Ati Nervous System Meds (Children And Adolescent Mental Health Meds)

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methylphenidate

Back 1

CNS stimulant
short-acting- Ritalin, Methylin
intermediate-acting- Ritalin SR, Methyln ER
long-acting- Ritalin LA, Concerta, Daytrana

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dexmethylphenidate

Back 2

CNS stimulant
short-acting-Focalin
long-acting-Focali XR

Front 3

dextroamphetamine

Back 3

CNS stimulant
short-acting-Dexetrine
long-acting- Dexetrine spansule

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amphetamine mixture

Back 4

CNS stimulant
short-acting- Adderall
long-term-Adderall XR

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lisdexamfetamine dimesylate

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CNS stimulant
long-acting- Vyvanse

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CNS stimulants MOA

Back 6

raise the level of norepinepherine, serotonin, and dopamine into the CNS

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CNS stimulants USE

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ADHD
Conduct disorder

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CNS stimulants adverse effects

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CNS stimulation, weight loss, cardivascular effects, psychotic manifestations, withdrawal reactions, hypersensitivity skin reaction to transdermal

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CNS stimulants contraindications

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substance abuse disorder, cardiovascular, severe anxiety, psychosis

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CNS stimulants Interactions

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MAOIs may cause hypertensive crisis, concurrent use of caffiene may increase CNS effects
methylphenidte inhibits metabolism of phenytoin, warfarin (Coumadin) and phenobarbital, leading to increased serum levels
OTC cold meds with sympathomimetic action can increase CNS stimulant effects

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CNS stimulants Administration

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transdermal meds- place patch on one hip daily in the morning and leave it in place no longer than 9 hr alternate hips daily
high potential for substance abuse disorder especially in adolescents

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CNS stimulant effectiveness

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improvement of ADHD manifestations
improved ability to stay awake

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Norepinepherine Selective reuptake inhibitor

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atomoxetine (Strattera)

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NSRI MOA:

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block reuptake of norepinepherine at synapses in the CNS, Atomoxetine is not a stimulant med

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NSRI USE

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ADHD

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NSRI adverse

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appetite suppression
GI effects
suicidal ideation
hepatoxicity

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NSRI contraindications

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cardiovascular disorders

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NSRI interactions

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MAOIs may cause hypertensive crisis
paroxetine (Paxil), floexetine (Prozac), inhibit hepatic metabolizing enzymes, thereby increasing levels of atomoxetine

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NSRI admin

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daily dose in the morning, or in two divided doses, morning and afternoon, with or without food

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NSRI effectiveness

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increase in ability to focus and complete tasks, and manage impulsitivity (ADHD manifestations)

Front 21

TCAs

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desipramine (Norpramin)

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imipramine (Tofranil)

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TCA

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clomipramine (Anafranil)

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TCA

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TCA MOA:

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block reuptake of monoamine neurotransmitters norepinepherine and serotonin in the synaptic space, thereby intensifying the effects that these neurotransmitters produce

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TCA USE

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depression, autism, ADHD, panic, school phobia, separation anxiety disorder, OCD

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TCA adverse

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orthostatic hypotension
anticholinergic effects
weight gain
sedation
toxicity resulting in cholinergic blockade and cardiac toxicity evidenced by dysrhythmias
decreased seizure threshold
excessive sweating

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TCA Interactions

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concurrent use of MAOI causes hypertension
antihistamines and other anticholinergic agents have additive anticholinergic effects
block uptake of epinepherine and NE in the synaptic space, leading to decreased intensity of effects
inhibit uptake of ephederine and amphetamine- leads to decreased responses of these meds
alcohol, benzodiazepines, opioids and antihistamines cause additive CNS depression

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TCA admin

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may take 1-3 weeks to experience therapeutic effects
full therapeutic effects may take 2-3 months
sudden discontinuation of the meds can result in relapse

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TCA contraindications

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seizure, diabetes, liver, kidney, and respiratory disorders

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TCA effectiveness

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improvement in mood
improved sleeping and eating habits
increased interaction with peers
decreased anger and compulsive behavior
less hyperactivity, greater ability to pay attention

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alpha2-adrenergic agonists

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guanfacine (Intuniv)

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clonidine (Kapvay)

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alpha adrenergic agonist

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alpha adrenergic agonists MOA

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known to activate presynaptic alpha adrenergic receptors within the brain

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alpha adrenergic agonist Uses

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ADHD

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alpha adrenergic agonists Adverse

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CNS effects, cardivascular effects, weight gain

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alpha adrenergic agonist contraindications

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clonidine is ccontraindicated for children less than 6 years old
clients who have cardiac disease

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alpha adrenergic agonist interactions

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cns depressants can increase CNS effects
antihypertensives can worsen hypotension
foods with high-fat content will increase guanfacine absorption

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alpha adrenergic agonist administration

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abrupt discontinuation can result in rebound hypertension

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alpha adrenergic agonist effectiveness

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improvement of manifestations of ADHD, such as an increase in ability to focus and complete tasks, interact with peers, and manage impulsitivity

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antipsychotic-atypical

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risperidone (Risperdal)

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antipsychotic- atypical MOA

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block serotonin, and to a lesser degree, dopamine receptors
also block norepinepherine, histamine, and acetylcholine

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antipsychotic- atypical Uses

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autism
conduct disorder
PTSD
relief of psychotic manifestations

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antipsychotic- atypical adverse

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new onset of diabetes, or loss of glucose control in clients who have diabetes
weight gain
hypercholesterolemia with increased risk for hypertension and other cardiovascular disease
orthostatic hypotension
anticholinergic effects
agitation, dizziness, sedation, and sleep disruption
mild extrapyramidial adverse effects, such as tremor

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antipsychotics-atypical interactions

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alcohol, opioids, and antihistamines cause additive CNS depressant effects
by activating dopamine receptors, levodopa counteracts effects of antipsychotic agents
TCAs amiodarone, and clarithromycin (Biaxin) prolong QT interval which increases risk of cardiac dysrhythmias
barbituates and phenytoin decrease drug levels of quetiapine
meds that inhibit CY3A4, such as fluconazole (Diflucan) inhibit hepatic drug metabolizing enzymes thereby increasing drug levels of aripprazole, queitiapine, and ziprasidone

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antipsychotic-atypical effectiveness

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reduction of hyperactivity and improvement in mood
decrease in aggressiveness
improvement in psychosis
improvement in ability to perform ADLs
improvement in ADHD manifestations