Central and Peripheral Nervous System Medications Chapter 16

Central and Peripheral Nervous System Medications Chapter 16

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

Antimigraine Agents Action n Block nerve impulses at receptors of the sympathetic nervous system n Relieve pain by narrowing dilated cerebral arteries Uses n Prevention and treatment of migraine headaches n Drug Table 16 -1 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 3

Antimigraine Agents (cont. ) Adverse Reactions Drug Interactions n Other vasoconstrictors, MAOIs Nursing Implications and Patient Teaching n n n Assessment Diagnosis Planning Implementation Evaluation Patient Teaching: administration considerations Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 4

Antimigraine Medications n Ergotamine Derivatives q Migranal n q dihydroergotamine n Ergomar n q n ergotamine Cafergot n caffeine & ergotamine Serotonin Receptor Agonists (-triptans) Axert q n Maxalt q n sumatriptan Zomig q n rizatriptan Imitrex * q n almotriptan zolmitriptan Relpax q elatriptan

Anticonvulsants or Antiepileptic Drugs n n n Seizures: chaotic electrical discharges causing sudden muscle contractions that happen without conscious control Etiology: disease or disorders; head injury; idiopathic Four major drug classes Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 6

Barbiturates Action n Long duration of action and sedative effect on the brain; action occurs in the brainstem Uses n Status epilepticus; to prevent and control grand mal seizures n May treat seizures caused by tetanus, fever, or drugs n RX: phenobarbital* Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 7

Benzodiazepines Action n CNS depressants; suppress electrical discharge in seizures Uses n Treat minor motor seizures; Lennox-Gastaut syndrome (petit mal) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 8

Benzodiazepines n n n End in –lam or –pam Anticonvulsant as well as sedative Valium q n Klonopin q n diazepam clonazepam Ativan q lorazepam

Hydantoins Action n 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 n Grand mal and psychomotor seizures, status epilepticus, migraines, and trigeminal neuralgia Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 10

Hydantoins n n n Cause gingival hyperplasia Cannot be given NG with feeding. MUST hold feeding for 2 hours before and after med. Cerebyx (name alert! Not Celebrex) q n fosphenytoin Dialntin q phenytoin

Succinimides Action and Uses n 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 n Other antiseizure agents and bone marrow –depressing drugs n RX: Zarontin (ethosuximide) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 12

Other Common Anticonvusants n Diamox q n n q n lamotrigine Keppra q n n levetiracetam topiramate Depakene / Depakote q n primidone Topamax q gabapentin Lamictal Mysoline q carbamazepine Neurontin q n acetazolamide Tegretol q n valproic acid Trileptal q oxcarbazepine

Antiemetic-Antivertigo Agents Action n n 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 n Prevent and treat motion sickness or the nausea and vomiting that occur with surgery, anesthesia, and cancer treatment Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 14

Antiemetic and Antivertigo Meds n n Antidopaminergics Phenothiazines q Thorazine n q q q Promethazine Other: Reglan (metaclopramide) Dramamine n q q dimenhydrinate Benadryl n prochlorperazine Phenergan n n Anticholinergics Antihistamines chlorpromazine Compazine n n diphenhydramine Antivert Dramamine n Meclizine Other: Marinol (dronabinol) Transderm – Scop (scopolamine) Tigan (trimethobenzamide)

Antiemetic and Antivertigo Meds n 5 HT receptor antagonists q Zofran n ondansetron Many forms of the medication Given frequently for nausea in patients undergoing chemotherapy for cancer

Antiparkinsonian Agents Actions n Change the neurotransmitters produced in the brain: excessive acetylcholine, deficient dopamine n Block the uptake of acetylcholine and elevate the functional levels of dopamine in the motor regulatory centers Uses n Control of the symptoms of Parkinson disease Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 17

Antiparkinsonian Medications n n Anticholinergic Cogentin q n n benztropine Benadryl q n Dopaminergic Symmetrel q n diphenhydramine Parlodel q n carbidopa- levadopa Comtan q n bromocriptine Sinemet q n ammantadine entacapone Dopar q levadopa

Dopamine Receptor Agonists, Nonergot n Mirapex (name alert! NOT Miralax) q n pramipexole Requip q ropinirole

Learning Objectives n n n 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 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 20

Antianxiety Agents n n 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 q May be used to manage alcohol withdrawal symptoms; used preoperatively; used to relieve muscle spasm Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 21

Antianxiety Medications n n Benzodiazepine Xanax q n n n diazepam Ativan q n clorazepate Valium q lorazepam Serax q n alprazolam Tranxene q n oxazepam Nonbenzodiazepine Buspar q n buspirone Vistaril q hydroxizine

Tricyclic Antidepressants Action n Believed to inhibit the reuptake of norepinephrine and or/serotonin Uses n To treat endogenous depression; mild depression due to exogenous causes n amitriptyline nortriptyline Tofranil (imipramine) Sinequan (doxepin) n n n Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 23

Monoamine Oxidase Inhibitors Action and Uses n n 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, 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) Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 24

Selective Serotonin Reuptake Inhibitors (SSRI) Action and Uses n n n 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 Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 25

SSRI and other Miscellaneous Antidepressants n n SSRI Celexa q n n escitalopram fluoxetine Paxil q n citalopram Prozac q sertraline Remeron n q n mirtazapine Desyrel n trazadone Unrelated Products q Wellbutrin n q paroxetine Zoloft q Tetracyclic Compounds q Lexapro q n n Cymbalta n q bupropion duloxetine Effexor n venlafaxine

Antipsychotic Drugs Action and Uses n All antipsychotic agents act by blocking the action of dopamine in the brain n Used in the treatment of severe mental illness n May be used in combination with major tranquilizers Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 27

Antipsychotic Medications n Aliphatic Phenothiazine q Thorazine n q n Compazine n prochlorperazine Nonphenothiazine Antipsychotics Haldol q n promazine Piperazine phenothiazine q n chlorpromazine Promazine n n Zyprexa q n quetiapine Risperdal q n olanzapine Seroquel q n haloperidol risperidone Geodon q ziprasidone

Antimanics Action and Uses n 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) n Mood-stabilizing drug n Used to treat patients with bipolar disorder who are in acute manic phase; prevents recurrent manic episodes Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 29

Antimanic Medication n Lithonate q q q 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 n Benzodiazepines q n Phenobarbitals q n n -lams and -pams -barbs Aquachlor (chloral hydrate) Miscellaneous sleep aids q q q Ambien (zolpidem) Lunesta (eszopiclone) Sonata (zaleplon)

Attention Deficit Hyperactivity Disorder (ADHD) n CNS stimulants increase blood flow to the frontal lobe where decision making is centered. q q Ritalin (methylphenidate) - stimulant Vyvanse (lisdexamfetamine)-phenethylamine and amphetamine Adderal (amphetamine) - psychostimulant Straterra (atomoxetine)- selective norepinephrine reuptake inhibitor Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 32

n Questions?