ANTI ANXIETY & HYPNOTIC o anxiety disorders

MEDICATIONS o alcohol withdrawal

o hyperexcitability and agitation
o preoperative relief of anxietv and tension
o muscle spasm epilepsy
DEFINITION OF TERMS: o tetanus
o insomnia
Gamma-aminobutyric acid (GABA) - can calm you
down Contraindications
o allergy
- ACTION: inhibits nerve activity and it is important o psychosis
in preventing over-excitability. o acute narrow-angle glaucoma
o shock, coma, acute alcohol intoxication
Reticular activating system (RAS) - o pregnancy
- ACTION: controls the arousal and awareness
Adverse Effects
stimuli and it contains the sleep center.
o sedation, drowsiness, depression, lethargy,
blurred vision, headaches, apathy,
ANXIETY
-feeling of tension, nervousness, apprehension, or lightheadedness, confusion
fear that usually involves unpleasant reactions to o dry mouth, constipation, nausea & vomiting,
stimulus hiccups
o hypotension,
- S/S: sweating, fast heart rate, rapid
breathing, and elevated blood pressure hypertension, arrhythmias,
palpitations and respiratory
Severe anxiety can interfere with ADLS and lead
to medical problems related to chronic stimulation difficulties
o blood dyscrasias and
of the sympathetic nervous system.
anemias

Adverse Effects
ANXIOLYTIC DRUGS o Urinary retention
o Loss of libido
Minor tranquilizer o Phlebitis, local reaction and thrombosis

● BENZODIAZEPINES Drug to Drug Interactions

● BARBITURATES o alcohol and other CNS depressants
o cimetidine, oral contraceptives and disulfiram
o theophylline and ranitidine
BENZODIAZEPINES
Assessment
o allergies to benzodiazepines, impaired liver or
kidney function, glaucoma, coma,
BENZODIAZEPINES psychoses, shock, acute alcohol
o most commonly prescribed anxiolytic drug class o intoxication: pregnancy and lactation

Action Diagnosis
o Increases the effect of gamma-amino o Disturbed thought process and disturbed sensory
butyric acid (GABA) and other inhibitory perception
neurotransmitters by binding to o Risk for Injury
specific benzodiazepine receptors in the limbic o Disturbed sleep pattern
and RAS of the CNS. o Deficient knowledge

Indication Implementation

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 o Oral forms are preferred o Latent or manifest porphyria
o Give IV drugs o Hepatic and renal impairment,
o Arrange to reduce the dosage of narcotic o Respiratory distress or severe respiratory
analgesics dysfunction
o Maintain patients in bed for at least 3 hours. o Pregnancy
o Monitor hepatic and renal function as well as CBC
o Taper dosage gradually after long-term therapy. Cautions
o Have patients void before giving the drug o Acute or chronic pain
o Give food with the drug if Gl upset is severe o Seizure disorders
o Environmental control o lactating women
o Safety precautions
o Have benzodiazepine overdose treatment ready: Adverse Effects
(Antidote flumazenil) o drowsiness, somnolence, lethargy, ataxia, vertigo, a
feeling of " hangover", paradoxical excitement,
anxiety and hallucinations
Sample Medications ( ends with am) o nausea, vomiting, constipation, diarrhea, epigastric
o alprazolam (Xanax) pain bradycardia, hypotension, syncope o Serious
o estazolam (ProSom) hypoventilation and respiratory depression and
o quazepam (Doral) laryngospasm
o chlordiazepoxide (Librium) o Hypersensitivity reactions including rash, serum
o flurazepam (Dalmane) sickness and Steven-Johnson syndrome Nursing
o temazepam (Restoril) Diagnosis
o clonazepam (Klonopin) o Disturbed Thought Process and Disturbed
o Lorazepam (Ativan) Sensory Perception
o triazolam (Halcion) o Risk for Injury
o clorazepate (Tranxene) o Impaired Gas Exchange
o midazolam (Versed) o Deficient knowledge
o diazepam (Valium)
o oxazepam (Serax) Implementation
o DO NOT mix IV drugs in solution with any other
drugs
o Oral forms are preferred
o Provide standby life-support facilities ( can cause
BARBITURATES respiratory depression)
o Taper dosage gradually after long-term therapy
o Assess respiratory rate and depth before
BARBITURATES
administration
o Be aware that the drug may cause physical and
Action
psychological dependence.
- Inhibits neuronal impulse conduction in
o May cause paradoxical stimulation in children.
the RAS depressing the cerebral
cortex, altering the cerebellar function,
Sample Medications ( end with barbital )
and depresses motor output.
o amobarbital (Amytal Sodium)
o pentobarbital (Nembutal)
Indications o aprobarbital (Alurate)
o Anxiety
o phenobarbital (Luminal)
o Insomnia
o butabarbital (Butisol)
o preoperative anxiety
o secobarbital (Seconal)
o seizures
o mephobarbital (Mebaral)
o buspirone hydrochloride
Contraindications
o Allergy and addiction to sedative/hypnotic drugs

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS

BUSPIRONE HYDROCHLORIDE
o Less sedation, no increase in CN depressant
effects, lower abuse potential
o Slow onset and not ideal for panic attacks
ANTIDEPRESSANTS
➢ Affect - refers to people's feeling in response to the
environment ( either its negative or positive).
➢ Norepinephrine - constriction of the blood vessel
(Increase BP & Decrease in Heart rate.)
➢ Dopamine - Coordination and and Responses (both
Motor and Intellectual).
➢ Serotonin- Found in lymphatic system (responsible in
arousal and sleep)
Deficiencies of neurotransmitters may develop because
• Monoamine oxidase may break
them down to be recycled or
stored in the neuron.
• Rapid fire of the neurons may
lead to their depletion
• The number of sensitivity of postsynaptic
receptors may increase thus depleting
neurotransmitter levels
Depression
• an abnormal state characterized by
exaggerated feelings of sadness, melancholy,
worthlessness, emptiness, and hopelessness
that are inappropriate and out of proportion to
reality.
• Left untreated, depression can lead to
multiple physical problems, even to
CLASSIFICATION:
Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
1. Tricyclic Antidepressant (TCA)
▪ Inhibit the presynaptic reuptake of the
neurotransmitters norepinephrine and serotonin
which leads to an accumulation of these
neurotransmitters in the synaptic cleft and
increased stimulation of the postsynaptic
receptors.
Indication
o Depression characterized by anxiety
and sleep disturbance; enuresis in
children older than 6
o Obsessive-compulsive disorders
(Clompramine)
Contraindication
o Allergy
o Recent myocardial infarction
o Concurrent use with MAOI
o Caution in patients with CV disorders
o Angle closure glaucoma,
urinary retention, prostate
hypertrophy or Gi or GU surgery
o Psychiatric patients
o Manic depressive patient
o History of seizures
o Hepatic or renal disease
Adverse Effects
o sedation, sleep disturbances, fatigue,
hallucinations, disorientation, visual disturbances,
difficulty in concentrating, weakness, ataxia,
tremors
o Dry mouth, constipation, nausea,
vomiting, anorexia, increased
salivation, cramps, diarrhea
o Orthostatic hypotension, hypertension,
palpitations, myocardial infarction, angina,
stroke.
o alopecia, nasal congestion, weight gain
or loss, flushing, chills
Drug to Drug Interactions
o Cimetidine, fluoxetine and ranitidine
o TCAs with MAO inhibitors leads to a risk of a
severe hypertensive crisis with severe
convulsions, hypertensive episodes and death. (
increase BP, occipital headache, palpitation &
chest pain, photophobia, dilate pupils)
*How do we intervene Hypertensive
crisis
1. Discontinue MAOIs .
 2. Contact Attending Physician o depression
3. Check/ recheck the BP/ reduce the
BP by giving. antiHypertensive or Contraindications
alpha 1 blocker. o Allergy risk of hypersensitive
4. Always monitor the vitals sign. o Pheochromocytoma
5. Manage fever. o Hypertension

