Cns Meds

Question 0

Dilantin therapeutic range

Answer 0

10- 20mcg/mL

Question 1

Hydantoins drugs, and indication.

Answer 1

Phenytoin (Dilantin)
Fosphenytoin (cerebrex)
Treat all seizure except absence seizure.

Question 2

Can Dilantin be diluted in D5W?

Answer 2

No… It is not compatible with dextrose!!!

Question 3

What are the consideration with Dilantin when given IV?

Answer 3

Monitor IV site,diluted and given into a large vein, not compatible with dextrose, monitor for anemia and folic acid depletion.
Never give it in the same line as KCL and never through a PICC line.

Question 4

What supplement should be given with Dilantin?

Answer 4

Folic acid (0.4- 4mg/ day)

Question 5

Imiostilbene drugs?

And indication..

Answer 5

Carbamazepine (Tegretol)
Oxycarbazepine (Trileptal)
To treat refractory seizure disorder…Tegretol is the drug of choice

Question 6

What is the therapeutic range for Tegretol?

Answer 6

4-12mcg/mL

Question 7

Trileptal range therapeutic range

Answer 7

12- 30mcg/mL

Question 8

Why a pt would experience anorexia when on Dilantin?

Answer 8

Anorexia may indicate toxic levels!

Question 9

What is used to decrease toxic serum levels of Depakote (valproic acid)?

Answer 9

Hemodialysis

Question 10

What is the CNS depressant reversal agent?

Answer 10

Narcan

Question 11

What is an adverse reaction with Vigabatrin (sabril)?

Adjunct anticonvulsant

Answer 11

Permanent vision loss

- baseline vision test should be done!

Question 12

What is the therapeutic range of Depakote?

Answer 12

50 to 150 mcg/mL

Question 13

What is the therapeutic range of Klonapin?

Answer 13

20- 80 ng/mL

Note: ng/mL only as opposed to all other that are mcg/mL

Question 14

Depakote considerations

Answer 14

Do not take with aspirin or etoh.

Vitamin E, D and folic acid deficiency

Question 15

Parkinson’s disease neurotransmitter

Answer 15

Dopamine depletion and acetylcholine increase

Question 16

What type of drug is use in the management of Parkinson’s disease?

Answer 16

Anticholinergic 
Dopaminergic (increase dopamine level)

Question 17

Which drug is the Gold standard to manage Parkinson’s disease?

Answer 17

Levadopa
Always combined with carbidopa
(carbidopa-levodopa) aka Sinemet

Question 18

What are early signs of toxicity of levodopa?

Answer 18

Spasmodic eye winkling and muscle twitching.

Question 19

Client teaching with Sinemet

Answer 19

Do not discontinue abruptly
Urine and perspiration may be discolored dark, but harmless.
Report side fx and symptoms of dyskinesia
May induce Gi upset, but food will decrease its absorption.
Conservative vit b6 diet

Question 20

What are contraindications of dopaminergic drugs?

Answer 20

Angle closure glaucoma
Suspicious skin lesion associated with dvlpt of melanoma
CV disease
Asthma
Urinary obstruction
Peptic ulcer disease

Question 21

Anticonvulsant that decrease sodium influx (5)

Answer 21

1- Phenyltoin (Dilantin)
2- Carbamazepine (Tegretol)
3- Valproic acid (depakote)
4- Topiramae (Topamax)
5- Levetriacetam (keppra)

Question 22

Anticonvulsant that decrease calcium influx

Answer 22

Valproic acid (Depakote )

Question 23

Anticonvulsant that INCREASE GABA effect (8)

Answer 23

1- Clonazepam (klonopin)
2- Diazepam (Valium)
3- Lorazepam (Ativan)
4- Gabapentin (Neuromtin)
5- Phenobarbital (Luminal)
6- Primidone (Mysoline)
7- Valproic acid  (Depakote )
8- Pregabalin (lyrica)

Question 24

Anticonvulsant that decrease sodium and calcium influx

Answer 24

``` Fosphenytoin (cerebrex) Valproic acid (Depakote) ```

Question 25

Adrenergic agonist (6)

Answer 25

``` 1- norepinephrine (Levophed) 2- Epinephrine (adrenalin chloride) 3- dopamine hcl (Intropin) 4- albuterol (Proventil) 5- Phenylephrine (Neo Synephrine) 6- Dobutamine hcl (dobutrex) ```

Question 26

What happens when alpha 1 receptors are stimulated???

Answer 26

Arterioles and venues constrict=> increase peripheral resistance and blood return to the heart Improved circulation + increased BP

Question 27

What happens when alpha 2 receptors are stimulated???

Answer 27

Inhibition of norepinephrine => vasodilation and decrease BP

Question 28

What are the side effect of carbidopa-levodopa ?

Answer 28

Nausea, vomiting, dystonia movement and psychotic behavior. | Cardiac dysrythmia, palpitation and ortho static hypotension can also occur.

Question 29

Contraindications for anticholinergic drugs

Answer 29

Glaucoma and person with chronic lung disease such as emphysema==> large dose of anticholinergic drugs can cause dry, thick mucous (dry)

Question 30

What is the drug of choice for absence seizure?

Answer 30

Ethrosuximide (Zarotin) Succinimide-> suppress seizure acting by delaying calcium influx Then 2nd choice is Dilantin

Question 31

Consideration for Valproic acid/ Depakote

Answer 31

Do not give with carbonated drink or ASA Prolong bleeding with anti platelet drugs, monitor liver function Avoid CNS depressant, monitor LOC, resp status Observe for agitation. Destroys enamel and cause gum erosion Range 50- 150

Question 32

Status epilepticus management with valium

Answer 32

Diazepam (Valium) pure 1) 10mgIVP over 30- 60 sec repeated every 10-15 min intervals Up to 30mg max. Most pt respond after 2nd dose 2) When given IV, no faster than 5mg/min and repeat every 2-4h Max 100mg/day

Question 33

Status epilepticus management | With Ativan

Answer 33

When given IV diluted 1:1 with NS or D5W 4mg IVP recommended repeat q 5-15min Max dose is 480mg/day Monitor for metabolic acidosis

Question 34

Which drug is the drug of choice for | Management of status epilepticus?

Answer 34

Lorazepam/ Ativan | Because it remain in the cerebral spinal fluid longer than Valium (up to 12hours vs 30-60min)

Question 35

What are the 3 drugs used for management of status epilepticus?

Answer 35

Ativan, Dilantin, Valium