Central and Peripheral Nervous
System Medications
Theresa Bucy
March 3, 2008
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NCLEX Test Plan Categories
Physiological Integrity
6. Pharmacological Therapies
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z ANTI
adrenergic type meds
z “Adrenergic
z ANTI
blocking agents”
acetylcholine type meds
z “Anticholinergic
meds”
z Terms
used throughout the chapter
and med book – become familiar.
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Antimigraine Agents
z BLOCK
nerve impulses in receptors of
the sympathetic nervous system
z Ergot
alkaloids – adrenergic-blocking
agents
z
z Dilate
veins in smooth muscle tissue of
peripheral vascular system
z
z Effect: reduces blood flow to brain resulting in
relief of headache
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Antimigraine Agents
z Serotonin
receptor antagonists
z
z Constrict
cranial blood vessels
z
z Effect: decreased blood flow to brain resulting
in relief of headache
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Antimigraine Agents
z Adverse
effects: heart murmur,
edema, tachycardia, confusion,
dizziness, fixed miosis, numbness and
tingling, weakness in legs
z Contraindications: Ischemic heart
disease, uncontrolled HTN, concurrent
MAOI (monoamine oxidase inhibitor)
use
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Integrated Process:
The Nursing Process
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Antimigraine Agents
z
z
Nursing Implications:
z
z
z
z
A: nature of headache, pain
scale, allergies, relief in past,
relief measures tried with no
success, concurrent symptoms,
suicidal ideations
Pt teaching: medication should
be taken as prescribed only, do
not increase dose or stop
abruptly, lie down after taking,
keep extremities warm
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NCLEX Test Plan Categories
Physiological Integrity
6. Pharmacological Therapies
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Anticonvulsants or Antiepileptic
Drugs
z Seizures:
z Sudden
muscle contractions that happen
without conscious control
z
z One
z
z
of most common causes is epilepsy
idiopathic
z
z Head
injury
z
z Brain tumor
z
z Poisoning (especially alcohol)
z
z Stroke
z
z Meningitis
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Anticonvulsants or Antiepileptic
Drugs
z
Types of seizures
Grand mal (tonic-clonic)
z
z Petit mal (absence)
z
z Febrile
z
z Others
z
z
z
Four major drug groups:
Barbiturates
z
z Benzodiazepines
z
z Hydantoins
z
z Succinimides
z
z
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Anticonvulsants or Antiepileptic
Drugs
z Barbiturates
z -barbital
ending (phenobarbital)
z sedative effect on the brain
z varying lengths of action
z
z Long
acting:
prevent and control grand mal seizures
z
z Used in Status Epilepticus
z
z
z
z Adverse
reactions: drowsiness, hangover,
headache, lethargy, dizziness
z Significant
additive effects with alcohol,
antihistamines
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Anticonvulsants or Antiepileptic
Drugs
z Benzodiazepines
z -azepam
ending (diazepam)
z CNS depressants
z Treatment of petit mal seizures
z Diazepam is drug of choice for Status
Epilepticus (hospitalized, IV)
z Adverse reactions: hypotension, shortness
of breath, drowsiness, blurred vision,
confusion, impaired gait
z Do not use with alcohol or other sedatives
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Anticonvulsants or Antiepileptic
Drugs
z Hydantoins
z -toin
endings (phenytoin aka Dilantin)
z most commonly prescribed anticonvulsant
z used in treating grand mal seizures
z teratogenic
z Adverse reactions: ataxia, dizziness,
drowsiness, nystagmus, constipation,
nausea
z Use cautiously with any other medication
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Anticonvulsants or Antiepileptic
Drugs
z Succinimides
z -imide
endings (ethosuximide)
z petit mal seizures
z Adverse Reactions: dizziness, drowsy, ,
urinary frequency, rashes, blurred vision,
anorexia, alopecia, sleep disturbances
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Integrated Process:
The Nursing Process
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Anticonvulsants or Antiepileptic
Drugs
z
Nursing Implications
A: drug history, allergies, medical history,
pregnancy status
z
z I:
z
z
Barbiturates are legally controlled substances. They
should not be given to patients with history of addiction.
z
z Elderly and weakened patients should receive reduced
doses and slowly increase or reduce dosages.
z
z
z
z
E: Drowsiness common adverse effect to all
antiseizure meds.
