ATI section 11: Medications for the Nervous System Flashcards
Antianxiety Medications
-lam, pam, Buspirone, Chlordiazepoxide
-Therapeutic Use Generalized anxiety disorder and panic disorder Insomnia Alcohol withdrawal Induction of anesthesia
-Precautions/Interventions
Diazepam and buspirone are used with caution in clients who have substance use disorder and liver disease
Buspirone is contraindicated for clients taking MAOIs
-Side/Adverse Effects CNS depression Paradoxical response (insomnia, excitation, euphoria) Withdrawal symptoms (not with Buspirone) Risk of abuse and potential overdose
-Nursing Interventions and Client Education
Monitor vital signs
Instruct clients to avoid alcohol
Treat overdose with flumazenil (Romazicon)
Antidepressant Classes
SSRI
-oxetine, Escitalopram, Fluvoxamine, Sertraline
-Precautions/Interactions
Avoid alcohol
Do not discontinue abruptly
Monitor for serotonin syndrome (agitation, confusion, hallucinations) within first 72 hr
-Side/Adverse Effects Weight gain Sexual dysfunction Fatigue Drowsiness
Antidepressant Classes
Tricyclic
-ine, Doxepin
-Precautions/Interactions
Do not administer with MAOIs or St John’s wort
Must avoid alcohol
Contraindicated for clients with seizure disorder
-Side/Adverse Effects Anticholinergic effects Sedation Toxicity Decreased seizure threshold
Antidepressant Classes
MAOI
-Isocarboxazid, Tranylcypromine, Phenelzine
-Precautions/Interactions
Avoid foods containing tyramine
Antihypertensives have additive hypotensive effect
Contraindicated with SSRIs, tricyclics, heart failure, CVA, renal insufficiency
-Side/Adverse Effects
CNS stimulation
Orthostatic hypotension
Hypertensive crisis with intake of tyramine, SSRIs, and tricyclics
Antidepressant Classes
- Nursing Interventions and Client Education
Assess client for suicide risk
Instruct client to take on daily basis and never miss a dose
Instruct client about therapeutic effects and time of onset
Instruct client to avoid discontinuing drug abruptly
Instruct client to take SSRIs in the morning to minimize sleep disturbances
Provide clients taking MAOIs a list of foods containing tyramine
Advise clients to avoid taking other medications without consulting a provider
Bipolar Disorder Medications
-Lithium Carbonate
-Therapeutic Use Bipolar disorder Alcohol use disorder Bulimia Schizophrenia
-Precautions/Interactions
Use cautiously in clients who have renal dysfunction, heart disease, hyponatremia, and dehydration
NSAIDs will increase lithium levels
Monitor serum sodium levels
-Side/Adverse Effects GI distress Fine hand tremors Polyuria Weight gain Renal toxicity
-Nursing Interventions and Client Education
Monitor therapeutic levels
Monitor serum sodium levels
Instruct clients that therapeutic effects begin in 7-14 days
Doses must be administered 2-3 times daily per prescriber
Provide nutritional counseling to include food sources for sodium
Administer with food to decrease GI distress
Antipsychotic Medications
- Conventional: azine, Haloperidol, Thiothixene
-Atypical (less severe side/adverse effects)
Aripiazole, apine, done
-Therapeutic Use Acute and chronic psychosis Schizophrenia Manic phase of bipolar disorders Tourette's syndrome Delusional and schizoaffective disorders Dementia
-Precautions/Interactions
Contraindicated for clients who have severe depression, Parkinson’s disease, prolactin-dependent cancer, and severe hypotension
Use caution in clients who have glaucoma, paralytic ileus, prostate enlargement, or seizure disorder
-Side/Adverse Effects
Sedation
Extrapyramidal effects (administer benzatropine)
Anticholinergic effects
Agranulocytosis
Neuroleptic malignant syndrome
Seizures (may require increased dose of anti seizure medications)
-Nursing Interventions and Client Education
Monitor for side effects within 5 hr-5 days of administration
Advise client of potential side effects
Monitor CBC
Encourage fluids
Stop medication for signs of neuroleptic malignant syndrome
Attention Deficit Hyperactive Disorder Medications
Stimulants
-amphetamine, Methylphenidate
-Side effects
Mood changes
Insomnia
Anxiety
-Nursing Interventions and Client Education
Administer in early morning
Do not abruptly discontinue
Monitor for signs of abuse, agitation
Attention Deficit Hyperactive Disorder Medications
