Central Nervous System Medications

Class: Alcohol Deterrent
Agent(s) Common Uses Contraindications Route Onset of Action Interactions

Acamprosate Alcohol abstinence Hypersensitivity PO Increase glucose,
(Campral) management Creatinine clearance < 30 mL/min bilirubin, uric acid.
Decrease Hgb/Hct,
platelets.
Mechanism of Action
Not completely understood. Thought to lower neuronal excitability, centrally mediated.
Advantages/Disadvantages
Side Effects Adverse Effects
Anxiety Depression Suicidal ideation

Dizziness Headache Dyspnea
Insomnia Tremors
Chills Drowsiness
Rhinitis Anorexia
Constipation Diarrhea
N/V
Nursing Interventions Client Education
Assess mental status for depression, abnormal thoughts, suicidal thoughts. Notify prescriber of depression, abnormal thoughts,
Obtain vital signs. suicidal thoughts.
Evaluate therapeutic response. Do not engage in hazardous activities.
Do not drink alcohol while taking medication.
References: Kee, J. L., Hayes, E. R., McCuistion, L. E. (2015). Pharmacology: A patient-centered nursing process approach (8th ed.). Elsevier Saunders.
Skidmore-Roth, L. (2016). Mosby’s 2016 nursing drug reference (29th ed.). Elsevier: St. Louis
Class: Aldehyde Dehydrogenase Inhibitor
Disulfiram (Antabuse) Alcoholism Myocardial disease PO 2-12 hours Severe unpleasant side effects when
Psychoses taken with alcohol, or foods/ products
Pregnancy containing alcohol such as mouthwash,
cough medicine, cooking wine, vinegar.
Use with phenytoin can lead to phenytoin
intoxication.
Mechanism of Action
Disulfiram blocks the oxidation of alcohol. Blocks an enzyme that is involved in metabolizing alcohol intake. Disulfiram produces very
unpleasant side effects when combined with alcohol in the body.
Flushing Sweating Allergic reaction: hives; difficult breathing; swelling of your

Increased thirst Swelling face, lips, tongue, or throat.
Rapid weight gain Nausea Severe abdominal pain
Severe vomiting Confusion Sudden vision loss
Blurred vision Weakness Optic neuritis/Peripheral neuritis
Throbbing headache Hepatitis
Monitor liver function studies. Do NOT drink alcohol while taking this medication. Severe unpleasant side
Assess for recent alcohol use. Do not administer for 12 hr effects when taken with alcohol, or foods/ products containing alcohol such
following alcohol ingestion. as mouthwash, cough medicine, cooking wine, vinegar.
If a severe disulfiram reaction occurs administer oxygen, Wear a medical alert tag or carry an ID card.
monitor ECG and serum potassium levels, and provide Used with behavior modification, psychotherapy, and counseling support.
supportive measures. Inform patient of purpose of disulfiram and the consequences of drinking
Monitor CBC and blood chemistry every 6 months during alcohol during therapy.
therapy. Avoid driving and other activities requiring alertness
Class: Anti-Anxiety Agents: Antihistamines
Hydroxyzine (Vistaril) Anxiety disorders 1st trimester PO 15-60 minutes Increased CNS effect with use of
Pre and post-op pregnancy IM barbiturates, opioids, analgesics,
sedation alcohol, sedative/hypnotics.
Hypersensitivity
Nausea/Vomiting
Increased anticholinergic effects
with use of phenothiazines,
antihistamines, antidepressants,
atropine, haloperidol, MAOIs
Mechanism of Action
Depresses subcortical levels of CNS, including the limbic system.
Headache Dry mouth Hypotension

Dizziness Fatigue Hives
Increased appetite Seizures
Nausea Diarrhea
Weight gain
Administer IM deep in large muscle using Z-track method to Avoid OTC medications.
decrease pain, chance of necrosis. Avoid driving, activities that require alertness.
Do NOT give IV or SQ. Avoid alcohol, psychotropic medications.
Monitor for sedative effects. Do not discontinue quickly.
Monitor BP Rise slowly.
Assist with ambulation
Class: Anti-Anxiety Agents: Benzodiazepines
Diazepam (Valium), Anxiety disorders Narrow angle PO 30 min Increase diazepam
Lorazepam (Ativan), Alcohol withdrawal glaucoma IM 15-30 min effect with amiodarone,
Personality disorders cimetidine, verapamil,
Alprazolam (Xanax), Hypersensitivity IV Immediate
Panic attacks valproic acid.
Triazolam (Halcion),
Seizures Myasthenia gravis Rectal
Increase toxicity with
Midazolam (Versed) Pre-op sedation Sleep apnea barbiturates, SSRIs,
cimetidine, CNS
depressants, valproic acid.
Mechanism of Action
Potentiates the actions of GABA, especially in the limbic system.
Does not produce life-threatening Drowsiness Dizziness Retrograde amnesia

respiratory depression or coma if taken in Sedation Hypotension
excessive amounts. Headache Depression Tachycardia
Result is less physical dependence than the Blurred vision Tinnitus Neutropenia
barbiturates. Constipation Diarrhea Respiratory depression
Increased risk of falls with elderly Anorexia Nausea/Vomiting
BP lying, sitting, standing. May take with food.

