CNS drugs 1

Question 1

CNS drugs indications

Answer 1

• seizure disorders
• Alzheimer’s
• Parkinson’s
• MS
• neuromuscular disorders/degenerative

Question 2

generalized seizure

Answer 2

• convulsive & non convulsive

- involve both hemispheres

Question 3

partial seizure

Answer 3

• one hemisphere

- no loss of consciousness

Question 4

tonic-clonic seizure

Answer 4

• grand mal
• tonic: skeletal muscles contract or tighten in a spasm lasting 3-5 secs
• clonic: dysrhythmic muscular contraction 2-4 minutes

Question 5

absence seizure

Answer 5

• petit mal

- brief loss of consciousness lasting less than 10 secs

Question 6

anticonvulsants/AEDs

Answer 6

• CNS depressant
• suppress Na & Ca influx
• increase GABA
• stabilize nerve cell membranes
• suppress the rapid & excessive firing of neurons that start a seizure
• prevents seizures, does not cure

Question 7

medical mgmt of seizure dx

Answer 7

• protect the person from injury during a seizure
• tx underlying cause (may reduce or eliminate sz)
• advise pt to avoid situations that could be dangerous or life threatening
• always start with lowest dose possible

Question 8

selecting a sz med

Answer 8

• type of seizure/frequency/severity
• age of pt
• PMH
• cultrual variations
• tolerance for s/e
• diagnostic studies (location of seizure)
• causes of seizure
• the goal to be achieved

Question 9

barbiturates

Answer 9

• *barbital
• reduces sz activity by intensifying GABA action
• CNS depression
• children experience hyperkinesis rather than sedation
• high potential for dependence

Question 10

phenobarbital

Answer 10

• *Luminal
• 1st line of defense for partial & generalized sz
• 1st line of defense for tx of neonatal sz
• 2nd line of defense for acute episodes of status epilepticus (d/t too slow acting)
• IV q6h
• withdrawal needs to be tapered

Question 11

phenobarbital therapeutic range

Answer 11

10-40mcg/mL

Question 12

barbiturates nursing s/e

Answer 12

• resp depression
• bradycardia
• syncope
• hypoTN
• tolerance

Question 13

barbiturates caution in…

Answer 13

• hepatic
• respiratory
• renal
• CV function
• *doses may need to be lowered to prevent toxicity

Question 14

benzodiazepines

Answer 14

• *“pams”
• very potent, mgmt of status epilepticus
• lorazepam (ativan)
• diazepam (valium)
• clonazepam (klonopin): too slow acting, usually for petit mal
• act on the limbic, thalamic, & hypothalamic regions

Question 15

clonazepam therapeutic range

Answer 15

20-80ng/mL

-for refractory seizures

Question 16

diazepam

Answer 16

• not mixed or diluted
• interacts with plastic containers & administration sets
• 10mg IVP 30-60 secs
• repeated 10-15 mins up to 30mg
• most pts respond after the 2nd dose
• IVP=no faster than 5mg/min
• repeat after 2-4 hrs
• max=100mg/day
• remains active in brain for 30-60 mins

Question 17

lorazepam

Answer 17

• drug of choice for status epilepticus
• remains in CSF longer than diazepam
• remains active for 12 hours
• IVP=dilute 1:1 with NS or D%W
• follow with Dilantin IV
• 4mg IVP repeated q5-15 mins
• max=480mg/day
• monitor for metabolic acidosis

Question 18

nursing considerations benzodiazepines

Answer 18

• monitor resp function & O2 sat
• maintain oxygenation & circulation
• establish cause of s/e
• assess labs, tox screen, etoh
• establish IV access for IV tx
• monitor for hypoglycemia & hypoTN

Question 19

succinimides

Answer 19

• • “ximides”
• suppress sz activity by delaying Ca influx into neurons
• mgmt of absence sz
• ethrosuximide (zarotin): drug of choice for absence sz
• valporic acid (depakote)

Question 20

OD of succinimides

Answer 20

• activated charcoal

- gastric lavage

Question 21

therapeutic range of succinimides

Answer 21

• usually use the pt’s response instead of a therapeutic dose
• 40-100mcg

Question 22

s/e of succinimides

Answer 22

• blood dyscrasias
• renal & liver impairment
• systemic lupus erythematosus

Question 23

valporic acid

Answer 23

-depakote
-petit mal, grandmal, & mixed type sz
-

Question 24

valporic acid therapeutic range

Answer 24

50-150mcg/mL