Nervous system meds

8/13/2019 Nervous system meds

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Medications Affecting theNervous System

(Classifications)

N203ATI (nit

Nervous Sys


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Muscarinic agonists (parasympathomimetic) Bethanechol

Muscarinic antagonists Atropine

Ganglionic-stimulating agents Nicotine

Cholinesterase inhibitors (ChE) Physostigmine or neostigmine

Neuromuscular-blocking agents Tubocurarine

Arenergic agonists (sympathomimetic) Epinephrine

Arenergic antagonistsblock ! " # receptors$

Pra%osin ! arenergic antagonist

Propanolol # arenergic antagonist


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NicotinicN#ece$tors

N203ATI (nit

Nervous Sys


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&elease o' epinephrine 'rom arenal meulla


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NicotinicM#ece$tors

N203ATI (nit

Nervous Sys


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ocate at neuromuscular unction o' skeletal muscle

Causes skeletal muscle contraction


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Muscarinic #ece$tors

N203ATI (nit

Nervous Sys


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secretions 'rom lungs* stomach* intestines* s+eat glans

in ,&

mooth muscle contraction in bronchi an G. tract

Miosis (sphincter contraction) an accommoation (ciliary contra

/oiing ue to contraction o' etrusor muscle an rela0ation o' tran sphincter muscles


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Al$ha1#ece$tors

N203ATI (nit

Nervous Sys


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Myriasis 1t raial muscle contraction

/eins an arterioles are acti2ate to constrict

peripheral resistance*bloo pressure

Male se0 organs are acti2ate to promote eaculation

Contraction o' prostatic capsule* trigone* an sphincter muscles


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%o$amine #ece$tors

N203ATI (nit

Nervous Sys


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3ilates bloo 2essels in the kineys


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&eta1#ece$tors

N203ATI (nit

Nervous Sys


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Preominant receptor 'oun on the heart

,&*Contraction 4orce* Conuction through A/ noe

lipolysis

&elease o' &enin by the kineys


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&eta2#ece$tors

N203ATI (nit

Nervous Sys


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3ilates bronchi &ela0es uterine smooth muscle

/asoilation o' arterioles in heart* lungs* an skeletal muscle

lightlyperipheral resistance

glycogenolysis in the li2er an muscles

keletal muscle contraction


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Medications Affecting theNervous System

('eneral oints)

N203ATI (nit

Nervous Sys


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Aapti2e changes +ithin brain +ith prolonge e0posure therapeutic e''ect

sie e''ects

Tolerance* physical epenence

3o not stop abruptly

,ighly 2ariable ini2iual response to meiations


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arinson*s %isease

N203ATI (nit

Nervous Sys


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Treatment uses t+o main classes5

Mes that acti2ate opamine receptors (irectly or inirectly)

Mes that block acetylcholine receptors


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Sei+ure %isorders

N203ATI (nit

Nervous Sys


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6 types o' sei%ures respon to 6 meications

7sually re8uire li'e-long management

Mes must be iscontinue slo+ly o2er 9 +eeks to se2eral month


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Schi+o$hrenia

N203ATI (nit

Nervous Sys


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Clinical course inclues semi-remission punctuate by acutee0acerbations

Positi2e symptoms (Agitation* elusions)

Con2entional antipsychotic Thora%ine

Atypical antipsychotic Clo%apine

Negati2e symptoms (ocial +ithra+al* poor sel'-care)

Atypical antipsychotic Clo%apine Cogniti2e symptoms (3i''iculties +ith memory an learning)

.nitial oses are high an gi2en throughout ay: maintenance oseat betime$


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%e$ression

N203ATI (nit

Nervous Sys


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ymptom relie' can take ;-< +eeks an possibly =-< months

Three main groups5

Tricyclic antiepressants (TCAs)

electi2e serotonin reuptake inhibitors (&.s)

Monamine o0iase inhibitors (MA>.s)


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&i$olar %isorder

N203ATI (nit

Nervous Sys


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Typically manage +ith mood stabilizers$ Antipsychotics anantiepressants may be use uring acute episoes o' mania orepression$

ithium

/alproic aci (3epakote) Carbama%epine (Tegretol)


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Cholinesterase Inhi,itors

N203ATI (nit

Nervous Sys


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Expected Action: Proto:Neostigmine* Phy

