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Butterbug10
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What are the five CNS neurotransmitters?
- acetylcholine
- norepinepherine
- serotonin
- dopamine
- GABA
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Key facts about CNS stimulants [Ex: Amphetamine-dextroamphetamine (Adderall), dexmethylphenidate (Focalin), dextroamphetamine (Dexedrine), doxapream (Dopram), methylphenidate (Metadate, Ritalin), modafinil (Provigil), pemoline (PemADD)]
- increased neurotransmitter levels in the CNS
- Metabolized by the liver
- Excreted in urine
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When to use CNS stimulants [Ex: Amphetamine-dextroamphetamine (Adderall), doxapream (Dopram), methylphenidate (Metadate, Ritalin), modafinil (Provigil), pemoline (PemADD)]
- ADHD
- Narcolepsy
- Respiratory stimulation after anesthesia
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When NOT to use CNS stimulants [Ex: Amphetamine-dextroamphetamine (Adderall), doxapram (Dopram), methylphenidate (Metadate, Ritalin), modafinil (Provigil), pemoline (PemADD)]
- Glaucoma
- Severe CV disease
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Adverse reactions to CNS stimulants [Ex: Amphetamine-dextroamphetamine (Adderall), doxapram (Dopram), methylphenidate (Metadate, Ritalin), modafinil (Provigil), pemoline (PemADD)]
Restless, tremor, irritability, insomnia, hypotension, arrhythmias, angina, hypotension, arrhythmias, angina, CV collapse, wt loss, fatigue, depression, growth suppression
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Key nursing actions [Ex: Amphetamine-dextroamphetamine (Adderall), doxapram (Dopram), methylphenidate (Metadate, Ritalin), modafinil (Provigil), pemolin (PemADD)]
- Assess pt behavior to determine drug effectiveness
- Monitor growth in a child receiving long-term therapy
- Instruct pt to take last daily dose 6 hrs before bedtime to prevent insomnia
- Instruct pt to avoid caffeine
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Key facts about anticonvulsants [Ex: ethotoin (Peganone), fosphenytoin (Cerebyx), phenytoin (Dilantin, Phenytek)]
- Inhibit seizure activity
- Metabolized in the liver
- Excreted in urine
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When to use anticonvulsants [Ex: ethotoin (Peganone), fosphenytoin (cerebyx), phenytoin (Dilantin, Phenytek)]
- Tonic-clonic seizures
- Status epilepticus
- Complex partial seizures
- Arrhythmias
- Painful conditions, such as trigeminal neuralgia
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When NOT to use anticonvulsants [Ex: ethotoin (Peganone), fosphenytoin (cerebyx), phenytoin (Dilantin, Phenytek)]
- Hypersensitivity
- Sinus cradycardia
- Sinoatrial block
- Second- and thrid- degree heart block
- Adam-Stokes syndrome
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Adverse reactions to anticonvulsants [Ex: ethotoin (Peganone), fosphenytoin (cerebyx), phenytoin (Dilantin, Phenytek)]
- Gingival hyperplasia, rare blood dyscrasias, diplopia, nystagmus, ataxia, drowsiness
- Ventricular fibrillation in toxic states
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Key nursing actions [Ex: ethotoin (Peganone), fosphenytoin (cerebyx), phenytoin (Dilantin, Phenytoin (Dilantin, Phenytek)]
- Monitor for signs and symptoms of toxicity
- Monitor therapeutic hydantoin, complete blood count, and liver enzyme levels
- If GI upset occurs, administer drug with food
- Monitor vital signs, blood pressure, and ECG during I.V. administration
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Signs of anticonvulsant toxicity for anticonvulsants [Ex: ethotoin (Peganone), fosphenytoin (Cerebyx), phenytoin (Dilantin, Phenytek)]
- Ataxia
- Nystagmus
- Dysarthria
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Topics for discussion for anticonvulsants [Ex: ethotoin (Peganone), fosphenytoin (Cerebyx), phenytoin (Dilantin, Phenytek)]
- Medication regimen
- Signs and symptoms to discuss with the practitioner
- Oral hygiene measures to minimize gingival hyperplasia
- Urine discoloration
- Activity allowances and restriction
- Avoidance of alcohol and over-the-counter drug use
- Compliance with therapy
- Follow-up care
- Care during and after a seizure
- Community resources for support and information
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Key facts about barbituates [Ex: ethotoin (Peganone), fosphenytoin (Cerebyx), phenytoin (Dilantin, Phenytek)]
- Depress sensory cortex and motor activity and alter cerebellar function, causing drowsiness, sedation,a nd hypnosis
- May induce anesthesia
- Metabolized by the liver
- Excreted in urine
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When to use barbituates [Ex: Mephobarbital (Mebaral), penobarbital (Nembutal), phenobarbital (Luminal), primidone (Mysoline)]
- Tonic-clonic seizures
- Partial seizures
- Acute convulsive episodes
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When NOT to use barbituates [Ex: mephobarbital (Mebaral), penobarbital (Nembutal), phenobarbital (Luminal), primidone (Mysoline)]
- Hypersensitivity
