CNS drugs Flashcards
Phenobarbital
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification-Barbituates
Use-Used as a sedative and to treat seizure disorder
Mechanism of action-Produces sedation and drowsiness by altering cerebellar function and depressing the actions of the brain and sensory cortex
Nursing consideration
-Do not use in children <1 month of age
- May cause fetal harm
- Avoid use in geriatric patients
adverse side affects-
May cause CNS depression, suicidal thoughts or behaviors, GI disturbances, rashes, or some fatal blood disorders
- May be habit forming
patient teaching-Take as prescribed
- Do not discontinue abruptly – may cause seizures
- Do not take with alcohol or other CNS depressants
- Use non-hormonal contraceptives if using oral contraceptive
Lorazepam
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification-Benzodiazepines
Use-Used for sedation, antianxiety, and anticonvulsant
Mechanism of action-Binds to specific GABA receptors to potentiate effects of GABA
Nursing consideration-
May cause fetal harm
- Children/elderly may experience paradoxical
reactions - Elderly are more susceptible to sedative/respiratory depression (monitor closely
& adjust dose) - Adjust dose with severe hepatic insufficiency
- Black Box Warning: sedation, respiratory
depression, coma and death – monitor airway
patency and respirations closely
adverse side affects-May result in sedation, respiratory depression, hypotension
unsteadiness, coma & death
- Abrupt termination may result in withdrawal
- May cause dependence
patient teaching-
Caution with driving
- Do not consume alcohol
- Caution with getting out of bed d/t risk for falls
IF OVERDOSE USE FLUMANZENIL
Methylphenidate
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification-CNS stimulate
Use-ADHD
Mechanism of action-Stimulates the brain and acts similar to amphetamines. Thought to block reuptake of norepinephrine and dopamine
Nursing consideration-Administer extended-release once in the morning
- DO NOT CRUSH, CHEW, OR DIVIDE
- Do not administer after 4pm
- Encourage foods of choice, high in calories and
protein
- Consider eating smaller meals throughout the
day
- Monitor for signs of abuse/dependence while
taking
adverse side affects-
May cause increased blood pressure and increased
heart rate
- May cause psychotic or manic symptoms in patients
with no prior history
- Avoid alcohol should - may cause a rapid release of
the drug in extended-release formulations.
patient teaching
May cause dependence/abuse – controlled substance
- Potential serious cardiovascular risk, including sudden
death, myocardial infarction, stroke, and hypertension.
- Instruct patients to contact a healthcare provider
immediately if they develop symptoms such as
exertional chest pain or unexplained syncope. - Extended-release capsules can cause elevations of
their blood pressure and pulse rate
Amitriptyline
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification-Tyicyclic antidepressant
Use-depression, neuropathic pain, and insomnia.
Mechanism of action-inhibit the membrane pump mechanism responsible for uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons. This interference with reuptake of norepinephrine and/or serotonin is believed to underlie the antidepressant
activity of amitriptyline
Nursing consideration
Administer at bedtime d/t sedation effects
- Contraindicated with MAOI’s
adverse side affects-
May result in anticholinergic effects (constipation, urinary retention, and drowsiness)
- Blockage of adrenergic and dopaminergic receptors can cause cardiac conduction
disturbances and hypotension - Histaminergic blockage can cause sedation
- Serotonergic blockade can alter the seizure threshold and cause sexual dysfunction
- Black Box Warnings: Children, adolescents, and young adults are at higher risk for suicide
patient teaching
May take 3-4 weeks to work
Fluoxetine
Classification
Use
Mechanism of action
adverse side affects
patient teaching
Classification- SSRI
Use-reat depression, but are also used to treat obsessive compulsive disorder, bulimia,
panic disorder, posttraumatic stress disorder, other forms of anxiety, premenstrual syndrome, and
migraines
Mechanism of action-SSRIs inhibit the reuptake of serotonin.
adverse side affects-Serotonin Syndrome has been reported with SNRIs and SSRIs,
particularly with concomitant use of serotonergic drugs, drugs that impair metabolism of serotonin. This includes MAOI’s, lithium, ST. JOHNS WORT, and grapefruit juice
- Symptoms of Serotonin Syndrome include HIGH FEVERS, mental status changes, and muscle rigidity
- Abrupt discontinuation may cause several adverse effects
- Black Box Warning: Children, adolescents, and young adults are at
higher risk for suicide. Monitor for changing behavior, especially when
starting or changing doses.
patient teaching-May take 3-4 weeks to work
Tranylcypromine
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification-monoamine oxidase inhibitor
Use-treat major depressive disorder in adult patients who have not responded adequately to other antidepressants. The
drug may also be used to treat Parkinson’s disease
Mechanism of action-Potentiation of monoamine neurotransmitter activity in the central
nervous system resulting from its irreversible inhibition of the enzyme monoamine oxidase (MAO).