Pre2ents ACh egraation transmission o' ner2e impulses by ?A

Therapeutic Uses:

muscle strength by

?ACh@ at neuromuscular unction in myastheni

&e2ersal o' nonepolari%ing neuromuscular blocking agents (tubocurarin

Adverse Effects:

E0cessi2e muscarinic stimulation5 G. motility " secretions* braycarurinary urgency (sie e''ect can be treate +ith atropine)

Cholinergic crisis5 Abo2e plus resp$ epression 'rom neuromuscular blo

Contraindications/Precautions: Pregnancy (C)

C. in obstruction o' G.1G7 systems 1 caution +ith sei%ures* asthma* brahypotension* peptic ulcer isease

Interactions: Tubocurarine Neostigmine re2erses blockae Atropine counteracts uccinylcholine - neuromuscular block

Education: ear meic-alert bracelet


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Neuromuscular &locingAgents

N203ATI (nit

Nervous Sys


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Expected Action:Proto:Nonepolari%ing5 tubocurarine* pa

3epolari%ing5 succ

Block ACh at neuromuscular unction ont cross bloo-brain barrier

Therapeutic Uses: Control spontaneous respiration in 2entilate pts$

Auncts to general anesthesia 3iagnose myasthenia gra2is

uccinylcholine 'or5 electrocon2ulsi2e therapy* intubation* enoscopy

Adverse Effects: ,ypotension 'rom histamine release " ganglionic blo

&espiratory arrest Braycaria* ysrhythmias

Succinylcholine: o+ pseuocholinesterase acti2ity apnea

Malignant hyperthermia (antrolene) Pain ,ypeContraindications/Precautions: Pregnancy (C)

Ch5 C. 'or hyperkalemia (trauma* burns)

Interactions: General anesthetics

Aminoglycosies1tetracyclines - NM blockae

Neostigmine1ChE inhibitors5 D nonepolari%ing 1 D epolari%ing


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%o$aminergics(Anti"arinson*s)

N203ATI (nit

Nervous Sys


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Expected Action: Proto:e2oopa* carbiopa

e2oopa taken up an con2erte to opamine$ Carbiopa augments le2

pre2enting con2ersion to opamine in intestine an periphery (?3A@ i

Therapeutic Uses: ymptomatic relie' 'rom yskinesias

Adverse Effects: 3yskinesias 3iscoloration o' s+eat " urine

Nausea 1 ro+siness >rthostatic hypotension

Psychosis (clo%apine) Acti2ation o' malignant mel

Contraindications/Precautions: F cariac or psychiatric isorers

C. F melanoma = +eeks 'rom MA>. Pregnancy (C)

Interactions: Proteins inter'ere +ith absorption an transport

Con2entional antipsychotics (halol* compa%ine) D

Pyrio0ine

D MA>. hypertension

Carbiopa* opamine agonists* anticholinergics* C>MT inhibitors an

releaserstherapeutic e''ects$


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C-MT

N203ATI (nit

Nervous Sys


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Catechol >-Methyltrans'erase

3eacti2ates catecholamines (opamine* norepinephrine* acetylchoepinephrine* serotonin* histamine* etc)

4oun in post-synaptic cell membranes o' arenergic neurons +h

egraes norepinephrine$

Also 'oun in gut


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%o$amine Agonists(Anti"arinson*s)

N203ATI (nit

Nervous Sys


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Expected Action: Proto:Pramipe0ole* ropinirole* bro

Act irectly on opamine receptors

Therapeutic Uses:

Monotherapy early 1 combine +ith le2oopa in later stages

Adverse Effects: >rthostatic hypotension Psychosis

leep attacks 3aytime sleepiness 3yskinesias Naus


Caution F li2er " kiney impairment

Interactions:

e2oopa5 Can motor-control 'luctuations permitting lo+er ose

e2oopa5 Also risk o' orthostatic hypotension an yskinesias

Education:


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Centrally ActingAnticholinergics

(Anti"arinson*s)

N203ATI (nit

Nervous Sys


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Expected Action: Proto:Ben%tropine (Cogentin)* trihe0ypheni

Block ACh at muscarinic receptors +hich helps maintain ACh* opamin

Adverse Effects: Nausea (take F 'oo)

Atropine-like e''ects (ry mouth* blurre 2ision* myriasis* constipation

Antihistamine e''ects (seation* ro+siness)

