Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (126 page)
(dex′meth-ul-fen′ih-dayt)
Focalin, Focalin XR
Func. class.:
Central nervous system (CNS) stimulant, psychostimulant
Do not confuse:
dexmethylphenidate
/methylphenidate
Increases release of norepinephrine and dopamine into the extraneuronal space, also blocks the reuptake of norepinephrine and dopamine into the presynaptic neuron; mode of action for treating attention-deficit/hyperactivity disorder (ADHD) is unknown
ADHD
Breastfeeding, children <6 yr, hypersensitivity to methylphenidate, anxiety, history of Gilles de la Tourette’s syndrome, tics, psychosis, glaucoma, concurrent treatment with MAOIs or within 14 days of discontinuing treatment with MAOIs
Precautions:
Pregnancy (C), hypertension, depression, seizures, CV disorders, alcoholism
Black Box Warning:
Substance abuse
Calculator
• Adult/adolescent/child >6 yr: PO
2.5 mg bid with doses at least 4 hr apart, gradually increase to a maximum of 20 mg/day (10 mg bid); for those taking methylphenidate, use 1/2 of methylphenidate dose initially then increase as needed to a max of 20 mg/day
• Adolescent and child ≥6 yr: EXT REL
5 mg/day, may adjust to 20 mg/day in 5-mg increments, max 30 mg/day
•
Adult: PO EXT REL
10 mg/day, may adjust to 20 mg/day in 10-mg increments, max 40 mg/day
Available forms:
Tabs 2.5, 5, 10 mg; ext rel caps 5, 10, 15, 20, 25, 30, 35, 40 mg (Focalin XR)
•
Twice daily at least 4 hr apart; ext rel once a day; in the morning, ext rel cap may be opened and contents sprinkled onto applesauce and consumed without chewing
•
Without regard to meals
•
Do not break, crush, or chew ext rel product
•
Med guide should be provided by dispenser
CNS:
Dizziness, headache, drowsiness, nervousness, insomnia,
toxic psychosis, neuroleptic malignant syndrome (rare),
Tourette’s syndrome
CV:
Palpitations, B/P changes, angina,
dysrhythmias, tachycardia, MI, stroke
GI:
Nausea, anorexia
, abnormal hepatic function,
hepatic coma,
abdominal pain
HEMA:
Leukopenia, anemia, thrombocytopenic purpura
INTEG:
Exfoliative dermatitis,
urticaria, rash, erythema multiforme
MISC:
Fever
, arthralgia, scalp hair loss
Readily absorbed, elimination half-life 2.2 hr, metabolized by liver, excreted by kidneys
PO:
Peak 1½ hr, onset 1/2-1 hr, duration 4 hr
PO-ER:
Onset unknown, peak 4 hr, duration 8 hr
Increase:
hypertensive crisis—MAOIs or within 14 days of MAOIs, vasopressors
Increase:
sympathomimetic effect—decongestants, vasoconstrictors
Increase:
effects of anticonvulsants, tricyclics, SSRIs, coumarin
Decrease:
effects of antihypertensives
•
Synergistic effect: melatonin
Black Box Warning:
Substance abuse, past or current; psychotic episodes may occur, especially with parental abuse
•
VS, B/P; may reverse antihypertensives; check patients with cardiac disease more often for increased B/P
•
CBC, differential platelet counts during long-term therapy, urinalysis; with diabetes: blood glucose, urine glucose; insulin changes may have to be made because eating will decrease; platelets
•
Height, growth rate q3mo in children; growth rate may be decreased
•
Mental status: mood, sensorium, affect, stimulation, insomnia, aggressiveness, hostility
Withdrawal symptoms: headache, nausea, vomiting, muscle pain, weakness
•
Appetite, sleep, speech patterns
•
For attention span, decreased hyperactivity in persons with ADHD
•
Therapeutic response: decreased hyperactivity or ability to stay awake
•
To decrease caffeine consumption (coffee, tea, cola, chocolate); may increase irritability, stimulation
•
To take early in day to prevent insomnia
•
To avoid OTC preparations unless approved by prescriber; to avoid alcohol ingestion
•
To taper off product over several wk to avoid depression, increased sleeping, lethargy
•
To avoid hazardous activities until stabilized on medication
•
To get needed rest; patients will feel more tired at end of day
•
To notify all health care workers, including school nurse, of medication and schedule
•
About information, instructions provided in patient information section
•
To notify prescriber if pregnancy is planned or suspected, avoid breastfeeding
Administer fluids; hemodialysis or peritoneal dialysis; antihypertensive for increased B/P; administer short-acting barbiturate before lavage
