[7] MIDTERMS | DRUGS ACTING ON THE CNS AND PNS Flashcards
- ____ are medicines that stimulate the brain, speeding up both mental and physical processes.
- They increase energy, ____, and elevate ____, heart rate and ____.
- They decrease ____, reduce appetite, improve confidence and concentration, and ____.
- CNS stimulants are medicines that stimulate the brain, speeding up both mental and physical processes.
- They increase energy, improve attention and alertness, and elevate blood pressure, heart rate and respiratory rate.
- They decrease the need for sleep, reduce appetite, improve confidence and concentration, and lessen inhibitions.
AMPHETAMINES
AMPHETAMINES
* Stimulates the release of neurotransmitters – ____ and ____
* Indications: ____, ADHD
* Can develop dependence
* Short-term (____ weeks)
* Avoid abrupt withdrawal
* Half Life: ____ hours
* S/E and A/R: ____, insomia, tachycardia, HPN, ____, dry mouth, ____, weight loss, diarrhea or constipation, and ____
AMPHETAMINES
* Stimulates the release of neurotransmitters – norepinephrine and dopamine
* Indications: narcolepsy, ADHD
* Can develop dependence
* Short-term (12 weeks)
* Avoid abrupt withdrawal
* Half Life: 9-13 hours
* S/E and A/R: restlessness, insomia, tachycardia, HPN, heart palpitations, dry mouth, anorexia, weight loss, diarrhea or constipation, and impotence
AMPHETAMINE-LIKE DRUGS
* Action: to increase child’s ____, ____ performance and to decrease ____, hyperactivity and ____
Example:
* ____ (Ritalin) – ADHD – Insomnia (Don’t give 6 hours before bedtime)
* ____ (Cylert) - narcolepsy
* ____ (Provigil) - newest
Nursing Responsibilities:
* Ritalin and Pemoline should be given ____ before meals (breakfast and lunch)
* Never give ____ sleep
* Instruct the patient to avoid ____
* Instruct the nursing mother to avoid taking CNS stimulants
* Explain to client that long-term use may lead to drug abuse
* Dry Mouth - ____
* WOF: ____ – involuntary twitching of eyes and mouth
AMPHETAMINE-LIKE DRUGS
* Action: to increase child’s attention span, cognitive performance and to decrease impulsiveness, hyperactivity and restlessness
Example:
* Methylphenidate (Ritalin) – ADHD – Insomnia (Don’t give 6 hours before bedtime)
* Pemoline (Cylert) - narcolepsy
* Modafinil (Provigil) - newest
Nursing Responsibilities:
* Ritalin and Pemoline should be given 30 to 45 minutes before meals (breakfast and lunch)
* Never give within 6 hours before sleep
* Instruct the patient to avoid driving
* Instruct the nursing mother to avoid taking CNS stimulants
* Explain to client that long-term use may lead to drug abuse
* Dry Mouth - sugarless gums
* WOF: Tourette Syndrome (Tics) – involuntary twitching of eyes and mouth
ANOREXIANTS
* Appetite ____
* S/E: nervousness, ____, irritability, ____, heart palpitations and HPN.
* Avoid: ____, ____
ANOREXIANTS
* Appetite suppresant
* S/E: nervousness, restlessness, irritability, insomnia, heart palpitations and HPN.
