Exam 5

• Methylphenidate- treats ADHD by increasing attention span and cognitive performance and decreasing impulsiveness, hyperactivity, and restlessness
• Methylphenidate considerations- monitor appetite in children
• Caffeine- Treats respiratory depression in infants

  • Class- stimulant
• Modafinil- treats narcolepsy
• Balanced anesthesia- a combination of drugs frequently used in general anesthesia

  • Hypnotic given the night before
  • Opioid analgesic and anticholinergic premedication
  • Short acting barbiturate, inhaled gas, and muscle relaxant right before procedure
• Butabarbital- barbiturate used to sustain sleep
• Sedative drugs- melatonin, Zolpidem. Given right before bed to help patient get to sleep
• Phenytoin- medication to treat seizures

  • Monitor: serum drug levels, albumin, glucose
  • Adverse reactions: nystagmus, gingival hyperplasia, purple glove syndrome, Stevens Johnson syndrome
  • Pt teaching: Urine may be harmless pink/ red color. Maintain good oral hygiene. Report gingivitis, rash, nystagmus, or dizziness
• Amantadine- treats Parkinsons disease

  • Class: Dopamine receptor antagonist
• Benztropine- treats Parkinson's disease.

  • Class: Anticholinergic
  • Side effects: Dizziness, anxiety, photophobia, blurred vision, weakness, tachycardia, GI distress, constipation, anhidrosis, dry mouth, urinary retention
  • Contraindications: Glaucoma, heart disease, myasthenia gravis, hyperthermia, urinary retention/ blockages
• Carbidopa levodopa- Treats Parkinson's Disease

  • Side effects: Nausea, vomiting, dystonic movement, psychotic behavior
• Pyridostigmine- treats muscle weakness associated with myasthenia gravis

  • Antidote- Atropine
• Muscle relaxer patient teaching: Take for max 3 weeks. Do not stop abruptly. Do not drive or make important decisions. Avoid alcohol. Use caution when pregnant/ nursing
• What types of foods/ drugs should you not mix with medications affecting the CNS?

  CNS depressants, alcohol, St. Johns wart, kava kava, gingko, grapefruit
• Tardive dyskinesia- involuntary movements resulting from use of typical antipsychotics

  • symptoms: protrusion/ rolling of tongue, sucking and smacking movements of lips, chewing, involuntary movement of body/ extremities
• Buspirone- treats anxiety

  • class: Azapirone
• Benzodiazepines- treats anxiety and alcohol withdrawal

  • Examples: alprazolam, clorazepate, diazepam, lorazepam, oxazepam
• Antipsychotics- chlorpromazine, fluphenazine, thioridazine, clozapine, haloperidol, risperidone
• Antipsychotics pt teaching- take drug as ordered. drug may take 6 weeks to reach full effect. avoid alcohol. avoid driving. rise slowly when standing
• In general, how are medication dosages different in older adults?

  Lower doses
• Antidepressant patient teaching: Take as prescribed. Avoid alcohol. Avoid driving. Full effectiveness may take 1-2 weeks. Do not abruptly stop.
• Tricyclic antidepressants- treat depression

  • Side effects: drowsiness, sedation, blurred vision, dry mouth, GI distress, constipation, urinary retention, sexual dysfunction, weight gain, seizures, orthostatic hypotension
  • Adverse reactions: Suicidal ideation, cardiotoxicity, dysrhythmias, neuroleptic malignant syndrome
• MAOIs- treat depression and panic disorders

  • Interactions: Hypertensive crisis with excess tyramine (from cheese, cream, yogurt, coffee, chocolate, bananas, raisins, liver, pickled foods, sausage, soy, yeast, beer, red wines).
  • Patient teaching: avoid CNS stimulants, Benadryl, and cold medicines
• Lithium- Treats bipolar disorder and mania

  • Therapeutic range: 0.8- 1.2
  • Toxicity: Seizures, dysrhythmias, coma, neurologic impairment, confusion, blurred vision, increased urination
  • Patient teaching: Take as prescribed. Adhere to follow up visits. Avoid driving. Take with meals. Avoid caffeine and maintain sodium intake
• COX-1 inhibitors- decrease platelet aggression
• COX-2 inhibitors- Reduce pain and fever, suppress inflammation
• NSAID interactions: Alcohol, ACE inhibitors, diuretics, anticoagulants, glucocorticoids, corticosteroids
• How should NSAIDs be taken?

  With food
• Acetylsalicylic acid (ASA)- inhibits prostaglandin to decrease inflammatory response

  • Toxicity- tinnitus, dizziness, bronchospasm
  • Patient teaching: take at mealtime
• Gout medications: Allopurinol, colchicine

  • Monitor ALT, AST, BUN, creatinine, urine output
  • Patient teaching: Take after meals, increase water intake, avoid alcohol, avoid large amounts of vitamin C and purine, report GI distress
  • Contraindications: Severe renal, cardiac, or GI problems
• Indomethacin (NSAID)- take with food. avoid if allergic to aspirin
• Opioids- morphine, hydromorphone, meperidine

  • Monitor: Respiratory changes, pupil constriction, pain
  • Overdose: Respiratory depression, pinpoint pupils, orthostatic hypotension
  • Antidote: Naloxone
• Acetaminophen- analgesic to relieve pain and fever. Does not treat inflammation

  • Monitor: ALT, AST, serum levels
  • Antidote: Acetlysteine
• What class of drugs treat acute migraine attack?

  Analgesics, opioids, ergot alkaloids, SSRIs
• Migraine prophylaxis- beta blockers, anticonvulsants, TSAs