Drugs Acting on the CNS & PNS (INCOMPLETE)

Methylphenidate

CNS stimulant indicated for the following conditions:

• ADHD

• Narcolepsy

• ADHD

• Narcolepsy

What are te indications of methylphenidate?

• depression augmentation

• Fatigue in neuro conds

What is the off label use of methylphenidate?

Blocks dopamine and norepinephrine transporters —> increased synaptic levels of dopamine and norepinephrine in prefrontal cortex(?)

MOA of methylphenidate

Familiarized na :)

FAMILIARIZE:

Methylphenidate is CI for the first:

• allergy

• Marked anxiety, agitation, or tendon and severe fatigue or glaucoma

• Cardiac dss: can further increase HR —> fatal dysarrhythmias

  • So pre-admin need full medical history and baseline ECG

• Pregnancy and lactation

Familiarized na :)

FAMILIARIZE

• Use methylphenidate cautiously in:

  • Seizures (excessive electrical firing)

  • History of drug dependency (can be addictive), alcoholism (alcohol is a stimulant which can lead to depression)

  • Hypertension: can increase norepinephrine, which is the main neurotransmitter that affects BP

• insomnia

• Decreased appetite & weight loss

Common SE of methylphenidate:

• ____: which is why need to administer in the morning

• ____: so need to collaborate with a dietician to figure out ways to induce this

• Nervousness, irritability, dry mouth

• growth suppression

• Reynolds’s phenomena

• Priapism

Serious SE of methylphenidate:

• Sudden cardiac death (rare)

• Psychosis or mania

• ____ ___ in children (the med can be started very early, so it shouldn’t be administered for an extremely long time as it will cause this)

  • Partly due to loss of appetite and insomnia

• ___ ____: blood vessels in extremities impeded

  • Sign: pallor in certain areas

• ___: long erection in penis of male px w/c would lead to much pain (smth wrong with the vessels supplying penile areas)

• caffeine

• Drug holidays

Nursing considerations for methylphenidate:

• Preadmin: assess cardiac history, baseline vitals, weight (BMI), and behavior

• Monitor: 

  • BP, pulse, and growth in children

  • Behavioral changes, mad shifts(?), dependency signs

• Educate

  • Avoid ____ since mo hyper and px

  • Avoid other stimulants like nicotine

  • Do not crush extended release tablets 

• ___ ___ may be used to assess the need and reduced S/E