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Questions and Answers
What is a common adverse reaction associated with prolonged use of amphetamine?
Which medication is primarily used for obesity?
What should clients taking methylphenidate avoid to prevent adverse effects?
What serious condition can abrupt withdrawal from valproic acid lead to?
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Which of the following is a potential adverse reaction of carbamazepine?
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Clients using benzodiazepines like diazepam should be cautious about which of the following?
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What adverse effect should patients be monitored for when prescribed midazolam?
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Which medication is not used for the treatment of seizures?
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What is the primary use of phenytoin (Dilantin)?
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Which of the following is an adverse effect of the MAOI B inhibitor selegiline?
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What should clients taking phenelzine be warned about concerning dietary restrictions?
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Ropinirole is primarily used in the treatment of which condition?
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What is a serious adverse effect of risperidone that patients should monitor for?
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What potential side effect may occur with the use of fluoxetine?
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When should tricyclic antidepressants ideally be taken?
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Which of the following should be closely monitored in patients taking lithium?
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What is a significant side effect associated with donepezil?
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What should be avoided when taking buprenorphine?
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What is the antidote for acetaminophen toxicity?
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What is a key consideration when administering morphine?
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Which of the following medications is known to cause blurred vision?
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What is the effect of NSAIDs that users should be cautious of?
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Study Notes
Central Nervous System Stimulants
- Amphetamine (Adderall) treats narcolepsy and is an adjunct for ADHD.
- Adverse reactions include cardiomyopathy, tachycardia, insomnia, and palpitations.
- Teach clients to report insomnia or palpitations.
- Using amphetamines with MAOIs or meperidine can result in a hypertensive crisis.
- Amphetamines have a high potential for dependence and abuse.
- Amphetamines may produce a false sense of euphoria and well-being.
- Phentermine is primarily used for obesity.
- Methylphenidate/Dexmethylphenidate treats ADHD and narcolepsy.
- Adverse reactions include insomnia, dry mouth, metallic taste, and rashes.
- Teach clients to have their weight assessed 2-3 times weekly, avoid caffeine, and report palpitations or insomnia.
- Methylphenidate/Dexmethylphenidate has a high potential for dependence and abuse.
- Using methylphenidate/dexmethylphenidate with MAOIs or vasopressors may result in a hypertensive crisis.
- CBC monitoring is necessary with use of methylphenidate/dexmethylphenidate
Anticonvulsants
- Valproic acid (Depakene) treats 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.
- Teach clients to take the medication at the exact same time each day, avoid alcohol, and that abrupt withdrawal may lead to status epilepticus.
- Monitor CBC, LFTs, amylase, lipase, and serum drug levels.
- Carbamazepine (Carbatrol, Epitol, Tegretol) 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.
- Teach clients to report dyspnea, bruising, edema in dependent areas, or frequent infections.
- Monitor EKG and serum electrolytes before and periodically.
- Auscultate lungs for crackles and assess for dependent edema (CHF).
Benzodiazepines
- Diazepam/Lorazepam treat anxiety.
- Diazepam is also used to treat stiff-man syndrome and conscious sedation.
- Adverse reactions include paradoxical excitation (confusion, anxiety), and physical dependence.
- Teach clients to avoid grapefruit juice, alcohol, and that older clients may have an increased "hangover effect" in the morning.
- Chamomile can increase CNS depression, liver, and renal function.
- Midazolam is used to promote presurgical sedation and anxiolysis in pediatric clients.
- Adverse effects include apnea, respiratory depression, cardiac arrest, and hiccups.
- Teach clients to expect decreased mental recall of the procedure.
- Monitor BP, respirations, pulse, arterial blood gas, and have oxygen readily available.
- The antidote is flumazenil.
Hydantoins
- Phenytoin (Dilantin) prevents 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.
- Teach clients to expect side effects such as urine discoloration and unwanted hair growth.
- Assess for skin rash, as it may progress to severe exfoliative dermatitis, and hypersensitivity syndrome.
MAOIB Inhibitors
- Selegine (Eldepryl, Zelapar) treats Parkinson's disease when clients are unresponsive to levodopa/carbidopa.
- Adverse effects include insomnia, hallucination, abdominal pain, and dry mouth.
- Teach clients to take the medication with food, notify the HCP if severe headaches occur, change positions slowly, and increase fluids or use sugarless gum.
- Monitor LFT and RFT as concurrent use of meperidine or other opioid analgesics can result in a fatal reaction.
MAOIs
- Phenelzine (Nardil) treats depression
- Adverse effects include orthostatic hypotension, anxiety, insomnia, and hypertensive crisis in the presence of tyramine-containing foods.
