REVIEW NOTES_ SUMMARY OF NERVOUS SYTEM DRUGS
AGENTS
1. CNS STIMULANTS
AMPHETAMINES:
Methylphenidate (Ritalin)
- Amphetamine is a potent CNS
stimulant of the phenethylamine
class
MOA
o Induces temporary improvements
in either mental or physical
functions or both.
o Increases the muscular (motor)
and the mental (sensory)
activities.
INDICATIONS ADVERSE EFFECTS
Treatment of attention deficit
hyperactivity disorder (ADHD) and
narcolepsy
Contraindications and Cautions:
1. Known allergy to the drug.
2. Patients with anxiety, agitation or
tension and cardiac disease which could
exacerbate the CNS stimulation caused by
these drugs.
3. Pregnant and lactating women.
4. Those with history of seizures.
5. History of drug dependence, including
alcoholism because it may result in
physical and psychological dependence.
6. Patients with hypertension.
NURSING IMPLICATIONS
CNS: nervousness, insomnia, dizziness,
headache, blurred vision, and difficulty
with accommodation.
GI: anorexia, nausea, weight loss.
CV: hypertension, arrythmias, and
angina.
Others: skin rashes, physical and
psychological dependence, dry mouth,
constipation, nausea, urinary hesitancy.
1.Assess for contraindications
and Cautions for the use of the
drugs.
2.Assess for temp., skin color and
lesions, CNS orientation, affect
and reflexes, ophthalmic
examination, bowel sounds and
reported output, & VS.
3. Arrange to dispense the least
amount of drug possible to
minimize the risk of overdose and
abuse.
4. Monitor weight, ECG to ensure
early detection of adverse effects.
5. Provide safety measure such
as side rails and assistance with
ambulation if CNS effects occur.
6. Provide thorough patient
teaching.
 AGENTS
2. ANXIOLYICS AND
HYPNOTIC AGENTS
BENZODIAZEPINES:
(Diazepam)
-The most frequently used
anxiolytic drugs.
-Prevents anxiety without causing
much associated sedation.
-Less likely to cause physical
dependence than many other
older sedatives
BARBITURATES
(Phenobarbital)
- Greater risk of addiction and
dependence.
- They can cause sedation,
hypnosis, anesthesia, and in
extreme cases coma.
- They have the tendency to
cause tolerance and
psychological and physical
dependence, they are now rarely
used as anxiolytics.
- Currently used principally for
their hypnotic actions (in
anaesthesia) and in rare cases as
antiepileptics.
AGENTS
MOA
BENZODIAZEPINES:
enhance response to the inhibitory
neurotransmitter GABA, by opening
GABA-activated chloride channels,
thereby rendering neurons resistant
to excitation.
BARBITURATES:
Suppress CNS activity and are
effective Barbiturates act as positive
allosteric modulators of GABA A
receptors to enhance the action of
neuroinhibitory GABA.
MOA
INDICATIONS
BENZODIAZEPINES:
Sedatives, hypnotics, anxiolytics,
anticonvulsants, and muscle relaxants
Treatment and management of:
a. anxiety disorders
b. alcohol withdrawal
c. hyperexcitability and agitation
d. preoperative relief of anxiety and
tension
Contraindications and Cautions:
1. Allergy to Benzodiazepine
2. Psychosis (may exacerbate sedation)
3. Acute narrow-angle glaucoma, shock,
coma or acute alcoholic intoxication.
4. Pregnancy and breastfeeding
6. Elderly and debilitated patients (possible
unpredictable reactions)
BARBITURATES:
Anxiolytics, antiepileptics, sedatives
and hypnotics.
- relief of signs and symptoms of anxiety
and for sedation, insomnia, pre
anesthesia, and treatment of seizures.
Key Point: It induces the liver enzyme
system: must be given lower dosage.
Contraindications and Cautions:
1.Allergy to any Barbiturates.
2. Previous history of addiction to
sedatives/ hypnotic drugs.
3. Pregnancy and lactation
4. Acute and chronic pain
5. Seizure disorder hepatic, cardiac and
respiratory disease.
