Module 3 - Anti- epileptic and Anti-Parkinson Medications

Question 1

what are sedatives and hypnotics

Answer 1

drugs that have a calming effect by inhibiting the transmission of nerve impulses to the central nervous system.

Question 2

what do sedatives do?

Answer 2

reduce nervousness, excitability and irritability without causing sleep

Question 3

what do hypnotics do?

Answer 3

cause sleep, stronger than sedatives

Question 4

central and direct acting muscle relaxants:

indications

Answer 4

-relax skeletal muscles and relieve pain associated with central-acting skeletal muscle spasm.
Most effective when taken with physical therapy and rest

Question 5

central and direct acting muscle relaxants:

Mechanism of Action

Answer 5

• work within the CNS to alter nerve transmission to brain, spinal cord, by working with GABA, a CNS inhibitor.
• Dantrolene acts at muscular level to inhibit nerve impulses (not in CNS) by decreasing amount of calcium released.
• Actions: sedative effect, relaxes muscle spasticity and rigidity.

Question 6

central and direct acting muscle relaxants:

what should nurses know and teach pts

Answer 6

• Known contraindications: allergy, severe kidney impairment

Adverse effects: euphoria, lightheadedness, dizziness, drowsiness, fatigue, muscle weakness (short term).

unusual adverse effects: gastrointestinal problems, headache, slurred speech, hypotension (orthostatic), tachycardia, weight gain.

Question 7

Muscle relaxant interactions

Answer 7

alcohol and other depressant drugs potentiate effects, may cause hypoglycemia

Question 8

muscle relaxants types

Answer 8

central acting:

• baclofen
• cyclobenzaprine hydrochloride
• tizanidine hydrochloride

Direct acting:
-dantrolene sodium

Question 9

what is the nursing process for muscle relaxants

Answer 9

1) assess: patient, allergies, vitals, contraindicating conditions (kidney impairment), LOC, breathing
2) Diagnoses:
- Risk for injury and falls, deficient knowledge
3) Plan
- Goals patient will be free from respiratory depression
4) Implementation
- avoid or e cautious with alcohol consumption and CNS depressants
5) Evaluation
- has spasm improves?

Question 10

Seizure

Answer 10

-Brief episode of abnormal electrical activity in the nerve cells of the brain, may cause brief lapse in consciousness or (period of blankness, searching for words)

Question 11

Convulsion

Answer 11

Involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles, recurrent sensory disturbances, abnormal behaviours, or combination

Question 12

Epilepsy

Answer 12

Chronic, recurrent seizures with or without a known cause.

• Brain injury, stroke ect
• Fibril seizures (in children due to temp)

Question 13

Antiepileptic Drugs (AED) uses

Answer 13

all types of epilepsy management, anticonvulsants prevent seizures

• Long-term maintenance therapy for chronic, recurring seizures
• Acute treatment of convulsions and status epilepticus
• Other uses:
• neuropathic pain and phantom limb pain (gabapentin)
• mood stabilizers (carbamazepine)
• anxiety (lorazepam)
• panic disorders (clonazepam)

Question 14

Antiepileptic Drugs (AED) Goals

Answer 14

control or prevent seizures while maintaining a reasonable quality of life

Question 15

how long are patients on AED’s

Answer 15

lifelong therapy

Question 16

Antiepileptic Drugs (AED): 
Mechanism of Action

Answer 16

unknown
- thought to alter movement of Na+, K+, Ca+ across brain neutrons

theories:

1) Reduce nerve’s ability to be stimulated
2) Suppress transmission of impulses from one nerve to the next
3) Decrease the speed of nerve impulse conduction within a neuron

Question 17

seizures: tonic phase

Answer 17

elbows and heels on ground but back arched

Question 18

seizures: clonic phase

Answer 18

rhythmic compulsions

Question 19

Status epileptic

Answer 19

continuous seizure activity without a pause for 30 minutes or 2 back to back seizures (i.e. without an intervening period of normal brain function).

Question 20

narrow therapeutic index

Answer 20

Safe and toxic levels are close

Question 21

AED: Barbiturate (phenobarbital)

dose, indication, advantage

Answer 21

dose - Adult 90-120 mg at HS po
indications - simple, complex, generalized tonic-clonic, absence
advantage - Provides sedative hypnotic effects in addition to contol, prevention of seizures

Question 22

AED: carbamazepine (Tegretol)

dose, indication, advantage, MOA

Answer 22

dose - 800-1,200 mg/day in 2-4 divided doses
indications - -partial seizures, tonic-clonic, trigeminal neuralgia, acute mania
Advantage - steady drug levels

MOA: decreases synaptic transmission in CNS by affecting sodium channels in neurons

Question 23

AED: phenytoin (Dilantin):

dose, indication, advantage, MOA

Answer 23

dose - 300-400 mg/day for maintenance
indications - tonic/clonic, status epilepticus
advantages:
 -daily or BID dosing
-parenteral form available
-inexpensive

MOA: limits seizure propagation by altering ion transport, may also decrease synaptic transmission

Question 24

AED: divalproex sodium (Epival):

dose, indication, advantage

Answer 24

dose: 750-1,000 mg/day in 2 divided doses
indications: multiple seizures, manic episodes, migraine prevention

advantages: broad spectrum, low incidence of rash, less cognitive effects than older AEDs

MOA: increase levels of GABA, an inhibitory neurotransmitter in the CNS

Question 25

Nursing Implications for AED's

Answer 25

pregnancy increases risk d/t probability of developing birth defects - Take regularly, same time each day (steady levels) - Take with meals to reduce gastrointestinal upset - Do not crush, chew, or open extended-release forms - abrupt withdrawal causes rebound seizures - IV route given slowly with NS - avoid extravasation (unintended leakage) of fluids - can cause blisters - IV phenytonin always have filtered needle (caustic to tissues and could cause purple discolouration and deem of tissue

Question 26

AED adverse effects

Answer 26

drowsiness, dizziness, nausea, vomiting, rash, urticaria, Stevens-Johnson syndrome (slough off all your skin), Dysrhythmias, heart failure, bone marrow depression, Thrombocytopenia, peripheral edema -mental status and mood changes, eye problems, visual disorders, sore throat, fever

Question 27

Anticholinergic drugs

Answer 27

block or impede the activity of the neurotransmitter acetylcholine (Ach) at the cholinergic receptors in the brain.

Question 28

Dopaminergic drugs

Answer 28

used to replace the deficiency of dopamine at dopamine receptors in the nerve endings, especially in the brain when treating Parkinson’s disease.

Question 29

Parkinson's Disease

Answer 29

a slowly progressive degenerative disease or neurological disorder characterized by resting tremour, pill-rolling, mask-like facies, shuffling gait, loss of postural reflexes, and muscle rigidity and weakness, Bradykinesia -progresses from tremors, jerky head movements, shuffling gait, postural reflexes -imbalance of dopamine (decreased) and ACh (increased): symptoms don't appear until 80% of dopamine is gone, leaving 20% dopaminergic terminals working treatment: levodopa- can enter brain, form dopamine, and block ACh at dopaminergic terminals.

Question 30

What kind of drug is used to treat parkinson's disease?

Answer 30

Monoamine oxidase inhibitor

Question 31

Parkinsons - MAO-A Inhibitors: interactions

Answer 31

cheese, wine, beer, yoghurt (not used often

Question 32

parkinsons: MAO-B inhibitor

Answer 32

Selegiline used with levodopa to treat PD

Question 33

parkinsons: MAO-B inhibitor | Mechanism Of Action:

Answer 33

Mechanism of action: - increase levels of dopaminergic stimulation in CNS -increases dopamine levels in brain, allowing dose of levodopa to be decreased. Indirect dopamine agonist. Adult dose: 5 mg bid with breakfast and lunch.

