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NURS 2514 > Pharmacology for acute neuro and seizures > Flashcards

Pharmacology for acute neuro and seizures Flashcards

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1
Q

What does mannitol do?

A

Mannitol reduces cerebral edema
It creates an osmotic force in the blood vessels, pulling fluid out of the brain into the blood

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2
Q

Brand name for mannitol

A

Osmitrol

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3
Q

Mannitol MOA

A

Increases osmotic pressure within glomerular filtrate, inhibiting reabsorption of water and electrolytes. Causes excretion of: water, sodium, potassium, chloride, calcium, phosphorus, magnesium, urea, and uric acid

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4
Q

Indication for mannitol

A

Renal failure, edema, increased intracranial pressure

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5
Q

Therapeutic effect of mannitol (Osmitrol)

A

Reduction of intracranial pressure. Urine output at least 30-50 cc/hr

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6
Q

How is mannitol (Osmitrol) administered?

A

Intravenously

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7
Q

Adverse effects of mannitol (Osmitrol)

A

Pulmonary edema
Electrolyte imbalances

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8
Q

Contraindications for mannitol (Osmitrol)

A

Hypersensitivity
Anuria
Dehydration
Pulmonary edema/ congestion

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9
Q

Nursing considerations for mannitol (Osmitrol)

A

Vital signs
Urine output
Signs and symptoms of dehydration
Signs and symptoms of fluid overload
Signs of electrolyte imbalance → confusion, anorexia, weakness, numbness, tingling, excessive thirst
Neurologic status → GSC, orientation
Monitor labs → electrolytes and kidney function (urea and creatinine)

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10
Q

Seizure MOA

A

Seizures involve a discharge from highly excitable neurone that spreads to other parts of the brain, thereby recruiting other neurons to discharge abnormally

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11
Q

Antiepileptic drugs aim to:

A

Suppress discharge of neurons
Suppress spread of seizure activity to other neurons

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12
Q

AED MOA

A

Suppress Na influx
Suppress Ca influx
Promote K efflux
Antagonize glutamate
Potentiate GABA

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13
Q

Patient education highlights for AED

A

Most antiepileptics require plasma drug level monitoring (helps to control seizures quickly)
Patient adherence - requires regular and continuous therapy
All antiepileptic drugs should be withdrawn slowly
Epilepsy and antiepileptic drugs carries a risk for depression in patients. All patients should be monitored for anxiety, agitation, depression, and suicidal ideation
Several antiepileptic drugs decrease the effectiveness of birth control pills
Teratogenic

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14
Q

Example of an osmotic diuretic

A

Mannitol (Osmitrol)

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15
Q

Description of hydantoin

A

Metabolized by liver
Narrow therapeutic window
Small changes in dosing can result in large changes to plasma levels

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16
Q

Small increases in hydantoin dose can lead to

A

toxicity

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17
Q

Small decreases in hydantoin dose can lead to

A

subtherapeutic levels

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18
Q

Brand name of phenytoin

A

Dilantin

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19
Q

Example of hydantoin

A

phenytoin (Dilantin)

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20
Q

Phenytoin (Dilantin) MOA

A

Inhibition of sodium channels, delays sodium channels from becoming active

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21
Q

Indication for phenytoin (Dilantin)

A

All types of seizures except absence seizures
Popular choice for tonic-clonic seizures

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22
Q

Therapeutic effect of phenytoin (Dilantin)

A

Diminished seizure activity

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23
Q

Protein binding info of phenytoin (Dilantin)

A

Dilantin is highly protein bound
Patients with low serum albumin levels will have increased effects of Dilantin
There are more freely unbound active drug present in their body
These patients require lower drug levels of Dilantin

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24
Q

Precautions and contraindications for phenytoin (Dilantin)

A

Hypersensitivity
Sinus bradycardia, heart block (2nd and 3rd degree)
Teratogenic
Use cautiously with depression and suicidal ideation
Use cautiously with renal, liver, cardiac disease