Nursing Diagnosis Adverse Reaction

o Acute pain o dizziness, excitement, nervousness,
o Decreased cardiac output mania, hyperreflexia, tremors, confusion,
o Disturbed Thought Process and Disturbed insomnia o nausea, vomiting, diarrhea or
Sensory Perception constipation, anorexia, dry mouth,
o Risk for injury abdominal pain, liver toxicity o urinary
o Deficient knowledge implementation retention, dysuria, incontinence and
changes in sexual functions
Implementation o orthostatic hypotension, arrhythmias,
o Don't give MAOls within 2 weeks of imipramine or palpitations, angina, HYPERTENSIVE CRISIS
TCA (occipital headache, palpitations, neck stiffness,
o Frequently assess for adverse reactions during the nausea, vomiting, sweating, dilated pupils,
first 2 hours of therapy. photophobia, tachycardia and chest pain which
o When drugs are used for depression, expect mood may progress to intracranial bleeding and fatal
elevation to take 2 to 3 weeks. ( in the book 2-4 stroke
weeks- to have full therapeutic effect ) o Hypertensive Crisis
o Taper drug gradually - Associated with eating foods containing
o Give a major portion of the dose at bedtime (if tyramine!- can Hypertinsive Crisis.
OPD- to stay for a while to monitor the px; If admitted - * food rich in Tyramine
- check every 30 minutes for the s/s and adverse ✓ Cheddar cheese, blue cheese, swiss
effect for Hypertensive Crisis) cheese, fermented meat, red wine,
sausage, corned beef, salami,
Sample Medications ( ends with INE / IME) pepperoni, bear, avocado
o amitriptyline (Elavil)
o imipramine (Tofranil) Drug to Drug Interactions
o amoxapine (Ascendin) o Drug interactions with other antidepressants
o maprotiline (Ludiomil) include hypertensive crisis, coma, and severe
o clomipramine (Anatranil) convulsions with TCAs and a potentially life
o nortriptyline (Aventyi) threatening serotonin syndrome with SSRIs.
o desipramine (Norpramin) o A period of 6 weeks should elapse after
o protriptyline (Vivactil) stopping an SSRI before beginning therapy with
o doxepin (Sinequan) an MAOI
o trimipramine (Surmontil) o If given with other sympathomimetic drugs,
sympathomimetic effects increase

Nursing Diagnosis
o Acute pain
2. MONOAMINE OXIDASE ( ENZYME) INHIBITORS o Decreased cardiac output
o Disturbed thought processes and disturbed
- ( MEDICATIONS; IT STOPS PRODUCING THIS sensory perception
TYPE OF ENZYME) o Risk for injury
• Relieves symptoms of depressive disorders by o Deficient Knowledge
inhibiting the enzyme monoamine oxidase (MAOI)
Nursing Implementation
Indications o Limit drug access to potentially suicidal patients

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 o Expect to observe some therapeutic effect within 7 sexual dysfunction, urgency
to 10 days . RESPI o cough, dyspnea, pharyngitis
o Monitor BP and orthostatic blood o sweating, rash, fever, pruritus (itchiness)
pressure closely. Keep phentolamine
( Antidote for Hypertensive Crisis; give 5mg, slow
IV) readily available to treat hypertensive crisis Drug to Drug Interactions
o To avoid hypertensive crisis, expect to wait o At least 2 to 4 weeks should be allowed between
10 to 14 days ( almost 2 weeks) when use of SSRis and MAOls to avoid serotonin syndrome
switching patients from one MAO inhibitor to Nursing Interventions
another. o Monitor patient for up to 4 weeks to ascertain
o Instruct to avoid onset of full therapeutic effect
tyramine-containing foods during o Establish suicide precaution.
therapy and two weeks o Administer the drug once a day in the morning
afterward. o Suggest that patients use barrier contraceptives to
o Monitor liver function before prevent pregnancy
and periodically during therapy
o Provide a list of potential drug food interactions Sample Medications ( ends with ine)
that can cause severe toxicity. o fluoxetine (Prozac)
o paroxetine (Paxil)
Sample Medications o sertraline (Zoloft)
o isocarboxazid (Marplan)
o phenelzine (Nardil)
o tranylcypromine (Parnate)
SUMMARY:
3. SELECTIVE SEROTONIN REUPTAKE INHIBITORS
(SSRI) 1st line of med- SSRI- does not have lethal side effects.
o Selectively inhibits reuptake of serotonin by 2nd line TCA- it has cardio toxic side effect
CNS neurons and increases the amount of 3rd line- MAOIs - it has tyramine + MAOIS effect which
serotonin is hypertensive crisis effect.
o A period of up to 4 weeks is necessary for the
realization of the full therapeutic effect. ● SSRI- inhibits serotonin ( fever, anticholinergic
cardiovascular and sedating side effect)
Indication CNS - insomnia, sexual dysfunction, serotonin
o Depression syndrome if SSRI + MAOIS are incontact or
o obsessive-compulsive disorder tryptophan.
o moderate to severe bulimia ● TCA - blocks the reacting of neurotransmitters
o panic disorder norepinephrine and serotonin.
o post traumatic stress disorders - log 2-4 WEEKS ( to have therapeutic effect)
o social phobias and social anxiety disorders can cause sedation the most cardiotoxic drug
● MAOIS- combine with tyramine can lead to
Contraindication hypertensive crisis : action: block the monoamine
o Allergy oxidase this is to inactivate the norepinephrine
o pregnancy and lactation and dopamine/
o renal and hepatic disease (2-4 weeks to have a therapeutic effect in
o diabetes all antidepressants).

