TEST 6 BLUEPRINT

Pharmacology

Extrapyramidal Effects

A group of adverse reactions occurring on the extrapyramidal portion of the nervous system

Parkinson like symptoms Akathisia Dystonia

Tardive Dyskinesia (TD) Syndrome of potentially irreversible involuntary rhythmic

movements of the tongue, face, mouth, jaw, or extremities. May occur in patients who are on antipsychotic drugs or

after discontinuing such drugs There is NO known treatment When it occurs the drug must be discontinued

Neuroleptic Malignant Syndrome

When taking an antipsychotic Neuroleptic Malignant Syndrome is developing: High fever Confusion Muscle rigidity

Precautions for stopping nervous system medication

Pg. 249 Abruptly stopping migraine agents after long term used can result in rebound migraines, therefore, they should be stopped slowly

Pg. 254 dependence can develop with indiscriminate use (barbiturates), and abrupt withdrawal is dangerous

Nursing interventions about meds + alcohol

Medications that work on the CNS should not be used with alcohol which is a CNS depressant.

Pg 253 synergistic effects with alcohol + barbituratesNurse should evaluate patient for med compliance

and alcohol usage pg. 255 when patient is taking anticonvulsives

Patients taking benzodiazepines should not drink alcohol within 24 hours of taking this medication pg. 257

Alcohol is contraindicated with the use of antiemetics and antivertigo drugs because of synergistic effects pg. 257

Sleep Meds

Sedative-hypnotic medications are often used in the hospital to relax patients and induce sleep and to treat patients with insomnia caused by mental/physical stress

Frightening dreams and “hangover” feeling are common

Once a patient has taken them it may take several weeks for normal sleep patterns to return

If used for more than 1 week they may cause further disturbances in the sleep cycle and rebound insomnia

Should be taken 15-30 minutes before bedShould be discontinued slowly to avoid reboundMAY be habit forming

Antidepressants Side Effects

Dizziness/drowsinessDysrhythmias/hypertension/hypotension/

tachycardiaDiarrhea/N/V/dyspepsia/anorexia/

constipationSedation/insomniaBlurred visionConfusion/hostility/deliriumTremor/twitchingSuicide

Antidepressant teachings…

Take medication in compliance with ordersDo not mix with alcohol or other CNS

depressantsInform doctor about new medicationsDo not stop the medication without doctor

supervisionAlert doctor to any new or troublesome side

effects

Lithium & BW

Primary drug used to treat patients in a manic state

Therapeutic levels are close to toxic levels, so serum lithium level must be monitored on a regular basis.

Blood should be drawn 12 hours after the dose of lithium is given.

Monitoring should be carried out every few days during the initial therapy and at least every 2 months thereafter

Therapeutic level is 1 to 1.5 mEq/L

Ritalin

CNS stimulant intended to treat ADD, ADHD, & narcolepsy

MAO inhibitors

Block the inactivation of the biogenic amines resulting in an increased concentration of dopamine, epinephrine, norepinephrine, and serotonin at neuronal synapses

Used to relieve the symptoms of severe reactive or endogenous depression that have NOT responded to tricyclic antidepressant therapy, electro-convulsive therapy, or other modes of psychotherapy

MAO inhibitor teachings…

What is the limbic system for?

The limbic system is a set of evolutionarily primitive brain structures located on top of the brainstem and buried under the cortex. Limbic system structures are involved in many of our emotions and motivations, particularly those that are related to survival. Such emotions include fear, anger, and emotions related to sexual behavior. The limbic system is also involved in feelings of pleasure that are related to our survival, such as those experienced from eating and sex.Certain structures of the limbic system are involved in memory as well. Two large limbic system structures, the amygdala and hippocampus play important roles in memory. The amygdala is responsible for determining what memories are stored and where the memories are stored in the brain. It is thought that this determination is based on how huge an emotional response an event invokes. The hippocampus sends memories out to the appropriate part of the cerebral hemisphere for long-term storage and retrieves them when necessary. Damage to this area of the brain may result in an inability to form new memories.

What is Elavil/Welbutrin used for?

Elavil Amitriptyline/elavil is a tricyclic antidepressant used

to treat the symptoms of endogenous depressionWelbutrin

Buproprion/welbutrin is an antidepressant that workd int eh brain to treat major depression, seasonal affective disorder, and for smoking cessation

What does an abrupt withdrawal of CNS dep. Cause?

Rebounding of symptoms

Tricyclic Antidepressants

Antidepressant effect of trycyclics is not completely understood

They are used primarily to relieve the symptoms of severe depression that has internal biologic causes (endogenous depression)

May be used to treat mild depression caused by factors in patient’s life (exogenous or reactive depression) which is NOT self-limiting and does not interfere with usual activities of daily living

Less commonly used for manic-depressive disorders

What is levdopa?

Antiparkinson medicationAlso used to treat muscular tremors caused

by other medicationsIt is turned into dopamine in the body

Antianxiety Teachings

Common Seizure meds

Barbiturates Luminal Phenobarbital

Benzodiazapines Klonopin Tranxene Valium

Hydantoins Cerebryx Dilantin

Succinimides Phensuximide

Miscellaneous Diamox Tegretol Neurontin Lamictal Topamax depakene

Side effects of seizure meds

What are neurotransmitters?

Chemical messengers that are released at the end of one neuron and passes across a small gap to activate the next neuron in the chain

At the end of the nerve chain it stimulates an organ, smooth muscle, or gland to produce a physiologic response

2 major: Norepinephrine-acts on sympathetic nerves Acetylcholine-acts on parasympathetic nerves

Nerve fibers that: Release norepinephrine are called adrenergic fibers Release acetylcholine are called cholinergic fibers

Status Epilepticus & meds

Status Epilepticus-a condition in which a series of severe grand mal seizures occur one after another without stopping

It is treated with long-acting barbiturates

What are common antimigraine meds?

Signs of Barbiturate OD

Exaggerated CNS depressionSlow, shallow respirationsMiosisTachycardiaAreflexiaShockcoma

What is phenobarb?

Phenobarbital is a barbiturate used for all forms of epilepsy, status epilepticus, severe recurrent seizures, & eclampsia

What is the special teaching about Dilantin?What is the initial dose?

Patients taking hydantoins (like Dilantin) should see a dentist every 6 months & maintain good oral hygiene brushing teeth and gums twice a day with a soft toothbrushing and rinsing well

Initial dose: Children 5 mg/kg/day PO in 2 or 3 equally divided doses

initiall Adults 100 mg PO 3 times daily intially

What are antivertigo medications?

Antivertigo medications agents are used to prevent and treat motion sickness and the N/V that occur with anesthesia and surgery or cancer treatments.

They are also used to treat severe, intractable vomiting and hiccups.

Special Teaching: If for motion sickness, take 30-60 minutes before departure

and 30 minutes after meals thereafter Patient should avoid all other CNS depressants including

alcohol Patient should not drive, operate dangerous machines, or do

anything that requires alertness

What are phentothiazines?

Phentothiazines are antidopaminergic agents used almost exclusively to control N/V.

Common phentothiazines: Thorazine Compazine Phenergen

What are dopaminergic agents?

Dopaminergic agents are Parkinson’s medications designed to elevate the functional levels of dopamine in motor regulatory centers

They: enhance the release of dopamine from pre-synaptic

nerve endings Directly stimulate dopamine receptors in corpus

straiatum

What are the signs of toxicity related to dopaminergic drugs?

Special Teaching for long-term use of dopaminergic drugs…

Overdosage is a common phenomenon with long-term therapy, so patients should be instruction to watch for signs of toxicity

Long-term use can cause Tardive DyskinesiaLong-term use often leads to akinesia (loss of

movelment) & dystonia (impairment of muscle tone)

To counteract these effects, the dosage is liekly to be reduced to the minimum effective level and dosages tapered as necessary to avoid overmedication

Best I could do on short notice!

Good Luck!