Categories
Drugs Acting on the Central and Peripheral Nervous Systems Nursing Pharmacology

Antiparkinsonism Agents

Antiparkinsonism Agents

Parkinson’s Disease

  • Progressive chronic neurologic disorder
  • May develop in people of any age
  • Usually affects those who are past middle age and entering their 60s
  • No cure for the disease
  • Therapy is aimed at management of signs and symptoms

Progression of Parkinson’s Disease

  • Lack of coordination
  • Rhythmic tremors
  • Rigidity/weakness
  • Trouble maintaining position or posture
  • Bradykinesia
  • Problem walking
  • Drooling and affected speech
  • Mask-like expressions

Theories About the Cause of Parkinson’s Disease

  • Viral infection
  • Blows to the head
  • Brain infection
  • Atherosclerosis
  • Exposure to certain drugs
  • Environmental factors

The Degeneration of Neurons Leads to Parkinson’s Disease

The Degeneration of Neurons Leads to Parkinson’s Disease
The Degeneration of Neurons Leads to Parkinson’s Disease

 

 

Management of Care for Patients With Parkinson’s Disease

  • Encourage patients to:
    • Be as active as possible
    • Perform exercises
    • Attend to their own care as long as they can
    • Follow drug protocols
  • Caregivers should:
    • Monitor adverse effects
    • Provide encouragement and support

Anticholinergics Used to Treat Parkinson’s Disease

  • Benztropine (Cogentin)
  • Biperiden (Akineton)
  • Diphenhydramine (Benadryl)
  • Procyclidine (Kemadrin)
  • Trihexyphenidyl (Artane)

Anticholinergics

  • Action
    • Block the action of acetylcholine in the CNS to help normalize the acetylcholine–dopamine imbalance
  • Indications
    • Treatment of parkinsonism
    • Relief of extrapyramidal symptoms
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 1 to 4 hours
    • Metabolized in the liver, excreted by cellular pathways
    • Cross the placenta and enter the breast milk
  • Contraindications
    • Known allergy
    • Narrow angle glaucoma
    • GI obstruction
    • GU obstruction
    • Prostatic hypertrophy
  • Cautions
    • Arrhythmias
    • Hypertension
    • Hypotension
    • Hepatic dysfunction
    • Pregnancy and lactation
  • Adverse reactions
    • Disorientation
    • Confusion
    • Agitation
    • Delirium
    • Nausea, vomiting, and paralytic ileus
  • Drug-to-drug interactions
    • Tricyclic antidepressants
    • Phenothiazines

Levodopa

  • Mainstay of treatment for parkinsonism
  • Precursor of dopamine that crosses the blood–brain barrier, where it is converted to dopamine
  • Almost always given in combination form with carbidopa as a fixed-combination drug (Sinemet)
    • Carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain
    • The dosage of levodopa can be decreased, reducing adverse side effects

Other Dopaminergics Used in the Treatment of Parkinsonism

  • Amantadine (Symmetrel)
  • Bromocriptine (Parlodel)
  • Pergolide (Permax)
  • Pramipexole (Mirapex)
  • Ropinirole (Requip)

Dopaminergics

  • Actions
    • Increase the levels of dopamine in the substantia nigra
    • Directly stimulate the dopamine receptors in that area
    • Help to restore the balance between the inhibitory and stimulating neurons
  • Indications
    • Relief of the signs and symptoms of idiopathic Parkinson’s disease
  • Pharmacokinetics
    • Well absorbed from the GI tract and widely distributed in the body
    • Metabolized in the liver and peripheral cells
    • Excreted in the urine
    • Cross the placenta
  • Contraindications
    • Known allergy
    • Angle closure glaucoma
    • GI obstruction
  • Cautions
    • CV disease
    • Bronchial asthma
    • H/O peptic ulcer
    • Urinary tract obstruction
    • Psychiatric disorders
  • Adverse reactions
    • Anxiety
    • Nervousness
    • Headache
    • Blurred vision
    • Arrhythmias
  • Drug-to-drug interactions
    • MAOIs
    • Vitamin B6

Goals of Therapy in Treating Parkinson’s Disease

Goals of Therapy in Treating Parkinson’s Disease
Goals of Therapy in Treating Parkinson’s Disease

