CLASSIFICA- DRUGS PHARMACO- PHARMACO- INDICATIONS SIDE EFFECTS INTERAC- NURSING

TION DYNAMICS KINETICS TIONS CONSIDERA-

TIONS

CENTRAL NERVOUS SYSTEM (CNS) DEPRESSANTS

SEDATIVES Pentobarbital Pentobarbital, a Half-Life: 15-50 hr A barbiturate Drowsiness, Pentobarbital -Monitor V/S.
AND barbiturate, is used mainly used as somnolence, has no report
HYPNOTICS for the treatment of Onset: 10-15 min a sedative dizziness, known irregularities
short term insomnia. (IM); 3-5 min (IV) and hypnotic. It anxiety, severe - Observe for
It belongs to a group has been insomnia; interactions withdrawal
of medicines called Duration: 3-4 hr suggested hypotension, with other symptoms (N
central nervous that its apnoea, resp drugs. and V,
system (CNS) Protein bound: pharmacologic depression, Severe weakness,
depressants that 45-70% effect is due to bronchospasm, interactions and
induce drowsiness its property to laryngospasm, of headache)
and relieve tension Vd: 0.8 L/kg enhance the bradycardia, pentobarbital - Monitor for
or nervousness. (children); 1 L/kg activity of CNS depression, include: side effects
Little analgesia is (adults) GABA by physical and artemether/lu - Avoid
conferred by altering GABA psychological mefantrine. alcohol
barbiturates; their Metabolism: receptor�medi dependence, consumption
use in the presence hepatic ated inhibitory psychiatric - Advise not
of pain may result in microsomal synaptic disturbance, to drive and
excitation. enzymes, transmissions. confusion, use
glucuronidation hallucinations, hazardous
nightmares, equipment
Excretion: Mostly thinking when
urine abnormality, experiencing
syncope, palpitation,
hyperkinesias, nervousness,
ataxia, agitation, tremors
nervousness, - Instruct
nausea, client not to
vomiting, discontinue
constipation, the drug
pain at inj site. abruptly
Potentially Fatal: - Advise not
Stevens-Johnso to eat foods
 n syndrome with
caffeine
- Instruct to
eat nutritious
food because
drug may
cause
anorexic
effect
- Teach to
report drug
side
effects such
as
tachycardia
and
palpitations

ANALGESIC Codeine Codeine is a weak Elimination A potent opioid Reduce artemether/lu - Monitor V/S.
S narcotic pain Half-life: 3-4 hr analgesic that pulmonary mefantrine report
reliever and cough increases compliance cariprazine irregularities
suppressant that is Absorption pain threshold, and/or apnoea, cobimetinib - Observe for
similar to morphine Onset: 30-60 min alters pain bronchoconstricti dienogest/est withdrawal
and hydrocodone. (PO); 10-30 min reception on, radiol symptoms (N
A small amount of (IM) and inhibits laryngospasm; valerate and V,
ingested codeine is ascending pain nausea, doravirine weakness,
converted to Duration: 4-6 hr pathways vomiting; elbasvir/graz and
morphine in the by binding to bradycardia, oprevir headache)
body. Codeine Peak plasma stereospecific oedema, CNS fostemsavir - Monitor for
increases tolerance time: 0.5-1 hr receptors depression, lonafarnib side effects
to pain,reducing w/in the CNS. confusion, lorlatinib - Avoid
existing discomfort. Distribution dizziness, lumacaftor/iv alcohol
In addition to Protein bound: drowsiness, acaftor consumption
decreasing pain, 25% headache, lumefantrine - Advise not
codeine also causes sedation, lurasidone to drive and
sedation, Vd: 3.5 L/kg (PO); hypotension, naloxegol use
drowsiness, and 2.6 L/kg (IM) peripheral ombitasvir/pa hazardous
respiratory vasodilation, ritaprevir/rito equipment
depression. Metabolism increased navir when
 Prodrug intracranial & dasabuvir experiencing
metabolized to pressure, panobinostat palpitation,
morphine by itching, rash, praziquantel nervousness,
CYP2D6; erythema, regorafenib tremors
demethylated/con papules, roflumilast - Instruct
jugated in pruritus, vandetanib client not to
liver (undergoes exfoliative discontinue
O-demethylation, dermatitis, the drug
N-demethylation, pustules, abruptly
and partial macular rash; - Advise not
conjugation with gum bleeding to eat foods
glucuronic acid) and irritation, with caffeine
taste - Instruct to
Excretion: Urine, perversion, eat nutritious
feces dental caries, food because
tooth drug may
loss, gum line cause
erosion; throat anorexic
irritation, nasal effect
ulcers, epistaxis, - Teach to
rhinorrhoea; report drug
coughing; side effects
urinary such as
retention. tachycardia
and
Potentially Fatal: palpitations
Resp
depression.

