DRUG STUDIES

NAME OF DRUG MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

ACTION
GENERIC NAME: Enhances action of - Treatment of ADHD CNS: hyperactivity, Before:
Dextroamphetamine dopamine, norepinephrine in hyperactive insomnia, restlessness, 1. Assess child’s attention span,
by blocking reuptake from children. dizziness, headache, impulse control, interaction
BRAND NAME: synapses. Inhibits - Treatment of irritability, talkativeness, with others.
Dexedrine monoamine oxidase, narcolepsy mild euphoria 2. Obtain patient’s health history
facilitates release of 3. Establish rapport with the
CLASSIFICATION: catecholamines CV: palpitations, patient
PHARMACOTHERAPEUTIC: tachycardia, chest pain 4. Monitor patient for new or
Amphetamine Therapeutic Effect: worsening aggressive behavior.
Increases motor activity, GI: nausea, vomiting,
(Schedule II). 5. Explain to the significant other
mental alertness; constipation, diarrhea,
CLINICAL: the dosage, route, timing,
decreases drowsiness, abdominal cramps, dry
CNS stimulant. indication, contraindications,
fatigue; suppresses mouth, decreased
DOSAGE: side effects and adverse effects
appetite. appetite
5mg of the drug.
During:
Skin: urticaria
ROUTE: 6. Instruct patient/SO to swallow
PO Other: metallic taste sustained release capsules
whole with liquid without
FREQUENCY: chewing or crushing.
OD 7. Monitor for CNS
overstimulation, increase in
TIMING: B/P, growth rate, change in
8:00 am

28
DRUG STUDIES

pulse rate, respirations, weight

loss.
8. Observe for improved attention
span.
9. Advise SO to take drug early in
day to avoid insomnia.
After:
10. Instruct SO to immediately
CONTRAINDICATION ADVERSE EFFECTS
notify prescriber if chest pain,
Advanced arteriosclerosis, CNS: tremor,
irregular pulse, or worsening
agitated mental states, depression, dizziness,
aggressive behavior occurs.
glaucoma, history of drug lethargy
11. Instruct patient and SO to avoid
abuse, hypersensitivity to CV: hypertension,
driving and other hazardous
sympathomimetic amines, hypotension, arrhythmias
activities until he knows how
hyperthyroidism, moderate GI: abdominal cramps, GI
drug affects him.
to severe hypertension, distress
12. Caution SO not to stop therapy
symptomatic cardiovascular GU: erectile dysfunction,
abruptly but to taper dosage
disease, use of MAOIs increased libido
gradually.
within 14 days. Skin: Pallor/flushing
13. As appropriate, review all other
Other:
significant and life-threatening
physical or psychological
adverse reactions and
drug dependence
interactions of drugs and
therapy.

29
DRUG STUDIES

NAME OF DRUG MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

ACTION
GENERIC NAME: Binds to dopamine - Treatment of CNS: headache, dizziness, Before:
Modafinil reuptake carrier sites, excessive daytime nervousness, fever, chills 1. Obtain baseline evidence of
increasing alpha activity, sleepiness CV: chest pain, sleep disorders, including
BRAND NAME: decreasing delta, theta, associated with palpitations pattern, environmental
Provigil beta brain wave activity narcolepsy, shift EENT: abnormal vision situations, length of sleep
work sleep disorder, GI: nausea, vomiting, episodes.
CLASSIFICATION: adjunct therapy for diarrhea, dry 2. Question for sudden loss of
PHARMACOTHERAPEUTIC: obstructive sleep mouth muscle tone (cataplexy)
Therapeutic Effect:
Alpha1-agonist, apnea/hypopnea GU: abnormal urine, precipitated by strong
Reduces number of sleep
CNS stimulant (Schedule syndrome. urinary retention, emotional responses before
episodes, total daytime
IV). - Treatment of ADHD, Musculoskeletal: neck sleep episode.
sleep.
multiple sclerosis– pain and rigidity 3. Assess frequency/severity of
CLINICAL: Wakefulness- related fatigue. Respiratory: dyspnea sleep episodes before drug
promoting Skin: dry skin therapy.
agent, antinarcoleptic. 4. Explain to the significant other
the dosage, route, timing,
DOSAGE: indication, contraindications,
100mg side effects and adverse
effects of the drug.

