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Nclex Study Cards > Drugs affecting the Nervous system > Flashcards

Drugs affecting the Nervous system Flashcards

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1
Q

Anticonvulsant Phenytoin

A

Given for Long term prevention against seizures, patients with epilepsy and other long-term chronic seizure disorders

Therapeutic range = 10-20
Below 10: secure risk
Over 20: toxic risk (hold med)
Routine blood tests: blood levels monitored routinely to check therapeutic index and liver function
Take med at same time daily - narrow therapeutic index

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2
Q

Phenytoin Early Signs off Toxicity

A

Ataxia (unsteady gait)
Hand tremor
Slurred speech

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3
Q

Phenytoin Adverse affects

A

Suicidal ideations
Skin rash (new, painful) = priority, could indicate Steven Johnston syndrome

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4
Q

Phenytoin Side effects

A

Bradycardia and Hypotension
CNS depressant = low and slow vitals
Gingival hyperplasia: overgrowth of gums around the teeth that bleed easy = expected, don’t stop drug
Teach: good dental hygiene with soft tooth brush and regular dental visits. Inform dentist they are taking phenytoin
Preform oral care every shift
Skinn rash, fatigue and dyspnea = priority
No phtosensitiviity
No metallic taste

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5
Q

Statements requiring immediate intervention when taking phenytoin

A

I notice a rash on my stomach last week
Lately I find myself thinking about driving off a cliff

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6
Q

Phenytoin Patient teaching

A

No oral contraceptives: deactivates the pill use alternative contraceptives
No stopping abruptly
Take folic acid, calcium and Vitamin D

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7
Q

Phenytoin Administration

A

Stop tube feeding for 1-2 hours before and after admin
Tube feeds can interfere with absorption and decrease effectiveness

Flush with 30-50ml tap water before and after drug is given

IV: flush with normal saline before and after giving this drug

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8
Q

Anticonvulsant levetiracetam

A

Given to prevent and treat seizures for those at high risk (brain tumor, surgery , trauma a to the head that may have increase ICP)

Preferred over phenytoin due to minimal drug-drug interactions

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9
Q

levetiracetam adverse effects

A

CNS depressant = low and slow body
Suicidal thoughts (new anxiety, irritation, depression, mood changes)
Steven-johnson (rash, blistering, muscle joint main, conjunctivitis)

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10
Q

levetiracetam Patient Teaching

A

Driving: get permission from HCP and follow transportation guidelines since drug can cause drowsiness and fatigue

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11
Q

Cholinergics Neostigmine and Pyridostigmine

A

Given to patients with myasthnia gravis, patients get too dry in result lack mobility and the strength to move since they have tons of muscle cramping

Neostigmine and Pyridostigmine

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12
Q

Neostigmine

A

Neostigmine: helps to lube up body with secretions - body gets wet but can sometimes cause too much fluid leading to a cholinergic crisis = secretion crisis

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13
Q

Cholinergic crisis

A

Pupil constriction
Tears lacrimation
Drooling
Diaphoresis
Diarrhea

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14
Q

How to stop cholinergic crisis

A

Anti cholinergic = Atropine
Turns off PNS turns on SNS

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15
Q

Patient being managed for myasthenia crisis develops asthma

A

Discontinue Pyridostigmine

Brochocontriction = last thing we want is lots of secretions

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16
Q

How to treat anticholinergic toxicity

A

Physostigmine

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17
Q

Med effectiveness of Stigmine

A

Absence of muscle cramps and adequate vision without diplopia

18
Q

Clint on pyridostigmine having salivation, lacrimation and urination

A

Notify the HCP
Cholinergic crisis

19
Q

Migraine - Sumatriptan

A

Used for migraines and cluster headaches by causing vasoconstriction in the blood vessels of the brain (this can cause serious adverse effects)

20
Q

Sumatriptan Contraindication

A

Cannot give to patients with CAD or uncontrolled hypertension (could cause hypertensive crisis, angina or MI)
Could cause clot in brain or heart
Teach patient to report angina (coronary vasospasms)

21
Q

Migrane: Ergotamine SL

A

Works similar to sumatriptan
Indication: migraine headaches
Teach: take one tablet immediately at onset of headaches

Priority finding: pale extremities - possible clot? decreased perfusion

22
Q

Parkinsons Medication

A

Carbidopa and Levodopa
levodopa: leaves the dopamine in the brain
Carbidopa: prevents the break down of levodopa allowing the body to use it down

23
Q

levodopa

A

Main drug for parkinsons treatment
Dopamine precursor

24
Q

Carbidopa and Levodpa side effects

A

Hallucinations
Orthostatic hypotension
Dizziness when standing resulting in falls
Slow position changes

25
Q

Carbidopa and Levodpa Administration

A

Start at low dose to prevent adverse affects
Prolonged use can lead too toxicity
Toxicity signs: ticks, face/eyelid twitching, grimacing, Tonge protrusion

26
Q

Carbidopa and Levodpa patient teaching

A

Low onset 2-6 weeks to become effective
Slow position changes
Red, brown urine, sweat and saliva = normal, no need to report

NO high protein meals, interferes with absorption
NOT elimination of tremors or rigidity, only decrease (watch for words such as cure and eliminate)
Life long drugs
Never stoop abruptly

MAOIs (antidepressant) enhane efficacy
Selegiline (MAOI) used as adjunct treatment with carbidopa - levodopa

27
Q

How to know if carbidopa + levodopa is effective

A

Improvement in spontaneous movement
(effective for bradykinesia)
Client is more ambulatory

28
Q

Anticholinergics Benztropine and Atropine

A

Cant see
Cant pee
Cant spit
Cant poop
Dry the body out, stop secretions
Speed up Heart

No more secretions, PNS turns off, SNS turns on which elevates HR and dries out body
Used to treat tremors

29
Q

Anticholingeics Key Points

A

Used to treat extrapyramidal s/s
Parkinsons tremors (bradykinesia)
Muscle rigidity
Shuffling gait

30
Q

Anticholinergics Contraindications

A

No bowel obstruction
Fluid retention
No Glaucoma
No BPH or urinary retention

Atropine may precipitate acute glaucoma
Clients with glaucoma - notify HCP

31
Q

Anticholinergics Patient Teaching

A

Notify the HCP if you develop urinary retention
This med can reduce the ability too sweat so do not overheat
Sit or stand up slowly to prevent light headedness

32
Q

Osmotic Diuretic Mannitol

A

Given to decrease cerebral edema with ICP
Increased ocular pressure
Assess LOC every hour
IV admin - cannot be given PO
Side effect: edema, begins 30-60 min after administration

33
Q

Why does Mannitol cause edema

A

Drains fluid out of cell into vascular spaces. Fluid from brain gets drained not blood vessels and can put the pt into fluid overload

Monitor for signs and symptoms of HF and pulmonary Edema

34
Q

Neuromuscular blocking agents

A

*Succinylchoolline
Pancuroonium
Cisatracurium

given to paralysis body before ET tube intubation and mechanical ventilation - difficult to intubate
Used to facilitate mechanical ventilation and produced deep muscle relaxation

only paralysis body does not sedate the patient, risk for respiratory arrest, patients can still feel pain
Sedate with bento when giving this drug
Primary result is Flac cid paralysis not loss of consciousness

Sedation first (midazolam)
Succinylcholine 2nd
Intubation 3rd

35
Q

Succinylcholine Deadly Adverse affects

A

Malignant hyperthermia (MH)
Immediate intervention
1st Notify HCP
2nd administer Dantrolene
3rd oxygen and cooling measure

36
Q

After administration of succinylcholine patient develops high fever and muscle rigidity

A

Prepare to give IV dantrolene

37
Q

Succinylcholine Key pints

A

Screen for HIGH RISK MH
Prior reaction to general anesthesia MOST critical
Blood relatives with significant reaction to general anesthesia
Alcoholics at high risk

38
Q

Which nursing actions are appropriate for a nurse preparing to administer phenytoin via a NG tube

A

Hold tube feedings for at least sone hour prior to administration

Flush the NG tube with 30ml water before and after administration

Monitor liever function tests on a regular basis for patients taking phenytoin

39
Q

Which adverse affects of phenytoin should the nurse immediately report to the provider

A

New reports of feeling unsteady when ambulating

The appearance of a new rash on the patients chest

A morning phenytoin level of 26mg/dl

Reports feeling hopeless and apathetic

Difficulty forming words and sentences

40
Q

The HCP has prescribed 4mg succinylcholine to be administered IV push during a rapid sequence intubation which is the nurses priority action when preparing to administer this medication

A

Ask the patient about history of alcohol abuse

41
Q

Which instructions should the nurse include in the plan of care for a patient newly prescribed carbidopa-levodopa for the treatment of Parkinson’s disease?

A

When going from a sitting to a standing position be sure too change your position slowly

Avoid eating meals that contain large amounts of protein while taking this medication

It is a good idea to remove any extra clutter from your home that could cause you to trip and fall

42
Q
A

Nclex Study Cards (38 decks)

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