CNS #1 - Pharm

Parkinson's Disease (PD)

- Is a chronic disorder of the CNS - Caused by imbalance of dopamine (not enough) and acetylcholine (too much) - Treatment is palliative rather than curative

selegiline (Eldepryl) rasgiline (Azilect)

- MAO-B Inhibitors - Prevent the breakdown of dopamine in the brain by blocking an enzyme called MAO-B SE: cheese effect" - Tyramine containing foods

- doxapram (Dopram) - Caffeine (NoDoz)(Vivarin)

- Respiratory Stimulants (Analeptic Agents) - Stimulates medullary respiratory center relaxes bronchial smooth muscle - se: Tremors, Sinus Tachy cardia

rivastigmine (Exelon)- topical/ oral donepezil (Aricept) tacrine (Cognex) galantamine hydrobromide (Razadyne) memantine (Namenda)

- Acetylcholinesterase Enzyme Inhibitors - stops cholinesterase helps Acetylcholine from breaking down, however do not stop or reverse loss of acetylcholine - Do not cure but slows down - Bradacardia/ Hypotension Bronchoconstriction Watch giving to pt with COPD / Asthma/ renal or liver disease

- methylphenidate (Ritalin, Concerta) - pemoline (Cylert) - atomoxetine (Straterra)

- Amphetamine-like Drugs - More effected; Less ability abuse and tolerance - Block the re uptake of dopamine and norepinephrine- leave them in the synapse longer, increasing the attention span - Best given 30-45 minutes before meals and early in the day to avoid wakefulness at bedtime

- benztropine mesylate (Cogentin) - trihexyphenidyl (Artane) - biperiden (Akineton) - diphenhydramine (Benadryl)

- Anticholinergic Therapy - SE: Dry throat, nose, mouth, respiratory secretions, Constipation, urinary retention - Contraindicated in clients with closed angel glaucoma

What are some Tyramine containing foods?

- Antidepressants+ cheese with tyramine in it= Hypertensive Crisis - Dairy/ Cheese - Meet - Chicken/Fish - RED WINE/ BEER

A patient taking methylphenidate (Ritalin) is nauseous and vomiting. What is the nurse's best action?

- Ask the patient if he or she has been taking the medication regularly. - Nausea, vomiting, and headache are symptoms of withdrawal. The nurse should find out if the patient has been taking the medication regularly.

- mephobarbital (Mebaral - phenobarbital - primidone (Mysoline)

- Barbiturates - DO NOT ABRUPTLY STOP TAKING - Can be habit forming - Causes mild sedation - Treats migraine headaches

- tolcapone (Tasmar)- - entacapone (Comtan)- - levodopa/carbidopa/entacapone (Stalevo)-

- COMT Inhibitors - O-methyltransferase (COMT), an enzyme, breaks down dopamine - COMT Inhibitors block this breakdown and increases amount of levodopa available in the brain

Chloral Hydrate (Noctec)

- Calming for pre and post op - Treats insomnia - Withdrawn from market in 2012 - Sometimes used in kids for small procedures

amantadine (Symmetrel)

- Dopamine Agonists - Stimulate the dopamine receptors in the brain= more dopamine - Slow destruction of dopamine - Cause dopamine be released by storage sites SE: GI, Rose color modeling to the skin, seizures

- bromocriptine mesylate (Parlodel)

- Dopamine Agonists -Blocks the release of prolactin from the pituitary gland, stimulating dopamine receptors in the brain - SE: MATALIC TASTE IN MOUTH, back pain, swelling in your ankles or feet, urinating less than usual or not at all

carbidopa/levodopa (Sinemet)

- Dopaminergic Therapy - Carbidopa is known as an enzyme blocker. - It works by preventing the breakdown of levodopa in the bloodstream. This allows more levodopa to enter the brain, where it can decrease Parkinson's symptoms. - By helping more levodopa get into the brain so that less stays in the bloodstream, carbidopa can reduce some of levodopa's side effects such as nausea. - Prevents shakiness, difficult moving, stiffness - SE: mental/mood changes, Chest pains, seizures, orthostatic hypotension, Avoid excess vitamin B6 intake to prevent medication reactions, Urine/sweat/ saliva: red, brow, black

The patient is noted to experience isolated clonic contractions lasting 3 to 10 seconds and limited to one limb. The nurse identifies this activity as which type of seizure?

