Mental Health Meds In Ati

Front 1

Major Medications to tx anxiety

Back 1

1. Benzodiazepine anxiolytics 2. Buspirone (BuSpar) 3. Antidepressants like Paxil-ssri, Elavil- tca, Nardil-maoi, Effexor-snri 4. Others like antihistamines, beta blockers, anticonvulsants.

Front 2

Examples of benzodiazepines

Back 2

Valium (diazepam), Xanax (alprzolam), Ativan (lorazepam), Librium (chlordiazepoxide), Serax (oxazepam), Klonopin (clonazepam)

Front 3

Action of Valium- sedative hypnotic anxiolytic- benzodiazepine

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enhances effects of GABA in the CNS

Front 4

Therapeutic uses of Valium- benzo

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for 1. anxiety disorders, social phobias, panic, compulsive, posttraumatic stress 2. Seizures 3. Insomnia 4. Muscle spasm 5. Alcohol withdrawal (for acute symptoms) 6. Induction of anesthesia

Front 5

For IV toxicity of Valium

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give flumazenil (Romazicon)

Front 6

For oral toxicity of Valium

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gastric lavage followed by charcoal or saline cathartics.

Front 7

s/e & intervention Valium - benzo

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1. CNS depression- sedation, light-headiness, ataxia, decreased cognitive function 2. Anterograde amnesia (stop meds if report this sym) 3. Paradoxical response=insomnia, excitation, euphoria, anxiety, rage 4. Withdrawal symptoms= taper the dose over weeks 5. Acute toxicity/OD= 1. oral toxicity, lethargy, confusion 2. IV toxicity- respiratory depression, stupor, coma

Front 8

Valium is contraindicated with…

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pt with sleep apnea, respiratory depression. Preg risk Cat D, schedule 1V, use cautiously with pts with substance abuse, liver disease.

Front 9

Food interactions with Valium-benzo

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CNS depressants lke alcohol, barbiturates, opiods= will have very high risk for respiratory depression

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Nursing interventions with Valium-benzo

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1. Avoid disrupt DC 2. DC slowly over weeks 3. Give with meals 4. Do not chew sustained released tabs 5. Inform pt about possible development of dependency.

Front 11

Buspirone (Buspar)= nonbarbiturate anxiolytic, action

Back 11

unknown, binds to serotonin and dopamine receptors. No risk for abuse! No sedation, no potentiate effects of other CNS depressants.

Front 12

Buspar therapeutic use

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1. long term management of anxiety 2. Tx GAD

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s/e buspar

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CNS effects= dizziness, nausea, headache, lightheadness, agitation. Does not interfere with activities because it does not cause sedation!

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Contraindications of Buspar

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1.Do not use with MAOI or 14 days after MAOI DC= can cause hypertensive crisis. 2. Caution with older adults with renal and liver dysfunction 3. Not for nursing mothers

Front 15

Food interactions with Buspar

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1. Increase effects when taken with erythromycin, ketoconazole, and grapefruit juice

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Nursing interventions with Buspar

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1. Take with meals 2. Effects take a week or more to work, months for full benefit 3. DO NOT take for acute need or for PRN.

Front 17

Paroxetine (Paxil)- nonbarbiturate anxiolytic -SSRI, action..

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selectively inhibits serotonin reuptake, allowing more serotonin at the junction of neurons. Does not block uptake of dopamine and noreepinephrine. Produces CNS excitation rather than sedation. Takes a long time to work (4 weeks)

Front 18

Paxil's therapeutic use

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for GAD, panic disorder, OCD (reduces symptom by increasing serotonin, social phobia, posttraumatic stress, depressive disorders

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Paxil's s/e early one that will subside

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happens first few days/weeks: nausea, diaphoresis, tremor, fatigue, drowsiness

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Paxil's s/e later 5-6 wks into therapy

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sexual dysfunction, weight gain, headache

Front 21

Paxiil other s/e

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Serotonin Syndrome

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Paxiil other s/e

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EPS (rare), withdrawal symptoms, bruxism (grinding teeth)

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Contraindications of Paxil

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1. Do NOT take with MAOI= will cause serotonin syndrome 2. Avoid alcohol 3. Use cautiously with hx of liver, renal, seizure, and GI bleeding.

