Classifications Drug Pharmacodynamics Pharmacokinetics Indications Side Effects Interaction Nursing

Considerations
Drug Class: Methylphenidate Methylphenidate Absorption: Well Methylphenidate is Anorexia, dry Drug: May increase  Assess for the
(Ritalin, Ritalin LA, inhibits the absorbed from GI indicated for the mouth, nausea, stimulatory effects presence of cardiac
disease by
CNS stimulants Ritalin-SR) reuptake of tract treatment of vomiting, dizziness, of performing careful
Amphetamines dopamine and Distribution: Attention Deficit insomnia, sympathomimetic history, family
norepinephrine, Protein-binding Hyperactivity irritability, and history of sudden
resulting in CNS 10%-30% Disorder (ADHD) in restlessness, psychostimulants; death and physical
stimulation and an Metabolism: Half- patients 6 years of anxiety, confusion, may reduce effect exam.
 Blood pressure and
augmentation of life is 1.3-7.7 hours age and older and depression, of heart rate should
serotonin action. Excretion: 90% for the treatment of euphoria, antihypertensives; be monitored in all
excreted narcolepsy. hyperhidrosis, increase effects of patients.
unchanged in urine tremors, blurred oral anticoagulants,  Obtain periodic
vision, headache, barbiturates, CBC with
differential and
abdominal pain, anticonvulsants and
platelet counts
weight loss, TCAs; increase during prolonged
constipation, hypertensive crisis therapy.
anemia. with MAOIs  If ADHD hasn’t
Food: Caffeine, improved after 1
month period at
chocolate, tea, and
the appropriate
colas may increase dose, prescriber
effects. may discontinue
Herbs: St. John’s drug.
wort may decrease  Check weight at
drug efficacy. least 2 or 3 times
weekly and report
weight loss. Check
height and weight
in children;
 Classification Drugs Pharmacodynamics Pharmacokinetics Indications Side effects Interaction Nursing
considerations
Drug Class: Modafinil (Provigil) The mechanism of Absorption: Rapidly Improve wakefulness Headache, nausea, Drug:  Monitor patient
action of Modafinil absorbed. in patients with nervousness, Methylphenidate for emergence or
CNS stimulants has not been clearly Peak: 2–4 h. narcolepsy or dizziness, insomnia, may delay absorption exacerbation of
Amphetamines established. Distribution: excessive sleepiness upper respiratory of modafinil; psychiatric signs
However, it may Approximately 60% associated with shift tract infection, modafinil may and symptoms
indirectly increase protein bound. work sleep disorder, diarrhea, anxiety, decrease levels of and HTN.
wakefulness, at least Metabolism: obstructive sleep agitation, cyclosporine, ORAL  Life threatening
in part, through Metabolized in liver apnea/hypnea dry mouth, chest CONTRACEPTIVES angioedema, SJS,
inhibition of cortical to inactive syndrome. pain, edema, may reduce and DRESS
γ-aminobutyric acid metabolites. tachycardia, contraceptives Syndrome can
(GABA) release via Elimination: Excreted palpitations, effectiveness; occur. Monitor
serotonergic in urine. sweating, asthma Phenytoin, warfarin patient for rash,
mechanisms. Half-Life: 15 h. other CYP3A4 may dysphagia,
increase levels of bronchospasm,
clomipramine, fever and organ
phenytoin, and dysfunction. Stop
warfarin levels. drug and begin
Drug-lifestyle: avoid appropriate
using together with treatment.
alcohol substance.  Coadministered
drugs: Monitor
INR with warfarin
for first several
months and
when dosage is
changed; monitor
for toxicity with
phenytoin.
 Classification Drugs Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
considerations
Drug class: Benzphetamine HCl Benzphetamine, a Absorption: Readily Short-term adjunct in CNS: Euphoria, Drug: Acetazolamide,  Assess for signs
phenylalkylamin, is absorbed from GI management of irritability, sodium bicarbonate of excessive CNS
CNS stimulants related to tract. exogenous obesity. hyperactivity, decrease stimulation:
Anorexiants amphetamine both Distribution: 75%- nervousness, AMPHETAMINE insomnia,
chemically and 99% protein binding restlessness, elimination; restlessness,
pharmacologically. It Metabolism: insomnia, tremor, ammonium chloride, tremor,
is an anorectic agent Hepatic headache, light- ascorbic acid increase palpitations.
indicated in the Elimination: Renal headedness, amphetamine These may
management of elimination. dizziness, depression elimination; indicate need for
exogenous obesity as following stimulant barbiturates may dosage
a short term adjunct effects. antagonize the adjustment.
(a few weeks) in a CV: Palpitation, effects of both drugs;  Monitor vital
regimen of weight tachycardia, elevated furazolidone may signs; report
reduction based on BP, irregular increase BP effects of elevated BP,
caloric restriction. heartbeat. amphetamines, and tachycardia, and
GI: Xerostomia, interaction may irregular heart
nausea, vomiting, persist for several rhythm.
diarrhea or weeks after  Monitor diabetics
constipation, discontinuation of for loss of
abdominal cramps. furazolidone; glycemic control.
 Classification Drugs Pharmacodynamics Pharmacokinetics Indications Side Effects Interactions Nursing
Consideration
Drug class: Phentermine HCl The main mechanism Absorption: Short term (8–12 wk)  Increased heart Drug: MAO  Use drug with a
of action of Absorbed from the adjunct for weight rate INHIBITORS, weight-reduction
CNS stimulants phentermine is the small intestine. loss.  Tingling or furazolidone may program.
Anorexiants generation of Distribution: prickling feeling increase pressor  Monitor patient
appetite suppression, protein binding of in hands or feet response resulting in for tolerance,
maybe due to the phentermine is  Dry mouth hypertensive crisis. dependence or
increase in leptin, but determined to be of  Sleeplessness TRICYCLIC potential abuse.
it is considered that 17.5%  Nervousness ANTIDEPRESSANTS Drug is chemically
other mechanisms Duration: 4–14 h.  Constipation may decrease related to
should be involved. Elimination: Excreted anorectic response. amphetamines,
primarily in urine May decrease which carry a
hypotensive effects high abuse
of guanethidine. potential.
 Don’t stop drug
abruptly; taper
dosage.
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side Effects Interactions Nursing
Considerations
Drug class: Caffeine citrate Caffeine is Absorption: Rapidly Mild CNS stimulant to Nausea, vomiting, Drug: Increases  Monitor vital
structurally related to absorbed. aid in staying awake stomach upset, effects of cimetidine; signs closely as
CNS Stimulants other Distribution: Widely and restoring mental headache, trouble increases large doses may
Analeptics methylxanthines, distributed alertness, and as an sleeping, cardiovascular cause
theophylline, and throughout body; adjunct in narcotic restlessness, poor stimulating effects of intensification
theobromine. It is a crosses blood-brain and nonnarcotic feeding, increased BETA-ADRENERGIC rather than
bronchial smooth barrier and placenta. analgesia. urination, rash or dry AGONISTS; possibly reversal of severe
muscle relaxant, a Metabolism: skin increases drug-induced
CNS stimulant, a Metabolized in liver. theophylline toxicity. depressions.
cardiac muscle Elimination: Excreted  Observe children
stimulant, and a in urine as closely following
diuretic. metabolites; excreted administration as
in breast milk in small they are more
amounts susceptible than
adults to the CNS
effects of
caffeine.
 Lab tests:
Monitor blood
glucose and
HbA1c levels in
diabetics.
