DRUG PRESENTATION

ON

CENTRAL NERVOUS SYSTEM

SUBMITTED TO: SUBMITTED BY:

Dr. KALAIVANI MS.M. BAVITHRA

Associate Professor MSc. (N) II-YEAR

Department Of Child Health Nursing Child Health Nursing

VMCON, Karaikal. VMCON, Karaikal.

SI.N DRUG DOSE/ SPECIAL INTERACTION CONTRA- SIDE-EFFECT NURSES
O ROUTE PRECAUTION INDICATION RESPONSIBILI
TY
1 ALPARAZIOALM ORAL Patient w/ signs & CNS depressants. Myasthenia CNS effects (e.g.
Adult:250- symptoms of Increased plasma gravis, severe – ataxia, cognitive
500mcg tid depressive disorder or concentrations w/ respiratory dysfunction,
Elderly: suicidal tendencies, CYP3A4 inhibitors insufficiency, depression,
250mcg chronic respiratory (e.g. nefazodone, sleep apnoea dizziness,
insufficiency. History fluvoxamine, syndrome, acute drowsiness,
of alcohol or drug cimetidine, fluoxetine, narrow angle dysarthria, fatigue,
abuse. Long-term use propoxyphene, OCs, glaucoma. irritability, memory
may lead to sertraline, diltiazem, Severe hepatic impairment,
dependence. Avoid or macrolide impairment. sedation);
abrupt withdrawal. antibiotics Concomitant decreased/increased
Renal & mild to use w/ potent libido, wt gain/loss;
moderate hepatic e.g. erythromycin, CYP3A4 Gl
impairment. Elderly & clarithromycin & inhibitors effects (e.g. appetite
debilitated patients. troleandomycin). (ketoconazole,
Pregnancy & lactation. Enhanced metabolism itraconazole).
Patient Counselling w/ CYP3A4 inducers
May impair ability to (e.g. ritonavir). May
drive or operate increase digoxin
machinery. Monitoring concentration. May
Parameters Monitor increase steady state
resp & CV status. plasma concentrations
of imipramine &
desipramine.
Significantly
increased plasma
concentrations w/
potent CYP3A4
inhibitors
(ketoconazole,
itraconazole).
 Patient w/ acute Increased serum conc
2 BUSPIRONE Adult: 5mg narrow-angle when used w/ Epilepsy. Nervousness,
BD glaucoma, myasthenia CYP3A4 enzyme Concomitant insomnia,
Usual dose: gravis, drug inhibitors (e.g. use w/ MAOIS. disturbance in
15-30MG dependence. Renal or erythromycin, Severe renal attention,
hepatic impairment. itraconazole, (CrCl depression,
Patient Counselling nefazodone, ritonavir, <20ml/min) or confusion, seizure,
This drug may cause diltiazem, verapamil). hepatic sleep disorder;
sedation & dizziness, if Decreased metabolism Impairment. dizziness, headache,
affected, do not drive & therapeutic effect Lactation. light-headedness,
or operate machinery. when used w/ excitement,
Monitoring Parameters CYP3A4 enzyme somnolence,
Monitor mental status. inducers (e.g. paraesthesia, blurred
rifampicin). Enhanced vision, coordination
sedative effect w/ disorder, tremor,
baclofen, lofexidine, tinnitus;
nabilone, tachycardia,
antihistamines. May palpitation, chest
increase serum conc pain; nasal
of haloperidol. congestion,
Buspirone does not pharyngolaryngeal
 exhibit cross-tolerance pain; nausea,
w/ sedative/hypnotics abdominal pain, dry
(e.g. benzodiazepine) mouth, diarrhoea,
& will not block constipation,
symptoms of their vomiting; cold
withdrawal, gradually sweat, rash,
w/draw such agents musculoskeletal
prior to initiation of pain, fatigue.
buspirone. Increased Rarely,
BP when taken w/ angioneurotic
MAOIs. Edema, ecchymosis,
urticaria.

