CENTRAL NERVOUS SYTEM AGENTS

Central nervous system agents

 medicines that affect the central nervous system (CNS). The CNS is responsible
for processing and controlling most of our bodily functions, and consists of
the nerves in the brain and spinal cord.
 There are many different types of drugs that work on the CNS, including
anesthetics, anticonvulsants, antiemetics, antiparkinson agents, CNS stimulants,
muscle relaxants, narcotic analgesics (pain relievers), nonnarcotic analgesics
(such as acetaminophen and NSAIDs), and sedatives.

TYPES OF CENTRAL NERVOUS SYSTEM AGENTS

 ADRENERGIC UPTAKE INHIBITORS FOR ADHD

 Adrenergic reuptake inhibitors work by preventing the reuptake of the
adrenergic neurotransmitter, norepinephrine, which increases the amount of
norepinephrine available in the nerve synapse (the space between two nerves).
This can improve focus and attention.
 Primary adrenergic reuptake inhibitors may be preferred in children or adults
who also have anxiety or other conditions such as bipolar disorder, Tourette
syndrome, or substance misuse disorders because ADHD treatments with a
stimulant effect can increase symptoms such as anxiety, aggression, mania,
suicidal ideation, or tics.
 Some adrenergic reuptake inhibitors work in multiple ways, in addition to
preventing the re-uptake of norepinephrine, and may have stimulant properties.

 ANALGESICS
 medicines that are used to relieve pain. They are also known as painkillers or
pain relievers. Technically, the term analgesic refers to a medication that
provides relief from pain without putting you to sleep or making you lose
consciousness.
 Many different types of medicines have pain-relieving properties, and experts
tend to group together those medicines that work in a similar way. Two of the
most common groups of pain killers are nonsteroidal anti-inflammatory
drugs (NSAIDs) and opioids (narcotics), but there are many more.
 Sometimes experts will group analgesics together based on their potency, or
how strong they are. An example of this is the World Health Organization’s
analgesic ladder. This step-wise approach to pain relief recommends non-opioid
analgesics such as acetaminophen and NSAIDs for mild-to-moderate pain; weak
opioids, such as codeine, dihydrocodeine or tramadol, for moderate-to-severe
pain; and stronger opioids, such as oxycodone and morphine, for severe pain.
 analgesic combinations
 antimigraine agents
 CGRP inhibitors
 cox-2 inhibitors
 miscellaneous analgesics
 narcotic analgesic combinations
 Nonsteroidal anti-inflammatory drugs
 Opioids (narcotic analgesics)
 salicylates
 ANOREXIANTS
 Anorexiants are drugs that act on the brain to suppress appetite. They have a
stimulant effect on the hypothalamic and limbic regions, which control satiety.
Anorexiants are used as therapy for obesity.

 ANTICONVULSANTS
 Anticonvulsants (antiepileptics or AEDs) helps to normalise the way nerve
impulses travel along the nerve cells which helps prevent or treat seizures. When
the brain is working normally the nerve cells talk to each other using controlled
electrical signals from one nerve cell to another. This tells the body to do
everything it needs or wants to do.
 During a seizure there is a change in the level of nerve cell electrical signals from
a normal level to an excessive or abnormal amount of nerve signals. This
increased nerve activity is responsible for the signs and symptoms of a seizure.
What causes the change is nerve impulses can be the result of an injury to part
of the brain, stroke, brain tumor, genetic causes, metabolic problems or toxicity
issues. Anticonvulsants can also be used to treat nerve pain and bipolar disorder.
 Anticonvulsants keep the nerve cell impulses to a normal level so they don’t
become excessive and uncontrolled, which is why they are used in seizure
disorders and epilepsy. The way anticonvulsants control the nerve impulses is
not fully understood but is thought to be by their action on neurotransmitters
like GABA, or acting on receptors such as glutamate or by changing the electrical
channels in the nerve cell.
Anticonvulsants stabilize the level of nerve cell impulses and are used for a range of
conditions including
 epilepsy
 seizure disorders
 nerve pain (neuropathic pain)
 bipolar disorder