* Avoid: < 12 y/o, self-medication
ANALEPTICS
* Stimulate ____
* ____: Caffeine (____ - infusion/oral preparation) and ____ (newborn - used in respiratory distress)
* S/E: nervousness, restlessness, ____, twitching, palpitations and insomia, ____, GI irritation, ____
ANALEPTICS
* Stimulate respiration
* Methylxanthines: Caffeine (caffeine citrate - infusion/oral preparation) and Theophylline (newborn - used in respiratory distress)
* S/E: nervousness, restlessness, tremors, twitching, palpitations and insomia, diuresis, GI irritation, tinnitus
CNS DEPRESSANTS: Sedative-Hypnotics
- ____ – diminish physical and mental response at a lower dosages of certain CNS depressants but does not affect consciousness
- ____ – natural sleep
- SEDATION – diminish physical and mental response at a lower dosages of certain CNS depressants but does not affect consciousness
- HYPNOTIC – natural sleep
CNS DEPRESSANTS: Sedative-Hypnotics
Non-Pharma to Promote Sleep
* S – ____ – stimulants (6 hrs before sleep), daytime naps, nicotine/smoking, strenous activity before bedtime, heavy meals before bedtime
* L – Limit ____ / Listen to quiet music
* E – Encourage ____, ____
* E – Ensure ____ (cut lights > increase melatonin)
* P – Practice healthy lifestyle habits
Non-Pharma to Promote Sleep
* S – **SAY “NO” **– stimulants (6 hrs before sleep), daytime naps, nicotine/smoking, strenous activity before bedtime, heavy meals before bedtime
* L – Limit loud noises / Listen to quiet music
* E – Encourage warm bath, warm water/milk
* E – Ensure soothing activities / quiet environment (cut lights > increase melatonin)
* P – Practice healthy lifestyle habits
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: BARBITURATES
Long-Acting
* ____ and ____
* Used to control seizures in ____
Intermediate-Acting
* ____ (Amytal)
* Aprobarbital (Alurate)
* ____ (Butisol)
* ____ for maintaining long period of sleep
* Causes drowsiness/hangover
Short-Acting
* ____ (Seconal)
* ____ (Nembutal)
* Induce sleep for those with ____
Ultrashort-Acting
* ____ (Pentothal)
* General anesthetics
Sedative-Hypnotics: BARBITURATES
Long-Acting
* Phenobarbital and Mephobarbital
* Used to control seizures in epilepsy
Intermediate-Acting
* Amobarbital (Amytal)
* Aprobarbital (Alurate)
* Butabarbital (Butisol)
* Sleep sustainers for maintaining long period of sleep
* Causes drowsiness/hangover
Short-Acting
* Secobarbital (Seconal)
* Pentobarbital (Nembutal)
* Induce sleep for those with difficulty falling asleep
Ultrashort-Acting
* Thiopental Na (Pentothal)
* General anesthetics
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics:
1. ____
2. ____
3. Nonbenzodiazepines
4. ____
5. ____ - induces sleep and decrease nocturnal awakenings
Sedative-Hypnotics:
1. Barbiturates
2. Benzodiazepines
3. Nonbenzodiazepines
4. Piperidinediones
5. Chloral Hydrate - induces sleep and decrease nocturnal awakenings
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: BARBITURATES
Nursing Responsibilities
* ____ – short term use only! (____ or less)
* Abrupt withdawal
* Raise ____
* Check skin for rashes.
* Administer ____ at a rate of less than ____ mg/min.
* Do not mix ____ with other medications.
* Deep IM in ____.
* Teach client to use ____ to induce sleep.
* Instruct to avoid alcohol and antidepressant, antipsychotic and narcotics – ____
* WOF: ____ depression / ____ depression; ____ esp. when combined with acetaminophen
Sedative-Hypnotics: BARBITURATES
Nursing Responsibilities
* Barbiturates – short term use only! (2 weeks or less)
* Abrupt withdawal
* Raise bedside rails
* Check skin for rashes.
* Administer IV pentobarbital at a rate of less than 50 mg/min.
* Do not mix pentobarbital with other medications.
* Deep IM in gluteus medius.
* Teach client to use non pharma ways to induce sleep.
