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NR565 Week 4 Study GuideWeek 4 is the midterm (no quiz) and includes all material
from Weeks 1-4; Be sure to also review the Weeks 1, 2 &
3 study guides to prepare for the exam
Many questions will are written to assess your clinical
application of the material from the textbook, in real-world
scenarios
Chapter 15: Drugs Affecting the Central Nervous System
Anorexiants: Precautions and contraindications
Examples; phentermine, benzphetamine, diethylproprion,
phendiametrazine and lorcaserin.
Anorexiants are sympathomimetic amines and are thought to exert their
action by stimulation of satiety centers in the hypothalamus and limbic
region. They act through noradrenergic, dopaminergic, or serotonergic
pathways. Lorcaserin promotes satiety by selectively activating 5-
HT2C receptors in the hypothalamus.
Thought to stimulate the release of norepinephrine and/or dopamine from
storage sites in nerve terminals in the lateral hypothalamic feeding center,
thereby producing a decrease in appetite
ADRs- CNS overstimulation, agitation, confusion, insomnia, dizziness, HTN,
headache, palpiatiations, arrhythmias, dry mouth, n/v. Sudden withdrawal in
patients who have a long history of use may cause withdrawal symptoms.
Increases glucose uptake from skeletal muscles and must be used cautiously in
diabetics- altered insulin or oral hypoglycemic dosage requirements . Carry a
high risk of tolerance and dependence. Use with caution in patients with ahistory
of alcohol or drug dependence. Use for a max period of 6 months.
Lorcaserin is a serotonergic drug and may develop serotonin syndrome if taken
with other serotonergic drugs.
Drug interactions- do not use with SSRIs, careful use with serotonergic meds due
to risk for serotonin syndrome, avoid MAOIs = result in hypertensive crisis,
careful use with adrenergic blockers, insulin sulfonylureas, and phenothiazines =
lithium toxicity, ovoid orlistat = decrease levels of levothyroxine and increases
, warfarin in the body.
Anticonvulsants: Hydantoins, iminostilbenes, succinimides
Mode of Action:
Essentially, anti-seizure drugs act by stimulating an influx of chloride ions; usually
this is associated with the neurotransmitter gamma-aminobutyric acid delaying
an influx of sodium and delaying an influx of calcium.
Hydantoins; phenytoin, ethotoin, fosphenytoin – first
line tx for tonic-clonic and complex seizures and are least
sedating drugs for seizure tx. Hydantoins inhibit and stabilize
electrical discharges in the motor cortex of the brain by affecting
the influx of sodium ions into the neuron during depolarization and
repolarization, slowing the propagation and spread of abnormal
discharges. They also affect the brainstem's contribution to grand
mal seizures and have antiarrhymic properties.
Metabolism and excretion Metabolism of
hydantoins takes place in the liver; excretion, via the kidneys. Plasma
half-lives range from 6 to 24 hours.
Precautions and Contraindications
Hydantoins are contraindicated under conditions of
hypersensitivity. Phenytoin-induced hepatitis is a common
hypersensitivity reaction. Other hypersensitivity reactions include
fever, rash, arthralgias, and lymphadenopathy. Phenytoin may
cause severe cardiovascular events and death has resulted from
too-rapid IV administration. Phenytoin has a Black-Box Warning
that IV administration should not exceed 50 mg/minute in adults
and 1 to 3 mg/kg/minute in pediatric patients owing to risk of
cardiovascular reactions associated with a too rapid rate of
administration. Phenytoin is contraindicated in sinus bradycardia,
sinoatrial block, second- and third-degree atrioventricular block,
and Stokes–Adams syndrome. It should be used cautiously in
patients with hepatic or renal disease. Ethotoin is contraindicated
in the presence of hepatic or hematological disorders.
Black box warning for IV administrations – do not give too fast or can
cause cardiovascular reactions.
MOAs, indications
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