Use of Antiparkinsonism Agents Across the Lifespan

Use of Antiparkinsonism Agents Across the Lifespan
Use of Antiparkinsonism Agents Across the Lifespan

Prototype Anticholinergics

Prototype Anticholinergics
Prototype Anticholinergics

Prototype Dopaminergic

Prototype Dopaminergic
Prototype Dopaminergic

Nursing Considerations for Anticholinergics/Antiparkinsonism Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Dopaminergic Antiparkinsonism Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Drugs Acting on the Central and Peripheral Nervous Systems Nursing Pharmacology

Antiepileptic Agents

Antiepileptic Agents

Factors Affecting the Type of Seizure

  • Location of the cells that initiate the electrical discharge
  • Neural pathways that are stimulated by the initial volley of electrical impulses

Classification of Seizures

  • Generalized seizures
    • Begin in one area of the brain and rapidly spread throughout both hemispheres of the brain
  • Partial seizures or focal seizures
    • Begin and remain in one area of the brain

Classification of Generalized Seizures

  • Tonic–clonic seizures (grand mal seizures)
  • Absence seizures (petit mal seizures)
  • Myoclonic seizures
  • Febrile seizures
  • Status epilepticus

Classification of Partial Seizures

  • Simple partial seizures
    • Occur in a single area of the brain and may involve a single muscle movement or sensory alteration
  • Complex partial seizures
    • Involve complex sensory changes
    • Motor changes may include involuntary urination, chewing motions, diarrhea, etc.

Drugs for Treating Tonic–Clonic Seizures

  • Hydantoins
  • Barbiturates
  • Barbiturate-like drugs

Sites of Action of Drugs Used to Treat Various Forms of Epilepsy

Sites of Action of Drugs Used to Treat Various Forms of Epilepsy
Sites of Action of Drugs Used to Treat Various Forms of Epilepsy

 

 

Hydantoins

  • Phenytoin (Dilantin)
    • Treats tonic–clonic seizures and status epilepticus; prevents and treats seizures after neurosurgery
  • Ethotoin (Peganone)
    • Controls tonic–clonic and myoclonic seizures
  • Fosphenytoin (Cerebyx)
    • Controls short-term status epilepticus; prevents seizures after neurosurgery
  • Mephenytoin (Mesantoin)
    • Treats tonic–clonic, myoclonic, and partial (focal) seizures in patients who do not respond to less toxic antiepileptic agents
  • Actions
    • Stabilize nerve membranes and limit the spread of excitability from the initiating focus
  • Indications
    • Treatment of tonic–clonic seizures
  • Pharmacokinetics
    • Well absorbed from the GI tract
    • Metabolized in the liver
    • Excreted in the urine
    • Cerebyx: given IM or IV
  • Contraindications
    • Hepatic or renal impairment at increased risk of toxicity
  • Adverse reactions
    • Nystagmus, ataxia, dysarthria, slurred speech, dizziness, fatigue, headache, dermatitis, and gingival hyperplasia
  • Drug-to-drug interactions
    • Alcohol
    • Wide variety of interactions

Barbiturates and Barbiturate-Like Drugs

  • Phenobarbital (Solfoton, Luminal)
    • Emergency control of status epilepticus and acute seizures; management of tonic–clonic and cortical focal seizures; treatment of simple partial seizures
  • Primidone (Mysoline)
    • Treatment of tonic–clonic or partial seizures
  • Mephobarbital (Mebaral)
    • Treatment of tonic–clonic and absence seizures; anxiolytic/hypnotic agent
  • Actions
    • CNS depressants; inhibit impulse conduction in the ascending RAS
  • Indications
    • Long-term treatment of generalized seizures and emergency control of certain acute convulsive episodes
  • Pharmacokinetics
    • Well absorbed from the GI tract
    • Metabolized in the liver
    • Excreted in the urine
    • T½ varies depending on the agent
    • Can be given IV, IM, or sub-q depending on the agent
  • Contraindications
    • Known allergy
  • Adverse reactions
    • Somnolence, insomnia, vertigo, hallucinations, and anxiety
  • Drug-to-drug interactions
    • Wide variety of interactions