Adverse Reactions
Cns o headache, drowsiness, dizziness, insomnia,
anxiety, tremor, agitation, seizures
GI o nausea, vomiting, diarrhea, dry mouth,
constipation, changes in taste
ANTIPSYCHOTIC DRUGS
o painful menstruation, impotence, cystitis,

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 ANTIPSYCHOTIC DRUGS
o Are used to treat disorders that involve thought
processes
o Also called agents and major tranquilizers. (minor
tranquilizers: benzodiazepine and Barbiturate)
o Are essentially dopamine receptor blockers
Definition of Terms
➢ Schizophrenia- S/S: hallucination, paranoid,
delusion, speech abnormalities
➢ Mania- S/S: extreme over excitement and over
activity
➢ Narcolepsy- S/S: daytime sleepiness, sudden period o Anticholinergic effects: Dry mouth, blurred
of loss of wakefulness.
➢ Attention-deficit disorders – S/S: inability on
concentrate one activity longer than a few minutes.
o Classified minutes and a stat of hyperiners
✓ CLASSIC/ TYPICAL antipsychotics
✓ ATYPICAL antipsychotics
- NOVEL antipsychotics
Action
o Typical antipsychotics
a. blocks dopamine receptors, preventing the
stimulation of the postsynaptic neurons
depresses the RAS, limiting the stimuli
coming into the brain.
b. Depress areas of the brain that control
activity and aggression including the
cerebral cortex, hypothalamus, and
limbic system
o Atypical antipsychotics- blocks both dopamine
receptors and serotonin receptors.
o alleviate some unpleasant
neurological effects and
depression
Indication
o Relieve symptoms of psychoses or severe
neuroses, including delusions, hallucinations,
agitation and combativeness
o Relieve nausea and vomiting
o Schizophrenia
Contraindication
o CNS depression
o circulatory collapse
Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
o Parkinson’s disease
o coronary disease
o severe hypotension
o Allergy and pregnancy
Adverse Effects
o Weakness, tremor, confusion, restlessness,
weakness, drowsiness and extrapyramidal
effects
o Postural hypotension, tachycardia,
bradycardia, vertigo, congestive heart failure,
pulmonary edema
o Insomnia, agitation, depression, headaches,
seizures
vision, nasal congestion, flushing, constipation,
urinary retention,sexual impotence, and fever
o Jaundice, rash, photosensitivity
o Constipation, urinary retention, anorexia
o Respiratory effects: laryngospasm, dyspnea and
bronchospasm
o Phenothiazines turn urine pink to reddish brown
as a result of their excretion.
Extrapyramidal Symptoms ( involuntary movement
cannot control)
➢ Parkinsonian symptoms: tremors,drooling,
dysphagia(9 trouble or difficulty in swallowing)
➢ Tardive dyskinesia: involuntary and often
irreversible very simple movement common in
female older adults
➢ Dystonic reactions: spasm in the head neck
thumb; common in children
➢ Akathisia - ants in a pants (like fidgets - kurog2
ang tiil)
➢ Pseudoparkinsonism- result from decreased
dopamine and increase acetylcholine.
Nursing Diagnosis
o Impaired physical mobility
o Decreased cardiac output
o Risk for Injury
o Impaired urinary elimination
o Deficient knowledge
Implementation
o Do not allow the patient to Crush or chew
sustained release capsules
 o If the patient receives parenteral forms, keep
patient recumbent for 30 minutes
o Education the family about the risk of development
of extrapyramidal symptoms. ( possibility/ chances to
feel dystonic reaction, parkinson's symptoms.)
o Arrange for gradual dose reduction after long term ANTIMANIC DRUGS
use. o Mania, the opposite of depression, occurs in
o Provide positioning of legs and arms individuals with bipolar disorders
o Provide sugarless candy and ice o an overstimulation of certain neurons in the brain.
chips to increase secretions and o BIPOLAR DISORDER (manic-depressive) are
frequent mouth care treated LONG TERM with lithium salts.
o Encourage patient to void before
taking a dose Action
o Provide safety measures such as side rails and o Alters sodium transport in nerve and muscle cells
assistance with ambulation o Inhibits the release of norepinephrine
o Provide for vision examinations and dopamine but not serotonin, from
stimulated neurons
Evaluation o Increases the intraneuronal stores of
o Monitor patient response to the drug norepinephrine and dopamine slightly
o Monitor for adverse effects
Indication
• Manic episodes of manic-depressive or bipolar
illness, maintenance therapy to prevent or
Sample Medication: diminish the frequency and intensity of future
manic episodes
Typical Antipsychotics ( ends with azine)
o chlorpromazine (Thorazine)
o pimozide (Orap) Contraindications
o Fluphenazine (Prolixin) o Hypersensitivity to lithium and tartrazine
o prochlorperazine (Compazine) o Significant renal and cardiac disease
o Haloperidol (Haldol) o Sodium depletion, dehydration, diuretic use
o promazine (Pronzine) o Pregnancy and lactation
o loxapine (Loxitane)
o thioridazine (Mellaril) Adverse Reactions (Normal serum level : 0.6 - 1.2
o mesoridazine (Serentil) meq/L )
o thiothixene (Navine) o Serum levels of less than 1.5 meq/L:
o molindone (Moban) ➢ lethargy, slurred speech, muscle
o trifluoperazine (Stelazine) weakness and fine tremor;
o perphenazine (Trilaton) polyuria, (renal toxicity and
o triflupromazine (Vesprin) beginning of gastric toxicity with
nausea, vomiting and diarrhea)
Atypical Antipsychotics clozapine (Clozaril) o Serum levels of 2 to 2.5 meq/L:
o quetiapine (Seroquel) ➢ ataxia, clonic movements, hyperreflexia
o olanzapine (Zyprexa) and seizures; possible CV effects such
o risperdone (Risperdal) as severe ECG changes and
hypotension; large output of dilute urine
secondary to urine secondary to renal
toxicity; fatalities secondary to
pulmonary toxicity
o Serum levels greater than 2.5 meq/L:
ANTIMANIC DRUGS ➢ complex multi organ toxicity, with a
significant risk of death.

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 o Act as cortical and RAS
Signs of toxicity stimulants, possibly by
o Drowsiness, confusion,blurred vision, photophobia increasing the release of
o Tremors, muscle weakness, seizures, coma and catecholamines from
cardiovascular collapse. presynaptic neurons

Diagnosis Contraindication
o Acute pain o Allergy
o Risk for injury o Marked anxiety, agitation or tension and
o Impaired urinary elimination severe fatigue or glaucoma
o Disturbed thought processes o Cardiac disease
o Deficit knowledge o Pregnancy and lactation

Implementation Caution
o Give the drug cautiously, with daily monitoring of o Seizures
serum lithium levels to patients with significant o History of drug dependence, alcoholism
renal or CV disease, dehydration, debilitation, o Hypertension
as well as those taking diuretics to monitor for
toxic levels and to arrange appropriate dosage Adverse Reaction
adjustment. o Nervousness, insomnia,
o Give the drug with food or milk dizziness, headache, blurred
o Arrange to decrease dose after acute manic vision, difficulty with
episodes. accommodation
o Ensure that the patient maintains adequate intake o Anorexia, nausea, weight
of salt and fluid loss
o Administer lithium after meals. Dilute o Hypertension, arrhythmias and angina
syrup with juice or other flavored drink o Skin rashes
before giving. o Physical and psychological dependance
o Expect prescriber to decrease
dosage after acute manic episode is Implementation
controlled. o Ensure proper diagnosis of behavioral
o Palpate thyroid gland to detect enlargement syndromes and narcolepsy
o Ensure that the patient's fluid and sodium intake is o Arrange to interrupt the drug
adequate during treatment. periodically in children who
Sample Medications are receiving the drug for
o lithium carbonate (Eskalith) behavioral symptoms
o carbamazepine (Tegretol) o Administer the drug before 6pm
o valproate (Depakote, Depakene) o Provide safety measures
Sample Medications
o methylphenidate (Ritalin)
CNS STIMULANTS

CNS STIMULANTS
o Attention deficit disorders and narcolepsy ANTICONVULSANTS/ ANTIEPILEPTIC
o Redirect and excite arousal stimuli from
the RAS

