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Unit 11: Drugs that affect the CNS

Unit 11: Drugs that affect the CNS. Nancy Pares, RN, MSN NURS 1950 Metropolitan Community College. Obj. 1: Describe the general cause of seizures and the two major clinical findings associated with seizures. Seizures Abnormal or uncontrolled neuronal discharges in the brain affect

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Unit 11: Drugs that affect the CNS

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  1. Unit 11: Drugs that affect the CNS Nancy Pares, RN, MSN NURS 1950 Metropolitan Community College

  2. Obj. 1: Describe the general cause of seizures and the two major clinical findings associated with seizures. Seizures Abnormal or uncontrolled neuronal discharges in the brain affect Consciousness Motor activity Sensation Symptom of an underlying disorder-not a disease itself

  3. Obj 2: Factors that precipitate seizures Infectious diseases Trauma Metabolic disorders Vascular diseases Pediatric disorders Neoplastic diseases

  4. Drugs as cause of seizures High dose of local anesthetics Drug abuse Withdrawal from alcohol Withdrawal from sedative-hypnotics

  5. Convulsion Involuntary violent spasm of large muscles of the face, neck, arms and legs Not synonymous with seizure

  6. Obj. 3: Name and describe major types of epileptic seizures Signs and symptoms Related to the area of the brain with abnormal activity Types-based on International Classification Partial (focal) Generalized Special epileptic syndromes

  7. Simple partial (focal) seizures Occur in limited portion of brain Point of origin: abnormal focus or foci Clients experience Feeling that is vague Hallucinations with all senses Extreme emotions Twitching of arms, legs or face

  8. Complex partial (focal) seizures Altered levels of consciousness Involve sensory, motor, autonomic symptoms Aura commonly precedes seizure No memory of seizure

  9. Generalized seizures Travel throughout the entire brain Subcatagories Absence Atonic Tonic-clonic

  10. Absence seizures Common in children Subtle symptoms Staring Transient loss of consciousness Eyelid fluttering Myclonic jerks

  11. Atonic seizures Usually last only a few seconds Characterized by stumbling or falling

  12. Tonic clonic Most common Usually preceded by aura Tonic phase Intense muscle contractions Hoarse cry at onset Loss of bowel/bladder control Shallow breathing

  13. Tonic clonic, cont Clonic phase Alternating contraction and relaxation of muscles Postictal state (post seizure) Drowsiness, disorientation, deep sleep

  14. Special epileptic syndromes Febrile seizures Myoclonic seizures Status epilepticus

  15. Febrile seizures Last one –two minutes Tonic clonic motor activity Common in 3-5 year olds Occur with rapid rise in body temperature Affect 5% of all children

  16. Myoclonic seizures Large jerking body movements Quick contraction of major muscles Stumbling and falling Similar to normal infantile Moro reflex

  17. Status epilepticus Medical emergency Continuously repeating seizure Common with generalized tonic-clonic Continuous muscle contractions May compromise airway May cause hypoglycemia, hypothermia, acidosis May produce lactic acid

  18. Obj. 4, 5, 6,and 7 (inclusive) The choice of drug depends upon Type of seizure Client history and diagnostic studies Pathologic process causing seizures

  19. Barbiturates and GABA Agents GABA= gamma aminobutyric acid Primary neuro transmitter of brain. Drugs that potentiate GABA action Barbiturates Benzodiazepines Misc. agents

  20. Barbiturates Prototype: phenobarbital (Luminal) Mechanism of action Changing the action of GABA Primary use Controlling seizures Adverse effects Dependence, drowsiness, vitamin deficiencies, laryngeospasm

  21. Benzodiazepines Prototype: diazepam (Valium) Mechanism of action Similar to barbiturates, but safer Primary use Short term seizure control Adverse effects Drowsiness and dizziness

  22. Miscellaneous GABA Agents Prototype: valproic acid (Depakene) Mechanism of action: similar to benzo’s and barbiturates Primary use Adjunct therapy Adverse effects: Sedation, drowsiness, GI upset, prolonged bleeding time

  23. Hydantoins • Prototype: phenytoin (Dilantin) • Mechanism of action: • Desensitize sodium channel blockers • Primary use • Treatment of all types of seizures, except absence seizures • Adverse effects: • CNS depression, gingival hyperplasia, skin rash, cardiact dysrhythmias, and hypotension

  24. Phenytoin-like Drugs • Prototype drug: valproic acid (Depakene) • Mechanism of action: • Desensitize sodium channels • Primary use: • Absence seizures • Adverse effects: • Limited CNS depression, visual disturbances, ataxia, vertigo, HA, GI, hepatotoxicity, pancreatitis

