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Definition
CAUT:
Children younger than 6 years old Pregnant women
Patients whose treatment involves radiographic contrast administration
Patients with psychosis, depression, substance abuse, myocardial
infarction, alcoholism, bipolar disorder, dysrhythmias, or seizures
INT: Drug
,Increased stimulatory effects such as irritability, nervousness,
tremors, and insomnia can occur if sympathomimetics (e.g.,
pseudoephedrine) or psychostimulants (e.g., caffeine) are taken
concurrently with methylphenidate.
Methylphenidate may reduce the effectiveness of antihypertensives.
Concurrent use of methylphenidate and MAOIs may cause
hypertensive crisis.
Use of methylphenidate can decrease metabolism and increase
serum levels of oral anticoagulants, barbiturates, antiseizure
medications, and tricyclic antidepressants.
Food
Foods containing caffeine may increase the effects of
methylphenidate.
Nuts, guarana, horsetail, yerba mate, and yohimbe may increase
CNS stimulation when taken with methylphenidate.
ADHD
Children over 6 years:PO: 5 to 10 mg before breakfast and lunch; if
necessary, increase dosage weekly by 5 to 10 mg; max: 60
mg/dayPO sustained-release: 18 mg/day; max: 2 mg/kg/day Adults:
PO: 20 to 30 mg/day in divided doses before breakfast and
lunch; max: 60 mg/dayPO sustained-release: 18 to 36 mg once daily;
max: 72 mg/day
Narcolepsy Adults:
PO: 10 to 60 mg/day in two to three divided doses 30 minutes before
meals
SE: CNS: Anxiety, insomnia, dizziness, hyperactivity, talkativeness GI:
Anorexia, abdominal pain
AE: CNS: Seizures, psychotic episodes, malignant neuroleptic
syndrome CV: Tachycardia, hypertension, palpitations, chest pain
,ENDO: Transient weight loss in children, growth suppression HEMA:
Leukopenia, anemia MISC: Rhabdomyolysis
Exfoliative dermatitis, stroke, thrombocytopenia, angioedema, and
hepatotoxicity
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Doxapram- analeptic used for postanesthesia respiratory depression.
Absorption Administered intravenously
Distribution Throughout the body
Metabolism Metabolized by the liver
Excretion Metabolites excreted in the urine
Doxapram stimulates an increase in patient’s tidal volume and a small increase in
respiratory rate. This effect is mediated via the cardiac carotid chemoreceptors.
Onset Intravenous (IV): 20-40 seconds
Peak plasma concentration1-2 minutes
Duration of action 5-12 minutes
Half-life 4-12 hours
CI: include seizure disorders, cardiovascular disorders, severe
hypertension, pulmonary embolism, pneumothorax, and acute bronchial
asthma.
Caution in patients with bronchial asthma, cardiac tachydysrhythmias, cerebral
edema or increased intracranial pressure, hyperthyroidism, or
pheochromocytoma
Antianxiety: Buspirone
Absorption: Well absorbed from the gastrointestinal (GI) tract (taking with food
delays absorption, yet enhances bioavailability by reducing first-pass
metabolism)
Distribution: Low and variable bioavailability as a result of extensive first-pass
metabolism
Metabolism: Extensively metabolized in the liver (see earlier for effect on first-
pass metabolism when taken with food)
E: In urine, primarily as metabolites
, MOA: Buspirone’s mechanism of action as an anxiolytic is not well understood.
It binds with high affinity to serotonin receptors and, to a lesser degree,
dopamine receptors. It does not depress the CNS.
AD. No abuse potential (may be especially appropriate for patients who abuse
drugs or alcohol)
Does not intensify the effects of CNS depressants (benzodiazepines, alcohol,
barbiturates)
Dis. Anxiolytic effects develop slowly (2-3 wks)
Not suitable (PRN)/ immediate relief is needed
Phentermine-used as an appetite suppressor for weight loss
Absorption Well absorbed from the GI tract
Distribution Protein binding about 16%
Metabolism Metabolized by the liver
ExcretionIn the urine, mostly unchanged
MOA: Anorexiants suppress the appetite by stimulating the limbic and
hypothalamic regions of the brain.
Onset: 1 to 2 hours
Peak: 3 to 4 hours
Duration: Unknown
Half-life: 19 to 25 hours
CI:
A history of drug abuse; an allergy to sympathomimetic amine drugs; is taking
or has taken an MAOI in the past 14 days; has cardiovascular disease,
hyperthyroidism, or glaucoma; or if the patient is pregnant or plans on becoming
pregnant.
Use with caution in patients with thyroid disease.
INTER: Drugs that increase the effect of phentermine include caffeine,
amphetamines, and CNS stimulants.
Alcohol decreases the effect of phentermine.