ANTICON- Phenobarbita Depresses sensory Absorption A long-acting Bradycardia, artemether/lu -Monitor V/S.
VULSANTS l and motor cortex, Bioavailability: barbiturate. It syncope, mefantrine report
cerebellum 70-90% depresses hypotension; atazanavir irregularities
the sensory anxiety, cabotegravir - Observe for
Antiseizure activity Onset: 5 min (IV) cortex, reduces agitation, ataxia, calcium/mag withdrawal
occurs primarily motor CNS nesium/potas symptoms (N
where GABA Duration: 4-6 hr activity, excitation or sium/s and V,
mediates (IV/IM) changes depression, odium weakness,
neurotransmission cerebellar confusion, oxybate and
Peak plasma function dizziness, cariprazine headache)
Hypnotic effects of time: 8-12 hr and produces drowsiness, cobimetinib -Monitor for
barbiturates result drowsiness, hallucinations, darunavir side effects
from activity at Therapeutic sedation and hangover dienogest/est - Avoid
GABA receptor in plasma hypnosis. Its effect,headache, radiol alcohol
the concentration: anticonvulsant hyperkinesias; valerate consumption
polysynaptic 10-40 mcg/mL; property is constipation, doravirine - Advise not
midbrain reticular may require 3-4 exhibited at nausea, elbasvir/graz to drive and
formation (controls weeks high doses. vomiting; oprevir use
CNS arousal) of treatment to agranulocytosis, elvitegravir/c hazardous
achieve thrombocytopeni obicistat/emtr equipment
Off-label use for therapeutic a, megaloblastic icitabi when
hyperbilirubinemia: levels anaemia; ne/tenofovir experiencing
Phenobarbital oliguria; pain at DF palpitation,
induces glucuronyl Distribution inj site, etravirine nervousness,
transferase and Protein bound: thrombophlebitis fostemsavir tremors
hepatic bilirubin 20-45% (w/ IV use); ledipasvir/sof - Instruct
binding Y-protein to laryngospasm, osbuvir client not to
lower serum Metabolism resp depression, lonafarnib discontinue
bilirubin Metabolized by apnoea (esp w/ lorlatinib the drug
concentrations hepatic oxidative rapid IV use), lumacaftor/iv abruptly
hydroxylation hypoventilation; acaftor - Advise not
gangrene (w/ lumefantrine to eat foods
Metabolites: unintentional lurasidone with
Inactive intra-arterial inj). naloxegol caffeine
Potentially Fatal: ombitasvir/pa - Instruct to
Enzymes Stevens-Johnso ritaprevir/rito eat nutritious
induced: n syndrome, navir food because
CYP1A2, toxic epidermal & dasabuvir drug may
CYP2B6, necrolysis. panobinostat cause
CYP2C19, pirfenidone anorexic
CYP2C9/10, praziquantel effect
CYP3A4 regorafenib - Teach to
rilpivirine report drug
Elimination roflumilast side
Half-life: 50-140 sodium effects such
hr oxybate as
vandetanib tachycardia
Excretion: Urine voriconazole and
(major) palpitations
 ANTI- Chlorpromazi Phenothiazine; Absorption A neuroleptic Tardive disopyramide -Monitor V/S.
PSYCHOTIC ne antagonizes Bioavailability: that acts by dyskinesia (on eliglustat report
S dopamine D2 20%; extensive blocking the long-term ibutilide irregularities
receptors in brain; 1st pass postsynaptic therapy). indapamide - Observe for
depresses release metabolism dopamine Involuntary metrizamide withdrawal
of hypothalamic and receptor in the movements pentamidine symptoms (N
hypophyseal Onset: 30-60 min mesolimbic of extremities pimozide and V,
hormones; may also dopaminergic may also occur. procainamid weakness,
depress reticular Duration: 4-6 hr; system and Dry e and
activating system extended release, inhibits the mouth, quinidine headache)
10-12 hr release of constipation, sotalol - Monitor for
hypothalamic urinary side effects
Distribution and retention, - Avoid
Protein bound: hypophyseal mydriasis, alcohol
92-97% hormones. It agitation, consumption
has antiemetic, insomnia, - Advise not
Vd: 20 L/kg serotonin-block depression and to drive and
ing, and weak convulsions; use
Metabolism antihistaminic postural hazardous
Metabolized by properties and hypotension, equipment
hepatic P450 slight ECG changes. when
enzyme ganglion-blocki Allergic skin experiencing
CYP2D6 ng activity. reaction, palpitation,
amenorrhoea, nervousness,
Metabolites: gynaecomastia, tremors
10-12 different weight gain. - Instruct
compounds Hyperglycaemia client not to
and discontinue
Elimination raised serum the drug
Half-life: 30 hr cholesterol. abruptly
- Advise not
Excretion: Urine Potentially Fatal: to eat foods
Agranulocytosis. with caffeine
Instantaneous - Instruct to
deaths eat nutritious
associated with food because
ventricular drug may
tachyarrhythmia cause
s anorexic
 Marked effect
elevation of body - Teach to
temperature with report drug
heat stroke. side effects
Neuroleptic such as
malignant tachycardia
syndrome, and
extrapyramidal palpitations
dysfunction.

ANTI- Amitriptyline Neurotransmitter Absorption Adibenzocyclo Significant: disopyramide - Monitor V/S.

DEPRESSAN (especially Peak serum time: heptadiene Serotonin dronedarone report
TS norepinephrine and 4 hr tricyclic syndrome ibutilide irregularities
serotonin) antidepressant. e.g. CNS indapamide - Observe for
reuptake inhibitor; Metabolism It inhibits the depression, iobenguane I withdrawal
anticholinergic Metabolized by neuronal bone 123 symptoms (N
hepatic reuptake of fractures, bone isocarboxazi and V,
CYP2C19, serotonin marrow d weakness,
CYP3A4 (5-HT) and/or suppression, pentamidine and
norepinephrine mild pupillary phenelzine headache)
Metabolites: by the dilation, pimozide - Monitor for
Nortriptyline presynaptic orthostatic procainamid side effects
neuronal hypotension, QT e - Avoid
Elimination membrane, interval procarbazine alcohol
Half-life: 9-27 hr hence prolongation. quinidine consumption
increasing the Blood and safinamide - Advise not
Excretion: Urine synaptic lymphatic selegiline to drive and
(18%), small concentration system sotalol use
amounts in the CNS. It disorders: tranylcypromi hazardous
in feces also possesses Agranulocytosis, ne equipment
affinity for leukopenia, when
muscarinic thrombocytopeni experiencing
and histamine a, purpura, palpitation,
(H1) receptors eosinophilia. nervousness,
to varying Cardiac tremors
degrees disorders: MI, - Instruct
heart block, client not to
arrythmias, discontinue
tachycardia, the drug
palpitation. abruptly
Ear and labyrinth - Advise not
disorders: to eat foods
Tinnitus. with
Eye disorders: caffeine
Mydriasis,blurre - Instruct to
d eat nutritious
vision, increased food because
intraocular drug may
pressure, cause
accommodation anorexic
disorder. effect
Gastrointestinal - Teach to
disorders: Dry report drug
mouth, side
constipation, effects such
nausea, as
epigastric tachycardia
distress, and
vomiting, palpitations
anorexia,
stomatitis,
peculiar taste,
diarrhoea,
parotid swelling,
black tongue.
General
disorders and
administration
site conditions:
Fever,
hyperthermia,
ataxia.
Investigations:
Increase or
decrease of
blood sugar,
weight gain or
loss.Metabolism
and nutrition
disorders:
Oedema.
Nervous system
disorders:
Headache,
seizures,
incoordination,
tremors,
peripheral
neuropathy,
numbness,
paraesthesia,
extrapyramidal
symptoms (e.g.
speech
difficulties),
involuntary
movements,
tardive
dyskinesia,
disturbed
concentration,
excitement,
insomnia, stroke,
restlessness,
drowsiness,
agitation,
dysgeusia.
Psychiatric
disorders:
Confusional
states,
hallucinations,
disorientation,
delusions,
nightmares,
dysarthria,
anxiety, delirium,
 hypomania,
mania. Renal
and urinary
disorders:
Urinary
retention,
frequency.
Reproductive
system and
breast disorders:
Testicular
swelling,
gynecomastia,
breast
enlargement,
galactorrhea,
libido decreased,
impotence.
Skin and
subcutaneous
tissue disorders:
Rash, urticaria,
photosensitivity,
alopecia.
Vascular
disorders:
Syncope,
hypertension,
hypotension.

