DRUGS AFFECTING THE CENTRAL

NERVOUS SYSTEM


ANATOMY OF THE NEUROLOGICAL SYSTEM
By: Ms. Louradel M. Ulbata, RN, MAN

PHYSIOLOGY OF THE NEUROLOGIC
SYSTEM
Organization of the Nervous System
A. Central nervous system (CNS).
1. Brain
2. Spinal Cord
B. Peripheral nervous system (PNS).
1. Twelve pairs of cranial nerves
2. Thirty-one pairs of spinal nerves
B.1. Autonomic nervous system
a. Sympathetic system
b. Parasympathetic system.
B.2. SOMATIC NERVOUS SYSTEM
a. Afferent Nerves
b. Efferent Nerves

CELLS OF THE NERVOUS SYSTEM

A. Neuron-the functional cell of the nervous
system.
1. Common characteristics.
a. Responds or reacts to stimuli
b. Conducts impulses
c. Influences other neurons.
2. Structure
a. Cell body-contains the cell nucleus which
controls cellular activity.
b. Axon-conducts impulses away from the cell
body
c. Dendrites-receive incoming stimuli and
transmit them to the axon of another neuron.

3. Function/classification.
a. Afferent neurons (sensory) transmit
information towards the CNS.
b. Efferent neurons (motor) transmit information
away from the CNS.

REMEMBER: SAME
Sensory = Afferent; Motor = Efferent


c. Somatic system
1). Afferent are sensory neurons that transmit
impulses from the skeletal muscles and skin to
the CNS.
2). Efferent are motor neurons that transmit
impulses that lead to contraction and control of
skeletal muscle.
d. Visceral system.
1). Afferent are sensory neurons that transmit
impulses from smooth muscle and cardiac
muscle to the CNS.
2) Efferent are motor neurons that transmit
impulses to the glands, cardiac muscle, and
smooth muscle.
e. Synapse or synaptic terminals are areas of
chemical transmission of an impulse from the
axon of one neuron to the dendrites of another
neuron.

Functional Properties of Neurons

Irritability ability to respond to stimuli
Conductivity ability to transmit an
impulse
NERVE FUNCTION is NERVE
CONDUCTION

ACTION POTENTIAL
Nerve Cell undergoes:
1. Resting Membrane Potential
2. Action Potential / Depolarization
3. Repolarization / Restabilization

1. RESTING MEMBRANE POTENTIAL
Sodium predominates outside the cell,
potassium inside the cell.
Inside of the cell is relatively negative
with the presence of potassium and
large amounts of negative ions.
2. Action Potential / Depolarization
When a cell is stimulated, cell
membranes become permeable to
sodium ions.
Sodium moves inside the cell and
potassium moves out.
Inside of the cell becomes positively
charged.
Sudden change in the charge of the cell
from negative to positive is called action
potential.

3. REPOLARIZATION
The sodium-potassium pump restores
the original configuration
This action requires ATP
Sodium is pumped out of the
cell and potassium back into the
cell.
B. Supporting cells provide support,
nourishment, and protection to the neuron.
1. Neurilemma protective cells which
surround the axons in the PNS.
a. Provide for effective regeneration of
PNS nerve fibers.
b. Form the myelin sheath in the PNS.
c. No neurilemma present in the CNS.

2. Glial cells protective cells in the CNS;
responsible for the formation of the
myelin.

3. Myelin sheath.
a. Dense membrane or insulator around
the axon.
b. Facilitates function of the neuron,
c. Contributes to the blood-brain barrier to
protect the central nervous system
against harmful molecules.

4. nodes of Ranvier
- Intermittent gaps between the
myelin sheath that allow
communication between nerve
fibers.
- Signals jumping from node to
node travel hundreds of
times faster than signals traveling
along the surface of the
axon.
D. Impulse conduction.
SALTATORY CONDUCTION
An action potential excites one section
of the nerve membrane and electrical
impulse then SKIPS from one node to
the next generating an action potential.
These node-to-node mode of
conduction is termed SALTATORY OR
LEAPING TRANSMISSION

ADVANTAGES OF SALTATORY Of
LEAPING TRANSMISSION
Membranes are forming fewer action
potentials so:
1. The speed of conduction is much faster
2. The nerve is protected from exhaustion
or using up energy to form multiple
action potentials

Synaptic transmission:
TRANSMISSION OF ELECTRICAL
IMPULSES FROM ONE NEURON TO
ANOTHER

a. A chemical synapse maintains a one-
way communication link between
neurons

synapse - junction between two
neurons.

NERVE SYNAPSE IS MADE UP OF:
1. presynaptic nerve -ends BEFORE
specific synapse
2. synaptic cleft -separates synapse by
a tiny gap (less than one-
millionth of an inch)
3. Post synaptic Nerve - begins AFTER
synapse
b. Chemical neurotransmitters (neuro-
mediators) facilitate the transmission of
the impulse across the synapse.
1). Acetylcholine.
2). Norepinephrine.
3). Dopamine.
4). Histamine.
c. Impulses pass in only one direction.
Impulses are able to cross the synapse
to another nerve
Neurotransmitter is released
from a nerves axon terminal
The dendrite of the next neuron
has receptors that are
stimulated by the
neurotransmitter
An action potential is started in
the dendrite

To return the effector to a resting state so
that it can be stimulated again, the actions
of these neurotransmitter must be stopped
by one or more of these processes:

1. Reuptake by the presynaptic nerve
- neurotransmitters are reabsorbed by
the presynaptic nerve to reuse/recycle
2. Inactivation by an enzyme
3. Broken down by enzymes in the area
4. Diffusion out of the synaptic cleft and
removal by the vascular system

d. Nerve regeneration entire neuron is unable
to undergo complete regeneration.

1. The axons of the PNS may regenerate via the
connective tissue neurilemma, providing the cell
body of the neuron remains viable.
2. Neuron regeneration in the CNS is very
limited, possibly due to the lack of neurilemma.
3. Scar tissue is a major deterrent to successful
cellular regeneration.

CENTRAL NERVOUS SYSTEM

The brain and the spinal cord within the
vertebral column make up the central nervous
system.

A. The brain and the spinal column
are protected by the rigid bony
structure of the skull and the
vertebral column.
B. Meninges protective
membranes that cover the brain
and are continuous with those of
the spinal cord. (DAP)

1. Dura mater-a tough membrane
immediately outside the
arachnoid; provides protection
to the brain and spinal cord.
2. Arachnoid-a delicate
nonvascular, waterproof
membrane that encases the
entire CNS; the subarachnoid
space contains the cerebral
spinal fluid.
3. Pia mater-a delicate vascular
connective tissue layer that
covers the surfaces of the brain
barrier.

