Download PowerPoint Chapter 16

Chapter 16
Central and Peripheral Nervous
System Medications
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Chapter 16
Lesson 16.1
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Learning Objectives
• 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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Nervous System
• Central nervous system
• Peripheral nervous system
• Neurotransmitters
• Adrenergic fibers
• Cholinergic fibers
• Receptors: alpha1, alpha2, beta blockers
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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
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Antimigraine Agents (cont.)
Adverse Reactions
Drug Interactions
• Other vasoconstrictors, MAOIs
Nursing Implications and Patient Teaching
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Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient Teaching: administration considerations
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Anticonvulsants or Antiepileptic
Drugs
• Seizures: sudden muscle contractions
that happen without conscious control
• Etiology: disease or disorders; head
injury; idiopathic
• Four major drug classes
• Drug Table 16-3
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Barbiturates
Action
• Long duration of action and sedative effect on
the brain; action occurs in the brainstem
Uses
• Status epilepticus; prevent and control grand
mal seizures
• May treat seizures caused by tetanus, fever,
or drugs
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Benzodiazepines
Action
• CNS depressants; suppress electrical
discharge in seizures
Uses
• Treat minor motor seizures; Lennox-Gestault
syndrome (petit mal)
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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
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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
Adverse Reactions
Drug Interactions
• Other antiseizure agents and bone marrow–
depressing drugs
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Succinimides (cont.)
Nursing Implications and Patient Teaching
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Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient Teaching
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Antiemetic-Antivertigo Agents
Action
• 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-Antivertigo Agents
(cont.)
Adverse Reactions
• Drowsiness and drug tolerance with longterm therapy
• Anticholinergic effects
Drug Interactions
• CNS depressants
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Antiemetic-Antivertigo Agents
(cont.)
Nursing Implications and Patient Teaching
• Assessment: patient history
• Diagnosis
• Planning
– Secondary problems: nutrition and hydration
• Implementation
• Evaluation
• Patient Teaching
Drug Table 16-4
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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’s disease
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Antiparkinsonian Agents (cont.)
Adverse Reactions
• Dysrhythmias, muscle twitching, GI
symptoms, etc.
• Anticholinergic agents
Drug Interactions
• Many; read product information closely
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Antiparkinsonian Agents (cont.)
Nursing Implications and Patient Teaching
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Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient Teaching
Drug Table 16-5
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Chapter 16
Lesson 16.2
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Learning Objectives
• 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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Psychotherapeutic Agents
• Antianxiety Medications
• Antidepressants
• Antipsychotic Drugs
• Antimanic Drugs
• Sedation-Hypnotic Medications
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Antianxiety Agents
• Drug Table 16-6
• Anxiety is common
• Problematic when it interferes with a
person’s ability to perform activities of
daily living
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Antianxiety Agents (cont.)
Action
• Produce a calming effect
Uses
• Relieve anxiety, tension, and fear
– May be used to manage alcohol withdrawal
symptoms; used preoperatively; used to relieve
muscle spasm
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Antianxiety Agents (cont.)
Adverse Reactions
Drug Interactions
• Increase effects
• Antagonize effects
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Antianxiety Agents (cont.)
Nursing Implications and Patient Teaching
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Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient and Family Teaching
– Dosing; appointments and follow-up; adverse reactions; safety
with storage; drug and alcohol interactions
– Habit-forming: should be used for the least time possible
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Antidepressants
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Tricyclics
MAOIs
SSRIs
Miscellaneous
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Tricyclic Antidepressants
Action
•
Believed to inhibit the reuptake of norepinephrine and or/serotonin
Uses
•
To treat endogenous depression; mild depression due to exogenous causes
Adverse Reactions
Drug Interactions
Nursing Implications and Patient Teaching
Drug Table 16-7
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Monoamine Oxidase Inhibitors
Action and Uses
• 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
Drug Table 16-8
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Selective Serotonin
Reuptake Inhibitors
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
Adverse Reactions
Drug Interactions
Nursing Implications and Patient Teaching
Drug Table 16-9
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Miscellaneous
Antidepressants
• Tetracyclic compounds: maprotiline,
mirtazapine (Remeron), trazodone
(Desyrel)
• Unrelated products: bupropion
(Wellbutrin), nefazodone (Serzone),
venlafaxine (Effexor)
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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
Drug Table 16-10
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Phenothiazines and
Thioxanthenes
Action
• Block dopamine at the postsynaptic receptor to
increase the metabolism of dopamine; reduce
sensory simulation and produce a sedating effect; act
as an antiemetic by inhibiting action in the
chemoreceptor center
Uses
• Reducing and relieving acute and chronic psychosis
of schizophrenia, schizoaffective disorders, and
involutional psychosis
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Nonphenothiazines
Action and Uses
• Mechanism of action for these products is
often not precisely understood when used to
treat psychotic patients
Drug Table 16-11
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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
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Sedative-Hypnotic Medications
Action and Uses
• Sedative agent: relaxes the patient and
allows him or her to sleep
• Hypnotic agent produces sleep in the patient
• Used to relax patients and induce sleep
before medical testing and surgical
procedures; used to treat insomnia caused by
mental and physical stress
Drug Tables 16-13, 16-14, 16-15
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Sedative-Hypnotic Medications
(cont.)
Adverse Reactions
Drug Interactions
Nursing Implications and Patient Teaching
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