Flashcards in Chp 12-15 Neurological Deck (81):
There are 4 types of CNS Drugs. What are they?
1). There are benzodiapenines which is Lorazepam (Ativan)
2). There are Nonbenzodiazepines which is Zolpidem (Ambien)
3). There are Barbiturates which is Phenobarbital
4). There are Muscle Relaxers which is Baclofen (Lioresal)
What is sedatives?
Drugs that have an inhibitory effect on the CNS to the degree that they reduce:
What are Hypnotics used for?
*It is use to cause sleep
*Much more potent effect on CNS than sedatives
* A sedative can become a hypnotic if it is given in large enough doses
What kind of acting is Benzodiazepines - Lorazepam (Ativan)
It is an Intermediate Acting
What are some mechanism of actions for the Benzodiazepines- Lorazepam (Ativan) Drug other than depressing the CNS
It affects the hypothalamic, thalamic, and limbic systems of the brain
Its receptors are GABA
Do not supress REM sleep as much as barbiturates
Do not increase metabolism of other drugs
Benzodiazepines - Lorazepam (Ativan) drug effects include
Calming the CNS
Useful in contolling Agitation and anxiety
Induce skeletal muscle relaxation
Indications for the Benzodiazepines - Lorazepam (Ativan) drug include
Anxiety and agitation
Treatment of acute seizure disorders
Treatment of alcohol withdrawal
Benzodiazepines - Lorazepam (Ativan) adverse effects include
Black Box Warning:
Use with other benzodiazepines or oipoids may result in sedation, respiratory depressions, coma, and death
Mild and infrequent:
*Drowsiness - lethargy
* Cognitive impairment
* Fall hazard for older adults
* "Hangover" effects or daytime sleeping
Benzodiazepines - Lorazepam (Ativan): Toxicity and Overdose include
Does not cause HTN and repiratory depression unless taken with other CNS depressants
Treatmentis symptomatic and supportive
What is the drug used for Benzodiazepines - Lorazepam (Ativan) Overdose?
Flumazenil which is and antidote
What are some drug interactions for Benzodiazepines - Lorazepam (Ativan)?
Azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics, grapefruit juice
CNS Depressants (alcohol, opiods)
What is the Doasage for the Benzodiazepines - Lorazepam (Ativan) drug?
Oral: 2-6 mg divided bid-tid
Maximum 10mg per day
Can be given IM or IV
* it is usually 1mg given
Nonbenzodiazepines- Zolpidem (Ambien) indications include
What are the mechanism of action for Nonbenzodiazepines- Zolpidem (Ambien) drug?
Interacts with GABA benzodiazepine receptor complex
What are some adverse effects for Nonbenzodiazepines- Zolpidem (Ambien)?
Inlfuenza like s/s
Complex sleep- related behavior
Impaired mental alertness( next day)
What are some drug interactions for Nonbenzodiazepines- Zolpidem (Ambien)?
What is the Doasage for Nonbenzodiazepines- Zolpidem (Ambien) and differentiate betweeen male and female dosage
Female patients- 5mg oral every hs(evening); maximum 10mg/ day
Male patient- 5- 10 mg oral every hs; maximum 10mg /day
What are Barbiturates used for and when was it first introduced?
It was first introduced in 1903
And it is used for insomnia and sedation
Only a handful is used because of the safety and efficacy of benzodiazepines
Low theraputic index
The effective, safe dosage range is narrow
Barbiturates:Phenobarbital mechanism of actions and its sites of action
Site of action: brainstem (reticular formation)
By potentiating the action of GABA, nerve impilses traveling in the cerebral cortex are inhibited.
Barbituates:phenobarbital drug effects include
Low doses: sedative effects
High doses: hypnotic effects
Barbituates: Phenobarbital included 3 types of indications. what are they?
Anesthesia for surgical procedures
Barbituates: Phenobarbital adverse effects include
Steven- johnson's Syndrome
What are some drug interactions and additive effects when used with Barbituates: Phenobarbital?
What are Barbituates: Phenobarbital recommended Dosage?
Oral: 60 mg bid- tid
IV: 10-40 mg tid
What are muscle relaxants Baclofen (Lioresal) used for?
It is used to relives pain associated with skeletal muscle spasms
*Majority are centrally acting
CNS is the site of action
Similar in structure and action to other CNS depressants
* Direct acting
Act directly on skeletal muscle
Closely resemble GABA
Muscle Relaxants - Baclofen ( Lioresal) indications include
Relief of painful musculoskeletal conditions
* muscle spasms
* management of spasticity of severe chronic disorders ( multiple sclerosis, cerbral palsy)
And it is worked best when used along physical therapy
What are some adverse effects for Muscle Relaxants - Baclofen ( Lioresal) thats is extension of effects on CNS and skeletal muscles?
