The document discusses various topics related to pharmacology including: 1) Extrapyramidal effects such as Parkinson-like symptoms and Tardive Dyskinesia that can occur with antipsychotic drugs. 2) Neuroleptic Malignant Syndrome, a potentially fatal reaction to antipsychotic drugs characterized by high fever, muscle rigidity and confusion. 3) Precautions for stopping medications that affect the nervous system like migraine medications and barbiturates which should be tapered to avoid rebound symptoms.

1. T E S T 6 B L U E P R I N T
Pharmacology

2. Extrapyramidal Effects
 A group of adverse reactions occurring on the
extrapyramidal portion of the nervous system
 Parkinson like symptoms
 Akathisia
 Dystonia
 Tardive Dyskinesia (TD)
 Syndrome of potentially irreversible involuntary rhythmic
movements of the tongue, face, mouth, jaw, or extremities.
 May occur in patients who are on antipsychotic drugs or after
discontinuing such drugs
 There is NO known treatment
 When it occurs the drug must be discontinued

3. Neuroleptic Malignant Syndrome
 When taking an antipsychotic Neuroleptic Malignant
Syndrome is developing:
 High fever
 Confusion
 Muscle rigidity

4. Precautions for stopping nervous system
medication
 Pg. 249 Abruptly stopping migraine agents after long
term used can result in rebound migraines,
therefore, they should be stopped slowly
 Pg. 254 dependence can develop with indiscriminate
use (barbiturates), and abrupt withdrawal is
dangerous

5. Nursing interventions about meds + alcohol
 Medications that work on the CNS should not be used
with alcohol which is a CNS depressant.
 Pg 253 synergistic effects with alcohol + barbiturates
 Nurse should evaluate patient for med compliance and
alcohol usage pg. 255 when patient is taking
anticonvulsives
 Patients taking benzodiazepines should not drink alcohol
within 24 hours of taking this medication pg. 257
 Alcohol is contraindicated with the use of antiemetics
and antivertigo drugs because of synergistic effects pg.
257

6. Sleep Meds
 Sedative-hypnotic medications are often used in the
hospital to relax patients and induce sleep and to treat
patients with insomnia caused by mental/physical stress
 Frightening dreams and “hangover” feeling are common
 Once a patient has taken them it may take several weeks
for normal sleep patterns to return
 If used for more than 1 week they may cause further
disturbances in the sleep cycle and rebound insomnia
 Should be taken 15-30 minutes before bed
 Should be discontinued slowly to avoid rebound
 MAY be habit forming

7. Antidepressants Side Effects
 Dizziness/drowsiness
 Dysrhythmias/hypertension/hypotension/tachycardi
a
 Diarrhea/N/V/dyspepsia/anorexia/constipation
 Sedation/insomnia
 Blurred vision
 Confusion/hostility/delirium
 Tremor/twitching
 Suicide

8. Antidepressant teachings…
 Take medication in compliance with orders
 Do not mix with alcohol or other CNS depressants
 Inform doctor about new medications
 Do not stop the medication without doctor
supervision
 Alert doctor to any new or troublesome side effects

9. Lithium & BW
 Primary drug used to treat patients in a manic state
 Therapeutic levels are close to toxic levels, so serum
lithium level must be monitored on a regular basis.
 Blood should be drawn 12 hours after the dose of
lithium is given.
 Monitoring should be carried out every few days
during the initial therapy and at least every 2 months
thereafter
 Therapeutic level is 1 to 1.5 mEq/L

10. Ritalin
 CNS stimulant intended to treat ADD, ADHD, &
narcolepsy

11. MAO inhibitors
 Block the inactivation of the biogenic amines
resulting in an increased concentration of dopamine,
epinephrine, norepinephrine, and serotonin at
neuronal synapses
 Used to relieve the symptoms of severe reactive or
endogenous depression that have NOT responded to
tricyclic antidepressant therapy, electro-convulsive
therapy, or other modes of psychotherapy