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Anticonvulsants or Antiepileptic
Drugs
z Nursing
Implications, cont.
z E:
Gum overgrowth around teeth is a
typical finding with hydantoins.
z Patient teaching:
z
z Good
oral hygiene with soft toothbrush
important.
z
z Wear medic alert bracelet.
z
z Some medications produce daytime sedation
which could interfere with work or child-care
responsibilities.
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NCLEX Test Plan Categories
Physiological Integrity
6. Pharmacological Therapies
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Antiemetic-Antivertigo Agents
z Nausea
and dizziness are caused by
neurotransmitter stimulation in the
brain
z Causes: Drugs, metabolic disorders,
motion, GI irritation, others
z These drugs typically used to prevent
or treat motion sickness, n/v associated
with anesthesia and surgery or cancer
treatment
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Antiemetic-Antivertigo Agents
z Adverse
effects: drowsiness, dry mouth,
blurred vision, constipation, urinary
retention (anticholinergic reactions)
z Nursing implications:
z
z Don’t
use with morning sickness (teratogenic)
z
z Mental alertness is diminished (safety?)
z
z Don’t mask n/v until cause is discovered
z
z Use alternative treatments such as fluids,
electrolyte balance
z
z Urine turns pink with phenothiazines
(prochlorperazine, promethazine) see pg 279
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Antiparkinsonian Agents
z Anticholinergic
and dopaminergic
z Block
uptake of acetylcholine
z Elevate the functional levels of dopamine
z Many
effects throughout body on tissue
affected by the autonomic nervous
system: eyes, respiratory tract, heart,
GI tract, urinary bladder, others
z Reduce muscle tremors and rigidity
AND improve mobility, coordination,
and performance
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Antiparkinsonian Agents
z
z
z
z
z
Parkinson’s Disease (Paralysis agitans)
Cause unknown
Too much acetylcholine and not enough
dopamine
Fine muscle tremors, slowness of movement,
rigidity, muscle weakness, shuffling gait,
changes in posture and balance
Treatment: no cure, maintain movement and
activity of patient
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Antiparkinsonian Agents
z Adverse
effects:
z Dopaminergic
agents: dysrhythmias,
muscle twitching, psychotic reactions,
rigidity, GI bleeding, urinary retention
z Anticholinergic agents: postural
hypotension, tachycardia, confusion,
depresson, memory loss, others – pg 282
z Overdose common – recognized by
suddenly worsening symptoms; taper
drugs gradually
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Integrated Process:
The Nursing Process
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Antiparkinsonian Agents
z
Nursing Implications –
A: how far progressed? ADLs impacted? Safety
impacted? Ability to communicate impacted?
z
z Tardive dyskinesia (difficulty in performing
voluntary movements)
z
z Concordance: drugs take 2 to 3 weeks to begin
working – continue taking
z
z Take meds after meals
z
z Avoid Vitamin B6 – competes with dopamine
z
z
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NCLEX Test Plan Categories
Physiological Integrity
6. Pharmacological Therapies
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Psychotherapeutic Agents
z Antianxiety
–
z Anxiety
is normal, too much can interfere
with ability to work, relate, care for self.
z Anxiety creates feelings of helplessness,
indecision, worry, apprehension
z Meds must be considered short term due
to addictive nature
z Benzodiazepines drug of choice for
anxiety.
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Psychotherapeutic Agents
z Antianxiety,
cont.
z Adverse
reactions: hypotension,
tachycardia, clumsiness, confusion fatigue,
insomnia, constipation, dry mouth.
z Should not be used with other CNS
depressants (antihistamines, barbiturates,
narcotics.
z Caffeine and cigarette smoking can
negatively impact the intended effect.
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Integrated Process:
The Nursing Process
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Psychotherapeutic Agents
z Antianxiety,
z Nursing
cont.
