Brand: Sinemet, Rytary, Crexont, Duopa
Class: Antiparkinson agent; dopamine precursor plus decarboxylase inhibitor
Indications: Parkinson disease, postencephalitic parkinsonism, parkinsonism after carbon monoxide or manganese poisoning
Action: Levodopa crosses into the brain and becomes dopamine; carbidopa blocks its breakdown in the periphery
Adverse Effects: Dyskinesia, hallucinations and confusion, orthostatic hypotension, sudden sleep onset, nausea, impulse control problems
Contraindications: Nonselective MAOIs within 2 weeks, narrow-angle glaucoma, hypersensitivity
Interactions: Nonselective MAOIs, antipsychotics and metoclopramide (blunt effect), iron salts, high-protein meals
Nursing Considerations: Assess for dyskinesia and wearing-off; check orthostatic BP; give doses on time; abrupt stop can cause NMS-like fever and rigidity
Patient Teaching: Spread protein through the day and separate from iron; dark urine or sweat is harmless; report sleep attacks or new urges
Carbidopa is the bodyguard: it keeps levodopa from turning into dopamine before it reaches the brain, so less levodopa causes less nausea.
Card 2
pramipexole
Answer
Brand: None (Mirapex and Mirapex ER discontinued)
Class: Antiparkinson agent; non-ergot dopamine agonist
Indications: Parkinson disease, moderate to severe restless legs syndrome (immediate release only)
Action: Directly stimulates D2 and D3 dopamine receptors in the striatum
Adverse Effects: Falling asleep during daily activities, orthostatic hypotension, hallucinations, impulse control disorders, dyskinesia, nausea
Contraindications: None listed in the label
Interactions: Antipsychotics and metoclopramide (reduce effect), cimetidine, CNS depressants, levodopa (more dyskinesia)
Nursing Considerations: Check orthostatic BP during titration; ask about gambling, shopping or sexual urges; reduce dose in renal impairment; taper to stop
Patient Teaching: Do not drive until you know whether it causes sudden sleepiness; rise slowly; tell your provider about any new compulsive urges
A dopamine agonist skips the conversion step and works on the receptor itself, which is why it can be used alone in early Parkinson disease.
Card 3
benztropine
Answer
Brand: None (Cogentin discontinued)
Class: Antiparkinson agent; centrally acting anticholinergic
Indications: Adjunct for parkinsonism, drug-induced extrapyramidal reactions (not tardive dyskinesia)
Action: Blocks muscarinic receptors, restoring the dopamine-acetylcholine balance in the basal ganglia
Adverse Effects: Anhidrosis with fatal hyperthermia, urinary retention, paralytic ileus, confusion and toxic psychosis, tachycardia, blurred vision
Contraindications: Children under 3, hypersensitivity; avoid in angle-closure glaucoma
Interactions: Other anticholinergics, antipsychotics and tricyclic antidepressants (ileus, heat stroke)
Nursing Considerations: Monitor I&O and bowel sounds; watch for confusion in older adults; limit heat and exertion; does not treat tardive dyskinesia
Patient Teaching: Avoid hot weather and heavy exercise and stay hydrated; use sugar-free gum for dry mouth; report trouble urinating or constipation
Remember the anticholinergic picture: hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, full as a flask.
Card 4
donepezil
Answer
Brand: Aricept
Class: Antidementia agent; reversible acetylcholinesterase inhibitor
Indications: Alzheimer dementia, mild, moderate and severe
Action: Slows breakdown of acetylcholine in the brain, improving cholinergic transmission
Adverse Effects: Bradycardia and heart block with syncope, GI bleeding, nausea, vomiting, diarrhea, weight loss, seizures, muscle cramps
Contraindications: Hypersensitivity to donepezil or piperidine derivatives
Interactions: Anticholinergics (oppose effect), succinylcholine (exaggerated relaxation), NSAIDs (GI bleeding), CYP3A4 inducers
Nursing Considerations: Check apical pulse and ask about syncope or falls; monitor weight and for GI bleeding; tell anesthesia before surgery
Patient Teaching: Take once daily in the evening at bedtime; report fainting, black stools or vomiting that does not stop
Cholinesterase inhibitors boost acetylcholine everywhere, including the vagal heart, which is why bradycardia and syncope matter in frail elders.