C. Cerebral spinal fluid (CSF).

1. Serves to cushion and protect
the brain and spinal cord; brain
literally floats in CSF.
2. CSF is clear, colorless, watery
fluid; approximately 100 to 200
cc total volume, with a normal
fluid pressure of 70 to 150 mm
of water 9average-125 cm water
pressure).
3. Formation and circulation of
CSF.
a. Fluid is secreted by the choroids
plexus located in the ventricles
of the brain.
b. CSF flows through the lateral
ventricles into the third ventricle,
flows through the Aqueduct of
Sylvius into the fourth ventricle
where the central of the spinal
column opens.
c. From the fourth ventricle, there
are openings into the cranial
subarachnoid space; CSF flows
around the spinal cord ad brain.
d. Since CSF is formed
continuously, it is reabsorbed at
a comparable rate by the
arachnoid villi.

D. Brain.

I. FOREBRAIN
Prosencephalon - "Pro Die & Tell
Diencephalon => Thalamus,
Hypothalamus
Telencephalon => Cerebrum

1. Cerebrum seat of
consciousness
- convolutions or gyri & grooves:
sulci or fissures which
expands or increases the surface
area of the brain
- is divided into left and right
hemispheres connected to
each other by the corpus
callosum
- the cerebral cortex is the
surface layer of each
hemisphere.
A. Major lobes of the
central cortex.
a. Frontal.
1). Coordination of voluntary
skeletal muscle movement.
2). Abstract thinking, morals,
judgment.
3). Speech area, motor speech area
(Brocas area) located in only one
hemisphere.
b. Parietal.
1. Interprets sensory nerve impulses
(pain, temperature,
touch).
2. Maintains proprioception.
3. Recognition of size, texture, and
shape of objects.
c. Temporal.
1. Auditory area- interprets meaning
of certain sounds.
2. Wernickes area- comprehension
and formulation of
speech.

d.Occipital area-interprets vision
and controls ability to understand
written words.
e. The limbic lobe is thought to be
a link bet emotional & cognitive
(thought) mechanisms.
f. The central lobe (insula) is
thought to be involved in both
autonomic & somatic activities.

2. Thalamus.
1. relay station for all sensory
information
2. Activities related to
consciousness.

3. . Hypothalamus.
1. Regulation of visceral
activities-body temperature,
motility and secretions of the GI
tract, arterial blood pressure.
2. Nerve connections with the
thalamus and the cerebral
cortex make it possible for our
emotions to influence visceral
activity.
3. Regulation of endocrine
glands via influence on the
pituitary gland.
4. Neurosecretion of antidiuretic
hormone (ADH) which is stored in
the pituitary

3. Motor areas of the cerebral
cortex.
a. Primary function is coordination
and control of skeletal muscle
activity.
b. Corticospinal tracts (pyramidal
tracts).
1. Descending tract from the
motor area of the
cerebral cortex to the spinal
cord.
2. Majority of nerves cross in the
medulla to the opposite
side before descending into
the spinal cord.
3. These pathways do not cross
over.
c. Brain cells and the nerve fibers in
the descending tracts of the central
nervous system are called upper
motor neurons.

II. MIDBRAIN (MESENCEPHALON)
- Consists of 4 rounded bodies, the corpora
quadrigemina:
Paired upper bodies: serve as
visual reflex centers for head &
eyeball movements
Paired lower bodies: serve as
relay centers for auditory
information
III. HINDBRAIN (RHOMBENCEPHALON)
Brainstem
Pons
Medulla oblongata
Cerebellum
A.. Pons- respiratory apneustic center,
nucleus of cranial nerves-
5,6,7,8
B. Medulla oblongata-a continuation of the
spinal cord as it enters into the cranial
vault in the brain.
- respiratory and cardiovascular centers,
nucleus of cranial nerves 9,10,11,12
1. Conduction center and crossing
center for the upper motor neurons.
2. Maintains control of cardiac rate.
3. Vasomotor center for constriction
and dilation of vessels.
4. Respiratory center for changes in
rate and depth of breathing.
5. Vomiting reflex center.
6. Swallowing reflex center.
C. The Cerebellum
2nd largest part of the brain w/c consists
of 2 hemispheres & a connecting
portion, the vermis
responsible for coordination of muscle
movements
functions:
1. helps make muscular movement
smooth instead of jerky &
trembling
2. helps maintain muscle tone &
posture
3. impulses from the vestibular
apparatus are continuously
delivered to the cerebellum to
help maintain equilibrium

RETICULAR FORMATION
Nerve fibers arising from the central
core of the medulla and lower pons
Reticular Activating System
- arises from reticular formation.
- essential for arousing from
sleep and remaining alert.
- Injury to RAS can cause
anesthesia and coma
Basal ganglia (cerebral nuclei)
regulate and program muscle
activity coming from the cerebral
cortex.

Movement is controlled by:

a. Cerebral cortex voluntary
initiation of motor activity.
b. Basal ganglia-assist to maintain
posture.
c. Cerebellum-coordinates muscle
movement.

CEREBRAL CIRCULATION
a. The internal carotid arteries enter the
cranial vault at the temporal area
b. Vertebral arteries arise from the
subclavian artery and enter the brain at
the foramen magnum.
c. The Circle of Willis is an arterial
anastomosis at the base of the brain.
The circle ensures continued circulation if
one of the main vessels is
disrupted.

THE SPINAL CORD
1. The spinal cord is continuous with the
medulla and extends down the vertebral
columns to the level of the first and
second lumbar vertebra.
2. Each column is divided into functional
groups of nerve fibers.
a. Ascending tracts transmit impulses to
the brain (sensory pathway).
b. Descending tracts transmit impulses
from the brain to the various levels of the
spinal cord (motor pathways).
3. Structure.
a. Closely approximately vertebrae
provide protection from the spinal cord
and nerve roots.
b. Intervertebral discs lie between each
vertebra to provide flexibility to the
spinal column.
c. Nucleus pulposus is a gelatin
substance in the vertebral disc.
5. Upper motor neurons-originate in the
brain, transmit impulses to the
muscles and organs.
6. Lower motor neurons originate in
the spinal cord, transmit impulses
to the muscles and organs.