CENTRAL NERVOUS SYSTEM (CNS) STIMULANTS

ANOREXIAN diethylpropio Diethylpropion is a Absorption: TENUATE nausea, iobenguane I -Monitor V/S.

TS n sympathomimetic rapidly absorbed (diethylpropion) vomiting, 123, report
stimulant drug from GI tract after and TENUATE diarrhea, isocarboxazi irregularities
marketed as an oral (diethylpropion) upset stomach, d, - Observe for
appetite administration DOSPAN are constipation, linezolid, withdrawal
suppressant. indicated in the headache, methylphenid symptoms (N
Chemically, it is the Duration: 4 hr management of blurred vision, ate, and V,
N,N-diethyl analog exogenous sleep problems phenelzine, weakness,
of cathinone. Its Metabolism: obesity as a (insomnia), procarbazine and
mechanism of action Undergoes short-term dizziness, safinamide, headache)
is similar to other reduction and adjunct (a few drowsiness, selegiline, - Monitor for
appetite N-dealkylation to weeks) in a tired feeling, transdermal, side effects
suppressants such form active regimen of depressed tranylcypromi - Avoid
as sibutramine, metabolites weight mood, ne alcohol
phentermine and reduction dry mouth, consumption
dextroamphetamine. Elimination based on unpleasant taste - Advise not
Half-life: 4-6 hr caloric in your mouth, to drive and
restriction in decreased sex use
Excretion: patients with an drive, and hazardous
primary urine initial body redness, equipment
(>75%) mass index bruising, or rash when
(BMI) of 30 experiencing
kg/m2 or higher palpitation,
and who have nervousness,
not responded tremors
to appropriate - Instruct
weight client not to
reducing discontinue
regimen (diet the drug
and/or abruptly
exercise) - Advise not
alone. to eat foods
with caffeine
- Instruct to
eat nutritious
food because
drug may
cause
anorexic
effect
- Teach to
report drug
side effects
such as
tachycardia
and
 palpitations

ANALEPTICS Doxapram Produces respiratory Onset: 20-40 sec. Doxapram Significant: benzphetami - Monitor V/S.
stimulation in stimulates Dysrrhythmias, ne report
medulla (which Duration: 5-12 respiration seizure, desfluranede irregularities
propagates min (single IV through action HTN or dexfenfluram - Observe for
stimulation to other injection) on peripheral hypotension, ine withdrawal
parts of brain & carotid dyspnoea. dexmethylph symptoms (N
spinal cord) through Peak Plasma chemoreceptor Nervous: enidate and V,
peripheral Time: 1-2 min s. It also Confusion, dextroamphe weakness,
carotid directly convulsions, tamine and
chemoreceptors Half-life: 3.4 hr stimulates the dizziness, diethylpropio headache)
(2.4-4.1 hr) central hallucinations, n - Monitor for
respiratory headache, dobutamine side effects
center in hyperactivity. dopamine - Avoid
medulla w/ GI: Diarrhoea, ephedrine alcohol
progressive nausea, epinephrine consumption
stimulation of vomiting. etomidate - Advise not
other parts of Resp: fenfluramine to drive and
the brain Bronchospasm, isocarboxazi use
and spinal cord cough, d hazardous
at higher hiccup, isoproterenol equipment
doses. laryngospasm, ketamine when
hyperventilation, linezolid experiencing
rebound lisdexamfeta palpitation,
hypoventilation. mine nervousness,
Genitourinary: methamphet tremors
Urinary amine - Instruct
retention, methylenedio client not to
urinary bladder xymethamph discontinue
stimulation w/ etami the drug
spontaneous ne abruptly
voiding. methylphenid - Advise not
Musculoskeletal: ate to eat foods
Muscle midodrine with
fasciculation or norepinephri caffeine
spasticity. ne - Instruct to
Dermatologic: phendimetra eat nutritious
Flushing, zine food because
 sweating, phenelzine drug may
warm sensation. phentermine cause
Others: Fever. phenylephrin anorexic
e effect
phenylephrin - Teach to
e PO report drug
propofol side
propylhexedr effects such
ine as
pseudoephe tachycardia
drine and
sevoflurane palpitations
tranylcypromi
ne
xylometazoli
ne
yohimbine

PSYCHOMO amphetamin Sympathomimetic Absorption This Loss of appetite amphetamin - Monitor V/S.
TOR e amine that Well absorbed combination Headache e and report
STIMULANTS and promotes release of medication is Insomnia dextroamphe irregularities
dextroamphe dopamine and Onset of action: used to Abdominal pain tamine has - Observe for
ta norepinephrine from 30-60 min treat attention Weight loss no withdrawal
mine their storage deficit Anxiety known symptoms (N
sites in the Duration: 4-6 hr hyperactivity Vomiting severe and V,
presynaptic nerve disorder - Nervousness interactions weakness,
terminals; may also Vd: 3.5-4.6 L/kg ADHD. It works Tachycardia with and
block reuptake of (distributes into by changing Fever other drugs headache)
catecholamines by CNS; mean CSF the amounts of Nausea - Monitor for
competitive concentrations certain natural Infection side effects
inhibition are 80% of substances in Emotional lability - Avoid
Absorption plasma) the brain. Dizziness alcohol
Well absorbed Diarrhea consumption
Onset of action: Peak plasma Fatigue - Advise not
30-60 min time: 3 hr Dry mouth to drive and
Duration: 4-6 hr (Adderall); 7 hr Dyspepsia use
V (Adderall XR) hazardous
equipment
Metabolism when
 Hepatic via experiencing
glucuronidation palpitation,
and CYP450 nervousness,
mono-oxygenase tremors
- Instruct
Elimination client not to
Half-life discontinue
elimination the drug
(children) abruptly
6-12 years: 9 hr - Advise not
(d-amphetamine); to eat foods
11 hr with
(l-amphetamine) caffeine
12-18 years: 11 - Instruct to
hr eat nutritious
(d-amphetamine); food because
13-14 hr drug may
(l-amphetamine) cause
Half-life anorexic
elimination effect
(adults)d-amphet - Teach to
amine: 10 hr report drug
l-amphetamine: side
13 hr effects such
Excretion as
Urine; dependent tachycardia
on urinary pH and
palpitations

