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Chapter 16

Chapter 16. Central and Peripheral Nervous System Medications. Chapter 16 Lesson 16.1. Learning Objectives. Identify the major classes of drugs that affect the central nervous system List different actions of antimigraine products

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Chapter 16

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  1. Chapter 16 Central and Peripheral Nervous System Medications

  2. Chapter 16 Lesson 16.1

  3. Learning Objectives • Identify the major classes of drugs that affect the central nervous system • List different actions of antimigraine products • Explain the major actions of drugs used to treat disorders of the central nervous system

  4. Nervous System • Central nervous system • Peripheral nervous system • Neurotransmitters • Adrenergic fibers • Cholinergic fibers • Receptors: alpha1, alpha2, beta blockers

  5. Central Nervous System

  6. Antimigraine Agents Action • Block nerve impulses at receptors of the sympathetic nervous system • Relieve pain by narrowing dilated cerebral arteries Uses • Prevention and treatment of migraine headaches • Drug Table 16-1

  7. Antimigraine Agents (cont.) Adverse Reactions Drug Interactions • Other vasoconstrictors, MAOIs Nursing Implications and Patient Teaching • Assessment • Diagnosis • Planning • Implementation • Evaluation • Patient Teaching: administration considerations

  8. Anticonvulsants or Antiepileptic Drugs • Seizures: sudden muscle contractions that happen without conscious control • Etiology: disease or disorders; head injury; idiopathic • Four major drug classes • Drug Table 16-3

  9. Barbiturates Action • Long duration of action and sedative effect on the brain; action occurs in the brainstem Uses • Status epilepticus; prevent and control grand mal seizures • May treat seizures caused by tetanus, fever, or drugs

  10. Benzodiazepines Action • CNS depressants; suppress electrical discharge in seizures Uses • Treat minor motor seizures; Lennox-Gestault syndrome (petit mal)

  11. Hydantoins Action • Work primarily on the motor cortex, where they stop the spread of seizure activity by increasing or decreasing Na+ ion movement across the motor cortex during the generation of nerve impulses Uses • Grand mal and psychomotor seizures, status epilepticus, migraines, and trigeminal neuralgia

  12. Succinimides Action and Uses • Elevation of the seizure threshold in the cortex and basal ganglia and reduced synaptic response to low-frequency repetitive stimulation; controls petit mal seizures Adverse Reactions Drug Interactions • Other antiseizure agents and bone marrow–depressing drugs

  13. Succinimides (cont.) Nursing Implications and Patient Teaching • Assessment • Diagnosis • Planning • Implementation • Evaluation • Patient Teaching

  14. Antiemetic-Antivertigo Agents Action • Factors that may provoke nausea and vomiting: some drugs, metabolic disorders, radiation, motion, gastric irritation, vestibular neuritis, or increases in central trigger zone dopamine levels or vomiting center acetylcholine levels • Agents act to redirect stimulation by stopping or reducing stimulation of the vomiting center Uses • Prevent and treat motion sickness or the nausea and vomiting that occur with surgery, anesthesia, and cancer treatment

  15. Antiemetic-Antivertigo Agents (cont.) Adverse Reactions • Drowsiness and drug tolerance with long-term therapy • Anticholinergic effects Drug Interactions • CNS depressants

  16. Antiemetic-Antivertigo Agents (cont.) Nursing Implications and Patient Teaching • Assessment: patient history • Diagnosis • Planning • Secondary problems: nutrition and hydration • Implementation • Evaluation • Patient Teaching Drug Table 16-4

  17. Antiparkinsonian Agents Actions • Change the neurotransmitters produced in the brain: excessive acetylcholine, deficient dopamine • Block the uptake of acetylcholine and elevate the functional levels of dopamine in the motor regulatory centers Uses • Control of the symptoms of Parkinson’s disease

  18. Antiparkinsonian Agents (cont.) Adverse Reactions • Dysrhythmias, muscle twitching, GI symptoms, etc. • Anticholinergic agents Drug Interactions • Many; read product information closely

  19. Antiparkinsonian Agents (cont.) Nursing Implications and Patient Teaching • Assessment • Diagnosis • Planning • Implementation • Evaluation • Patient Teaching Drug Table 16-5

