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Questions and Answers
What should a client using methylphenidate be advised to avoid?
Which of the following is a common adverse reaction of Valproic acid?
When using amphetamines, what serious condition could occur if they are taken with MAOIs?
In the case of carbamazepine, what should clients monitor for indicating potential complications?
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What is an important instruction for clients taking benzodiazepines?
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What is a potential adverse effect of midazolam that healthcare providers should watch for?
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Which medication is primarily used for the treatment of obesity?
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What should clients be aware of when discontinuing valproic acid suddenly?
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What is a significant adverse effect associated with Phenytoin (Dilantin)?
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Which food must be avoided when taking Phenelzine (Nardil) due to the risk of hypertensive crisis?
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What should a client taking Ropinirole or Pramipexole be cautious about?
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What is an adverse effect of Selective Serotonin Reuptake Inhibitors (SSRIs)?
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Which medication is used as an antidote for opioid overdose?
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Which of the following is a teaching point for clients prescribed Lithium?
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For which condition is Donepezil (Aricept) primarily prescribed?
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What is a common adverse effect of Opioid Agonists like Morphine?
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Which of the following vitamins should be avoided by clients on Carbidopa/Levodopa?
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What is a notable adverse effect of Cholinesterase Inhibitors?
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Which teaching point is essential for a patient on Buprenorphine?
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Which drug class is primarily used to treat mild to moderate depression?
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What side effect is commonly associated with excessive use of acetaminophen?
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What is a primary contraindication for Cholinesterase Inhibitors?
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Study Notes
Central Nervous System Stimulants
- Amphetamine (Adderall) is used to treat narcolepsy and as an adjunct for ADHD.
- Adverse reactions include cardiomyopathy, tachycardia, insomnia, and palpitations.
- Patients should report insomnia or palpitations to their healthcare provider.
- Using amphetamine with MAOIs or meperidine can lead to a hypertensive crisis.
- Amphetamine has a high dependence and abuse potential.
- Phentermine is primarily used for obesity.
Methylphenidate/Dexmethylphenidate
- Methylphenidate/Dexmethylphenidate are used to treat ADHD and for symptomatic treatment of narcolepsy.
- Adverse reactions include insomnia, dry mouth, metallic taste, and rashes.
- Patients should have their weight assessed 2-3 times weekly, avoid caffeine, and report palpitations or insomnia.
- Methylphenidate/Dexmethylphenidate have a high dependence and abuse potential.
- Using them with MAOIs or vasopressors may result in a hypertensive crisis.
- Monitor complete blood count (CBC).
Anticonvulsants
- Valproic acid (Depakene) is used to treat simple and complex absence seizures, partial seizures, manic episodes associated with bipolar disorder, and migraine headaches.
- Adverse reactions include hepatotoxicity, hypersalivation, and increased serum ammonia levels.
- Patients should take the medication at the same time each day exactly as directed, avoid alcohol, and report drowsiness or dizziness.
- Monitor CBC, liver function tests (LFTs), amylase, lipase, and serum drug levels.
Carbamazepine (Carbatrol, Epitol, Tegretol)
- Carbamazepine is used as monotherapy or adjunctive therapy for tonic-clonic, mixed, or complex partial seizures in adults with epilepsy.
- Adverse reactions include heart failure, hyponatremia, Stevens-Johnson syndrome, and abnormal vision.
- Patients should report dyspnea, bruising, edema in dependent areas, or frequent infections.
- Monitor electrocardiogram (EKG) and serum electrolytes before and periodically.
- Auscultate lungs for crackles and assess for dependent edema (congestive heart failure).
Benzodiazepines
- Diazepam/Lorazepam are used to treat anxiety.
- Diazepam is also used to treat stiff-man syndrome and for conscious sedation.
- Adverse reactions include paradoxical excitation, confusion, anxiety, and physical dependence.
- Patients should avoid grapefruit juice during therapy, avoid alcohol, and be aware that older clients have an increased "hangover effect" in the morning, which increases their risk for falls.