- Focal myoclonic seizure - Focal myoclonic activity consists of isolated clonic contractions that last 3 to 10 seconds that are limited to one limb.

What are the types of drugs used to treat seizures

- Hydantoins - Barbiturates - Succinimides - Benzodiazepines - valproic acid (Depakene) - Iminostilbenes

- phenytoin (Dilantin) - fosphenytoin (Cerebyx)

- Hydantoins - Stabilizes nerve cells, against hyper-excitability and peripheral nerves such as the spinal cord - se: Gingival hyperplasia, Nystagmis- twitching of the eyes - Very narrow therapeutic range- 10-20 mcg/ml

- carbamzepine (Tegretol) - oxcarbazepine (Trileptal)

- Iminostilbenes - Inhibits the transfer of sodium thru. the sodium channels and decreases the discharge of neurons around the areas of activity - se: Chest pain, Jaundice, Insomnia/ confusion

Alzheimer's disease

- Irreversible form of senile dementia resulting from nerve cell deterioration - Experience cognitive deterioration and steady decline of physical and mental functioning

- thiopentothal Na (Sodium Pentothal) - methohexital Na (Brevital) - pentobarbital (Nembutal) - secobarbital (Seconal) - butabarbital (Butisol) - Phenobarbital (Luminal) - mephobarbital (Mebaral)

- Sedative/Hypnotics - Barbiturates (Generic names all end in "tal") - Happens by stopping the impulse through the synaptic junction - Uses: Induce sleep, Anxiety - Se: "Hangover effect, Rem Rebound- bad/ vivid nightmares - Liver/ renal impairment- pulmonary disease use cautiously - When used with opioids, histamines, alochol see more depression of resp - Suppress non- REM sleep and delay REM sleep

- ethosuximide (Zarontin) - drug of choice - methsuximide (Celontin)

- Succinimides - Depresses the motor cortex, by decreasing the amount of Ca that enters the CNS - Raise the seizure threshold - Absent (Partial) seizures - GI side effects

- phentermine (Suprenza) - benzphetamine (Didrex) - diethypropion (Tenuate) - phendimetrazine (Bontril) - lorcaserin (Belviq) - orlistat (Xenical - Rx)(Alli - OTC)

- Suppress the appetite - No kids under 12 - Anorexiants - Lipase Inhibitors

methamphetamine is a Amphetamine that is used for what? and does what?

- Used to treat ADHD and obesity - Increases Dopamine in the brain

What is the drug of choice for status epileptics?

- diazepam (Valium)

Lipase Inhibitors

- have replaced Anorectic Agents, as the drug of choice for wight loss d/t decreasing GI absorption of dietary fats - Oily discharge form the, rectum, Fecal Urgency, Incontinence, Fatty stool, Shartting, Headaches, NVD, Abdominal cramping

Anorectic Agents

- no longer used as appetite suppresses d/t: dependence, abuse, tolerance also known to cause renal failure, physcosis, hpyertension, arythmias - se: nervousness, restlessness, irritable, insomnia, palpitations, hypertension

paraldehyde (Paral)

- produces nonspecific, reversible - depression of CNS -In large doses, causes respiratory depression and hypotension -Liquid: tastes sharply of acetic acid. -Must be mixed in milk or iced fruit juice. -Has a strong odor

Seizure

A brief episode of abnormal electrical activity in nerve cells of the brain

Epilepsy

A chronic, recurrent pattern of seizures

The patient has recently been prescribed a sedative-hypnotic medication and reports experiencing a "hangover"-type effect upon awakening. What does this symptom indicate?

A need to change to a different medication

- dextroamphetamine sulfate (Dexadrine) - methamphetamine - amphetamine sulfate (Adderall)(Adderall XR)

Amphetamines Narcolepsy ADHD se: Insomnia, Hypertension, impotense Needs to be withdrawn gradually Best time to administer 6 - 8 hours before sleep

The nurse is caring for a child taking methylphenidate (Ritalin). Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's highest priority action?

Assess for over-the-counter medication use. - Methylphenidate interacts with over-the-counter cold medication. The nurse should assess for the use of over-the-counter medication use.

While obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). What is the nurse's primary assessment?