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
considerations
Drug class: Theophylline Theophylline, an Absorption: Most Prophylaxis and Nausea/vomiting, Drug: Increases  Caution patient not
xanthine derivative products are 100% symptomatic relief of stomach/abdominal lithium excretion, to chew or crush
CNS Stimulants chemically similar to absorbed from GI bronchial asthma, as pain, headache, lowering lithium enteric-coated
Analeptics caffeine and tract. well as trouble sleeping, levels; cimetidine, timed-release
preparations.
theobromine, is used Distribution: Crosses bronchospasm diarrhea, irritability, high-dose allopurinol
 Give immediate
to treat asthma and placenta. associated with restlessness, (600 mg/d), tacrine,
release, liquid
bronchospasm. Metabolism: chronic bronchitis nervousness, shaking, QUINOLONES, dosage forms with
Theophylline has two Extensively and emphysema. Also or increased MACROLIDE food if GI effects
distinct actions in the metabolized in liver. used for emergency urination ANTIBIOTICS, and occur.
airways of patients Elimination: Parent treatment of zileuton can  Do not give timed-
with reversible drug and metabolites paroxysmal cardiac significantly increase release
(asthmatic) excreted by kidneys; dyspnea and edema theophylline levels; preparations with
obstruction; smooth excreted in breast of CHF. tobacco use food; these should
muscle relaxation milk. significantly be given on an
empty stomach, 1
(i.e., bronchodilation) decreases levels.
hr before or 2 hr
and suppression of Herbal: St. John's
after meals.
the response of the wort may decrease  Advise patients
airways to stimuli theophylline efficacy. that this drug
(i.e., non- should not be used
bronchodilator during pregnancy;
prophylactic effects). using barrier
contraceptives is
recommended.
 Monitor carefully
for clinical signs of
adverse effects,
particularly if
serum theophylline
levels are not
available.
 Classifications
Drug class: Alprazolam (Xanax)
CNS depressant:
Sedative- Hypnotics
(benzodiazepine)
Drugs Pharmacodynamics Pharmacokinetics Indications Side Effects Interaction Nursing
Considerations
CNS Depression binds Absorption: 90% Management of Lethargy, drowsiness, Drug: Decrease  Monitor for S&S
receptors in limbic absorbed from GI anxiety disorders or dizziness, headache, respiration with of drowsiness
system and reticular tract orally. for short-term relief constipation, alcohol; CNS and sedation,
formation, increases Distribution: Crosses of anxiety symptoms. anterograde depressants; azole especially in
GABA to GABA placenta. 90% protein Also used as adjunct amnesia, memory fungals,(ketoconazole), older adults or
receptors; shift to binding. in management of impairment, fatigue, antibiotics the debilitated;
chloride ions leads to Metabolism: anxiety associated agitation, ataxia, (erythromycin), they may require
less excitability and Oxidized in liver to with depression and increase appetite, aprepitant, cimetidine, supervised
stabilizes neuronal inactive metabolites. agitation, and for blurred vision, diltiazem, and ambulation
membranes. Elimination: Renal panic disorders, such deacreased and verapamil increases and/or side rails.
elimination as as agoraphobia. increased libido, dry blood levels of  Lab tests:
metabolites. mouth, nausea, alprazolam; Rifampin, Monitor periodic
edema, weight rifabutin, cortisone blood counts,
gain/loss and phenytoin urinalyses, and
decreases blood levels. blood chemistry
Food: Grapefruit studies,
increases alprazolam particularly
levels; green tea during continuing
decreases alprazolam therapy.
effects.  Give smallest
Herbal: Kava-kava, effective dose to
valerian may prevent ataxia or
potentiate sedation; over sedation,
St. John's wort especially in
decreases serum level elderly or
of alprazolam. deliberated
patients.
