THE central NERVOUS SYSTEM DRUGS

Ma. Biehn Kyrsti S. Guevarra, SN12

Central Nervous System

Peripheral Nervous System ANS Somatic NS Sympathetic

Brain

Spinal Cord

Parasympathetic

CNS STIMULANTS

I. AMPHETAMINES
Stimulates the release of neurotransmitters norepi and dopamine INDICATIONS: narcolepsy, ADHD

I. AMPHETAMINES
S/E and A/R: restlessness, insomnia, tachycardia, HPN, heart palpitations, dry mouth, anorexia, weight loss, diarrhea or constipation, and impotence

II. AMPHETAMINE-LIKE DRUGS

- increases childs attention span, cognitive performance and to decrease impulsiveness, hyperactivity and restlessness Ex: Methylphenidate (Ritalin) - ADHD Pemoline (Cylert) narcolepsy Modafinil (Provigil) newest, narcolepsy

NURSING RESPONSIBILITIES
1. RITALIN and Pemoline should be given 30 to 45 minutes before meals (breakfast and lunch) 2. Give within 6 hours before sleep 3. Instruct the patient to avoid driving 4. Instruct the nursing mother to avoid taking CNS stimulants 5. Explain to client that long-term use may lead to drug abuse.

III. ANOREXIANTS
Aka as APPETITE SUPPRESSANTS Ex: Phenylpropanolamine

S/E: nervousness, restlessness, irritability, insomnia, heart palpitations & HPN.

III. ANALEPTICS
- stimulate respiration Ex: METHYXANTHINES: caffeine & theophylline S/E: nervousness, restlesness, tremors, twitchings, palpitations and insomnia, diuresis, GI irritation, tinnitus

IV. RESPIRATORY CNS STIMULANTS

Ex: DOXAPRAM (DOPRAM) -Treat respiratory depression caused by drug overdose, pre-post anesthetic respiratory depression, and COPD IV S/E: HPN, tachycardia, trembling, and convulsions

HEADACHES: Migraine & Cluster

Migraine headache : Classic & common Cluster headache TX: Propranolol Valproic acid Aminotriptylline

CNS DEPRESSANTS

I. SEDATIVE-HYPNOTICS
SEDATION diminish physical and mental response at a lower dosages of certain CNS depressants but does not affect consciousness HYPNOTIC EFFECT form of natural sleep

I. SEDATIVE-HYPNOTICS
Barbiturates Benzodiazepines Nonbenzodiazepines Piperidinediones Chloral Hydrate

A. Barbiturates
LONG ACTING -used to control seizures in epilepsy Ex: Phenobarbital and Mephobarbital INTERMEDIATE-ACTING - sleep sustainers for maintaining long period of sleep Ex:- Amobarbital (Amytal) - Aprobarbital (Alurate) - Butabarbital (Butisol)

A. Barbiturates
SHORT-ACTING - induce sleep for those difficulty falling asleep Ex:- Secobarbital (Seconal) - Pentobarbital (Nembutal) ULTRASHORT-ACTING - general anesthetics Ex: Thiopental Na (Pentothal)

BARBITURATES NURSING RESPONSIBILITIES

Raise bedside rails . Check skin for rashes. Do not mix pentobarbital w/ other medications. Teach client to use non pharmacologic ways to induce sleep. Instruct to avoid alcohol and antidepressant, antipsychotic and narcotics.

B. Benzodiazepines
ACTION: increase the action of inhibitory neurotransmitter GABA Ex: FLURAZEPAM (DALMANE) first - used to treat insomnia Triazolam (Halcion) A/R: loss of memory Temazepam (Restoril), Estazolam (ProSom), Quazepam (Doral) Diazepam (Valium), Lorazepam (Ativan)

BENZODIAZEPINES NURSING RESPONSIBILITIES

1. 2. 3. 4. 5. Teach non-pharmacologic ways to induce sleep Avoid alcohol, antidepressants, antipsychotics Urinate before taking the drug No OTC drugs Caution in driving