Contraindications/Precautions:

C. in narro+-angle glaucoma

Interactions:

Education:


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Antiviral(Anti"arinson*s)

N203ATI (nit

Nervous Sys


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Expected Action: Proto:A

timulate opamine release* pre2ent opamine reuptake* an may block

cholinergic an glutamate receptorsTherapeutic Uses: Parkinsons 3isease

Adverse Effects: CN E''ects 3iscoloration o' skin (temporary)

Atropine-like e''ects


Interactions:

Education:


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Antie$ile$tic Medications(Medication .ist)

N203ATI (nit

Nervous Sys

Barbiturates phenobarbital (uminal)

,yantoins phenytoin (3ilantin)


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,yantoins phenytoin (3ilantin)

Ben%oia%epines ia%epam (/alium)

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ora%epam (Ati2an)

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Carbama%epine (Tegretol)

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Ethosu0imie (arontin)

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$/alproic aci (3epakote)

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$Gabapentin (Neurontin)

>ther mes lamotrigine (amictal)

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$o0carba%epine (Trileptal)


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&ar,iturate(Antie$ile$tic)

N203ATI (nit

Nervous Sys


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Therapeutic Uses: Proto:Phenobarbita

Partial sei%ures an generali%e tonic-clonic sei%ures

Not e''ecti2e against absence sei%uresAdverse Effects:

CN e''ects5 Aults as seation an an0iety* kis as irritability an hype

To0icity5 Nystagmus* ata0ia* respiratory epression* pinpoint pupils

Contraindications/Precautions: Pregnancy (3)

C. F intermittent porphyria

Interactions:

Education:


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/ydantoins(Antie$ile$tic)

N203ATI (nit

Nervous Sys


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Therapeutic Uses: Proto:Phenytoin

E''ecti2e against all maor 'orms e0cept absence sei%ures

Adverse Effects: CN e''ects kin rash Teratogenic Gingi2al hyperp

Cario2ascular Enocrine e''ects /itamin 3 me


C.5 sinus braycaria* A blocks* =n" ral contracepti2es* +ar'arin* glucocorticois5

D o' the Et>,* ia%epam* cimetiine* 2alproic aci5 phenytoin le2els

Carbama%epine* phenobarbital* chronic Et>,5 phenytoin le2els

CN epressants (e$g$ barbiturates1Et>,)5 Aiti2e e''ects +ith concurr

Education: 7se ./ route 'or status epilepticus Antiysrhythmics


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Car,ama+e$ine(Antie$ile$tic)

N203ATI (nit

Nervous Sys


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Therapeutic Uses: Prot

Partial sei%ures* tonic-clonic sei%ures* bipolar isorer* trigeminal neural

Adverse Effects: kin isorers

Cogniti2e 'unction is minimally a''ecte but CN e''ects can occur Bloo yscrasias Teratogenic ,ypo-osmolarity (A3, se


C.5 marro+ suppression 1 bleeing isorers

Interactions: Grape'ruit uice5 inhibits metabolism ?carbama%epine@

Phenytoin " phenobarbital5 D carbama%epine >ral contracepti2es an +ar'arin5 Carbama%epine stimulates hepatic en%

+hichle2els o' these meications

Education:


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thosu1imide(Antie$ile$tic)

N203ATI (nit

Nervous Sys


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Therapeutic Uses: Prot

.nicate >NH 'or absence sei%ures

Adverse Effects:

G. e''ects (take F 'oo)

CN e''ects ('atigue* i%%iness)


Interactions:

Education:


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al$roic Acid(Antie$ile$tic)

N203ATI (nit

Nervous Sys


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Therapeutic Uses: Proto

Partial* generali%e* an absence sei%ures* bipolar isorer* an migraine

Adverse Effects:

G. e''ects (take F 'oo) ,epatoto0icity Thrombocyt

Pancreatitis as e2ience by nausea* 2omiting* an abominal pain


A2oi in chilren younger than < (hepatoto0icity) i2er isorers

Interactions:

Phenytoin an phenobarbital5 Concurrent use these meications

Education:


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'a,a$entin(Antie$ile$tic)

N203ATI (nit

Nervous Sys


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Therapeutic Uses: Proto

ingle agent use 'or partial sei%ures

Neuropathic pain

MigraAdverse Effects:

CN e''ects (ro+siness* nystagmus)


Interactions:

Education:


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&en+odia+e$ines(Antie$ile$tic)

N203ATI (nit

Nervous Sys


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Therapeutic Uses: Proto:3ia%epam

7se in status epilepticus

Adverse Effects: &espiratory epression

Anterograe amnesia

Teratogenic


Interactions:

Education:


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Muscle #ela1ants Antis$asmodics

(Medication .ist)

N203ATI (nit

Nervous Sys


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Centrally Acting Muscle Relaxants

3ia%epam (2alium) Baclo'en (ioresal) Cycloben%aprine (4le0eril) Meta0alone (kela0in)

Peripherally Acting Muscle Relaxants

3antrolene (3antrium)


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%ia+e$am(Muscle #ela1ant Antis$asmodic)

N203ATI (nit

Nervous Sys

Expected Action: Proto:3ia%epam


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Acts in CN to enhance GABA an prouce seation

Acts in CN to epress spasticity o' muscles

Therapeutic Uses: &elie' o' spasticity 1t Cerebral Palsy or M

An0iety " panic isorers Et>, +ithra+al .nsomnia tatus epilepticus Anesthesia inuction &elie' o' spasm 1t i

Adverse Effects:

CN epression Physical epenence 'rom long-term use


Pregnancy (3) Caution F impaire li2er or renal 'unctionInteractions:

CN epressants (Et>,* opiois* antihistamines* barbiturates)5 Aiti2eepressi2e e''ects +ith concurrent use$

Education:


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Centrally Acting(Muscle #ela1ant Antis$asmodic)

N203ATI (nit

Nervous Sys

Expected Action: Proto: Baclo'en cycloben%aprine m


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Expected Action: Proto:Baclo'en* cycloben%aprine* m

Acts in CN to epress spasticity o' muscles

Therapeutic Uses: &elie' o' muscle spasm 1t inury

&elie' o' spasticity r1t cerebral palsy or multiple sclerosisAdverse Effects:

CN epression Physical epenence 'rom long-term use

Metaxalone:hepatoto0icity Baclofen5 nausea* urinary retention* co

Contraindications/Precautions: Caution in patients +ith impaire li2er o

'unction$ Baclofen5 Pregnancy (C)Interactions: CN epressants (Et>,* opiois* antihistamines) aiti

epressant e''ects +ith concurrent use$

Education:


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Cue(Muscle #ela1ant Antis$asmodic)

N203ATI (nit

Nervous Sys


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&esponse


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eri$herally Acting(Muscle #ela1ant Antis$asmodic)

N203ATI (nit

Nervous Sys

Expected Action: a!e: 3antrolene (3an


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Expected Action: a!e:3antrolene (3an

>nly peripherally acting muscle rela0ant$ .nhibits muscle contraction bypre2enting release o' calcium in skeletal muscles$

Therapeutic Uses:

&elie' o' spasticity 1t cerebral palsy or multiple sclerosis

Treatment o' malignant hyperthermia

Adverse Effects:

CN epression ,epatic to0icity


Pregnancy (C) Caution +ith impaire li2er " renal

'unction

Interactions:

CN epressants aiti2e e''ects


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.ocal Anesthetics

N203ATI (nit

Nervous Sys


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Expected Action:A!ide type5 iocaine Ester type5 tetrac

proc

pain by blocking local conuction o' pain impulsesAdverse Effects:

CN e0citation -- treat F mia%olam (/erse) oria%epam

,ypotension* braycaria* heart block* cariac arrest

Allergic reactions (more likely F esters)

uterine contractility$ 4reely cross placenta

pinal heaache (lay 'lat 'or ;= hrs) 7rinary retention (call a'ter

hrs)

Contraindications/Precautions: C. in ysrhythmias an1or heart block

Caution +ith li2er1kiney ys'unction* heart 'ailure* myasthenia gra2is


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'eneral Inhalation Anesthetics

N203ATI (nit

Nervous Sys


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Expected

Action:Proto:,alothane (4luothane)* iso'lurane (4orane)* nitrou

oss o' consciousness* loss o' sensation* rela0ation o' muscles* amnesia

Adverse Effects: ,epatoto0icity Gastric aspiration ,ypotension &espiratory " cario2ascular epression

Malignant hyperthermia (1c me* ice or ice saline in'usion* antrolene)

Interactions:

CN epressants5 Aiti2e e''ect >piois5 constipation " urinary

retention

Education: uccinylcholine use as a muscle rela0ant

Encourage early ambulation Assist +ith lung e0pansion


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Intravenous Anesthetics(4ey oints)

N203ATI (nit

Nervous Sys


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Barbiturates5 Thiopental (Pentothal) Jetamine (Jetalar)

Ben%oia%epines5 3ia%epam (/alium)* mia%olam (/erse)* lora%epam

(Ati2an) Propo'ol (3ipri2an)

Therapeutic

Uses: Aunct to inhalation anesthesia

.nuction " maintenance o' anesthesia Amnesia

Mia%olam " an opioi result in conscious seation

Jetamine can be use +ith chilren


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Intravenous Anesthetics(ffects and Interactions)

N203ATI (nit

Nervous Sys

Expected Action: Thiopental* 3ia%epam* Jetamine* Propo'ol* Mia%


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Adverse Effects:

&espiratory an cario2ascular epression

Propofol5 Bacterial in'ection (use opene 2ial +ithin 9 hrs)

Ketamine5 Psychologic reaction (premeicate +ith ia%epam to risk)


Ketamineshoul be a2oie +ith psychiatric isorers

Interactions:

CN epressants an stimulants5 Aiti2e e''ects

>pioi analgesics5 Constipation an urinary retentionEducation:

Midazolam (Versed):inect o2er K= minutes

Propofol (Diprivan)5 inect into large 2ein: prep site +ith lidocaine$


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Anti$sychotics " Conventional

N203ATI (nit

Nervous Sys

Expected

Action:

Proto:D5 chlorproma%ine (Thora%ine)* D5 haloperiol "thers5 'luphena%ine* molinone* perphena%ine* thio

3 i t l h li hi t i " i h i t i b i


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3opamine* acetylcholine* histamine* " norepinephrine receptors in brainperiphery are blocke$ ymptom inhibition 1t opamine#blockae in br

Therapeutic Uses: 3elusional isorer Bipolar isorer

Tourettes ynrome chi%oa''ecti2e isor 3ementia chi%ophrenia ,untingtons chorea

Adverse Effects: Agranulocytosis eation Photosensiti2

Anticholinergic e''ects >rtho hypotension Neuroenocrine e

ei%ures Parkinsonism e0ual ys'unction 3ysrhy

3ystonia Akathisia Tari2e yskinesia Neuroleptic malignant synrome

Interactions: Anticholinergics5D CN epressants5 Aiti2e e''

e2oopa5 Counteracts antipsychotics by stimulating opamine receptor

Education: Consier epot preparations Protect li8ui prep 'rom

Early EP symptoms +ith anticholinergics*!loc"ers# !enzodiazepines


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Anti$sychotics " Aty$ical

N203ATI (nit

Nervous Sys

Expected

Action:Proto:clo%apine "thers5 risperione* olan%apine* 8ueti


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Action results 'rom blockingserotoninan dopaminereceptors (block o

receptors* too) -- Pr e2eloping EP or tari2e yskinesia

Therapeutic Uses: e2ere schi%ophrenia

Psychosis inuce by levodopatherapy

Adverse Effects: Agranulocytosis (BC


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Normal .a, alues

N203ATI (nit

Nervous Sys

&BCQ$R-9$;0 ;;=1 BC O-;0 ;S1 PT ;O-Q0

P> RO ; PC>


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P>#RO-;mm ,g PC>=


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Cue

N203ATI (nit

Nervous Sys


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&esponse


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Antide$ressants 5 Tricyclic (TCA

N203ATI (nit

Nervous Sys

Expected Action:Proto:amitriptyline (

"thers5 imipramine (To'ranil)* o0epin (in


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Block reuptake o' norepinephrineanserotoninin synaptic space

Therapeutic Uses: 3epression " bipolar isorers

Adverse Effects: >rthostatic hypotension eation Anticholinergic e''ects Cariac to0icity V oses

To0icity e2ience by ysrhythmias* con'usion* " agitation 'ollo+e bysei%ures


Interactions: MA>.s hypertension

Antihistamine " anticholinergicsaiti2e e''ects

Epi1Norepi amounts o' arenergics because reuptake is blocke by

Epherine1amphetamine responses to these 1t uptake inhibition keethem 'rom reaching site o' action in ner2e terminal

Et>,* ben%oia%epines* opiois* antihistamines Aiti2e CN epress


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Selective Serotonin#eu$tae Inhi,itors (SS#Is)

N203ATI (nit

Nervous Sys

Expected

Action:

Proto:'luo0etine (Pro%ac) "thers:citalopram (escitalopram (e0apro)* paro0etine (Pa0il)* sertraline


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Action: escitalopram (e0apro)* paro0etine (Pa0il)* sertraline

Block reuptake o'serotoninin synaptic space

Therapeutic Uses:

Maor epression

Panic isorers

Bulim >C3 PT3 PM33

Adverse Effects: e0ual ys'unction eight gain &

ithra+al synrome leepiness* 'aintness ,yponatremi

erotonin synrome =-R= hrs (con'usion* an0iety* agitation* hallucination


C.5 MA>.s

Interactions: MA>.s risk o' serotonin synrome

ar'arin +ar'arin le2els TCA " ithium le2els o' thes

NA.3s " anticoagulants 'luo0etine suppresses platelets bleein


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Monoamine -1idase Inhi,itors(MA-I)

N203ATI (nit

Nervous Sys

Expected

Action:Proto:phenel%ine (Naril) "thers5 isocarb

Block MA> in brain norepinephrine an serotonin a2ailable 'or imp

Th i U At i l i >C3 B li i


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Therapeutic Uses: Atypical epression >C3 Bulimia

Adverse Effects: >rthostatic hypotension CN stimulation

,ypertensi2e crisis 'rom ietary tyramine (

,&*

BP)5 .nuce 2asoi+ith ./phentolamine(!-blocker) or sublingual nifedipine$


C.5 &.s* pheochromocytoma* cario2ascular isease " renal insu''ici

Interactions: .nirect sympathomimetic release NE causing hypertens

crisis TCA hypertensi2e crisis &.s serotonin synrome

Antihypertensi2es aiti2e hypotensi2e e''ect Meperidine

hyperpyre0ia Tyramine-rich 'oos hypertensi2e crisis (age cheese* salami* a2ocao

bananas* protein* " re +ine)

/asopressors (phen$leth$lamine* caffeine)

hypertension


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Aty$ical Antide$ressants

N203ATI (nit

Nervous Sys

E t dProto:bupropion (ellbutrin) "thers:mirta%apine (&em


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Expected

Action:

p p ( ) p (2enla'a0ine (E''e0or)* rebo0etine (/estra)* tra%o

.nhibit opamine uptakeTherapeutic Uses: 3epression Ai to 8uit smoki

Adverse Effects: ei%ures

,eaache* ry mouth* constipation* ,&* restlessness* +eight loss


Pregnancy B C.5 ei%ure isorers* MA>.s

Interactions: MA>.s (e$g$phenelzine) risk o' to0icity


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Mood Sta,ili+ers

N203ATI (nit

Nervous Sys


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Sedative"/y$notics ""&en+odia+e$ines

N203ATI (nit

Nervous Sys

Expected Action:Proto:ia%epam (/alium) "thers:alpra%olam (W

lora%epam (Ati2an)* chloria%epo0ie (i

E h h i ' i b i i (GABA)


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Enhance the action o' gamma-aminobutyric aci (GABA)

Therapeutic Uses: An0iety ei%ures Panic isorer

Muscle spasms Anesthesia Et>, +1 .nsomAdverse Effects: CN epression Anterograe amne

Parao0ical response &espiratory epression

Acute to0icity (treat oral F charcoal* treat ./ Ffl%mazenil)

Contraindications/Precautions: Teratogenic

Interactions:


Education:


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Sedative"/y$noticsNon"&en+odia+e$ine

N203ATI (nit

Nervous Sys

Expected Action:Proto:%olpiem (Ambien) >thers5 %aleplon (

es%opiclone (unesta) * tra%oone (3

Enhance action o' GABA in CN leaing to prolonge sleep uration$ T


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g p g pnot 'unction as antian0iety* muscle rela0ant* or antiepileptic agents$

Therapeutic Uses:

Management o' insomnia

Adverse Effects:

3aytime sleepiness an lightheaeness


Interactions:


4oo absorption +hen taken +ith 'oo

Education:


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An1iolytic 5 Non"&ar,iturate

