CNS/Neuro Meds Flashcards
(26 cards)
Seizure Management: Phenytoin
Mechanism of action
Decrease sodium influx into neurons that are firing excessively
Therapeutic level: 10-20 mcg/mL
Loading dose usually required
Contraindications: Known drug allergy Pregnancy: these are responsible for many birth defects in offspring of epileptic women Sinus bradycardia & AV Block Pregnancy category C & D
Adverse Effects
Most Common: dizziness, ataxia, blurred vision, confusion, nystagmus, slurred speech
Gingival hyperplasia
Phenytoin cont.d
Most serious Adverse Effects:
Life-threatening dermatologic reaction/skin falls off (Stevens-Johnson syndrome)
Liver damage
Blood dyscrasias (monitor CBC)
CV collapse if given rapid IV push (2 mg a minute. 1000 mg in total, so give piggy back) LESS THEN 50 MG A MINUTE.
increases metabolism of some drugs.
Decreased serum levels and effectiveness of:
Oral contraceptives, glucocorticoids
Instruct: Need for good oral hygiene
Need for drug levels
Do not stop taking drug abruptly
Benzodiazapines (Sedative-Hypnotics)
Lorzapam/Diazapam
Drug of choice for epileptic attack. Needs to be given through IV
Potentiate the inhibitory neurotransmitter GABA
Tolerance, physical dependence, & withdrawal can develop with long-term use
Provide anxiolysis and amnesia but have no analgesic properties.
Therapeutic effects
Relieve anxiety
Promote sleep
Antiepileptic effects: to abort seizure activity
Muscle relaxation
Acute alcohol w/d tx
Pre-op sedation, conscious sedation, & induction of general anesthesia
***Reversal Agent: Flumazenil (Romazicon)
Reversal Agent for Benzodiazapines/Opiods
Benzodiazapines: Flumazenil (Romazicon)
Opiods: Naloxone (Narcan)
Treatment of Parkinson’s Disease
Carbidopa-Levodopa (Sinemet)- mainstay of treatment
Avoid alcohol and be aware of possible drug interactions with OTC and herbal medications, certain antidepressants, & antiseizure meds (hydantoins)
***Avoid foods high in pyroxidine (vitamin B6)…avocados, bananas, beef liver, oatmeal, chicken, pork…
Levedopa
Promotes synthesis of dopamine
Given orally – may take several months to achieve full therapeutic effect
Most common adverse effects:
N & V, anorexia, weight loss
Orthostatic hypotension
Dystonias & dyskinesias, psychosis
Most serious adverse effects:
NMS AKA “Parkinsonian crisis” (with abrupt discontinuation of drug)
Caution w/ cardiac disease, PUD, DM, pulmonary disease, psychosis, pregnancy
Carbidopa
Inhibits an enzyme (DDT) which converts levodopa to dopamine in the periphery
Makes more Dopamine available in CNS
Sinemet (combo of levodopa and carbidopa)
Lithium
Prevention of extreme mood swings
Increase neutrophil count in patients with cancer chemotherapy-induced neutropenia and AIDS receiving zidovudine (unlabeled uses)
***Therapeutic Range: 0.6-1.2 mEq/L
Contraindications
Patients with severe cardiovascular or renal disease
Pregnancy and lactation
Adverse Effects
Acute effects: increased thirst, nausea, increased urination, and fine hand tremor
Toxic effects: coarse hand tremor, severe GI upset, blurred vision, drowsiness, mental dullness, slurred speech, confusion, muscle twitching, and dizzy or spinning sensation.
***Most serious when levels>2 mEq/L
Administering drug with or shortly after meals accompanied by 10 to 12 glasses of water (8 oz) each day
Patient Education for Lithium
Caution to avoid products containing NSAIDs (↓ renal clearance), against changing sodium intake, starting new drug therapy, or even using over-the-counter drugs without first consulting the prescriber
Anorectic Drugs: phentermine
Manages obesity by promoting weight loss
DEA Schedule IV drug
Indirect sympathomimetic (mimics sympathetic NS)
Contraindications and precautions
Arteriosclerosis, hypertension, glaucoma, cardiac arrhythmias
Adverse effects
Hypertension, constipation, insomnia, headache, and dry mouth
Maximizing therapeutic effects
Take daily.
Exercise and low-calorie diet are important.
Minimizing adverse effects
Refrain from using drugs that may induce serotonin syndrome or elevate the blood pressure.