INDICATIONS
ADVERSE EFFECTS
BENZODIAZEPINES:
CNS: sedation, drowsiness, depression,
lethargy, blurred vision, headaches,
apathy, light-headedness, and
confusion.
GI: dry mouth, constipation, nausea,
vomiting, elevated liver enzymes.
CV: hypotension, hypertension,
arrhythmias, palpitations, & respiratory
difficulties.
Hema: blood dyscrasia and anemia
GU: urinary retention & hesitancy, loss
of libido, change in sexual functioning.
***At local injection site : phlebitis,
local reactions, and thrombosis
***Abrupt cessation lead to withdrawal
syndrome: nausea, headache, vertigo,
malaise, and nightmares).
BARBITURATES:
CNS effects: drowsiness, somnolence,
, lethargy, ataxia, vertigo, feeling of
“hangover”, thinking abnormalities,
paradoxical excitement, anxiety and
hallucinations.
GI symptoms: nausea and vomiting,
constipation, diarrhea, and epigastric
pain.
Cardiovascular effects: bradycardia,
hypotension, and syncope.
Hypersensitivity Reaction: rash,
serum sickness, Steven-Johnson
syndrome.
ADVERSE EFFECTS
NURSING IMPLICATIONS
BENZODIAZEPINES:
1. Assess patient’s allergy to
benzodiazepines.
2. Assess for baseline status
(V/S).
3. Perform laboratory tests,
including renal and liver function
test and complete blood count.
4. Carefully monitor injection
sites.
5.Give IV drugs very slowly
because these agents have been
associated with hypotension,
bradycardia, and cardiac arrest.
BARBITURATES:
1. Assess for baseline status
before beginning therapy and for
occurrence of any adverse
effects.
2. Do not mix IV drugs with any
other drugs to avoid potential
drug-drug interactions.
3. Give parenteral forms only if
oral forms are not feasible.
4. Give IV medications slowly
(rapid admin. May cause cardiac
problems.)
5. Provide standby life-support
facilities in case of severe
respiratory or hypersensitivity
reactions.
6.Taper dose gradually. (may
precipitate seizures, and
withdrawal syndrome).
7. Provide support measures.
NURSING IMPLICATIONS
3. ADRENERIC /
ADRENERGIC
BLOCKERS
Fight or Flight-STRESS
• Increased BP
• Increased blood flow to brain,
heart and skeletal muscles
• Increased muscle glycogen for
energy
• Increased rate of coagulation
• Pupil dilation
3 TYPES OF
ADRENERGIC DRUGS
a. Direct adrenergic drug
action: act directly on one or
more adrenergic receptors.
According to receptor
selectivity they are two types
- Non-selective: Adrenaline
, confusion, seizures, and other
- Selective:
α1 Selective: Phenylephrine
α2 selective: α-Methyl dopa
β1 selective: Dobutamine
β2 selective: Salbutamol
a. ADRENERIC
- Non-selective: Adrenaline/
EPINEPHRINE
- Effects: increased BP, increased
heart rate, relaxation of bronchial
smooth muscle, vasoconstriction in
peripheral blood vessels
- Increased glucose, lactate, and fatty
acids in the blood due to metabolic
effects
- Increased leukocyte and increased
coagulation
- Inhibition of insulin secretion
- Affects both alpha and beta
receptors
- Selective:
α1 Selective: Phenylephrine:
smooth muscle contraction
α2 selective: α-Methyl dopa
Negative feedback causes less
norepinephrine to be released so
BP is reduced.
β1 selective: Dobutamine
Increased heart rate
β2 selective: Salbutamol
Bronchoconstriction
a. ADRENERIC
- Non-selective: Adrenaline/
EPINEPHRINE
• Emergency drugs in treatment of
acute cardiovascular, respiratory,
and allergic disorders
• In children , epinephrine is used to
treat bronchospasm due to asthma
or allergic reactions .
