THE central NERVOUS SYSTEM DRUGS

Ma. Biehn Kyrsti S. Guevarra, SN12

Central Nervous System

Peripheral Nervous System

Brain Spinal Cord

Somatic NS

ANS

SympatheticParasympathetic

CNS STIMULANTS

I. AMPHETAMINES

• Stimulates the release of neurotransmitters – norepi and

dopamine

INDICATIONS: narcolepsy, ADHD

I. AMPHETAMINESS/E and A/R: restlessness, insomnia,

tachycardia, HPN, heart palpitations, dry mouth, anorexia, weight loss, diarrhea or constipation, and impotence

II. AMPHETAMINE-LIKE DRUGS

- increases child’s attention span, cognitive performance and to decrease impulsiveness, hyperactivity and restlessness

Ex: Methylphenidate (Ritalin) - ADHD

Pemoline (Cylert) – narcolepsy

Modafinil (Provigil) – newest, narcolepsy

NURSING RESPONSIBILITIES

1. RITALIN and Pemoline should be given 30 to 45 minutes before meals (breakfast and lunch)

2. Give within 6 hours before sleep3. Instruct the patient to avoid driving4. Instruct the nursing mother to avoid

taking CNS stimulants5. Explain to client that long-term use may

lead to drug abuse.

III. ANOREXIANTS

Aka as APPETITE SUPPRESSANTS

Ex: Phenylpropanolamine

S/E: nervousness, restlessness, irritability, insomnia, heart palpitations & HPN.

III. ANALEPTICS

- stimulate respiration

Ex: METHYXANTHINES: caffeine &theophylline

S/E: nervousness, restlesness, tremors, twitchings, palpitations and insomnia, diuresis, GI irritation, tinnitus

IV. RESPIRATORY CNS STIMULANTS

Ex: DOXAPRAM (DOPRAM)

-Treat respiratory depression caused by drug overdose, pre-post anesthetic respiratory depression, and COPD

• IV• S/E: HPN, tachycardia, trembling, and

convulsions

HEADACHES: Migraine & Cluster

• Migraine headache : Classic & common• Cluster headache

TX:• Propranolol• Valproic acid• Aminotriptylline

CNS DEPRESSANTS

I. SEDATIVE-HYPNOTICS

• SEDATION – diminish physical and mental response at a lower dosages of certain CNS depressants but does not affect consciousness

• HYPNOTIC EFFECT – form of natural sleep

I. SEDATIVE-HYPNOTICS

• Barbiturates• Benzodiazepines• Nonbenzodiazepines• Piperidinediones• Chloral Hydrate

A. Barbiturates• LONG ACTING

-used to control seizures in epilepsyEx: Phenobarbital and Mephobarbital

• INTERMEDIATE-ACTING - sleep sustainers for maintaining

long period of sleepEx:- Amobarbital (Amytal)

- Aprobarbital (Alurate)- Butabarbital (Butisol)

A. Barbiturates

• SHORT-ACTING- induce sleep for those difficulty

falling asleepEx:- Secobarbital (Seconal)

- Pentobarbital (Nembutal)

• ULTRASHORT-ACTING- general anesthetics

Ex: Thiopental Na (Pentothal)

BARBITURATES NURSING RESPONSIBILITIES

• Raise bedside rails .• Check skin for rashes.• Do not mix pentobarbital w/ other

medications. • Teach client to use non pharmacologic ways

to induce sleep.• Instruct to avoid alcohol and antidepressant,

antipsychotic and narcotics.

B. Benzodiazepines

ACTION: increase the action of inhibitory neurotransmitter GABA

Ex:• FLURAZEPAM (DALMANE) – first

- used to treat insomnia • Triazolam (Halcion) – A/R: loss of memory• Temazepam (Restoril), Estazolam (ProSom),

Quazepam (Doral)• Diazepam (Valium), Lorazepam (Ativan)

BENZODIAZEPINES NURSING RESPONSIBILITIES

1. Teach non-pharmacologic ways to induce sleep

2. Avoid alcohol, antidepressants, antipsychotics

3. Urinate before taking the drug

4. No OTC drugs

5. Caution in driving

C. Non-benzodiazepines

ZOLPIDEM (AMBIEN)