Card 5
memantine
Answer
Brand: None (Namenda and Namenda XR discontinued)
Class: Antidementia agent; NMDA receptor antagonist
Indications: Moderate to severe Alzheimer dementia
Action: Blocks overstimulated NMDA glutamate channels, reducing excitotoxic signaling
Adverse Effects: Dizziness, headache, confusion, constipation
Contraindications: Hypersensitivity
Interactions: Urine alkalinizers such as sodium bicarbonate and carbonic anhydrase inhibitors (raise levels), amantadine, ketamine, dextromethorphan
Nursing Considerations: Monitor for dizziness and falls; reduce dose in severe renal impairment; watch for urine-alkalinizing drugs or conditions
Patient Teaching: Caregivers should report worsening confusion; ER capsules may be opened onto applesauce but not crushed or chewed
Donepezil turns acetylcholine up; memantine turns glutamate noise down, so the two act on different targets and are often used together.
Card 6
pyridostigmine
Answer
Brand: Mestinon, Regonol
Class: Antimyasthenic; reversible cholinesterase inhibitor
Indications: Myasthenia gravis; injection reverses nondepolarizing neuromuscular blockers
Action: Inhibits acetylcholinesterase so more acetylcholine is available at the neuromuscular junction
Adverse Effects: Cholinergic crisis with weakness and respiratory failure, bradycardia, bronchial secretions, salivation, diarrhea, cramps, fasciculations
Contraindications: Mechanical intestinal or urinary obstruction, hypersensitivity; caution in asthma
Interactions: Anticholinergics (oppose), succinylcholine (prolonged block), drugs that worsen myasthenia such as aminoglycosides
Nursing Considerations: Give exactly on schedule; assess swallowing and respiratory effort; keep atropine available; new weakness can mean too much or too little drug
Patient Teaching: Take doses exactly on time; report trouble breathing or swallowing at once; wear medical alert identification
Myasthenic crisis and cholinergic crisis both cause weakness, but cholinergic crisis adds SLUDGE signs such as drooling, sweating and diarrhea.
Card 7
phenytoin
Answer
Brand: Dilantin, Phenytek
Class: Antiseizure drug; hydantoin, sodium channel blocker
Indications: Tonic-clonic and focal seizures, status epilepticus (IV), seizures during or after neurosurgery
Action: Stabilizes neuronal membranes by slowing recovery of voltage-gated sodium channels
Adverse Effects: Hypotension and arrhythmias with rapid IV infusion (boxed), purple glove syndrome, SJS/TEN, DRESS, nystagmus and ataxia, gingival hyperplasia
Contraindications: Hydantoin allergy, prior phenytoin hepatotoxicity, delavirdine; IV in sinus bradycardia, SA block, 2nd or 3rd degree AV block, Adams-Stokes
Interactions: CYP inducer (lowers DOACs, contraceptives); warfarin effect unpredictable; amiodarone and azoles raise levels; valproate raises or lowers; tube feeds
Nursing Considerations: IV max 50 mg/min in adults, cardiac monitor, saline only, large vein; check site for purple glove; separate tube feeds per protocol
Patient Teaching: Brush and floss daily and see the dentist; do not switch brands without asking; report rash, unsteady gait or double vision
Phenytoin has saturable metabolism, so a small dose increase can produce a large jump in serum level and sudden toxicity.