30
DRUG STUDIES

ROUTE:
PO

During:
FREQUENCY: 5. Monitor respiratory and
OD cardiovascular status, including
vital signs and ECG.
TIMING: 6. Monitor neurologic status,
CONTRAINDICATION ADVERSE EFFECTS
8:00 AM including mood, motor
Hypersensitivity to milk CNS: insomnia,
function, cognition, and
proteins. Status depression, anxiety,
emotional lability.
asthmaticus or acute amnesia, tremor,
7. Monitor sleep pattern, evidence
bronchospasm (inhalation). emotional lability
of restlessness during sleep,
CV: hypertension,
length of insomnia episodes at
Cautions: Adrenal vasodilation, hypotension,
night.
insufficiency, glaucoma, syncope, arrhythmias
8. Assess for dizziness, anxiety;
untreated infection, EENT: amblyopia,
initiate fall precautions.
tuberculosis, ocular herpes epistaxis, rhinitis,
9. Provide sugarless gum, sips of
simplex, Candida albicans pharyngitis
tepid water may relieve dry
infection of mouth/pharynx. GI: anorexia
mouth.
GU: albuminuria,
After:
abnormal ejaculation
10. Instruct SO to avoid tasks that
Hematologic:
require alertness, motor skills
eosinophilia
until response to drug is
Metabolic:
established.
hyperglycemia

31
DRUG STUDIES

Musculoskeletal: joint 11. Instruct SO not to increase

disorders dose without physician
Respiratory: lung approval.
disorder, asthma 12. Tell patient/SO that he may
Other: herpes simplex take with or without food, but
infection that food may delay drug
absorption up to 1 hour.
13. Advise patient and SO to
immediately report chest pain,
irregular heartbeats, light-
headedness, or fainting.

32
DRUG STUDIES

NAME OF DRUG MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

ACTION
GENERIC NAME: Blocks reuptake of Adjunct in treatment of CNS: nervousness, Before:
Dexmethylphenidate norepinephrine, dopamine ADHD with moderate insomnia, dizziness,
into presynaptic neurons, to severe distractibility, drowsiness, headache, 1. Obtain patient’s full health
BRAND NAME: increasing release of short attention spans, fever history
Focalin these neurotransmitters hyperactivity, emotional 2. Explain the dosage, route,
into synaptic cleft. impulsivity in children 6 yrs. CV: increased or timing, indication,
CLASSIFICATION: and older. Focalin XR decreased heart rate and contraindication, side effects
PHARMACOTHERAPEUTIC: extended-release capsule blood pressure, and adverse effects of the
Cerebral cortex stimulator approved for 30- min onset tachycardia, palpitations drug.
Therapeutic Effect:
(Schedule II). of action for treatment of 3. Assess patient’s level of
Decreases motor EENT: blurred vision
ADHD. functioning.
restlessness, fatigue;
CLINICAL: CNS stimulant. 4. Evaluate patient for cardiac
increases motor activity, GI: nausea, abdominal
disease, psychiatric conditions.
mental alertness, pain, decreased appetite,
DOSAGE:
attention span; elevates weight loss
5mg During:
mood
Skin: rash
ROUTE: 5. Monitor blood pressure closely
PO 6. Evaluate cardiac status. Report
palpitations and other signs
FREQUENCY: and symptoms of arrhythmias.
OD 7. CBC, differential, platelet
TIMING: count, B/P, heartrate should be
8:00 AM

33
DRUG STUDIES

performed routinely during

therapy.
8. If paradoxical return of ADHD
occurs, dosage should be
reduced or discontinued.
9. Weigh pediatric patient
regularly to detect delayed
growth.
CONTRAINDICATION ADVERSE EFFECTS
Diagnosis or family history CNS: dyskinesia,
After:
of Tourette’s syndrome; chorea, Tourette
glaucoma; history of syndrome, toxic psychosis
10. Advise patient or parents that
marked agitation, anxiety, CV: angina, arrhythmias
drug should be taken at same
tension; motor tics; use of EENT: visual
time each day.
MAOIs within 14 days. accommodation problems
11. Instruct patient not to crush or
Hematologic: anemia,
chew capsule. If patient is
Cautions: Cardiovascular leukopenia,
unable to swallow capsules
disease (heart failure, thrombocytopenia
whole, advise him to open
recent MI), seizure disorder, Hepatic: hepatic
capsules, sprinkle contents
psychosis, emotional dysfunction, hepatic
over spoonful of applesauce,
instability, acute stress coma
and take immediately.
reactions, hyperthyroidism. Skin: alopecia
12. Tell patient or parents that
Avoid use in those with Other: psychological drug
drug usually is discontinued if
history of substance abuse. dependence,
symptoms don’t improve within
drug tolerance, growth
1 month.
suppression in

