C8- Central Nervous System Medications Flashcards
What are some positive symptoms of schizophrenia?
hallucinations
paranoia
delusions
speech abnormalities
affective problems
Mania is defined as?
associated with bipolar periods of extreme over activity and excitement
Narcolepsy is defined as?
Daytime sleepiness and sudden periods of loss of wakefulness
Typical antipsychotic (first generation) prototype name?
Haloperidol
Haloperidol typical antipsychotic action?
block dopamine receptors in the brain
-suppress symptoms of psychosis
lipid soluble highly protein bound
What are the therapeutic of using haloperidol typical antipsychotic?
Schizophrenia (onset 1-2 days, therapeutic 2-4 weeks)
Bipolar mania suppression
Prevention of emesis (low dose)
What are antipsychotic adverse effects?
extrapyramidal syndrome
neuroleptic malignant syndrome (NMS) ** MEDICAL EMERGENCY **
Sexual dysfunction
Seizures
Dermatologic effects
Agranulocytosis
Severe dysrhythmias
Anticholinergic effects
Orthostatic hypotension
Sedation
Neuroendocrine effects
Extrapyramidal syndrome symptoms include?
Tardive Dyskinesia (jerky irregular movements)
Akathisia (motor restlessness)
Dystonia (continuous spasms and contractions)
Parkinson’s like movements
Typical Antipsychotic drug interactions?
Anticholinergic drugs (intensify anticholinergic effects)
CNS depressants (including alcohol) (intensified CNS Depression)
Levodopa and direct dopamine receptor agonist (counteract antipsychotic effect)
Atypical antipsychotic prototype drug name?
Risperidone
Atypical antipsychotic risperidone uses?
Schizophrenia
BPD
Levodopa induced psychosis
Irritability from autistic disorder
Atypical antipsychotic risperidone action?
blocks SEROTONIN & DOPAMINE
Adverse effects of atypical antipsychotic risperidone?
weight gain
diabetes
seizures
low risk of EPS
low anticholinergic effets
What are depot antipschotics?
used for long term maintenence therapy (injectable)
may be court ordered
first or second generation
ideal for clients with poor compliance
What is the drug prototype for mood stabilizers?
Lithium
What is a pure manic episode?
Euphoric Mania
What is a hypomanic episode
hypomania
what is major depressive episode
depression
What are mixed episodes?
patients experience symptoms of mania and depression simultaneously
this combination puts them at high risk for suicide
What are the kinetics of Lithium?
absorbed rapidly through GI (water soluble)
not metabolized
excreted unchanged
short half life and high toxicity require divided daily doses (3-4/day)
Lithium action is unknown, what are the known dynamics of lithium?
Increase NE & 5HT reuptake
reduce release of NE
inhibit action of NE
Lithium is what pregnancy category?
D
Side effects of lithium include?
diabetes insipidus
hypothyroidism
tremors
seizures
heart block
What happens to the body in the presence of low sodium when taking lithium?
Can accumulate to toxic levels
low sodium = reduced lithium excretion
Lithium drug interations
Increased by low sodium
loop and thiazide diuretics - use caution
NSAIDS
anticholinergic drugs - dehydration causes lithium retention
antihistamines
TCA
phenothiazine antipschotics
Long term use of lithium can lead to _______ dysfunction?
thyroid dysfunction (hypo)
Therapeutic levels of lithium are?
0.5-1.5 mEq/L
What should a nurse monitor in a patient using lithium?
Regular lithium levels
sodium levels
renal and liver function tests
suicidal ideation and neuro status
glucose level in pt with diabetes
What should a nurse do if toxic lithium levels appear?
withhold one dose and notify prescriber
When should lithium be taken?
with meals
Lithium may cause excessive thirst, what should the nurse advise to the patient about this?
patient should maintain normal diet
fluid intake of 2000-3000 m during the dose stabilization period ad 1500ml afterward
expect transient thirst
advise patient to report continued thirst and dilute urine to provider
What are the toxic levels of lithium?
> 2.0mEq/L
What is parkinsons disease?
chronic progressive neurologic disorder that affects the extrapyramidal motor tract responsible for controlling posture, balance, and locomotion.
What is pseudoparkinsonism
Occurs as an adverse reaction to various drugs, carbon monoxide, manganese, or disorders.
combination of similar symptoms; rigidity, bradykinesia, gait disturbances, and tremors
What causes parkinson’s?
Low dopamine
-creates an imbalance of dopamine and acetylcholine
Parkinson’s disease treatment?
symptomatic relief
dopaminergics - dopamine cannot cross blood brain barrier
anticholinergics
Anti-parkinson’s medications
Levodopa-Carbidopa
What does levodopa do?
crosses BBB and is converted to dopamine in the brain tissue
** CANNOT BE USED ALONE **
What does Carbidopa do?
** CANNOT BE USED ALONE **
in combination with levodopa, allows more levodopa to cross BBB more effectively with lower dosages. Carbidopa prevets peripheral/intestinal breakdown of levodopa to reach the brain.
How does a provider dose Levodopa-Carbidopa?
Variable depending on severity
short duration of action (on-off phenomenon)
-extended release capsules decrease “off” frequency
dosing changes as disease progresses
What are levodopa side effects?
Nausea (administer with food)
Othrostatic hypotension (teach precautions)
psychosis (teach symptoms to report)
discoloration of urine and sweat
Interactions of levodopa include?
MAOI
Vitamin B6 (reverses levodopa effects)
Antipsychotics
Benzodiazepines
What are the three common generalized seizure types?
Tonic Clonic (grand mal)
Absence (petit mal)
Common partial seizure
What happens in a tonic clonic seizure?
unconsciousness, convulsions, muscle rigidity
(usually involve both hemispheres of brain)
What happens in an absence seizure?
brief loss of consciousnes
What is the target goal for antiepileptic drugs?
stabilize nerve cell membrane.
suppress abnormal electric impulses in cerebral cortex
Antiepileptic drugs action
suppress sodium influx
suppress calcium influx
enhance action of GABA
promote GABA release
Hydantoin
Phenytoin
Hydantoin/Phenytoin therapeutic range
10-20 mcg/ml