* Instruct to avoid alcohol and antidepressant, antipsychotic and narcotics – morphine sulfate
* WOF: respiratory depression / CNS depression; hepatotoxicity esp. when combined with acetaminophen
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: BENZODIAZEPINES
* Action: increase the action of inhibitory neurotransmitter ____ > neuron excitability is reduced
* ____ – first; used to treat insomia
* ____ – A/R: loss of memory (anterograde amnesia / memory impairment); should not be taken longer than 7-10 days
* Temazepam (Restoril), Estazolam (ProSom), Quazepam (Doral)
* ____ (Valium), ____ (Ativan)
Sedative-Hypnotics: BENZODIAZEPINES
* Action: increase the action of inhibitory neurotransmitter GABA > neuron excitability is reduced
* Flurazepam (Dalmane) – first; used to treat insomia
* Triazolam (Halcion) – A/R: loss of memory (anterograde amnesia / memory impairment); should not be taken longer than 7-10 days
* Temazepam (Restoril), Estazolam (ProSom), Quazepam (Doral)
* Diazepam (Valium), Lorazepam (Ativan)
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: BENZODIAZEPINES
Nursing Responsibilities
* Avoid ____, antidepressants, antipsychotics
* ____ before taking the drug – causes ____
* No ____
* Caution in driving
* Antidote: ____
Sedative-Hypnotics: BENZODIAZEPINES
Nursing Responsibilities
* Avoid alcohol, antidepressants, antipsychotics
* Urinate before taking the drug – causes urinary retention
* No OTC drugs
* Caution in driving
* Antidote: Flumazenil
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: NONBENZODIAZEPINES
* ____ (Ambien)
* Short term treatment of Insomnia (< ____ )
* Duration of Action: ____
* Metabolized in the ____
* Excreted in the ____
Sedative-Hypnotics: NONBENZODIAZEPINES
* Zolpidem (Ambien)
* Short term treatment of Insomnia (< 10 days)
* Duration of Action: 6-8 hours
* Metabolized in the liver
* Excreted in the urine
First anesthetic
Nitrous Oxide or “Laughing Gas”
ANESTHESIA
BALANCED ANESTHESIA
* A ____ – given at night before surgery
* ____ (narcotic and benzodiazepine) and ____ (Atropine) – given ____ before surgery > to decrease secretions > prevent aspiration
* A short acting nonbarbiturate - ____
* An ____
* A ____ – PRN! – as needed!
BALANCED ANESTHESIA
* A hypnotic – given at night before surgery
* Premedication (narcotic and benzodiazepine) and anticholinergic (Atropine) – given 1 hr before surgery > to decrease secretions > prevent aspiration
* A short acting nonbarbiturate - Propofol
* An inhaled gas
* A muscle relaxant – PRN! – as needed!
ANESTHESIA
STAGES OF GENERAL ANESTHESIA
1. ____ - decreased pain awareness,sometimes with amnesia, impaired consciousness but not lost
2. ____ - excitation, amnesia, enhanced reflexes, uncontrolled movement, irregular respiration, urinary incontinence
3. ____ - unconscious, no pain reflex, regular respiration, maintained BP
4. ____ - too deep > overdosage > circulatory/respiratory collapse > death
STAGES OF GENERAL ANESTHESIA
1. Analgesia/Induction - decreased pain awareness,sometimes with amnesia, impaired consciousness but not lost
2. Excitement/Delirium - excitation, amnesia, enhanced reflexes, uncontrolled movement, irregular respiration, urinary incontinence
3. Surgical Stage - unconscious, no pain reflex, regular respiration, maintained BP
