day 4 medication aide

MEDICATION AIDE CHAPTERS 14-17

COMMON CONDITIONS AFFECTING THE NERVOUS SYSTEM

• Epilepsy• Parkinson’s disease• Depression• Anxiety• Pain• Insomnia• Psychosis/schizophrenia• Cerebral palsy• Multiple sclerosis• Spinal cord injury• CVA

CONT.

• Consists of the central nervous system• Brain & spinal cord

• Peripheral nervous system• Nerves throughout the body• Nerves carry messages to/from the brain• Nerves connect to the spinal cord-are easily damaged & take a long time to heal• Some have a protective covering(myelin sheath) that protects & insulates-

causes impulses to travel faster

• Central nervous system-brain is protected by the skull• The 3 main parts

• Cerebrum-the outside is called the cerebral cortex & controls the highest functions of the brain-center of thought & intelligence

• Cerebellum-regulates & co-ordinates body movements-balance & smooth movement of the muscles

• Brainstem-connects the cerebrum to the spinal cord-it controls vital functioning of the organs such as breathing, heart rate, blood vessel size, swallowing, coughing & vomiting

DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM

• They maintain a constant internal environment & responds to emergencies• Most organs have both adrenergic(excite or

increase ht. rate) & cholinergic(slows the ht. rate)

BETA BLOCKERS

• Used after a MI-use with caution with respiratory diseases as can cause severe broncho-constriction

• Onset is fairly rapid though takes several days/weeks to stabilize(must be DC’d slowly)

• Examples Side Effects• Tenorrmin SOB• Coreg Low BP• Lopressor Low BS’s if Diabetic• TopralXL Slow Pulse• Inderal Peripheral constriction(skin

• becomes purple & mottled)

CHOLINERGIC AGENTS

• Slows the heart beat• Increases GI motility & secretion• Increases bladder contractions• Increases smooth muscle contractions of the resp.

system• Causes the pupil to contract which decreases

intraocular pressure & increases skeletal muscle contraction• Used to treat myasthenia gravis

CONT.

• Examples Side Effects• Urecholine Nausea & Vomiting• Mytelase Dizziness & hypotension• Guanindine Broncho-spasm, wheezing• Isopto Carpine bradycardia• Mestinon

ANTI-CHOLINERGIC

• Dilates the pupils(increases intraocular pressure)• Dries oral & respiratory secretions• Decreases motility of the GI tract• Increases ht. rate• Used to treat GI & eye disorders, Parkinson’s,

genital-urinary disorders & preoperatively to decrease respiratory secretions

CONT.

• Examples Side Effects• Atropine Blurred vision• Belladonna tincture Urinary retention• Bentyl Dry mouth, nose & throat• Robinal Confusion,

nightmares• Orthostatic Hypotension

SEDATIVES/HYPNOTICS

• Used for sleep, rest or sedation• Common side effects• Nausea• Vomiting• Confusion• Disorientation• Distorted vision• Weakness• dizziness

• Nursing precautions• Monitor closely for side effects when beginning doses of

medication• Monitor sleep patterns

EXAMPLES

• Sedative/hypnotics• Zolphidem (Ambien)• Zaleplon (Sonata)• Halcion (triazolam)• Restoril (temazepam)• Doral (quazepam)

• Other sleep medications• Diphenhydramine (benadryl, tylenol PM)• Trazodone (Desyrel)• Doxylamine (Unisom)• Lunesta (Eszopiclone)

BARBITURATES

• Depresses the CNS, used in anesthesia & seizures• Risk of addiction is high• Short acting ones can be used for sedation prior to

diagnostic procedures• Long acting-phenobarbital is used for control of seizures

• Side Effects• Drowsiness• Lethargy• HA• Muscle or joint pain• Mental depression• Increased confusion

BENZODIAZEPINES

• Most commonly used as sedative-hypnotics• Not to be used more then 4 wks.• Very highly addictive• Must be DC’d over a period of 2-4 wks.

