DRUGS USED IN CHILD

PSYCHIATRY
Clonidine
Indications
Control of withdrawal symptoms from
opioids
OTourette's disorder
Mavement disar deep
Control of aggressive or hyperactive beh-
avior in children
Autism

Mechanism of Action

Alpha 2-adrenergicreceptoragonist
The agonist effects ofclonidineon presynap-
result in a
tic alpha 2-adrenergic receptors
decrease in the amount of neurotransmitter
released from the presynaptic nerve

terminals. This decrease serves, generally,

to reset the sympathetic tone at a lower
level and to decrease arousal.

Dosage
Usual starting dosage is 0.1 mg orally twice a
day; the dosage can be raised by 0.3 mg day
a

to an appropriate level.
 Side Effects OKeep stimulilowand environment as quj.
et as possible to discourage over stimul
ymouth, dryness ofeyes,fatigue,irritability, ation.
Sedation, dizziness, nausea, vomiun8 nypo
tension and constipation. O To decrease anorexia, the medication
may be administered immediately after
Nurse's Responsibility meals. The patient shold be weighed

Monitor BP, the drug should be withheld if regularly (at least weekly) during hosp-
Advise
the patient becomes hypotensive. italization and at home while on therapy
frequentmouth rinses and good oral hygiene with CNS stimulants, due to the potential
for dry mouth. for anorexia/weight loss and temporary
interruptions of growth and develop-
Methylphenidate (Ritalin) ment.

Methylphenidate, dextroamphetamine and To prevent insomnia administer last dose

pemoline are sympathomimetics. atleast 6 hours before bedtime.
OIn children with behavioral disorders,
Indications ADHD a drug 'holiday should be attempted
Attention-deficit hyperactivity disorder periodically under the direction of the
Narcolepsy Seep cus0Role
physician to determine effectiveness of the
Depressive disorders medication and the need for continuation.
Obesity OEnsure that parents are aware of the
Mechanism of Action delayed effects of Ritalin. Therapeutic
Sympathomimetics cause the stimulation of responsemay not be seen for 2-4 weeks;
alpha and beta-adrenergic receptors directly the drug should not be discontinued for
as agonists and indirectly by stimulating the lack of immediate results.
releaseof dopamine and norepinephrine from Infornm parents that OTC (over-the-
presynaptic terminals. Dextroamphetamine counter) medications should be avoided,
nd methylphenidate are also inhibitors of while the child is on stimulant
catecholamine reuptake, especially medication.
dopamine
reuptake and inhibitors of monoamino oxidase.
Some OTC medications,
particularly cold
and hay fever
The net result of these activities is believed
to be
preparations contain certain
the stimulation of several brain sympathomimetic agents that could
regions. compound the effects of the stimulant and
Dosage Create drug interactions
that may be toxicC
Starting dose is 5-1O mg/day orally, to the child.
daily dose is 80 mg/day. maximum
O Ensure that
parents are aware that the drug
Side Effects should not be withdrawn
Anorexia or dyspepsia, weight losS, slowed drawal should be abruptly. With-
growth, dizziness, insomnia or gradual and under the
nightmares, direction of the
dysphoric mood, tics and psychosis. physician.
Nurse's Responsibilities GERIATRIC CONSIDERATIONS
Assess mental statu_ for change in mood,
level of activity, degree of Elderly are more sensitive to
stimulation and drugs due to
age-related changes in the brain.
aggressiveness. These are
Ensure that patient changes in the receptor
is
protected from neuronal death) and availability (due to
injury. sensitivity and
membrane properties. changes
in neural
Further