Drugs Affecting the nervous system (CNS) Flashcards
(121 cards)
1
Q
Drugs fall into two basic categories
A
- stimulants(analeptics) which stimulate the nervous system
- depressants, which depress activity within the nervous system
2
Q
Central nervous system drug
A
1) Analgesic(Narcotics)
2) Sedative/Hypnotic
3) Anesthetic
4) Anticonvulsant
3
Q
Analgesics are classified as
A
1) agonist
2) Agonist-Antagonist
3) Antagonist
4) Anticonvulsant
4
Q
Opioid Agonist
A
Drugs that will bind well to the receptor
ex:
5
Q
Opioid Agonist-Antagonist
A
Drugs that have properties of both the agonist and antagonist. These drugs have some agonist and antagonist activity at the receptor sites
6
Q
Opioid Antagonist
A
Drugs that bind to the receptor site and cause no response, agonist can reverse effects
7
Q
Opioid Agonist (Action)
A
- do not effect nerve ending
- increase pain threshold: opioid narcotic
- causes euphoria
- changes patients perception about the pain
- alters emotional response patient has about the pain
- attitude changes pain remains the same
8
Q
Opioid Agonist (Indication)
A
- treat mod-severe pain and manage opiate dependency
- control pain during abort(obstetric analgesia)
- mod-severe visceral pain
- can be given post op/during surgery to manage pain
- relieve anxiety
- induce mild-mod sedation
- cough suppressant
- slows respiration(side effect): used in pt who have tachypnea to slow respirations
- decrease g.i motility(anti-diarrheal)
- control anxiety on patient with mi/pe because they cause euphoria, decrease fear and anxiety about death
- decrease cardiac workload
- support anesthesia
- relieve anxiety in patients with dyspnea associated with pulmonary edema
- relieve pain associated with a myocardial infarction(morphine sulfate is agent of choice)
- induce conscious sedation before diagnostic/therapeutic procedure in the hospital setting
9
Q
Opioid Agonist (origin)
A
obtained from opium plant. obtained from the unripe seed of the opium poppy
10
Q
Codeine
A
- Agonist
- Opoid Analgesic
- treat mod-severe pain,ANTIUSSIVE, considered a weak analgesic
- 30-60mg
- can be added with acetaminophen(non salicylate) or ASA(Salicylate)
11
Q
Equianalgesic
A
- term used to equivalate pain receiving properties to another drug
- all narcotics are compared to morphine
12
Q
Codeine + Acetaminophen
A
Tylenol 1= 325mg Acetaminophen + 7.5 codeine
Tylenol 2= 325mg Acetaminophen + 15 codeine
Tylenol 3= 325mg Acetaminophen + 30 codeine
Tylenol 4= 325mg Acetaminophen + 60 codeine
13
Q
Empirin
A
Aspirin + Codeine
14
Q
Hydromorphone(Dilaudid)
A
- strongest opoid compound to morphine
- given 1mg can be given orally/parentally
15
Q
Fentanyl
A
- has oral/buccal route
- Duragesic Fentanyl Transdermal
- topical drug application to skin
- systemic action
- takes time to work, change q3days
16
Q
Propoxyphene(Darvon,Darvon-N)
A
-Propoxyphene + Acetaminophen = Darvocet N
17
Q
Meperidine(Demerol)
A
- Agonist
- Opoid Analgesic
- treat mod-severe pain, prep sedation, anesthetic adjunct
- last about 2-3hours
- limited because causes greatest amount of hypotension
- elderly can cause paradoxical reaction: effects you dont expect(causes excitement)
- dosage 50-500mg
- synthetic developed to treat opioid withdrawal
18
Q
Methadone(Dolophine)
A
- -Agonist
- Opoid Analgesic
- treat mod-severe pain, treat of opioid dependency
- used frequently for heroine addicts/drug abuse, treats pain,
- 10-20mg
- given by mouth usually
- used to withdraw from opioid dependency
19
Q
Oxycodone(Roxicodone & Oxycontin)
A
- weak analgesic compared to morphine
- oxycodone + Ibprofen(Combunox)
- oxycodone + acetaminophen(Percocet)
- oxycodone + aspirin(Percodan)
-the sustained release version oxycotin, frequency q12h, effective for chronic pain=last more than 6 months, most abused opioit.
