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Neuro drugs Flashcards

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1
Q

Valproic acid uses

A
  1. all seizure types
  2. mania associated with bipolar
  3. migraine headache prevention
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2
Q

valproic acid prototype

A

valproic acid (depakote)

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3
Q

valproic acid action

A
  1. inhibits the influx of sodium
  2. decrease neuron activity
  3. inhibit influx of calcium through calcium channels
  4. enhances inhibitory effects of GABA
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4
Q

valproic acid SE

A
  1. GI upset
  2. thrombocytopenia
  3. skin rash
  4. severe liver toxicity
  5. hyperammonemia
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5
Q

valproic acid safety alert

A

hyperammonemia, from altered fatty acid metabolism. Also need to monitor for hepatitis and pancreatitis

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6
Q

valproic acid interventions

A
  1. monitor platelets and bleeding times
  2. monitor pancreatis and liver enzymes
  3. monitor ammonia levels
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7
Q

valproic acid admin

A
  1. oral or IV

2. give enteric coated form if it causes GI distress

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8
Q

valproic acid teaching

A
  1. avoid getting pregnant, if you do then you must take folic acid in order to avoid neural tube defects. such as spinal bifida (the vertebra of the back do not close)
  2. report signs of liver failure or pancreatitis (pain)
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9
Q

valproic acid contraindications

A
  1. pregnancy
  2. liver problems
  3. thrombocytopenia
  4. hyperammonemia
  5. other anticonvulsants
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10
Q

valproic acid interactions

A
  1. increases phenytoin and phenobarbital levels

2. topiramate increases risk for hyperammonemia

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11
Q

Immunomodulators uses

A

treat multiple sclerosis

destruction of the myelin sheath

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12
Q

beta 1a vs beta 1b

A

1b. is worse because there are no periods of remission they just keep getting worse.

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13
Q

prototype immunomodulators

A
  1. Interferon beta-1a (avonex)
  2. Beta-1b (betaseron)
  3. Glatiramer acetate (copaxone)
  4. Natalizumab (tysbri)
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14
Q

immunomodulators action

A

1.inhibit the movement of leukocytes across BBB protecting the myelin from the damaging effect of leukocytes

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15
Q

Immunomodulators SEs

A
  1. Flu like symptoms
  2. myelosuppression
  3. liver toxicity
  4. pain, redness at subQ injection site
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16
Q

immunomodulators interventions

A
  1. give acetaminophen or NSAIDs for flu like symptoms

2. Liver and CBC baselines

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17
Q

immunomodulators safety alert

A

monitor closely for thrombocytopenia and neutropenia

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18
Q

immunomodulators admin

A

Give beta 1a(avonex) IM weekly

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19
Q

patient teaching immunomodulators

A
  1. cold compress before admin
  2. warm compress after admin
  3. report liver failure
    - abdominal tenderness, anorexia, jaundice
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20
Q

immunomodulators contraindications

A

1.allergy to interferon beta, human albumin, or mannitol

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21
Q

Serotonin agonists uses

A

relieves symptoms of migraine, or cluster headache

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22
Q

serotonin agonist prototype

A
  1. Sumatriptan (imitrex)

2. Zolmitriptan (zomig)

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23
Q

serotonin agonist action

A

activates 5-hydroxy-tryptamine receptors (5-HT) which promotes

  1. vasoconstrictions
  2. prevents the release of CGRP which prevents the inflammatory response from occuring
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24
Q