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Nursing interventions with Paxil

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1. Report sexual dysfunction 2. Restrict calories and get exercise to minimize weight gain 3. Report bruxism.

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Examples of SSRI's

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First choice drug for depression. 1. Fluoxetine (Prozac) 2. Citalopram (Celexa) 3. Escitalopram oxalate (Lexapro) 4. Paroxetine (Paxil) 5. Sertraline (Zoloft)

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Examples of TCAs

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oldest class of antidepressants that are still used today 1. Amitriptyline (Elavil) 2. Imipramine (Tofranil) 3. doxepin (Sinequan) 4. Nortriptyline (Aventyl)

Front 27

Examples of MAOIs

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second and third choice meds for depression b/c of many s/e 1. Phenelzine (Nardil) 2. Isocarboxazid (Marplan) 3. Tranylcypromine (Parnate)

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atypical anti-depressant that inhibits dopamine uptake

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bupropion (Wellbutrin)

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atypical anti-depressant that inhibits reuptake of serotonin and norepinephrine

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venlafaxine

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atypical anti-depressant that increases the release of serotonin and norepinephrine

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mirtazapine (Remeron)

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atypical anti-depressant that selectively inhibits norepinephrine uptake -not approve in US

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reboxetine

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atypical anti-depressant that inhibits moderate selective uptake of serotonin

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trazodone (Desyrel)

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action of Prosac-SSRI

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selectively blocks reuptake of the monoamine neurotransmitter serotonin in the synaptic space, intensifying the effects that can be produced

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therapeutic uses of Prosac-SSRI

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depressive disorders, anxiety disorders, panic, social phobia, OCD, GAD, posttraumatic, and bulimia nervosa

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s/e of prosac-SSRI

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1. Sexual dysfunction 2. Weight gain 3. Serotonin syndrome 4. Withdrawal syndrome 5. Hyponatremia (more likely in older pt taking diuretics 6. Rash 7. Sleepiness, faintness, light-headness

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atypical depressants with fewer sexual dysfunctional s/e:

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bupropion (Wellbutrin), nefazodone (Serzonel)

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signs of serotonin syndrome

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1. Mental confusion 2. Agitation 3. Anxiety 4. Hallucinations 5. Hyperreflexia 6. Fever 7. Tremors

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signs of withdrawal syndrome:

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headache, nausea, visual disturbances, anxiety

Front 39

Prosac-SSRI should not be taken with:

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1. MAOI's= serotonin syndrome 2. Warfarin(coumadin)- displaces warfinfrom bound protein increasing levels= monitor PT and INR levles 3. TCAs and lithium= increase levels 4. NSAIDs and anticoagulants= suppresses platelet aggregation increases bleeding.

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Nursing interventions with Prosac-SSRI

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1. Take with meals 2. Will take long time to work 3. When sym pass encourage con't use= Sudden DC of meds can cause relapse 4. Therapy usually goes on for 6mnths to 1 year after symptoms pass. 5. Monitor sodium levels on older adults

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Action of amitriptyline (Elavil) :TCA

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blocks reuptake of the monoamine neurotransmitters norepinephrine and serotonin in the synaptic space, increasing effect

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Therapeutic use of Elavil

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depressive disorders, depressive episodes of bipolar

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s/e of Elavil

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1. Orthostatic hypotension 2. Anticholinergic effects 3. Cardiac toxicity 4. Sedation 5. Toxicity

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s/s of anticholinergic effects

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1. Dry mouth 2. Blurred vision 3. Photophobia 4. Acute urinary retention 5. Constipation 6. Tachycardia

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interventions to minimize anticholingeric effects

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sipping fluids, chewing gum for dry mouth, avoid hazardous activities because of blurred vision, wearing sunglasses to prevent photophobia, voiding before taking meds to reduce urinary retention, increasing fiber and water (6-8 8oz glasses a day)for constipation, and avoid hard exercise in warm weather due to the suppression of sweating.