 AMPA receptor antagonists

 barbiturate anticonvulsants
 benzodiazepine anticonvulsants
 carbamate anticonvulsants
 carbonic anhydrase inhibitor anticonvulsants
 dibenzazepine anticonvulsants
 fatty acid derivative anticonvulsants
 gamma-aminobutyric acid analogs
 gamma-aminobutyric acid reuptake inhibitors
 hydantoin anticonvulsants
 miscellaneous anticonvulsants
 neuronal potassium channel openers
 oxazolidinedione anticonvulsants
 pyrrolidine anticonvulsants
 succinimide anticonvulsants
 triazine anticonvulsants

 ANTIEMETIC/ANTIVERTIGO AGENTS
 Vomiting is controlled by the vomiting center in the medulla. Vomiting center is
activated by either one of four trigger zones: chemoreceptor trigger zone,
vestibular nuclei, cerebral cortex and gastrointestinal tract. Vomiting center is
controlled by serotonin (5-HT3), muscarinic and histamine (H1) receptors.
  Chemoreceptor trigger zone is sensitive to chemical stimuli, such as opioids and
cytotoxic drugs. It is under the control of dopamine, serotonin (5-HT3) and
opioid receptors.
 Vestibular nuclei is controlled by muscarinic and histamine (H1) receptors. This is
activated in vertigo or motion sickness.
 Cerebral cortex activates vomiting from smell, thought and so on.
Gastrointestinal tract has serotonin (5-HT3) receptors, which are affected by
chemotherapeutic drugs.
 Different classes of drugs work on different receptors and act as antiemetics and
antivertigo agents.
 5HT3 receptor antagonists
 anticholinergic antiemetics
 miscellaneous antiemetics
 NK1 receptor antagonists
 phenothiazine antiemetics

 ANTIPARKINSON AGENTS
 Antiparkinson agents aim to replace dopamine either by drugs that release
dopamine or those that mimic the action of dopamine. Parkinson's disease is a
degenerative disorder of movement that occurs due to dopamine deficiency in
the basal ganglia. Antiparkinson agents attempt to replace dopamine and treat
or halt the symptoms such as tremor, hypokinesia, and so on.
 anticholinergic antiparkinson agents
 dopaminergic antiparkinsonism agents
 miscellaneous antiparkinson agents

 ANXIOLYTICS, SEDATIVES, AND HYPNOTICS

 Anxiolytics, sedatives and hypnotics are medicines that work on the central
nervous system to relieve anxiety, aid sleep, or have a calming effect.
 The benzodiazepines are the main class of drugs that fit into this category.
Although there are more than twenty benzodiazepine derivatives, only certain
ones have been approved to treat anxiety (eg, alprazolam, clonazepam,
diazepam, and lorazepam), sleeplessness (insomnia) (eg, estazolam, flurazepam,
quazepam, temazepam and triazolam), or panic disorder (eg, alprazolam).
Barbiturates are an older class of medicine that used to be used for these
indications as well; however, barbiturates have a narrow therapeutic index
(window of effectiveness before toxicity occurs), and are more likely to
cause respiratory depression, coma and death, and are very rarely used
nowadays. The main issue with use of benzodiazepines is dependence.
Benzodiazepines differ in their propensity to cause sedation and in the length of
time they act for. All benzodiazepines are thought to work by enhancing the
inhibitory action of γ-aminobutyric acid (GABA).
 Other drug classes that are also considered effective at relieving anxiety include
the SSRIs, SNRIs, tricyclic antidepressants and buspirone; other medicines may
also be prescribed off-label. These drugs are often preferred over
benzodiazepines for anxiety because they are unlikely to cause dependence;
however, they may not work as quickly as benzodiazepines. SSRIs typically have a
delayed onset-of-action and may initially worsen anxiety.
 Other drug classes that have a sedative effective include first-generation
antihistamines, agonists of melatonin receptors, anesthetics, eszopiclone,
zaleplon, zolpidem, zopiclone, and several others. Many of these drugs also have
a hypnotic effect.
  barbiturates
 benzodiazepines
 miscellaneous anxiolytics, sedatives and hypnotics