20
Q
Oxycodone + aspirin(Percodan)
A
- opioid/non-opiod combination oral analgesic
- Oxycodone 5mg/aspirin 325mg
- narcotic medicine used to relieve moderate to severe pain.
- Percodan contains a combination of aspirin and oxycodone. Aspirin is in a group of drugs called salicylates (sa-LIS-il-ates). It works by reducing substances in the body that cause pain, fever, and inflammation. Oxycodone is an opioid pain medication. An opioid is sometimes called a narcotic.
- Percodan is used to relieve moderate to severe pain.
- Aspirin should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. -Aspirin can cause a serious and sometimes fatal condition called Reye’s syndrome in children.
21
Q
Hydrocodone
A
- can be antitussive
- weak analgesic compared to morphine
Hydrocodone+Acetaminophen=vicodin
Hydrocodone+Ibuprofen=vicoprofen
22
Q
Alfentanil(Alfenta)
A
- -Agonist
- Opoid Analgesic
- balance analgesia used to help induce analgesia
23
Q
Sufentanil Citrate(Sufenta)
A
- -Agonist
- Opoid Analgesic
- induce and maintain analgesia
24
Q
Morphine Sulfate
A
- -Agonist
- Opoid Analgesic
- attaches to mu receptor cite
- drug of choice for severe pain
- duration 4-5 hrs
- developed from plant prooduct white poppy plant
- opium called morphine
- all pain relieving drugs are compared to morphine
25
Long Acting morphine
- for mod to sever pain
- for acute pain that last several days
- also for chronic pain
ex:
-Ronal SR- last 8hrs-frequency 6A,2P,10P
dose=30mg
-MS Contin= last 12hrs last long 10A,10P
-Avina=24hrs daily dosing
26
Morphine Sulfate
PO: 10mg(DOSE): 10-20mins(ONSET): 60mins(PEAK): 4-5hrs(DURATION
SubQ: 4-10mg(DOSE): 10-20mins(ONSET): 30-60min(PEAK): 4-5(DURATION)
IM: 4-10mg(DOSE): 1-3mins(ONSET): 20mins(PEAK): Duration(varies)
27
Morphine Sulfate is drug of choice for?
mi(heart attack), pe(pulmonary edema)
28
Opiate Receptors
cells in the nevous system that have receptor sites
-mu and kappa receptors produce the analgesic,sedative, and euphoric effects associated with analgesic drugs
- mu,kappa, delta=located in the brain
- kapppa and delta=located in spinal coloum
- mu is important for analgesics and resp. depression and physical dependence(euphoria), morphine attaches to this receptor site and has a theraputic response
- kappa=has analgesics/resp depression(dysphoria)
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mu and kappa receptors
produce the analgesic,sedative, and euphoric effects associated with analgesic drugs
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mu,kappa,delta receptors
located in the brain
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kapppa and delta receptors
located in spinal coloum
32
mu receptors
important for analgesics and resp. depression and physical dependence(euphoria), morphine attaches to this receptor site and has a theraputic response
33
kappa receptors
Has analgesics/resp depression(dysphoria=unwell unhappy feeling)
34
Side effects of Opioid Agonist:
CNS:
- Drowsiness: pronounced inthe first three days
- light headed,dizziness,euphora,
pupils:
- myosis-constriction of pupils,
- pinpoint pupil=toxcity
Resp:
-decresed respiration: treats tachypnea
Cardio:
- tachycardia
- hypotention: demerol drug
GU:
-urine retention or hesitancy
Gastrointestinal:
- N,V=more pronounced in first 3 days
- antiemtics given if needed
- decreases g.i. motility causing constipation, asses bowel sounds, develop bowel management plan
Integumentary:
- puritis,rash,utiacria
- always report rash=hypersensitivity
35
Contradiction of Opioid Agonist:
COPD=because causes resp depression
Head Injury:because effects cns
Pregnant females: crosses placenta barrier
36
Tolerance
decrease response after repeated doses
37
Dependency
physiological/psychological need for medication
38
Addiction
change in behavioral patterns
39
Withdrawal
