Neurological System Part 1 Flashcards
1
Q
Prototype (Centrally Acting Muscle Relaxants)
A
Prototype: Baclofen
Other Drugs: Carisoprodol, Chlorzoxazone, Cyclobenzaprine
For muscle spasms
2
Q
Mechanism of Action (Centrally Acting Muscle Relaxants)
A
Mechanism: Enhances the inhibitory effects of GABA on receptors in the spinal cord, resulting in suppression of hyperactive reflexes.
3
Q
Side Effects (Centrally Acting Muscle Relaxants)
A
Common: Drowsiness, dizziness, weakness, fatigue
Less Frequent: Nausea, vomiting, constipation, urinary retention
Withdrawal Effects: Anxiety, restlessness, visual hallucinations, seizures (with abrupt discontinuation)
4
Q
Interventions (New Prescriptions)
A
Dosing: Start with the lowest effective dose and gradually increase to minimize adverse effects like dizziness and drowsiness.
Monitor: Encourage clients to drink plenty of fluids and increase fiber to avoid constipation.
5
Q
Safety Alert (Discontinuation)
A
Alert: Taper dose over 1–2 weeks to prevent withdrawal effects such as seizures, hallucinations, and anxiety.
6
Q
Administration (Baclofen)
A
Oral Doses: Gradually increase by 5 mg every 3 days, aiming for 20 mg three to four times per day. Administer with food or milk to prevent GI upset.
Intrathecal Infusion: Administered directly into the spine when oral doses are ineffective.
7
Q
Client Instructions (Adverse Effects)
A
CNS Effects: Instruct clients that drowsiness and dizziness usually subside over time. Advise slow position changes if dizzy.
Constipation: Encourage increasing fiber and fluid intake to prevent constipation.
8
Q
Contraindications and Precautions (Centrally Acting Muscle Relaxants)
A
Contraindications: Known hypersensitivity to the drug, concurrent use with MAOIs. Cyclobenzaprine is contraindicated within 2 weeks of MAOI use.
Precautions: Use cautiously in older adults, children, and clients with severe mental illness, seizure disorders, or cerebrovascular accidents.
9
Q
Interactions (Cyclobenzaprine)
A
MAOI Interaction: Using cyclobenzaprine with MAOIs can result in hyperpyretic crisis and seizures.
Serotonin Syndrome: Risk when combined with SSRIs, SSNRIs, or tricyclic antidepressants.
10
Q
Prototype (Peripherally Acting Muscle Relaxants)
A
Prototype: Dantrolene
For muscle spasms
10
Q
Mechanism of Action (Peripherally Acting Muscle Relaxants)
A
Mechanism: Inhibits the release of calcium in skeletal muscle tissue, which is necessary for muscle contraction, leading to muscle relaxation and relief of spasticity.
11
Q
Side Effects (Dantrolene)
A
Common: Muscle weakness, drowsiness, dizziness, diarrhea
Severe: Liver toxicity (more common with higher doses and long-term use)
11
Q
Interventions (Dantrolene)
A
Monitor: Watch for CNS side effects (drowsiness, dizziness) and assist with ambulation.
Start with low doses: Gradually increase to minimize side effects.
Monitor liver function: Especially with long-term use or higher doses, and monitor for diarrhea.
12
Q
Safety Alert (Dantrolene and Muscle Weakness)
A
Alert: Monitor muscle strength regularly to ensure that weakness doesn’t impair ambulation, which could lead to dangerous falls.
13
Q
Administration (Dantrolene)
A
Oral: Most commonly used for spasticity.
IV: Use for treating malignant hyperthermia via IV bolus during life-threatening situations.
Preoperative use: Take orally 1–2 days before surgery for prevention of malignant hyperthermia in at-risk clients.
14
Q
Client Instructions (Dantrolene)
A
Muscle Weakness: Report any weakness that interferes with daily activities.
Avoid driving: If feeling drowsy or dizzy.
CNS Depressants: Avoid alcohol and other CNS depressants.
Liver Damage: Report signs of liver damage, such as abdominal pain, jaundice, or yellowing of skin/eyes.
15
Q
Contraindications and Precautions (Dantrolene)
A
Contraindications: Clients with liver disease.
Precautions: Use cautiously in clients with cardiac/pulmonary disease or
neuromuscular disorders.
Age Risk: Clients over age 35 are at increased risk for liver damage.
16
Q
Interactions (Dantrolene)
A
Liver Toxicity: Increased risk in females over 35 who take estrogen.
CNS Depressants: Avoid using with other CNS depressants (e.g., alcohol), as it increases the risk of excessive sedation.
Cardiac Risks: May cause severe cardiac dysrhythmias when taken with calcium channel blockers.
17
Q
Prototype (Hydantoins)
A
Prototype: Phenytoin
Other Medication: Fosphenytoin
For seizure
17
Q
Mechanism of Action (Hydantoins)
A
Mechanism: Decreases neuronal activity by inhibiting sodium influx through sodium channels, slowing nerve impulses and preventing seizure activity. Prolongs the inactive state of neurons, reducing the frequency of seizures.
18
Q
Side Effects (Hydantoins)
A
Common: Mild drowsiness, CNS depressant effects, gingival hyperplasia (especially in children/adolescents)
Serious: Skin rash, potential Stevens-Johnson syndrome, epidermal necrolysis
19
Q
Interventions (Hydantoins)
A
Monitor: Drowsiness, CNS effects (may indicate toxicity).
Oral care: Check for gingival hyperplasia in children/adolescents.