• Phenylephrine: treat sinus
congestion
• Shock
• Inhibition of uterine contractions
• For vasoconstrictive and hemostatic
purposes
• Added to local anesthetic
- Selective:
α1 Selective: Phenylephrine:
: Treatment of nasal congestion or
hypotension; cause mydriasis (dilation
of the pupil of the eye) during
ophthalmic examinations
α2 selective: α-Methyl dopa
Treatment of hypertension through
centrally acting mechanism
β1 selective: Dobutamine
Treatment of cardiac arrest, heart
failure, and shock
β2 selective: Salbutamol
a. ADRENERIC
Contraindications: Cardiac
dysrhythmias, angina pectoris
Hyperthyroidism, CVA, renal
impairment
ADVERSE EFFECS
Cardiovascular effects such as
tachycardia, hypertension, and
dysrhythmias are particularly
troublesome and may limit therapy.
Large doses can induce CNS
excitement and seizures .
Some of these agents cause anorexia ,
which has led to their historical use as
appetite suppressants.
1. Careful monitoring of a client's
condition and providing
education.
2. Because many of these
medications are administered
intravenously, carefully assess
clients prior to and during
administration.
3. Frequently assess V/S, skin
color and integrity capillary refill,
and urine output while adrenergic
agents are being administered.
3. Inspect the IV site and
surrounding tissues frequently for
extravasation.
4. Be aware that severe
hypertension is the primary
manifestation of
sympathomimetic toxicity. 5.
Assess for headache,
related CNS changes.
Lifespan Considerations: 1.
Use adrenergic agents carefully
during pregnancy and lactation.
2. Older adults are at increased
risk for adverse reactions
owing to chronic
cardiovascular disease.
3. Use cautiously in children, as
they are very sensitive to drug
effects- Carefully calculate
dosages
CLIENT TEACHING
1. Do not take any other meds
like herbal remedies and OTC
drugs without prescription – may
cause serious CV and CNS
disturbances.
2. If taking meds for asthma or
b. Indirect adrenergic
drug action: agents that
increase neurotransmission in
endogenous chemicals (
Epinephrine and Norepinephrine)
Examples: Amphetamines,
Nicotine, Caffeine,
Methylphenidate
c. Mixed: combination of
direct and indirect receptor
stimulation
Examples are ephedrine and
pseudoephedrine
a. ADRENERIC
- Non-selective: Adrenaline
, Dopamine
- Selective:
α1 Selective: Phenylephrine
α2 selective: α-Methyl dopa
β1 selective: Dobutamine
β2 selective: Salbutamol
b. ADRENERGIC
BLOCKERS
ADRENERGIC BLOCKING
AGENTS:
Minipress (prazosin):
HPN
Flomax (tamsulosin):
BPH
other chronic lung diseases,
follow the instructions on inhaler.
3. May elevate blood glucose
levels- monitor blood glucose
levels carefully if with diabetes.
5. Use proper medication self-
administration techniques.
6. Immediately report tremors,
Pseudoephedrine: a palpitations, changes in blood
decongestant that shrinks pressure, dizziness, urinary
blood vessels in the nasal retention, or changes in skin
passages. Dilated blood integrity.
vessels can cause nasal
congestion (stuffy nose).
b. ADRENERGIC BLOCKERS
b. ADRENERGIC BLOCKERS ADRENERGIC BLOCKING
ADRENERGIC BLOCKING AGENTS: Minipress (prazosin)-
AGENTS: Minipress hypertension
(prazosin) Block or decrease the
effects of sympathetic nerve
stimulation, endogenous
catecholamines and adrenergic drugs
- Activates alpha 2 resulting in
negative feedback.
- Decreases release of additional
norepinephrine, thus, decrease
effects on entire body: Results in
decrease of BP
Alpha 1 Adrenergic Blockers:
 Alpha 1 Adrenergic Thus, useful in treating BPH ( Flomax:
Blockers: tamsulosin) as inhibit contraction of
Act on skin, mucosa, intestines, lungs muscles in prostate and bladder
and kidneys to prevent
vasoconstriction
- Effects: dilation of arterioles and
veins, decreased blood pressure
Minipress (prazosin), pupillary c. CHOLONERGICS
constriction, and increased motility of Anticholinesterases
GI tract Keep atropine available to
c. CHOLINERGICS: c. CHOLONERGICS counteract the increased levels of
DIRECT- ACTING: bethanchol Anticholinesterases Ach by providing selective
c. CHOLINERGICS: profuse salivation, increased blockage of muscarinic
DIRECT- ACTING: INDIRECT ACTING: muscle lone, urinary cholinergic receptors. Monitor the
CHOLINERGIC/ bethanchol Anticholinesterases Carbamates. frequency, client for drug-induced insomnia.