METHYLXAN theophylline Theophylline relaxes Absorption Theophylline is Peak serum dipyridamole - Monitor V/S.
THI smooth muscles Onset: Variable indicated for concentration febuxostat report
NES of respiratory tract the treatment <20 mcg/mL riociguat irregularities
STIMULANTS and suppresses Duration: Variable of the Central nervous - Observe for
the response of the symptoms and system withdrawal
airways to stimuli Peak plasma reversible excitement, symptoms (N
May increase tissue time: 1-2 hr airflow headache, and V,
concentration of obstruction insomnia, weakness,
cyclic adenine Peak plasma associated with irritability, and
monophosphate concentration: 10 chronic asthma restlessness, headache)
(cAMP) by inhibiting mcg/mL and other seizure - Monitor for
2 isoenzymes of chronic lung Diarrhea, side effects
phosphodiesterase Distribution diseases, e.g., nausea, vomiting - Avoid
(PDE III and, to a Protein bound: emphysema Diuresis alcohol
lesser extent, PDE 40-55% and chronic (transient) consumption
IV), which bronchitis. Exfoliative - Advise not
ultimately induces Vd: 0.3-0.7 L/kg dermatitis to drive and
release of Skeletal muscle use
epinephrine from the Metabolism tremors hazardous
adrenal medulla Metabolized in Tachycardia, equipment
cells liver by CYP1A2 flutter when
and Hypercalcemia experiencing
CYP3A4 (with palpitation,
concomitant nervousness,
Metabolites: hyperthyroid tremors
1,3-Dimethyluric disease) - Instruct
acid, 1- Difficulty client not to
methyluric acid, urinating (elderly discontinue
3-methylxanthine males the drug
with prostatism) abruptly
Elimination Peak serum - Advise not
Half-life: concentration to eat foods
Nonsmoker, 8 hr; >30 with caffeine
smoker, 4-5 mcg/mL - Instruct to
hr Acute eat nutritious
myocardial food because
Clearance: 1.45 infarction drug may
mL/min/kg Seizures cause
(resistant to anorexic
Excretion: Urine anticonvulsants) effect
Urinary retention - Teach to
report drug
side effects
such as
tachycardia
and
palpitations

CENTRAL NERVOUS SYSTEM (CNS) DISSOCIATIVE ANESTHETICS

DISSOCIATIV Dextrome- Nonnarcotic Absorption Dextromethorp Nausea High risk of Monitor for
E thorphan derivative of han is used to Vomiting excitation, dizziness and
ANESTHETIC (DXM) levorphanol. Onset: 15-30 min temporarily Constipation hypotension, drowsiness,
S Chemically related relieve cough Drowsiness and especially
to morphine but Duration: ≤6 hr caused by the Dizziness hyperpyrexia when
without central common cold, Sedation with MAO concurrent
hypnotic or Time to peak: the flu, or other Confusion INHIBITORS therapy with
analgesic effect or 2-3hr conditions. Nervousness CNS
capacity to cause Dextromethorp depressant is
tolerance or Metabolism han will used.
addiction. Hepatic P450 relieve a cough
Antitussive activity enzyme CYP2D6 but will not
comparable to that treat the
of codeine but is Elimination cause of the
less likely than Half-life: 2-4hr cough or speed
codeine to cause (extensive recovery.
constipation, metabolizers); 24 Dextromethorp
drowsiness, or GI hr (poor han is in a
disturbances. metabolizers) class of
medications
Excretion: Urine called
antitussives. It
works by
decreasing
activity in the
part of the
brain that
causes
coughing.

DISSOCIATIV Phencyclidin Phencyclidine works Metabolism PCP is also euphoria Avoid taking Monitor for
E e primarily as an Oxidative known as a with dizziness and
ANESTHETIC (PCP) NMDA receptor hydroxylation in dissociative sound, image apraclonidine drowsiness,
antagonist, which liver by CYP450 drug. It causes and body ophthalmic, especially
blocks the activity of enzymes, you to feel distortion brexanolone, when
the NMDA Receptor. glucuronidation separated brimonidine concurrent
Metabolites from your body depersonalizatio ophthalmic therapy with
PCHP, PPC, and n or feelings of brimonidine CNS
PCAA surroundings. detachment topical depressant is
 esketamine, used.
Onset of action loss of balance flibanserin,
2–60 min and coordination ioflupane I
123,
Elimination loss of sensation lasmiditan
half-life and inability to
7–46 hours feel pain