Monitor CBC, AST, ALT, bilirubin, creatinine, LDH, alkaline phosphate. Do not use for everyday stress or for > 4 months unless
Monitor degree of anxiety, mental status. directed by prescriber.
Avoid OTC medications.
Avoid driving, activities that require alertness. Rise slowly.
Avoid alcohol.
Class: Anticonvulsant
Topiramate Seizures Hypersensitivity PO Increased CNS depression
(Topamax) Unlabeled: bipolar Metabolic acidosis with alcohol, CNS
disorder, alcohol depressants. Decreased
Pregnancy
dependence, mania,
bulimia
level of oral contraceptives,
estrogen, digoxin, lithium.
Mechanism of Action
May prevent seizure spread as opposed to an elevation of seizure threshold.
Dizziness Fatigue Suicidal ideation

Insomnia Anxiety Pancreatitis
Memory loss Tremors Death
Diplopia Anorexia
Nausea Dyspepsia
Weight loss
Assess mental status, mood, behavior. Swallow whole. Do not break, crush, or chew.
Monitor seizures. Carry emergency ID.
Assess renal and hepatic studies. Avoid driving, other activities that require alertness.
Assist with ambulation. Notify prescriber of blurred vision, periorbital pain.
Seizure precautions. Maintain adequate fluid intake to prevent kidney stones.
May need to increase amount of food consumed since weight
loss may occur.
Class: Antidepressant Agents: Monamine Oxidase Inhibitors (MAOIs)
Phenelzine (Nardil), Severe depression Concurrent use PO Up to 3 weeks High serotonin levels result
Tranylcypromine Psychosis / PTSD of meperidine, in confusion, high BP, tremor,
Dissociative disorders hyperactivity, coma, and death
(Parnate) barbiturates, tricyclic when taken with paroxetine,
Bulimia
Panic disorders when antidepressants, fluoxetine, amitriptyline,
other agents are antihistamines, CNS nortriptyline,bupropion; pain
ineffective. depressants, OTC cold medications like methadone,
tramadol, and meperidine;
medications. dextromethorphan, St. John’s Wort,
cyclobenzaprine, and mirtazapine.
Mechanism of Action
Affects chemical messengers (neurotransmitters) used to communicate between brain cells. MAOIs work by effecting changes in the brain
chemistry. An enzyme called monoamine oxidase is involved in removing the neurotransmitters norepinephrine, serotonin and dopamine
from the brain. MAOIs prevent this from happening, which makes more of these brain chemicals available to effect changes in both cells and
circuits that have been impacted by depression.
Prescribed when client does not Dizziness Constipation Orthostatic hypotension

respond to other antidepressants. Diarrhea Tremors Seizures
Diaphoresis Sexual dysfunction Coma
Hypertensive crisis can be triggered by
Weight gain Tachycardia
foods rich in tyramine.
Monitor vital signs, reflexes, affect, orientation, UOP. Avoid tyramine containing foods and beverages (pickled
Obtain CBC, urinalysis, thyroid function tests, ECG, EEG. foods, aged cheese, fermented alcohol, sour cream, figs,
Monitor for symptoms of hypertensive crisis (elevated BP and severe shrimp, bananas, chocolate or caffeinated drinks).
headache) Do not take any other medications without checking with
primary healthcare provider when taking a MAOI.
Class: Antidepressant Agents: Selective Serotonin Reuptake Inhibitors (SSRIs)
Fluoxetine (Prozac), Depression, Bi-polar disorder Hypersensitivity PO 2-4 weeks Increase effects of
Paroxetine (Paxil), Eating disorders, OCD MI CNS and respiratory
Panic attacks, depression, and
Escitalopram (Lexapro), Taking MAOIs
Anxiety disorder
Citalopram (Celexa),
PTSD / Phobia Dehydration hypotensive effect
Sertraline HCL (Zoloft) Dissociative disorder Breastfeeding with alcohol and CNS
Premenstrual dysphoric depressants.
disorder Increase effect of
hypoglycemic.
Mechanism of Action
Serotonin is increased in nerve cells because of blockage from nerve fibers.
Insomnia Seizures
Weight loss Hyponatremia
Sexual dysfunction Dehydration
Palpitations Bleeding
Headache Suicidal ideation
Diaphoresis
GI complaints
Do NOT give with MAOIs. Wait 14 days after stopping MAOIs to administer. Therapeutic effect may take several weeks.
Monitor liver functions. Do not discontinue abruptly.
Withdrawal should be gradual. Use with caution when driving.
Avoid alcohol, other CNS depressants.
Class: Antidepressant Agents: Tricyclic Antidepressants
Amitryptyline (Elavil), Depression Clients with suicidal PO 45 minutes Alcohol, hypnotics, sedatives,
Nortriptyline (Pamelor), Anxiety ideations. barbiturates potentiate central
Panic disorder nervous system depression
Imipramine (Tofranil) History of seizures
OCD when taken with tricyclic
Bulimia Chronic cardiac
antidepressants.
Depression related to disease. Concurrent use of MAOIs
alcohol and cocaine with amitriptyline may lead to
withdrawal. cardiovascular instability and
Chronic pain disorder.
toxic psychosis.
Tofranil – childhood enuresis
Antithyroid medications taken
with amitriptyline may increase
the risk of dysrhythmias.
Mechanism of Action
Blocks the uptake of the neurotransmitters norepinephrine and serotonin in the brain.
Effective and less expensive than SSRIs and other Headache Dry mouth Orthostatic hypotension
drugs. Sedation Impotence Dysrhythmias
Urinary retention
Overdose is generally lethal Photosensitivity
Increase fluids, bulk in diet if constipation, urinary retention occur. Therapeutic effects may take 2-3 weeks.
Administer with food, milk for GI symptoms. Use caution when driving, performing activities that require
Crush is client unable to swallow medication whole. alertness.
Administer at bedtime if over sedation occurs during day. Avoid alcohol, other CNS depressants.
Wear sunscreen or large hat when outdoors.
Class: Antipsychotic Agents: Phenothiazines
Chlorpromazine Psychotic disorders Hypersensitivity PO 2-3 hours Kava kava may increase the
(Thorazine), Schizophrenia Subcortical brain damage IM risk and severity of dystonic
Mania reactions when taken with
Fluphenazine Blood dyscrasias IV
Paranoia phenothiazines.
Tourette’s syndrome Renal or liver damage Rectal
Increase depressive effects
Coma when taken with alcohol or
other CNS depressants.
Mechanism of Action
Blocks norepinephrine, causing sedation and hypotensive effects early in treatment. Also blocks the actions of dopamine.
Anorexia Urinary retention Orthostatic hypotension Hypertension