 CHOLINERGIC AGONISTS
 Cholinergic agonists are the name given to a group of medicines that mimic the
actions of acetylcholine. Acetylcholine is one of the most common
neurotransmitters in our body, and it has actions in both the central and
peripheral nervous systems.
 The peripheral nervous system consists of the autonomic nervous system (which
regulates involuntary processes including digestion and breathing) and the
somatic nervous system, which transmits signals from the central nervous
system and external stimuli to skeletal muscle and also mediates hearing, sight,
and touch. The autonomic nervous system can be further broken down into the
sympathetic and parasympathetic nervous systems. The parasympathetic
nervous system regulates various organ and gland functions at rest, including
digestion, defecation, lacrimation, salivation, and urination, and primarily uses
acetylcholine as its main neurotransmitter.
 In medicine, the use of cholinergic agonists is limited because of their propensity
to cause adverse effects in any organ under the control of the parasympathetic
nervous system; adverse effects include blurred vision, cramps and diarrhea, low
blood pressure and decreased heart rate, nausea and vomiting, salivation and
sweating, shortness of breath, and increased urinary frequency. Currently,
cholinergic agonists are only used to increase salivation in patients who suffer
from a severely dry mouth, caused by radiation therapy or medical conditions
such as Sjogren's syndrome.

 CHOLINESTERASE INHIBITORS
 Cholinesterase inhibitors (also called acetylcholinesterase inhibitors) are a group
of medicines that block the normal breakdown of acetylcholine. Acetylcholine is
the main neurotransmitter found in the body and has functions in both the
peripheral nervous system and the central nervous system. For example,
acetylcholine is released by motor neurons to activate muscles; acetylcholine
also has an important role in arousal, attention, learning, memory and
motivation.
 Cholinesterase inhibitors block the action of the enzyme cholinesterase, which is
responsible for breaking down acetylcholine. This increases levels of
acetylcholine in the synaptic cleft (the space between two nerve endings).
 The main use of cholinesterase inhibitors is for the treatment of dementia in
patients with Alzheimer's disease. People with Alzheimer's disease have reduced
levels of acetylcholine in the brain. Cholinesterase inhibitors have been shown to
have a modest effect on dementia symptoms such as cognition.
 Cholinesterase inhibitors tend to cause side effects such as vasodilation,
constriction of the pupils in the eyes, increased secretion of sweat, saliva and
tears, slow heart rate, mucus secretion in the respiratory tract and constriction
of the airways.

 CNS STIMULANTS
 CNS stimulants (CNS stands for central nervous system) are medicines that
stimulate the brain, speeding up both mental and physical processes.
 They increase energy, improve attention and alertness, and elevate blood
pressure, heart rate and respiratory rate. They decrease the need for sleep,
reduce appetite, improve confidence and concentration, and lessen inhibitions.
  Experts aren’t exactly sure how CNS stimulants work, although they suspect they
increase levels of one or more neurotransmitters in the brain, such as dopamine,
norepinephrine, or serotonin. They may also have other effects, depending on
the actual drug. For example, phentermine possibly indirectly increases leptin
levels – leptin is a substance that tells us we feel full.

 CNS stimulants may be useful for the treatment of certain conditions

characterized by symptoms such as prolonged fatigue, inability to concentrate,
or excessive sleepiness. CNS stimulants may also be used to help with weight
loss in people who are morbidly obese. CNS stimulants have been used for the
following conditions:
 Attention deficit disorder
 Chronic lethargy
 Morbid obesity unresponsive to other treatments
 Narcolepsy
 Neonatal apnea
 Postural orthostatic tachycardia syndrome
 Prolonged depression that is unresponsive to traditional antidepressants
Unfortunately, some people misuse CNS stimulants for their ability to increase energy
levels. Some CNS stimulants also create a brief feeling of euphoria or temporarily
increase self-confidence.
 CNS stimulants differ in their ability to increase levels of certain
neurotransmitters which determines what effect they have in the body and their
side effects.
 There are also differences in the length of time they act for in the body and how
quickly they start to work. Some CNS stimulants have been modified to improve
their effect, for example, a methyl group was added to amphetamine to
make methamphetamine which lasts longer than amphetamine, penetrates the
brain better, and is less likely to detrimentally affect the heart.