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side Effects Interactions Nursing
Considerations
Drug class: Zolpidem Tartrate Zolpidem is a short- Absorption: Readily Short-term treatment Drowsiness, lethargy, Drug: CNS  Assess
acting absorbed from GI of insomnia. headache, hot depressants, alcohol, respiratory
CNS depressant: nonbenzodiazepine tract. 70% reaches flashes, hangover phenothiazine by function in
Sedative- Hypnotics hypnotic and it systemic circulation. (residual sedation), augmenting CNS patients with
(non-benzodiazepine) interacts with Food decreases rate irritability, dizziness, depression. compromised
gamma-aminobutyric and extent of ataxia, visual Food: Extent and rate respiratory
acid (GABA) - absorption. impairment, anxiety, of absorption of status. Report
benzodiazepine Distribution: Protein nausea and vomiting, zolpidem are immediately to
receptor complexes binding of 92%, edema, erectile significantly physician
and shares some of crosses placenta and dysfunction decreased. significantly
the pharmacological distributed in anterograde amnesia, depressed
properties of breastmilk. memory impairment, respiratory rate
benzodiazepines. Metabolism: nightmares, binge (less than
Metabolized in the eating 12/min).
liver to 3 inactive  Monitor patients
metabolites. for S&S of
Elimination: 79–96% depression
of dose appears as zolpidem may
metabolites in the increase level of
bile, urine, and feces. depression.
 Monitor older
adult or
debilitated
patients closely
for impaired
cognitive or
motor function
and unusual
sensitivity to the
drug's effects
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
considerations
Drug class: Droperidol Droperidol produces Absorption: To produce tachycardia, Drug: Possible  Monitor ECG
marked Completely absorbed tranquilizing effect drowsiness, pharmacodynamics throughout
CNS depressant tranquilization and following and to reduce nausea dizziness, interactions can therapy. Report
Anesthetic (general sedation. It allays intramuscular and vomiting during feeling restless, occur between immediately
prolongation of
anesthetic) apprehension and administration. surgical and anxiety, and INAPSINE and
QTc interval.
provides a state of Distribution: Crosses diagnostic Uneasiness. potentially
 Monitor vital signs
mental detachment placenta. procedures. Also for arrhythmogenic closely.
and indifference Metabolism: premedication, agents such as class I Hypotension and
while maintaining a Metabolized in liver. during induction, and or III antiarrhythmic, tachycardia are
state of reflex Elimination: Excreted as adjunct in antihistamines that common adverse
alertness. Droperidol in urine and feces. maintenance of prolong the QT effects.
produces an general or regional interval, antimalarial,  Exercise care in
antiemetic effect as anesthesia. calcium channel moving medicated
evidenced by the blockers, neuroleptics patients because of
possibility of severe
antagonism of that prolong the QT
orthostatic
apomorphine in dogs. interval, and
hypotension. Avoid
It lowers the antidepressants. abrupt changes in
incidence of nausea position.
and vomiting during  Observe patients
surgical procedures for signs of
and provides impending
antiemetic protection respiratory
in the postoperative depression
period. carefully when
receiving a
concurrent narcotic
analgesic carefully.
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side Effects Interactions Nursing
Considerations
Drug class: Propofol (Diprivan) The action of Absorption: Rapid - Induction or CNS: Headache, Drug: Concurrent  Monitor
propofol involves a time to onset of maintenance of dizziness, twitching, continuous infusions hemodynamic
CNS depressants positive modulation unconsciousness is anesthesia as part of bucking, jerking, of propofol and status and assess
Anesthetic (general of the inhibitory 15-30 seconds, due to a balanced thrashing, alfentanil produce for dose-related
anesthesia) function of the rapid distribution anesthesia technique; clonic/myoclonic higher plasma levels hypotension.
neurotransmitter from plasma to the conscious sedation in movements. Special of alfentanil than  Take seizure
gama-aminobutyric CNS. mechanically Senses: Decreased expected. CNS precautions.
acid (GABA) through Distribution: Highly ventilated patients. intraocular pressure. DEPRESSANTS cause Tonic-clonic
GABA-A receptors. lipophilic, crosses CV: Hypotension, additive CNS seizures have
placenta, excreted in ventricular asystole depression. occurred
breast milk. (rare). following general
Metabolism: GI: Vomiting, anesthesia with
Extensively abdominal cramping. propafol.
metabolized in the Respiratory: Cough,  Be alert to the
liver. hiccups, apnea. potential for drug
Elimination: Other: Pain at induced
Approximately 88% injection site. excitation (e.g.,
of the dose is twitching,
recovered in the tremor,
urine as metabolites. hyperclonus) and
take appropriate
safety measures.