  25. Succinimides • Prototype: ethosuximide (Zarontin) • Mechanism of action • Suppress calcium influx • Primary use • Absence seizures • Adverse effects: • Rare, but include drowsiness, dizziness, lethargy • Rare, but serious: lupus, leukopenia, aplastic anemia, Stevens-Johnson syndrome

  26. Nurse’s role in pharmacological management • Barbiturates: • Monitor for liver and kidney function • Category D in pregnancy • Depletion of nutrients • Alcohol and ginko biloba interactions • Client teaching • Use reliable contraception • Immediately report pregnancy • Report excessive bleeding,drowsiness, bone pain • Avoid alcohol and gingko biloba

  27. Benzodiazepines-schedule IV drug • Monitor for drug abuse potential • Pregnancy risk (category D) • Contraindicated in narrow angle glaucoma • Liver and kidney function monitored • Respiratory depression • In event of overdose • Give flumazenil (Romazicon)

  28. Status epilepticus • Give IV valium and ativan • Do not mix with other drugs in IV line • Client teaching • Avoid ETOH, OTC drugs, herbal preps, nicotine, driving and hazardous activities • Rebound seizures if d/c abruptly • Take with food • These drugs most often used illegally

  29. Hydantoin and Phenytoin-like drugs • Monitor serum drug levels, liver and kidney function • Monitor for bleeding disorders • Fatal hepatotoxicity can occur • Contraindicated • Hx of heart block or seizures due to low BS • Client teaching • Routine labs; report s/s of toxicity, bleeding, pregnancy, hypoglycemia

  30. Succinimides • Monitor for liver and kidney function • Pregnancy category C • Adverse reactions: • Drowsiness, HA, euphoria, n/v, weight loss, abd. Pain • Life threatening reactions: • Mental depression with suicide intent • Blood dyscrasias and Stevens-Johnson syndrome

  31. Succinimides • Symptoms of overdose • CNS depression, stupor, ataxia, coma • Client teaching • Report mood changes or suicidal thoughts • Avoid driving and hazardous activities • Take with food • Do not stop abruptly • Report weight loss and anorexia

  32. General client teachings for epilepsy • Start with smallest dose of med • Add additional drugs, if needed • Monitor serum drug levels • Withdrawal of meds • Seizure free for three years • Done gradually • Resume meds if seizures return • Knowledge of rebound seizures

  33. Nursing diagnosis for epilepsy Disturbed sensory perception RT seizure activity Risk for injury RT seizure activity Deficient knowledge RT disease/drugs Noncompliance RT drug regime Noncompliance RT serum lab testing

  34. Goals in epilepsy treatment Absence/reduction in number of seizures No injury during seizure Understanding of disease Understanding of drug regimen Compliance with lab testing

  35. Obj. 13: define sedative and hypnotic • Sedative: • An agent that calms nervousness, irritability and excitement • Hypnotic • An agent that induces sleep

  36. Obj. 16: Name the conditions that may cause muscle spasticity. • Results from damage to the motor area of the cerebral cortex • Conditions: • Cerebral palsy • severe head injury, spinal cord injury or lesions • stroke • dystonia

  37. Obj. 17: Goals of drug therapy for muscle spasms • Goals of muscle relaxants • Minimize discomfort • Increase ROM • Improve ability to function independently

  38. Obj. 18: Name the musculoskeletal relaxants • Centrally acting muscle relaxants • Prototype: cyclobenzaprine (Flexeril) • Mechanism of action • Inhibits upper motor neuron activity • Alters simple spinal reflexes, causes CNS depression • Primary Use • Treat localized spasms • Adverse effects • CNS depression, hepatic toxicity, physical dependence, anticholinergic effects

  39. Obj. 18: cont • Direct acting antispasmodics • Prototype: dantrolene (Danantrium) • Mechanism of action • Interferes with release of calcium ions in skeletal muscle • Primary use • Relieve dystonias and leg cramps • Adverse effects • Hepatic toxicity, muscle weakness, drowsiness, diarrhea

  40. Obj. 19 Nursing process for CNS drugs • Assessment • Monitor pain, LOC, vital signs • Monitor muscle tone, ROM, degree of spasms • Monitor labs • Nursing Dx • Pain • Impaired physical mobility • Risk for injury • Deficient knowledge

  41. Obj. 19 cont • Goals • Decrease pain • Increase range of motion (ROM) • Reduce muscle spasms • No adverse effects of drugs • Knowledge of drug regimen

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