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toxicity from Elavil TCA s/s are:

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dysrythmias, mental confusion, agitation, followed by seizures and coma.

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what pts should not use Elavil/TCAs

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preg Ccat, cautiously with seizures disorders, CAD, diabetes, liver, kidney, RR disorder, urinary retention or obstruction, hyperthyroidism.

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Meds that should not be taken with TCAs

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1. MAOI= hypertension 2. antihistamines=cause additive anticholinergic effects 3. Epinephrine/norepinephrine=increase their amount, which increase their effects 4. Ephedrine/amphetamine= decrease responses to meds b/c inhibition of their uptake and inability to et to the action site in nerve terminal. 5. alcohol/benzodiazpines/opiods/antihistamines=additive CNS depression.

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Nursing Interventions for Elavil/TCAs

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1. Take daily to maintain therapeutic levels 2. Will work in 1-3weeks and 2-3months for full effect 3. Continue, sudden DC can cause relapse and will continue for 6 month to 1 year after symptoms go away 4. Suicide prevention- prescribe 1 week of meds for acute ill, then give 1 month at a time. 5. minize anticholergeric effects

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Action for phenelzine (Nardil) MAOI:

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blocks MAO-A in the brain, increasing the amount of norepinephrine and serotonin available, this intensifies respone and relieves depression

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Therapeutic use for Nardil/MAOI:

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tx of choice for atypical depression 2. Bulimia nervosa 3. OCD

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s/e of Nardil

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1. CNS stimulation 2. Orthostatic hypertension 3. Hypertensive crisis (from intake of tyramine)

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s/s of hypertensive crisis

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(c/b intense vasoconstriction) headache, nausea, increased HR, increased BP

Front 54

how to tx a hypertensive crisis

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we want rapid vasodilatation so 1. IV phentolamine (a rapid acting alpha adrenergic blocker) 2. Sublingual nifedipine. Then provide continuous cardiac monitoring and respiratory support.

Front 55

Contraindications for Nardil/MAOI:

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preg Ccat, not for pt on SSRI, pheochromocytoma, HF, cardiovascular disease, renal insufficiency. Use cautiously with diabetes and seizure disorders.

Front 56

Meds/Food interactions for Nardil/MAOIs

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1. Ephedrine/amphetamine- leads to more release of NE, which leads to hypertensive crisis 2. TCA= leads to hypertensive crisis 3. SSRI= leads to serotonin syndrome 4. Antihistamines= adds to hypotensive effects 5. Meperidine (Demerol)= leads to hyperpyrexia 6. tyramine rich foods=hypertensive crisis 7. vasopressor (caffeine, phenylethylamine)= hypertension.

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Nursing interventions for MAOI/Nadil

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1. Take daily to maintain therapeutic levels 2. Will work in 1-3weeks and 2-3months for full effect 3. Continue, sudden DC can cause relapse and will continue for 6 month to 1 year after symptoms go away. 4. Give list of tyramine rich foods to avoid 5. avoid taking OTC's and other medication-contact HCP 1st.

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Action for Bupropion (Wellbutrin) atpyical antidepressant

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inhibits dopamine uptake

Front 59

therapeutic use for Wellbutrin

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depressive disorders, aid to quit smoking

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s/e of Wellbutrin

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seizures, headache, dry mouth, constipation, increased HR, nausea, restlessness, weight loss.

Front 61

Contraindications for wellbutrin/atypical

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pts with seizure disorders, pts taking MAOI

Front 62

do not take atypical antidepressants (wellbutrin) with:

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MAOIs= will cause toxicity.

Front 63

nursing interventions for atypicals (wellbutrin)

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1. Take daily to maintain therapeutic levels 2. Will work in 1-3weeks and 2-3months for full effect 3. Continue, sudden DC can cause relapse and will continue for 6 month to 1 year after symptoms go away.

Front 64

First line drugs used for bipolar disorder

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1. Lithium 2. Valproic acid (Depakote)

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With Bipolar atpyical antipsychotics are used for

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early tx for promotion of sleep and decrease anxiety with mood stabilizing qualities.

