Module Neuro 1 Flashcards

1
Q

baclofen (Lioresal) class

A

centrally acting muscle relaxant

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2
Q

baclofen (Lioresal) expected pharmacologic action

A

enhance inhibitory effects of GABA on receptors in the spinal cord, results in suppression of hyperactive reflexes

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3
Q

baclofen (Lioresal) adverse drug reactions

A

drowsiness, dizziness, weakness, fatigue

nausea, vomiting, constipation, urinary retention rare but possible

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4
Q

baclofen (Lioresal) nursing considerations

A

take oral doses with food to decrease gastric irritation

encourage fluids and dietary fiber to avoid constipation

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5
Q

centrally acting muscle relaxants - name prototype and others

A

baclofen (Lioresal)

carisoprodol (Soma)
chlorzoxazone (Parafon Forte)
cyclobenzaprine (Flexeril)

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6
Q

baclofen (Lioresal) contraindications

A

known hypersensitivity
use of MAOI antidepressants

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7
Q

centrally acting muscle relaxant interactions

A

avoid alcohol or other CNS depressants

serotonin syndrome can occur if cyclobanzaprine is given to patient on SSRIs, SSNRIs, or tricyclic antidepressants

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8
Q

baclofen (Lioresal) therapeutic use

A

spinal cord injury
multiple sclerosis
cerebral palsy

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9
Q

peripherally acting muscle relaxants prototype

A

dantrolene (Dantrium)

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10
Q

dantrolene (Dantrium) class

A

peripherally acting muscle relaxant

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11
Q

dantrolene (Dantrium) therapeutic use

A

prevent muscle spasms in CVA, stroke, spinal cord injury, MS, CP

prevent malignant hyperthermia

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12
Q

dantrolene (Dantrium) adverse drug reactions

A

weakness
drowsiness
dizziness
diarrhea
liver toxicity

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13
Q

dantrolene (Dantrium) nursing considerations

A

assess muscle strength during treatment
monitor for CNS effects
monitor for diarrhea
monitor liver function

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14
Q

dantrolene (Dantrium) contraindications

A

liver disease

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15
Q

dantrolene (Dantrium) precautions

A

cardiac disease
pulmonary disease
neuromuscular disorders
age over 35 years - increased risk for liver damage

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16
Q

dantrolene (Dantrium) interactions

A

age over 35 and use of estrogen can lead to liver toxicity

avoid use with alcohol or CNS depressants

can cause cardiac dysrhythmias if taken with calcium channel blockers

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17
Q

baclofen (Lioresal) precautions

A

patients with:
severe mental illness
seizure disorders
stroke

older adults and children under 2 years

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18
Q

AEDs

A

anti-epileptic drugs

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19
Q

what are hydantoins?

A

help control tonic-clonic seizures and partial seizures

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20
Q

hydantoins - name prototype and others

A

phenytoin (Dilantin)

fosphenytoin (Cerebyx)

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21
Q

expected pharmacologic action of hydantoins

A

decrease neuronal activity by inhibiting influx of sodium through sodium channels

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22
Q

hydantoins - adverse drug reactions

A

drowsiness
CNS depression
gingival hyperplasia - abnormal tissue growth around gums
skin rash

abrupt discontinuation can lead to recurrence of seizures

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23
Q

hydantoins - nursing actions

A

monitor for drowsiness and CNS effects
observe gums for hyperplasia
monitor for rashes

phenytoin should be given with meals to prevent GI distress

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24
Q

what precautions should be taken when administering phenytoin IV?