ANTICHOLINERGICS: Alcohols bronchoconstriction, and
Rest and Digest INDIRECT ACTING: Treatment of Alzheimer’s bradycardia.
Anticholinesterases Disease
c. CHOLINERGICS: intensify smooth-muscle d. ANTICHOLINERGICS:
DIRECT- ACTING: contractions. Atropine
bethanchol Use with caution in individuals
INDIRECT ACTING: A with cardiac disease.
nticholinesterases d. ANTICHOLINERGICS: d. ANTICHOLINERGICS: May precipitate acute glaucoma
Carbamates. Alcohols d. ANTICHOLINERGICS: Atropine Atropine in susceptible individuals, convert
Atropine - GI disorders: decrease the secretion of CV: Sinus tachycardia, cardiac partial pyloric stenosis into
d. ANTICHOLINERGICS: block the action of acetylcholine: gastric acid in peptic ulcer disease, also arrhythmia complete pyloric obstruction,
Atropine and Benztropine causes symptoms of sympathetic slow intestinal motility and may be useful CNS: hallucinations (visual or aural), precipitate urinary retention in
nervous system activation to for reducing the cramping and diarrhea seizures (generally tonic clonic), individuals with prostatic
predominate. associated with irritable bowel syndrome. abnormal movements, coma, confusion, hypertrophy, or cause
- Ophthalmic procedures . stupor, dizziness, amnesia, headache inspissation of bronchial
Psychiatric: Agitation, restlessness, secretions and formation of
- Cardiac rhythm abnormalities: used to
delirium, paranoia, anxiety, mental dangerous viscid plugs in
accelerate the heart rate in clients
disorders, mania, withdrawn behavior, individuals with chronic lung
experiencing bradycardia
- Preanesthesia Combined with other behavior changes. disease.
agents: can decrease excessive GI: Nausea, abdominal pain , paralytic
respiratory secretions and reverse the ileus, decreased bowel sounds ,
bradycardia caused by anesthetics . distended abdomen, vomiting, delayed
- Asthma A few agents, such as gastric emptying, decreased food
ipratropium (Atrovent), are useful in absorption, dysphagia.
treating asthma, because of their ability to

Benztropine
Blocks acetylcholine: helps decrease
muscle stiffness, sweating, and
the production of saliva, and helps
improve walking ability in people
with Parkinson's disease
. Benztropine belongs to a class of
dilate the bronchi
Benztropine
Treat symptoms of Parkinson's disease or
involuntary movements due to the side
effects of certain psychiatric drugs
(antipsychotics such as chlorpromazine/
haloperidol).
medication called anticholinergics that
work by
 AGENTS
4. ANTI-SEIZURE/
ANTICONVULSANTS
a. Stimulating an influx of
chloride ions:
BARBITURATES:
Phenobarbital
- Therapeutic range:
15-35 mcg/m
- low margin for safety
- High potential for dependence
- Cause profound CNS
depression
BENZODIAZEPINES:
Diazepam (Valium)
- Tolerance may develop quickly
One of the most widely
prescribed classes
b. Delaying an influx of
sodium:
HYDANTOINS: phenytoin
(Dilantin)
- Provides effective seizure
suppression, without the abuse
potential or CNS depression
associated with barbiturates
MOA
a. Stimulating an influx of
chloride ions:
BARBITURATES:
Phenobarbital
- intensify the effect of GABA
(suppress the firing ability of neurons)
by stimulating influx of Chloride ions
BENZODIAZEPINES:
Diazepam
Binds directly to GABA receptors
(safer than Barbiturates)
Benzodiazepines- Diazepam
b. Delaying an influx of
sodium: HYDANTOINS:
Phenytoin and RELATED
DRUGS: VALPROIC Acid
dampens CNS activity by delaying
Sodium influx (determines
neuronal action potential)
INDICATIONS ADVERSE EFFECTS
BARBITURATES: Phenobarbital BARBITURATES:
Overall effective against all major seizure Phenobarbital
types except absence seizures Dependence, drowsiness, vitamin
-Preferred for Neonatal seizures deficiencies & laryngospasm, Postural
- Primary use: controlling seizures Hypotension
Overdose: respiratory depression,
CNS depression, coma & death.