- Chamomile can increase CNS depression, and liver and renal function should be monitored.
Midazolam
- Midazolam is used to promote presurgical sedation and anxiolysis in pediatric clients.
- Adverse effects include apnea, respiratory depression, cardiac arrest, and hiccups.
- Patients may have decreased mental recall of the procedure.
- Monitor blood pressure, respirations, pulse, arterial blood gases, and provide oxygen via nasal cannula.
- Have resuscitation equipment readily available.
- Flumazenil is the antidote.
Hydantoins
- Phenytoin (Dilantin) is used to prevent tonic-clonic seizures and complex partial seizures.
- Adverse effects include cerebral edema, extrapyramidal syndrome, hypotension, tachycardia, altered taste, dry mouth, weight loss, and Stevens-Johnson syndrome.
- Patients should be aware that side effects such as urine discoloration and unwanted hair growth may occur.
- Assess for skin rash, as it may progress to severe exfoliative dermatitis.
- Monitor for hypersensitivity syndrome.
MAOI B Inhibitors
- Selegiline (Eldepryl, Zelapar) is used to treat Parkinson's disease in patients who fail to respond to levodopa/carbidopa.
- Adverse effects include insomnia, hallucinations, abdominal pain, and dry mouth.
- Patients should take the medication with food, notify their healthcare provider if they experience a severe headache, change positions slowly, increase fluids or use sugarless gum, and report increased body temperature, sweating, or muscle twitching.
- Concurrent use with meperidine or other opioid analgesics can result in a fatal reaction.
- Monitor liver function tests (LFTs) and renal function tests (RFTs).
MAOIs
- Phenelzine (Nardil) is used to treat depression.
- Adverse effects include orthostatic hypotension, anxiety, insomnia, and hypertensive crisis in the presence of tyramine-containing foods.
- Patients should rise slowly from a lying or sitting position, take the medication with non-tyramine-containing foods, and avoid foods high in tyramine, such as avocados, bananas, beer, bologna, chocolate, pepperoni, salami, wine, and yeast.
- MAOIs are contraindicated in clients with cardiac disease, those older than 60, and those younger than 6 years.
Dopamine Agonists
- Ropinirole, Pramipexole (Mirapex) are used to treat mild Parkinson's disease as monotherapy or as adjunctive therapy with levodopa/carbidopa, and for the treatment of restless leg syndrome.
- Adverse effects include sleep attacks, orthostatic hypotension, arrhythmias, and compulsive behaviors.
- Patients should use good oral hygiene and sugarless gum and should immediately contact their healthcare provider if they experience uncontrollable urges.
- Assess patients for drowsiness and sleep attacks.
- Administer the medication with meals to minimize nausea.
Benzisoxazoles
- Risperidone (Risperdal) is used to treat schizophrenia and bipolar disorder.
- Adverse effects include neuroleptic malignant syndrome, suicidal thoughts, tardive dyskinesia, increased salivation, decreased libido, itchy skin rash, photosensitivity, and hyperglycemia.
- Patients should watch for abnormal muscle movements or twitches and avoid alcohol.
- Monitor EKG for cardiac abnormalities and for the development of neuroleptic malignant syndrome.
Phenothiazines
- Chlorpromazine is used to treat acute and chronic psychoses.
- Adverse effects; include hypotension, tachycardia, urinary retention, rashes, hyperthermia, and extrapyramidal reactions.
- Patients should avoid extremes of temperature.
- Monitor for orthostatic hypotension and the development of neuroleptic malignant syndrome.
- Monitor for extrapyramidal symptoms.
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Fluoxetine (Prozac), citalopram (Celexa), and escitalopram (Lexapro) are used to treat depression, OCD, social phobias, bulimia and anorexia nervosa, and panic disorder.
- Adverse effects include seizures, stuffy nose, cough, sexual dysfunction, excessive sweating, and pruritis.