Assess patient for absence seizures. - Ethosuximide (Zarontin) is the first-line drug of choice to treat absence seizures

Which is a priority nursing action when assessing for side effects expected in a patient taking analeptics?

Assessing patient for nervousness - Analeptics are CNS stimulants, thus causing nervousness as a side effect. The stimulation effect can result in increased heart rate, increased mental alertness, and hypertension as well.

flumazenil (Romazicon)

Benzodiazepine Antagonist Used to treat Benzodiazepine toxicity/overdose

- lorazepam (Ativan) - alprazolam (Xanax) - diazepam (Valium) - estazolam (ProSom) - temazepam (Restoril) - triazolam (Halcion)

Benzodiazepines (generic names all end in "am") Anxiety, Panic attacks, Seizures, insomnia Rapid onset, Alcohol with draw, muscle relaxant Schedule 4 controlled substance Take with food/ milk if upset stomach Very safe

ID: 1111283231 The nurse is monitoring phenytoin (Dilantin) being infused intravenously at 55 mg/min. What action will the nurse take next? A. Continue to monitor the infusion. B. Have the drug changed to PO. C. Decrease the infusion and assess blood pressure. D. Increase the infusion.

C. Decrease the infusion and assess blood pressure. - Infusing phenytoin (Dilantin) at rates >50 mg/min can cause severe hypotension or cardiac dysrhythmias.

The nurse is developing a teaching plan for a patient prescribed carbidopa-levodopa (Sinemet). What information does the nurse use as a basis for the teaching plan?

Carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier.

A patient has been taking benztropine (Cogentin). Which outcome assessment helps the nurse verify therapeutic effects of this medication?

Patient has had a decrease in tremors.

Sedation

Diminished physical and mental responses

Anticonvulsants (Antiepileptics)

Drugs used to treat seizures by decreasing the number and severity of seizures

A patient is admitted to the emergency department with an overdose of a benzodiazepine. Which antidote will the nurse expect to administer

Flumazenil (Romazicon)

The nurse is caring for a patient who describes symptoms indicative of narcolepsy. The nurse recognizes that the physician is most likely to order which medication for the patient?

Modafinil (Provigil)

What is a priority nursing action when taking care of a patient who is prescribed a central nervous system (CNS) stimulant?

Monitor the patient for seizure activity. - Central nervous system (CNS) stimulation occurs when the amount and duration of action of excitatory neurotransmitters are increased. This can lead to the development of seizure activity in the patient who has received a central nervous system stimulant.

- zolpidem tartrate (Ambien) - eszopiclone (Lunesta) - zaleplon (Sonata) - ramelteon (Rozerem)

Non-Benzodiazepines

Status Epilepticus

Rapid succession of seizures without a rest period between them

The nurse expects that a newborn who is experiencing apnea is most likely to be ordered treatment with which medication?

Theophylline

The patient has recently been prescribed a benzodiazepine and reports experiencing vivid dreams. What does this symptom indicate?

Therapeutic effect of the medication

The nurse is caring for a patient who is taking a barbiturate. Which assessment finding requires immediate action by the nurse?

Urinary output of 10 mL/hr

Hypnotic

a form of "natural" sleep

The patient asks the nurse if there is anything that the physician could order that would function as an appetite suppressant. The nurse anticipates that the physician may order which medications? (Select all that apply.) a. Phentermine-topiramate (Qsymia) b. Caffeine citrate (Cafcit, NoDoz) c. Diethylpropion HCl (Tenuate) d. Benzphetamine HCl (Didrex) e. Armodafinil (Nuvigil)

a. Phentermine-topiramate (Qsymia) c. Diethylpropion HCl (Tenuate) d. Benzphetamine HCl (Didrex)

The patient is receiving triazolam (Halcion) as part of treatment for insomnia. The patient complains of experiencing memory problems. The nurse recognizes this as

an adverse reaction to the drug.

What Acetylcholinesterase Enzyme Inhibitors are VERY HEPATO TOXIC

donepezil (Aricept) tacrine (Cognex)

Drug of choice to treat respiratory depression caused by drug overdose.

doxapram (Dopram)

The patient has been ordered doxapram HCl (Dopram). The nurse recognizes that this medication is intended as a/an

respiratory depressant

Diskynesia

uncontrolled involuntary movements while awake