c) Adequate blood supply to

deliver (e.g., most

chemotherapy does not
cross the blood-brain
barrier.
ANTINEOPLASTIC d) Drug resistance

DRUGS Results of Chemotherapy

Administration
✓ Complete remission: no
CHEMOTHERAPY evidence of cancer
✓ Partial remission: regression of
• Systematic administration of at least 50% or greater
drugs to kill cancer cells ✓ Improvement: regression of 25-
• 2 major categories of drugs 50%
a. Cell cycle specific: cell must ✓ Nonresponsive: less than 25%
be in a certain phase of regression
division; nit effective during ✓ Progression: tumor growth
G0 phase. despite drug
b. Cell cycle nonspecific:
effective in all phases of cell Administration
division. • Primarily by IV or oral routes
depending on accepted
Action regimen.
a. Affects metabolism and • Direct administration to the
reproduction of normal cells as tumor site may also be used
well as cancer cells. depending on tumor location.
b. Tumor cell growth and response • Care must be given when
to chemotherapy defined by the administering certain
Gompertzian curve chemotherapy agents IV since
c. Tumor response to some (vesicants) may cause
chemotherapy based on the severe tissue damage if
client’s: extravasation occurs; others
1. health status (irritants) will also cause tissue
2. ability to tolerate the dose, inflammation.
regimen, adverse reactions. • May be administered centrally
3. previous experience with (PICC line, central venous
chemotherapy catheters, implanted ports) or
4. tumor characteristics through a peripheral IV line
a) Greater effect with higher depending on the planned
mitotic rate length of the regimen, drug,
b) Smaller tumors more institutional guidelines, and
affected status of client’s veins.
 blood cells) but not sufficiently
long for cancer cells to
replenish.

