The Neurological System (Pharm Made Easy 3.0 Part 1)

Front 1

CNS depressants

Back 1

•Benzodiazepines

•Non-benzodiazepines

Front 2

Benzodiazepines

Back 2

•Treats: Relieve insomnia, relieve anxiety, relieve seizures, muscle spasms and help with moderate sedation

•Examples:

-Temazepam

-Diazepam

-Lorazepam

-Flurazepam

•Enhance the inhibitory effects of GABA and promote sleep because they cause sedation

•Side effects

-Drowsiness, dizziness

-Tolerance (loses effectiveness with small doses)

-Withdrawal symptoms (taper benzodiazepines slowly over 2 weeks or so)

•Assist patient with ambulation

•Watch for toxicity CNS symptoms

-Weakness

-Slurred speech

-Ataxia

-Respiratory depression

•Take benzodiazepines 30 before bedtime

•Avoid taking other CNS depressants and alcohol because it increases the depressive CNS effects

•Do NOT give to pregnant women and lactating moms (category X)

•Do NOT give to patients with glaucoma

•Do NOT give to patients younger than 18 years old

Front 3

Non benzodiazepines

Back 3

•Treat: short term treatment of insomnia

•Examples:

-Zolpidem (Ambien)

-Zaleplon (Sonata)

-Eszopiclone (Lunesta)

•Enhance the inhibitory effects of GABA

•Side effects

-Daytime drowsiness

-Amnesia (memory loss)

-Headache

-Diplopia (double vision)

-Confusion

•Take fall precautions during therapy with non benzodiazepines

•Give non benzodiazepines before bedtime

•Give on an empty stomach for better absorption

•Avoid taking drug with other CNS depressants or alcohol because it increases the CNS depressive effects

•Do NOT give to children younger than 18 years old

•Do NOT give to patients with suicidal ideation

•Do NOT give to moms in labor & delivery

Front 4

CNS depressants (Muscle relaxants)

Back 4

•Centrally acting muscle relaxants

•Peripherally acting muscle relaxants

Front 5

Centrally acting muscle relaxants

Back 5

•Treat: Muscle spasms due to

-spinal cord injury

-Multiple sclerosis

-Cerebral palsy

-Musculoskeletal injury or other disorders

•Examples:

-Baclofen

-Carisoprodol

-Chlorzoxazone

-Cyclobenzaprine

•Enhance the inhibitory effects of GABA

•Side effects:

-Drowsiness

-Nausea

-Constipation (Increase fiber intake & fluid) ☆

-Withdrawal symptoms (anxiety, restlessness, visual hallucinations, seizures) ☆

•Do not stop abruptly

•Do not give cyclobenzaprine concurrently with M.A.O.I within 14 days

•Do NOT give cyclobenzaprine to patients with cerebral palsy ☆

Front 6

Peripherally acting muscle relaxants

Back 6

•Treat: relax skeletal muscle spasms related to

-Cerebro vascular accident

-Spinal cord injury

-Multiple Sclerosis

-Cerebral palsy

-Also treats malignant hyperthermia, a side effect of general anesthesia

•Example:

-Dantrolene

•Inhibit release of calcium and blocks contraction of muscles

•Side effects:

-Muscle weakness

-Drowsiness, dizziness

-Diarrhea

-Liver toxicity (monitor liver function tests ALT and AST) ☆

•Give I.V dantrolene to patients with history of malignant hyperthermia (post general anesthesia) over 2 weeks to prevent such occurrence

•Do NOT give to patients with liver disease

Front 7

CNS depressants (Anticonvulsants)

Back 7

•Hydantoin

•Iminostilbenes

•Valproic acid

•Others

Front 8

Hydantoins

Back 8

•Treat: tonic clonic seizures and partial seizures

•Examples:

-Phenytoin

-Ethotoin

-Fosphenytoin

•Inhibit influx of sodium through sodium channels and decreases neural discharge around areas of increase activity

•Side effects:

-Mild drowsiness (EXCESSIVE drowsiness indicates toxicity!)

