CNS drugs 1 Flashcards
1
Q
CNS drugs indications
A
- seizure disorders
- Alzheimer’s
- Parkinson’s
- MS
- neuromuscular disorders/degenerative
2
Q
generalized seizure
A
- convulsive & non convulsive
- involve both hemispheres
3
Q
partial seizure
A
- one hemisphere
- no loss of consciousness
4
Q
tonic-clonic seizure
A
- grand mal
- tonic: skeletal muscles contract or tighten in a spasm lasting 3-5 secs
- clonic: dysrhythmic muscular contraction 2-4 minutes
5
Q
absence seizure
A
- petit mal
- brief loss of consciousness lasting less than 10 secs
6
Q
anticonvulsants/AEDs
A
- 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
7
Q
medical mgmt of seizure dx
A
- 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
8
Q
selecting a sz med
A
- 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
9
Q
barbiturates
A
- *barbital
- reduces sz activity by intensifying GABA action
- CNS depression
- children experience hyperkinesis rather than sedation
- high potential for dependence
10
Q
phenobarbital
A
- *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
11
Q
phenobarbital therapeutic range
A
10-40mcg/mL
12
Q
barbiturates nursing s/e
A
- resp depression
- bradycardia
- syncope
- hypoTN
- tolerance
13
Q
barbiturates caution in…
A
- hepatic
- respiratory
- renal
- CV function
- *doses may need to be lowered to prevent toxicity
14
Q
benzodiazepines
A
- *“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
15
Q
clonazepam therapeutic range
A
20-80ng/mL
-for refractory seizures
16
Q
diazepam
A
- 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
17
Q
lorazepam
A
- 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
18
Q
nursing considerations benzodiazepines
A
- 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
19
Q
succinimides
A
- “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)
20
Q
OD of succinimides
A
- activated charcoal
- gastric lavage
21
Q
therapeutic range of succinimides
A
- usually use the pt’s response instead of a therapeutic dose
- 40-100mcg
22
Q
s/e of succinimides
A
- blood dyscrasias
- renal & liver impairment
- systemic lupus erythematosus
23
Q
valporic acid
A
-depakote
-petit mal, grandmal, & mixed type sz
-
24
Q
valporic acid therapeutic range
A
50-150mcg/mL