cessation(abprut stopping), results in diarrhea,stomach cramps, sneezing,runny nose, yawning,irritablility,nervousness, and large pupils
- methadone(treats withdrawal, manage pain)
- levomethodyl given for withdrawal when methadone is not effective anymore than put back on methadone in 2 day period
40
Opoid Agonist-Antagonist(Action)
- effect kappa and delta receptor sites
- for patient who cant tolerate agonist
- less respiratory depression and less dependency
41
Opoid Agonist-Antagonist(side effects)
- sedation,N&V,headache,dizzinesss(vertigo),euphoria,hallucination
- withdrawal can occur in patients addicted to opiates
42
Opoid Agonist-Antagonist(Drugs)
1-Pentazocine Lactate
- Pentazocine and ASA (Talwin)
- Pentazocine and Tylenol (Talacen)
2-Butorphanol (Stadol)
3-Nalbuphine(HCL)-pain manangement in pregnancy
4. Burenorphine(Buprenex,Subutex, Butrans)
- Buprenorphine & Naloxone(Suboxone)-C3, used to treat opoid dependency
43
Butorphanol(stadol)
- Opoid Agonist-Antagonist(Drugs)
- Butorphanol tartrate is a synthetically derived opioid agonist-antagonist analgesic of the phenanthrene series.
- Stadol (butorphanol tartrate) Injection and Stadol NS (butorphanol tartrate) Nasal Spray are indicated for the management of pain when the use of an opioid analgesic is appropriate.
-Stadol Injection is also indicated as a preoperative or preanesthetic medication, as a supplement to balanced anesthesia, and for the relief of pain during labor.
44
Opoid Antagonist
action:
- prevents or revereses opiate effects
- may restore resp function in 1-2min
- adverse effect-increase cns activity reversal of analgesic
- indication: pain relieving ability will be reversed
Drugs:
- Naltexone HCL(Revia,Vivitrol)
- Revia: used to decrease cravings for alcohol
- Naloxone HCL(Narcan)
45
Naloxone HCL(narcan)
- Naloxone is an special narcotic drug that reverses the effects of other narcotic medicines.
- Naloxone is used to reverse the effects of narcotic drugs used during surgery or to treat pain.
- 0.4 to 2 mg/dose IV/IM/subcutaneously.
46
Non-Narcotic Analgesic
```
NSAID=Toradol=im/iv
Acetaminophen(Tylenol)=hepatotocity, activated charcol
Acetylsalicylic acid(Asprin)
```
47
Migraine Headaches
vascular headaches caused when blood vessels dialte in head
48
3 groups of drugs used for migraine headaches
1-analgesics: non narcotic analgesic,saliclates(ASA),NSAIDS(Ibprofen),Acetaminophen(tylenol)
2-ergot derivatives
3-triptans
49
Ergot derivatives
- cause vasoconstriction
- direct effect on blood vessels
- non-narcotic
50
Ergot derivaticves(drugs)
```
Dihydroergotamine Mesylate(D.H.E. 45, Migranal)- drug of choice for migraine, most effective during the first sign of migraine, route:po,sublingual,inhal)
-Ergotamine Tartrate(Ergomar)-taken early migraine for best results, route:sublingual
```
assessment: causes constriction of blood vessels, pale skin, cap refill,pedal pulses to be assesed
- prolonged use can cause ergotism(toxcitiy)-vommiting,decrease periphal pulses,can cause hypotension/hypertension,adverse effect
51
Triptans
action: bind w/ vascular receptors to produce vasocontrictions
side effect:N&V,paresthesia fibrosis in heart and lungs, given for 1mont then rest period 4-6months
52
Triptan(Drugs)
- sumatriptan(imitex)
- nartiptan(Amerge)
- Rizatriptain(Maxalt)
- Zolmitiptan(Zomig)
53
Caffeine
-treat migraine,vasoconstriction,used in combo w/ other meds
54
Cafergot
-caffeine+ergot, take at first sign of headache
55
Betablockers(propranolol(inderal))
-used for several months(3 months) before they notice decrease in effect of migraine attacks
56
Antiepileptic(Valproic Acid(Depakene))
used to treat headaches
Usual Adult Dose for Migraine Prophylaxis:
Initial dose: 250 mg valproic acid delayed release capsules orally twice daily. Valproic acid delayed release capsules must be swallowed whole.