Card 8
valproic acid
Answer
Brand: Depakote, Depakote ER
Class: Antiseizure drug and mood stabilizer; valproate
Indications: Focal and absence seizures, bipolar mania, migraine prevention
Action: Exact mechanism unknown; thought to increase brain GABA activity
Adverse Effects: Hepatotoxicity, pancreatitis, fetal harm with neural tube defects and lower IQ (all boxed), hyperammonemia, thrombocytopenia, tremor
Contraindications: Liver disease, POLG mitochondrial disorders, urea cycle disorders, migraine prevention in pregnancy or without effective contraception
Interactions: Carbapenems (sharply lower levels), lamotrigine (raises levels, rash risk), aspirin, topiramate (hyperammonemia)
Nursing Considerations: Check liver tests and platelets; report vomiting, abdominal pain or lethargy; check ammonia if mental status changes
Patient Teaching: Use effective birth control and plan pregnancy with your provider; report yellow skin, belly pain, easy bruising or confusion
The valproate boxed warning reads like a list of organs: liver, pancreas and the developing fetus.
Card 9
carbamazepine
Answer
Brand: Tegretol, Tegretol-XR, Carbatrol, Equetro
Class: Antiseizure drug and mood stabilizer; sodium channel blocker
Indications: Focal and tonic-clonic seizures, trigeminal neuralgia, bipolar I mania (Equetro)
Action: Blocks voltage-gated sodium channels, limiting repetitive neuronal firing
Adverse Effects: SJS/TEN linked to HLA-B*1502, aplastic anemia and agranulocytosis (both boxed), hyponatremia, DRESS, dizziness, ataxia
Contraindications: Bone marrow depression, MAOIs within 14 days, nefazodone, tricyclic hypersensitivity
Interactions: Strong CYP3A4 inducer that induces itself; lowers contraceptives and many drugs; grapefruit and macrolides raise levels
Nursing Considerations: Screen for HLA-B*1502 in at-risk Asian ancestry; check CBC and sodium; not for absence seizures or general pain
Patient Teaching: Use a backup birth control method; avoid grapefruit; report rash, sore throat, fever, bruising or mouth sores at once
Carbamazepine speeds its own metabolism over the first weeks, so levels drift down and doses often need adjusting.
Card 10
lamotrigine
Answer
Brand: Lamictal, Lamictal XR, Lamictal ODT, Subvenite
Class: Antiseizure drug and mood stabilizer; phenyltriazine sodium channel blocker
Indications: Focal and generalized seizures, Lennox-Gastaut syndrome, bipolar I maintenance (not acute mood episodes)
Action: Blocks voltage-gated sodium channels and reduces glutamate release
Adverse Effects: Serious rash including SJS/TEN (boxed), HLH, DRESS, aseptic meningitis, arrhythmia in structural heart disease, dizziness
Contraindications: Hypersensitivity
Interactions: Valproate more than doubles levels; estrogen contraceptives, carbamazepine and phenytoin lower levels
Nursing Considerations: Titrate exactly as ordered; stop at the first rash unless clearly unrelated; a restart after a gap needs re-titration; beware name mix-ups
Patient Teaching: Report any rash, fever or swollen glands right away; tell your provider before starting or stopping birth control pills
Rash risk rises with a fast start, too high a dose, or valproate, which is why lamotrigine is titrated over weeks.
Card 11
sumatriptan
Answer
Brand: Imitrex, Zembrace SymTouch, Tosymra
Class: Antimigraine agent; serotonin 5-HT1B/1D receptor agonist (triptan)
Indications: Acute migraine with or without aura; cluster headache (subcutaneous injection); not for prevention
Action: Constricts dilated cranial vessels and blocks release of inflammatory neuropeptides
Adverse Effects: Chest, throat or jaw tightness, coronary vasospasm, MI and arrhythmias, stroke, serotonin syndrome, medication overuse headache
Contraindications: CAD, Prinzmetal angina, WPW, stroke or TIA, PVD, uncontrolled HTN, hemiplegic or basilar migraine, severe liver disease
Interactions: Ergots or another triptan within 24 h, MAO-A inhibitors within 2 weeks, SSRIs and SNRIs (serotonin syndrome)
Nursing Considerations: Screen for cardiac risk before first dose; injection is subcutaneous only, never IV; check BP; ask how many days a month it is used
Patient Teaching: Take at the first sign of migraine pain; report chest pain that persists; limit use to avoid rebound headaches
Triptans squeeze blood vessels, so anything that already narrows coronary or cerebral vessels is a contraindication.