- Patients should avoid alcohol and herbal products, and report chest pain, palpitations, or suicidal thoughts immediately.
- Assess for suicidal tendencies in the first 2-4 weeks of treatment.
- SSRIs are the first-line drug prescribed for depression.
Tricyclic Antidepressants (TCAs)
- Desipramine, nortriptyline, and imipramine are used to treat depression.
- Adverse effects include dry mouth, arrhythmias, constipation, urinary retention, changes in blood glucose, and hypotension.
- Patients should take the medications at bedtime, avoid alcohol, use sunscreen, and notify their healthcare provider if they experience suicidal thoughts.
- TCAs can increase the risk of suicide attempts and ideation.
- Monitor for anticholinergic effects, CBC, LFTs, RFTs, and serum alkaline phosphatase.
- Have patients urinate before their daily dose and encourage increased fiber and fluids.
Serotonin and Norepinephrine Reuptake Inhibitors
- Venlafaxine (Effexor) and duloxetine (Cymbalta) are used to treat major depressive illness or relapse, and generalized anxiety disorder and social anxiety.
- Adverse effects include seizures, rhinitis, tinnitus, altered taste, sexual dysfunction, itching, photosensitivity, chills, and yawning.
- Patients should avoid alcohol and report suicidal thoughts immediately.
- The risk of serotonin syndrome increases with the use of MAOIs.
- Take the medication in the morning.
- Report headaches.
Mood Stabilizer
- Lithium is used to treat bipolar affective disorders.
- Adverse effects include fatigue, blurred vision, tinnitus, arrhythmias, EKG changes, hypotension, metallic taste, hyperglycemia, weight gain, leukocytosis, and rigidity.
- Patients should report palpitations or shortness of breath (SOB) to their healthcare provider, do not limit sodium intake, and notify their healthcare provider if they develop a fever, vomiting, or diarrhea..
- Assess for suicidal ideation.
- Monitor serum drug levels.
- Lithium toxicity looks like someone is inebriated, with ataxia, slurred speech, and drowsiness. Other symptoms of toxicity include drowsiness, muscle weakness, seizures, coma, and blurred vision.
- Patients should avoid table salt.
Cholinesterase Inhibitors
- Donepezil (Aricept), galantamine (Razadyne), and pilocarpine are used to treat mild to moderate dementia associated with Alzheimer's disease.
- Adverse effects include atrial fibrillation, peptic ulcer disease, frequent urination, hot flashes, weight loss, arthritis, bronchospasms, decreased heart rate, respirations, and blood pressure, increased salivation, tears, and sweating, muscle cramps, and weakness.
- Patients should notify their healthcare provider if they experience abdominal pain, coffee ground emesis, nausea, diarrhea, or changes in stool color.
- Cholinergic side effects (SLUDGE) include salivation, lacrimation, urination, defecation, GI distress, and emesis.
- Contraindications include asthma, benign prostatic hyperplasia (BPH), cardiac disease, gastrointestinal disorders, and hyperthyroidism.
Anticholinergic
- Atropine (Atropen) is used to treat bladder, stomach, or intestinal spasms, and for poisoning.
- Adverse effects include blurred vision, confusion, decreased gastrointestinal motility, dilation of pupils, drying of secretions, fever, flushing, headache, and increased heart rate.
Dopamine Agonists
- Carbidopa/Levodopa (Sinemet) is used to treat Parkinson's disease.
- Adverse effects include involuntary movements, hallucinations, leukopenia, and darkening of urine or sweat.
- Patients should avoid high protein meals, change positions slowly, use sugarless gum, avoid multivitamins, and notify their healthcare provider if they develop palpitations, urinary retention, involuntary movements, or new skin lesions.
- Monitor hepatic and renal function and CBC.
- Assess for signs of toxicity, such as involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of the tongue, and behavioral changes.
Opioid Agonist/Antagonist
- Buprenorphine (Buprenex) is used to treat moderate to severe acute pain and for opioid dependence.
