CNS part 3 Flashcards by Alyssa Holland

dopaminergic agents

increase effects of dopamine at receptor sites

more effective than anticholinergics

How well did you know this?

Not at all

Perfectly

carbidopa-levodopa (sinemet) indications

Parkinson disease

How well did you know this?

Not at all

Perfectly

carbidopa-levodopa (sinemet) action

levodopa: a dopamine precursor that relieves parkinsonian symptoms by being converted to dopamine in the braine
carbidopa: inhibits decarboxylation of peripheral levodopa which allows more intact levodopa to travel to the brain

How well did you know this?

Not at all

Perfectly

carbidopa-levodopa (sinemet) contraindications

glaucoma
hx melanoma
suicidal thoughts, bipolar disorder
renal, hepatic, respiratory disorders
peptic ulcer disease

How well did you know this?

Not at all

Perfectly

carbidopa-levodopa (sinemet) adverse effects

anxiety, nervousness
photophobia, blurred vision
flushing, sweating
hypotension, arrhythmia
anorexia, nausea, constipation
urinary retention
teratogenic

How well did you know this?

Not at all

Perfectly

carbidopa-levodopa (sinemet) interactions

high protein meals, iron salts, antipsychotics, metoclopramide: decreased action/effect of carbidopa-levodopa

anticholinergics: increased response to carbidopa-levodopa
phenytoin: may antagonize antiparkinsonian action

How well did you know this?

Not at all

Perfectly

carbidopa-levodopa (sinemet) interventions

monitor for s/s orthostatic hypotension
changes in client urine/sweat color
give quetiapine to relieve psychotic sx
give COMT inhibitor to increase half-life of levodopa and deliver more to the brain

How well did you know this?

Not at all

Perfectly

carbidopa-levodopa (sinemet) pt teaching

take with food to avoid GI distress
darkening of urine/sweat may occur
change positions slowly
avoid high protein foods
can take up to 6 months for full response

How well did you know this?

Not at all

Perfectly

anticholinergic agents

oppose the effects of acetylcholine at receptor sites in the substantia nigra and the corpus striatum, thus helping to restore chemical balance in the area

How well did you know this?

Not at all

Perfectly

benztropin (cogentin) indications

adjunctive therapy for parkinson disease

relief of symptoms of extrapyramidal disorders

How well did you know this?

Not at all

Perfectly

benztropin (cogentin) action

acts as an anticholinergic in CNS to return balance to basal ganglia
peripheral anticholinergic effects help reduce drooling and other secondary effects of parkinsonism

How well did you know this?

Not at all

Perfectly

benztropin (cogentin) contraindications

angle closure glaucoma
anhidrosis
arrhythmias
seizure disorders

How well did you know this?

Not at all

Perfectly

benztropin (cogentin) adverse effects

memory impairment, depression, hallucinations, fever
tachycardia, arrhythmias
dilated pupils, dry mouth
constipation, n/v/d, paralytic ileus
urinary retention, dysuria
sweating, heat stroke

How well did you know this?

Not at all

Perfectly

benztropin (cogentin) interactions

amantadine, TCAs: may cause additive anticholinergic adverse reactions

cholinergics (donepezil, rivastigmine): may antagonize therapeutic effects

How well did you know this?

Not at all

Perfectly

benztropin (cogentin) interventions

monitor vital signs
monitor for adverse effects especially in elderly pts
recognize s/s paralytic ileus (intermittent constipation and abdominal distention and pain)

How well did you know this?

Not at all

Perfectly

benztropin (cogentin) pt education

take dose at bedtime
report s/s dysuria, retention
limit hot weather activity; risk of overheating

How well did you know this?

Not at all

Perfectly

dopamine agonists

medications that mimic the actions of dopamine in the body to relieve symptoms related to low levels of dopamine

How well did you know this?

Not at all

Perfectly

pramipexole (mirapex) indications

idiopathic parkinsonism

restless leg syndrome

How well did you know this?

Not at all

Perfectly

pramipexole (mirapex) action

stimulates dopamine receptors

How well did you know this?