34
DRUG STUDIES

children (with long-term 13. Instruct parents to monitor

use) child’s height and weight,
because CNS stimulants have
been associated with growth
suppression.
14. Instruct patient or SO to avoid
tasks that require alertness,
motor skills until response to
drug is established.
15. Advise SO to report any
increase in seizures, chest
pain, unexplained syncope.
16. Instruct SO that last dose
should be given several hours
before bedtime to prevent
insomnia
17. Advise to report anxiety or
fever.

35
DRUG STUDIES

NAME OF DRUG MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

ACTION
GENERIC NAME: Blocks reuptake of - Treatment of CNS: fatigue, confusion, Before:
Imipramine neurotransmitters depression, often in drowsiness, dizziness, 1. Assess appearance, behavior,
(norepinephrine, conjunction with fever, chills speech pattern, level of
BRAND NAME: serotonin) at presynaptic psychotherapy. interest, mood.
Tofranil membranes, increasing - Treatment of CV: palpitations, 2. Obtain baseline CBC,
their concentration at nocturnal enuresis in tachycardia hepatic/renal function tests.
CLASSIFICATION: postsynaptic receptor children older than 6 3. Obtain patient’s full health
EENT: blurred vision
PHARMACOTHERAPEUTIC: sites. yrs. history
Tricyclic antidepressant. - Treatment of ADHD, 4. Explain the dosage, route,
GI: diarrhea, dry mouth,
CLINICAL: Antidepressant Therapeutic Effect: post-traumatic timing, indication,
increased appetite, weight
Relieves depression, stress disorder, contraindication, side effects
gain or loss
DOSAGE: controls nocturnal neurogenic pain, and adverse effects of the
10mg enuresis. panic disorder. drug.
GU: urinary retention

ROUTE: Skin: flushing, During:

PO diaphoresis,
photosensitivity, rash 5. Supervise suicidal-risk patient
FREQUENCY: closely during early therapy (as
OD depression lessens, energy
level improves, increasing
TIMING: suicide potential).
8:00 AM

36
DRUG STUDIES

6. Monitor appearance, behavior,

speech pattern, level of
interest, mood.
7. Monitor daily pattern of bowel
activity, stool consistency.
8. Monitor B/P, pulse for
hypotension, arrhythmias.
9. Assess for urinary retention by
CONTRAINDICATION ADVERSE EFFECTS
bladder palpation.
Hypersensitivity to drug or CNS: sedation, agitation,
10. Assess for signs and symptoms
bisulfites; Untreated angle- hallucinations, syncope,
of infection. Monitor CBC with
closure glaucoma; MAO extrapyramidal effects,
white cell differential.
inhibitor use within past 14 poor concentration,
After:
days; Acute recovery period cerebrovascular
11. Teach patient or caregiver to
after MI, pregnancy. accident, seizures, suicidal
recognize and immediately
behavior or ideation
report signs of suicidal intent or
Cautions: (especially in
expressions of suicidal ideation
child or adolescent)
Prostatic hypertrophy; (especially in child or
CV: hypotension, ECG
history of urinary retention, adolescent).
changes, hypertension,
obstruction; glaucoma; 12. Instruct patient or caregiver to
vasculitis, arrhythmias,
diabetes mellitus; history of eat small, frequent meals to
myocardial infarction,
seizures; hyperthyroidism; minimize GI upset.
heart block
cardiac, hepatic, renal 13. Tell patient and SO to
EENT: increased
disease; schizophrenia; immediately report seizure,
intraocular pressure
increased intraocular chest pain, abdominal pain or
(IOP), lacrimation,

37
DRUG STUDIES
pressure; hiatal hernia; pts
with high risk for suicide
tinnitus, nasal congestion bloating, easy bruising or
GI: paralytic ileus bleeding, unusual tiredness, or
GU: urinary tract yellowing of skin or eyes.
dilation, gynecomastia, 14. Advise patient and SO to report
menstrual irregularities, fever, chills, sore throat, dry
galactorrhea, testicular mouth, excessive sedation,
swelling, libido changes, difficulty urinating, or
erectile dysfunction palpitations.
Hematologic: 15. Caution patient and SO to
eosinophilia, purpura, avoid hazardous activities.
bone marrow suppression,
agranulocytosis,
thrombocytopenia,
leukopenia
Hepatic: hepatitis
Metabolic: hyperthermia,
hyperglycemia,
hypoglycemia
Skin: urticaria, pruritus,
petechiae, alopecia
Other: edema,
hypersensitivity reactions
38
DRUG STUDIES