Action

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS

ANTICONVULSANTS/ ANTIEPILEPTIC
o Epilepsy is a chronic neurologic condition
characterized by sudden discharge of excessive
electrical energy from nerve cells located within
the brain which leads to a seizure.
o antiepileptics or anticonvulsants
a Generalized seizure begin in one area of the
brain and rapidly spread throughout both
hemispheres of the brain
A. Tonic Clonic Seizures
o a.k.a Grand mal seizures
o involve dramatic tonic-clonic muscle
contractions, loss of consciousness and
a recovery period characterized by
confusion and exhaustion
➢ Hydantoins
Sample Medication ( ends with toin)
➢ Phenytoin (Dilantin)
➢ ethotoin (Peganone)
➢ fosphenytoin (Cerebyx)
➢ mephenytoin (Mesantoin)
Action:
• Limits the spread of seizure activity and the
start of new seizures by regulating
voltage-dependent sodium and calcium
channels in neurons, inhibiting calcium
movement across neuronal membranes,
and enhancing sodium-potassium ATP
activity in neurons and glial cells.
B. Barbiturates
Sample Medication
o phenobarbital sodium (Luminal)
o primidone (Mysoline) - a seizure ( px with
seizure)
Action
• inhibits ascending conduction of impulses in
the reticular formation , depress the cerebral
cortex, alter cerebellar function, and
depress motor nerve output,
• decreases the spread of seizure activity in the
cortex, thalamus, and limbic system.
• promotes an increased threshold for electrical
stimulation in the motor cortex, which may
contribute to its anticonvulsant properties.
Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
C. Benzodiazepines
o diazepam (Valium)
o clonazepam (Kionopin) antidote: Flumazenil
o clorazepate (Tranxene)
Action
o potentiates the effects of gamma aminobutyric
acid, an inhibitory neurotransmitter that
stabilizes nerve cell membranes.
o act primarily in the limbic system and RAS.
o causes muscle relaxation and relieves anxiety.
Indication
o Tonic-clonic seizure
o status epilepticus
o prevention of seizures after neurosurgery
o sedation and muscle relaxation
Adverse Effects
o depression, confusion, lethargy, fatigue,
constipation, dry mouth, anorexia, urinary
retention and loss of libido
o hydantoins: severe liver toxicity, bone marrow
suppression, gingival hyperplasia, and potentially
serious dermatological reactions
Nursing Considerations
o Caution with activities requiring alertness.
o Careful oral hygiene because phenytoin
o Always take medication on time and never omit
dosage.
Petit-mal seizures.
o abrupt, brief periods of loss of consciousness
o commonly in children 3 years of age
Myoclonic seizures
o involve short, sporadic
periods of muscle contractions
that last for several minutes
o Succinimides
o suppress the abnormal electrical
activity in the brain that is associated with
absence seizures
Adverse Reactions
o Depression, drowsiness, fatigue, ataxia, insomnia,
headache and blurred vision
o Gl depression: nausea, vomiting,
anorexia, weight loss, Gl pain,
constipation or diarrhea o Bone
marrow suppression : potentially
 fatal pancytopenia
o Dermatological reactions such as
pruritus, urticaria, alopecia, and Steven
Johnson syndrome
Sample Medications
o ethosuximide (Zarontin) PO
o methsuximide (Celontin) PO
bone marrow depression
o valproic acid (Depakene)
✓ DOC for myoclonic seizures
✓ reduces abnormal electrical activity in
the brain and may also increase
GABA activity at the inhibitory
receptors
✓ second choice treatment of absence
seizures
⦿ acetazolamide (Diamox)
a sulfonamide drug that is especially effective for
treatment of absence seizures in children
Partial Seizures
o involve only part of the brain and usually originate
from one site or focus
o may involve only a single muscle or reaction, or
complex, involving a series of reactions or
emotional changes
Sample Medication
*carbamazepine (Tegretol)
o DOC for the treatment of partial seizure
o tonic-clonic seizures, trigeminal neuralgia and
bipolar disorder
o Inhibit polysynaptic responses and to block
sodium channels to prevent the formation of
repetitive action potentials in the abnormal focus Nursing Diagnosis
o Excreted in the urine, may cause fetal harm
*gabapentin (Neurontin)
o adjunctive therapy in the treatment of
partial seizures in children and adults 3 to 12
years of age
o tremors associated with multiple sclerosis, for
neuropathic pain, and for migraine prophylaxis
o well absorbed in the GI tract and widely
distributed in the body; excreted unchanged
in the urine; crosses the placenta and enters
the breast milk.
*Pregabalin (Lyrica)
Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
o has a high binding affinity for voltage-gated
calcium channels in the cerebrovascular system
o modulate the calcium function in these
neurons leading to a decreased release of
neurotransmitters ( dopamine, serotonin,
norepinephrine) into the synaptic cleft and a
decrease in cell activity.
o for adjunctive treatment of adults with
partial-onset seizures and for the
management of neuropathic pain associated
with diabetic peripheral neuropathy and
postherpetic neuralgia
o absorbed orally, not metabolized but eliminated
unchanged in the urine; not known if the drug
crosses the placenta or enters the breast milk
o males receiving this drug had
decreased fertility and associated birth
defects in offspring ActIon
o stabilize nerve membranes
✓ directly by altering sodium and calcium
channels
✓ indirectly by increasing the activity of GABA
an inhibitory neurotransmitter and thereby
decreasing excessive activity
Contraindication
o Allergy
o Bone marrow suppression
o Severe hepatic dysfunction
Adverse Effects
o drowsiness, fatigue, weakness, confusion,
headache and insomnia
o nausea, vomiting and anorexia
o Upper respiratory infections
o Directly toxic to the liver and the bone marrow
o Acute Pain related to Gl, CNS and dermatological
effects
o Disturbed Thought Process related to CNS effects
o Risk for infection related to bone marrow
suppression
o Impaired skin integrity related to dermatological
effects
o Deficient Knowledge regarding drug therapy
Nursing Implementations
o Administer the drug with food
o Monitor Complete blood count (CBC) before and
periodically during therapy
o Discontinue the drug if skin rash, bone
 marrow suppression or unusual depression
changes occur
o Discontinue the drug slowly and never
withdraw the drug quickly
o Arrange for counseling for
women of childbearing age
who are taking these drugs
o Evaluate therapeutic levels
for ethosuximide
o Provide thorough patient teaching
o Suggest wearing or carrying a Medic Alert bracelet
o Monitor neurological status, especially
changes in level of consciousness and/or
mental status.
o Monitor vital signs, especially blood
pressure and depth and rate of
respirations.
o Protect the client from injury during seizure
events until therapeutic effects of drugs are
achieved.
o Monitor effectiveness of drug therapy.
o Monitor children for paradoxical response to
barbiturates.
o Observe for hypersensitivity, nephrotoxicity, and
hepatotoxicity
o Monitor oral health. Observe
for signs of gingival hypertrophy,
bleeding, or inflammation
o Monitor Gl status.
o Conduct guaiac stool ( test
for occult blood- blood that
cannot be seen by naked eye)
testing for occult blood.
o Instruct client to:
✓ Report any significant change in sensorium,
such as slurred speech, confusion,
hallucinations, or lethargy.
✓ Report any changes in seizure quality
or unexpected involuntary muscle
movement, such as twitching, tremor,
or unusual eye movement.
✓ Keep a seizure diary to chronicle seizures.
✓ Be aware that some medications may cause
initial drowsiness.
as twitching, tremor, or unusual eye movement.
● Keep a seizure diary to keep an easier diary to
chronic seizure now px ( not sure about this one.)
● Be aware that some medications may cause
initial drowsiness.
Monitor nutritional status:
o Phenytoin - folic acid, vit D, mg, Ca
o Barbiturates - vit D, vit K, folate
o Valproic - increase in weight & appetite
Report signs of :
✓ vitamin K deficiency: easy bleeding, tarry
stools, bruising, and pallor.
✓ vitamin D deficiency: skin changes,
dandruff, peripheral neuropathy, fatigue.
o Instruct client to withhold medication if
any difficulty in breathing is experienced
o Avoid driving and other hazardous activities
o Request assistance when getting out of bed and
ambulating
o Take the medication exactly as ordered,
including the same manufacturer's drug each
time the prescription is refilled.
o Take a missed dose as soon as remembered, but do
not take double doses.
Nursing Implementations
o Report any signs of toxicity such as nausea,
vomiting, rash, diarrhea, jaundice, abdominal
pain, change in color of stool, flank pain, or
blood in urine
o Adhere to a regular schedule of laboratory testing
for liver and kidney function
o Use a soft toothbrush and oral rinses
o Avoid mouthwashes

