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Neurological Drugs
CNS Stimulants & Related Drugs
| Question | Answer |
|---|---|
| What are CNS Stimulants? | 1. Drugs that stimulate a specific area of the brain or spinal cord 2. Neurons contain receptors for excitatory neurotransmitters, including dopamine (dopaminergic drugs), norepinephrine (adrenergic drugs), and serotonin (serotonergic drugs). |
| What are primary symptoms of ADHD? | Primary symptoms of ADHD are inappropriate ability to maintain attention span or the presence of hyperactivity and impulsivity. |
| Narcolepsy | Incurable neurologic condition in which patients unexpectedly fall asleep in the middle of normal daily activities. These “sleep attacks” are reported to cause car accidents or near-misses in 70% or more of patients. |
| Cataplexy | Sudden acute skeletal muscle weakness. Associated symptom in at least 70% of narcolepsy cases. It involves sudden acute skeletal muscle weakness. |
| Migraine | Common type of recurring headache, usually lasting from 4 to 72 hours Typical features: pulsatile quality with pain that worsens with each pulse Most commonly unilateral but may occur on both sides of the head |
| Migraine Symptoms | Nausea, vomiting, photophobia (avoidance of light), and phonophobia (avoidance of sounds) |
| Dopaminergic Drugs: Apomorphine, Amantadine | Dopaminergic drugs stimulate dopamine receptors and increase dopamine concentration. |
| Dopaminergic Drugs Side Effects | Muscle twitching Chest pain Nausea and Vomiting Urinary retention Confusion Hallucinations Constipation Orthostatic hypotension |
| Indication for Dopaminergic Drugs | Parkinson's Disease |
| Contraindications of Dopaminergic Drugs | Hypersensitivity Glaucoma Psychiatric disorder |
| Assessment/Nursing Considerations for Dopaminergic Drugs | Assess interactions/contraindications Assess VS Note that carbidopa-levodopa can cause hypertensive crisis Provide safety precautions |
| Patient/Family Teaching for Dopaminergic Drugs | Encourage patient to change position slowly to minimize orthostatic hypotension Avoid alcohol |
| Benzodiazepines SUFFIX: PAM. LAM Diazepam, Lorazepam | Benzodiazepines are used to treat absence seizures. They enhance the effect of GABA resulting in sedative, sleepinducing, anti-anxiety, anticonvulsant, and muscle relaxant properties |
| Adverse/Side Effects | Sedation, drowsiness BP changes Hypotension Blurred vision Hepatoxicity |
| Indications for Benzodiazepines | Preoperative anxiety Seizures Skeletal muscle spams |
| Contraindications for Benzodiazepines | Hypersensitivity Myasthenia gravis COPD Bronchitis Sleep apnea |
| Assessment/ Nursing Considerations for Benzodiazepines | Anti-seizure precautions Provide safety precaution Monitor lab values Monitor renal function test Monitor liver function test Antidote: Flumazenil |
| Patient/Family Teaching for Benzodiazepines | Educate patient to: a. Avoid alcohol and OTC b. Caution when performing activities that requires alertness |
| Hydantoins Phenytoin | Blocks sodium channels and inhibits neurons from firing to stabilize central nervous system membrane |
| Adverse/Side Effects of Hydantoins | Sedation, drowsiness Nausea Vomiting Decrease platelet count Increase serum glucose level Changes in BP Blurred vision |
| Indications of Hydantoins | Partial and generalized tonic clonic seizures Phenytoin can also treat dysrhythmias |
| Contraindications of Hydantoins | Hypersensitivity Psychoses Impaired renal and hepatic function Pregnancy |
| Assessment/ Nursing Considerations of Hydantoins | Anti-seizure precautions Provide safety precaution Monitor lab values Monitor renal function test Monitor liver function test Phenytoin should be given at a slow rate to prevent hypotension |
| Patient Education for Hydantoins | 1.Educate patient to: a. Avoid alcohol and OTC b. Caution when performing activities that requires alertness |
| Barbiturates SUFFIX: arbital Phenobarbital, butabarbital | Stimulates the inhibitory neurotransmitter system in the brain. |
| Adverse/Side Effects of Barbiturates | Sedation, drowsiness Hypotension Respiratory depression |
| Indications for Barbiturates | 1. Tonic-clonic seizures |
| Contraindications for Barbiturates | Hypersensitivity Psychoses Impaired renal and hepatic function Pregnancy |
| Assessment/ Nursing Considerations for Barbiturates | Anti-seizure precautions Provide safety precaution Monitor lab values Monitor renal function test Monitor liver function test |
| Patient Education for Barbiturates | Educate patient to: a. Avoid alcohol and OTC b. Caution when performing activities that requires alertness |
| ADHD & Narcolepsy Drugs Amphetamines, methylphenidate Dextroamphetamine sulfate (Dexedrine) Dextroamphetamine saccharate Amphetamine sulfate Amphetamine aspartate (Adderall): | Stimulate areas of the brain associated with mental alertness CNS effects Mood elevation or euphoria Increased mental alertness and capacity for work Decreased fatigue and drowsiness Prolonged wakefulness |
| Indications for Amphetamines | ADHD Narcolepsy Obesity |
| Contraindications of Amphetamines | Known drug allergy Cardiac structural abnormalities Recent MAOI usage |
| Adverse Effects of Amphetamines | Tend to “speed up” body systems Common adverse effects include: Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency, others |
