Pharmacology Ati Medications For Children And Adolescents With Mental Health Issues (Chapter 11; Unit 2)

Front 1

when treating children/adolescents, parents should understand that pharmacological management is most effective when accompanied by _____________

Back 1

techniques to modify behavior

Front 2

what are the type of meds used to treat children/adolescents with mental health issues?

Back 2

1. TCAs

2. antipsychotics

3. nonbarbiturate/atypical anxiolytics

4. CNS stimulants

5. norepinephrine selective reuptake inhibitors

Front 3

name the CNS stimulants and their co rresponding short-acting, intermediate-acting, or long-acting brands

Back 3

1. methylphenidate (short: Ritalin, Methylin; intermediate: Ritalin SR, Methylin ER; long-acting Ritalin LA, Concerta, Daytrana)

2. dexmethylphenidate (short: Focelin; long: Focalin XR)

3. dextroamphetamine (short: Dexedrine; long: Dexedrine spansule)

4. amphetamine mixture (short: Adderall; long: Adderall XR)

5. lisdexamfetamine dimesylate (long: Vyvanse)

Front 4

MOA of CNS stimulants

Back 4

raise levels of norepinephrine, serotonin, and dopamine into the CNS

Front 5

what are the therapeutic uses of CNS stimulants

Back 5

1. ADHD

2. Conduct disorder

Front 6

what are the adverse effects of CNS stimulants?

Back 6

1. CNS stimulation

2. weight loss

3. cardiovascular effects

4. development of psychotic manifestations

5. withdrawal reaction

6. hypersensitivity skin reaction to transdermal methylphenidate

Front 7

how is methylphenidate normall administered?

Back 7

transdermal patch

Front 8

what are the adverse CNS stimulation effects of CNS stimulants?

Back 8

insomnia, restlessness

Front 9

what are the cardiovascular effects of CNS stimulants?

Back 9

dysrhythmias, chest pain, high BP; may increase risk of sudden death in clients who have heart abnormalities

Front 10

what are the adverse psychotic manifestations of CNS stimulants?

Back 10

hallucinations, paranoia

Front 11

what manifestations occur with a hypersensitivity reaction due to transdermal methylphenidate?

Back 11

hives, papules

Front 12

what are the nursing interventions for the adverse effects of CNS stimulants?

Back 12

1. cns stimulation -> effects and notify, adminster last dose before 4 pm

2. weight loss -> monitor weight and compare to baseline height/weight; admin med immediately before or after meals; promote good nutrition in children; encourage children to eat at regular meal times and avoid unhealthy foods for snacks

3. cardiovascular effects -- monitor vital signs and ECG; effects notify

4. psychotic manifestations --report manifestations immediately and discontinue med

5. withdrawal -- advise not stop taking med suddenly, doing so may lead to depressions and severe fatigue

6. hypersensitivity -- remove patch and notify provider

Front 13

what are the contraindications for CNS stimulants?

Back 13

clients who have a history of substance use disorder, cardiovascular disorders, severe anxiety, and psychosis

Front 14

med/food interactions of CNS stimulants and corresponding nursing interventions

Back 14

1. with MAOIs can cause hypertensive crisis -- avoid concurrent use

2. with caffeine may increase CNS stimulant effects -- avoid food with caffeine

3. methylphenidate inhibits metabolism of phenytoin (Dilantin), warfarin (Coumadin) and phenobarbital leading to increased serum levels -- monitor for adverse effects (CNS depression, indications of bleeding); with these meds with caution

4. OTC cold and decongestant meds with sympathomimetic action can increase CNS stimulant effects -- instruct clients to avoid use of OTC meds

Front 15

when taking sustained-release tablets who, what should you advise client to do?

Back 15

to not chew or crush the tablets

Front 16

when using the transdermal med Daytrana, what should you advise the client to do?

Back 16

place patch on one hip daily in morning and leave it in place no longer than 9 hr.; alternate hips daily

Front 17

which medication cures ADHD?

Back 17

no medication can cure ADHD; management is with an overall treatment plan of family therapy, cognitive therapy etc

Front 18

what does federal law dictate about CNS stimulants?

Back 18

special handling procedures -- handwritten prescriptions are required for med refills

Front 19

CNS stimulants have a high potential for _____

Back 19

substance use disorder, especially in adolescents

Front 20

nursing evaluation for CNS stimulants

Back 20

1. improvement of ADHD manifestations such as increased ability to focus and complete tasks, interact with peers and manage impulsivity

2. improved ability to stay awake

Front 21

what is the select norepinephrine selective reuptake inhibitor?