CNS stimulants are associated with a number of severe and undesirable side effects such
as:
 Depersonalization (a feeling that you are an observer of yourself)
 Dizziness
 Facial tics
 Headaches
 Inability to sleep
 Increased blood pressure
 Increased rate of breathing
 Irritability
 Feelings of depression
 Increased anxiety
 Loss of appetite
 Manic behavior
 Mood swings
 Panic attacks
 Paranoia
 Restlessness
 Tachycardia (a rapid heart rate)
 Tremors or body shakes
 Weight loss
 In addition, a dry mouth, unpleasant taste in the mouth, or
gastrointestinal disturbances (nausea, diarrhea, or constipation)
may also occur.
 DRUGS USED IN ALCOHOL DEPENDENCE
 Alcohol dependence is an illness marked by consumption of alcoholic beverages
at a level that interferes with physical or mental health, and social, family, or
occupational responsibilities. People with alcohol dependence, usually
experience tolerance where there is a need for markedly increased amounts of
alcohol to achieve intoxication or the desired effect, and withdrawal symptoms
when alcohol is discontinued or intake is decreased. Medication such as
naltrexone and acamprosate in some cases can help reduce cravings.
Alternatively disulfiram may be prescribed, which creates an incentive not to
drink, because drinking alcohol while taking it causes nausea and vomiting.

 GENERAL ANESTHETICS
 General anesthetics are medicines that render a patient reversibly unconscious
and unresponsive in order to allow surgeons to operate on that patient. General
anesthetics are normally administered intravenously or by inhalation by a
specialist doctor called an anesthetist who also monitors the patient's vital signs
(breathing, heart rate, blood pressure, temperature) during the procedure.
While under general anesthesia, a patient is unable to feel pain and will likely
wake with some short-term amnesia (memory loss). Experts are unsure exactly
how general anesthetics work.

 MISCELLANEOUS CENTRAL NERVOUS SYSTEM AGENTS

 Central nervous system agents are drugs that affect the central nervous system
i.e. the brain and the spinal cord, and produce a response that could be used to
alleviate or treat a particular medical condition.
 Central nervous system agents can be used as analgesics, anesthetics, anti-
emetics, anti-convulsants, and have many other therapeutic uses.

 MUSCLE RELAXANTS
 Muscle relaxants (also called skeletal muscle relaxants) are a diverse group of
medicines that have the ability to relax or reduce tension in muscle. Some (such
as baclofen, methocarbamol, and tizanidine) work in the brain or spinal cord to
block over-excited neuronal (nerve) pathways. Others (such as dantrolene and
botulinum toxin) act directly on muscle. Cannabis extract is thought to have a
dual effect.
 Muscle relaxants treat two main conditions: spasticity (stiff, rigid muscles)
caused by conditions such as cerebral palsy, multiple sclerosis, and stroke; or
muscle spasms which are typically temporary and associated with conditions
such as tension headache, low back pain, or fibromyalgia.
 Only three muscle relaxants - baclofen, dantrolene, and tizanidine are FDA
approved to treat spasticity; however, six (carisoprodol, chlorzoxazone,
cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine) are approved
to treat muscle spasm. Botulinum toxin is only approved to treat spasticity in
certain muscle groups of the upper and lower limbs. Many other medications are
also used to treat spasticity or muscle spasm although most are not approved for
this indication.
 Evidence supporting the effectiveness of skeletal muscle relaxants for muscle
spasm is sparse; most trials are old and not of good quality. For this reason,
skeletal muscle relaxants should only be used to treat muscle spasm if other
treatments fail.
  neuromuscular blocking agents
 skeletal muscle relaxant combinations
 skeletal muscle relaxants

