drug of the central nervous system

8/7/2019 drug of the central nervous system

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DRUGS AFFECTING THE

CENTRAL NERVOUS SYSTEM


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DRUGS AFFECTINGMENTAL FUNCTIONING


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I. Antianxiety/Anxiolytics

Benzodiazepines: alprazolam

(Xanax), chlordiazepoxide

(Librium), diazepam (Valium),

lorazapam (ativan)

Action: increases GABA,depresses CNS and limbic

system

Nonbenzodiazepines: buspirone

(Buspar)Warnings: Hypersensitivity,

elderly, COPD, depression

Side Effects:

1. Drowsiness

2. Decreased BP

3. Dizziness4. Dependence

5. Liver dysfunction

6. Respiratory

depression7. Blood dyscrasias


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A

void abrupt d/c

N- ot give if BP, renal/hepatic dysfunction , Hx. Of drugabuse

X

anax, Ativan : a few examples

I ncreased in 3 Ds

E nhances action of GABA

T each to rise slowly

Y es! Alcohol is out

I. Antianxiety/Anxiolytics


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Antidepressants


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Tricyclic Antidepressants

Nursing Responsibility:

1. Instruct client to change

position slowly

2. Administer daily dose

preferably at bedtime

3. Avoid alcohol

4. Promote safety24/7

amitryptiline (Elavil), imipramine (Tofranil), nortriptyline (Aventyl,

Pamelor), desipramine (Norpramin)

Action: receptor

sensitivity to serotonin and

norepinephrine

Warnings: urinary retention,

glaucoma, seizure, P/L

Side Effects:

1. Hypotension

2. Anticholinergic effects/arrhythmias3. Tachycardia

4. Sedation


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SSRI (Selective Serotonin Reuptake Inhibitors)

Use: Depression, OCD, Panic

disorder, and appetite disorder

Side Effects:1. CNS stimulant

2. Nervousness

3. GI distress

4. Skin rash

5. Sexual dysfunction

6. Photosensitivity

7. Seizure

Nursing Responsibility

1. Initiate safety precaution

2. Administer with snack or

meals to reduce risk of

dizziness

3. Administer early in the day

4. Monitor for priapism

fluoxetine (Prozac), fluvoxamine (Luvox), paroxetineHcl(Paxil), citalopram (Celexa), sertraline Hcl(

Zoloft)


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MAOI (Monoamine Oxidase Inhibitor)

phenelzine sulfate (Nardil),

isocarboxazid

(Marplan),tranylcypromine

sulfate(Parnate)

Warnings: hypotension,

uncontrolled

hypertension, CHF,

pheochromocytoma,

headache

Side Effects:

1. Orthostatic hypotension

2. CNS effects: agitation,

headache, anxiety, mania

3. Delay ejaculation

4. GI distress

5. Anticholinergic effects

6. Photosensitivity

7. Hypertensive crisis, if foodcontains Tyramine


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1. Monitor BP!!

2. Rise slowly

3. Administer with food , ifwith GI distress

4. Avoid administering at

evening

5. Avoid caffeine, OTC meds,

Tyramine containing food

MAOI (Monoamine Oxidase Inhibitor)


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III. Antimanic/Mood Stabilizers

lithium carbonate (Eskalith,

Lithobid, Lithonate),

carbamazepine (Tegretol),

divalproex sodium (Depakote),

gabapentin (Neurontin)

Action: Increases norepinephrineand serotonin uptake

Use: Bipolar disorders, manic

episodes

Precaution: hypertension ,

dehydration, elderly

Side Effects:1. Polyuria

2. Anorexia, nausea, thirst,

dry mouth

3. Abdominal bloating4. Fine hand tremors

5. Inability to concentrate

6. Headache


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III. Antimanic/Mood Stabilizers


1. Monitor for lithium toxicity: Normal level is 0.6 to 1.2 mEq/L

Mild Toxicity: lethargy, coarse hand tremors, slight muscle weakness,

mild ataxia

Moderate Toxicity: nausea, vomiting, severe diarrhea, tinnitus,

slurred speech, muscle twitching, irregular tremors Severe Toxicity: nystagmus, muscle fasciculations, deep tendon

hyperreflexia, Oliguria/Anuria, impaired LOC, tonic-clonic seizures

2. Administer med with food

3. Increase fluid intake

4. Avoid coffee, tea, cola, and alcohol (Diuretic effect)


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IV. Antipsychotic

chlorpromazine Hcl(Thorazine),fluphenazine (Prolixin),

rifluoperazine (Stelazine),

haloperidol(Haldol), risperidone

(Risperdal), clozapine (Clozaril)

