Presentation is loading. Please wait.

Presentation is loading. Please wait.

Central and Peripheral Nervous System Medications

Similar presentations


Presentation on theme: "Central and Peripheral Nervous System Medications"— Presentation transcript:

1 Central and Peripheral Nervous System Medications
Chapter 16

2 Learning Objectives Identify the major classes of drugs that affect the central nervous system List different actions of antimigraine products Explain the major actions of drugs used to treat disorders of the central nervous system Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 2 2

3 Antimigraine Agents Action
Block nerve impulses at receptors of the sympathetic nervous system Relieve pain by narrowing dilated cerebral arteries Uses Prevention and treatment of migraine headaches Drug Table 16-1 What is the cause of migraine headaches? What other actions in the body do antimigraine agents cause? How would you describe an “aura” that may occur before the onset of a migraine headache? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 3 3

4 Antimigraine Agents (cont.)
Adverse Reactions Drug Interactions Other vasoconstrictors, MAOIs Nursing Implications and Patient Teaching Assessment Diagnosis Planning Implementation Evaluation Patient Teaching: administration considerations What are common cardiac symptoms the patient may experience while taking antimigraine drugs? What are the symptoms of overdose the patient may experience? What significant medical history is a contraindication to using antimigraine drugs? Women who are pregnant should not use this drug. What activities should the patient follow after taking an antimigraine drug? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 4 4

5 Antimigraine Medications
Serotonin Receptor Agonists (-triptans) Axert almotriptan Maxalt rizatriptan Imitrex * sumatriptan Zomig zolmitriptan Relpax elatriptan Ergotamine Derivatives Migranal dihydroergotamine Ergomar ergotamine Cafergot caffeine & ergotamine

6 Anticonvulsants or Antiepileptic Drugs
Seizures: chaotic electrical discharges causing sudden muscle contractions that happen without conscious control Etiology: disease or disorders; head injury; idiopathic Four major drug classes Can you identify nonpharmacologic treatments for epilepsy? What is the diagnostic test used to determine whether seizures are present? Drugs used to treat seizures may slow abnormal electrical discharges in the CNS. The four major classifications of antiseizure drugs are barbiturates, benzodiazepines, hydantoins, and succinimides. What route of drug administration is often used when patients are newly diagnosed with a seizure? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 6 6

7 Barbiturates Action Long duration of action and sedative effect on the brain; action occurs in the brainstem Uses Status epilepticus; to prevent and control grand mal seizures May treat seizures caused by tetanus, fever, or drugs RX: phenobarbital* How are barbiturates classified? What are some of the adverse reactions seen with the use of this drug? If a patient is on an anticoagulant and then is prescribed a barbiturate, what type of interaction will occur? The nurse should instruct the patient to avoid alcohol, antihistamines, benzodiazepines, methotrimeprazine, narcotics, and tranquilizers when using this drug because of the additive effects that will occur when combined with barbiturates. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 7 7

8 Benzodiazepines Action
CNS depressants; suppress electrical discharge in seizures Uses Treat minor motor seizures; Lennox-Gastaut syndrome (petit mal) What are the names of the three benzodiazepine drugs approved for use as anticonvulsants? If the patient is experiencing adverse effects to this drug, would you expect the blood pressure to be high or low? What are the signs of benzodiazepine overdose? Additive sedative effects will be produced when benzodiazepines are combined with what other drugs? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 8 8

9 Benzodiazepines End in –lam or –pam Anticonvulsant as well as sedative
Valium diazepam Klonopin clonazepam Ativan lorazepam

10 Hydantoins Action Work primarily on the motor cortex, where they stop the spread of seizure activity by increasing or decreasing Na+ ion movement across the motor cortex during the generation of nerve impulses Uses Grand mal and psychomotor seizures, status epilepticus, migraines, and trigeminal neuralgia When a patient is exhibiting nystagmus, what will the nurse observe? Dosages for children are generally higher than for adults. Why? What laboratory values should be monitored when patients are taking hydantoins? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 10 10

11 Hydantoins Cause gingival hyperplasia
Cannot be given NG with feeding. MUST hold feeding for 2 hours before and after med. Cerebyx (name alert! Not Celebrex) fosphenytoin Dialntin phenytoin

