5.0 CNS Regulation, Mood, and Cognition Introduction V2
- Review the structure and function of the central nervous system, including the role of neurotransmitters.
- Understand the classifications and actions of drugs related to the central nervous system (CNS), mood, and cognition.
- For each drug classification, understand the mechanism of action, therapeutic effects, side and adverse effects and nursing considerations.
- Identify considerations and implications of using CNS, mood, and cognitive medications across the lifespan.
- Consider evidence-based concepts when using the nursing process and clinical judgment for psychotherapeutic medications to application questions.
Key Terms
- action potential
- acute dystonia
- affect
- akathisia
- anxiety
- blood-brain barrier
- bradykinesia
- central nervous system
- chemical synapse
- cognition
- "DRESS"
- dystonia
- electrical synapse
- extrapyramidal symptoms
- gait disturbance
- hypertensive crisis
- mania
- mood
- nerve
- neuroleptic malignant syndrome
- neurons
- mechanism of action
- methicillin-resistant S. aureus
- narrow-spectrum antimicrobial
- pathogen
- prototype
- resistance
- sensitivity analysis
- superinfection
- synergistic interaction
- time dependent
- trough
- vancomycin-resistant S. aureus
In Canada, more than 3.6 million people or 10% of the population are experiencing a neurological condition or disorder, according to a nationwide study conducted in 2014, the National Population Health Study of Neurological Conditions. It is projected that this number will only increase over the next 20 years due to the aging population (Government of Canada, 2017). “Those with chronic neurological conditions experience higher stress levels and a higher prevalence of self-diagnosed mood or anxiety disorders. Many suffer functional impairments with regard to cognition, mobility, dexterity, bowel, and bladder control.” The impact on quality of life, supportive care and health resources is significant. Medications to manage or treat the wide variety of neurological conditions is considerable, with meds used to improve cognition and mood, alleviate pain, and improve mobility issues (Appireddy et al, 2020).
To effectively treat these conditions, an understanding of the disorder is required for the researchers to develop effective treatments. The challenge is that the central nervous system (CNS) is a complex organ system involving the brain and spinal cord. Together, they are collectively responsible for collecting, interpreting and processing sensory information. The complexity of the CNS comes from the anatomic structure and neurochemical intricacies that researchers are still trying to fully understand. Typically, research is initially carried out on animal subjects. Due to the uniqueness of the human brain in comparison to other species, as well as the inability to fully assess the therapeutic response of treatments on animal subjects, understanding the brain and effective treatments is difficult. The other challenge is the complexity of neurological disorders. For example, there are many types of depression, with a variety of symptoms and the response to medications can vary considerably. As such, although CNS drugs are used extensively to treat or manage many neurological conditions, there is still much unknown. The complexity of the nervous system and understanding of the brain can make treating and preventing diseases that affect this system complicated (OpenStax, 2025).
Due to the extensive nature of central nervous system conditions, the next three chapters will focus on different CNS medication classifications. In this chapter, it will begin with a review of the CNS, its structures, functions and neurotransmitters, followed by Unit 5.2 will review more common neurological conditions. The rest of the units in this chapter will focus on the different categories of CNS medications.
References:
- Appireddy, R., Jalini, S., Shukla, G. & Lomax, L. (2020). Tackling the Burden of Neurological Diseases in Canada with Virtual Care During the COVID-19 Pandemic and Beyond. Canadian Journal of Neurological Science, May, 1-4. doi: 10.1017/cjn.2020.92 Tackling the Burden of Neurological Diseases in Canada with Virtual Care During the COVID-19 Pandemic and Beyond – PMC
- Government of Canada (2017). Fact Sheet – Mapping Connections: An Understanding of Neurological Conditions in Canada. Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/chronic-diseases/neurological-conditions/fact-sheet-mapping-connections-understanding-neurological-conditions-canada.html
- OpenStax (2025). This work is a derivative of Anatomy and Physiology by OpenStax licensed under CC BY 4.0. Access for free at https://openstax.org/books/anatomy-and-physiology/pages/1-introduction ↵
A change in voltage of a cell membrane in response to a stimulus that results in transmission of an electrical signal; unique to neurons and muscle fibers.
Painful muscle spasms.
the observable response a person has to his or her own feelings, [1]
Distressing motor restlessness.
an alert to the human condition of impending doom, either real or imagined, and is accompanied by autonomic responses that serve as protective [2].
A nearly impenetrable barricade that is built from a tightly woven mesh of capillaries cemented together to protect the brain from potentially dangerous substances such as poisons or viruses.
Slowness in initiation and execution of voluntary movements.
Connection between two neurons, or between a neuron and its target, where a neurotransmitter diffuses across a very short distance.
the process of thought that embodies perception, attention, visuospatial cognition, language, learning, memory, and executive function with the higher order thinking skills of comprehension, insight, problem solving, reasoning, decision making, creativity, and metacognition
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A condition reported in patients taking antiepileptic drugs. Some of these events have been fatal or life-threatening. DRESS typically presents with fever, rash, lymphadenopathy, and/or facial swelling.
Inappropriate and continuous muscle contraction.
Connection between two neurons, or any two electrically active cells, where ions flow directly through channels spanning their adjacent cell membranes.
Involuntary motor symptoms similar to those associated with Parkinson’s disease. Includes symptoms such as akathisia (distressing motor restlessness) and acute dystonia (painful muscle spasms.) Often treated with anticholinergic medications such as benztropine and trihexyphenidyl.
An abnormal way of walking, such as shuffling feet.
Severe hypertension (blood pressure greater than 180/120 mm Hg) with evidence of organ dysfunction. Symptoms may include occipital headache (which may radiate frontally), palpitations, neck stiffness or soreness, nausea or vomiting, sweating, dilated pupils, photophobia, shortness of breath, or confusion. Either tachycardia or bradycardia may be present and may be associated with constricting chest pain. Seizures may also occur. Intracranial bleeding, sometimes fatal, has been reported in association with the increase in blood pressure.
Periods of extreme highs in bipolar disorder. Manic episodes may include these symptoms rapid speech, hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgement, aggression/hostility, risky sexual behavior, neglected basic self-care, or decreased impulse control.
the way a person feels [3].
Cord-like bundle of axons located in the peripheral nervous system that transmits sensory input and response output to and from the central nervous system.
Cells that carry electrical impulses to the synapse of a target organ.
How a medication works at a cellular level within the body.
An infection caused by Methicillin-resistant Staphylococcus aureus that is difficult to treat because it exhibits resistance to nearly all available antibiotics.
An antibiotic that targets only specific subsets of bacterial pathogens.
An organism causing disease to its host.
A common individual drug that represents a drug class or group of medications having similar chemical structures, mechanism of action and mode of action.
A characteristic of bacteria demonstrating lack of effective treatment by an antibiotic when a sensitivity analysis is performed.
A test performed in addition to a culture in order to select an effective antibiotic to treat the microorganism.
A secondary infection in a patient having a preexisting infection. C diff and yeast infections as a result of antibiotic therapy are examples of superinfections.
Concurrent drug administration producing a synergistic interaction that is better than the efficacy of either drug alone. An example of synergistic drug combinations is trimethoprim and sulfamethoxazole (Bactrim).
Time dependency occurs when greater therapeutic effects are seen with lower blood levels over a longer period of time.
The trough level of medication indicates the lowest concentration of that medication in a person's body. Troughs of medication concentration occur after the drug has been broken down and metabolized by the body.
An infection caused by Vancomycin-resistant Staphylococcus aureus that is difficult to treat because it exhibits resistance to nearly all available antibiotics.