Rash: Monitor for serious rashes like Stevens-Johnson syndrome and discontinue medication immediately if rash develops.
20
Q
Administration (Hydantoins)
A
Oral: Give with meals to reduce gastrointestinal distress.
IV: Do not inject more than 50 mg/min (or 25 mg/min for older adults). Monitor for cardiac collapse and dysrhythmias during IV administration.
Therapeutic Range: Maintain phenytoin levels between 10-20 mcg/mL. Monitor regularly to avoid toxicity.
20
Q
Safety Alert (Hydantoins)
A
Abrupt discontinuation: Can result in seizure recurrence or status epilepticus.
Rash Alert: Epidermal necrolysis or Stevens-Johnson syndrome can occur—discontinue immediately if rash develops.
21
Client Instructions (Hydantoins)
Avoid: Driving or mental alertness activities if drowsiness occurs.
Oral Care: Regular dental checkups, use a soft-bristled toothbrush, floss, and massage gums to prevent gingivitis.
Blood Levels: Periodic monitoring may be required to check therapeutic range.
Report: Rashes or severe side effects immediately.
Do not stop suddenly: Taper to avoid seizures.
22
Side Effects (Carbamazepine)
Common: Visual disturbances, headache, ataxia, nystagmus, blurred vision, fluid retention
Serious: Skin rash (Stevens-Johnson syndrome, epidermal necrolysis), bone marrow suppression, photosensitivity reactions
23
Interactions (Hydantoins)
Incompatibility: IV phenytoin is incompatible with many other medications and dextrose solutions.
Increased Phenytoin Levels: Diazepam, isoniazid, cimetidine, valproic acid.
Decreased Levels: Phenobarbital, carbamazepine.
Alcohol: May increase or decrease phenytoin levels.
Oral Contraceptives: Phenytoin reduces effectiveness—recommend alternative birth control methods.
23
Contraindications and Precautions (Hydantoins)
Contraindications: Pregnancy (teratogenic risk), skin rash, bradycardia, heart block, low blood sugar seizures, allergy to hydantoins.
Caution: Use carefully in clients with liver/kidney disease, cardiac dysfunction, diabetes, respiratory dysfunction, or alcoholism. Risk of toxicity in older adults and clients in a weakened state.
24
Drug Class (Carbamazepine)
Anticonvulsants / Antiseizure Medication (ASM)
25
Mechanism of Action (Carbamazepine)
Mechanism: Inhibits sodium influx through sodium channels, decreasing the neuronal discharge in areas of increased activity. This helps prevent seizures and stabilize mood in bipolar disorder.
26
Interventions (Carbamazepine)
Monitor: CNS effects, skin rashes, fluid retention.
Labs: Baseline and periodic blood counts to check for bone marrow suppression, particularly white blood cell count (WBC).
Dose: Start with a low dose and gradually increase. Administer the larger dose at bedtime to reduce daytime side effects.
27
Safety Alert (Carbamazepine)
Bone marrow suppression: Watch for low WBCs; obtain baseline and periodic blood counts.
Rash: Monitor for Stevens-Johnson syndrome, especially in clients of Asian descent (test for HLA-B*1502 gene).
Fluid retention: Can cause heart failure symptoms—report decreased urine output, edema, and shortness of breath.
28
Administration (Carbamazepine)
With Meals: Take with food to reduce gastric upset.
Sustained Release: Swallow whole, chewable tablets can be crushed.
Oral Suspension: Do not mix with other suspensions. Keep plasma levels consistent; administer with a sip of water if NPO.
29
Client Instructions (Carbamazepine)
CNS Effects: Inform clients that visual disturbances and incoordination should lessen over time; avoid driving or hazardous activities until effects are known.
Sun Protection: Use sunscreen and protective measures due to photosensitivity.
Fluid Retention: Report signs of heart failure (edema, decreased urine output, shortness of breath).
Rash: Report any rash immediately.
Bone Marrow Suppression: Report fever, sore throat, easy bruising.
30
Contraindications and Precautions (Carbamazepine)
Contraindications: Pregnancy risk (teratogenic), hematologic disorders, heart failure, absence or myoclonic seizures.
Caution: Clients with cardiac/hepatic disease, alcoholism, or positive for HLA-B*1502 gene (risk for Stevens-Johnson syndrome).
31
Interactions (Carbamazepine)
Increases Plasma Levels: Grapefruit juice, antifungals, erythromycin, isoniazid, some antiretrovirals, valproic acid, verapamil, niacin, loratadine, nefazodone, and MAOIs.
Decreases Plasma Levels: Phenytoin, barbiturates, rifampin, cisplatin, theophylline.
Oral Contraceptives: Decreased effectiveness—use alternative birth control methods.
32
Drug Class (Valproic Acid)
Class: Anticonvulsants / Antiseizure Medication (ASM)
33
Mechanism of Action (Valproic Acid)
Mechanism: Inhibits sodium influx through sodium channels and decreases neuron discharge. May also affect calcium influx and enhance the inhibitory effects of GABA.
33
Prototype (Valproic Acid)
Prototype: Valproic Acid
Other Medications: Valproate, Divalproex Sodium
An Antiseizure
34
Contraindications and Precautions (Valproic Acid)
Contraindications: Pregnancy risk (teratogenic), liver disorder, thrombocytopenia, hyperammonemia, concurrent anticonvulsant use.
Caution: Clients with kidney disease, older adults, and children under 2 years old.
34
Side Effects (Valproic Acid)
Common: GI upset, indigestion
Serious: Bruising, bleeding, prolonged bleeding time, decreased platelets, skin rash, liver toxicity, hyperammonemia
35
Administration (Valproic Acid)
Oral/IV: Can be given orally or IV. For GI issues, use enteric-coated tablets.
