Bipolar, antiepileptic, muscle spasm drugs

Question 1

mood stabilizer: lithium (lithobid): MOA

Answer 1

unknown
may block serotonin receptor
alter glutamate reuptake/release

Question 2

mood stabilizer: lithium (lithobid) indications

Answer 2

manic episodes
prophylaxis mania/depression

Question 3

mood stabilizer: lithium (lithobid) AE

Answer 3

GI upset
muscle weakness
fine hand tremors
poluria
lethargy
slurred speech

Question 4

mood stabilizer: lithium (lithobid) nursing considerations

Answer 4

therapeutic range: 0.8-1mEq/L
draw labs in AM, 12 hrs after evening dose
initiation= levels every 2-3 days
established dosing= levels every 3-6 months
hemodialysis levels > 2.5mEq/L
improvements seen in 5-7 days
!full benefits in 2-3 weeks!
!adequate hydration!

Question 5

Antiepileptic Drugs: Phenytoin (Dilantin) MOA

Answer 5

decreases Na+ into cell

Question 6

Antiepileptic Drugs: Phenytoin (Dilantin) indications

Answer 6

partial and tonic-clonic seizures, post-neuro sx
off label antiarrhythmic, severe preeclampsia

Question 7

Antiepileptic Drugs: Phenytoin (Dilantin) AE

Answer 7

nystagmus
ataxia
dysarthria
slurred speech
mental confusion
tremor
headache
insomnia
hirsutism
gingival hyperplasia (20% of pt)
increase glucose level
teratogenic effects
purple glove syndrome
!Vesicant!

Question 8

Antiepileptic Drugs: Phenytoin (Dilantin) nursing considerations

Answer 8

therapeutic range: 10-20mcg/ml
toxicity >20
dose adjustments: levels Q 5-7 days, taper off discontinuation
take with food

Question 9

Antiepileptic Drugs: Oxcarbazapine MOA

Answer 9

decreased Na+ into cell

Question 10

Antiepileptic Drugs: Oxcarbazapine indicaitions

Answer 10

partial seizures

Question 11

Antiepileptic Drugs: Oxcarbazapine AE

Answer 11

dizziness
drowsiness
double vision
nystamus
headache
ataxia
hyponatremia
hypothyroidism
stevens-johnson syndrome
hypersensitivity

Question 12

Antiepileptic Drugs: Oxcarbazapine nursing considerations

Answer 12

take without regard to food
XR tablets- swallow whole
decrease effectiveness of oral contraceptives

Question 13

Baclofen (Lioresal) MOA

Answer 13

mimics GABA, no direct effect on muscle strength

Question 14

Baclofen (Lioresal) indications

Answer 14

multiple sclerosis
spinal cord injuries
NOT used for cerebral palsy, stroke, parkinson disease, huntingtons chorea

Question 15

Baclofen (Lioresal) AE

Answer 15

drowsiness
dissiness
weakness
fatigue
abrupt withdrawal= visual hallucinations, paranoid ideations, seizures

Question 16

Baclofen (Lioresal) nursing considerations

Answer 16

monitor neuro especially if on other CNS depressants
monitor UOP especially if exiting BPH or on anticholinergics
taper off slowly
overdose= supportive care only

Question 17

Dantrolene (dantrium) MOA

Answer 17

decreases Ca+ release to decrease muscle contraction

Question 18

Dantrolene (dantrium) indications

Answer 18

MS
cerebral palst
spinal cord injuries
malignant hyperthermia associated with succinylcholine

Question 19

Dantrolene (dantrium) nursing considerations

Answer 19

monitor liver funtion

Question 20

Dantrolene (dantrium) AE

Answer 20

hepatotoxicity

Question 21

Cyclobenzaprine (Flexeril/Amrix) MOA

Answer 21

structurally like TCAs
acts on brainstem to reduce tonic somatic muscle activity

Question 22

Cyclobenzaprine (Flexeril/Amrix) indications

Answer 22

localized muscle spasms/pain

Question 23

Cyclobenzaprine (Flexeril/Amrix) AE

Answer 23

drowsiness & dizziness: mostly during early tx
fatigue
dry mouth
blurred vision
photophobia
urinary retention
constipation
dysrhythmias

Question 24

Cyclobenzaprine (Flexeril/Amrix) nursing considerations

Answer 24

caution against operating heavy machinery