- Pregnancy
- Breast-feeding
- Hepatic impairment
- Severe respiratory disease
- Previous addiction to sedative or hypnotic
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Adverse reaction to barbituates [Ex: mephobarbital (Mebaral), penobarbital (Nembutal), phenobarbital (Luminal), primidone (Mysoline)]
- Dizziness
- Drowsiness
- Confusion
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Key nursing actions for barbituates [Ex: mephobarbital (Mebaral), penobarbital (Nembutal), phenobarbital (Luminal), primidone (Mysoline)]
- Assess respiratory status before and during drug therapy
- Discourage alcohol use during drug therapy
- Monitor for withdrawal symptoms (anxiety, muscle twitching, hand and finger tremors, weakness, dizziness, nausea and vomiting, convulsions, delirium)
- Notify practitioner immediately of patient develops fever, sore throat, mouth sores, bruising, bleeding, or tiny broken blood vessels under the skin during drug therapy
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Key facts about benzodiazepines [Ex:clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan)]
- Depress CNS at limbic and subcortical levels, suppressing seizure activity; action is poorly understood
- Metabolized by the liver
- Excreted in urine
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When to use benzodiazepines [Ex: clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan)]
- Absence seizures
- Lennox-Gastaut syndrome
- Akinetic and myoclonic seizures
- Long-term treatment of epilepsy (clonazepam only)
- Partial sezures
- Acute alcohol withdrawal
- Acute status epilepticus
- Anxiety
- Skeletal muscle spasms
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When NOT to use benzodiazepines (Ex: clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan)]
- Hypersensitivity
- Acute angle-closure glaucoma
- Acute alcohol intoxication
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Adverse reactions to be benzodiazepines [Ex: clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan)]
- Ataxia
- drug dependence
- drowsiness
- dizziness
- tremors
- confusion
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Key nursing actions of benzodiazepines [Ex: clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan)]
- Caution pt not to stop abruptly (could produce status epilepticus or worsen disorder)
- Administer I.V. diazepam no faster than 5 mg/min in adults and over at least 3 minutes in children
- Don't mix I.V. diazepam with other drugs in same syringe
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Key facts about succinimides [Ex" ethosuximide (Zarontin), methsuximide (Celontin)]
- Raise seizure threshold by depressing neural transmission in the motor cortex and basal ganglia
- Metabolized in the liver
- Excreted in urine
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When not to use succinimides [Ex: ethosuximide (Zarontin, methsuximide (Celontin)]
Hypersensitivity
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Adverse reactions to succinimides [Ex: ethosuximide (Zarontin) methsuximide (Celontin)]
Anorexia, nausea, vomiting
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Key nursing actions for succinimides [Ex: ethosuximide (Zarontin), methsuximide (Celontin)]
- Don't withdrawa the drug abruptly
- If GI upset occurs, give drug with food or milk
- Monitor for adverse reactions
- Notify practitioner if reashes, joint pain, unexplained fever, sore throat, unusual bleeding or bruising, drowsiness, dizziness, or blurred vision develops
- Tell pt to avoid alcohol during therapy
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Key facts about sulfonamides [Ex: zonisamide (Zonegran)]
- Action unknown; raise the threshold for generalized seizures in rats
- Increased dopaminergic and serotonergic neurotransmission
- Block sodium channels
- Stabilize neuronal membranes
- Suppress neuronal hypersynchronization
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When to use sufonamides [Ex: zonisamide (Zonegran)]
Partial seizures related to epilepsy
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When NOT to use sulfonamides [Ex: zonisamide (Zonegran)]
Hypersensitivity
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Adverse reactions [Ex: zonisamide (Zonegran)]
Somnolence, ataxia, dizziness, h/a, anorexia, Stevens-Johnson syndrome, toxic epidermal necrolysis
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Key nursing actions [Ex: zonisamide (Zonegran)]
- Monitor for adverse reactions
- If rash or seizures worsen, contact practitioner immediately
- Also notify the practitioner if the pt develops fever, easy bruising, sore throat, or oral ulcers
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Key facts about anticonvulsants [Ex: carbamazepine (Tegretol), divalproex (Depakote), gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax), valopric acid (Depakene)]
- Action largely unknow; may reduce plysynaptic responses and block posttetanic potentiation by blocking voltage-sensitive sodium channels
- Metabolized by the liver
- Excreted in urine