 Provide comfort
measures; pain at
the injection site
is quite common
especially when
small veins are
used.
 Classifications Drugs Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
Cosiderations
Drug class: Phenytoin Phenytoin is often Absorption: To control tonic- Headache, confusion, Drug: Increases  Continuously
described as a non- Completely absorbed clonic seizures, dizziness, drowsiness, effects with monitor vital signs
CNS Depressant specific sodium from GI tract psychomotor and insomnia, cimetidine, isoniazid, and symptoms
Anticonvulsant channel blocker and Distribution: 95% nonepileptic seizures nervousness, mood chloramphenicol, during IV infusion
and for an hour
(hydratonin) targets almost all protein bound; (e.g., Reye's changes, nystagmus, decreased effects
afterward. Watch
voltage-gated sodium crosses placenta; syndrome, after head asthenia, slurred with folic acid, for respiratory
channel subtypes.7 small amount in trauma). Also used to speech, ataxia, rash, calcium, antacids, depression.
More specifically, breast milk. prevent or treat paresthesia, Decrease effects of Constant
phenytoin prevents Metabolism: seizures occurring hyperreflexia, tremor, anticoagulants, oral observation and a
seizures by inhibiting Oxidized in liver to during or after abdominal pain, contraceptives, cardiac monitor are
the positive feedback inactive metabolites. neurosurgery. Is not nausea, vomiting, antihistamines, necessary with
loop that results in Elimination: effective for absence constipation corticosteroids, older adults or
neuronal propagation Metabolites excreted seizures. cyclosporine, patients with
of high frequency by kidneys. quinidine, dopamine cardiac disease.
Margin between
action potentials and rifampin
toxic and
Food: Decreases therapeutic IV
effects of folic acid, doses is relatively
calcium, and vitamin small.
D because absorption  Make sure patients
is decreases by on prolonged
phenytoin. therapy have
adequate intake of
vitamin D-
containing foods.
 Monitor CBC and
calcium level every
6 months, and
periodically
monitor hepatic
function
 Classification Drugs Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
Considerations
Drug class: Primidone Primidone alters Absorption: Alone or excessive tiredness Drug: Alcohol, CNS  Lab tests: Perform
sodium and calcium Approximately 60– concomitantly with dizziness, difficulty DEPRESSANTS baseline and
CNS Depressant channel transport, 80% absorbed from other anticonvulsant coordinating compound CNS periodic CBC,
Anticonvulsant reducing the GI tract. agents in the movements, nausea, depression; complete blood
chemistry (q6mo),
(Barbiturate) frequency of nerve Distribution: prophylactic vomiting, loss of phenobarbital may
and primidone
firing, which may be Distributed into management of appetite, double decrease absorption blood levels.
responsible for its breast milk. complex partial vision, uncontrollable and increase (Therapeutic blood
effect on convulsions Metabolism: (psychomotor) and eye movements, metabolism of oral level for primidone:
and essential tremor Metabolized in liver generalized tonic- decrease in sexual anticoagulants; 5–10 mcg/mL.)
to phenobarbital and clonic (grand mal) ability increases metabolism  Monitor primidone
PEMA. seizures. of corticosteroids, plasma levels
Elimination: oral contraceptives, (concentrations of
Excreted in urine anticonvulsants, primidone >10
digitoxin, possibly mcg/mL are usually
associated with
decreasing their
significant ataxia
effects; and lethargy).
antidepressants  Therapeutic
potentiate adverse response may not
effects of primidone; be evident for
griseofulvin several weeks.
decreases absorption  Observe for S&S of
of primidone. folic acid
Herbal: Kava-kava, deficiency: Mental
valerian may dysfunction,
potentiate sedation. psychiatric
disorders,
neuropathy,
megaloblastic
anemia. Determine
serum folate levels
if indicated.
