Nervous System Flashcards
Anxiety Medications: Benzodiazepines
+ alprazolam (Xanax)
OTHER BENZOS: Diazepam, lorazepam, (many end with -pam, except chlordiazepoxide)
INDICATIONS: Anxiety, seizures, muscle spasms, alcohol withdrawal, and induce/maintain anesthesia
MODE OF ACTION: Enhances GABA effect in the CNS.
SIDE EFFECTS: SEDATION, amnesia, dependency/withdrawal, RESPIRATORY DEPRESSION.
KEY POINTS: short-term use only! Do not discontinue abruptly. ANTIDOTE IS FLUMAZENIL.
Anxiety Medications: Atypical Anxiolytics
+ buspirone (BuSpar)
INDICATIONS: Anxiety, panic disorder, OCD, PTSD.
SIDE EFFECTS: Dizziness, nausea, headache.
KEY POINTS: NO SEDATION. Dependency not likely, LONG-TERM USE OK. Full effects not fat for several weeks. Take with meals to decrease GI upset.
Anxiety and Depression: SSRIs
+ paroxetine (Paxil)
OTHER SSRIs: Sertraline, fluoxetine (many end with -ine).
INDICATIONS: Anxiety, depression, OCD, PTSD.
MODE OF ACTION: Inhibits serotonin reuptake (i.e., increases serotonin).
SIDE EFFECTS: Sexual dysfunction, weight gain, INSOMNIA.
KEY POINTS: WATCH FOR SEROTONIN SYNDROME! Symptoms: agitation, hallucinations, fever, diaphoresis, tremors. Do not take with St. John’s wort, as this increases the risk for serotonin syndrome. Full effects not felt for up to a month.
Depression Medications: Atypical Antidepressants
+ bupropion (Wellbutrin)
INDICATIONS: Depressions AND as an aid to quit smoking.
SIDE EFFECTS: INSOMNIA, headache, GI dishes, weight loss, agitation, seizures.
OTHER ATYPICAL ANTIDEPRESSANT: Trazadone (MAJOR SIDE EFFECT IS SEDATION!).
Depression Medications: Tricyclic Antidepressants
+ amitriptyline (Elavil)
OTHER TRICYCLIC ANTIDEPRESSANT: Imipramine.
INDICATIONS: Depression, neuropathy, fibromyalgia, anxiety, insomnia.
SIDE EFFECTS: Sedation, orthostatic hypotension, ANTICHOLINERGIC SIDE EFFECTS (urinary retention, constipation, dry mouth, blurry vision, photophobia, tachycardia), sweating, seizures.
KEY POINTS: To counteract anticholinergic side effects - chew gum, wear sunglasses, high fiber diet, increase fluid intake.
Depression Medications: MAOIs
+ phenelzine (Nardil)
OTHER MAOI: Tranylcyrpomine
iNDICATIONS: Depression
SIDE EFFECTS: Agitation/anxiety, orthostatic hypotension, HYPERTENSIVE CRISIS.
KEY POINTS: Interactions with MANY other medications (including OTC cold medications, which can result in severe hypertension). DO NOT EAT WITH FOODS RICH IN TYRAMINE such as: aged cheese, avocados, bananas, red wine, salami/pepperoni, chocolate.
Bipolar Medications: Mood Stabilizers
+ Lithium
INDICATIONS: Bipolar disorder
SIDE EFFECTS: GI upset, FINE HAND TREMORS, polyuria, weight gain, nephrotoxicity, electrolyte imbalances.
KEY POINTS: Monitor plasma levels! TOXICITY OVER 1.5 mEg/L. Symptoms of toxicity: COARSE TREMORS, confusion, hypotension, seizures, tinnitus. No diuretics, anticholinergics, or NSAIDS. Contraindicated for patients with renal disease. Closely monitor sodium levels. Need adequate fluid intake (2-3 liters) and sodium intake!