Benzodiazepines

  • Diazepam (Valium)
  • Prototype benzodiazepine
  • Useful in relieving tension, anxiety, and muscle spasm
  • Clonazepam (Klonopin)
  • Used for the treatment of absence (petit mal) seizures and myoclonic seizures
  • Actions
    • Potentiate the effects of GABA, an inhibitory neurotransmitter that stabilizes nerve cell membranes
  • Indications
    • Management of anxiety disorders and acute alcohol withdrawal; muscle relaxant; adjunct in status epilepticus and severe recurrent
  • seizures
  • Pharmacokinetics
    • Well absorbed from the GI tract
    • Metabolized in the liver and excreted in the urine
    • T½ depends on the drug
  • Contraindications
    • Known allergy
  • Adverse reactions
    • Drowsiness, sedation, depression, lethargy, fatigue, disorientation, and urinary retention
  • Drug-to-drug interactions
    • Wide variety of interactions

Succinimides

  • Ethosuximide (Zarontin)
    • Drug of choice for treating absence seizures
    • Relatively few adverse effects compared with many other antiepileptic drugs
  • Methsuximide (Celontin)
    • Used to treat absence seizures that are resistant to other drugs
    • Associated with bone marrow suppression
  • Actions
    • Modulate the inhibitory neurotransmitter GABA
    • Suppress the abnormal activity in the brain
  • Indications
    • Absence seizures or petit mal seizures
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 1 to 7 hours
    • Metabolized in the liver and excreted in the urine
    • Crosses the placenta and enters the breast milk
  • Contraindications
    • Known allergy
  • Cautions
    • Renal or hepatic disease
  • Adverse reactions
    • Depression, drowsiness, fatigue, ataxia, insomnia, headache, and blurred vision
  • Drug-to-drug interactions
    • Primidone

Other Drugs for Treating Absence Seizures

  • Valproic acid (Depakene)
    • Reduces abnormal electrical activity in the brain; may increase GABA activity at inhibitory receptors
  • Acetazolamide (Diamox)
    • A sulfonamide drug especially effective for treatment of absence seizures in children
  • Zonisamide (Zonegran)
    • Used as an adjunct to other drugs for the treatment of absence seizures

Drugs for Treating Partial Seizures

  • Action
    • Stabilize nerve membranes
      • Altering sodium and calcium channels
      • Increasing the activity of GABA
  • Indication
    • Treatment of partial seizures
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Metabolized in the liver and excreted in the urine and feces
  • Contraindications
    • Known allergy, bone marrow suppression, and hepatic dysfunction
  • Cautions
    • Pregnancy, lactation, and renal stones
  • Adverse reactions
    • Drowsiness, fatigue, weakness, confusion, nausea, vomiting, and anorexia
  • Drug to-drug interactions
    • CNS depressants
    • Numerous interactions

Use of Antiepileptic Agents Across the Lifespan

Use of Antiepileptic Agents Across the Lifespan
Use of Antiepileptic Agents Across the Lifespan

 

 

Prototype Hydantoins

Prototype Hydantoins
Prototype Hydantoins

 

 

Prototype Barbiturates and Barbiturate-Like Drugs

Prototype Barbiturates and Barbiturate-Like Drugs
Prototype Barbiturates and Barbiturate-Like Drugs

 

 

Prototype Benzodiazepines

Prototype Benzodiazepines
Prototype Benzodiazepines

 

 

Prototype Succinimides

Prototype Succinimides
Prototype Succinimides

 

 

Prototype Drugs for Treating Partial Seizures

Prototype Drugs for Treating Partial Seizures
Prototype Drugs for Treating Partial Seizures

 

 

Nursing Considerations for Hydantoins

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Succinimides

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Drugs for Treating Partial Seizures

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Drugs Acting on the Central and Peripheral Nervous Systems Nursing Pharmacology

Psychotherapeutic Agents

Psychotherapeutic Agents

Psychotherapeutic Agents

  • Used to treat psychoses: perceptual and behavioral disorders
  • Drugs do not cure psychoses: they help patients function in a more acceptable manner and carry on activities of daily living
  • Used in both children and adults

Mental Disorders and Their Classifications

  • Schizophrenia
  • Mania/bipolar disease
  • Narcolepsy
  • Attention-deficit disorder

Schizophrenia

  • Characteristics
    • Hallucinations, paranoia, delusions, speech abnormalities, and affective problems
  • Causes
    • Strong genetic association
    • May reflect a fundamental biochemical abnormality

