
High potential for abuse.
Norepinephrine Selective Reuptake Inhibiter
Strattera:
PURPOSE: ADHD (tolerated well with minimal SE)
SE: Appetite suppression, weight loss, growth suppression
GI effects Nausea and vomiting
Suicidal ideation (children and Adolescent)
Hepatotoxicity
CONTRAINDICATIONS: Cautiously with cardiovascular disorders
INTERACTIONS: MAOI can cause hypertensive crisis
Paxil, Prozac, and quinidine can increase levels of atomoxetine
NURSING INTERVENTIONS: Takes about 1 week to full develop.
Antipsychotics- Atypical
Risperal
PURPOSE: PDD pervasive development disorders
decrease autistic disorder
conduct disorders
PTSD
Relief of psychotic symptoms
SE: Onset of diabetes or loss of glucose control in clients with diabetes
weight gain hypercholesterolemia ( risk for hypertension and other cardiovascular
disease
Orthostatic
Anticholinergic
Agitation, dizziness, sedation, sleep disruption
Mild EPY such as tremors
CONTRAINDICATIONS: Avoid alcohol
Cautiously used with cardiovascular disease, seizures or DM
(obtain baseline on fasting glucose for diabetic
patients)
INTERACTIONS: Alcohol, opoids, and antihistamine cause CNS depression
BARBITURATES (dilatin)
Diflucan
NURSING INTERVENTIONS: Give low dose and then gradually increase
Medications to support
Withdrawal/Abstienence from Alcohol
detox: Benzodiazepine: Librium
PURPOSE: Client vital sign within expected reference range
decrease in the risk of seizure and delirium tremors
decrease in the intensity of symptoms
Adjunct medication
following Detox:
Tegretol
PURPOSE: Decrease in seizures
Abstinenece Maintenance
Antabuse:
PURPOSE: Oral type of aversion (behavioral therapy)
if use with alcohol will cause Acetaldehyde Syndrome
N/V weakness, sweating, palpitations and hyportnesion
Acetaldehyde syndrome can progress to respiratory depression,
cardiovascular suppression, seizure and death.
reVial
PURPOSE: Pure opioid antagonist that suppresses the craving and pleasurable
effects of alcohol
(also used for opioid withdrawal)
Campral
PURPOSE: decrease unpleasant effects resulting from abstinence (anxiety and
restlessness)
Medications to support withdrawal
Abstinence from Opoids
Catapress and Narcan
PURPOSE Opioid overdose
Assist with withdrawal of symptoms related to autonomic
hyperactivity (diarrhea, N/V)
Does not reduce the craving for opioids.
Mdications to support withdrawal
Abstinence from Nicotine
Wellbutrin
PURPOSE decrease nicotine craving with symptom withdrawal
Cholinsesterase inhibitors
Prostigmin
PURPOSE: treatment of maysthenia gravis (abnormal weakness of certain muscle)
Reversal of non depolarizing neuromuscular blocking agents
SE: increase GI secretion
Bradycardia excessive muscarinic stimulation which cause
cholinergic
Urinary Urgency crisis
CONTRAINDICATION: with obstruction of GI & GU (genitourinary)
peptic ulcer, asthma and coronary insuffiency
INTERACTION: Atropine
Succinylcholine increase neuromuscular blockade
NURSING INTERVENTION: PO, IM, IV and Subcutaneously
Start low does and titrated until desired muscle
function is achieve Recognize signs of inadequate dosing
such as difficulty swallowing
or signs of overmedicated such as urinary
urgency
Advise clients to wear medical bracelet
Anti-parkinson medication
dopaminergics: levodopa or carbidopa (sinemet)
PURPOSE: Parkinson (usually dose dependent)
1st line of PD treatment
SE: N/V
dyskinesia (head tremors)
orthostatic
cardiovascular
psychosis (hallucinations, nightmares)
discoloration of sweat & urine
Activation of malignant melanoma
CARBIDOPA