4. Reflex activity.
a. The reflex arch must be intact, the
spinal cord serves as the connection
between the afferent pathway (sensory), and
the efferent pathway (motor).
b. By testing the reflex arc (deep tendon
reflexes), the lower motor neuron and the
sensory/motor fibers from the spinal
column can be evaluated.

Reflex arc

a. Reflex are is the functional unit which
provides pathways over which nerve
impulses travel.
b. Passage of impulses over a reflex arc
is called a reflex act or a reflex.
c. Reflex arc The afferent neuron
carries the stimulus to the spine; integrates
it into and through the spine (CNS) to the
efferent neuron; crosses the synapse
with the message from the CNS to the
organ or muscle which responds to the
stimuli. This is the sequence of events
when testing the deep tendon
reflexes.

PERIPHERAL NERVOUS SYSTEM
(PNS)

Cranial nerves
1. Twelve pairs of cranial nerves.
2. Originate from under the surface
of the brain.
A. Spinal nerves.
1. Each pair of nerves is
numbered according to
the level of the spinal
cord from which it
originates.
2. Each spinal nerve is connected
to the cord by two roots.
A. DORSAL (PoSterior)
root- receives SENSORY
input from sensory
receptors throughout the
body.
B. Ventral (anterior root) a
motor nerve carrying neuron
messages to glands and to
the peripheral area.

REMEMBER!
DORSAL ROOT/ POSTERIOR
=SENSORY
VENTRAL ROOT/ ANTERIOR
= MOTOR

3. The roots fuse at the exit from
the vertebra to form a mixed
spinal nerve.
4. SPINAL NERVE
PLEXUSES
- network of interwoven spinal
nerves

MAJOR PLEXUSES:
A. CERVICAL PLEXUSES
a. sends motor impulses to the
NECK muscles
b. Sends out PHRENIC nerve,
activating the diaphragm
c. Receives sensory impulses from
neck snd back of the head
B. BRACHIAL PLEXUSES
- Innervates shoulder, arm,
forearm, wrist and hand

c. LUMBOSACRAL PLEXUS
- Innervates the lower
extremities.
- Sends out the large SCIATIC
NERVE

C. Somatic nervous system associated with
the voluntary control of body movements via
skeletal muscles, and with sensory reception of
external stimuli (e.g., touch, hearing, and sight

D. autonomic nervous system regulates
involuntary activity (cardiovascular, respiratory,
metabolic, body temperature, etc.)

1. Consists of two divisions that have
antagonistic activity.
2. Parasympathetic division maintains
normal body functions.
- REST & DIGEST
3. Sympathetic division-prepares the
body to meet a challenge or an emergency
(preparation for fight/flight).


SYMPATHETIC VS PARASYMPATHETIC

Parasympathetic
:
REST AND
DIGEST
Sympathetic:
FIGHT &
FLIGHT
Function: => slows stuff
down
=> speed stuff
up
Control Craniosacral:
brain + below
the belt
Thoracolumbar:
above the belt
Neurotransmitt
er
ACETYLCHOLI
NE
EPINEPHRINE
& NE
"DUMBBELS":
Diarrhea
Urination
Miosis
"constrict"
Bradycardia
Bronchoconstrict
Erection "point"
Lacrimation
Salivation
Opposite of
Parasympatheti
cs:
Constipation
Urinary retention
Mydriasis "eyes
wide with fright"
Tachycardia
Bronchodilate
Ejaculation
"shoot"
Xerophthalmia
(dry eyes)
Xerostomia (dry
mouth)

CRANIAL NERVES

are nerves which start directly from the
brainstem instead of the spinal cord.

Only the first and the second pair
emerge from the cerebrum; the
remaining 10 pairs emerge from the
brainstem.


NUMBER NAME FUNCTION
I.
II.

III.




IV.
V.




VI.
VII.




Olfactory
Optic

Oculomotor




Trochlear
Trigeminal:
Opthalmic
Macillary
Mandibular

Abducens
Facial



Sense of smell
Vision-conducts
information from
the retina
Down and outward
movement of the
eye
Pupillary
constriction and
accommodation
Muscle of the
upper eyelid (ability
to keep the eye
open)
Movement of the
eye

Corneal reflex
Sensory fibers of
the face
Motor nerves for
chewing and
swallowing
Inward movement
of the eye
Facial expression
Sense of taste on
anterior tongue
Muscle of the
eyelid (ability to
close the eye)

VIII.

IX.


X.




Acoustic

Glossopharyngeal


Vagus nerve




Reception of
hearing and
maintenance of
equilibrium
Sense of taste on
posterior tongue
Salivation
Swallowing or
gag reflex
Assists in

XI.

XII.

Accessory (Spinal)

Hypoglossal
swallowing action
Motor fibers to
larynx for speech
Innervation of
organs in thorax
and abdomen
Important in
respiratory,
cardiac, and
circulatory
reflexes
Ability to rotate
the head and
raise the shoulder
Muscles of the
tongue


PSYCHOTROPIC DRUGS

Drugs that affect mental function
Cannot cure psychiatric illness but
they can modify or lessen
symptoms

Classification of Psychotropic Drugs
1. Tranquilizers
- decrease anxiety and
hyperactivity causing a marked decrease
in the level of consciousness
1. Antidepressants
- Used to treat depression that has
become severe enough to interfere with a
persons ability to function normally.

TRANQUILIZERS

1. Major Tranquilizers
- also known as
ANTIPSYCHOTICS
- used to treat psychoses
2. Minor Tranquilizers
- also knows as
ANXIOLYTICS
- used to treat the less
severe neurotic and psychosomatic

MAJOR TRANQUILIZERS/
ANTIPSYCHOTICS

Psychotic Disorders

Definition: Psychotic disorders are
defined as mental disorders in which the
personality is severely altered and a
persons contact with reality is impaired.

Characteristics: delusions, hallucinations,
odd behavior, and incoherent or
disorganized speech


Schizophrenia

literal translation split
mind
separate emotional side
from intellectual side
emotional &
cognitive processes
don't function
together


Positive schizophrenia
symptoms are caused by an excess
or distortion of normal functions.

