1. Central and Peripheral Nervous System Medications
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
What structures in the body make up the central nervous system (CNS)?
What is the role of a neurotransmitter in the brain?
What drugs produce effects in the body similar to norepinephrine?
Where are naturally occurring catecholamines in the body?
What agent blocks the action of epinephrine and norepinephrine?

5. Central Nervous System

6. Antimigraine Agents Action Uses
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
What is the cause of migraine headaches?
What other actions in the body do antimigraine agents cause?
How would you describe an “aura” that may occur before the onset of a migraine headache?

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
What are common cardiac symptoms the patient may experience while taking antimigraine drugs?
What are the symptoms of overdose the patient may experience?
What significant medical history is a contraindication to using antimigraine drugs?
Women who are pregnant should not use this drug.
What activities should the patient follow after taking an antimigraine drug?

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
Can you identify nonpharmacologic treatments for epilepsy?
What is the diagnostic test used to determine whether seizures are present?
Drugs used to treat seizures may slow abnormal electrical discharges in the CNS.
The four major classifications of antiseizure drugs are barbiturates, benzodiazepines, hydantoins, and succinimides.
What route of drug administration is often used when patients are newly diagnosed with a seizure?

9. Barbiturates Action Uses
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
How are barbiturates classified?
What are some of the adverse reactions seen with the use of this drug?
If a patient is on an anticoagulant and then is prescribed a barbiturate, what type of interaction will occur?
The nurse should instruct the patient to avoid alcohol, antihistamines, benzodiazepines, methorimeprazine, narcotics, and tranquilizers when using this drug because of the additive effects that will occur when combined with barbiturates.

10. Benzodiazepines Action Uses
CNS depressants; suppress electrical discharge in seizures
Uses
Treat minor motor seizures; Lennox-Gestault syndrome (petit mal)
What are the names of the three benzodiazepine drugs approved for use as anticonvulsants?
If the patient is experiencing adverse effects to this drug, would you expect the blood pressure to be high or low?
What are the signs of benzodiazepine overdose?
Additive sedative effects will be produced when benzodiazepines are combined with what other drugs?

11. Hydantoins Action Uses
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
When a patient is exhibiting nystagmus, what will the nurse observe?
Dosages for children are generally higher than for adults. Why?
What laboratory values should be monitored when patients are taking hydantoins?

12. Succinimides Action and Uses Adverse Reactions Drug Interactions
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
What adverse reactions are seen with the use of succinimides?
If used in combination with other anticonvulsant drugs, what may occur?
Drug dependence occurs with indiscriminate use, and abrupt withdrawal is dangerous.

13. Succinimides (cont.) Nursing Implications and Patient Teaching
Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient Teaching
If a patient has a substance abuse problem, there may be problems with withdrawal, legal problems, or difficulties with compliance that will need to be part of the care plan.
What anticonvulsant drugs are legally controlled substances?
Can prescriptions for anticonvulsant drugs be substituted with a less expensive generic brand if the original drug order was written for a different brand?
What is the importance of oral hygiene for patients on anticonvulsant therapy?
Which laboratory tests are routinely monitored?

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
Which neurotransmitters are reduced to produce this effect?
How does the presence of vertigo stimulate nausea and vomiting?
When would these drugs be used to treat hiccups?

15. Antiemetic-Antivertigo Agents (cont.)
Adverse Reactions
Drowsiness and drug tolerance with long-term therapy
Anticholinergic effects
Drug Interactions
CNS depressants
What are some common symptoms associated with anticholinergic responses in the body?
What drugs may potentiate the drowsiness effect if combined with these drugs?
Clients should avoid alcohol.

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
What herbs may be used to treat motion sickness?
In what lifespan population would the use of these drugs be contraindicated?
The nurse should instruct the patient to use caution when completing tasks that require alertness while on these drugs.
The nurse should inform the patient taking phenothiazine derivatives that urine may turn pink or brown.
What other routes of administration would the nurse consider if the patient is vomiting and unable to take oral medications?

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
What are the common symptoms seen in the patient with Parkinson’s disease?
Treatment goals for Parkinson’s disease are designed to relieve symptoms and to maintain movement and activity of the patient.

18. Antiparkinsonian Agents (cont.)
Adverse Reactions
Dysrhythmias, muscle twitching, GI symptoms, etc.
Anticholinergic agents
Drug Interactions
Many; read product information closely
What is postural hypotension, and when would the nurse observe this condition?
What adverse symptoms would the patient exhibit if taking anticholinergic drugs?
Which complementary and alternative products may be used to treat symptoms of Parkinson’s disease?

19. Antiparkinsonian Agents (cont.)
Nursing Implications and Patient Teaching
Assessment
Diagnosis
Planning
Implementation
Evaluation
Patient Teaching
Drug Table 16-5
Antiparkinsonian agents are contraindicated for patients with what medical history?
Why is it necessary to taper the withdrawal of these drugs?
What administration consideration should the LPN/LVN be aware of when the patient is receiving levodopa therapy and has been prescribed the combination drug carbidopa-levodopa?
Antiparkinsonian agents are best tolerated after meals to avoid GI Upset.
Which vitamin should the patient avoid taking while using this drug?
What are some other significant patient teaching considerations for antiparkinsonian drugs?