Implications/Patient Teaching
z
z A:
History, current health, other meds, etc.
z
z Dependence easily developed.
z
z Depression often accompanies anxiety –
assess suicidal tendencies
S – specificity of plan
z
z L – lethality of means
z
z A – access to means
z
z P – proximity of help
z
z
z
z Legal
responsibility to report suicidal ideations
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Psychotherapeutic Agents
z Antianxiety,
cont.
z Take
meds in conjunction with
psychotherapy; drugs don’t cure
z Don’t use alcohol
z Med is habit-forming
z Caffeine can diminish effectiveness
z Contraindicated in pregnancy or
breastfeeding
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NCLEX Test Plan Categories
Physiological Integrity
6. Pharmacological Therapies
College of DuPage – Grant # CB-15948-07-60-A-17 - PN Program Toolkit
Psychotherapeutic Agents
z Antidepressants
z Three
z
z 1)
major drug groups:
Tricyclic Antidepressants
Relieve symptoms of severe depression that has
internal biological causes
z
z Mild depression related to life issues
z
z Adverse effects: common to many meds
z
z Don’t mix with other CNS depressants
z
z Assess for suicidal ideations
z
z Assess for lack of self-care
z
z Don’t stop suddenly.
z
z Can take up to 8 weeks to see effects.
z
z Gum or hard candy may relieve dry mouth.
z
z
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Psychotherapeutic Agents
z Antidepressants
z Three
z
z 2)
major drug groups:
Monoamine Oxidase (MAO) Inhibitors
Last resort for patients with severe depression who
have not responded to tricyclic therapy.
z
z Many dietary restrictions – see Clinical Landmine and
Memory Jogger on page 294 – sudden and severe
hypertension can result if restrictions ignored
z
z Many adverse effects and drug interactions
z
z antihypertensive agents
z
z antidiabetic agents
z
z Drug stays in body two weeks after stopping
z
z
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Psychotherapeutic Agents
z Antidepressants
z Three
major drug groups:
z
z 3)
Selective Serotonin Reuptake Inhibitors
(SSRI)
Well-tolerated, much preferred over MAOIs
z
z Serotonin AKA 5-HT
z
z Drugs are more selective, therefore cardio and other
system side effects are less
z
z Used for short- or long-term
z
z Adverse effects common – see page 296
z
z Avoid alcohol
z
z
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Psychotherapeutic Agents
z
Antipsychotic Drugs
z
z
Used in treating
severe mental
illness:
schizophrenia,
psychotic depression,
mania
Goal of therapy:
sedate or slow pt
down
z
z Block dopamine in
brain
z
z 2 major groups
z
z
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Psychotherapeutic Agents
z Phenothiazines
and Thioxanthenes
z These
two similar so covered together
z Relief of acute and chronic psychoses
z Adverse effects:
z
z postural
hypotension, tachycardia, confusion,
drowsiness, insomnia, hyperglycemia, others
z Patient
teaching:
z
z photosensitivity
possible; use sunblock
z
z avoid overheating
z
z gum, hard candy can relieve dry mouth
z
z antacids interfere with absorption
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Psychotherapeutic Agents
z Nonphenothiazines
z See
Table 16-11, fyi.
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Antimanics
z
z
z
z
z
z
z
z
z
z
Lithium is the primary
drug used to treat
patients in manic
states.
Mood-stabilizer.
NO sedative,
depressant, or euphoric
actions
Blood levels monitored:
1.0 to 1.5 mEq/L
Geriatric
Considerations: Page
304
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Antimanics
z Lithium,
cont.
z Toxic
effects: Severe N/V, confusion,
unsteady gait
z Use with diuretic can lead to toxicity
z Toxicity possible with dehydration from
vomiting or diarrhea or excessive sweating
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Sedative-Hypnotic Medications
z Used
to relax and/or induce sleep
z Insomnia
z Difficulty
falling asleep – Initial insomnia
z Can’t stay asleep – Intermittent insomnia
z Early awakening – Terminal insomnia
z Sedative
– relaxes pt and allows sleep
z Hypnotic – produces sleep
z Dose of medication determines effect,
not the drug itself
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Sedative-Hypnotic Medications
z
z
z
Clinical Goldmine – page 306
Once these agents have been used, a normal
sleep pattern may not return for several
weeks.
Drugs used:
Barbiturates – short-term, psychosocial stresses
z
z Benzodiazepines – used in patients with medical
conditions who require restful sleep
z
z Non – Barb/Ben – not commonly used
z
z
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Integrated Process:
The Nursing Process
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Sedative-Hypnotic Medications
z Geriatric
Considerations: Page 307
z Rebound insomnia – page 307
z Patients on sleep aids and diuretics are
at risk for falls
z Short-term use: dependence, tolerance
z Hangover feeling may occur, affecting
alertness
z No alcohol
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