The positive symptoms of schizophrenia
include:
Delusions. Delusions are inflexible
misleading beliefs. They appear as
a result of exaggerations or
distortions of reasoning, as well as
false interpretations of things and
events. For example, one can think
that some book was written
especially for him/her.
Hallucinations. False sensory
perceptions or perceptual
experiences that do not exist in
reality.
Ambivalence. Holding seemingly
contradictory beliefs or feelings
about the same person, event , or
situation
Echopraxia. Imitation of the
movements and gestures of
another person whom the client is
observing.
Flight of ideas. Continuous flow of
verbalization in which the person
jumps rapidly from one topic to
another.
Ideas of Reference. False
impressions that external events
have special meaning for the
person.
Perseveration. Persistent
adherence to a single idea or topic
; verbal repetition of a sentence,
word or phrase.
Associative Looseness.
Fragmented or poorly related
thoughts or ideas


Negative Symptoms of Schizophrenia

Negative schizophrenia symptoms are
those that reflect a decrease in normal
functions, or a loss of them
Affective flattening ( Flat affect) is
usually expressed by the absence
or reduction of emotional
expression, such as mimicry, voice
tone, eye contact and body
language.
Alogia is the tendency to speak
very little or to convey little
substance of meaning ( poverty of
content)
Avolition (Lack of volition) is the
absence of goal-oriented behavior,
absence of will, ambition, or drive
to take action or accomplish task.
A person loses interest to the
surrounding world, doesn't do
anything, and sits doing nothing
for long periods of time.
Apathy. Feelings of indifference
toward people, activities and
events.
Anhedonia. Feeling no joy or
pleasure from life or any activities
or relationships.
Blunted Affect. Restricted range of
emotional feeling, tone or mood.
Catatonia. Psychologically-induced
immobility occasionally marked by
periods of agitation or excitement;
the client seems motionless, as if in
a trance.
ETIOLOGY OF SCHIZOPHRENIA

NEUROCHEMICAL FACTORS
The dopamine and serotonin
hypothesis:
- schizophrenia is caused by an excess
of dopamine and serotonin activity in the
brain.

Dopamine Pathways
1. Mesolimbic
Projects from brainstem to limbic
areas.
Mesolimbic- mesocortical (
behavior )
Overactivity produces delusions and
hallucinations

2. Mesocortical
- May be associated with both
positive and negative symptoms
- Blockade may help increase
negative symptoms of schizophrenia
3. Nigrostriatal
- Projects from the
substania nigra to the basal
ganglia
A part of the
extrapyramidal system
Thus side effects are
called extrapyramidal
Extrapyramidal
-> part of the
nervous system that regulates muscle
reflexes.


Types of movement disorders
caused by this pathway include:
Akathisia
Dystonia
Tardive dyskinesia
Tremor, rigidity,
bradykinesia
Drug-induced
Parkinsonism
4. Tuberoinfundibular
Tuberoinfundibular- pituitary
system (endocrine)
Endocrine control - tubero-
infundibular system.
- Dopamine and dopamine
agonists suppress prolactin release,
dopamine antagonists may stimulate it
leading to increased prolactin
Blockade produces galactorrhea


Antipsychotic drugs

- block DA receptors in both systems and
therefore Parkinsonian symptoms and
EPS are side effects.


CATEGORIES OF ANTIPSYCHOTIC

1. CONVENTIONAL/ TRADITIONAL/
TYPICAL ANTIPSYCHOTIC DRUGS
- are dopamine
antagonists
- targets only the
positive signs of schizophrenia
2. ATYPICAL/ NEWER
ANTIPSYCHOTIC DRUGS
- are both dopamine
and serotonin antagonist
- targets both
positive and negative signs of
schizophrenia


Traditional/ Conventional
/Typical Antipsychotics

Phenothiazines
chlorpromazine
(Chlorpromazine Mixture,
Chlorpromazine Mixture
Forte, Largactil)
fluphenazine (Anatensol,
Modecate)
flupenthixol (Fluanxol)
pericyazine (Neulactil)
pimozide (Orap)
thioridazine (Aldazine)
trifluoperazine (Stelazine)
zuclopenthixol (Clopixol)
Butyrophenones
haloperidol (Haldol,
Serenace)
droperidol (Droleptan
Injection)

Chlorpromazine was the
first anti-psychotic drug developed

Mechanism of Action of
Phenothiazines

The drugs found in this class are
antagonists.
They work by blocking the
Dopamine receptors in the
dopamine pathways of the brain;
thus, decreasing the normal effect
of dopamine release.
Blocking the dopamine receptors
in the mesolimbic pathway results
in the antipsychotic effect.

Butyrophenones

Butyrophenones are high-potency
antipsychotics (potency refers not
to effectiveness but rather to the
ability to bind to dopamine
receptors)
Haloperidol (Haldol) is the most
common of the butyrophenones

Mechanism of Action

All the butyrophenones work in
the same manner as the
phenothiazines.
They block the dopamine
receptors in the dopamine
pathways, thus, thwarting any
possible over excitation of the
dopamine receptors.

Typical Antipsychotics

Phenothiazines and
Butyrophenones are typical
antipsychotics
These drugs are no longer
regarded as the best practice for
treating psychotic disorders, even
though they are still commonly
utilized in emergency treatments.
The reason for this is that they are
not very selective. They do not
only block the D2 receptors of the
mesolimbic pathway but also
block the D2 receptors in the
nigrostriatal pathway,
mesocortical zone, and
tuberoinfundibular pathway.
The fact that they are not very
selective causes the extra
pyramidal symptoms such as
tardive diskinesia


Atypical Anti-psychotics

Were developed in an attempt to
minimize the side effects of typical
anti-psychotics
They have proven to cause fewer
extra
pyramidal symptoms (EPS) when
compared
to typical anti-psychotics.
They produce fewer EPS because
they are
more selective.


Atypical agents
aripiprazole (Abilify)
clozapine (CloSyn, Clopine,
Clozaril)
risperidone (Risperdal)
quetiapine (Seroquel)
amisulpride (Solian)
olanzapine (Zyprexa)
ziprazidone (Zeldoxx)

Mode of Action

Dopamine and serotonin
Antagonists
Atypical antipsychotic drugs have
a similar blocking effect on
dopamine receptors but appear to
be more selective in targeting the
intended pathway to a larger
degree than typical antipsychotics.
They also interact with other
neurotransmission systems,
particularly with the serotonergic
and noradrenergic pathways.

SIDE EFFECTS OF
ANTIPSYCHOTIC DRUGS

A. NEUROLOGIC SIDE EFFECTS

1. EXTRAPYRAMIDAL SIDE EFFECTS
(EPS)
2. TARDIVE DYSKENISIA
3. SEIZURES
4. NEUROLEPTIC MALIGNANT
SYNDROME

EXTRAPYRAMIDAL SIDE
EFFECTS (EPS)

- Are reversible movement
disorders induced by neuroleptic
medication.
- Include:
a. Dystonic reactions
b.
Pseudoparkinsonism
c. Akathisia

1. DYSTONIA
- characterized by spasms in
discrete muscle groups such as the
neck muscles (torticollis) or eye
muscles ( oculogyric crisis)
- these may also be accompanied
by protrusion of the tongue,
dysphagia, and laryngeal spasms
- extremely frightening and painful
to the pt
- Treatment:
Diphenhydramine (Benadryl)
Benztropine (Cogentin)

2. Pseudoparkinsonism
- Neuroleptic-induced
parkinsonism
- characterized by:
a. shuffling gait
b. masklike facies
c. muscle stiffness
d. rigidity
e. drooling
f. akinesia ( slowness and
difficulty
initiating movement)
g. tremors
Treatment:
-Benztropine Sulfate
(Cogentin)
- Biperiden ( Akineton)

3. AKATHISIA
- characterized by restlessness,
movement, pacing, inability to
remain still.
Treatment:

Propranolol (Inderal)

Benzodiazepines

TARDIVE DYSKINESIA

- a late appearing
side effect of antipsychotic
medications
- characterized by
abnormal, involuntary movements
such as lip smacking, tongue
protrusion, chewing, blinking,
grimacing.
- Irreversible once it
has appeared
CLOZAPINE atypical
antipsychotic has not not been
found to have this effect


SEIZURE
- Clozapine is a
notable exception
- associated with
high dosage of med

NEUROLEPTIC MALIGNANT
SYNDROME ( NMS)
- serious and fatal side
effect
- characterized by:
F Fever
A Autonomic instability
L Leukocytosis
T Tremor
E Elevated enzymes (elevated
CPK)
R Rigidity of muscles
- treated by stopping the medication
- Prescribe bromocriptine and
dantrolene (dopaminergic
agonists)


NON-NEUROLOGIC SIDE
EFFECTS

Blurred vision
Constipation
Urinary retention
Memory dysfunction
Dry mouth
Sinus tachycardia
Sedation, drowsiness
Weight gain
Hypotension

AGRANULOCYTOSIS

Potentially fatal side effect of
Clozapin ( Clozaril)
Failure of the bone marrow to
produce adequate white
blood cells
Characterized by:
- fever
- sore throat
- leukopenia
- Drug must be discontinued
immediately.
- Client should have WEEKLY
WBC count.

MINOR
TRANQUILIZERS/
ANXIOLYTICS


- Also called sedatives
- Anti-anxiety drugs
- Hypnotics

STATES AFFECTED BY
ANXIOLYTIC AND HYPNOTIC
DRUGS

1. ANXIETY
2. SEDATION
3. HYPNOSIS

ANXIETY

- Apprehensive anticipation
of future danger


SEDATION

The loss of awareness and reaction
to environmental stimuli
Desirable for patients who are
restless, nervous ,irritable or
overreacting to stimuli

HYPNOSIS

An extreme state of sedation
A hypnotic should produce, as
much as possible, a state of sleep
that resembles normal sleep.




SEDATIVE/HYPNOTICS
ANXIOLYTICS












GABAERGIC SYSTEM



GABA
- Major player in Inhibitory
Synapses.

BENZODIAZEPINES


Diazepam
Chlordiazepoxide
Triazolam
Lorazepam
Alprazolam
Clorazepate => nordiazepam
Halazepam
Clonazepam
Oxazepam
Prazepam

BARBITURATES


Phenobarbital ( Luminal)
Pentobarbital ( Nembutal)
Amobarbital ( Amytal Sodium)
Mephobarbital ( Mebaral)
Secobarbital ( Seconal)


THERAPEUTIC ACTION:

- Act on the limbic system
and the RAS to make gamma-
BENZODIAZEPINES BARBITURATES
aminobutyric acid (GABA) more
effective causing interference with
neuron firing.


OTHER ANXIOLYTIC AND
HYPNOTIC DRUGS


1. Paraldehyde ( Paral)

- A very old drug used orally and
rectally to sedate patients with
delirium tremens or psychiatric
conditions characterized by
extreme excitement
- Has distinctive odor
- Cannot be stored in plastic
containers or dispensed with a
plastic spoon or syringe
- Dilute first before using, use food
to improve taste, keep away from
heat and flame, discard any
unused portion


2. Buspirone ( Buspar)

A newer antianxiety agent
Has no sedative, anticonvulsant or
muscle relaxant properties
It reduces the signs and symptoms
of anxiety w/o many of the CNS
effects and severe adverse effects
associated with other anxiolytic
drugs.
Rapidly absorbed by the GI
Metabolized in the LIVER
Excreted in the URINE
Caution in pts with hepatic or
renal impairment and elderly
patients
May cause dry mouth and
headache





3. Ramelteon ( Rozerem)

Introduced in 2005
First of a new class of
sedatives/hypnotics, MELATONIN
RECEPTOR AGONISTS
Stimulates the melatonin receptor
which are thought to be involved
in the maintenance of circadian
rhythm and the sleep-wake cycle
Used for treatment of insomnia
characterized by difficulty with
sleep onset
Metabolized in the LIVER
Excreted in FECES and URINE
Should be administered 30
minutes before bed; allow 8 hours
of sleep
Patients should be monitored for
depression and suicidal ideation


NURSING IMPLICATION FOR
PSYCHOTROPIC DRUGS

1. Careful initial assessment of pts
behavior
2. Pts with psychiatric disturbances
should watched as they take their
meds
- stay w/ them as
they take the meds and check the
mouth if it has been swallowed
3. MAJOR TRANQUILIZERS: Close
observation and reporting of the
earliest signs of EPS.
Earliest sign of TD : AbN
movt of tongue muscles

4. Caution pt not to drive or
perform potentially dangerous
activities
5. POSTURAL HYPOTENSION :
Warn not to change body position
quickly.
6. PHOTOSENSITIVIY: Warn not to
stay outside in bright sunlight as
this can lead to eye damage and
skin pigmentation.
7. Warn pt & family bwt changes in
body appearance and sexual
function (eg; weight gain,
gynecomastia, changes in mens,
galactorrhea, decreased libido)
8. inform client of side effects and
encourage to report problems
instead of discontinuing
medication
teach client methods of managing
or avoiding unpleasant side effects
and maintaining medication
regimen:
dry mouth sugar-free
fluids and sugar-free hard
candy
* client should avoid calorie-laden
beverages and candy
constipation exercise,
increase water and bulk-
forming foods; stool
softener permissible but
avoid laxatives
photosensitivity
sunscreen
10. Report signs of infection (fever,
sorethroat