- Teach clients to rise slowly from lying and sitting positions, avoid tyramine-containing foods, and report any side effects,
- Tyramine can trigger severe HTN. Examples of tyramine-containing foods include avocados, bananas, beer, bologna, chocolate, pepperoni, salami, wine, and yeast.
- Contraindications include those with cardiac disease, over 60 years of age, and under 6 years of age.
Dopamine Agonist Agents
- Ropinirole, Pramipexole (Mirapex) treat mild Parkinson's disease as monotherapy or as adjunctive therapy with levodopa/carbidopa. These medications also treat Restless Leg Syndrome.
- Adverse effects include sleep attacks, orthostatic hypotension, arrhythmias, and compulsive behaviors.
- Teach clients to be aware of drowsiness and sleep attacks, use good oral hygiene and sugarless gum, and report any uncontrollable urges immediately.
- Assess clients for drowsiness and sleep attacks.
- Administer with meals to minimize nausea.
Benzisoxazoles
- Risperidone (Risperdal) treats schizophrenia and bipolar disorder.
- Adverse effects include neuroleptic malignant syndrome, suicidal thoughts, tardive dyskinesia, increased salivation, decreased libido, itchy skin rash, photosensitivity, and hyperglycemia.
- Teach clients to monitor for abnormal muscle movements or twitches and avoid alcohol.
- Monitor EKG for cardiac abnormalities and the development of neuroleptic malignant syndrome.
Phenothiazines
- Chlorpromazine treats acute and chronic psychoses.
- Adverse effects include hypotension, tachycardia, urinary retention, rashes, hyperthermia, and extrapyramidal reactions.
- Teach clients to avoid extremes of temperature.
- Monitor for orthostatic hypotension and the development of neuroleptic malignant syndrome.
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro) treat depression, obsessive-compulsive disorder, social phobias, bulimia and anorexia nervosa, and panic disorder.
- Adverse effects include seizures, stuffy nose, cough, sexual dysfunction, excessive sweating, and pruritus.
- Teach clients to avoid alcohol and herbal products, and report chest pain, palpitations, or suicidal thoughts immediately.
- Assess clients for suicidal tendencies during the first 2-4 weeks of treatment.
- SSRIs are the first-line treatment for depression.
Tricyclic Antidepressants (TCAs)
- Desipramine, nortiptyline, imipramine treat depression.
- Adverse effects include dry mouth, arrhythmias, constipation, urinary retention, changes in blood glucose, and hypotension.
- Teach clients that TCAs are typically taken at bedtime because they can cause drowsiness, to avoid alcohol and use sunscreen, and to report suicidal thoughts.
- TCAs may increase the risk for suicide attempts/ideation.
- TCAs have anticholinergic effects, monitor CBC, LFT, RFT, and serum alkaline phosphatase.
- Remind clients to urinate before the daily dose and encourage increasing fiber and fluids.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
- Venlafaxine (Effexor), duloxetine (Cymbalta) treat major depressive illness or relapse, generalized anxiety disorder, and social anxiety.
- Adverse effects include seizures, rhinitis, tinnitus, altered taste, sexual dysfunction, itching, photosensitivity, chills, and yawning.
- Teach clients to avoid alcohol, report suicidal thoughts immediately.
- The risk of serotonin syndrome increases with the use of MAOIs.
- Take in the morning.
- Report any headaches.
Mood Stabilizer
- Lithium treats bipolar affective disorders.
- Adverse effects include fatigue, blurred vision, tinnitus, arrhythmias, EKG changes, hypotension, metallic taste, hyperglycemia, weight gain, leukocytosis, and rigidity.
- Teach clients to report palpitations or shortness of breath to the HCP, do not limit sodium intake, and contact the HCP if fever, vomiting, or diarrhea occurs.
- Assess for suicidal ideation.
- Monitor serum drug levels. Clients with lithium toxicity look like they are intoxicated, with ataxia, slurred speech, and drowsiness.
- Lithium toxicity can cause drowsiness, muscle weakness, seizures, coma, and blurred vision.
- Do not use table salt.
Cholinesterase Inhibitors
- Donepezil (Aricept), Galatamine (Razadyne), Pilocarpine treat mild to moderate dementia associated with Alzheimer's disease.
- Adverse effects include atrial fibrillation, peptic ulcer, frequent urination, hot flashes, weight loss, arthritis, bronchospasms, decreased HR, respirations, and BP, increased salivation, tears, and sweating, muscle cramps, and weakness.
- Teach clients to notify the HCP if there is abdominal pain, coffee ground emesis, nausea, diarrhea, or changes in stool color, or if new symptoms occur.
- These medications do not cure Alzheimer's disease.
- SLUDGE (Salivation, lacrimation, urination, diarrhea, GI distress, emesis) are cholinergic side effects.
