NCMA216 (MIDTERMS) WEEK 7 – CNS/ANS AGENTS

LEARNING OBJECTIVES: 1. AMPHETAMINES AND AMPHETAMINE-

At the end of the course unit (CU), learners will be LIKE DRUGS
able to: Action: stimulate the release of norepinephrine,
• Understand the basic concept of drugs affecting which causes increased alertness, less fatigue
the Central Nervous System and elevate the mood.
• Classify Neurotransmitters that affect nervous Common drugs:
function • Methylphenidate (Ritalin, Concerta) – for ADHD
• Comprehend the basic impulse transmission in most commonly
the nervous system to understand • Dextroamphetamine sulfate (Dexedrine,
pharmacodynamics of drugs affecting the nervous adderall)
system • Methamphetamine HCL (Desoxyn)
• Identify classifications of drugs affecting the
CNS METHYLPENIDATE
• Describe the specific actions of drugs and its • Methylphenidate (MPH) non-competitively
adverse effects. blocks the reuptake of dopamine and
• Understand the pharmacokinetics of drugs noradrenaline into the terminal by blocking
affecting the nervous system dopamine transporter (DAT) and noradrenaline
• Determine specific nursing considerations or transporter (NAT), increasing levels of dopamine
precautions in safe drug administration and noradrenaline in the synaptic cleft.
• Provide appropriate health drug education • Attention Deficit hyperactivity Disorder
related to drug therapy (ADHD) - Childhood condition involving
• Use available clinical evidence that can ensure inattention, impulsivity and hyperactivity
safe medication administration • Amphetamine increases attention span while
CENTRAL NERVOUS SYSTEM (CNS) decreasing the hyperactivity
MEDICATIONS
A. CNS STIMULANTS
STIMULANT – a substance that quickens the
activity of the CNS by increasing the rate of
neuronal discharge or by blocking an inhibitory
neurotransmitter

3 CLASSIFICATION OF CNS STIMULANTS:

- Amphetamines
- Anorexiants
Other Uses:
- Analeptics
Narcolepsy - Characterized by sudden sleep
attack

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 NCMA216 (MIDTERMS) WEEK 7 – CNS/ANS AGENTS

Endogenous obesity - Obesity resulting from

dysfunction of the endocrine or metabolic BENZPHETAMINE HCL
systems. Amphetamines suppress the appetite • similar to that of amphetamines. Amphetamines
Mental depression – elevate the mood stimulate norepinephrine and dopamine release in
nerve endings in the lateral hypothalamic feeding
Nursing Applications: centre, decreasing appetite.
• Weight reduction diet and exercise program
should accompany the use of these agents for
obesity. Short term is recommended
• Check with pharmacist about all OTC
medications
• Do not abruptly stop taking the drugs
• Do not try to make up dose if one is skipped
• Avoid other stimulants while on these drugs 3. ANALEPTICS
• Avoid taking the last dose after 4 to 6 PM to Action: stimulates the CNS by acting on the
prevent insomnia cerebral cortex and the medulla

ANOREXIANTS Uses:
Action: suppress the appetite by acting on the • Respiratory stimulation  primary use
hypothalamus
Use: weight reduction when accompanied by Common drugs:
medical complications • Methylxanthines: theophylline (used for
Tolerance and abuse are possible asthma), theobromide
• Respiratory stimulant: Doxapram HCL (Dopram)
Common drugs: • caffeine (85 mg/cup of coffee, 50 mg/cup of
• Benzphetamine HCL (Didrex) tea or cola)
• Diethylpropion (tenuate, Tepanil, Dospan)
• Phenmetrazine HCL (Preludin)
• Phentermine HCL ( Adipex-P, lonamin)
• Dextroamphetamine sulfate (Dexedrine)
PHENTERMINE
• Phentermine (Adipex): Phentermine is the
most commonly prescribed weight loss THEOPHYLLINE
medication. It is an adrenergic agonist that • Theophylline relaxes the smooth muscle of the
increases the release of norepinephrine in the bronchial airways and pulmonary blood vessels
hypothalamus. Norepinephrine release induces and reduces airway responsiveness to histamine,
appetite suppression and increases resting energy methacholine, adenosine, and allergen.
expenditure. • inhibits type III and type IV
phosphodiesterase (PDE), the enzyme
responsible for breaking down cyclic AMP in
smooth muscle cells, possibly resulting in
bronchodilation

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 NCMA216 (MIDTERMS) WEEK 7 – CNS/ANS AGENTS

• Anxiolytics
• Antidepressants
1. SEDATIVE-HYPNOTICS
SEDATIVE- agent that produces a state of
calmness

DOXAPRAM HYPNOTIC- an agent given at bedtime to

• Doxapram is a respiratory stimulant with induce sleep (usually in a larger dosage than a
analeptic activity. sedative)
- Doxapram, independent of oxygen levels,
directly stimulates the peripheral carotid
chemoreceptors, possibly by inhibiting the
potassium channels of type I cells within the
carotid body, thereby stimulating catecholamines
release.

