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55 Cards in this Set

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Medications Affecting the Nervous System
(Classifications)
• Muscarinic agonists (parasympathomimetic)  Bethanechol
• Muscarinic antagonists  Atropine
• Ganglionic-stimulating agents  Nicotine
• Cholinesterase inhibitors (ChE)  Physostigmine or neostigmine
• Neuromuscular-blocking agents  Tubocurarine
• Adrenergic agonists (sympathomimetic)  Epinephrine
• Adrenergic antagonists block α & β receptors.  Prazosin  α adrenergic antagonist
 Propanolol  β adrenergic antagonist
NicotinicN Receptors
• Release of epinephrine from adrenal medulla
NicotinicM Receptors
• Located at neuromuscular junction of skeletal muscle
• Causes skeletal muscle contraction
Muscarinic Receptors
•  secretions from lungs, stomach, intestines, sweat glands
•  in HR
• Smooth muscle contraction in bronchi and GI tract
• Miosis (sphincter contraction) and accommodation (ciliary contraction)
• Voiding due to contraction of detrusor muscle and relaxation of trigone and sphincter muscles
Alpha1 Receptors
• Mydriasis d/t radial muscle contraction
• Veins and arterioles are activated to constrict
•  peripheral resistance,  blood pressure
• Male sex organs are activated to promote ejaculation
• Contraction of prostatic capsule, trigone, and
Dopamine Receptors
• Dilates blood vessels in the kidneys
Beta1 Receptors
• Predominant receptor found on the heart
•  HR,  Contraction Force,  Conduction through AV node
•  lipolysis
• Release of Renin by the kidneys
Beta2 Receptors
• Dilates bronchi
• Relaxes uterine smooth muscle
• Vasodilation of arterioles in heart, lungs, and skeletal muscle
• Slightly  peripheral resistance
•  glycogenolysis in the liver and muscles
• Skeletal muscle contraction
Medications Affecting the Nervous System
(General Points)
• Adaptive changes within brain with prolonged exposure
•  therapeutic effect
•  side effects
• Tolerance, physical dependence
• Do not stop abruptly
• Highly variable individual response to mediations
Parkinson’s Disease
• Treatment uses two main classes:
• Meds that activate dopamine receptors (directly or indirectly)
• Meds that block acetylcholine receptors
Seizure Disorders
• Δ types of seizures respond to Δ medications
• Usually require life-long management
• Meds must be discontinued slowly over 6 weeks
Schizophrenia
• Clinical course includes semi-remission punctuated by acute exacerbations
• Positive symptoms (Agitation, delusions)
• Conventional antipsychotic  Thorazine
• Atypical antipsychotic  Clozapine
• Negative symptoms (Social withdrawal, poor self-care)
• Atypical antipsychotic  Clozapine
• Cognitive symptoms (Difficulties with memory and learning)
• Initial doses are high and given throughout day; maintenance doses given at bedtime.
Depression
• Symptom relief can take 1-3 weeks and possibly 2-3 months
• Three main groups:
• Tricyclic antidepressants (TCAs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Monamine oxidase inhibitors (MAOIs)
Bipolar Disorder
• Typically managed with mood stabilizers. Antipsychotics and antidepressants may be used during acute episodes of mania or depression
Cholinesterase Inhibitors
Expected Action: Proto: Neostigmine, Physostigmine
• Prevents ACh degradation   transmission of nerve impulses by  [ACh]
Therapeutic Uses:
•  muscle strength by  [ACh] at neuromuscular junction in myasthenia gravis
• Reversal of nondepolarizing neuromuscular blocking agents (tubocurarine)
Adverse Effects:
• Excessive muscarinic stimulation:  GI motility & secretions, bradycardia, urinary urgency (side effect can be treated with atropine)
• Cholinergic crisis: Above plus resp. depression from neuromuscular blockade.
Contraindications/Precautions: • Pregnancy (C)
• CI in obstruction of GI/GU systems / caution with seizures, asthma, bradycardia, hypotension, peptic ulcer disease
Interactions: Tubocurarine – Neostigmine reverses blockade
• Atropine – counteracts • Succinylcholine -  neuromuscular blockade
Education: • Wear medic-alert bracelet
Neuromuscular Blocking Agents
Expected Action: Proto: Nondepolarizing: tubocurarine, pancuronium Depolarizing: succinylcholine
• Block ACh at neuromuscular junction – don’t cross blood-brain barrier
Therapeutic Uses: • Control spontaneous respiration in ventilated pts.
• Adjuncts to general anesthesia • Diagnose myasthenia gravis
• Succinylcholine for: electroconvulsive therapy, intubation, endoscopy
Adverse Effects: • Hypotension from histamine release & ganglionic blockade
• Respiratory arrest • Bradycardia, dysrhythmias
Succinylcholine: • Low pseudocholinesterase activity  apnea
• Malignant hyperthermia (dantrolene) • Pain • Hyperkalemia
Contraindications/Precautions: • Pregnancy (C) •
• SCh: CI for hyperkalemia (trauma, burns) •
Interactions: • General anesthetics
• • Aminoglycosides/tetracyclines -  NM blockade
• Neostigmine/ChE inhibitors: η nondepolarizing / η depolarizing
Dopaminergics
(Anti-Parkinson’s
Expected Action: Proto: Levodopa, carbidopa, Sinemet
• Levodopa taken up and converted to dopamine. Carbidopa augments levodopa by preventing conversion to dopamine in intestine and periphery ([DA] in CNS).
Therapeutic Uses: • Symptomatic relief from dyskinesias
Adverse Effects: • Dyskinesias • Discoloration of sweat & urine
• Nausea / drowsiness • Orthostatic hypotension
• Psychosis (clozapine) • Activation of malignant melanoma
Contraindications/Precautions: • !! ĉ cardiac or psychiatric disorders
• CI ĉ melanoma • 2 weeks from MAOI • Pregnancy (C)
Interactions: • Proteins interfere with absorption and transport
• Conventional antipsychotics (haldol, compazine) η
• Pyridoxine η • MAOI  hypertension
• Carbidopa, dopamine agonists, anticholinergics, COMT inhibitors and dopamine releasers  therapeutic effects.
COMT
• Catechol O-Methyltransferase
• Deactivates catecholamines (dopamine, norepinephrine, acetylcholine, epinephrine, serotonin, histamine, etc)
• Found in post-synaptic cell membranes of adrenergic neurons where it degrades norepinephrine.
• Also found in gut
Dopamine Agonists
(Anti-Parkinson’s
Expected Action: Proto: Pramipexole, ropinirole, bromocryptine
• Act directly on dopamine receptors
Therapeutic Uses:
• Monotherapy early / combined with levodopa in later stages
Adverse Effects: • Orthostatic hypotension • Psychosis
• Sleep attacks • Daytime sleepiness • Dyskinesias • Nausea
Contraindications/Precautions: • Pregnancy (C)
• Caution ĉ liver & kidney impairment
Interactions:
• Levodopa: Can  motor-control fluctuations permitting lower dose
• Levodopa: Also  risk of orthostatic hypotension and dyskinesias
Education:
Centrally Acting Anticholinergics
(Anti-Parkinson’s)
Expected Action: Proto: Benztropine (Cogentin), trihexyphenidyl (Artane)
• Block ACh at muscarinic receptors which helps maintain ACh, dopamine balance
Adverse Effects: • Nausea (take ĉ food) •
• Atropine-like effects (dry mouth, blurred vision, mydriasis, constipation)
• Antihistamine effects (sedation, drowsiness)
Contraindications/Precautions:
• CI in narrow-angle glaucoma •
Interactions:

Education:
Antiviral
(Anti-Parkinson’s)
Expected Action: Proto: Amantadine
• Stimulate dopamine release, prevent dopamine reuptake, and may block cholinergic and glutamate receptors
Therapeutic Uses: • Parkinson’s Disease
Adverse Effects: • CNS Effects • Discoloration of skin (temporary)
• Atropine-like effects
Contraindications/Precautions:

Interactions:

Education:
Antiepileptic Medications
(Medication List)
• Barbiturates phenobarbital (Luminal)
• Hydantoins phenytoin (Dilantin)
• Benzodiazepines diazepam (Valium)
• Lorazepam (Ativan)
• Carbamazepine (Tegretol)
• Ethosuximide (Zarontin)
• Valproic acid (Depakote)
• Gabapentin (Neurontin)
• Other meds lamotrigine (Lamictal)
• oxcarbazepine (Trileptal)
• clonazepam (Klonopin)
• Mechanisms:
• Slow Ca2+ and Na+ reentry to neuron • Potentiating inhibitory effect of (GABA)
• Suppress neuron firing
Barbiturate
(Antiepileptic)
Therapeutic Uses: Proto: Phenobarbital (Luminal)
• Partial seizures and generalized tonic-clonic seizures
• Not effective against absence seizures
Adverse Effects:
• CNS effects: Adults as sedation and anxiety, kids as irritability and hyperactivity
• Toxicity: Nystagmus, ataxia, respiratory depression, pinpoint pupils
Contraindications/Precautions: • Pregnancy (D)
• CI ĉ intermittent porphyria
Interactions:

Education:
Hydantoins
(Antiepileptic)
Therapeutic Uses: Proto: Phenytoin (Dilantin)
• Effective against all major forms except absence seizures
Adverse Effects:
• CNS effects • Skin rash • Teratogenic • Gingival hyperplasia
• Cardiovascular • Endocrine effects • Vitamin D metabolism
Contraindications/Precautions:
• CI: sinus bradycardia, SA blocks, 2nd & 3rd degree AV blocks
Interactions: • Oral contraceptives, warfarin, glucocorticoids: η of these
• EtOH, diazepam, cimetidine, valproic acid:  phenytoin levels
• Carbamazepine, phenobarbital, chronic EtOH:  phenytoin levels
• CNS depressants (e.g. barbiturates/EtOH): Additive effects with concurrent use
Education: • Use IV route for status epilepticus • Antidysrhythmics
Carbamazepine
(Antiepileptic)
Therapeutic Uses: Proto: Tegretol
• Partial seizures, tonic-clonic seizures, bipolar disorder, trigeminal neuralgia
Adverse Effects: • Skin disorders
• Cognitive function is minimally affected but CNS effects can occur
• Blood dyscrasias • Teratogenic • Hypo-osmolarity ( ADH secretion)
Contraindications/Precautions:
• CI: marrow suppression / bleeding disorders
Interactions: • Grapefruit juice: inhibits metabolism  [carbamazepine]
• Phenytoin & phenobarbital: η carbamazepine
• Oral contraceptives and warfarin: Carbamazepine stimulates hepatic enzymes which  levels of these medications
Education:
Ethosuximide
(Antiepileptic)
Therapeutic Uses: Proto: Zarontin
• Indicated ONLY for absence seizures
Adverse Effects:
• GI effects (take ĉ food)
• CNS effects (fatigue, dizziness)
Contraindications/Precautions:

Interactions:

Education:
Valproic Acid
(Antiepileptic)
Therapeutic Uses: Proto: Depakote
• Partial, generalized, and absence seizures, bipolar disorder, and migraines
Adverse Effects:
• GI effects (take ĉ food) • Hepatotoxicity • Thrombocytopenia
• Pancreatitis as evidenced by nausea, vomiting, and abdominal pain
Contraindications/Precautions:
• Avoid in children younger than 3 (hepatotoxicity) • Liver disorders
Interactions:
• Phenytoin and phenobarbital: Concurrent use  these medications
Education:
Gabapentin
(Antiepileptic)
Therapeutic Uses: Proto: Neurontin
• Single agent used for partial seizures • Neuropathic pain • Migraine prev.
Adverse Effects:
• CNS effects (drowsiness, nystagmus)
Contraindications/Precautions:

Interactions:

Education:
Benzodiazepines
(Antiepileptic)
Therapeutic Uses: Proto: Diazepam (Valium)
• Used in status epilepticus
Adverse Effects:
• Respiratory depression
• Anterograde amnesia
• Teratogenic
Contraindications/Precautions:

Interactions:

Education:
Muscle Relaxants / Antispasmodics
(Medication List)
Centrally Acting Muscle Relaxants
• Diazepam (valium) • Baclofen (Lioresal)
• Cyclobenzaprine (Flexeril) • Metaxalone (Skelaxin)
Peripherally Acting Muscle Relaxants
• Dantrolene (Dantrium) •
• •
• •
Diazepam
(Muscle Relaxant / Antispasmodic)
Expected Action: Proto: Diazepam (Valium)
• Acts in CNS to enhance GABA and produce sedation
• Acts in CNS to depress spasticity of muscles
Therapeutic Uses: • Relief of spasticity d/t Cerebral Palsy or MS
• Anxiety & panic disorders • EtOH withdrawal • Insomnia
• Status epilepticus • Anesthesia induction • Relief of spasm d/t injury
Adverse Effects: •
• CNS depression • Physical dependence from long-term use
Contraindications/Precautions:
• Pregnancy (D) • Caution ĉ impaired liver or renal function
Interactions:
• CNS depressants (EtOH, opioids, antihistamines, barbiturates): Additive CNS depressive effects with concurrent use.
Education:
Centrally Acting
(Muscle Relaxant / Antispasmodic
Expected Action: Proto: Baclofen, cyclobenzaprine, metaxalone
• Acts in CNS to depress spasticity of muscles
Therapeutic Uses: • Relief of muscle spasm d/t injury
• Relief of spasticity r/t cerebral palsy or multiple sclerosis
Adverse Effects:
• CNS depression • Physical dependence from long-term use
• Metaxalone: hepatotoxicity • Baclofen: nausea, urinary retention, constipation
Contraindications/Precautions: • Caution in patients with impaired liver or renal function.
• Baclofen: Pregnancy (C)
Interactions: • CNS depressants (EtOH, opioids, antihistamines) – additive CNS depressant effects with concurrent use.

Education:
Cue
(Muscle Relaxant / Antispasmodic)
• Response
Peripherally Acting
(Muscle Relaxant / Antispasmodic
Expected Action: Name: Dantrolene (Dantrium)
• Only peripherally acting muscle relaxant. Inhibits muscle contraction by preventing release of calcium in skeletal muscles.
Therapeutic Uses:
• Relief of spasticity d/t cerebral palsy or multiple sclerosis
• Treatment of malignant hyperthermia
Adverse Effects:
• CNS depression • Hepatic toxicity
Contraindications/Precautions:
• Pregnancy (C) • Caution with impaired liver & renal function
Interactions:
• CNS depressants – additive effects
Local Anesthetics
Expected Action: Amide type: Lidocaine – Ester type: tetracaine, procaine
•  pain by blocking local conduction of pain impulses
Adverse Effects: • CNS excitation -- treat ĉ midazolam (Versed) or diazepam
• Hypotension, bradycardia, heart block, cardiac arrest
• Allergic reactions (more likely ĉ esters)
•  uterine contractility. • Freely cross placenta
• Spinal headache (lay flat for 12 hrs) • Urinary retention (call after 8 hrs)
Contraindications/Precautions: • CI in dysrhythmias and/or heart block
• Caution with liver/kidney dysfunction, heart failure, myasthenia gravis
General Inhalation Anesthetics
Expected Action: Proto: Halothane (Fluothane), isoflurane (Forane), nitrous oxide
• Loss of consciousness, loss of sensation, relaxation of muscles, amnesia
Adverse Effects: • Hepatotoxicity • Gastric aspiration
• Hypotension • Respiratory & cardiovascular depression
• Malignant hyperthermia (d/c med, ice or ice saline infusion, dantrolene)
Interactions: •
• CNS depressants: Additive effect • Opioids: constipation & urinary retention

