CNS Drugs Flashcards
What are three classes of CNS stimulants?
Amphetamines
Analeptics
Anorexiants
What is the primary use for amphetamine like drugs?
Tx ADHD and narcolepsy
List two drugs that treat narcolepsy
Modafinil
Armodafinil
What is the primary use of analeptics
Stimulate respiration in newborns and reversal of respiratory distress
What is the primary use of anorexiants
Help suppress appetite in obese persons
What class of drug is Doxapram?
Analeptic
What are 3 different classes of sedative hypnotics (CNS depressants)?
Barbiturates
Benzodiazepines
Non-Benzodiazepines
What are the four types of barbiturates and their primary use?
Ultra short- acting (used as general anesthetic) Short acting (induce sleep but may cause person to wake early) Intermediate acting (induce and sustain sleep) Long acting (used for epileptic seizure control)
Name an ultra short acting barbiturate.
Thiopental
Pentobarbital and secobarbital are examples of _____?
Short acting barbiturates
They induce sleep but may cause the person to wake early.
Butabarbital is an example of a _____?
Intermediate acting barbiturate
Used to induce and sustain sleep
Phenobarbital is an example of a ____?
Long acting barbiturate used to control epileptic seizures
what is the primary use of benzodiazepines? Give an example
Temazepam
May be used to reduce anxiety and treat insomnia
What may be a use for non-benzodiazepines? Give an example
Treat short term insomnia
Zolpidem
What are the four different mechanisms by which anticonvulsants (antiepileptics) act?
- Suppress sodium influx
- Suppress Calcium influx
- Enhance action of GABA
- Promote the release of GABA
What is the mechanism of action of amphetamine like drugs?
Stimulate the release of norepinephrine and dopamine
What is the use of amphetamine like drugs?
Inc. wakefulness in narcolepsy
Inc. attention span/ cognition
Dec. hyperactivity, impulsiveness, and restlessness in ADHD
Action and use of Methylphenidate; what class of drug
Increase attention span and decrease impulsivity
Amphetamine (CNS stimulant)
A person taking methylphenidate should be advised to avoid taking _____. Why?
Caffeine because it may increase the effects of the drug
What are the potential side effects of Methylphenidate?
Tachycardia, palpitations, dizziness, HTN, sleeplessness, restlessness, nervousness, tremors, irritability, anorexia, dry mouth, N/V, diarrhea, weight loss.
What nursing interventions should be implemented for a person taking Methylphenidate?
Give before breakfast and lunch Report irregular heart beats Record, ht, wt, & growth in kids Avoid alcohol and caffeine Use sugar free gum to relieve dry mouth Do not stop taking abruptly Utilize counseling
What is the primary use of doxapram?
Stimulate respiration in newborns/ reverse respiratory distress
SE of Doxapram and other analeptics?
Restlessness, tremors, twitching, palpitations, insomnia, tinnitus, nausea, diarrhea, psychological dependence
Give an example of an anorexiant. What is it’s action?
Dextroamphetamine
Suppresses appetite
SE of dextroamphetamine
Nervousness, restlessness, irritability, palpitations, HTN
SE of sedative hypnotics
- residual drowsiness (hangover effect)
- drug dependence
- drug tolerance
- excessive depression
- respiratory depression
- withdrawal symptoms
Drug interactions of sedative hypnotics
Alcohol and other CNS depressants
Nursing interventions for sedative hypnotics
- advise nonpharmacologic methods first
- take 15-45 min before bed
- report hangover effect
- be attentive to safety
- avoid alcohol & other CNS depressants
- monitor BP, P
- monitor for withdrawal symptoms
What is the action of barbiturates
Enhance the action of GABA
Action and use of benzodiazepines
Enhance the action of GABA; used to reduce anxiety & treat insomnia
Temazepam
CNS depressant
Benzodiazepine
Used to reduce anxiety and treat insomnia
- barbital
Barbiturates
Anticonvulsants that suppress Na influx
Phenytoin, fosphenytoin, Carbamazepine, valproic acid
Anticonvulsants that supress Ca2+ influx
Valproic acid
Anticonvulsants that enhance action of GABA
Barbiturates & Benzodiazepines
Anticonvulsants that promote GABA release
Gabapentin
Class of drugs that are a CNS depressant and anticonvulsant
Hydantoins
For what persons is phenytoin contraindicated? What patient education should be implemented?