57
Pain Control Analgesia
- provides analgesia controlled by the patient
- provides more steady pain relief
- less respiratory depression
- less drowsiness
- continous infusion: mg/hr
- programmed bolus: prn
- lock mechanism
58
Nerve Pain
- antidepression: amytriptyline, impramine
| - anticonvulsants:carba,zepine(tegretol), Clonazepam(Klonopin), Diazepem(Valium)
59
Nursing implication for analgesics:
- onset action 15-30mins after SC,IM
- onset action 1-5mins for IV
- assess for pain
- check when drug last given
- provide comfort
- give drug before pain severe
- rqual intervals around the clock
- vital signs hold resp. below 12
- hold if bp lower than baseline
- check pupils and LOC
- withhold if frequently drowsy
- withhold if arousable but drifts off to sleep during conversation
- withhold if minimal somnolence
- whithhold if no response to physical stimulus
- safety,bed low position,rails,supervised ambulation
- discourage use of heavy dangerous equipment
- bowel care
- enhance medication effect with comfort measures
- discontinue gradually to prevent withdrawal
- if the patient must switch drugs give an equinalgesic dose. dosing chart in all areas where doctors are written or dispensed
60
Jacho recommendations
- inform patient verbal or written that pain control is an important part of care
- clear lines of authority regarding pain treatment decision
- expert on pain management on staff
- pain assessment and documentation
- documentation of pain relief or revision of POC
61
Nursing impplication for migraine
- have the patient lie in darkened room
- symptoms relief usual in 15-30mins
- avoid exposure to extreme cold
- report reduced circulation
- discontinue if pregnancy suspected
- watch for Ergotism: nausea,numbness,tingling,decrease peripheral pulses,hypertension/hypotension,drowsiness,stupor seizure
- avoid migraine triggers
62
Sedative
-allays fear and excitement, calmns
63
Hypnotic(Soporifies)
- induces sleep
- same medicaiton can have both effects
- can lead to tolerance and dependence
64
Insomnia
-hypnotics are used to treat insomnia
65
Two basic types of Sedatives/Hypnotics(Soporifies)
- Barbiturate
| - Non-Barbiturate
66
Bariturates(indicaiton)
- inhibit the uptake of GABA
- used as a sedative
- used as a hypnotic-to put to sleep
- anticonvulsant-for seizure
- anesthetic
67
Barbiturates(onset of action and duraction)
- Ultra short acting used as anesthetic
- Short acting used as sedative hypnotic
- Intermediate used as sedative hypnotic
- Long acting used as anticonvulsant
68
Barbiturates(side effects)
- reduce rapid eye movement(REM) sleep
- pinpoint pupils(signs of toxcity
- CNS:depression,hangover(stilll feel affects over several days)
- GI:N&V,diarrhea,constipation
- Hypersensitivty
- Integument:exfoliative,dermatitis,SJS
- Resp:resp depression
- Cardiac: decrease Bp,cause syncope
- Hepatoxicity
- Withdrawal:if suddenly discontinued can lead to seizures
- dependency
69
Barbiturates(Antidotes)
drug of choice Bemegride,Picrotoxin
70
Barbiturtes(Drugs)
```
Phenobarbital Na(Luminal)
Pentobarbital Na(Nembutal sodium)
Amobarbital Na(Amytal)
