Exam 3 Neuro Drugs Flashcards
What are the 6 drugs for pain
First generation NSAIDS
Second generation NSAIDS
Acetaminophen
Dual mechanism agents
Opioid agonists
Opioid antagonists
First Generation NSAIDS
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: Ibuprofen
Routes: PO
Uses: reduces inflammation and treats mild pain
Pharmacologic action: Inhibit actions of both COX 1 and 2 which inhibits prostaglandin synthesis-this reduces pain, inflammation, and fever (COX 2 responsible for these responses)-works at the site of injury
Major adverse reactions: Inhibition of COX 1 results in reduced gastric mucosa protection (risk for ulcers), decreased platelet aggregation, and impaired renal perfusion
Nursing Interventions: monitor for bleeding, especially in the GI system, monitor renal function
Client education: drug should be taken with food, milk, or at minimum 8 oz water to decrease GI effects; monitor for bleeding
Interactions: Lithium (can increase likelihood of nephrotoxicity)
Second Generation NSAIDS
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: Celecoxib
Routes: PO
Uses: Reduce pain and inflammation
Pharmacologic action: Inhibits production of COX 2 only to reduce pain by inhibiting prostaglandin synthesis-fewer adverse effects than first generation NSAIDS ideally-works at the site of injury
Major adverse reactions: Causes severe platelet aggregation and vasoconstriction which can result in hypertension, stroke, and MI; also, diarrhea, gastric ulceration, can be a teratogen
Nursing Interventions: monitor for CV, renal issues
Client education: take with food, avoid alcohol, monitor for CV manifestations
Interactions: decreases diuretic effects of furosemide, fluconazole can increase celecoxib levels, decreases effects of ACE inhibitors
Acetaminophen: Name the route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: acetaminophen
Routes: PO, IV, suppository
Uses: Reduce pain and fever
Pharmacologic action: Works as a COX inhibitor, but in the CNS-does not relieve inflammation or alter platelet aggregation
Major adverse reactions: liver dysfunction
Nursing Interventions: monitor for manifestations of liver failure
Client education: monitor for liver dysfunction, the importance of knowing what is in medications to ensure that there is not an accidental overdose
Interactions: alcohol increases likelihood of liver dysfunction, acetaminophen increases the action of warfarin
Dual Mechanism Agents
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: tramadol
Routes: PO
Uses: relieves pain
Pharmacologic action: binds to opioid receptors to mimic natural pain modulators and blocks reuptake of norepinephrine and serotonin which inhibits the transmission of pain in the spinal cord
Major adverse reactions: sedation, nausea, constipation, seizures, respiratory depression (rare)
Nursing Interventions: monitor neurological status and respiratory status
Client education: Clients will not feel effects until approximately 1 hour after administration, avoid activities that required mental alertness, monitor for constipation
Interactions: MAOIs (risk for hypertensive crisis), SSRIs, TCAs, and MAOIs increase risk for serotonin syndrome
Opioid Agonists
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: Morphine
Routes: PO, IV, IM
Uses: Relieves moderate to severe pain
Pharmacologic action: Bind to mu receptors on opioid receptor sites and mimic the actions of naturally occurring pain modulators like endorphins, enkephalins, and opioids
Major adverse reactions: sedation, respiratory depression, dizziness, constipation, nausea, vomiting, urinary retention, cough suppression, euphoria
Nursing Interventions: monitor VS (especially BP and RR), monitor for constipation, nausea, UOP
Client education: Opioids should only be taken short-term, should avoid when need to be mentally alert, take fiber and increase fluids
Interactions: CNS depressants, anticholinergic agents, antihypertensives
Opioid Antagonists
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: Naloxone
Routes: IV, intranasal, IM, Sub-Q
Uses: Reverse the effects of opioids, specifically respiratory depression and sedation
Pharmacologic action: Block opioid receptors which keeps opioids from being able to act on those same receptors
Major adverse reactions: increased HR and RR, possible dysrhythmias, severe agitation, return of pain
Nursing Interventions: monitor VS, heart rhythm
Client education: If client is awake they will need to know that the pain will likely return
Interactions: decrease effects of opioids
Cholinesterase Inhibitors
(Alzheimer’s drug)
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: donepezil
Routes: PO
Uses: Improve cognitive function in mild to moderate AD and possibly delay progression