 VMAT2 INHIBITORS
 VMAT2 inhibitors (vesicular monoamine transporter-2 inhibitors) are used to
treat movement disorders such as Huntington’s disease or tardive dyskinesia. In
Huntington’s disease the uncontrollable movements may start out mild as
fidgeting or quick movements of the feet and hands and then, as the disease
progresses, the movements can become bigger and can involve flailing of arms
and legs. Tardive dyskinesias are involuntary, repetitive body movements that
can develop as a side effect of long term use of a group of medicines called
neuroleptics. VMAT2 inhibitors reduce unwanted body movements for these
conditions.
 Body movement or motor function is controlled in the brain by nerve cells
(neurons) which speak to each other by passing chemical messengers
(neurotransmitters) from one nerve cell to another nerve cell. In movement
disorders there can be a problem with this system and by lowering the amount
of chemical messengers between the nerve cells you relieve the uncontrolled
movements. A protein called VMAT2 controls how much chemical messenger is
stored in the nerve cell and how much is released. The VMAT2 inhibitors blocks
VMAT2 which means there is a lower amount of neurotransmitter available and
therefore reduces the unwanted body movements.
 VMAT2 inhibitors are used to treat specific conditions that have involuntary
body movements like Huntington’s disease and tardive dyskinesia.

VMAT2 inhibitors may have unwanted side effects which can depend on which type of
VMAT2 inhibitor has been taken. These may include:
 sleepiness
 dry mouth
 vision problems
 constipation
 heart conduction changes (change in QT interval)
 an increase risk of suicide.

SOURCE: https://www.drugs.com/drug-class/central-nervous-system-agents.html
DIFFERENT DRUGS, DIFFERENT EFFECTS

Drugs affect your body's central nervous system. They affect how you think, feel and
behave. The three main types are depressants, hallucinogens and stimulants:

 Depressants slow or 'depress' the function of the central nervous system. They

slow the messages going to and from your brain. In small quantities depressants
can cause a person to feel relaxed and less inhibited. In large amounts they may
cause vomiting, unconsciousness and death. Depressants affect your
concentration and coordination, and slow your ability to respond to situations. It
is important to not operate heavy machinery while taking depressants. Alcohol,
cannabis, GHB, opiates (heroin, morphine, codeine) and benzodiazepines (minor
tranquillisers) are examples of depressants.

 Hallucinogens distort your sense of reality. You may see or hear things that are
not really there, or see things in a distorted way. Other effects can include
emotional and psychological euphoria, jaw clenching, panic, paranoia, gastric
upset and nausea. Ketamine, LSD, PCP, 'magic mushrooms' and cannabis are
examples of hallucinogens.

 Stimulants speed or 'stimulate' the central nervous system. They speed up

messaging to and from the brain, making you feel more alert and confident. This
can cause increased heart rate, blood pressure and body temperature, reduced
appetite, agitation and sleeplessness. In large amounts stimulants may cause
anxiety, panic, seizures, stomach cramps and paranoia. Caffeine, nicotine,
amphetamines (speed and Ice), cocaine and ecstasy (MDMA) are examples of
stimulants.

Risk factors for drug-related harm

The effects of a drug, and how long they last, depend on a number of factors:
 the type and strength of drugs that you use
 how the drug was made -- substances manufactured in home labs may contain
bacteria, dangerous chemicals and other unsafe substances, and have an
unknown strength. Even one dose may cause an overdose that leads to brain
damage or death
 your physical characteristics (including height, weight, age, body fat and
metabolism)
 the dose that you take
 how often and for how long you have been using drugs
 how you ingest the drug (by inhalation, by injection or orally). Compared with
swallowing a drug, inhalation and injection are more likely to lead to overdose
and dependence. If you are injecting drugs, sharing injecting equipment will
increase your risk of contracting serious diseases such as hepatitis and HIV. It will
also increase your risk of serious infection
 your mental health, mood and environment (that is, whether you are in a secure,
happy place or an unsafe place) can affect the experience you have when taking
drugs. If you have a mental health condition, drugs may exacerbate or
complicate the symptoms of that condition
 whether you mix drugs, including alcohol. In particular, alcohol use may lead to
high risk behaviour (such as drink driving) which can result in the serious injury
or death of yourself or others.
Physical harms from drug use
Drug use can affect short- and long-term health outcomes. Some of these health
outcomes can be serious, and possibly irreversible.