-Gingival hyperplasia ☆

-Skin rash

-Withdrawal symptoms

•Give with meals

•Tell patients to avoid hazardous activities due to CNS depressive effects (if it occurs)

•Do NOT abruptly stop drug

•Tell patients to have regular dental check ups (gingival hyperplasia) ☆

•Do not give to pregnant women (category D)

•Do NOT give to patients with bradycardia or heart block

•Do NOT give to patients experiencing seizures from HYPOglycemia

•Do NOT give to patients with a skin rash

Front 9

Iminostilbenes

Back 9

•Treat: partial seizures, tonic clonic, bipolar disorder and trigeminal neuralgia

•Examples:

-Carbamazepine

•Inhibit the influx of sodium through sodium channels and decreases the discharge of neurons around areas of increased activity

•Side effects:

-Visual disturbance

-Decreased excretion of water (INCREASES water retention) ☆

-Skin rash (epidermal necrolysis and Steven Johnson syndrome) ☆

-Bone marrow suppression (monitor WBC,CBC and withhold drug if low levels) ☆

•Give carbamazepine at bedtime

•Do not take during pregnancy (D)

•Do NOT give to patients with absence or myoclonic seizures

•Do NOT give to patients with hematologic disorders

•Do NOT give to patients with heart failure

Front 10

Valproic acid

Back 10

•Treats: all seizures, mania associated with bipolar disorder and migraine headache (prevention)

•Example

-Valproic acid

•INHIBITS influx of sodium through sodium channels, decreases the discharge of neurons around areas of increased activity, INHIBITS the influx of calcium through calcium channels, and ENHANCES the inhibitory effects of GABA

•Side effects:

-G.I upset

-Bruising, bleeding and prolonged bleeding time, decreased platelet count (monitor liver function test: ALT & AST)

-Skin rash

-Liver toxicity (can be fatal; check liver function test) ☆

-HYPERammonemia (monitor ammonia serum levels) ☆

•Observe for symptoms of hepatitis ☆

•Monitor serum amylase if symptoms of pancreatitis occur

•Do NOT give to pregnant women (D)

•Do NOT give to patients with liver disorder

•Do NOT give to patients with thrombocytopenia

•Do NOT give to patients with hyperammonemia

•Do NOT give to patients on other anticonvulsants

Front 11

CNS depressants: Drugs that support Anesthesia

Back 11

•Local anesthesia

-Lidocaine

•General anesthesia

-Barbiturates

-Benzodiazepines

-Opioids

Front 12

Local anesthesia

Back 12

•Treats: provides local anesthesia, provides I.V regional anesthesia, blocks nerves near surgical field and injected for epidural or spinal anesthesia

•Examples:

-Lidocaine

-Procaine

-Benzocaine

•BLOCKS influx of sodium through sodium channels

•Side effects:

-CNS stimulation effects (initially like restlessness)

-CNS depressant effects (like respiratory depression)

-Hypotension (If this happens, lower the head of the bed; when BP goes low head goes low, when BP goes High head goes High)

•I.V lidocaine (can be fatal; do not place lidocaine on broken skin because it can cause systemic adverse effects)

•Monitor respiratory status

•Do NOT give to patients allergic to amide type anesthetic

•Do NOT give to patients with sepsis or severe trauma

•Do NOT give to patients with bradycardia or heart block

Front 13

General anesthesia (Barbiturates)

Back 13

•Treats: provide rapid induction of anesthesia and hypnosis for brief procedure and provide adjunct anesthesia with other drugs for procedures that take longer than 15 minutes

•Examples:

-Sodium thiopental

-Methohexital sodium

•DEPRESSES CNS and ENHANCES inhibitory effects of GABA

•Side effects:

-Decreases heart rate

-Decreases blood pressure

-Cardiovascular toxicity (HYPOtension & tachycardia)

-Respiratory depression and apnea ☆

•Check respiratory status (check vitals before and after)

•Monitor I.V site and prevent extravasation (tissue & vessel injury)

•Do NOT give to patients with hepatic porphyria

•Do NOT give to patients with status asthmaticus

•Do NOT give to patients with a history of paradoxical excitation with use of CNS depressants

Front 14

General anesthesia (Benzodiazepines)

Back 14

•Treats: sedation before general anesthesia, moderate sedation (induction of amnesia) and supplements inhalation anesthesia for surgery

•Examples

-Midazolam (Versed)

-Diazepam (Valium)

•ENHANCE inhibitory effects of GABA (causes sedation)

•Side effects

-Amnesia (memory loss) ☆

-Cardiac or respiratory arrest

•Do NOT give to pregnant, lactating and labor & delivery

•Do NOT give to patients with acute angle glaucoma

Front 15

General anesthesia (opioids)

Back 15

•Treats: supplements general anesthesia, provides “neurolept anesthesia” with droperidol and nitrous oxide and provide anesthesia with a muscle relaxant for high risk patients in selected situations

•Example:

-Fentanyl (Sublimaze)