Pharmacologic action: prevent acetylcholinesterase from breaking down acetylcholine, resulting in more being present for brain function
Major adverse reactions: nausea, GI distress, insomnia, headache, dizziness, bradycardia
Nursing Interventions: observe for CV issues, or s/s GI bleeding, assist with ambulation
Client education: should be taken with food at bedtime
Interactions: antihistamines decrease effects of the drug; when used with NSAIDs, there is an increased risk of GI bleeding
NMDA Receptor Antagonists
(Alzheimer’s drug)
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: memantine
Routes: PO
Uses: Slow cognitive decline in moderate to severe AD
Pharmacologic action: Block glutamate from stimulating NMDA receptors which reduces intracellular calcium-this helps to restore transmission and prevent damage to neurons from calcium influx
Major adverse reactions: dizziness, headache, confusion, possible constipation
Nursing Interventions: monitor for CNS issues and constipation
Client education: report side effects
Interactions: OTC antacids can increase levels of memantine
What are the two drugs you use to treat seizures that have no known cause
Antiepileptic drugs (AEDs) (phenytoin, carbamazepine)
Valproic acid
Traditional Antiepileptic drugs AEDs
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: phenytoin
Routes: PO, IV
Uses: Control clonic-tonic as well as partial seizures
Pharmacologic action: inhibit the influx of sodium into cells via sodium channels and decrease the activity of cells that could cause seizures
Major adverse reactions: CNS depression, gingival hyperplasia, rash
Nursing Interventions: monitor for excessive drowsiness, monitor gums and for rashes
Client education: Don’t participate in activities that require mental alertness, get regular dental checkups, don’t stop the drug abruptly
Interactions: Diazepam, isonazid, cimetidine, valproic acid can increase levels of the drug; alcohol, can alter levels of the drug
Traditional Antiepileptic drugs AEDs
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: carbamazepine
Routes:
Uses: Control clonic-tonic as well as partial seizures
Pharmacologic action: inhibits the influx of sodium into cells via sodium channels and decrease the activity of cells that could cause seizures
Major adverse reactions: visual disturbances, fluid retention, skin rash, photosensitivity, bone marrow suppression
Nursing Interventions: Monitor CBC, assess for rash, protect from sun exposure
Client education: take with meals, don’t mix suspension with other drugs, take consistently, don’t discontinue suddenly
Interactions: grapefruit juice increases levels; decreases effectiveness of oral contraceptives and can cause false negative on pregnancy tests
What are the 3 types of meds used for Parkinson’s
Dopamine Replacement Drugs
Direct-acting Dopamine Receptor Agonists
Monamine Oxidase Type B/MAO-B Inhibitors
Dopamine Replacement Drugs
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: levodopa/carbidopa
Routes: PO
Uses: Drugs designed to cross the blood-brain barrier where they be taken up by substantia nigra and converted to dopamine
Pharmacologic action: Carbidopa helps to keep levodopa (a dopamine precursor) from being converted to dopamine outside of the CNS so that more can cross the BBB and be used to increase dopamine production in the CNS
Major adverse reactions: nausea, vomiting, orthostatic hypotension, darkened sweat and urine, increased dyskinesia at the beginning of treatment
Nursing Interventions: monitor for dyskinesia, orthostatic hypotension
Client education: start with low dose and then increase; may take up to 6 months to achieve therapeutic dose; take with foods, but not high-protein foods
Interactions: first-generation antipsychotics decrease absorption; anticholinergic drugs increase response; can cause hypertensive crisis if taken with MAOIs
Direct-acting Dopamine Receptor Agonists
Name the example drug, route, uses, pharmacologic action, major adverse reactions, nursing interventions, client education, and drug interactions
Example drug: pramipexole
Routes: PO
Uses: Decrease Parkinson-related symptoms
Pharmacologic action: binds to dopamine receptors and mimics the actions of dopamine in the body
Major adverse reactions: nausea, orthostatic hypotension, dyskinesia, drowsiness
Nursing Interventions: give with food to decrease GI issues, monitor for drowsiness and orthostatic hypotension
Client education: start with low dose and titrate up to desired effect; take with food if experiencing nausea; move slowly while changing positions; taper doses if discontinuing
Interactions: cimetidine increases amount of pramipexole; metoclopramide decreases effects of drug; first-generation antipsychotics decrease effects of drug