Education: • Succinylcholine – used as a muscle relaxant
• Encourage early ambulation • Assist with lung expansion
Intravenous Anesthetics
(Key Points
• Barbiturates: Thiopental (Pentothal) • Ketamine (Ketalar)
• Benzodiazepines: Diazepam (Valium), midazolam (Versed), lorazepam (Ativan)
• Propofol (Diprivan)
Therapeutic Uses: • Adjunct to inhalation anesthesia
• Induction & maintenance of anesthesia • Amnesia
• Midazolam & an opioid result in conscious sedation
• Ketamine can be used with children
Intravenous Anesthetics
(Effects and Interactions)
Expected Action: Thiopental, Diazepam, Ketamine, Propofol, Midazolam
Adverse Effects: •
• Respiratory and cardiovascular depression
• Propofol: Bacterial infection (use opened vial within 6 hrs)
• Ketamine: Psychologic reaction (premedicate with diazepam to  risk)
Contraindications/Precautions: •
• Ketamine should be avoided with psychiatric disorders
Interactions: •
• CNS depressants and stimulants: Additive effects
• Opioid analgesics: Constipation and urinary retention
Education: •
• Midazolam (Versed): inject over >2 minutes
• Propofol (Diprivan): inject into large vein; prep site with lidocaine.
Antipsychotics - Conventional
Expected Action: Proto: η: chlorpromazine (Thorazine), η: haloperidol (Haldol)
Others: fluphenazine, molindone, perphenazine, thiothixene
• Dopamine, acetylcholine, histamine, & norepinephrine receptors in brain and periphery are blocked. Symptom inhibition d/t dopamine2 blockade in brain.
Therapeutic Uses: • Delusional disorder • Bipolar disorder
• Tourette’s Syndrome • • Schizoaffective disorder
• Dementia • Schizophrenia • Huntington’s chorea
Adverse Effects: • Agranulocytosis • Sedation • Photosensitivity
• Anticholinergic effects • Ortho hypotension • Neuroendocrine effects
• Seizures • Parkinsonism • Sexual dysfunction • Dysrhythmias
• Dystonia • Akathisia • Tardive dyskinesia •
• Neuroleptic malignant syndrome
Interactions: • Anticholinergics: η • CNS depressants: Additive effects
• Levodopa: Counteracts antipsychotics by stimulating dopamine receptors
Education: • Consider depot preparations • Protect liquid prep from ☼
• Early EPS symptoms with anticholinergics, β-blockers, benzodiazepines
Antipsychotic
Expected Action: Proto: clozapine – Others: risperidone, olanzapine, quetiapine
• Action results from blocking serotonin and dopamine receptors (block other receptors, too) --  Pr developing EPS or tardive dyskinesia
Therapeutic Uses: • Severe schizophrenia
• Psychosis induced by levodopa therapy
Adverse Effects: • Agranulocytosis (WBC<3000/cc, Neu<1500/cc)
• Weight gain • New onset diabetes • Seizures
• Myocarditis (dyspnea, RR, lethargy, chest pain, palpitations)
Contraindications/Precautions: •