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When to use anticonvulsants [Ex: carbamazepine (Tegretol, divalproex (Depakote), gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax), valporic acid (Depakene)]
- Tonic-clonic seizures
- Simple and complex partial seizures
- Trigeminal neuroplagia
- Neurgenic pain
- Absence seizures
- Postherpetic neuralgia
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When NOT to use other anticonvulsants [Ex: carbamazepine (Tegretol), gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax), valporic acid (Depakene)]
- Hypersensitivity
- Bone marrow suppression
- Within 14 days of MAO inhibitor therapy
- Pregnancy
- Breast-feeding
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Adverse reactions for anticonvulsants [Ex: carbamazepine (Tegretol), gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax), valporic acid (Depakene)]
- Sedation
- Photophobia
- Drowsiness
- Steven's-Johnson syndrome
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Key nursing actions of anticonvulsants[Ex: carbamazepine (Tegretol), gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax), valporic acid (Depakene)]
- Assess seizure characteristics
- Implement seizure precautions, as indicated
- Watch for signs and symptoms for anticonvulsant toxicity
- Instruct the pt not to discontinue the drug without consulting the practitioner
- Warn the pt to carry identification describing the disorder and drug regimen
- Notify practitioner if fever, sore throat, ora ulcer, easy bruising or bleeding, or fatigue develops
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Key facts about dopaminergic agonistsamantadine (Symmetrel), bromocriptine (Parlodel), levodopa (Dopar), levodopa-carbidopa (Sinemet), pergolide (Permax), pramipexole (Mirapex), ropinirole (Requip), selegiline (Elderpryl)
- Restore natural balance of acetylcholine and dopamine in the CNS
- Decrease signs and symptoms pf Parkinson's disease
- Metabolized in the brain, preiphery, and the liver
- Excreted in urine
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When to use dopaminergic agonists [Ex: dopaminergic agonistsamantadine (Symmetrel), bromocriptine (Parlodel), levodopa (Dopar), levodopa-carbidopa (Sinemet), pergolide (Permax), pramipexole (Mirapex), ropinirole (Requip), selegiline (Elderpyryl)
- Parkinson's disease
- Influenza A (amantadine)
- Hyperprolactinemia
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When NOT to use dopaminergic agonists [Ex: dopaminergic agonistsamadtadine (Symmetrel), bromocriptine (Parlodel), levodopa (Dopar), levodopa-carbidopa (Sinemet), pergolide (Permax), pramipexole (Mirapex), ropinirole (Requip), selegiline (Elderpyryl)]
- Glaucoma
- Breast-feeding
- Ischemic heart disease
- Psychoses
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Adverse reactions to dopaminergic agonists [Ex: dopaminergic agonistsamadtadine (Symmetrel), bromocriptine (Parlodel), levodopa (Dopar), levodopa-carbidopa (Sinemet), pergolide (Permax), pramipexole (Mirapex), ropinirole (Requip), selegiline (Eldepryl)]
Dizziness, confusion, mood changes, involuntary body movements, orthostatic hypotension, nausea, vomiting, dry mouth, altered tastes, tremors, insomnia, agitation, hallucinations
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Topics for discussion for dopaminergic agonists [Ex: dopaminergic agonistsamadtadine (Symmetrel), bromocriptine (Parlodel), levodopa (Dopar), levodopa-carbidopa (Sinemet), pergolide (Permax), pramipexole (Mirapex), ropinirole (Requip), selegiline (Elderpryl)]
- Medication regimen
- Signs and symptoms to discuss with practitioner
- Time required for drug to reach maximum effectiveness
- Safety measures
- Avoidance of alcohol and ocer-the-counter drug use
- Follow-up care
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Key nursing actions for dopaminergic agonists [Ex: dopaminergic agonistsamadtadine (Symmetrel), bromocriptine (Parlodel), levodopa (Dopar), levodopa-carbidopa (Sinemet), pergolide (Permax), pramipexole (Mirapex), ropinirole (Requip), slegiline (Elderpryl)]
- Assess for signs and symptoms of parkinsonism
- Base pt evaluation on improvement in signs and symptoms of parkinsonism without severe adverse effects
- Taper medication slowly to prevent serious adverse reactions
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Key facts about cholinergic blockers [Ex:Benzotropine (Cogentin)biperiden (Akineton), trihexyphenidyl (Trihexy-2, Truhexy-5)]
Block acetylcholine receptors in the CNS and ANS, thereby suppressing acetylcholine activity
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When to use cholinergic blockers [Ex: benzotropine (Cogentin), biperiden (Akineton), trihexyphenidyl (Trihexy-2, Trihexy-5)]
- Parkinson's disease
- Postencephalitic parkinsonism
- Acute dystonic reactions
- Drug-induced extrapyramidal reactions
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When NOT to use cholinergic blocker [Ex: benzotropine (Cogentin), biperiden (Akineton), trihexyphenidyl (Trihexy-2, Trihexy-5)]
- Angle-closure glaucoma
- Myasthenia gravis
- Stenosing peptic ulcers