Selective Serotonin Reuptake Inhibitors (SSRIs): Sertraline (Zoloft)
SSRIs as first choice for treating depression
Acute depression, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder (PTSD)
Contraindications
Caution with compromised liver function
Adverse Effects
Fewer adverse anticholinergic and cardiovascular effects & usually no weight gain
GI distress
Headache, fatigue, insomnia, and sexual dysfunction
Hematologic problems (i.e. leukopenia, altered platelet function)
***MAOIs, tryptans &/or St. John’s wort- may cause serotonin syndrome. WASH OUT Period to prevent syndrome
Serotonin Syndrome
Overactivity of serotonin receptors
Sweating, fever, HTN, tachycardia, abdominal pain, diarrhea, muscle spasm, irritability, hostility, altered mental state
Can lead to CV shock and death
Sertraline Signs/Symptoms of Adverse Effects
Assessing for signs and symptoms of toxicity, overdose, or serotonin reuptake inhibitor withdrawal syndrome- F.L.U.S.H Flu-like symptoms Light-headedness, dizziness, or both Uneasiness, restlessness, or both Sleep & sensory disturbances Headache
Use of protective covering and sunscreen
Cautions for driving and use of heavy machinery, alcohol, and caffeine
Drug takes several weeks to kick in
Tricyclic Antidepressants: Nortriptyline (Pamelor)
Used for: Relief of symptoms of depression, Phantom limb pain, Chronic pain
Blockage of norepinephrine reuptake into nerve terminals
Blockage of amine pump, sedation, and peripheral and central anticholinergic action
Adverse Effects
Sedation and anticholinergic effects most common
Bone marrow depression, urinary retention, sexual dysfunction, nasal congestion, and weight gain
Photosensitivity, skin rash (drug fever)
Nortriptyline Patient Teaching, Minimizing Adverse Effects
Minimizing Adverse Effects
Possible need for divided doses
Monitoring for signs and symptoms of infection
Monitoring of complete blood count, serum glucose level, and renal and hepatic function
Regular ECG monitoring of cardiac rhythm
Assessment for low mood and suicidal thoughts
Realistic expectations and importance of adhering to continued therapy exactly as prescribed
Precautions to reduce possible photosensitivity reactions
Cautions about driving, using heavy machinery, or engaging in activities requiring concentration
Assessment for suicidal thoughts
Evaluation of leukocyte counts, differential blood cell counts, liver function studies, and ECGs
Monoamine Oxidase Inhibitors MAOI’s: Phenelzine (Nardil)
Rarely used as first-line drugs
Used for:
Treatment of depression unresponsive to other drug therapy
Bulimia, cocaine addiction, and panic disorder with agoraphobia
Adverse Effects
Anticholinergic effects: blurred vision, constipation, and dry mouth; urinary retention
CNS related effects: akathisia, ataxia, dizziness, headache, nystagmus
Hematologic effects: agranulocytosis, anemia, leukopenia, thrombocytopenia
Contraindications
Poor liver function
Patients with congestive heart failure
Phenelzine (Nardil) Minimizing Adverse Effects and Patient Teaching
Minimizing Adverse Effects
Avoidance of foods high in tyramine (wine, soy sauce, aged cheeses, sausages, processed meat, etc.) certain drugs (such as stimulants or illicit drugs), alcohol, and herbal preparations (i.e. St John’s wort, ginseng)
Providing warnings against: Taking phenelzine & eating foods high in tyramine; consuming alcohol during and for 2 weeks following phenelzine treatment; and consuming excessive amounts of caffeine
Neuropletic Malignant Syndrome (NMS)
Fever, sweating, tachycardia, muscle rigidity, ↑CK, renal fx…, Agranulocytosis
Found as an adverse effect of Antipsychotics
Dextroamphetamine (Dexedrine)
Used for: Treatment of narcolepsy and ADHD, Adjunct therapy in obesity
Schedule II controlled substance
Contraindications
Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity, glaucoma, or history of drug abuse
***Within 14 days use of MAOIs
Adverse Effects
Decreased appetite, rebound irritability and depression, headache, jittery feeling, GI upset, sleep difficulties, anxiety, and increased blood pressure or heart rate
Elevated blood glucose
Increased ocular irritation and mydriasis
Inability to ejaculate; increased or decreased libido
Dextroamphetamine Minimizing/Maximizing Adverse/Therapeutic Effects
Maximizing Therapeutic Effects
Administering with food in morning and no later than 6 hours before bed
Providing psychological support and enhancing self-esteem
Minimizing Adverse Effects
Administering morning dose before or with breakfast
Monitoring for rebound irritability
Monitor vital signs and anticipate use of anticonvulsants and antipsychotics in event of toxicity or overdose
Atypical Antipsychotic: Haloperidol
Used for: Treatment of psychotic and Tourette disorders
Hyperactivity or severe behavior problems in children
Blockage of dopamine (specifically D2), alpha receptors, serotonin receptors
Precautions
In patients w/ exposure to extreme heat or phosphorous insecticides
Use of anticholinergic drugs
Current withdrawal from alcohol
Adverse Effects Extrapyramidal symptoms (EPS) Parkinson-like effects Akathisia: restlessness/fidgeting Acute dystonia: neck twisting Tardive dyskinesia (permanent): lip smacking/eye blinking (face) Neuroleptic malignant syndrome (NMS)!!
Patient Teaching, Minimizing Adverse Effects, Maximizing Therapeutic Effects for Haloperidol
Maximizing Therapeutic Effects
Ensuring routine drug intake
Assessing for cheeking (pocketing medication in cheek)
Minimizing Adverse Effects
Administering anticholinergic drugs to relieve excess cholinergic stimulation
diphenhydramine or benztropine for acute dystonic reactions
Need to drink extra fluids when out in the heat
Cautions against using heavy machinery or driving
Atropine: Anticholinergic Agent
To decrease GI activity and secretions (treat ulcers) and salivation
To increase in HR; bronchial dilation
To decrease bladder contraction and promote urinary retention for urinary incontinence
Increases IOP; pupils dilate (mydriasis)
Blocks parasympathetic effects for many conditions
Used to block the effects of acetylcholine
Atropine Adverse Effects
Blurred vision, Mydriasis, Photophobia Palpitations, tachycardia Dry mouth, altered taste perception Urinary hesitancy and retention Decreased sweating; predisposition to heat exhaustion
“mad as a hatter (CNS psychotic effects, dry as a bone (salivary), red as a beet (peripheral vasodilation), & blind as a bat (mydriasis)”
Avoid over-the-counter medications