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With bipolar anxiolytics are used for

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Clonazepam (Klonopin) and lorazepam (Ativan) tx of acute mania, and managing psychomotor agitiation with mania.

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With bipolar antidepressants are used

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for the depression part of bipolar

Front 68

With bipolar anticonvulsants are used for:

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1. carbamazepine (tegretol) used along with lithium or an antipsychotic to manage severely manic clients with tx resistant bipolar 1 and pts with rapid cycling. 2. Lamotrigine (lamictal) first line med for bipolar that does not respond well to other med therapy.

Front 69

Action of Lithium-mood stabilizer

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produces neurochemical changes in the brain, including serotonin receptor blockade, also decreases neuronal atrophy and increase in neuronal growth.

Front 70

Therapeutic uses for lithium

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controls bipolar mania and is used for long term maintance of clients with bipolar 1 disorder.

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s/e of lithium

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tremors, GI effects (ab pain, diarrhea, nausea), fatigue, muscle weakness, headache, memory loss, confusion, weight gain, polyuria, goiter and hypothyroid symptoms, degenerative kindey changes.

Front 72

interventions for tremors caused by lithium:

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prescribe beta-adrengergic blocking agents such as propranolol (Inderal). 2. Reduce peak levels by using lowest possible dose, giving divided doses, or using long-acting formulations.

Front 73

interventions for polyuria caused by lithium

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prescribe potassium sparing diuretic like amiloride (Midamor) or instruct pt to drink 8 to 10 (8oz) glasses of water/day.

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interventions for hypothyroid symptoms from lithium

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obtain baseline T3, T4, and TSH levels prior to tx. Give thyroid hormone such as

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s/s for hypothyroidism

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cold dry skin, decreased HR, weight gain

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s/s of lithium toxicity

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hand tremors moving to coarse tremors, mild GI moving to persistent pain, slurred speech and muscle weakness moving to mental confusion, muscle hyperirritability, poor coordination, electroencephalogram…severe: decreased LOC, stupor, coma, seizures, hypotension, polyuria with dilute urine...death from pulmonary complications.

Front 77

contradictions with lithium

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preg cat D, no breastfeeding, with pt with low renal function "start low, go slow" use with caution with clients with heart disease, sodium depletion, dehydration

Front 78

why should diuretics not be used with lithium

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sodium is excreted witht the use of diuretics. With decreased serum sodium, lithium excretion is decreased, leading to lithium toxicity.

Front 79

medications not to use with lithium

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NSAIDs like ibuprofen (Motrin) and celecoxib (Celebrex= causes renal reabsorption of lithium, anticholinergics (antihistamines, TCAs)= ab pain, and induce urinary retention and polyuria.

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Interventions for lithium

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1. maintain fluid and sodium intake, 2. maintain lithium levels (0.4 to 1.3) check every 2-3 days at start then every 1-3 months. Toxicity is at 1.5 or greater, 2.0 or greater is life threatening. 3. Effects of tx begin in 5-7 days and takes 2-3 weeks to get full effects. 4. go to follow up appointments to monitor lithium levels, renal function, and thyroid function.

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action of valporoic acid (depkote): antiepiletic

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unknown, believed affect neurotransmitter GABA by increasing available levels in the brain.

Front 82

therapeutic use for depakote

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used for acute manic episodes with bipolar 1 and rapid cyling mania

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s/e of depokote

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1. Hepatotoxcitiy (anorexia, ab pain, jaundice) 2. Pancreatitis (nausea, vomiting, ab pain) 3. Thrombocytopenia (reduce platelets) 4. GI effects (nausea, vomiting, indigestion)

Front 84

interventions for hepatotoxicity caused by depakote

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observe for s/s, don't give to children younger than 3 yrs old, give at lowest dose.

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interventions for thrombocytopenia

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observe for s/s of bruising, monitor platelet counts

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Contraindications for depakote

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preg D cat, no breastfeeding, not for pt with liver disorders because it is metabolized in the liver.

