Pharm topic 2 drug cards

Methylphenidate

1. Classification: amphetamine- like drug/ CNS stimulant

2. primary use/indications: ADHD, narcolepsy

3. mode/mech of action: inhibits reuptake of dopamine and norepinephrine, CNS stimulation and increased effects of serotonin action, increase sympathomimetic activity (fight/flight)

4. contraindications: MAOI therapy, hereditary fructose intolerance

5. cautions: glaucoma, hyperthyroidism, seizure disorder, psychosis/mental health issues, cardiac dysrhythmias, hypertension, CVD, tourettes, pregnancy

6. Side effects: anorexia, dry mouth, nausea, vomiting, dizziness, insomnia, abdominal pain, tremors, anxiety, HA

7. Adverse effects: tachycardia, hypertension, palpitations, seizures, psychosis, growth suppression in children, MI, stroke

8. Life-threatening: blood dyscrasias, cardiac dysrhythmias, hepatotoxicity, ocular hypertension

9. Interactions: increased stimulatory effects of sympathomimetics/psychostimulants, reduced antihypertensive efficacy, increased effects of anticoagulants, barbiturates, anticonvulsants, and TCAs, MAOIs (hypertensive crisis), caffeine, St.Johns wort may increase effects

*Evaluate height, weight, and growth rate in children at routine intervals

*Do not discontinue abruptly to avoid severe withdrawal depression

Alprazolam (Xanax)

1. Classification: benzodiazepine/ anxiolytic/ sedative-hypnotic

2. Primary use: anxiety + panic disorder

3. Mode of action: Causes CNS depression by binding to benzodiazepine receptors to increase GABA = reducing excitability and producing a calming effect

4. Contraindications: severe respiratory depression; don’t mix with alcohol = too sedated, worsens psychosis; other CNS depressants (opioids)

5. Cautions: suicidal, substance abuse, renal/hepatic impairment, elderly

6. side effects: drowsy, dizzy, amnesia, memory loss, GI issues

7. Adverse effects: depression, drug tolerance, drug dependence, withdrawal, hypotension, tachycardia, seizures

8. Life-threatening: hepatic failure, Stevens-Johnson syndrome

9. Antidote: FLUMAZENIL

10. Interactions: CNS depressants (alcohol, opioids, barbiturates, antihistamines, kava or valerian) = sedation or respiratory depression

Zolpidem tartrate (ambien)

1. Classification: non-benzodiazepine sedative-hypnotic

2. Primary use: short-term treatment of insomnia

3. Mode of action: targeted CNS depression via selective neurotransmitter inhibition at specific GABA receptor complexes

4. Contraindications: hypersensitivity to benzodiazepines/non-benzodiazepines, severe respiratory depression, lactation

5. Cautions: renal/hepatic dysfunction, severe depression, suicidal, pregnant, peds, old ppl

6. Side effects: residual sedation (sleep hangover), memory loss, nightmares, binge eating

7. Adverse effects: tolerance, drug dependence, withdrawal, sleep-related behaviors (sleepwalking, driving, eating…), hypotension, angioedema, depression, suicidal

8. Life-threatening: pulmonary edema, renal failure

9. Drug interactions: alcohol, narcotics, antipsychotics, antidepressants = increased CNS and respiratory depression; kava kava & valerian = increased sedation

*set bed alarms + fall precautions for elderly/debilitated

*take immediately b4 bedtime→ rapid onset w/ in 15-30 mins

Phenytoin (Dilantin)

1. Classification: hydantoin Anticonvulsant/ anti seizure agent

2. Primary uses: prevent/control tonic-clonic seizures, partial seizures and status epilepticus

3. Mode of action: reduces motor cortex hyperactivity by altering cell membrane ion transport, suppressing sodium influx and stabilizing neuronal membranes

4. Contraindications: pregnancy, hypersensitivity, heart block, severe sinus bradycardia

5. Cautions: hypotension (especially IV), liver disease, heart disease/dysrhythmias, rapid IV admin, hypotension, renal impairment, DM, thyroid disease

6. Therapeutic range: 10-20 mcg/mL

7. side effects: gingival hyperplasia (overgrowth of gums), N/V, fatigue, HA, drowsy, dizzy