12. MAO inhibitor teachings…
Patient must not
eat/drink:
• Cheese/yogurt/sour cream
• Raisins
• Bananas
• Avacados
• Bean pods
• Chicken livers
• Pickled herring
• Meat tenderizers
• Soy sauce
Limited amounts of:
• Coffee
• Tea
• Cola
• Chocolate
Teachings:
• Compliance is essential
• Increases alcohol effects
• Effects continue 2 weeks after
cessation
• Move slowly when changing
positions
• Avoid driving
• Discontinue 2 weeks before
surgery
• Keep out of reach of children
• MedicAlert bracelet

13. What is the limbic system for?
 The limbic system is a set of evolutionarily primitive brain structures
located on top of the brainstem and buried under the cortex. Limbic
system structures are involved in many of our emotions and
motivations, particularly those that are related to survival. Such
emotions include fear, anger, and emotions related to sexual
behavior. The limbic system is also involved in feelings of pleasure
that are related to our survival, such as those experienced from
eating and sex.Certain structures of the limbic system are involved in
memory as well. Two large limbic system structures, the amygdala
and hippocampus play important roles in memory. The amygdala is
responsible for determining what memories are stored and where the
memories are stored in the brain. It is thought that this
determination is based on how huge an emotional response an event
invokes. The hippocampus sends memories out to the appropriate
part of the cerebral hemisphere for long-term storage and retrieves
them when necessary. Damage to this area of the brain may result in
an inability to form new memories.

14. What is Elavil/Welbutrin used for?
 Elavil
 Amitriptyline/elavil is a tricyclic antidepressant used to treat
the symptoms of endogenous depression
 Welbutrin
 Buproprion/welbutrin is an antidepressant that workd int eh
brain to treat major depression, seasonal affective disorder,
and for smoking cessation

15. What does an abrupt withdrawal of CNS dep.
Cause?
 Rebounding of symptoms

16. Tricyclic Antidepressants
 Antidepressant effect of trycyclics is not completely
understood
 They are used primarily to relieve the symptoms of
severe depression that has internal biologic causes
(endogenous depression)
 May be used to treat mild depression caused by
factors in patient’s life (exogenous or reactive
depression) which is NOT self-limiting and does not
interfere with usual activities of daily living
 Less commonly used for manic-depressive disorders

17. What is levdopa?
 Antiparkinson medication
 Also used to treat muscular tremors caused by other
medications
 It is turned into dopamine in the body

18. Antianxiety Teachings
MAY be habit forming
Not for use by pregnant women
Pt. should not drink alcohol with this medication
Patient should keep doctor informed of any new medications
Keep out of reach of children
Notify health care provider with any new or troublesome symptoms
Can cause dizziness, etc. so patient shouldn’t drive/operate machinery until response to drug has been established
Pt. must keep regular appts. w/ doctor
Medication dosing schedule should be followed with strict compliance

19. Common Seizure meds
 Barbiturates
 Luminal
 Phenobarbital
 Benzodiazapines
 Klonopin
 Tranxene
 Valium
 Hydantoins
 Cerebryx
 Dilantin
 Succinimides
 Phensuximide
 Miscellaneous
 Diamox
 Tegretol
 Neurontin
 Lamictal
 Topamax
 depakene

20. Side effects of seizure meds
Barbiturates
• Dizziness/drowsiness/lethargy
• Hangover headache
• Rash/urticaria
• Paradoxical restlessness
• Photosensitivity
• Diarrhea/N/V
• Joint pain
• CNS depression
• Slow/shallow respirations
• Tachycardia
• coma
Benzodiazepines
• hypotention
• Shortness of breath
• Blurred vision
• Flushing
• Drowsiness/weakness/confusion
• Pradocixal reactions
• Anorexia & bitter taste in mouth
• Diarrhea/N/V/heartburn
• Rash/pruritus
• Coma
Hydantoins
• Ataxia
• Dizziness/drowsiness
• Hallucinations/inattentiveness/poor
memory
• N/V
• Ocular disturbances
• Blood cell disturbances
• Bruising
• Acne like eruptions
• Gingival hyperplasia
• Lupus erythematosus
• Hepatitis w/ jaundice
• Coma
Succinimides
• Dizziness
• Headaches
• Hiccups
• Hyperactivity
• Lethargy
• Mood/mental changes
• Diarrheas/cramping/N/V
• Lupus
• Night terrors
• Urinary frequency
• Vaginal bleeding
• Alopecia

21. What are neurotransmitters?
 Chemical messengers that are released at the end of one
neuron and passes across a small gap to activate the next
neuron in the chain
 At the end of the nerve chain it stimulates an organ,
smooth muscle, or gland to produce a physiologic
response
 2 major:
 Norepinephrine-acts on sympathetic nerves
 Acetylcholine-acts on parasympathetic nerves
 Nerve fibers that:
 Release norepinephrine are called adrenergic fibers
 Release acetylcholine are called cholinergic fibers

22. Status Epilepticus & meds
 Status Epilepticus-a condition in which a series of
severe grand mal seizures occur one after another
without stopping
 It is treated with long-acting barbiturates

23. What are common antimigraine meds?Ergotamine
derivatives
Migranal
Ergomar
Cafergot
Ercaf
Va-Zone
Serotoning(5-HT)
ReceptorAgonists
Axert
Amerge
Maxalt
Imitrex
Zomig

24. Signs of Barbiturate OD
 Exaggerated CNS depression
 Slow, shallow respirations
 Miosis
 Tachycardia
 Areflexia
 Shock
 coma

25. What is phenobarb?
 Phenobarbital is a barbiturate used for all forms of
epilepsy, status epilepticus, severe recurrent
seizures, & eclampsia

26. What is the special teaching about Dilantin?
What is the initial dose?
 Patients taking hydantoins (like Dilantin) should see
a dentist every 6 months & maintain good oral
hygiene brushing teeth and gums twice a day with a
soft toothbrushing and rinsing well
 Initial dose:
 Children 5 mg/kg/day PO in 2 or 3 equally divided doses initiall
 Adults 100 mg PO 3 times daily intially

27. What are antivertigo medications?
 Antivertigo medications agents are used to prevent
and treat motion sickness and the N/V that occur
with anesthesia and surgery or cancer treatments.
 They are also used to treat severe, intractable
vomiting and hiccups.
 Special Teaching:
 If for motion sickness, take 30-60 minutes before departure
and 30 minutes after meals thereafter
 Patient should avoid all other CNS depressants including
alcohol
 Patient should not drive, operate dangerous machines, or do
anything that requires alertness

28. What are phentothiazines?
 Phentothiazines are antidopaminergic agents used
almost exclusively to control N/V.
 Common phentothiazines:
 Thorazine
 Compazine
 Phenergen

29. What are dopaminergic agents?
 Dopaminergic agents are Parkinson’s medications
designed to elevate the functional levels of dopamine
in motor regulatory centers
 They:
 enhance the release of dopamine from pre-synaptic nerve
endings
 Directly stimulate dopamine receptors in corpus straiatum

30. What are the signs of toxicity related to
dopaminergic drugs?
Muscle twitching
Blepharospasm (eyelid
spasms)
Rapidly worsening
Parkinson’s symptoms

31. Special Teaching for long-term use of
dopaminergic drugs…
 Overdosage is a common phenomenon with long-
term therapy, so patients should be instruction to
watch for signs of toxicity
 Long-term use can cause Tardive Dyskinesia
 Long-term use often leads to akinesia (loss of
movelment) & dystonia (impairment of muscle tone)
 To counteract these effects, the dosage is liekly to be
reduced to the minimum effective level and dosages
tapered as necessary to avoid overmedication

32. Best I could do on short notice!
 Good Luck!