SE: Abnormal movements of psychiatric disorders
heart disease
psychiatric disorder in older clients
INTERACTION: proteins interefere
conventional antipsychotic (haldol)
pyridoxine (vit B)
MAOI (Hypertensive crisis)
Carbidopa, dopamine &anticholinergics increase levels of rx
Dopamine agonists: Pramipede (mirapex)
PURPOSE: Parkinson disease
SE: sudden inability to stay awake
daytime sleepiness
orthostatic
psychosis
Dyskinesias (head throbbing)
Nausea
CONTRAINDICATIONS: In clients with liver and kidney impairment
INTERACTIONS: Used with levodopa can decrease motor control fluctuation and
allow lower dosage of levodopa
NURSING INTERVENTIONS: effects may not be noticeable for several weeks to
several months
Instruct patient that a medication"holiday" may be
prescribed but
will take place in a inpatient setting
Antiepileptic (AEDS)
Pheytoin (dilantin)
PURPOSE: control seizure
use for all form of epilepsy except absence seizure
use IV route
use dysrhythmias with QT prolong action
CONTRAINDICATIONS: With sinus bradycardia SA blocks 2nd & 3rd AV block or
stocks adam syndrome
SE: CNS effects (nystagmsu, sedation, ataxia, cognitive impairment, double vision
Gingival hyperplasia
Skin rash
Teratogenic
Endocrine (causing of facial features, hirsutism & interfere with Vit D.
INTERACTIONS: decrease coumadin and glucorticoids
Alcohol, Valium, tagament & depakote decrease phenytoin levels
carbamazepin (tegretol)
PURPOSE: Use for treatment of partial (simple & complex seizures) tonic clonic
seizure bipolar
disorder and trigeminal and glosspharngeal neuralgias
SE: cognitive function is minimal affected but CNS effect can occur
Blood dyscrasias );eukopenia, anemia, throbocytopenia)
Hypo-osmolarity (promotes secretion of ADH which inhibits water excretion by
kidneys and places clients who have heart failure at risk for fluid overload
skin disorders
CONTRAINDICATIONS: With Bone marrow or bleeding disorders
INTERACTIONS: decrease effects of oral contraceptives and coumadin because of
stimulation of hepatic drug metabolize enzyme
grapefruit
pheyntoin and phenobarbital decrease tegretol
ethosuximide (zarontin)
PURPOSE: Use only for absence seizure
SE: GI effects (N/V)
Valproic acid (depakote)
PURPOSE: use for partial generalized and absentce seizure, bipolar disorder and
migraine headaches
SE: GI effects
hepatoxixity (anorexia, abdominal pain, jaundice)
pancreatitis (N/V and abdominal pain)
throbocytopenia
CONTRAINDICATIONS: Patients with liver disorder and children less than 3yrs of age
INTERACTIONS: Concurrent use with valproic acid increase the levels of phenytoin
and phenobarbital.
Non- selective Beta-adrenergic Blockers
Timolol
PURPOSE: Decrease IOP
treatment of POAG
SE: Temporary stinging and discomfort
Occasinal conjuctivitits, blurred vision photophobia, and dry eyes
Systmeic effects of Beta blockade on heart and lungs may occur
CONTRAINDICATION: Bradycardia
heart block
Cautiously in clients who have heart failure
INTERACTION: Calcium channel blockers can increase cardiovascular and
respiratory effects
interfere with some insulin
NURSING: Hold gentle pressure on nasolacrimal duct for 30 to 60 seconds
immediately after i nstilling any expected systemic effect
monitor pulse rate
Second line topical for glaucoma
Carbonic anhydrage inhibitor
dorzolamide (trust Both increase effects works better
Timolol (Cosopt)
SE: Allergic reaction in 15% of clients
Blurred vision
Dryness
Photophobia
osmotic agents
Mannitol (osmitrol IV)
Purpose: treat rapid progression of angle-closure glaucoma to prevent blindness