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
considerations
Drug class: Acetaminophen Acetaminophen is a Absorption: Rapid Fever reduction. nausea, Drug: Cholestyramine  Monitor for S&S of:
p-aminophenol and almost complete Temporary relief of stomach pain, may decrease hepatotoxicity, ,
CNS depressant derivative that absorption from GI mild to moderate loss of appetite, acetaminophen especially in
Analgesics exhibits analgesic and tract; less complete pain. Generally as itching, absorption. With individuals with
poor nutrition or
antipyretic activity. It absorption from substitute for aspirin rash, chronic
who have ingested
does not possess rectal suppository. when the latter is not headache, coadministration, alcohol over
anti-inflammatory Distribution: Well tolerated or is dark urine, BARBITURATES, prolonged periods
activity. distributed in all body contraindicated. clay-colored stools, carbamazepine,  Do not exceed the
Acetaminophen is fluids; crosses or jaundice (yellowing phenytoin, and recommended
thought to produce placenta. of skin or eyes). rifampin may dosage.
analgesia through a Metabolism: increase potential for  Consult physician if
central inhibition of Extensively chronic needed for children
prostaglandin metabolized in liver. hepatotoxicity. < 3 yr; if needed for
synthesis. Elimination: 90– Chronic, excessive longer than 10
days; if continued
100% of drug ingestion of alcohol
fever, severe or
excreted as will increase risk of
recurrent pain
metabolites in urine; hepatotoxicity. occurs (possible
excreted in breast serious illness).
milk.  Avoid using
multiple
preparations
containing
acetaminophen.
Carefully check all
OTC products.
 Give drug with food
if GI upset occurs.
 Discontinue drug if
hypersensitivity
reactions occur.
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
considerations
Drug class: Fentanyl Citrate Fentanyl produces Absorption:  Short-acting Nausea, vomiting, Drug: Alcohol and  Monitor vital signs
strong analgesia Absorbed through analgesic during constipation, other CNS and observe
CNS depressant through its activation the skin, leveling off operative and lightheadedness, DEPRESSANTS patient for signs of
Analgesics of opioid receptors. It between 12–24 h. perioperative dizziness, drowsiness, potentiate effects; skeletal and
periods, as a thoracic muscle
has duration of action Metabolism: or headache, Pain, MAO INHIBITORS
narcotic analgesic (depressed
of several hours and a Metabolized in liver. supplement in
sores, or irritation in may precipitate respirations)
wider therapeutic Elimination: Excreted general and the mouth hypertensive crisis. rigidity and
index as patients in urine. regional weakness.
develop tolerance to anesthesia, and  Watch carefully for
opioids. Fentanyl is with droperidol or respiratory
associated with a risk with diazepam to depression and for
of addiction and produce movements of
abuse and should not neuroleptoanalgesi various groups of
be mixed with alcohol a. skeletal muscle in
 Also given with extremities,
or benzodiazepines
oxygen and a external eye, and
skeletal muscle neck during
relaxant postoperative
(neuroleptoanesth period. These
esia) to selected movements may
high-risk patients present patient
(e.g., those management
undergoing open problems; report
heart surgery) promptly.
when attenuation
of the response to
surgical stress
without use of
additional
anesthesia agents
is important.
