Neurological Medications Study Notes

Neurological Medications Study Guide

Week 3 Theory Contact Information

• Instructor: Lori Fulton, MSN, RN

• Email: lori.fulton@tulsacc.edu

• Appointment Scheduling: Available via email

• Discussion Platform: Blackboard discussion forum available for queries

Overview of Neurological Medications

• Types of Medications:

  • CNS Stimulants

  • CNS Depressants

  • Anti-Seizure Medications

• Definition of CNS:

  • Stands for Central Nervous System, which is the master control unit of the body including the brain and spinal cord, responsible for receiving, processing, and responding to information.

CNS Stimulants

• Function: Increase brain activity.

• Categories include:

  • Amphetamines

  • Analeptics

  • Anorexiants

Amphetamines

• Mechanisms of Action:

  • Release neurotransmitters, specifically catecholamines, and prevent their reuptake.

  • Key neurotransmitters affected:

  • Dopamine: Involved in movement, memory, pleasure/reward, cognition, sleep, learning, and mood.

  • Norepinephrine: Regulates arousal, attention, cognitive function, and stress reactions.

• Medical Uses:

  • Conditions Treated:

  • Attention Deficit Hyperactivity Disorder (ADHD)

  • Narcolepsy

  • Obesity

  • When other weight loss medications are ineffective

Examples of Medications:

Methylphenidate Hydrochloride (Ritalin)

• History and Assessment:

  • Contraindications:

  • Heart disease or irregular rhythms

  • Hypertension

  • Parkinson's

  • Hyperthyroidism

  • Stroke

  • Physical Assessment:

  • Vital signs, mental status, mood, height, and weight

• Nursing Diagnosis:

  • Ineffective attention secondary to neurotransmitter deficit

  • Altered cognition, mood disturbances, disrupted sleep patterns

  • Nutritional impairment due to excessive caloric intake

Planning and Interventions

• Goals for Patient:

  • Ability to self-manage medication adherence

  • Self-report side effects accurately

  • Achieve desired therapeutic outcomes within a specified timeframe

• Patient Education Strategies:

  • Avoid abrupt discontinuation of medication to mitigate withdrawal symptoms

  • Limit caffeine intake and monitor product labels for caffeine content

  • Avoid alcohol consumption and report significant weight loss

  • Monitor mood changes, cardiac symptoms like tachycardia or palpitations

  • Educate about the interaction of St. John's Wort and MAOIs leading to hypertensive crises

  • Managing side effects such as dry mouth and excessive sweating

• Evaluation of Outcomes:

  • Monitor vital signs, cardiac rhythm, sleep patterns, focus, academic performance, and interpersonal relations.

  • Expected outcome: Client reports improved attention, reduced hyperactivity, and better sleep cycles.

Analeptics and Anorexiants

Analeptics (Caffeine)

• Effects Induced by Caffeine:

  • Promotes mental alertness and treats neonatal sleep apnea.

• Monitor for Side Effects:

  • Headaches, insomnia, tachycardia, withdrawal symptoms, tremors

Anorexiants

• Use: Treatment for obesity, often short-term.

• Side Effects Include:

  • Restlessness, dizziness, headaches, insomnia, dry mouth

  • Gastrointestinal issues including constipation and diarrhea

  • Cardiovascular effects such as hypertension and tachycardia

  • Development of tolerance over time

CNS Depressants

• Types of CNS Depressants:

  • Sedatives-hypnotics

  • Barbiturates

  • Benzodiazepines

  • Non-benzodiazepines

  • Anesthetics (General and Local)

  • Non-pharmacological management strategies

Barbiturates (Hypnotic)

• Types Based on Duration of Action:

  • Long-acting: Phenobarbital – controls seizures

  • Intermediate: Used for inducing sleep

  • Short-acting: For procedural sedation

• Indications for Use:

  • Sedation, seizure control, anxiety reduction, and treatment of insomnia

• Monitoring: Primarily for respiratory depression

Benzodiazepines

• Mechanism of Action:

  • Increase the effectiveness of GABA, leading to reduced neuronal excitability

• Indications for Use:

  • Anxiety management, insomnia alleviation, seizure control

• Examples of Medications:

  • Alprazolam (Xanax)

  • Lorazepam (Ativan)

  • Temazepam (Restoril)

Monitoring for Benzodiazepines

• Side Effects to Monitor:

  • Ataxia, depression, bradycardia, hypotension, dizziness, confusion, drowsiness, headaches, impaired judgment, nightmares, constipation

Patient Management and Intervention for Alprazolam (Xanax)

• Assessment Needs:

  • Comprehensive history including psychiatric and sleep disorder background

  • Medication reconciliation including herbal supplements

  • Evaluation of vital signs and EKG as needed

• Patient Education and Planning Goals:

  • Self-manage anxiety symptoms

  • Report improvements in sleep and anxiety without respiratory depression

Non-benzodiazepines (e.g., Zolpidem/Ambien)

• Action: Neurotransmitter inhibition aimed at treating insomnia, generally short-term use (less than 10 days).

• Potential Side Effects:

  • Drowsiness, lethargy, headaches, hot flashes, hangover effects, irritability, dizziness, ataxia, visual impairment, nausea, vomiting, edema

• Consideration for Non-pharmacological Alternatives:

  • Examples:

  • Apple cider vinegar (unfiltered with