central and peripheral nervous system medications chapter 16

Central and Peripheral Nervous System Medications

Chapter 16

Learning Objectives

Identify the major classes of drugs that affect the central nervous system

List different actions of antimigraine products Explain the major actions of drugs used to

treat disorders of the central nervous system

2Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Antimigraine Agents

Action Block nerve impulses at receptors of the

sympathetic nervous system Relieve pain by narrowing dilated cerebral

arteriesUses Prevention and treatment of migraine

headaches Drug Table 16-1


Antimigraine Agents (cont.)

Adverse Reactions Drug Interactions Other vasoconstrictors, MAOIsNursing Implications and Patient Teaching Assessment Diagnosis Planning Implementation Evaluation Patient Teaching: administration considerations


Antimigraine Medications Ergotamine Derivatives

Migranal dihydroergotamine

Ergomar ergotamine

Cafergot caffeine & ergotamine

Serotonin Receptor Agonists (-triptans)

Axert almotriptan

Maxalt rizatriptan

Imitrex * sumatriptan

Zomig zolmitriptan

Relpax elatriptan

Anticonvulsants or Antiepileptic Drugs Seizures: chaotic electrical discharges

causing sudden muscle contractions that happen without conscious control

Etiology: disease or disorders; head injury; idiopathic

Four major drug classes


Barbiturates Action Long duration of action and sedative effect

on the brain; action occurs in the brainstem

Uses Status epilepticus; to prevent and control

grand mal seizures May treat seizures caused by tetanus,

fever, or drugs RX: phenobarbital*


Benzodiazepines

Action CNS depressants; suppress electrical

discharge in seizures

Uses Treat minor motor seizures; Lennox-Gastaut

syndrome (petit mal)


Benzodiazepines

End in –lam or –pam Anticonvulsant as well as sedative Valium

diazepam Klonopin

clonazepam Ativan

lorazepam

Hydantoins Action Work primarily on the motor cortex, where

they stop the spread of seizure activity by increasing or decreasing Na+ ion movement across the motor cortex during the generation of nerve impulses

Uses Grand mal and psychomotor seizures,

status epilepticus, migraines, and trigeminal neuralgia


Hydantoins

Cause gingival hyperplasia Cannot be given NG with feeding. MUST hold

feeding for 2 hours before and after med. Cerebyx (name alert! Not Celebrex)

fosphenytoin Dialntin

phenytoin

Succinimides Action and Uses Elevation of the seizure threshold in the

cortex and basal ganglia and reduced synaptic response to low-frequency repetitive stimulation; controls petit mal seizures

Drug Interactions Other antiseizure agents and bone

marrow–depressing drugs RX: Zarontin (ethosuximide)


Other Common Anticonvusants Diamox

acetazolamide Tegretol

carbamazepine Neurontin

gabapentin Lamictal

lamotrigine Keppra

levetiracetam

Mysoline primidone

Topamax topiramate

Depakene / Depakote valproic acid

Trileptal oxcarbazepine

Antiemetic-Antivertigo Agents Action Factors that may provoke nausea and vomiting:

some drugs, metabolic disorders, radiation, motion, gastric irritation, vestibular neuritis, or increases in central trigger zone dopamine levels or vomiting center acetylcholine levels

Agents act to redirect stimulation by stopping or reducing stimulation of the vomiting center

Uses Prevent and treat motion sickness or the nausea

and vomiting that occur with surgery, anesthesia, and cancer treatment


Antiemetic and Antivertigo Meds Antidopaminergics Phenothiazines

Thorazine chlorpromazine

Compazine prochlorperazine

Phenergan Promethazine

Other:

Reglan (metaclopramide)

Anticholinergics Antihistamines

Dramamine dimenhydrinate

Benadryl diphenhydramine

Antivert Dramamine Meclizine

Other:

Marinol (dronabinol)

Transderm – Scop

(scopolamine)

Tigan (trimethobenzamide)

Antiemetic and Antivertigo Meds 5 HT receptor antagonists

Zofran ondansetron Many forms of the medication Given frequently for nausea in patients undergoing

chemotherapy for cancer

Antiparkinsonian Agents

Actions Change the neurotransmitters produced in the

brain: excessive acetylcholine, deficient dopamine

Block the uptake of acetylcholine and elevate the functional levels of dopamine in the motor regulatory centers