4. Medullary Paralysis - too deep > overdosage > circulatory/respiratory collapse > death
ANESTHESIA
INHALATION ANESTHETICS
* ____ or ____ administered as gas
* A/R: ____, hypotension, dysrhythmias, ____
* ____, methoxyflurane, ____, isoflurane, ____, sevoflurane, nitrous oxide, ____
* WOF: ____
* MGT: ____
INHALATION ANESTHETICS
* Gas or volatile liquids administered as gas
* A/R: respiratory depression, hypotension, dysrhythmias, hepatic dysfunction
* Halothane, methoxyflurane, enflurane, isoflurane, desflurane, sevoflurane, nitrous oxide, cyclopropane
* WOF: Malignant Hyperthermia
* MGT: Dantrolene
ANESTHESIA
IV ANESTHETICS
* As general anesthesia
* ____ (Pentothal), ____ (Brevital), ____ (Ketalar)
* ____ - intubation/minor surgeries
* Adverse Reactions: ____
* WOF: Infections - ____ supports microbial growth
IV ANESTHETICS
* As general anesthesia
* Thiopental sodium (Pentothal), Methohexital Sodium (Brevital), Ketamine HCl (Ketalar)
* Midazolam/Propofol - intubation/minor surgeries
* Adverse Reactions: respiratory and cardiovascular effects
* WOF: Infections - Propofol supports microbial growth
ANESTHESIA
TOPICAL ANESTHETICS
* ____, broken or unbroken ____, ____
* Solution, liquid spray, ointment, cream, and gel
* Local Anesthetics: Lidocaine for dental procedures, sutures, and diagnostics such as lumbar punctures and thorcentesis
TOPICAL ANESTHETICS
* Mucous membrane, broken or unbroken skin surface, burns
* Solution, liquid spray, ointment, cream, and gel
* Local Anesthetics: Lidocaine for dental procedures, sutures, and diagnostics such as lumbar punctures and thorcentesis
ANESTHESIA
SPINAL ANESTHESIA
* Local anesthesia injected into ____ (children) or ____ (adults)
* S/E and A/R: ____ (spread too high in spinal column > respiratory muscle), ____ (decrease in CSF pressure), ____ (sympathetic blockade)
* Nerve block: spinal block ( ____ ), epidural block ( ____ ), caudal block ( ____ ), saddle block ( ____ )
* Nurse role: complete the pre-operative orders including pre-medications
SPINAL ANESTHESIA
* Local anesthesia injected into subarachnoid space 3rd to 4th lumbar space (children) or 1st lumbosacral space (adults)
* S/E and A/R: respiratory distress (spread too high in spinal column > respiratory muscle), headache (decrease in CSF pressure), hypotension (sympathetic blockade)
* Nerve block: spinal block (subarachnoid space), epidural block (dura mater), caudal block (near the sacrum), saddle block (lower end of spnal cord)
* Nurse role: complete the pre-operative orders including pre-medications
ANTICONVULSANTS
ANTICONVULSANTS
* Also called “____”
* Action: to suppress the abnormal ____ from the seizure focus to ____, preventing seizures
Actions:
* Suppress ____ and ____ influx
* Increase the action of ____
ANTICONVULSANTS
* Also called “antiepileptics”
* Action: to suppress the abnormal electrical impulses from the seizure focus to other cortical areas, preventing seizures
Actions:
* Suppress Na and Ca influx
* Increase the action of GABA
ANTICONVULSANTS
Classification of Seizures (5)
- Tonic-Clonic
- Tonic
- Clonic
- Absence (Petit Mal)
- Myoclonic
ANTICONVULSANTS
Suppress Na Influx:
* ____ (Dilantin)
* Fosphenytoin
* Oxcarbazepine
* ____
Suppress Ca Influx:
* ____
* Ethosuzimide
Enhance the Action of GABA
* Barbituates
