Drugs affecting CNS Flashcards
appetite suppressant medications education
short term use only- 8-12 weeks
-monitor thyroid and hormone levels
only for those with BMI 30 or greater
-works by stimulating satiety centers of the hypothalamus
monitoring of appetite suppresants
- thyroid levels
- controlled substance d/t its abuse and dependence levels
anorexiants ADRs:
CNS overtstimulation: agitation, confusion, palpitations, arrythmias, sudden withdrawal can cause withdrawal symptoms, inc glucose in pts with diabetes
avoid anorexiants in patients with
heart problems, drug history, eldcerly
lipase inhibitors: ex of drug and facts
-Orlistat: taken orally with meals
works by preventing absorption of fats in the intestine; therefore, fat gets excreted quick out into feces
side effect: fatty oily stools, fecal urgency
epilepsy vs seizure
epilepsy- 2 or more unprovoked seizures
seizures- may be provoked (stressor, dehydration, chock, etc), if provoked, doesn’t count as the one tally for epilepsy
Anticonvulsant medications also being used in the treatment of mood disorders
gabapentin and Lamotrigine
drug choices for anticonvulsants
Hydantoins
Carbamazepines (Tegretol)
Succinimides
Drugs that affect GABA (Neurontin
hydantoin drug example
dilantin:
special dilantin consideration
unlike phenobarbitals, where doubling dose where you double dose, it doubles serum level), Dilantin does not work that way. Dilantin as its doubled, you can sometimes triple serum level , or slightly inc therapeutic effect. Does and therap effects are not 1:1 relationship like phenobarb
-can interact with antacid, valium use
First-line treatment for tonic-clonic and partial complex seizures
hydantoins
MoA of hydantoins
increasing influx of sodium ions across cell membranes in the motor cortex
anti-seizure meds consideration and talk to PCP when takin
birth control meds
common side effects of dilantin
itching, paresthesias, gingival hyperplasia, urinary retention,
monitoring of hydantoins
monitor liver labs, thyroid tests, kidney fx, OTC meds (antacids and nsaids)
driving and seizures
cannot drive if had seizure within a year
carbamezapine class drug
tegretol: black box warning: Steven Johnson syndrome (esp in asian ppl)
teaching for pt taking carbamezapine (tegretol)
teach about S/S of bone marrow suppression
Succinimide drug class:
Used for treatment of absence seizures in children and adults
Ethosuximide (Zarontin)
Ethosuximide (zarontin)-
Suppresses seizures by delaying calcium influx into neuron
Side effects: GI most common; somnolence
Lamictal (lamotrigine)
tonic clonic seizures, mood disorders, and absence disorders
can be used with valproic acid and phenytoin
Levateracitam (keppra)
few drug interactions (cleaner drug for seizure)
Gabapentin (Neurontin)
gaba working in body; suicidal thinking; can be used for neuropathic pain assoc with diabetic neuropathy, herpes zoster
gabapentin lab monitoring
renal fx:
if GFR too low, renal dosing may be required
Inhibits excitatory neurotransmitter release in the CNS
Used in treatment of focal onset seizures, diabetic peripheral neuropathy, post herpetic neuralgia, and fbromyalgia
Excreted unchanged by kidneys – reduced dosing in renal disease required
lyrica
TCA’s (first ones in the market)
Slavic, tofranil; overdose can lead to death, EKG changes, ortho hypotension, and anticholinergic effects
pt education: report chest pain, suicidal thinking, don’t drive, no alchohol
Most commonly prescribed antidepressant and well tolerated
ssri’s; inc levels of serotonin in body;
ADRs: CNS, GI, sexual dysfunction , weight gain
- can’t take up to 3-4 weeks to start working
- taper between 2-3 weeks
sari warnings
Suicide ideation and increased suicide risk- especially with children early in treatment
serotonin syndrome
diarrhea, tremor, sweating, restlessness, hyperreflexia - if untreated leads to disorientation, fever, rigidity, coma, seizures, and death – 10% mortality rate
SNRI’s examples
duloxetine (Cymbalta) and vanlafaxine (Effexor)
sari’s and children
NOT approved
SNRI’s monitoring
watch with antibiotic : quinolones
Decreased alertness and low energy and depressed-
snri’s
depression with pain or fibromyalgia ->
Cymbalta
Inhibits reuptake of both norepinephrine and dopamine
bupropion (Wellbutrin): dec attention span, dec motivation,
-few sexual side effects
-contrindicated in siezure disorders
can be used with smoking cessation too; decide when they want to quit, then start wellbutrin 10-15 days before
thorazine and haldol side efects
Parkinsonism, eps syndrome,
inc mortality with old people
monitor: prolactin levels and aim scale
These drugs attempt to restore the functional balance of dopamine and acetylcholine (ACh) in the corpus striatum of the brain.
dopaminergic: good for parkinson's Amantadine (Symmetrel) Bromocriptine (Parlodel) Levodopa (L-Dopa, Larodopa) Carbidopa-levodopa (Sinemet) Pramipexole (Mirapex) – also used for RLS Ropinirole (Requip) – also used for RLS
Must better to treat anxiety with ssri’s than anxiolytics and hypnotics d/t
phys/psych dependence and abuse potential
anxiety drugs : short acting
lorazepam (Ativan) and alprazolam (xanax)
anxiety drugs: long acting
clonazepam (klonipin) and diazepam (valium)
Long term treatment of general anxiety disorder
Exerts effect by enhancing serotonin; no CNS depression
Little risk of dependence and few drug interactions
Pharmacokinetics: reduced first-pass affect, has many metabolites, one has noradrenergic effects, NOT used with panic attacks
Takes up to 2 weeks for onset to occur and up to 6 weeks for maximum effect
Needs to be taken daily – not prn
busperone (buspar)
3rd class of anxiolytics: barbiturates
Used today for pre-anesthesia sedation; seizure disorders; status epilepticus (phenobarbitals)
sedative hypnotics:
Benzos and nonbenzos
Benzos: high tolerance
nonbenzos: take immediately before bed and sleep for 6-7 hrs of sleep
High incidence of drug-drug and drug-food interactions, especially with foods containing tyramine with this drug
maoi’s (Nardil marplan)
low safety margin
lithium (mood stablizer)
bipolar disorder, very low therapy index
at toxic levels: neuro changes (ataxia, tremors, confusion)
2 types of muscle relaxants/antispasmodics
centrally-acting and direct acting
centrally acting muscle relaxant
CNS depression likely; flexeril take at night;
direct acting antispasmodics:
dantrolene treats spasticity in upper neurons
-pt education: titration schedule
amphetamines vs strattera
schedules vs nonscheduled substance; no amphetamine side effects for Strattera;
ampetamines can take drug holidays, not straterra, as it takes forever to start working
Modafinil (Provigil)
Amodafinil (Nuvigil)
used to treat narcolepsy and SWCD (sleep wake cycle disorder)
xanthine
coffee