serotonin agonists SEs

A
  1. chest pressure (may result from vasoconstrictions in the lungs and esophagus)
  2. Coronary vasospasm (angina)
  3. CNS effects
    - tingling and vertigo
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25
serotonin agonists safety
1. monitor for chest pressure and angina if they occur measure vital signs immediately to make sure it is not cardiac ischemia 2. do not take more then 200 mg in a 24 hour period as it can cause coronary ischemia
26
cholinesterase inhibitors interactions
1. Anticholinergics decrease effects | 2. NSAIDs increase risk for GI bleed
27
serotonin agonist teaching
1.notify provider if chest pressure or back, jaw or throat pain occurs that is not immediately relieved
28
serotonin agonist contraindications
1. CAD, angina or previous MI 2. severe HTN 3. PVD 4. acute CVA
29
serotonin agonist interactions
1. MAOIs taken withing 2 weeks can cause sumatriptan toxicity 2. Using ergotamine or another triptan within 24 hours increases the risk for angina 3. Serotonin agonists with sumatriptan may cause serotonin syndrome 4. St Johns wort increases blood levels (toxicity)
30
immunomodulators contraindications
1.allergy to interferon beta, human albumin, or mannitol
31
Serotonin agonists uses
relieves symptoms of migraine, or cluster headache
32
dopamine replacement uses
1. relieves symptoms of parkinsons 2. when combined with carbidopa it can reduce the dose of levodopa and prevent some of the adverse effects of levodopa. Carbidopa augments levodopa by alters the amount of levodopa that gets converted to dopamine in the GI resulting in more levodopa reaching the CNS
33
Protoype dopamine replacement
Levodopa/carbidopa (sinemet)
34
dopamine replacement action
1. crosses BBB | 2. taken up by dopaminergic nerves (substantia nigra) and converted into dopamine
35
dopamine replacement drugs SEs
1. N/V (activates dopamine receptors in the vomiting center of the brain, CTZ area) 2. orthostatic hypotension 3. darkening of urine and sweat 4. dyskinesia, tremors, twitching (inappropriate dosing) 5. psychosis and paranoia
36
Dopamine replacement interventions
1. decrease levodopa and prescribe amantadine for dyskinesias 2. seroquel for psychosis 3. orthostatic hypotension can be very severe (fall risk)
37
dopamine replacement drug admin
1. can take up to 6 months for full response 2. SAFETY ALERT.... times of the day when muscle rigidity and tremors recur are called on-off episodes. Patients need to regulate both time and dosage.
38
dopamine replacement teaching
1. take with food (avoid high protein as it decreases absorption) 2. urine and sweat may darken but its nothing to worry about 3. orthostatic teaching
39
dopamine replacement contraindications
1. narrow angle glaucoma 2. history of melanoma 3. psychosis/suicidal thoughts
40
dopamine replacement interactions
1. first gen antipsychotics and supplements with vitamine B6 decrease action 2. MAOIs within two weeks can cause HTN crisis 3. high protein meals decrease absorption 4. anticholinergic drugs increase the response to levodopa/carbidopa
41
direct acting dopamine receptor agonist uses
1. parkinsons | 2. restless leg syndrome
42
direct acting dopamine receptor agonist prototype
1. Pramipexole (Mirapex) | 2. Ropinirole (Requip)
43
direct acting dopamine receptor agonist action
bind to dopamine receptors and mimic action of dopamine in the body
44
direct acting dopamine receptor agonist SEs
1. N/V 2. Orthostatic hypotension (more severe then dopamine replacement) 3. Dyskinesia 4. Sleep attacks 5. muscle weakness (along with OH it causes a super severe risk for falls)
45
direct acting dopamine receptor agonist interventions
1. give with food for nausea 2. orthostatic precautions 3. watch for dyskinesias 4. (Safety alert) monitor serum creatine phosphokinases (CPK) b/c it is an indication that muscle damage is occuring.
46
direct acting dopamine receptor agonist admin
1.take 3 hours before bedtime for restless leg syndrome
47
direct acting dopamine receptor agonist teaching
1. avoid alcohol and other CNS dperessants as they will increase drowisness 2. orthostatic teaching 3. must be tapered off
48
direct acting dopamine receptor agonist contraindictions
no contraindications
49
direct acting dopamine receptor agonist interactions
1. Cimetidine increase levels of pramipexole | 2. Metoclopramide and phenothiazine(first gen anti-psychotic) decrease therapeutic effects
50
MAOIs uses
1. parkinsons as adjunct to levodopa/carbidopa | 2. MDD
51
MAOIs prototypes
1. Selegiline | 2. Rasagiline
52
MAOIs action
inhibit MAO-B. This enzyme inactivates several chemical neurotransmitters. MAO-A inactivates epi and norepi. MAO-B inactivates dopamine. By inhibiting MAO-B dopamine is not inactivated