* Benzodiazepines
Suppress Na Influx:
* Phenytoin (Dilantin)
* Fosphenytoin
* Oxcarbazepine
* Valproic Acid
Suppress Ca Influx:
* Valproic Acid
* Ethosuzimide
Enhance the Action of GABA
* Barbituates
* Benzodiazepines
ANTICONVULSANTS
HYDANTOINS: Phenytoin (Dilantin)
* First anticonvulsant (____)
* Teratogenic
* Therapeutic Range = ____
* IV, PO, no ____ (tissue damage)
S/E and A/R
* ____
* Slurred speech
* ____
* ____
* Thrombocytopenia
* Leukopenia
* Hyperglycemia
* ____
HYDANTOINS: Phenytoin (Dilantin)
* First anticonvulsant (1938)
* Teratogenic
* Therapeutic Range = 10-20 mcg/mL
* IV, PO, no IM (tissue damage)
S/E and A/R
* Gingival hyperplasia
* Slurred speech
* Confusion
* Depression
* Thrombocytopenia
* Leukopenia
* Hyperglycemia
* N/V, constipation
ANTICONVULSANTS
BARBITUATES: Phenobarbital
* For partial, ____, and ____
* Teratogenic
* Gradual ____
BARBITUATES: Phenobarbital
* For partial, grand mal, and status epilepticus
* Teratogenic
* Gradual discontinuance
ANTICONVULSANTS
SUCCINIMIDES
* Used for ____ or ____ → blank stare → children
* ____ - succinimide of choice
* Methsuximide and Phensuximide
SUCCINIMIDES
* Used for absence or petit-mal seizures → blank stare → children
* Ethosuxinimide - succinimide of choice
* Methsuximide and Phensuximide
ANTICONVULSANTS
BENZODIAZEPINES
* ____ - petit-mal
* ____ - partial seizure
* ____ - acute status epilepticus (severe seizure); IV
BENZODIAZEPINES
* Clonazepam - petit-mal
* Clorazepate - partial seizure
* Diazepam - acute status epilepticus (severe seizure); IV
ANTICONVULSANTS
IMINOSTILBENES: Carbamezapine
* ____ and ____
* ____, ____, alcohol withdrawal
* PO
IMINOSTILBENES: Carbamezapine
* Grand mal and partial seizures
* Bipolar Disease, trigeminal neuralgia, alcohol withdrawal
* PO
ANTICONVULSANTS
VALPROATE: Valproic Acid
* Petit-mal, grand mal, mixed type of seizures
* Hepatotoxic
ANTICONVULSANTS
NURSING RESPONSIBILITIES: Phenytoin
* Shake the suspension well
* Instruct the client not to drive
* No ____ and ____
* Medic alert ID
* Not to abruptly stop the drug therapy
* No OTC
* With food or milk
* Instruct the client about the ____ urine
* Inform about the adverse reaction
* Use ____
NURSING RESPONSIBILITIES: Phenytoin
* Shake the suspension well
* Instruct the client not to drive
* No alcohol and antidepressants
* Medic alert ID
* Not to abruptly stop the drug therapy
* No OTC
* With food or milk
* Instruct the client about the pinkish red/reddish brown urine
* Inform about the adverse reaction
* Use soft toothbrush
DRUGS FOR PARKINSON’S DISEASE
ANTICHOLINERGIC - inhibit the release of Acetylcholine
* Benztropine (Cogentin)
* Biperiden (Akineton)
* Trihexyphenidyl (Artane)
* Diphenhydramine HCl (Benadryl)
ANTICHOLINERGIC - inhibit the release of Acetylcholine
* Benztropine (Cogentin)
* Biperiden (Akineton)
* Trihexyphenidyl (Artane)
* Diphenhydramine HCl (Benadryl)
DRUGS FOR PARKINSON’S DISEASE
DOPAMINERGICS
____ - does not cross the blood-brain barrier
* Converted to dopamine; most effective in diminshing the symptoms of ____
* S/E: nausea, vomiting, dyskinesia, hypotension, psychosis, cardiac dysrhythmias
____ - alternative drug comined with Levodopa
DOPAMINERGICS
Levodopa - does not cross the blood-brain barrier
* Converted to dopamine; most effective in diminshing the symptoms of Parkinson’s Disease