Back 21

atomoxetine (Strattera)

Front 22

atomoxetine

Back 22

Strattera

Front 23

MOA of norepinephrine selective reuptake inhibitor (NSRI)

Back 23

blocks reuptake of norepinephrine at synapses in the CNS, atomoxetine is not a stimulant medication

Front 24

what are the therapeutic uses of norepinephrine selective reuptake inhibitors?

Back 24

ADHD

Front 25

what are the adverse effects/nursing interventions of atomoxetine?

Back 25

***atomoxetine is usually tolerated well

1. appetite suppression, weight loss, growth suppression (monitor weight and compare baseline height/weight); administer med right before meals; encourage children to eat at regular meal times and avoid unhealthy food/snacks

2. GI effects (nausea vomiting) -- advise client to take food if these occur

3. suicidal ideation (in children/adolescents) -- monitor for indications of depression, advise client to report change in mood, excessive sleeping, agitation, and irritability

4. hepatotoxicity -- advise to report indications of liver damage

Front 26

what are the indications of liver damage from hepatotoxicity from atomoxetine?

Back 26

flu-like manifestations, yellowing skin, abdomnial pain

Front 27

us atomoxetine (Strattera) cautiously in clients who _______

Back 27

have cardiovascular disorders

Front 28

med/food interactions of atomoxetine (Strattera) plus nursing interventions

Back 28

1. concurrent use of MAOIs may cause hypertensive crisis -- avoid concurrent use

2. Paroxetine (Paxil), fluoxetine (Prozac) or quinidine gluconate (Quinidine duratabs) inhibit hepatic metabolizing enzymes, thereby increasing levels of atomoxetine -- teach about symptoms of increased atomoxetine, dosage of atomoxetine may need ot be altered

Front 29

nursing administration for atomoxetine (Strattera)/norepinephrine selective reuptake inhibitors

Back 29

1. note changes in child's behavior related to dosing and timing of med

2. administer med in daily dose in the morning or in two divided doses, morning and afternoon with or without food

3. instruct clients that therapeutic effects may take at 1 to 3 weeks to fully develop

Front 30

nursing evaluation of atomoxetine (Strattera)/norepinephrine selective reuptake inhibitors

Back 30

1. improvement of manifestations of ADHD such as increase in ability to focus and complete tasks, interact with peers, and manage impulsivity

Front 31

name the tricyclic antidepressants (TCAs) for children and adolescents with mental health issues

Back 31

1. desipramine (Norpramin)

2. imipramine (Tofranil)

3. clomipramine (Anafranil)

Front 32

desipramine

Back 32

Norpramin

Front 33

imipramine

Back 33

Tofranil

Front 34

MOA of TCAs

Back 34

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

Front 35

therapeutic uses in children for TCAs

Back 35

1. depression

2. autism spectrum disorder

3. ADHD

4. panic, school phobia, separation anxiety disorder

5. OCD

Front 36

what are the dverse effects of desipramine (Norpramin)

Back 36

1. orthostatic hypotension

2. anticholinergic effects

3. weight gain

4. sedation

5. toxicity

6. decreased seizure threshold

7. excessive sweating

Front 37

what are the adverse anticholinergic effects of desipramine (Norpramin)

Back 37

dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia

Front 38

define the type of toxicity that can arise as an adverse effect of desipramine (Norpramin)

Back 38

toxicity resulting in cholinergic blockade and cardiac toxicity EVB dysrhythmias, mental confusion and agitation followed by seizures and coma

Front 39

nursing interventions for adverse effects of desipramine (Norpramin)

Back 39

1. orthostatic hypotension -- monitor BP with first dose, instruct client to change positions slowly

2. anticholinergic effects -- to minimize anticholinergic effects...

a. chewing sugarless gum

b. sipping on water

c. avoiding hazardous activities

d. wearing sunglasses when outdoors

e. eating food high in fiber

f. participating in regular exercise

g. increasing fluid intake to at least 2 to 3 L/day from beverages or food sources

h. voiding just before taking med

(advise of manifestations/notify provider if)

3. weight gain -- monitor cleint weight, encourage regular exercise/follow healthy, low-calorie diet

4. sedation -- advise adverse effects diminish over time, avoid hazardous activities such as driving, take at bedtime to minimized daytime sleepiness and to promote sleep