Muscle Relaxants - Baclofen ( Lioresal) drug interactions include 3 types what are they?
Lowers seizures threshold
Muscle Relaxants - Baclofen ( Lioresal) doasge recommendations include
Oral: 20-80 mg daily divided tid to qid
What are some CNS depressants nursing implications?
Before beginning theraly, obtain a thorough history regarding allergies, use of medications, health history, and medic history. Obtain vital signs, assess for potential disorders and drug interactions
Use with caustion in elderly
Avoid drinking alcohol and other CNS depressants
What are some therapeutic effects for Muscle Relaxants - Baclofen ( Lioresal) that u should monitor?
Increased ability to sleep at night
Shorter sleep induction time
Few adverse effects such as Hangover effects
For muscle relaxants" decreases spasticity, decreased rigidity
What are CNS stimulants? And who are the people that use it
Drugs that stimulate a specific area of the brain and spinal cord
People that use it are either Anti-attention deficit disorder (ADHD), Antimigraine
What are some symptoms of ADHD? What is it the percentage? Who are affected often? and is the drug therapy the same?
Some symptoms of ADHD are inappropriate ability to maintain attentiom span or the presence of hyperactivity and impulsivity
It is moslty common in phychiatric children afecting 4% to 10% of school age children
Boys are affected two to nine times than girls
The drug therapy is the same for a child to adulthood
What kind of drug is used to treat ADHD?
The methamphetamine stimulant
* Atomoxetine (straterra)
Nonamphetamine stimulant- Atomoxetine (Strattera) indications include
Approbed for treating ADHD in children older than 6 years of age and adult
What is the mechanism of action for Nonamphetamine stimulant- Atomoxetine (Strattera)
Selectively inhibits norepinephrine reuptake
What is the black box warning for Nonamphetamine stimulant- Atomoxetine (Strattera)?
Increased risk of suicide in children and adolescents with ADHD, especially during the 1st month of treatment
Some adverse effects for Nonamphetamine stimulant- Atomoxetine (Strattera) include
HTN, tachycardia, MI, stroke, QT prolongation
Nonamphetamine stimulant- Atomoxetine (Strattera) drug interacrions include 2 types. What are they?
What is the recommended Dosage for Nonamphetamine stimulant- Atomoxetine (Strattera)?
Oral: 80 mg daily, divided bid
Some nursing implications for Nonamphetamine stimulant- Atomoxetine (Strattera) inlcude
The last daily dose should be given 4 to 6 hrs before bedtime to reduce insomnia.
Take on an empty stomach 30 to 45 minutes before meals
Keep a journal to monitor child therapy response
Monitor child for phyocal growth, height and weight
Monitor for thereputic responses: decreased hyperactivity, increased attention span and concentration
In the drug Nonamphetamine stimulant- Atomoxetine (Strattera) what shouldbyou assess for?
You should assess for potential contraindications
interaction, including herbal therapies
Conditions such as abnormal cardia rhythms, seizures, palpitations, liver problems
For children assess basline height and weight
The patient states that she has a pulsatile recurring headache lasted 4 to 72 hours on one side of the head, and have had symptoms of nausea, vomiting, photophobia, phonophobia, and aura. What is the diagnosis for this patient
This patient has a Migraine
Antimigraine- Sumatriptan (Imitrex) is also called?
Triptans and it is a serotonin agonist
What is the indication for use for Triptans- Sumatriptan (Imitrex)?
It is used for migraine
The mechanism of action for Triptans- Sumatriptan (Imitrex) are to
Stimulate vascular sertonin 5 HT receptors in cerebral arteries, causing vasconstrictions and reducing headache symptoms
Reduce the production of inflammatory neuropeptides
What are some contraindications for Triptans- Sumatriptan (Imitrex)
Coronary artery disease
Caurion in elderly
Some mild and serious adverse effects for Triptans- Sumatriptan (Imitrex) includes
Injection site reaction
Ventricular tachycardia/ fibrillation
What are the two drug interactions for Triptans- Sumatriptan (Imitrex)
Serotonergic effects, strong
The Triptans- Sumatriptan (Imitrex) Dosage include
Multiple ways to administer:
Dissolvable wafers, nasal spray, oral, and self injectable forms
Oral: 25-100mg oral x1 dose; repeat x1 after 2 hours
Subcutaneous: 1-6mg x1 dose; may repeat x1after 1 hour
Sumatriptan (Imitrex) nursing implications include
Teach about correct administration
Instruct patient to keep a journal to monitor response to therapy
Monitor theraputic effects: decrease in frequency, duration, and severity of migraines
Monitor for adverse effects
What is epilepsy?
Epilepsy is chronic, recurrent patterns of seizures
What is epilepsy?
Epilepsy is chronic, recurrent patterns of seizures
What is a seizure?
Brief episode of abnormal electrical activity in nerve cells of the brain
What is a convulsion?