12 Succinimides Action and Uses
Elevation of the seizure threshold in the cortex and basal ganglia and reduced synaptic response to low-frequency repetitive stimulation; controls petit mal seizures Drug Interactions Other antiseizure agents and bone marrow–depressing drugs RX: Zarontin (ethosuximide) What adverse reactions are seen with the use of succinimides? If used in combination with other anticonvulsant drugs, what may occur? Drug dependence occurs with indiscriminate use, and abrupt withdrawal is dangerous. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 12 12

13 Other Common Anticonvusants
Diamox acetazolamide Tegretol carbamazepine Neurontin gabapentin Lamictal lamotrigine Keppra levetiracetam Mysoline primidone Topamax topiramate Depakene / Depakote valproic acid Trileptal oxcarbazepine

14 Antiemetic-Antivertigo Agents
Action Factors that may provoke nausea and vomiting: some drugs, metabolic disorders, radiation, motion, gastric irritation, vestibular neuritis, or increases in central trigger zone dopamine levels or vomiting center acetylcholine levels Agents act to redirect stimulation by stopping or reducing stimulation of the vomiting center Uses Prevent and treat motion sickness or the nausea and vomiting that occur with surgery, anesthesia, and cancer treatment Which neurotransmitters are reduced to produce this effect? How does the presence of vertigo stimulate nausea and vomiting? When would these drugs be used to treat hiccups? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 14 14

15 Antiemetic and Antivertigo Meds
Anticholinergics Antihistamines Dramamine dimenhydrinate Benadryl diphenhydramine Antivert Dramamine Meclizine Other: Marinol (dronabinol) Transderm – Scop (scopolamine) Tigan (trimethobenzamide) Antidopaminergics Phenothiazines Thorazine chlorpromazine Compazine prochlorperazine Phenergan Promethazine Other: Reglan (metaclopramide)

16 Antiemetic and Antivertigo Meds
5 HT receptor antagonists Zofran ondansetron Many forms of the medication Given frequently for nausea in patients undergoing chemotherapy for cancer

17 Antiparkinsonian Agents
Actions Change the neurotransmitters produced in the brain: excessive acetylcholine, deficient dopamine Block the uptake of acetylcholine and elevate the functional levels of dopamine in the motor regulatory centers Uses Control of the symptoms of Parkinson disease What are the common symptoms seen in the patient with Parkinson disease? Treatment goals for Parkinson disease are designed to relieve symptoms and to maintain movement and activity of the patient. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 17 17

18 Antiparkinsonian Medications
Dopaminergic Symmetrel ammantadine Parlodel bromocriptine Sinemet carbidopa- levadopa Comtan entacapone Dopar levadopa Anticholinergic Cogentin benztropine Benadryl diphenhydramine

19 Dopamine Receptor Agonists, Nonergot
Mirapex (name alert! NOT Miralax) pramipexole Requip ropinirole

20 Learning Objectives Identify the role of psychotropic drugs in psychotherapeutic intervention Compare and contrast different categories of medications used to treat depression Identify the major classes of drugs that affect the central nervous system Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 20 20

21 Antianxiety Agents Some anxiety is common
It is problematic when it interferes with a person’s ability to perform activities of daily living Produces a calming effect Relieves anxiety, tension, and fear May be used to manage alcohol withdrawal symptoms; used preoperatively; used to relieve muscle spasm What are the subjective feelings associated with anxiety? What are the objective symptoms of anxiety? Why are antianxiety agents prescribed for short-term use? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 21 21

22 Antianxiety Medications
Benzodiazepine Xanax alprazolam Tranxene clorazepate Valium diazepam Ativan lorazepam Serax oxazepam Nonbenzodiazepine Buspar buspirone Vistaril hydroxizine

23 Tricyclic Antidepressants
Action Believed to inhibit the reuptake of norepinephrine and or/serotonin Uses To treat endogenous depression; mild depression due to exogenous causes amitriptyline nortriptyline Tofranil (imipramine) Sinequan (doxepin) What is the result when a drug prevents the reuptake of a neurotransmitter? If the patient is taking a tricyclic antidepressant and an anticonvulsant, what type of interaction may occur? What amount of time is usually required for an antidepressant to be effective? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 23 23