* S/E: nausea, vomiting, dyskinesia, hypotension, psychosis, cardiac dysrhythmias
Carbidopa - alternative drug comined with Levodopa
DRUGS FOR PARKINSON’S DISEASE
CARBIDOPA-LEVODOPA: Nursing Responsibilities
* Monitor VS especially BP
* ____
* Asess for s/sx of Parkinsonism
* Low ____ food
CARBIDOPA-LEVODOPA: Nursing Responsibilities
* Monitor VS especially BP
* ECG
* Asess for s/sx of Parkinsonism
* Low protein food
DRUGS FOR PARKINSON’S DISEASE
DOPAMINE AGONISTS - stimulate the dopamine receptors
____ (Symmetrel)
* Antiviral that acts on the dopamine receptors
* S/E: orthostatic hypotension, confusion, ____, constipation
____ (Parlodel)
* Acts directly on CNS, CVS, and GIT
* S/E: orthostatic hypotension, palpitations, chest pain, edema, ____, ____, ____
DOPAMINE AGONISTS - stimulate the dopamine receptors
Amantadine HCl (Symmetrel)
* Antiviral that acts on the dopamine receptors
* S/E: orthostatic hypotension, confusion, urinary retention, constipation
Bromocriptine (Parlodel)
* Acts directly on CNS, CVS, and GIT
* S/E: orthostatic hypotension, palpitations, chest pain, edema, nightmares, delusions, confusion
DRUGS FOR PARKINSON’S DISEASE
DOPAMINE AGONISTS: Nursing Responsibilities
* Report any signs of ____, seizures, or ____
* Assess for ____
* Avoid alcohol
* Monitor VS especially ____ and HR
* Not to ____ stop the drug
DOPAMINE AGONISTS: Nursing Responsibilities
* Report any signs of skin lesions, seizures, or depression
* Assess for orthostatic hypotension
* Avoid alcohol
* Monitor VS especially BP and HR
* Not to abruptly stop the drug
DRUGS FOR PARKINSON’S DISEASE
MAO-B INHIBITORS
* Prolongs the action of ____
* ____ (Eldepryl)
MAO-B INHIBITORS
* Prolongs the action of Levodopa
* Selegiline HCl (Eldepryl)
DRUGS FOR PARKINSON’S DISEASE
COMT INHIBITORS
* Inactivates ____
* ____ (Tasmar) - can cause liver damage
* ____ (Comtan)
COMT INHIBITORS
* Inactivates dopamine
* Tolcapone (Tasmar) - can cause liver damage
* Entacapone (Comtan)
DRUG FOR ALZHEIMER’S DISEASE: Acetylcholinesterase or Cholinesterase Inhibitors
* Improve the cognitive function of clients with ____ Alzheimer’s disease
* ____ (Cognex) - 1st
* ____ (Aricept)
* ____ (Exelon)
DRUG FOR ALZHEIMER’S DISEASE: Acetylcholinesterase or Cholinesterase Inhibitors
* Improve the cognitive function of clients with mild to moderate Alzheimer’s disease
* Tacrine (Cognex) - 1st
* Donepezil (Aricept)
* Rivastigmine (Exelon)
DRUGS FOR MYASTHENIA GRAVIS
ACETYLCHOLINESTERASE INHIBITORS OR CHOLINESTERASE INHIBITORS
* ____ (Prostigmin) - 1st drug
* ____ (Mestinon) - increases muscle strength
* ____ (Mytelase)
* ____ (Tensilon) - used to distinguish myasthenia crisis from cholinergic crisis
* S/E and A/R: GI disturbances, increased salivation, ____, ____, HPN
ACETYLCHOLINESTERASE INHIBITORS OR CHOLINESTERASE INHIBITORS
* Neostigmine (Prostigmin) - 1st drug
* Pyridostigmine Bromide (Mestinon) - increases muscle strength
* Ambenonium Chloride (Mytelase)
* Edrophonium Chloride (Tensilon) - used to distinguish myasthenia crisis from cholinergic crisis
* S/E and A/R: GI disturbances, increased salivation, tearing, miosis, HPN
DRUGS FOR MYASTHENIA GRAVIS
MESTINON: Nursing Responsibilities
* Administer IV ____
* ____ as antidote for cholinergic crisis
* Take the drug ____ meals