Bipolar Medications: Antiepiletic Drugs
+ carbamazepine (Tegretol)
+ valproic acid (Depakote)
INDICATIONS: Bipolar disorder AND use as an anticonvulsant/antiepileptic.
CARBAMAZEPINE SIDE EFFECTS: BLOOD DYSCRASIAS (anemia, leukopenia, thrombocytopenia); vision issues (nystagmus, double vision), hypo-osmolarity, rash.
VALPROIC ACID SIDE EFFECTS: GI upset, HEPATOTOXICITY, pancreatitis, thrombocytopenia.
Antipsychotic Medications: Conventional
+ chlorpromazine (Thorazine)
+ haloperidol (Haldol)
INDICATIONS: Schizophrenia, psychotic disorders. Mainly controls positive symptoms (i.e. delusions, hallucinations).
SIDE EFFECTS: (MANY!)
+ EXTRAPYRAMIDAL SIDE EFFECTS (EPS): Dystonia, Parkinson’s symptoms (shuffling gait, rigidity), tardive dyskinesia (lip smacking, tongue rolling), akathisia.
+NEUROLEPTIC MALIGNANT SYNDROME (NMS): Fever, BP fluctuations, dysrhythmias, muscle rigidity.
+ OTHERS: Agranulocytosis, anticholinergic effects, orthostatic hypotension, sedation, seizures.
KEY POINTS: Monitor vital signs every 1-2 hours. Anticholinergics (ex: benztropine) can be used to control EPS symptoms. Muscle relaxant (ex: dantrolene) can be used to treat NMS.
Antipsychotic Medications: Atypical
resperidone (Risperdal)
OTHER ATYPICAL ANTIPSYCHOTICS: Clozapine, olanzapine (many end in -done or -pine.
INDICATIONS: Schizophrenia. Controls positive and negative symptoms (anergia, anhedonia, social withdrawal).
SIDE EFFECTS: DIABETES, WEIGHT GAIN, INCREASED CHOLESTEROL, sedation, orthostatic hypotension, anticholinergic effects, menorrhagia, decreased libido. CLOZAPINE CARRIES RISK FOR AGRANULOCYTOSIS!
KEY POINTS: Risperdone can be administered by IM injections q 2 weeks (for non-compliant patients). Avoid alcohol.
ADHD Medications
+ methylphenidate (Ritalin, Methylin)
OTHER ADHD MEDICATIONS: Amphetamine mixture (Adderall)
INDICATIONS: ADHD and conduct disorders
SIDE EFFECTS: Insomnia, dysrhythmias, DECREASED APPETITE, WEIGHT LOSS.
KEY POINTS: Do not administer at night, give medication immediately before or after meals, MONITOR CHILD’S WEIGHT DURING THERAPY.
Alcohol Abuse: Medications during Withdrawal
****NOTE: WITHDRAWAL STARTS WITHIN 4-12 HOURS OF LAST DRINK, PEAKS AT 24-48 HOURS.
BENZODIAZEPINES (chlordiazepoxide, diazepam, lorazepam): Used to stabilize vital signs, decrease risk of seizures, decrease withdrawal manifestations.
CARBAMAZEPINE; Decreases risk of seizures.
CLONIDINE: Decreases autonomic response (decreases BP, HR).
BETA BLOCKERS (propranolol, atenolol): Decreases autonomic response (decreases BP, HR) and cravings.
Alcohol Abuse: Medications to promote Abstinence
DISULFIRAM (Antabuse): If patient ingests alcohol, they will get many unpleasant side effects, including nausea, vomiting, sweating, palpitations, and hypotension.
NALTREXONE (Vivitrol): Suppresses craving for alcohol (also available as monthly IM injections).
ACAMPROSATE (Campral): Decreases abstinence symptoms (anxiety, restlessness).
Medications for Opioid and Nicotine Withdrawal
OPIOID WITHDRAWAL:
+ Methadone: Used for withdrawal and long-term maintenance.