Tx: gastric lavage, activated charcoal &
hemodialysis
BENZODIAZEPINES: Diazepam
Primary use : for SHORT-TERM seizure BENZODIAZEPINES:
control Diazepam
Given IV- terminates STATUS Pregnancy risk—pregnancy Category D
EPILEPTICUS Respiratory depression may result with
- Used also for anxiety, skeletal muscle other CNS depressants.
spasms, and alcohol withdrawal symptoms Common side effects include dizziness,
drowsiness.
Overdose—give flumazenil
(Romazicon)
Adverse effects : drowsiness and
dizziness
b. Delaying an influx of sodium:
HYDANTOINS: Phenytoin and
RELATED DRUGS: VALPROIC b. Delaying an influx of
Acid sodium:
Primary Use: Useful in treating all HYDANTOINS: Phenytoin and
types of epilepsy except absence RELATED DRUGS: VALPROIC
seizures. Acid
PREGNANCY CATEGORY C/D
NURSING IMPLICATIONS
BARBITURATES:
Phenobarbital
1. Monitor patient's Liver and
kidney function (drug metabolism
& excretion)
2. Use reliable contraception
3. Immediately report pregnancy
4. Report excessive signs of
bleeding
5. Report drowsiness and bone
pain (reduced bone density)
6. AVOID Alcohol and Gingko
Biloba (decrease the effect of
barbiturates)
BENZODIAZEPINES:
Diazepam
SCHEDULE IV DRUGS: Monitor
for drug-abuse potential &
dependence
Contraindicated in narrow-
angle glaucoma
Avoid alcohol, OTC drugs, and
herbal medications and nicotine
Avoid driving and hazardous
activities
Rebound seizures if
discontinued abruptly
Take with food (prevent GI
disturbance)
b. Delaying an influx of
sodium:
HYDANTOINS: Phenytoin
and RELATED DRUGS:
VALPROIC Acid
1. Be cautious to patients with
hypersensitivity to hydantoin
products.
2. Monitor serum-drug levels
- Phenytoin-related drugs used
less frequently
Therapeutic Range :
- Phenytoin: 1 0-20 mcg/mL
- Valproic Acid: 50-120 mcg/mL
c. Delaying an influx of
calcium:
SUCCINMIDE:
Ethosuxinimide
Therapeutic range:
40-100 mcg/mL
- (Sodium channels are not
blocked; they are just desensitized)
c. Delaying an influx of
calcium:
SUCCINMIDE:
Ethosuxinimide
- Delays calcium influx: INCREASE
SEIZURE THRESHOLD of neuron-
KEEPS NEURON FROM FIRING
TOO QUICKLY
c. Delaying an influx of calcium:
SUCCINMIDE: Ethosuxinimide
Primary use: effective for absence
seizures: lapses in awareness, sometimes
with staring; are a type of generalized
onset seizures, meaning they begin in both
sides of the brain at the same time. An
older term is petit mal seizures.
A/E Hydantoins : CNS depression (with
excessive dosages), gingival
hyperplasia (20% of patients), skin rash,
cardiac dysrhythmias, and hypotension
A/E Phenytoin-like drugs : limited CNS
depression, visual disturbances, ataxia,
vertigo, headache
Additional adverse reactions :
gastrointestinal effects, hepatotoxicity,
c. Delaying an influx of
calcium:
SUCCINMIDE: Ethosuxinimide
Pregnancy Category C
Common Adverse Effects:
drowsiness, headache, fatigue,
dizziness
Depression or euphoria
Nausea, vomiting, weight loss
Abdominal pain
Life-Threatening Reactions: Severe
mental depression with suicide intent,
SLE,
Blood dyscrasias (aplastic anemia,
leukopenia & agranulocytosis)
OVERDOSE: CNS depression, stupor,
ataxia & Coma
Monitor for signs of toxicity:
dizziness, ataxia, diplopia &
lethargy.