Duration of action acute anxiety,

6–48 hour agitation, and
mood swings
Excretion
Urine feelings of
impending doom

numbness in the
arms and legs

CENTRAL NERVOUS SYSTEM (CNS) NARCOTIC ANALGESICS

NARCOTIC Opium May cause Duration: Opium, Adverse buprenorphin Assess for
ANALGESIC increased CNS or Antidiarrhoeal obtained from Reactions e mentioned
S respiratory effect: 3-4 dried latex of Significant: Drug cautions and
depression with hours. unripe Papaver dependence, buprenorphin contraindicati
other narcotic somniferum apnoea, e buccal ons (e.g. drug
analgesics, general Absorption: capsules, hypotension. allergy,
anaesthetics, Variably absorbed contains butorphanol respiratory
sedative/hypnotics, from the morphine, Eye dysfunction,
antihistamines, gastrointestinal codeine, disorders:Miosis. calcium/mag myocardial
phenothiazines, tract. thebaine and Gastrointestinal nesium/potas infarction and
or other CNS other alkaloids disorders: sium/sodium CAD,
depressants. May Distribution: (e.g. Nausea, oxybates hepatorenal
cause decreased Crosses the noscapine, vomiting, dysfunction,
effect or increased placenta and papaverine). constipation, dry cimetidine etc.)
withdrawal enters breast The mouth. to prevent
symptoms with other milk. pharmacologic General clonidine untoward
morphine effect disorders and complications
agonists/antagonist Metabolism: of opium is administration desvenlafaxi
(e.g. buprenorphine, Morphine is mainly due to site conditions: ne Conduct pain
nalbuphine, metabolised in the morphine Asthenia. assessment
pentazocine). the liver via content. As an Immune system eluxadoline with patient to
Decreased effect glucuronidation at antidiarrhoeal, disorders: establish
with CYP3A4 the 3-hydroxyl morphine Urticaria. fentanyl baseline and
inducer (e.g. group; further increases Metabolism and evaluate
rifampicin). metabolised gastrointestinal nutrition fentanyl effectiveness
Increased toxicity of via glucuronida- muscle tone disorders: intranasal of drug
squill with tion at the and Anorexia. therapy.
concomitant 6-hydroxyl group decreases Nervous system fentanyl
diuretics. into morphine- peristalsis, disorders: transdermal Perform
3,6-diglucuronide. thereby Lightheadednes thorough
Potentially Fatal: decreasing s fentanyl physical
May cause serotonin Excretion: Via gastrointestinal dizziness, transmucosal (CNS, vital
syndrome if used urine (approx propulsion. drowsiness, signs, bowel
with MAOIs 75%; mainly as Morphine is sedation. isocarboxazi sounds, urine
morphine-3-glucu used in Psychiatric d output) to
ronide,morphine- combination disorders:Confus establish
3,6-diglucuronide with belladonna ion, euphoria, linezolid baseline
and unchanged in dysphoria. metocloprami status before
drug). suppositories Renal and de intranasal beginning
for its analgesic urinary therapy,
effect. It disorders:Urinar nalbuphine determine
is also used in y retention. drug
combination Respiratory, pentazocine effectiveness
with squill in thoracic and and evaluate
cough mediastinal phenelzine for any
preparations as disorders: potential
it directly Bronchospasms. procarbazine adverse
depresses the Skin and effects.
cough reflex. subcutaneous selegiline
tissue disorders: Monitor
Pruritus.Vascular selegiline laboratory
disorders: transdermal results (liver
Flushing. function,
sodium kidney
Potentially oxybate function) to
Fatal:Severe determine
respiratory tramadol need
depression; for possible
 increased tranylcypromi dose
intracranial ne adjustment
pressure. and
venlafaxine identify toxic
drug
effects.

NARCOTIC Morphine As morphine sulfate: Onset: 2-4 Morphine is Drowsiness, Some Monitor blood
ANALGESIC Dosage is minutes for IV used for the mental clouding, products that pressure prior
S individualised based boluses management of anxiety may interact to
on the severity of chronic, reduction, with this drug administration
pain, patient Peak: 20 minutes moderate to euphoria, are: certain . Hold if
response and prior for IV boluses severe pain. disorientation pain systolic BP <
analgesic medications 100 mm Hg
experience. Initially, Half-Life: 2-3 Opiods, Orthostatic (mixed opioid or 30 mm Hg
5 mg epidural inj, if hours including hypotension agonist/anta below
desired pain relief is morphine, are gonists such baseline.
not achieved within Metabolism: effective for the Respiratory as
1 hour, incremental primarily short term depression pentazocine, Monitor
doses of 1-2 mg metabolized by management of nalbuphine, patient's
may be given up to the liver pain. Patients Constipation butorphanol), respiratory
10mg/24 hour. taking opioids naltrexone. rate prior to
long term may Urinary retention administration
need to be (sphincter .
monitored for constriction) Reassess
the pain after
development of Cough administration
physical suppression of morphine.
dependence,
addiction Biliary colic Monitor for
disorder, and (constriction of respiratory
drug abuse. the Sphincter of depression
Oddi) and
hypotension
Nausea, emesis frequently up
to 24 hours
Miosis after
(constricted administration
pupils) of morphine.
 Place call
light signal
close to
patient.

Accompany
patient if need
to get out of
bed to
minimize risk
of falls.

CENTRAL NERVOUS SYSTEM (CNS) INHALANTS

INHALANTS Atrovent Ipratropium bromide The half-life of Bronchodilator Headache, Not -If
is an anticholinergic elimination is for throat irritation, recommende administered
(parasympatholytic) about 2 maintenance cough, d for chronic by nebulisers
agent which, based hours after treatment of dry mouth, GI co-administra use a
on animal studies, inhalation or bronchospasm motility disorders tion w/ other mouthpiece
appears to inhibit intravenous associated (including anticholinergi rather than
vagally-mediated administration. w/ COPD constipation, cs. face mask.
reflexes by Ipratropium including diarrhoea Bronchodilat
antagonizing the bromide chronic & vomiting), ory effect - If
action of is minimally bronchitis & nausea & may be administered
acetylcholine, the bound (0% to 9% emphysema. dizziness. intensified by by nebuliser
transmitter agent in vitro) Acute β-adrenergic the dilution of
released at the to plasma bronchospasm s & xanthine the solution
neuromuscular albumin and associated w/ prep. should be
junctions in the lung. α1-acid COPD Precipitation adjusted
glycoprotein. It is including may occur in according to
partially bronchitis & concurrent equipment
metabolized to asthma, in administratio and length of
inactive ester combination w/ n w/ diNa administration
hydrolysis inhaled cromoglycate
products. β-agonists. nebuliser - Paradoxical
Following soln. May bronchospas
intravenous increase risk m has
administration, of acute occurred with
 approximately glaucoma in nebulised
one-half of the patients w/ solution,
dose is narrow angle therefore first
excreted glaucoma dose should
unchanged in the history be used
urine under medical
supervision.
Metabolism
occurs by ester - Caution
hydrolysis to should be
inactive taken not to
metabolites. confuse
Atrovent with
Approximately Alupent.
50% of the
absorbed drug is - Evaluate
excreted therapeutic
unchanged in the response.
urine.