NICOTINE WITHDRAWAL:
+ Guproprion (Wellbutrin): See atypical antidepressants for more information.
+ Nicotine replacements: Gum, patch, nasal spray.
+ Varenicline (Chantix): Reduces cravings and withdrawal symptoms; monitor patient closely for depression/suicidal thoughts.
Cholinergics
+ neostigmine (Prostigmin)
OTHER CHOLINERGICS: Pyridostigmine, edrophonium.
INDICATIONS: Myasthenia Gravis; improves strength/mobility. Reversal of neuromuscular blocking agents.
MODE OF ACTION: Increases ACh at receptor sites (by inhibiting cholinesterase).
SIDE EFFECTS: Excess ACh, causing increased salivation, diarrhea, nausea/vomiting, sweating, bradycardia.
KEY POINTS: EDROPHONIUM GIVEN TO PATIENTS TO DIAGNOSE MYASTHENIA GRAVIS (VS. CHOLINERGIC CRISIS). ANTIDOTE IS ATROPINE!
Anti-Parkinson’s Agent: Dopamine agonist
+ levodopa/carbidopa (Sinemet)
INDICATIONS: Parkinson’s; decreases tremors and muscle rigidity.
MODE OF ACTION: Increases dopamine in CNS (levodopa converted to dopamine in CNS, and carbidopa prevents breakdown of levodopa).
SIDE EFFECTS: Nausea/vomiting, drowsiness, dyskinesias (such as tics), orthostatic hypotension, darkening of urine and sweat, psychosis.
KEY POINTS: High-protein meals DECREASE the effectiveness of Levadopa/carbidopa.
Anti-Parkinson’s Agent: Anticholinergic Agent
+ benztropine (Cogentin)
INDICATIONS: Parkinson’s; decreases tremors and muscle rigidity.
MODE OF ACTION: Decreases Each in CNS.
SIDE EFFECTS: ANTICHOLINERGIC EFFECTS (dry mouth, dry eyes, blurry vision, urinary retention, constipation).
KEY POINTS: To counteract anticholinergic side effects - chew gum, wear sunglasses, high fiber diet, increase fluid intake.
Antiepileptics
+ phenytoin (Dilantin)
OTHER ANTIEPILEPTICS: Lamotrigine, carbamazepine, valproic acid (See Bipolar Medications/Antiepileptics drugs for information on carbamazepine, valproic acid).
INDICATIONS: Seizures.
SIDE EFFECTS: GINGIVAL HYPERPLASIA, diplopia, nystagmus, rash, ataxia, hypotension.
KEY POINTS: SERUM PHENYTOIN LEVELS NEED TO BE MONITORED ROUTINELY (NARROW THERAPEUTIC RANGE)! Decreases effectiveness of oral contraceptives.
Antiglaucoma agent (topical beta blocker) \+ timolol
INDICATIONS: Glaucoma (primarily open angle)
MODE OF ACTION: Non-selective beta blocker, decreases aqueous humor production, which increases IOP.
SIDE EFFECTS: Temporary stinging of eye.
KEY POINTS: Do not touch eye w/applicator, hold gentle pressure on the nasalacrimal duct fo 30-6- seconds after application. Overdose can cause systemic effects.
Antiglaucoma Agent (Carbonic Anhydrase Inhibitor) \+ acetazolamide (Diamox Sequels)
INDICATIONS: Glaucoma, heart failure, altitude sickness.
MODE OF ACTION: Causes diuresis and lowers IOP by decreasing queues humor secretion.
SIDE EFFECTS: Flulike symptoms, GI upset, electrolyte imbalances (Na and K).
KEY POINTS: Administer with food to minimize GI upset. Monitor electrolytes.
Ear drops to treat Otitis Externa
+ ciprofloxacin with hydrocortisone (pro HC)
INDICATIONS: Otitis exert (Swimmer’s ear).
