nervous system medications

Question 1

Alprazolam

Answer 1

stimulates: Parasympathetic system (sedative)
class: Benzodiazepine
MOA: enchances the inhibitory effects of GABA in the CNS
route: PO
Indications: GAD, Panic Disorder
Adverse effects: CNS depression, Dependence, amnesia, Respirtory depression
contraindications: pregnancy/lactation, Sleep apnea, Glaucoma, liver/renal disease
diet: no grapefruit juice, low fat diet
Antidote: FLUMAZENIL
Nursing actions: notify provider if CNS depression occurs, administer at bed time, monitore RR and BP
interactions: anxiety medications
Evaluation: decreased anxiety, Amnesia pre-procedure

Question 2

what is the sympathetic nervous system?

Answer 2

a system that regulates various involuntary bodily functions (heart, BP, breathing and digestion)
key: FIGHT or FLIGHT

Question 3

what is the parasympathetic nervous system?

Answer 3

maintains homeostasis and promotes relaxation of the body
key: Rest and Digest

Question 4

Fluoxetine

Answer 4

Class: SSRI
Indications: panic disorder, OCD, and PTSD
MOA:Inhibits serotonin reuptake, allowing more serotonin to stay in the junction neurons
Route: PO
Adverse effects: Nausea, diaphoresis, tremor, fatigue, sexual dysfunction, weight changes. (these are usually short term) hyponatremia
contraindications: st johns wart, SAMe,MAOI’S, TCA, Antiplatelets/anticoagulants- increases risk of bleeding
nursing actions: monitor clients weight
report signs and symptoms of bleeding, monitor for serotonin syndrome, report any s/s of suicidal ideation
evaluation: decreased anxiety, panic

Question 5

venlafaxine

Answer 5

stimulates: sympathetic nervous system
Class: SNRI
Indications: Major depression, GAD, Anxiety, Panic
MOA: blocks the reuptake of norepinephrine as well as serotonin
Route: PO
Adverse effects: Nausea, Anorexia, weight loss, HTN, Tachycardia, NEUROLEPTIC MALIGNANT SYNDROME
Contraindications: 3rd trimester pregnancy/Lactation, Kava, Valerian, st.johns wort, BPD, mania, abnormal EKG, No MAOI USE WITHIN 14 DAYS
nursing actions: monitor client for manifestations of NMS, seizure percautions, observe suicidal ideation, TORSADES DE POINTES, serotonin syndrome
evaluation: improved mood stability, better sleep, reduced anxiety

Question 6

Bupropion

Answer 6

class: NDRI
stimulates: sympathetic nervous system
MOA: inhibits norepinephrine and dopamine reuptake
indications: smoking cessation, depression
Route: PO
Adverse effects: headache, consipation, increased heart rate, hypertention, restlessness, insomnia
contraindications: eating disorders, liver/renal impairment, MAOI, seizure disorders, BPD.
nursing action: administer in the morning, monitor weight, and food intake, monitor for seizures, discontinue MAOI 14 days prior, increase fluids and fiber.
Evaluation: person stops smoking, less depression

Question 7

lithium carbonate

Answer 7

class: mood stabilizer
indications: BPD, Acute mania
MOA: increases inhibitory transmission while reducing excititory transmission
Route:PO
Adverse effects: fine hand tremor, hypothyroidism, nephrotoxicity, lithium toxicity
containdictaions: Heart disease, hyponatremia, scizophrenia, thyroid disease
interactions: Diuretics, NSAIDS, Anticholingerics
nursing action: monitor lithium levels, administer with food/milk, MONITOR THYROID FUNCTION, maintaine sodium intake
Evaluation: mood stability, less mania

Question 8

carbamazepine

Answer 8

class: mood stabilizing, ANTIEPILEPTIC
Indication: Bipolar Disorder
MOA: inhibits sodium channel which reduces neuronal firing
Route: PO
Adverse effects: Hepatoxicity, STEVEN JHONSON SYNDROME, NYSTAGMUS
Contraindications: avoid pregnancy, bone marrow suppression, bleeding disorders
interactions: warfarin, oral contraceptives, grapefruit juice, phenytoin, phenobarbital
Nursing actions: administer at bedtime, CBC, sodium levels, edema, anihistamines(prn), liver function, WEAR SUNSCREEN
Evaluation: mood is stable, BPD symptoms are better

Question 9

Haloperidol

Answer 9

class: first generation antpsychotic
indication: schizophrenia, tourettes, acute psychosis
MOA: inhibits psychotic manifestations by blocking dopamine, histamine, norepinephrine
Route: PO, IM
Adverse effects: EPS, Tardive Dyskinesia, NMS
contraindications: prolonged QT interval, hypotension, paralytic illeus.
Interactions: Anticholinergics, CNS depressant, levodopa, Antihistamines
Nursing action:monitor EPS using the AIMS scale, bloodwork, ECG, monitor for seizures, AVOID TOUCHING MEDICATION DIRECTLY, get up slowly from lying/sitting
evaluation: decreased hallucinations, uncontrollable actions.

Question 10

Risperidone & Ziprasidone

Answer 10

Class: Antipsychotics
MOA: blocks serotonin and dopamine receptors
Indications: schizophrenia and depression
Route: PO(quick dissolving tabs) IM
Adverse effects: diabetes, weight gain, orthostatic hypotension, sedation
contraindications: dementia, cardiac issues, diabetes
interactions: immunosuppressants, alcohol, opioids, clarithromycin, barbituates, phenytoin, fluconazole
Nurse action: monitor glucose, EKG, triglycerides
Evaluation: improved condition in schizophrenia and depression

Question 11

Symptoms of EPS

Answer 11

-tremors
-drooling
-shuffled gait
-slow movement

Question 12

symptoms of Neuroleptic Malignant Syndrome

Answer 12

high fever, blood pressure changes, dysrhythmias, muscle rigidity, diaphoresis, tachycardia, change in LOC leading to coma.