Contraindicated in pregnancy
Teach patients to use additional contraceptives
Side effects of Phenytoin
Gingivitis, gingival hyperplasia, nystagmus, HA, diplopia, dizziness, slurred speech, decreased coordination, thrombocytopenia
Nursing interventions for persons taking Phenytoin
Shake suspension well, monitor serum levels, instruct to use additional contraceptives, do not discontinue abruptly, frequent oral hygiene and checkups, teach to take Rx same time every day, warn of harmless pinkish red or brown urine; teach safety.
Gold standard for status epilepticus (continued seizure state)
Diazepam
What precautions should be implemented when administering diazepam
Admin slowly to prevent HTN and respiratory depression
What drugs are included in treatment for Parkinsonism
Anticholinergics, dopaminergics
Dopamine agonists, MAOB inhibitors, and COMT inhibitors
What is the action of anticholinergics for treating parkinsonim
Blocks cholinergic receptors to decrease muscle rigidity
What is the action of dopaminergics
Convert to dopamine
Action of dopamine agonists
Stimulate dopamine receptors
Action of MAOB inhibitors
Inhibit MAOB enzyme from breaking down dopamine
Action of COMT inhibitors
Inhibit the COMT enzyme that inactivates dopamine
What class of drug is carbidopalevodopa? What is its action and potential SE?
- carbidopa prevents levodopa from being metabolized before reaching the brain
- levodopa crosses BBB and is converted to dopamine
Dopaminergic
SE include N/V, dystonic movements, and psychosis
What class of drug is Amantadine. What is its action and use?
Amantadine is a dopamine agonist so it will stimulate dopamine receptors. It’s used to treat Parkinsonism as drug tolerance develops and improves symptoms.
Nursing interventions with antiparkinsonism drugs
Monitor for orthostatic HTN Avoid alcohol and other depressants Don’t abruptly stop taking Warn of harmless brown color of sweat/ urine Assess for suicidal thought Monitor blood cell count Monitor liver & kindney function
Characteristics of Alzheimers disease
Progressive and degenerative Formation of neuritic plaques Presence of neurofibrillary tangles Cholinergic NT abnormality No cure only slow progression
List two cholinesterase inhibitors used to treat Alzheimer’s
Donepril
Rivastigmine
What is the action of Rivastigmine and Donepril
Allow more ACh in neuron receptors to improve cognition
Use of Donepril and Rivastigmine
Used to treat mild to moderate Alzheimer’s
Nursing interventions to implement for Alzheimer’s treatment
Monitor v/s Maintain consistency in care Monitor behavioral changes Provide safety when wandering Rise slowly to avoid dizziness
Characteristics of Myasthenia Gravis
- autoimmune disease
- lack of nerve impulses and muscle responses
- lack of ACh reaching cholinergic receptors
- muscular weakness and fatigue
- respiratory muscle paralysis, ptosis, difficulty chewing and swallowing
Cholinesterase inhibitors to treat Myasthenia gravis. What is their duration of action?
Neo-stig-mine (short acting)
Ed-ro-pho-nium (ultra short acting for diagnosis)
Py-rid-o-stig-mine (intermediate acting)
Use of neostigmine and pyridostigmine
Control and treat MG; increase muscle strength
Nursing interventions for medications prescribed to treat MG
Admin doses on time
Take drugs before meals
Monitor drug effectiveness
Have antidote (atropine) available for cholinergic crisis
How can you tell if the patient has been overdosed or under-dosed with a cholinesterase inhibitor?
Administer Edrophonium for Dx
If the severe muscle weakness is improved after administration you know you have a Myasthenia crisis and were underdosed . If the muscle weakness gets worse after the edrophonium, you know you have a cholinergic crisis and will need to administer the antidote (atropine)
Carisoprodol
Skeletal muscle relaxant
Cyclobenzaprine
Skeletal muscle relaxant
Methocarbamol
Skeletal muscle relaxant
Nursing interventions for patients taking muscle relaxants
Take with food Monitor v/s Don’t drive Do not take longer than 3 weeks Do not stop abruptly Avoid alcohol and other CNS depressants
When is amantadine better to treat parkinsons vs. when should something like carbidopalevodopa be given.
Amantadine is better in the early stages of the disease before drug tolerance builds
