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Chapter 16 Central and Peripheral Nervous System Medications Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 1 Chapter 16 Lesson 16.1 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 2 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 3 Nervous System • Central nervous system • Peripheral nervous system • Neurotransmitters • Adrenergic fibers • Cholinergic fibers • Receptors: alpha1, alpha2, beta blockers Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 4 Central Nervous System Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 5 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 6 Antimigraine Agents (cont.) Adverse Reactions Drug Interactions • Other vasoconstrictors, MAOIs Nursing Implications and Patient Teaching • • • • • • Assessment Diagnosis Planning Implementation Evaluation Patient Teaching: administration considerations Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 7 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 8 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 9 Benzodiazepines Action • CNS depressants; suppress electrical discharge in seizures Uses • Treat minor motor seizures; Lennox-Gestault syndrome (petit mal) Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 10 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 11 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 12 Succinimides (cont.) Nursing Implications and Patient Teaching • • • • • • Assessment Diagnosis Planning Implementation Evaluation Patient Teaching Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 13 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 14 Antiemetic-Antivertigo Agents (cont.) Adverse Reactions • Drowsiness and drug tolerance with longterm therapy • Anticholinergic effects Drug Interactions • CNS depressants Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 15 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 16 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 17 Antiparkinsonian Agents (cont.) Adverse Reactions • Dysrhythmias, muscle twitching, GI symptoms, etc. • Anticholinergic agents Drug Interactions • Many; read product information closely Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 18 Antiparkinsonian Agents (cont.) Nursing Implications and Patient Teaching • • • • • • Assessment Diagnosis Planning Implementation Evaluation Patient Teaching Drug Table 16-5 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 19 Chapter 16 Lesson 16.2 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 20 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 21 Psychotherapeutic Agents • Antianxiety Medications • Antidepressants • Antipsychotic Drugs • Antimanic Drugs • Sedation-Hypnotic Medications Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 22 Antianxiety Agents • Drug Table 16-6 • Anxiety is common • Problematic when it interferes with a person’s ability to perform activities of daily living Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 23 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 24 Antianxiety Agents (cont.) Adverse Reactions Drug Interactions • Increase effects • Antagonize effects Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 25 Antianxiety Agents (cont.) Nursing Implications and Patient Teaching • • • • • • 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 26 Antidepressants • • • • Tricyclics MAOIs SSRIs Miscellaneous Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 27 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 28 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 29 Selective Serotonin Reuptake Inhibitors Action and Uses • • • 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 30 Miscellaneous Antidepressants • Tetracyclic compounds: maprotiline, mirtazapine (Remeron), trazodone (Desyrel) • Unrelated products: bupropion (Wellbutrin), nefazodone (Serzone), venlafaxine (Effexor) Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 31 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 32 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 33 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 34 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 35 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 Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 36 Sedative-Hypnotic Medications (cont.) Adverse Reactions Drug Interactions Nursing Implications and Patient Teaching Elsevier items and derived items © 2010, 2006, 2003, 2000 by Mosby, an imprint of Elsevier Inc. 37