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
considerations
Drug class: Fluphenazine Fluphenazine blocks Absorption: HCl is Management of upset stomach Drug: Alcohol and  Monitor and
hydrochloride postsynaptic readily absorbed PO manifestations of weakness or other CNS report signs of
CNS Depressants mesolimbic and IM; decanoate, psychotic disorders. tiredness, excitement DEPRESSANTS may neuroleptic
Antipsychotic drugs dopaminergic D1 and enanthate have or anxiety, insomnia, potentiate depressive malignant
D2 receptors in the delayed IM nightmares, dry effects; decreases syndrome
brain; depresses the absorption. mouth, skin more seizure threshold, (hyperthermia,
release of Distribution: Crosses sensitive to sunlight may need to adjust diaphoresis,
hypothalamic and blood–brain barrier than usual, changes dosage of generalized
muscle rigidity,
hypophyseal and placenta. in appetite or weight ANTICONVULSANTS.
altered mental
hormones and is Metabolism: Herbal: Kava-kava
status,
believed to depress Metabolized in liver. may increase risk and
tachycardia,
the reticular severity of dystonic changes in blood
activating system reactions. pressure [BP],
thus affecting basal incontinence
metabolism, body  Assess motor
temperature, function, and be
wakefulness, alert for
vasomotor tone, and extrapyramidal
emesis. symptoms.
 Assess BP and
compare to
normal values.
Report changes in
BP, either a
problematic
decrease in BP
(hypotension) or a
sustained increase
in BP
(hypertension).
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
considerations
Drug class: Haloperidol Haloperidol Absorption: Well Management of nausea, vomiting, Drug: CNS  Monitor for
competitively blocks absorbed from GI manifestations of diarrhea, dry mouth, DEPRESSANTS, therapeutic
CNS Depressants post-synaptic tract; 60% reaches psychotic disorders nervousness, OPIATES, alcohol effectiveness.
Antipsychotic drugs dopamine (D2) systemic circulation. and for control of tics headache, dizziness, increase CNS  Monitor patient's
mental status daily.
receptors in the Distribution: and vocal utterances drowsiness, depression; may
 Monitor for
brain, eliminating distributes mainly to of Gilles de la insomnia, antagonize activity of
neuroleptic
dopamine liver with lower Tourette's syndrome; restlessness, ORAL malignant
neurotransmission concentration in for treatment of anxiety, skin rash, ANTICOAGULANTS; syndrome (NMS)
and leading to the brain, lung, kidney, agitated states in itching, mood ANTICHOLINERGICS especially in those
relief of delusions spleen, heart. acute and chronic changes, breast may increase with hypertension
and hallucinations Metabolism: psychoses. Used for enlargement, intraocular pressure; or taking lithium
that are commonly Metabolized in liver. short-term treatment irregular menstrual methyldopa may  Be alert for
associated with Elimination: 40% of hyperactive periods, precipitate dementia. behavioral changes
psychosis. excreted in urine children and for loss of interest in sex, in patients who are
within 5 days; 15% severe behavior blurred vision, concurrently
receiving
eliminated in feces; problems in children difficulty urinating or
antiparkinson
excreted in breast of combative, urinating less than drugs.
milk. explosive usual, and  Monitor for
hyperexcitability. occasional movement exacerbation of
disorders seizure activity.
 Observe patients
closely for rapid
mood shift to
depression when
haloperidol is used
to control mania or
cyclic disorders
  Monitor WBC
count with
differential and
liver function in
patients on
prolonged therapy.
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
considerations
Drug class: Imipramine Imipramine works by Absorption: Management of Nausea, constipation Drug: MAO INHIBITORS  Assess heart rate,
inhibiting the Completely absorbed Endogenous Diarrhea, vomiting may precipitate ECG, and heart
CNS Depressants neuronal reuptake of from GI tract. depression and dry mouth, blurred hyperpyrexic crisis, sounds, especially
Antidepressants the Metabolism: occasionally for vision, trouble tachycardia, or seizures; during exercise.