Mania/Bipolar Illness

  • Characteristics
    • Mania: periods of extreme overactivity and excitement
    • Bipolar illness: extremes of depression followed by hyperactivity and excitement
  • Cause
    • May reflect a biochemical imbalance followed by overcompensation on the part of neurons and their inability to re-establish stability

Narcolepsy

  • Characteristics
    • Daytime sleepiness and sudden periods of loss of wakefulness
  • Causes
    • Problems with stimulation of the brain by the reticular activating system (RAS)
    • Problems with response to that stimulation

Characteristics of Attention-Deficit Disorders

  • Inability to concentrate on one activity for longer than a few minutes
  • State of hyperkinesis
  • Usually diagnosed in school-age children but can occur in adults

Sites of Action of the Drugs Used to Treat Mental Disorders

Sites of Action of the Drugs Used to Treat Mental Disorders
Sites of Action of the Drugs Used to Treat Mental Disorders

 

 

Classifications of Antipsychotics

  • Typical
    • Primarily dopamine receptor blockers
    • Cause several adverse effects including hypotension, anticholinergic effects, and extrapyramidal side effects (EPS)
  • Atypical
    • Block both dopamine receptors and serotonin receptors
    • May alleviate some of the unpleasant neurological effects and depression caused by typical antipsychotics

Types of Extrapyramidal Effects

  • Pseudoparkinsonism
  • Dystonia
  • Akathisia
  • Tardive dyskinesia
  • Potentially irreversible neuroleptic malignant syndrome

Antipsychotic/Neuroleptic Drugs

  • Actions
    • Typical antipsychotic drugs block dopamine receptors, preventing the stimulation of the postsynaptic neurons by dopamine
    • Depress the RAS, limiting the stimuli coming into the brain
    • Atypical antipsychotics block both dopamine and serotonin receptors
  • Indications
    • Schizophrenia, hyperactivity, combative behavior, agitation in the elderly, and severe behavioral problems in children
  • Pharmacokinetics
    • Absorbed from the GI tract
    • IM dose provides 4 to 5 times the active dose as oral doses
    • Widely distributed in the tissues
    • Metabolized in the liver
    • Excreted through bile and urine
    • Cross placenta and enter breast milk
  • Contraindications
    • Underlying diseases that could be exacerbated by the dopamine-blocking effects of these drugs
    • CNS depression
    • Circulatory collapse
    • Parkinson’s disease
    • Coronary disease
    • Severe hypotension
    • Prolonged QT interval
  • Adverse reactions
    • Sedation
    • Weakness
    • Tremors
    • Drowsiness
    • Extrapyramidal effects
    • Dry mouth
    • Nasal congestion
    • Constipation
  • Drug-to-drug interactions
    • Beta blockers, alcohol, mesoridazine, thioridazine

Drugs Used to Treat Mania/Bipolar Disease

  • Lithium salts (Lithane, Lithotabs)
  • Lamotrigine (Lamictal)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)

Action of Lithium

  • Alters sodium transport in nerve and muscle cells
  • Inhibits the release of norepinephrine and dopamine—but not serotonin—from stimulated neurons
  • Increases the intraneuronal stores of norepinephrine and dopamine slightly
  • Decreases intraneuronal content of second messengers

Antimanic Drugs

  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 30 minutes
    • Same distribution pattern in the body as water
    • Slowly crosses the blood–brain barrier
    • Excreted from the kidney, 80% is reabsorbed
    • Crosses the placenta: associated with congenital abnormalities
    • Enters the breast milk
  • Contraindications
    • Known allergy, renal or cardiac disease, leukemia, metabolic disorders, pregnancy, and lactation
  • Adverse reactions
    • Effects directly related to the lithium serum level
      • Levels less than 1.5: lethargy, slurred speech, muscle weakness, nausea, and vomiting
      • Levels 1.5 to 2: above reactions plus ECG changes
      • Levels 2 to 2.5: ataxia, clonic movements, hyperreflexia, and seizures
      • Levels less than 2.5: complex multiorgan toxicity and significant risk of death
  • Drug-to-drug interactions
    • Haloperidol
    • Carbamazepine
    • Thiazide diuretic

Site of Action of the CNS Stimulants in the RAS

Site of Action of the CNS Stimulants in the RAS
Site of Action of the CNS Stimulants in the RAS

