Chonic Neurologic Disorders Flashcards
What are the two main disease processes that will be covered in this chapter?
Parkinsons
Seizure disorders
What is the therapeutic action/outcome for anticholinesterase agents (cholinesterase inhibitors)?
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
What are some adverse effects of anticholinesterase agents?
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
What are some patient teaching points for patients taking anticholinesterase agents?
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)
What is the therapeutic outcome of dopaminergics?
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
What does carbidopa do to levadopa?
increases the therapeutic effects of levadopa (synergistic effect)
What are some adverse effects for dopaminergics?
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
What are some nursing considerations for dopaminergics?
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
What are some patient teaching points for dopaminergics?
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
What is the therapeutic outcome of anticholinergics?
diminished cholinergic effects (blocks muscarinic receptors), reduced neuron excitability, helps amintain balance between dopamine and ACh
What are some adverse effects for anticholinergics?
anticholinergic effects: urinary retention, dry mouth, tachycardia, blurred vision, constipation, photophobia
sedation/drowsiness
What are some nursing considerations for anticholinergics?
same as for anticholinergic effects and sedation/drowsiness
What is the therapeutic outcome of barbituates?
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!!
What are some adverse effects of barbituates?
CNS depression - respiratory, sedation
toxicity - nystagmus, ataxia (lack of muscle control), respiratory depression, coma, pinpoint pupils, hypotension
CAN BE GIVEN TO INDUCE COMA
What is the pregnancy category for barbituates as well as most antiseizure medications including hydantoins?
Category D
What do barbituates and hydantoins do to oral contraceptives?
decrease their effects
teach two barrier method of birth control
What situation is a key use for benzodiazepines?
status epilepticus (diazepam, valium)
What are some key assessments with the use of benzodiazepines?
respiratory (depression/obstruction), BP (hypotension), neuro (sedation)
What are two key precautions for the use of benzodiazepines?
Have emergency equipment available
have reversal agent (flumazenil (Romazicon)) ready
What is the therapeutic outcome/action of hydantoins?
Same as barbituates! suppresses seizures!
How do first dose hydantoins when using for status epilepticus?
LOADING DOSE FIRST
then maintenance dosing
What can you mix IV dilantin with?
normal saline only
What can you mix fosphenytoin sodium (Cerebyx) with?
normal saline OR D5W (IV only in the hospital)
What are some nursing considerations for hydantoins?
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
What are some adverse effects of hydantoins?
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)
What are some patient teaching points for hydantoins?
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
What are some adverse effects of carbamazepine (tegretol), an AED (other antiepileptic)?
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
What are some adverse effects of valproic acid (Depakote, Depakene), and AED (other antilipemic)?
liver dysfunction (hepatotoxic) - monitor liver function
take with food if GI upset
thrombocytopenia - monitor CBC
What is a key adverse effect of gabapentin (Neurotonin) and ethosoxide (Zarotonin), which are AEDs (other antiepileptics)?
CNS effects (sedation) - avoid driving, other CNS depressants
What are some main points for most antiseizure medications (except for valproic acid)?
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
