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488 > Class 6: Neuro & AED > Flashcards

Class 6: Neuro & AED Flashcards

1
Q

Antiepileptic drugs goals of therapy & length

A

-AKA anticonvulsants
-Control/prevent seizures
-Lifelong therapy, a combination of drugs may be used

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2
Q

AED therapy & what to monitor

A

-Single-drug therapy is tried first
-Measure phenytoin (dilantin) serum concentrations

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3
Q

AED effect

A

-Prevent generation and spread of electrical discharge from dysfunctional nerves
-Protect surrounding cells
-Neurons are stabilized

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4
Q

AED MOA

A

-Exact MOA is unknown
-Thought to alter movement of Na+, K+ and Ca+ ions across nerve cells in the brain to reduce nerve excitability

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5
Q

AED indications

A

-Long-term therapy of seizures
-Acute tx of convulsions and status epilepticus
Other uses: BPD

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6
Q

Most common first line seizure drugs

A

-CPPPF
-Carbamazepine, phenobarbital, primidone, phenytoin, & fosphenytoin
-Used for focal, secondary & tonic-clonic seizures

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7
Q

Adjunct seizure drugs

A

-ACOZ
-Acetazolomide, clonazepine, oxcarbazepine & zonisamide

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8
Q

Clonazepine is used in…

A

Focal, secondary, tonic-clonic, & myoclonic seizures

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9
Q

First-line & adjunct drugs for focal seizures

A

-First-line: CPPPF
-Adjunct drugs: Clonazepam, oxcarbazepine, topiramate, gabapentin, clorazepate, pregabalin, lamotrigine, levetiracetam & perampanel

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10
Q

First-line & adjunct drugs for secondary generalized seizures

A

-First line: CPPPF & lamotrigine
-Adjunct: Clonazepam, oxcarbazepine, topiramate, gabapentin, & levetiracetam

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11
Q

First-line & adjunct drugs for generalized tonic-clonic seizures

A

-First-line: CPPPF, lamotrigine & valproic acid
-Adjunct: Clonazepine, zonisamide & topiramate

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12
Q

First-line & adjunct drugs for absent seizures

A

-First-line: Valproic acid & ethosuximide
-Adjunct: Acetazolamide

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13
Q

First-line & adjunct drugs for myoclonic seizures

A

-First-line: Valproic acid
-Adjunct: Clonazepam

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14
Q

Diazepam IV dose

A

5-10mg

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15
Q

Diazepam onset, duration & half-life

A

-Onset: 3-10 min
-Duration: Minutes
-Half-life: 35 hr

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16
Q

Diazepam adverse effects

A

-Apnea, hypotension & somnolence (sleepy/drowsy) (same as lorazepam)

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17
Q

Fosphenytoin IV dose

A

15-20 phenytoin equivalents/kg

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18
Q

Fosphenytoin onset, duration & half-life

A

-Onset: 15-30 min
-Duration: 12-24hr (same as phenytoin)
-Half-life: 10-60hr

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19
Q

Fosphenytoin adverse effects

A

-Dysrhythmias & hypotension (same as phenytoin)

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20
Q

Lorazepam IV dose

A

0.05mg/kg (max 4mg)

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21
Q

Lorazepam onset, duration & half-life

A

-Onset: 1-20 min
-Duration: Hours
-Half-life: 12-15 hr

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22
Q

Lorazepam adverse effects

A

-Apnea, hypotension & somnolence (same as diazepam)

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23
Q

Phenytoin IV dose (Adults & peds)

A

-Adults: 150-200mg
-Children: 250mg/m^2

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24
Q

Phenytoin onset, duration & half-life

A

-Onset: 1-2hr
-Duration: 12-24hr (same as fosphenytoin)
-Half-life: 7-42hr

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25
Q

Phenytoin adverse effects

A

Dysrhythmias & hypotension

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26
Q

Antiepleptic drug adverse effect

A

-Often result in the need to change meds
-Narrow therapeutic index
-Monitor plasma levels

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27
Q

Adverse effects of barbiturates: phenobarbital & primidone

A

Lethargic & restless

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28
Q

Adverse effects of hydantoins: Phenytoin & fosphenytoin

A

Ataxia, agranulocytosis, rash, nystagmus, gingival hyperplasia, thrombocytopenia & hepatitis

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29
Q

Adverse effects of iminostilbenes: Carbamazepine & oxcarbazepine

A

aGait, abdominal pain, nausea, headache, unusual eye movement, visual & behavioural change, rash