Interactions: •
• Immunosuppressive medications: Avoid
Education: •
Normal Lab Values
• RBC=4.7-6.1 x 1012/L • WBC = 5-10 x 109/L • PLT = 150-400 x 109/L
• PO2=75-100 mm Hg • PCO2=34-45 mm Hg • pH = 7.35-7.45
• Hgb=14-18 g/dL • Hct=42-52% • PT=11-12.5 s • PTT=60-70 s
• Na+=135-145 mEq/L • Cl-=100-108 mEq/L • Ca2+=9-10.5 mEq/L
• K+=3.5-5 mEq/L • PO43-=3-4.5 mg/dL • Mg2+=1.3-2.1 mEq/L
• Prot=6-8 g/dL • • BUN=8-25 mg/dL
• Alb=3.5-5 g/dL • Osm=275-295 mOsm/kg • Creatinine=0.6-1.5 mg/dL
Neu=55-70%
(2,500-8,000) Lym=20-40%
(1,000-4,000) Mon=2-8%
(100-700) Eos=1-4%
(50-500)
Cue
• Response
Antidepressants – Tricyclic (TCA)
Expected Action: Proto: amitriptyline (Elavil)
Others: imipramine (Tofranil), doxepin (Sinequan)
• Block reuptake of norepinephrine and serotonin in synaptic space
Therapeutic Uses: • Depression & bipolar disorders
Adverse Effects: • Orthostatic hypotension • Sedation
• Anticholinergic effects • Cardiac toxicity @  doses
• Toxicity evidenced by dysrhythmias, confusion, & agitation followed by seizures
Contraindications/Precautions: • Pregnancy (C)
Interactions: • MAOIs  hypertension
• Antihistamine & anticholinergicsadditive effects
• Epi/Norepi   amounts of adrenergics because reuptake is blocked by TCA
• Ephedrine/amphetamine   responses to these d/t uptake inhibition keeps them from reaching site of action in nerve terminal
• EtOH, benzodiazepines, opioids, antihistamines  Additive CNS depression
Selective Serotonin
Reuptake Inhibitors (SSRIs)
Expected Action: Proto: fluoxetine (Prozac) – Others: citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), sertraline (Zoloft)
• Block reuptake of serotonin in synaptic space
Therapeutic Uses: • Major depression • Panic disorders • Bulimia
• OCD • PTSD • PMDD
Adverse Effects: • Sexual dysfunction • Weight gain • Rash
• Withdrawal syndrome • Sleepiness, faintness • Hyponatremia
• Serotonin syndrome 2-72 hrs (confusion, anxiety, agitation, hallucinations)
Contraindications/Precautions: • Pregnancy (C)
• CI: MAOIs
Interactions: • MAOIs   risk of serotonin syndrome
• Warfarin   warfarin levels • TCA & Lithium   levels of these
• NSAIDs & anticoagulants  fluoxetine suppresses platelets   bleeding risk
Monoamine Oxidase Inhibitors
(MAOI
Expected Action: Proto: phenelzine (Nardil) – Others: isocarboxazide
• Block MAO in brain   norepinephrine and serotonin available for impulses
Therapeutic Uses: • Atypical depression • OCD • Bulimia nervosa
Adverse Effects: • Orthostatic hypotension • CNS stimulation
• Hypertensive crisis from dietary tyramine (HR, BP): Induce vasodilation with IV phentolamine (α-blocker) or sublingual nifedipine.
Contraindications/Precautions: •
• CI: SSRIs, pheochromocytoma, cardiovascular disease & renal insufficiency
Interactions: • Indirect sympathomimetic  release NE causing hypertensive crisis
• TCA  hypertensive crisis • SSRIs  serotonin syndrome
• Antihypertensives  additive hypotensive effect • Meperidine  hyperpyrexia
• Tyramine-rich foods  hypertensive crisis (aged cheese, salami, avocados, bananas, protein, & red wine)
• Vasopressors (phenylethylamine, caffeine)  hypertension
Atypical Antidepressants
Expected Action: Proto: bupropion (Wellbutrin) – Others: mirtazapine (Remeron), venlafaxine (Effexor), reboxetine (Vestra), trazodone
• Inhibit dopamine uptake
Therapeutic Uses: • Depression • Aid to quit smoking
Adverse Effects: • Seizures
• Headache, dry mouth, constipation, HR, restlessness, weight loss
Contraindications/Precautions: • Pregnancy – B
• CI: Seizure disorders, MAOIs
Interactions: • MAOIs (e.g. phenelzine)   risk of toxicity
Mood Stabilizers
Expected Action: Proto: Lithium, mood-stabilizing anticonvulsants:
valproic acid (Depakote), carbamazepine (Tegretol)
• Lithium causes serotonin receptor blockade
• Lithium use will evidence  neuronal apathy and/or  in neuronal growth.
Therapeutic Uses: • Bipolar / alcoholism / bulimia / schizophrenia
Adverse Effects: • GI effects, usually transient (give ĉ milk)
• Tremors (give β-blocker like propanolol) • Polyuria • Renal toxicity
• Goiter/hypothyroidism • Teratogenic
Contraindications/Precautions: • Pregnancy - D •  lactation
• Caution ĉ renal dysfunction, heart disease, Na+ depletion & dehydration
Interactions: •
• Diuretics   Na+   lithium excretion  toxicity
• NSAIDs   renal absorption lithium  toxicity (aspirin OK)
• Anticholinergics  abdominal discomfort from urinary retention & polyuria
Education: • Maintain adequate sodium intake and 8-12 glasses of H2O
• Plasma lithium levels must be monitored (> 1.5 mEq/L is toxic)
Sedative-Hypnotics -- Benzodiazepines
Expected Action: Proto: diazepam (Valium) – Others: alprazolam (Xanax), lorazepam (Ativan), chlordiazepoxide (Librium)
• Enhance the action of gamma-aminobutyric acid (GABA)
Therapeutic Uses: • Anxiety • Seizures • Panic disorder
• Muscle spasms • Anesthesia • EtOH w/d • Insomnia
Adverse Effects: • CNS depression • Anterograde amnesia
• Paradoxical response • Respiratory depression •
• Acute toxicity (treat oral ĉ charcoal, treat IV ĉ flumazenil)
Contraindications/Precautions: • Teratogenic

Interactions: •
• CNS depressants  additive effects
Education: •
Sedative-Hypnotics
Non-Benzodiazepine
Expected Action: Proto: zolpidem (Ambien) – Others: zaleplon (Sonata), eszopiclone (Lunesta) , trazodone (Desyrel)
• Enhance action of GABA in CNS leading to prolonged sleep duration. They do not function as antianxiety, muscle relaxant, or antiepileptic agents.
Therapeutic Uses: •
• Management of insomnia
Adverse Effects: •
• Daytime sleepiness and lightheadedness
Contraindications/Precautions: •