Adverse Reaction
• Chemotherapy agents produce
adverse reaction related to their
effects on normal cells that
divide most often such as
epithelial and bone marrow cells
Figure 1- central line as well as their toxic nature.
• More or lesser degree adverse
reaction:
a. Alopecia ranging from thinning
hair to total loss of all body hair.
b. Nausea and vomiting
c. Neutropenia, anemia.
Thrombocytopenia
d. Constipation, diarrhea
e. Mucositis, stomatitis, alteration
in taste
f. Skin, eye, vaginal dryness, and
nail changes
g. Loss of fertility
h. Alteration in body image,
Figure 2- PICC line coping, fear of death
• Long-term adverse reactions:
• Given for both solid and a. Leukemia and other secondary
hematologic malignancies. malignancies
• Various types often used in b. Various organ toxicities
combination to: c. Infertility
1) Decrease adverse d. Alteration in memory or learning
reaction ability
2) Decrease drug resistance
3) Attain greatest tumor cell CELL CYCLE SPECIFIC
kill CHEMOTHERAPY AGENTS
• Time between each
administration is called a cycle. 1. Antimetabolites
• Cycle length is determined by • Drug examples: capecitabine
the type of chemotherapy and (Xeloda), cytosine arabinoside
cancer being treated. (Cytosar-U), 5-fluorouracil
• Cycle length must be long (Adrucil), fludarabine (Fludara),
enough for recuperation of gemcitabine (Gemzar),
normal cells (including white hydroxyurea (Hydrea),
 methotrexate, 6-thioguanine (6- c. Bleomycin (Blenoxane): causes
TG) cell death in G1
• Action d. Etoposide (VePesid): interferes
1. Work primarily during the with synthesis of DNA in the S
S phase and G2 phases.
2. Interfere with DNA and
RNA synthesis Table 1. Selected Cell Cycle Specific
Chemotherapy Agents
2. Vinca Alkaloids
• Drug examples: vinblastine Class/ Pot Rout Vesic Specif Nurs
Drug ent es ant/ir ic ing
(Velban), vincristine (Oncovin),
ial ritant toxicit inter
vinorelbine (Navelbine) ind ies venti
• Action icat on
1. Work primarily during the ion
M phase Antime Adm
tabolit inist
2. Prevent cell division by
es: er
affecting microtubules Methot Mu IV, NO Nephr leuc
rexate ltip IM, otoxic ovori
3. Taxanes le IT, ity n as
• Drug examples: paclitaxel can po orde
cer red
(Taxol), docetaxel (Taxotere)
IV, to
• Action 5- Sto topi NO Photo mini
1. Work during the M phase fluorou ma cal sensiti mize
2. Strengthen microtubules, racil ch, vity; toxic
preventing pulling apart col diarrh ities,
on, ea asse
of replicated strands of bre ss
DNA during mitosis ast, renal
pa funct
4. Camptothecins ncr ion.
• Drug examples: topotecan eas
Instr
(Hycamtin), irontecan uct
(Camptosar) the
• Action clien
1. Work in the S phase t to
2. Inhibit topoisomerase 1 avoi
d
used in DNA synthesis sun
and replication. expo
sure
5. Other miscellaneous drugs Vinca Mu IV Vesic Neuro Asse
a. L-asparaginase (Elspar): causes Alkaloi ltip ant toxicit ss
ds le y for
cell death in G1 can num
b. Prednisone: causes cell death in cer bnes
G1 s
and
 cons orde
tipati red.
on
Taxane Bre IV Vesic Hyper Pre
s ast, over ant sensiti medi
ova 3 vity cate
CELL CYCLE NONSPECIFIC
ria hour as CHEMOTHERAPY AGENT
n s orde
red 1. Alkylating agent
with • Drug examples:
antih
ista cyclophosphamide (Cytoxan),
mine carboplatin (Paraplatin), cisplatin
or (Platinol), nitrogen mustard
corti • Action
cost
1. Create breaks and links in
eroi
ds DNA chains, making
Campt Ov IV NO Myelo Moni replication at the time of
otheci aria suppr tor synthesis impossible.
ns n ession CBC
Epipo Tes IV, Irrita Hypot Adm 2. Antitumor Antibiotics
dophyl ticu p.o. nt ensio inist
lotoxin lar, n and er • Drug examples: doxorubicin
s sm bronc over hydrochloride (Adriamycin),
all hospa 30- mitomycin C (Mutamycin),
cell sm 60 mitoxantrone (Novantrone)
lun minu
• Action
g tes
to 1. variety of mechanisms to
mini prevent DNA and RNA synthesis
mize (breaks in chain, links, etc) when
this time comes for the cell to enter
effec
the cycle.
t
Bleom Sq IV, Irrita Pulmo Asse
ycin ua IM, nt nary; ss 3. Nitrosureas
(Bleno mo Sub hyper for • Drug example: carmustine
xane) us cuta sensiti coug (BiCNU)
cell neo vity h,
• Action
at us dysp
vari nea, 1. similar to alkylating agent
ous rales 2. able to cross the blood-
site ; brain barrier
s; admi
ho niste
Table 2. Selected Cell Cycle
dg r test
kin’ dose Nonspecific Chemotherapy Agents
s; of
test the Class Pote Ro Vesica Specif Nursi
icul drug /. ntial ut nt/Irrit ic ng
ar as Drug Indi es ant toxicit Interv
ies
 cati entio irrigat
on n ion as
Alkyl order
ating ed.

