Exam 3 Flashcards
T3
stimulates metabolism
T4
inactive until converted into T3 by the tissues
Iodine and tyrosine
needed to make TH
hypothalamus anterior pituitary and the thyroid
can all lead to thyroid problems
primary thyroid dysfunction
problem with thyroid
primary hyperthyroid
TSH is low and TH is high
primary hypothyroid
TSH is high and TH is low
secondary thyroid dysfunction
problem due to pituitary gland
secondary hyperthyroid
TSH is high and TH is high
secondary hypothyroid
TSH is low and TH is low
tertiary thyroid dysfunction
due to hypothalamus
increase TRH —->
TSH ——> TH
Increase metabolic rate
decrease TH —- TRH —– TSH
women are ____ times more likely then men to have thyroid imbalance
5-10
hypothyroidism
can be congenital (cretinism) or acquired (hashimoto thyroiditis or thyroidectomy)
hyperthyroidism
can be graves disease or thyroid tumors, can cause a goiter, everything becomes excited
hashimoto thyroiditis
autoimmune disease, destruction of thyroid, 20’s or 50s-60s
graves disease
bug eyes, can be in 20s or 40s
causes of hypothyroidism
absence of the thyroid gland, lack of insufficient iodine in diet, autoimmune disorder, lack of TSH (pituitary gland disease), lack of TRH ( tumor or disorder of hypothalamus)
signs of hypothyroidism
lethargy hypotension hypoventilation slow GI intolerance to cold
cretinism
child with hypothyroidism, untreated leads to poor growth and development, preventable with hormone replacement
myxedema
life threatening, severe adult hypothyroidism
myxedema coma
end stage of hypothyroidism, life-threatening, most often in elderly women, 30% mortality rate
levothyroxine (synthroid, levonoxyl)
synthetic T4, given PO unless myxedema (given IV), can cause symptoms of hyperthyroidism, BLACK BOX- use for weight loss is contraindicated, take the same time each day with a full glass of water on empty stomach 30 minutes prior to eating
contraindications of TH
known allergy thyrotoxicosis (thyroid storm) hyperthyroidism acute MI, caution with lactation (still can give)
Thyroid storm or crisis
extreme manifestation of hyperthyroidism, caused by untreated hyperthyroidism precipitated by stress, manifested by high fever (NO aspirin) tachycardia MI coma delirium, 80-90% mortality if not treated
thyroidectomy
take out thyroid, increased TH right after surgery, airway issues, can save parathyroid (if not watch serum calcium, can drop), increased potential to bleed (watch for frequent swallowing)
anti-thyroid agent
prevent iodine from getting into the thyroid and partially inhibits conversion of T4 to T3, used for hyperthyroidism. if needed during pregnancy use PTU, can cause thyroid suppression development of goiter, iodine drugs can cause metallic taste and staining of teeth
propylthiouracil PTU
drug of choice for children used for hyperthyroidism, inhibits synthesis of TH and conversion of T4 to T3, therapeutic effect can be delayed for 3 weeks, can cause leukopenia or hepatotoxicity, given 3-4 times daily
methimazole (Tapazole)
used to treat hyperthyroidism by inhibiting production of TH, more bone marrow suppression, used in management of thyroid storm (bc can be given PO or IV), less likely to cause GI effects, less likely to induce hypothyroidism
sodium Iodine 131
radioactive, given for hyperthyroid, used in adults over 30, NOT in pregnancy may have adverse effects on fertility, used for thyroid destruction, limited contact with patient for only 1 hr per day, no contact with pregnant women or children
potassium iodide (lugol’s solution)
used for acute thyrotoxicosis, immediately blocks release of TH, can be used to make meth
Iodine solutions
contraindicated with pregnancy and Pulmonary edma/TB, adverse effects can stain teeth (drink through straw behind teeth) toxicity/ iodism
Calcium
found in bones, reciprocal relationship with phosphate, normal level 8.6- 10.2 total, transmission of nerve impulses, blood clotting
if PTH is taken out _____ type symptoms
hypocalcemia
functional tumor
secretes hormones
non-functional tumor
grows and presses on gland = hypo___
hypoparathyroidism