Dry mouth Sedation Extrapyramidal reactions Seizures
Polyuria Dizziness Leukopenia Agranulocytosis
Headache Nasal congestion Tardive dyskinesia
Neuroleptic malignant syndrome
Assess baseline vital signs. Monitor serum glucose level. Encourage client to take the drug exactly as prescribed.
Assess mental status, cardiac, eye, and respiratory disorders. Medication may take 6 weeks or longer to achieve full
Remain with client while medication is taken and swallowed. clinical effect. Advise to wear an ID bracelet.
Avoid skin contact with liquid concentrations to prevent contact Do not consume alcohol or other CNS depressants, such
dermatitis. as narcotics.
Protect liquid from light. Dilute liquid with fruit juice. Do not abruptly discontinue the drug.
Administer with food or milk to decrease gastric irritation. Teach smoking cessation (Smoking increases metabolism
Administer IM deep into muscle. of some antipsychotics).
Observe for Extra Pyramidal Symptoms. Guide client to maintain good oral hygiene by frequent
brushing and flossing of teeth.
Class: Atypical Antipsychotics (AAP)
Risperidone (Risperdal), Psychotic disorders Hypersensitivity PO Use with other CNS
Quetiapine (Seroquel), Schizophrenia Seizure disorders IM depressants, alcohol will
Bipolar mania increase sedation.
Aripiprazole (Abilify) Suicidal ideation
Paranoia
Personality disorder
Use with other antipsychotics,
lithium increase risk of EPS.
Mechanism of Action
The exact mechanism is unknown. May be mediated through both dopamine and serotonin antagonism.
Less likely to cause extrapyramidal effects, Sedation Drowsiness Orthostatic hypotension

neuroleptic malignant syndrome and Headache Dry mouth Seizures
tardive dyskinesia than the phenothiazines. Agitation Anxiety Stroke
Suicidal ideation
Appetite stimulation with Neuroleptic malignant syndrome
weight gain
IM – give deeply into muscle mass. Rise slowly from lying or sitting position.
Monitor for hoarding / not swallowing medication. Avoid hot tubs, hot showers, hot tub baths as hypotension may
I&O occur.
Check bilirubin, CBC, weight, lipid profile, fasting glucose monthly. Avoid OTC medications unless approved by prescriber.
BP lying, sitting, standing. Avoid use with alcohol.
Heat stroke may occur in hot weather.
Class: CNS Stimulants: ADHD/ADD Stimulants
Methylphenidate (Ritalin), ADD Heart problems PO 20-30-minutes Taking MAO inhibitors with
Amphetamine (Adderall), ADHD Bipolar disorder this medication may cause a
Lisdexamfetamine (Vyvanse), Glaucoma serious (possibly fatal) drug
Dexmethylphenidate (Focalin) Tourette’s Syndrome interaction.
Mechanism of Action
Blocking the dopamine transporter and norepinephrine transporter, leading to increased concentrations of dopamine and
norepinephrine within the synaptic cleft.
Headache Insomnia Hypertension