| Nonamphetamine Stimulants | Pemoline and modafinil Atomoxetine: nonstimulant drug that is also used to treat ADHD Lisdexamfetamine (Vyvanse) prodrug for dextroamphetamine |
| One of the most commonly prescribed medications for ADHD | Amphetamine aspartate (Adderall): |
| Approved for treating ADHD in children older than 6 years of age and in adults | Atomoxetine (Strattera) |
| What warning did the FDA give regarding Atomoxetine (Strattera)? | In September 2005, the FDA issued a warning describing cases of suicidal thinking and behavior in small numbers of adolescent patients receiving this medication. |
| First prescription drug indicated for ADHD | Methylphenidate (Ritalin). Also used for narcolepsy Extended-release dosage forms Ritalin SR Concerta Metadate CD |
| Modafinil (Provigil) | Use: improvement of wakefulness in patients with excessive daytime sleepiness associated with narcolepsy and with shift work sleep disorder Less abuse potential than amphetamines and methylphenidate Schedule IV drug |
| Anorexiants Phentermine (Ionamin) Benzphetamine (Regimex)* Methamphetamine (Desoxyn)* Diethylpropion (Tenuate) | Used to treat obesity Suppress appetite control centers in the brain Increase the body’s basal metabolic rate Mobilization of adipose tissue stores Enhanced cellular glucose uptake Reduce dietary fat absorption |
| Drugs approved to treat obesity | Phentermine (Ionamin) Benzphetamine (Regimex)* Methamphetamine (Desoxyn)* Diethylpropion (Tenuate) |
| Orlistate (Xenical) | Nonstimulant drug used to treat obesity. Restrict fatty foods to less than 30% or you may have fecal incontinence and foul flatulence |
| Contraindications of Anorexiants | Drug allergy Severe cardiovascular disease Uncontrolled HTN Hyperthyroidism Eating disorders MAOI usage |
| Adverse Effects of Anorexiants | Possible elevated blood pressure and heart palpitations Anxiety Agitation Dizziness Headache Orlistat: fecal incontinence with oily stools |
| Antimigraine Drugs Serotonin Agonists (triptan) Sumatriptan (Imitrex) Almotriptan (Axert) Eletriptan (Relpax) Naratriptan (Amerge) Rizatriptan (Maxalt) Zolmitriptan (Zomig) Frovatriptan (Frova) | Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms Reduce the production of inflammatory neuropeptides Abortive therapy for migraines |
| Ergot alkaloids Dihydroergotamine mesylate Ergotamine tartrate with caffeine (Cafergot) | Another medication used to treat migraines before being replaced by triptans Narrow or constrict blood vessels in the brain |
| Adverse Effects of Antimigraine Drugs | Triptans Vasoconstriction Irritation at injection site Tingling, flushing Ergot alkaloids Nausea and vomiting Cold or clammy hands and feet Muscle pain Dizziness Others |
| Analeptics Doxapram (Dopram) Methylxanthines, such as aminophylline, theophylline, and caffeine | Stimulate areas of CNS that control respiration Methylxanthines Inhibit phosphodiesterase, leading to buildup of cyclic adenosine monophosphate (cAMP) Caffeine Antagonizes adenosine receptors Used less frequently Still used for neonatal apnea |
| What are Analeptics found in? | Over-the-counter drugs: NoDoz Combination prescription drugs: Fioricet, Fiorinal Foods and beverages |
| Analeptics should be used with caution with these patients | Use with caution in patients with a history of: Peptic ulcer Recent myocardial infarction Dysrhythmias |
| Doxapram (Dopram) | Treatment of respiratory depression associated with anesthetic drugs and drugs of abuse, COPD-induced hypercapnia Monitor deep tendon reflexes, in addition to vital signs and heart rhythm, to prevent overdosage of this drug. |
| Adverse Effects of Analeptics | Vagal Stimulation of gastric secretions, diarrhea, and reflex tachycardia Vasomotor Flushing, sweating Respiratory Elevated respiratory rate Musculoskeletal Muscular tension and tremors |
| Nursing Considerations for Analeptics | Assess for: Potential contraindications Potential interactions, including herbal therapies Conditions such as abnormal cardiac rhythms, seizures, palpitations, liver problems For children, assess baseline height and weight. |
| When should the last dose of ADHD medication be given? | Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia. |
| How are ADHD drugs taken? | Take on an empty stomach 30 to 45 minutes before meals. |
| What must be avoided when taking Anorexiants? | Caffeine in any form must be avoided by patients taking anorexiants. |
| Nursing Considerations for Anorexiants | These medications should be taken in the morning to prevent interference with sleep. The drugs are taken on a short-term basis. Dry mouth frequently develops. These drugs should not be abruptly stopped because a rebound increase in appetite may develop. |
| Signs to monitor for with ADHD | ADHD: decreased hyperactivity, increased attention span and concentration Anorexiant: appetite control and weight loss Narcolepsy: decrease in sleepiness Serotonin agonist: decrease in frequency, duration, and severity of migraines |
| If taking an Analeptic Medication, must pay close attention to: | Pay close attention to the ABCs because of the patient’s diminished sensorium. |
| If taking Ergot alkaloids, must monitor for: | Chest pain, confusion, slurred speech, and vision changes need immediate medical attention. |
Created by:
jamievwilson
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