Interactions: •
• CNS depressants  additive effects
• Food   absorption when taken with food
Education: •
Anxiolytic – Non-Barbiturate
Expected Action: Proto: Buspirone (BuSpar)
• Uncertain – it does bind to serotonin and dopamine receptors.
Therapeutic Uses: • Treatment of Generalized Anxiety Disorder

Adverse Effects: • CNS effects • NO SEDATION

Contraindications/Precautions: •
• Erythromycin, ketoconazole, and grapefruit juice   effects of buspirone
• Does NOT potentiate CNS depressants
Interactions: •

Education: •
• Take with meals to prevent gastric irritation
CNS Stimulants
Expected Action: Proto: methylphenidate (Ritalin) – Others: amphetamine, dextroamphetamine (Dexedrine), Adderall, caffeine
• Release norepinephrine and dopamine and prevent their reuptake in CNS.
Therapeutic Uses: • ADHD • Obesity • Narcolepsy
Adverse Effects: • CNS stimulation • Weight loss
• Cardiovascular effects (dysrhythmias, chest pain, BP)
Contraindications/Precautions: •
• Caution: hyperthyroidism, heart disease, glaucoma, Hx of drug abuse, MAOIs
Interactions: •
• MAOIs  hypertensive crisis • Caffeine   CNS stimulant effects
• Phenytoin, warfarin, phenobarbital  Inhibited metabolism of these   levels
• OTC cold & decongestants   CNS stimulant effects
Education: •
Drugs of Abuse
Alcohol
Withdrawal Symptoms • Usually start within 12-72 hours / Persist 5-7 days
• Can be mild: nausea, anxiety, tremors
• Can be life-threatening: hallucinations, cramps, tremors, seizures, HR, BP, T
Support Meds:
• Benzodiazepines (chlordiazepoxide, diazepam, lorazepam)   DT and risk of seizures,  intensity of symptoms
• Adjuncts (carbamazepine, clonidine, propanolol)   seizure,  craving, depress autonomic response (HR, BP, T)
Maintenance Meds:
• Disulfiram (Antabuse) ĉ EtOH, aldehyde syndrome occurs (nausea, extreme vomiting, hypotension)  Can progress to respiratory and cardiac depression, seizures, and death.
• Naltrexone (ReVia)  Opioid antagonist that  craving and pleasurable effects
• Acamprosate (Campral)   unpleasant effects of abstinence (anxiety, etc)
Drugs of Abuse
Opioids
Withdrawal Symptoms • Self-limiting in 7-10 days
• Begins with sweating and rhinorrhea, progressing from tremors and irritability to weakness, nausea, vomiting, muscle/bone pain, and spasticity.
• NOT life-threatening.
Detox Meds:
• Methadone substitution  Prevents withdrawal syndrome.
Maintenance Meds:
• Methadone  Long-term maintenance. Dependence is transferred to methadone.
• Clonidine (Catapres)  Control autonomic hyperactivity (nausea, vomiting)
• Buprenorphine (Subutex)  Opioid agonist/antagonist
• Naloxone (Suboxone)  Opioid agonist/antagonist
Drugs of Abuse
Nicotine
Withdrawal Symptoms
• Abstinence syndrome is evidenced by irritability, nervousness, restlessness

Support Meds:
• Bupropion (Zyban)’  craving and symptoms of withdrawal.
• Nicotine ’ Pharmaceutical replacement to alleviate symptoms

Education
• Chew gum over 30 minutes; avoid eating and drinking within 15 minutes of gum
• Gum not recommended for use longer than 6 months
• Avoid use of all nicotine products while pregnant or breastfeeding.
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Expected Action: Proto: vasopressin (Pitressin) — Others: desmopressin (DDAVP)
• Promote H2O reabsorption in kidneys (desmopressin preferred)
• Vasoconstriction due to smooth muscle contraction (vasopressin)
Therapeutic Uses: • Diabetes insipidus • Cardiac arrest
Adverse Effects: • Overhydration (sleepiness, pounding headache)
Contraindications/Precautions: ♀ (X) • Pregnancy
• CAD or  peripheral circulation (risk for gangrene)
Education: • Monitor site carefully; extravasation can cause gangrene.