- Achalasia
- Prostatic hypertrophy
- Bladder neck obstructions
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Adverse reactions to cholinergic blockers [Ex: benzotropine (Cogentin), biperiden (Akineton), trihexyphenidyl (Trihexy-2, Trihexy-5)]
- Blurred vision
- Constipation
- Dry mouth
- Urine retention
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Key nursing actions for cholinergic blockers [Ex: benzotropine (Cogentin), biperiden (Akineton), trihexyphenidyl (Trihexy-2, Trihexy-5)]
- Assess bowel and urinary function for evidence of adverse effects
- Instruct pt to consult practitioner or pharmacist before taking nonprescription drugs
- If GI upset occurs, administer drug with food
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Key facts about COMT inhibitors [Ex: Entacaptone (Comtan), tolcapone (Tasmar)]
- Inhibit transmission of COMT leading to sustained dopaminergic stimulation of the brain
- Metabolized by the liver
- Excreted in urine
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When to use COMT inhibitors [Ex: entacaptone (Comtan), tolcapone (Tasmar)]
- Parkinson's disease
- Adjunctive treatment with levodopa and carbidopa
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When NOT to use COMT inhibitors [Ex: entacapone (Comtan), tolcapone (Tasmar)]
Liver disease
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Adverse reactions for COMT inhibitors [Ex: entacapone (Comtan), tolcapone (Tasmar)]
- Disorientation
- Hallucinations
- Dizziness
- Nausea
- Muscular weakness
- Diarrhea
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Key nursing actions for COMT inhibitors [Ex: entacapone (Comtan), tolcapone (Tasmar)]
- Administer with levodopa-carbidopa' COMT inhibitors aren't single-therapy agents
- Monitor for hallucinations and orthostatic hypotension
- Discontinue drug slowly
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Key facts about antimigraine drugs [Ex: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), suatriptan (Imitrex)]
- Cause 5-HT to bind to serotonin receptors, reducing inflammatory process along the trigeminal nerve pathway
- Metabolized by the liver
- Excretion varies by drug
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When to use anitmigraine drugs [Ex: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex)]
- Moderate to severe migraines
- Cluster headaches
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When NOT to use antimigraine drugs [Ex: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex)]
Triptan allergy, coronary artery disease, ischemic heart disease, uncontrolled hypertension, basilar or hemiplegic migraines, hx of stroke, temporary ischemic attakcs, peripheral vascular disease, pregnancy
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Adverse reactions to antimigraine drugs [Ex: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex)]
Dizziness, vertigo, BP alterations, chest tightness, weakness, tingling, nausea, palpitations
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Key nursing actions for antimigraine drugs [Ex: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex)]
- Administer at onset of migraine
- Provide appropriate concurrent pain relief measures and therapeutic treatments
- Monitor injection site for redness or irritation
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Key facts about antimyasthenics [Ex: ambenonium (Mytelase), edrophonium (Tensilon), neostigmine (Prostigmin), pyridostigmine (Mestinon)]
- Relieve muscle weakness associated with myasthenia gravis by blocking acetylcholine breakdown at the neuromuscular junction
- Undergoes hydrolysis by cholinesterases or metabolized by the liver
- Excreted in urine
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When to use antimyasthenics [Ex: ambenonium (Mytelase), edrophonium (Tensilon), neostigmine (Prostgmin), pyridostigmine (Mestinon)]
Myasthenia gravis
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When NOT to use antimyasthenics [Ex: ambenonium (Mytelase), edrophonium (Tensilon), neostigmine (Prostigmin), pyridostigmine (Mestinon)]
- Hypersensitivity
- Bromide allergy
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Adverse reactions to antimyasthenics [Ex: ambenonium (Mytelase), edrophonium (Tensilon), neostigmine (Prostigmin), pyridostigmine (Mestinon)]
Abdominal pain, nausea, vomiting, diarrhea, sweating, miosis, increased salivation, increased bronchial secretions, difficulty breathing
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Key nursing actions for antimyasthenics [Ex: ambenonium (Mytelase), edrophonium (Tensilon), neostigmine (Prostigmin), pyridostigmine (Mestinon)]
- Assess neuromuscular status
- Monitor pt for signs and symptoms of drug overdose or underdose
- Urge pt to carry identification describing the disease and drug regimen
- Base pt evaluation on improvement of neuromuscular symptoms of strength without cholinergic signs or symptoms
- Know that cholinergic overdose and increasing anticholinesterase dosage is the tx for myasthenic crisis
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