Nervous System Medications PDF

Nervous System Medications Central Nervous System Stimulants: - Amphetamine (Adderall) - Tx: Narcolepsy; adjunct of ADHD - Adverse Reactions: cardiomyopathy (increased with prolong use), tachycardia, - Teach Client: report insomnia or palpitations - Using with...

Nervous System Medications Central Nervous System Stimulants: - Amphetamine (Adderall) - Tx: Narcolepsy; adjunct of ADHD - Adverse Reactions: cardiomyopathy (increased with prolong use), tachycardia, - Teach Client: report insomnia or palpitations - Using with MAOIs or meperidine can result in hypertensive crisis - High dependence and abuse potential - May produce a false sense of euphoria and well-being - Phentermine -- primary for obesity - Methylphenidate/Dexmethylphenidate - Tx: ADHA; symptomatic tx of narcolepsy - Adverse Reactions: insomnia, dry mouth, metallic taste, rashes - Teach Client: weight assessed 2-3x weekly, avoid caffeine, report palpitations or insomnia - High Dependence and abuse - Using MAOIs or vasopressors may result in hypertensive crisis - Monitor CBC Anticonvulsants: - Valproic acid (Depakene) - Tx: simple and complex absence seizures, partial seizures, manic episodes associated with bipolar disorder, migraine HA - Adverse Reactions: hepatotoxicity, hypersalivation, increase serum ammonia levels - Teach Client: take same time each day exactly as directed, abrupt withdrawal may lead to status epilepticus, no alcohol, may cause drowsiness or dizziness - Monitor CBC; LFTs, and amylase, lipase, serum drug levels - Carbamazepine (Carbatrol, Epitol, Tegretol) - Tx: monotherapy of adjunctive therapy of tonic-clonic, mixed, or complex partial seizures in adults with epilepsy - Adverse Reactions: heart failure, hyponatremia, stevens-johnson syndrome, abnormal vision - Teach client: report dyspnea, bruising, edema in dependent areas or frequent infections - Monitor EKG and serum electrolytes before and periodically - Auscultate lungs for crackles and assess for dependent edema (CHF) - Give info about ketogenic client Benzodiazepines: - Diazepam/Lorazepam - Tx: anxiety - Diazepam -- tx of stiff-man syndrome and in conscious sedation - Adverse Reactions: paradoxical excitation (confusion, anxiety), physical dependence - Teach client: avoid grapefruit juice during therapy, avoid alcohol, older clients have increased "hangover effect" in the morning = increased risk of falls - Chamomile can increase CNS depression, liver and renal function - Midazolam - Tx: promotion of presurgical sedation and anxiolysis in pediatric clients - Adverse Effects: apnea, respiratory depression, cardiac arrest, hiccups - Teach clients: decreased mental recall of procedure - Monitor BP, respirations, pulse, arterial blood gas, oxygen should be given nasal cannula, resuscitation equipment near by. - Antidote is flumazenil Hydantoins: - Phenytoin (Dilantin) - Tx: prevent tonic-clonic seizures and complex partial seizures - Adverse Effects: cerebral edema, extrapyramidal syndrome, hypotension, tachycardia, altered taste, dry mouth, weight loss. Stevens-Johnson syndrome - Teach client: side effects such as urine discoloration and unwanted hair growth may occur - Assess skin rash, may progress to severe exfoliate dermatitis, assess for hypersensitivity syndrome MAOI B Inhibitors - Selegine (Eldepryl, zelapar) - Tx: Parkinson's disease who fail to respond to levodopa/carbidopa - Adverse Effects: insomnia, hallucination, abdominal pain, dry mouth - Teach client: take as directed with food, notify HCP if severe HA occurs, change positions slowly, increase fluids or use sugarless gum, report increased body temperature, sweating, muscle twitching - Concurrent with meperidine or other opioid analgesics may result in fatal reaction, monitor LFT and RFT MAOIs: - Phenelzine (nardil) - Tx: depression - Adverse effects: orthostatic hypotension, anxiety, insomnia, hypertensive crisis in presence of tyramine-containing foods - Teach client: rise from slowly from lying and sitting position, instruct clint to take with non-tyramine-containing food - Tyramine -- suffer critical HTN - Avocados, bananas, beer, bologna, chocolate, pepperoni, salami, wine, yeast - Contraindication: cardiac disease, greater than 60yr, less than 6yr Dopamine Agonists Agents: - Ropinirole, Pramipexole (Mirapex) - Tx: mild Parkinson's disease as monotherapy or as adjunctive therapy with levodopa/carbidopa, tx of restless leg syndrome - Adverse Effects: sleep attacks, orthostatic hypotension, arrhythmias, compulsive behaviors - Teach client: cause drowsiness and episodes of falling asleep, use good oral hygiene and sugarless gum, if uncontrollable urge occurs; immediately call HCP - Assess client for drowsiness and sleep attacks - Administer with meals to minimize nausea Benzisoxizoles: - Risperidone (Risperdal) - Tx: schizophrenia, BP - Adverse Effects: neuroleptic malignant syndrome, suicidal thoughts, tardive dyskinesia, increase salivation, decrease libido, itchy skin rash, photosensitivity, hyperglycemia - Teach client: watch for abnormal muscle movements or twitches, Avoid alcohol - Monitor EKG for cardiac abnormalities, monitor for development of neuroleptic malignant syndrome Phenothiazines: - Chlorpromazine - Tx: acute and chronic psychoses - Adverse Effects: hypotension, tachycardia, urinary retention, rashes, hyperthermia, extrapyramidal reactions - Teach client: extremes of temperature should be avoided - Monitor for orthostatic hypotension, development of neuroleptic malignant syndrome Selective Serotonin Reuptake Inhibitors: - Fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro) - Tx: depression, OCD, social phobias, bulimia and anorexia nervosa, panic disorder - Adverse Effects: seizures, stuffy nose, cough, sexual dysfunction, excessive sweating, pruritis - Teach client: may cause drowsiness, dizziness, impaired judgement, blurred vision, and dry mouth, avoid alcohol and herbal products, report chest pain, palpitations, or suicidal thoughts immediately - Assess for suicidal tendencies in first 2-4 weeks - First class of drug prescribed for depression Tricyclic Antidepressants: - Desipramine, nortiptyline, imipramine - Tx: depression - Adverse Effects: dry mouth, arrhythmias, constipation, urinary retention, changes in blood glucose, hypotension - Teach client: best to be taken at bedtime, cause drowsiness, avoid alcohol, use sunscreen, notify if having suicidal thoughts - May increase risk for suicide attempt/ideation, anticholinergic effects, monitor CBC, LFT, RFT, and serum alkaline phosphatase - Urinate before daily dose, increase fiber and fluids Serotonin and Norepinephrine Reuptake Inhibitors: - Venlafaxine (Effexor), duloxetine (Cymbalta) - Tx: major depressive illness or relapse, tx for generalized anxiety disorder and social anxiety - Adverse Effects: seizures, rhinitis, tinnitus, altered taste, sexual dysfunction, itching, photosensitivity, chills, yawning - Teach client: avoid alcohol, report suicidal thoughts immediately - Risk of serotonin syndrome increases with use of MAOIs - Take in morning - Report HA Mood Stabilizer: - Lithium - Tx: bipolar affective disorders - Adverse Effects: fatigue, blurred vision, tinnitus, arrhythmias, EKG changes, hypotension, metallic taste, hyperglycemia, weight gain, leukocytosis, rigidity - Teach client: report palpitations or SOB to HCP, do not limit sodium intake, HCP if fever, vomiting, diarrhea occurs - Assess suicidal ideation - Monitor serum drug levels; client with toxicity looks like a person who is inebriated, with ataxia, slurred speech, and drowsiness - Lithium toxicity -- drowsiness, muscle weakness, seizure, coma, blurred vision - No table salt Cholinesterase Inhibitors: - Donepezil (Aricept), Galatamine (Razadyne), Pilocarpine - Tx: mild to moderate dementia associated with Alzheimer's disease - Adverse Effects: A.fib, peptic ulcer, frequent urination, hot flashes, weight loss, arthritis, bronchospasms, decreased heart rate, respirations, BP, increased salivation, tears, and sweating, muscle cramps and weakness - Teach client: notify HCP if abdominal pain, coffee ground emesis, nausea, diarrhea, or changes in color of stool occur or if new symptoms occur, does not provide cure - SLUDGE: Salivation, lacrimation, urination, diarrhea, GI distress, emesis -- cholinergic side effects, evening just before bed - Contraindications: asthma, BPH, cardiac disease, GI