decreased PTH, decreased serum calcium, can be related to thyroidectomy parathyroidectomy or radical neck dissection, can be autoimmune, can manifest as hypocalcaemia
hyperparathyroidism
increased PTH, can be related to PTH tumor, can be secondary to renal failure or malabsorption of calcium, more common in women, more common over 50, patient will have hypercalcemia, demineralization of bone
Vitamin D therapy
increase absorption of calcium, indicated for hypocalcemia renal failure hypoparathyroidism, teach pt to increase weight bearing and the decrease consumption of alcohol and smoking
calcitrol (rocaltrol)
active form of vitamin D, need 400-600 units of vitamin D per day, decreased bone reabsorption , promotes calcium absorption in the gut and renal reabsorption of calcium
other forms of vitamin D
ergocalciferol, calcifediol, dihydrotachysterol
biphosphonates
act on calcium levels, lower serum calcium, can cause paget disease (demineralizes bone) or osteoporosis, contraindicated with pregnancy renal dysfunction or upper GI disease, can cause esophageal erosion (take in the morning sitting up with glass of water, don’t eat or drink for 30 minutes after
list of biphosphonates
etidronate (didronel), ibandronate (Boniva) taken monthly, pamidronate (Aredia) taken weekly, risedronate (Actonel) taken weekly, alendronate (Fosamax) taken weekly
raloxifene (Evista)
selective estrogen receptor modulator, prevents osteoporosis by increasing estrogen receptors on bone and increasing bone density, PO can cause hot flashes,
Denosumab (prolia)
monoclonal antibody prevents bone reabsorption, given subQ every 6 months
Teriparatide
stimulates bone formation, derivative of PTH
Calcitonin
hormones secreted by the thyroid gland to balance effects of PHT, inhibits bone reabsorption, increased secretion of calcium, emergency treatment of hypercalcemia, calcitonin -salmon nasal spray no used a lot linked to cancer
Calcitonin is released when
Serum Calcium levels are high
androgens
Male and female sex hormones (estrogen and testosteron)
Glucocorticoids (cortisol)
Stimulate an increase in glucose levels for energy, Increased breakdown of fat, Increase protein breakdown, decrease protein synthesis, Stress hormones, Suppression of inflammatory and immune responses
Mineralocorticoids (aldosterone)
Affect fluid and electrolyte levels, Causes the reabsorption of sodium and water and the elimination of potassium
CRH —> ——->
ACTH, cortisol
increase cortisol =
decrease CRH and ACTH which shuts down loop (why we tapper doses)
anti-inflammatory corticosteroids
supresses the leukocytes and chemical mediators in the inflammatory responce
immunosuppressive corticosteroids
supresses humoral and cell mediated immunity
maintenance of normal BP with corticosteroids
Enhance vasoconstriction (norepinephrine) Cause reabsorption of sodium and water and elimination of potassium (aldosterone-mineralocorticoid)
carbohydrates and metabolism with corticosteroids
Increased glycogenolysis and insulin resistance
Increase breakdown of protein (for gluconeogenesis)
Mobilize free fatty acids and redistribute fat
therapeutic uses of corticosteroids
Hormone replacement for adrenocortical insufficiency, Suppression of allergic reactions (Anaphylaxis and Drug reaction), Suppression of inflammatory disorders (RA, SLE, Inflammatory bowel disease, OA), Autoimmune disorders (Hashimoto’s thyroiditis), pulmonary disorders, prevention of transplant rejection, can decrease pain from inflammation
Adverse effects of corticosteroids
Hypokalemia, GI distress (prone to PUD), Muscle atrophy and weakness, Mood changes, insomnia, fatigue, Hyperglycemia, Fat redistribution to trunk and face, immunosupressive, suppress the release of ACTH, hypocalcemia, hypertension, weight gain, inhibit antibody responce to vaccines, protein depletion (osteoporosis), frail skin
contraindications of corticosteroids
acute infections, allergy and lactation, Caution in pregnancy (unless benefit to mother clearly outweighs risk to baby), diabetes (increase BG), peptic ulcer disease (increase irratation to the stomach)
name corticosteroids
betamethasone (Celestone), budesonide (Rhinocort) – rhinitis (intranasal), dexamethasone (Decadron) – inflammatory disorders (long acting), triamcinolone (Aristospan) – asthma, methylprednisolone (Medrol), prednisone (Deltasone), hydrocortisone (Cortef, Solu-Cortef) (has mineralocorticoid activity), prednisolone (Delta-Cortef), cortisone (has some mineralocorticoid activity)
nursing care with corticosteroids
use as low of dose as possible, take in the morning with food, may need vitamin D and calcium replacement, wean from drug, high protein calcium and potassium low sodium diet
mineralocorticoids
cortisone (Cortisone Acetate) (has some glucocorticoid activity as well) short acting (orally and parenterally), hydrocortisone (has some glucocorticoid activity as well) short acting, Fludrocortisone (Florinef)- small doses produce sodium retention, increased excretion of potassium and elevate BP. May be combined with glucocorticoid. given for fainting problem
mineralocorticoids contraindications and adverse reactions
Contraindications- Hypersensitivity, Heart failure, hypertension
Adverse Reactions- Increase fluid volumes, Allergic reactions, Hypokalemia
calcium is needed to
initiate the release of neurotransmitters into the synaptic space
three main types of neurotransmitters
Aminoacides (ex. Gamma aminobutyric acid [GABA}*** inhibits the CNS )
Peptides (endorphins, enkephalins, substance P- pain responce)
Monoamines (serotonin, dopamine, norepinephrine
sympathetic nervous systems
fight or flight, neurotransmitters: norepinephrine dopamine and epinephrine, have adrenergic receptors (Alpha and Beta)
parasympathetic nervous system
rest and digest, cholinergic nervous system, neurotransmitter is acetlycholine, has cholinergic receptors
effects of PSNS stimulation
increase in secretions urinary frequency and sweating (nicotinic receptors), constriction of pupil and bronchi, decrease heart rate
adrenergic stimulation (SNS)
inhibits digestion secretions except sweat and ejaculation, causes piloerection, increase muscle strength, stimulation of RAAS
alpha 1 stimulation
vasoconstriction, mydriasis (pupil dilation), ejaculation, CNS stimulation, uterus contraction
Alpha 2 stimulation
shut off vavle for SNS, Receptors are located on the presynaptic nerve terminals, Control the release of neurotransmitters, Inhibit the release of norepinephrine
beta 1 receptors
primarily in the heart, increase HR BP contractility and conduction, also increase renin secretion and angiotensin
Positive Inotropic effect
Positive Chronotropic Effect
Positive Dromotropic Effect
increase myocardial contractility
increase HR
increase conduction through heart
beta 2 receptors
primarily in the lungs, bronchioles dialate, Arterioles (some dilation), GI tract- decreased motility and tone, Uterus- relaxation of uterine smooth muscle, Liver- activation of glycogenolysis (increase BG)
adrenergic agonists
Direct acting-bind to the adrenergic receptors and cause the fight or flight response, Indirect acting-increase the amount of norepinephrine at the synapse
indications and examples of adrenergic agonist
indications= Cardiac arrest, Heart failure, AV block, Shock
examples=Epinephrine, Norepinephrine, Dopamine, Dobutamine, Phenylephrine
Epinephrine (Adrenalin)
Therapeutic uses= Shock, cardiac arrest, Anaphylaxis, Bronchodilator, Mydriatic (pupil dilation), Reduce nasal congestion, Non-selective adrenergic agonist (catecholamine), Receptors stimulated, alpha one, beta one, beta two, Administer IV, Subcutaneous, IM, inhalation, topical, ophthalmic, intracardiac (in emergencies)
adverse effecs of epinephrine
CNS – headache, restlessness, excitement, insomnia, tremors, dizziness
Cardiovascular – chest pain, vasoconstriction, hypertension, tachycardia, palpitations, dysrhythmias
Other body systems – dry mouth, anorexia, nausea, vomiting
Can cause tissue necrosis at site of infusion if extravasatio
alpha adrenergic agonist
given to relieve nasal congestion, treat hypotension or orthostatic hypotension, Contraindicated in patient with hypertension, Pregnancy Category C