 

 

Central Nervous System Stimulants

  • Action
    • CNS stimulants act as cortical and RAS, possibly by increasing the release of catecholamines from presynaptic neurons; this leads to an increase in stimulation of the postsynaptic neurons
  • Indications
    • Treatment attention: deficit syndromes
    • Narcolepsy
  • Pharmacokinetics
    • Rapidly absorbed from the GI tract
    • Peak in 2 to 4 hours
    • Metabolized in the liver
    • Excreted in the urine
    • T½ 2 to 15 hours
  • Contraindications
    • Known allergy, marked anxiety, agitation, tension, severe fatigue, and glaucoma
  • Adverse effects
    • Nervousness, insomnia, dizziness, headache, blurred vision, anorexia, nausea, and weight loss
  • Drug-to-drug interactions
    • MAOIs
    • Guanethidine
    • Tricyclic antidepressants
    • Phenytoin

Use of Psychotherapeutic Agents Across the Lifespan

Use of Psychotherapeutic Agents Across the Lifespan
Use of Psychotherapeutic Agents Across the Lifespan

Prototype Typical Antipsychotic Drugs

Prototype Typical Antipsychotic Drugs
Prototype Typical Antipsychotic Drugs

Prototype Atypical Antipsychotic Drugs

Prototype Atypical Antipsychotic Drugs
Prototype Atypical Antipsychotic Drugs

Prototype Central Nervous System Stimulants

Prototype Central Nervous System Stimulants
Prototype Central Nervous System Stimulants

Nursing Considerations for Antipsychotic/Neuroleptic Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Antimanic Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Central Nervous System Stimulants

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Drugs Acting on the Central and Peripheral Nervous Systems Nursing Pharmacology

Antidepressant Agents

Antidepressant Agents

Affective Disorders vs Depression

  • Affective disorder
    • A person’s mood goes far beyond the normal “ups and downs”
  • Depression
    • Severe and long-lasting feelings of sadness beyond the precipitating event

Signs and Symptoms of Depression

  • Low energy level
  • Sleep disturbances
  • Lack of appetite
  • Limited libido
  • Inability to perform activities of daily living
  • Overwhelming feelings of sadness, despair, hopelessness, and disorganization

Biogenic Amine Theory of Depression

  • Depression results from a deficiency of norepinephrine (NE), dopamine, or serotonin (5HT)
    • Monoamine oxidase (MAO) may break them down to be recycled or restored in the neuron
    • Rapid fire of neurons may lead to their depletion
    • The number or sensitivity of postsynaptic receptors may increase, depleting neurotransmitter levels

Actions of Antidepressant Therapy

  • Inhibits the effects of MAO, leading to increased NE or 5HT in the synaptic cleft
  • Blocks reuptake by the releasing nerve, leading to increased neurotransmitter levels in the synaptic cleft
  • Regulates receptor sites and breakdown of neurotransmitters, leading to an accumulation of neurotransmitters in the synaptic cleft

Classifications of Antidepressants

  • Tricyclic antidepressants (TCAs)
  • MAO inhibitors (MAOIs)
  • Selective serotonin reuptake inhibitors (SSRIs)

Sites of Action for Selected Antidepressants

Sites of Action for Selected Antidepressants
Sites of Action for Selected Antidepressants

 

 

Tricyclic Antidepressants

  • Actions
    • Reduce the reuptake of 5HT and NE into nerves
  • Use
    • All TCAs are similar
    • Choice depends on individual response to the drug and tolerance of adverse effects
  • Indications
    • Relief of symptoms of depression
    • Used for patients with sleep disorders
    • Treatment of enuresis
    • Chronic pain
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 2 to 4 hours
    • Bound to plasma proteins and lipid soluble
    • Metabolized in the liver and excreted in the urine
    • T½ 8 to 46 hours
  • Contraindications
    • Known allergy, recent MI, myelography, pregnancy, and lactation
  • Cautions
    • CV disease, angle closure glaucoma, urinary retention, and manic depression
  • Adverse reactions
    • Sedation, sleep disturbances, fatigue, hallucinations, ataxia, dry mouth, constipation, nausea, and vomiting
  • Drug-to-drug interactions
    • MAOIs, cimetidine, fluoxetine, ranitidine, and oral anticoagulants

