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PassAssured's Pharmacy Technician Training Systems Medication Review Central Nervous System (CNS). Pharmacy Technician Training Systems © Passassured, LLC p1 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Medication Review, Central Nervous System (CNS) Click Here to Print Topic Help File (.pdf) (Internet Access is Required for this Feature) Click Here for Glossary Index! Definitions Antipsychotics Therapeutic Classes Antidepressants Sedative Hypnotics Skeletal Muscle Relaxants Antianxiety Agents (Anxiolytics) Anticonvulsants CNS Stimulants Narcotic Analgesics Anti-Parkinson's Agents Pass Assured, LLC, Pharmacy Technician Training Systems Copyright © Pass Assured, LLC, Web Site - passassured.com -o- p2 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Definitions Click Here to Print Topic Help File (.pdf) (Internet Access is Required for this Feature) Click Here for Glossary Index! Dependence An altered state where continued administration of the drug is necessary to prevent physical and psychological withdrawal systems Addiction A pattern of compulsive use characterized by overwhelming involvement with drug use and abuse Tolerance The need for larger doses or an increase in the number of doses to achieve the desired response May develop after repeated or chronic administration of the drugs Example: Some with chronic pain increase dose of analgesic Physiology The CNS is composed of the brain and spinal cord Example: Burn your finger, goes to spinal cord to brain, brain says "move finger" Involved in integrating and deciphering all incoming messages and sending responses to the organs and tissues of the body Co-ordinates muscle movements, visualization, temperature regulation, pain and sensation Pass Assured, LLC, Pharmacy Technician Training Systems Copyright © Pass Assured, LLC, Web Site - passassured.com -o- p3 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Therapeutic Classes Click Here to Print Topic Help File (.pdf) (Internet Access is Required for this Feature) Click Here for Glossary Index! Sedative Hypnotics Uses Short-term use (days to a few weeks) for insomnia, not for long term use Long-term use (months or years), long-term use can cause drug-induced abnormalities in the patient's sleep cycle Antidotes for overdoses of stimulants In combination with analgesics in painful situations Preoperative anesthetics Mechanism of Action Not sure, but is though to reduce the activity of the brain and spinal cord Side Effects Drowsiness Addiction Tolerance & dependence Respiratory and cardiac depression (with high doses) Examples Benzodiazepines: Flurazepam (Dalmane) Alprazolam (Xanax) Lorazepam (Ativan) Diazepam (Valium) Oxazepam (Serax) Midazolam (Versed) Temazepam (Restoril) Triazolam (Halcion) Estazolam (ProSom) p4 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Clonazepam(Klonopin) used to treat epilepsy seizures Barbiturates: Secobarbital (Seconal) Amobarbital (Amytal) Pentobarbitol (Nembutal) Primidone (Mysoline) Miscellaneous: Zolpidem Tartrate (Ambien) Chloral Hydrate (Noctec) Alcohol Diphenhydramine (Benadryl, Compoz, Nytol, Sominex) Eszopiclone (Lunesta) Skeletal Muscle Relaxants Uses Relieve muscle spasm associated with muscle inflammation and injury Useful in neuromuscular disorders such as Multiple Sclerosis and Cerebral Palsy Mechanism of Action Not understood, but may block nerve response within the spinal column. This has an effect of reducing, muscle tone and relieving muscle spasm and tension Side Effects Drowsiness Addiction Tolerance and dependence Respiratory and cardiac depression (with high doses) Examples Diazepam (Valium) Cyclobenzaprine (Flexeril) Methocarbamol (Robaxin) Baclofen (Lioresal) p5 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Chlorzoxazone (Parafon Forte) Carisoprodol (Soma) Metaxalone (Skelaxin) Tizanidine(Zanaflex) Orphenadrine(Norflex) Anticonvulsants Uses Epilepsy: Seizures accompanied by loss or disturbance of consciousness and possibly abnormal body movements (convulsions) Needs to be individualized by dose and addition of other anticonvulsant agents Prevent the occurrence of seizures, they do not cure