3. Monitor for blood dyscrasias
and bleeding disorders (effects
on vitamin K metabolism)
4. Monitor liver and kidney
function
Fatal hepatotoxicity can occur
(valproic acid with multiple
antiseizure drugs)
5. Immediately report unusual
bleeding.
6. Immediately report liver or
brain disease.
c. Delaying an influx of
calcium:
SUCCINMIDE:
Ethosuxinimide
1. Monitor liver & kidney function:
metabolism & excretion
2. Monitor Serum Levels
3. Use with caution with
antiseizure medications,
phenothiazines, and
antidepressants (interact with
succinimides & result in lower
seizure threshold & decreased
effectiveness of the drug)
4. Immediately report mood
changes, mental depression, or
suicidal thoughts.
5. Avoid driving and hazardous
activities.
6. Do not abruptly withdraw
medication: rebound seizure.
7. Take with food to avoid GI
effects.
Report symptoms of fever or sore
throat
 Report weight loss and anorexia

AMINO ACID
COMPOUNDS:
AMINO ACID AMINO ACID COMPOUNDS: ACETAZOLAMIDE
COMPOUNDS: ACETAZOLAMIDE (Diamox) (Diamox)
ACETAZOLAMIDE AMINO ACID COMPOUNDS: Generally effective against paroxysmal AMINO ACID COMPOUNDS: Monitor for potential Allergic
(Diamox) ACETAZOLAMIDE (Diamox) & psychopathologic component of ACETAZOLAMIDE (Diamox) reaction
- Carbonic anhydrase inhibitor SUPPRESS GLUTAMATE release- Epilepsy Diuretic property
positive ion influxes & accumulation - Treatment of Absence & Myoclonic Other uses : glaucoma & altitude
of Intracellular Calcium are slowed Seizure sickness
ADVERSE EFFECTS: drowsiness,
dizziness, irregular heartbeat &
problems with coordination
 AGENTS MOA INDICATIONS ADVERSE EFFECTS NURSING IMPLICATIONS
5. DRUGS FOR Parkinson’s Disease: Parkinson’s Disease: Parkinson’s Disease: Parkinson’s Disease:
DENEGERATIVE DOPAMINERGIC AGENTS: DOPAMINERGIC AGENTS: DOPAMINERGIC AGENTS: DOPAMINERGIC
DISORDERS Levodopa (Larodopa) Levodopa (Larodopa) Levodopa (Larodopa) AGENTS: Levodopa
- Increases dopamine in the corpus - Used early in treatment of Parkinson’s ▫ Dry mouth, blurred vision, (Larodopa)
Parkinson’s Disease: striatum of the brain Disease tachycardia, urinary retention and 1. Caution w/patient’s w/ BPH,
DOPAMINERGIC - Levodopa is the precursor to constipation narrow angle glaucoma,
AGENTS: Levodopa dopamine synthesis – increases the myasthenia gravis, obstruction of
(Larodopa) synthesis of dopamine within the GI/GU tract
nerve terminals 2. Baseline lab values, mental
- Blocks the effect of acetylcholine status and baseline assessment
inhibit the overactivity of the of Parkinson’s disease
neurotransmitter in the corpus 3. Ongoing assessment
striatum of the brain

Alzheimer’s Disease-
ANTICHOLINERGICS:
Benztropine (Cogentin),
Acetylcholinesterase
Inhibitors, Donepezil (Aricept)
Alzheimer’s Disease-
ANTICHOLINERGICS:
Acetylcholinesterase Inhibitors,
Donepezil (Aricept)
- binds reversibly to acetylcholinesterase
and inhibits the hydrolysis of
acetylcholine, thus increasing the
availability of acetylcholine at the
synapses, enhancing cholinergic
transmission
Alzheimer’s Disease-
ANTICHOLINERGICS:
Acetylcholinesterase Inhibitors,
Donepezil (Aricept)
- Treats the symptoms of dementia
associated with Alzheimer disease; may
be used alone or with other medications.