With Food: Administer with food to minimize gastric distress.
IV Administration: Dilute in at least 50 mL of diluent, and do not mix with other medications.
36
Safety Alert (Valproic Acid)
Hepatic & Pancreatic Failure: Monitor closely for signs of liver toxicity (e.g., jaundice) and pancreatitis (e.g., abdominal pain, nausea, vomiting).
Pregnancy: Avoid during pregnancy due to risk of neural tube defects (e.g., spina bifida). If pregnant, take folic acid to reduce the risk.
37
Client Instructions (Valproic Acid)
Report: Rash, nausea, vomiting, abdominal pain, jaundice, unexplained bruising, bleeding.
For caregivers: Watch for confusion or changes in consciousness (signs of hyperammonemia) and contact the provider.
37
Interventions (Valproic Acid)
Monitor: Platelet count, bleeding time, ammonia levels, liver function (baseline and periodic tests).
Look for: Unexpected bruising, blood in urine or stool, hyperammonemia (vomiting, confusion, decreased consciousness).
Report: Elevated serum amylase (pancreatitis risk), jaundice, and abdominal pain.
38
Interactions (Valproic Acid)
Increases Levels of: Phenytoin, phenobarbital
Increased Risk of Hyperammonemia: When taken with topiramate.
39
Prototype (Second- and Third-Generation ASMs) antiseizure medication
Prototype: Oxcarbazepine
Other Medications: Gabapentin, Lamotrigine, Topiramate, Levetiracetam, Zonisamide, Brivaracetam, Cenobamate
40
Mechanism of Action (Oxcarbazepine)
Mechanism: Binds to sodium channels, inhibiting the release of glutamate (an excitatory neurotransmitter), reducing seizures.
41
Side Effects (Oxcarbazepine)
Common: Dizziness, drowsiness, vision changes, headache, ataxia
Serious: Stevens-Johnson syndrome, hypothyroidism, decreased bone mineral density, leukopenia
42
Safety Alert (Oxcarbazepine)
Hyponatremia: Monitor sodium levels, especially in clients using diuretics or sodium-depleting medications.
Abrupt Discontinuation: May lead to increased seizure frequency or status epilepticus.
43
Interventions (Oxcarbazepine)
Monitor: Sodium levels, white blood cell count, and complete blood count.
Start with low dose: Gradually increase the dosage, dividing it into two daily doses.
Genetic Testing: Test for the HLA-B*1502 gene in clients of Asian descent to avoid severe skin reactions.
44
Administration (Oxcarbazepine)
Route: Administer orally as a tablet or liquid.
Dosing: Divide the total daily dose into two doses.
45
Client Instructions (Oxcarbazepine)
Sun Protection: Always use protection against sun exposure.
Birth Control: Use additional forms of contraception, as oxcarbazepine reduces the effectiveness of oral contraceptives.
Skin Reactions: Report any skin reactions immediately.
46
Contraindications and Precautions (Oxcarbazepine)
Contraindications: Allergy to carbamazepine.
Precautions: Use cautiously with clients who are at risk for hyponatremia.
47
Interactions (Oxcarbazepine)
Increases Phenytoin Levels: Concurrent use with phenytoin may cause elevated serum phenytoin levels.
Decreased Oxcarbazepine Levels: May occur when used with phenytoin, phenobarbital, or carbamazepine.
Oral Contraceptives: Oxcarbazepine reduces the effectiveness of oral contraceptives.
48
Prototype (Local Anesthesia)
Prototype: Lidocaine (Amide-type)
Other Medications: Procaine, Benzocaine (Ester-type)
49
Mechanism of Action (Local Anesthesia)
Mechanism: Blocks the influx of sodium through sodium channels, preventing depolarization and blocking the initiation of action potentials.
50
Side Effects (Local Anesthesia)
CNS Stimulation: Restlessness, irritability, tremors, confusion, convulsions
CNS Depression: Respiratory depression
Cardiac Effects: Hypotension, life-threatening cardiac conduction disorders (at high doses)
51
Safety Alert (Local Anesthesia)
Cardiac Risks: High doses of lidocaine can cause life-threatening conduction disorders.
Systemic Absorption: CNS stimulation followed by depression can occur with systemic absorption of high doses.
52
Administration (Lidocaine)
Application: Avoid application to eyes or broken skin due to risk of systemic absorption and toxicity.
Epinephrine Addition: Extends anesthetic effect but may cause vasoconstriction—monitor for lack of circulation in distal areas (e.g., fingers, toes).
52
Interventions (Local Anesthesia)
Monitor: Vital signs during and after procedures, particularly for signs of CNS stimulation (restlessness, tremors) or hypotension (especially with spinal anesthesia).
Treatment: If hypotension occurs, lower the head of the bed and have ephedrine or phenylephrine available.
53
Client Instructions (Local Anesthesia)
Report: Dizziness, abnormal sensations (paresthesia), and breathing difficulties during or after the procedure.
Monitoring: Expect careful monitoring of vital signs during and after the procedure.
54
Interactions (Lidocaine)
Increases Lidocaine Levels: Beta blockers, cimetidine, quinidine
Cardiac Risk: Increased risk of cardiac effects with phenytoin.
Increased CNS/Cardiac Effects: With concurrent use of procainamide and lidocaine.
54
Contraindications and Precautions (Lidocaine)
Contraindications: Allergy to lidocaine or amide-type anesthetics.
Precautions: Avoid viscous lidocaine in children under 3 years old.
