CNS meds Flashcards
CNS stimulants
med uses
- Attention deficit hyperactive disorder (ADHD)
- Narcolepsy
- Reversal of respiratory distress
- Obesity
amphetamines
-cause euphoria and alertness but they can also cause sleeplessness, restlessness, tremors, and irritability.
CV problems such as increased heart rate palpitations, cardiac dysthymias, and hypertension can occur
- used to treat ADHD and narcolepsy
Amphetamines
drugs
- amphetamine (Adderall) -1
- dextroamphetamine (Dexedrine) -2
amphetamines
action and uses
- Action
- Stimulate release of norepinephrine and dopamine
- Uses
- Increase __________ in narcolepsy (1 & 2)
- Decrease hyperactivity, ______________, restlessness of ADHD (1)
- Treatment of obesity (2)
amphetamines
SE/AD
- Side effects/adverse reactions
- Tachycardia, palpitations, hypertension
- Sleeplessness, restlessness
- Anorexia, dry mouth, weight loss, diarrhea, constipation
- Impotence
amphetamine-like
drugs
•ADHD
•methylphenidate (Ritalin) – Controlled –substance Schedule 2 (CSS II)
•methamphetamine (Desoxyn)
•Increases a persons attention span, cognitive performance, decrease impulsiveness, hyperactivity, and restlessness
•Narcolepsy
•Modafinil (Provigil)
•Pemoline (Cylert)
•__________ amount of time patients feel awake – action unknown
amphetamine
SE
- Wide range of side effects, dose related
- Tend to “speed up” body systems
- Increased HR and palpitation
• Hypertension – may reverse effects of antihypertensive – methylphenidate – (Ritalin)
- Angina
- Dysrhythmias
- Nervousness, restlessness, anxiety, insomnia
- Dry mouth
- Increased urinary frequency
Amphetamine/Amphetamine like Drugs
Nursing Interventions
- Give before breakfast and lunch
- Assess heart rate/rhythm
- Record height, weight, and growth of children
- Avoid alcohol, caffeine
- Use sugarless gum to relieve dry mouth
- Do not stop abruptly– taper off instead
anorexiants
Short Term use only due to tolerance. Psychological dependence and possible psychosis – no longer recommended for use as appetite suppressants due to the effects of the CNS stimulation.
lipase inhibitors
- replaced anorexiants as drug of choice for weight loss -decrease GI absorption of fats so that they are secreted in the feces
- May have side effects of diarrhea, flatus with discharge, HA.
- Abdominal cramping
- Hypoglycemia may occur in DM
anorexiants -
appetite suppression
- Prescriptive or over the counter (OTC)
- Dextroamphetamine (Dexedrine) – ADHD no longer used as an anorexiant
•Orlistat (Xenical or Alli) – Lipase Inhibitors
•Action
•Suppress appetite
•Use
•Obesity
•Side effects
•Nervousness, restlessness, irritability, insomnia, palpitations, hypertension
•Do not give to children under the age of 12
CNS stimulants- analeptics
Affect the brainstem, spinal cord and cerebral cortex.
Used to stimulate respirations
One subgroup in this class of medications is: xanthines
(methylxanthines)
- Caffeine – stimulates the CNS
- Theophylline to relax the bronchioles and increase respiration in newborns
CNS Stimulants Analeptics - Xanthines
Caffeine (NoDoz, coffee, chocolate, cold meds)
Theophylline
CNS Stimulants Analeptics - Xanthines
Uses
•Uses
- Caffeine and Theophylline–stimulate respiration in newborns
- Theophylline—relax bronchioles
CNS Stimulants Analeptics - Xanthines
SE
- Side effects
- Restlessness, tremors, twitching
- Palpitations, insomnia
- Tinnitus, nausea, diarrhea
- Psychologic dependence
- High doses negatively affects the CNS and heart: dysrythmias, convulsions
CNS Respiratory Stimulants
Doxapram (Dopram)
CNS Respiratory Stimulants
Doxapram (Dopram)
uses
•Uses:
- Treat respiratory depression due to drug overdose
- Post-anesthetic respiratory depression
- COPD
- Administered IV with onset of action within 20-40 seconds
CNS Respiratory Stimulants
Doxapram (Dopram)
SE
•Side effects —infrequent
- Overdose SE—Hypertension; tachycardia; tremors; spasticity & hyperactive reflexes
- Mechanical ventilation is more effective if OD on certain drugs
CNS Stimulate Nursing Process
•Assessment – check history of heart disease, hypertension, hyperthyroidism, parkinsonism, glaucoma, mood, affect, aggressiveness, herbal use
- Ritalin may reverse the effects of antihypertensive medication.
- Labs” CBC, WBC, Platelets during treatment
- Nursing Diagnosis: Risk prone health behavior, Deficient knowledge.
•Planning: Patient will…….statement
•Interventions – nursing actions – must be measurable
•Patient Teaching – Avoid alcohol, side effects, notify provider before modifying dose, avoid food products and over the counter medications that have caffeine
•Evaluation – Is medication working, Decreased hyperactivity, normal sleep patterns ___8__ hours a night, patient knowledge verbalized.
CNS Depressants
- Sedative hypnotics – barbiturates, benzodiazepines, non benzodiazepines, melatonin agents.