* Assess for the effectiveness of the drug therapy
* Avoid: ____ – can lead to paralysis
MESTINON: Nursing Responsibilities
* Administer IV undiluted
* Atropine sulfate as antidote for cholinergic crisis
* Take the drug before meals
* Assess for the effectiveness of the drug therapy
* Avoid: Baclofen (Lioresal) – can lead to paralysis
DRUGS FOR MULTIPLE SCLEROSIS - SKELETAL MUSCLE RELAXANT
Centrally-Acting Skeletal Muscle Relaxants
* ____
* Suppress ____ reflexes
* Decrease pain and increase range of motion
* Have a ____ effect
Centrally-Acting Skeletal Muscle Relaxants
* Spasmolytics
* Suppress hyperactive reflexes
* Decrease pain and increase range of motion
* Have a sedative effect
DRUGS FOR MULTIPLE SCLEROSIS - SKELETAL MUSCLE RELAXANT
Drugs for Skeletal Muscle Spasticity (3)
Drugs for Muscle Spasms (3)
Drugs for Skeletal Muscle Spasticity (3)
* Baclofen (Lioresal)
* Dantrolene (Dantrium)
* Diazepam (Valium)
Drugs for Muscle Spasms (3)
* Carisoprodol (Soma)
* Methocarbamol (Robaxin)
* Orphenadrine citrate (Norflex)
DRUGS FOR MULTIPLE SCLEROSIS - SKELETAL MUSCLE RELAXANT
S/E and A/Rs:
* Drowsiness
* ____
* Lightheadedness
* Nausea
* Vomiting
* ____
* ____
S/E and A/Rs:
* Drowsiness
* Dizziness
* Lightheadedness
* Nausea
* Vomiting
* Diarrhea
* Abdominal cramps
DRUGS FOR MULTIPLE SCLEROSIS - SKELETAL MUSCLE RELAXANT
NURSING RESPONSIBILITIES
* Monitor ____ levels
* Do not abruptly stop the medication
* Not to ____ or operate ____
* Avoid alcohol and CNS depressants
* C/I with ____ ; ____
* Take with food
NURSING RESPONSIBILITIES
* Monitor serum liver enzyme levels
* Do not abruptly stop the medication
* Not to drive or operate dangerous machinery
* Avoid alcohol and CNS depressants
* C/I with pregnant women ; nursing mothers
* Take with food
PSYCHIATRIC AGENTS
ANTIPSYCHOTICS
* A.K.A. ____
* Action: blocks ____
* S/E: ____, dry mouth, ____, orthostatic hypotension
* E.g. ____ (Haldol), ____ (Thorazine)
ANTIPSYCHOTICS
* A.K.A. major tranquilizers
* Action: blocks dopamine
* S/E: blurred vission, dry mouth, photosensitivity, orthostatic hypotension
* E.g. Haloperidol (Haldol), Chlorpromazine (Thorazine)
PSYCHIATRIC AGENTS
ANTIPSYCHOTICS: Extrapyramidal Symptoms
* ____ - pill-rolling, mask-like face, propulsive gait
* ____ - restless leg syndrome
* ____ - poor muscle tone
ANTIPSYCHOTICS: Extrapyramidal Symptoms
* Pseudoparkinsonism - pill-rolling, mask-like face, propulsive gait
* Akathisia - restless leg syndrome
* Dystonia - poor muscle tone
PSYCHIATRIC AGENTS
ANTIPSYCHOTICS
A/R:
* ____ - irreversible
* ____ - low WBC → risk for infection → fever → report
* Hepatotoxicity
Nursing Considerations:
* Give pc
* Rise ____
* Avoid ____
* HR and BP
* Report ____ and ____
ANTIPSYCHOTICS
A/R:
* Tardive Dyskinesia - irreversible
* Aggranulocytosis - low WBC → risk for infection → fever → report
* Hepatotoxicity
Nursing Considerations:
* Give pc
* Rise slowly
* Avoid sunlight exposure
* HR and BP
* Report fever and body malaise
PSYCHIATRIC AGENTS
ANXIOLYTICS
* AKA: ____, anti-anxiety
* ACTION: ____ → stimulates the action of GABA
* Examples: ____ (Valium), ____ (Serax), ____ (Librium), ____ (Xanax)
* S/E: dizziness, drowsiness, dry mouth, sedation
Nursing Considerations:
* Give ac
* Ask patient to avoid ____ and ____
* Administer separately.