5. toxicity -- give acutely ill clients a 1 week supply of medication, obtain clients baseline ECG, monitor vital signs frequently, monitor/notify

6. seizure threshold -- monitor clients who have seizure disorders

7. sweating -- inform of effect/change bed linens

Front 40

use desipramine (Norpramin) cautiously in clients who have _________

Back 40

seizure disorders, diabetes, liver, kidney/respiratory disorders, and hyperthyroidism

Front 41

med/food interactions of desipramine (Norpramin) plus nursing interventions

Back 41

1. concurrent use of MAOIs cause hypertension

2. antihistamines and other anticholinergic agents have additive anticholinergic effects

3. TCAs bock uptake of epinephrine and norepi (direct-acting smpathomimetics) in the synaptic space, leading to decreased intensity of their effects

4. TCAs inhibit uptake of ephedrine and amphetamine (indirect-acting sympathomimetics) and reduce their ability to get to the site of action in the nerve terminal, leading to decreased responses to these meds
(nursing intervention for 1-4, avoid use with TCAs)

5. alochol benzodiazepines, opiods, and antihistamines cause additive CNS depression when used concurrently -- avoid CNS depressants

Front 42

nursing administration of desipramine (Norpramin)/norepinephrine selective reuptake inhibitors

Back 42

1. instruct to take as prescribed on daily basis

2. may take 1 to 3 weeks to experience effects, 2 to 3 months for full effects

3. sudden discontinuation can result in relapse

4. give only a week's worth of med at a time for an acutely ill client

Front 43

nursing evaluation of medication effectiveness for norepinephrine selective reuptake inhibitors/desipramine (Norpramin)

Back 43

1. depression -- verbalizing improvement in mood, improved sleeping/eating habits, increased interaction with peers

2. autism spectrum disorder -- decreased anger and compulsive behavior

3. ADHD -- less hyperacitivity, greater ability to pay attention

Front 44

name the alpha2-adrenergic agonists for children and adolescents with mental health issues

Back 44

1. guanfacine (Intuniv)

2. clonidine (Kapvay)

Front 45

MOA of alpha2-adrenergic agonists

Back 45

not completely understood however known to activate presynaptic alpha2-adrenergic receptors within the brain

Front 46

what are the therapeutic uses of alpha2-adrenergic agonists?

Back 46

1. ADHD

Front 47

what are the adverse effects of guanfacine (Intuniv) plus nursing interventions

Back 47

1. CNS effects -- monitor, notify, avoid hazardous activities

2. cardiovascular effects -- monitor BP and pulse especially during initial treatment, advise client not to abruptly discontinue medication which can cause rebound hypertension

3. weight gain -- monitor weight, regular exercise/healthy diet

Front 48

what are the adverse CNS effects of guanfacine (Intuniv)

Back 48

sedation, drowsiness, fatigue

Front 49

what are the adverse cardiovascular effects of guanfacine (Intuniv)

Back 49

hypotension, bradycardia

Front 50

extended-release clonidine is contraindicated for which clients

Back 50

children less than 6 years old

Front 51

which alpha2-adrenergic agonist is contraindicated for children less than 6 years old

Back 51

extended-release clonidine

Front 52

use alpha2-adrenergic agonists cautiously with which clients?

Back 52

those who have cardiac disease

Front 53

med/food interactions of guanfacine (Intuniv) plus nursing interventions

Back 53

1. CNS depressant like alcohol can increase CNS effects -- avoid use

2. antihypertensives can worsen hypotension -- avoid use

3. foods with high-fat content will increase guanfacine absorption -- avoid taking meds with high-fat meal

Front 54

nursing administration for alpha2-adrenergic agonists in children and adolescents with mental health issues

Back 54

1. asses use of alcohol/CNS depressant especially in adolescents

2. instruct not to chew/crush/split extended release preparations

3. monitor BP and pulse at baseline with initial treatment and each dosage changes

4. advise to avoid abrupt discontinuation can result in rebound hypertension, med should be tapered to discontinue

Front 55

nursing evaluation for alpha2-adrenergic agonists in children and adolescents with mental health issues

Back 55

1. improvemnt of ADHD manifestations wuch as increase in ability to focus and complete tasks, interact with peers and manage impulsivity

Front 56

name the antipsychotics (atypical) to treat children/adolescents with ,mental health issues

Back 56

1. risperidone (Risperdal)

2. olanzapine (Zyprexa)

Front 57

MOA of atypical antipsychotics for children/adolescents with mental health issues