- Adverse effects include respiratory depression, hepatotoxicity, constipation, dry mouth, urinary retention, and tolerance.
- Patients should contact their healthcare provider immediately if they have difficulty breathing, and report yellowing of the whites of their eyes, dark urine, or light-colored stools.
- Fall precautions are recommended. Narcan can reverse symptoms. Monitor LFTs, RFTs, and lung sounds.
Nonopioid Analgesics
- Acetaminophen is used to treat mild pain and fever.
- Adverse effects include hepatotoxicity, constipation, renal failure, Stevens-Johnson syndrome, rash, increased bleeding time, tinnitus, depression, and dizziness.
- Patients should not combine opioids with acetaminophen.
- Report rash, blisters, or lesions.
- Acetylcysteine is the antidote in acetaminophen overdose. Monitor LFTs, RFTs, and CBC.
- Patients should avoid alcohol, oral contraceptives, and loop diuretics.
General Anesthesia/Opioids
- Fentanyl is used to treat moderate to severe chronic pain that requires continuous opioid analgesic therapy.
- Adverse effects include apnea, respiratory depression, and physical and psychological dependence.
- Patients should change positions slowly, avoid alcohol, and use sugarless gum.
- Assess bowel function routinely for constipation.
- Narcan is an antidote. Discontinue the medication gradually.
Opioid Agonists
- Morphine, hydromorphone, and oxycodone are used to treat moderate to severe pain.
- Adverse effects include seizures, euphoria, blurred vision, respiratory depression, constipation, sweating, and urinary retention.
- Patients should report constipation and avoid alcohol.
- Monitor plasma amylase and lipase. Narcan is the antidote. Discontinue the medication gradually.
Opioid antagonist
- Naloxone (Narcan) is used to reverse CNS and respiratory depression.
- Adverse effects include nausea and vomiting, and ventricular fibrillation.
- Patients should be reassured that experiencing withdrawal symptoms is normal.
- Monitor respiratory rate (RR), EKG, blood pressure, and level of consciousness (LOC). Assess clients for signs and symptoms of opioid or alcohol withdrawal.
Opioid
- Tramadol (Ultram) is used to treat moderate to moderately severe pain.
- Adverse effects include seizures, serotonin syndrome, visual disturbances, vasodilation, dry mouth, and CNS stimulation.
- Patients should ask for pain medication before their pain becomes severe.
- Tramadol can cause dizziness and drowsiness, so patients should change positions slowly.
- Patients should report any use of antidepressants, as Tramadol increases the risk of serotonin syndrome when used with SSRIs, SNRIs, TCAs, or MAOIs.
- Assess bowel function routinely. Monitor for seizures.
Non-Amphetamines
- Modafinil (Provigil) is used to treat narcolepsy.
- Adverse effects include nausea, headaches, tachycardia, hypertension, rash (including Stevens-Johnson syndrome), and decreased effectiveness of oral contraceptives.
- Patients should report palpitations, chest pain, and rash to their healthcare provider.
- Modafinil can decrease the effectiveness of oral contraceptives, so patients should consider using a backup method of contraception.
Adrenergic
- Norepinephrine and epinephrine are used to treat extreme hypotension, severe wheezing, and severe allergic reactions.
- Adverse effects include chest pain, fast heart rate, headaches, increased blood glucose, nervousness, tissue death, and tremors.
Adrenergic Blockers
- Alfuzosin, doxazosin, tamsulosin, acebutolol, metoprolol, nadolol, and propranolol are used to treat benign prostatic hyperplasia (BPH), hypertension, cardiac arrhythmias, angina, prevent myocardial infarction (MI), and for migraine headaches.
- Adverse effects include confusion, decreased blood pressure, blood glucose, energy, and heart rate.
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Description
This quiz covers essential information about central nervous system stimulants, focusing on amphetamine and methylphenidate. It highlights their uses, adverse reactions, and important precautions for patients. Test your knowledge on these medications for ADHD and narcolepsy.
