Understanding Nervous System Medications for Health Management

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