Drug use can lead to risky or out of character behaviour. When affected by drugs:
 You are more likely to have an accident (at home, in a car, or wherever you are).
 You may be vulnerable to sexual assault or you may engage in unprotected sex.
Either of these could lead to pregnancy and sexually transmitted infection.
 You could commit a sexual assault or other violent act.
 You may find it hard to sleep, think, reason, remember and solve problems.

Drug use can also result in long-term health outcomes that include:
 harm to organs and systems in your body, such as your throat, stomach, lungs,
liver, pancreas, heart, brain, nervous system
 cancer (such as lung cancer from inhaling drugs)
 infectious disease, from shared injecting equipment and increased incidence of
risk-taking behaviors
 harm to your baby, if you are pregnant
 acne, or skin lesions if the drug you are taking causes you to pick or scratch at
your skin
 needle marks and collapsed veins, if you inject regularly
 baldness
 male pattern hair growth in women, such as facial hair
 jaw and teeth issues due to clenching and grinding your teeth; or bad breath,
teeth cavities and gum disease
 mood swings and erratic behavior
 addiction
 psychosis (losing touch with reality)
 accidental overdose
 higher risk of mental illness, depression, suicide and death.

EFFECTS OF COMMON DRUGS

Cannabis (hash, pot, dope, weed, grass, skunk, marijuana)

 may cause relaxation and altered perception
 can lead to increased heart rate and low blood pressure
 can make you feel relaxed and happy, but can also cause lethargy, anxiety,
paranoia, and psychosis in extreme cases. A history or family history of mental
illness may increase the possibility of more extreme psychotic reactions
 is linked to mental health problems such as schizophrenia and, when smoked, to
lung diseases such as asthma, chronic bronchitis and lung, throat, mouth and
tongue cancer
 affects how your brain works. Regular use can make it hard for you to
concentrate, learn and retain information
 reduces your fertility
 when mixed with tobacco, is likely to increase the risk of heart disease and lung
cancer.

Cocaine (powder cocaine, coke, blow, Charlie, crack)

 gives you increased energy
 makes you feel happy, awake, confident and less inhibited, but has a nasty 'come
down' that makes you feel depressed and unwell. (Using depressant drugs to
 help with the severity of come downs can increase the chances of the
development of negative cycles of dependence.)
 can overstimulate the heart and nervous system and lead to a seizure, brain
haemorrhage, stroke or heart attack (people have died from cocaine-induced
heart failure)
 reduces your pain perception and may result in injury
 carries greater risk if mixed with alcohol or other stimulants, especially if you
have high blood pressure or if you have an existing heart condition
 can harm your baby during pregnancy, and may cause miscarriage
 can increase the risk of mental health issues such a s anxiety, paranoia and
psychosis
 if snorted, can cause damage to the lining of the nasal passage and nose
 if injected, can cause vein collapse and increased risk of HIV and hepatitis
infection.

Mephedrone (meow meow, m-cat, plant food, bubble, meph)

 can induce feelings of happiness, euphoria and confidence, but can also cause
anxiety and paranoia
 causes vomiting, sweating and headaches in some users
 can overstimulate your heart and nervous system
 can cause periods of insomnia
 can lead to fits and agitated and hallucinatory states
 if used in large amounts, can cause tingling of the hands and feet, seizure and
respiratory failure
 has been linked to a number of deaths
 if injected, can cause vein collapse and increases the risk of HIV and hepatitis
infection.

Ecstasy (MDMA, pills, E, eckies)

 can make you feel alert, warm and chatty
 can make sounds and colours seem more intense
 may cause anxiety, confusion, paranoia and even psychosis
 is linked (in cases of long-term use) to memory loss, depression and anxiety
 can lead to overheating and dehydration
 tends to stop your body producing enough urine, so your body retains fluid.

Speed (amphetamine, billy, whizz)

 can make you feel alert, confident and energetic
 can reduce appetite
 may make you agitated and aggressive
 may cause confusion, paranoia and even psychosis
 can make you very depressed and lethargic for hours or days, when used a lot
 can cause high blood pressure and heart attacks
 is more risky if mixed with alcohol, or if you have blood pressure or heart
problems
 puts you at risk of overdose, vein and tissue damage, and infectious disease
(such as hepatitis C and HIV), if you inject speed.