NURSING IMPLEMENTATION:
Instruct client to:
● Report any significant change in sensorium, such
as slurred speech, confusion, hallucinations, or
lethargy.
● Report any changes in seizure quality or
unexpected involuntary muscle movement, such

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 o Tachycardia, palpitations and hypotension
Nursing considerations
o Provide sugarless lozenges and frequent
mouth care.
ANTIPARKINSONISM AGENTS o Give the drug with caution and arrange for a
• progressive, Fronic neurological disorder decrease in dosage in hot weather
characterized by lack of motor coordination. o Give the drug with meals if Gl upset is
• past middle age and a problem, before meals if dry mouth
entering their 60s or even is a problem, and after meals if
older drooling occurs and the drug causes
• s/s: rhythmic tremors, rigidity and nausea.
weakness; trouble maintaining position or o Monitor bowel function and institute a bowel
posture, bradykinesia, a shuffling gait, program
patients may drool and their speech may o Ensure that the patient voids before taking
be slow and slurred; mask like expression the drugs can cause urinary retention
• Caused by an imbalance between the
stimulating cholinergic effects and the Sample Medications
inhibitory effects of dopamine in the basal o benztropine (Cogentin)
ganglia o biperiden (Akineton)
o Diphenhydramine (Benadryl)
Anticholinergics o procyclidine (Kemadrin)
o Block the action of acetylcholine in the o trihexyphenidyl (Artane)
CNS to help normalize the
acetylcholine-dopamine imbalance.. Dopaminergic
o The peripheral anticholinergic effects • Drugs that increase the effects of
help alleviate some of the other adverse dopamine at receptor sites have been
effects associated with Parkinson's disease proven more effective than
including drooling anticholinergics in the treatment of
Indication parkinsonism.
o Parkinsonism Action
o Extrapyramidal disorders o Increases the levels of dopamine in
Contraindication the substantia nigra by directly stimulating
o Narrow-angle glaucoma; dopamine receptors Contraindication
gastrointestinal & genitourinary o Allergy
obstruction, prostatic hypertrophy o Angle closure glaucoma
erects o History or presence of suspicious skin
o Myasthenia gravis lesions with levodopa because this
Caution drug has been associated with the
o Tachycardia and other dysrhythmias development of melanoma
o Hypertension or hypotension o Lactation
o Hepatic dysfunction Adverse Effects
o Lactation and pregnancy o CNS effects: anxiety, nervousness,
o Individuals who work in hot environments headache, malaise, fatigue, confusion,
Adverse Reactions mental changes © blurred vision,
o CNS: disorientation, confusion, muscle twitching, ataxia
memory loss, agitation, o PNS effects: anorexia,
nervousness, delirium, nausea, vomiting, dysphagia,
dizziness, lightheadedness and constipation, hypotension,
weakness palpitations
o PNS: dry mouth, nausea, vomiting, o Bizarre breathing patterns,
paralytic ileus, constipation, urinary urinary retention, flushing,
retention and hesitancy, blurring of vision increased sweating, hot flashes
and photophobia, flushing and reduced o Bone marrow depression

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 o Work in the CNS
o prescription-only drugs

Nursing Considerations Action

o Monitor for muscle twitching and eyelid • increasing level of inhibition (GABA) while
spasm decreasing level of excitation.
o Instruct patients to avoid high-protein meals Indication
during levodopa therapy. o backache and neck strain
o levodopa (Dopar) o multiple sclerosis and cerebral palsy
o Precursor of dopamine which o huntington's chorea
crosses the blood-brain barrier, o parkinson's disease
where it is converted to dopamine o malignant hyperthermia crisis
o Given in with carbidopa = o muscle spasticity
(Sinemet) Contraindication
o Carbidopa inhibits the enzyme dopa o Allergy
decarboxylase in the periphery o Skeletal muscle spasms resulting from
diminishing the metabolism of rheumatoid disorders
levodopa in the Gi tract and in o Baclofen should not be used to treat
peripheral tissues any spasticity that contributes to
locomotion, upright position or
amantadine (Symmetrel) increased function
o Increase the release of dopamine Caution
bromocriptine (Parlodel) o History of epilepsy
o Acts as a direct dopamine agonist on o Cardiac dysfunction
dopamine receptor sites in the o Any condition marked by muscle weakness
substantia nigra o Hepatic or renal dysfunction
o Does not depend on cells in the area o Pregnancy and lactation
to biotransform it or to increase release Adverse Effects
of already produced dopamine, it may o drowsiness, fatigue, weakness, confusion,
be effective longer than levodopa or headache, insomnia
amantadine o nausea, dry mouth, anorexia, constipation
o Hypotension and arrhythmias
Muscie relaxants o Urinary frequency, enuresis and feelings of
MUSCLE INJURIES urinary urgency
o spasm and pain o baclofen (Lioresal) - do not use to treat any
o trauma, inflammation, anxiety, and pain SPACITY that contributes to the locomotion,
o relief of pain & spasms & increase range of upright position or increase function.
motion of affected part ✓ muscle spasticity associated with
MUSCLE SPASM neuromuscular diseases such as MR, MS,
1. Flood of sensory impulses from spinal cord injuries
2. intense muscle contraction
3. cuts off blood flow to the muscle fibers Sample medication
4. Lactic acid to accumulate o carisoprodol (Soma)
5. pain o chlorphenesin (Malate)
MUSCLE SPASTICITY o chlorzoxazone (Paraflex)
o damage to neurons within the CNS o cyclobenzaprine (Flexeril)
o Permanent o methocarbamol (RobaXin)
o EXCESSIVE STIMULATION OF MUSCLES o Metaxalone
or hypertonia o tizanidine (Zanaflex)
Ex. paraplegia and cerebral palsy
⦿ DIAZEPAM (VALIUM) -anxiety - anti-anxiety
Centrally Acting Skeletal Muscle Relaxants medication
o spasmolytics / antispasmodics SAMPLE MEDICATIONS