Cardiac Risk: Clients with bradycardia or heart block may experience cardiac arrest when using lidocaine.
55
Mechanism of Action (Short-Acting Barbiturates)
Mechanism: Causes significant CNS depression and enhances the inhibitory effects of GABA, inducing rapid anesthesia and hypnosis.
55
Prototype (Short-Acting Barbiturates)
Prototype: Methohexital Sodium
Other Medication: Propofol (widely used, but linked to misuse)
Class: General Anesthetics – Barbiturates / Intravenous Anesthetics
Induce General anesthesia and hypnosis
56
Side Effects (Short-Acting Barbiturates)
Common: Decreased heart rate and blood pressure
Serious: Hypotension, tachycardia (compensatory), respiratory depression, apnea, overdose leading to death
57
Interventions (Short-Acting Barbiturates)
Monitor: Vital signs before, during, and after anesthesia; monitor for hypotension and respiratory depression.
Slow IV Administration: Administer slowly to minimize risks.
Constant Observation: Keep resuscitation equipment nearby.
58
Safety Alert (Short-Acting Barbiturates)
Respiratory Risk: Monitor respiratory status carefully for decreased respirations or apnea, which can occur due to CNS depression.
59
Client Instructions (Short-Acting Barbiturates)
Reassurance: Inform clients they will be closely monitored before, during, and after the procedure to ensure safety.
60
Administration (Short-Acting Barbiturates)
Route: IV injection or infusion only.
Patency Check: Ensure IV line is in the vein to avoid extravasation, which can cause severe damage to surrounding tissue.
61
Contraindications and Precautions (Short-Acting Barbiturates)
Contraindications: Known sensitivity to the medication.
Precautions: Use cautiously in clients with hepatic or renal disease, as these conditions can prolong the effects of the drug.
62
Prototype (Benzodiazepines)
Prototype: Midazolam
Other Medication: Diazepam
A General anesthetic
62
Interactions (Short-Acting Barbiturates)
Increased CNS Effects: Occurs when used with other CNS depressants, increasing the risk of respiratory depression and hypotension.
Duplicate Therapy: Using benzodiazepines like midazolam may prolong anesthesia unnecessarily.
62
Mechanism of Action (Benzodiazepines)
Mechanism: Enhances the inhibitory effects of GABA, causing CNS depression and promoting sedation and hypnosis (sleep induction).
63
Side Effects (Benzodiazepines)
Common: Amnesia (memory loss from injection to reversal)
Serious: Risk of cardiac or respiratory arrest (especially with higher doses for anesthesia)
64
Safety Alert (Benzodiazepines)
Cardiac/Respiratory Arrest: Potential for arrest during anesthesia—ensure resuscitation equipment is available and monitor heart and respiratory rates closely.
65
Administration (Benzodiazepines)
Routes: Administer IM into a large muscle, orally for children, or by IV bolus (titrated for sedation depth).
Conscious Sedation: Combine with opioids for conscious sedation.
Neonates: Do not give IV bolus doses to neonates.
65
Interventions (Benzodiazepines)
Monitor: Vital signs before, during, and after the procedure.
Amnesia: Inform clients they will not recall the procedure and may have memory loss for several hours afterward.
Slow IV Administration: Administer IV bolus slowly, allowing 2 minutes between doses.
66
Client Instructions (Benzodiazepines)
Reassurance: Inform clients they will be monitored frequently before, during, and after the procedure for safety.
Amnesia: Warn clients they will likely not remember the procedure.
67
Contraindications and Precautions (Benzodiazepines)
Contraindications: Pregnancy, delivery, lactation (teratogenic), acute angle-closure glaucoma, sensitivity to benzodiazepines.
Precautions: Use cautiously in clients with neuromuscular, cardiac, pulmonary, or renal disorders.
68
Interactions (Benzodiazepines)
CNS Depressants: Enhanced effects with concurrent CNS depressants (e.g., anticonvulsants).
Midazolam Toxicity: May occur with concurrent use of cimetidine.
Herbal Products: May increase or decrease the effects of midazolam.
69
Prototype (Opioids for General Anesthesia)
Prototype: Fentanyl
Used as a part of general anesthetic regimen
70
Safety Alert (Opioids for General Anesthesia)
Naloxone Availability: Always have naloxone ready to reverse opioid-induced respiratory depression. Monitor respiratory status carefully.
71
Side Effects (Opioids for General Anesthesia)
Common: Sedation (desired effect during anesthesia), nausea
Serious: Respiratory depression, circulatory collapse
72
Mechanism of Action (Opioids for General Anesthesia)
Mechanism: Narcotic agonists that provide analgesic and sedative effects, valuable as adjuncts to general anesthesia.
73
Interventions (Opioids for General Anesthesia)
Monitor: Vital signs and level of consciousness before, during, and after the procedure.
Nausea: Administer antiemetics as needed to prevent vomiting.
Resuscitation Equipment: Keep nearby in case of respiratory depression.
74
Administration (Fentanyl)
Forms: Available as IV or stick lozenge.
Lozenge: Place between cheek and gum, and instruct clients to suck for 15 minutes or longer—do not chew.
75
Client Instructions (Opioids for General Anesthesia)
Expect: Drowsiness as part of the medication's effect.
Report: Any nausea immediately so antiemetics can be given.
76
Contraindications and Precautions (Fentanyl)
Contraindications: History of substance use disorder, obstetric deliveries (teratogenic, risk of neonatal respiratory depression).
Precautions: Use cautiously in clients with increased intracranial pressure, older adults, young children, and those with cardiac, respiratory, liver, or kidney disorders.
