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INTRODUCTION

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atomoxetine (a-to-mox-e-teen)

Strattera

Classification

Therapeutic: agents for attention deficit disorder

Pharmacologic: selective norepinephrine reuptake inhibitors

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Indications
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Attention-Deficit/Hyperactivity Disorder (ADHD).

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Action
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Selectively inhibits the presynaptic transporter of norepinephrine. Therapeutic Effects: Increased attention span.

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Adverse Reactions/Side Effects
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CNS: SUICIDAL THOUGHTS, dizziness, fatigue, mood swings, behavioral disturbances, hallucinations, mania, thought disorder. Adults: insomnia. CV: hypertension, orthostatic hypotension, tachycardia. GI: dyspepsia, severe liver injury (rare), nausea, vomiting. Adults: dry mouth, constipation. Derm: rash, urticaria. GU: Adults: dysmenorrhea, ejaculatory problems, ↓ libido, erectile dysfunction, urinary hesitation, urinary retention. Metab:appetite, weight/growth loss. Misc: ALLERGIC REACTIONS, INCLUDING ANGIONEUROTIC EDEMA.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor signs of allergic reactions and angioneurotic edema. Signs include rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician of these signs immediately.

  • Be alert for signs of suicidal thoughts, especially in the initial period of drug therapy, and in children and teenagers. Likewise, inform physician if patient demonstrates other thought disturbances or behavioral changes such as mania, moods swings, or hallucinations.

  • Monitor attentiveness and behavior in patients with ADHD. Report any changes in attention and hyperactivity, and document whether this drug appears to be producing the desired effects.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report fast heart rate (tachycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP: either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Periodically assess body weight, and monitor growth rate in children. Report a rapid or unexplained weight loss or stunted growth.

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Interventions
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  • Because of the risk of arrhythmias and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

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Patient/Client-Related Instruction
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  • Instruct patient and family/caregivers to report other troublesome side effects, including severe or prolonged menstrual irregularities, sexual dysfunction, urinary dysfunction, skin reactions (rash, hives, itching), or GI problems (indigestion, nausea, vomiting, constipation, dry mouth).

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Pharmacokinetics
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Absorption: Well absorbed following oral administration.

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Distribution: Unknown.

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Protein Binding: 98%.

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