Dry mouth Blurred vision Tachycardia
High abuse potential due to stimulant effects.
Sudden death has been reported in children Anxiety Nervousness Suicidal thoughts
taking amphetamine with structural cardiac Weight loss Nausea/Vomiting Sudden death in children with structural Cardiac
abnormalities. Decreased Appetite abnormalities.
Monitor mental status and observe for changes in level of consciousness May be habit forming. Avoid drinking alcohol.
and adverse effects such as persistent drowsiness, psychomotor agitation To prevent sleep problems, take this medicine in the morning.
or anxiety, dizziness, trembling or seizures. Methylphenidate may impair thinking or reactions. Do not drive or do
Monitor vital signs. anything that requires alertness.
Monitor gastrointestinal and nutritional status. Instruct client to report any significant increase in motor behavior,
Monitor laboratory tests such as CBC, differential, and platelet count. changes in sensorium, or feelings of dysphoria.
Monitor effectiveness of drug therapy. Monitor growth and development. Take drug with meals to reduce GI upset and counteract anorexia; eat
Monitor sleep–wake cycle frequent, small nutrient-and calorie-dense snacks. Weigh weekly and
report significant losses over 1 lb. Report shortness of breath, profound
fatigue, pallor, bleeding or excessive bruising (these are signs of blood
disorder).
Class: CNS Stimulants: Anorexiants
Phentermine Appetite Suppressant Hypersensitivity PO Taking MAO inhibitors
(Ionamin) Obesity Hypertension with this medication may
Glaucoma cause a serious (possibly
Heart disease fatal) drug interaction.
Mechanism of Action
Reduces hunger perception, a cognitive process mediated through nuclei within the hypothalamus. Outside the brain,
phentermine releases norepinephrine and epinephrine causing fat cells to break down stored fat as well.
Indicated for treatment of obesity (BMI Anxiety Dizziness Hypertension

>30) and for those overweight (BMI Insomnia Headache Hallucinations
27-30) who have comorbidities such as Dry mouth Nausea/Vomiting Seizures
hypertension, high cholesterol, diabetes. Diarrhea Constipation Pulmonary hypertension
Chest pain
Assess for tolerance to the anorectic effect of the drug. Withhold Take 1 or 2 hours after breakfast. Do not crush or chew.
drug and report to physician when this occurs. Avoid drinking alcohol with Ionamin. May affect blood sugar
Lab tests: Periodic CBC with differential and blood glucose. of client with diabetes. Do not breast feed while taking this
Monitor periodic cardiovascular status, including BP, exercise drug.
tolerance, peripheral edema. Report immediately any of the following: Shortness of breath,
Monitor weight at least 3 times/wk. chest pains, dizziness or fainting, swelling of the extremities.
Tolerance to the appetite suppression effects of the drug
usually develops in a few weeks. Notify physician, but do not
increase the drug dose. Weigh self at least 3 times/week at
the same time with the same amount of clothing.
Class: CNS Stimulants
Caffeine Migraine headache History of cardiac PO 5-10 minutes Taking caffeine along with ephedrine might
Tension headache disease or peptic Rectal cause heart problems. Caffeine might block
Promotes alertness the effects of adenosine, dipyridamole.
ulcer disease IV Rapid
Alleviates fatigue Ciprofloxacin, cimetidine, disulfiram, estrogen
In combination with Pregnancy
decrease how quickly the body breaks down
pain medication. caffeine. Caffeine decreases how quickly the
body breaks down clozapine. Taking caffeine
along with medications that slow clotting
might increase the chances bleeding.
Mechanism of Action
Stimulates the CNS, especially the medullary respiratory center. Has a pronounced diuretic effect and is a myocardial stimulant. It can
worsen peripheral vasoconstriction in those with hypertension and causes cerebral vasoconstriction, making it an effective treatment
for migraines and headaches.
Nervousness Insomnia Cardiac arrhythmias

Caffeine combined with alcohol Irritability Flushing Hypertension
appears to improve response time Palpitations Headache Tachypnea
but does not reduce the errors in Confusion
judgment caused by alcohol. Dehydration
For IV use: Assess respiratory status frequently. Instruct on correct technique for administration. Measure oral dose accurately
Monitor for signs of necrotizing enterocolitis (abdominal with a 1-mL syringe.
distension, vomiting, bloody stools, lethargy). Advise to consult health care professional immediately if signs of necrotizing
Monitor serum caffeine levels before and during therapy. enterocolitis occur.
Monitor serum glucose levels.
Class: CNS Depressants - Barbiturates
Phenobarbital Anesthesia induction. Pregnancy PO 30 minutes Increased CNS depression with
(Luminal), Secobarbital Short-term anesthesia Hypersensitivity IM alcohol, narcotics, sedative-
Seizures hypnotics.
(Seconal), Pentobarbital Depression IV 5 minutes
Short-term use of Decreased effectiveness of
(Nembutal)
insomnia Suicidal tendency
beta-adrenergic blockers,
Liver disease clozapine, corticosteroids,
Respiratory disease digitoxin, doxycycline,
estrogens, oral contraceptives,
quinidine, theophyllines,
voriconazole, or warfarin.
Mechanism of Action
Acts on GABAA receptors, increasing synaptic inhibition. This has the effect of elevating seizure threshold. Phenobarbital may also
inhibit calcium channels, resulting in a decrease in excitatory transmitter release. The sedative-hypnotic effects of phenobarbital
are likely the result of its effect on the polysynaptic midbrain reticular formation, which controls CNS arousal.
Drowsiness Lethargy Respiratory depression

Loading dose may be required. Cautious Dizziness Headache Mental depression
use in elderly, associated with increased Hangover effect Hepatic toxicity
risk of falls. Interferes with REM sleep Renal toxicity

