Chapter 10 Drugs for CNS Problems and
Chapter 11 Drugs for Mental health
CNS Depressants
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Sedatives and Hypnotics
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3 main groups
o Barbiturates
o Benzodiazepines
o Miscellaneous drugs
Benzodiazepines
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MOA: Depress CNS activity.
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Receptors are GABA
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Indications: Sedation, Anxiety, Sleep Induction, Skeletal relaxation, acute seizure disorders,
alcohol withdrawal
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Contraindications: Drug Allergy, narrow Angle glaucoma, pregnancy
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Adverse effects: Headache, drowsiness, cognitive impairment, lethargy
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Toxicity/Overdose symptoms: Coma, confusion, diminished reflexes
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Antidote for overdose: Flumazenil
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Interactions: Azole, verapamil, CNS depressants, Rifampin, Opioids
Diazepam
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Benzodiazepine
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Interaction: anxiety, sedation, skeletal muscle relaxation
Midazolam
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Benzodiazepine
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Used for moderate sedation.
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Adverse effects: Amnesia and anxiety
Temazepam
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Benzodiazepine
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Used for a sleep aid
Eszopiclone
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Hypnotic
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Designed to provide a full 8 hours of sleep
Ramelteon
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Like melatonin hormone. Works as an agonist at melatonin receptors
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Used for patients who have difficulty falling asleep.
Barbiturates
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Indications: Anesthesia, seizures, sedation, reductions of intracranial pressure
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Contraindications: drug allergy, pregnancy, respiratory difficulties, kidney/liver disease
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Toxicity/ overdose can lead to respiratory depression. Treatment is fluids, maintain adequate
airway, oxygen therapy, fluids and activated charcoal.
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Interactions: CNS depressants, MAOIs, reduce anticoagulant response
Doxylamine
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Sleep aid that is nonprescription
Muscle relaxants
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Indications: muscle spasms, MS and Cerebral Palsy
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Adverse effects: euphoria, light headiness, dizziness, drowsiness, fatigue, muscle weakness
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Drugs: Baclofen, Tizanidine, cyclobenzaprine
Amphetamines
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Used to treat ADHD and Narcolepsy
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Types: Dextroamphetamine sulfate, dextroamphetamine Saccharate, amphetamine sulfate and
Amphetamine Aspartate (most commonly prescribed for ADHD)
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Nursing implication for ADHD meds: give 4-6 before bed, take on empty stomach
Atomoxetine
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Used to treat ADHD.
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Black box warning for suicidal thoughts
Methylphenidate
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Uses: ADHD and Narcolepsy
Anorexiants
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Used to treat obesity and suppress appetite.
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Drugs: Phentermine, Benzphetamine, Methamphetamine, Diethylpropion
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Contraindications: severe cardiovascular disease, hypotension, hyperthyroidism, MAO
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Adverse effects: Agitation, anxiety, dizziness, headache, hypertension, heart palpitations
Orlistat
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Non stimulant drug used to treat obesity.
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MOA: inhibits absorptions of caloric fatty foods.
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Adverse effect: fecal incontinence
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Educate patients about limited fatty food intake.
Antimigraine
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Sumatriptan, almotriptan, eletriptan, naratriptan, rizatriptan, zolmitriptan
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MOA stimulate serotonin receptors causing vasoconstriction reducing headache symptoms.
reduce the production of inflammatory neuropeptides.
Serotonin Receptor Agonist
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Used to treat migraine
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Relief within 2 hours
Indirect acting Dopaminergic Drugs: Monoamine Oxidase
inhibitors
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Suppress MAO-B allowing dopamine levels to increase and reduce symptoms of Parkinson
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Drugs: Selegiline and Rasagiline
Amantadine
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Antiviral drug used for Parkinson treatment
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Used early in the course of the disease, and treats dyskinesia
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Adverse effects: dizziness, insomnia and nausea
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Interactions: anticholinergic drugs
Catechol Ortho Methyltransferase inhibitor (COMT)
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Blocks COMT which will then allow naturally occurring dopamine and dopamine drugs to remain
active longer
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Drugs: Tolcapone and Entacapone
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Adverse effects: GI, Urine discoloration
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Prolongs the duration of action of levodopa: reduces wearing of phenomenon
Beomoxeiprine
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Direct acting dopamine receptor agonist. Activates presynaptic dopamine receptors to stimulate
the production of more dopamine. Inhibits the production of prolactin, which stimulates
lactation and can be used to treat women with excessive breast milk production
Dopamine Replace Drugs/dopamine agonist
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Helps reduce muscle tremors and improve mobility, muscular coordinate and performance.
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Drugs Carbidopa, Levodopa, Pramipexole, Ropinirole, Rotigotine
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Levodopa-is synthesized in the brain and converted to natural dopamine. Carbidopa is given in
combo because it allows more levodopa to get into the brain.
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Do not give with high protein foods. Get up slowly, monitor liver function. Be aware of any
hallucinators or delusions. Monitor patients with history of cardiac disease for hypotension and
dysrhythmia.
Anticholinergic Therapy
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Used to treat muscle tremors and muscle stiffness, these symptoms are caused by excessive
cholinergic activity.