ANTIDEPRESSANTS

DEPRESSION

- Is an affective disorder
characterized by overwhelming
sadness, despair and hopelessness
that is inappropriate with respect
to the event or events that
precipitated the depression.
-
BIOGENIC AMINE THEORY OF
DEPRESSION

States that depression is caused by
deficiency of biogenic amines
norepinephrine (NE), serotonin (
5HT) and dopamine in certain
areas of the brain


Causes of Deficiency of Biogenic
Amine

1. Monoamine Oxidase ( MAO) may
break them down to be recycled or
restored in the neuron
2. Rapid fire of the neurons may lead
to their depletion
3. Numbers or sensitivity of
postsynaptic receptors may
increase depleting
neurotransmitter levels


DRUG THERAPY FOR
DEPRESSION

ANTIDEPRESSANT DRUGS
- most effective
means of treating depression
- counteracts the
effects of neurotransmitter
deficiencies
- Increases the level
of biogenic amines in the brain
in three ways:
a) may inhibit the
effects of MAO
b) block reuptake by
the releasing nerve
c) may regulate
receptor sites and breakdown
of neurotransmitters

THREE (3) GROUPS:
1. TRICYLIC ANTIDEPRESSANTS
(TCAs)
2. MONOAMINE OXIDASE
INHIBITORS (MAOIs)
3. SELECTIVE SEROTONIN
REUPTAKE INHIBITORS (SSRIs)

MONOAMINE OXIDASE INHIBITORS
(PANAMA)
1. Tranylcypromine (Parnate)
2. Phenelzine ( Nardil)
3. Isocarboxacid ( Marplan)

THERAPEUTIC ACTIONS

- Inhibit MAO, an enzyme found in
nerves and other tissues that
breaks down the biogenic amine
NE, dopamine and 5GT.
It takes 2-3 weeks before initial
therapeutic effects become
noticeable

DRUG FOOD INTERACTIONS

Patients taking MAOIs should
avoid TYRAMINE-CONTAINING
FOODS
Tyramine and other amines that
are found in food which are
normally metabolized by MAO
enzymes in the GI may be
absorbed in high concentrations in
the presence of MAOIs, resulting in
increased blood pressure (
HYPERTENSIVE CRISIS)
Tyramine causes the release of
stored NE in the nerve terminals
which further contributes to high
BP


HYPERTENSIVE CRISIS

- characterized by:
a. Occipital
Headache
b. Palpitations
c. Neck stiffness
d. N& V
e. sweating
f. dilated pupils
g. photophobia
h. tachycardia
i. chestpain
j. may progress to
intracranial bleeding and stroke

TYRAMINE CONTAINING FOODS

A VOCADO
B ANANA
C HEDDAR and AGED CHEESE
S OY SAUCE & PRESERVED
FOODS





DRUG-DRUG INTERACTIONS

MAOIs w/ TCAs:
- hypertensive crisis
- coma
- severe convulsions
MAOIs with SSRI :
- Serotonin
Syndrome
- rapid
changes in vital signs (fever,
oscillations in blood pressure),
sweating, nausea, vomiting,
rigid muscles, myoclonus,
agitation, delirium, seizures,
and coma.
- A period of 6 weeks should elapse
after stopping an SSRI before
beginning therapy with a MAOI

TRICYCLIC ANTIDEPRESSANTS
(TCAs)

- All reduces the reuptake of 5HT
and NE into the nerves
- It takes 2-3 weeks before initial
therapeutic effects become
noticeable.

THERAPEUTIC ACTIONS

Inhibit presynaptic reuptake of the
neurotransmitters NE and 5HT
which leads to the accumulation of
these neurotransmitters in the
synaptic cleft and increased
stimulation of the postsynaptic
receptors.

TRICYCLIC ANTIDEPRESSANTS

Imipramine (Tofranil)
Amitriptylline
Amoxapine (Asendril)
Clomipramine (Anafranil)
Desipramine (Nopramin)
Doxepin (Sinequan)

TCA:

CHECK:
1. BP it causes HYPOTENSION
2. HEART RATE it causes CARDIAC
ARRYTHMIAS

SELECTIVE SEROTONIN
REUPTAKE INHIBITORS

Newest group of antidepressant
drugs
Specifically blocks the reuptake of
5HT, with little to no known effect
on NE
Do not have the many adverse
effects associated with TCAs and
MAOIs so they are a better choice
for many patients

THERAPEUTIC ACTIONS
Specifically blocks the reuptake of
5HT, with little to no known effect
on NE, increasing the levels of 5HT
in the synaptic cleft.

SELECTIVE SEROTONIN
REUPTAKE INHIBITORS

FLUOXETINE (prozac)
- first SSRI
- Indicated to treat
depression, obsessive-
compulsive d/o, bulimia, panic
disorders and premestrual
dysphoric disorder
Fluvoxamine (Luvox)

Paroxetine (Paxil)
Sertraline (Zoloft)
Citalopram (Celexa)

SIDE EFFECTS OF
ANTIDEPRESSANTS

Dry mouth -it is helpful to drink
sips of water; chew sugarless gum;
brush teeth daily.
Constipation -bran cereals, prunes,
fruit, and vegetables should be in
the diet.
Bladder problems -emptying the
bladder completely may be
difficult, and the urine stream may
not be as strong as usual. Older
men with enlarged prostate
conditions may be at particular
risk for this problem. The doctor
should be notified if there is any
pain.
Sexual problems -sexual
functioning may be impaired; if
this is worrisome, it should be
discussed with the doctor.
Blurred vision -this is usually
temporary and will not necessitate
new glasses. Glaucoma patients
should report any change in vision
to the doctor.

Dizziness -rising from the bed or
chair slowly is helpful.
Drowsiness as a daytime problem -
this usually passes soon. A person
who feels drowsy or sedated
should not drive or operate heavy
equipment. The more sedating
antidepressants are generally
taken at bedtime to help sleep and
to minimize daytime drowsiness.
Increased heart rate -pulse rate is
often elevated. Older patients
should have an electrocardiogram
(EKG) before beginning tricyclic
treatment.