A

no more than 50 mg per minute, no more than 25 mg per minute for older adults

injecting drug too quickly can cause cardiac collapse

monitor vital signs to identify dysrhythmias or hypotension

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25
hydantoins contraindications
pregnancy - teratogenic skin rash bradycardia heart block hydantoin allergy seizures caused my low blood sugar
26
hydantoins precautions
liver or kidney disease cardiac dysfunction diabetes mellitus respiratory dysfunction history of alcoholism = high risk of toxicity
27
phenytoin (Dilantin) interactions
diazepam, isoniazid, cimetidine, valproic acid increase levels of phenytoin alcohol use can increase or decrease phenytoin levels phenobarbital and carbamazepine decrease phenytoin levels
28
carbamazepine (Tegretol) class
anticonvulsant
29
carbamazepine (Tegretol) therapeutic use
partial seizures tonic-clonic seizures mood stabilizer for bipolar reduces trigeminal neuralgia pain
30
carbamazepine (Tegretol) adverse drug reactions
visual disturbances ataxia headache skin rash photosensitivity
31
carbamazepine (Tegretol) considerations
give before bed to avoid side effects during daytime give with meals monitor WBC and CBC counts monitor for skin rash Asian patients may have genetic predisposition to severe skin reaction protect from sun exposure
32
carbamazepine (Tegretol) contraindications
pregnancy - teratogenic absence or myoclonic seizures hematologic disorders heart failure MAOI use in last two weeks concurrent use of nefazodone or NNRTIs
33
carbamazepine (Tegretol) precautions
cardiac or hepatic disease alcoholism
34
carbamazepine (Tegretol) interactions
grapefruit juice increases levels false negative pregnancy test decrease efficacy of oral contraceptives some antifungals and antiretrovirals can increase levels phenytoin and others decrease plasma levels
35
valproic acid class
anticonvulsant
36
valproic acid brand names
Depakote, Depacon, Depakene
37
valproiic acid therapeutic use
all seizure types controls mania in bipolar prevents migraines
38
valproic acid adverse drug reactions
brusing, bleeding, decreased platelets GI symptoms skin rash neural tube defect in pregnancy hyperammonemia pancreatitis liver toxicity
39
valproic acid considerations
monitor bleeding, bruising, platelet count give with food use ER form monitor for rash folic acid supplementation in pregnancy assess for vomiting, confuson liver function tests
40
valproic acid contraindications
pregnancy and lactation liver disorders concurrent use of other anticonvulsants
41
valproic acid precautions
kidney disease older adults children younger than 2 years
42
valproic acid expected pharmacologic action
inhibiting influx of sodium through sodium channels may enhance inhibitory effects of GABA
43
local anesthetics - prototype and others
lidocaine (Xylocaine) procaine (Novocain) benzocaine (Americaine)
44
local anesthetic expected pharmacologic action
blocks influx of sodium through sodium channels prevents depolarization prevents action potentials from being activated
45
local anesthetics adverse drug reactions
CNS stimulation - restlessness, irritability, tremors, confusion, convulsions
46
local anesthetics nursing considerations
monitor vital signs do not place in eyes or broken skin ask patient to report paresthesias - tingling or pain ask patient to report breathing difficulties
47
lidocaine contraindications
previous allergy viscous lidocaine should not be used in children under 3
48
lidocaine interactions
beta blockers, quinidine, cimetidine increase level in blood concurrent administration of procainamide increases risk of CNS and cardiac effects phenytoin increases risk of cardiac effects
49
Barbituates - General Anesthetics - Intravenous anesthetics name the prototype drug and others
methohexital sodium (Brevital) is the prototype propofol (Diprivan) most widely used
50
therapeutic use of general anesthesia barbiturates
rapid induction of anesthesia and hypnosis for brief procedures adjunct anesthesia with other anesthetic agents if procedure is longer than 15 minutes
51
general anesthesia barbiturate adverse drug reactions
respiratory depression cardiovascular toxicity - tachycardia or hypotension suicide or abuse
52
general anesthesia barbiturate nursing considerations
monitor vitals IV injection should be slow resuscitation equipment should be kept on hand
53
contraindications for general anesthesia barbiturates
known sensitivity use precaution with hepatic and renal disease because they can prolong the effects of the drug
54
general anesthesia barbiturate interactions
potentiates CNS effects of other CNS depressants giving with general benzodiazepine anesthetics will prolong anesthesia
55
general anesthesia benzodiazepines - name prototype and others
midazolam (Versed) is prototype diazepam (Valium)
56
therapeutic use of general anesthetic benzodiazepines
sedation before general anesthesia conscious sedations with induction of amnesia supplement to inhalation anesthesia for surgeries
57
general anesthetic benzodiazepine adverse drug reactions
amnesia from time prior to injection cardiac or respiratory arrest
58
general anesthetic benzodiazepine nursing considerations
monitor vitals inject IV bolus slowly and wait at least 2 minutes between doses resuscitation equipment on hand
59
general anesthetic benzodiazepine administration considerations
do not give IV bolus to neonate can be given orally to children can administer IM for conscious sedation can combine with opioid for conscious sedation
60
general anesthetic benzodiazepine contraindications
pregnancy and lactation risk benzo sensitivity acute angle-closure glaucoma use caution for neuromuscular, cardiac, pulmonary, or renal disorders
61
general anesthetic benzodiazepine interactions
enhances effects of anticonvulsants herbal products can increase or decrease effects of midazolam
62