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Meds/foods not to have with depakote

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1. Anything that effects blood clotting (warfarin, ticlopidine, NSAID 2. It can decrease the elimination of these drugs: lamictal, Zarontin, Valium, AZT, phenobarbital= which then increase blood concentration of these drugs.

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Nurising interventions for Depakote

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1. Ask pt not to stop without talking to HCP 2. When traveling carry extra medication.

Front 89

conventional (typical antipsychotic agents do what:

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suppress positive symptoms. !, reserved for clients who can tolerate the s/e 2. Are vilent and aggressive.

Front 90

Examples of typical antipsychotic meds

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low potency: 1. Chlorpromazine (Tharazine) 2. Thioridazine (Mellaril) Medium potency: 1. Molindone (Moban) High potency: 1. Haloperidol (Haldol) 2. Fluphenazine decanote (Prolixin)

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Atypical antipsychotics are used for:

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the 1st choice for pt receiving initial tx and for breakthrough episodes pts on conventional therapy b/c more effective with less s/e.

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Advantages of atypical antipsychotics

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1. Tx positive and negative symptoms 2. Decrease affective symptoms: depression, anxiety, suicidal behaviors 3. Improve poor memory 4. Few or no EPS s/e due to less dopamine blockade 5. Less anticholnergic adverse effects (except clozapine (Clozaril) which has high. this is b/c atypicals cause no blockade of cholinergic receptors.

Front 93

Examples of atypical antipsychotics:

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risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), clozapine (Clozoaril).

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action of conventional/typical antipsychotic:

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1.block dopamine, acetycholine, histamine, and NE receptors in the brain and periphery. 2. Inhibition psychotic symptoms is believed to be a result of the dopmaine blockade.

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effects of blocking dopamine

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Good: reduces psychosis (hallucinations, delusions) Bad or s/e: EPS symtpoms, increased prolactin= gynecomastia in men menstrual irregularities in women

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effects of blocking muscarinic receptors for acetylcholine

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good: no tx for psychosis Bad or s/e: anticholnergic effects: blurred vision, dry mouth, urinary retention, constipation, tachycardia

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effects of blocking alpha receptors for NE and histamine

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Good: no tx Bad or s/e: orthostatic hypotension, dizziness, reflex tachycardia, ed disfunction

Front 98

effetcs of blocking H1 receptors for histamine

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Good: unclear tx for psychosis Bad or s/e: sedation, weight gain.

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effect of blocking 5-HT for serotonin

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good: has antipsychtic effects and relieves depression bad or s/e: weight gain, hyptension, ed

Front 100

effects of GABA receptors

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good: increase in these receptors reduces symptoms of schizophrenia bad or s/e: lower seizure threshold.

Front 101

uses for typical antipsychtics Thorazine:

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schizo, bipolar, tourettes, delusional disorders, schizoaffective, dementia, huntington's chorea, prevents n/v through blocking dopamine

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s/e of typical antipsychotics:

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1. EPS, neuroleptic malignant syndrome, anticholinergic effects, orthostatic hypotension, sedation, neuroendocrine effects (gynecomastia), seizures, sexual dysfunction, skin effects, agranulocytosis, severe dysrhythmias.

Front 103

Meds to tx early EPS

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severe acute: IM/IV benzotropine (cogentin) or diphenhydramine (Benadryl). Pair up with these meds after

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tx for late EPS

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no tx for TD and stopping med may not make the symptoms go away. Lower dose and monitor 12 months later then every 3 months after late. If still has TD symptoms change to an atypical med, screening exams AIMS test.

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interventions for neuroleptic malignant syndrome

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1. stop med 2. Apply cooling blankets 3. Increase fluid intake 4. Administer benzos to control anxiety 5. Give dantrolene (Dantrium) to relax muscles 6. Wait 2 weeks before resuming therapy- may want to switch to atypical.

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s/s of neuroleptic malignant syndrome

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sudden high grade fever, BP fluctutuates, dysrythmias, muscle rigidity, change in LOC

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interventions for anticholnergic effects

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assess for urinary retention, monitor I&O 2. Give gum, candy 3. Increase water, eat high fiber foods 4. Teach to monitor HR.