Card 12
sertraline
Answer
Brand: Zoloft
Class: Antidepressant; selective serotonin reuptake inhibitor (SSRI)
Indications: Major depression, OCD, panic disorder, PTSD, social anxiety disorder, PMDD
Action: Blocks serotonin reuptake, increasing serotonin in the synapse
Adverse Effects: Suicidal thoughts in children and young adults (boxed), serotonin syndrome, bleeding, hyponatremia, mania, sexual dysfunction
Contraindications: MAOIs within 14 days, linezolid or IV methylene blue, pimozide, disulfiram with oral concentrate
Interactions: Other serotonergic drugs (triptans, tramadol, lithium), NSAIDs, aspirin and warfarin (bleeding), QT-prolonging drugs
Nursing Considerations: Assess suicide risk early and after dose changes; screen for bipolar disorder; check sodium in older adults; taper to stop
Patient Teaching: Full effect takes several weeks; do not stop suddenly; report agitation, fever, sweating or worsening mood
SSRIs are a first-line choice largely because overdose is far less lethal than with older tricyclics or MAOIs.
Card 13
fluoxetine
Answer
Brand: None (Prozac and Symbyax discontinued)
Class: Antidepressant; selective serotonin reuptake inhibitor (SSRI)
Indications: Major depression, OCD, bulimia nervosa, panic disorder; bipolar and resistant depression with olanzapine (combination product)
Action: Blocks serotonin reuptake; active metabolite norfluoxetine has a very long half-life
Adverse Effects: Suicidal thoughts in children and young adults (boxed), serotonin syndrome, insomnia and anxiety, bleeding, hyponatremia, QT prolongation
Contraindications: MAOIs (wait 5 weeks after stopping fluoxetine), linezolid or IV methylene blue, pimozide, thioridazine
Interactions: Strong CYP2D6 inhibitor (raises many drug levels), serotonergic drugs, NSAIDs and warfarin (bleeding)
Nursing Considerations: Give in the morning if insomnia occurs; assess suicide risk early; dose changes take weeks to show; screen for bipolar disorder
Patient Teaching: Effects build over several weeks; report rash, agitation or thoughts of self-harm; avoid starting new drugs without asking
Fluoxetine's long half-life makes withdrawal mild but means a 5-week washout before any MAOI.
Card 14
venlafaxine
Answer
Brand: Effexor XR
Class: Antidepressant; serotonin-norepinephrine reuptake inhibitor (SNRI)
Indications: Major depression; ER form also GAD, social anxiety disorder, panic disorder
Action: Blocks reuptake of serotonin and norepinephrine
Adverse Effects: Suicidal thoughts in children and young adults (boxed), sustained hypertension, serotonin syndrome, bleeding, hyponatremia, nausea, sweating
Contraindications: MAOIs (14 days off before starting, 7 days off before an MAOI), linezolid or IV methylene blue, hypersensitivity
Interactions: Other serotonergic drugs, NSAIDs, aspirin and warfarin (bleeding), CYP3A4 inhibitors
Nursing Considerations: Check BP at baseline and regularly; assess suicide risk; taper slowly to avoid discontinuation symptoms; check sodium in older adults
Patient Teaching: Take with food; swallow ER capsules whole; do not stop suddenly; report severe headache or dizziness
Norepinephrine is the extra piece in an SNRI, which explains the dose-related rise in blood pressure.