the disease Mechanism of Action Control the excessive discharge of signals from the brain (seizures) Side Effects Drowsiness Slurred speech Addiction Tolerance and dependence Respiratory and cardiac depression (with high doses) Examples The anticonvulsant drug chosen depends on the type of seizure the patient has (e.g. partial vs. generalized onset seizures). Valium and Ativan are the drugs of choice to treat a life threatening seizure disorder called Status Epilepticus Phenobarbital Phenytoin (Dilantin) Carbamazepine (Tegretol) Valproic acid and its derivatives (Depakene, Depakote) Gabapentin (Neurontin) Lamotrigine (Lamictal) Clonazepam (Klonopin) a benzodiazepine p6 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Clorazepate (Tranxene) Ethosuximide (Zarontin) Oxcarbazepine (Trileptal) Felbamate (Felbatol) Lamotrigine (Lamicta) Levetiracetam (Keppra) Tiagabine (Gabitril Filmtabs) Topiramate (Topamax) Primidone (Mysoline) Trimethadione (Tridione) Narcotic Analgesics Uses Relief of moderate to severe pain Cough suppressant Severe diarrhea Mechanism of Action Bind to specific receptors within the brain and depress certain parts of the CNS to cause pain relief, respiratory depression, decreased GI motility, and suppression of cough Side Effects Drowsiness Constipation Nausea/vomiting Addiction, tolerance and physical an psychological dependence Overdoses can cause respiratory depression, profound coma, and pinpoint pupils (narcotic antagonists are used to treat overdoses - Naloxone (Narcan) Examples Single Agents: Codeine Morphine Sulfate (MS Contin, Roxanol) Oxycodone (Roxicodone) p7 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Nalbuphine (Nubain) Meperidine (Demerol) Fentanyl (Duragesic) (Actiq lozenges on a stick) Hydromorphone (Dilaudid) Remifentanil (Ultiva) Pentazocine (Talwin) Levorphanol (Levo-Dromoran) Propoxyphene (Darvon) Butorphanol (Stadol) Combination Products: Acetaminophen with Codeine (Tylenol with Codeine) Hydrocodone and Acetaminophen (Lorcet, Lortab, Vicodin) Propoxyphene and Acetaminophen (Darvocet-N, Propacet, Wygesic) Oxycodone and Acetaminophen (Percocet, Roxicet) Oxycodone and Aspirin (Percodan) Antipsychotics Uses Relieve the signs and symptoms of psychoses (e.g. Schizophrenia) Have a much better effect on the positive symptoms of psychosis: Auditory and visual hallucinations, agitation, suspiciousness, felling of persecution, ideas of reference, and intrusion of unwanted thoughts Noncompliance is the leading cause of recurrent positive psychotic symptoms in those patients who initially responded Negative symptoms include emotional apathy, extreme inattentiveness, and social withdrawal Some analgesic, antiemetic, antinausea, and antihistaminic effects Mechanism of Action Originally, it was proposed that these drugs block dopamine (a chemical in the brain) receptors in the brain Chemically effects unknown p8 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Side Effects Sedation Extrapyramidal symptoms (abnormal body movements) - with typicals Anticholinergic symptoms Orthostatic hypotension Abnormal heart rhythms (arrhythmia's) Examples Typical: Haloperidol (Haldol) Chlorpromazine (Thorazine) Prochlorperazine (Compazine) Fluphenazine (Prolixin - Permitil) Thioridazine (Mellaril) Thiothixene (Navane) Trifluoperazine (Stelazine) Atypical: Clozapine (Clozaril) Risperidone (Risperdal ) Olanzapine (Zyprexa) Antipiprazole (Abilify) Quetiapine (Seqroquel) Antidepressants Uses Treat severe depression Mechanism of Action Exact mechanism unknown Appear to increase neurotransmitters in the brain (Norepinephrine and serotonin) Usually takes 3-6 weeks for these drugs to relieve the depression Side Effects Sedation p9 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Anticholinergic Abnormal heart rhythm Seizures Examples Tricyclic antidepressants (TCAs): Amitriptyline (Elavil) Desipramine (Norpramin) Imipramine (Tofranil) Nortriptyline (Pamelor) Trimipramine (Surmontil) Clomipramine (Anafranil) Mirtazpine (Remeron) Serotonin-reuptake inhibitors: Fluoxetine (Prozac) Venlafaxine (Effexor) Paroxetine (Paxil) Sertraline (Zoloft) Fluvoxamine (Luvox) Citalopram (Celexa) Escitalopram (Lexapro) Serotonin