MODE OF ACTION: Ciprofloxacin is an antibiotic, hydrocortisone is a steroid that decreases inflammation.
KEY POINTS: Roll container gently prior to administration (or gently shake for suspension form), position patient on unaffected side, keep patient on side for 5 minutes after installation (lightly pack ear w/cotton), dry ear canal after swimming, bathing.
Neuromuscular Blocking Agent
+ succinylcholine (Anectine)
OTHER NEUROMUSCULAR BLOCKING AGENT: Pancuronium
INDICATIONS: Used as an adjunct to anesthesia in surgery or intubation procedures.
MODE OF ACTION: Blocks ACh at neuromuscular junction, causing skeletal muscle paralysis.
SIDE EFFECTS: Respiratory arrest, apnea, MALIGNANT HYPERTHERMIA (sx: muscle rigidity, fever), muscle pain following surgery.
KEY POINTS: Treatment of malignant hyperthermia includes administering 100% oxygen, cooling measures, and administration of dantrolene (skeletal muscle relaxation).
Muscle Relaxants: Direct acting on skeletal muscle
+dantrolene (Dantrium)
INDICATIONS: Muscle spasticity r/t spinal cord injury, cerebral palsy, multiple sclerosis. Also used to treat and prevent malignant hyperthermia.
MODE OF ACTION: Prevents release of calcium in skeletal muscles (inhibiting muscle contraction) to reduce muscle spasticity.
SIDE EFFECTS: Drowsiness, muscle weakness, GI upset, hepatic toxicity.
KEY POINTS: Monitor for signs of liver damage.
Muscle Relaxants: Centrally Acting
+ baclofen (Lioresal)
INDICATIONS: Spasticity r/t spinal cord injury, cerebral palsy, multiple sclerosis. Also used to treat malignant hyperthermia.
MODE OF ACTON: Enhances GABA in CNS to reduce muscle spasticity.
SIDE EFFECTS: Drowsiness, GI upset (nausea), constipation.
KEY POINTS: Increase fiber consumption.
Urinary Tract Stimulant
+ bethanechol (Urecholine)
INDICATIONS: Non-obstructive urinary retention.
MODE OF ACTION: Stimulates cholinergic receptors n GU tract, allowing for bladder emptying.
SIDE EFFECTS: CHOLINERGIC SYMPTOMS (flushing, sweating, urinary urgency, bradycardia, hypotension).
KEY POINTS: Administer 1 hour before or 2 hours after meals to minimize nausea and vomiting.
Urinary Tract Antispasmodic
+ oxybutynin (Ditropan)
INDICATIONS: Overactive bladder symptoms (frequency, urgency, nocturia).
MODE OF ACTION: Inhibits ACh in the bladder, therefore reducing urinary urgency and frequency.
SIDE EFFECTS: ANTICHOLINERGIC SYMPTOMS (dry mouth, urinary retention, constipation, blurred vision).
KEY POINTS: Increase fiber and fluid intake.
Insomnia Medication
+ zolpidem (Ambien)
INDICATIONS: Insomnia.
MODE OF ACTION: Increases GABA in the CNS, promoting sedation/sleep.
SIDE EFFECTS: DAYTIME SLEEPINESS, dizziness.
KEY POINTS: Allow for at least 8 hours of sleep.
Sedative/Hypnotic
+ pentobarbital (Nembutal)
OTHER SEDEATIVE/HYPNOTIC MEDS: PROPOFOL, MIDAZOLAM
INDICATIONS: Induction and maintenance of anesthesia, conscious sedation, intubation.
MODE OF ACTION: CNS depression and loss of consciousness.
SIDE EFFECTS: Respiratory and cardiovascular depression. Propofol side effects: pain at IV site, high risk of bacterial contamination.
KEY POINTS: Have resuscitation equipment available, monitor ECG and vital signs. Vials of propofol should be used within 6 hours. Monitor for signs of infection.