Card 15
bupropion
Answer
Brand: Wellbutrin SR, Wellbutrin XL, Aplenzin, Forfivo XL
Class: Antidepressant; norepinephrine-dopamine reuptake inhibitor (aminoketone)
Indications: Major depression, seasonal affective disorder prevention, smoking cessation (some generic SR tablets)
Action: Weakly blocks reuptake of norepinephrine and dopamine
Adverse Effects: Dose-related seizures, suicidal thoughts in children and young adults (boxed), hypertension, agitation, insomnia, mania
Contraindications: Seizure disorder, bulimia or anorexia, abrupt stop of alcohol, benzodiazepines or AEDs, MAOIs within 14 days
Interactions: CYP2D6 inhibitor (raises many drug levels), drugs that lower seizure threshold, other bupropion products
Nursing Considerations: Screen for seizure and eating-disorder history; check BP; confirm only one bupropion product; give the last dose early
Patient Teaching: Do not crush or chew ER tablets; do not double a missed dose; limit alcohol
Bupropion has little serotonin effect, so it rarely causes sexual dysfunction or weight gain, but it lowers the seizure threshold.
Card 16
mirtazapine
Answer
Brand: Remeron, RemeronSolTab
Class: Antidepressant; noradrenergic and specific serotonergic antidepressant (alpha-2 antagonist)
Indications: Major depression in adults
Action: Blocks presynaptic alpha-2 receptors, increasing norepinephrine and serotonin release
Adverse Effects: Suicidal thoughts in children and young adults (boxed), agranulocytosis, somnolence, increased appetite and weight gain, serotonin syndrome, QT prolongation
Contraindications: MAOIs within 14 days, linezolid or IV methylene blue, hypersensitivity
Interactions: CNS depressants and alcohol, other serotonergic drugs, QT-prolonging drugs, strong CYP3A4 inhibitors or inducers
Nursing Considerations: Give at bedtime; monitor weight, cholesterol and triglycerides; sore throat or fever needs a CBC; assess suicide risk early in therapy
Patient Teaching: Expect drowsiness and increased appetite; avoid alcohol; report fever, sore throat or mouth sores right away
Mirtazapine's sedation and appetite boost can be useful for depressed patients who cannot sleep or eat.
Card 17
phenelzine
Answer
Brand: Nardil
Class: Antidepressant; nonselective monoamine oxidase inhibitor (MAOI)
Indications: Atypical depression not responding to other antidepressants
Action: Irreversibly inhibits MAO-A and MAO-B, raising norepinephrine, serotonin and dopamine
Adverse Effects: Hypertensive crisis, suicidal thoughts in children and young adults (boxed), serotonin syndrome, orthostatic hypotension, hepatotoxicity
Contraindications: Pheochromocytoma, HF, liver disease, severe renal disease, tyramine foods, sympathomimetics, other antidepressants
Interactions: Meperidine, dextromethorphan, SSRIs and SNRIs, bupropion, buspirone, decongestants and stimulants, epinephrine
Nursing Considerations: Monitor BP; ask about occipital headache, palpitations or stiff neck; 14-day washout (5 weeks after fluoxetine); stop before elective surgery
Patient Teaching: Avoid aged cheese, cured meats, beer and wine, sauerkraut and other tyramine foods until 2 weeks after stopping; no OTC cold or cough products
Tyramine is normally destroyed by gut MAO; with an MAOI it reaches the blood and releases norepinephrine, causing a hypertensive crisis.
Card 18
lithium
Answer
Brand: Lithobid
Class: Mood stabilizer; monovalent cation
Indications: Bipolar I disorder, acute manic or mixed episodes and maintenance
Action: Alters sodium transport and neurotransmitter signaling; exact mechanism unknown
Adverse Effects: Toxicity near therapeutic levels (boxed), nephrogenic DI, hypothyroidism, hypercalcemia, tremor, Brugada unmasking
Contraindications: Hypersensitivity per label; label warns of high toxicity risk in renal disease, dehydration or sodium depletion
Interactions: Diuretics, ACE inhibitors, ARBs, NSAIDs and metronidazole raise levels; serotonergic drugs; antipsychotics
Monitoring: Serum lithium 12 h after last dose until stable and after any dose, drug or illness change; electrolytes, kidney and thyroid function, serum calcium
Nursing Considerations: Draw levels 12 h after the last dose; hold and report vomiting, diarrhea, coarse tremor, ataxia or confusion; ask about NSAIDs or diuretics
Patient Teaching: Keep salt and fluid intake steady and drink extra in heat, fever or diarrhea; do not take OTC NSAIDs without asking
Lithium is handled like sodium by the kidney, so anything that drops sodium or fluid makes lithium climb.