C. Non-benzodiazepines
ZOLPIDEM (AMBIEN) - Short term treatment of Insomnia CHLORAL HYDRATE - Induces sleep and decrease nocturnal awakenings

ANESTHETICS

STAGES OF GENERAL ANESTHESIA

1. ANALGESIA 2. DELIRIUM OR EXCITEMENT 3. SURGICAL STAGE 4. MEDULLARY PARALYSIS

BALANCED ANESTHESIA
Components: (HyPreSIM) Hypnotic Premedication (narcotic and benzodiazepine) & anticholinergic Short acting barbiturate Inhaled gas Muscle relaxant

INHALATION ANESTHETICS
Gas or volatile liquids Nitrous oxide Ex: Halothane, isoflurane, desflurane, enflurane, sevoflurane Nitrous oxide, cyclopropane A/R: respiratory depression, hypotension, dysrhythmias, hepatic dysfunction

INTRAVENOUS ANESTHETICS
-May be used as general anesthesia

Ex: Thiopental sodium (pentothal)

Droperidol (Innovar) Ketamine HCl (ketalar) Midazolam (Versed) & Propofol (Diprivan) A/R: respiratory and cardiovascular effects

TOPICAL ANESTHETICS
Mucous membrane; broken or unbroken skin surface, burns Solution, liquid spray, ointment, cream, and gel

LOCAL ANESTHETICS
- Blocks pain at site where its administered & doesnt produce loss of consciousness Ex: Lidocaine (Xylocaine)

SPINAL ANESTHESIA
- Local anesthesia is injected into subarachnoid space 3rd ot 4th lumbar space Nerve block: spinal block (subarachnoid space); epidural block (dura mater); caudal block (near the sacrum); saddle block (lower end of spinal column) S/E and A/R: respi distress, headache, hypotension

ANTICONVULSANTS

Classification of seizures
Tonic-Clonic Tonic Clonic Absence (Petit mal) Myoclonic

ANTICONVULSANTS
Also called ANTIEPILEPTICS ACTION: to suppress the abnormal electrical impulses from the seizure focus to other cortical areas, preventing seizures

Anticonvulsant ACTIONS
1. Suppress Na influx 2. Suppress the Ca influx 3. By increasing the action of GABA

Suppress Na influx

Suppress Ca influx

Phenytoin, Fosphenytoin, Carbamazepine, Oxcarbazepine, Valproic acid, Valproic Acid Ethosuximide

Enhance the action of Barbiturates GABA Benzodiazepines

HYDANTOINS
PHENYTOIN First anticonvulsant 1938 TERATOGENIC Therapeutic range = 10-20 mcg/ml IV, PO, no IM (tissue damage) S/E and A/R: gingival hyperplasia slurred speech confusion depression thrombocytopenia leukopenia hyperglycemia NV, constipation

BARBITURATES
PHENOBARBITAL - partial, grand mal and status epilepticus - teratogenic - gradual discontinuance

SUCCINIMIDES
- Used for absence or petit-mal seizures ETHOSUXINIMIDE = succinimide of choice

OXAZOLIDONES/ OXAZOLIDINEDIONE
- Used to treat petit-mal seizure Ex: Trimethadione (first)

BENZODIAZEPINES
CLONAZEPAM -petit-mal

CLORAZEPATE DIPOTASSIUM DIAZEPAM

- partial seizure

-acute status epilepticus - IV

IMINOSTILBENES
Ex: Carbamazepine grand mal and partial seizures - PO

VALPROATE
petit-mal, grand mal, mixed types of seizures Ex: Valproic acid (hepatotoxic)

NURSING RESPONSIBILITIES
PHENYTOIN 1. Shake the suspension well 2. Instruct client not to drive 3. No alcohol and antidepressants 4. Medic alert ID 5. Not to abruptly stop the drug therapy 6. No OTC 7. W/ food or milk

NURSING RESPONSIBILITIES
PHENYTOIN 8. Instruct the client about the pinkish red urine / reddish brown. 9. Use a soft toothbrush.