INHALANTS Clenbuterol Clenbuterol is a Absorption Used as a Fine tremor of Increased Assess for
substituted 89-98% orally bronchodilator skeletal muscle, risk of mentioned
phenylaminoethanol in the treatment palpitations, cardiac cautions and
that has beta-2 Half-life of asthma tachycardia, arrhythmias contraindicati
adrenomimetic 36-39 hours patients. nervous when used ons (e.g. drug
properties at very tension, with allergy,
low doses. It is used headaches, potassium-d respiratory
as a bronchodilator peripheral epleting dysfunction,
in asthma. Although vasodilatation, drugs e.g. myocardial
approved for use in muscle cramps thiazide or infarction and
some countries, as (rare), loop CAD,
of fall, 2006, hypokalaemia diuretics, hepatorenal
clenbuterol is not an (large doses), amphotericin dysfunction,
ingredient of any hypersensitivity B, etc.) to
therapeutic drug reactions. corticosteroid prevent
approved by the s. Increased untoward
U.S. Food and Drug risk of complications
Administration.C hypokalaemi
a and Conduct pain
tachycardia assessment
when used with patient to
with high- establish
dose baseline and
theophylline. evaluate
effectiveness
of drug
therapy.

Perform
thorough
physical
(CNS, vital
signs, bowel
sounds, urine
output) to
establish
baseline
status before
beginning
therapy,
determine
drug
effectiveness
and evaluate
for any
potential
adverse
effects.

Monitor
laboratory
results (liver
function,
kidney
function) to
determine
need for
possible dose
 adjustment
and identify
toxic drug
effects.

CENTRAL NERVOUS SYSTEM (CNS) CANNABIS

CANNABIS Marijuana Cannabis is an The pharmaco- Pregnancy: When taken by Major 1 The nurse
herbal drug that is kinetics of THC Cannabis is mouth: Cannabis Interaction shall have a
made from the vary as a function UNSAFE when is POSSIBLY Do not take working
Cannabis plant. It of its route of taken by mouth UNSAFE when this knowledge of
contains chemicals administration. or smoked taken by mouth combination the current
called cannabinoids. Pulmonary duringpregnanc in large amounts Sedative state of
Cannabinoids affect assimilation of y. Cannabis or for a long medications legalization
the central inhaled THC passes through time. Cannabis (Barbiturates of medical
nervous system, causes a the placenta containing large ) interacts and
which includes maximum plasma and can slow amounts of THC with recreational
the brain and concentration the growth (50 mg or more) CANNABIS cannabis use.
nerves. within minutes, of the fetus and has been linked Marijuana
Cannabinoids are psychotropic increase the with anxiety, might cause 2 The nurse
found in the highest effects start within risk for psychosis, heart sleepiness shall have a
levels in the leaves seconds to a few premature attack, and and working
and flowers of minutes, reach a birth. Cannabis irregular heart drowsiness. knowledge of
cannabis. These are maximum after use during rhythm.Regularly Medications the
the parts of the herb 15-30 minutes, pregnancy is taking large that cause jurisdiction’s
that are used to and taper off also associated amounts of Sleepiness is medical
make medicine within 2-3 hours. with stillbirth, cannabis over a called marijuana
Following childhood long period of sedatives. program.
oral ingestion, leukemia, time might Taking
psychotropic abnormalities cause a disorder marijuana 3 The nurse
effects set in with in the fetus, called along with shall have an
a delay of 30-90 and the need cannabinoid sedative understandin
minutes, reach for intensive hyperemesis medications g of the
their maximum care after birth. syndrome, or might cause endocannabin
after 2-3 hours Cannabis use CHS. CHS too much oid system,
and last for about during leads to severe, sleepiness. cannabinoid
4-12 hours, pregnancy has repeated bouts Sedative receptors,
depending on also been of nausea and medications cannabinoids,
dose and specific linked with vomiting that (CNS and the
effect. At doses lower don't respond to depressants) interactions
exceeding the intelligence and typical interacts with between
psychotropic increased anti-nausea CANNABIS them.
threshold, emotional medicine. In a Marijuana
ingestion of problems in few reports, might cause 4 The nurse
cannabis children when CHS has been sleepiness shall have an
usually causes they grow up. linked to severe and understandin
enhanced Also, cannabis complications drowsiness. g of cannabis
well-being and use is that caused Medications pharmacology
relaxation with an associated with death. that cause and the
intensification an increased sleepiness research
of ordinary risk for anemia Using cannabis are called associated
sensory and high blood for at least 1-2 sedatives. with the
experiences. pressure in the weeks can also Taking medical use
mother. lead to marijuana of cannabis.
dependence. along with
Breast-feeding: People with sedative 5 The nurse
Using cannabis medications shall be able
cannabis, dependence might cause to identify the
either by mouth might too much safety
or by inhalation experience sleepiness. consideration
is LIKELY withdrawal after Some s for patient
UNSAFE stopping sedative use of
during breast- cannabis use. medications cannabis.
feeding. The Symptoms of include
chemicals in withdrawal clonazepam 6 The nurse
cannabis pass include (Klonopin), shall
into breast nervousness, lorazepam approach
milk. Too much shaking, trouble (Ativan), the patient
of these sleeping, phenobarbita without
chemicals decreased l (Donnatal), judgment
might slow appetite, zolpidem regarding the
down the sweating, (Ambien), patient’s
development of headache, and and others. choice
the baby. depressed Theophylline of treatment
mood. There interacts with or
Bipolar isn't enough CANNABIS preferences
disorder: Using information to Taking in managing
cannabis might know if marijuana pain and
make manic cannabis is safe might other
symptoms to use in decrease the distressing
worse in moderation for effects of symptoms.
people short periods of theophylline.
with bipolar time. But there
disorder. isn't enough
When sprayed information
Heart disease: into the mouth: A to know if
Cannabis might specific this is a big
cause fast cannabis extract concern.
heartbeat and spray Moderate
high blood (Sativex, GW InteractionBe
pressure. It Pharmaceuticals cautious
might also ) is POSSIBLY with this
increase the SAFE when combination
risk of a having applied under
a heart attack. the tongue. Side Disulfiram
However, in effects may (Antabuse)
many cases, include interacts
people who headache, with
experienced dizziness, CANNABIS
these events drowsiness, dry Disulfiram
after smoking mouth, nausea, (Antabuse)
cannabis had and paranoid might
other risk thinking. This interact with
factors for cannabis marijuana.
heart-related extract spray is Taking
events such as available as a marijuana
smoking prescription-only along with
cigarettes or product in the Disulfiram
being U.K. and can cause
overweight. Canada. It has agitation,
not been trouble
A weakened approved as a sleeping, and
immune prescription irritability.
system: Certain product in the Fluoxetine
chemicals in U.S. (Prozac)
cannabis can interacts
weaken the When inhaled: with
immune Cannabis CANNABIS
system. This is POSSIBLY Taking
might make it UNSAFE when marijuana
more difficult inhaled. with
for the body to Smoking or fluoxetine
fight infections. vaping cannabis (Prozac)
can cause might
Allergies to various cause you to
fruits and breathing feel irritated,
vegetables: problems nervous,
Cannabis might such as jittery, and
increase the wheezing and excited.
risk of an coughing. Doctors call
allergic Some reports this
reaction in suggest that hypomania.
people with smoking Minor
allergies to cannabis might Interaction
foods like cause air-filled Be watchful
tomatoes, cavities in the with this
bananas, and lungs. These combination.
citrus fruit. air-filled cavities
can cause Warfarin
Depression: symptoms such (Coumadin)
Cannabis use, as chest interacts
especially pressure, with
frequent use, soreness, and CANNABIS
might increase difficulty Using
the chance of breathing. Use marijuana
getting of e-cigarettes might
depression. It and other vaping increase the
can also products effects of
worsen containing THC warfarin
symptoms of has been linked (Coumadin).
depression and to serious lung Smoking
increase injury in some marijuana
thoughts about people. Smoking while taking
suicide in those cannabis can warfarin
that already also cause (Coumadin)
have headache, might
depression. dizziness, increase the
drowsiness, dry chance of
Diabetes: mouth, nausea, bruising and
Cannabis use and paranoid bleeding.
might make it thinking.
harder to Smoking
control blood cannabis might
sugar levels. It also increase
might also appetite,
increase the increase heart
risk for rate, change
long-term blood pressure,
complications and impair
from diabetes. mental
Until more is functioning.
known, be Some reports
cautious using suggest that
cannabis smoking
cannabis may
Liver disease: also increase the
It is unclear if risk of heart
cannabis problems such
worsens as heart attack
chronic liver and abnormal
disease. While heart rhythm.
some weak Regularly
evidence smoking large
suggests that amounts of
there might be cannabis
a link, other for a long time
evidence may cause CHS.
has not found a It might also lead
link. Until more to dependence.
is known, be People with
cautious using cannabis
cannabis. dependence
Multiple might
sclerosis: experience
Taking withdrawal after
cannabis by stopping
mouth might cannabis use.
make Symptoms of
symptoms of withdrawal
multiple include
sclerosis nervousness,
worse. shaking, trouble
sleeping,
Lung diseases: decreased
Cannabis can appetite,
make lung sweating,
problems are headache, and
worse. Regular depressed
use over a mood.
period of years
might increase
the risk of lung
cancer. Some
people develop
a type of lung
disease called
emphysema.