Inactivates norepinephrine, dopamine, epinephrine, and serotonin. By inhibiting MAO, the levels of
these transmitters rise
Nursing consideration-
Serious interactions with several medications, as well as foods and beverages containing
tyramine
- Examples: Aged cheese, sausage, beer, and red wines
- Elderly are at increased risk for hypotension and serious side effects
adverse side affects-
Use with caution due to the risks of hypertensive crisis
- Defined by severe hypertension (>180/120) with organ dysfunction, occipital headache, palpitations, neck
stiffness or soreness, nausea/vomiting, sweating, dilated pupils, photophobia, shortness of breath, or
confusion
patient teaching-Avoid abrupt cessation to avoid withdrawal
- Avoid alcohol and other CNS depressants and tyramine containing products for two weeks
after therapy is discontinued
Tranylcypromine
Used to treat major depressive disorder in adult patients who have not responded adequately to other antidepressants. The
drug may also be used to treat Parkinson’s disease.
Lithium
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification-antimania
Use-Used to treat bipolar affective disorder.
Mechanism of action-They alter sodium transport in nerve and muscle cells and effects a shift toward intraneuronal metabolism of catecholamines
Nursing consideration-Narrow therapeutic serum range (0.8 – 1.2 mEq/L)
- Monitor serum sodium levels due to potential hyponatremia
- Manic episode may normalize within 1 to 3 weeks
adverse side affects-
Lithium Toxicity: Diarrhea, vomiting, drowsiness, muscular weakness, and lack of coordination
- Higher Levels: Giddiness, ataxia, blurred vision, tinnitus, large output of dilute urine
- No antidote for lithium poisoning
- Fine hand tremor, polyuria, and mild thirst may persist throughout treatment
- Black Box Warning: Lithium toxicity is closely related to serum lithium levels and can occur at doses close to
therapeutic levels (1.5 mEq/L)
patient teaching
Take as prescribed
- Closely monitor serum sodium and lithium levels
- May cause weight gain
Haloperidol/risperidone
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification-antipsyhcotics
Use-treat schizophrenia, Tourette’s disorder, acute manic episodes and for irritability
caused by autism
Mechanism of action-Block dopamine receptors in the brain
Nursing consideration-Monitor elderly patient with dementia-related psychosis closely for cardiovascular events and pneumonia
- Contraindicated with Parkinson’s and Lewey-body dementia
- Monitor patients taking lithium and antipsychotics closely for neurotoxicit
adverse side affects-Tardive Dyskinesia
- Involuntary contraction of oral/facial muscles, wavelike movements of extremities
- Neuroleptic Malignant Syndrome (NMS)
- High fever, unstable blood pressure, and myoglobinemia
- Extrapyramidal Symptoms
- Akathisia, acute dystonia (sometimes treated with anticholinergics)
patient teaching
Take as prescribed – evenly space
- May require several weeks for desired effects
- Avoid alcohol and other CNS depressant
Phenytoin
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification-anticonvulsants
Use-Seizures and for seizure prevention during or following neurosurgery
Mechanism of action-Interferes with sodium channels in the brain, resulting in a reduction of sustained high-frequency neuronal discharges
Nursing consideration-Narrow therapeutic drug level (10 – 20mcg/mL)
- Monitor closely
- Elevated levels may cause confusional states referred to as delirium, psychosis, or encephalopathy
- Category X – can cause fetal harm
adverse side affects-oxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS)
- Onset is usually within 28 days of starting
- Discontinue at the first sign of a rash
patient teaching-May require several weeks for desired effects
- Avoid abrupt cessation, may cause status epilepticus
- May use benzodiazepines to treat seizures
carbidopa/levodopa
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification-anti parkinsons
Use-management of Parkinson’s Disease
Mechanism of action- levodopa does cross the blood-brain barrier and presumably is converted to dopamine in the brain. Carbidopa is combined with levodopa to help stop the breakdown of levodopa before it is able to cross the blood-brain barrier
Nursing consideration-
Contraindicated for use with MAOIs
- Use caution with positional changes and operating heavy equipm
adverse side affects
May cause drowsiness, dizziness, and orthostatic changes
patient teaching-
Plan mealtimes around medication administration to improve utensil use
- Avoid diets high in protein due to decreased medication absorpt
Amantadine
Classification
Use
Mechanism of action
Nursing consideration
adverse side affects
patient teaching
Classification antiparkisons/antiviral
Use-early stages of Parkinson’s disease but can be effective in moderate or advanced stages in reducing tremor and muscle rigidity
Mechanism of action-Antiviral drug that acts on dopamine receptors
Nursing consideration
Use caution with renal impairment
- May cause suicidal ideation
- Do not stop abruptly
adverse side affects
May cause nausea, dizziness/lightheadedness, and insomnia
- May cause anticholinergic side effects, impaired thinking, and orthostatic
hypotension
patient teaching
Take as directed – do not skip or double doses
- May cause drowsiness, dizziness, and orthostatic blood pressure changes