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
Many of these drugs act on more than one type of receptor.
Excessive dosages may lead to widespread and serious effects.

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
What are the subjective feelings associated with anxiety?
What are the objective symptoms of anxiety?
Why are antianxiety agents prescribed for short-term use?

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
Why would an antianxiety agent be prescribed before elective cardioversion?
Which benzodiazepine is commonly used to treat convulsive disorders?
Elderly patients may require smaller initial dosages and must be closely monitored.

25. Antianxiety Agents (cont.)
Adverse Reactions
Drug Interactions
Increase effects
Antagonize effects
What symptoms may be seen with overdose of these drugs?
Paradoxical reactions may be an adverse effect. What type of symptoms would the patient exhibit?
Syncope is manifested by what type of symptoms?
In an effort to avoid antagonizing drug effects, what patient education will the LPN/LVN include?
Can you identify common complementary and alternative therapies patients often use to treat anxiety?

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
What are important nursing assessment findings that may contraindicate the use of antianxiety medications?
What role do the family and support system of the patient have in relation to his or her treatment?
Depression often accompanies anxiety. What should alert you to suicidal tendencies?
To benefit the patient, what nonpharmacologic treatments might be considered?
When these drugs are discontinued, why is it important to taper off the drug?

27. Antidepressants Tricyclics MAOIs SSRIs Miscellaneous
Depression may interfere with activities of daily living.
Not all patients respond to medications.
How may side effects of antidepressants vary for each patient?
When would an MAOI be used to treat depression?

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
What is the result when a drug prevents the reuptake of a neurotransmitter?
If the patient is taking a tricyclic antidepressant and an anticonvulsant, what type of interaction may occur?
What amount of time is usually required for an antidepressant to be effective?

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
What are the symptoms of overdose, and how long could these last?
MAOIs may cause very dangerous reactions if taken with certain foods or beverages high in tyramine or other vasopressor amines. What foods and beverages should the patient be instructed to avoid when taking this drug?
Why would ECT (electroconvulsive therapy) be used in combination with antidepressants?
When assessing the depressed patient, what is an important question the LPN/LVN should ask?
How will the nurse evaluate the patient for postural hypotension?

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
What are the three antidepressant agents that act similarly to selective serotonin reuptake inhibitors (SSRIs) but are not part of this classification?
What does the DSM-IV manual title stand for, and how is it used in psychiatric diagnosis?
Which drugs may be displaced by the SSRIs if used in combination?
What is the usual dosage levels for these drugs?
What length of time from the onset of treatment does the patient begin to feel better?

31. Miscellaneous Antidepressants
Tetracyclic compounds: maprotiline, mirtazapine (Remeron), trazodone (Desyrel)
Unrelated products: bupropion (Wellbutrin), nefazodone (Serzone), venlafaxine (Effexor)
Bupropion causes an increased incidence of seizure development that is approximately four times greater than if patients are taking other antidepressants
Which of these drugs may be used for smoking cessation?
How are drugs discontinued?
What are some of the nursing implications and patient teaching considerations for these medications?

32. Antipsychotic Drugs Action and Uses Drug Table 16-10
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
Which mental illnesses may have psychotic symptoms?
Antipsychotic drugs are grouped into two broad categories: (1) the phenothiazines and thioxanthenes and (2) the nonphenothiazines.

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
When is the use of thioxanthenes preferred over phenothiazines for treatment of the psychotic patient?
What type of adverse reactions and/or symptoms would the nurse observe in the patient who is taking these drugs?
What other assessment areas should the LPN/LVN observe for in the psychotic patient?
When would antipsychotic agents be prescribed for administration by the parenteral route?
What education should be provided to the patient and family about reducing the mouth dryness that may accompany use of these agents?

34. Nonphenothiazines Action and Uses Drug Table 16-11
Mechanism of action for these products is often not precisely understood when used to treat psychotic patients
Drug Table 16-11
What mental illnesses are treated with these drugs?
What laboratory values would be closely monitored when a patient is receiving clozapine (Clozaril)?

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
What patient symptoms would alert the nurse to a possible overdose of this drug?
Which drug, when combined with lithium, places the patient at great risk for toxicity?
What are signs that the patient may be experiencing a manic episode?
Lithium has a very narrow therapeutic margin. What is a therapeutic serum lithium level? (1 to 1.5 mEq/mL)
What activities should the patient avoid while taking lithium?

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
What determines whether a drug is a sedative or a hypnotic?
What problems can result from the postmedication “hangover”?
Why would a sedative-hypnotic be indicated the night before a patient is scheduled for surgery?
How long should a patient receive sedatives-hypnotics for the treatment of insomnia?

37. Sedative-Hypnotic Medications (cont.)
Adverse Reactions
Drug Interactions
Nursing Implications and Patient Teaching
Sedative-hypnotics are not considered safe during pregnancy.
Alcohol, when used in combination with sedatives-hypnotics, may increase sedation and depress vital brain functions.