Monoamine Oxidase Inhibitors (MAOIs)

  • Isocarboxazid (Marplan)
    • Used for patients who do not respond to or cannot take newer, safer antidepressants
  • Phenelzine (Nardil)
    • Used for some patients who do not respond to newer, safer antidepressants
  • Tranylcypromine (Parnate)
    • Used for adult outpatients with reactive depression
  • Action
    • Irreversibly inhibit MAOs, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft
  • Indication
    • Treatment of patients with depression who are unresponsive to or unable to take other antidepression agents
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 2 to 3 hours
    • Metabolized in the liver and excreted in the urine
    • Cross placenta and enter breast milk
  • Contraindications
    • Known allergy, pheochromocytoma, CV disease, headaches, and renal or hepatic impairment
  • Adverse reactions
    • Dizziness, excitement, nervousness, mania, hyperreflexia, tremors, confusion, insomnia, agitation, liver toxicity, nausea, vomiting, diarrhea or constipation, anorexia, weight gain, dry mouth, and abdominal pain
  • Drug-to-drug interactions
    • Other antidepressants: hypertensive crisis and coma
    • Methyldopa: sympathomimetic effects increase
    • Insulin or oral antidiabetic agents: additive hypoglycemia
  • Food interactions
    • Tyramine or pressor amines: increase blood pressure

Selective Serotonin Reuptake Inhibitors (SSRIs)

  • The newest group of antidepressant drugs
  • Specifically block the reuptake of 5HT, with little to no known effect on NE
  • Do not have the many adverse effects associated with TCAs and MAOIs
  • Action
    • Inhibit CNS neuronal reuptake of serotonin with little effect on norepinephrine and little affinity for cholinergic, histaminic, or alpha-adrenergic sites
  • Indications
    • Depression, OCD, panic attacks, bulimia, PMDD, posttraumatic stress disorders, social phobias, and social anxiety disorders
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Metabolized in the liver
    • Associated with congenital abnormalities
  • Contraindications
    • Known allergy, pregnancy, lactation, and impaired renal or hepatic function
  • Adverse reactions
    • Headache, drowsiness, dizziness, insomnia, anxiety, tremor, and agitation
  • Drug-to-drug interactions
    • MAOIs
    • TCAs increase therapeutic and toxic effect

Miscellaneous Antidepressants

  • Bupropion (Wellbutrin, Zyban)
  • Mirtazapine (Remeron)
  • Nefazodone (Serzone)
  • Trazodone (Desyrel)
  • Venlafaxine (Effexor)

Use of Antidepressant Agents Across the Lifespan

Use of Antidepressant Agents Across the Lifespan
Use of Antidepressant Agents Across the Lifespan

Prototype Tricyclic Agent

Prototype Tricyclic Agent
Prototype Tricyclic Agent

Prototype MAOIs Agent

Prototype MAOIs Agent
Prototype MAOIs Agent

Prototype SSRI Agent

Prototype SSRI Agent
Prototype SSRI Agent

Nursing Considerations for Tricyclic Antidepressant Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for MAOI Antidepressant Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for SSRI Antidepressant Agents

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
Categories
Drugs Acting on the Central and Peripheral Nervous Systems Nursing Pharmacology

Anxiolytic and Hypnotic Agents

Anxiolytic and Hypnotic Agents

Types of Anxiolytic and Hypnotic Agents

  • Anxiolytics
    • Prevent feelings of tension or fear
  • Sedatives
    • Calm and make patients unaware of the environment
  • Hypnotics
    • Cause sleep
  • Minor tranquilizers
    • Produce a state of tranquility in anxious patients

States Affected by Anxiolytic and Hypnotic Drugs

  • Anxiety
  • –Feeling of tension, nervousness, apprehension, or fear involving unpleasant reactions to a stimulus
  • Sedation
  • –Loss of awareness and reaction to environmental stimuli
  • Hypnosis
  • –Extreme sedation resulting in further CNS depression and sleep

Sites of Action of Benzodiazepines and Barbiturates

Sites of Action of Benzodiazepines and Barbiturates
Sites of Action of Benzodiazepines and Barbiturates

 

 