Back 57

block serotonin and to a lesser degree dopamine receptors; meds block receptors for norepi, histamine, and acetylcholine

Front 58

therapeutic uses for atypical antipsychotics for children/adolescents with mental health issues

Back 58

1. autism spectrum disorder

2. conduct disorder

3. PTSD

4. relief of psychotic manifestations

Front 59

adverse effects of atypical antipsychotics for children/adolescents with mental health issues

Back 59

1. new onset of diabetes or loss of glucose control in clients who have diabetes

2. weight gain

3. hypercholesterolemia

4. orthostatic hypotension

5. anticholinergic effects

6. agitation, dizziness, sedation, and sleep disruption

7. may cause mild extrapyramidal adverse effects such as tremor

Front 60

hypercholesterolemia as an adverse result from atypical antipsychotics for children/adolescents can increase risk for _________

Back 60

hypertension and other cardiovascular diseases

Front 61

what are the adverse anticholinergic effects of atypical antipsychotics/risperidone (Risperdal) for children/adolescents

Back 61

urinary hesitancy or retention, dry mouth

Front 62

nursing interventions for the adverse effects of risperidone (Risperdal) for children/adolescents

Back 62

1. diabetes -- baseline fasting blood glucose and monitor throughout, instruct to report indications liek increased thirst, urination and appetite

2. weight gain -- diet/exercise, monitor weight

3. hypercholesterolemia -- monitor cholesterol, triglycerides, and blood glucose if weight gain is more than 14 kg (30lbs)

4. orthostatic hypotension -- monitor BP with first dose, instruct client to change positions slowly

5. anticholinergic effects -- monitor/notify; encourage client to use measures to relieve dry mouth such as sipping fluids

6. agitation etc -- monitor/notify, administer an alternative medication if prescribed

7. exrapyramidal adverse effects -- monitor/teach to recognize, ***usually dose related

Front 63

what should the nurse be aware of when an child/adolescent client is taking atypical antipsychotics?

Back 63

use of alcohol, especially with adolescents

Front 64

uses atypical antipsychotics cautiously in clients with _________

Back 64

cardiovascular disease, seizures, DM (obtain baseline fasting glucose for DM clients and monitor carefully)

Front 65

med/food interactions of risperidone (Risperdal)/atypical antipsychotics plus nursing interventions

Back 65

1. alcohol opioids and antihistamines cause additive CNS depressant effects -- avoid use, avoid hazardous effects

2. levodopa activates dopamine receptors and counteracts effects of antipsychotics -- avoid use of levodopa and other direct dopamine receptor agonists

3. TCAs, amiodarone (Cordarone) and clarithromycin (Biaxin) prolong QT interval and increase risk of cardiac dysrhythmias -- avoid concurrent use

4. barbiturates and phenytoin (Dilantin) promote hepatic drug-metabolizing enzymes, thereby decreasing drug levels of quetiapine -- monitor med effectiveness

5. medications that inhibit CYP3A4 such as fluconazole (Diflucan) inhibit hepatic drug-metabolizing enzymes thereby increasing drug levels of aripiprazole, quetiapine, and ziprasidone -- monitor adverse effects

Front 66

what medication inhibits CYP3A4

Back 66

fluconazole (Diflucan)

Front 67

which atypical antipsychotic are affected if CYP3A4 is inhibited? inhibition of CYP3A4 causes what? the affected atypical antipyschotics, what happens to them?

Back 67

1. aripiprazole, quetiapine, and ziprasidone

2. causes inhibition of hepatic drug-metabolizing enzymes

3. increased drug levels

Front 68

what forms does risperidone (Risperdal) come in?

Back 68

oral solution and quick-dissolving tablets

Front 69

which forms does olanzapine (Zyprexa) come in?

Back 69

orally disintegrating tablet for ease in administration

Front 70

how is dosage done for atypical antipsychotics for children/adolescents?

Back 70

intially low doses are given and then gradually increased

Front 71

nursing evaluation of atypical antipsychotics for children/adolescents

Back 71

1. autism spectrum disorder: reduction of hyperactivity and improvement in mood

2. conduct disorder -- decrease in aggresiveness

3. PTSD -- decrease in aggresiveness and reduction of flashbacks, improvement of psychosis (prevention of acute psychotic manifestations and absence of hallucinations, delusions, anxiety and hostility); improvement in ability to perform ADLs; improvement in ability to interact socially with peers

6. improvement of sleeping and eating habits