and Norepinephrine reuptake inhibitors Duloxetine (Cymbalta) Miscellaneous: Trazodone (Desyrel) Nefazodone (Serzone) Bupropion (Wellbutrin) Lithium (Eskalith, Lithobid, Lithonate) Monoamine oxidase inhibitors: Phenelzine (Nardil) Tranylcypromine (Parnate) p10 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Important to do a drug interaction check Manic-depressive disorder: Periods of elation, followed by periods of depression Drugs used to moderate mood swings Lithium Carbonate (Eskalith, Lithonate) Alzheimer disease: Alzheimer is an illness that makes it hard for people to remember, think, and use language. It can make them act strange. Uses Treat Alzheimer T Mechanism of action NMDA Receptor antagonists Cholinesterase inhibitors Side Effects Dizziness Confusion Insomnia Nausea Agitation Coughing Fatique Abdnormal thinking NMDA Receptor antagonists Example: Memantine (Namenda) Cholinesterase inhibitors Examples: Tacrine (Cognex) Donepezil (Aricept) p11 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Rivastigmine (Exelon) Antianxiety Agents (Anxiolytics) Uses To relieve nervousness and tension in normal or neurotic patients Have muscle-relaxing capabilities Some have anticonvulsant activity Mechanism of Action Benzodiazepines work by binding to and affecting certain receptors and neurotransmitters (GABA) in the brain The second-generation drug, Buspirone, has an effect at the serotonin and dopamine receptors Side Effects Drowsiness Dizziness Fatigue Abrupt termination of high does can cause coma, convulsions, and death Examples Benzodiazepines: Alprazolam (Xanax) Lorazepam (Ativan) Diazepam (Valium) Oxazepam (Serax) Flurazepam (Dalmane) Midazolam (Versed) Miscellaneous: Buspirone (BuSpar) Doxepin (Sinequan) Hydroxyzine (Atarax) CNS Stimulants p12 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Uses To improve mental function, elevate mood, overcome fatigue, and produce a general feeling of well being Narcolepsy Hyperkinesis (Attention Deficit Hyperactivity Disorder - ADHD in children) Anorexiants ( Management of Obesity) Mechanism of Action Amphetamines stimulate activity and are mediated by the release of Norepinephrine and Dopamine in the brain Pemoline and Methylphenidate's action is unknown Side Effects Dependence Increased blood pressure Increased respiratory rate Stomach upset Examples Caffeine Methylphenidate (Ritalin) Dextroamphetamine (Dexadrine) Pemoline (Cylert) Adderall (Amphetamine Mixture) Modafinil (Provigil) Dexmethylphenidate (Focalin) Examples of Anorexiants Benzphetamine (Didrex) Phentermine (Adipex-P) Anti-Parkinson's Agents Uses To treat the shaking, rigidity, salvation, and slowing of initial movements associated with p13 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Parkinson's disease Mechanism of Action Parkinson's is a disease characterized by loss of dopamine manufacturing neurons. There is an imbalance in the brain between Acetylcholine (increased) and dopamine (decreased) Anticholinergics decrease the amount of CNS Acetylcholine Drugs such as Levodopa increase the amount of dopamine in the CNS Amantadine augments dopamine release from presynaptic nerve terminals and inhibits dopamine reuptake Side Effects Anticholinergics: Dry mouth Blurred vision Constipation Hallucinations Memory impairment Amantadine: Dizziness Insomnia Nervousness Irritability Confusion Nausea and vomiting Constipation Levodopa: Nausea and vomiting Confusion Depression Restlessness Postural hypotension Arrhythmias Examples Levodopa/Carbidopa (Sinemet) p14 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com PassAssured's Pharmacy Technician Training Systems Bromocriptine (Parlodel) Amantadine (Symmetrel) Pergolide (Permax) Pramipexole (Mirapex) Ropinirole (Requip) Selegiline (Eldepryl) Benztropine (Cogentin) Special Note Alcohol and other CNS depressants can have additive CNS depressant effects and concomitant use should be avoided Pass Assured, LLC, Pharmacy Technician Training Systems Copyright © Pass Assured, LLC, Web Site - passassured.com -o- p15 ________________________________________________________________ © PassAssured, LLC - Serving the Pharmacy Technician Commuinty www.passassured.com