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 • BOTULINUM TOXIN TYPE B arrhythmias
(MYOBLOC) - cervical dystonia o CHLORZOXAZONE: orange to purple- red
•5000 - 10000 units given urine
IM
• BOTULINUM TOXIN TYPE A BOTULINUM TOXINS: anaphylactic reactions,
-Improve appearance of headache, dizziness, muscle pain and paralysis
glabellar lines
-Cervical dystonia, severe Nursing Considerations
primary axillary o Assess for pain, muscle stiffness
hyperhidrosis o Discontinue the drug at any signs of liver
-(headache, respiratory dysfunction
infections, flu like syndrome o Monitor intravenous access sites for
& droopy eyes) potential extravasation
o D/C the drug for 2 to 4 days
DIRECT ACTING MUSCLE RELAXANT o D/C the drug (diarrhea)
⦿ DANTROLEN - sample med - upper motor o Do not drive or operate machinery
neuron. o Take medication with food
Indications o Use frequent mouth rinses and sugarless
o cerebral palsy candy
o amyotrophic lateral sclerosis o Inform the patient that the muscle
o muscular dystrophy relaxants should not be taken for more
o polio, tetanus than 3 weeks and should not be stopped
o spinal cord injury (quadriplegia) abruptly.
o pre-op induction of paralysis o Avoid other CNS depressants at the same
o malignant hyperthermia crisis time
Contraindication o Rest, ice, compression, elevation for
o Allergy musculoskeletal injuries to extremities.
o Spasticity that contributes to locomotion,
upright position, or increased function ANALGESICS
o Epilepsy ⦿ PAIN – sensory and emotional experience;
o Cardiac dysfunction associated with actual potential tissue
o Hepatic & renal dysfunction damage.
o Pregnancy & lactation ⦿ Physical Pain
⦿ Defense system
Caution
o In women and in all patients older than 35 Nociceptive Pain
years o Superficial somatic pain (or cutaneous
o Respiratory depression pain): produce a sharp, well-defined,
Adverse Effects localized pain of short duration.
o drowsiness, fatigue, weakness, confusion, o Deep somatic pain originates from
headache, insomnia ligaments, tendons, bones, blood vessels,
o nausea, dry mouth, anorexia, constipation fasciae, and muscles. produces a dull,
& diarrhea aching, poorly-localized pain of longer
o urinary frequency, duration than cutaneous pain
enuresis, urgency, o Visceral pain originates from body's
crystalline urine with pain or viscera, or organs; produces pain that is
burning on urination usually more aching or cramping and of a
o HEPATOCELLULAR longer duration than somatic pain; may be
damage and hepatitis well-localized, but often it is extremely
o Acne, abnormal hair growth,
difficult to localize, and several injuries to
rashes, photosensitivity, visceral tissue exhibit "referred" pain
abnormal sweating, chills and
myalgia o Hypotension and Gate Control Theory of Pain

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 o theory asserts that activation, at the spine depression
level or even by higher cognitive brain
processes, of nerves or neurons that do Pharmacokinetics
not transmit pain signals can interfere o Metabolized in the liver and excreted in the
with signals from pain fibers and inhibit urine and bile
or modulate an individual's experience Contraindication
of pain. o Allergy
o somatosensory cortex which mostly o Pregnancy, labor or lactation
accounts sensory discriminative o Diarrhea caused by poisons
dimension of pain, and the limbic o After biliary surgery or surgical anastomosis
system, of which the thalamus and the Caution:
anterior cingulate cortex are said to be o Respiratory dysfunction
especially involved in the affective o COPD, asthma
dimension. o Recent Gl or genitourinary surgery
o Acute abdomen or ulcerative colitis
Opioid Analgesics / narcotics agonist o Head injuries
o opium plants o alcoholism
o morphine, codeine, papaverine o Delirium tremens
o Act at specific opioid receptor sites in o Cerebrovascular disease & cardiac disease
the CNS to produce analgesia, & hypotension
sedation and a sense of well being o Addiction prone, suicidal and alcoholic
o Opioid Receptors o Older adults and debilitated
➢ Mu- pain blocking receptors; o Liver or renal dysfunction
respiratory depression, Adverse Reactions
euphoria, decreased Gl o Sedation, confusion, euphoria,
activity, pupil constriction restlessness, agitation, headache,
and physical dependence lightheadedness, psychoses, anxiety,
➢ Kappa - analgesia, pupillary fear,hallucinations, pupil constriction,
constriction, sedation, dysphoria impaired mental processes and
➢ Beta - dizziness
➢ Sigma - papillary dilation and o Hypotension and bradycardia
hallucinations, dysphoria and o Urinary retention, ureteral spasm,
psychoses hesitancy, loss of libido
➢ Enkephalins - react with beta o Nausea, vomiting, biliary spasm and
receptors in the periphery to modulate constipation a breathing
pain transmissions o Respiratory depression with aprea, cardiac
arrest and shock
Action: o Physical and psychological dependence
• acts on the cerebrum and medulla of Sample Medications
the central nervous system and on the o Morphine sulfate (Astramorph)
smooth muscle and glandular o Codeine sulfate
secretions of the respiratory and o Meperidine HCI (Demerol)
gastro-Intestinal tract © produce o Fentanyl (Duragesic)
analgesia, sedation and a sense of well o Hydrocodone (Hycodan)
being o Hydromorphone (Dilaudid)
Indication
o Moderate to severe acute or chronic pain NARCOTIC AGONIST ANTAGONIST
o Preoperative medication • Stimulate certain opioid receptors, but block
o Cough suppression other such receptors
o diarrhea • desirable in relieving chronic
o Used in combination with general pain in patients who are
anesthesia to produce rapid susceptible to narcotic
analgesia, sedation, respiratory dependence Sample Medication

