Chap 14
Stimulation causes heightened awareness
and arousal
Inhibition causes general drowsiness and
sleep
Reticular Formation
PHARMACOLOGIC CLASS: SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRI)
TREATMENT OF DEPRESSION, SOCIAL ANXIETY DISORDER, OBSESSIVE-COMPULSIVE DISORDER, PTSD, AND PREMENSTRUAL DYSPHORIC DISORDER
ABRUPT DISCONTINUATION CAN RESULT IN WITHDRAWAL SYMPTOMS
the use of MAOIs are not advisable
sertraline (Zoloft)
sur·truh·leen
• Patient exhibits
– Elevated temperature
– Unstable blood pressure
– Profuse sweating
– Dyspnea
– Muscle rigidity
– Incontinence
Neuroleptic Malignant Syndrome
Barbiturate; GABA a receptor agonist that is a long-acting barbiturate used for the management of
a variety of seizures.
Affects are severe respiratory depression, CNS
depression, coma, and death and it should not be taken with alcohol or other CNS depressants
phenobarbital (Luminal)
fee·now·baar·buh·taal
Tonic–clonic activity lasting 1–2 minutes
• Rapid return to consciousness
• Occurs in children usually between 3 months and 5 years of age
febrile seizure
Pharmacologic class: SSRI
increases availability of serotonin, treats generalized anxiety and depression.
Adverse affects: dizziness, nausea, insomnia, somnolence, confusion, seizure
Counter indicated in people who use MORIs
escitalopram (Lexapro)
eh-suh-ta-luh-pram
THERAPEUTIC CLASS: ANTIDEPRESSANT; TREATMENT OF NOCTURNAL ENURESIS IN CHILDREN
PHARMACOLOGIC CLASS: TRICYCLIC ANTIDEPRESSANT
BLOCKS THE REUPTAKE OF SEROTONIN AND
NOREPINEPHRINE INTO NERVE TERMINALS.
THERAPEUTIC EFFECTIVENESS MAY NOT OCCUR FOR 2 OR MORE WEEKS.
CAUSES ANTICHOLINERGIC EFFECTS
DO NOT DISCONTINUE ABRUPTLY
CONCURRENT USE OF OTHER CNS DEPRESSANTS,
INCLUDING ALCOHOL, MAY CAUSE SEDATION
Imipramine (Tofranil)
uh·mi·pruh·meen
• Muscle spasms of face, tongue, neck, or back (acute dystonias)
• Inability to rest and relax; pacing (akathisia)
• Tremor, muscle rigidity, stooped posture (secondary or
pseudoparkinsonism)
• Lip smacking; wormlike movements of the tongue; uncontrolled chewing and grimacing (tardive dyskinesias)
Extrapyramidal Symptoms (EPS)
Antiseizure benzodiazepine GABAa receptor agonist.
used for status epilepticus
Because of tolerance and dependency, use of diazepam is reserved for short-term seizure control or for status epilepticus, and respiratory depression.
Do not take with alcohol and the antidote is flumazenil
diazepam (Valium)
dai·a·zuh·pam
• Considered a medical emergency
• Continuous seizure activity, which can lead to coma and death
Status Epilepticus
• Considered a medical emergency
• Continuous seizure activity, which can lead to coma and death
Pharmacological class: non-Benzodiazepine
Binds to Gaba receptors
used for hypnotic
Adverse effects: mild nausea, dizziness,
diarrhea, daytime drowsiness, amnesia,
sleepwalking, eating while asleep
zolpidem (Ambien)
zowl·puh·dem
THERAPEUTIC CLASS: ANTIDEPRESSANT
PHARMACOLOGIC CLASS: MONOAMINE OXIDASE INHIBITOR (MAOI)
WASHOUT PERIODS OF 2 TO 3 WEEKS ARE REQUIRED BEFORE INTRODUCING OTHER DRUGS
COMMON SIDE EFFECTS ARE CONSTIPATION, DRY MOUTH, ORTHOSTATIC HYPOTENSION, INSOMNIA, NAUSEA, AND LOSS OF APPETITE
SEVERE HYPERTENSION MAY OCCUR WHEN
INGESTING FOODS CONTAINING TYRAMINE
SSRIS SHOULD BE AVOIDED
Phenelzine (Nardil)
feh·nuhl·zeen
Therapeutic Class: Atypical antipsychotic; schizophrenia drug
Pharmacologic Class: dopamine receptor antagonist (weaker affinity for receptors); serotonin (5-HT) receptor antagonist
first-line drug for the treatment of schizophrenia and acute mania associated with bipolar disorder
dministration Alerts
• Several weeks are required for therapeutic effectiveness.