77
Interactions (Fentanyl)
CNS Depressants: Increased risk of sedation and respiratory depression when used with other CNS depressants.
MAOIs: Risk of hypertensive crisis when taken with MAOI antidepressants—ensure clients are not on MAOIs before administration.
78
Prototype (Amphetamines)
Prototype: Amphetamine/Dextroamphetamine Sulfate
Other Medications: Lisdexamfetamine Dimesylate, Methamphetamine Hydrochloride, Dextroamphetamine Sulfate
CNS Stimulant for ADHD and Narcolepsy
79
Safety Alert (Amphetamines)
Hypertensive Crisis Risk: If combined with MAOIs, may result in hypertensive crisis. Ask about MAOI use in the last 2 weeks before prescribing.
79
Mechanism of Action (Amphetamines)
Mechanism: Increases the release of norepinephrine and dopamine, enhancing alertness, energy, mood, and focus. Increases blood pressure, pulse, and respiratory rate.
80
Side Effects (Amphetamines)
Common: Insomnia, nervousness, hypertension, tachycardia, palpitations, weight loss
Serious: Growth suppression in children, risk of misuse and dependence, withdrawal symptoms (depression, fatigue), toxicity (psychosis, dysrhythmias, seizures)
81
Interventions (Amphetamines)
Monitor: Weight, height (in children), blood pressure, pulse, and signs of misuse.
Medication Holidays: Consider for children to avoid growth suppression.
Withdrawal: Taper doses slowly to avoid withdrawal symptoms like depression and fatigue.
82
Administration (Amphetamines)
Forms: Available as regular tablets and extended-release formulations.
Extended Release: Instruct clients not to crush or chew the extended-release form to avoid increased side effects.
83
Client Instructions (Amphetamines)
Avoid Caffeine: Potentiates stimulant effects.
Timing: Take medication early in the day, no later than 4:00 p.m., to prevent insomnia.
Report: Weight loss, palpitations, or cardiovascular symptoms to the provider.
Taper: Do not stop abruptly; taper slowly under provider supervision.
84
Contraindications and Precautions (Amphetamines)
Contraindications: Allergy to amphetamines, moderate to severe hypertension, cardiovascular disease, hyperthyroidism, structural cardiac defects in children
Precautions: Clients with mild hypertension (monitor blood pressure closely), history of medication misuse (risk of dependence)
85
Interactions (Amphetamines)
Increases Cardiac Effects: Stimulants, digoxin, beta blockers, tricyclic antidepressants
Decreases Effects: Ascorbic acid, ammonium chloride
Increases Effects: Sodium bicarbonate, acetazolamide
Dangerous Combination: MAOIs—risk of hypertensive crisis
86
Drug Class (Methylphenidate)
Class: CNS Stimulant for ADHD and Narcolepsy
87
Prototype (Methylphenidate)
Prototype: Methylphenidate
Other Medication: Dexmethylphenidate
88
Mechanism of Action (Methylphenidate)
Mechanism: Increases norepinephrine and dopamine release, improving alertness, energy, and mood, while decreasing appetite and increasing blood pressure, pulse, and respiratory rate.
89
Side Effects (Methylphenidate)
Common: Insomnia, nervousness, hypertension, tachycardia, palpitations
Serious: Weight loss, growth suppression in children, psychosis, dysrhythmias, seizures, potential for misuse and dependence, withdrawal (depression, fatigue)
90
Safety Alert (Methylphenidate)
Hypertensive Crisis Risk: Ensure no recent MAOI use (within 2 weeks) due to risk of hypertensive crisis.
91
Administration (Methylphenidate)
Oral: Give sustained-release forms whole, do not crush or chew.
Transdermal Patch: Apply in the morning, press for 30 seconds, rotate sites daily, and remove after 9 hours to avoid excessive dosing.
91
Interventions (Methylphenidate)
Monitor: Weight and height in children, vital signs (BP, pulse), and signs of misuse.
Medication Holidays: Consider for children to avoid growth suppression.
Withdrawal: Taper doses gradually to avoid withdrawal symptoms.
92
Client Instructions (Methylphenidate)
Avoid Caffeine: Potentiates stimulant effects.
Timing: Take the medication early in the day (last dose before 4 p.m.).
Report: Unexpected weight loss or cardiovascular symptoms to the provider.
Taper Gradually: Do not stop abruptly.
93
Interactions (Methylphenidate)
Increases Cardiac Effects: When used with other stimulants or tricyclic antidepressants.
Dangerous Combination: MAOIs—risk of hypertensive crisis.
93
Contraindications and Precautions (Methylphenidate)
Contraindications: History of medication misuse, allergy to methylphenidate, cardiac dysrhythmias, structural heart defects, psychosis or depression.
Precautions: Use cautiously in children under 6, clients with mild hypertension, or hyperthyroidism (monitor blood pressure closely).
94
Prototype (Non-Amphetamines CNS Stimulant )
Prototype: Modafinil
Other Medication: Armodafinil
CNS Stimulant for ADHD and Narcolepsy
95
Mechanism of Action (Non-Amphetamines CNS Stimulant)
Mechanism: Unclear, but thought to involve blocking the reuptake of norepinephrine, prolonging its action.
96
Administration (Non-Amphetamines CNS Stimulant)
Narcolepsy/Sleep Apnea: Administer in the morning.
Shift-Work Sleepiness: Take 1 hour before work.