Schizophrenia:
Using cannabis
might make
symptoms of
schizophrenia
worse.

Quitting
smoking: Using
cannabis might
make it harder
to quit
smoking. Early
research
suggests that
people who
use cannabis
and want to
quit smoking
cigarettes are
less likely to
quit smoking
after 6 months
than people
who don't
use cannabis.

Stroke: Using
cannabis after
having a stroke
might increase
the risk of
having a
second stroke.

Surgery:
Cannabis
affects the
central nervous
system or the
brain and
nerves.It might
slow the central
nervous
system too
much when
combined with
anesthesia and
other
medications
during and
after surgery.
Stop using
cannabis at
least 2 weeks
 before a
scheduled
surgery.

CANNABIS Cannabidiol The CB1 receptor is Absorption: Seizures CNS: SUICIDAL Drug-Drug Assess
present at a high Extent of associated with THOUGHTS/BE Concurrent location,
density on the absorption Lennox HAVIORS, use of duration, and
presynaptic level of unknown. High Gastaut drowsiness, valproic acid characteristic
the neuronal fat/high calorie syndrome or fatigue,insomnia, or clobazam s of seizure
synapses, where its meals increase Dravet aggressive ↑ risk of activity.
stimulation activates the extent of syndrome. behavior, hepatotoxicit Institute
potassium absorption. agitation y. seizure
channels and on the precautions.
contrary, inhibits Distribution: Derm: rash Moderate or
calcium-dependent Extensively strong Monitor
channels, what distributed EENT: dry mouth CYP2C9 or closely for
results in inhibition to tissues. CYP3A4 notable
of the neuro- GI: inhibitors changes in
transmitter release. Protein Binding: HEPATOTOXICI may ↑ levels behavior that
Concerning this >94%. TY, ↓ and risk of could indicate
mechanism of action appetite, toxicity; the emer-
mentioned, Metabolism and diarrhea, ↑ liver consider ↓ gence or
endocannabinoids Excretion: enzymes, cannabidiol worsening of
are also called as Primarily abdominal pain, dose. suicidal
the “Retrograde metabolized in ↓weight thoughts or
Synaptic the liver by the Strong behavior or
Messengers” CYP2C9 and GU: ↑ serum CYP2C9 or depression.
CYP3A4 creatinine CYP3A4
isoenzymes to an inducers may Monitor for
active metabolite Hemat: anemia ↓ levels and signs and
(7-OH-CBD). effectiveness symptom of
Primarily excreted Neuro: ataxia ; consider ↑ hepatotoxicity
in feces. cannabidiol (unexplained
Misc: dose. nausea,
Half-life: 56–61 hr hypersensitivity vomiting, right
reactions May ↑ levels upper
Peak: 2.5-5 hr (angioedema, and risk of quadrant
pruritus), toxicity of abdominal
infection, CYP2C8, pain, fatigue,
physical CYP2C9, anorexia,
dependence, or CYP2C19 jaundice
psychological substrates ; and/or dark
dependence consider ↓ urine). If signs
(high doses or dose of and
prolonged CYP2C8, symptoms
therapy) CYP2C9, or occur,
* CAPITALS CYP2C19 promptly
indicate life substrate. measure
threatening. serum
Underline May ↑ or ↓ transaminase
indicates most levels of s and total
frequent. CYP1A2 or bilirubin and
CYP2B6 interrupt or
substrates ; discontinue
consider ↓ treatment
dose of with
CYP1A2 or cannabidiol.
CYP2B6
substrate. Monitor for
signs and
Additive CNS symptoms of
depression hypersensitivi
with alcohol, ty reactions
antihistamine (pruritus,
barbiturates, erythema,
benzodiazepi and
nes, muscle angioedema)
relaxants, during
opioid therapy.
analgesics, Discontinue
tricyclic cannabidiol if
antidepressa symptoms
nts, and occur.
sedative/hyp
notics. Lab Test
Consideration
s:
Obtain serum
transaminase
s
(ALT, AST)
and total
bilirubin
levels before
starting
therapy.
Elevations
usually
respond to
decreased
dose or
discontinuatio
n of therapy.
Monitor levels
at 1, 3, and 6
mo after
starting
therapy,
within 1 mo
following
dose
changes, and
as needed
thereafter.
Discontinue
cannabidiol if
transaminase
levels >3
times upper
limit of
normal (ULN)
and bilirubin
levels >2
times ULN.
Also
 discontinue
therapy if
transaminase
persistently
>5 times
ULN.