ANTIHYPERTENSIVE  Measure blood
neurotransmitters Metabolized to the reactive depression. urinating, breast
AGENTS potentiate pressure
norepinephrine and active metabolite Imipramine is the swelling in men and orthostatic periodically and
serotonin. It binds desipramine in liver. only TCA used as women, nervousness, hypotension; CNS compare to normal
the sodium- Elimination: Primarily temporary adjuvant stomach pain DEPRESSANTS, alcohol values. Report low
dependent serotonin excreted in urine, treatment of enuresis add to CNS depression; blood pressure
transporter and small amount in in children >6 y. norepinephrine and (hypotension),
sodium-dependent feces; crosses other especially if patient
norepinephrine placenta; may be SYMPATHOMIMETICS experiences
transporter reducing secreted in breast may increase cardiac dizziness or
toxicity; cimetidine syncope.
the reuptake of milk.
decreases hepatic  Monitor signs of
norepinephrine and
metabolism, thus leukopenia or
serotonin by neurons. increasing imipramine unusual weakness
levels; methylphenidate and fatigue that
inhibits metabolism of might be due to
imipramine and thus anemia or other
may increase its blood dyscrasias
toxicity.  Assess confusion,
agitation,
Herbal: Ginkgo may hallucinations, or
decrease seizure other alterations in
threshold; St. John's mental status
wort may cause  Assess confusion,
serotonin syndrome. agitation,
hallucinations, or
other alterations in
mental status
 Classification Drug Pharmacodynamics Pharmacokinetics Indications Side effects Interactions Nursing
considerations
Drug class: Phenelzine The basic mechanism Absorption: Readily Management of dizziness, feeling Drug: TRICYCLIC  Evaluate patient's
of action of absorbed from GI endogenous light-headed; ANTIDEPRESSANTS may BP in standing and
CNS Depressants phenelzine acts as an tract. depression, drowsiness, sleep cause hyperpyrexia, recumbent
Antidepressants inhibitor and Metabolism: Rapidly depressive phase of problems; headache; seizures; fluoxetine, positions. Prior to
sertraline, paroxetine initiation of
substrate of metabolized. manic-depressive feeling weak or tired;
may cause treatment.
monoamine oxidase Elimination: 79% of psychosis, and severe Tremors, muscle hyperthermia,  Lab tests: Perform
which subsequently metabolites excreted exogenous (reactive) twitching; dry mouth, diaphoresis, tremors, baseline CBC and
causes an elevation in in urine in 96 h. depression not stomach discomfort, seizures, delirium; liver function tests.
brain levels of responsive to more constipation; SYMPATHOMIMETIC Also perform
catecholamines and commonly used swelling, weight gain; AGENTS guanethidine periodic CBC and
serotonin. It also therapy. or sexual problems. and reserpine may liver function tests
presents a similar cause hypertensive during prolonged
structure to crisis; CNS or high-dose
DEPRESSANTS have therapy.
amphetamine which
additive CNS depressive  Monitor BP and
explains the effect on
effects; OPIATE pulse between
the uptake and ANALGESICS (especially doses when
release of dopamine, meperidine) may cause titrating initial
noradrenaline, and hypertensive crisis and dosages. Observe
serotonin. circulatory collapse; closely for evidence
buspirone, of adverse drug
hypertension; GENERAL effects. Thereafter,
ANESTHETICS, monitor at regular
prolonged hypotensive intervals
and CNS depressant throughout therapy
effects; hypertension,  Report
headache, immediately if
hyperexcitability hypomania occurs
reported with as depression
dopamine, methyldopa, improves
levodopa, tryptophan;  Observe for and
HYPOTENSIVE AGENTS report therapeutic
and DIURETICS have effectiveness of
additive hypotensive drug: Improvement
effects.
Food: Aged meats or
aged cheeses, protein
extracts, sour cream,
alcohol, anchovies,
liver, sausages, overripe
figs, bananas, avocados,
chocolate, soy sauce,
bean curd, natural
yogurt, fava beans—  Observe patient
tyramine-containing
foods—may precipitate
hypertensive crisis.
Avoid chocolate or
caffeine.
Herbal: Ginseng,
ephedra, ma huang, St.
John's wort may cause
hypertensive crisis.
in sleep pattern,
appetite, physical
activity, interest in
self and
surroundings, as
well as lessening of
anxiety and bodily
complaints.
with diabetes
closely for S&S of
hypoglycemia