palpitations. The most common long-term problem
with stimulants is the growth and weight suppression
that occurs in some children. This can usually be pre-
vented by taking “drug holidays” on weekends and
holidays or during summer vacation, which helps to
restore normal eating and growth patterns.
odorant, and over-the-counter medications such as
cough preparations contain alcohol; when used by
the client taking disulfiram, these products can pro-
duce the same reaction as drinking alcohol. The
client must read product labels carefully and select
items that are alcohol-free.2 NEUROBIOLOGICTHEORIES ANDPSYCHOPHARMACOLOGY 41
WARNING: Pemoline
Can cause life-threatening liver failure, which
can result in death or require liver transplanta-
tion in 4 weeks from the onset of symptoms. The
physician should obtain written consent prior to
the initiation of this drug.WARNING: Disulfiram
Never give to a client in a state of alcohol intoxi-
cation or without the client’s full knowledge. In-
struct the client’s relatives accordingly.CLIENT TEACHING
The potential for abuse exists with stimulants, but
this is seldom a problem in children. Taking doses of
stimulants after meals may minimize anorexia and
nausea. Caffeine-free beverages are suggested; clients
should avoid chocolate and excessive sugar. Most
important is to keep the medication out of the child’s
reach because as little as a 10-day supply can be fatal.
Disulfiram (Antabuse)
Disulfiram is a sensitizing agent that causes an ad-
verse reaction when mixed with alcohol in the body.
This agent’s only use is as a deterrent to drinking
alcohol in persons receiving treatment for alcoholism.
It is useful for persons who are motivated to abstain
from drinking and who are not impulsive. Five to ten
minutes after someone who is taking disulfiram in-
gests alcohol, symptoms begin to appear: facial and
body flushing from vasodilation, a throbbing headache,
sweating, dry mouth, nausea, vomiting, dizziness,
and weakness. In severe cases, there may be chest
pain, dyspnea, severe hypotension, confusion, and
even death. Symptoms progress rapidly and last
from 30 minutes to 2 hours. Because the liver
metabolizes disulfiram, it is most effective in per-
sons whose liver enzyme levels are within or close
to normal range.
Disulfiram inhibits the enzyme aldehyde dehy-
drogenase, which is involved in the metabolism of
ethanol. Acetaldehyde levels are then increased from
5 to 10 times higher than normal, resulting in the
disulfiram–alcohol reaction. This reaction is potenti-
ated by decreased levels of epinephrine and norepi-
nephrine in the sympathetic nervous system caused
by inhibition of dopamine beta-hydroxylase (Drug
Facts and Comparisons, 2002).
Education is extremely important for the client
taking disulfiram. Many common products such as
shaving cream, aftershave lotion, cologne, and de-
Other side effects reported by persons taking
disulfiram include fatigue, drowsiness,halitosis,
tremor, or impotence. Disulfiram also can interfere
with the metabolism of other drugs the client is taking
such as phenytoin (Dilantin), isoniazid (INH), war-
farin (Coumadin), barbiturates, and long-acting ben-
zodiazepines such as diazepam and chlordiazepoxide.CULTURAL CONSIDERATIONS
Studies have shown that people from different ethnic
backgrounds respond differently to certain drugs used
to treat mental disorders. The nurse should be famil-
iar with these cultural differences.
Studies have shown that African Americans re-
spond more rapidly to antipsychotic medications and
tricyclic antidepressants than Caucasians do. Also,
African Americans have a greater risk of develop-
ing side effects from both these classes of drugs than
do Caucasians (Lawson, 1996; Sramek & Pi, 1996).
Asians metabolize antipsychotics and tricyclic anti-
depressants more slowly than do Caucasians and,
therefore, require lower dosages to achieve the same
effects (Ruiz et al., 1996). Hispanics also require lower
dosages of antidepressants than do Caucasians to
achieve the desired results (Kudzma, 1999).
Asians respond therapeutically to lower dosages
of lithium than do Caucasians (Sramek & Pi, 1996).
African Americans have higher blood levels of lithium
than Caucasians when given the same dosage, and
they also experience more side effects (Sramek & Pi,
1996). This suggests that African Americans require
lower dosages of lithium than do Caucasians to pro-
duce desired effects (Lawson, 1996).
Herbal medicines have been used for hundreds of
years in many countries and are now being used with
increasing frequency in the United States. St. John’s
wort is used to treat depression and is the second most
commonly purchased herbal product in the United
States (Beaubrun & Gray, 2000). Kava is used to treat
anxiety and can potentiate the effects of alcohol, benzo-