Drugs affecting the Nervous system Flashcards
Anticonvulsant Phenytoin
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
Phenytoin Early Signs off Toxicity
Ataxia (unsteady gait)
Hand tremor
Slurred speech
Phenytoin Adverse affects
Suicidal ideations
Skin rash (new, painful) = priority, could indicate Steven Johnston syndrome
Phenytoin Side effects
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
Statements requiring immediate intervention when taking phenytoin
I notice a rash on my stomach last week
Lately I find myself thinking about driving off a cliff
Phenytoin Patient teaching
No oral contraceptives: deactivates the pill use alternative contraceptives
No stopping abruptly
Take folic acid, calcium and Vitamin D
Phenytoin Administration
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
Anticonvulsant levetiracetam
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
levetiracetam adverse effects
CNS depressant = low and slow body
Suicidal thoughts (new anxiety, irritation, depression, mood changes)
Steven-johnson (rash, blistering, muscle joint main, conjunctivitis)
levetiracetam Patient Teaching
Driving: get permission from HCP and follow transportation guidelines since drug can cause drowsiness and fatigue
Cholinergics Neostigmine and Pyridostigmine
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
Neostigmine
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
Cholinergic crisis
Pupil constriction
Tears lacrimation
Drooling
Diaphoresis
Diarrhea
How to stop cholinergic crisis
Anti cholinergic = Atropine
Turns off PNS turns on SNS
Patient being managed for myasthenia crisis develops asthma
Discontinue Pyridostigmine
Brochocontriction = last thing we want is lots of secretions
How to treat anticholinergic toxicity
Physostigmine
Med effectiveness of Stigmine
Absence of muscle cramps and adequate vision without diplopia
Clint on pyridostigmine having salivation, lacrimation and urination
Notify the HCP
Cholinergic crisis
Migraine - Sumatriptan
Used for migraines and cluster headaches by causing vasoconstriction in the blood vessels of the brain (this can cause serious adverse effects)
Sumatriptan Contraindication
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)
Migrane: Ergotamine SL
Works similar to sumatriptan
Indication: migraine headaches
Teach: take one tablet immediately at onset of headaches
Priority finding: pale extremities - possible clot? decreased perfusion
Parkinsons Medication
Carbidopa and Levodopa
levodopa: leaves the dopamine in the brain
Carbidopa: prevents the break down of levodopa allowing the body to use it down
levodopa
Main drug for parkinsons treatment
Dopamine precursor
Carbidopa and Levodpa side effects
Hallucinations
Orthostatic hypotension
Dizziness when standing resulting in falls
Slow position changes
Carbidopa and Levodpa Administration
Start at low dose to prevent adverse affects
Prolonged use can lead too toxicity
Toxicity signs: ticks, face/eyelid twitching, grimacing, Tonge protrusion
Carbidopa and Levodpa patient teaching
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
How to know if carbidopa + levodopa is effective
Improvement in spontaneous movement
(effective for bradykinesia)
Client is more ambulatory
Anticholinergics Benztropine and Atropine
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
Anticholingeics Key Points
Used to treat extrapyramidal s/s
Parkinsons tremors (bradykinesia)
Muscle rigidity
Shuffling gait
Anticholinergics Contraindications
No bowel obstruction
Fluid retention
No Glaucoma
No BPH or urinary retention
Atropine may precipitate acute glaucoma
Clients with glaucoma - notify HCP
Anticholinergics Patient Teaching
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
Osmotic Diuretic Mannitol
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
Why does Mannitol cause edema
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
Neuromuscular blocking agents
*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
Succinylcholine Deadly Adverse affects
Malignant hyperthermia (MH)
Immediate intervention
1st Notify HCP
2nd administer Dantrolene
3rd oxygen and cooling measure
After administration of succinylcholine patient develops high fever and muscle rigidity
Prepare to give IV dantrolene
Succinylcholine Key pints
Screen for HIGH RISK MH
Prior reaction to general anesthesia MOST critical
Blood relatives with significant reaction to general anesthesia
Alcoholics at high risk
Which nursing actions are appropriate for a nurse preparing to administer phenytoin via a NG tube
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
Which adverse affects of phenytoin should the nurse immediately report to the provider
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
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
Ask the patient about history of alcohol abuse
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?
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