Not recommended for use in infants and children
Do not use nasal sprays for longer than 3 days
Use sunglasses to prevent photosensitivity
Safety precautions due to blurred vision
phenylephrine (neo-synephrine)
ALPHA ADRENERGIC AGONIST
Oral and intranasal to relieve nasal congestion
Parenteral for hypotension
IV, IM, subcutaneously, PO, intranasal, ophthalmic
Can cause stinging of the nasal mucosa and rebound congestion, Photophobia if administered ophthalmic
Midodrine (Proamatine)
ALPHA ADRENERGIC AGONIST, used to treat orthostatic hypotension
intra-nasal decongestants
ALPHA ADRENERGIC AGONIST
Oxymetazoline (Afrin)
Psuedoephedrine (Sudafed)
Potential for misuse in the development of methamphetamine= Limited in the amount that can be purchased
Limit use to 3-5 days
Can cause rebound congestion if abrupt withdrawal
ol=
beta something
isoproterenol (isuprel)
NON SELECTIVE BETA AGONIST
Bronchodilator, Increases HR, myocardial contractility, conduction through the heart, Pregnancy category C
Eliminate caffeine due to stimulatory effect and increase in insomnia, anxiety and tremors
May increase blood glucose
beta 2 adrenergic agonist
bronchodilators
Selective= Albuterol (Proventil), Formoterol (Foridil), Levalbuterol (Xopenex), Salmeterol (Serevent), Pirbuterol (Maxair)
Non Selective= epinephrine
Alpha Blocker indications (osin)
Hypertension
-doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin),
Raynaud’s disease
-Vasospasms of vessels to the extremities
Benign Prostatic Hypertrophy
-tamsulosin (Flomax), alfuzosin (Uroxatral)
Beta Blockers (lol)
Non-selective= propranolol (Inderal), nebivolol (Bystolic), nadolol (Corgard), sotalol (Betapace), timolol (Timoptic)
Selective beta 1= atenolol (Tenormin), metoprolol (Lopressor), esmolol (Brevibloc), bisoprolol (Zebeta), acebutalol (Brevibloc)
beta blocker information
slows HR, do not suddenly stop, hold drug if BP less than 100
Alpha- and Beta-Adrenergic Blocking Agents and Their Indications
Carvedilol (Coreg): Hypertension, congestive heart failure (adult)
Given orally
Labetalol (Normodyne, Trandate): Hypertension, pheochromocytoma, clonidine withdrawal
Can be given IV and oral
cholinergic agonist
Stimulate the acetylcholine receptors, Stimulate the parasympathetic nervous system, Are called: Cholinergics, Parasympathomimetics, Response is similar to adrenergic antagonist which inhibit the Sympathetic Nervous system
Cholinergic antagonist
Block or inhibit the acetylcholine receptors, Inhibit the parasympathetic nervous system, Are called: Anticholinergic s, Cholinergic blockers, Parasympatholytics
Response is similar to adrenergic agonist which stimulate the Sympathetic Nervous system
direct acting cholinergic agonists
Occupy receptor sites for ACh on the membranes of the effector cells of the postganglionic cholinergic nerves
Cause increased stimulation of the cholinergic receptor
indirect acting cholinergic agonists
React with the enzyme acetylcholinesterase and prevent it from breaking down the ACh that was released from the nerve
cholinergic drug indications PNS
Eye drops (topical)= Reduce IOP – glaucoma (contracts ciliary muscle allowing fluid to drain from the eye) Bladder= increases bladder tone (relaxes the urinary spinchter) Given to patients with urinary retention Stimulate exocrine glands (lacrimation, sweat, saliva) GI= Increase GI motility Increase GI secretion
cevimeline (evoxac)
direct acting cholinergic used to treat dry mouth
bethanechol (urecholine)
cholinergic used to treat non-obstructive urinary retention
pilocarpine (pilocar)
direct acting cholinergic used to decrease IOP
Acetylcholinesterase Inhibitors Used to Treat Myasthenia Gravis
Neostigmine (Prostigmine): Has a strong influence at the neuromuscular junction, 2nd line to pyridostigmine
Pyridostigmine (Regonol, Mestinon): Has a longer duration of action than neostigmine, first line drug
Ambenonium (Mytelase): Available only in oral form; cannot be used if patient is unable to swallow tablets, not first line drug
Edrophonium (Tensilon, Enlon): Diagnostic agent for myasthenia gravis
Drugs Used to Treat Alzheimer’s Disease