•Provide analgesia and sedation

•Side effects:

-Sedation

-Nausea

-Respiratory depression

-Circulatory collapse

•Antidote: naloxone

•Do NOT give to patients with substance abuse

•Do NOT give to patients with myasthenia gravis

•Do NOT give to pregnant women (category D)

Front 16

CNS stimulants: Drugs for ADHD and Narcolepsy

Back 16

•Amphetamines

•Methylphenidate

•Non-amphetamines

Front 17

Amphetamines

Back 17

•Treats: ADHD, narcolepsy and obesity

•Examples:

-Amphetamine

-Dextroamphetamine

-Methamphetamine hydrochloride

•Increases norepinephrine and dopamine in the CNS, increases alertness, mood, blood pressure, pulse, respiratory rate and inhibits the appetite centers of the CNS and in children with ADHD, amphetamine increases focus and length of attention span

•Side effects:

-Insomnia

-Nervousness

-Hypertension

-Weight loss

-Tolerance

-Dependence

-Withdraw symptom (depression)

-Toxicity (psychosis, dysrhythmia and seizures)

•Facilitate drug holiday for children to PREVENT growth suppression (do not give to children under 6 years unless benefit are greater)

•Give AMPHETAMINES in the morning to allow for rest at night

•Do NOT give to patients with moderate to severe hypertension

•Do NOT give to patients with cardiovascular disease

•Do NOT give to patients with hyperthyroidism

•Do NOT give to patients with cardiac defects (children)

•Avoid caffeine

Front 18

Methylphenidate

Back 18

•Treats: ADHD & narcolepsy

•Examples:

-Methylphenidate

-Dexmethylphenidate

•Increases norepinephrine and dopamine in the CNS, increases alertness, mood, blood pressure, pulse, respiratory rate and inhibits the appetite centers of the CNS and in children with ADHD, amphetamine increases focus and length of attention span

•Side effects:

-Insomnia

-Nervousness

-Hypertension

-Weight loss

-Tolerance

-Dependence

-Withdraw symptom (depression)

-Toxicity (psychosis, dysrhythmia and seizures)

•Do NOT give to patients with moderate to severe hypertension

•Do NOT give to patients with cardiovascular disease

•Do NOT give to patients with hyperthyroidism

•Do NOT give to patients with cardiac defects (children)

•Facilitate drug holiday for children to prevent growth suppression (do not give to children under 6 years unless benefits are greater)

•Take early in the day to allow for rest during the night

•Avoid caffeine

Front 19

Non-amphetamines

Back 19

•Treat: cause wakefulness in patients with narcolepsy, shift work sleepiness and obstructive sleep apnea

•Examples:

-Modafinil

-Armodafinil

•Unclear mechanism of action (may be related to block reuptake of norepinephrine)

•Side effects

-Nausea

-Diarrhea

-Minor CNS effects (headache, tachycardia, hypertension)

-Rash (Steven Johnson syndrome; can be fatal)

•Give early in the morning to allow for rest at night

•Report any rash immediately to provider

•Non-amphetamines INTERFERE with effectiveness of oral contraceptives

•Do NOT give to patients with history of valvular heart disease

Front 20

Drugs for Parkinson's disease

Back 20

•Dopamine replacement drugs

•Direct acting dopamine receptor agonist

•Indirect acting dopamine receptor agonist/MAOI

Front 21

Dopamine replacement Drugs

Back 21

•Treat: relief symptoms of Parkinson's disease & combined with carbidopa

•Example:

-Levodopa/carbidopa

•Crosses the blood brain barrier, taken up by dopaminergic nerves and are converted to dopamine

•Side effects:

-Nausea, vomiting (add carbidopa to levodopa)

-Orthostatic hypotension

-Darkening urine & sweat

-Dyskinesia, tremors, twitching (decrease levodopa and prescribe AMANTADINE) ☆

-Symptoms of psychosis-hallucinations, paranoia

•Takes 6 months to achieve full effectiveness

•Do NOT give to patients with narrow angle glaucoma

•Do NOT give to patients with history of melanoma

•Do NOT give to patients with psychosis or suicidal ideation

Front 22

Direct acting dopamine receptor agonists

Back 22

•Treats: Parkinson’s disease and restless leg syndrome

•Examples:

-Pramipexole

-Ropinirole

•Binds to dopamine receptors and mimics action of dopamine in the body

•Side effects

-Nausea or G.I symptoms

-Orthostatic hypotension

-Dyskinesia

-Drowsiness (sleep attacks)

-Muscle weakness

•Give 3 hours before BEDTIME for restless leg syndrome

•Taper dose, slowly in 1 to 2 weeks

•Avoid alcohol or other CNS depressants

Front 23

Indirect-acting Dopamine Receptor Agonist (MAOI)

Back 23

•Treat: Parkinson's disease (adjunct to levodopa & carbidopa) and depression

•Examples:

-Selegiline

-Rasagiline

•Inhibit the enzyme (monoamine oxidase) in the brain, monoamine oxidase inactivates neurotransmitters; monoamine oxidase inhibitors (MAOI) make dopamine more available to the brain (which lessens Parkinson’s disease symptoms)

•Side effects

-Insomnia (SELEGILINE)

-Hypertensive crisis ☆

-Orthostatic hypotension

-Irritation of oral mucous membranes (oral disintegrating tablet)

•Give BEFORE morning meal

•Make sure the patient doesn't eat or drink for 5 minutes before or 5 minutes after administration

•Do NOT give to patients with uncontrolled hypertension

•Do NOT give to patients with suicidal ideation

•Do NOT give to patients with meperidine use

Front 24

Drugs to treat Alzheimer's Disease

Back 24

•Cholinesterase inhibitors

•NMDA receptor antagonist

Front 25

Cholinesterase inhibitors

Back 25

•Treat: mild to moderate Alzheimer's disease (improves cognitive function)

•Examples:

-Donepezil

-Rivastigmine

-Galantamine

•Prevents acetylcholinesterase from inactivating acetylcholine and INCREASES acetylcholine at receptor sites in the brain

•Side effects:

-Nausea and G.I symptoms (give with food)

-CNS effects (insomnia, dizziness and headache)

-Bradycardia

-Syncope

•Assess for G.I bleeding (dark stools, coffee ground emesis)

•Monitor heart rate, weight loss

•Assist with ambulation

•Do NOT give to children

•Do NOT give to patients with G.I bleeding

•Do NOT give to patients with jaundice

Front 26

NMDA receptor Antagonist

Back 26

•Treats: patients with mild to moderate Alzheimer's disease (SLOWS decline in functioning) & may take with cholinesterase inhibitors

•Examples:

-Memantine

•BLOCKS excess glutamate from NMDA receptors, this decreases overstimulation of NMDA receptors, DECREASES intracellular calcium and neuronal damage and SLOWS the progression of Alzheimer's disease

•Side effects:

-CNS effects (dizziness, headache, increased confusion)

-Constipation (increase fluid & fiber; give laxatives as needed) ☆

•Do NOT give to patients with renal failure

Front 27

Drugs that treat multiple sclerosis

Back 27

•Immunomodulators treat multiple sclerosis

Front 28

Immunomodulators

Back 28

•Treats: Beta 1a (relapsing-remitting type) & Beta 1b (relapsing and relapsing-remitting types)

•Examples:

-Interferon beta 1a

-Beta 1b

-Glatiramer acetate

-Natalizumab

•Inhibits movement of leukocytes across the blood brain barrier and protect myelin from the damaging effects of leukocytes

•Side effects:

-Flu like symptoms (lessen with prolonged treatment (give acetaminophen to lower fever symptoms)

-Bone marrow suppression (monitor CBC) ☆

-Liver toxicity (monitor ALT & AST) ☆

-Pain, redness start subcutaneous injection site

•Give Beta 1a (I.M)

•Give Beta 1b (S.C): administer late in the day for 3 days a week and allow 48 hours in between

•Do NOT give to patients with previous ALLERGY to interferon beta, human albumin or mannitol

Front 29

Serotonin agonists

Back 29

•Treat: relieve symptoms of existing migraine & cluster headache

•Examples:

-Sumatriptan

-Zolmitriptan

•Activates 5-hydroxyl-tryptamine (5-HT) receptor (causes vasoconstriction), suppresses release of calcitonin gene related peptide (CGRP) and prevents inflammatory response

•Side effects

-Chest pressure or “heaviness” (Patient may REPORT chest pain; you as a nurse should report it to the provider)

-Coronary vasospasm

-CNS effects (tingling sensation and vertigo)

•S.C injection (no more than 2 doses in 24 hours)

•Oral and nasal spray give once after 2 hours (2 doses)

•Do NOT give to patients with artery disease, angina, previous M.I

•Do NOT give to patients with severe hypertension or peripheral vascular disease (PVD)

•Do NOT give to patients with CVA or stroke