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Pharmacology Test #2 > Chonic Neurologic Disorders > Flashcards

Chonic Neurologic Disorders Flashcards

1
Q

What are the two main disease processes that will be covered in this chapter?

A

Parkinsons

Seizure disorders

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2
Q

What is the therapeutic action/outcome for anticholinesterase agents (cholinesterase inhibitors)?

A

blocks cholinesterase from inactivating acetycholine, making Ach more available at receptor sites; used for myasthenia gravis, alzheimers disease, parkinsons disease.. it essentially activates the parasympathetic nervous system and restores the balance between dopamine and Ach

This is aimed at improving strength and perform ADLs (muscle control), prevent episodes of fatigue

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3
Q

What are some adverse effects of anticholinesterase agents?

A

excessive muscarine stimulation (cholinergic effects): n/v, diarrhea, salivation, urinary urgency, blurred vision

cholinergic crisis: respiratory depression, bradycardia

ATROPINE (ANTICHOLINERGIC AGENT) REVERSES CHOLINERGIC SYMPTOMS BY BLOCKING PARASYMPATHETIC ACTIVITY

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4
Q

What are some patient teaching points for patients taking anticholinesterase agents?

A

wear medical alert bracelet (so providers know what may be causing symptoms)

take at the same time every day

BE AWARE OF MUSCARINE SYMPTOMS: URINARY URGENCY, BLURRED VISION, DIARRHEA… may need to adjust dosage

TEACH THEM SIGNS OF CHOLINERGIC CRISIS: EXCESSIVE SALIVATION, SWEATING, RESPIRATORY FAILURE, FLACCID PARALYSIS

make sure they know the medication is not a cure but will help with symptoms

self-adjust dosages based on response (myasthenia gravis)

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5
Q

What is the therapeutic outcome of dopaminergics?

A

Increase the effects of dopamine at receptor sites (most effective treatment for parkinsons disease, usually first-line treatment)

Provides relief from muscle rigidity and increases ability to perform ADLs… does not halt progression

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6
Q

What does carbidopa do to levadopa?

A

increases the therapeutic effects of levadopa (synergistic effect)

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7
Q

What are some adverse effects for dopaminergics?

A

GI - n/v

dyskinesias (tics, tremors, head bobbing, discoordination)

cardiovascular - tachycardia, palpitations, ORTHOSTATIC HYPOTENSION

psychosis - hallucinations

discoloration of sweat and urine - HARMLESS

activated malignant melanoma

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8
Q

What are some nursing considerations for dopaminergics?

A

GI - give with food… but avoid foods high in protein and pyridoxine (decreases effects) - foods like whole grain cereals, legumes (beans), green vegetables, bananas

report signs of dyskinesias - may reduce the dose, or give amantadine (can control symptoms)

cardiovascular - monitor, rise slowly, report adverse effects

Watch out for psychosis (hallucinations)

avoid giving to patients with skin lesions - Activate malignant melanoma

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9
Q

What are some patient teaching points for dopaminergics?

A

report cardiovascular symptoms - tachycardia (palpitations)

report dyskinesias - especially if interfering with quality of life

rise from lying slowly

take with meals

avoid foods high in protein and pridoxine (reduces therapeutic effect

urine and sweat color changes are harmless

Report any new skin lesions

“drug holidays” (a way to learn baseline symptoms) - very controversial

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10
Q

What is the therapeutic outcome of anticholinergics?

A

diminished cholinergic effects (blocks muscarinic receptors), reduced neuron excitability, helps amintain balance between dopamine and ACh

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11
Q

What are some adverse effects for anticholinergics?

A

anticholinergic effects: urinary retention, dry mouth, tachycardia, blurred vision, constipation, photophobia

sedation/drowsiness

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12
Q

What are some nursing considerations for anticholinergics?

A

same as for anticholinergic effects and sedation/drowsiness

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13
Q

What is the therapeutic outcome of barbituates?

A

by depressing impulse conduction, the cerebral cortex, and cerebellar function there is a reduction/suppression of tonic-clonic, muscular, and emotional responses

mainly to reduce seizures!!

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14
Q

What are some adverse effects of barbituates?

A

CNS depression - respiratory, sedation

toxicity - nystagmus, ataxia (lack of muscle control), respiratory depression, coma, pinpoint pupils, hypotension

CAN BE GIVEN TO INDUCE COMA

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15
Q

What is the pregnancy category for barbituates as well as most antiseizure medications including hydantoins?

A

Category D

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16
Q

What do barbituates and hydantoins do to oral contraceptives?

A

decrease their effects

teach two barrier method of birth control

17
Q

What situation is a key use for benzodiazepines?

A

status epilepticus (diazepam, valium)

18
Q

What are some key assessments with the use of benzodiazepines?

A

respiratory (depression/obstruction), BP (hypotension), neuro (sedation)

19
Q

What are two key precautions for the use of benzodiazepines?

A

Have emergency equipment available

have reversal agent (flumazenil (Romazicon)) ready

20
Q

What is the therapeutic outcome/action of hydantoins?

A

Same as barbituates! suppresses seizures!

21
Q

How do first dose hydantoins when using for status epilepticus?

A

LOADING DOSE FIRST

then maintenance dosing

22
Q

What can you mix IV dilantin with?

A

normal saline only

23
Q

What can you mix fosphenytoin sodium (Cerebyx) with?

A

normal saline OR D5W (IV only in the hospital)

24
Q

What are some nursing considerations for hydantoins?

A

Very narrow therapeutic range - monitor serum drug levels

IV administration:
mix phenytoin with normal saline only!!
Fosphenytoin can be given with D5W or NS
Best if given through central lines slowly (infusion)
can be irritating to veins
prevent cardiovascular effects (from fast administration)

decreases effects of oral contraceptives

decreases effectiveness of warfarin

monitor and report cardiovascular effects (ECG)

report to physician if rash occurs (stop medication) (purple glove syndrome, stevens-johnson syndrome)

Monitor WBC and CBC

25
Q

What are some adverse effects of hydantoins?

A

cardiovascular - BRADYCARDIA, dysrhythmias, HYPOTENSION

Integumentary - purple glove syndrome, stevens-johnson syndrome

CNS - nystagmus, sedation, ataxia, slurred speech, loss of balance

endocrine - course facial features, hirsutism (male pattern hair growth in women)

leukopenia, anemia, thrombocytopenia

GINGIVAL HYPERPLASIA/HYPERTROPHY (possible bleeding) - maintain good oral care (chronic maintenance)

26
Q

What are some patient teaching points for hydantoins?

A

Good oral hygiene (gingival hypertrophy/hyperplasia)

take as ordered

avoid other CNS depressants

cautious driving (shouldnt be driving till seizures are controlled anyways)

avoid OTC/ herbal remedies

use back-up birth control

report rashes

report neuro changes

keep lab appointments (narrow therapeutic range, WBC, CBC)

wear medical alert bracelet

27
Q

What are some adverse effects of carbamazepine (tegretol), an AED (other antiepileptic)?

A

Blood dyscrasias - leukopenia, anemia, thrombocytopenia - monitor WBC and CBC REMEMBER THIS

drug-drug interaction with birth contol pills and warfarin (decreases effects of them)

avoid grapefruit juice

28
Q

What are some adverse effects of valproic acid (Depakote, Depakene), and AED (other antilipemic)?

A

liver dysfunction (hepatotoxic) - monitor liver function

take with food if GI upset

thrombocytopenia - monitor CBC

29
Q

What is a key adverse effect of gabapentin (Neurotonin) and ethosoxide (Zarotonin), which are AEDs (other antiepileptics)?

A

CNS effects (sedation) - avoid driving, other CNS depressants

30
Q

What are some main points for most antiseizure medications (except for valproic acid)?

A

dont take with anticoagulants

avoid driving until seizures are controlled

CNS effects! (dont drink alcohol)

pregnancy category D!

many interfere with birth control pills

monitor serum drug levels (narrow ranges)

they are not a cure, they manage symptoms

sudden cessation can trigger seizures

watch out for skin rashes

Pharmacology Test #2 (11 decks)

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