CENTRAL NERVOUS SYSTEM (CNS) HALLUCINOGENS

Diphenhydra Histamine Absorption Diphenhydrami Frequency Not Aspirin Low Assessment

mine H1-receptor Bioavailability: ne is an Defined Strength History:
antagonist of PO, 42-62% antihistamine (aspirin) Allergy to any
effector cells in (drug is used to relieve Sedation, CoQ10 antihistamine
respiratory tract, well absorbed but symptoms of Confusion, (ubiquinone) s, narrow-
blood vessels, and undergoes first- allergy, hay Anticholinergic Cymbalta angle
GI smooth muscle pass metabolism) fever, and the effects, (duloxetine) glaucoma,
common cold. May decrease Fish Oil stenosing
Moderate to high Onset: 15-30 min These cognitive (omega-3 peptic ulcer,
anticholinergic and symptoms function in polyunsatura symptomatic
antiemetic Duration: ≤12 hr include rash, geriatric ted fatty prostatic
properties (histamine- itching, watery patients, acids) hypertrophy,
induced flare eyes, itchy Xerostomia, Flonase asthmatic
suppression); ≤10 eyes/nose/thro Dry nasal (fluticasone attack,
hr (histamine- at, cough, mucosa, nasal) bladder neck
induced wheal runny nose, Pharyngeal Lexapro obstruction,
suppression) and sneezing. dryness, (escitalopram pyloroduoden
It is also used Thick bronchial ) Lyrica al obstruction,
Peak serum time: to prevent and sputum, (pregabalin) third trimester
2 hr (PO) treat nausea, Agranulocytosis, Metoprolol of pregnancy,
vomiting Hemolytic Succinate lactation
Distribution and dizziness anemia,Throm- ER Physical: Skin
Protein bound: caused by bocytopenia, (metoprolol) color, lesions,
98.5% motion MiraLAX texture;
sickness. (polyethylene orientation,
Vd: 22 L/kg glycol 3350) reflexes,
(Children); 17 Norco affect; vision
L/kg (adults); 14 (acetaminop examination;
L/kg (elderly) hen / P, BP; R,
hydrocodone adventitious
 Metabolism ) sounds;
Metabolized by ProAir HFA bowel
liver (first-pass) (albuterol) sounds;
Singulair prostate
Elimination (montelukast palpation;
Half-life: 5 hr ) CBC with
(children); 9 hr Synthroid differential
(adults); 13.5 hr (levothyroxin
(elderly) e) Interventions
Tylenol Administer
Excretion: Urine (acetaminop with food if GI
(50-75%), mainly hen) upset occurs.
as Vitamin B12 Administer
metabolites (cyanocobala syrup form if
min) patient is
Vitamin C unable to take
(ascorbic tablets.
acid) Monitor
Vitamin D3 patient
(cholecalcifer response,
ol) and arrange
Xanax for
(alprazolam) adjustment
Zoloft of dosage to
(sertraline) lowest
Zyrtec possible
(cetirizine) effective
dose.

DISSOCIATIV ketamine Produces Absorption Anesthesia- Emergence rxns, ketamine has Monitor
ES dissociative induction and HTN, no known patient
anesthesia Onset: 30 sec maintenance Increased severe response to
Blocks NMDA (IV); 3-4 min (IM) cardiac output, interactions therapy
receptor Analgesic for Increased ICP, with other (analgesia,
Overdose may lead Duration: 5-10 procedure Tachycardia, drugs. loss of
to panic attacks min (IV); 12-25 Tonic-clonic consciousnes
and aggressive min (IM): movements, s).
behavior; rarely dissociative state Visual
seizures, increased may last >20 min hallucinations, Monitor for
 ICP, and cardiac Vivid dreams, adverse
arrest Peak plasma Bradycardia, effects
Very similar in concentration: Diplopia, (e.g.
chemical makeup to 0.75 mcg/mL Hypotension, respiratory
PCP Increased IOP, depression,
(phencyclidine), but Metabolism Injection-site hypotension,
it is shorter Liver pain, bronchospas
acting and less toxic Nystagmus, m, skin
Elimination Anaphylaxis, breakdown,
Excretion: Urine Cardiac etc).
(91%), feces (3%) arrhythmia,
Depressed Evaluate
T cough reflex, patient
Fasciculations, understandin
Hypersalivation, g on drug
Increased therapy by
metabolic rate, asking patient
Hypertonia, to name the
Laryngospasm. drug, its
indication,
Respiratory and adverse
depression or effects to
apnea with large watch
doses or rapid for.
infusions
Monitor
patient
compliance
to drug
therapy.

References:
● MIMS
● Medscape by WebMD LLC.
● Robholland.com / Nursing Drug Guide
● An article from IACP website entitled: 7 Drug Category/Classification of CNS