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NURS 2514 > ACUTE NEURO/SEIZURES MEDS > Flashcards

ACUTE NEURO/SEIZURES MEDS Flashcards

1
Q

What is the MOA of Mannitol (Osmitrol)?

A
  • increases osmotic pressure with GF –> inhibiting reabsorption of water and electrolytes
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2
Q

What does Mannitol (Osmitrol) excrete?

A

-H20
-Na
-K
-Cl
-Ca
-P
-Mg
-urea
-uric acid

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3
Q

What is the indication for Mannitol (Osmitrol)?

A

increased ICP

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4
Q

What is the therapeutic effect of Mannitol (Osmitrol)?

A
  • reduction of intracranial pressure
  • UO –> at least 30-50 cc/hr
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5
Q

What are the adverse effects of Mannitol (Osmitrol)?

A
  • pulmonary edema
  • electrolyte imbalances
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6
Q

What are the CI of Mannitol (Osmitrol)?

A
  • hypersensitivity
  • anuria
  • dehydration
  • pulmonary edema/congestion
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7
Q

What are the nursing considerations and assessment of Mannitol (Osmitrol)?

A

assess:
- VS
- UO
- s/s of dehydration
- s/s of fluid overload
- signs of electrolyte imbalance (confusion, anorexia, weakness, numbness, tingling, excessive thirst)
- neurologic status –> GCS, orientation

nursing considerations:
- monitor labs –> electrolytes + kidney function (urea, cr)
- administered IV

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8
Q

What is the classification of Phenytoin (Dilantin)?

A

Hydantoin

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9
Q

What is the MOA of Phenytoin (Dilantin)?

A

inhibition of Na+ channels –> delays Na+ channels from becoming active

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10
Q

What is the indication for Phenytoin (Dilantin)?

A
  • all types of seizures except absence seizures
  • popular choice for tonic-clonic seizures
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11
Q

What is the therapeutic effect of Phenytoin (Dilantin)?

A

diminished seizure activity

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12
Q

What is the pharmacokinetics of Phenytoin (Dilantin)?

A
  • metabolized by the liver
  • very narrow TI
  • small changes (changes to plasma lvls, toxicity, or subtherapeutic lvls)
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13
Q

What are the CI and precautions of Phenytoin (Dilantin)?

A
  • hypersensitivity
  • sinus bradycardia, heart block (2nd/3rd degree_
  • teratogenic

precautions:
- pts with depression, suicidal ideation
- pts with renal/liver/cardiac disease
- low albumin lvls (require lower drug levels)

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14
Q

What are the adverse effects of Phenytoin (Dilantin)?

A
  • suicidal thoughts
  • nystagmus, drowsiness, ataxia diplopia, cognitive impairment
  • rash
  • rare: increase blood sugar
  • IV: hypotension, cardiac dysrhythmias
  • GINGIVAL HYPERPLASIA
  • thrombocytopenia
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15
Q

What are the nursing considerations and assessments of Phenytoin (Dilantin)?

A

assess:
- mental status (suicidal thoughts/changes in behaviour)
- mouth and gums
- rash (hypersensitivity) –> within 2 weeks of therapy
- seizure activity
- BP/P
- IV: ECG rhythms
- monitor labs (albumin, CBC, calcium, liver enzymes, Phenytoin lvls, blood sugar)

nursing considerations:
- pt education on vigorous teeth cleanings
- avoid alcohol and CNS depressants (increase drowsiness)
- do not skip doses
- med alert bracelet
- DM pts monitor BG closely
- highly protein bound med

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16
Q

What are the special nursing care of Phenytoin (Dilantin)?

A
  • implement seizure precautions
  • tube feeds –> stopped 2hrs before and 2hrs after PO admin
  • IV Phenytoin never mix with dextrose (will crystalize) –> USE ONLY NS
  • monitor IV site closely (risk of PURPLE GLOVE SYNDROME)
  • use special tubing with a filter
  • administer IV slowly
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17
Q

What is the classification of Lorazepam (Ativan)?

A

Benzodiazepine

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18
Q

What is the MOA of Lorazepam (Ativan)?

A

potentiates GABA

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19
Q

What is the indication for Lorazepam (Ativan)?

A

seizures

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20
Q

What is the therapeutic effect of Lorazepam (Ativan)?

A

decreased seizures

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21
Q

What are the CI and precautions of Lorazepam (Ativan)?

A
  • hypersensitivity
  • pts with pre-existing CNS depression
  • severe hypotension
  • sleep apnea
  • pregnancy
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22
Q

What are the adverse effects of Lorazepam (Ativan)?

A
  • APNEA, RESP DEPRESSION
  • bradycardia, hypotension
  • drowsiness, lethargy, dizziness
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23
Q

What are the nursing considerations and assessments of Lorazepam (Ativan)?

A

assess:
- LOC
- VS
- resp. status

nursing considerations:
- antidote (FLUMAZENIL) –> could induce seizure
- do not take other CNS depressants or alcohol
- do not drive or engage in activities requiring alertness
- can lead to physical dependence
- seizure rescue med (PERF FOR STATUS EPILEPTICUS)

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24
Q

What is the classification of Phenobarbital (Ancalixir)?

A

Barbiturates

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25
Q

What is the MOA of Phenobarbital (Ancalixir)?

A
  • produces all lvls of CNS depression
  • inhibits impulse transmission in the CNS and raises seizures threshold
  • binds to GABA receptors (respond more intensely to GABA)
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26
Q

What is the indication for Phenobarbital (Ancalixir)?

A
  • seizures
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27
Q

What is the therapeutic effect of Phenobarbital (Ancalixir)?

A

anticonvulsant activity

28
Q

What are the CI and precautions of Phenobarbital (Ancalixir)?

A
  • hypersensitivity
  • pre-existing CNS depression
  • resp disease
  • teratogenic (cause dependence in fetus)

precautions:
- liver disease
- renal impairment
- history of suicide attempts/depression
- history of drug abuse

29
Q

What are the adverse effects of Phenobarbital (Ancalixir)?

A
  • drowsiness
  • resp depression
  • bronchospasm
  • physical dependence/addiction
  • hypotension (IV)
  • thrombocytopenia
30
Q

What are the nursing considerations and assessments of Phenobarbital (Ancalixir)?

A

assess:
- resp status
- BP/P
- history of depression, suicidal ideation, drug dependence
- LOC
- seizure activity
- labs (hepatic and renal function, CBC, phenobarb. serum lvls)

nursing considerations:
- takes 2-3 weeks for plasma lvls to reach a steady therapeutic state
- institute seizure and fall precautions
- doses should be decreased gradually
- do not abruptly stop
- do not skip doses
- avoid CNS depressants/alcohol

31
Q

What is the classification of Carbamazepine (Tegretol)?

A

anticonvulsant

32
Q

What is the MOA of Carbamazepine (Tegretol)?

A

decreases synaptic transmission in the CNS by affecting Na channels in neurons

33
Q

What is the indication for Carbamazepine (Tegretol)?

A

most seizure types (not absence seizures)

34
Q

What is the therapeutic effect of Carbamazepine (Tegretol)?

A

prevention of seizures

35
Q

What are the CI and precautions of Carbamazepine (Tegretol)?

A
  • hypersensitivity
  • bone marrow suppression (on chemo)

precautions:
- pregnancy
- depression/suicidal
- liver disease
- renal impairment
- heart disease

36
Q

What are the adverse effects of Carbamazepine (Tegretol)?

A
  • neurologic effects (nystagmus, blurred vision, diplopia, ataxia) –> common at the start and decreases, minimized low doses
  • bone marrow suppression (neutropenia, anemia, thrombocytopenia) –> rare, improves after d/c
  • teratogenic (birth defects)
  • water retention (secretion of antidiuretic hormone
37
Q

What are the nursing considerations and assessments of Carbamazepine (Tegretol)?

A

assess:
- mental status (suicide risk/depression)
- seizure activity
- CBC (platelets, RBC, WBC)
- LFTs, renal lab, carbamazepine serum levels

nursing considerations:
- d/c if signs of bone marrow suppression
- avoid grapefruit juice (inhibits drug metabolism, increase peak lvls of drugs)
- preferred drug (less adverse effects than others)
- minimal effects on cognitive function

38
Q

What is the classification of Valproic Acid (Depakene)?

A

anticonvulsant

39
Q

What is the MOA of Valproic acid (Depakene)?

A
  • suppresses neuronal firing by blocking Na channels
  • suppresses calcium influx
  • increase lvls of GABA
40
Q

What is the indication of Valproic acid (Depakene)?

A

treats all major seizure types

41
Q

What is the therapeutic effect of Valproic acid (Depakene)?

A

suppression of seizure activity

42
Q

What are the CI and precautions of Valproic acid (Depakene)?

A
  • hypersensitivity
  • liver/renal impairment
  • teratogenic

precautions:
- pts w/ bleeding disorder and bone marrow suppression
- pts w/ depression and suicidal thoughts

43
Q

What are the adverse effects of Valproic acid (Depakene)?

A
  • GI effects (N/V, indigestion)
  • hepatotoxic
  • pancreatitis
  • highly teratogenic (in 1st trimester
44
Q

What are the nursing considerations and assessments of Valproic acid (Depakene)?

A

assess:
- seizure activity
- mental status, behaviour changes
- CBC (platelets, WBC, RBC)
- LFTs, monitor serum drug lvls

nursing considerations;
- med alert bracelet
- do not skip doses
- take as ordered
- do not drive or engage in activities requiring alertness
- generally, well tolerated
- administer w/ food to minimize GI effects

45
Q

What is the classification of Gabapentin (Neurontin)?

A

anticonvulsant

46
Q

What is the MOA of Gabapentin (Neurontin)?

A

increase GABA release (still unknown)

47
Q

What indication for Gabapentin (Neurontin)?

A

partial seizures (adjunctive therapy for seizures)

48
Q

What is the therapeutic effect of Gabapentin (Neurontin)?

A

decreased incidence of seizures

49
Q

What are the CI and precautions of Gabapentin (Neurontin)?

A
  • hypersensitivity

precautions:
- pts w/ depression, suicidal thoughts
- renal disease

50
Q

What are the adverse effects of Gabapentin (Neurontin)?

A

mild to moderate
- drowsiness, dizziness
- elderly (eliminate drug more slowly and are more susceptible to side effects) –> greater risk of FALLS

51
Q

What are the nursing considerations and assessments of Gabapentin (Neurontin)?

A

assess:
- mental status (depression/suicidal thoughts)
- seizure activity

nursing considerations:
- considered a very safe med
- does not interact with other meds

52
Q

What is the classification of Levetiracetam (Keppra)?

A

anticonvulsant

53
Q

What is the MOA of Levetiracetam (Keppra)?

A

UNKNOWN

54
Q

What is the indication for Levetiracetam (Keppra)?

A

all types of seizures (adjunct for partial seizures and generalized seiuzres)

55
Q

What is the therapeutic effect of Levetiracetam (Keppra)?

A

decreased seizure activity

56
Q

What are the CI and precautions of Levetiracetam (Keppra)?

A
  • hypersensitivity
  • breast feeding

precautions:
- renal impairment

57
Q

What are the adverse effects of Levetiracetam (Keppra)?

A

generally mild
- renal injury
- drowsiness, weakness
-RARE: agitation, anxiety, depression, psychosis, hallucinations

58
Q

What are the nursing considerations and assessments of Levetiracetam (Keppra)?

A

assess:
- seizure activity
- weakness, drowsiness
- behavioural changes, emotional lability (first 4 weeks of therapy)

nursing considerations:
- advise pt to notify if they have changes in thought processes (suicidal thoughts, depression)
- generally mild side effects
- does not affect cognition, concentration, speech

59
Q

What is the classification of Topiramate (Topamax)?

A

anticonvulsant

60
Q

What is the MOA of Topiramate (Topamax)?

A
  • potentiates GABA
  • blockage of: Na channels, Ca channels, glutamate receptors
61
Q

What is the indication of Topiramate (Topamax)?

A

adjunctive therapy for partial and generalized seizures

62
Q

What is the therapeutic effect of Topiramate (Topamax)?

A

decreased incidence of seizures

63
Q

What are the CI and precautions of Topiramate (Topamax)?

A
  • hypersensitivity
  • pts who regularly drink alcohol
  • breast feeding, TERATOGENIC

precautions:
- pts with depression/suicidal thoughts
- liver/renal impairment
- dehydration

64
Q

What are the adverse effects of Topiramate (Topamax)?

A
  • drowsiness, dizziness
  • weight loss, anorexia
  • metabolic acidosis (increases excretion of bicarbonate, causing pH to decrease) –> hyperventilation
  • suicidal ideation (HIGHER RISK)
  • anemia
  • decreased sweating (hyperthermia)
65
Q

What are the nursing considerations and assessments of Topiramate (Topamax)?

A

assess:
- changes in behaviour/mood
- seizure activity
- labs (CBC, liver enzymes, serum bicarb)

nursing considerations;
- avoid driving or activities requiring alertness
- change positions slowly
- NO ALCOHOL (6hrs before and after)
- may affect hormonal contraceptive effectiveness

NURS 2514 (4 decks)

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