```
71
Non-Barbiturates(Benzodiazepines)
action: inhibit the uptake of GABA
indiaction: antianxiety,insomnia,seizures,conscious sedation
- do not interfere with REM Sleep
- less risk of tolerance
- route:po/parental
72
Benzodiazepines(Non-Barbiturates)(Drugs)
- Lorazpem(Ativan)
- Alprazolam(Xanax)
- Diazepam(Valium)
- Clonzepam(Klonopin)
73
Benzodiazepines(Non-Barbiturates)(Antidote)
- Flumazenil(Romazicon)
| - reverses the effect of non-barbiturates benzodiazepines, takes about 1 minute for conscious to occur(onset 1min)
74
Non Benzodiazepine(Non-Barbiturates)
- do not effect REM sleep
- non barbituate
- non benzodiazepine
- sedative/hypnotic
75
Non Benzodiazepine(Non-Barbiturates)(Drugs)
Chloral hydrate(Noctec)-gives nearest to normal sleep activity
- Zolpidem(Ambien)-5-10mg po,most commonly used
- Eszopiclone(Lunesta)-chronic insomina
- rebound insomnia can be withdrawal effect
- decrease in tolerance and dependence
76
Non Benzodiazepine(Non-Barbiturates)(Nursing Implication)
- Hypnotics are generally not given after 2am-3am
- drugs order at bedtime prn,repeat x1
- provide environment conductive to sleep
- plan care to plan for uninterrupted sleep
- provide saftery with supervised ambulation
- avoid beverages that interfers with sleep
- increase physical activity during the day
- most drugs loose ability to induce sleep in 1-2weeks dailyuse
- after 2 weeks use may lead to dependency
- watch for addictive effect with other CNS depressants
- need two hours between analgesic and sedative
- dont mix barnituates in a syringe with other drugs(it will precipitate)
- parental barbiturates once reconstituted must be used within 30mins
- when barbiturates are given IM watch for tissue necrosis
- long term barbiturates must be tapered off slowly or will result in dreaming,nightmares,insomnia or withdrawal
- neither barbiturates or benzodiazepines relieve pain
- older adults need smaller dose and must be monitored for CNS excitment,depression,and confusion
77
Anesthesia
-causing loss of sensation, decrease sensation to pain, effecting nerve conduction,dimish pain
78
Anesthesia(Two Types)
General: partial loss of conscious or complete , entire body free of pain
Regional/Local(often interchangeable)
- local-effect area locally
- regional-decrease in region its applied
- causes a specfic area to be pain free
- patient is conscious/awake
79
Selection of Anesthesia
-depending on location of organ being operated on and length of procedure, and patients condition
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Balanced Anaesthesia
-doctors using different medication for their individual effects to help achieve anaesthesia
81
General Anesthesia
route: inhalation/injection
| - results in partial or complete loss of consciousness
82
General Anesthesia(4 stages)
1-Analgesia: decreased awareness of sensory stimulus
2-Excitment/Delirium: Hyperreflexes and dilated
3-Surgical Anesthesia: compleete relaxation,constricted pupils, decreased reflex,normal resp. and pulse
4.Medullary Paralysis: requires life support,resp or cardiac arrest artifical ventilation needed.