Tacrine (Cognex) First drug to treat Alzheimer’s dementia Galantamine (Reminyl) Used to stop progression of Alzheimer’s dementia Rivastigmine (Exelon) Available in solution for swallowing ease Donepezil (Aricept) Has once-a-day dosing
Cholinergic crisis
Overdose with cholinergic agents or exposure to nerve gas (Sarin) or organophosphate insecticides(Malathion)
Manifested as miosis, nausea, vomiting, urinary incontinence, increased secretions, abdominal cramping, diarrhea, blurred vision
Treat with atropine (anticholinergic)
DONT GIVE CHOLINERGICs TO A PT WITH
active asthma, chronic obstructive pulmonary disease (COPD), bradycardia, hypotension, Parkinson’s disease, PUD, GI or urinary obstruction
side effects of anticholinergics
fever, dry secretions, blurred vision, confusion
Parkinson’s Disease
Progressive degenerative disorder of the basal ganglia caused by a dopamine depletion in the substantia nigra, Results in an imbalance between dopamine and acetylcholine, seen more in man over the age of 60
TRAP parkinson’s disease
Tremor Rigidity Akinesia (bradykinesia) Postural instability
drug types for parkinson’s
Do not cure just alleviate symptoms, Dopaminergic Agents Anticholinergic Agents MAOI’s Anti-virals COMT inhibitors
Dopaminergic agents
Levadopa(Dopar), carbidopa-levodopa(Sinemet)
Precursor of dopamine that crosses the blood–brain barrier, where it is converted to dopamine
The dosage of levodopa can be decreased, reducing adverse side effects
Dopamine agonists
Prototype Drug= Pramipexole (Mirapex)
Apomorphine (Apokyn)- Used as single dose, subcu injection, Used to treat “off” episodes, not routine management
Bromocriptine (Parlodel)
Ropinirole (Requip)- Monotherapy early and with levodopa in advanced disease; less dyskinesias than levodopa; also used for restless leg syndrome
Amantadine (Symmetrel)
sites and blocks reuptake of dopamine, Rapid reduction in symptoms followed by diminished effects after several months, Adverse effects: confusion, dizziness, irritability, headache, sedation
Can exacerbate hallucinations and suicidal ideations
Anti-viral agent
Catechol-O-methyltransferase (COMT) inhibitors
Adjunct to levodopa, Prevent the destruction of levodopa in the peripheral tissues, Not used as monotherapy (just with levodopa to prolong its half life)
Decrease “off” time during levodopa therapy
Entacapone (Comtan)
Tolcapone (Tasmar)
MAO-B Inhibitors
Selegiline (Eldepryl), rasagiline (Azilect)
May slow progression of PD, Available as an oral tablet, an orally disintegrating tablet and a patch, Inhibiting MAO allows more dopamine to be present in the CNS
Can be used as monotherapy or with levodopa
Used early in PD, may delay the need for levodopa
Anticholinergic drugs
effective at reducing tremor, Restore balance between acetylcholine and dopamine by blocking muscarinic receptors in the striatum, inhibiting the effects of acetylcholine
Benzotropine (Cogentin) Trihexyphenidyl (Artane)
nociceptors are
pain receptors
natural pain modifiers
Endogenous Opioids- Endorphins Enkephalins
drugs that target pain transmission
Opioids analgesics – bind to opioid receptors and mimic the inhibitory effects of endogenous opioids.
Baclofen (Lioresal) inhibits transmission by binding to GABA receptors thus mimicking the inhibitory effects (CNS) of GABA. (Centrally acting muscle relaxer)
intense acute pain
is top priority
types of headaches
Migraine, Cluster, Tension-type, Temporomandibular joint pain
Migraine headache
Neuronal hypersensitivity in the cerebral cortex and occipital cortex. Serotonin appears to be a key factor
Usually recurring, unilateral, throbbing (pulsing) pain, pounding, intense.
Prodrome and aura may precede the headache, Last 4-72 hours
cluster headache
Dysfunction of intracranial blood vessels, sympathetic nervous system and pain modulation systems.Repeated headaches that can occur for weeks to months followed by a remission. Sharp stabbing, penetrating, burning, severe, intense pain. Last a few minutes to 3 hours.
Associated with tearing periorbital swelling facial flushing nasal congestion and constriction of the pupil.
