ACUTE NEURO/SEIZURES MEDS Flashcards
What is the MOA of Mannitol (Osmitrol)?
- increases osmotic pressure with GF –> inhibiting reabsorption of water and electrolytes
What does Mannitol (Osmitrol) excrete?
-H20
-Na
-K
-Cl
-Ca
-P
-Mg
-urea
-uric acid
What is the indication for Mannitol (Osmitrol)?
increased ICP
What is the therapeutic effect of Mannitol (Osmitrol)?
- reduction of intracranial pressure
- UO –> at least 30-50 cc/hr
What are the adverse effects of Mannitol (Osmitrol)?
- pulmonary edema
- electrolyte imbalances
What are the CI of Mannitol (Osmitrol)?
- hypersensitivity
- anuria
- dehydration
- pulmonary edema/congestion
What are the nursing considerations and assessment of Mannitol (Osmitrol)?
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
What is the classification of Phenytoin (Dilantin)?
Hydantoin
What is the MOA of Phenytoin (Dilantin)?
inhibition of Na+ channels –> delays Na+ channels from becoming active
What is the indication for Phenytoin (Dilantin)?
- all types of seizures except absence seizures
- popular choice for tonic-clonic seizures
What is the therapeutic effect of Phenytoin (Dilantin)?
diminished seizure activity
What is the pharmacokinetics of Phenytoin (Dilantin)?
- metabolized by the liver
- very narrow TI
- small changes (changes to plasma lvls, toxicity, or subtherapeutic lvls)
What are the CI and precautions of Phenytoin (Dilantin)?
- 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)
What are the adverse effects of Phenytoin (Dilantin)?
- suicidal thoughts
- nystagmus, drowsiness, ataxia diplopia, cognitive impairment
- rash
- rare: increase blood sugar
- IV: hypotension, cardiac dysrhythmias
- GINGIVAL HYPERPLASIA
- thrombocytopenia
What are the nursing considerations and assessments of Phenytoin (Dilantin)?
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
What are the special nursing care of Phenytoin (Dilantin)?
- 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
What is the classification of Lorazepam (Ativan)?
Benzodiazepine
What is the MOA of Lorazepam (Ativan)?
potentiates GABA
What is the indication for Lorazepam (Ativan)?
seizures
What is the therapeutic effect of Lorazepam (Ativan)?
decreased seizures
What are the CI and precautions of Lorazepam (Ativan)?
- hypersensitivity
- pts with pre-existing CNS depression
- severe hypotension
- sleep apnea
- pregnancy
What are the adverse effects of Lorazepam (Ativan)?
- APNEA, RESP DEPRESSION
- bradycardia, hypotension
- drowsiness, lethargy, dizziness
What are the nursing considerations and assessments of Lorazepam (Ativan)?
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)
What is the classification of Phenobarbital (Ancalixir)?
Barbiturates
What is the MOA of Phenobarbital (Ancalixir)?
- 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)
What is the indication for Phenobarbital (Ancalixir)?
- seizures
What is the therapeutic effect of Phenobarbital (Ancalixir)?
anticonvulsant activity
What are the CI and precautions of Phenobarbital (Ancalixir)?
- 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
What are the adverse effects of Phenobarbital (Ancalixir)?
- drowsiness
- resp depression
- bronchospasm
- physical dependence/addiction
- hypotension (IV)
- thrombocytopenia
What are the nursing considerations and assessments of Phenobarbital (Ancalixir)?
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
What is the classification of Carbamazepine (Tegretol)?
anticonvulsant
What is the MOA of Carbamazepine (Tegretol)?
decreases synaptic transmission in the CNS by affecting Na channels in neurons
What is the indication for Carbamazepine (Tegretol)?
most seizure types (not absence seizures)
What is the therapeutic effect of Carbamazepine (Tegretol)?
prevention of seizures
What are the CI and precautions of Carbamazepine (Tegretol)?
- hypersensitivity
- bone marrow suppression (on chemo)
precautions:
- pregnancy
- depression/suicidal
- liver disease
- renal impairment
- heart disease
What are the adverse effects of Carbamazepine (Tegretol)?
- 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
What are the nursing considerations and assessments of Carbamazepine (Tegretol)?
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
What is the classification of Valproic Acid (Depakene)?
anticonvulsant
What is the MOA of Valproic acid (Depakene)?
- suppresses neuronal firing by blocking Na channels
- suppresses calcium influx
- increase lvls of GABA
What is the indication of Valproic acid (Depakene)?
treats all major seizure types
What is the therapeutic effect of Valproic acid (Depakene)?
suppression of seizure activity
What are the CI and precautions of Valproic acid (Depakene)?
- hypersensitivity
- liver/renal impairment
- teratogenic
precautions:
- pts w/ bleeding disorder and bone marrow suppression
- pts w/ depression and suicidal thoughts
What are the adverse effects of Valproic acid (Depakene)?
- GI effects (N/V, indigestion)
- hepatotoxic
- pancreatitis
- highly teratogenic (in 1st trimester
What are the nursing considerations and assessments of Valproic acid (Depakene)?
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
What is the classification of Gabapentin (Neurontin)?
anticonvulsant
What is the MOA of Gabapentin (Neurontin)?
increase GABA release (still unknown)
What indication for Gabapentin (Neurontin)?
partial seizures (adjunctive therapy for seizures)
What is the therapeutic effect of Gabapentin (Neurontin)?
decreased incidence of seizures
What are the CI and precautions of Gabapentin (Neurontin)?
- hypersensitivity
precautions:
- pts w/ depression, suicidal thoughts
- renal disease
What are the adverse effects of Gabapentin (Neurontin)?
mild to moderate
- drowsiness, dizziness
- elderly (eliminate drug more slowly and are more susceptible to side effects) –> greater risk of FALLS
What are the nursing considerations and assessments of Gabapentin (Neurontin)?
assess:
- mental status (depression/suicidal thoughts)
- seizure activity
nursing considerations:
- considered a very safe med
- does not interact with other meds
What is the classification of Levetiracetam (Keppra)?
anticonvulsant
What is the MOA of Levetiracetam (Keppra)?
UNKNOWN
What is the indication for Levetiracetam (Keppra)?
all types of seizures (adjunct for partial seizures and generalized seiuzres)
What is the therapeutic effect of Levetiracetam (Keppra)?
decreased seizure activity
What are the CI and precautions of Levetiracetam (Keppra)?
- hypersensitivity
- breast feeding
precautions:
- renal impairment
What are the adverse effects of Levetiracetam (Keppra)?
generally mild
- renal injury
- drowsiness, weakness
-RARE: agitation, anxiety, depression, psychosis, hallucinations
What are the nursing considerations and assessments of Levetiracetam (Keppra)?
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
What is the classification of Topiramate (Topamax)?
anticonvulsant
What is the MOA of Topiramate (Topamax)?
- potentiates GABA
- blockage of: Na channels, Ca channels, glutamate receptors
What is the indication of Topiramate (Topamax)?
adjunctive therapy for partial and generalized seizures
What is the therapeutic effect of Topiramate (Topamax)?
decreased incidence of seizures
What are the CI and precautions of Topiramate (Topamax)?
- hypersensitivity
- pts who regularly drink alcohol
- breast feeding, TERATOGENIC
precautions:
- pts with depression/suicidal thoughts
- liver/renal impairment
- dehydration
What are the adverse effects of Topiramate (Topamax)?
- drowsiness, dizziness
- weight loss, anorexia
- metabolic acidosis (increases excretion of bicarbonate, causing pH to decrease) –> hyperventilation
- suicidal ideation (HIGHER RISK)
- anemia
- decreased sweating (hyperthermia)
What are the nursing considerations and assessments of Topiramate (Topamax)?
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