ANXIOLYTICS
* AKA: Minor tranquilizers, anti-anxiety
* ACTION: decrease R.A.S → stimulates the action of GABA
* Examples: Diazepam (Valium), Oxazepam (Serax), Cholorodiazepoxide (Librium), Alprazolam (Xanax)
* S/E: dizziness, drowsiness, dry mouth, sedation
Nursing Considerations:
* Give ac
* Ask patient to avoid caffeine and alcohol
* Administer separately.
PSYCHIATRIC AGENTS
ANTIDEPRESSANTS: Tricyclics (TCA)
* ____ (Tofranil) - 1st antidepressant
* ____ (Elavil)
* ACTION: prolongs norepinephrine’s action
* S/E: ____; cardiovascular effects
Nursing Considerations:
* After meals
* Therapeutic effects: ____ weeks
* BP/HR
ANTIDEPRESSANTS: Tricyclics (TCA)
* Imipramine (Tofranil) - 1st antidepressant
* Amititriptylline (Elavil)
* ACTION: prolongs norepinephrine’s action
* S/E: anticholinergic; cardiovascular effects
Nursing Considerations:
* After meals
* Therapeutic effects: 2-4 weeks
* BP/HR
PSYCHIATRIC AGENTS
ANTIDEPRESSANTS: MAO Inhibitors
* Most sensitive; least used
* ____ (Parnate), ____ (Nardil), and ____ (Marplan)
* ACTION: ____ of norepinephrine
* S/E: hypertensive crisis
Nursing Considerations:
* After meals
* Report headache
* Avoid ____
ANTIDEPRESSANTS: MAO Inhibitors
* Most sensitive; least used
* Tranylcypromine (Parnate), Phenelzine (Nardil), and Isocarboxazid (Marplan)
* ACTION: prevents destruction of norepinephrine
* S/E: hypertensive crisis
Nursing Considerations:
* After meals
* Report headache
* Avoid tyramine-containing food
PSYCHIATRIC AGENTS
ANTIDEPRESSANTS: Selective Serotonin Reuptake Inhibitor (SSRI)
* ____ (Prozac)
* ACTION: prolongs ____ action
* S/E: restlessness, ____, insomnia
* Nursing Consideration: avoid ____
ANTIDEPRESSANTS: Selective Serotonin Reuptake Inhibitor (SSRI)
* Fluoxetin (Prozac)
* ACTION: prolongs serotonin action
* S/E: restlessness, agitation, insomnia
* Nursing Consideration: avoid bedtime doses
PSYCHIATRIC AGENTS
MOOD STABILIZER/ANTIMANIC AGENTS: Lithium Carbonate (Eskalith/Lithane)
* ACTION: ____; reduce the release of ____
* S/E: ____, excessive tears and urination, ____
* WOF: ____ (persistent vomiting, profuse diarrhea, lethargy)
* Therapeutic Range: ____ (0.6-1.2 mEq/L)
* Toxic Range: ____
Nursing Considerations:
- Best taken ____ meals.
- Therapeutic effects: ____
- Increase fluid intake ( ____ ) and sodium ( ____ ).
- ____ (osmotic diuretic) administered if toxicity occurs
CARBAMAZEPINE (Tegretol)
* Other agent - for bipolar disorder
* WOF: ____ → infection → fever
MOOD STABILIZER/ANTIMANIC AGENTS: Lithium Carbonate (Eskalith/Lithane)
* ACTION: idiopathic; reduce the release of norepinephrine
* S/E: NAVDA, excessive tears and urination, fine hand tremors
* WOF: lithium toxicity (persistent vomiting, profuse diarrhea, lethargy)
* Therapeutic Range: 0.5-1.5 mEq/L (0.6-1.2 mEq/L)
* Toxic Range: 1.5-2.0 mEq/L
Nursing Considerations:
- Best taken after meals.
- Therapeutic effects: 10-14 days
- Increase fluid intake (3 L/day) and sodium (3 g/day).
- Mannitol (osmotic diuretic) administered if toxicity occurs
CARBAMAZEPINE (Tegretol)
* Other agent - for bipolar disorder
* WOF: Agranulocytosis → infection → fever
