Medications Affecting The Nervous System

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Medications Affecting The Nervous System

  1. 1. Medications Affecting the Nervous System Adrenergic blocking Drugs Anticonvulsants Antianxiety Antiparkinson Antipyschotic Antidepressants Narcotic analgesics Non narcotic analgesics Narcotic antagonists 06/03/09 Created by Amanda McBride
  2. 2. 06/03/09 Created by Amanda McBride
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  6. 6. Adrenergic effects 06/03/09 Created by Amanda McBride Type Location Neurotrans mitter Effects of stimulation Alpha1 Blood vessels Kidney Intestinal smooth muscle Liver Eye Norepinephrine Epinephrine Vasoconstriction Decreased renin secreation Relaxation glycogenolysis Blinking Alpha2 Nerve endings Vascular smooth muscle Pancreatic beta cells platelets Norepinephrine Epinephrine Inhibit release of norepinephrine Vasoconstriction Inhibit insulin secreation Aggregation Beta1 Heart Epinephrine Increased HR, force of contraction, automaticity, rate of AV conduction Beta2 Bronchioles Blood vessels GI tract Liver Urinary bladder Epinephrine Bronchodilation Vasodilation Decreased motility Glycogenolysis Relaxed muscle
  7. 7. Adrenergic Drugs <ul><li>Epinephrine </li></ul><ul><ul><li>Cardiac arrest </li></ul></ul><ul><ul><li>Anaphylaxis </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Shock </li></ul></ul><ul><ul><li>Nasal congestion </li></ul></ul>06/03/09 Created by Amanda McBride
  8. 8. Adrenergic blocking Drugs <ul><li>Alpha adrenergic blocking </li></ul><ul><ul><li>Drugs that block alpha adrenergic receptors </li></ul></ul><ul><li>Beta adrenergic blocking </li></ul><ul><ul><li>Drugs that block beta adrenergic receptors </li></ul></ul><ul><li>Alpha/beta adrenergic blocking </li></ul><ul><ul><li>Drugs that block both </li></ul></ul><ul><li>Antiadrenergic drugs </li></ul><ul><ul><li>Drugs that prevent the release of neurotransmitter norepinephrine </li></ul></ul>06/03/09 Created by Amanda McBride
  9. 9. Action <ul><li>Stimulation of alpha adrenergic nerves results in vasoconstriction </li></ul><ul><li>If stimulation is interrupted or blocked the result is vasodilation </li></ul>06/03/09 Created by Amanda McBride
  10. 10. Use of Alpha adrenergic blocking drugs <ul><li>Hypertension caused by pheochromocytoma </li></ul><ul><li>hypertension </li></ul>06/03/09 Created by Amanda McBride
  11. 11. Adverse effects <ul><li>Weakness </li></ul><ul><li>Orthostatic hypotension </li></ul><ul><li>Cardiac arrhythmias </li></ul><ul><li>Hypotension </li></ul><ul><li>Tachycardia </li></ul>06/03/09 Created by Amanda McBride
  12. 12. Contraindications, precautions, interactions <ul><li>CAD </li></ul><ul><li>Used cautiously in pregnancy, recent MI </li></ul>06/03/09 Created by Amanda McBride
  13. 13. Beta adrenergic Blocking drugs <ul><li>Decrease the stimulation of sympathetic nervous system on certain tissues </li></ul><ul><li>Decreases heart rate </li></ul><ul><li>Dilates blood vessels </li></ul><ul><li>Decrease cardiac excitability </li></ul><ul><li>Decrease cardiac workload and oxygen consumption </li></ul><ul><li>Provides membrane stabilizing effects that contribute to the antiarrhythmic activity </li></ul>06/03/09 Created by Amanda McBride
  14. 14. Uses <ul><li>HTN </li></ul><ul><li>HF </li></ul><ul><li>Cardiac arrhythmia </li></ul><ul><li>Migraine </li></ul><ul><li>Angina </li></ul><ul><li>Glaucoma </li></ul><ul><li>Used to prevent reinfarction in pts with recent MI </li></ul>06/03/09 Created by Amanda McBride
  15. 15. Adverse Reactions <ul><li>Orthostatic hypotension </li></ul><ul><li>Bradycardia </li></ul><ul><li>Dizziness, vertigo, headache </li></ul><ul><li>GI </li></ul><ul><li>Bronchospasm with hx asthma </li></ul><ul><li>CHF </li></ul>06/03/09 Created by Amanda McBride
  16. 16. Contraindications, precautions, interactions <ul><li>Sinus bradycardia </li></ul><ul><li>HB </li></ul><ul><li>Heart failure </li></ul><ul><li>Asthma </li></ul><ul><li>Hypotension </li></ul><ul><li>Emphysema </li></ul>06/03/09 Created by Amanda McBride
  17. 17. Alpha/Beta adrenergic blocking drugs <ul><li>Block the stimulation of both receptors, resulting in peripheral vasodilation </li></ul><ul><li>Carvedilol </li></ul><ul><li>Labetalol </li></ul>06/03/09 Created by Amanda McBride
  18. 18. Use <ul><li>HTN </li></ul><ul><li>CHF, prevents progression of disease </li></ul>06/03/09 Created by Amanda McBride
  19. 19. Adverse Reactions <ul><li>Fatigue </li></ul><ul><li>Dizziness </li></ul><ul><li>Hypotension </li></ul><ul><li>Drowsiness </li></ul><ul><li>Insomnia </li></ul><ul><li>Weakness </li></ul><ul><li>Diarrhea </li></ul><ul><li>Chest pain </li></ul><ul><li>bradycardia </li></ul>06/03/09 Created by Amanda McBride
  20. 20. Contraindications, precautions, interactions <ul><li>Bronchial asthma </li></ul><ul><li>Decompensated heart failure </li></ul><ul><li>Severe bradycardia </li></ul><ul><li>Used cautiously in drug controlled CHF, chronic bronchitis, impaired hepatic or cardiac function </li></ul><ul><li>Page 289 </li></ul>06/03/09 Created by Amanda McBride
  21. 21. Beta blocker drugs 06/03/09 Created by Amanda McBride Non-selective beta blockers Cardio-selective beta blockers <ul><li>Levobunolol </li></ul><ul><li>Nadolol </li></ul><ul><li>Pindolol </li></ul><ul><li>Propanolol </li></ul><ul><li>Sotalol </li></ul><ul><li>Timolol </li></ul><ul><li>Acebutolol </li></ul><ul><li>Atenolol </li></ul><ul><li>Betaxolol </li></ul><ul><li>Bisoprolol </li></ul><ul><li>Esmolol </li></ul><ul><li>Metoprolol </li></ul><ul><li>At high doses this effect is lost. </li></ul>
  22. 22. Nursing Process <ul><li>Assessment </li></ul><ul><ul><li>Vitals </li></ul></ul><ul><ul><li>Baseline assessment </li></ul></ul><ul><li>Implementation </li></ul><ul><ul><li>Take same time everyday </li></ul></ul><ul><ul><li>When given for cardiac arrhythmias, these drugs can provoke new or worsen existing ventricular arrhythmias </li></ul></ul><ul><ul><li>Orhtostatic hypotension </li></ul></ul><ul><li>Evaluation </li></ul><ul><ul><li>effectiveness </li></ul></ul>06/03/09 Created by Amanda McBride
  23. 23. Cholinergic effects 06/03/09 Created by Amanda McBride Organ Effects Heart Decreased rate Blood vessels vasodilation GI smooth muscle Increased tone and contractility Bronchial smooth muscle Increased tone and contractility Increased resp secreations Pupils Constriction
  24. 24. Uses <ul><li>Urinary bladder atony </li></ul><ul><li>Paralytic ileus </li></ul><ul><li>Reversal of NMB agents </li></ul><ul><li>Alzheimer’s disease </li></ul>06/03/09 Created by Amanda McBride
  25. 25. Anti-cholinergic drugs <ul><li>Block the action of acetylcholine on the PNS. </li></ul>06/03/09 Created by Amanda McBride
  26. 26. 06/03/09 Created by Amanda McBride System Effect CNS Stimulation followed by depression CVS Increase in heart rate Respiratory Bronchodilation Decrease resp secretions GI Antispasmodic effects d/t decreased muscle tone and motility Miscellaneous effects Decreased salivary secretions and sweat glands, relaxation of urinary bladder
  27. 27. Uses <ul><li>GI disorders </li></ul><ul><li>GU disorders </li></ul><ul><li>Resp disorders-bronchoconstriction. Atrovent </li></ul><ul><li>Cardiac disorders- HB, brady </li></ul><ul><li>Parkinson’s disease </li></ul><ul><li>Pre-op </li></ul>06/03/09 Created by Amanda McBride
  28. 28. Atropine <ul><li>Belladonna plant </li></ul><ul><li>Used in symptomatic bradycardia </li></ul>06/03/09 Created by Amanda McBride
  29. 29. Atrovent <ul><li>COPD as a bronchodilator </li></ul><ul><li>Less thickening of resp secretions </li></ul>06/03/09 Created by Amanda McBride
  30. 30. Scopolamine <ul><li>Depresses CNS and causes amnesia, drowsiness, euphoria, relaxation and sleep </li></ul><ul><li>Used in motion sickness </li></ul>06/03/09 Created by Amanda McBride
  31. 31. Spiriva <ul><li>Long acting bronchodilator </li></ul><ul><li>Daily maintenance tx of bronchospasm assoc with COPD </li></ul>06/03/09 Created by Amanda McBride
  32. 32. Extrapyramidal reactions 06/03/09 Created by Amanda McBride
  33. 33. 06/03/09 Created by Amanda McBride
  34. 34. Education <ul><li>Take as prescribed </li></ul><ul><li>Hypotension </li></ul><ul><li>Do not stop taking abruptly </li></ul><ul><li>May cause dizziness or drowsiness </li></ul><ul><li>Don’t use OTC cold, flu or decongestants without MD advice </li></ul><ul><li>Monitor own BP </li></ul>06/03/09 Created by Amanda McBride
  35. 35. Antianxiety Drugs and Sedative-Hypnotic Drugs Benzodiazepines Ativan Valium Nonbenzodiazepines Buspar Sinequan atarax 06/03/09 Created by Amanda McBride
  36. 36. 06/03/09 Created by Amanda McBride
  37. 37. 06/03/09 Created by Amanda McBride
  38. 38. Actions <ul><li>Block certain neurotransmitter receptor sites, norepinephrine. </li></ul><ul><li>High lipid solubility enters CNS easily. </li></ul><ul><li>Prevents the neurotransmission of the anxious perception and the body’s physcial reaction to the anxiety </li></ul><ul><li>Benzodiazepines exert their tranquillizing effect by potentiating the effects of GABA </li></ul><ul><li>Nonbenzodiazepines exert their action in various ways. </li></ul>06/03/09 Created by Amanda McBride
  39. 39. Uses <ul><li>Anxiety disorders </li></ul><ul><li>Panic attacks </li></ul><ul><li>Seizures </li></ul><ul><li>Alcohol withdrawa </li></ul><ul><li>Acute psychosis </li></ul><ul><li>Adjunct for pain </li></ul>06/03/09 Created by Amanda McBride
  40. 40. Adverse Effects <ul><li>Mild drowsiness-sedation </li></ul><ul><li>Lightheadedness, dizziness </li></ul><ul><li>Headache </li></ul><ul><li>Lethargy </li></ul><ul><li>Disorientation </li></ul><ul><li>Anger </li></ul><ul><li>Restlessness </li></ul><ul><li>Nausea </li></ul><ul><li>Visual disturbances </li></ul>06/03/09 Created by Amanda McBride
  41. 41. Non benzodiazepines <ul><li>Buspar </li></ul><ul><ul><li>Not like benzos </li></ul></ul><ul><li>Chloral hydrate </li></ul><ul><ul><li>Doesn’t suppress REM </li></ul></ul><ul><ul><li>Tolerance after 2 weeks of use. </li></ul></ul><ul><ul><li>Physical dependence. </li></ul></ul><ul><li>Antidepressants </li></ul><ul><ul><li>Prozac, Paxil, Effexor, Zoloft. </li></ul></ul><ul><li>Imovane </li></ul><ul><ul><li>Transient insomnia </li></ul></ul>06/03/09 Created by Amanda McBride
  42. 42. Dependence <ul><li>Long term use may result in physical drug dependence and tolerance </li></ul><ul><li>With as little as 4-6 weeks of therapy with benzos </li></ul>06/03/09 Created by Amanda McBride
  43. 43. Symptoms of withdrawal <ul><li>Restlessness </li></ul><ul><li>Muscle or bone pain </li></ul><ul><li>Insomnia </li></ul><ul><li>Diarrhea </li></ul><ul><li>Vomiting </li></ul><ul><li>Cold flashes </li></ul><ul><li>Involuntary leg movements </li></ul><ul><li>Seizures </li></ul><ul><li>Increased anxiety </li></ul><ul><li>Nausea </li></ul><ul><li>Sweating </li></ul><ul><li>psychoses </li></ul>06/03/09 Created by Amanda McBride
  44. 44. Prevention of withdrawal <ul><li>Mild symptoms occur after 6-12 weeks of therapeutic doses. </li></ul><ul><li>Sever symptoms occur after 4 months of high doses. </li></ul><ul><li>Dose should be tapered, reduce 10-25% every 1-2 weeks over 4-16 weeks. </li></ul>06/03/09 Created by Amanda McBride
  45. 45. Antidote <ul><li>Anexate competes with benzo receptors. </li></ul><ul><li>Onset within 2 mins peaks within 6-10 mins. </li></ul><ul><li>Half life 60-90 mins. </li></ul>06/03/09 Created by Amanda McBride
  46. 46. Contraindications <ul><li>Pregnancy </li></ul><ul><li>Lactation </li></ul>06/03/09 Created by Amanda McBride
  47. 47. Precautions, Interactions <ul><li>Used cautiously in elderly pts </li></ul><ul><li>Impaired liver and kidney function </li></ul><ul><li>Page 230 </li></ul>06/03/09 Created by Amanda McBride
  48. 48. Nursing Process <ul><li>Assessment </li></ul><ul><ul><li>Vitals </li></ul></ul><ul><ul><li>Assessment </li></ul></ul><ul><li>Implementation </li></ul><ul><ul><li>Observe pt closely for new tx </li></ul></ul><ul><ul><li>Report signs of tolerance </li></ul></ul><ul><li>Evaluation </li></ul><ul><ul><li>Therapeutic effect is achieved </li></ul></ul>06/03/09 Created by Amanda McBride
  49. 49. Education <ul><li>Take as prescribed </li></ul><ul><li>Don’t discontinue abruptly </li></ul><ul><li>Avoid driving </li></ul><ul><li>Avoid alcohol </li></ul><ul><li>Try to find healthier coping mechanisms. </li></ul>06/03/09 Created by Amanda McBride
  50. 50. Opioids <ul><li>Rx for pain relief, post-op, cough, acute pulm edema, and diarrhea </li></ul><ul><li>Attach to opioid receptors in the brain, spinal cord and GI tract </li></ul><ul><li>Cause euphoria by affecting the brain regions that mediate what we perceive as pleasure </li></ul>06/03/09 Created by Amanda McBrideCreated by Amanda McBride
  51. 51. Opioid Analgesics <ul><li>Uses </li></ul><ul><ul><li>Treatment of mod to severe pain </li></ul></ul><ul><ul><li>Obstetric pain </li></ul></ul><ul><ul><li>Anxiety related dyspnea </li></ul></ul><ul><ul><li>Opiate dependence </li></ul></ul><ul><ul><li>Relieve persistent cough </li></ul></ul>06/03/09 Created by Amanda McBride
  52. 52. How they work <ul><li>Increase norepinephrine and dopamine </li></ul><ul><li>Increases BP, HR, constricts blood vessels, increases blood glucose and opens resp pathways </li></ul><ul><li>Increase Dopamine is associated with a sense of euphoria </li></ul>06/03/09 Created by Amanda McBrideCreated by Amanda McBride Created by Amanda McBride
  53. 53. The WHO Pain Ladder 06/03/09 Created by Amanda McBride 06/03/09 Created by Amanda McBride
  54. 54. Pain <ul><li>Subjective </li></ul><ul><li>Cultural </li></ul><ul><li>Acute </li></ul><ul><li>Chronic </li></ul><ul><li>Can be affected by mood. </li></ul><ul><li>Complex </li></ul>06/03/09 Created by Amanda McBride
  55. 55. Morphine <ul><li>Half life 2-4 hours. </li></ul><ul><li>Accumulates in pts with liver or kidney dysfunction. </li></ul><ul><li>Other routes of admin, epidural, intrathecal, inhalation, rectal. </li></ul>06/03/09 Created by Amanda McBride
  56. 56. Fentanyl <ul><li>Very potent opioid. </li></ul><ul><li>Transdermal or IV </li></ul><ul><li>High risk of resp depression, given in monitored areas. </li></ul>06/03/09 Created by Amanda McBride
  57. 57. Codeine <ul><li>Weaker opioid. </li></ul><ul><li>Antitussive. </li></ul><ul><li>IV or PO </li></ul>06/03/09 Created by Amanda McBride
  58. 58. Hydrocodone <ul><li>Analgesic, antitussive </li></ul><ul><li>Similar to codeine. </li></ul>06/03/09 Created by Amanda McBride
  59. 59. Hydromorphone <ul><li>Similar to morphine. </li></ul><ul><li>Very potent. </li></ul>06/03/09 Created by Amanda McBride
  60. 60. Meperidine <ul><li>Similar to morphine </li></ul><ul><li>Preferred in pts with renal or biliary colic. </li></ul><ul><li>Less resp distress in newborns. </li></ul><ul><li>Normeperidine </li></ul><ul><ul><li>Metabolite of meperidine </li></ul></ul><ul><ul><li>Accumulates with chronic use, renal failure, Dilantin, rifamipin. </li></ul></ul><ul><ul><li>Produces CNS stimulation, hallucinations, seizures, agitation, tremors. </li></ul></ul><ul><ul><li>Half life 15-30 hours </li></ul></ul><ul><ul><li>Narcan doesn’t work. </li></ul></ul><ul><ul><li>Can precipitate serotonin syndrome in people who take MAOI, or amphetamines. </li></ul></ul>06/03/09 Created by Amanda McBride
  61. 61. 06/03/09 Created by Amanda McBride
  62. 62. Methadone <ul><li>Similar to morphine </li></ul><ul><li>Longer duration. </li></ul><ul><li>Half life 15-30 hours. </li></ul>06/03/09 Created by Amanda McBride
  63. 63. Oxycodone <ul><li>Similar to codeine. </li></ul><ul><li>Crushing and snorting or injecting has led to deaths. </li></ul>06/03/09 Created by Amanda McBride
  64. 64. Drug selection <ul><li>Morphine, hydromorphone and methadone, non ceiling drugs. </li></ul><ul><li>Least potent drug, in smallest dosage for least amount of time. </li></ul>06/03/09 Created by Amanda McBride
  65. 65. Drug dose <ul><li>Choose according to pain type, severity, quality, pts size, age, health status. </li></ul><ul><li>Choose smallest dose 1 st. </li></ul><ul><li>Slow release for chronic </li></ul><ul><li>IV for acute or breakthrough. </li></ul>06/03/09 Created by Amanda McBride
  66. 66. Patient Controlled Analgesic 06/03/09 Created by Amanda McBride
  67. 67. Epidural analgesia 06/03/09 Created by Amanda McBride
  68. 68. Uses <ul><li>Decrease anxiety and sedate before surgery </li></ul><ul><li>Support anesthesia </li></ul><ul><li>Obstetric analgesia </li></ul><ul><li>Relieve anxiety in pts with dyspnea </li></ul><ul><li>Pain assoc with MI </li></ul><ul><li>Opiate dependence </li></ul><ul><li>Severe diarrhea </li></ul><ul><li>Persistent cough </li></ul>06/03/09 Created by Amanda McBride
  69. 69. Adverse effects <ul><li>Weakness, lightheadedness </li></ul><ul><li>Resp depression </li></ul><ul><li>Constipation, nausea </li></ul><ul><li>Tachycardia, bradycardia </li></ul><ul><li>Urinary retention </li></ul><ul><li>Rash </li></ul><ul><li>Sweating </li></ul>06/03/09 Created by Amanda McBride
  70. 70. Contraindication, precautions, interactions <ul><li>Acute bronchial asthma </li></ul><ul><li>Increased ICP </li></ul><ul><li>Convulsive disorders </li></ul><ul><li>Severe renal hepatic impairment </li></ul><ul><li>Pregnancy </li></ul><ul><li>Use cautiously in elderly </li></ul><ul><li>Opiate naïve </li></ul><ul><li>Undx abdo pain </li></ul><ul><li>Hypoxia </li></ul><ul><li>SVT </li></ul>06/03/09 Created by Amanda McBride
  71. 71. Nursing Process <ul><li>Assessment </li></ul><ul><ul><li>Vital signs </li></ul></ul><ul><ul><li>Assessment including pain </li></ul></ul><ul><li>Implementation </li></ul><ul><ul><li>Masking pain symptoms </li></ul></ul><ul><ul><li>Long acting and breakthru </li></ul></ul><ul><ul><li>Constipation prevention and tx </li></ul></ul><ul><li>Evaluation </li></ul>06/03/09 Created by Amanda McBride
  72. 72. PQRST Method for Pain Assessment <ul><li>P = Provokes </li></ul><ul><ul><li>What causes pain? </li></ul></ul><ul><ul><li>What makes it better? </li></ul></ul><ul><ul><li>Worse? </li></ul></ul><ul><li>Q = Quality </li></ul><ul><ul><li>What does it feel like? </li></ul></ul><ul><ul><li>Is it sharp? </li></ul></ul><ul><ul><li>Dull? </li></ul></ul><ul><ul><li>Stabbing? </li></ul></ul><ul><ul><li>Burning? </li></ul></ul><ul><ul><li>Crushing? ( Try to let patient describe the pain, sometimes they say what they think you would like to hear. ) </li></ul></ul><ul><li>R = Radiates </li></ul><ul><ul><li>Where does the pain radiate? </li></ul></ul><ul><ul><li>Is it in one place? </li></ul></ul><ul><ul><li>Does it go anywhere else? </li></ul></ul><ul><ul><li>Did it start elsewhere and now localised to one spot? </li></ul></ul><ul><li>S = Severity </li></ul><ul><ul><li>How severe is the pain on a scale of 1 - 10? </li></ul></ul><ul><li>( This is a difficult one as the rating will differ from patient to patient. ) </li></ul><ul><li>T = Time </li></ul><ul><ul><li>Time pain started? </li></ul></ul><ul><ul><li>How long did it last? </li></ul></ul>06/03/09 Created by Amanda McBride
  73. 73. Education <ul><li>No driving </li></ul><ul><li>No alcohol </li></ul><ul><li>Signs of tolerance </li></ul><ul><li>Take as prescribed </li></ul><ul><li>GI upset take food </li></ul>06/03/09 Created by Amanda McBride
  74. 74. Opioid toxicity <ul><li>Resp depression </li></ul><ul><li>Low BP </li></ul><ul><li>CNS depression </li></ul><ul><li>Narcan </li></ul>06/03/09 Created by Amanda McBride
  75. 75. Treatment specific Disorders <ul><li>Cancer </li></ul><ul><li>Post op </li></ul><ul><li>Burns </li></ul><ul><li>Biliary, renal or uretral colic </li></ul>06/03/09 Created by Amanda McBride
  76. 76. Special populations <ul><li>Opiate tolerant pts. </li></ul><ul><li>Use in children. </li></ul><ul><li>Use in older adults. </li></ul><ul><li>Renal impairment. </li></ul><ul><li>Hepatic impairment. </li></ul><ul><li>Home care. </li></ul>06/03/09 Created by Amanda McBride
  77. 77. Opiate Antagonist <ul><li>Action </li></ul><ul><ul><li>Counteracts effect of narcotic </li></ul></ul><ul><ul><li>Competes for opiate receptors </li></ul></ul><ul><li>Narcan </li></ul><ul><ul><li>Short half life, repeated dosing usually needed. </li></ul></ul><ul><ul><li>Few adverse reactions. </li></ul></ul>06/03/09 Created by Amanda McBride
  78. 78. Use <ul><li>Postop acute resp depression </li></ul><ul><li>Opioid reversal </li></ul><ul><li>Opioid overdose </li></ul>06/03/09 Created by Amanda McBride
  79. 79. Adverse Effects <ul><li>Nausea vomiting </li></ul><ul><li>Sweating </li></ul><ul><li>Tachycardia </li></ul><ul><li>Increased BP </li></ul><ul><li>tremors </li></ul>06/03/09 Created by Amanda McBride
  80. 80. Contraindications, precautions, interactions <ul><li>Used cautiously in pregnancy </li></ul><ul><li>Opioid dependency </li></ul><ul><li>CVS disease </li></ul><ul><li>May produce withdrawal in pts who are addicted </li></ul>06/03/09 Created by Amanda McBride
  81. 81. Nursing Process <ul><li>Assessment </li></ul><ul><ul><li>Vitals </li></ul></ul><ul><ul><li>Assessment </li></ul></ul><ul><ul><li>Attempt to stimulate postop pt </li></ul></ul><ul><li>Implementation </li></ul><ul><ul><li>Balance need for pain control and resps </li></ul></ul><ul><ul><li>Keep suction close by for vomiting </li></ul></ul><ul><ul><li>If pain recurs must treat pain again </li></ul></ul>06/03/09 Created by Amanda McBride
  82. 82. Antidepressant Tricyclic Antidepressants SSRI Misc 06/03/09 Created by Amanda McBride
  83. 83. Depressive disorders <ul><li>Depressive disorders are mental illnesses characterized by deep, long-lasting feelings of sadness or despair. The patient may also lose interest in things that were once pleasurable. Changes in sleep patterns, appetite, and mental processes may also accompany depressive disorders. Depressive disorders are also known simply as depression or as unipolar (one-sided) depression </li></ul>06/03/09 Created by Amanda McBride
  84. 84. Tricyclic Antidepressants <ul><li>Action </li></ul><ul><ul><li>Increasing and decreasing sensitivity to neurotransmitters </li></ul></ul><ul><li>Uses </li></ul><ul><ul><li>Depressive episodes </li></ul></ul><ul><ul><li>Obsessive compulsive disorders </li></ul></ul><ul><ul><li>Chronic neuropathic pain </li></ul></ul><ul><ul><li>Anxiety disorders </li></ul></ul><ul><ul><li>enuresis </li></ul></ul>06/03/09 Created by Amanda McBride
  85. 85. Adverse Reactions <ul><li>Anticholinergic effects </li></ul><ul><li>Constipation </li></ul><ul><li>Photosensitivy </li></ul>06/03/09 Created by Amanda McBride
  86. 86. Contraindications, Precautions, Interactions <ul><li>MAOI </li></ul><ul><li>Recent MI </li></ul><ul><li>Children </li></ul><ul><li>Pregnancy </li></ul><ul><li>Used cautiously in cardiac disease, hepatic, renal impairment, glaucoma, urinary retention, risk of suicidal behaviour </li></ul><ul><li>Page 244 </li></ul>06/03/09 Created by Amanda McBride
  87. 87. Selective Serotonin Reuptake Inhibitors 06/03/09 Created by Amanda McBride
  88. 88. Actions <ul><li>Increase in serotonin levels is thought to act as a stimulant to reverse depression </li></ul>06/03/09 Created by Amanda McBride
  89. 89. Uses <ul><li>Depressive episodes </li></ul><ul><li>Obsessive compulsive disorders </li></ul><ul><li>Bulimia nervosa </li></ul><ul><li>Panic </li></ul><ul><li>Premenstrual syndrome </li></ul><ul><li>Post traumatic stress disorder </li></ul><ul><li>Generalized anxiety </li></ul><ul><li>Migraines </li></ul>06/03/09 Created by Amanda McBride
  90. 90. Adverse Reactions <ul><li>Somnolence </li></ul><ul><li>Dizziness </li></ul><ul><li>Headache </li></ul><ul><li>Insomnia </li></ul><ul><li>Tremor </li></ul><ul><li>Weakness </li></ul><ul><li>Constipation, dry mouth, nausea </li></ul><ul><li>Pharyngitis </li></ul>06/03/09 Created by Amanda McBride
  91. 91. Contraindications, Precautions, Interactions <ul><li>Pregnancy </li></ul><ul><li>use cautiously in diabetes, cardiac disease, liver renal impairment, suicidal ideation </li></ul><ul><li>Page 246 </li></ul>06/03/09 Created by Amanda McBride
  92. 92. Nursing Process <ul><li>Assessment </li></ul><ul><ul><li>Medical history </li></ul></ul><ul><ul><li>Psych assessment </li></ul></ul><ul><li>Implementation </li></ul><ul><ul><li>Response is not rapid </li></ul></ul><ul><ul><li>Orthostatic hypotension </li></ul></ul><ul><ul><li>Don’t stop abruptly </li></ul></ul><ul><ul><li>Report any suicidal ideation </li></ul></ul><ul><li>Evaluation </li></ul><ul><ul><li>Effect </li></ul></ul>06/03/09 Created by Amanda McBride
  93. 93. Education <ul><li>If dizziness occurs, rise slowly </li></ul><ul><li>Keep appts </li></ul><ul><li>Report any unusual effects </li></ul><ul><li>Take as prescribed </li></ul>06/03/09 Created by Amanda McBride
  94. 94. Symptoms of Psychosis <ul><li>False personal beliefs that are not part of reality </li></ul><ul><li>• Truly believes something that doesn’t make sense to others </li></ul><ul><li>around them, and any reasoning and showing evidence that contradicts </li></ul><ul><li>their belief doesn’t convince them that their belief is false </li></ul><ul><li>• Includes the belief that they are being spied on, plotted against, </li></ul><ul><li>harmed or tormented; many report receiving messages from the </li></ul><ul><li>radio or television </li></ul><ul><li>Sensing things that aren’t actually there </li></ul><ul><li>• Includes hearing, seeing, smelling, tasting or feeling things </li></ul><ul><li>that others don’t perceive </li></ul><ul><li>• The most common hallucinations involve hearing voices usually </li></ul><ul><li>saying negative, critical or frightening things to the person, </li></ul><ul><li>warning of danger, or even giving orders </li></ul><ul><li>Being unable to &quot;think straight&quot; </li></ul><ul><li>• Organizing thoughts is difficult, making it impossible to </li></ul><ul><li>communicate clearly with others </li></ul><ul><li>• Unable to concentrate on one thought for very long; thoughts may </li></ul><ul><li>come and go quickly </li></ul><ul><li>• Unable to connect thoughts into logical sequences; thoughts are </li></ul><ul><li>often blocked and become fragmented </li></ul><ul><li>Being emotionally disturbed or excited </li></ul><ul><li>• Includes appearing disturbed, excited, restless or hyperactive </li></ul><ul><li>Trying to seem very important </li></ul><ul><li>• Believe that they are powerful, wealthy, very intelligent, famous or </li></ul><ul><li>have special powers </li></ul><ul><li>Being untrusting and guarded </li></ul><ul><li>• Might think they are being watched, followed, persecuted or </li></ul><ul><li>conspired against </li></ul><ul><li>Acting unfriendly and showing ill feelings towards </li></ul><ul><li>others </li></ul><ul><li>• Behaving in an abusive, sarcastic and difficult manner </li></ul>06/03/09 Created by Amanda McBride
  95. 95. Antipsychotic Drugs <ul><li>Act by inhibiting or blocking the release of neurotransmitter dopamine </li></ul>06/03/09 Created by Amanda McBride
  96. 96. Uses <ul><li>Acute or chronic pyschosis </li></ul><ul><li>Bipolar illness </li></ul><ul><li>Agitated behaviours associated with dementia </li></ul>06/03/09 Created by Amanda McBride
  97. 97. Adverse Reactions <ul><li>Sedation, headache, hypotension, dry mouth, urticaria </li></ul><ul><li>Behavioural changes, increase in psychotic symptoms </li></ul><ul><li>Lethargy, hyperactivity, paranoid reactions, agitation, confusion </li></ul>06/03/09 Created by Amanda McBride
  98. 98. Extrapyramidal Symptoms <ul><li>Extrapyramidal symptoms (EPS) are the various movement disorders such as tardive dyskinesia suffered as a result of taking dopamine antagonists , usually antipsychotic (neuroleptic) drugs , which are often used to control psychosis , especially schizophrenia . Other antidopaminergic drugs like the antiemetic metoclopramide or the tricyclic antidepressant amoxapine can also cause extrapyramidal side effects </li></ul>06/03/09 Created by Amanda McBride
  99. 99. Tardive Dyskinesia <ul><li>Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of the arms, legs, and trunk may also occur. Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano. Patients with Parkinson's disease have difficulty moving, while patients with tardive dyskinesia have difficulty not moving . </li></ul>06/03/09 Created by Amanda McBride
  100. 100. NeurolepticMalignant Syndrome <ul><li>Rare, fatal complication </li></ul><ul><li>Clinical manifestations: </li></ul><ul><li>Hyperthermia </li></ul><ul><li>Hypertonicityof skeletal muscles </li></ul><ul><li>Mental changes </li></ul><ul><li>Autonomic instability </li></ul>06/03/09 Created by Amanda McBride
  101. 101. Contraindications, Precautions, Interactions <ul><li>Severely depressed </li></ul><ul><li>Blood dyscrasias </li></ul><ul><li>Liver impariment </li></ul><ul><li>Sever hypo/hypertension </li></ul><ul><li>Used cautiously in resp disorders, epilepsy, renal impairment, PUD </li></ul><ul><li>Page 267 </li></ul>06/03/09 Created by Amanda McBride
  102. 102. Nursing Process <ul><li>Assessment </li></ul><ul><ul><li>Psych assessment </li></ul></ul><ul><li>Implementation </li></ul><ul><ul><li>As prescribed </li></ul></ul><ul><ul><li>Safety </li></ul></ul><ul><li>Evaluation </li></ul><ul><ul><li>Effect </li></ul></ul>06/03/09 Created by Amanda McBride
  103. 103. Education <ul><li>Keep appts </li></ul><ul><li>Report any unusual effects </li></ul><ul><li>No alcohol </li></ul><ul><li>Avoid sun exposure </li></ul>06/03/09 Created by Amanda McBride
  104. 104. <ul><li>Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity - from illness to brain damage to abnormal brain development - can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, or some combination of these factors. Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. EEGs and brain scans are common diagnostic test for epilepsy . </li></ul>06/03/09 Created by Amanda McBride
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  108. 108. Status Epilepticus <ul><li>A state of continuous seizures or repetitive, discrete seizures with impaired consciousness in the interictal period </li></ul><ul><ul><li>Duration </li></ul></ul><ul><ul><ul><li>Traditional criterion: 15–30 minutes </li></ul></ul></ul><ul><ul><ul><li>Practical criterion: duration prompting acute use of anticonvulsant therapy; typically > 5 minutes </li></ul></ul></ul><ul><ul><li>May occur with all type of seizures: grand mal (tonic-clonic) status, myoclonic status, petit mal status, and temporal lobe (complex partial) status </li></ul></ul><ul><ul><li>Associated with major cerebral and systemic physiologic changes </li></ul></ul><ul><ul><ul><li>Initial stage (first 30–60 minutes) </li></ul></ul></ul><ul><ul><ul><ul><li>Cerebral metabolism is greatly increased because of seizure activity, but physiologic mechanisms are sufficient to meet the metabolic demands. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cerebral: increased blood flow, increased metabolism </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Autonomic and cardiovascular: hypertension, increased cardiac output, massive catecholamine release, tachycardia, arrhythmias, hyperpyrexia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Metabolic: lactic acidosis, hyperglycemia </li></ul></ul></ul></ul><ul><ul><ul><li>Decompensated phase </li></ul></ul></ul><ul><ul><ul><ul><li>Cerebral metabolic demands cannot be fully met, resulting in hypoxia and altered cerebral and systemic metabolic patterns. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cerebral: hypoxia, hypoglycemia, increased intracranial pressure </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Autonomic and cardiovascular: hypoxia, hypotension, hyperpyrexia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Metabolic: hypoglycemia, hyponatremia, hyperkalemia, metabolic acidosis </li></ul></ul></ul></ul><ul><ul><li>Generalized status is life threatening when accompanied by hyperpyrexia, acidosis (from prolonged muscle activity), and respiratory or cardiovascular compromise. </li></ul></ul>06/03/09 Created by Amanda McBride
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  110. 110. Anticonvulsants <ul><li>Action </li></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><ul><li>Inhibit uptake of GABA </li></ul></ul></ul><ul><ul><li>Hydantoins </li></ul></ul><ul><ul><ul><li>Stabilize the hyperexcitability </li></ul></ul></ul><ul><li>Uses </li></ul><ul><ul><li>Seizures </li></ul></ul><ul><ul><li>Neuropathic pain </li></ul></ul><ul><ul><li>Bipolar disorders </li></ul></ul><ul><ul><li>Anxiety disorders </li></ul></ul>06/03/09 Created by Amanda McBride
  111. 111. <ul><li>Adverse </li></ul><ul><ul><li>Drowsiness, weakness, dizziness </li></ul></ul><ul><ul><li>Headache, somnolence </li></ul></ul><ul><ul><li>Slurred speech, ataxia, nystagmus </li></ul></ul><ul><ul><li>Nausea, vomiting, anorexia </li></ul></ul><ul><ul><li>Rash, urticaria </li></ul></ul><ul><ul><li>Ataxia </li></ul></ul><ul><li>Contraindicated </li></ul><ul><ul><li>Dilantin in bradycardia and HB </li></ul></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>CNS depression </li></ul></ul><ul><li>Precautions </li></ul><ul><ul><li>Liver renal impairment </li></ul></ul><ul><li>Interactions </li></ul>06/03/09 Created by Amanda McBride
  112. 112. Dilantin <ul><li>Not to be given IM </li></ul><ul><li>Not stable in D5W </li></ul><ul><li>Interacts with many medications. </li></ul>06/03/09 Created by Amanda McBride
  113. 113. Gabapentin <ul><li>Partial seizures </li></ul><ul><li>Treat neuralgia pain. </li></ul><ul><li>Chronic pain syndromes </li></ul><ul><li>Adjunct therapy in post ortho pt. </li></ul>06/03/09 Created by Amanda McBride
  114. 114. Phenobarbital <ul><li>Long acting barbiturate. </li></ul><ul><li>Half life 50-140 hours </li></ul>06/03/09 Created by Amanda McBride
  115. 115. Drug Selection <ul><li>Type of seizure </li></ul><ul><li>Generalized seizures </li></ul><ul><ul><li>valproic acid </li></ul></ul><ul><ul><li>Dilantin </li></ul></ul><ul><li>Partial seizures </li></ul><ul><ul><li>Gabapentin, phenobarb, Dilantin </li></ul></ul><ul><li>Adverse effects </li></ul><ul><ul><li>CNS depression </li></ul></ul><ul><ul><li>Cognitive impairment </li></ul></ul>06/03/09 Created by Amanda McBride
  116. 116. Nursing Process <ul><li>Vitals </li></ul><ul><li>Neuro assessment </li></ul><ul><li>History of seizure type/activity </li></ul><ul><li>Implementation </li></ul><ul><ul><li>Do not stop abruptly </li></ul></ul><ul><li>Evaluation </li></ul><ul><ul><li>Blood levels </li></ul></ul><ul><ul><li>effect </li></ul></ul>06/03/09 Created by Amanda McBride
  117. 117. Monitoring Anti-Epileptic drug therapy <ul><li>Pt response </li></ul><ul><li>Serum drug levels periodically </li></ul><ul><li>Monitor for toxicity </li></ul><ul><li>Baseline bloodwork. </li></ul><ul><li>Changes made gradually over 2-3 months </li></ul>06/03/09 Created by Amanda McBride
  118. 118. Toxicity <ul><li>Fatalities have been assoc with all AED </li></ul><ul><li>SS are extensions of adverse effects </li></ul><ul><ul><li>CNS depression </li></ul></ul><ul><ul><li>Coma </li></ul></ul><ul><ul><li>Resp depression </li></ul></ul><ul><ul><li>CVS problems </li></ul></ul><ul><ul><li>Life threatening. </li></ul></ul>06/03/09 Created by Amanda McBride
  119. 119. Antiparkinsonism Drugs <ul><li>Action </li></ul><ul><ul><li>Stimulate dopamine receptor sites </li></ul></ul><ul><li>Uses </li></ul><ul><ul><li>Parkinsons disease </li></ul></ul><ul><ul><li>RLS </li></ul></ul><ul><ul><li>Viral infections </li></ul></ul>06/03/09 Created by Amanda McBride
  120. 120. Adverse Effects <ul><li>Dry mouth, anorexia, nausea, vomiting, abdo pain, constipation </li></ul><ul><li>Increased hand tremor </li></ul><ul><li>Headache </li></ul><ul><li>Dizziness </li></ul><ul><li>Choreiform movement: ceaseless occurrence of rapid, highly complex jerky movements that appear to be well coordinated but are performed involuntarily </li></ul><ul><li>Dystonia is a syndrome of spasms and sustained contractions of the muscles. These muscle movements are not under voluntary control and they result in repetitive abnormal movements of parts of the body or persistently abnormal postures. </li></ul>06/03/09 Created by Amanda McBride
  121. 121. Contraindications, Precautions, Interactions <ul><li>Glaucoma </li></ul><ul><li>MAOI </li></ul><ul><li>Levodopa can activate malignant melanoma </li></ul><ul><li>Used cautiously in CVS or pulm diseases, PUD, renal or hepatic impairment, pychosis </li></ul><ul><li>Interactions pg 327 </li></ul>06/03/09 Created by Amanda McBride
  122. 122. Nursing Process <ul><li>Assessment </li></ul><ul><ul><li>ADL’s </li></ul></ul><ul><ul><li>Neuro assessment </li></ul></ul><ul><ul><li>Neuro muscular assessment </li></ul></ul><ul><li>Implementation </li></ul><ul><ul><li>Psychosis </li></ul></ul><ul><li>Evaluation </li></ul><ul><ul><li>Effect </li></ul></ul>06/03/09 Created by Amanda McBride
  123. 123. Education <ul><li>Do not use alcohol </li></ul><ul><li>GI upset </li></ul><ul><li>Pts with diabetes, drug may affect urine testing </li></ul><ul><li>Keep all appts </li></ul>06/03/09 Created by Amanda McBride

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