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30
Q

Adverse effect of valproic acid & derivatives including Na+ & divalproex Na+

A

GI upset, weight gain, hepatotoxicity & pancreatitis

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31
Q

Gabapentin adverse effects

A

-Nausea, aVision & speech, edema

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32
Q

Pregabalin adverse effects

A

Edema & blurred vision

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33
Q

AED contraindications

A

Pregnancy

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34
Q

AED interactions

A

-Bone marrow toxicity, CNS depression & breakthrough seizures
-Decreased half-life, aDrug levels

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35
Q

Phenytoin or diphenylhydantoin absorption

A

-Limited water solubility (not given IM)
-Slow, incomplete & variable absorption
-Extensive binding to plasma

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36
Q

Phenytoin or diphenylhydantoin metabolism

A

Metabolized by hepatic enzymes via hydroxylation (chance for drug interactions)

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37
Q

Phenytoin or diphenylhydantoin therapeutic concentration & IV considerations

A

-10-20ug/ml
-If given IV it should only be given in a NS solution

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38
Q

Phenytoin acute toxicity & adverse events high IV & oral OD

A

-High IV rate can cause arrythmias, hypotension & CNS depression
-Acute PO OD: Cerebellar & vestibular S&S: Nystagmus, ataxia, diplopia & vertigo

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39
Q

Phenytoin chronic toxicity

A

-Vestibular/cerebellar effects, behavioral changes, gingival hyperplasia, GI disturbances

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40
Q

Sexual & endocrine effects of phenytoin chronic toxicity

A

Osteomalacia, hirsutism & hyperglycemia

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41
Q

Osteomalacia

A

Bones become soft & weak

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42
Q

Hirsutism

A

Condition in women where they grow hair in a male-like pattern

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43
Q

Chronic phenytoin toxicity adverse effects

A

-Folate deficiency; megaloblastic anemia
-Hypoprothrombinemia & hemorrhage in newborns
-Hypersensitivity reactions
-Pseudolymphoma syndrome; teratrogenic
-FHPH

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44
Q

Hypersensitivity reactions in chronic toxicity effects

A

SLE, hepatic necrosis, & stevens-johnson syndrome

45
Q

Stevens-Johnson syndrome

A

Disorder of the skin & mucous membranes causing blisters and superficial skin cell death

46
Q

Phenytoin chronic toxicity drug interactions

A

-Cimetidine & isoniazid decrease metabolism
-Phenobarbital & other AEDs increase metabolism
-Decreased & increased metabolism r/t competition for protein binding sites

47
Q

AED nursing implications for assessment

A

-Health hx, BPMH, liver function tests & CBC

48
Q

AED nursing implications + PO drugs

A

-Take w meals to reduce GI upset
-Contact physician for alternatives if NPO

49
Q

AED nursing implications for IV

A

-Given slowly
-Monitor VS during administration
-Use NS w phenytoin

50
Q

AED nursing implications & pt considerations

A

-Journal response, seizure occurence & description and other AEs
-Med alert bracelet, do not abruptly discontinue
-Do not drive until drug levels stabilize
-Long-term/lifelong therapy that is not a cure

51
Q

AED implications + monitoring

A

-Monitor for decreased or absent seizure activity
-aLOC, sensation, vision or mood; sore throat, fever (blood dyscrasia may occur with hydantoins)

52
Q

Seizure management in pediatrics

A

-Meds, ketogenic diet, vagal stimulation & surgery
-Tx for status epilepticus

53
Q

Ketogenic diet + pediatric seizures

A

-High-fat low carb
-Body uses fat as energy source, state of ketosis ensues
-Half of children on the diet had a >50% reduction in seizure episodes

54
Q

Osmotic diuretics

A

-Mannitol (osmitrol); most used osmotic diuretic
-Urea, organic acids & glucose

55
Q

Osmotic diuretic MOA

A

-Mostly works in the proximal tubule and descending loop of Henle of the nephron
-Nonabsorbable, producing an osmotic effect
-Pull water into the renal tubules from the surrounding tissues
-Inhibit tubular resorption of water and solutes which produces rapid diuresis

56
Q

Osmotic diuretic drug effects

A

-Increase GFR & renal plasma flow; helps prevent kidney damage during AKI
-Reduce ICP or cerebral edema associated with head trauma, reduces intraocular pressure

57
Q

Osmotic diuretic indications

A

-Early oliguric phase of AKI, cerebral edema
-Promotes excretion of toxic substances, reduces ICP
-GI irrigant to prepare pts for transurethral surgery

58
Q

Osmotic diuretic adverse effects

A

-Convulsions, pulmonary congestion, thrombophlebitis
-Other: Blurred vision, chills, chest pain, fever, headaches, & tachycardia

59
Q

Osmotic diuretics: Mannitol (osmitrol)

A

-IV only, use a filter
-Store in warmer, crystallizes in low temperatures

60
Q

Neurological disorders

A

-Tumors
-Guillian Barre Syndrome
-Hematoma & hydrocephalus
-MS & myasthenia gravis
-Infections – Brain abscess, meningitis & encephalitis
-Parkinson’s disease

61
Q

Neurological disorders cont’d

A

-Headaches, seizures, spinal Injuries, ischemic & hemorrhagic strokes
-Carotid endarterectomy
-Intervertebral disc injury

62
Q

Neurological disorder comorbidities

A

Cardiac, diabetes & COPD

63
Q

Medical considerations of neurological disorders & stroke

A

-Repositioning
-Medications for cardiac, diabetes & other comorbidities

64
Q

Rehabilitation for neurological disorders & strokes

A

-PT, OT, & SLP

65
Q

Tests for neurological disorders & strokes

A

MRI, CT, D-Dimer (fibrinolysis resulting protein fragment)

66
Q

Surgical considerations for neurological disorders & stroke

A

-Surgical and aseptic technique critical
-Assessment and VS q15, 30, 1h x 4, 4h x4, & 8, infection and pain (5th vital sign)
-TED stockings, I/O monitoring
-Pituitary tumor, specific gravity urine testing re: Diabetes

67
Q

Neurological disorders & stroke considerations for nutrition

A

-NPO until SLP follows (has implications if your patient is diabetic)
-Watch for aspiration if pt has dysphagia, tube feeding may be required
-Watch for bowel obstruction

68
Q

Pyschosocial & family considerations for neurological disorders

A

-Depression common in most neurological disorders
-Great need for re-assurance and support for family – DNR orders
Issues: Powerlessness, loss

69
Q

Causes of IICP

A

-Aneurysm rupture & subarachnoid hemorrhage, meningitis
-Brain tumor, encephalitis, head trauma, hydrocephalus, hypertensive brain hemorrhage, Subdural hemorrhage
-Status epilepticus, stroke

70
Q

Signs of IICP

A

-Headache, double vision, pupils unresponsive to light, N/V, aMental abilities, loss of conciousness, coma
-Confusion about time then location then people as the pressure worsens
-Separating sutures in infants, seizures, shallow breathing, increased BP

71
Q

IICP goals of care… Literally

A

-Maintain patent airway
-ICP within normal limits
-Normal fluid & electrolyte balance
-No secondary complications of immobility and decreased LOC

72
Q

IICP acute interventions

A

-Airway protection, adequate oxygenation (monitor PaO2 & PaCO2)
-Maintain SBP
-CPP = MAP – ICP (> 60 mm Hg); mannitol & hypertonic saline

73
Q

IICP acute intervention medications

A

AED, sedation & analgesic

74
Q

IICP acute intervention labs

A

Glucose & Na+: Prevent hyponatremia as it can mimic IICP

75
Q

Additional medications used to manage IICP

A

-AEDs, antipyretics & corticosteroids
-Histamine H2; receptor antagonists
-Stool softeners

76
Q

IICP acute interventions cont’d

A

-Head midline, SF= 30 degree, quiet & calm environment
-Nutritional therapy
-Prevent hyperthermia
-Pain assessment unconscious patient & pediatric considerations

77
Q

Hydrocephalus

A

-Imbalance in the production and absorption of CSF causing ventriculomegaly

78
Q

Hydrocephalus tx goals

A

-Relief of hydrocephalus, promote psychomotor development
-Treat complications

79
Q

Hydrocephalus tx

A

-Tx: Remove obstruction or place a shunt
-A ventriculoperitoneal (VP) shunt drains CSF

80
Q

Complications of VP shunts

A

Infection or malfunction

81
Q

Head injury nursing diagnosis + perfusion

A

Risk for ineffective cerebral tissue perfusion r/t interruption of CBF associated with cerebral hemorrhage, hematoma, and edema

82
Q

Head injury nursing diagnosis + hyperthermia

A

Hyperthermia r/t increased metabolism, infection, and loss of cerebral integrative function s/t possible hypothalamic injury

83
Q

Head injury nursing diagnosis + acute pain

A

Acute pain (headache) r/t trauma and cerebral edema

84
Q

Head injury nursing diagnosis + mobility

A

Impaired physical mobility r/t decreased LOC, impaired motor responses, and uncertain future

85
Q

Head injury nursing diagnosis + anxiety

A

Anxiety r/t abrupt change in health status, hospital environment, and uncertain future

86
Q

Potential complications of head injuries

A

IICP r/t cerebral edema and hemorrhage

87
Q

Head injury goals of care

A

-Maintain cerebral perfusion & temp
-Attain maximal cognitive, motor, and sensory function

88
Q

Head injury management

A

-Prevention of secondary injury r/t cerebral edema and IICP
-Craniotomy or burr-hole

89
Q

Emergency care of head injuries

A

-ABC, C-spine, O2 via NP or NRM
-Establish 2 large bore IVs, control external bleeding
-Asses for rhinorrhea, otorrhea, scalp wounds
-Remove clothing

90
Q

Ongoing monitoring of head injuries

A

-Administer fluids cautiously, anticipate need for intubation
-Maintain temp
-Monitor S&S of IICP or decreased ICP
-V/S & neuro V/S, LOC, GCS, O2, rhythm

91
Q

Primary prevention strategy of head injury

A

Health Promotion

92
Q

Drug therapy for nursing implementations

A

Antiemetic’s & headache medication

93
Q

NANDA for acute meningitis

A

-Risk for ineffective cerebral perfusion
-Acute pain
-Hyperthermia
-Seizure activity

94
Q

Management of acute meningitis

A

-Isolation, I&O/fluid balance
-LOC/ICP, VS/NVS
-Seizure prevention/precaution

95
Q

Stroke “brain attack” cause & types

A

-Injury to part of the brain from lack of blood flow
-Two Types: Ischemic & hemorrhagic

96
Q

Ischemic stroke types

A

-Thrombotic; blood clot forms within the arteries
-Embolic; plaque fragment or blood clot travels to the brain from the heart or another artery

97
Q

Tx of strokes

A

-Antiplatelet & antithrombotic therapy:
-tPA (tissue plasminogen activator), coumadin
-Heparin infusion/sc inj, aspirin
-Plavix (Clopidogrel)

98
Q

Nursing management of ischemic strokes

A

-NVS including GCS & NIHSS
-Monitor for IICP, cerebral edema or ICH
-HTN is common: BP parameters

99
Q

HTN drug management post ischemic stroke

A

-Labetolol IV push
-Captopril

100
Q

Post ischemic stroke monitoring

A

-Observe for cardiac abnormalities, TED stockings
-O2, maintain airway, intubation supplies
-Observe for changes in patient deficits: Hemiplegia, neglect, facial droop, aVision, memory, speech (aphasia)

101
Q

Nursing management of ischemic strokes: Family

A

-Emotional support and reassurance to both the patient and the family
-Loss: Loss of the person they once knew, function & role shifts

102
Q

Hemorrhagic stroke types

A

-Intracerebral hemorrhage; spontaneous hemorrhage r/t HTN
-Subarachnoid hemorrhage; bleeding into the subarachnoid space, commonly r/t ruptured aneurysm

103
Q

Tx of hemorrhagic stroke

A

-Damage control caused by bleed
-Poor prognosis (coma)
-Manage BP & IICP

104
Q

Nursing management of hemorrhagic stroke + family

A

-GOC discussion
-Emotional support and reassurance early with patients and families is essential

105
Q

Nursing management of hemorrhagic is the same as ischemic except…

A

-Monitor BP, and keep BP between set parameters to limit/prevent re-bleed
-Monitor for IICP
-May require a EVD (external ventricular drain)

106
Q

External Ventricular Drain (EVD)

A

-Drains CSF to decrease ICP
-Closed system, easily contaminated

107
Q

Surgical management of an aneurysm

A

Clipping, endovascular coiling, or flow diverters

108
Q

Triple H therapy of nursing management

A

-HTN (Labetalol, Hydralazine, Nimodipine)
-Hypervolemia (ICP care, goal euvolemia)
-Hemodilution (prevent and treat cerebral vasospasm)

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