Action: Block dopamine receptor

sites, depresses limbic system,

control aggression. Antiemetic

Use: Schizoprenia, mania,

agitation, delusional disorder

Side Effects:

1. Sedation

2. Photosensitivity

3. Tachycardia, tremors

4. Anticholinergic effect

5. Hypotension6. Drowsiness

7. Agranulocytosis

8. Extrapyramidal Syndrome:

a. Parkinsonism

b. Dystonia

c. Tardive dyskinesia

d. Akathisia


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1. Monitor for EPS: Tx: anticholinergics

2. Teach that urine may turn pink or reddish

brown

3. Change position slowly

4. Administer med with food or milk

5. Avoid alcohol

IV. Antipsychotic


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I. AnticonvulsantsAction: depress abnormal neuronal discharges and prevent

the spread of seizures

General Interventions:

1. Give with food to decrease GI irritation, avoid giving with

milk and antacids, impairs absorption2. Do not discontinue

3. Avoid alcohol and OTC drugs

4. Maintain good oral hygiene

5. Monitor serum glucose levels

6. Note that urine may turn pink-red or red-brown color


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A. Hydantoins - phenytoin(Dilantin)

Use: treat seizures

Side Effects:

1. Gingival hyperplasia

2. Slurred speech

3. Confusion, depression

4. GI distress

5. Blood dyscrasia: decreased

platelet and WBC

6. Elevated blood glucose

7. Hirsutism

Use: tonic-clonic seizures,

status epilepticus

Side Effects:

1. Drowsiness, dizziness

2. Hypotension

3. Respiratory depression

4. Tolerance to medication

I. Anticonvulsants

B. Barbiturates phenobarbital(Luminal)


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Use: treat absence seizuresSide Effects:

1. Ataxia

2. Respiratory and cardiac

depression3. Drug dependency

D. valproicacid(

Depakote, Depakene)Use: seizures, manic episodes

Side Effects:

1. GI distress

2. Weight gain

3. Sedation, Confusion

4. Tremor

5. HepatotoxicNursing Responsibility: Avoid

carbonated beverages

I. Anticonvulsants

C. Benzodiazepines

diazepam(Valium),

lorazepam (Ativan)


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A. carbamazepine(Tegretol),Use: tonic-clonic, mixed seizures

Side Effects:

1. Anorexia (sign of toxicity)

2. Nausea

3. Dizziness and sedation

4. Headaches

5. Dry mouth

6. Constipation

Nursing Responsibility: Give with

food, milk

B. gabapentin(Neurontin)

Use: partial seizures

Side Effects:

1. Dizziness2. Insomnia

3. Somnolence

4. Ataxia

5. Nervousness

6. Nausea/vomiting

7. Rhinitis, pruritus

II. Antiepileptic:


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IV. Antiparkinsonian Medication

A. Dopaminergic Drugs

amantadine (Symmetrel),

bromocriptine (Parlodel),

levodopa, carbidopa-levodopa

(Sinemet)

Action: stimulates dopamine

receptors increasing the amount

of dopamine available for CNS

CI: cardiac, renal, psychiatric

disorder

Side Effects:

1. Dyskinesia

2. Involuntary movements

3. Tachycardia4. Nausea and Vomiting

5. Urinary retention, constipation

6. Hypotension, dizziness

7. Confusion

8. Mood changes

9. Hallucinations


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1. Promote safety

2. Give with food, if nausea and vomiting occurs

3. carbidopa-levodopa: avoid high protein diet

4. Change position slowly

5. Avoid alcohol

6. DO not discontinue drug abruptly

A. Dopaminergic Drugs


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B. Anticholinergics

benztropine mesylate

(Cogentin), biperiden

hydrochloride (Akineton),trihexyphenidyl Hcl

(Artane),

Action: Suppresses Ach

activity, reducing the

rigidity tremors

CI: Glaucoma, COPD

Side Effects:

1. Blurred vision

2. Dry mouth and dry

secretions3. Increased PR

4. Constipation

5. Urinary retention

6. Restlessness and confusion

7. Photophobia


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1. Avoid alcohol, smoking, caffeine, andaspirin

2. Avoid OTC meds

3. Relieve dry mouth and constipation4. Use sunglasses


B. Anticholinergics

drug of the central nervous system

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