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25
Adverse effects of phenytoin (Dilantin)
Suicidal thoughts Nystagmus, drowsiness, ataxia, diplopia, cognitive impairment Rash Increase blood sugar (rare) Hypotension, cardiac dysrhythmias (IV) Gingival hyperplasia Thrombocytopenia
26
Nursing considerations and assessment for phenytoin (Dilantin)
Monitor mental status closely → suicidal thoughts and changes in behaviour Assess mouth and gums Assess for rash (check for hypersensitivity) → usually within 2 wks of therapy Assess for seizure activity, pt may be monitored with EEG Monitor BP, pulse. ECG heart rhythms when IV Monitor labs → albumin, CBC, calcium, liver enzymes, phenytoin levels during treatment, blood sugar
27
Patient education for phenytoin (Dilantin)
Avoid alcohol and CNS depressants because will cause extreme drowsiness Do not skip doses Have med alert bracelet Diabetic patients should monitor blood sugars
28
Nursing care for phenytoin (Dilantin)
Implement seizure precautions For pts with tube feed → stop feed 2hrs before and 2hrs after PO admin IV phenytoin → never mix w/ dextrose ONLY normal saline Monitor IV site closely → purple glove syndrome Use special tubing w/ a filter Admin IV slowly
29
Drug example for benzodiazepine
Lorazepam (Ativan)
30
Lorazepam (Ativan) MOA
Potentiated GABA
31
Indication for lorazepam (Ativan)
Anxity disorders Insomnia Seizures
32
Therapeutic effect of lorazepam (Ativan)
Decreased seizures
33
Additional info for lorazepam (Ativan)
Seizure rescue med - excellent for status epilepticus
34
Adverse effects of lorazepam (Ativan)
Apnea, respiratory depression Bradycardia, hypotension Drowsiness, lethargy, dizziness Can lead to physical dependence
35
Precautions/ contraindications for lorazepam (Ativan)
Hypersensitivity Patients with pre-existing CNS depression Severe hypotension Sleep apnea Pregnancy
36
Nursing considerations for lorazepam (Ativan)
Antidote → Flumazenil, but if given to someone with seizures then could induce a seizures Do not take with other CNS depressants or alcohol, do not drive or engage in activities requiring alertness Assess levels of consciousness, vitals, respiratory status
37
Drug example of barbiturates
Phenobarbital (Ancalixir)
38
Phenobarbital (Ancalixir) MOA
Produces all levels of CNS depression. Inhibits impulse transmission in the CNS and raises seizure threshold. Binds to GABA receptors, causing the receptors to respond more intensely to GABA
39
Indication for phenobarbital (Ancalixir)
Seizures Sedation
40
Therapeutic effect of phenobarbital (Ancalixir)
Anticonvulsant activity
41
Additional info of phenobarbital (Ancalixir)
Takes 2-3 weeks for plasma levels to reach a steady therapeutic state, therefore loading doses are often given to increase serum levels
42
Precautions/ contraindications for phenobarbital (Ancalixir)
Hypersensitivity Pre-existing CNS depression Respiratory disease Use cautiously in: liver disease, renal impairment, history of suicide attempts/ depression, history of drug abuse Use in pregnancy will cause dependence in fetus Teratogenic
43
Adverse effects of phenobarbital (Ancalixir)
Drowsiness Respiratory depression Bronchospasm Physical dependence and addiction Hypotension when given IV Thrombocytopenia
44
Nursing considerations and assessment for phenobarbital (Ancalixir)
Monitor respiratory status, pulse, BP Monitor pt carefully if hx of depression, suicidal ideation, or drug dependence Assess for level of consciousness Assess seizure activity Labs → hepatic and renal function blood work, CBC, phenobarbital serum levels Institute seizure and fall precautions Doses should be decreased gradually
45
Patient education for phenobarbital (Ancalixir)
Do not abruptly stop Do not skip doses Do not take with other CNS depressants or alcohol
46
Drug family of carbamazepine (Tegretol)
Anticonvulsant
47
Carbamazepine (Tegretol) MOA
Decreases synaptic transmission in the CNS by affecting sodium channels in neurons
48
Indication for carbamazepine (Tegretol)
Most seizure types, not absence seizures
49
Therapeutic effect of carbamazepine (Tegretol)
Prevention of seizures
50
Additional info for carbamazepine (Tegretol)
Preferred drug because it has less adverse effects than others Minimal effects on cognitive function
51
Precautions/ contraindications for carbamazepine (Tegretol)
Hypersensitivity Bone marrow suppression (on chemo) Use cautiously in: pregnancy, depression/ suicidal, liver disease, renal impairment, heart disease
52
Adverse effects of carbamazepine (Tegretol)
Neurologic effects → nystagmus blurred vision, diplopia, ataxia, more common in beginning then decreases (minimized with low dose) Bone marrow suppression → cause neutropenia, anemia, and thrombocytopenia (rare; improves after discontinuation) Teratogenic Water retention → secretion of antidiuretic hormone
53
Nursing consideration and assessment for carbamazepine (Tegretol)