  20. Chapter 16 Lesson 16.2

  21. Learning Objectives • Identify the role of psychotropic drugs in psychotherapeutic intervention • Compare and contrast different categories of medications used to treat depression • Identify the major classes of drugs that affect the central nervous system

  22. Psychotherapeutic Agents • Antianxiety Medications • Antidepressants • Antipsychotic Drugs • Antimanic Drugs • Sedation-Hypnotic Medications

  23. Antianxiety Agents • Drug Table 16-6 • Anxiety is common • Problematic when it interferes with a person’s ability to perform activities of daily living

  24. Antianxiety Agents (cont.) Action • Produce a calming effect Uses • Relieve anxiety, tension, and fear • May be used to manage alcohol withdrawal symptoms; used preoperatively; used to relieve muscle spasm

  25. Antianxiety Agents (cont.) Adverse Reactions Drug Interactions • Increase effects • Antagonize effects

  26. Antianxiety Agents (cont.) Nursing Implications and Patient Teaching • Assessment • Diagnosis • Planning • Implementation • Evaluation • Patient and Family Teaching • Dosing; appointments and follow-up; adverse reactions; safety with storage; drug and alcohol interactions • Habit-forming: should be used for the least time possible

  27. Antidepressants • Tricyclics • MAOIs • SSRIs • Miscellaneous

  28. Tricyclic Antidepressants Action • Believed to inhibit the reuptake of norepinephrine and or/serotonin Uses • To treat endogenous depression; mild depression due to exogenous causes Adverse Reactions Drug Interactions Nursing Implications and Patient Teaching Drug Table 16-7

  29. Monoamine Oxidase Inhibitors Action and Uses • Monoamine oxidase: naturally occurring enzyme found in the mitochondria of cells; located in nerve endings, kidneys, liver, and intestines; normally acts as catalyst to inactivate dopamine, norepinephrine, epinephrine, and serotonin • MAO inhibitors (MAOIs) block inactivation of these biogenic amines, resulting in increased concentrations at neuronal synapses and antidepressant effects Drug Table 16-8

  30. Selective Serotonin Reuptake Inhibitors Action and Uses • Act by inhibiting CNS neuronal uptake of serotonin • Used short-term for treatment of outpatients with diagnosis listed as a category of Major Depressive Disorders in the DSM-IV • Used long-term for dysthymic and minor depressive disorders Adverse Reactions Drug Interactions Nursing Implications and Patient Teaching Drug Table 16-9

  31. Miscellaneous Antidepressants • Tetracyclic compounds: maprotiline, mirtazapine (Remeron), trazodone (Desyrel) • Unrelated products: bupropion (Wellbutrin), nefazodone (Serzone), venlafaxine (Effexor)

  32. Antipsychotic Drugs Action and Uses • All antipsychotic agents act by blocking the action of dopamine in the brain • Used in the treatment of severe mental illness • May be used in combination with major tranquilizers Drug Table 16-10

  33. Phenothiazines and Thioxanthenes Action • Block dopamine at the postsynaptic receptor to increase the metabolism of dopamine; reduce sensory simulation and produce a sedating effect; act as an antiemetic by inhibiting action in the chemoreceptor center Uses • Reducing and relieving acute and chronic psychosis of schizophrenia, schizoaffective disorders, and involutional psychosis

  34. Nonphenothiazines Action and Uses • Mechanism of action for these products is often not precisely understood when used to treat psychotic patients Drug Table 16-11

  35. Antimanics Action and Uses • Exact mechanism of lithium’s action is unknown; alters sodium transport at nerve endings and enhances uptake of serotonin and norepinephrine by the cells (inactivates these neurotransmitters) • Mood-stabilizing drug • Used to treat patients with bipolar disorder who are in acute manic phase; prevents recurrent manic episodes

  36. Sedative-Hypnotic Medications Action and Uses • Sedative agent: relaxes the patient and allows him or her to sleep • Hypnotic agent produces sleep in the patient • Used to relax patients and induce sleep before medical testing and surgical procedures; used to treat insomnia caused by mental and physical stress Drug Tables 16-13, 16-14, 16-15

  37. Sedative-Hypnotic Medications (cont.) Adverse Reactions Drug Interactions Nursing Implications and Patient Teaching

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