CATEGORIES OF SEDATIVE-HYPNOTICS
a. Barbiturates

Major side Effects:

CV: dysrhythmias, heart attacks, tachycardia,
HPN, tachypnea
• Caffeinism: restlessness, insomia, nervousness,
muscle twitching, headache
• Seizures
• Tolerance and abuse

Nursing implication:
• Monitor the dietary intake of caffeine Action: stimulating the inhibitory
• Assess respiratory and CV systems neurotransmitter system in the brain called the
• Watch for withdrawal symptoms: nausea, [gamma]- aminobutyric acid (GABA) system.
vomiting, headache
• Avoid other foods and drinks that contain Uses:
stimulants

CNS DEPRESSANTS
• Sedative-hypnotics
• Anesthetics
• Analgesics
• Anticonvulsants

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 NCMA216 (MIDTERMS) WEEK 7 – CNS/ANS AGENTS

Major side Effects: 2. Benzodiazepine - act by facilitating the binding

• Excessive CNS depression: dizziness, of the inhibitory neurotransmitter GABA at
drowsiness, hang-over effect, convulsion various GABA receptors throughout the CNS.
• Rebound insomnia, respiratory depression • diazepam, lorazepam, midazolam
• Anxiety, hypersensitivity • can cause anterograde amnesia

• Interacts with alcohol and narcotics which may

further depress the CNS

Nursing implications:
• Teach safety precautions to clients
• Assess level of consciousness, respiratory status,
and effectiveness of the agent
• Hold if respirations is <10/min
• Do not abruptly stop the medication for those on
chronic use

B. BENZODIAZEPINES
Common drugs:
• flurazepam (Dalmane)
• estozolam (Esilgan)
• temazapam
3. Ketamine hydrochloride - Antagonism of the
• triazolam
NMDA receptor is responsible for the anesthetic,
• quazepam
analgesic, and psychotomimetic effects
• for children and patients with hypotension
Action:
• used for short surgical procedures
increase in GABA (inhibitor)à calming effect –
decrease anxiety, induce sleep, hypnotic therapy

4. Propofol - positive modulation of the inhibitory

function of the neurotransmitter gama-
aminobutyric acid (GABA) through GABA-A
receptors.
• can cause respiratory depression
2. ANESTHETICS
ANESTHESIA- the loss of sensation as a result
of reversible CNS depression
1. Barbiturates - depress nerve synapses in the
reticular activating system, the portion of the
nervous system responsible for the level of
consciousness
• e.g., thiopental sodium (Penthotal)

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 NCMA216 (MIDTERMS) WEEK 7 – CNS/ANS AGENTS

Major side effects: hangover effect, apnea,

laryngospasm, bronchospasm, coughing, CVS a.2. NON-STEROIDAL ANTI-
depression INFLAMMATORY DRUGS (NSAIDS)
• non-selective: ibuprofen, naproxen
• COX-2 selective: celecoxib, meloxicam

Nursing implication:
• Have emergency equipment and IV fluids ready
• Know each individual drug
• Practice and stress safety measures
• Monitor vital signs
• Monitor elimination and status (urine output)
• Cautiously administer analgesics

3. ANALGESICS
ANALGESICS – drugs that relieve the sensation
of pain

TYPES OF ANALGESICS
A. NONNARCOTIC ANALGESICS
• not addictive and are less potent than narcotic
analgesics
• used to treat mild to moderate pain have
analgesic and antipyretic action

Actions:
• inhibits cyclooxygenase (produces COX-1 and
2)
COX – 1  protects stomach lining increases
temperature, promotes platelet aggregation
COX – 2  triggers pain and inflammation
• Inhibit the formation or reactivity of
prostaglandins and thus also control fever.

TYPES:
a.1. SALICYLATES
a.3. PARA-AMINOPHENOLS
• e.g., aspirin  oldest nonnarcotic analgesic
• e.g., acetaminophen (administered q4h as
• contraindicated in children < 12 years of age
needed with a maximum dose of 4g/day)
(danger of Reye’s syndrome)
• effect: analgesic and antipyretic
• effect: analgesic, antipyretic, anti-inflammatory,
• (NOT anti-inflammatory)
decreases platelet aggregation

Nursing implication:
• assess temperature every 4 hours
• check liver enzymes for those taking high doses
• evaluate the degree of pain relief obtain

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 NCMA216 (MIDTERMS) WEEK 7 – CNS/ANS AGENTS

B. NARCOTIC OR OPIOID ANALGESICS:

• act mostly on the CNS
• uses: analgesia (moderate to severe pain)
• cough suppression (antitussive)
• anesthesia

Drug interactions:
• CNS depressants  additive effect
• smoking  decreased effect Nursing
implications
• assess respiratory status
• assess for hypotension
Examples: • monitor bowel elimination
• meperidine (Demerol)  diaphenoxylate • evaluate pain response to medication
• codeine - dextromethorphan • implement and teach client about safety
• methadone • do not administer to client with head injuries.
• fentanyl (Sublimaze)
• oxycodone (Percocet)
• nalbuphine (Nubain)
• butorphanol tartrate (Stadol)
• naloxone (Narcan) – opioid antagonist

4, ANTICONVULSANTS
• ANTICONVULSANT – substance that
prevents, reduces, or stops the severity of
epileptic or other convulsive disorders.

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 NCMA216 (MIDTERMS) WEEK 7 – CNS/ANS AGENTS

Mechanisms:
• Suppress sodium influx → prolonging channel
inactivation → prevents neuron firing

• Suppress calcium influx → prevents electric

current generated
• Increase the action of GABA

NURSING CONSIDERATIONS
• CNS: dizziness
• Eat food with drug
• Antacids decrease
• Support group for epileptics
• Alert tag indicating specific drug
• Report adverse effects

• Anxiolytics or Antianxiety Drugs

• Action: to enhance the effect of GABA (Gamma
AminoButyric Acid), an inhibitory
neurotransmitter to decrease impulses in the
synapses of the brain, therefore decreasing
conduction of rapid impulses causing symptoms of
anxiety.depression of the CNS, produces
relaxation.

Common Drugs:
• Benzodiazepines:
- diazepam (Valium)

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 NCMA216 (MIDTERMS) WEEK 7 – CNS/ANS AGENTS

• Increase in 3Ds - drowsiness, dizziness, and

decrease in BP
• Enhance action of GABA
• Teach to rise slowly from supine
• Yes, alcohol and caffeine should be avoided

Antidepressants and Mood Stabilizers

- Alprazolam (Xanor) • A. TRICYCLIC ANTIDEPRESSANTS
- Lorazepam (Ativan) (TCAS)
• Antihistamines: • Common drugs: amitriptyline doxepin
- diphehydramine (Benadryl) imipramine (Torfranil)
• Other agents: • Action: increases neurotransmitter concentration
- hydroxyzine HCL (iterax) levels of NE and serotonin.

• Major side effects: sedation, othostatic

hypotension, anticholinergic effect

NURSING CONSIDERATIONS • Nursing implication

• Avoid abrupt discontinuation after prolonged use • It will take 1 to 3 weeks before the drug will take
• Not given if BP is decreased, with renal/hepatic effect.
dysfunction, or history of drug abuse • Drug can mask suicidal tendencies.
• Xanax (Alprazolam), Ativan (Lorazepam), Serax • Institute safety measures.
(Oxazepam) - examples with brand names

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 NCMA216 (MIDTERMS) WEEK 7 – CNS/ANS AGENTS

• Side effects: hypertensive crisis (if given with

tyramine rich foods like cheese, yogurt, red
wines), CNS stimulation (anxiety, agitation,
mania), orthostatic hypotension.

• B. MONOAMINE OXIDASE INHIBITORS

(MAOIS)
• Common drugs: phenelzine sulfate
• Tranylycpromine sulphate
• Isocarboxazid
• Action: inhibit MAO enzymes (present in the
brain, blood platelets, liver, spleen and kidneys)
that metabolizes NE and serotonin. • Uses: 2nd
line antidepressant

C. SELECTIVE SEROTONIN REUPTAKE

INHIBITORS (SSRIS)
• Common drugs: fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Seroxat)
• Action: antidepressant response is from the
inhibition of the serotonin uptake
• Uses: depression, obsessivecompulsive disorders
disorders
• Side effects: nausea, diarrhea, CNS stimulation
insomnia, headache, nervousness, dizziness), skin
rash
Nursing implication:
• administer with meals to reduce nausea
• use cautiously in patients with impaired renal
function

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