CNS

CNS

DRUGS OF THE CNS pg 83-89

Lily Painter, RN

Med Aide Instructor 2021

Structures of the CNS

• BRAIN-control center

• SPINAL CORD-pathways for communication

ADD, NARCOLEPSY, & DEPRESSION

• ADD-attention defecit disorder-difficulty paying attention, organizing thoughts, & OCD behaviors

• NARCOLEPSY-chronic sleep disorder, daytime drowsiness, sudden attacks of sleep

• DEPRESSION-constant feeling of sadness, hopeless, guilt,irritability, decreased interest & pleasure, decreased ability to concentrate, suicide thoughts

STIMULANTS

• ACTION: Speeds up brain activity leading to increased body activity!

• INDICATION: improve cognitive awareness Example-ADD, NARCOLEPSY

• S/S: excitement, dizzy, dry mouth, HTN, insomnia

• SCHEDULE II DRUGS- METHYLPHENIDATE, DEXMETHYLPHENIDATE, CAFFEINE

• PRECAUTIONS: give early in the day

ANTIDEPRESSANTS

• ACTION: alters chemicals in brain to relieve depression s/s

• INDICATION: Depression

• S/S: hypotension, dry mouth, blurred vision,, constipation, urine retention, agitation, tremors

• CLASSES: TCA-amitriptyline, MAOI-phenylzine, SSRI-fluoxetine, SNRI-venlafaxine, OTHER-trazodone, mirtazapine

• PRECAUTIONS: avoid alcohol, give in a.m., may decrease appetite

TRAZODONE USES

• DEPRESSION

• INSOMNIA

• COCAINE W/D

• MIGRAINES

MIRTAZAPINE

• DEPRESSION

• PTSD

• INSOMNIA

• HOT FLASHES

BUPROPION

• MAJOR DEPRESSIVE DISORDER

• SMOKING SENSATION

• ADHD

• NEUROPATHIC PAIN

Multiple Choice

WHICH DRUG IS COMMONLY USED TO TREAT NARCOLEPSY?

• AMITRITYLINE

• METHYLPHENIDATE

• FLUOXETINE

• VENLAFAXINE

Multiple Select

WHICH TYPE OF DRUGS ALTER THE CHEMICAL PROCESS OF THE BRAIN?

• STIMULANTS

• ANTIDEPRESSANTS

Multiple Select

POSSIBLE SIDE EFFECTS OF STIMULANTS ARE WHICH OF THE FOLLOWING?

• EXCITEMENT

• DIZZINESS

• INSOMNIA

• CONSTIPATION

Multiple Choice

MOST STIMULANT DRUGS FALL INTO WHICH SCHEDULE OF DRUGS?

• SCHEDULE II

• SCHEDULE III

• SCHEDULE IV

• SCHEDULE V

DRUGS THAT DEPRESS THE CNS

• NARCOTIC ANALGESICS

• NON-NARCOTIC ANALGESICS/ANTIPYRETICS

• SEDATIVE/HYPNOTICS

NARCOTIC CNS DEPRESSANTS-ANALGESIC

INDICATION: pain

• ACTION: relieve pain, slow peristalsis, antitussive effect

• S/S: Drowsiness, dizziness, respiratory depression, constipation

• EXAMPLES: codeine, hydrocodone, meperidine, oxycodone, hydromorphone, morphine, fentanyl patch

• PRECAUTIONS: dependency, give before pain is bad, prevent constipation, report respirations <12

RESIDENT ASSESSMENT/IDENTIFYING PAIN

• RECOGNIZE NON VERBAL S/S OF PAIN

• FROWNING

• RESTLESSNESS

• AGITATION

• PAIN SCALE USE IF PT VERBAL 1-10

NON-NARCOTIC ANALGESIC-ANTIPYRETIC PG 85

• INDICATION: pain, fever

• ACTION: reduces pain & fever by CNS depression

• S/S: ASA-gi upset, interferes w/ blood clotting

• EXAMPLES: Aspirin, acetaminophen, ibuprofen(NSAID), naproxen(NSAID), Tramadol

• PRECAUTIONS: give ASA & NSAID w/ food, avoid if on anticoagulantS, or hx of gastric surgery. COATED ASA is less harsh

SEDATIVE/HYPNOTICS-NARCOTIC

• INDICATION: HYPNOTICS for insomnia, SEDATIVES for calming effect

• ACTION: reduces anxiety/brain activity temporarily slows down

• S/S: morning hangover, memory loss, excitement(reversed effect)

• EXAMPLES: temazepam, flurazzepam, zolpidem

• PRECAUTIONS: don't use long term, check that resident swallows med, safety first-clear pathways, call light in reach

BENZODIAZEPINES vs. HYPNOSEDATIVES & other FACTS

• BENZOS-usually: end in "azepam," schedule II, are addictive, will show on drug screen

• HYPNOSEDATIVES-long term use in small doses, prn use, less harsh on CNS

• DIPHENHYDRAMINE: in ELDERLY may cause constipation, urine retention, reverse effect such as hyperactivity, or DELIRIUM

• NON-DRUG MEASURES to PROMOTE SLEEP: snacks, empty bladder, relieve pain

Multiple Choice

WHICH OF THE FOLLOWING S/S SHOULD BE REPORTED BEFORE ADMINISTERING A NARCOTIC ANALGESIC?

• EXCITEMENT

• CONSTIPATION

• RESPIRATIONS LESS THAN 12

• DIZZINESS

Multiple Choice

WHICH OF THE FOLLOWING IS AN ANTIPYRETIC MEDICATION?

• HYDROCODONE

• IBUPROFEN

• TEMAZEPAM

• VENLAFAXINE

Multiple Choice

WHICH MEDICATION WILL PROMOTE SLEEP?

• ASPIRIN

• MEPERIDINE

• METHYLPHENIDATE

• ZOLPIDEM

Multiple Choice

NARCOTIC ANALGESICS MAINLY WORK TO RELIEVE PAIN, CAN REDUCE COUGHING, & ALSO DO WHAT?

• REDUCE FEVER

• GIVE CALMING EFFECT

• SPEED UP BRAIN ACTIVITY

• SLOW PERISTALSIS

ANTICONVULSANTS PG 86

• INDICATION: stop Seizures

• ACTION: depress neuron(nerves) action on CNS

• S/S: drowsiness, lethargy, decrease cognitive awareness

• EXAMPLES: phenytoin, carbamazepine, valproic acid, divalproex, phenobarbitol, primidone, gabapentin

• PRECAUTIONS: good oral hygeine, give at same time qd, shake liquid meds, phenytoin requires lab testing regularly

SEIZURE/CONVULSION CARE

• PAD THE BED WITH PILLOWS or BLANKETS/USE FALL MAT

• LOOSEN TIGHT CLOTHING/DO NOT RESTRAIN THEM

• KEEP AIRWAY CLEAR/TURN THEM TO SIDE/DO NOT PLACE OBJECTS IN MOUTH

• TALK SOFTLY & OBSERVE THE SEIZURE

• TIME THE LENGTH OF THE SEIZURE

• PROVIDE INCONTINENT CARE POST SEIZURE

ANTIPARKINSONIAN AGENTS PG 86

• INDICATION: PARKINSONS DISEASE

• ACTION: various actions, DOPAMINE AGONIST for SINEMET

• S/S: dizziness, drowsiness, hypotension, blurred vision, dysuria, dry mouth, gi upset

• EXAMPLES: benztropine, trihexyphenidyl, levodopa, carbidopa, amantadine, selegiline

• PRECAUTIONS: hydration, give w/ food, give at same time each day, promote voiding-toileting schedule

PARKINSONS DISEASE

• Progressively robs muscles of ability to move normally, making them rigid, and tremors occur

• EPS-extrapyramidal symptoms: DRUG INDUCED - tongue movements, pill rolling of fingers,muscle twitching

• EPS can cause permanent damage, may show up 2 hours after first dose or within first few weeks

• Treatment for EPS is beta blockers or lower dose of the medication causing the EPS

• WATCH THE MOVIE FROM 1990 CALLED "AWAKENINGS" ROBIN WILLIAMS, ROBERT DENIRO(on HULU)

FOODS THAT SHOULD BE LIMITED/AVOIDED WHILE TAKING PARKINSON'S MEDS

• SUGARY ITEMS

• PROTEIN IN MODERATION

• SODIUM,TRANS & SATURATED FAT, CHOLESTEROL

• VITAMIN B 6 & LEVODOPA DO NOT MIX, limit bananas, egg yolks, lima beans, meats, peanuts, & cereals

PSYCHOACTIVE MEDICATIONS

• ACTION: affects the mind, selectively

• INDICATION: treat mental illness, nervousness & anxiety

• EXAMPLES: DIAZEPAM, CHLORDIAZEPOXIDE, LORAZEPAM, ALPRAZOLAM, CLONAZEPAM, BUSPIRONE, HYDROXYZINE "anxiolytics"

• S/S: drowsy, dizzy, dry mouth, blurry vision, constipation, impaired coordination, decreased respirs

• PRECAUTIONS: monitoring required, safety measures

ANTIPSYCHOTIC MEDICATIONS PG 87

• THIORIDAZINE, CHLORPROMAZINE, HALOPERIDOL

• RISPERIDONE, ZIPRASIDONE, ARIPIPRAZOLE

• QUIETIAPINE, CLOZAPINE

• S/S: EPS-abnormal movements of extremities, tongue movements, lip smacking, jaw movements

• NEVER STOP THESE MEDS ABRUPTLY-MUST WEAN OFF SLOWLY to PREVENT SEIZURES

PRECAUTIONS & PROBLEMS with ANXIOLYTICS/ANTIPSYCHOTICS

• AVOID ALCOHOL

• EPS-EXTRA PYRIMIDAL SYMPTOMS

• TARDIVE DYSKINESIA

• FALL RISK

BIPOLAR DISORDER(MANIC DEPRESSION)

• ACTION: control & prevent manic episodes

• EXAMPLE: LITHIUM

• S/S: drowsy, TOXIC S/S-nausea, tremor, muscle weakness

• PRECAUTION: AVOID ALCOHOL, ADD SALT & JUICE TO DIET

BIPOLAR TREATMENT

• VALPROIC ACID-slows down brain cells

• TREATS SEIZURES, BIPOLAR, MIGRAINES

• S/S: STOMACH PAIN, DIARRHEA, DRY MOUTH, SWOLLEN GUMS, TREMORS

• PRECAUTIONS: DO NOT CRUSH OR CHEW, MAY OPEN CAPSULE & SPRINKLE ON FOOD

MOOD STABILIZERS

• CARBAMAZEPINE-EPILEPSY, TRIGEMINAL NEURALGIA, BIPOLAR

• LAMOTRIGINE

ALZHEIMER'S DISEASE PG 88

• S/S: MENTAL DECLINE, DIFFICULTY THINKING, UNDERSTANDING, "SUNDOWNER" CONFUSION, MEMORY LOSS, UNABLE TO CREATE NEW MEMORIES

• DISCOVERED IN 1906 BY DR. ALZHEIMER WHO NOTICED CHANGES IN BRAIN TISSUE OF A WOMAN WHO DIED & HAD S/S OF MEMORY LOSS, LANGUAGE PROBLEMS, UNPREDICTABLE BEHAVIORS

MISCONCEPTIONS/MYTHS of ALZHEIMER'S

• Only happens to older people

• It's hereditary

• Caused by aluminum, flu shots, aspartame

• Alzheimer's s/s are a normal part of aging

• Alzheimer's doesn't lead to death

Basic strategy for Alzheimer's Patient

• Calm & Safe environment-decrease stimulation

• Maintain as much freedom & independence as able

• Monitor mobility & function of resident

• Establish a routine with med administration-one drug at a time & don't argue/they no longer possess reasoning ability

ALZHEIMER'S MEDICATIONS

• DONEPEZIL, MEMANTINE, TACTINE, RIVASTIGMINE

• NO CURE, SLOWS PROGRESSION OF DISEASE

• TAKE AT HS

• S/S: NAUSEA, AGITATION, AGGRESSION

Multiple Choice

WHAT IS THE PURPOSE OF AN ANTICONVULSANT MEDICATION

• PREVENT TREMORS

• TREAT BIPOLAR DEPRESSION

• PREVENT SEIZURES

• TREAT ALZHEIMER'S DISEASE

Multiple Choice

WHAT IS AN IMPORTANT PRECAUTION WHEN TAKING THE MEDICATION PHENYTOIN/DILANTIN?

• AVOID USE OF TYLENOL

• GOOD ORAL HYGEINE

• PREVENT CONSTIPATION

• TAKE VITAMIN B DAILY

Multiple Choice

WHICH MEDICATION IS COMMONLY USED TO TREAT PARKINSON'S DISEASE?

• CARBAMAZAPINE

• VALPROIC ACID

• LITHIUM

• CARBIDOPA/LEVODOPA

Multiple Choice

LIP SMACKING, TONGUE MOVEMENTS, & PILL ROLLING OF FINGERS ARE EXAMPLES OF WHAT?

• EXTRAPYRAMIDAL SYMPTOMS

• SYMPTOMS OF DEPRESSION

• SYMPTOMS OF BIPOLAR DISEASE

• CLASSIC SEIZURE ACTIVITY

Multiple Choice

WHY SHOULD YOU WEAN OFF OF ANTIPSYCHOTIC MEDICATIONS INSTEAD OF STOPPING THEM ABRUPTLY?

• TO PREVENT CONSTIPATION

• TO PREVENT VOMITING

• TO PREVENT SEIZURES

• TO PREVENT EPS

Multiple Choice

BASIC CARE OF THE PATIENT WITH ALZHEIMER'S DISEASE INCLUDE ALL EXCEPT?

• CALM/SAFE ENVIRONMENT

• TALK LOUDLY

• FREEDOM/INDEPENDENCE

• MONITOR FUNCTION/MOBILITY

• ROUTINE

MIGRAINE HEADACHES PG 88

• Severe, intense pain in one area of the head, & include other s/s; nausea/vomiting, vision loss/seeing spots/flashes, pain in temple/eye/ear, light/sound sensitive

• May have an "aura" prior to onset of migraine

• Tylenol/Advil don't relieve the pain

• Can last hours to days

MIGRAINE MEDICATIONS

• INDICATION: relieve throbbing headaches

• S/S: chest discomfort, fatigue, dizziness

• PRECAUTIONS: caution with use in pt's with heart conditions

• EXAMPLES: ERGOT ALKALOIDS (Dihydroergotamine & Ergotamine), SUMATRIPTAN, RIZATRIPTAN

ORGANIC BRAIN SYNDROME PG 89

• BEHAVIOR is not random, is predictable

• PROBLEMS: cognitive impairment, catastrophic reaction, delusion, hallucinations, depression, physical illness, drug toxicity

• OBS definition: cerebral dysfunction, causing disturbance in consciousness, cognition, mood, affect, & behavior

• WHY/WHEN: abscence of drugs, infection, metabolic cause

ALZHEIMER'S DISEASE

• AMNESIA-memory loss for a period of time

• APHASIA-speech is delayed, absent, unable to express or understand communication

• APRAXIA-trouble speaking due to brain control of muscle movement with lips, tongue, jaw

• AGNOSIA-loss of ability to identify objects/people

PARKINSONISM-MOVEMENT DISORDERS

• AKINESIA-loss of ability to move your muscles voluntarily

• DYSTONIA-abnormal muscle tone, spasms, abnormal posture

• AKATHISIA-agitation, distress, restlessness

• TARDIVE DYSKINESIA-involuntary movements of face & jaw(LATE ONSET OF EPS)

OBS CLINICAL DISCOMFORTS

• HYPOTENSION

• URINARY RETENTION

• DRY MOUTH

• FECAL IMPACTION

OTHER TYPES OF OBS PG 89

• PSYCHOSIS-severe mental disorder, thought & emotions are impaired, loss of reality

• MANIA-periods of excitement, euphoria, delusions, & overactivity

• DEMENTIA-caused by brain disease or injury-memory loss, personality change, impaired reasoning

• PARANOIA-delusions of persecution, unwarranted jealousy, exaggerated self-importance, organized system of thoughts. LOSS OF TOUCH W/ REALITY

• SCHIZOPHRENIA-Disorder of relation between thought, emotion, & behavior, inappropriate actions, feeling, withdrawal from reality, fantasy, mental fragmentation

Multiple Choice

WHICH TYPE OF MEDICATIONS SHOULD BE USED CAUTIOUSLY IN PT'S WITH HEART CONDITIONS?

• SEIZURE MEDS

• PARKINSON'S MEDS

• MIGRAINE MEDS

• BIPOLAR MEDS

Multiple Choice

TRUE or FALSE?

INFECTION CAN CAUSE ORGANIC BRAIN SYDROME.

• TRUE

• FALSE

Multiple Choice

WHICH DISEASE MAINLY AFFECTS MUSCLE MOVEMENT?

• PARKINSON'S DISEASE

• ALZHEIMER'S DISEASE

• BIPOLAR DISORDER

• OBS

Multiple Choice

WHICH MEDICINE IS BEST FOR TREATING A MIGRAINE HEADACHE?

• ACETAMINOPHEN

• IBUPROFEN

• SUMATRIPTAN

• ASPIRIN

Multiple Choice

WHICH TERM DESCRIBES PROBLEMS WITH SPEECH?

• DYSPHAGIA

• APHASIA

• DYSTONIA

• AKATHISIA