Monitor vital signs. Ensure patient safety. Perform neuro-checks regularly. Do not drive or perform unsafe tasks.
Keep resuscitative equipment accessible. Do not drink alcohol or use medicines that may cause
Monitor response to and effectiveness of drug therapy. drowsiness
Monitor for signs of hepatic or renal toxicity. Hormonal birth control may not work as well.
Monitor laboratory blood tests and urinalysis: CBC with differential, To prevent pregnancy, use an extra form of birth control.
electrolytes, BUN, PT, PTT, liver enzymes.
Class: Miscellaneous Anti-Seizure
Gabapentin Seizures Hypersensitivity PO 1-3 hours CNS depression with alcohol,
(Neurontin) Peripheral neuropathy sedatives, antihistamines.
Migraine prophylaxis Increase gabapentin levels
Vasomotor symptoms in
women with breast cancer
with morphine.
or postmenopausal Decrease gabapentin levels
women. with antacids, cimetidine.
Mechanism of Action
Acts on the peripheral nerves and CNS by inhibiting spontaneous neuronal firing. May increase seizure threshold.
Drowsiness Dizziness Increased frequency of partial seizures

Fatigue Confusion Leukopenia
Anxiety Rhinitis Depression
Should be used cautiously with elderly. Constipation Leukopenia
Thrombocytopenia
Monitor seizure activity. Do not crush or chew caps.

Monitor mental status. Take at least 2 hours from antacids.
Seizure precautions May take without regard to meals.
Increase fluids, bulk in diet for constipation. Carry ID
Avoid driving and other activities requiring alertness.
Class: Miscellaneous Anti-Seizure
Phenytoin (Dilantin) Seizures Pregnancy PO 2-24 hours Increase phenytoin effect with
Status epilepticus Hypersensitivity IV 1-2 hours benzodiazepines, cimetidine,
Unlabeled: migraines, tricyclics, salicylates, alcohol.
Bradycardia
paroxysmal atrial Decrease phenytoin effects
tachycardia, ventricular Heart block
with antacids, barbiturates,
tachycardia Stokes-Adams syndrome rifampin.
Mechanism of Action
Inhibits spread of seizure activity in motor cortex by altering ion transport. Increases AV conduction.
Gingival hyperplasia Dizziness Aplastic anemia Agranulocytosis

Insomnia Paresthesias Pancytopenia Hepatitis
Depression Nystagmus Suicidal tendency Bradycardia
Blurred vision Anorexia Ventricular fibrillation Cardiac arrest
Weight loss Nausea/vomiting Stevens-Johnson Syndrome
Blue-Glove syndrome
IV administration should not exceed 50 mg/min in adults. Administer Take with meals to decrease side effects.
slow IVP. Take antacids two hours before or after phenytoin.
Monitor phenytoin level. Urine may turn pink
Monitor seizure activity. Oral hygiene
Monitor EKG, BP, respiratory function during IV infusion. Avoid hazardous activities.
Carry ID
Class: Miscellaneous Sedative-Hypnotics
Chloral Hydrate Short term Hypersensitivity PO 10-20 minutes Side effects of barbiturates
(Noctec) treatment of Hepatic failure may be increased.
insomnia Renal failure Use with loop diuretics may
Sedation cause tachycardia and blood
Alcohol withdrawal pressure changes.
Anticoagulants side effects
may increase.
Mechanism of Action
The mechanism of action by which the Central Nervous System (CNS) is affected is not known.
Does not interfere with REM sleep Drowsiness Hangover effect Cardiac arrhythmias
Nausea/Vomiting Flatulence Sudden death
Diarrhea Confusion Difficulty breathing
Chest pain
May dilute syrup in water or other oral liquid (eg, fruit juice or ginger If stomach upset occurs, take with food.
ale) to minimize gastric irritation. Swallow chloral hydrate whole.
Administer capsules after meals (when used as sedative). Take chloral hydrate with a full glass of water or other.
Do not take 2 doses at once.
Chloral hydrate may cause drowsiness or dizziness. Do not
drive, operate machinery, or do anything else that could be
dangerous.
Avoid drinking alcohol or taking other medications that cause
drowsiness while taking chloral hydrate.
Class: Miscellaneous Sedative-Hypnotics
Eszopiclone (Lunesta), Insomnia Hypersensitivity to PO 10 minutes Decrease CNS function with
Zolpidem (Ambien) benzodiazepine. alcohol, CNS depressants,
Respiratory depression anticonvulsants.
Food decreases absorption.
Mechanism of Action
The precise mechanism of action of eszopiclone as a hypnotic is unknown, but its effect is believed to result from its interaction
with GABA-receptor complexes at binding domains located close to benzodiazepine receptors.
Zolpidem interacts with a GABA-BZ receptor complex and shares some of the pharmacological properties of the benzodiazepines.
Headache Nervousness Tachycardia

Anxiety Drowsiness Depression
Hot flashes Irritability Hypotension
Nausea / vomiting Sleep driving (Zolpidem)
Erectile dysfunction
Assess vital signs. Teach nonpharmacologic ways to induce sleep – warm bath,
Check for signs of respiratory depression. listening to music, drinking warm fluids, avoiding caffeine.
Use bed alarm for older clients. Avoid alcohol, antidepressants, antipsychotics, and narcotic
Observe for side effects. drugs.
Take 15-30 minutes before bedtime.
Class: Miscellaneous
Carbamazepine Acute mania associated Hypersensitivity PO Slow Increase CNS toxicity with
(Tegretol) with bipolar disorder. Pregnancy Lithium.
Alcohol withdrawal Fatal reaction with use of
Seizure disorder MAOIs.
Trigeminal neuralgia Decrease anticonvulsant
Diabetic neuropathy effect with use of St. John’s
wort.
Mechanism of Action
Exact mechanism unknown. Appears to decrease polysynaptic responses and block posttetanic potentiation.
Drowsiness Dizziness A plastic anemia

Confusion Fatigue Agranulocytosis
Headache Hallucinations Respiratory depression
Tinnitus Dry mouth Arrhythmias
Blurred vision Photosensitivity AV block
Constipation Diarrhea Stevens-Johnson Syndrome
Nausea/vomiting
Monitor drug effectiveness. Carry emergency ID regarding medication.

Assess urinalysis, BUN, creatinine q 3 months. Avoid driving and other activities that require alertness.
Provide hard candy, gum, frequent rinses for dry mouth. Report chills, rash, light colored stools, dark urine, jaundice.
Urine may turn pink to brown.
Class: Miscellaneous
Valproic Acid Mania Hypersensitivity PO Increase risk of toxicity with
(Depakote) Schizophrenia erythromycin, salicylates,
Seizure disorder NSAIDs.
Migraine prophylaxis Increase CNS depression
Unlabeled: Febrile with alcohol, opioids,
seizures barbiturates, MAOIs,
tricyclics.
Mechanism of Action
Increases levels of GABA in the brain, which decreases seizure activity.
Drowsiness Dizziness Bone marrow depression

Headache Weakness Pancreatitis
Nausea/Vomiting Diarrhea Hepatotoxicity
Constipation Dyspepsia Stevens-Johnson syndrome
Weight loss Coma/Death with overdose
Monitor mental status, mood activity, sleeping/eating behavior, Physical dependency may result from extended use.
suicidal thoughts. Avoid driving, other activities that require alertness
Monitor CBC, PT/PTT, serum ammonia, platelets. Drink plenty of fluids.
Monitor for signs of pancreatitis. Report visual disturbances, rash, abdominal pain, light-
colored stools, jaundice, protracted vomiting.
Class: Mood Stabilizers
Lithium (Lithane, Mania Children < 12 years’ PO Rapid May increase lithium level with
Lithobid) Bipolar disorder old thiazide, methyldopa, haloperidol,
Thyroid disease NSAIDS, calcium channel blockers,
ACE inhibitors.
Liver disease
May increase hyperglycemia with
Renal disease antidiabetics.
Caffeine may decrease lithium levels.
Mechanism of Action
Alteration of ion transport in muscle and nerve cells. Increased receptor sensitivity to serotonin.
Headache Memory impairment Toxic effects: tremor, confusion, seizures, death.

Blurred vision Metallic taste
Dental caries Lethargy Hypotension
Long-term therapy may cause Drowsiness Tremors Hyperglycemia
hypothyroidism Slurred speech Dry mouth Hyponatremia
Anorexia Vomiting Proteinuria
Diarrhea Polyuria Cardiac dysrhythmias
Dehydration
Monitor serum sodium (Normal serum sodium helps to Maintain adequate fluid intake of 1-2 L daily.
maintain therapeutic lithium levels). Importance of lab tests and follow-up visits.
Frequently monitor Lithium level (Therapeutic range – 1-1.5 Do not drive until stable lithium level.
mEq/L for acute mania; Maintenance levels are 0.6-1.2 Take with meals to decrease gastric irritation.
mEq/L. Levels exceeding 1.5-2.5 mEq/L begin to produce Wear ID indicating medication taking.
toxicity. Normal levels and toxicity levels are very close).
Class: Neuromuscular Blocker
Succinylcholine Facilitation of ET Hypersensitivity IM 2-3 minutes Increase dysrhythmias with
Chloride (Anectine) intubation. Malignant IV 1 minute theophylline. Melatonin blocks
Skeletal muscle succinylcholine. Increase
hyperthermia
relaxation. neuromuscular blockade with
Trauma
aminoglycosides, beta blockers,
glycosides, procainamide, lithium,
opioids, thiazides.
Mechanism of Action
Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, thus antagonizing action of acetylcholine.
Causes release of histamine.
Bradycardia Tachycardia Sinus arrest Dysrhythmias

Flushing Weakness Myoglobulinemia Rhabdomyolysis
Muscle pain Apnea Bronchospasm
Increased secretions Respiratory depression Anaphylaxis
Angioedema
Monitor for electrolyte imbalances: May lead to increased action Use of medication.
of product. Care during recovery.
Monitor vital signs until fully recovered.
I&O
Check for urinary retention, frequency, hesitancy.
Class: Non-phenothiazines
Haloperidol Acute and chronic psychosis Narrow angle glaucoma PO Erratic Increase sedation with
(Haldol) Schizophrenia resistant to Severe hepatic, renal, IM 15-30 minutes alcohol, CNS depressants.
other medications. Increase toxicity with
cardiovascular disease. IV
Tourette’s syndrome anticholinergics, CNS
Paranoia Parkinson’s disease
depressants, Lithium.
Children with severe behavior Bone marrow depression Decrease effects with
problems who are combative. phenobarbital, caffeine.
Suppress narcotic withdrawal.
Mechanism of Action
Alters the effects of dopamine by blocking dopamine receptors.

Tachycardia Urinary retention Seizures Respiratory depression

Constipation Blurred vision Laryngospasm Dysrhythmias
Headache Dry mouth Neuromalignant syndrome
Nausea/vomiting Weight gain Tardive dyskinesia
Photosensitivity Orthostatic hypotension
Assess CBC Rise slowly from lying or sitting position.

Obtain BP lying, sitting, standing. Avoid hazardous activities until stabilized on medication.
Monitor for dizziness, faintness, tachycardia on rising. Avoid abrupt withdrawal of medication.
Monitor for EPS. Avoid OTC preparations.
Supervise ambulation until client stabilized on medication. About EPS.
Provide sips of water, sugarless candy, gum for dry mouth. Oral care.
Report impaired vision, jaundice, tremors, muscle twitching.
Class: Opioid Antagonist
Naltrexone Opiate addiction Hypersensitivity PO 15-30 minutes Increased lethargy with phenothiazines
(ReVia) Alcoholism Opioid dependence IM Increased hepatotoxicity with disulfiram.
Nicotine withdrawal Increased bleeding risk with
anticoagulants.
Mechanism of Action
Competes with opioids at opioid-receptor sites.

Stimulation Drowsiness Seizures

Dizziness Confusion Suicidal ideation
Headache Flushing Pulmonary edema
Nervousness Irritability DVT
Anxiety Tinnitus Hepatotoxicity
Blurred vision Diarrhea
Constipation Impotence
Nausea/vomiting
Give with food, antacid to prevent N/V. Must be drug free to start treatment.
Do not give until opioid free for 7-10 days to prevent opioid Using opioid while taking this medication could be fatal.
withdrawal. Carry emergency ID.
Administer IM deep in gluteal. Alternate injection sites. Use caution while driving or performing hazardous tasks.
Aspirate before injection. Report suicidal thoughts.
Monitor cardiac status and respiratory function.
Class: Serotonin Agonists (SSRAs – Selective Serotonin Receptor Agonists)
Ergot Alkaloids: Migraine headache Pregnant SL Variable seconds Severe hypertension can occur
Ergotamine tartrate Breastfeeding Intranasal with the use of Droxidopa or
(Ergostat), Ergotamine Heart disease IM sympathomimetics. Risk of
increase ergotamine side effects
with caffeine (Cafergot, Hypertension IV
can occur with Azole antifungals,
Ercaf)
beta-blockers, fluconazole,
fluoxetine, fluvoxamine, HIV
protease inhibitors, sumatriptan,
macrolide antibiotics.
Mechanism of Action
Works by narrowing blood vessels in the brain, which helps to relieve migraine headaches.
Can be used to prevent or treat acute Dizziness Angioedema Chest pain

migraine headache with or without an aura. Nausea/vomiting Arrhythmias Muscle pain
Toxicity may occur. SOB
Assess frequency, location, duration, and characteristics Proper use of inhaler.

headaches. During acute attack, assess type, location, and Take at the first sign of a migraine attack.
intensity of pain before and 60 min after administration. Do not swallow, crush, or chew sublingual tablets. Do not eat,
Monitor BP and peripheral pulses periodically during therapy. drink, or smoke while tablet is dissolving.
Report any increases in BP. If more than 1 dose needed to treat a migraine, take the second
Assess for nausea and vomiting. dose at least 30 minutes after the first dose. Do not take more
Assess for toxicity manifested by severe ergotism (chest pain, than 2 tablets for any migraine attack. Do not take more than 3
abdominal pain, persistent paresthesia in the extremities) and tablets in a 24 hour period. Do not take more than 5 tablets within
gangrene. Vasodilators, dextran, or heparin may be ordered to a 7 day period.
improve circulation. Do not use ergotamine daily on a regular basis.
Class: Serotonin Agonists (SSRAs – Selective Serotonin Receptor Agonists)
Triptans: Sumatriptan Migraine headaches History of coronary artery PO 60 minutes Increase vasospastic
(Imitrex), Almotriptan Cluster headaches disease, uncontrolled SubQ 10 minutes effects with ergot
(Axert) hypertension, Intranasal 15 minutes derivatives.
cerebrovascular disease, Increase serotonin
MI. Obesity, diabetes, syndrome with SSRIs
smoking, hepatic disease.
Mechanism of Action
Causes vasoconstriction of cranial arteries to relieve migraine headaches.
Nausea/vomiting Dizziness Hypertension Hypotension

Numbness Tingling Cardiac arrhythmias MI
Dry mouth Diarrhea Seizures Stroke
Abdominal cramping Coronary artery vasospasms
Assess type of headache, pain, aura, alleviating and aggravating Keeping a journal: Ingestion of tyramine foods, food
factors. additives, preservatives, coloring, artificial sweeteners,
Monitor for serotonin syndrome (delirium, coma, agitation, diaphoresis, chocolate, caffeine, may precipitate a migraine attack.
hypertension, fever, tremors). Report chest pain or tightness, sudden and severe
Monitor BP, ECG abdominal pain, swelling around eyes, face, lips.
Monitor neurologic status Do not use for more than 3-4 headaches per month.
Nasal spray: Use 1 spray in 1 nostril. Repeat if headache
returns, but not if pain continues after 1st dose. Lie in dark,
quiet environment.
Avoid hazardous activities if dizziness, drowsiness occurs.
Avoid alcohol: may increase headache.
Class: Skeletal Muscle Relaxants
Lioresal (Baclofen), Muscle spasms. Hypersensitivity PO 1-3 hours CNS depression with
Cyclobenzaprine (Flexeril), Baclofen and Intrathecal 30 minutes alcohol, tricyclics, opiates,
Dantrium: multiple barbiturates, sedatives.
Dantrolene (Dantrium), IM/IV
sclerosis, Increase hypotension with
Methocarbamol (Robaxin)
cerebral palsy. antihypertensives.
Mechanism of Action
Inhibits synaptic responses in CNS by stimulating GABAb receptors. This decreases neurotransmitter function; decreases
frequency, severity of muscle spasms.
Dizziness Drowsiness Hypotension Bradycardia

Fatigue Lightheadedness Angioedema Anaphylaxis
Dry mouth Muscle weakness Hepatotoxicity CNS depression
Constipation Urinary retention Seizures
Anorexia Nausea/vomiting
Assess spasms, spasticity, ataxia for improvement with medication. Methocarbamol may turn urine green, brown, or black.
Assess BP, weight, glucose, hepatic function studies periodically. Take with meals for GI symptoms.
Monitor ALT, AST with long-term Dantrium use. Do not discontinue abruptly.
I&O Do not take with alcohol, other CNS depressants.
Avoid hazardous activities if drowsiness/dizziness occurs.

Central Nervous System Medications

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Central Nervous System Medications

Uploaded by

Copyright:

Available Formats

Class: Alcohol Deterrent

Agent(s) Common Uses Contraindications Route Onset of Action Interactions

Not completely understood. Thought to lower neuronal excitability, centrally mediated.

Anxiety Depression Suicidal ideation

Nursing Interventions Client Education

Flushing Sweating Allergic reaction: hives; difficult breathing; swelling of your

Nursing Interventions Client Education

Depresses subcortical levels of CNS, including the limbic system.

Headache Dry mouth Hypotension

Nursing Interventions Client Education

Potentiates the actions of GABA, especially in the limbic system.

Does not produce life-threatening Drowsiness Dizziness Retrograde amnesia

Nursing Interventions Client Education

BP lying, sitting, standing. May take with food.

May prevent seizure spread as opposed to an elevation of seizure threshold.

Dizziness Fatigue Suicidal ideation

Nursing Interventions Client Education

Prescribed when client does not Dizziness Constipation Orthostatic hypotension

Serotonin is increased in nerve cells because of blockage from nerve fibers.

Nursing Interventions Client Education

Nursing Interventions Client Education

Anorexia Urinary retention Orthostatic hypotension Hypertension

Nursing Interventions Client Education

Less likely to cause extrapyramidal effects, Sedation Drowsiness Orthostatic hypotension

Nursing Interventions Client Education

Headache Insomnia Hypertension

Nursing Interventions Client Education

Indicated for treatment of obesity (BMI Anxiety Dizziness Hypertension

Nursing Interventions Client Education

Nervousness Insomnia Cardiac arrhythmias

Nursing Interventions Client Education

Drowsiness Lethargy Respiratory depression

Nursing Interventions Client Education

Drowsiness Dizziness Increased frequency of partial seizures

Nursing Interventions Client Education

Monitor seizure activity. Do not crush or chew caps.

Gingival hyperplasia Dizziness Aplastic anemia Agranulocytosis

Nursing Interventions Client Education

Nursing Interventions Client Education

Headache Nervousness Tachycardia

Nursing Interventions Client Education

Drowsiness Dizziness A plastic anemia

Nursing Interventions Client Education

Monitor drug effectiveness. Carry emergency ID regarding medication.

Increases levels of GABA in the brain, which decreases seizure activity.

Drowsiness Dizziness Bone marrow depression

Nursing Interventions Client Education

Headache Memory impairment Toxic effects: tremor, confusion, seizures, death.

Nursing Interventions Client Education

Bradycardia Tachycardia Sinus arrest Dysrhythmias

Nursing Interventions Client Education

Alters the effects of dopamine by blocking dopamine receptors.

Tachycardia Urinary retention Seizures Respiratory depression

Nursing Interventions Client Education

Assess CBC Rise slowly from lying or sitting position.

Competes with opioids at opioid-receptor sites.

Stimulation Drowsiness Seizures

Nursing Interventions Client Education

Can be used to prevent or treat acute Dizziness Angioedema Chest pain

Nursing Interventions Client Education

Assess frequency, location, duration, and characteristics Proper use of inhaler.

Nausea/vomiting Dizziness Hypertension Hypotension

Nursing Interventions Client Education