Uses Control of the symptoms of Parkinson disease


Antiparkinsonian Medications Anticholinergic Cogentin

benztropine Benadryl

diphenhydramine

Dopaminergic Symmetrel

ammantadine Parlodel

bromocriptine Sinemet

carbidopa- levadopa Comtan

entacapone Dopar

levadopa

Dopamine Receptor Agonists, Nonergot Mirapex (name alert! NOT Miralax)

pramipexole Requip

ropinirole

Learning Objectives

Identify the role of psychotropic drugs in psychotherapeutic intervention

Compare and contrast different categories of medications used to treat depression

Identify the major classes of drugs that affect the central nervous system


Antianxiety Agents Some anxiety is common It is problematic when it interferes with a

person’s ability to perform activities of daily living

Produces a calming effect Relieves anxiety, tension, and fear

May be used to manage alcohol withdrawal symptoms; used preoperatively; used to relieve muscle spasm


Antianxiety Medications Benzodiazepine Xanax

alprazolam Tranxene

clorazepate Valium

diazepam Ativan

lorazepam Serax

oxazepam

Nonbenzodiazepine Buspar

buspirone Vistaril

hydroxizine

Tricyclic Antidepressants Action Believed to inhibit the reuptake of norepinephrine

and or/serotonin Uses To treat endogenous depression; mild depression

due to exogenous causes

amitriptyline nortriptyline Tofranil (imipramine) Sinequan (doxepin)


Monoamine Oxidase Inhibitors

Action and Uses Monoamine oxidase: naturally occurring enzyme

found in the mitochondria of cells; located in nerve endings, kidneys, liver, and intestines; normally acts as catalyst to inactivate dopamine, norepinephrine, epinephrine, and serotonin

MAO inhibitors (MAOIs) block inactivation of these biogenic amines, resulting in increased concentrations at neuronal synapses and antidepressant effects

Nardil (phenelzine) Parnate (tranylcypromine)


Selective Serotonin Reuptake Inhibitors (SSRI)

Action and Uses Act by inhibiting CNS neuronal uptake of serotonin Used short-term for treatment of outpatients with

diagnosis listed as a category of Major Depressive Disorders in the DSM-IV

Used long-term for dysthymic and minor depressive disorders


SSRI and other Miscellaneous Antidepressants SSRI Celexa

citalopram Lexapro

escitalopram Prozac

fluoxetine Paxil

paroxetine Zoloft

sertraline

Tetracyclic Compounds Remeron

mirtazapine Desyrel

trazadone Unrelated Products

Wellbutrin bupropion

Cymbalta duloxetine

Effexor venlafaxine

Antipsychotic Drugs

Action and Uses All antipsychotic agents act by blocking the

action of dopamine in the brain Used in the treatment of severe mental

illness May be used in combination with major

tranquilizers


Antipsychotic Medications Aliphatic

Phenothiazine Thorazine

chlorpromazine Promazine

promazine Piperazine

phenothiazine Compazine

prochlorperazine

Nonphenothiazine Antipsychotics

Haldol haloperidol

Zyprexa olanzapine

Seroquel quetiapine

Risperdal risperidone

Geodon ziprasidone

Antimanics

Action and Uses Exact mechanism of lithium’s action is

unknown; alters sodium transport at nerve endings and enhances uptake of serotonin and norepinephrine by the cells (inactivates these neurotransmitters)

Mood-stabilizing drug Used to treat patients with bipolar disorder

who are in acute manic phase; prevents recurrent manic episodes


Antimanic Medication

Lithonate lithium Lithium is a salt so it is retained when serum

sodium is low. Excreted by the kidneys, so monitor the BUN and

creatinine levels. May need to lower the doses in elderly patients.

Sedative and Hypnotics

Benzodiazepines -lams and -pams

Phenobarbitals -barbs

Aquachlor (chloral hydrate) Miscellaneous sleep aids

Ambien (zolpidem) Lunesta (eszopiclone) Sonata (zaleplon)

Attention Deficit Hyperactivity Disorder (ADHD) CNS stimulants increase blood flow to the

frontal lobe where decision making is centered. Ritalin (methylphenidate) - stimulant Vyvanse (lisdexamfetamine)-phenethylamine and

amphetamine Adderal (amphetamine) - psychostimulant Straterra (atomoxetine)- selective norepinephrine

reuptake inhibitor


Questions?

central and peripheral nervous system medications chapter 16

Documents