Card 19
quetiapine
Answer
Brand: Seroquel, Seroquel XR
Class: Antipsychotic; second-generation (atypical) dopamine and serotonin antagonist
Indications: Schizophrenia, bipolar mania and depression, bipolar maintenance; XR also MDD adjunct
Action: Antagonizes D2 and 5-HT2A receptors; strong histamine blockade causes sedation
Adverse Effects: Death in dementia-related psychosis and suicidality (boxed), metabolic changes, orthostatic hypotension, QT, NMS, cataracts
Contraindications: Hypersensitivity
Interactions: Strong CYP3A4 inhibitors (large dose cut) and inducers, CNS depressants, QT-prolonging drugs, antihypertensives
Nursing Considerations: Monitor weight, glucose and lipids; check orthostatic BP and use fall precautions; periodic eye exams for cataracts
Patient Teaching: Rise slowly; expect drowsiness and avoid alcohol; report fever with stiff muscles or excessive thirst and urination
Quetiapine is the sleepiest common atypical because of its antihistamine effect, which also drives falls in older adults.
Card 20
risperidone
Answer
Brand: Risperdal, Risperdal Consta, Uzedy, Rykindo
Class: Antipsychotic; second-generation (atypical) dopamine and serotonin antagonist
Indications: Schizophrenia, bipolar I mania, irritability with autism in children 5 to 17
Action: Antagonizes D2 and 5-HT2A receptors
Adverse Effects: Death in dementia-related psychosis (boxed), hyperprolactinemia, EPS, metabolic changes, orthostatic hypotension, NMS, TD
Contraindications: Hypersensitivity to risperidone or paliperidone
Interactions: Carbamazepine and other inducers (lower levels), fluoxetine and paroxetine (raise levels), CNS depressants
Nursing Considerations: Assess for EPS and tardive dyskinesia; monitor weight, glucose and lipids; ask about breast changes or missed periods; check orthostatic BP
Patient Teaching: Rise slowly; stay hydrated in hot weather; report fever with muscle rigidity, breast discharge or a prolonged erection
Risperidone raises prolactin more than most atypicals, so ask about gynecomastia, galactorrhea and missed periods.
Card 21
clozapine
Answer
Brand: Clozaril, Versacloz
Class: Antipsychotic; second-generation (atypical) dibenzodiazepine
Indications: Treatment-resistant schizophrenia, recurrent suicidal behavior in schizophrenia or schizoaffective disorder
Action: Antagonizes D2 and 5-HT2A receptors, with weaker D2 binding than most antipsychotics
Adverse Effects: Boxed: severe neutropenia, orthostasis with bradycardia and syncope, seizures, myocarditis and cardiomyopathy, dementia deaths; ileus, drooling
Contraindications: Hypersensitivity
Interactions: Strong CYP1A2 inhibitors (fluvoxamine, ciprofloxacin), smoking changes, other drugs that cause neutropenia or constipation
Monitoring: ANC weekly for 6 months, every 2 weeks to month 12, then monthly (label; REMS ended 2025); bowel function; myocarditis signs
Nursing Considerations: Get baseline ANC; assess bowel pattern every shift; fever, chest pain or tachycardia needs prompt evaluation; titrate slowly
Patient Teaching: Report sore throat, fever or flu-like symptoms right away; report constipation early; tell your provider if you start or quit smoking
Clozapine works when others fail, but its biggest killers are neutropenia and constipation that progresses to ileus.