97
Side Effects (Non-Amphetamines CNS Stimulant)
Common: Nausea, diarrhea, headache, tachycardia, hypertension
Serious: Rash (risk of Stevens-Johnson syndrome)
98
Safety Alert (Non-Amphetamines CNS Stimulant)
Stevens-Johnson Syndrome: A rare but serious complication involving red/purple rash, blisters, skin sloughing, and possible internal organ damage. Immediate discontinuation and treatment are required.
99
Client Instructions (Non-Amphetamines CNS Stimulant)
With Food: To minimize gastrointestinal distress.
Report: Headache, nervousness, dizziness, palpitations, or any rash/blistering immediately.
Birth Control: Use barrier methods as non-amphetamines reduce the effectiveness of oral contraceptives.
99
Interventions (Non-Amphetamines CNS Stimulant)
Monitor: Vital signs for CNS effects (hypertension, tachycardia).
With Food: To prevent nausea and diarrhea.
Rash: Discontinue immediately if rash or blistering occurs.
100
Contraindications and Precautions (Non-Amphetamines CNS Stimulant)
Contraindications: History of valvular heart disease.
Precautions: Use cautiously in clients with cardiovascular disease, hypertension, liver or kidney impairment, or history of substance misuse. Not recommended for children under 16 or during pregnancy.
101
Interactions (Non-Amphetamines CNS Stimulant)
Decreases Effectiveness of: Oral contraceptives.
Increases Levels of: Warfarin, phenytoin.
Concurrent Use Risks: Diazepam, phenytoin, propranolol, tricyclic antidepressants—may decrease metabolism and increase effects.
102
Prototype (Dopamine-Replacement Medications)
Prototype: Levodopa/Carbidopa
For Parkinson's disease
103
Mechanism of Action (Dopamine-Replacement Medications)
Mechanism: Levodopa crosses the blood-brain barrier and converts to dopamine in dopaminergic neurons, replenishing dopamine levels in the CNS. Carbidopa enhances levodopa's effects by preventing its breakdown in the periphery.
104
Side Effects (Dopamine-Replacement Medications)
Common: Nausea, vomiting, orthostatic hypotension, darkened urine/sweat
Serious: Dyskinesias (movement disorders)
105
Safety Alert (Dopamine-Replacement Medications)
Orthostatic Hypotension: Monitor blood pressure lying, sitting, and standing. Assist clients with ambulation to prevent falls. Watch for a significant drop in systolic or diastolic pressure.
106
Interventions (Dopamine-Replacement Medications)
Monitor: For dyskinesias and adjust dosage or timing if necessary.
Orthostatic Hypotension: Advise slow movements and assist with ambulation.
“On/Off” Phenomenon: Adjust dosing to regulate muscle control throughout the day.
107
Administration (Dopamine-Replacement Medications)
Initial Dose: Start with a low dose and increase gradually.
Timing: Immediate-release tablets work within 30 minutes but wear off quickly, extended-release work over 4-6 hours but take longer to start.
6 Months: Full therapeutic response may take up to 6 months.
108
Client Instructions (Dopamine-Replacement Medications)
With Food: Take with food if necessary but avoid high-protein meals, as they can reduce absorption.
Darkened Urine/Sweat: Inform that this is harmless.
Dizziness: Move slowly from sitting/lying to standing to avoid dizziness.
108
Contraindications and Precautions (Dopamine-Replacement Medications)
Contraindications: Angle-closure glaucoma, history of melanoma, psychosis, suicidal thoughts.
Precautions: Use cautiously with older adults, and clients with renal, hepatic, respiratory, or endocrine disorders, wide-angle glaucoma, peptic ulcer disease, depression, or bipolar disorder.
109
Interactions (Dopamine-Replacement Medications)
Decreases Effectiveness: First-generation antipsychotics (haloperidol), vitamin B6 (pyridoxine).
Delays Absorption: High-protein meals.
Increases Response: Anticholinergic medications.
MAOIs: Risk of hypertensive crisis if taken within 2 weeks of each other.
109
Prototype (Direct-Acting Dopamine Receptor Agonists)
Prototype: Pramipexole
Other Medication: Ropinirole
For Parkinson's disease
110
Mechanism of Action (Direct-Acting Dopamine Receptor Agonists)
Mechanism: Mimics the effects of dopamine by directly binding to dopamine receptors, producing a response similar to the body’s natural dopamine.
111
Side Effects (Direct-Acting Dopamine Receptor Agonists)
Common: Nausea, orthostatic hypotension, dyskinesias, drowsiness, "sleep attacks"
Serious: Muscle weakness, risk of falls
112
Safety Alert (Direct-Acting Dopamine Receptor Agonists)
Falls Risk: Clients with muscle weakness from this medication are at a higher risk for falls. Implement fall-prevention measures, especially for older adults.
113
Interventions (Direct-Acting Dopamine Receptor Agonists)
Monitor: Nausea (give with food), drowsiness, muscle weakness, and abnormal movements (dyskinesias).
Prevent Falls: Assist with ambulation if needed, and monitor for orthostatic hypotension (measure BP sitting and standing).
114
Administration (Direct-Acting Dopamine Receptor Agonists)
Start Low: Begin with a low dose and gradually increase every 5-7 days.
Restless Leg Syndrome: Administer 2-3 hours before bedtime.
115
Client Instructions (Direct-Acting Dopamine Receptor Agonists)
With Food: Take with food if nausea occurs.
Avoid Alcohol: To prevent increased drowsiness.
Report: Muscle weakness, lack of energy, and abnormal movements to the provider.
Move Slowly: To prevent orthostatic hypotension, and taper doses slowly when discontinuing.
