CNS Meds Flashcards by Denise Paola

seizure

is a brain dysfunction, they cause electrolyte imbalances

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phenobarbital

is a long acting barbiturate. Are sedating, may cause tolerance/dependence, excessive CNS depression. Nurse role monitor VS.

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phenobarbital therapeutic level

15-40mcg/ml. tx of grand mal, partial seizures, to control status epilepticus.

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benzodiazepines

(anxiolytics). There are 3 that have anticonvulsant effects: Clonazepam(klonopin) ,Diazepam(Valium), Lorapezam(Ativan). ANTIDOTE: FLOMASANIL

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benzodiazepines used to tx status epilepticus

only in acute care setting. SE are dangerous because they use up a lot of energy and are 2 min or longer.

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Lorazepam (Ativan)

IV o=15-30min peak=15-20min d=8-12hr.
PO o=15-60min peak=1-6hr d=8-12hr
IM o=30-60min peak=1-2hr d=8-1hr
dose= 0.1mg/kg (up to 4mg)

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Ativan continuous infusion

given when IVP doesn’t work. Controls status epilepticus. Infusion rate should not exceed 2mg/min. Also tx alcohol withdrawal.

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nursing interventions for pt on IV Ativan

EEG if necessary, monitor VS, O2 sat monitor, pt needs 2 have 2 lines: 1 for Ativan, 1 extra incase BP drops and IV fluids are needed. Have ambu bag and ET to mainatain airway

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Succinimides drug group

tx absent (petit mal seizures) 
ex. Ethosuximide (Zarontin)
Affects liver, kidneys, & causes blood dyscrasias (affects platelets)
Monitor CBC, LFT, Renal fxn
Therapeutic range: 40-100mcg/ml

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CNS depressants

Pt teaching avoid alcohol and other CNS depressants. Monitor VS!!!!

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Valproic Acid (Depakote)

Succinimide drug group. Tx bipolar and seizures.
therapeutic range: 40-100mcg/ml
PO liq o2–4d p15–120min d6–24 hr 
PO cap o2–4d p1–4 hr d6–24 hr 
PO DR o2–4d p3–5hr d12–24 hr 
PO ER o2–4d p7–14hr d24 hr 
IV o2–4d pend of infusion d6–24 hr 
Increases levels of GABA & suppresses seizure activity

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Phenytoin (Dilantin)

Hydantoin - works by inhibiting sodium influx. Stops potential axn of seizure. Inhibits both brain & heart activity. Contraindicated for cardiac pt./psych d/o, pregnancy

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Phenytoin (Dilantin) nsg axns

Monitor VS & apical pulse, if pt feels dizzy request for EKG.
Therapeutic: 10-20mcg/ml Toxic: 30-50m.
Highly protein bound, pt needs to b on low Protein diet to prevent seizure.
Monitor protein and albumin levels. For GT pt feeding off 1hr before and 1 hr after admin.

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Phenytoin (Dilantin) drug interactions

Increases effect of cimetidine(antiulcer), isoniazid(antituberuclar), chloramphenicol(antiinfective). Decrease effects w/folic acid, calcium, antacids, sucralfate, vinblastine(antineoplastic), Cisplatin(antineoplastic)

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Phenytoin (Dilantin) lab interactions

decreases the effects of anticoagulants, oral contraceptives, antihistamines, corticosteroids, theophylline(bronchodilator), cyclosporine, quinidine(antiarrhytmic), dopamine, rifampin(antitubercular)

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Phenytoin (Dilantin) food interactions

decreased absorption rate; of folic acid, calcium, vit D.

Phenytoin (Dilantin) herb interactions

Antipsychotics and herbs (evening primrose & borage) can lower sz threshold.
Ginko= affects platelet aggregation, lowers effectives

Phenytoin (Dilantin) s/e & a/r

gingival hypertrophy, tx- dentists cuts ever so often and pt needs really good oral care!! use soft toothbrush.
Nystagmus- involuntary eye movements= high fall risk.
Hypeglycemia- caused by long term use.
Pink-red/brown urine

Phenytoin (Dilantin) nsg intervention

S/S of toxicity- eyes rolling back, unarousable, decreased RR..
Tx - dialysis to clean blood of excess levels.
GIve O2, IV fluids

Carbamazepine (Tegretol)

dx category=Iminostilbenes. Used tx of sz, bipolar, trigeminal neuralgia, alcohol withdrawal.
Therapeutic range- 5-12mcg/ml

Carbamazepine (Tegretol) interactions

Avoid grapefruit juice= increases risk for toxicity. This drug has easily toxic levels.

Carbamazepine (Tegretol) s/e

Dizziness is very common. Orthostatic hypotension
Nsg dx= Risk for falls
BLACK BOX WARNING. a/r TEN’S/STEVEN JOHNSON

Anti-Parkinson

Parkison caused by imbalance between Dopamine & Ach (dopamine decreases, and Ach goes unopposed)

Parkinson s/s

masked face, pill rolling motion, shuffling gait.

High risk for fall, pt teaching= to walk with hands behind back to off balance their center of gravity.

Levadopa (L-dopa)

antiparkinson | only 1% crosses blood-brain barrier. Not very effective. Large doses needed for therapeutic effect

Carbidopa-Levodopa (Sinemet)

antiparkinson Allows for > % to cross blood-brain barrier. Levodopa is converted to dopamine. Enzyme carbidopa helps dopamine get to brain and req less levodopa.

Carbidopa-Levodopa (Sinemet) food interactions

Avoid foods with vit B6 (sunflowers seeds, pistachios, tuna, chicken, turkey, lean pork, dried fruits, lean beef, bananas, avocados, spinach

Carbidopa-Levodopa (Sinemet) pt teaching

Avoid high protein meal when taking med, may decrease potency. Save high protein meal for later time. May turn urine/sweat brown

Carbidopa-Levodopa (Sinemet) dx interaction

antipsychotics decrease levels of dopamine, so may worsen Parkinson disease

Amantadine (Symmetrel)

Antiparkinson (also antiviral use) | Is effective in tx drug-induce Parkinsonism, has fewer s/e than anticholinergics.

Bromocriptine (Parlodel)

D2 receptor agonist. Can be given w/levodopa therapy. Used as alternative if Sinemet doesn't work. Tx of early Parkinson's

Carisoprodol (Soma)

Central acting muscle relaxant. Contraindicated for severe liver/renal disease Take w/food to prevent GI upset. s/e: n/v/dizzy/diplopia/face flush/drowsy/confusion/ataxia a/r: tachycardia, hypotension, phys dependence

Herbs: Kava kava and valerian

MAY POTENTIATE CNS DEPRESSION when taking Diazepam (Valium)

Cyclobenzprine (Flexeril)

Cental acting muscle relaxant Contraindicated in narrow-angle glaucoma & myasthenia gravis. Take w/milk/food to prevent GI upset

Methocarbamol (Robaxin)

Cental acting muscle relaxant Also used for tx of tetanus Avoid alcohol and other CNS depressants. Urine may be green, brown, or black

Cental acting muscle relaxant drug-drug interactions

Increased CNS depression w/alcohol, narcotics, sedative-hypnotics, anthistamines, tricyclic antidepressants. May increase risk of ventricular fib w/calcium channel blocker

Dantrolene (Dantrium)

Peripherally acting muscle relaxant. For chronic neurologic d/o causing spams: spinal injuries, CVA, MS. BLACK BOX WARNING. May cause Malignant Hyperthemia. Use w/opiates=DANGERIOUS, CAN CAUSE DEATH. Also Ca channel blockers potentiate effects