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interventions for skin effects of typical antipsychotics:

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avoid excessive exposure to the sun, wear sunscreen, avoid direct contact with meds (contact dermatitis), wear sunglasses.

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interventions for agranulocytosis

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observe for signs of infection (fever sore throat), get baseline WBC, DC meds if infection present

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interventions for dsyrthmias

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baseline ECG, and potassium level, no meds that prolong QT interval

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pt who should not use typical antipsychotics

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coma pt, depressive pt, Parkinson's, prolactin dependent cancer pt, hypotension. Use with caution: glaucoma, HD, liver and kidney disease, seizure disorders.

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Meds not to take with typical antipyschotics

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no OTC, cns depressants= alcohol, opiods, antihistamines. Levodopa (Dopar)= activates dopamine receptors which counteracts antipyschotics.

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EPS should be controlled with:

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benzos, anticholingerics, beta-blockers

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action of atypical antipsychotics/ Riseridone (Risperdal)

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primary action is block serotonin receptors and some dopmaine receptors. Blocks for NE, histamine, and acetylcholine.

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Therapeutic effect of atypical antipsychotics

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1. Relieves both positive and negative symptoms 2. Begins to take effect in less than 1 week 3. Tx psychosis in other disorders like mania phase of bipolar 1 disorder 4. Tx irritability of autistic kids from 5-16 yrs old.

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s/e of atypical antipsychotics

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headache, sleepiness, anxiety, weight gain, long QT, dizziness, sedation, orthostatic hypotension, mild EPS

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meds that interact with atypical antipsychotics

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1. With cloazpine it will increase cloazoine blood leves 2. Increases the effects of antihypertensive meds- especially in 1st weeks.

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interventions for atypicals antipsychotics

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start low, go slow, 2. Observe s/s of diabetes, urinary retention, and weight gain.

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Olanzapine (Zyprexa)

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atypical antipsychotic that has anticholinergic effect and moderate EPS effects. S/e include weight gain, drowsiness, insomnia, restlessness.

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Quetiapine (Seroquel)

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atypical antipsychotic with mild anticholinergic effects. Low risk for EPS, s/e weight gain, headache, drowsiness

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Aripiprazole (Ablilify)

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atypical antipsychotic with mild anticholinergic effects. Low risk for EPS, s/e headache, anxiety, insomnia, GI upset

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Ziprasidone (Geodon)

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atypical antipsychotic but good for a depressed client too.low risk for anticholinergic effects. Mild risk for EPS, s/e ECG changes and long QT

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Clozapine (clozaril)

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atypical antipsychotic with HIGh risk anticholinergic effects and no EPS, s/e AGRANULOCYTOSIS, severe weight gain, seizure risk, lots of salvation, tachycardia.

Front 124

Alzheimer's theory is that it is a result from a depletion of what enzyme?

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depleted levels of acetyltransferase which produces acetylcholine

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meds used for Alzheimer's

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1. Cholinesterase inhibitors 2. Memantine (NMDA) antagonist 3. Antipsychotics, antidepressants, anxiolytics, estrogen therapy, gingko biloba

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types of cholinesterase inhibitors

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1.donepezil (Aricept) 2. Tacrine (Cognex) 3. Rivastigmine(Exelon) 4. Galantamine (Razadyne)

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what is the n-methyl-D-asparate (NMDA)

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memantine (Namenda)

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estrogen therapy helps prevent Alzheimer's but is not useful for what?

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it does not decrease the effects of preexisting dementia

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action of donepezil (Aricept)

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cholinesterase inhibitor: increases availability of acetycholine at neurotransmitter receptor sites.

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Therapeutic use for Aricept

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improve self-care, slow cognitive degeneration by an average of 2 yrs. Used in mild to moderate Alzheimer's cases.

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s/e of Aricept

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1. N/V 2. Bradycardia

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pt who should not take Aricept

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preg cat C, pt with asthma, COPD= bronchoconstriction may be caused by an increase in ACE.

