HFHS Orientation - CNS Drugs PDF

# Central Nervous System ## Pharmacology Study Guide ### A. General Information 1. All patients need to be assessed for pain. Analgesics are most effective if administered before pain becomes severe. The nurse should focus on relief of pain as perceived by the patient. 2. Opioids are categorized ac...

# Central Nervous System ## Pharmacology Study Guide ### A. General Information 1. All patients need to be assessed for pain. Analgesics are most effective if administered before pain becomes severe. The nurse should focus on relief of pain as perceived by the patient. 2. Opioids are categorized according to potential for abuse. Schedule 1 drugs, (heroin, etc.) have high potential for abuse. Schedule 2-5 drugs are controlled by the Controlled Substance Act of 1970, which means every drug is accounted for by licensed personnel. Even if part of a dosage is used, the wastage must be witnessed and co-signed by another licensed person. ### B. Non-Opioid Analgesics; Antipyretics #### Acetylsalicylic acid (Aspirin) 1. Has anti-inflammatory, anticoagulant, analgesic, & antipyretic actions; inhibits prostaglandin syntheses 2. Irritating to gastric mucosa. Instruct patient to take with milk or food. Should be used with caution for patients with peptic ulcers. High risk for bleeding when given with anticoagulant therapy. 3. Toxicity is indicated by tinnitus (ringing in the ears) #### Acetaminophen (Tylenol) 1. Non-irritating to gastric mucosa 2. Has analgesic and antipyretic actions 3. Toxic reaction includes liver damage 4. Do NOT exceed 4 Gm per day 5. Check OTC drugs patient may be taking for other sources of acetaminophen ### C. Nonsteroidal Anti-inflammatory Drugs (NSAIDs): - Ibuprofen (Motrin) - Naproxen (Naprosyn) - Indocin (Indomethacin), - Ketorolac (Toradol) 1. Has anti-inflammatory, analgesic, antipyretic effects 2. Can be irritating to the gastric mucosa. Take with milk and/or food. 3. Use cautiously with patients with history of peptic ulcer 4. Affects coagulation (platelet aggregation) 5. Use cautiously with the elderly. As many as 60% can develop peptic ulceration and/or hemorrhage asymptomatically. Use lowest possible dose for shortest period possible if necessary to use NSAIDs in elderly patients. 6. Avoid taking over-the-counter drugs while taking NSAIDS 7. Avoid taking NSAIDs with ACE Inhibitors ### D. Opioid Analgesics Codeine, morphine, opium, and various opium derivatives 1. Use caution: Respiratory depression may occur in elderly 2. Codeine - Mild to moderate pain - Duration of action 4-6 hours - Very constipating - monitor bowel function - Common side effects: dizziness, sedation 3. Combination Dosage Forms - Tylenol #1 Acetaminophen 300 mg and Codeine phosphate 7.5 mg - Tylenol #2 Acetaminophen 300 mg and Codeine phosphate 15 mg - Tylenol #3 Acetaminophen 300 mg and Codeine phosphate 30 mg - Tylenol #4 Acetaminophen 300 mg and Codeine phosphate 60 mg 4. Morphine - For moderate to severe pain; acute and chronic pain - Common side effects: Nausea, vomiting, sedation, and dizziness; emptying of stomach is delayed, peristalsis decreased - Most versatile: Can be given SC, IM, rectal supp, PO, epidural, intrathecal, IV injection - IV push slowly, 4-5 minutes for each 15 mg; dilute - Do not mix with any other drug solutions - May form a precipitate. Flush tubing thoroughly with 0.9% saline before and after IV administration. Do NOT use dextrose solutions. Use an in-line filter to collect in-line particulate matter ### E. Benzodiazepines: - Lorazepam (Ativan) - Diazepam (Valium) - Alprazolam (Xanax) - Triazolam (Halcion) - Midazolam (Versed) - Temazepam (Restoril) 1. Sedative/Hypnotic Medication 2. Indications: - Anxiety - To provide sedation - Treatment or prevention of alcohol withdrawal - Treatment of seizures/status epilepticus - Nausea - Muscle spasm 3. Available as an oral medication or as an injection/infusion 4. Adverse reactions: - Drowsiness - Confusion - Lethargy - Ataxia - Respiratory depression - Increased intraocular pressure 5. Nursing Considerations: administer cautiously with other CNS depressants and monitor patient for effect. Benzodiazepine medications carry potential for abuse, misuse, and addiction. Consider weaning or tapering dose to prevent withdrawal symptoms 7. Antidote is flumazenil ### F. Antidepressants - Tricyclic: Amitriptyline (Elavil), Trazodone (Desyrel) - Serotonin Reuptake Inhibitor: Fluoxetine (Prozac), Sertraline Hydrochloride - Selective Serotonin Reuptake Inhibitor: Lexapro (Escitalopram) - (Zoloft) - Paroxetine (Paxil) - Venlafaxine (Effexor) - Citalopram (Celexa) 1. Takes 3-4 weeks to achieve a therapeutic effect 2. Overdose characterized by CNS signs such as confusion, agitation, autonomic effects (dilated pupils, flushing, hyperpyrexia) and cardiovascular signs such as tachycardia, arrhythmias, hypotension 3. Common side effects: sedation, atropine-like reactions (dryness of mouth, blurred vision, tachycardia, etc.), rash, urticaria, & constipation 4. Advise patient not to abruptly stop taking drug. Drug must be slowly weaned. 5. Tricyclics used with caution in elderly clients 6. Serotonin Reuptake Inhibitors tolerated better than tricyclics in elderly clients 7. Safety for use in children has not been established