May significantly
Patient w/ open angle enhance CNS
3 LORAZEPAM ORAL glaucoma, chronic depressant effect w/ Patient w/ acute Sedation,
Adult: 1- pulmonary antivirals (e.g. angle closure drowsiness, ataxia,
4mg/day insufficiency, muscle amprenavir, ritonavir). glaucoma, pre- muscle weakness,
Elderly: half weakness, organic May enhance CNS existing CNS fatigue, confusion,
of the tablet. brain changes depressant effect w/ depression, depression,
particularly narcotic analgesics, coma, severe or headache, vertigo,
arteriosclerosis, antidepressants, acute amnesia,
personality disorder, antipsychotics, respiratory paradoxical
phobia or on insufficiency, reactions (e.g.
obsessional state, sleep apnoea anxiety,
chronic psychosis. syndrome, hallucinations,
Used in patient w/ myasthenia insomnia,
depression or anxiety gravis, severe psychoses, sleep
associated w/ hepatic disturbances), visual
depression esp those w/ impairment. disturbances,
suicidal or aggressive tremor, slurred
behaviour. History of speech or
drug & alcohol dysarthria,
addiction. Avoid abrupt paradoxical
withdrawal. Renal & excitation,
hepatic impairment. respiratory
Elderly & debilitated depression,
patient. Pregnancy & hypotension,
lactation. Patient changes in libido &
Counselling May salivation, Gl
impair ability to drive disturbances,
or operate machinery. urinary retention or
May increase incontinence; pain
metabolism by & thrombophlebitis
smoking. Monitoring (IV). Rarely,
Parameters Monitor hypersensitivity,
CV, resp & mental blood disorders,
status. jaundice, increased
liver enzyme values.

Increased risk of
Patients who suffer convulsions or C
from emotional serotonin syndrome Suicidal Resp depression,
 disturbance or w/ SSRI, serotonin- patients; acute seizure, dizziness,
4 TRAMADOL ORAL/IV depression, history of norepinephrine intoxication w/ headache,
Adult: IV 50- epilepsy or risk of reuptake inhibitors hypnotics, somnolence,
100mg seizure, 11 head injury, (SNRI), TCA & other centrally acting weakness, CNS
increased intracranial seizure threshold analgesics, stimulation (e.g.
pressure. Renal & lowering drugs (e.g. opioids, anxiety, euphoria,
hepatic impairment. bupropion, psychotropic hallucinations),
Elderly. Pregnancy & mirtazapine, drugs or asthenia, sweating,
lactation. Patient tetrahydrocannabinol). alcohol; confusion,
Counselling May Decreased serum uncontrolled coordination
impair ability to drive concentrations w/ epilepsy, acute disturbance,
or operate machinery. carbamazepine. May or severe paraesthesia,
Monitoring Parameters potentiate the anti- bronchial hypoaesthesia,
Monitor pain relief, depressant effect of asthma, amnesia, cognitive
resp rate, BP, pulse norepinephrine, 5-HT hypercapnia or dysfunction,
rate; signs of tolerance, agonists or lithium significant resp depression,
abuse, or suicidal depression in dysphoria,
ideation. unmonitored constipation,
settings or nausea, vomiting,
absence of dyspepsia,
resuscitative diarrhoea,
equipment. Not abdominal pain,
intended for anorexia, flatulence,
narcotic wt loss,
withdrawal gastroenteritis,
treatment. pruritus, rash,
Severe renal & dermatitis, urticaria,
hepatic bronchospasm,
impairment. angioedema,
Concomitant anaphylaxis, allergic
use w/ MAOIs reaction, Stevens-
or w/in 2 wk Johnson syndrome,
after withdrawal toxic epidermal
of MAOIs. necrolysis,
vasodilation,
orthostatic
hypotension,
syncope,
tachycardia,
flushing, chest pain,
palpitations, MI,
HTN, peripheral
ischaemia,
menopausal
 symptoms, dysuria,
menstrual disorder,
micturition
difficulty, haematuia
.

Alcohol, Gl disturbances;
History of peptic ulcer corticosteroids, Hypersensitivit prolonged bleeding
or those prone to analgin, y (attacks of time, rhinitis,
dyspepsia & those w/ phenylbutazone & asthma, urticaria &
ORAL gastric mucosal lesion, oxyphenbutazone may angioedema, epigastric
5 ASPRIN Adult:2.4- asthma or allergic increase risk of Gl urticaria or discomfort;
3.6g/day disorders, dehydrated ulceration. Aspirin rhinitis), active angioedema,
Child: 8- patients, uncontrolled increases phenytoin peptic salicylism, tinnitus;
100mg/kg/day hypertension, impaired levels. May ulceration; bronchospasm.
renal or hepatic antagonize actions of pregnancy (3rd Gastric erosion,
function, elderly. uricosurics & trimester), child ulceration &
spironolactone. May <12 yr, patients bleeding; severe,
potentiate effects of w/ haemophilia occasionally fatal
anticoagulants, or haemorrhagic exacerbation of
methotrexate & oral disorders, gout, airway obstruction
hypoglycaemics. severe renal or in asthma; Reye's
hepatic syndrome (children)
impairment, .
lactation.