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meds not to take with Aricept

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1. No NSAID = increase GI bleed 2. Antihistamines, TCAs, typical/convential antipyschotics = they block cholinergic receptors which reduce the effects of donepezil.

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with tacrine (Cognex) there is a high risk for what?

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liver damage, therefore this med is no longer used.

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action of Namenda

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blocks entry of calcium into nerve cells and thus slows down brain cell death.

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therapeutic us for Namenda

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only med used for moderate to severe cases of Alzheimer's. 2. May be added to the cholinesterase med already prescribed.

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nursing interventions for Namenda

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asses for memory improvement. 2. Watch the pt ability to swallow meds.

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most common mental disorder of childhood

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ADHD c/s by hyperactivity, inattention, impulsivity

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Stimulant meds do what

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reduce negative symptoms of ADHD by increasing clients ability to focus on tasks. Therapy is then used for the positive behaviors like studying schoolwork.

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positive

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thought, speech, behavior

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negative

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social withdrawal, lack of emotion, lack of energy.

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meds used to tx ADHD

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1. CNS stimulants 2. Nonstimulants

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examples of CNS stimulants

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methylphenidate (ritalin, concerta) 2. Dextroamphetamine (Dexedrine) 3. Dexmethylphenidate (Focalin)

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examples of nonstimulants

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atomoxetine (Strattera)

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action of CNS stimulants/ Ritalin

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release NE and dopamine into the CNS and inhibit the reuptake of NE and dopamine

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therapeutic use for Ritalin

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increase attention span and goal directed behavior, narcolepsy and get rid of the s/s of extreme drowsiness during daytime

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s/e of ritalin

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insomnia, restlessness, unwanted weight loss, growth retardation, Cardio effects- high BP, chest pain, dsrythmias

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precautions with ritalin

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1. Preg C cat, 2. Pt with hyperthyroidism, HD, glaucoma, hx of drug use, those taking MAOIs

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OD on ritalin can lead to

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seizures and psychotic behavior

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Ritalin can produce tolerance which is represented as:

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mood elevation, appetite suppression, stimulation of heart nd blood vessels…..and it causes dependence!!

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abrupt withdrawal from Ritalin after long-term use will cause

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abstinence syndrome= exhaustion, prolonged sleep, excessive eating, depression, craving more of the drug.

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meds not to use with Ritalin

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MAOIs= hypertensive crisis 2. Caffeine= increase CNS effects 3. Phenytoin (Dilatin) warfarin (coumadin) and phenobarbital= ritalin inhibits the metabolism of these so it increase serum levels. 4. OTC cough decongestants = leads to increase CNS effects.

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interventions with ritalin

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1. Obtain med hx /drug abuse hx and OTC meds used 2. Obtain baseline height and weight and monitor 3. Give meds AFTER meals to minimize appetite suppression and growth stunts 4. Education= sow releasing tabs=do not chew, take exactly the same time every day, monitor signs of slight OD, take 6 hours before bedtime, suck on candy, take sips of water.

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s/s of severe OD with Ritalin

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panic, hallucinations, circulatory collapse, seizures.

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short duration ritalin give:

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2-3 times a day

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intermediate duration ritalin give:

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delayed release last 4 to 8 hr taken twice daily Once in morning, once in early afternoon

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long duration ritalin give

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once in the morning= it is important not to chew these tabs= slow releasing

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patch (Daytrana)

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applied 2 hour before desired effect and then removed after 9 hours. May be removed earlier.

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action of nonstimulant Strattera

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controls ADHD symptoms through selective inhibition of presynaptic NE transport. 1st response happened in a few days with max response in 1-3 weeks.

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therapeutic use of Strattera

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increase attention span and goal directed behavior

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s/e of Strattera

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GI upset, anorexia, mood swings, insomnia, weight loss, growth retardation, severe allergic reaction (rare), sexual dysfunction and urinary retention, slight increase in HR and BP.

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interventions for Strattera

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1. Med hx and hx od drug abuse and OTC meds used 2. Obtain weight and height baseline and monitor growth 3. Take after meals 4. Avoid coffee, tea, alcohol 5. Swallow tabs whole.