NEUROLOGICAL SYSTEM PT.2

old me-clara la san

drug therapy for anxiety disorders

alprazolam/diazepam & buspirone

drug therapy for depression

amitriptyline, fluoxetine, venlafaxine, phenelzine, and bupropion

drug therapy for bipolar disorder

lithium carbonate and valproate

drug therapy for schizophrenia

chlorpromazine and risperidone

drug therapy for glaucoma

betaxolol, pilocarpine, and echothiophate

diazepam/alprazolam (benzodiazepines)

CNS depressants that enhance the inhibitory effects of GABA, reducing feelings of anxiety. ADRs include dizziness, drowsiness, and lethargy; can also include impaired memory, paradoxical reactions of confusion and anxiety, tachycardia, phlebitis, tolerance and dependence, and hypotension and respiratory depression in an overdose. antidote is flumazenil. important to taper the patient off the drug and instruct them to not stop it abruptly. patient should also be placed on fall precautions and have all ADRs monitored. patency of IV line should be checked to avoid phlebitis. client should avoid alcohol and other CNS depressants while on this drug. teratogenic.

buspirone (non-benzodiazepines)

binds to serotonin and dopamine receptors in the brain to increase norepinephrine metabolism and treat anxiety without the risk of dependance. also does not cause sedation. ADRs include paradoxical effects such as insomnia, anxiety, and restlessness; GI upset, headache, dizziness, and nausea. place client on fall precautions and monitor for all ADRs. is not a PRN med, must be given orally on a regular basis to have therapeutic effect, which can take a week to several weeks to show and peak respectively. take with food to combat nausea. concurrent use with MAOIs can cause severe hypertension. grapefruits, erythromycin, and ketoconazole are contraindicated.

amitriptyline (tricyclic antidepressants)

blocks reuptake of norepinephrine and serotonin to relieve depression. can take weeks to show therapeutic action. ADRs include drowsiness, sedation, orthostatic hypotension, and tachycardia. other ADRs include anticholinergic effects (dry mouth, constipation, urinary retention, and blurred vision), an increased risk for suicide, and withdrawal with abrupt discontinuation. overdose causes cardiac toxicity. treat toxicity with activated charcoal, stomach pumping, and sodium bicarbonate. place client on fall precautions, monitor ortho stats, and evaluate client for increases in depression and suicidal ideation. taper over 2 weeks to prevent withdrawal. give at bedtime to avoid daytime drowsiness; concurrent admin with MAOIs can cause HTN crisis.

fluoxetine (SSRI)

selectively blocks the reuptake of serotonin, strengthening the transmission of serotonin at synapses, treating bipolar disorder, panic disorder, OCD, premenstrual dysphoric disorder, and bulimia. ADRs include insomnia, nervousness, s3xual dysfunction, headache, weight gain in long term use, hyponatremia, suicide, and serotonin syndrome in excess serotonin levels. monitor for ADRs and closely watch Na levels. clients taking diuretics and SSRIs are at high risk for hyponatremia. can take 4-6 weeks to achieve effectiveness. client should take in the morning w/ food; concurrent use with NSAIDs can cause GI bleeds.

venlafaxine (SNRI)

blocks reuptake of norepinephrine and serotonin to relieve depression, social anxiety, and GAD; similar to SSRIs. ADRs include n/v, anorexia, headache, hypertension, insomnia, hyponatremia (high risk in older adults and those on diuretics), increased suicide risk, and nervousness. abrupt stoppage can cause anxiety, agitation, headache, and tachycardia. client should take with food. monitor for weight loss related to anorexia and monitor blood pressure as well. lower dosages may help with some ADRs. taper client for 2-4 weeks. client should avoid taking close to bedtime if possible and report any worsening depression or suicidal thoughts.

phenelzine (MAOIs)

blocks MAO-A and MAO-B enzymes in the brain to increase norepinephrine, serotonin, and dopamine, relieving depression. serious ADRs and precautions make this drug be reserved for clients who have depression that has not responded to other classes of antidepressants or those who have depression associated with bipolar disorder. ADRs include orthostatic hypotension, constipation, n/v, suicidal ideation, serotonin syndrome, and HTN crisis when paired with tyramines (cheese, aged meats, processed foods, chocolate, etc). antidote is IV phentolamine or sublingual nifedipine; give in the event of HTN crisis. monitor orthostats and dietary intake. provide the client with a list of foods to avoid and determine their willingness to adhere to the diet. taper the dose. med reconciliation is extremely important as this drug can interact with many other things; client should check with pharmacy before taking any OTCs

bupropion hydrochloride (atypical antidepressants)

treats depression, seasonal affective disorder, and can be used as an adjunct for smoking cessation. exact pharmacological action is unknown. ADRs include n/v, weight loss, seizure risk, insomnia, agitation, tremor, psychosis, hallucinations, delusions, suicidal ideation, and headache. should be given with food. track clients weight weekly to monitor for weight loss. avoid giving in clients who have previously had head trauma or those who take drugs that decrease seizure threshold. is given PO only. caregiver should watch for manifestations of depression or sucidal thoughts; not recommended for those with anorexia.