Cispl Rest IV Irritant Renal Vigor

atin icula .vesica ; ous IV
r, nt ototo hydra Cytox
ovar xicity tion an
ian, and IV, NO
blad diuret Brea P Hemo
der ics as st, O rrhagi
monit lym c
ored. pho cystiti
Monit ma s
or
BUN,
creati
nine;
intsru
ct the
client
to
repor
t
tinnit
us
Antit
IV or umor
oral Antib
Ifosfa hydra iotic
mide Testi IV Irritant tion
cula Hemo with Doxo Mult IV Vesica Cardi Monit
r rrhagi frequ rubici iple nt otoxic or
c ent n canc ity cumu
cystiti voidi an lative
s ng; dose;
asses asses
s and s ECG
instru and
ct the for
client SOB,
to hyper
repor tensio
t n,
frequ edem
ency, a
hema
turia, Mitox Leu IV Irritant Cardi
admi antro kem /Vesic otoxic
nister ne ia, ant ity
bladd lym
er
 pho or lactating nurses should use
ma particular caution).
• Institute universal body fluid
ADMINISTRATION OF precautions (especially within 48
CHEMOTHERAPEUTIC AGENT hours of administration)
• Wear disposable gown with
Safe Handling cuffs, a mask, and nonpowdered
a. Preparation gloves for administration, and
• Under vented, laminar-flow clean up any spills.
cabinet with the blower • Do not prime the tubing with the
operated around the clock. chemotherapy agent under
• Wash hands before and after nonvented conditions.
preparation • Do not expel air from the syringe
• Do not eat, drink, or attend to into the air under nonvented
personal hygiene in the area. conditions (expel air into the
• Wear disposable, protective gauze, disposing of it properly)
gown and nonpowdered gloves. • Dispose of waste in approved,
• Use a plastic-backed absorbent appropriately marked
pad on the work area. containers.
• Use luer-lock attachments • Double-bag contaminated client
(instead of needles) as possible. gowns or linens; mark and send
• Open ampules away from self for appropriate washing.
and with gauze around their • Have an approved spill kit
necks. available in the area where
• Add diluents slowly and chemotherapy is given.
cautiously; aspirate air from the • Wash self or other contaminated
vial before adding the diluent objects several times with
and wait for pressure generous amount of soap and
equalization before withdrawing water.
the needle to avoid spray of • Seek medical attention if
contents. contamination occurs.
• Dispose of waste in approved
containers. CLIENT SAFETY
• Prime the tubing before adding
chemotherapy to the IV bag. Peripheral IV
✓ Select a distal site on the
b. Administration extremity, utilizing the side of
• Chemotherapy should only be the body opposite that of
administered by trained nurses prior surgery, radiation, or
• Wash hands thoroughly before injury.
and after administration. ✓ Examine the extremity for
• Prevent contact with proximal venipuncture sites
chemotherapy agents (pregnant and more proximal to that
site.
 ✓ Choose sites between the vesicles may appear without
antecubital space and wrist. pain.
✓ Check for blood return • Follow institutional policy or
before starting infusion. procedures.
✓ Secure the IV site with clear • Stop infusion
tape to promote visualization. • Inform the physician
✓ Begin infusion with fluids and immediately.
antiemetics as ordered. • Leave the needle or IV catheter
✓ Instruct the client to inform in the client’s arm.
the nurse of pain or burning • Aspirate the remaining
sensation during chemotherapy agent from the IV
chemotherapy infusion; stop catheter.
infusion immediately if this • Infuse the antidote (if one exists)
occurs. into the catheter as ordered or
✓ If more than one agent is to according to standing order.
be given, infuse the vesicant • Antidote may also be injected
first when venous flow is into the skin around the IV site as
optimal. ordered.
✓ Infuse agents via an infusion • Apply topical corticosteroids
pump if ordered; vesicants cream to the site as ordered and
should be monitored directly cover.
and not allowed to infuse • Apply warmth or cold to the site
unobserved by the nurse. based on the agent that
✓ Flush the IV with up to 10mL infiltrated.
of normal saline on • Elevate arm.
completion. • Instruct the client to notify the
nurse or physician of worsening
MANAGEMENT OF EXTRAVASATION changes.
• Thoroughly document the date,
time, site of infiltration, needle
size, drug being administered,
amount believed to be
extravasated, appearance of site,
nursing intervention used, and
physician notification.