- Short term treatment of Insomnia

CHLORAL HYDRATE- Induces sleep and decrease nocturnal awakenings

ANESTHETICS

STAGES OF GENERAL ANESTHESIA

1. ANALGESIA

2. DELIRIUM OR EXCITEMENT

3. SURGICAL STAGE

4. MEDULLARY PARALYSIS

BALANCED ANESTHESIA

Components: (HyPreSIM)• Hypnotic• Premedication (narcotic and

benzodiazepine) & anticholinergic• Short acting barbiturate• Inhaled gas• Muscle relaxant

INHALATION ANESTHETICS

• Gas or volatile liquids• Nitrous oxide

Ex: Halothane, isoflurane, desflurane, enflurane, sevoflurane

Nitrous oxide, cyclopropane

A/R: respiratory depression, hypotension, dysrhythmias, hepatic dysfunction

INTRAVENOUS ANESTHETICS

-May be used as general anesthesia

Ex: Thiopental sodium (pentothal)

Droperidol (Innovar)

Ketamine HCl (ketalar)

Midazolam (Versed) & Propofol (Diprivan)

A/R: respiratory and cardiovascular effects

TOPICAL ANESTHETICS

• Mucous membrane; broken or unbroken skin surface, burns

• Solution, liquid spray, ointment, cream, and gel

LOCAL ANESTHETICS

- Blocks pain at site where it’s administered & doesn’t produce loss of consciousness

Ex: Lidocaine (Xylocaine)

SPINAL ANESTHESIA

- Local anesthesia is injected into subarachnoid space 3rd ot 4th lumbar space

Nerve block: spinal block (subarachnoid space); epidural block (dura mater); caudal block (near the sacrum); saddle block (lower end of spinal column)

S/E and A/R: respi distress, headache, hypotension

ANTICONVULSANTS

Classification of seizures

• Tonic-Clonic • Tonic• Clonic• Absence (Petit mal)• Myoclonic

ANTICONVULSANTS

• Also called “ANTIEPILEPTICS”• ACTION: to suppress the

abnormal electrical impulses from the seizure focus to other cortical areas, preventing seizures

Anticonvulsant ACTIONS

1. Suppress Na influx2. Suppress the Ca influx3. By increasing the action of

GABA

Suppress Na influx Phenytoin, Fosphenytoin, Carbamazepine, Oxcarbazepine, Valproic acid,

Suppress Ca influx Valproic AcidEthosuximide

Enhance the action of GABA

BarbituratesBenzodiazepines

HYDANTOINS

PHENYTOIN• First anticonvulsant • 1938• TERATOGENIC• Therapeutic range = 10-20 mcg/ml• IV, PO, no IM (tissue damage)

• S/E and A/R:gingival hyperplasiaslurred speechconfusiondepressionthrombocytopenialeukopeniahyperglycemiaNV, constipation

BARBITURATES

PHENOBARBITAL

- partial, grand mal and status epilepticus

- teratogenic

- gradual discontinuance

SUCCINIMIDES

- Used for absence or petit-mal seizures

ETHOSUXINIMIDE = succinimide of choice

OXAZOLIDONES/ OXAZOLIDINEDIONE

- Used to treat petit-mal seizure

Ex: Trimethadione (first)

BENZODIAZEPINES

CLONAZEPAM -petit-mal

CLORAZEPATE DIPOTASSIUM

- partial seizure

DIAZEPAM -acute status epilepticus- IV

IMINOSTILBENES

Ex: Carbamazepine

– grand mal and partial seizures

- PO

VALPROATE

• – petit-mal, grand mal, mixed types of seizures

Ex: Valproic acid

(hepatotoxic)

NURSING RESPONSIBILITIES

PHENYTOIN

1. Shake the suspension well

2. Instruct client not to drive

3. No alcohol and antidepressants

4. Medic alert ID

5. Not to abruptly stop the drug therapy

6. No OTC

7. W/ food or milk

NURSING RESPONSIBILITIES

PHENYTOIN

8. Instruct the client about the pinkish red urine / reddish brown.

9. Use a soft toothbrush.

--END--