8. Adverse effects: leukopenia, peripheral neuropathy, purple glove syndrome (IV drug leaks into tissue= pain, swelling, discoloration, necrosis)

9. Life-threatening: aplastic anemia, Stevens-Johnson syndrome, severe hypotension, vFIB, suicidal, thrombocytopenia

10. Drug interaction: decreases effects of oral contraceptives, interacts w/ coagulants, corticosteroids, antihistamines and CNS depressants; ginkgo biloba may reduce meds effects

*teach client about need for barrier contraceptive method

*perform good oral hygiene to control gingival hyperplasia

*DON’T stop abruptly

Cyclobenzaprine (flexeril)

1. Classification: central-acting muscle relaxant

2. Primary action: short-term management of acute painful musculoskeletal spasms

3. Mode of action: relieves muscle spasms @ the spinal cord/brain= depresses motor neuron activity without interfering with muscle function

4. Contraindications: MI, severe bradycardia, heart block, severe heart failure, concurrent MAOI use, hyperthyroidism, severe hypertension

5. Cautions: seizure disorder, alcohol use, other CNS depressants= increase sedation, glaucoma, urinary retention?BPH, hepatic disease, cerebral palsy, DM

6. Side effects: anticholinergic effects (dry mouth, urinary retention, blurred vision, constipation), cardiac arrhythmias, CNS depression, unpleasant taste

7. Adverse effects: allergic reactions, angioedema, MI, seizures, paralytic ileus

8. Interactions: severe CNS depression when combined w/ alcohol, barbiturates, narcotics, anxiolytics, hypertensive crisis when taken w/MAOIs

Lorazepam (ativan)

1. Classification: anxiolytic/ benzodiazepine

2. Primary use: control of severe anxiety, manage epilepsy preoperative sedation, acute insomnia

3. Mode of action: strengthens GABA effects by binding to specific benzo receptors (GABA-A)= enhances GABA = calming effect

4. Contraindications: hypersensitivity to benzos, severe narrow-angle glaucoma, severe respiratory depression, sleep apnea

5. Cautions: suicidal, hx of drug abuse, hepatic/renal dysfunction, elderly clients

6. Side effects: CNS depression, ataxia( poor balance), amnesia, GI distress, visual hallucinations

7. Adverse effects: bradycardia, severe hypotension/ rebound hypertension, seizures

8. Life-threatening: suicide, neuroleptic malignant syndrome not typical, fever+rigid muscles+confusion) severe respiratory depression (especially w/ opioids/alcohol)

9. Interactions: respiratory depression/ CNS sedation w/ alcohol, opioids, hypnotics; kava +valerian increase sedation

*monitor for suicidal ideations

DON’T stop abruptly

selective serotonin reuptake inhibitors (SSRIS) (fluoxetine / Prozac)

1. Classification: selective serotonin reuptake inhibitor (ssri) antidepressant

2. Primary use: MDD, bipolar disorder, bulimia, OCD, panic disorder, PMDD, phobias, PTSD, migraine prophylaxis

3. Mode of action: selectively inhibits neuronal reuptake of serotonin at presynaptic nerve terminals→ increase serotonin accumulation in synaptic clefts

4. Contraindications: hypersensitivity, concurrent use w MAOIs

5. Cautions: recent MI, dehydration, lactation, suicidal, liver disease, osteoporosis, glaucoma, seizure disorder, DM, malnourishment, anticoagulant therapy, diarrhea

6. Side effects: CNS stim/sedation, memory impairment, fine tremors, dry mouth, blurred vision, GI issues, ED

7. Adverse effects: seizures, angioedema, hyponatremia, hypo/hyperkalemia, hypoglycemia, severe dehydration, bleeding, osteoporosis

8. Life-threatening: Stevens-Johnson syndrome, hepatic dysfunction, suicidal

9. Interactions: grapefruit juice, alcohol/CNS depressants; aspirin, nsaids and anticoagulants increase bleeding potential; MAOIs taken with SSRIs cause severe Serotonin Syndrome, St.Johns wort= increase hypoglycemic effects