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3. Nursing Pharmacology > CNS meds > Flashcards

CNS meds Flashcards

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1
Q

CNS stimulants

med uses

A
  • Attention deficit hyperactive disorder (ADHD)
  • Narcolepsy
  • Reversal of respiratory distress
  • Obesity
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2
Q

amphetamines

A

-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
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3
Q

Amphetamines

drugs

A
  • amphetamine (Adderall) -1
  • dextroamphetamine (Dexedrine) -2
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4
Q

amphetamines

action and uses

A
  • Action
  • Stimulate release of norepinephrine and dopamine
  • Uses
  • Increase __________ in narcolepsy (1 & 2)
  • Decrease hyperactivity, ______________, restlessness of ADHD (1)
  • Treatment of obesity (2)
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5
Q

amphetamines

SE/AD

A
  • Side effects/adverse reactions
  • Tachycardia, palpitations, hypertension
  • Sleeplessness, restlessness
  • Anorexia, dry mouth, weight loss, diarrhea, constipation
  • Impotence
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6
Q

amphetamine-like

drugs

A

•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

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7
Q

amphetamine

SE

A
  • 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
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8
Q

Amphetamine/Amphetamine like Drugs
Nursing Interventions

A
  • 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
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9
Q

anorexiants

A

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.

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10
Q

lipase inhibitors

A
  • 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
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11
Q

anorexiants -

appetite suppression

A
  • 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

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12
Q

CNS stimulants- analeptics

A

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
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13
Q

CNS Stimulants Analeptics - Xanthines

A

Caffeine (NoDoz, coffee, chocolate, cold meds)

Theophylline

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14
Q

CNS Stimulants Analeptics - Xanthines

Uses

A

•Uses

  • Caffeine and Theophylline–stimulate respiration in newborns
  • Theophylline—relax bronchioles
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15
Q

CNS Stimulants Analeptics - Xanthines

SE

A
  • Side effects
  • Restlessness, tremors, twitching
  • Palpitations, insomnia
  • Tinnitus, nausea, diarrhea
  • Psychologic dependence
  • High doses negatively affects the CNS and heart: dysrythmias, convulsions
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16
Q

CNS Respiratory Stimulants

A

Doxapram (Dopram)

17
Q

CNS Respiratory Stimulants

Doxapram (Dopram)

uses

A

•Uses:

  • Treat respiratory depression due to drug overdose
  • Post-anesthetic respiratory depression
  • COPD
  • Administered IV with onset of action within 20-40 seconds
18
Q

CNS Respiratory Stimulants

Doxapram (Dopram)

SE

A

•Side effects —infrequent

  • Overdose SE—Hypertension; tachycardia; tremors; spasticity & hyperactive reflexes
  • Mechanical ventilation is more effective if OD on certain drugs
19
Q

CNS Stimulate Nursing Process

A

•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.

20
Q

CNS Depressants

A
  • 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

21
Q

CNS Depressants

A

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
22
Q

sedative-hypnotics

A

•Sedatives - Mildest form of CNS depression

•Sedative-hypnotics

  • Barbiturates
  • Benzodiazepiness
  • Nonbenzodiazepines

•OTC

  • Nytol, Sleep-Eze, Tylenol PM
  • diphenhydramine (Benadryl)
23
Q

sedative hypnotics

A

Should be short term to prevent drug tolerance

-Monitor high doses over long period of time for withdrawal symptoms

24
Q

Sedative-Hypnotics Barbiturates

ultra-short acting

A
  • Used as a general anesthetic
  • Example: thiopental sodium (Pentothal)
25
Q

Sedative-Hypnotics Barbiturates

Short-acting

A
  • Induce sleep sedation pre-op
  • Examples: pentobarbital (Nembutal), secobarbital (Seconal)
26
Q

Sedative-Hypnotics Barbiturates

intermediate-acting

A
  • Induce and sustain long periods of sleep
  • Examples: amobarbital (Amytal), butabarbital (Butisol)
27
Q

Sedative-Hypnotics Barbiturates

Long-acting

A
  • Used to control seizures in epilepsy
  • Example: phenobarbital
28
Q

Sedative –Hypnotics – Benzodiazepines - Controlled Medication

antianxiety (am, lam)

A
  • alprazolam (Xanax)
  • lorazepam (Ativan) – short acting
  • diazepam (Valium) – long acting and long half life 56-72 hours
  • chlordiazepoxide (Librium)
29
Q

Benzodiazepines marketed as hypnotics

A
  • temazepam (Restoril)
  • alprazolam (Xanax)
30
Q

•Non-Benzodiazepines -sedative-hypnotics

A
  • zolpidem (Ambien) – sleep walking
  • eszopiclone (Lunesta)
  • Hydroxizine (Atarax)

-ALL GENERALLY USED SHORT TERM TO AVOID ADDICTION

31
Q

Sedative-Hypnotics – Side Effects

A
  • Residual drowsiness
  • Drug dependence
  • Drug tolerance
  • Excessive depression
  • Respiratory depression
  • Withdrawal symptoms
32
Q

sedative hypnotics drug interactions

A

Drug interactions

  • Alcohol
  • CNS depressants
33
Q

Sedative-Hypnotics – Nursing Interventions

A
  • 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
34
Q

melatonin agonists

A

•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
35
Q

Nursing Process CNS Depressants

A
  • 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?
36
Q

Anesthetics - Types

A
  • 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

37
Q

Anesthetics -Routes

A

•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

38
Q

Anesthetics – Nursing Interventions

A

•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

3. Nursing Pharmacology (22 decks)

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