lithium carbonate (mood stabilizer)

alters metabolism of catecholamines to help decrease the mania associated with bipolar disorder. can also protect against neuronal atrophy and promotes neuronal growth. ADRs include GI s/s, transient fatigue, headache, confusion, muscle weakness, memory impairment, polyuria, hypothyroidism, and tremors. toxicity can show ataxia, muscle hyperirritability, dysrhythmias, incoordination, hypotension, and coma. therapeutic range is 0.6-1.2 mEq/L. monitor clients serum levels, VS, Is and Os, and thyroid function. watch sodium levels and kidney function as well. give with milk or meals. client should increase fluid intake. teratogenic.

chlorpromazine (traditional antipsychotics)

blocks several CNS and non CNS receptors, including dopamine receptors, which accounts for the suppression of manifestations of psychosis. ADRs include extrapyramidal side effects, such as akathisia (restlessness, need for constant motion), parkinsonism (rigidity, tremors, sluggish movements), acute dystonia (painful spasms causing client to assume an arched position), and tardive dyskinesia (writhing movements of tongue and neck). other ADRs include anticholinergic effects (via treating EPS), photosensivitiy, suppressed s3xual drive, dysrhythmias, and NMS (antidote is dantrolene and bromocriptine). monitor client VS, EKGs, K levels, and Is and Os.

risperidone (atypical antipsychotic)

blocks dopamine receptors and strongly blocks serotonin receptors, treating schizophrenia. ADRs include CNS effects, wt gain, diabetes onset or exaggeration, hypercholesterolemia, and EP effects in high doses. monitor client for CNS effects and implement fall precautions; monitor weight, blood glucose, cholesterol, and triglyceride levels. treat possible acute dystonia with anticholinergics. mix oral solution form with juice, milk, water, or coffee. avoid in those on anti-parkinsons meds as they may have an increase in manifestations due to dopamine blockage.

betaxolol/timolol (beta adrenergic blocker)

decreases production of aqueous humor, reducing IOP and treating open or closed angle glaucoma. ADRs include stinging, burning, and eye discomfort. systemic absorption can cause cardiac or respiratory effects such as bradycardia, hypotension, and bronchospasm. is contraindicated in those with AV heart block, sinus bradycardia, cariogenic shock, asthma, or COPD. apply pressure to puncta and nasolacrimal sac for 60 sec to minimize risk of systemic absorption. use gloves when handling, take care to not touch or drop the eye dropper. patient should remove corrective lenses before administration and refrain from rubbing their eyes after installation.

pilocarpine (cholinergic agonist)

increases availability of aCh at muscarinic receptor sites, causing the pupil to contract and the ciliary muscle to contract, which enhances the drainage of aqueous humor, treating glaucoma. can also be used as an adjunct to laser eye surgery. ADRs include decreased visual acuity/myopia, reduced night time vision due to pupil not being able to dilate in dark environments, headache, urinary urgency, bradycardia, contraction of bronchioles, and retinal detachment. mild analgesics can be used for headaches; atropine can be used to reverse drug effects. important to apply pressure to nasolacrimal for 60 sec after admin. patient should be provided night lights in room and avoid driving, especially at night. client should report s/s of retinal detachment (floaters, flashes of light, loss of peripherals).

echothiophate (cholinesterase inhibitors)

decrease breakdown of aCH, allowing more to available for use by muscarinic receptors in the body, treating glaucoma by lowering IOP. ADRs include decreased visual acuity/myopia, reduced night light vision, and cataract development in long term use. cholinergic s/s arise when the med is systemically absorbed (urinary urgency, bradycardia, and bronchoconstriciton). patient should be provided with a night light and apply pressure on nasolacrimal sac to prevent systemic absorption. wait 5 min before or after installing any other eye drops. monitor for cataracts with penlight. client should avoid driving, especially at night and avoid other activities that require good visual acuity.