Not at all

Perfectly

pramipexole (mirapex) contraindications

renal impairment
major psychotic disorder
hypotension

pramipexole (mirapex) adverse effects

sleep disorders, thought abnormalities, fever, pneumonia
chest pain, peripheral edema
vision problems
UTI
weight loss
arthritis, twitching

pramipexole (mirapex) interactions

antipsychotics, dopamine antagonists: may diminish effects
diltiazem, ranitidine, verapamil: may decrease pramipexole clearance
alcohol: may increase sedative effects

pramipexole (mirapex) interventions

monitor for nausea, drowsiness, sudden sleepiness, muscle weakness and prevent falls
monitor cardiac status
observe for abnormal muscle movement/dyskinesia

pramipexole (mirapex) pt teaching

avoid alcohol and CNS depressants
take before bedtime if taking once daily
taper gradually to avoid w/d
change positions slowly

baclofen (lioresal)

centrally acting skeletal muscle relaxant

baclofen (lioresal) indications

muscle spasm/pain caused by injury, MS, cerebral palsy

baclofen (lioresal) action

appears to reduce transmission of impulses from the spinal cord to skeletal muscle this in turn decreases the frequency and amplitude of muscle spasms in pts with spinal cord lesions

baclofen (lioresal) contraindications

concurrent use with MAOIs age extremes seizure disorders stroke

baclofen (lioresal) adverse effects

``` drowsiness, dizziness, seizures, psychosis n/v, constipation urinary retention peripheral edema pneumonia diaphoresis ```

baclofen (lioresal) interactions

alcohol/CNS depressants/opioids: can increase sedation

baclofen (lioresal) interventions

administer low dose and gradually increase to minimize adverse effects give with food to prevent GI upset taper gradually to avoid w/d encourage fluids/fiber if constipation occurs

baclofen (lioresal) pt teaching

change positions slowly take with food to avoid GI upset increase fluid/fiber intake do not stop abruptly to avoid w/d

pyridostigmine (mestinon) indications

indirectly acting cholinergic agonist used to treat myasthenia gravis antidote for neuromuscular blockers

pyridostigmine (mestinon) action

reversible cholinesterase inhibitor that increases the levels of acetylcholine, facilitating transmission at the neuromuscular junction

pyridostigmine (mestinon) contraindications

``` GI/GU obstruction bronchial asthma arrhythmias epilepsy peptic ulcer pregnancy/lactation ```

pyridostigmine (mestinon) adverse effects

``` headache, syncope cardiac arrest, thrombophlebitis increased peristalsis urinary urgency muscle cramps, tingling in extremities bronchoconstriction, bronchial secretions ```

pyridostigmine (mestinon) interactions

anticholinergics, corticosteroids, general or local anesthetics: may antagonize cholinergic effects beta blockers: bradycardia

pyridostigmine (mestinon) interventions

stop all other cholinergics before giving this drug | administer antidote if needed

pyridostigmine (mestinon) antidote

atropine sulfate is the antidote for mestinon

pyridostigmine (mestinon) pt education

take as prescribed and on time carry ID stating pt has myasthenia gravis may be taking drug for life

donepezil (aricept) indications

mild to moderate alzheimer's disease

donepezil (aricept) action

reversible cholinesterase inhibitor that causes elevated acetylcholine levels in the cortex this in turn slows the neuronal degradation of alzheimer's disease

donepezil (aricept) contraindications

``` renal/hepatic impairment cardiac/respiratory disorders seizures hyperthyroidism GI bleeding ```

donepezil (aricept) adverse effects

insomnia, dizziness, headache bradycardia nausea, GI upset rash

donepezil (aricept) interactions

NSAIDs: risk of GI bleeding | anticholinergic drugs: decrease effect of aricept

donepezil (aricept) nursing dx

acute pain r/t GI effects decreased cardiac output r/t BP changes and arrhythmias

donepezil (aricept) interventions

give with food if GI upset monitor weight and vitals monitor and report s/s GI bleeding monitor for bradycardia (potential for vagotonic effects)

donepezil (aricept) pt teaching

take with food at bedtime to minimize GI effects report LOC to provider drug does not alter underlying degenerative disease; treats symptoms avoid OTC cold/sleep remedies

memantine (namenda)

adjunctive therapy with aricept to slow memory loss in alzheimer's pts antagonizes N-methyl-D-aspartate receptors and decreases symptoms interacts with OTC antacids; possible toxicity