24 Monoamine Oxidase Inhibitors
Action and Uses Monoamine oxidase: naturally occurring enzyme found in the mitochondria of cells; located in nerve endings, kidneys, liver, and intestines; normally acts as catalyst to inactivate dopamine, norepinephrine, epinephrine, and serotonin MAO inhibitors (MAOIs) block inactivation of these biogenic amines, resulting in increased concentrations at neuronal synapses and antidepressant effects Nardil (phenelzine) Parnate (tranylcypromine) What are the symptoms of overdose, and how long could these last? MAOIs may cause very dangerous reactions if taken with certain foods or beverages high in tyramine or other vasopressor amines. What foods and beverages should the patient be instructed to avoid when taking this drug? Why would ECT (electroconvulsive therapy) be used in combination with antidepressants? When assessing the depressed patient, what is an important question the LPN/LVN should ask? How will the nurse evaluate the patient for postural hypotension? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 24 24

25 Selective Serotonin Reuptake Inhibitors (SSRI)
Action and Uses Act by inhibiting CNS neuronal uptake of serotonin Used short-term for treatment of outpatients with diagnosis listed as a category of Major Depressive Disorders in the DSM-IV Used long-term for dysthymic and minor depressive disorders What are the three antidepressant agents that act similarly to selective serotonin reuptake inhibitors (SSRIs) but are not part of this classification? What does the DSM-IV manual title stand for, and how is it used in psychiatric diagnosis? Which drugs may be displaced by the SSRIs if used in combination? What is the usual dosage levels for these drugs? What is the usual length of time from the onset of treatment before the patient begins to feel better? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 25 25

26 SSRI and other Miscellaneous Antidepressants
Celexa citalopram Lexapro escitalopram Prozac fluoxetine Paxil paroxetine Zoloft sertraline Tetracyclic Compounds Remeron mirtazapine Desyrel trazadone Unrelated Products Wellbutrin bupropion Cymbalta duloxetine Effexor venlafaxine

27 Antipsychotic Drugs Action and Uses
All antipsychotic agents act by blocking the action of dopamine in the brain Used in the treatment of severe mental illness May be used in combination with major tranquilizers Which mental illnesses may have psychotic symptoms? Antipsychotic drugs are grouped into two broad categories: (1) the phenothiazines and thioxanthenes and (2) the nonphenothiazines. Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 27 27

28 Antipsychotic Medications
Nonphenothiazine Antipsychotics Haldol haloperidol Zyprexa olanzapine Seroquel quetiapine Risperdal risperidone Geodon ziprasidone Aliphatic Phenothiazine Thorazine chlorpromazine Promazine promazine Piperazine phenothiazine Compazine prochlorperazine

29 Antimanics Action and Uses
Exact mechanism of lithium’s action is unknown; alters sodium transport at nerve endings and enhances uptake of serotonin and norepinephrine by the cells (inactivates these neurotransmitters) Mood-stabilizing drug Used to treat patients with bipolar disorder who are in acute manic phase; prevents recurrent manic episodes What patient symptoms would alert the nurse to a possible overdose of this drug? Which drug, when combined with lithium, places the patient at great risk for toxicity? What are signs that the patient may be experiencing a manic episode? Lithium has a very narrow therapeutic margin. What is a therapeutic serum lithium level? (1 to 1.5 mEq/mL) What activities should the patient avoid while taking lithium? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 29 29

30 Antimanic Medication Lithonate lithium
Lithium is a salt so it is retained when serum sodium is low. Excreted by the kidneys, so monitor the BUN and creatinine levels. May need to lower the doses in elderly patients.

31 Sedative and Hypnotics
Benzodiazepines -lams and -pams Phenobarbitals -barbs Aquachlor (chloral hydrate) Miscellaneous sleep aids Ambien (zolpidem) Lunesta (eszopiclone) Sonata (zaleplon)

32 Attention Deficit Hyperactivity Disorder (ADHD)
CNS stimulants increase blood flow to the frontal lobe where decision making is centered. Ritalin (methylphenidate) - stimulant Vyvanse (lisdexamfetamine)-phenethylamine and amphetamine Adderal (amphetamine) - psychostimulant Straterra (atomoxetine)- selective norepinephrine reuptake inhibitor How should the patient or caregiver monitor therapy with an ADHD drug? What class of drugs is contraindicated with ADHD stimulants? Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 32 32

33 Questions?


Download ppt "Central and Peripheral Nervous System Medications"

Similar presentations


Ads by Google