• Side effects include• Drowsiness• Hangover• Sedation• Lethargy• Liver toxicity

PARKINSON’S DISEASE

• Is a slow, progressive disorder with no cure. • The area of the brain that controls muscle

movement is affected.• Dopamine deficiency • Persons over the age of 50 are at risk.• Signs and symptoms• Tremors• Rigid, stiff muscles• Slow movements• Stooped posture and impaired balance• Mask-like expression

ANTIPARKINSONIANS

• Used to treat Parkinson’s disease• Common side affects• Nausea• Vomiting• Confusion • Hallucinations• Fatigue• Diarrhea• Constipation• Dry mouth

• Nursing precautions• Observe for signs of improvement in symptoms of disease

(muscle tremors, rigidity)

EXAMPLES

• Levodopa/carbidopa (Sinemet)• Pramipexole (Mirapex)• Ropinirole (Requip)• Selegiline (Eldepryl, Zelapar)• Entacapone (Comtan, Stalevo)• Benztropine (Cogentin)• Trihexyphenidyl (Artane)• Amantadine Hydrochloride (symmetrel)• Bromocriptine mesylate (Parlodel)

ALZHEIMER’S DISEASE

• Brain disease• Memory, thinking, reasoning, judgment, language,

behavior, mood, and personality are affected• Gradual onset• Seven stages• No impairment• Very mild cognitive decline• Mild cognitive decline• Moderate cognitive decline• Moderately severe decline• Severe cognitive decline• Very severe decline

DEMENTIA/ALZHEIMER’S DISEASE

• Used to treat symptoms of Alzheimer’s by helping to slow cognitive decline

• Common side affects• Nausea• Diarrhea• Vomiting• Muscle cramps• Dizziness• insomnia

• Nursing precautions• Monitor for side effects

• Examples• Donepezil (Aricept)• Rivastigmine (Exelon)• Galantamine (Razadyne)• Tacrine HCL (Cognex)• Memantine (Namenda)

MENTAL DISORDERS

• Mental- means mind• Causes of mental health disorders• Not being able to cope or adjust to stress• Chemical imbalances (lithium)• Genetics• Drug or substance abuse• Social and cultural factors

ANXIETY

• Vague, uneasy feeling in response to stress• Signs and symptoms(Responses to stressful

situations)• Abnormal or irrational• Impair normal daily function

• Can last months

ANTIANXIETY

• Used to reduce anxiety• Common side affects

• Drowsiness• Confusion• Tremor• Dizziness• Dry mouth• Nausea• Diarrhea• Vomiting• Constipation

• Nursing precautions • Safety precautions for falls• Don’t abruptly discontinue medications

• Examples • Alprazolam (Xanax)• Lorazepam (Ativan)• Diazepam (Valium)• Buspirone (BuSpar)• Fluvoxamine (Luvox)• Hydroxyzine (Vistaril, Atarx)

DEPRESSION

• Affects relate to feelings and emotions• Signs and symptoms• Fatigue• Inability to experience pleasure• Hopelessness• Anxiety• Agitation• Change in sleep patterns• Increased dependency• Paranoia

THREE THERAPY PHASES

• Acute phase• Diagnose and treatment

• Continuation phase• Preventing a relapse

• Maintenance phase• Prevent episode from recurring

ANTIDEPRESSANTS

• Medications that help depression• Common side affects• Drowsiness• Insomnia• Nausea• Vomiting• Diarrhea• headache

• Nursing precautions• Medications shouldn’t be withdrawn suddenly• Monitor for constipation, diarrhea, sleeplessness

ANTI-DEPRESSANTS

• Elavil• Anafranil• Norpramin• Sinequin• Tofranil• Aventyl• Celexa• Cymbalta• Lexapro• Paxil

PSYCHOSES

• Delusions• False belief

• Hallucination• Seeing, hearing, smelling, or feeling something that is not real

• Paranoia• Suspicion

• Delusion of grandeur• Exaggerated belief about one’s importance

• Delusion of persecution• False belief that one is being mistreated or abused

• Schizophrenia is most common cause• Dementia, delirium, mood disorders, and drugs and

substance abuse

ANTIPSYCHOTICS

• Used to treat schizophrenia, mania, & dementia- related problems (psychotic disorder group of sever mental health illnesses where person’s ability to perceive reality, communicate, and form stable interpersonal relationships are impaired

• Common side affects• Drowsiness• Dry mouth• Constipation• Blurred vision• Confusion• Headache• Sedation• Muscle spasms• Stiffness• Spasms

CONT…

• Nursing precautions• Monitor for adverse effects• Report new signs of muscle tremors, stiffness, spasms(cogentin

is used to reduce involuntary muscle movements)

• Examples• Thioridazine (mellaril)• Chlorpromazine (thorazine)• Haloperidol (Haldol)• Risperidone (Risperdal)• Olanzapine (Zyprexa)• Quetiapine (Seroquel)• Lithium (Lithotabs)• Aripiprazole (Abilify)

ALCOHOL REHAB

• Is a chronic disease with no cure(can be treated)• Counceling• Meds are Antabuse & Campral• Side effects• Drowsiness & fatique• Anorexia, nausea & vomiting• Hives(allergic reaction)

SEIZURE DISORDERS

• Involves violent and sudden contractions or tremors of muscle groups. Movements are uncontrolled. • Causes • Head injury• High fever• Brain tumors• Poisoning• Drug overdose or withdrawal• Nervous system disorders

• Epilepsy- clusters of nerve cells signal abnormally• No cure

ANTIEPILEPTIC

• Used to reduce or prevent generalized, partial and other seizure types

• Common side effects• Dizziness• Fatigue• Vision problems• Somnolence• Unsteadiness• Nausea• vomiting

• Nursing precautions• Monitor for seizure frequency• Shake oral suspensions before using• Don’t crush tablets or capsules unless labeled chewable• Never stop antiepileptic medication suddenly

EXAMPLES

• carbamazepine (Tegretol)• gabapentin (Neurontin)• phenytoin (Dilantin)• divalproex Sodium (Depakote)• oxcarbasepine (Trileptal)• levetiracetam (Keppa)• Diazepam(Valium)• lamotrigine(Lamictal)• phenobarbital (Luminal)• primidone (Mysoline)• tiagabine (Gabitril)• topiramate (Topamax)• valproic Acid (Depakene)• Clonazepam(Klonopin)

PAIN

• Means to ache, hurt, or be sore• Is personal• A warning from the body• Acute pain less than 6 months- isolated incident• Chronic pain greater than 6 months• Radiating pain • Phantom pain • Past experience• Anxiety• Rest and sleep • Attention

PAIN CONT…

• Personal and family duties• Value or meaning to pain• Support from others• Culture• Illness• Age

ANALGESICS

• Used to relieve pain• Common side effects

• Nausea• Dizziness• Abdominal pain• Constipation• confusion

• Nursing precautions• Monitor pain relief using pain scale• Provide alternative comfort measures

• Examples• Hydrocodone (vicodin, lortab)• Acetminophen (tylenol, datril, tempra)• Tylenol with codeine• Morphine (MS Contin, Percocet)• Aspirin (Zoprin, ASA, Empirin)• Ibuprofin (Motrin, Advil)• Naproxen (Naprosyn, Aleve)• Celebrex (celecoxib)• Feldene (Piroxicam)• Anacin, Excedrine, Emprin• Fiorinal• Talwin• Codiene• Oxycodone(oxycontin)

QUESTIONS TO ASK

• Location• Onset and duration• Description• Factors causing pain• Factors affecting pain• Other signs and symptoms

DOCUMENTATION

• Response to the pain med• Need for additional pain med• Response to any additional interventions

ASA

• Inhibits platelet Activity• Used to reduce risks of TIA or CVA• Reduce risks of MI with previous history• Enteric forms is usually used to reduce stomach

irritation• Watch for S/S of GI bleed

NSAID’S

• ASA like drugs• Used to reduce pain, inflammation & fever• Examples• Celebrex• Lodine• Motrin• Advil• Aleve• Toradol• Feldene

TYLENOL

• Max dose of 4000mg/day• Give with food or milk• Side effects• Stomach irritation• Anorexia, nausea or vomiting• Low blood pressure• Confusion• Drowsiness• Abd. Pain & jaundice(liver toxicity)

CONT.

• Nsg. Precaution: Give with food• Side Effects• GI bleed• Dizziness or drowsiness• Constipation• Confusion• Anorexia, nausea or vomiting