HORMONAL AGENT
• Kill hormonally sensitive
cancer cells such as in the
Figure 3-severe extravasation
prostate, breast, and ovarian
tumors.
• Pain is the primary symptom,
although swelling, redness, and • Drug example:
adrenocorticoids,
androgens, estrogens,
 antiestrogens, progesterone, ✓ Refer to sexual
antitestosterone. dysfunction counseling as
• Action needed.
1. kill lymphoid cells and ✓ Monitor glucose and
promote cells entering the electrolytes when
cell cycle, making them administering
vulnerable to chemotherapy. adrenocorticosteroids.
2. compete with the body’s
natural hormones for BIOLOGIC RESPONSE MODIFIER
receptors such as an • Less commonly used than
antiestrogen-like tamoxifen chemotherapy.
(Tamofen) • May be use alone or in addition
3. act on the feedback to chemotherapy and radiation.
mechanism within the • Based on enhancing immune
pituitary to stop hormone system to recognize and destroy
production by the end organ cancer cells.
such as an antitestosterone • Modifiers are cytokines usually
like leuprolide acetate released from cells of the
(Lupron) immune system such as
leukocytes, lymphocytes,
• Adverse reaction macrophages,
1. associated with • Many are still in clinical trials.
adrenocorticoids • Drug example: interferons,
a) Increased appetite, interleukins, tumor necrosis
weight gain factor, and colony stimulating
b) Gastric irritation, ulcer factors.
c) Hyperglycemia • Action
d) Fluid retention 1. Change client’s immune
e) Moon face response
f) Immunosuppression 2. Kill tumor cells directly
2. Associated with Sex 3. Affect the tumor cell’s
Hormone ability to grow or spread.
a.) hot flashes • May be administered by multiple
b.) loss of libido routes, including client self-
c.) weight gain injection at home over several
d.) thrombolytic event days or weeks.
e.) nausea, vomiting • Adverse reaction
1. Flu-like clinical
• Nursing Intervention manifestations
✓ Instruct the client about a. fever
potential adverse b. chills
reactions and which to c, body aches
report immediately. d. headache
e. malaise or fatigue
 f. tachycardia REFERENCE:
g. hypotension
h. capillary leak syndrome Gauwitz, Donna F. 2007. Complete
and pulmonary edema Review for NCLEX-RN.USA. Thomson
(high dose IL-2) Delmar Learning.
i. nausea, vomiting,
diarrhea
j. rash, hives, pruritus
• Nursing Intervention
✓ Administer
acetaminophen
pretreatment and every 4
hours after, as ordered, if
flulike clinical
manifestations appear.
✓ Administer prescribed
meperidine (Demerol) if
rigors occur during drug
administration.
✓ Monitor vital signs and
blood counts.
✓ Instruct the client to
report clinical
manifestations of
shortness of breath, pain,
edema.
✓ Obtain daily weights if the
client is hospitalized and
receiving modifier likely
to cause edema.
✓ Pace the client’s activities
due to what may be
severe fatigue.
✓ Inform the client on self-
injection as ordered.
 delusional disorder (positive and

PSYCHOTIC negative manifestation)

Positive manifestation: thought of an

DRUGS excess or distortion of normal function.
e.g., hallucinations, delusional thinking,
bizarre behavior, aggression, and
paranoia (the general term thought
disorders refers to this manifestation)
ANTIPSYCHOTICS
Negative manifestation: thought of as a
▪ Medications used loss of normal function. E.g.,
to treat psychotic amotivation, anhedonia, blunted affect,
symptoms. This asocial behavior, and avolition.
group includes two
distinct types of 2. used to treat clients with bipolar
medications. The disorders, major depression with
exact mechanism psychotic features, and borderline
of action is personality disorders in which there are
unknown in many psychotic clinical manifestation.
of these
medications. ADVERSE REACTIONS
▪ It is postulated that a. Extrapyramidal adverse reactions
a dysregulation of (EPS). Usually comprised of 3
neurotransmitter categories:
occurs in
schizophrenia and 1. Akathisia: characterized by motor
the related restlessness, apprehension and
disorders. irritability.
▪ Antipsychotic
medications help 2. Dystonia: acute reaction requiring
regulate these immediate medical attention
neurotransmitters ❖ Signs: facial grimaces;
systems. (include exaggerated posturing of the
dopamine, head, neck, or jaw; and
serotonin, oculogyric crisis.
norepinephrine, ❖ Younger male clients are at
GABA, and particular risk for dystonic
acetylcholine) reactions.