- General anesthetics
- Analgesics
- Opioid analgesics
- Non-opioid analgesics
- Anticonvulsants
•Antipsychotics
•Antidepressants
-cause CNS depression or decreased CNS Activity
CNS Depressants
Sedatives
•Drugs that diminishes physical and mental response
•Hypnotics
- Cause hypnotic effect (not hypnosis) – form of natural sleep
- A sedative can become a hypnotic if it is given in large enough doses
Sedative-hypnotics—dose dependent
- At low doses, calm the CNS without inducing sleep
- At high doses, calm the CNS to the point of causing sleep
sedative-hypnotics
•Sedatives - Mildest form of CNS depression
•Sedative-hypnotics
- Barbiturates
- Benzodiazepiness
- Nonbenzodiazepines
•OTC
- Nytol, Sleep-Eze, Tylenol PM
- diphenhydramine (Benadryl)
sedative hypnotics
Should be short term to prevent drug tolerance
-Monitor high doses over long period of time for withdrawal symptoms
Sedative-Hypnotics Barbiturates
ultra-short acting
- Used as a general anesthetic
- Example: thiopental sodium (Pentothal)
Sedative-Hypnotics Barbiturates
Short-acting
- Induce sleep sedation pre-op
- Examples: pentobarbital (Nembutal), secobarbital (Seconal)
Sedative-Hypnotics Barbiturates
intermediate-acting
- Induce and sustain long periods of sleep
- Examples: amobarbital (Amytal), butabarbital (Butisol)
Sedative-Hypnotics Barbiturates
Long-acting
- Used to control seizures in epilepsy
- Example: phenobarbital
Sedative –Hypnotics – Benzodiazepines - Controlled Medication
antianxiety (am, lam)
- alprazolam (Xanax)
- lorazepam (Ativan) – short acting
- diazepam (Valium) – long acting and long half life 56-72 hours
- chlordiazepoxide (Librium)
Benzodiazepines marketed as hypnotics
- temazepam (Restoril)
- alprazolam (Xanax)
•Non-Benzodiazepines -sedative-hypnotics
- zolpidem (Ambien) – sleep walking
- eszopiclone (Lunesta)
- Hydroxizine (Atarax)
-ALL GENERALLY USED SHORT TERM TO AVOID ADDICTION
Sedative-Hypnotics – Side Effects
- Residual drowsiness
- Drug dependence
- Drug tolerance
- Excessive depression
- Respiratory depression
- Withdrawal symptoms
sedative hypnotics drug interactions
Drug interactions
- Alcohol
- CNS depressants
Sedative-Hypnotics – Nursing Interventions
- First use non-pharmacologic methods
- Take 15-45 min before bedtime
- Must be able to have 6-8 hours of sleep
- Report hangover effect
- Be attentive to safety – monitor for drowsniness and avoid driving
- Monitor BP, Respiration and withdrawal symptoms
melatonin agonists
•Ramelteon (Rozerem)
- Not a controlled substance
- Selectivity targets melatonin receptors to regulate the circadian rhythm in the treatment of insomnia
- Half life of 1-3 hours
- Side Effects – drowsiness, vertigo, fatigue, headache, suicidal ideation, and vivid dreams
Nursing Process CNS Depressants
- Assessment – Labs AST, ALT, bilirubin – monitor liver, obtain drug and herbal history, assess patient’s sleeping problems.
- Nursing Diagnosis: Sleep deprivation, Fatigue, Risk for injury due to insomnia.
- Planning/Goal: patient will sleep _8__ hours a night
- Interventions – monitor VS, sleep patterns, side effects of medication, respiratory depression, safety checks.
- Patient Education -
- Evaluation – Did this medication work? Sleep pattern? Was goal met, partially met or unmet?
Anesthetics - Types
- General – Total body analgesia, muscle relaxation, loss of consciousness, amnesia
- Local - analgesia in limited area of the body
•Balanced anesthesia Combination of drugs frequently used in general anesthesia
- Hypnotic (Given the night before)
- Zolpidem (Ambien)
- Narcotic analgesic or benzodiazepine
- Morphine or Midazolam (Versed)
- Atropine
- Barbiturate
- Thiopental sodium (Pentothal)
- Muscle relaxant
•Purpose of balanced anesthesia: ↓ amount of general anesthetic needed; minimizes cardiovascular problems; ↓ N & V; ↓ pain
Anesthetics -Routes
•Inhalation – General Anesthesia
- Gas or Volatile liquids
- Adverse effects: respiratory depression; hypotension; dysrhythmias; hepatic dysfunction; malignant hyperthermia
- Intravenous (IV)
- Used for general anesthesia
- Conscious sedation (Midazolam—Versed)
- Adverse effects: respiratory depression
•Topical
•Decrease sensitivity of the affected area
•Local
- Block pain at the site where drug is given
- Used in dental procedures & other minor surgeries
- Example: lidocaine
•Spinal - Spinal block - Epidural block - Caudal block
Anesthetics – Nursing Interventions
•Monitor patient’s level of consciousness and safety
•Monitor vital signs (respirations, P, BP)
•Respiratory status RR<10 BP <100/60
- Cardiovascular status
- Monitor urine output
- Administer analgesics as necessary
- For local and topical anesthetics—take precaution to avoid injury to area anesthetized
- Monitor for nausea and vomiting
•
•Monitor for constipation and decreased GI motility