Question 34

contraindications for selegiiline

Answer 34

allergy, use of meperidine

Question 35

MAO-B inhibitors: | Adverse Effects

Answer 35

nausea, lightheadedness, dizziness, abdominal pain, insomnia, dry mouth, confusion. When dose is more than 10 mg per day, hypertensive crisis with consumption of tyramine containing food, memory loss, muscular twitches and jerks, grinding of teeth.

Question 36

what are dopaminergics

Answer 36

provide exogenous replacement of dopamine to enhance the function of the few neurons that are still producing dopamine in brain

Question 37

Dopaminergics: | MOA

Answer 37

depends on category amantadine: Release dopamine from remaining functional dopamine vesicles of neurons, or inhibit dopamine metabolizing enzymes levodopa-carbidopa: Provide exogenous dopamine in tablet form to increase brain levels of dopamine bromocriptine, pramipexole (Mirapex), and ropinirole (ReQuip): -Dopaminergic agonists that act as dopamine substitutes and stimulate dopamine receptors in place of dopamine

Question 38

Parkinson's: Catechol Ortho-Methyl-Tranferase (COMT) inhibitors - indication - contraindication - MOA - interactions

Answer 38

- treat parkinsons - Contraindications: allergy to dopaminergic drugs, history of melanoma or known skin condition, narrow-angle glaucoma. - MOA: Inhibit the breakdown of levodopa in peripheral circulation, and prolongs the effect of levodopa, with less wearing off phenomenon. (pre-synaptic or indirect acting) - interactions: CNS drugs

Question 39

what do anticholinergic drugs do to treat parkinson's disease

Answer 39

Block the effects of acetylcholine, can be useful in treating muscle tremours and rigidity (caused by excess ACh)

Question 40

anticholinergic drugs and their adverse effects MOA

Answer 40

belladona alkaloids, atropine and scopolamin adverse effects: dry mouth, urinary retention, and blurred vision MOA: block acetylcholine pathways in brain.

Question 41

symptoms of excess Ach and how are these reversed

Answer 41

``` SLUGE S-salavation L - lacrimation U- urination D - diarrhea G - gastrointestinal motility E - emesis. ``` *Anti-cholinergic drugs block these effects Anticholinergic drugs act on basal area of ganglions to help stop acetocholine from being produced so much to reduce tremors

Question 42

anticholinergic drugs | contraindications, adverse effects, and interactions

Answer 42

contraindications: allergy, glaucoma, gastric or bladder outlet obstruction, heart disease, and myasthenia gravis adverse effects: - CNS: drowsiness, confusion, disorientation, hallucinations - Gastrointestinal: Constipation, nausea, vomiting - Genitourinary: Urinary retention, pain on voiding - Other: blurred vision, dilated pupils, photophobia, dry skin interactions: additive effects c/ alcohol, CNS depressants, amantadine, phenothiazine, tricyclic antidepressants, and antihistamines ph change in stomach and delayed absorption caused by antacids

Question 43

nursing interventions with parkinson drugs

Answer 43

- Assist with ambulation (messing with movement centre) - give oral doses with food - Vitamin B6 10 mg - reverse effects of levodopa and should be avoided. - encourage extra fluid and a high finer diet - give doses hours before bed as it can cause insomnia

Question 44

Which of the following reflects the most appropriate nursing action for IV phenytoin (Dilantin) administration? A. ensure continuous infusion of the drug B. give IV doses via rapid IV push C. administer in dextrose solutions D. administer in normal saline solutions

Answer 44

D. administer in normal saline solutions

Question 45

Which of the following is the most appropriate when administering an antiepileptic drug? A. take on an empty stomach B. take at the same time every day C. crush tablets if unable to swallow D. stop if seizure activity disappears

Answer 45

B. take at the same time every day

Question 46

A patient with parkinson’s disease is not responding well to levodopa (single source drug that is a dopomine substance). The physician adds carbidopa to prevent peripheral destruction of levodopa and result in increased amounts of levodopa to the brain. True or False

Answer 46

true