N203ATI (nit

Nervous Sys

Expected Action: Proto:Buspirone (Bu

7ncertain it oes bin toserotoninan dopaminereceptors$


100/110

p p

Therapeutic Uses: Treatment o' Generali%e An0iety 3isorer

Adverse Effects: CN e''ects N> E3AT.>N


&r$throm$cin# "etoconazole* an grape'ruit uice e''ects o' buspiron

3oes N>T potentiate CN epressants

Interactions:

Education:

Take +ith meals to pre2ent gastric irritation


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CNS Stimulants

N203ATI (nit

Nervous Sys

Expected

Action:

Proto:methylpheniate (&italin) "thers5 amphete0troamphetamine (3e0erine)* Aerall* c

&elease norepinephrine an opamine an pre2ent their reuptake in CN


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&elease norepinephrine an opamine an pre2ent their reuptake in CN

Therapeutic Uses: A3,3 >besity Narcolepsy

Adverse Effects: CN stimulation eight loss Cario2ascular e''ects (ysrhythmias* chest pain* BP)


Caution5 hyperthyroiism* heart isease* glaucoma* ,0 o' rug abuse* M

Interactions:

MA'shypertensi2e crisis

affeine

CN stimulant e''ects Phen$toin# *arfarin# pheno!ar!ital.nhibite metabolism o' these

>TC col " econgestants CN stimulant e''ects

Education:


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%rugs of A,use

Alcohol

N203ATI (nit

Nervous Sys

%ithdra&al 'y!pto!s 7sually start +ithin ;=-R= hours 1 Persist O-R

Can be mil5 nausea* an0iety* tremors

Can be li'e-threatening5 hallucinations* cramps* tremors* sei%ures* ,&


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T

'upport Meds:

Ben%oia%epines (chlordiazepoxide# diazepam# lorazepam) 3T an

sei%ures*intensity o' symptoms Auncts (car!amazepine# clonidine# propanolol) sei%ure*cra2in

epress autonomic response (,&*BP*T)

Maintenance Meds:

Dis%lfiram (Anta!%se)F Et>,* alehye synrome occurs (nausea* e0tr2omiting* hypotension) Can progress to respiratory an cariac epresssei%ures* an eath$

+altrexone (,eVia)>pioi antagonist that cra2ing an pleasurable

Acamprosate (ampral)unpleasant e''ects o' abstinence (an0iety* e


105/110

%rugs of A,use

-$ioids

N203ATI (nit

Nervous Sys

%ithdra&al 'y!pto!s el'-limiting in R-; ays

Begins +ith s+eating an rhinorrhea progressing 'rom tremors an irrit


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Begins +ith s+eating an rhinorrhea* progressing 'rom tremors an irritto +eakness* nausea* 2omiting* muscle1bone pain* an spasticity$

N>T li'e-threatening$(etox Meds:

Methadone substitution Pre2ents +ithra+al synrome$

Maintenance Meds:

Methadone ong-term maintenance$ 3epenence is trans'erre tomethaone$

lonidine (atapres)Control autonomic hyperacti2ity (nausea* 2omiti

B%prenorphine (-%!%tex)>pioi agonist1antagonist

+aloxone (-%!oxone)>pioi agonist1antagonist


107/110

%rugs of A,use

Nicotine

N203ATI (nit

Nervous Sys

%ithdra&al 'y!pto!s

Abstinence synrome is e2ience by irritability ner2ousness restlessn


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Abstinence synrome is e2ience by irritability* ner2ousness* restlessn

'upport Meds: B%propion (.$!an)cra2ing an symptoms o' +ithra+al$

+icotinePharmaceutical replacement to alle2iate symptoms

Education

Che+ gum o2er


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N20ATI (

Nervous S

Expected Action: Proto:2asopressin (Pitressin) X "thers5 esmopressin (3

Promote ,=> reabsorption in kineys (esmopressin pre'erre)


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Promote ,=> reabsorption in kineys (esmopressin pre'erre)

/asoconstriction ue to smooth muscle contraction (2asopressin)

Therapeutic Uses: 3iabetes insipius Cariac arrest

Adverse Effects: >2erhyration (sleepiness* pouning heaache)

Contraindications/Precautions: Y (W) Pregnancy

CA3 orperipheral circulation (risk 'or gangrene)

Education: Monitor site care'ully: e0tra2asation can cause gangrene$

Nervous system meds

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