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 o Nalbulphine (Nubain)
o Buprenorphine (IM, IV)
o Butorphanol (IM, IV, nasal spray)
o Pentazocine (Talwin)
Action
o Binds with Opioid receptors, primarily
kappa and sigma receptors, at many
CNS sites to alter the perception of
and emotional response to pain
o act at specific receptor sites in the CNS to
produce analgesia, sedation, euphoria,
and hallucinations © they block opioid
receptors that may be stimulated by other
narcotics
Indication
o relief of moderate to severe pain
o adjuncts to general anesthesia
o relief of pain during labor and delivery
INDICATION:
- Relief of moderate to severe pain
- Adjuncts to general anesthesia
- Relief of pain during labor and delivery
Contraindication
o COPD
o acute MI, CAD, hypertension
o renal and hepatic dysfunction
o allergy, pregnancy and lactation
o Physical dependence
o Narcotic
antagonistic properties
can block the analgesic
effect and intensify pain.
Adverse Reactions
o respiratory depression, apnea, suppression
of the cough reflex
o orthostatic hypotension, cardiac
hypotension
o nausea, vomiting, constipation with biliary
spasm
o lightheadedness, dizziness,
psychoses, anxiety, fear,
hallucinations, pupil constriction,
impaired mental process
o urinary retention, hesitancy, loss of libido
Nursing Considerations
o Use with extreme caution in patients who have
head injury, increased intracranial pressure
o When giving repeated parenteral doses, use
IM or IV route. Rotate IM sites
Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
o Caution patient not to use alcohol or OTC
drugs
o Monitor vital signs especially rate and depth
of respirations and pulse oximetry.
o Withhold medication for respirations below 12
breaths per minute.
o Keep resuscitative equipment and
NARCOTIC ANTAGONIST (naloxone)
medication at hand.
o Do not give narcotic agonists with
barbiturate general anesthetics,
phenothiazines and MAO inhibitors.
o Monitor injection sites for irritation and
extravasation
o Monitor timing of analgesic doses
o Use extreme caution when injecting a
narcotic into any body area that is chilled
or has poor perfusion or shock
o Use additional measures for pain relief
o Reassure patients that the risk of addiction
is minimal
o Perform neuro checks regularly. Monitor
changes in level of consciousness.
o Avoid the use of sleep-inducing
medications like antihistamines
without consulting health care
providers.
o Avoid the use of alcohol.
o Monitor for tolerance/dependence.
o Use additional measures for relief of pain.
o Reassure patients that the risk of addiction
is minimal
Narcotic Antagonists
o antidotes to narcotic toxicity
(ANTIDOTE FOR NARCOTIC TOXICITY: NALOXONE)
o Useful in blocking unwanted
adverse effects associated with
narcotics such as respiratory
depression
o play a role in the treatment of
narcotic overdose
Sample Medication
• nalmerene (Revex) IM, IV, SQ
• naloxone HCI(/Narcan) IM, IV, 50- naloxone
challenge
• naltrexone (ReVia) - narcotic or alcoholic
dependence
Action
o Briefly and competitively
antagonizes mu, kappa and sigma
receptors in the CNS o
REVERSING the analgesia,
 hypotension, respiratory or a response to other hormones and
depression, psychomimetic effects chemicals.
and hypotension and sedation
Indication Ergot Derivatives
o known or suspected opioid overdose o dihydroergotamine (Migranol) IM, IV, nasal
o postoperative opioid-induced respiratory spray
depression o Ergotamine (Cafergot)
o reversal of adverse effects of narcotics use o methysergide (Sansert)
Contraindication Action
o pregnancy and lactation o Block alpha adrenergic and serotonin
o extreme caution with narcotic addiction receptor sites in the brain to cause a
o cardiovascular disease constriction of cranial blood vessels and
Adverse Reactions decrease the pulsation of cranial arteries.
o acute narcotic abstinence Indication
syndrome: nausea, vomiting, o prevention or abortion of migraine or
sweating, tachycardia, vascular headache
hypertension and feelings of Contraindications
anxiety o CAD, hypertension, PVD
o CNS excitement and reversal of analgesia o Impaired liver and renal function
o CV: tachycardia, bp changes, dysrhythmias o Allergy, pregnancy and lactation
and pulmonary edema Caution
o Pruritus
Nursing Consideration o Malnutrition
o Maintain open airway and provide artificial Adverse Reactions
ventilation and cardiac massage o CNS: numbness, tingling of extremities,
o Monitor patient continually, adjusting the muscle pain
dosage as needed o CV: pulselessness,
o Provide comfort and safety measures with weakness, chest pain,
withdrawal syndrome. arrhythmias, localized
o Ensure that patients have been narcotic edema and itching
free for 7 to 10 days. Check urine opioid o GI upset, nausea,
levels. o Administer naloxone challenge vomiting, diarrhea
before giving naltrexone because of the o Ergotism: nausea, vomiting, severe thirst,
serious risk of acute withdrawal o Wear chest pain, confusion
medic alert bracelet Nursing Considerations
o Avoid prolonged use or excessive dosage
Non opioid analgesics o Arrange for the use of
o NSAIDS atropine or
o Aspirin phenothiazines if nausea
o Acetaminophen and vomiting are severe
o Tramadol (also an NSAID) o Provide comfort and
safety measures
Migraine o Assess extremities carefully to ensure that
o a recurrent headache disorder manifesting no decubitus ulcer or gangrene is present
in attacks lasting 4-72 hours
o unilateral location, pulsating quality, Triptans
moderate or severe intensity, ⦿ aratriptan HCI(Amerge) - acute migraines
aggravation by routine physical ⦿ rizatriptan benzoate (Maxalt) PO -
activity and association with nausea fast dissolving tablet; Cl: hx of CAD,
and/or photophobia and fetal abnormalities ⦿ sumatriptan
phonophobia. succinate (Imitrex) PO, SQ, nasal
o Caused by arterial dilation. spray; acute migraine attacks,
o due to the release of bradykinins, serotonin, cluster headache ⦿ zolmitriptan

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 (Zomig) - orally disintegrating tablet o Encourage patients to lie down in a dark, quiet
room after taking the drug to relieve migraine
Action o May experience burning, pain and
• Bind to selective serotonin receptor sites to redness for 10 to 30 minutes after SC
cause vasoconstriction of cranial vessels, injection. Apply an ice pack.
relieving the signs and symptoms of
migraine headache. General and Local Anesthetics
• depress the CNS, which produces
Indication depression of consciousness, loss of
o Acute migraine. responsiveness to sensory
stimulation, or muscle relaxation.
Contraindication • Anesthesia refers to a state of depressed
o allergy, pregnancy and lactation CNS activity.
o CAD & PVD General Anesthesia
o Renal and hepatic dysfunction o Are CNS depressants used
o PVD to produce loss of pain
o Elderly patients sensation and loss of
Caution consciousness
o Elderly ➢ Analgesia - loss of pain
o Risk factors of CAD perception
o Lactating women ➢ Unconsciousness - loss of awareness of
Adverse Reaction one's surroundings
o Numbness, tingling, burning sensation, ➢ Amnesia - inability to recall what took place
feelings of coldness o Autonomic reflexes are blocked
o dizziness, weakness, myalgia, vertigo o Anesthesia is delivered by a physician or
o Dysphagia, abdominal discomfort tightness nurse anesthetist with equipment for
or pressure in the chest intubation, mechanical ventilation, and
o blood pressure alterations and tightness or full life support.
pressure in the chest
o Triptans with ergot containing drugs result in Stages of Anesthesia
a risk of prolonged vasoactive reactions ➢ Stage 1: analgesia stage
o Ensure that the patient o Loss of pain sensation, with the patient still
has not used MAOI for 2 conscious and able to communicate.
weeks. ➢ Stage 2:
Nursing Considerations excitement stage
o Administer the drug to relieve acute o Period of excitement and often combative
migraine behavior.
o Provide comfort and safety measures for o With signs of sympathetic stimulation
the relief of headache. (tachycardia, increased respirations,
o Assess patients for chest pain, and monitor blood pressure changes)
blood pressure in patients with CAD ➢ Stage 3: surgical anesthesia
before and for at least 1 hour after triptan o Relaxation of skeletal muscles
administration. o Return of regular respirations
o Don't give another triptan within 24 hours of o Progressive loss of eye reflex and pupil
another. dilation
o After nasal administration, rinse the o Surgery can be safely performed in stage 3
tip of the bottle with hot water and dry ➢ Stage 4: medullary paralysis
with a clean tissue. o Very deep CNS depression with loss of
o Drug should not be administered I because respiratory and vasomotor center
this may precipitate coronary artery vasospasm. stimuli in which death can occur
o Advise patients to use triptan as rapidly
soon as possible after the onset of
migraine symptoms.

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 Action
o Depression of the RAS and the cerebral
cortex occurs
(IMR) Indication
o for producing sedation, hypnosis,
● Induction -beginning of anesthesia until anesthesia, amnesia and
stage 3 unconsciousness to allow performance
● Maintenance -after stage 3 until the of painful surgical procedure
surgical procedure is complete Contraindication
● Recovery -discontinuation of the o status asthmaticus
anesthetic until the patient has regained o absence of suitable veins for IV
consciousness, movement and ability to administration
communicate Caution
o severe cardiovascular disease,
▪ Balanced anesthesia hypotension or shock
o anticholinergics (pre-op), sedative/hypnotics, o hypnotic effects may be prolonged or
antiemetics, antihistamines and narcotics potentiated with increased intracranial
o Barbiturate Anesthetics pressure and myasthenia gravis
➢ IV drugs used to induce rapid Adverse Effects
anesthesia o circulatory depression; hypotension; shock;
➢ No analgesic properties decreased cardiac output, arrhythmias;
➢ Maintained by inhaled drug respiratory depression;hypotension; shock;
- Thiopental sodium (Pentothal) - decreased cardiac output; arrhythmias;
most widely used respiratory depression including apnea,
- Methohexital (Brevital) - should laryngospasm, bronchospasm, hiccups and
not come in contact with silicone coughing; headache; nausea and vomiting;
• Respiratory depression and apnea prolonged somnolence and delirium
o Non barbiturate analgesics o malignant hyperthermia with extreme
o Administered IV muscle rigidity, severe hyperpyrexia,
o Midazolam (Versed) - potent amnesiac; acidosis and in some cases death
N&V (dantrolene)
o Droperidol (Inapsine) - renal/ hepatic failure o skin breakdown secondary to immobility
Nursing Considerations
• Hypotension, chills, hallucinations, o The drug must be administered by trained
drowsiness personnel
o Etomidate (Amidate) -bizarre state of o Have equipment on standby to maintain
unconsciousness airway and provide mechanical ventilation
o Ketamine (Ketalar) o Monitor temperature
o Propofol (Diprivan) - short procedures o Monitor pulse, respiration, blood pressure,
ECG and cardiac output continually
Anesthetic Gases during administration. Monitor
o Nitrous oxide (blue cylinder) - weakest, temperature and reflexes.
least toxic; 02 block. o Monitor the patient until recovery phase is
o Cyclopropane (orange cylinder) complete and the patient is conscious
o Ethylene (red cylinder) and able to move and Communicate
o Volatile Liquids o Provide comfort measures
o Halothane (Fluothane) o Provide pain relief as appropriate, along
o Destlurane (Suprane) with reassurance and support; skin care
o Enflurane (Ethrane) and turning supportive care
o Isoflurane
o Methoxyflurane (Penthrane) Local Anesthesia
o Sevoflurane (Sevorane, Ulane) - minimal o Cause a loss of sensation in limited areas
adverse effects of the body

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 o In increasing concentrations, local Nursing Consideration
anesthetics can also cause loss o Ensure that patients receiving spinal
of the following sensations: anesthesia are well hydrated and
temperature, touch, remain lying down for up to 12 hours
proprioception and skeletal after the anesthesia to minimize
muscle tone headache
o Topical administration - applying a
cream, lotion, ointment or a drop
of local anesthetic, to traumatized NON-DEPOLARIZING NEUROMUSCULAR
skin or mucous membrane to JUNCTION BLOCKER
relieve pain • ACh, occupy the muscular
o Infiltration anesthesia involves injecting cholinergic receptor site,
the anesthetic directly into the tissues to be preventing ACh and occupy the
treated muscular cholinergic receptor
o Field block anesthesia involves injecting site
the anesthetic all around the area that will
be affected by the operation DEPOLARIZING NEUROMUSCULAR
o Nerve block involves injecting the JUNCTION BLOCKER
anesthetic at some point along the • Succinylcholine
nerve or nerves that run to and from o Attaches to the ACh receptor site on the
the region in which the loss of pain muscle cell, depolarizing the muscle
sensation or muscle paralysis is Causes stimulation of the muscle and
desired muscle contraction
o Intravenous Regional anesthesia o Prolonged contraction of the muscle which
involves carefully draining all of the blood from cannot be restimulated
the patient's arm or leg, securing a tourniquet
to prevent the anesthetic from entering the Action
general circulation Action o Structurally similar to ACh and compete
with ACh for muscle receptor sites
• Cause a temporary interruption in the
production and conduction of nerve o Hydrophilic
impulses o Act by blocking the ACh receptor so that it
cannot be stimulated
• affect the permeability of nerve
o Prevent muscle
membranes to sodium ions, which
movement by prohibiting the
normally infuse into the cell in
depolarization of the muscle
response to stimulation
membrane
Indication
o Muscle twitching occurs
o Reliet of local pain
when the drug is first given
Contraindication
and is followed by flaccid
o allergy to any one of these agents or
paralysis
parabens splal
o heart block
Indication
o shock
o Adjunct to general anesthetics during
o decreased plasma esterases
surgery
Adverse Reactions
o Facilitate mechanical intubation by
o skin breakdown, self injury
preventing resistance to passing the
o CNS effects such as headache,
endotracheal tube
restlessness, anxiety, dizziness, tremors,
o Facilitate electroconvulsive therapy when
blurred vision, and backache Gl effects
intense skeletal muscle contractions could
such as nausea and vomiting
cause the patient broken bones or other
o Cardiovascular effects such as peripheral
injury
vasodilation, myocardial depression,
arrhythmias, and blood pressure
Contraindication
changes

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS
 o Myasthenia gravis
o Renal or hepatic disease
o Pregnancy

Caution
o Family of personal history of malignant
hyperthermia
o Pulmonary or cardiovascular dysfunction
o Altered fluid and electrolyte imbalance
o Respiratory conditions
o Fractures
o Low plasma cholinesterase levels
Adverse Reactions
o Profound and prolonged muscle paralysis
o Depressed respiration, bronchospasm and
apnea
o Respiratory obstruction with wheezing and
bronchospasm
o Hypotension and cardiac arrhythmias
o Gl: constipation, vomiting, regurgitation and
aspiration
o Decubitus ulcers
o Muscle pain
o Malignant hyperthermia

Nursing Considerations
o Administration of the drug should be
performed by trained personnel
o Supplies and equipment should be on
standby
o Do not mix the drug with any alkaline
solutions such as barbiturates
o Monitor patient temperature. Maintain
dantrolene on standby
o Arrange for a small dose of
nondepolarizing NMJ blocker before
the use of succinylcholine
o Maintain a cholinesterase inhibitor
on stand by Provide a peripheral
nerve stimulator on stand by
o Provide a peripheral nerve
stimulator on stand by.

Nursing, BSN II-1std Semester, Nursing Pharmacology, S.Y. 2022-2023 Prepared by: Stella Marriz
H. Pinote, RN, MAN ( c )
Drug Acting on the CNS and CNS