disorders, hyperthyroidism Anticholinergic: - Atropine (atropen) - Tx: bladder, stomach, or intestinal spasms, poisoning - Adverse Effects: blurred vision, confusion, decreased GI motility, dilation of pupils, drying of secretions, fever, flushing, HA, increased HR Dopamine Agonists: - Carbidopa/Levodopa (Sinemet) - Tx: parkinson's disease - Adverse Effects: involuntary movements, hallucinations, leukopenia, darkening of urine or sweat - Teach client: high protein meals may impair the drug effects, change positions slowly, dry mouth- sugarless gums, avoid multivitamins, notify HCP if palpitations, urinary retention, involuntary movements, or new skin lesions - Hepatic and renal function and CBC - Assess for signs of toxicity (involuntarily muscle twitching, facial grimacing, spasmodic eye winking, exaggerating protrusion of tongue, behavioral changes Opioid Agonist/Antagonist: - Buprenorphine (buprenex) - Tx: moderate to severe acute pain, tx for opioid dependence - Adverse Effects: respiratory depression, hepatotoxicity, constipation, dry mouth, urinary retention, tolerance - Teach Client: contact immediately if difficulty ot changes in breathing, report yellowing of white of eyes, dark urine, or light stools - Fall precautions, Narcan can reverse symptoms, LFT, RFT, and lung sounds Nonopioid Analgesics: - Acetaminophen - Tx: mild pain and fever - Adverse Effects: hepatotoxicity, constipation, renal failure, Steven's Johnson syndrome, rash, increased bleeding time, tinnitus, depression, dizziness - Teach client: do not combine with opioids with acetaminophen, take full glass water, report rash, blisters, or lesions - Assess for rash, blister, bullae, or other lesions, if overdose occurs, acetylcysteine is antidote, monitor LFT, RFT, CBC - No alcohol, oral contraceptives, loop directives General Anesthesia/Opioids: - Fentanyl - Tx: moderate to severe chronic pain requiring continuous opioid analgesic therapy - Adverse Effects: apnea, respiratory depression, physical and psychological dependence - Teach Client: Change positions slowly, avoid alcohol, use sugarless gum - Assess bowel function routinely for constipation, Narcan is the antidote, discontinue gradually Opioid Agonists: - Morphine, hydromorphone, oxycodone - Tx: moderate to severe pain - Adverse Effects: seizures, euphoria, blurred vision, respiratory depression, constipation, sweating, urinary retention - Teach Client: report constipation, cause drowsiness, avoid alcohol - Monitor plasma amylase and lipase, Narcan is the antidote, gradually discontinue Opioid Antagonist: - Naloxone (Narcan) - Tx: reverse CNS depression and respiratory depression - Adverse Effects: N/V, ventricular fibrillation - Teach client: decrease fear of physical symptoms of withdrawal - Monitor RR, EKG, BP, and LOC, assess client for signs and symptoms of opioid or alcohol withdrawal Opioids: - Tramadol (ultram) - Tx: moderate to moderately severe pain - Adverse Effects: seizures, serotonin sickness, visual disturbance, vasodilation, dry mouth, CNS stimulation - Teach client: ask for pain before the pain become severe, may cause dizziness and drowsiness, change positions slowly, report antidepressant medications - Assess bowel function routinely, monitor for seizures, medications causes increase risk of serotonin syndrome when used SSRI or SNRI antidepressants, TCAs, MAOIs Non-amphetamines: - Modafinil (Provigil) - Tx: narcolepsy - Adverse Effects: nausea, HA, tachycardia, HTN, rash including Stevens-Johnson, decreased effectiveness of oral contraceptives - Teach client: HCP if have palpitations, chest pain, report rash, change contraceptive method, back up contraceptives LOOK OVER NSAIDS AND ANESTHIAS- NOT ON HERE Adrenergic: - Norepinephrine, epinephrine - Tx: extreme hypotension, severe wheezing, severe allergic reactions - Adverse Effects: chest pain, fast heart rate, HA, increased blood glucose, nervousness, tissue death, tremors - Teach client: Adrenergic blockers: - Alfuzosin, doxazosin, tamsulosin, acebutolol, metoprolol, nadolol, propranolol - Tx: BPH, HTN, cardiac arrhythmias, angina, prevention of MI, migraine HA - Adverse Effects: confusion, decreased BP, blood glucose, energy, heart rate - Teach client: