Pharmacology Drug Cards.

RN Pharmacology Neurologic System Drugs

Adeline Samba DNP, MSN ed, RN

Drug class Drugs Action and use Adverse effects Nursing implications

Amphetamines (Anti ADHD, & Nacolepsy)  

Methylphenidate Amphetamine aspartate Dextroamphetamine sulfate

Stimulate areas of the brain associated with mental alertness

dizziness, headache, euphoria, insomnia, tachycardia, hypertension, palpitations, dry mouth, anorexia, diarrhea, and erectile dysfunction. weight loss, anxiety, fatigue

Pt teaching: Monitor effectiveness: Drug holiday; off drug during weekends or holidays; decrease chance of dependency. Monitor ht and weight Give in AM at most 6 hrs before bedtime Avoid alcohol, Do not abruptly stop taking drug Monitor BP, HR Avoid caffeine

Nonamphetami ne stimulants

Modafinil (narcolepsy only)  

Increase wakefulness but lacks addictive property

Fever, depression, chest pain headache, dizziness, anxiety, anorexia, nausea, diarrhea, dry mouth, insomnia, rhinitis, back pain

 

Nonamphetami ne stimulants

Atomoxetine (ADHD only) Increase attention span but lacks addictive property

Dry mouth, NV, dizziness drowsiness  

Phentermine (Anorexiants)

phentermine benzphetamine methamphetamine

Suppress appetite control centers in the brain Increase the body’s basal metabolic rate

HTN, tachycardia palpitations Anxiety, Agitation Euphoria,insomnia Seizures, erectile dysfunction

 

Analeptics (for Apnea)

Theophylline: COPD and asthma Doxapram (Dopram): adult, with COPD Caffeine citrate: newborn apnea

Stimulate areas of CNS that control respiration Treatment of respiratory depression

Flushing, sweating Increase respiration tremors, tachycardia, increase gastric secretion

Therapeutic index for Theophylline: 10-20mcg/ml

CNS Stimulant: Chapter 17

Drug class Drugs Action and use Adverse effects Nursing implications

Benzodiazepi nes

Alprazolam: anxiety diazepam (Valium): anxiety, seizure lorazepam (Ativan) anxiety, seizure temazepam: insomnia Midazolam (Versed), Moderate sedation  

Depress CNS activity Use: insomnia, anxiety, seizure, moderate sedation

Headache Drowsiness, lethargy Constipation, Dizziness Cognitive impairment Vertigo Dependence, tolerance hypotension “Hangover” effect or daytime sleepiness

Toxicity: Somnolence Confusion Coma Diminished reflexes Antidote: Flumazenil   Monitor for adverse effects. Not stop dug abruptly Safety measures Avoid alcohol

Nonbenzodiazepine used for insomnia

Zolpidem (Ambien)

Induce sleep  

Zolpidem: sleepwalking, drowsiness, lethargy, dizziness, nightmares, tolerance, hypotension, ED headache, hot flashes, hangover (residual sedation), irritability, dizziness, ataxia, visual impairment, anxiety, nausea and vomiting, edema, amnesia, memory impairment, nightmares, binge eating

Safety precautions

Nonbenzodiazepine used for insomnia

Ramelteon  

Induce sleep  

Dizziness, drowsiness, fatigue, headache, nausea, suicidal ideation

 

Barbiturates Phenobarbital: long acting Pentobarbital: short acting

By potentiating the action of GABA, nerve impulses traveling in the cerebral cortex are inhibited. Use: Sedatives Anticonvulsants Anesthesia for surgical procedures Induce coma

Vasodilation, hypotension Drowsiness, lethargy, vertigo Respiratory depression, cough Nausea, vomiting, diarrhea Stevens-Johnson syndrome

TX: Toxicity and Overdose? -Manage airway -activated charcoal -Iv fluids  

CNS depressants: Chapter 18

Anesthesia: Used for patients going for surgery or invasive procedures to prevent pain.

Drug class Drugs Action and use Adverse effects Nursing implications

General Anesthetics

Dexmedetomidine Ketamine Nitrous Oxide Propofol (Diprivan) Sevoflurane (Ultane)

Pain relief Depression of consciousness Skeletal muscle relaxation Reflex reduction

Myocardial depression Respiratory suppression Malignant hyperthermia

Tx of MH Dantrolene

Moderate Sedation Midazolam fentanyl or morphine

Decrease Anxiety and sensitivity to pain and the patient cannot recall the procedure.

Amnesia, dizziness, drowsiness etc. Also depends on specific drugs.

 

Local Anesthetics Lidocaine procaine Bupivacaine Chloroprocaine Mepivacaine

Paralysis Decrease pain and sensory function lost

Inadvertent intravascular injection Spinal headache

Tx of spinal HA:______ Bed rest fluids  

Neuromuscular Blocking Drugs

Succinylcholine Pavulon Vecuronium

Prevent nerve transmission in skeletal and smooth muscle, resulting in muscle paralysis

Respiratory paralysis Damage to muscle

 

Chapter 19: Antiseizure

Drug class Drugs Action and use Adverse effects Nursing implications

Antiepileptic Drugs   Phenytoin 1 st line

Alters movement of Na, K, Ca, and Mg ions. This results in a more stabilized and less excited cell membrane

CNS effects(Dowsiness, dizziness) gingival hyperplasia, acne, hirsutism, Dilantin facies, and osteoporosis  

Therapeutic drug levels:_____________ 10-20mcg/ml Status epilepticus: seizure lasting more than 5 minutes. Tx: Diazepam, lorazepam (IV, IM) If not effective give barbiturates Follow with routine drug phenytoin IV

Antiepileptic Drugs *Carbamazepine (Tegretol) 2nd line

Action similar to phenytoin  

CNS and GI symptoms Autoinduction of hepatic enzymes  

Monitor liver enzyme

Antiepileptic Drugs Ethosuximide (Zarontin) Action similar to phenytoin  

CNS and GI symptoms  

 

Antiepileptic Drugs *Gabapentin (Neurontin) Potentiate GABA CNS and GI symptoms Most commonly used for neuropathy Antiepileptic Drugs Levetiracetam (Keppra) unknown generally, well tolerated, CNS

effects      

 

Antiepileptic Drugs *Pregabalin (Lyrica) Action similar to phenytoin Use: neuropathic pain, postherpetic neuralgia, and fibromyalgia

CNS effects, blurred vision, peripheral edema        

 

DRUG CL ASS

DRUGS ACT ION AND USE ADVERSE EFFECTS NURS ING IMPL ICAT IONS

Antiparkinson Drugs

Carbidopa levodopa

Converts to dopamine and increases mobility Fatigue, insomnia, dry mouth, blurred vision, N/V Orthostatic hypotension, palpitations, dysrhythmias GI distress, urinary retention Dyskinesia, psychosis, severe depression

Identify signs and symptoms to monitor to determine therapeutic effects of the drugs.

Antiparkinson Drugs (COMT) Inhibitors

entacapone Inhibit COMT enzyme that inactivates dopamine Dizziness, drowsiness, headache GI distress, excess dreams Insomnia, sudden sleep onset Orthostatic hypotension Impulse control disorder Hepatic dysfunction

 

Antiparkinson Drugs

Bromocriptine (Parlodel)

Works by activating presynaptic dopamine receptors to stimulate the production of more dopamine

Ataxia, dizziness, HA, depression, drowsiness, visual changes.

 

Antiparkinson Drugs

Ropinirole (Requip)

Stimulate dopamine receptors Also used to treat restless legs syndrome

Dizziness, drowsiness, GI upset, edema, fatigue, syncope, dyskinesia, fatigue.

 

Antiparkinson Drugs

Anticholinergic Therapy benztropine (Cogentin)

Anticholinergics block the effects of ACh Used to treat muscle tremors and muscle rigidity associated with PD

Dizziness, drowsiness, anxiety, headache Insomnia, paresthesia, restlessness Blurred vision, ocular hypertension Weakness, dry mouth, GI distress Anhidrosis, urinary retention

routine eye exams relieve a dry mouth with hard candy, ice chips, or sugarless gum  

Alzheimer’s Drugs

rivastigmine Allow more acetylcholine in neuron receptors Increase cognitive function, slows disease process

Dizziness, headache, confusion, depression Dry mouth, GI distress, dehydration, weight loss Bradycardia, orthostatic hypotension, dysrhythmia Hepatotoxicity, suicidal ideation Stevens-Johnson syndrome

 

Alzheimer’s Drugs

Donepezil Same as above diarrhea, headache, infection, vomiting and nausea.

 

  Memantine Same as above Stevens-Johnson syndrome, dizziness, headache, drowsiness, confusion, diarrhea, depression, hallucinations, hypertension, hypotension, urinary incontinence and constipation.

 

Antiparkinson (Parkinson’s is result of increase acetylcholine and decrease dopamine)

Chapter 20

Drug Class Drug Action Adverse effects Nursing implications

Acetylcholinester ase Inhibitors   Treatment of MG

Neostigmine Pyridostigmine Edrophonium

preventing the destruction of acetylcholine by cholinesterase

GI disturbances (nausea, vomiting, diarrhea, abdominal cramps), increased salivation and tearing, miosis (constricted pupil of the eye), blurred vision, and bradycardia

Observe patient for signs and symptoms of cholinergic crisis caused by overdosing or underdosing, such as muscle weakness, respiratory failure, increased salivation, sweating, and bronchial secretions along with miosis.

Immunosuppress ant Treatment of MG

Azathioprine Supress inflammtion Increased myelosuppression leukopenia, nausea and vomiting Risk for infection

Monitor for signs of infection

Immunomodulato rs Treatment of MS  

Beta-Interferon suppresses the inflammatory response through different mechanisms.

Increased myelosuppression depression, dizziness, fatigue, suicidal ideation, vision problems, dyspnea, chest pain, edema, abdominal pain, autoimmune hepatitis, , neutropenia, arthralgia, muscle spasm, flulike symptoms

Monitor for signs of infection Teach patients Infection control measures

Muscle relaxant  

Baclofen (Lioresal): MS Cyclobenzaprine (Flexeril):Musculoskeletal injury Dantrolene (Dantrium): MH Metaxalone (Skelaxin) Tizanidine (Zanaflex)

Act to relieve pain associated with skeletal muscle spasms

Euphoria Lightheadedness Dizziness Drowsiness Fatigue Muscle weakness, others

Teach patient to avoid alcohol while on this drug   Safety precautions dueto sedation  

Neuromuscular Blocking Drugs

Succinylcholine Pavulon Vecuronium

Prevent nerve transmission in skeletal and smooth muscle, resulting in muscle paralysis

Respiratory paralysis Damage to muscle

Monitor for symptoms of malignant hyperthermia

Chapter 21: Drugs for Neuromuscular Disorders and Muscle Spasms

Drug class Drugs Action and use Adverse effects Nursing implications

Antipsychoti cs Typical

  Haloperidol (Haldol)

Block dopamine receptors in the brain

Drowsiness, anticholinnergic effects Neuroleptic malignant syndrome (NMS) Extrapyramidal symptoms (EPS): pseudoparkinsonism-akathisia:Motor restlessness acute dystonia: painful muscle mvts Tardive dyskinesia: abnormal facial mvts

Define and Describe management of: EPS________________________________ Akathisia___________________________ _ Dystonia___________________________ _ Tardive dyskinesia____________________ Neuroleptic malignant syndrome________ ___________________________________

Antipsychoti cs Atypical

clozapine (Clozaril) Aripiprazole (Abilify) ziprasidone (Geodon) risperidone (Risperdal) Quetiapine (Seroquel)

See above See above Monitor WBC for clozapine(can cause leukocytosis)

 

Anxiolytic Benzodiazepines alprazolam (Xanax) diazepam (Valium) lorazepam (Ativan)  

Reduce Anxiety by reducing overactivity in central nervous system (CNS)

Decreased CNS activity, sedation Hypotension if taken with other CNS depressant Drowsiness, loss of coordination, dizziness, headaches Nausea, vomiting, dry mouth, constipation

Flumazenil (Romazicon) may be used to reverse benzodiazepines’ effects.

Anxiolytic Non Benzodiazepine buspirone (BuSpar)

Unknown mechanism of action

Paradoxical Anxiety Blurred vision Headache Nausea

 

Chapter 22: Antipsychotic and anxiolytics

Drug class Drugs Action and use Adverse effects Nursing implications Antidepressants Tricyclic antidepressants

amitriptyline (Elavil) Block reuptake of neurotransmitters, causing accumulation at the nerve endings

Sedation Impotence Orthostatic hypotension Dizziness, postural hypotension, constipation, cardiotoxicity,

 

Antidepressants Monoamine oxidase inhibitors (MAOIs) also given to treat Parkinson disease

Phenelzine Selegiline

Inhibits reuptake of serotonin CNS stimulation (insomnia), orthostatic hypotension, and anticholinergic effects

potential to cause hypertensive crisis when taken with tyramine wine, cheese, chocolate

Antidepressants Second generation SSRI

Citalopram (Celexa) Fluoxetine (Prozac)**  

Selective serotonin reuptake inhibitor

Headache, dizziness, drowsiness, insomnia, anxiety, weakness, confusion, abnormal dreams, tremors, hyperhidrosis, pharyngitis, dry mouth, anorexia, nausea, diarrhea, constipation, peripheral edema, akathisia, urinary retention, erectile/ejaculatory dysfunction

 

Second generation Antidepressants SNRI

Duloxetine(Cymbalta)* Serotonin-norepinephrine reuptake inhibitor (SSNRI)

drowsiness, dizziness, insomnia, headache, amnesia, blurred vision, and erectile/ejaculation dysfunction

Identify a common SE of antidepressant and describe nursing management and teaching.

Miscellaneous Bupropion Tx of depression, and smoking cessation

Dizziness, confusion, tachycardia, agitation. Tremors, dry mouth.

 

Mood-Stabilizing Drugs See prototype chart page275

Lithium carbonate It is thought to potentiate serotonergic neurotransmission

cardiac dysrhythmia drowsiness, slurred speech, epilepsy-type seizures, choreoathetotic movements (involuntary wavelike movements of the extremities), ataxia (generalized disturbance of muscular coordination), and hypotension

Therapeutic index: 0.8 and 1.2 mEq/L Hyponatremia potentiates lithium toxicity.

Other mood stabilizing drugs

carbamazepine, valproic acid or divalproex, lamotrigine, cariprazine,

  Giupset and CNS depression  

Chapter 23 Antidepressants and Mood Stabilizers

Reference

• Yeager, L.M.K.D.M.B.W. J. (2023). Pharmacology (11th ed.). Elsevier Health Sciences (US).  https://pageburstls.elsevier.com/books/9780323793179