Nonstimulants
-Atomoxetine, Guanfacine
-Side effects
GI upset
Constipation
Fatigue
-Nursing Interventions and Client Education
Take medication daily
Do not crush or chew
Instruct client to immediately report worsening of anxiety, agitation
Do not take with MAOIs
Sedative/Hypnotic Medications
-Eszopiclone, Temazepam, Zolpidem tartrate
-Therapeutic Use
Short term insomnia
Difficulty falling or staying asleep
-Precautions/Interactions
Use cautiously in clients who have severe mental depression
Avoid combined use with alcohol and medications that depress CNS function
-Side/Adverse Effects
Dry mouth
Decreased libido
Respiratory depression
-Nursing Interventions and Client Education
Instruct client to take immediately before bedtime because medication has abrupt onset of sleep
Instruct client to avoid alcohol
Warn client and caregivers of potential for sleep activities without recall; notify prescriber immediately
Abstinence Maintenance Medications
Disulfiram
-Therapeutic Use
Adjunct to maintain sobriety in tx of alcohol use disorder
-Precautions/Interactions
INH will increase risk of adverse CNS effects for clients taking disulfiram
Ingestion of large amounts of alcohol may cause respiratory depression, arrhythmias, and cardiac arrest
Adjust medication doses of warfarin and phenytoin
-Side/Adverse effects
Drowsiness
Headache
Metallic taste
Nursing Interventions and Client Education
- Must wait 12hr between time of last alcohol intake and starting medication
- Instruct client that consumption of alcohol while taking disulfiram will result in flushing, throbbing in head and neck, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion
- Instruct client that undesirable effects last 30 min- several hrs when alcohol is consumed
- Instruct client the effects of disulfiram may stay in the body for weeks after therapy is discontinued
- Instruct client that therapy may last months-years
Abstinence Maintenance Medications
Methadone
-Therapeutic Use
Prevents withdrawal symptoms in clients who were addicted to opiate drugs
-Precautions/Interactions
Do not use in clients who have severe asthma, chronic respiratory disease, or hx of head injury
-Side/Adverse effects
Sedation
Respiratory depression
Paradoxical CNS excitation
Nursing Interventions and Client Education
- Monitor clients for signs of drug tolerance and psychological dependence
- Monitor pancreatic enzymes because medication may cause biliary spasms
- Instruct client that methadone must be slowly reduced to produce detoxification
- Client must be monitored through tx center
Chronic Neurological Disorders
Cholinesterase Inhibitors
-Neostigmine, onium
-Therapeutic Use
Myasthenia gravis
-Precautions/Interactions
Do not administer if systolic BP less than 90 mm Hg
-Side/Adverse Effects Slow HR Chest pain, weak pulse, increased sweating, and dizziness Client feeling like he or she might pass out Weak or shallow breathing Urinating more than usual Seizures Trouble swallowing
-Nursing Interventions and Client Education
Dose must be individualized
Instruct client to keep individual diary to record side effects
Advise client to wear medical alert bracelet
Monitor for cholinergic crisis
Chronic Neurological Disorders
Anti-Parkinson’s
-Benztropine, dopa
-Therapeutic Use
Parkinson’s disease
-Precautions/Interactions
Do not use levodopa within 2 weeks of MAOI use
Pyridoxine (vitamin B6) decreases effects of levodopa
Bentropine is contraindicated in clients who have narrow-angle glaucoma
Must discontinue 6-8 hrs before anesthesia
-Side/Adverse Effects Muscle twitching (especially eyelid spasms Headache Dizziness Dark urine Agitation
Nursing Interventions and Client Education
- Instruct family members to assist with medication regimen
- Instruct client to notify prescriber if sudden loss of the medication effects occurs
- Instruct client that maximum therapeutic effects may take 4-6 weeks
- Monitor closely for signs of adverse reactions
- Instruct client to avoid high-protein meals and snacks
- Keep medication away from heat, light, and moisture. If pills become darkened, they have lost potency and must be discarded
Chronic Neurological Disorders
Antiseizure
-Carbamzepine, Gabapentin, Phenobarbital, Phenytoin, Valproic acid
-Therapeutic Use
Prevent and/or control seizure activity
