CHAPTER 15

Miscellaneous central nervous system medications

MEDICATION CLASSIFICATION

Muscle Relaxants and antispasmodics

• Diazepam (Valium) - central acting
• Dantrolene (Dantrium) - periphereal acting
• Baclofen (Lioresal) - ca
  Cyclobenzaprine (Skelaxin) - ca
• Tizanidine (Zanaflex) -ca

All of the meds

• CNS depression

Centrally Acting Agents

• Hepatic Toxicity
• Physical Dependance
• Nausea, constipation, and urinary retention (Baclofen)

Peripherally Acting

• Hepatic Toxicity
• Muscle Weakness

Baclofen and Dantrolene

preg risk C

Diazepam

Preg risk D

All Meds

use cautiously with impaired liver and renal function

other CNS Depressants

MEDICATION CLASSIFICATION

Muscarine Agonists

MEDICATION CLASSIFICATION

Muscarinic Antagonists

• Oxybutynin (Ditropan)
• Oxybutynin transdermal system (Oxytrol)
• Darifenacin (Enablex)
• Tolterodine (Detrol)

• Anticholinergic effects
• CNS effect - hallucinations, confusion, insomnia, nervousness

glaucoma

GI or GU obstruction

urinary rentention

use cautiously in pts with GERD, heart failure, kidney or liver impairment

Chapter 16

Sedative-Hypnotics

MEDICATION CLASSIFICATION

Benzodiazepines

• Diazepam (Valium)
• Alprazolam (Xanax)
• Lorazepam ( Ativan)
• Chlordiazepoxide (Librium)
• Temazepam (Restoril)

• Anxiety
• Seizure disorders
• Insomnia
• Muscle Spasm
• Alcohol Withdrawal
• Panic Disorder
• Induction of Ansthesia

• CNS Depression
• Anterograde Amnesia
• Paradoxical Response
• Resp depression
• Physical Dependance
• AcuteToxicity

• preg risk D
• sleep apnea, respiratory depression, organic brain disease, during lactation
• hx of substance abuse use cautiously
• other CNS depressants

MEDICATION CLASSIFICATION

Nonbenzodiazepines

• Zolpidem (Ambien)
• Zaleplon (Sonata)
• Eczopicone (Lunesta)
• Trazadone

• Daytime Sleepiness
• Lightheadness

Preg risk B

breastfeeding pts

older clients use cautiously

MEDICATION CLASSIFICATION

Melatonin Agonist

• Sleepiness
• Dizziness
• Hormonal Effects

Preg Risk C

Use cautiously in pts with liver disease

high fat foods

concurrent use of fluvoxamine (Luvox)

CNS Depressants

MEDICATION CLASSIFICATION

Beta2 - Adrenergic Agonists

• Albuterol (Proventil, Ventolin)
• Formoterol (Foradil Aerolizer)
• Salmeterol (Serevent)
• Terbutaline (Brethine)
• Levalbuterol (Xopenex)

• inhaled agents have minimal adverse effects
• oral agents can cause tachycardia and angina
• Tremors

Preg Risk C

pts with tachydysrhythmias

use cautiously pts with diabetes, hyperthyroidism, hypertension, and angina

use of propranolol

MAOIS and Tricyclic antidepressants

MEDICATION CLASSIFICATION

Methylxanthines

Long term control for chronic asthma (oral)

• Mild toxicity
• dysrhythmias and seizures

• Preg risk C
• Use cautiously in children and older adults
• Caffeine can increase med
• Phenobarbital and Phenytoin decrease med
• Cimetidine (Tagamet), ciproflaxin (Cipro) and other Fluoroquinolone abx's increase drug 

MEDICATION CLASSIFICATION

Inhaled Anticholenergics

• Ipratropium (Atrovent)
• Tiotropium (Spiriva)

• relief of bronchospasm associated with COPD
• Allergen and exercise induced ashtma
• Inhalation

Preg Risk  B

pts who have allergies to peanuts

MEDICATION CLASSIFICATION

Glucocorticoids

Inhalation

•  Beclomethasone (QVAR)
• Budesonide (Pulmicort Flexhaler)
• Fluticasone ( Advair, Flovent)
• Triamcinolone acetonide (Azmacort)

Oral

• Prenisone (Deltasone)
• Prednosolone (Prelone)

IV

• Hydrocortisone Sodium Succinate (Solu-Cortef)
• Methylprednisone Sodium Succinate (Solu Medrol)

Inhaled Glucorticoids

• dificulty speaking, hoarsenss, and candidiasis

Prednisone (When used more than 10 days)

• suppression of adrenal gland
• bone loss
• hyperglycemia and glucosuria
• myopathy
• peptic ulcer disease
• Infection
• Disturbances of fluid and electrolytes

• Preg Risk C
• clients who have recieved a live virus vaccine
• systemic fungal infections
• use cautiously with NSAIDS
  concurrent use of K+
• concurrent use of glucocorticoids and hypyglycemic agents

consume a diet with sufficient calcium and vit D

MEDICATION CLASSIFICATION

mast cell stabilizers (anti-inflammatories)

• management of chronic asthma
• prophylaxis of exercised - induced asthma
• prevention of allergen - induced attack
• allergic rhinitis by nasal route
• inhalation route of admin

• Safest of all asthma medications
• Safe to use for children

Preg Risk B

use cautiously with pt with liver and kidney disease

MEDICATION CLASSIFICATION

Leukotriene Modifiers

• Montelukast (Singulair)
• Zileuton (Zyflo)
• Zafirlukast (Accolate)

cautiously in pts with liver dysfunction

Zileuton and Zafirlukat inhibit metabolism of coumadin

Zileuton and Zafirlukat inhibits metabolism of Theophylline

Chapter 18 - Upper Respiratory Disorders

MEDICATION CLASSIFCIATION

Antitussived -Opioids  

• Codiene
• Hydrocodone

CNS Effect - dizziness, light headness, drowsiness, resp depression

GI Distress

Potential for Abuse

• Codiene is Preg Risk C
• acute ashthma, head trauma, liver and renal dysfunction, and acute alcoholism

MEDICATION CLASSIFICATION

antitussives - non-opoids

• Dextromethorphan - found in robitussin
• Benzonatate (Tessalon)
• Diphenhydramine (Benadryl)

• Few adverse effects
• mild nausea, dizziness, and sedation
• some potential for abuse

• Preg Risk C
• may cause high fever if used within 2 weeks of MAOI antidepressants

MEDICATION CLASSIFICATION

Expectorants

• increases cough production
• often used with atitussives or a decongestant
• relieve colds
• rhinitis

• GI Upset
• Drowsiness, dizziness
• Allergic Reaction (rash)

• Preg Risk C
• talk to MD before breastfeeding
• may or may not be recommended for children

MEDICATION CLASSIFICATION

Mucolytics

• Acetylcysteine (Mucomyst, Acetadote)
• Hypertonic Saline

• acute and chronic pulmonary disorders
• cystic fibrosis
• Acetylcysteine is the antidote for acetaminophen poisoning

• Preg Risk B
• clients at risk for Gi Bleed

MEDICATION CLASSIFICATION

Decongestants

Phenylephrine

Ephedrine

Naphazoline

Phenylypropanolamine

• treat allergic rhinitis
• sinusitis and common cold

• Rebound Congestion secondary to prolonged use of topical agents
• CNS Stimulation
• Vasoconstriction

• chronic rhinitis
• caustiously with pts with coronary artery and hypertension

MEDICATION CLASSIFICATION

Antihistamines

1st generation h1 antagonists

• Diphenhydramine (Benadryl)
• Promethazine (Phenergan)
• Dimenhydrinate (Dramamine)

2nd generation h1 antagonists

• Loratadine (Claritin)
• Cetirizine (Zyrtec)
• Fexofenadine (Allegra)
• Desloratadine (Clarinex)

1st generation

• mild allergic reactions
• Anaphylaxis
• Motion Sickness
• Insomnia

• Sedation
• Anticholinergic Effects
• GI Discomfort
• Acute Toxicity - children have symptoms of excitation and hallucinations

•  during third trimester of pregnancy
• use cautiously in children
• CNS Depressants