Drug facts for central nervous system

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  1. What are the five CNS neurotransmitters?
    • acetylcholine
    • norepinepherine
    • serotonin
    • dopamine
    • GABA
  2. 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
  3. When to use CNS stimulants [Ex: Amphetamine-dextroamphetamine (Adderall), doxapream (Dopram), methylphenidate (Metadate, Ritalin), modafinil (Provigil), pemoline (PemADD)]
    • ADHD
    • Narcolepsy
    • Respiratory stimulation after anesthesia
  4. When NOT to use CNS stimulants [Ex: Amphetamine-dextroamphetamine (Adderall), doxapram (Dopram), methylphenidate (Metadate, Ritalin), modafinil (Provigil), pemoline (PemADD)]
    • Glaucoma
    • Severe CV disease
  5. 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
  6. 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
  7. Key facts about anticonvulsants [Ex: ethotoin (Peganone), fosphenytoin (Cerebyx), phenytoin (Dilantin, Phenytek)]
    • Inhibit seizure activity
    • Metabolized in the liver
    • Excreted in urine
  8. 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
  9. 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
  10. 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
  11. 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
  12. Signs of anticonvulsant toxicity for anticonvulsants [Ex: ethotoin (Peganone), fosphenytoin (Cerebyx), phenytoin (Dilantin, Phenytek)]
    • Ataxia
    • Nystagmus
    • Dysarthria
  13. 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
  14. 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
  15. When to use barbituates [Ex: Mephobarbital (Mebaral), penobarbital (Nembutal), phenobarbital (Luminal), primidone (Mysoline)]
    • Tonic-clonic seizures
    • Partial seizures
    • Acute convulsive episodes
  16. 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
  17. Adverse reaction to barbituates [Ex: mephobarbital (Mebaral), penobarbital (Nembutal), phenobarbital (Luminal), primidone (Mysoline)]
    • Dizziness
    • Drowsiness
    • Confusion
  18. 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
  19. 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
  20. 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
  21. When NOT to use benzodiazepines (Ex: clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan)]
    • Hypersensitivity
    • Acute angle-closure glaucoma
    • Acute alcohol intoxication
  22. Adverse reactions to be benzodiazepines [Ex: clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan)]
    • Ataxia
    • drug dependence
    • drowsiness
    • dizziness
    • tremors
    • confusion
  23. 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
  24. 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
  25. When not to use succinimides [Ex: ethosuximide (Zarontin, methsuximide (Celontin)]
    Hypersensitivity
  26. Adverse reactions to succinimides [Ex: ethosuximide (Zarontin) methsuximide (Celontin)]
    Anorexia, nausea, vomiting
  27. 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
  28. 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
  29. When to use sufonamides [Ex: zonisamide (Zonegran)]
    Partial seizures related to epilepsy
  30. When NOT to use sulfonamides [Ex: zonisamide (Zonegran)]
    Hypersensitivity
  31. Adverse reactions [Ex: zonisamide (Zonegran)]
    Somnolence, ataxia, dizziness, h/a, anorexia, Stevens-Johnson syndrome, toxic epidermal necrolysis
  32. 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
  33. 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
  34. 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
  35. 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
  36. Adverse reactions for anticonvulsants [Ex: carbamazepine (Tegretol), gabapentin (Neurontin), pregabalin (Lyrica), topiramate (Topamax), valporic acid (Depakene)]
    • Sedation
    • Photophobia
    • Drowsiness
    • Steven's-Johnson syndrome
  37. 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
  38. 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
  39. 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
  40. 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
  41. 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
  42. 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
  43. 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
  44. 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
  45. 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
  46. 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
  47. Adverse reactions to cholinergic blockers [Ex: benzotropine (Cogentin), biperiden (Akineton), trihexyphenidyl (Trihexy-2, Trihexy-5)]
    • Blurred vision
    • Constipation
    • Dry mouth
    • Urine retention
  48. 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
  49. 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
  50. When to use COMT inhibitors [Ex: entacaptone (Comtan), tolcapone (Tasmar)]
    • Parkinson's disease
    • Adjunctive treatment with levodopa and carbidopa
  51. When NOT to use COMT inhibitors [Ex: entacapone (Comtan), tolcapone (Tasmar)]
    Liver disease
  52. Adverse reactions for COMT inhibitors [Ex: entacapone (Comtan), tolcapone (Tasmar)]
    • Disorientation
    • Hallucinations
    • Dizziness
    • Nausea
    • Muscular weakness
    • Diarrhea
  53. 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
  54. 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
  55. When to use anitmigraine drugs [Ex: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex)]
    • Moderate to severe migraines
    • Cluster headaches
  56. 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
  57. 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
  58. 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
  59. 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
  60. When to use antimyasthenics [Ex: ambenonium (Mytelase), edrophonium (Tensilon), neostigmine (Prostgmin), pyridostigmine (Mestinon)]
    Myasthenia gravis
  61. When NOT to use antimyasthenics [Ex: ambenonium (Mytelase), edrophonium (Tensilon), neostigmine (Prostigmin), pyridostigmine (Mestinon)]
    • Hypersensitivity
    • Bromide allergy
  62. 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
  63. 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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Drug facts for central nervous system
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Drug facts for central nervous system
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