nervous system meds
TRANSCRIPT
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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$amine Agonists(Anti"arinson*s)
N203ATI (nit
Nervous Sys
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Expected Action: Proto:Pramipe0ole* ropinirole* bro
Act irectly on opamine receptors
Therapeutic Uses:
Monotherapy early 1 combine +ith le2oopa in later stages
Adverse Effects: >rthostatic hypotension Psychosis
leep attacks 3aytime sleepiness 3yskinesias Naus
Contraindications/Precautions: Pregnancy (C)
Caution F li2er " kiney impairment
Interactions:
e2oopa5 Can motor-control 'luctuations permitting lo+er ose
e2oopa5 Also risk o' orthostatic hypotension an yskinesias
Education:
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Centrally ActingAnticholinergics
(Anti"arinson*s)
N203ATI (nit
Nervous Sys
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Expected Action: Proto:Ben%tropine (Cogentin)* trihe0ypheni
Block ACh at muscarinic receptors +hich helps maintain ACh* opamin
Adverse Effects: Nausea (take F 'oo)
Atropine-like e''ects (ry mouth* blurre 2ision* myriasis* constipation
Antihistamine e''ects (seation* ro+siness)
Contraindications/Precautions:
C. in narro+-angle glaucoma
Interactions:
Education:
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Antiviral(Anti"arinson*s)
N203ATI (nit
Nervous Sys
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Expected Action: Proto:A
timulate opamine release* pre2ent opamine reuptake* an may block
cholinergic an glutamate receptorsTherapeutic Uses: Parkinsons 3isease
Adverse Effects: CN E''ects 3iscoloration o' skin (temporary)
Atropine-like e''ects
Contraindications/Precautions:
Interactions:
Education:
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Antie$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
Contraindications/Precautions:
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$tic)
N203ATI (nit
Nervous Sys
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Therapeutic Uses: Prot
Partial sei%ures* tonic-clonic sei%ures* bipolar isorer* trigeminal neural
Adverse Effects: kin isorers
Cogniti2e 'unction is minimally a''ecte but CN e''ects can occur Bloo yscrasias Teratogenic ,ypo-osmolarity (A3, se
Contraindications/Precautions:
C.5 marro+ suppression 1 bleeing isorers
Interactions: Grape'ruit uice5 inhibits metabolism ?carbama%epine@
Phenytoin " phenobarbital5 D carbama%epine >ral contracepti2es an +ar'arin5 Carbama%epine stimulates hepatic en%
+hichle2els o' these meications
Education:
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thosu1imide(Antie$ile$tic)
N203ATI (nit
Nervous Sys
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Therapeutic Uses: Prot
.nicate >NH 'or absence sei%ures
Adverse Effects:
G. e''ects (take F 'oo)
CN e''ects ('atigue* i%%iness)
Contraindications/Precautions:
Interactions:
Education:
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al$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
Contraindications/Precautions:
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$tic)
N203ATI (nit
Nervous Sys
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Therapeutic Uses: Proto
ingle agent use 'or partial sei%ures
Neuropathic pain
MigraAdverse Effects:
CN e''ects (ro+siness* nystagmus)
Contraindications/Precautions:
Interactions:
Education:
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&en+odia+e$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
Contraindications/Precautions:
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$asmodic)
N203ATI (nit
Nervous Sys
Expected Action: Proto:3ia%epam
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Acts in CN to enhance GABA an prouce seation
Acts in CN to epress spasticity o' muscles
Therapeutic Uses: &elie' o' spasticity 1t Cerebral Palsy or M
An0iety " panic isorers Et>, +ithra+al .nsomnia tatus epilepticus Anesthesia inuction &elie' o' spasm 1t i
Adverse Effects:
CN epression Physical epenence 'rom long-term use
Contraindications/Precautions:
Pregnancy (3) Caution F impaire li2er or renal 'unctionInteractions:
CN epressants (Et>,* opiois* antihistamines* barbiturates)5 Aiti2eepressi2e e''ects +ith concurrent use$
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
Contraindications/Precautions:
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)
Contraindications/Precautions:
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$ressants 5 Tricyclic (TCA
N203ATI (nit
Nervous Sys
Expected Action:Proto:amitriptyline (
"thers5 imipramine (To'ranil)* o0epin (in
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Block reuptake o' norepinephrineanserotoninin synaptic space
Therapeutic Uses: 3epression " bipolar isorers
Adverse Effects: >rthostatic hypotension eation Anticholinergic e''ects Cariac to0icity V oses
To0icity e2ience by ysrhythmias* con'usion* " agitation 'ollo+e bysei%ures
Contraindications/Precautions: Pregnancy (C)
Interactions: MA>.s hypertension
Antihistamine " anticholinergicsaiti2e e''ects
Epi1Norepi amounts o' arenergics because reuptake is blocke by
Epherine1amphetamine responses to these 1t uptake inhibition keethem 'rom reaching site o' action in ner2e terminal
Et>,* ben%oia%epines* opiois* antihistamines Aiti2e CN epress
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Selective Serotonin#eu$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
Contraindications/Precautions: Pregnancy (C)
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$
Contraindications/Precautions:
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
Contraindications/Precautions:
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:
CN epressants aiti2e e''ects
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
Contraindications/Precautions:
Interactions:
CN epressants aiti2e e''ects
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$
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p p
Therapeutic Uses: Treatment o' Generali%e An0iety 3isorer
Adverse Effects: CN e''ects N> E3AT.>N
Contraindications/Precautions:
&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)
Contraindications/Precautions:
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
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%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
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%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$