53
MAOIs SE
1. Insomnia (Selegiline) - due to sudden increase in cathecholamines 2. HTN if taken with tyramine which causes release of norepi 3. OH(common) 4. irritation of oral mucous membranes with the orally disintegrating tablet form)
54
MAOIs interventions
1. insomnia (change time or dose) 2. monitor BP for HTN or hypotension 3. Diet (no tyramine or caffeine) 4. monitor for sudden headache, n/v if they develop measure BP immediately.
55
MAOIs admin
1. dont give at night (insomnia) 2. place orally disintegrating form on top of the tonguqe and make sure PT does not eat or drink for 5 mins before or after admin. Give it before morning meal.
56
MAOI teaching
1. take last dose before noon 2. report irritation of oral cavity 3. orthostatic teaching
57
MAOIs contraindications
1. controlled HTN 2. Suicidal ideation 3. Meperidine use
58
MAOIs interactions
1. opioids, mainly meperidine, TCAs, or SSRIs can cause high fever and rigidity 2. Tyramine ->HTN 3. St.johns, gingseng, ma huang, ephedra also can lead to HTN crisis
59
direct acting dopamine receptor agonist interactions
1. Cimetidine increase levels of pramipexole | 2. Metoclopramide and phenothiazine(first gen anti-psychotic) decrease therapeutic effects
60
MAOIs uses
1. parkinsons as adjunct to levodopa/carbidopa | 2. MDD
61
MAOIs prototypes
1. Selegiline | 2. Rasagiline
62
MAOIs action
inhibit MAO-B. This enzyme inactivates several chemical neurotransmitters. MAO-A inactivates epi and norepi. MAO-B inactivates dopamine. By inhibiting MAO-B dopamine is not inactivated
63
MAOIs SE
1. Insomnia (Selegiline) - due to sudden increase in cathecholamines 2. HTN if taken with tyramine which causes release of norepi 3. OH(common) 4. irritation of oral mucous membranes with the orally disintegrating tablet form)
64
MAOIs interventions
1. insomnia (change time or dose) 2. monitor BP for HTN or hypotension 3. Diet (no tyramine or caffeine) 4. monitor for sudden headache, n/v if they develop measure BP immediately.
65
MAOIs admin
1. dont give at night (insomnia) 2. place orally disintegrating form on top of the tonguqe and make sure PT does not eat or drink for 5 mins before or after admin. Give it before morning meal.
66
MAOI teaching
1. take last dose before noon 2. report irritation of oral cavity 3. orthostatic teaching
67
MAOIs contraindications
1. controlled HTN 2. Suicidal ideation 3. Meperidine use
68
MAOIs interactions
1. opioids, mainly meperidine, TCAs, or SSRIs can cause high fever and rigidity 2. Tyramine ->HTN 3. St.johns, gingseng, ma huang, ephedra also can lead to HTN crisis
69
Cholinesterase Inhibitors uses
improves cognitive function in mild to moderate alzheimers disease
70
cholinesterase inhibitors prototypes
1. donepezil(aricept) 2. Rivastigmine (exelon) 3. Galantamine(Razadyne)
71
cholinesterase inhibitors action
prevent acetylcholinesterase from inactivating acetylcholine
72
cholinesterase inhibitors SEs
1. Nausea and other GI symptoms 2. CNS effects - insomnia, dizziness, headache 3. bradycardia 4. syncope (temporary decrease in blood flow to the brain)
73
cholinesterase inhibitors intervention
1. give with food to minimize GI effects 2. monitor for weight loss r/t loss of apetite 3. monitor for GI bleeding 4. monitor for CNS effects 5. be careful with syncope 6. monitor heart rate (safety alert) (increased risk of syncopy)
74
cholinesterase inhibitors admin
available as tablets, orally disintegrating tablets and syrup
75
cholinesterase inhibitors teaching
1. take with food at bedtime to minimize GI effects 2. report CNS symptoms 3. report vomiting, severe diarrhea, weight loss, GI bleeding
76
cholinesterase inhibitors contraindications
1. children 2. GI bleed 3. jaundice
77
cholinesterase inhibitors interactions
1. anticholinergic drugs (antihistamines) decrease effects of donepezil 2. NSAIDs increase risk for GI bleed (recommond tylenol instead)
78
NMDA receptor antagonists uses
1.slows cognitive decline in patients with mild to moderate alzheimers and may be combined with cholinesterase inhibitors
79
NMDA prototype
1.memantine (Namenda)
80
NMDA action
blocks excess glutamate from acting on NMDA receptors | 1.decreasing intracellular calcium leading to less neuronal damage and more normal functioning of neurons
81
NMDA SEs
1. CNS effects - dizziness, headache, increased confusion 2. constipation
82
NMDA interventions
1. monitor for CNS effects | 2. give stool softeners PRN
83
NMDA admin
give with or without food
84
NMDA teaching
1.increase fiber
85
NMDA contraindications
1.renal failure
86
NMDA safety alert
patients with DM may experience an increase in B.S leading to DKA

Med surg (35 decks)

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