Medications for CNS Disorders

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Author:
jtmercado2005
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36636
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Medications for CNS Disorders
Updated:
2010-09-22 17:27:43
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Meds CNS
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CNS flash cards
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  1. What is Parkinson's Disease?
    • Pathophysiology
    • - degeneration of substantia nigra
    • - imbalance of dopamine and acetylcholine
    • - disruption of extrapyramidal system

    • Symptoms
    • - Bradykinesthia
    • - Tremor
    • - Rigidity
  2. Major Classes of Drugs for Parkinson's
    • - Levodopa/Carbidopa (Sinemet)
    • - Dopamine Agonists:
    • - Pramipexole (Mirapex)
    • - Ropinirole (Requip)
    • - Anticholinergics
    • - Benztropine (Cogentin)
    • - COMT Inhibitors
    • - Entacapone (Comtan)
    • - Combination Product
    • - Levodopa/Carbidopa with Entacapone (Stalevo)
  3. Levodopa/Carbidopa (Sinemet)
    • - Carbidopa prevents breakdown in preiphery
    • - Decreased efficacy over time
    • - MOA:
    • - promotes synthesis of dopamine

    • Adverse Effects:
    • - N/V
    • - Dyskinesias
    • - Orthostatic Hypotension
    • - Psychosis

    • Nursing Implications:
    • - Dosage Timings
    • - Freezing
    • - Protein intake
  4. Dopamine Agonists
    • - First-line agents
    • - MOA
    • - direct action on dopamine receptors

    • Adverse Effects:
    • - nausea
    • - dizziness
    • - sedation
    • - psychosis
    • - compulsive behavior

    • Nursing Implications:
    • - give with food
    • - titrate dose
  5. Benztropine (Cogentin)
    • - primarily for tremor
    • - MOA
    • - decreases acetylcholine levels in CNS

    • Adverse Effects:
    • - anticholinergic

    • Nursing Implications:
    • - caution in elderly
    • - cognitive impairment
    • - assess elimination
  6. COMT Inhibitors
    prevents breakdown of Sinemet
  7. What is Alzheimer's Disease
    • Pathophysiology:
    • - Neurodgenerative disorder
    • - Neurofibrillary tangles and plaques
    • - Decreased levels of acetylcholine
    • - increased risk with aging and family hx

    • Symptoms:
    • - progressive memory loss
    • - global cognitive deficits and executive planning
    • - impaired speech/communication
    • - decreased self-care
    • - eventual death
  8. Cholinesterase Inhibitors
    Alzheimer's

    • - Prototype
    • - Donepezil (Aricept)
    • - MOA
    • - prevent breakdown of acetylcholine
    • - increase availability of acetylcholine in CNS
    • - Effect
    • - mild symptom improvement or delay in progression

    • Adverse Effects:
    • - Cholinergic (GI and CV)

    • Nursing Implications:
    • - Assess for adverse effects
    • - realistic expectations
  9. Memantine (Namenda)
    • Alzheimer's
    • - MOA
    • - NMDA receptor antagonist
    • - prevents over stimulation of neuron by glutamate
    • - Effect
    • - mild symptom improvement or delay in progression

    • Adverse Effects:
    • - Dizziness
    • - Sedation

    • Nursing Implications:
    • - can be combined with Cholinesterase inhibitor
    • - realistic expectations
  10. What is Multiple Sclerosis (MS)?
    • Pathophysiology:
    • - Demyelinization of CNS
    • - autoimmune

    • Symptoms:
    • - highly variable in presentation and progression
    • - exacerbations and remissions
    • - weakness, numbness, pain, visual impairment, bowel and bladder issues
  11. Interferon beta
    MS

    • - MOA
    • - inhibits passage of inflammatory leukocytes into CNS

    • Adverse Effects:
    • - flu-like symptoms
    • - hepatotoxicity
    • - bone marrow suppression
    • - injection site reactions
    • - depression

    • Nursing Implications:
    • - assessments
    • - monitor labs
    • - patient education
  12. Glatiramer Acetate (Copaxone)
    MS

    • - MOA
    • - increases production of anti-inflammatory cells

    • Adverse Effects:
    • - injection site reactions
    • - post injection reactions

    - Patient education
  13. Treatment for MS Exacerbation
    • - IV Corticosteroids
    • - Methylprednisolone (Solu-Medrol)

    • Adverse Effects:
    • - hyperglycemia
    • - peptic ulcer disease
    • - sodium and fluid retention
    • - psychosis
    • - immune suppression
    • - fat redistribution
    • - loss of bone and muscle mass

    Need to taper (ween)
  14. Anticonvulsants (Antiepileptic Drugs) Indications
    • Seizures
    • - uncontrolled discharge of neurons
    • - different types
    • Bipolar Mania
    • Migraine Headaches
    • Neuropathic Pain
  15. Phenytoin (Dilantin)
    • Indication:
    • - seizure control

    • MOA
    • - selective suppression of sodium channels

    • Narrow Therapeutic Index
    • - therapeutic level 10-20 mcg/ml

    • Adverse Effects:
    • - CNS Suppression
    • - Gingival hyperplasia
    • - skin rash (can result in Stevens-Johnson syndrome)

    • Drug Interactions:
    • - induces hepatic metabolism of warfarin and OCPs (oral conctraceptive pill)

    Patient Education
  16. IV Phenytoin (Dilantin)
    Incompatibilities

    • Rapid dministration Results in CV Collapse
    • IV Vesicant (blistering)
    • Fosphenytoin (Cerebyx)
    • - prodrug
    • - less CV risk
    • - less caustic
  17. Carbamazepine (Tegretol)
    • Indication:
    • Seizure control
    • Bipolar disorder
    • Trigeminal neuralgia

    • MOA:
    • Selective suppression of sodium channels

    • Narrow Therapeutic index:
    • therapeutic level 4-12 mcg/ml

    • Adverse Effects:
    • - CNS depression
    • - bone marrow suppression
    • - Stevens-Johnson syndrome
    • - test for HLA-B 1502 in Asians

    • Drug Interactions:
    • - induces hepatic metabolism of warfarin and OCPs

    Patient Education
  18. Valprioc Acid (Depakote)
    • Indication:
    • Seizure control
    • Bipolar Disorder
    • Migraine Prophylaxis

    • MOA:
    • Selective suppression of sodium channels
    • suppression of Neuronal Calcium channels
    • Augments GABA

    • Narrow Therapeutic Index:
    • therapeutic level 40-100 mcg/ml

    • Adverse Effects:
    • - CNS Depression
    • - Hepatotoxicity
    • - pancreatitis
    • - hair loss
    • - Tremor
    • - bone marrow suppression

    Patient Education
  19. Gabapentin (Neurontin)
    • Indication:
    • - primarily used for neuropathic pain

    • MOA:
    • - enhanced GABA release

    • Adverse Effects:
    • - CNS Depression

    Patient Education
  20. Levetiracetam (Keppra)
    • Indication:
    • - becoming drug of choice for control of tonic-clonic seizures

    • MOA:
    • - unknown

    • Adverse Effects:
    • - sedation

    • Advantages:
    • - no significant interactions
    • - no need to monitor levels
  21. Management of Status Epilepticus
    • Status Epilepticus:
    • - continuous tonic-clonic seizures for 30 minutes
    • - seizures lasting greater than 5 minutes impending status
    • - can result in brain damage, acidosis, hypoglycemia, death

    • Administration of IV Benzodiazepine
    • - Lorazepam (Ativan)

    Administration of Fosphenytoin (Cerebyx)

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