NAME OF DRUG MECHANISM OF INDICATION SIDE EFFECTS NURSING RESPONSIBILITIES

ACTION
GENERIC NAME: Blocks reuptake of - Treatment of CNS: weakness, Before:
Desipramine neurotransmitters, depression, often in restlessness, insomnia, 1. For those on long-term
(norepinephrine, conjunction with confusion, hypothermia, therapy, hepatic/renal function
BRAND NAME: serotonin) at presynaptic psychotherapy. headache tests, blood counts should be
Norpramin membranes, increasing - Treatment of ADHD, performed periodically.
their availability at adjunct in chronic CV: tachycardia, 2. For those at risk for
CLASSIFICATION: postsynaptic receptor pain treatment, palpitations arrhythmias, perform baseline
PHARMACOTHERAPEUTIC: sites. Strong neurogenic pain, EKG.
EENT: blurred vision, dry
Tricyclic. anticholinergic activity. panic disorder, 3. Assess for suicidal tendencies
eyes
CLINICAL: Antidepressant depression in before starting therapy.
children 6–12 yrs. 4. Monitor blood glucose level and
GI: nausea, vomiting,
DOSAGE: CBC with white cell differential
Therapeutic Effect: constipation, dry mouth,
25-50 mg during therapy.
Relieves depression. peculiar taste
5. Explain the dosage, route,
ROUTE: GU: urinary retention, timing, indication,
PO delayed voiding contraindication, side effects
and adverse effects of the
FREQUENCY: Hematologic: purpura drug.
OD During:
Musculoskeletal: muscle
6. Monitor for worsening of
weakness
TIMING: depression, suicidal ideation.
8:00 AM Assess appearance, behavior,

39
DRUG STUDIES

Skin: dry skin, speech pattern, level of

photosensitivity, rash, interest, mood.
sweating 7. Monitor EKG if patient has
history of arrhythmias.
8. Watch for severe CNS,
cardiovascular, and
hematologic adverse reactions.
After:
CONTRAINDICATION ADVERSE EFFECTS
Hypersensitivity to drug; CNS: sedation, delusions,
9. Tell patient or caregiver to take
Recovery phase of agitation, hallucinations,
full dose at bedtime to avoid
myocardial infarction (MI); disorientation,
daytime drowsiness.
MAO inhibitor use within extrapyramidal reactions,
10. Urge patient and SO to
past 14 days seizures, suicidal behavior
promptly report chest pain or
or ideation (especially in
easy bruising or bleeding.
Cautions: child or adolescent)
11. Inform patient and SO that
CV: hypotension,
Cardiovascular disease, desired therapeutic effect may
hypertension,
cardiac conduction take 2 to 3 weeks.
arrhythmias, MI, heart
disturbances, urinary 12. Instruct patient or parent to
block
retention, diabetes, benign immediately report increasing
EENT: laryngitis
prostatic hyperplasia, depression or suicidal ideation
GI: abdominal cramps,
glaucoma, narrow-angle (especially in child or
epigastric distress,
glaucoma, xerostomia, adolescent).
difficulty swallowing,
visual problems, 13. Caution patient or caregiver to
parotid gland swelling,
constipation, history of avoid hazardous activities until
mouth inflammation,

40
DRUG STUDIES

bowel obstruction, seizure black tongue he knows how drug affects

disorders, hyperthyroidism, GU: urinary tract dilation, alertness, vision, and
those taking thyroid testicular swelling, erectile coordination.
replacement therapy, high or other male sexual
risk of suicide, renal/hepatic dysfunction,
impairment. gynecomastia, menstrual
irregularities,
galactorrhea, increased
or decreased libido
Hematologic:
Eosinophilia,
bone marrow depression,
agranulocytosis,
thrombocytopenia
Metabolic: syndrome of
inappropriate
antidiuretic hormone
secretion
Skin: pruritus, petechiae,
flushing
Other: weight gain,
edema, withdrawal
symptoms with abrupt
drug cessation (dizziness,
nausea, vomiting,

41
DRUG STUDIES

headache, malaise, sleep

disturbances, irritability,
worsening of depression),
sudden death (in children)

42