83
General Anesthesia(routes)
inhalation/injection
| -agents used volatile liquid and gases
84
General Anesthesia(inhaltion/gases)
- gases:cyclopropane:gases combined with oxygen,maintain/induce anesthesia-orange cyclinder
- nitrous oxide:commonly used:weaker-combined with other meds part of balanced anesthesia
85
General Anesthesia(inhaltion/volatile liquid)
- vapors are inhaled
- Enflurane(Ethrane)
- Sevoflurane(Ultane)
86
General Anesthesia(Adverse effects)
- N&v
- cardiac arrhythmia
- resp depression
- highly flammable
- hepatoxicity
87
General Anesthesia(injection)
-used prior to gases, make easier to induce anesthia, for short procedures,theoponal=ultra short acting barbituate
88
General Anesthesia(Non-Barbiturates)
Propofol(Diprivan)
- used for conscious sedation before diagonstic procedure w/ local anesthesia
- used to intubate patients and patiend on vent
- choice because post surgery less drowsiness
- dose is determing factor if its a sedative or hypnotic
Midazolam=non barbiturate benzadiapen. used for conscious sedation
Ketamine(Ketalar)=conscious sedation,use if patient does not require skeletal muscle relaxant
89
General Anesthesia(Barbiturate)
-Methohexital Na(brevital)
90
Neuroleptic Analgesics
(tranquleizer w/ analgesic)
- condition where there is going to be analgesic and anethesia
- used for deep sedation
91
Neuroleptic Analgesics(adverse effects)
- coughing, laryngeal spasms,bronch-spasms
- resp depression
- malignant hyperthermia-temp increase,increase metabolism
* dandrolin(antispastic/direct acting) to reduce effect of malignant hyperthermia
92
Regional/Local Anesthesia
action: block never condition when applied locally to nerve tissue w/o loss of consciousenss
drugs: drived from coca plant, drugs end in"caine""novacaine"
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Regional/Local Anesthesia(adverse effects)
- hypersensitivity
- hypotension
- cause stimulating effects or depressing effects
94
Regional/Local Anesthesia(types)
1-topical-dental procedure on gums(novacaine)
2-Infiltration-used to relieve pan before minor surgery procedures
3-nerve block(regional anesthic) injected along the course of the nerve in specfic area
-spinal-injected in the subaracnoid space,injected in 2nd-4th lumbar vertebrae,cause hypotension,monitor bp
-epidural-injected in extra/epidural space btw L1 and L2
95
Regional/Local Anesthesia(nursing implication)
- go to the bathroom before the procedure
- baseline Bp/hypotension
- urinary retention(urine 30ml after procedure)
- assess for respirations
- make sure sensation returns as well as movement
96
Adjuncts to general anesthesia/Pre anesthetic drugs
-given by anesthesia to decrease anxiety
97
Adjuncts to general anesthesia/Pre anesthetic drugs
```
sedative/hypnotics:
Hydroxyzine HCL(Vistaril)(Atarax)
Pentobarbital Na(Nembutal)
```
AntiAnxiety-Diazepam(Valium)
Opiates
- morphine
- fentanyl citrate(sublimaze)
- meperidine(demerol)
- Pentazocine(talwin)
- Sufentanil(Sufental)
Antiemetics(decrease nausea/vomitting
-droperidol(inapsine)-often along with opiate to induce surgery
-
Anticholinergies
-Atropine Sulfate-effects movement and dry secretions
Skeletal muscle relaxants:
-pancronium bromide:relaxe paralyze muscle:to reverse effect use neostagmin
98
Anticonvulsants
abnormal disturbances in electrical activity to the brain
- classification:partial & generalized
action: stablize nerve cell against hyperexcitabilty
99
drugs used in anticonvulsants
1. Hydantoins-most common used
2. Barbiutates-long term in combination without others
3. Benzodiazepines-status epilepticus
4. Oxazolidinediones
5. Succinimides
6. Miscellaneous
100
Hydantoins(action)