Alzheimer’s Disease-
ANTICHOLINERGICS:
Acetylcholinesterase Inhibitors,
Donepezil (Aricept)
GI: Most common -new or worsening
stomach pain, heartburn, nausea,
vomiting, bloody or tarry stools, and
coughing up blood or vomit that looks
like coffee grounds.
CNS: slow heartbeats, lightheadedness,
convulsions (
Others: painful or difficult urination,
new or worsening breathing problems,
Alzheimer’s Disease-
ANTICHOLINERGICS:
Acetylcholinesterase
Inhibitors, Donepezil (Aricept)
Assessment BEFORE
Administration:
• Severity of Alzheimer’s disease
as
baseline to determine
effectiveness.
• Use of other medications,
especially
anticholinergics, NSAIDS,
carbamazepines,
dexamethasone, phenytoin,
phenobarbital or rifampin.
• Lab work to include CBC, liver
and renal function studies.
• Baseline V/S, especially BP and
PR: May cause changes in BP
and atrial fibrillation

Implementation:
 Evaluate for COPD or asthma:
meds can further decrease
diameter of bronchioles, thus
decreasing already compromised
air exchange.
- Evaluate for CV problems: May
cause bradycardia secondary to
vagotonic effects on heart,
especially if patient also has
conduction abnormalities.
- Monitor for safety: may cause
dizziness or bradycardia.
- Monitor for seizures: can cause
general seizures. Seizures may
also be due to Alzheimer’s
disease itself.
- Monitor for GI problems may
cause anorexia and increase
gastric acid secretion, leading to
increased risk for developing
ulcers with resultant GI bleeding.
- Monitor for symptoms of
OVERDOSE: : severe
nausea/vomiting, sweating,
salivation, hypotension,
bradycardia, convulsions,
increased muscle weakness,
including respiratory muscle

AGENTS MOA INDICATIONS ADVERSE EFFECTS NURSING IMPLICATIONS

4. DRUGS AFFECTING Neuromuscular blockers: Neuromuscular blockers: Neuromuscular blockers: Neuromuscular blockers:
MUSCLE SPASM AND
SPASTICITY
a. Neuromuscular
blockers:
atracurium
act by interfering with
transmission at the
neuromuscular end plate and
have no CNS activity.
- often used during surgical
procedures and in intensive care
and emergency medicine to
cause temporary paralysis.
b. Spasmolytics:
(Centrally Acting Muscle
Relaxants): used to alleviate
musculo-skeletal pain and
spasms and to reduce spasticity
in a variety of neurological
conditions
DIRECT ACTING
SPASMODIC: Dantrolene
(Dantrium)
SKELETAL MUSCLE
RELAXANTS: Baclofen
(Lioresal)
atracurium
Affects skeletal muscle function and
decreases the muscle tone .
b. Spasmolytics: (Centrally
Acting Muscle Relaxants):
work by either enhancing the level of
inhibition or reducing the level of
excitation. Inhibition is enhanced by
mimicking or enhancing the actions of
endogenous inhibitory substances,
such as GABA.
atracurium
-Skeletal muscle relaxation during surgery
Spasmolytics: (Centrally Acting
Muscle Relaxants):
Used to alleviate symptoms such as
muscle spasms, pain, and hyperreflexia
atracurium
Increased bronchial secretions,
Bronchospasm, Cyanosis,
Changes in heart rate
Spasmolytics: (Centrally
Acting Muscle Relaxants):
- Sedation as the main adverse effect of
muscle relaxants. Usually, people
become less alert when they are under
the effects of these drugs.
- Confusion and lethargy, as well as
anticholinergic side effects.
When taken in excess or in combination
with other substances, it may also be
toxic.
- Dry mouth , fatigue, lightheadedness,
constipation or blurred vision .
- Serious but unlikely : mental or mood
changes, possible confusion and
hallucinations, and difficulty urinating.
atracurium
The healthcare team must make
sure that patients undergoing
neuromuscular blockade are
carefully monitored for adverse
events.
A complete medication list for the
patient is necessary before
administering a NMBA to prevent
clinically significant drug
interactions.
Spasmolytics: (Centrally
Acting Muscle
Relaxants):
People are normally advised not
to drive vehicles or operate heavy
machinery while under muscle
relaxants' effects .