USES 3. Drug – induced Parkinsonism:

1. PSYCHOTIC MANIFESTATION such shuffling gait, excessive drooling,
as schizoaffective disorder, brief tremors, and muscle rigidity. Older
reactive psychosis, and paranoid
adults are at greater risk for developing ✓ Thioridazine (Mellaril)
this effect. No proven treatment. ✓ Perphenazine (Trilafon)

b. Tardive Dyskinesia- a long term side b. Thioxanthenes which include

effect. thiothixene (Navane)
▪ Results from extended use of c. Butyrophenone derivatives such
antipsychotic drugs. as haloperidol (Haldol)
▪ Clinical manifestation: abnormal
involuntary muscle movements 2. Atypical antipsychotic- also referred
around the mouth, lip smacking, as new or novel. Effectively treat both
tongue darting, constant positive and negative manifestations.
chewing movement, and e.g., a. clozapine (Clozaril)
involuntary movements of the b. risperidone (Risperdal)
arms or legs. c. olanzapine (Zyprexa)
▪ Older female clients are at d. quetiapine (Seroquel)
greater risk for developing this e. ziprasidone (Geodon)
disorder.
Adverse Reactions (Typical)
c. photosensitivity- especially Sed Anticho Ortho EPS
chlorpromazine (Thorazine) atio linergic static sypm
n Effect hypot toms
d. Anticholinergic adverse reactions ention
are common Thoraz +++ ++++ ++++ ++
a) Dry mouth, urinary retention ine +
b) Blurred vision, constipation Prolixi + + + +++
c) Confusion and decreased n +
memory Decon
ate
e. Orthostatic hypotension Haldol + + + +++
+
f. Agranulocytosis- rare, serious side Serenti ++ ++++ ++ +
effect that can occur with clozapine l
(Clozaril), require weekly or biweekly Apo- ++ ++ ++++
monitoring of WBC counts. Perph
enazin
TYPES e
1. Typical antipsychotic (also known as Mellari +++ +++ +++ +
conventional, traditional, or old). Treat l
the positive manifestation but are not Navan + = + +++
very effective with negative e +
manifestation. Key: +++++ most effect; + = least effect
e.g., a. Phenothiazine derivatives
✓ Chlorpromazine (Thorazine)
✓ Mesoridazine (Serentil)
Adverse Reactions (Atypical) machinery until the effects of the drug
Clo Zyp Risp Ser ge are known.
zari rex erd oqu od 6. administer with food or milk.
l a al el on 7. monitor for manifestations of blood
Sedati ++ ++ + +++ + dyscrasias.
on + 8. inform the client that the urine may
Weigh ++ ++ + + 0 turn pink or reddish brown.
t gain + + 9. instruct the client on long term
Excessi ++ ++ 0 0 0 therapy to have routine ophthalmic
ve + exams because long-term therapy may
salivati affect vision.
on 10. monitor the client for tardive
EPS 0 0 * 0 0 dyskinesia.
antich ++ ++ + ++ +
olinerg +
ic
Key: +++ = most common; 0 = not present; * = ANTIDEPRESSANT
occurs with high dose ▪ Widely used to treat variety of
mood disorders.
Contraindication/Precaution ▪ Target specific neurotransmitters
1. Hypersensitivity in the brain such as serotonin
2. CNS depression and norepinephrine.
3. Bone Marrow Depression
4. Lactation INDICATIONS
5. Hepatic or Renal disease 1. major depressive episodes
6. Older Adult 2. dysthymia
3. clients with bipolar disorder who are
Nursing Intervention in depressed state.
1. monitor client for EPS manifestations 4. anxiety disorders and anxiety that
and notify the physician. may be associated with an agitated