Benzodiazepines—Actions

  • Act in the limbic system and the RAS
  • Make GABA more effective
  • Cause interference with neurons firing
  • Lower doses cause anxiolytic effects
  • Higher doses cause sedation and hypnosis

Benzodiazepines—Indications

  • Anxiety disorders
  • Alcohol withdrawal
  • Hyperexcitability and agitation
  • Preoperative relief of anxiety and tension

Benzodiazepines—Pharmacokinetics

  • Well absorbed from the GI tract
  • Peak levels achieved in 30 minutes to 2 hours
  • Lipid soluble and well distributed throughout the body
  • Cross placenta
  • Enter breast milk
  • Metabolized in the liver
  • Excretion is primarily in the urine

Benzodiazepines—Contraindications & Cautions

  • Allergy to benzodiazepines
  • Psychosis
  • Acute narrow angle glaucoma
  • Shock
  • Coma
  • Acute alcohol intoxication
  • Pregnancy

Benzodiazepines—Adverse Effects

  • Sedation
  • Drowsiness
  • Depression
  • Lethargy
  • Blurred vision
  • Confusion
  • Dry mouth
  • Constipation
  • Nausea
  • Vomiting
  • Hypotension
  • Urinary retention

Benzodiazepines—Drug-to-Drug Interactions

  • Increase CNS depression when taken with alcohol
  • Increase in effect when taken with cimetidine, oral contraceptives, or disulfiram
  • Decrease in effect if given with theophylline or ranitidine

Barbiturates

  • Act as a general CNS depressant
  • Inhibit neuronal impulse conduction in the ascending RAS
  • Depress the cerebral cortex
  • Alter cerebellar function
  • Depress motor output

Barbiturates—Actions

  • CNS depressant
  • Inhibit neuronal impulse conduction in the ascending RAS
  • Depress cerebral cortex
  • Depress motor output
  • Cause sedation, hypnosis, anesthesia, and coma

Barbiturates—Indications

  • Relief of the signs and symptoms of anxiety
  • Sedation
  • Insomnia
  • Preanesthesia
  • Seizures

Barbiturates—Pharmacokinetics

  • Well absorbed
  • Reach peak in 20 to 60 minutes
  • Metabolized in the liver
  • Excreted in the urine

Barbiturates—Contraindications & Cautions

  • Allergy to any barbiturate
  • Previous history of addiction to sedative–hypnotic drugs
  • Latent or manifest porphyria
  • Marked hepatic impairment or nephritis
  • Respiratory distress or severe respiratory dysfunction
  • Pregnancy

Barbiturates—Adverse Reactions

  • CNS depression
  • Physical dependency
  • Drowsiness
  • Somnolence
  • Lethargy
  • Ataxia
  • Vertigo
  • Nausea
  • Vomiting
  • Constipation

Barbiturates—Drug-to-Drug Interactions

  • Increase CNS depression when given with alcohol, antihistamines, and other tranquilizers
  • Alter response to phenytoin
  • MAOs increase serum levels and effect
  • Decrease effectiveness of the following drugs:  anticoagulants, digoxin, tricyclic antidepressants, corticosteroids, and oral contraceptives

Other Anxiolytic and Hypnotic Drugs

  • Paraldehyde (Paral): sedates patients with delirium tremens or psychiatric conditions characterized by extreme excitement
  • Meprobamate (Miltown): manages acute anxiety for up to 4 months
  • Chloral hydrate (Aquachloral): produces nocturnal sedation or preoperative sedation
  • Glutethimide (generic), zaleplon (Sonata), and zolpidem (Ambien): short-term treatment of insomnia
  • Antihistamines (promethazine [Phenergan], diphenhydramine [Benadryl]: preoperative medications, and postoperatively to decrease the need for narcotics
  • Buspirone (BuSpar): reduces the signs and symptoms of anxiety without severe CNS and adverse effects

Use of Anxiolytic and Hypnotic Agents Across the Lifespan

Use of Anxiolytic and Hypnotic Agents Across the Lifespan
Use of Anxiolytic and Hypnotic Agents Across the Lifespan

Prototype Benzodiazepines Agent

Prototype Benzodiazepines Agent
Prototype Benzodiazepines Agent

Prototype Barbiturates Agent

Prototype Barbiturates Agent
Prototype Barbiturates Agent

Nursing Considerations for Benzodiazepines

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Barbiturates

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation