Neuro Drug Classes PDF

Neurological Drugs by Class UNRS 113 Pharmacology  Important Neurology Terms Central vs Peripheral Nervous System Autonomic Nervous System Agonist - Increases Antagonist - Decreases Sympathetic Nervous System Parasympathetic Nervous System Adrenergic Receptors...

Neurological Drugs by Class UNRS 113 Pharmacology  Important Neurology Terms Central vs Peripheral Nervous System Autonomic Nervous System Agonist - Increases Antagonist - Decreases Sympathetic Nervous System Parasympathetic Nervous System Adrenergic Receptors Cholinergic Receptors Epinephrine (EPI) Acetylcholine (Ach) Norepinephrine (NE) 1. Anti-Spasmodics (muscle spasms) Eg baclofen Eg dantrolene What it does: Suppresses hyperactive reflexes in What it does: relaxes skeletal muscles; inhibits the CNS (ie centrally-acting) release of Ca++ (ie peripherally-acting) Screening/education: Check for MAOI use; Screening/education: Hx of cardiac, pulmonary, encourage fluid intake; dizziness, weakness, neuromuscular DOs drowsiness, and fatigue Safety: Estrogen ↑ risk of hepatotoxicity, Ca++ Safety: Falls precautions; don’t stop abruptly Channel Blockers ↑ risk of dysrhythmias; CNS after prolonged use. depressants ↑ risk of oversedation; falls precautions. Monitoring: Fluid retention Monitoring: AST/ALT (LFTs), diarrhea 2. Anticonvulsants (anti-seizure drugs=ASDs) Eg phenytoin, carbamazepine*, valproic acid**, oxcarbazepine What it does: decrease abnormal electrical activity in the brain (blocking neuro-tranmission) Screening/education: Use of other neuro drugs, hx alcoholism, use of oral contraceptives, pregnancy test; be cautious until impact on consciousness/motor function is known; don’t stop use abruptly (change dose only under prescriber supervision); may need to take with food Safety: Falls precautions, seizure precautions; many are teratogenic Monitoring: Changes in vision/neuro function/mood/abilities, therapeutic drug levels, LFTs *carbamazepine causes sun sensitivity; no grapefruit juice; alters oral contraceptives **valproic acid: check CBC and monitor for bleeding (bone marrow suppression) Oxcarbazepine also treats migraines. Valproic Acid is also a mood stabilizer and migraine treatment.  3. Anesthetics Eg lidocaine, ketamine What it does: They work by interrupting nerve signals, preventing pain and discomfort. Screening/education: checking for interactions with neuro drugs, history of alcoholism, and oral contraceptive use. A pregnancy test may be required before procedures. Patients should avoid driving or operating machinery until fully alert post-anesthesia. Medications should not be stopped abruptly. Fasting before anesthesia and following post-procedure care instructions are essential. Safety: Falls precautions; nausea precautions; ensure the airway is clear during and after anesthesia to avoid breathing complications Monitoring: Changes in vision, neuro function, mood, and abilities post-anesthesia; ensure anesthetic agents are within safe ranges during procedures; monitor liver health; monitor for respiratory function; assess for any allergic reactions, including skin changes or anaphylaxis signs, especially after administration of anesthetics 4. Benzodiazepines Eg. Diazepam, alprazolam, lorazepam, chlordiazepoxide, clorazepate. oxazepam What it does: (used in anesthesia and to treat anxiety) Screening/education: pregnancy, schedule IV controlled substances, glaucoma, coma, shock, neonates, labor/delivery (IV diazepam) Safety: Inject IV bolus slowly and wait at least 2 minutes before giving a second dose, Neuromuscular disorders, Cardiac, pulmonary, or renal disorders, Reverse sedation: Flumazenil Monitoring: Renal/ hepatic impairment, mental health/ suicidal thoughts, respiratory disorder, neuromusclular disorder 5. Opioid Analgesics (Anesthesia support) Eg. Fentanyl What it does: when used with skeletal muscle relaxant = form of anesthesia (bind to receptors = block the transmission of pain signals) Screening/education: substance use disorder, obstetric deliveries, cardiac, respiratory, liver or kidney disorders; levels of consciousness: expect drowsiness, report nausea Safety: excessive sedation and respiratory depression; use of MAOIs within 2 weeks of fentanyl = hypertensive crisis, schedule II; always have naloxone ready to reverse respiratory depression Monitoring: vital signs before, during, and after for CNS depression; LOC *Also used for muscle spasms 6. Amphetamines Adderall What it does: CNS stimulants used to treat ADHD and narcolepsy Screening/education: Avoid caffeine, alcohol, bp medications, take early (No later than 4pm), may cause mild hypertension and fast heart rate Safety: avoid abruptly stopping dosage avoid taking with other stimulants, MAOIs, digoxin, beta blockers, or tricyclic antidepressants avoid taking if you have an allergy to amphetamines avoid taking if you have glaucoma, hyperthyroidism, or cardiovascular disease Monitoring: Depression, fatigue, weight loss, insomnia, stomach pain, nausea/vomiting, diarrhea, fever, dry mouth, dizziness, headache 7. Dopaminergics Eg - selegiline Eg - pramipexole What it does: blocks dopamine transport to keep What it does: increases dopamine synthesis in the brain existing dopamine in the brain Screening/education: Do not take with alcohol or other CNS depressants, which will increase drowsiness. Take before Screening/education: don’t eat/drink for 5 min bedtime. Move slowly to a sitting/ standing position if before/after administration; take last dose of day by orthostatic hypotension occurs. noon Safety: Instruct client to take medication with food if nausea Safety: avoid foods containing tyramine and herbal occurs, avoid driving or performing activities that require alertness. Cimetidine increases levels of pramipexole. medications (ephedra, St, John’s war, ginseng, or ma Metoclopramide and phenothiazine antipsychotics decrease huang); avoid antihypertensive medications, therapeutic effect. Alcohol and other CNS depressants diuretics, or general anesthetics increases risk for adverse effects Monitoring: insomnia, hypertension, tongue and oral Monitoring: Monitor for nausea, drowsiness or sudden cavity irritation, BP, and other meds patient may be sleepiness and keep client safe from accidents, for muscle weakness and prevent falls, Monitor cardiac status, and observe taking for abnormal muscle movement/dyskinesia (tremors, etc.) 8. Monoamine Oxidase-B Inhibitors (MAOIs) Eg selegiline (for Parkinson’s), phenelzine (for depression) What it does: MAOI’s work on removing the neurotransmitters norepinephrine, serotonin, and dopamine from the brain. Screening/education: avoid foods high in tyramine (aged cheese, bananas,etc), wait 2+ weeks between MAOIs and other antidepressants (SSRIs) Safety: Serotonine Syndrome, hypertensive crisis, consumption of Tyramine, overdose Monitoring: The patient's vitals need to be monitored while taking an MAOI specifically the patients blood pressure and and heart rate. Another thing to monitor is the patient's mood and affect. Monitor for serotonin syndrome 9. Cholinesterase Inhibitors Eg- echothiophate ophthalmic drops What it does: Improves cognitive function in clients who have mild to moderate Alzheimer’s disease. Also helps lower intraocular pressure (IOP) for clients with glaucoma Screening/education: Monitor vitals, hold gentle pressure on puncta and nasolacrimal sac - 60 sec right after instilling to minimize systemic effects, safety measures for nighttime ambulation, monitor for retinal detachment, observe for opacity behind pupil when shining penlight into eye, report red reflex finding to provider. Safety: Cardiac or chronic respiratory disease, hyperthyroidism, urinary tract blockage, and Parkinson’s disease. Monitoring: Cognitive function, eye pain, heart rate 10. NMDA Receptor Antagonists Eg ketamine, dextromethorphan, memantine, and amantadine. What it does: It binds directly to the glutamate site of the NMDA receptor to inhibit the action of glutamate. Helps treat alzheimer's disease Screening/education: Give with or without food. Instruct client to report presence of CNS (Dizziness, headache, increased confusion) Patients with schizophrenia are not recommended to use. Patients at risk for hypertension should also not use this medication. Kids under 3 years old using ketamine over extended times of periods might get neurotoxicity. Obtain liver function tests before administering medication. Do not take with over the counter antacids. Safety: Do not give if they have renal failure. Can be given to clients that have liver or renal disorders but with caution. Exercise caution for older clients and clients with history of seizure disorders. Not safe for pregnancy. Monitoring: Dizziness, Diarrhea, Constipation. Monitor BP, HR, RR, SPO2. Also monitor neuropsychiatric function. 11. Immunomodulators Eg Interferon beta-1a and Interferon beta-1b What it does: Immunomodulators inhibit the movement of leukocytes which are a product of the body’s defective autoimmune response from entering the blood brain barrier. This protects the myelin sheath of neurons from the damaging effect of leukocytes. Screening/education: advise pre-medicating with acetaminophen if flu-like symptoms tend to occur. Tell the clients to notify the provider if unexplained bruising, bleeding, or fatigue occurs. Show them or their caregiver how to perform injections, rotate the injection sites, reconstitute medication, and explain to them to place a cool compressor before the injection on the injection site, and then place a warm, wet compressor on the injection site after the injection. Lastly, make sure that they report any skin ulcers. Safety: Start with low dose, titrate to higher dose to prevent initial adverse effects. If flu-like manifestations appear, recommend acetaminophen. Liver function tests before and periodically after treatment begins. Monitoring: Injection Site, unexplained bruising, bleeding, or fatigue, skin ulceration, liver toxicity, bone marrow suppression 12. Serotonin Receptor Agonists Eg. sumatriptan What it does: Relieve manifestations of existing migraine or cluster headache. Screening/education: repeat once after 2 hours of relief, nasal spray, oral tablet. MAOI within last 2 weeks and/or another triptan within last 24 hours. Nasal spray: Single doses range from 5-20 mg with a maximum dose of 40mg within 24 hours. A maximum of 2 SUBQ injections can be given per day if needed. Oral: single dose ranges from 25-100 mg with the max dose being 200 mg in 24 hours. Safety: clients who have a history of coronary artery disease, angina, or MI should avoid taking. Chest pressure or heaviness may progress to angina pain caused by coronary vasospasm. Monitoring: chest pressure, heaviness with back, jaw, and throat, angina pain, tingling sensation, vertigo Valproic Acid and Oxcarbazepine (ASDs) are also used for migraines. 13. Anxiolytics (non-benzos) Eg. buspirone What it does: Treats anxiety disorders without the risk of dependence for the patient. Reduces anxiety by binding to serotonin and dopamine receptors in the brain, and increases norepinephrine metabolism in the brain. Screening/education: There is only one real contraindication: previous hypersensitivity reaction to the medication. Simultaneous use with MAO inhibitors can cause severe hypertension. Safety: Prevent falls from dizziness, caution in clients with liver or kidney insufficiency. Monitoring: Monitor for increased anxiety, gastrointestinal effects, nausea, dizziness, lightheadedness, headache and prevent falls from dizziness. 14. Tricyclic Antidepressants Eg amitriptyline What it does: Helps relieve major depression Screening/education: Tell client to urinate before taking daily dose to increase fiber and fluids and minimize medications’ anticholinergic effects, drowsiness, sedation dry mouth, constipation, urinary retention, check for MAOI use, alcoholism, herbal supplements Safety: Falls precautions, stop taking medication abruptly if they report feelings of self-harm or worsening depression, urinate, do not participate in activities that require mental alertness if they feel drowsy (driving) Monitoring: orthostatic vital signs, increases in depression and suicidal thoughts 15. SSRIs Fluoxetine What it does: Blocks reuptake of serotonin. Increases serotonin levels. Treats major depression, bipolar disorder panic disorder. Screening/education: Do not take if already taking MAOIs. Children less than 7, patients with liver diseases, peptic ulcer diseases, or diabetes mellitus must be cautious. Safety: sexual dysfunction, risk of Serotonin Syndrome, risk of suicide, levels of tricyclic antidepressants and lithium. Monitoring: Look out for insomnia and nervousness. 16. Serotonin/Norepinephrine Reuptake Inhibitors Eg: Venlafaxine, (or desvenlafaxine, duloxetine) What it does: Serotonin and norepinephrine reuptake inhibitors, called SNRIs, useful for treating major depression, social anxiety disorder, and generalized anxiety disorder. SNRIs block the neuronal reuptake of both serotonin and norepinephrine. Screening/education: concurrent use of MAOIs or within 14 days of last dose. take the medication with food to avoid or minimize gastrointestinal upset. Tell pt to report headache, insomnia, and nervousness Trazodone and the herbal supplements St. John’s wort and sour date nut increase the risk of serotonin syndrome. Safety: The risk of suicide when clients take antidepressants may increase during the initial phase of treatment, and report any worsening of depression or thoughts of suicide. Use with caution for clients who have liver or kidney disease, glaucoma, cardiac disorders, or hypertension. Monitoring: Check for weight loss related to anorexia and monitor blood pressure and monitor for insomnia and nervousness. 17. Atypical Antidepressants Eg bupropion hydrochloride What it does: - Treats depression - Prevents seasonal affective disorder (SAD) - Smoking cessation adjunct (helps to quit smoking) Screening/education: Give with food to minimize GI effects, swallow extended and sustained-release tablets whole, take medication exactly as prescribed to avoid overdose, and report any CNS manifestations Safety: - Monitor for psychosis, hallucination, and delusions - If using with MAOI depressants, it may increase risk of toxicity - May decrease certain blood levels (cimetidine, phenytoin, phenobarbital, and carbamazepine) (increasing risk for seizures) Monitoring: weight gain, sedation, blood pressure, heart rate, and increased depression/suicidal ideation 18. Mood Stabilizers Eg lithium carbonate What it does: Controls acute manic episodes in bipolar disorder by restoring the balance of neurotransmitters in the brain Screening/education: Monitor dosage because too much lithium in the body can cause nausea, diarrhea, dizziness, seizures and twitching. Take with food and only prescribe in settings where serum concentration monitoring is available. Safety: Lithium may be confused with lanthanum, Ultram (sound-alike/look-alike issues), older patients are considered at high risk for this medication Monitoring: Monitor renal function including BUN and Scr baseline every 2-3 months during the 1st 6 months of treatment since this treatment is known to decrease kidney function Valproic Acid (an ASD) is also used for bipolar disorder. 19. Conventional (Traditional) Antipsychotics Eg chlorpromazine What it does: Suppresses manifestations of schizophrenia and the acute manic phase of bipolar disorder; relieves nausea/vomiting and intractable hiccups. Screening/education: Give antacids and antidiarrheals 2 hours before taking med because of the effect on absorption. Take with food and water, Can cause parkinson symptoms like tremors,muscle rigidity, acute dystonia (muscle spasms of back, face, neck, and tongue). Safety: Patients may experience photosensitivity (sensitivity to light)so wear sunscreen + sunglasses. Caution for people with COPD, glaucome, diabetes mellitus, hyperten ion, etc. Contradiction for people going through alcohol withdrawal, bone marrow suppression, pregnancy, etc. Monitoring: Monitor blood pressure. 20. Atypical Antipsychotics Eg risperidone, olanzapine, quetiapine, aripiprazole, ziprasidon, clozapine, and lumateperone What it does: treat a wide range of manifestations of schizophrenia and bipolar disorder and help manage the irritability associated with autism Screening/education: No driving, or operating hazardous equipment until CNS effects are known. Report any involuntary movements to provider. Report excess in urine and in thirst (diabetes). Increase excercise and lower diet, sugar, fat, calories. Safety: Weight gain, onset of new diabetes or worsening of existing diabetes. Monitoring: Monitor for drowsiness, insomnia, dizziness, and other CNS effects. Monitor weight weight,blood glucose, and cholesterol,/ triglyceride levels periodically. Risperidone is also used to treat ADHD. 21. Prostaglandin Analogs Eg latanoprost What it does: Topical therapy for glaucoma to lower IOP (intraocular pressure) or ocular hypertension. Screening/education: Check for known allergies to latanoprost or preservative benzalkonium chloride. If client’s experience irritation or inflammation, inform provider. Contact lenses removed before instilling eye drops. Safety: Hold pressure immediately on punctuation and nasolacrimal sac for 30-60 seconds. Should not be administered more than once daily. Monitoring: changes in pigmentation, manifestations of inflammation or irritation, blurred vision, burning, stinging of eye. 22. Beta-Adrenergic Blockers (for glaucoma*) Eg betaxolol, timolol What it does: lowers intraocular pressure (IOP) in open-angle glaucoma. Used in emergencies to lower IOP in closed-angle glaucoma. Screening/education: Possible systemic cardiac/respiratory effects, interaction with systemic Beta Blockers and Ca++ Channel Blockers. Wait 5 min between different eye gtts to prevent interactions. Stinging/burning may happen with use, avoid rubbing eyes, which increases discomfort. Safety: Check pulse before administration. Put pressure on the inner canthus for 60 seconds to reduce chance of systemic effects (lowered heart rate, BP, and respiratory function). Monitoring: Monitor VS to check for systemic effects. Notify provider of low pulse, fainting, or wheezing. *Beta blockers are also used for cardiac conditions, and those aspects will be covered later. 23. Cholinergic Agonists Eg Pilocarpine What it does: Lower IOP in glaucoma Screening/education: Don’t rub eyes after administration. Younger pts may have acute frontal HA. Don’t use with contacts. Safety: Avoid driving, especially at night. Systemic effects → muscle contractions (can be reversed with atropine). Monitoring: Decreases in visual acuity. Retinal detachment.