Ice (crystal meth, shabu, crystal, glass, shard, P):

 may create feelings of pleasure and confidence
 can make you feel alert and energetic
 can cause you to repeat simple things like itching and scratching
 can cause enlarged or dilated pupils and a dry mouth
 may make you grind your teeth
  can cause excessive sweat
 can increase your heart rate and breathing
 may reduce your appetite
 may increase your sex drive
 puts you at risk of infectious diseases (such as hepatitis B, hepatitis C and HIV) if
you inject it
 can damage your nasal passages and cause nose bleeds if you snort it.

Effects of a 'come down'

A 'come down' is your body's reaction to the substances that you have taken, after the
initial reaction. In other words, it is the after effect.
How long it lasts, and how bad it is, depends on the type of drug (stimulant or
depressant) and your age, sex and tolerance.
Common after effects are flatness, depression and exhaustion. Or you may feel:
 shaky, dizzy, sweaty
 headachey
 nauseous
 fatigued
 not hungry
 sleepy or unable to sleep.
NURSING MANAGEMENT
The importance of the nursing process in guiding the nurse who administers CNS
medication:

Assessment

When thinking about administering CNS medication, there are many things to consider.
Each medication is given for a specific purpose for your patient, and it is your job as a
nurse to assess your patients and collect important data before safely administering
medication. As a nurse, you will be not only performing the skill of administering
medications, but also be expected to think critically about your patient and the safety of
any medication at any particular time.

A nursing assessment completed prior to administering CNS medication will likely look
different than an assessment for other types of medication because most of the
associated assessments are done by collecting subjective data rather than objective
data. For example, prior to administering a cardiac medication, a nurse will obtain
objective data such as blood pressure and an apical heart rate. However, prior to
administering CNS medication, a nurse will use therapeutic communication to ask
questions to gather subjective data about how the patient is feeling. After reviewing the
possible diseases connecting with the CNS system, you probably noticed that there is
usually an associated imbalance of a neurotransmitter. As a nurse, you cannot directly
measure a neurotransmitter to determine the effects of the medication, but you can ask
questions to determine how your patient is feeling emotionally and perceiving the
world, which are influenced by neurotransmitter levels. An example of a nurse using
therapeutic communication to perform subjective assessment is asking a question such
as, “Tell me more about how you are feeling today?” The nurse may also use general
survey techniques such as simply observing the patient to assess for cues of behavior.
Examples of data collected by a general survey could be assessing the patient’s mood,
hygiene, appearance, or movement.

Implementation of Interventions

With the administration of any medications, it is important to always perform the five
rights (right patient, medication, dose, route, and time) and to check for allergies prior
to administration. It is important to anticipate any common side effects and the
expected outcome of the medication. When you administer CNS medication, it is key to
perform assessments before administering medication because many patients may have
changing behaviors and habits that influence the way they think and feel about taking
their medication. Additionally, some medications require assessment of lab values
before administration. Many CNS medications may also have cumulative effects when
used in conjunction with other medications, so careful assessment of the impact of the
medications on one another is needed.

Evaluation

Finally, it is important to always evaluate the patient’s response to a medication. Some

CNS medications will take weeks to become therapeutic for the patient. It is key to teach
the patient about when the medication is expected to produce an effect. Nurses should
assess for mood, behavior, and movement improvement. If medications are effective,
then patients should report fewer negative thoughts, worry, and symptomatic
behaviors, as well as demonstrate fewer abnormal movements. Nurses also need to
continually monitor for adverse effects, some of which can be life threatening and
require prompt notification to the prescribing provider. Additionally, if symptoms are
not improving or the patient’s condition is worsening, the nurse should promptly notify
the prescribing provider for further orders. For example, a symptom and/or adverse
reaction of several CNS medications is increased thoughts of suicide. If a patient is
experiencing thoughts of suicide, immediate assistance should be obtained to keep
them safe.

SOURCE: https://wtcs.pressbooks.pub/pharmacology/chapter/8-4-nursing-process-cns-
medications/