Download Central and Peripheral Nervous System Medications

Central and Peripheral Nervous
System Medications
Chapter 16
Learning Objectives
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
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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
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Antimigraine Agents
Action
 Block nerve impulses at receptors of the
sympathetic nervous system
 Relieve pain by narrowing dilated cerebral
arteries
Uses
 Prevention and treatment of migraine
headaches
 Drug Table 16-1
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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Antimigraine Agents (cont.)
Adverse Reactions
Drug Interactions
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Other vasoconstrictors, MAOIs
Nursing Implications and Patient Teaching
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Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient Teaching: administration considerations
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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Antimigraine Medications
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Ergotamine Derivatives
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Migranal
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dihydroergotamine
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Ergomar
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ergotamine
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Cafergot
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caffeine & ergotamine
Serotonin Receptor
Agonists (-triptans)
Axert
Maxalt
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sumatriptan
Zomig
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rizatriptan
Imitrex *
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almotriptan
zolmitriptan
Relpax

elatriptan
Anticonvulsants or Antiepileptic
Drugs
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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.
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Barbiturates
Action
 Long duration of action and sedative effect
on the brain; action occurs in the
brainstem
Uses
 Status epilepticus; to prevent and control
grand mal seizures
 May treat seizures caused by tetanus,
fever, or drugs
 RX: phenobarbital*
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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Benzodiazepines
Action
 CNS depressants; suppress electrical
discharge in seizures
Uses
 Treat minor motor seizures; Lennox-Gastaut
syndrome (petit mal)
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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Benzodiazepines
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End in –lam or –pam
Anticonvulsant as well as sedative
Valium
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Klonopin
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diazepam
clonazepam
Ativan

lorazepam
Hydantoins
Action
 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
 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.
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Hydantoins
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Cause gingival hyperplasia
Cannot be given NG with feeding. MUST hold
feeding for 2 hours before and after med.
Cerebyx (name alert! Not Celebrex)
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fosphenytoin
Dialntin
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phenytoin
Succinimides
Action and Uses
 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
 Other antiseizure agents and bone
marrow–depressing drugs
 RX: Zarontin (ethosuximide)
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Other Common Anticonvusants
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Diamox
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lamotrigine
Keppra
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levetiracetam
topiramate
Depakene / Depakote
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primidone
Topamax
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gabapentin
Lamictal
Mysoline
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carbamazepine
Neurontin
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acetazolamide
Tegretol
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valproic acid
Trileptal
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oxcarbazepine
Antiemetic-Antivertigo Agents
Action
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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

Prevent and treat motion sickness or the nausea
and vomiting that occur with surgery, anesthesia,
and cancer treatment
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Antiemetic and Antivertigo Meds
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Antidopaminergics
Phenothiazines
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Thorazine
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Promethazine
Other:
Reglan (metaclopramide)
Dramamine
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dimenhydrinate
Benadryl
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prochlorperazine
Phenergan
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Anticholinergics
Antihistamines
chlorpromazine
Compazine
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diphenhydramine
Antivert Dramamine
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Meclizine
Other:
Marinol (dronabinol)
Transderm – Scop
(scopolamine)
Tigan (trimethobenzamide)
Antiemetic and Antivertigo Meds
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5 HT receptor antagonists
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Zofran
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ondansetron
Many forms of the medication
Given frequently for nausea in patients undergoing
chemotherapy for cancer
Antiparkinsonian Agents
Actions
 Change the neurotransmitters produced in the
brain: excessive acetylcholine, deficient
dopamine
 Block the uptake of acetylcholine and elevate
the functional levels of dopamine in the motor
regulatory centers
Uses
 Control of the symptoms of Parkinson disease
Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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Antiparkinsonian Medications
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Anticholinergic
Cogentin
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Dopaminergic
Symmetrel
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benztropine
Benadryl
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Parlodel
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diphenhydramine
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carbidopa- levadopa
Comtan
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bromocriptine
Sinemet
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ammantadine
entacapone
Dopar
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levadopa
Dopamine Receptor Agonists, Nonergot
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Mirapex (name alert! NOT Miralax)
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pramipexole
Requip
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ropinirole
Learning Objectives
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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
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Antianxiety Agents
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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

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.
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Antianxiety Medications
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Benzodiazepine
Xanax
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diazepam
Ativan
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clorazepate
Valium
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lorazepam
Serax
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alprazolam
Tranxene
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oxazepam
Nonbenzodiazepine
Buspar
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buspirone
Vistaril
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hydroxizine
Tricyclic Antidepressants
Action

Believed to inhibit the reuptake of norepinephrine
and or/serotonin
Uses

To treat endogenous depression; mild
depression due to exogenous causes

amitriptyline
nortriptyline
Tofranil (imipramine)
Sinequan (doxepin)
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Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.
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Monoamine Oxidase Inhibitors
Action and Uses
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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,
epinephrine, 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.
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Selective Serotonin
Reuptake Inhibitors (SSRI)
Action and Uses
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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.
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SSRI and other Miscellaneous
Antidepressants
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SSRI
Celexa
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fluoxetine
Paxil
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escitalopram
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sertraline
mirtazapine
Desyrel
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trazadone
Unrelated Products
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Wellbutrin
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paroxetine
Zoloft
Remeron
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citalopram
Prozac
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Tetracyclic Compounds
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Lexapro
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Cymbalta
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bupropion
duloxetine
Effexor
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venlafaxine
Antipsychotic Drugs
Action and Uses
 All antipsychotic agents act by blocking the
action of dopamine in the brain
 Used in the treatment of severe mental
illness
 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
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Aliphatic
Phenothiazine
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Thorazine
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Compazine
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prochlorperazine
Nonphenothiazine
Antipsychotics
Haldol
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promazine
Piperazine
phenothiazine
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chlorpromazine
Promazine
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Zyprexa
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quetiapine
Risperdal
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olanzapine
Seroquel
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haloperidol
risperidone
Geodon
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ziprasidone
Antimanics
Action and Uses
 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)
 Mood-stabilizing drug
 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.
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Antimanic Medication
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Lithonate
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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
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Benzodiazepines
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Phenobarbitals
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-lams and -pams
-barbs
Aquachlor (chloral hydrate)
Miscellaneous sleep aids
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Ambien (zolpidem)
Lunesta (eszopiclone)
Sonata (zaleplon)
Attention Deficit Hyperactivity
Disorder (ADHD)
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CNS stimulants increase blood flow to the
frontal lobe where decision making is
centered.
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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.
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
Questions?