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Benztropine-used for PD . caution for excessive sweating could cause hyperthermia. Adverse
effects: tachycardia, confusion, disorientation, toxic psychosis, anticholinergic effects.
Antiepileptic drugs
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Traditionally used: Barbiturates, Hydantoins, Iminostilbenes with Valproic acid
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MOA UNKNOWN. Reduces nerves ability to be stimulated. Suppress transmission of impulses
from one nerve to another.
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Adverse effects: black box warning for suicidal thoughts.
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Interactions: each other, induce hepatic metabolism resulting in reduction of effects of other
drugs, birth control, grape fruit juice and carbamazepine
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Barbiturate drugs: Phenobarbital and primidone-therapeutic range 10-40. Adverse effect:
sedation cardiovascular, cns, GI. Contraindication: liver or kidney impairment, respiratory illness
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Hydantoin: Phenytoin-adverse effect: gingival hyperplasia, hirsutism and osteoporosis.
Therapeutic level 10-20. Must be administered slowly via IV and filter must be used.
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Iminostilbenes: Carbamazepine
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Gabapentin: treatment of partial seizure. Most common treatment of neuropathy. Adverse
effect: CNS and GI.
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Levetiracetam: partial seizure treatment. MOA unknown. Adverse effect: CNS
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Nursing implication: instruct patients to wear a medical alert ID, follow driving
recommendations,
Selective Serotonin Reuptake Inhibitor
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Blocks the reabsorption of the neurotransmitter serotonin, which increases serotonin levels
thus improving patient sense of well being .
· Uses: depression, premenstrual dysphoric disorder PTSD, OCD, general anxiety
o Drugs: Escitalopram, Floxetine, paroxetine, sertraline
o Adverse effects: risk of suicide, bleeding, hyponatremia (low sodium) and bone
fractor.
o Should be avoided in pregnancy .
o Interactions: other antidepressants,NSAIDS
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Serotonin syndrome symptoms: confusion, agitation, restlessness, stomach disturbances,
sweating, extreme high blood pressure, seizures, dilated pupils tremors.
Serotonin- Norepinephrine reuptake inibtors
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Similar to ssri.
They can be used to treat depression, hot flushes, premenstrual dysphoric disorder,
fibromyalgia, chronic pain
o Drugs: Venlafaxine, Duloxetine
o Adverse effects: nosebleeds (epistaxis) GI bleed and liver damage hyponatremia, skin
reactions, risk for suicide . avoid in pregnancy
o Interactions : Antidepressants, NSAIDS, St Johns wort.
Tricyclic antidepressants
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reserved for severe depression, migraines, panic disorder, OCD and peripheral neuropathy.
o Drugs Amitriptyline and imipramine
o Adverse effects: cardiac dysrhythmias, heart failure, seizures. Can trigger manic
episodes , deliruium , increase risk of suicide in younger patients. Should not be used in
patients with glaucoma. Increased risk of respiratory depression
o Interactions: cns depressants, MAOI, SSRI and SNRI
Monoamine Oxidase Inhibitors
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reduces anxiety
○ Drugs: Pheneizine, Isocarbaoxazid, Selegiline
○ Used to treat severe depression
○ adverse effects: possible liver damage, blood disorders and thoughts of suicide
○ interactions: foods containing tyramine (beer, wine, aged cheese/products, bologna,
caffeinated drinks), SSRI, SNRI, St johns worth, stimulant drugs
Mood stabilizer
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primarily used to treat patients with bipolar illness
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drugs: Lithium, Carbamazepine, divalproex sodium
Narrow therapeutic range for lithium 1-1.5mEq/L
adverse effects hypothyroidism, renal failure, diabetes insipuds , neuroleptic malignant
syndrom
interactions: NSAIDs antidepressants, antipsychotics
Typical Antipsychotics
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block dopamine receptors in the brain, used to manage psychosis
○ drugs: Chlorpromazine, Fluphenazine
○ adverse effects: EPS (tremors at rest, pill rolling motion, facial grimacing , restless,
chewing motions)
○ interactions: acetaminophen, diuretics, calcium channel blockers
Atypical antipsychotic drugs
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used primarily for schizophrenia and bipolar illness. lower risk of EPS and have the benefit of
treating negative and positive symptoms. commonly used for long term management
○ drugs : Risperidone, Ziprasidone, quetiapine, aripoprazole, clozapine
○ adverse effects: weight gain Hypertriglycerid , risk of insulin resistance. ECG prolonging
the QT intervals
○ interactions: antidepressants, cns depressants
Chapter 12 Drugs for Pain Management
Classifications of Pain
Acute, chronic, continuous, intermittent, Nociceptive (specific to a body area easy to locate), Visceral
(hard to locate), Neuropathic (sharp, shooting pain), Cancer pain.
Principles of Pain Management
Ask about pain, asses pain, Believe the Patient, Choose pain management options that are appropriate
for the patient, deliver interventions timely, empower patients, enable them to manage their pain
Categories of drugs used for pain management
Opiod agonist, opioid agonist antagonist, nonopiod centrally acting analgesics, miscellaneous analgesics