- Take in the evening before bed.
- Contraindications include asthma, BPH, cardiac disease, GI disorders, and hyperthyroidism.
Anticholinergic
- Atropine (Atropen) treats bladder, stomach, or intestinal spasms, and poisoning.
- Adverse effects include blurred vision, confusion, decreased GI motility, dilation of pupils, drying of secretions, fever, flushing, HA, and increased HR.
Dopamine Agonists
- Carbidopa/Levodopa (Sinemet) treats Parkinson's disease.
- Adverse effects include involuntary movements, hallucinations, leukopenia, and darkening of urine/sweat.
- Teach clients that high protein meals may affect the drug's effectiveness, to change positions slowly, and use sugarless gum to manage dry mouth, avoid multivitamins, and notify the HCP if palpitations, urinary retention, involuntary movements, or new skin lesions occur.
- Monitor hepatic and renal function, and CBC.
- Assess for signs of toxicity (involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of the tongue, behavioral changes).
Opioid Agonist/Antagonist
- Buprenorphine (Buprenex) treats moderate to severe acute pain and opioid dependence.
- Adverse effects include respiratory depression, hepatotoxicity, constipation, dry mouth, urinary retention, and tolerance.
- Teach clients to contact healthcare personnel immediately if they experience difficulty or changes in breathing, and to report yellowing of the whites of the eyes, dark urine, or light stools.
- Fall precautions are necessary.
- Narcan can reverse the symptoms of Buprenorphine.
- Monitor LFT, RFT, and lung sounds.
Nonopioid Analgesics
- Acetaminophen treats mild pain and fever.
- Adverse effects include hepatotoxicity, constipation, renal failure, Stevens-Johnson syndrome, rash, increased bleeding time, tinnitus, depression, and dizziness.
- Teach clients to avoid combining opioids with acetaminophen, drink plenty of water, and report rash, blisters, or lesions.
- Assess for rash, blisters, bullae, or lesions.
- Acetylcysteine is the antidote in cases of overdose.
- Monitor LFT, RFT, and CBC.
- Avoid alcohol, oral contraceptives, and loop diuretics.
General Anesthesia/Opioids
- Fentanyl treats moderate to severe chronic pain requiring continuous opioid analgesic therapy.
- Adverse effects include apnea, respiratory depression, physical and psychological dependence.
- Teach clients to change positions slowly, avoid alcohol, and use sugarless gum.
- Assess bowel function routinely for constipation.
- Narcan is the antidote. Discontinue fentanyl gradually.
Opioid Agonists
- Morphine, hydromorphone, oxycodone treat moderate to severe pain.
- Adverse effects include seizures, euphoria, blurred vision, respiratory depression, constipation, sweating, and urinary retention.
- Teach clients to report constipation and avoid alcohol.
- Monitor plasma amylase and lipase.
- Narcan is the antidote.
- Discontinue opioid agonists gradually.
Opioid Antagonist
- Naloxone (Narcan) reverses CNS depression and respiratory depression.
- Adverse effects include nausea, vomiting, and ventricular fibrillation.
- Teach clients to decrease fear of physical symptoms of withdrawal.
- Monitor RR, EKG, BP, and LOC and assess clients for signs and symptoms of opioid or alcohol withdrawal.
Opioids
- Tramadol (Ultram) treats moderate to moderately severe pain.
- Adverse effects include seizures, serotonin syndrome, visual disturbance, vasodilation, dry mouth, and CNS stimulation.
- Teach clients to ask for pain medication before the pain becomes severe, that tramadol can cause dizziness and drowsiness, to change positions slowly, and to report use of antidepressant medications.
- Assess bowel function routinely for constipation.
- Monitor for seizures as tramadol can increase the risk of serotonin syndrome when combined with SSRIs, SNRIs, TCAs, and MAOIs.
Non-amphetamines
- Modafinil (Provigil) treats narcolepsy.
- Adverse effects include nausea, HA, tachycardia, HTN, rash (including Stevens-Johnson), and decreased effectiveness of oral contraceptives.
- Teach clients to report palpitations, chest pain, rash, and to change their contraceptive method.
Adrenergic
- Norepinephrine, epinephrine treat extreme hypotension, severe wheezing, and severe allergic reactions.
- Adverse effects include chest pain, fast HR, HA, increased blood glucose, nervousness, tissue death, and tremors.
Adrenergic Blockers
- Alfuzosin, doxazosin, tamsulosin, acebutolol, metoprolol, nadolol, propranolol treat BPH, HTN, cardiac arrhythmias, angina, prevention of MI, and migraine HA.
- Adverse effects include confusion, decreased BP, blood glucose, energy, and HR.
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