2. Instruct the client who is taking depression.
atypical antipsychotic to use sunblock 5. post-traumatic stress disorder
and protective clothing when she is 6. residual attention-deficit disorder
outside in the sun for photosensitivity.
3. instruct client with orthostatic ADVERSE REACTION
hypotension to stand up slowly from a 1. anticholinergic adverse reaction:
sitting or reclining position. primary adverse reaction of tricyclic
4. instruct client with dry mouth to antidepressant (dry mouth, urinary
chew sugar-free gum, suck on retention, memory loss, blurred vision)
sugarless candy, or take ice chips and 2. in selective serotonin reuptake
cool sugar-free drinks. inhibitors (SSRI) class are related to
5. instruct patient to avoid extremes in serotonin uptake blockade and the
temperature; driving car or operating subsequent effect on the GI system.
 a) Diarrhea and nausea due to neurotransmitter mechanisms that are
serotonin uptake blockade different than the SSRIs, tricyclics, and
b) Blockage of norepinephrine MAO inhibitors.
uptake may result in anxiety and ❖ Venlafaxine (Effexor), bupropion
sweating. (Wellbutrin), mirtazapine
c) Others: sexual dysfunction, (Remeron), trazodone (Desyrel),
insomnia, and headaches and nefazodone (Serzone)
3. Bupropion (Wellbutrin) lowers the ❖ They have more tolerable
seizure thresholds. Decreased appetite adverse reaction profile.
and insomnia
4. Mirtazipine (Remeron) causes LITHIUM
somnolence and increased appetite. ❖ A salt that is excreted by the
kidneys.
CONTRAINDICATION ❖ Not metabolized in the liver. The
1. severely impaired liver function exact mechanism of action is
2. acute recovery phase from MI unknown.
3. concomitant use of MAO inhibitors ❖ Believed that lithium works via
4. Lactation an antikindling effect. Kindling
5. Seizures is a process in which repeated
stimulation of a neuron results in
an action potential within that
TYPES neuron.
1. TRICYCLIC Antidepressant – an
older class of drugs USES
❖ Amitriptyline (Elavil), 1. mood stabilizer for clients with
clomipramine (Anafranil), bipolar disorders
desipramine (Norpramin), 2. both mania and the depressive
doxepin (Sinequan), imipramine episodes characteristics of bipolar
(Tofranil) and nortriptyline disorder
(Pamelor) 3. treatment resistant depressions as an
❖ Used less with the advent of the adjunct medication.
newer antidepressant which
have more tolerable adverse ADVERSE REACTION
reaction profile. 1. nausea 5. edema
2. SELECTIVE SEROTONIN 2. diarrhea 6. Confusion &
REUPTAKE INHIBITORS (SSRIs)- memory
popular class of antidepressant. impairment
❖ Fluoxetine (Prozac), sertraline 3. fine hand tremor
(Zoloft), paroxetine (Paxil), 4. weight gain 7. Lithium toxicity
fluvoxamine (Luvox), and
citalopram (Celexa) Lithium Toxicity: vomiting, abdominal
❖ More tolerable adverse reaction pain, profuse diarrhea, severe tremor,
3. SECOND GENERATION coma, seizures.
Antidepressant- work on
CONTRAINDICATION/PRECAUTION ANTIANXIETY AGENTS
1. renal disease 4. children ▪ These classes of agents treat
2. brain damage 5. Older adults anxiety and daytime tension
3. lactation 6. Dehydration ▪ Mediate the actions of gamma
aminobutyric acid (GABA), which
TYPES is an inhibitory neurotransmitter
1. Lithium Carbonate (Eskalith)- most ▪ Some may act through
common anticholinergic actions.
2. available in a slow-release form.
USES
NURSING INTERVENTION ✓ Anxiety
1. inform the client of the importance ✓ Panic disorder
of measuring the level of lithium in the ✓ Social anxiety disorders
blood to ensure that an adequate ✓ Anger and aggression
amount of the drug is in the body. ✓ Post-traumatic stress disorder
2. monitor lithium level 1-2 x a week ✓ Alcohol withdrawal:
during initiation of therapy and benzodiazapines
monthly.
3. obtain lithium level 8-12 hours after ADVERSE REACTION
the latest dose. 1. CNS effect: sedation, confusion,
4. encourage the client to drink 10-12 disorientation
glasses of water each day to avoid 2. orthostatic hypotension
dehydration (lithium is a salt that is 3. dry mouth
excreted by the kidneys and alters the 4. blurred vision
level of drug in the body by the intake
of fluid) CONTRAINDICATION/PRECAUTION
5. instruct the client to avoid excessive 1. history of substance abuse or
sweating due to exercising on a hot dependence
day and increasing concentrations of 2. hypersensitivity
lithium in the urine. 3. acute narrow-angle glaucoma
6. administer lithium 2 or 3 x a day. 4. liver disease
7. avoid administering lithium to clients 5. lactation
with poor compliance.
8. instruct the client to avoid beverages TYPES
with caffeine because they may 1. BENZODIAZEPINES refer to a
aggravate episodes of mania. family of medications, including
9. instruct the client to avoid all over- alprazolam (Xanax), chlordiazepoxide
the-counter drugs unless prescribed. (Librium), diazepam (Valium),
10. maintain a constant level of salt lorazepam (Ativan), clonazepam
intake to avoid weight gain and edema, (Rivotril, Klonopin), and oxazepam
which means sodium retention. (Serax)
2. BETA BLOCKERS such as
propranolol (Inderal), may be used to
treat certain forms of anxiety
3.BUSPIRONE (BuSpar)- a 1. history of substance abuse
nonbenzodiazepine antianxiety drugs. 2. alcohol
3. hypersensitivity
NURSING INTERVENTION
1. monitor the client for tolerance and TYPES
physical dependence. 1. barbiturates: treat insomnia
2. instruct the client to avoid stopping 2. chloral hydrate (Noctec): a type of
these drugs abruptly after long term barbiturate
use. 3. antihistamine: are sedating, used to
3. instruct the client to avoid alcohol or treat insomnia
barbiturates which could be fatal due 4. Zolpiden (Ambien): a
to CNS depression. nonbenzodiazepines hypnotic
4. instruct the client to avoid driving or
operating heavy equipment while NURSING INTERVENTION
taking these drugs because they can 1. Instruct the client about the risk for
cause drowsiness. potential falls and fractures related to
ataxia and confusion.
2. monitor the client for hangover
HYPNOTICS 3. instruct the client to avoid the use of
▪ TREAT INSOMNIA alcohol
▪ Used at times to treat anxiety 4. instruct the client to avoid driving or
▪ Nonbenzodiazepine hypnotics operating heavy equipment
act by reducing electrical activity 5. instruct the client to avoid abruptly
in the brain. discontinuing the use of hypnotics after
▪ Hypnotics may become habit- long-term use
forming. They are intended for 6. administer ½-1 hour before bedtime.
short-term use.