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(dex-troe-am-fet′a-meen)
Dexedrine, ProCentra
Func. class.:
Cerebral stimulant
Chem. class.:
Amphetamine
Increases release of norepinephrine, dopamine in cerebral cortex to reticular activating system
Narcolepsy, attention-deficit/hyperactivity disorder (ADHD)
Unlabeled uses:
Obesity
Hypersensitivity to sympathomimetic amines, hyperthyroidism, hypertension, glaucoma, severe arteriosclerosis, anxiety, anorexia nervosa, tartrazine dye hypersensitivity
Black Box Warning:
Symptomatic CV disease, substance abuse
Precautions:
Pregnancy (C), breastfeeding, children <3 yr, depression, Gilles de la Tourette’s disorder, cardiomyopathy, bipolar disorder, abrupt discontinuation, acute MI; benzyl alcohol, salicylate hypersensitivity; hypercortisolism, obesity, psychosis, seizure disorder
Calculator
•
Adult: PO
5 mg bid, titrate daily dose by no more than 10 mg/wk, max 60 mg/day
• Child 6-12 yr: PO
5 mg/day, titrate daily dose by no more than 5 mg/day at weekly intervals
•
Adult: PO
5-60 mg/day in divided doses
• Child 3-5 yr: PO
2.5 mg/day increasing by 2.5 mg/day at weekly intervals, max 40 mg/day
• Child >6-12 yr: PO
5 mg daily-bid increasing by 5 mg/day at weekly intervals
• Adult and adolescent: PO
5-30 mg/dose given 30-60 min before meals, use for 3-6 wk only
Available forms:
Tabs 5, 10 mg; oral sol 5 mg/5 ml
•
At least 6 hr before bedtime to avoid sleeplessness
•
Use calibrated measuring device for oral sol
•
Store all forms at room temperature
CNS:
Hyperactivity, insomnia, restlessness, talkativeness
, dizziness, headache, chills, stimulation, dysphoria, irritability, aggressiveness, tremor, dependence, addiction
CV:
Palpitations, tachycardia
, hypertension, decrease in heart rate,
dysrhythmias
GI:
Anorexia
, dry mouth, diarrhea, constipation, weight loss, metallic taste
GU:
Impotence, change in libido
INTEG:
Urticaria
Onset 1 hr; peak 2 hr; duration 4-20 hr; ext rel onset 1 hr, peak 2 hr, duration 8 hr; metabolized by liver; urine excretion pH dependent; crosses placenta, breast milk; half-life 6-8 hr (child), 10-12 hr (adult)
Hypertensive crisis: MAOIs or within 14 days of MAOIs
Increase:
serotonin syndrome, neuroleptic malignant syndrome: SSRIs, SNRIs, serotonin-receptor agonists; do not use concurrently
Increase:
dextroamphetamine effect—acetaZOLAMIDE, antacids, sodium bicarbonate
Increase:
CNS effect—haloperidol, tricyclics, phenothiazines
Decrease:
absorption of barbiturates, phenytoin
Decrease:
dextroamphetamine effect—ascorbic acid, ammonium chloride, guanethidine
Decrease:
effect of adrenergic blockers, antidiabetics, antihypertensives, antihistamines
•
Serotonin syndrome: St. John’s wort
Decrease:
stimulant effect—eucalyptus
Increase:
amine effect—caffeine (cola, coffee, tea [green/black])
Increase:
plasma corticosteroids, urinary steroids
Black Box Warning:
Cardiac disease:
VS, B/P; product may reverse antihypertensives; check patients with cardiac disease often
Black Box Warning:
Substance abuse:
use for prolonged periods may lead to dependence; sudden death or serious CV events can occur from misuse; chronic intoxication (insomnia, irritability, personality changes)
•
CBC, urinalysis; with diabetes: blood glucose, urine glucose; insulin changes may be required because eating will decrease
•
Height, growth rate in children; growth rate may be decreased, weight
•
Mental status: mood, sensorium, affect, stimulation, insomnia, irritability
•
Tolerance or dependency: increased amount may be used to get same effect; will develop after long-term use
•
Overdose:
pain, fever, dehydration, insomnia, hyperactivity
•
Therapeutic response: increased CNS stimulation, decreased drowsiness
•
To take before meals (obesity)
•
To decrease caffeine consumption (coffee, tea, cola, chocolate); may increase irritability, stimulation
•
To avoid OTC preparations unless approved by prescriber
•
To taper product over several wk; depression, increased sleeping, lethargy may occur
•
To avoid alcohol ingestion
•
To avoid hazardous activities until stabilized on medication
•
To get needed rest; patient will feel more tired at end of day
Administer fluids, hemodialysis, or peritoneal dialysis; antihypertensive for increased B/P, ammonium Cl for increased excretion