• When switching from other antipsychotics, discontinue medications to avoid overlap.
may cause weight gain and hyperglycemia
Black Box Warning: Older adult patients with dementia-related psychosis are at increased risk for death
Risperidone (Risperdal)
ruh·speh·ruh·down
Hydantoin; sodium influx–suppressing drug
desensitizing sodium channels in the CNS preventing
the spread of abnormal electrical charges in the brain that produce seizures.
Monitor labs for serum drug level, monitor kidney function. Narrow range between therapeutic and toxic dose, alcohol increases chance of toxicity.
Contraindications: Patients with hypersensitivity to hydantoin products should be cautious. Rash, seizures due to hypoglycemia, sinus bradycardia, and heart block are contraindications.
Phenytoin (Dilantin)
feh·nuh·toyn
Most antiseizure drugs are
pregnancy category D
4 types of antidepressants
– Selective serotonin reuptake inhibitors (SSRIs)
– Atypical antidepressants do not fall conveniently into the other categories
– Tricyclic antidepressants (TCAs)
– Monoamine oxidase inhibitors (MAOIs)
PRIMARY USE: BIPOLAR DISORDER
STIMULATES SEROTONIN RELEASE, AFFECTS SODIUM TRANSPORT ACROSS CELL MEMBRANES, BODY TREATS IT LIKE SODIUM
EXCESSIVE LOSS OF SODIUM,VOMITING CAN INDICATE TOXICITY, DEHYDRATION CAN CAUSE TOXICITY, VERY SMALL THERAPEUTIC INDEX
LITHIUM (ESKALITH)
li·thee·uhm
herapeutic Class: First-generation antipsychotic; schizophrenia drug
Pharmacologic Class: dopamine receptor antagonist; phenothiazine
provides symptomatic relief of positive symptoms of schizophrenia and controls manic symptoms
The drug must be gradually withdrawn over 2 to 3 weeks, and nausea, vomiting, dizziness, tremors, or dyskinesia may occur.
adverse effects are dizziness, drowsiness, and orthostatic hypotension
Black Box Warning: Older adult patients with dementia-related psychosis are at increased risk for death
Chlorpromazine
klor·praa·muh·zeen
Succinimide depresses the activity of neurons in the motor cortex by elevating the neuronal threshold.
Generally effective against absence seizures
Do not abruptly withdraw this medication because doing so may induce tonic–clonic seizures
Effects are CNS effects include dizziness, headache, lethargy, fatigue
Drug- drug interaction are increases phenytoin serum levels. Valproic acid causes ethosuximide serum levels to fluctuate
ethosuximide (Zarontin)
ee·thow·suhk·suh·mide
Partial (focal)
– Generalized
– Special epileptic syndromes
– Absence
International Classification of Epileptic Seizures
This is a Benzodiazepine that binds to GABA receptor-chloride channel molecule
used for anxiety disorders and insomnia
drowsiness, dizziness, respiratory depression, sedation
lorazepam (Ativan) diazepam (Valium)
lr-a-zuh-pam dai·a·zuh·pam
THERAPEUTIC CLASS: ATTENTION-DEFICIT/HYPERACTIVITY DISORDER DRUG
PHARMACOLOGIC CLASS: CNS STIMULANT
Black Box Warning: is a Schedule
PATIENTS ARE AT RISK FOR IRREGULAR HEARTBEAT, HIGH BLOOD PRESSURE,
AND HEART
Methylphenidate
meh·thuhl·feh·nuh·dayt
Therapeutic Class: Conventional antipsychotic; schizophrenia drug
Pharmacologic Class: dopamine receptor antagonist; nonphenothiazine
Black Box Warning: Older adult patients with dementia-related psychosis are at increased risk for death
for the management of acute and chronic psychotic disorders
Haloperidol (Haldol)
ha·luh·peh·ruh·daal
first-line drug for treating many types of epilepsy.
Side effects include sedation, drowsiness, GI upset and fatal hepatotoxicity.
Valproic Acid (Depakene)
val·prow·uhk a·suhd
• Large jerking movements of a major muscle group, such as an arm
• Falling from a sitting position or dropping what is held
Myoclonic Seizures