cns drugs part 1 Flashcards by Alyssa Holland

limbic system

responsible for emotions, expression, learning, memory

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amygdala

can signal a threat and set off a fear response/anxiety

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hippocampus

processes threats and traumatic stimuli

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panic disorder

intense anxiety and feelings of immediate apprehension, fearfulness, terror or doom

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nonpharm tx of anxiety

CBT
counseling
biofeedback
meditation

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sedatives

depress CNS
benzos
barbiturates
anthihistamines

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hypnotics

induce sleep

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SSRIs (Prozac) pregnancy

category C

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SSRIs (Prozac) indications

depression
OCD
bulimia
panic disorder

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SSRIs (Prozac) pharmacokinetics

given PO
metabolized in liver
excreted in urine, feces

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SSRIs (Prozac) action

blocks the reuptake of 5HT (serotonin) and increases levels of 5HT in the synaptic cleft

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SSRIs (Prozac) contraindications

hypersensitivity
pregnancy
hepatic impairment
suicidal or severely depressed patients

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SSRIs (Prozac) side effects

headache, mania, insomnia
n/v/d, constipation
urinary urgency
cough, dyspnea, URI
rash
increased IOP

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SSRIs (Prozac) interactions

aspirin, NSAIDs, anticoagulants: risk of bleeding
MAOIs
other SSRIs: serotonin syndrome
TCAs

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SSRIs (Prozac) interventions

look for s/s hyponatremia
monitor for insomnia, increased depression, suicidal ideation
taper gradually to prevent w/d

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SSRIs (Prozac) pt teaching

full effect in >4 wks
take in AM to avoid sleep disruption
report dizziness, headache, increased depression/anxiety

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TCAs (imipramine/Toframil) indications

depression
chronic pain
bed wetting in kids >6 y/o

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TCAs (imipramine/Toframil) action

inhibits presynaptic reuptake of norepinepherine and serotonin

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TCAs (imipramine/Toframil) contraindications

CV disorders
urinary retention
seizure disorders
thyroid drugs

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TCAs (imipramine/Toframil) black box warning

may increase suicidal tendencies

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TCAs (imipramine/Toframil) adverse effects

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seizures, stroke, confusion, hallucinations, ataxia, extrapyramidal reactions
MI, arrhythmias, precipitation of HF
tinnitus, blurred vision, black tongue
paralytic ileus, urinary retention/freqency
bone marrow depression
unstable blood sugar
alopecia

TCAs (imipramine/Toframil) interactions

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barbiturates, CNS depressants: may increase CNS depression
clonidine: HTN
other antidepressants: increased effect
MAOI: seizures, fever, death
QTc prolonging drugs (quinidine, etc): arrhythmias

TCAs (imipramine/Toframil) interventions

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monitor for s/s withdrawal if stopping l/t therapy
stop drug several days before surgery
monitor for mood changes, suicidal tendencies
monitor WBCs

TCAs (imipramine/Toframil) pt teaching

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recognize and report s/s serotonin toxicity
take at bedtime 
avoid alcohol
do not stop drug suddenly
sun protection

monoamine oxidase

enzyme that degrades serotonin in synapse | higher levels of serotonin can remain active in the synapse when MAO is inhibited

MAOIs (phenelzine/Tardil) indications

depression

MAOIs (phenelzine/Tardil) action

irreversibly inhibits MAO, allowing norepinepherine, 5HT and dopamine to accumulate in the synaptic cleft

MAOIs (phenelzine/Tardil) contraindications

hepatic impairment HF pregnancy (C) dye used in myelography

MAOIs (phenelzine/Tardil) adverse effects

anxiety, insomnia, suicidal thoughts, twitching, drowsiness HTN, orthostatic hypotension n/v/d, constipation, urinary retention weight gain

MAOIs (phenelzine/Tardil) interactions

antihypertensives: may cause hypotension demerol: fever SSRIs: serotonin syndrome TCAs: HTN

MAOIs (phenelzine/Tardil) food interactions

foods containing tyramine chocolate caffeine all cause HTN

MAOIs (phenelzine/Tardil) interventions

monitor BP carefully monitor for insomnia, agitation, increased depression, seizures give IV nitroprusside if HTN crisis

MAOIs (phenelzine/Tardil) pt teaching

change positions slowly avoid foods containing tyramine take with food if GI upset DM pts -- monitor glucose

atypical antidepressants

trazodone (sedating) | mirtazapine (remeron)

benzodiazepines (diazepam) indications

seizures anxiety muscle spasm ETOH w/d

benzodiazepines (diazepam) action

acts in limbic system to potentiate the effects of GABA | may act in spinal cord to produce muscle relaxation

benzodiazepines (diazepam) contraindications/precautions

``` pregnancy (D, teratogenic) coma age extremes addiction risk chronic respiratory disorders ```

benzodiazepines (diazepam) adverse effects

sedation, drowsiness, amnesia, confusion BP changes, arrhythmias dry mouth, constipation, n/v urinary retention, decreased sex drive

benzodiazepines (diazepam) interactions

CNS depressants: increased sedation, resp depression cimetidine: increases benzo levels smoking: decreases effects digoxin: increases dig levels cardizem: CNS depression, increased benzo effects

benzodiazepines (diazepam) interventions

fall risk assessment taper dosage to avoid withdrawal monitor vitals assess for s/s dependence, tolerance, w/d

benzodiazepines (diazepam) reversal

IV flumazenil to reverse sedation | flumazenil = antidote to bdz

benzodiazepines (diazepam) pt teaching

``` cautious ambulation to avoid falls amnesia may occur tolerance occurs with time taper slowly to avoid w/d do not drink alcohol ```

hydroxyzine (vistaril)

antihistamine used to treat anxiety CNS depressant in subcortical areas rapid feeling of calmness without impairing mental alertness

zolpidem (ambien)

short-term treatment of insomnia give immediately before bedtime; works fast interacts with GABA-benzodiazepine receptors

barbiturates

anxiolytics-hypnotics | habit forming

barbiturates (phenobarbitol) indications

insomnia seizures preanesthetic

barbiturates (phenobarbitol) actions

inhibits conduction in the ascending RAS alters cerebral function depresses motor output

barbiturates (phenobarbitol) adverse effects

``` drowsiness, confusion, ataxia bradycardia, hypotension n/v/d, constipation hypoventilation, apnea rash, stevens-johnson syndrome ```

barbiturates (phenobarbitol) interactions

CNS depressants: increased CNS depression MAOIs: increase serum levels of phenobarbitol anticoagulants, digoxin, TCAs, oral contraceptives, acetaminophen, beta blockers, doxycycline: decreased effect of drugs

barbiturates (phenobarbitol) interventions

fall risk assess for dependence monitor respirations do not mix IV drugs in solution with anything else IV push slowly to decrease adverse CV effects taper slowly

barbiturates (phenobarbitol) pt education

taper gradually to avoid w/d tolerance/dependence can develop oral contraceptives may be less effective with or without food

cns drugs part 1 Flashcards

(51 cards)