Module 5-6 Drugs

Question 1

Lamotrigine

Answer 1

Use: Decreased incidence of seizures; also bipolar; AE/SE: cardiac arrest, SJS, hepatic failure, blurred vision; monitor for behavior changes and skin changes

Question 1

Clonazepam

Answer 1

Use: lennox-gastaut, akinetic or myoclonic seizures; prevention of acute/abrupt seizures; AE/SE: palpitations, rash, nystagmus, SI, diplopia; NC: assess pt for drowsiness, unsteadiness; monitor for notable changes in beahvior

Question 2

Levetiracetam

Answer 2

use: decreased incidence and severity of seizures; AE/SE: HTN, SJS, aggression, SI;monitor for skin and behavior changes

Question 3

Topiramate

Answer 3

decreased incidence of seizures; AE/SE: SJS, decreased growth in children, vision changes, bleeding, seizures, SI; monitor growth rate and behavior

Question 4

Valproic Acid

Answer 4

suppression of seizure activity; SE/AE: peripheral edema, pancreatitis, hypothermia, rash; assess seizure activity, assess for SI, monitor for S/S of pancreatitis

Question 5

Carbamazepine

Answer 5

used for epilepsy therapy and bipolar disorder; SE/AE: CNS depressant effects, visual disturbances, ataxia, vertigo, unsteadiness, HA, edema, HF, hypotension, syncope, aplastic anemai; monitor skin and behavior, monitor for therapeutic level sin lab, AVOID GRAPEFRUIT

Question 6

Gabapentin

Answer 6

decrease incidence of seizures (also for neuropathy pain); SE/AE: SJS< nystagmus, gingivitis, rhabdo, ataxia, confusion; DO NOT take within 2 hours of antacid, monitor behavior changes, monitor skin, home med inxn with herbal

Question 7

Oxcarbazepine

Answer 7

for partial seizures (mono or adjunct therapy); SE/AE: rash, SJS, vision changes, diplopia, nystagmus, NV, GI, dizziness, and headache; monitor for skin, CNS, and behavior changes

Question 8

Phenytoin

Answer 8

treat both focal-onset and generalized onset and terminate ventricular arrythmias; SE/AE: nystagmus, sedation, ataxia, diplopia, cognitive impairment, GINGIVAL HYPERPLASIA, CLEFT PALATE to fetus, dysrhythmias and hypotension, PURPLE GLOVE; monitor phenytoin levels, GI upset with PO, monitor enteral feedings, practice good oral hygiene

Question 9

Pregabalin

Answer 9

decreased partial-onset seizures; SE/AE: peripheral edema, SJS, vision changes, NVD, dizziness, respiratory depression; monitor behavior ESPECIALLY SUICIDAL THOUGHTS

Question 10

Phenobarbital

Answer 10

tx anticonvulsant activity; AE/SE: hypotension, rash, constipation, NVD, delirium, depression; monitor respiratory status, pulse, BP, and s/s of angioedema

Question 11

Mannitol

Answer 11

reduces intraocular/intracranial pressure; AE/SE: HF, chest pain, blurred vision, electrolyte changes, NV, COMA, pulmonary edema; monitor neuro staus and IC pressure readings; may have some decreased UOP but still should monitor

Question 12

Carbidopa/Levodopa

Answer 12

dopaminergic agents; activates dopamine receptors; SE: n/v, dyskinesia, hypotension, dysthmyias (depression); avoid high protein foods (competes with levodopa); drug intxn w/ antipsychotics, MAO inhibitors (toxicity causes HTN crisis); levodopa CANNOT act alone and needs carbidopa to cross BBB

Question 13

Pramipexole

Answer 13

dopamine agonist; activates dopamine receptors; SE: hallucinations, daytime sleepiness, compulsive bahviors r/t dopamine increase and postural hypotension, n/constipation

Question 14

Entacapone

Answer 14

COMT inhibitor; inhibits breakdown of levodopa by COMT (COMT normally inhibits dopamine); SE: dyskinesias, sleep distrubances, impulse control disorder, orthostatic hypotension

Question 15

Selegline

Answer 15

MAO-B inhibitor (early tx); inhibits breakdown of dopamine by MAO-B; SE: insomnia (r/t CNS excitation), orthostatic hypotension, dizziness, and GI symptoms; GIVE BEFORE NOON (insomnia); MANY drug intxn (MAO=HTN Crisis, opioids= resp depression, SSRIs = serotonin syndrome); AVOID high levels of tyramine (found in aged, cured or fermented foods)

Question 16

Amantadine

Answer 16

dopamine releaser; reduces dyskinesias caused by levodopa; SE: CNS effects (confusion, lightneded, anxiety), anticholinergic effects (blurred vision, urinary retention, dry mouth)

Question 17

Benzotropine, Triexyphenidyl, Diphenhydramine

Answer 17

anticholinergics; for Tremors (blocks receptors of acetylcholine and improving dopamine and acytlcholine balance); SE: Anticholinergic effects (dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia) ; BEERS criteria: potentially inappropriate for use in geriatric pts and pts with glaucoma

Question 18

Donepezil

Answer 18

cholinesterase inhibitor; make more acytlcholine available; SE: cholinergic effects: badycardia, n/d, bronchoconstriction (caution with asthma and COPD), increased GI peristalsis, increased urinary contraction, increased saliva, increased respiratroy secretion, constrict pupils ; antipsychotics reduce therapeutic effects; contraindications: urinary or GI obstruct, asthma, peptic ulcer dz, inflammed bowels, CAD (bc of bradycardia)

Question 19

Rivastigmine

Answer 19

cholinesterase inhibitor; SE same as donepezil; can intensify peptic ulcer dz, take with meals, wt loss, do not repeat patch site for 14 days

Question 20

Galantamine

Answer 20

cholinesterase inhibitor; SE same as donepezil and add wt loss;

Question 21

Memantine

Answer 21

N-Methyl-D-Aspartate (NMDA) receptor antagonist; has to do with regulating calcium entry into the neurons, it promotes calcium influx which signals learning and memory loss; SE: tolerated well, may have dizziness, HA, confusion (5-7%); can combine with donepezil