116
Contraindications and Precautions (Direct-Acting Dopamine Receptor Agonists)
Contraindications: Allergy to the medication.
Precautions: Use cautiously with clients with psychotic disorders, renal or liver dysfunction, older adults, and those with compulsive behaviors. Safety during pregnancy or lactation is not established.
117
Interactions (Direct-Acting Dopamine Receptor Agonists)
Increases Levels: Cimetidine.
Decreases Effects: Metoclopramide, phenothiazine antipsychotics (chlorpromazine).
Increases Risk for Drowsiness: Alcohol and other CNS depressants.
118
Drug Class (MAO-B Inhibitors)
Class: Antiparkinson Agent / Monoamine Oxidase-B Inhibitors
119
Mechanism of Action (MAO-B Inhibitors)
Mechanism: Inhibits the enzyme monoamine oxidase B, which inactivates dopamine. By blocking MAO-B, dopamine is not broken down, increasing its availability in the brain and improving Parkinson’s symptoms.
120
Safety Alert (MAO-B Inhibitors)
Hypertensive Crisis: If clients experience headache, nausea, vomiting, or blood pressure spikes, measure BP immediately as this may indicate a hypertensive crisis.
120
Prototype (MAO-B Inhibitors)
Prototype: Selegiline
Other Medication: Rasagiline
121
Side Effects (MAO-B Inhibitors)
Common: Insomnia, oral mucosa irritation (orally-disintegrating tablet)
Serious: Hypertensive crisis (at high doses when interacting with foods containing tyramine or ephedrine medications)
122
Interventions (MAO-B Inhibitors)
Monitor: For insomnia, blood pressure (hypertension), and oral mucosa irritation.
Tyramine: Help clients avoid foods high in tyramine (aged cheese, processed meats) and caffeine.
Medication Review: Evaluate other medications for interactions.
123
Administration (MAO-B Inhibitors)
Orally-Disintegrating Tablets: Place on top of the tongue, avoid eating/drinking for 5 minutes before or after.
Timing: Administer in the morning, no later than noon, to prevent insomnia.
124
Client Instructions (MAO-B Inhibitors)
Timing: Take the last dose of the day by noon to prevent insomnia.
Report: Any irritation in the mouth or tongue.
New Medications: Inform the provider before starting any new prescription, over-the-counter, or herbal medications due to the risk of interaction and hypertensive crisis.
125
Contraindications and Precautions (MAO-B Inhibitors)
Contraindications: Hypersensitivity to the medication.
Precautions: Use cautiously in clients with a history of peptic ulcer disease.
126
Interactions (MAO-B Inhibitors)
Dangerous Combinations: Meperidine (Demerol), opioids, tricyclic antidepressants, SSRIs, and other MAOIs—may cause fever, muscle rigidity, and hypertensive crisis.
Food Interactions: Avoid foods with tyramine (aged cheeses, processed meats) and herbal supplements like ephedra, St. John’s wort, and ginseng due to risk of severe hypertension.
Blood Pressure Medications: Antihypertensives and diuretics may cause hypotension when taken together.
127
Prototype (Cholinesterase Inhibitors)
Prototype: Donepezil
Other Medications: Rivastigmine, Galantamine
For Alzheimer's disease
128
Mechanism of Action (Cholinesterase Inhibitors)
Mechanism: Inhibits acetylcholinesterase, increasing acetylcholine availability at receptor sites in the brain, improving cognitive function in Alzheimer's disease.
129
Side Effects (Cholinesterase Inhibitors)
Common: Nausea, vomiting, diarrhea, dizziness, insomnia, headache
Serious: Bradycardia (which may lead to syncope)
130
Safety Alert (Cholinesterase Inhibitors)
Syncope: Bradycardia can lead to fainting episodes. If heart rate drops below 60/min, place the client on bed rest and notify the provider.
131
Interventions (Cholinesterase Inhibitors)
Monitor: For gastrointestinal bleeding, CNS effects, and bradycardia.
With Food: Give the medication with food to reduce nausea.
Assist: With ambulation due to dizziness and risk of syncope.
132
Administration (Cholinesterase Inhibitors)
Oral: Donepezil is given at bedtime, with or without food. Available as tablets, disintegrating tablets, and syrup.
Patch: Rivastigmine is available as a weekly transdermal patch.
133
Client Instructions (Cholinesterase Inhibitors)
Take with Food: To reduce nausea and gastrointestinal discomfort.
Report: Vomiting, severe diarrhea, weight loss, gastrointestinal bleeding, dizziness, or any episodes of fainting.
134
Contraindications and Precautions (Cholinesterase Inhibitors)
Contraindications: Children, history of gastrointestinal bleeding, or allergy to donepezil.
Precautions: Use cautiously with clients with cardiac, GI, or pulmonary disorders, hyperthyroidism, or seizure history.
135
Interactions (Cholinesterase Inhibitors)
Decreases Effects: Anticholinergic medications (e.g., antihistamines).
Increases Risk of GI Bleeding: NSAIDs (e.g., aspirin, ibuprofen).
Safety: Use acetaminophen for mild pain to avoid increased bleeding risk from NSAIDs.
136
Prototype (NMDA Receptor Antagonist)
Prototype: Memantine
For Alzheimer's disease
137
Mechanism of Action (NMDA Receptor Antagonist)
Mechanism: Blocks excess glutamate from stimulating NMDA receptors, reducing calcium influx into neurons. This helps prevent neuronal damage and may slow the progression of Alzheimer's disease.