Monitor mental status Assess seizure activity Monitor CBC → platelets, RBC, WBC, d/c if signs of bone marrow suppression Liver function tests and renal lab work, carbamazepine serum levels Avoid grapefruit juice → can inhibit drug metabolism and increase peak levels of drugs
54
Valproic acid (Depakene) drug family
Anticonvulsant
55
Valproic acid (Depakene) MOA
Suppresses neuronal firing by blocking sodium channels Suppresses calcium influx Increases levels of GABA
56
Indication for valproic acid (Depakene)
Treats all major seizure types Bipolar disorder Migraine headaches
57
Therapeutic effect of valproic acid (Depakene)
Suppression of seizure activity
58
Additional info for valproic acid (Depakene)
Generally well tolerated
59
Contraindicatins/ precautions for valproic acid (Depakene)
Hypersensitivity Liver and renal impairment Use cautiously in patients with bleeding disorders and bone marrow suppression Use cautiously in patients with depression and suicidal thoughts Teratogenic
60
Adverse effects of valproic acid (Depakene)
Gastrointestinal effects → nausea/ vomiting, indigestion, take w/ food to minimize symptoms Hepatotoxic Pancreatitis Highly teratogenic, especially in first trimester
61
Nursing considerations and assessment for valproic acid (Depakene)
Assess for seizure activity Assess mental status, behaviour changes Monitor CBC (platelets, WBC, RBC) Monitor liver function tests, monitor serum drug levels
62
Patient education for valproic acid (Depakene)
Med alert bracelet Do not skip doses Take as ordered Do not drive or engage in activities requiring alertness
63
Drug family of gabapentin (Neurontin)
Anticonvulsant
64
MOA of gabapentin (Neurontin)
Exact MOA unknown Thought to increase GABA release
65
Indication for gabapentin (Neurontin)
Neuropathic pain Migraines Partial seizures (Adjunctive therapy for seizures)
66
Therapeutic effect of gabapentin (Neurontin)
Decreased incidence of seizures
67
Precautions and contraindications for gabapentin (Neurontin)
Hypersensitivity Use cautiously in patients with depression and suicidal thoughts Use cautiously with renal disease
68
Adverse effects of gabapentin (Neurontin)
Mild to mod side effects - drowsiness and dizziness Considered a very safe med Elderly patients eliminate the drug slowly and more susceptible to side effects → greater fall risk Does not interact with other meds
69
Nursing considerations and assessments for gabapentin (Neurontin)
Monitor mental status - assess for depression and suicidal thoughts Assess seizure activity
70
Drug family of levetiracetam (Keppra)
Anticonvulsant
71
Levetiracetam (Keppra) MOA
unknown
72
Indication for levetiracetam (Keppra)
All types of seizures (adjunct for partial seizures and generalized seizures) Migraines Bipolar disorder
73
Therapeutic effect of levetiracetam (Keppra)
Decreased seizure activity
74
Contraindications and precautions for levetiracetam (Keppra)
Hypersensitivity Use cautiously in renal impairment Could pose risk to fetus, should not be taken while breastfeeding
75
Adverse effects of levetiracetam (Keppra)
Renal injury Side effects generally mild otherwise Does not affect cognition, concentration, or speech Drowsiness and weakness Very rare → agitation, anxiety, depression, psychosis, hallucinations
76
Nursing considerations and assessments for levetiracetam (Keppra)
Assess seizure activity Assess for weakness and drowsiness Assess for behavioural changes, emotional lability during first 4 wks of therapy Advise pt to notify if changes in thought processes
77
Drug family of topiramate (Topamax)
Anticonvulsant
78
Topiramate (Topamax) MOA
Potentiates GABA Blockage of sodium channels Blockage of calcium channels Blockage of glutamate receptors
79
Indication for topiramate (Topamax)
Adjunctive therapy for partial and generalized seizures Bipolar disorder Headaches Eating disorders
80
Therapeutic effect of topiramate (Topamax)
Decreased incidence of seizures
81
Contraindications and precautions of topiramate (Topamax)
Hypersensitivity In patients who regularly drink alcohol Breastfeeding, teratogenic Use cautiously in patients with depression and suicidal thoughts, liver and renal impairment, dehydration
82
Important info for topiramate (Topamax)
NO alcohol use within 6 hrs before and 6 hrs after taking meds
83
Adverse effects of topiramate (Topamax)
Drowsiness, dizziness Weight loss, anorexia Metabolic acidoses → increases renal excretion of bicarb, causing pH to decrease, leading to hyperventilation to compensate Suicide ideation - higher risk Anemia Decreased sweating → hyperthermia
84
Nursing considerations and assessment for topiramate (Topamax)
Monitor for changes in behaviour and mood Assess seizure activity Monitor labs → CBC, liver enzymes, serum bicarb Advice against driving or activities requiring alertness Change positions slowly No alcohol with this med May affect hormonal contraceptive effectiveness

NURS 2514 (14 decks)

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