CNS Drugs

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Author:
dsherman
ID:
92283
Filename:
CNS Drugs
Updated:
2011-06-29 08:44:15
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CNS Drugs
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CNS Drugs
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  1. Classification (Antiepileptics)
    Phenytoin ( Dilantin)-PO or IV
    Carbamazepine (Tegretol)-PO
    Valproic Acid (Depakene)-PO or IV
    • Action: stabilizes neuronal membranes and limits the spread of seizure activity by affecting the motor cortex
    • Uses:
    • control grand mal (tonic-clonic) and psychomotor seizures (in all age groups)
    • can be used for status epilepticus
    • Contraindications:
    • hypersensitivity, pregnancy
    • Precautions:
    • hepatic, hematologic, and respiratory disorders
    • sinus bradycardia, sinoartial block, second and third- degree block (Dilantin)
    • Side effects:
    • Constipation, nausea, vomiting, diarrhea
    • headache, drowsiness, somnolence (urge to sleep, long periods of sleep), or insomnia
    • blood dyscrasias-(Tegretol)
    • cardiac dysrhythmias and gingival hyperplasia-(Dilantin)
    • hepatotoxicity-(Valproic acid)
    • Nursing implications:
    • usually give orally. Administer by deep intramuscular (IM) or intravenous (IV) injection in emergencies.
    • Do not mix IV Dilantin with other medications. Give IV Dilantin slowly (do not exceed 50mg/min)
    • perform periodic blood studies for therapeutic levels
    • check hepatic and renal functions
    • teach client to purchase a medic-alert bracelet or carry a medical ID card
    • teach client to never abruptly discontinue medication
    • with Dilantin, watch for gingival hyperplasia; encourage routine prophylactic dental care, and instruct client to take with meals
  2. Phenytoin (Dilantin)
    • Classification: Antiepileptic
    • given PO or IV
    • Action: reduces voltage frequency and spread of electrical discharges
    • Uses: Control grand mal (tonic-clonic) and psychomotor seizures in all age groups
    • Contraindications: hypersensitivity, pregnancy
    • Percautions:
    • hepatic, hematologic, and respiratory disorders
    • sinus brsdycardia, sinoarial block, second and third-degree heart block
    • Side effects:
    • gingival hyperplasia
    • bradycardia
    • Constipation, nausea, vomiting, diarrhea
    • headache, drowsiness, somnolence, or insomnia
    • Nursing implications:
    • Noncompliance is frequently responsible for treatment failure
    • you need to do drug levels
    • teach client to purchase a medic-alert bracelet or carry a medical ID card
    • teach client to never abruptly discontinue medication
    • While on dilantin watch for gingival hyperplasia; encourage routine prophlactic dental care and instruct client to take with meals
    • Do not mix IV dilantin with other medications. Give slowly (do not exceed 50 mg/min)
  3. Carbamazepine (Tegretol)
    • Clasification: Antiepileptic
    • given PO
    • Action: reduces symptic reaction
    • Uses: Control grand mal (tonic-clonic) and psychomotor seizures (in all age groups)
    • Contraindications: hypersensitivity, pregnancy
    • Percautions:
    • hepatic, hematologic, and respiratory disorders
    • sinus brsdycardia, sinoarial block, second and third-degree heart block
    • Side Effects:
    • visual problems, ataxia, vertigo
    • Constipation, nausea, vomiting, diarrhea
    • headache, drowsiness, somnolence (urge to sleep, prolonged periods of sleep), or insomnia
    • Blood dyscrasias (blood disease)
    • Nursing inplications:
    • Noncompliance is frequently responsible for treatment failure
    • you need to do drug levels
    • teach client to purchase a medic-alert bracelet or carry a medical ID card
    • teach client to never abruptly discontinue medication
  4. Valproic Acid (Depakene)
    • Classification: Antiepileptic
    • given PO or IV
    • Action: Blocks sodium and calcium channels to prevent neuron firing
    • Uses: Control grand mal (tonic-clonic) and psychomotor seizures in all age groups
    • Contraindications: hypersensitivity, pregnancy
    • Percautions:
    • hepatic, hematologic, and respiratory disorders
    • sinus brsdycardia, sinoarial block, second and third-degree heart block
    • Side effects:
    • GI upset
    • hepatotoxicity
    • Constipation, nausea, vomiting, diarrhea
    • headache, drowsiness, somnolence (urge to sleep,prolonged periods of sleep), or insomnia
    • Nursing implications:
    • Noncompliance is frequently responsible for treatment failure
    • you need to do drug levels
    • teach client to purchase a medic-alert bracelet or carry a medical ID card
    • teach client to never abruptly discontinue medication
  5. Hydroxyzine (Vistaril)
    • Classification: Antianxiety, sedative hypnotic
    • given IM or PO
    • Action: produces anticholinergic, antihistaminic, analgesic effects; relaxes skeletal muscle; helps control nausea and vomiting
    • Uses: Preoperative and postoperative sedation; antiemetic
    • Contraindications: third trimester of pregnancy, breastfeeding women, newborns
    • Percautions: open-angle glaucoma, prostatic hypertropy, asthma, COPD
    • Side effects:
    • drowsiness, dry mouth, dizziness, ataxia (lack of cordination of muscle movement), and pain
    • with IM injection use Z-track
    • Nursing implications:
    • offer emotional support; assess motor response; monitor vital signs and fluids and electrolytes; monitor bowel and bladder activity (I & O)
    • assess for desired preoperative effects (LOC)
    • administer intravenous (IV) medications slowly to avoid life-threatening reactions (severe hypotension, respiratory and cardiac arrest)
    • teach client to never abruptly stop medication
  6. Lorazepam (Ativan)
    • Classification: Antianxiety, sedative hypnotic
    • given PO, IM, or IV push
    • Action: produces muscle relaxation; has anticonvulsant, sedative, antemetic effects; decreased anxiety
    • Uses: preoperative sedation, seizures, anxiety
    • Contraindications: pregnancy,sleep apnea
    • Precautions: clients with suicidal tendencies and substance abuse
    • Side effects:
    • Central nervous system (CNS) depression
    • paradoxical effect (excitement, heightened anxiety)
    • physical dependence
    • Nursing implications:
    • offer emotional support; assess motor response; monitor vital signs and fluids and electrolytes; monitor bowel and bladder activity (I & O)
    • assess for desired preoperative effects (LOC)
    • administer intravenous (IV) medications slowly to avoid life-threatening reactions (severe hypotension, respiratory and cardiac arrest)
    • teach client that oral preparations of ativan should be taken with meals
    • teach client to never abruptly stop medication
  7. Prochlorperazine (Compazine)
    • Classification: Antiemetic
    • given PO, IM, IV, Rectal
    • Action: Blocks dopamine receptors involved in activating the vomiting reflex
    • Uses: suppression of nausea and vomiting that are associated with surgery, chemotherapy, and varied noxious stimuli
    • Contraindications:
    • Hypersensitivity
    • glaucoma
    • bone marrow depression
    • central nervous system (CNS) depression
    • Precautions: infants, pregnancy, breastfeeding
    • Side effects:
    • Drowsiness, hypotension
    • Dry mouth, flushing
    • Dizziness, fainting
    • prolonged use; dystonia (muscle twitching), akathisia (inability to sit still, restlesness), tardive dyskinesia (involentary repetive movements usually appear with long term use), and other extrapyramidal reactions
    • Nursing indications:
    • assess for cause of nausea and vomiting
    • monitor vital signs
    • observe for hypersensitivity reactions
    • monitor level of hydration
    • instruct client about orthostatic hypotension
    • avoid skin contact with solution
    • instruct client to avoid hazardous or activities requiring mental alertness
  8. Promethazine (Phenergan)
    • Classification: Antiemetic; antihistamine
    • given PO, PR, IM, IV
    • Action: Blocks histamine receptors in the neuronal pathway, leading from the vestibular apparatus of the inner ear to the vomiting center in the medulla
    • Uses: Nausea and vomiting caused by noxious stimuli and motion sickness, virtigo
    • Contraindications and Percautions:
    • severe central nervous system (CNS) depression, acute asthma
    • glaucoma
    • gastrointestinal or genitourinary obstruction
    • pregnancy, seizure
    • Side effects;
    • sedation, drowsiness, disorientation
    • hypotension
    • dry mouth, urinary retention
    • confusion
    • Nursing indications:
    • evaluate client's respiratory status during use of this drug
    • teach client to avoid tasks that require mental alertness
    • direct client to report tremors or anormal body movement
    • long-term therapy, teach client to have complete blood count (CBC) drawn
  9. Midazolam (Versed)
    • Classification: Benzodiazepine
    • given PO, IV, IM
    • Action: produces unconsciousness and amnesia
    • Uses: induction of anesthesia and conscious sedation
    • Contraindications:
    • shock
    • coma
    • acute alcohol intoxication
    • acute narrow-angle glaucoma
    • Precautions:
    • can cause dangerous cardiorespiratory effects, including respiratory depression and cardiac arrest
    • acute illness
    • severe electrolyte imbalance
    • Side effects;
    • decreased respiratory rate
    • tenderness at intramuscular/intravenous (IM/IV) injection site
    • hypotension
    • Nursing indications:
    • administer slowly over 2 or more minutes. Wait another 2 or more minutes for full effects to develop before giving additional doses to avoid cardiorespiratory problems
    • unconsciousness develops quickly (within 60 to 80 seconds). Conscious sedation persists for approximately 1 hour
    • perform constand cardiac and respiratory monitoring during administration with resuscitative equipment near by
    • the client will not remember any postoperative instructions. After outpatient procedures, the client must be accompanied home by a responsible adult

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