-prevent excessive electrical discharge from a epileptic foci by depressing the cerebral cortex
101
Hydantoins(indication)
- generalized and partial seizures
- mood and behavior disorder
- pain of trigeminal neurologia
- delirum tremens
- digoxin induced arrhythmia
- prophylaxis after head trauma or crainiotomy
102
Hydantoins(drugs)
- phenytoin(dilantin)-dose:100-300mg/day, theuraputic levels(10-20meg.ml)
- ethotoin(peganone)
- fosphenytoin(cerebyx)(look alike/sound alike drug
103
Phenytoin(dilantin)
- hydantoin
- theuraptic levels: 10-20mcg/ml
- Dose: 100-300mg/day(po/parentral)
- i/v=infuse slowly,rapid infusion can cause hypotension
- oral care important
- assess skin photosensitivity
- asses skin for jaundice
- assess urine fo color
104
Hydantoins(side effects)
Gi:gastrotoxic/gingival,hypoxia
skin:dermatitis
CNS:drowsiness,dizzy,ataxia,parasthesia,slurred speech, nystagmus psychosis
Hematological:Bone marrow,depression,folic acid deficiency, anemia
GU:hyperglycemia,pink,green,brown urine
Hepatoxic
105
Baribiiturates
- effect drowsiness
- can induce sedation/hypnosis
- ultra short acting anesthesia
- intermediate sedation
- long acting seizures
drugs: phenobartital-long acting barbiturate
Na Amytal-immediate sedation/hypnotic
mephobarbital(mebaral)
106
Benzodiazepines
use for status epilepticus(seizures for 30mins or more
drugs: Diazepam(Valium)=drug of choice for status epileptics
Lorazepam(Ativan)-subsequent choice for status epileptics
107
Oxazolidinediones(anti-convulsant)
-petit mal seizure(general seizure) used when safer drugs are not effective
side effects:pancytopenia,effect bone marrow,effect kidneys, and cause fetal abnormality
drug: Trimethadione(tridione)
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Succinimides
- used for peti mal seizures(general seizures)
- depress motor cortex creating a higher threshold for seizures
- drugs:ethosuximide(zarontin)
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Miscellaneous
Carbamazepine(Tegretol)-gran mal seizures and trigeminal neuralegic, monitor cbc cause aplastic anemia
Valproic acid(Depakene)-long term seizure control,hepatotoxcity, used for mania manic phase of bipolar
Acetazolamide(Diamox)-used because interaction of other med causing those meds to work better(potentiate effect)
Magnesium Sulfate-eletrolytes used in bg/gyn patients
Gabapentin(Neurontin)-used for partial seizures
Lamotrigine(Lamictal)-parital seizure,used for depression phase of bipolar
Tiagabine(Gabitril)-partial seizures
Levetiracetam(partial seizures),most have common therapeutic levels
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Anticonvulsants(Nursing Implication)
- give with meals(because dilantin is gastrotoxic)
- gingival hyperplasia, notify dentist, keep clean,massage gum watch for infection(dilatin causes gingival hyperplasia)
- may need folic acid
- IV dilantin precipitate in most IV fluids
- IVP rate slow at 50mg/min(decrease risk of hypotention), Dilantin must infuse with NS, will preciptate with other fluids
- rapid infusion can lead to hypotension and cardiac arrest
- Dilantin most effective orally
- initial therapy cause drowsiness ensure safety(take drug ontime an as ordered)
- encourage to wear or carry medic alert
- ensure adherence
- drugs do not cure seizures but control one dose at a time
- status epilepticus can be induced if missed dosage
- status epilepticus is a medical emergency. drug of choice is valium and substitute is ativan
- valium ivp rate not to exceed 5mg/min
- dilantin most commonly used antiseizure(can be used for general and partial seizure)
- cerebyx substitute for parental use
- valprocid acid long term for generalized,partial seizures, and status eliepticus