Card 22
buspirone
Answer
Brand: Bucapsol
Class: Anxiolytic; azapirone, serotonin 5-HT1A partial agonist
Indications: Anxiety disorders (efficacy shown in generalized anxiety disorder), short-term relief of anxiety symptoms
Action: Partial agonist at 5-HT1A receptors; no effect on GABA or benzodiazepine receptors
Adverse Effects: Dizziness, nausea, headache, nervousness, lightheadedness, serotonin syndrome with other serotonergic drugs
Contraindications: Hypersensitivity; do not combine with MAOIs
Interactions: Strong CYP3A4 inhibitors such as ketoconazole and grapefruit juice (raise levels), rifampin (lowers), serotonergic drugs
Nursing Considerations: Not for PRN use or acute panic; will not prevent benzodiazepine withdrawal, so taper a benzodiazepine separately; low sedation and abuse risk
Patient Teaching: Take daily and consistently, always with food or always without; it does not give immediate relief; avoid large amounts of grapefruit juice
Buspirone is the anxiolytic with no sedation, no dependence and no quick relief, which makes it a poor rescue drug and a good daily one.
Card 23
zolpidem
Answer
Brand: Ambien, Ambien CR, Edluar
Class: Sedative-hypnotic; nonbenzodiazepine GABA-A receptor modulator (Schedule IV)
Indications: Short-term treatment of insomnia with trouble falling asleep (CR also staying asleep)
Action: Binds the benzodiazepine site on GABA-A receptors containing the alpha-1 subunit
Adverse Effects: Complex sleep behaviors such as sleep-driving (boxed), next-day impairment, CNS and respiratory depression, abnormal thinking
Contraindications: Prior complex sleep behavior on zolpidem, hypersensitivity
Interactions: Opioids, alcohol and other CNS depressants, CYP3A4 inhibitors and inducers
Nursing Considerations: Give only if 7 to 8 h of sleep remain; lower starting dose for women and older adults; fall precautions; avoid in severe liver disease
Patient Teaching: Take right before bed, not with or after a meal; no alcohol; stop and report any sleepwalking or sleep-driving
Zolpidem leaves women's blood more slowly, which is why the label gives them a lower starting dose and warns about morning driving.
Card 24
methylphenidate
Answer
Brand: Ritalin, Concerta, Jornay PM, Quillivant XR
Class: CNS stimulant; dopamine and norepinephrine reuptake inhibitor (Schedule II)
Indications: ADHD in patients 6 and older, narcolepsy (some products)
Action: Blocks reuptake of dopamine and norepinephrine in the brain
Adverse Effects: Abuse, misuse and addiction (boxed), raised BP and HR, psychosis or mania, growth suppression, priapism, Raynaud
Contraindications: MAOIs within 14 days, hypersensitivity
Interactions: MAOIs (hypertensive crisis), antihypertensives (less effect), halogenated anesthetics on surgery day
Nursing Considerations: Assess cardiac history and abuse risk before starting; monitor BP, HR, height and weight; count and secure doses; watch for new tics
Patient Teaching: Take in the morning to limit insomnia; swallow ER products whole; keep in a locked place and never share
Stimulants are Schedule II, so treat every dose like an opioid: count it, secure it and document it.
Card 25
baclofen
Answer
Brand: Ozobax DS, Fleqsuvy, Lyvispah, Lioresal Intrathecal, Gablofen
Class: Skeletal muscle relaxant; centrally acting GABA analog
Indications: Spasticity from multiple sclerosis or spinal cord injury and disease; intrathecal for severe spasticity
Action: Inhibits reflexes at the spinal level, likely by acting on GABA-B receptors
Adverse Effects: Intrathecal abrupt stop: high fever, altered mental status, rebound spasticity, rhabdomyolysis, death (boxed); oral abrupt stop: hallucinations, seizures
Contraindications: Hypersensitivity
Interactions: Alcohol, opioids, benzodiazepines and other CNS depressants
Nursing Considerations: Never stop abruptly; reduce dose in renal impairment; for pumps, track refill dates and alarms; monitor for drowsiness, weakness and falls
Patient Teaching: Do not stop suddenly; avoid alcohol and driving until you know the effect; keep every pump refill appointment
Baclofen withdrawal can look like sepsis or NMS, so a missed intrathecal refill is an emergency.