Focused around one eye
tension headache
Usually occur at times of stress; dull band of pain around the entire head, squeezing the head, Bilateral, Palpable neck and shoulder muscles, Stiff neck ( but not nuchal rigidity), given OTC analgesics (Aspirin, Acetaminophen, ibuprofen)
opioids
moderate to serve pain, narcotic analgesic, Prototype: morphine sulfate
narcotic agonists list
codeine, fentanyl(Actiq, Duragesic), hydrocodone(Hycodan), hydromorphone(Dilaudid), meperidine(Demerol), Methadone(Dolophine), opium(Paregoric), oxycodone(Oxycontin)
combination drugs narcotic agonists
Vicodin(Hydrocodone bitartrate 5mg & acetaminophen 500mg) Schedule II
Percocet(Oxycodone Hcl 2.5mg &acetaminophen 325 mg) Schedule III
narcotic antagonists
Nalmefene (Revex)
Reverses the effects of narcotics; manages known or suspected narcotic overdose
Naloxone (Narcan)
Reverses adverse effects of narcotics; diagnoses suspected acute narcotic overdose
medications given for migraine headaches
Mild – NSAIDS, Acetaminophen and Caffeine combinations, triptans or ergot derivatives.
acetaminophen combination with butalbital (barbiturate), caffeine (Fioricet) Fiorinal has ASA instead of acetaminophen
Moderate – oral, intranasal or subcutaneous serotonin agonist
Severe – IM, subcutaneous or IV serotonin agonist, or narcotic analgesics
ergot derivatives
Causes constriction of cranial vessels, Decreases the pulsations of a migraine, Prevention migraine or vascular headaches
EX: Ergotamine (Ergostat)- prototype, Dihydroergotamine mesylate (D.H.E. 45), Ergotamine tartrate with caffeine (Cafergot)
Triptans
Bind to selective serotonin receptors sites to cause vasoconstriction of cranial vessels, Treatment of acute migraine, Abortive therapy (stops a migraine that has already started)
triptans cannot be taken within _____ of ergots
24hrs
list of Triptans (triptan)
sumatriptan (Imitrex), sumatriptan/naproxen (Treximet), almotriptan (Axert), eletriptan (Relpax), naratriptan (Amerge), rizatriptan (Maxalt), zolmitriptan (Zomig), frovatriptan (Frova)
beta blockers for migraines
Used preventatively in the treatment of chronic migraines, The beta-blockers used in preventing migraine headaches include propranolol (Inderal), atenolol (Tenormin), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol (Corgard), and timolol (Blocadren).
other drugs for migraines
Antidepressants (migraine prophylaxis)= Amitriptyline (Elavil) (TCA) Fluoxetine (Prozac) (SSRI)
Anti-seizure (migraine prophylaxis)= Divalproex sodium (Depakote) topiramate (Topamax)
Anti-emetics= metoclopramide (Reglan)
Sedatives
muscle spasms
Involuntary contraction, Usually localized to specific muscle group, Caused by injury or overuse of muscles, Diminishes in a few minutes, Can produce pain, Can impair joint mobility, Pain may be related to decreased blood flow leading to ischemia and lactic acid production, Can be from hypokelemia or hypocalcimia
herbal therapy for muscle spasms
Kava (oral, also has anti-anxiety effects), Black cohosh (topical application to relax muscles), Castor oil packs (topical application), Capsaicin (topical application)
drug therapy for muscle spasms
NSAIDS (aspirin, naproxen, ibuprofen), muscle relaxants
what is the drug of choice for treating muscle spasms
Centrally acting skeletal muscle relaxants
Centrally acting skeletal muscle relaxants
inhibit CNS (safety), cause a sedative effect
Cyclobenzaprine (Amrix, Flexeril)
Skeletal muscle relaxant
Mechanism of action-Thought to occur at brainstem and spinal cord Increases norepinephrine activity by blocking its synaptic reuptake to produce anticholinergic effect
Acts centrally, no direct action on skeletal muscle
Baclofen (Lioresal)
can cause dependence, resembles GABA (safety)
Metaxalone (Skelaxin)
Ineffective in treatment of spasticity-related neurologic disorders
Can cause liver toxicity; monitor liver function tests, contraindicated in patients with liver dysfunction
Tizanidine (Zanaflex)
Spasticity related to brain or spinal cord injury of MS
Centrally acting alpha 2 adrenergic agonist
Can cause hypotension
First line drug in the management of spasticity (along with baclofen)
Has to be dosed every 6-8 hours
Can cause liver impairment
Benzodiazepines
Adjunct to relieve skeletal muscle spasm associated with cerebral palsy, paraplegia and tetanus
Used only if other medications fail to produce adequate muscle relaxation
Scheduled IV drug and can cause dependence.