- comes as a sprinkle capsule can open and sprinkle on soft foods
- need liver profile for hepatoxcity
111
Central Nervous System Stimulants divided into:
1-Anorexiants
2-Non-Anorexiants/Analeptics
action: increase levels of neurotransmitters in the brain, increase motor activity,increase mental alertness,improve spirits,decrease fatigue,increase breathing
use:
- Narcolepsy
- ADHD
- Appetite suppressant
- resp. depression
112
Anorexiants
- used for obesity and appetite suppression
- to be effective give 30-60min before meals(AC)
- drugs are used intermetingly(for 1-3months of duration) because of tolerance, expect break in drug use
113
Anorexiants(drugs)
```
Dextroamphetamine(Dexedrine)
Benzphetamine(Didrex)
Phentermine(Adipex-P)
Phendimetrazine(Brontil)
Phenylpropanolamine-FDA removed due to hemorrhagic strokes
```
114
Non-Anorexiants/Analeptics
- used for ADHD
- paradoxical effect(used for children 6yr n over)
- counteract effect of narcotic narcolepsy-increase wakefulness
- increase respirations
- ADHD-treats complusiveness
115
Non-Anorexiant/Analeptic(Drugs)
- Methlyphenidate(ritalin)
- Dextroamphetamine Sulfate(Dexedrine)
- Methamphetamine HCL (Desoxyn)=used for narcolpsy
- Amphetamine Sulfate(Adderall)
- Amtomoxetine HCL(stattera)
116
Methyphenidate(Ritalin)
- Non-Anorexiant/Analeptic
- (concerta,methylin,metadate,daytana,ritalin)
- dosage:5-10mg,1-2wk/day, increasely
- 5-10mg weekly not to exceed 60mg/day
- must be give early before breakfast and lunch
- daytana is a patch
- when meds are not titrated cause seizures except for (Atomoxetine HCL(stattera))
- may take a full month before benefits are noticed
- sudden death and suicidal thoughts can occur, and retard growth
117
Non Amphetamines for Narcolepsy
non-anorexiant-narcolepsy
- use: decrease excessive daytime sleeping
- Side effect: dry mouth,anorexia,appetite change,tachycardia,cp,headache,anxiety,parathesia
non amphetamines for narcolepsy(drugs)
- modafinil (provigil)
- sodium oxybate(xyrem)
- armodafinil (nuvigil)
118
Non-Anorexiants/Analeptic used as resp stimulants
1. caffeine
2. Doxapram HCL(Dopram)
used for:
- mild resp depression due to
- cns depressant
- post anesthesia
- resp depression in newborn
- fatigue
- must be monitored for heart rate when alert
119
CNS Stimulants Side effects
cardiac: palpitaitons,increase heart rate,increase bp,dysrythmia
cns:restlessness,insomnia,irritability,nervous,tremor,anxiety,seizures,can be drowsy and less alert after tolerance,suicidual thought,aggressive effect
loss of appetite
impotence
children: abdominal pain,anorexia,weight loss,insomnia,tachycardia
interaction: cns stimulants,antidepressant,anticoagulants,anticholinerges,and maoi(within 15days)-can cause hypertension crisis reaction must give 2 weeks apart
120
CNS Stimulants(contraindication)
- heart disease=stimulating to heart
- hyperthyroidism=elevate metabolism even more
- diabetes
- narrow angle glaucoma-drug dilates pupil
- nephritis
- renal faliure
- h/o of drug abuse-dependency
- pregnacy-children
121
CNS Stimulants(Nursing implication)
- watch for excessive CNS stimulation(agitation,irritability)
- question when two stimulant given together
- decrease caffeine intake(because its a cns stimulant)
- give last dose at least 6hr before bedtime
- adults before 6pm, children before lunch(can cause insomnia)
- weight loss take 30-60min before meals
- given for long time or large doses to stop wean off gradually to prevent seizures except strattera no tapering necessary
- hyperactive children wean off q6-12 months for 2-3 weeks and evaluate need, holiday from med because not needed like in the summer
- methyphendate(ritalin)-before breakfast and lunch
