Drugs Affecting the nervous system (CNS) Flashcards Preview

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Flashcards in Drugs Affecting the nervous system (CNS) Deck (121):
1

Drugs fall into two basic categories

-stimulants(analeptics) which stimulate the nervous system
-depressants, which depress activity within the nervous system

2

Central nervous system drug

1)Analgesic(Narcotics)
2)Sedative/Hypnotic
3)Anesthetic
4)Anticonvulsant

3

Analgesics are classified as

1)agonist
2)Agonist-Antagonist
3)Antagonist
4)Anticonvulsant

4

Opioid Agonist

Drugs that will bind well to the receptor

ex:

5

Opioid Agonist-Antagonist

Drugs that have properties of both the agonist and antagonist. These drugs have some agonist and antagonist activity at the receptor sites

6

Opioid Antagonist

Drugs that bind to the receptor site and cause no response, agonist can reverse effects

7

Opioid Agonist (Action)

-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

Opioid Agonist (Indication)

-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

Opioid Agonist (origin)

obtained from opium plant. obtained from the unripe seed of the opium poppy

10

Codeine

-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

Equianalgesic

-term used to equivalate pain receiving properties to another drug
*all narcotics are compared to morphine

12

Codeine + Acetaminophen

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

Empirin

Aspirin + Codeine

14

Hydromorphone(Dilaudid)

-strongest opoid compound to morphine
-given 1mg can be given orally/parentally

15

Fentanyl

-has oral/buccal route
-Duragesic Fentanyl Transdermal
-topical drug application to skin
-systemic action
-takes time to work, change q3days

16

Propoxyphene(Darvon,Darvon-N)

-Propoxyphene + Acetaminophen = Darvocet N

17

Meperidine(Demerol)

-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

Methadone(Dolophine)

--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

Oxycodone(Roxicodone & Oxycontin)

-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

Oxycodone + aspirin(Percodan)

-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

Hydrocodone

-can be antitussive
-weak analgesic compared to morphine

Hydrocodone+Acetaminophen=vicodin
Hydrocodone+Ibuprofen=vicoprofen

22

Alfentanil(Alfenta)

--Agonist
-Opoid Analgesic
-balance analgesia used to help induce analgesia

23

Sufentanil Citrate(Sufenta)

--Agonist
-Opoid Analgesic
-induce and maintain analgesia

24

Morphine Sulfate

--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)

29

mu and kappa receptors

produce the analgesic,sedative, and euphoric effects associated with analgesic drugs

30

mu,kappa,delta receptors

located in the brain

31

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

80

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"

93

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)

108

Succinimides

-used for peti mal seizures(general seizures)
-depress motor cortex creating a higher threshold for seizures
-drugs:ethosuximide(zarontin)

109

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

110

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