138
Side Effects (NMDA Receptor Antagonist)
Common: Headache, dizziness, increased confusion
Other: Constipation
139
Safety Alert (NMDA Receptor Antagonist)
CNS Effects: Clients with Alzheimer’s may not recognize dizziness or confusion. Caregivers should monitor for these side effects and report them to the provider.
140
Interventions (NMDA Receptor Antagonist)
Monitor: For CNS effects such as dizziness, headache, and confusion.
Constipation: Monitor bowel movements and provide fiber supplements or laxatives as needed.
141
Administration (NMDA Receptor Antagonist)
Forms: Memantine is available as oral tablets or liquid.
With or Without Food: Can be given with or without food.
142
Client Instructions (NMDA Receptor Antagonist)
Report: Any dizziness, headaches, or increased confusion to the provider.
Constipation: Adjust diet as needed to manage constipation and report if severe.
143
Contraindications and Precautions (NMDA Receptor Antagonist)
Contraindications: Do not give to clients with renal failure.
Precautions: Use cautiously with clients with liver/renal disorders, seizure history, and older adults. Dosage adjustments may be needed.
144
Interactions (NMDA Receptor Antagonist)
Interacts With: Antacids like sodium bicarbonate and medications that increase urine pH, which may raise memantine levels and cause toxicity.
145
Prototype drug for Immunomodulators
Prototype Medications: Interferon beta-1a, Interferon beta-1b
Other Medications: Glatiramer acetate, Natalizumab, Ocrelizumab, Dimethyl fumarate, Fingolimod hydrochloride
For Multiple Sclerosis
146
Mechanism of Action (Immunomodulators)
Mechanism: Inhibit the movement of leukocytes across the blood-brain barrier, protecting the myelin sheath of neurons from autoimmune damage.
147
Side Effects (Immunomodulators)
Common: Flu-like symptoms (fever, headache, chills, myalgia)
Serious: Myelosuppression, liver toxicity, injection site reactions
148
Interventions (Immunomodulators)
Start Low: Begin therapy with a low dose and gradually increase.
Monitor: Liver function tests and blood counts regularly.
Manage Flu-like Symptoms: Recommend acetaminophen for flu-like effects.
148
Safety Alert (Immunomodulators)
Myelosuppression: Monitor for thrombocytopenia and neutropenia, as these increase the risk of bleeding and infection.
Hepatotoxicity: Watch for abdominal tenderness, anorexia, jaundice, and other signs of liver damage.
149
Administration (Immunomodulators)
Form: Oral, IM, IV, or subcutaneous
Self-Administration: Rotate injection sites, apply cool compress before and warm compress after injections.
150
Client Instructions (Immunomodulators)
Flu-like Symptoms: Pre-medicate with acetaminophen.
Report: Unexplained bruising, bleeding, fatigue, and any injection site reactions.
Injection Site Care: Rotate sites, use cool compress before and warm compress after injections.
151
Contraindications and Precautions (Immunomodulators)
Contraindications: Allergies to interferon beta, human albumin, or mannitol
Precautions: Suicidal tendencies, liver disorders, alcohol misuse, seizures, thyroid disorders, or age under 18.
151
Interactions (Immunomodulators)
Interaction: Avoid concurrent use with other immunosuppressants like prednisone due to increased risk of bone marrow suppression.
152
Mechanism of Action (Serotonin Agonists)
Mechanism: Activates 5-HT receptors, promoting vasoconstriction and suppressing the release of CGRP, preventing the inflammatory response and reversing the 5-HT/CGRP ratio.
153
Prototype for Serotonin Agonists
Prototype Medication: Sumatriptan
Other Medications: Zolmitriptan
For Migraine Headache
154
Side Effects (Serotonin Agonists)
Common: Chest pressure, heaviness, tingling sensations, vertigo
Serious: Vasospasm of coronary vessels, anginal pain
155
Safety Alert (Serotonin Agonists)
Chest Heaviness/Angina: Heaviness in the chest could be benign, but it could also indicate coronary vasospasm leading to anginal pain. Monitor vital signs and be cautious of cardiac ischemia.
Excessive Vasoconstriction: Do not exceed the maximum daily dose to avoid compromised blood flow to vital organs.
156
Administration (Serotonin Agonists)
Forms: Oral, nasal spray, subcutaneous injection
Dosing: Oral doses should not exceed 200 mg in 24 hours, nasal doses 40 mg, and subcutaneous injections should not exceed two doses in 24 hours.
156
Interventions (Serotonin Agonists)
Monitor: Vital signs closely after the first dose to detect any vasospasm or coronary issues.
Reassure Clients: Chest pressure is common but should be monitored. Report any unresolved chest pain immediately.
157
Client Instructions (Serotonin Agonists)
Chest Pain: Report chest pressure, tightness, or heaviness in the back, jaw, or throat immediately.
CNS Effects: Report symptoms like tingling or vertigo during the next doctor visit.
158
Contraindications and Precautions (Serotonin Agonists)
Contraindications: History of coronary artery disease, angina, MI, severe hypertension, peripheral vascular disease, or stroke
Precautions: Liver or kidney insufficiency
159
Interactions (Serotonin Agonists)
MAO Inhibitors: Risk of toxicity if taken within 2 weeks of sumatriptan
Ergotamine/Other Triptans: Increased risk of angina if taken within 24 hours
Serotonin Syndrome: Risk with concurrent use of serotonin agonists for other disorders
Herbal Interactions: St. John’s wort increases toxicity risk.
160
What are the only Immunosuppressants used for MS?
The only immunosuppressant currently available and approved to treat Multiple Sclerosis include mitoxantrone, which was originally used in the treatment of cancer, and cladribine.