Diazepam (Valium)
muscle spasticity
in bigger muscle groups, comes from brain Result is increased muscle tone and pain Pain more intense than muscle spasm Greater mobility impairment than spasm Longer term
hypertonia
Continuous state of contraction, Irritable deep tendon reflexes, Muscle spasms, Involuntary jerking, Scissoring movements lower extremities, Fixed joint movement
management of muscle spasticity
Direct-acting skeletal muscle relaxants, Physical therapy= Increases movement Prevents contractures, CNS muscle relaxants= Baclofen (Lioresal) Tizanidine (Zanafle)
Dantrolene Sodium (Dantrium)
Direct-acting skeletal muscle relaxant, antispasticity agent, Calcium release blocker (muscle cells), Pregnancy category C, contraindicated with hepatic disease (hepatotoxicity)
Botulinum toxin (Botox, Botox Cosmetic, Dysport, Myobloc, Xeomin)
Obtained from Clostridium botulinum, Inhibits release of acetylcholine= Paralysis of muscle
Treatment for Cervical dystonia, migraines (if other treatments fail), glabellar lines (wrinkles), upper limb spasticity
black box warning with botulinum toxin
May spread to distant muscles, leading to risk for:
Asthenia, generalized muscle weakness, diplopia, blurred vision, dysphagia, dysphonia, urinary incontinence, swallowing and breathing difficulties
seizures
electric storm in the brain, can be provoked or unprovoked, CNS problem= safety
epilepsy
recurrent seizures, unprovoked
convulsions
involuntary, violent spasms of the large skeletal muscles of the face, neck arms and legs.
characteristic sign of a tonic-clonic seizure.
All convulsions are seizures, but all seizures are not convulsions
generalized seizure
wide spread, entire brain, can be absence (just disconnected) atonic (stiffening- drop attack) myoclonic (jerking- can be small muscles) or tonic-clonic (grand mal, stiffening and jerking)
partial seizure
focused area of brain, can be simple (have memory, are aware and conscious) or complex (missing one of the three)
treatment of seizures does not
cure just helps patients
antiseizure drugs
Barbiturates – not first line, Benzodiazepines, Hydantoins, Iminostilbenes, Succinimides
nursing care for seizures
Prevent aspiration, don’t limit movement, time it, do not put anything in the mouth, give O2, check VS and BG after, put bed as low as possible
Barbiturates and barbiturate like drugs
Phenobarbital(Luminal), Produces fewer adverse effects, May take several weeks to see desired outcome
Adverse effects: CNS depression Sedation, hypnosis, anesthesia, coma Can cause dependence
Emergency treatment of status epilepticus (long seizure)
Benzodiazepines
Mechanism of Action: Binding of BZ to GABA Receptors
Common BZ’s for seizures
EX: diazepam(Valium) clonazepam(Klonopin) Lorazepam(Ativan)
Hydantoins
Phenytoin (Dilantin), Generally less sedating, May be the drugs of choice for patients who are not willing to tolerate sedation and drowsiness, Adverse Effects: CNS depression, Liver toxicity, BM suppression, Gingival hyperplasia, SJS (call MD at first sign of rash)
Iminostilbene
Carbamazepine (Tegretol)
for Parital seizures, Tonic clonic seizures, Trigeminal neuralgia
Mechanism of action: similar to phenytoin in regard to suppression of sodium across the cell membrane
succinimides
Work by delaying the influx of calcium into the cell, Work best for absence seizures
Drug example: ethosuximide(Zarontin) suximide(Celontin)
Adverse Effects: Suicidal intent Severe metal depression Stevens-Johnson Syndrome Skin reactions-pruritis, urticaria, alopecia
Gabapentin (Neurontin)
partial seizures with or without generalization.
Does not induce CYP450 enzymes
Ezogabine (Potiga)
adjunctive treatment for partial seizures in adults
Lamotrigine (Lamictal)
adjunctive therapy of partial, absence and tonic-clonic seizures, dose must be reduced if used with Valproic Acid.
Levetiracetam (Keppra)
adjunctive treatment of partial seizures in adults
Pregabalin (Lyrica)
partial seizures.
dizziness and drowsiness in 20-40% of patients treated. May cause dependence (Schedule V)
Zonisamide (Zonegran)
- for partial seizures.
avoid in patients allergic to sulfa.
Long ½ life. May take 2 weeks to be optimally therapeutic
Valproic acid (Depakene)
decreases electrical activity in the brain and increases GABA activity, Give orally and intravenously, Can be used in the management of absence seizures, Can be used to treat bipolar disorder
Causes CNS depression
Potentiates GABA
Liver toxic