NURSING IMPLICATION

Arrange for lower dosage in
elderly patients and in those with
renal or hepatic impairment bcoz
of the potential for severe adverse
effects
Monitor for patients for up to 4
weeks to ascertain onset of full
therapeutic effect before adjusting
dosage
Establish suicide precautions for
severely depressed patients and
limit the quantity of the drug
dispensed to decrease the risk of
overdose
Administer the drug once a day in
the morning to achieve optimal
therapeutic effects. If the dosage is
increased or if the patient is having
severe GI effects, the dosage can be
divided
MAOI:
Monitor BP and signs of HPN Crisis
Have phentolamine or another
adrenergic blocker on standby as
treatment in case of hypertensive
crisis
Provide a list of potential drug-
food interactions that can cause
severe toxicity to decrease the risk
of a serious drug-food interaction.
Provide a diet low in tyramine.
Inform pt that these foods must
not be eaten while the medication
is being taken or 2-3 weeks after it
has been discontinued.





Anti- manic agent

LITHIUM CARBONATE

Decreases pts HYPERACTIVITY
Best taken after meals
Takes 10-14 days before
therapeutic effect becomes
evident.
- Antipsychotic is
administered during the first two
(2) weeks to manage the acute
symptoms of mania until lithium
takes effect.
Instruct pt to increase fluid intake
(3L/ day) and sodium intake
(3gm/day)
Monitor serum level
Normal : .5 -
1.5 meq/ L
LITHIUM TOXICITY
- Nausea, Anorexia,
Vomiting, Diarrhea, Abdominal
Cramps
Mannitol administered if toxicity
occurs


ANTI-EPILEPTIC DRUGS

I. Epilepsy
- Is characterized by seizures that
result from sudden discharge of
excessive electrical energy from
nerve cells in the brain

Pathological Basis:
Abnormal electrical discharge in the
brain.
Imbalances occur between
glutamate-mediated excitatory
neurotransmission and gamma-
aminobutyric acid (GABA) mediated
inhibitory neurotransmission.
Changes in ion channels


TYPES OF SEIZURES

2 BROAD CATEGORIES:

1.generalized
- are produced by electrical impulses
from throughout the entire brain,
2. partial (also called local or focal).
- are produced (at least initially) by
electrical impulses in a relatively small part
of the brain.
- The part of the brain generating the
seizures is sometimes called the FOCUS

Generalized seizures

1. Grand-mal seizure
- also known as tonic-clonic
seizure
- involve dramatic tonic-clonic
muscle contractions, loss of consciousness
and a recovery period characterized
by confusion and exhaustion.

2. Absence seizures ( Petit mal)
- involve abrupt, brief (3-5 seconds)
periods of loss of consciousness.


- The patient typically interrupts an activity
and stares blankly.
- Patients are usually not aware that they are
having a seizure, except that they
may be aware of "losing time."
- occurs more frequently in children and
disappears at puberty

3. Myoclonic seizures
- consist of sporadic periods of
muscle contractions, usually on both sides of
the body.
- Patients sometimes describe the jerks as
brief electrical shocks. When violent, these
seizures may result in dropping or
involuntarily throwing objects.

4. FEBRILE SEIZURES
- are related to very high fevers and usually
involve convulsions.
- most frequently occur in children
- usually self-limited and do not reappear

5. STATUS EPILEPTICUS
- the most dangerous of all seizure
conditions
- a state in which seizures rapidly recur
again and again

Partial Seizures

Partial seizures are divided into:
1. simple
2. complex

1. SIMPLE
- awareness is retained
- occur in a single part of the brain and may
involve a single muscle movement or
sensory alteration

2. Complex partial seizures
- by definition, include impairment of
awareness.
- involve complex sensory changes such as
hallucinations, mental distortion, changes in
personality, loss of consciousness and loss
of social inhibition


ANTIEPILEPTIC DRUGS

A drug which decreases the frequency
and/or severity of seizures in people with
epilepsy
Treats the symptom of seizures, not the
underlying epileptic condition
Goalmaximize quality of life by
minimizing seizures and adverse drug
effects

Basis of Pharmacological Rx

Most anti-epileptic agents act either by
blockade of depolarization channels (Na+
and Ca++)

OR

Enhancing the activity of GABA
(neurotransmission inhibition)


DRUGS FOR TREATING TONIC-
CLONIC SEIZURES


1. HYDANTOINS
2. BARBITURATES AND
BARBITURATE-LIKE DRUGS
3. BENZODIAZEPINES

THERAPEUTIC ACTION

- all stabilize nerve membranes
throughout the CNS to decrease excitability
and hyperexcitability to stimulation.
- BENZODIAZEPINES
- Decrease excitability and
conduction

HYDANTOINS & BARBITURATES
- Stabilize the nerve membrane
by influencing ionic channels in
the cell membranes

HYDANTOINS
* promote the exit of sodium ions from the
cell, returning the cell to a stable resting
membrane potential

* less sedating than many other
antiepileptics
- Phenytoin ( Dilantin)
- Ethotoin ( Peganone)
- Fosphenytoin (Cerebyx)
PHENYTOIN (DILANTIN)

Although an effective and well tried
antiepileptic, it is not the first line in
treatment of partial or generalized
epilepsy due to its toxicity
Limited water solubility not given
i.m.
Slow, incomplete and variable
absorption..
Metabolized by liver
Therapeuticplasma concentration:
10-20 g/ml

CONTRAINDICATION

Those who are allergic to Dilantin,
phenytoin, or any inactive
components used to make the
medication.

DRUG INTERACTIONS

Alcohol
- Alcohol can interfere with the way
the body handles Dilantin.
- Chronic alcohol intake can
decrease the level of Dilantin in the
blood, while short-term intake of a large
amount of alcohol can increase the level
of Dilantin in the blood.

SIDE EFFECTS:


Confusion.
Dizziness
Insomnia
Twitching
Headaches
Nausea,vomiting, or constipation
Larger or fuller lips
Excessive body or facial hair.
High blood sugar (hyperglycemia)
Signs of liver damage, such as
yellow skin or eyes (jaundice)
Unexplained bruising or bleeding
Swollen or tender lymph nodes
Bending of the penis (which makes
intercourse difficult)
Suicidal thoughts or behavior
Signs of an allergic reaction,
including unexplained rash, hives,
itching, and unexplained swelling.
Gingival Hyperplasia
Sexual-Endocrine Effects:
Osteomalacia
- softening of the bones due
to defective bone mineralization.
Hirsutism
- excessive hairiness on
humans in those parts of the body where
terminal hair does not normally occur or is
minimal
Hyperglycemia

Teratogenic effects

Fetal hydantoin syndrome
Cleft lip
Cleft palate
Congenital heart disease
Mental retardation

NURSING RESPONSIBILITIES:

Dilantin comes in extended-release
capsules, chewable tablets, and an
oral suspension. These products are
not interchangeable.
It can be taken with or without food.
If it upsets the stomach, it may be
taken with food. It is important that
pt takes it consistently the same way
(either with food or without food).
The medication should be taken at
the same time each day to maintain
even levels of the drug in the blood.
It should not be stopped without first
discussing with thehealthcare
provider.
Seizure medications, including
Dilantin, may increase the risk of
suicidal thoughts or behavior. If pt
feels depressed or has any suicidal
thoughts, let the healthcare provider
know right away
Dilantin may increase blood sugar.
This is especially important for
people with diabetes.
Dilantin may cause bone weakness,
because it affects the way the body
deals with vitamin D (which is
important for strong bones).
* As with all seizure medications, Dilantin
should not be stopped suddenly.
* Because Dilantin can cause gum problems,
good dental care is very important while pt
is taking Dilantin

BARBITURATES & BARBITURATE-
LIKE DRUGS

Phenobarbital (Luminal)
- Primidone (Mysoline)
- Mephobarbital (Mebaral)

PHENOBARBITAL
(SOLFOTON, LUMINAL)

- available in oral and parenteral
forms
- used for emergency control of
status epilepticus and acute
seizures
- TSL: 15-40 mcg/ml

BENZODIAZEPINES

DIAZEPAM (VALIUM)
CLONAZEPAM ( KLONOPIN)
Potentiate the effects of GABA, an
inhibitory neurotransmitter

DIAZEPAM (VALIUM)
- not used for long term management
of epilepsy
- well absorbed from the GI tract
- metabolized in the liver
- excreted in the urine

DRUGS FOR TREATING ABSENCE
SEIZURES

1. SUCCINAMIDES
Modulate the inhibitory
neurotransmitter GABA

a. Ethosuximide (Zarontin)
B. Methsuximide (Celontin)

ETHOSUXIMIDE (ZARONTIN)

DOC for treating absence seizures
Has fewer adverse effects compared
with many other antiepileptic drugs
Available for oral use
TSL: 40-100 mcg/ml
METHOSUXIMIDE (CELONTIN)

Oral drug used to treat absence
seizures that are resistant to other
drugs
Associated with bone marrow
suppression

THERAPEUTIC ACTION:

Suppress the abnormal electrical
activity in the brain that is assoc with
absence seizure
Ethosuximide should be tried first;
methosuximide should be reserved
for the tx of seizures that are
resistant to other agents because it is
associated with more severe adverse
effects

OTHER DRUGS FOR TREATING
ABSENCE SEIZURES

1. VALPROIC ACID (DEPAKENE)
- reduces abnormal electrical activity
in the brain and may also increase GABA
activity at inhibitory receptors
- DOC for the treatment of
myoclonic seizures
- 2nd DOC for the treatment of
absence seizures because it is associated
with hepatic toxicity and has more SE.

2. Acetazolamide (Diamox)

- sulfonamide drug
- tx of absence seizures
- also used to tx open-angle and
secondary glaucoma, acute mountain
sickness, decrease edema assoc with CHF

3. ZONISAMIDE (Zonegram)
- newer agents that inhibit voltage-
sensitive sodium and calcium channels, thus
stabilizing nerve cell membranes
- should be tapered over 2 weeks
when discontinuing as this could increase
the risk of seizure.
- pt should increase fluid intake
because of the risk of renal calculi



DRUGS FOR TREATING PARTIAL
(FOCAL)SEIZURES

1. CARBAMAZEPINE (TEGRETOL)

MECHANISM OF ACTION
It works by blocking sodium
channels in the brain. By blocking
sodium channels, the medication
may decrease the activity of nerve
cells, preventing them from firing
abnormally.

SIDE EFFECTS
dizziness
upset stomach
headache
unsteadiness
double vision
N& v

ADVERSE EFFECTS:
Anemia or other blood disorders
- Aplastic anemia
- Agranulocytosis
Unusual bruising or bleeding
Worsening of seizures
Hallucinations
Depression
Suicidal thoughts or behaviors
Increased infections or infections
that do not go away
Water retention, swelling, or
difficulty breathing, which can be
signs of (CHF)
HBP (HPN) or LBP (hypotension)
An irregular heart rhythm
(arrhythmia)
Yellowing of the whites of the eyes
or skin (jaundice), which may be a
sign of liver damage, including liver
failure or hepatitis
Difficulty passing urine or a sudden,
unexplained decrease in urine
production (which can be a sign of
kidney damage)
Low sodium levels in the blood
(hyponatremia), which may cause
symptoms such as:

Loss of appetite
Nausea or vomiting
Irritability
Excessive tiredness
Confusion
Hallucinations
Muscle weakness
Muscle spasms or cramps
Signs of an allergic reaction,
including:
An unexplained rash
Hives
Itching
Unexplained swelling

Stevens-Johnson syndrome (SJS) or
toxic epidermal necrolysis (TEN).
- very dangerous skin
reactions
- These problems start out
as skin rashes but can progress
to permanent disfigurement or
even loss of life.

CONTRAINDICATIONS:
Those who:
Are allergic to carbamazepine or any
of the inactive components used to
make carbamazepine.
Have had bone marrow depression in
the past. Bone marrow depression is
a blood disorder in which the bone
marrow does not function properly to
produce blood cells.
Are allergic to TCAs
Have taken a monoamine oxidase
inhibitor (MAOI) within the past two
weeks.

2. Oxacarbazepine
derivative of carbamazepine
Similar mechanism of action and
toxicity to carbamazepine
No report of hepatic failure or bone
marrow suppression
less drug interactions
Partial seizure

3. LAMOTRIGINE (LAMICTAL)

Indications
Partial seizures +/- secondary
generalization
Lennox-Gastaut Syndrome
Also used in primary
generalized epilepsy
(absence, myoclonic)


Lennox-Gestaut syndrome
Childhood epileptic encephalopathy
(Lennox-Gastaut syndrome [LGS])
is a devastating pediatric epilepsy
syndrome
Child-onset epilepsy (4-6 years)
5 % of epileptic attacks in children
Severe and difficult to treat
Multiple attacks daily

ADVERSE EFFECTS
Signs of a dangerous allergic
reaction, including:
Hives or any rash
Fever
Swollen lymph nodes
(swollen "glands")
Painful sores in or around the
mouth or eyes
Swelling of the lips or tongue
Suicidal thinking or behavior
Lamictal can cause very serious skin
rashes and allergic reactions.
- These rashes can cause
large sections of the skin to die
and can cause disfigurement or
even loss of life
- SJS and TEN
- Gradual administration
decreases the risk