USES ANTICONVULSANT
1. insomnia ▪ Primarily used to treat epilepsy,
2. sleep movement disorder have also been found to be
3. restless leg syndrome effective in treating mood
disorders.
ADVERSE REACTION
1. dry mouth, constipation, urinary USES
retention: antihistamine 1. bipolar disorders
2. clumsiness, dizziness, and morning 2. prevent mood swings seen in bipolar
hangover: barbiturates disorder
3. nausea, vomiting, headache, and 3. useful for manic episodes
dizziness: chloral hydrate (Noctec) 4. aggression
4. drowsiness, dizziness, and diarrhea: 5. anxiety disorders: gabapentin
zolpidem (Ambien) (Neurontin)

CONTRAINDICATION/PRECAUTION ADVERSE REACTION

1. GI: nausea, diarrhea, and dyspepsia 2. instruct the client that a decrease in
2. sedation mental alertness may occur with the
3. tremors: valproic acid (Depakote) initiation of therapy, which may resolve
4. dizziness, lightheadedness, or with continued therapy.
blurred vision with carbamazepine 3. monitor client taking lamotrigine
(Tegretol) (Lamictal) for rashes because this can
5. rashes, which may lead to Stevens- lead to Stevens-Johnson syndrome.
Johnson Syndrome, a potentially life- 4. Instruct client to avoid taking an
threatening condition with lamotrigine anticonvulsant drug abruptly because
(Lamictal). seizures may result.
5. instruct the client to take as
CONTRAINDICATION/PRECAUTION prescribed.
1. impaired liver function:
carbamazepine (Tegretol) and valproic
acid (Depakote) MONOAMINE OXIDASE INHIBITORS
2. hypersensitivity ▪ Used primarily to treat
3. pregnancy depressive disorders.
4. urea cycle disorder ▪ Used less commonly than other
5. Lactation antidepressant due to the diet
restrictions indicated with their
TYPES use.
1. carbamazepine (Tegretol): acts ▪ Act by irreversibly inhibiting
through an antikindling process, is monoamine oxidase. This drug
metabolized in the liver, and has the metabolized in the liver.
potential for several drug interactions. ▪ 2 types:
2. valproic acid (Depakote): acts also a. MAO-A: oxidizes
through an antikindling process, is norepinephrine and serotonin
metabolized also in the liver. and is found primarily in the
3. lamotrigine (Lamictal): antiepileptic brain.
drug used frequently to treat bipolar b. MAO-B: oxidizes tyramine,
disorders. It acts by stabilizing neuronal dopamine, and
membranes. phenylethyamine and is found
4. gabapentin (Neurontin): an throughout the body.
antiepeliptic drug used for bipolar
disorder with an unknown mechanism USES
of action. 1. major depression
5. Topiramate (Topamax): a newer 2. atypical depression
antiepileptic drug used in bipolar 3. treatment-resistant depression
disorder, with an exact mechanism of
action unknown. ADVERSE REACTIONS
1. dizziness 3. insomnia
NURSING INTERVENTION 2. headache
1. instruct the client about the potential
adverse reactions. CONTRAINDICATION/PRECAUTION
1. Hypersensitivity 3. CVD them increasing the potential for
2. CHF 4. Liver disease abuse.
• May be used without a
TYPES prescription or illegally for
1. phenelzine (Nardil) weight loss.
2. tranylcypromine (Parnate)
3. selgiline (Eldepryl) USES
1. Attention- deficit hyperactivity
NURSING INTERVENTION disorder in children.
1. instruct the client to avoid driving or 2. adults who have residual attention-
operating heavy equipment while deficit disorder.
taking these until the effects are known. 3. Narcolepsy and daytime sleepiness
2. instruct client to avoid alcohol. 4. Treatment-resistant depression
3. instruct the client to avoid abruptly 5. Chronic medical conditions that are
discontinuing the use of MAOIs after debilitating, such as cancer and chronic
long-term use. fatigue syndrome.
4. instruct the client to chew sugar-free
gum, suck on hard candy, or take ice ADVERSE REACTION
chips or diet soda to reduce dry mouth. a. anorexia or appetite suppression
5. instruct the client to avoid foods high b. weight loss
in tyramine such as aged cheese, aged c. irritability
wines, and beers, which can precipitate d. abdominal pain
a hypertensive crisis. e. headaches
6. monitor the client taking a MAOI for f. insomnia
“hoarding” or “cheeking” the g. palpitations and tachycardia
medications to prevent any suicide
attempt. CONTRAINDICATION/PRECAUTION
1. Tourette’s syndrome (having “TICS”
that cannot stop from doing it)
STIMULANTS 2. History of drug abuse
• Drugs that result in increased 3. Anxiety and agitation
alertness and a feeling of 4. History of Cardiac Diseases
increased energy. 5. Hypertension
• There is a high potential for
abused. TYPES
• Act on the catecholamines at 1) Dextroamphetamine
postsynaptic receptor sites in the (Dexedrine)
brain. 2) Methylpenidate (Ritalin):
• Block the reuptake of commonly use in children
catecholamines which prolongs 3) Pemoline (Cylert): commonly
their action. use in children
• Increased attention and 4) Modafinil (Provigil): use to treat
concentration in any who takes Narcolepsy
NURSING INTERVENTION
a) Instruct the client about the
potential of abuse.
b) Monitor blood pressure
c) Monitor height and weight of a
child since the growth rate may
be decreased and appetite
depressed.
d) Instruct the client that drug
tolerance develops after long-
term use.
e) Instruct the client to avoid
caffeine which increases the
stimulant effect.

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