It is involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles
What are primary (idiopathic) mean?
Its cause cannot be determined
Roughly 50% of epilepsy cases
What does secondary ( symptomatic) mean?
Distinct cause is identified
Trauma, infection, cerebrovascular disorder
What are some classifications of epilepsy including its generalized onset seizures and its partial onset seizures?
Generalized onset seizures:
Formerly known as GRAND MAL seizures
Tonic- clonic seizures
Partial onset seizures:
Simple( formerly known as PETIT MAL seizures)
Secondary generalized tonic-clonic
What is the meaning of status epilepticus? And its results?
It means multiple seizured occur with no recovery between them
Its results include: hypotension, hypoxia, brain damage, and death
True medical emergency
What is Antiepileptic Drugs (AEDs)? And is the therapy lifelong?
Its goal of therapy is to:
* control or prevent seizures whole maintaining a reasonable quality of life
* to minimize adverse effects and drug - induced toxicity
AED therapy are usually lifelong
Combination of drugs may be used
What is another name for AEDs?
AEDs drug therapy should include
Single drug therapy which should be started before multiple drug therapy is tried
Serum drug concentrations must be measured
* Therapeutic drug monitoring
AEDs- Phenytonin (Dilantin) indications include
Prevention or control of seizures activity
Long term maintenance therapy for chronic, recurring seizures
Acute treatment of status epilepticus
What are some mechaism of actions for AEDs- Phenytonin (Dilantin)
Modulates neuronal sodium and calcium channels
Supress transmission of impulses from one nerve to the other
Decrease speed of nerve impulse conduction
What is the black box effect for AEDs- Phenytonin (Dilantin)?
Suicidal thoughts and behavior
What are some adverse efrects for AEDs- Phenytonin (Dilantin) drug?
What are the recommended Dosage for AEDs- Phenytonin (Dilantin)?
Oral: 300mg -400mg every day divided bid-tid
IV: 100mg IV every 6 hours (maintenance)
* 15 - 20mg/kg IV x1; repeat 10mg/kg after 20 minutes(status epilepticus)
* Very irritating to veins
* Give slowly
* Diluted in normal saline(NS) for IV infusion
* Filter must be used
*** THERAPEUTIC DRUG LEVELS 10- 20 mcg/ml***
What are some nursing implications for AEDs- Phenytonin (Dilantin) drug for oral and IV?
Take regularly, same time each day
Take with meals to reduce GI upset
Do not crush, chew, or open extended-release forms
**If patients is NPO for a procedure, contact prescriber regarding AED dosage**
Follow manufacturers recommendations for IV delivery-- usually given slowly
Monitor vital signs during administration
Avoid extravasation of fluids
Use only normal saline(NS) with IV phenytoin (Dilantin)
**Instruct patient to wear a medical alert tag or ID*
*Life long therapy**
*Monitor for therapeutic effects: Decreased or absent seizure activity**
What is Parkinson's disease (PD)?
*It chronic, progressive, degenerative disorder
*Affects dopamine( which produces neurons in the brain)
* Caused by an imbalance of two neurotransmitters: dopamine, Acetylcholine (ACh)
* Occurs when the 80% of dopamine stored in the substantia nigra of the basal ganglia is depleted
* Rapid swings in response to levodopa occur ("on- off phenomenon")
PD worsens when too little dopamine is present
Dyskinesia occurs when too much dopamine is present
PD is associated with dementia
What are some symptoms of Parkinsons Disease?
Alkinesia- absencs of phychomoto acrivity resulting in mask- like facila expression
Bradykinesia- slowness of movement
Rigidity- "cogwheel" rigidity, resistance to passive movement
Postural instability- unsteadiness and leads to damger of falling either leaning or sitting
After the start of levodopa therapy it usually takes how many years?
5 to 10
What are some mechanism of action for Anti- Parkinson Drugs: Levodopa/Carbidopa?
Levodopa: dopamine must be admjnistered orally as levodopa as dopamine cannot pass through the blood- brain barrier
Work presynaptically to increase the levels of dopamine
Levodopa is able to cross the blood- brain barrier, where it is converted to dopamine
***CARBIDOPA IS GIVEN WITH LEVODOPA**
Carbidopa does not cross the blood-brain barrier and prevents levodopa breakdown in the periphery
Anti- Parkinson Drugs: Levodopa/Carbidopa adverse effects include
What are the two containdications for Anti- Parkinson Drugs: Levodopa/Carbidopa?
Contraindicated in cases of angle- closure glaucoma
Use cautiously in patients with open angle glaucoma
What are the two drug interacrions for Anti- Parkinson Drugs: Levodopa/Carbidopa?
What is the dosage recommendations for Anti- Parkinson Drugs: Levodopa/Carbidopa?
Oral: 10mg/100mg tid