name the prototype drug for the general anesthesia neuroleptic-opioid combination class
fentanyl (Duragesic or Actiq)
63
fentanyl (Duragesic) therapeutic use
supplemental to general anesthesia used with droperidol and nitrous oxide for neurolepanalgesia used with skeletal muscle relaxant as anesthesia for high-risk patients
64
fentanyl (Duragesic) adverse reactions
sedation nausea respiratory or circulatory depression
65
fentanyl nursing consiiderations
monitor LOC monitor for nausea monitor vitals resuscitation equipment on hand naloxone (Narcan) on hand
66
fentanyl contraindications
substance abuse childbirth
67
fentanyl precautions
patients who have increased ICP older adults and young children patients with cardiac or respiratory disorders patients with liver or kidney disorders
68
fentanyl interactions
MAOI antidepressants can cause hypertensive crisis other CNS depressants increase risk for sedation and respiratory depression
69
what kind of drugs are used to treat ADHD and narcolepsy?
CNS stimulants amphetamines, methylphenidate, non-amphetamines
70
amphetamines prototype and others
amphetamine/dextroamphetamine sulfate (Adderall) methamphetamine hydrochloride (Desoxyn)
71
expected pharmacological action of amphetamines
increase release of norepinephrine and dopamine increase alertness and energy can inhibit appetite
72
amphetamine/dextroamphetamine sulfate (Adderall) adverse reactions
insomnia and nervousness weight loss hypertension, tachycardia, heart palpitations toxicity can cause psychosis dependence and abuse withdrawal - depression
73
considerations for Adderall
time doses to allow for nighttime sleep monitor weight children need breaks to prevent growth suppression taper dose if discontinuing treat symptoms with antipsychotics or antihypertensives monitor for fatigue and depression
74
Adderall client instructions
avoid caffeine take as early in day as possible time large meals when appetite is greatest do not stop abruptly
75
Adderall contraindications
amphetamine allergy hypertension heart disease structural cardiac defects in children drug abuse history MAOI use in last 14 days glaucoma
76
Adderall precautions
mild hypertension
77
Adderall interactions
use within 2 weeks of MAOI causes hypertension increased chance of cardiac effects if taken with other stimulants vitamin C and ammonium chloride decrease elimination
78
CNS stimulant category prototype drug and others
methylphenidate (Ritalin or Concerta) dexmethylphenidate (Focalin)
79
expected pharmacologic action of methylphenidate (Ritalin)
increasing norepinephrine and dopamine release increases energy and alertness
80
methylphenidate (Ritalin) adverse drug reactions
insomnia, nervousness weight loss hypertension and heart palpitations dependence and abuse withdrawal depression
81
methylphenidate (Ritalin) considerations
time doses to allow for nighttime sleep monitor weight children need breaks to prevent growth suppression taper dose if discontinuing monitor for fatigue and depression
82
methylphenidate (Ritalin) client instructions
avoid caffeine take as early in day as possible report weight loss or cardio symptoms time large meals when appetite is greatest do not stop abruptly
83
methylphenidate (Ritalin) contraindications
amphetamine allergy cardiac arrhythmia or structural defects psychosis, depression, mania drug abuse history children younger than 6 MAOI use within 2 weeks glaucoma tics or Tourette's syndrome
84
methylphenidate (Ritalin) precautions
hypertension hyperthyroidism
85
methylphenidate (Ritalin) innteractions
hypertension if used within 2 weeks of MAOI increase chance of cardiac effects if taken with other stimulants
86
non-amphetamine prototype and others
modafinil (Provigil) armodafinil (Nuvigil) remember vigil like vigilant = alert
87
expected pharmacologic action of non-amphetamines
unknown, may block reuptake up norepinephrine
88
modafinil (Provigil) adverse reactions
nausea and diarrhea headache tachycardia and hypertension rash - stevens-johnson syndrome
89
modafinil (Provigil) considerations
take with food monitor vitals for cardiac effects discontinue if rash develops
90
modafinil (Provigil) interactions
decrease levels of oral contraceptives methylphenidate can cause delayed absorption
91
modafinil (Provigil) contraindications
valvular heart disease pregnancy
92
modafinil (Provigil) precautions
heart disease hypertension hepatic or renal impairment substance abuse history mania or psychosis older adults or children younger than 16
93
dopamine replacement drugs prototype
levodopa/carbidopa (Sinemet)
94
therapeutic use of levodopa/carbidopa (Sinemet)
relieves parkinson's symptoms
95
expected pharmacologic action of levodopa/carbidopa (Sinemet)
drug converts to dopamine and is used
96
levodopa/carbidopa (Sinemet) adverse reactions
nausea vomiting postural hypotension dyskinesias
97
levodopa/carbidopa (Sinemet) considerations
fall prevention measures gradually increase dose to reduce adverse effects take with food avoid high-protein foods
98
levodopa/carbidopa (Sinemet) contraindications
glaucoma melanoma psychosis suicidal ideation
99
levodopa/carbidopa (Sinemet) precautions
renal, hepatic, endocrine, respiratory disorders wide-angle glaucoma peptic ulcers depression or bipolar
100
levodopa/carbidopa (Sinemet) interactions
first gen antipsychotics and B6 decrease action MAOI within 2 weeks causes hypertensive crisis anticholinergic drugs increase response
101
Direct-acting dopamine receptor agonist prototype and others
pramipexole (Mirapex) ropinirole (Requip)
102
therapeutic use of pramipexole (Mirapex)
restless leg syndrome parkinson's symptoms
103
pramipexole (Mirapex) adverse reactions
nausea drowsiness muscle weakness orthostatic hypotension dyskinesias
104
pramipexole (Mirapex) expected pharmacologic action
bind to dopamine receptors and mimic dopamine
105
pramipexole (Mirapex) considerations
monitor LOC monitor nausea monitor muscle weakness and prevent falls monitor cardiac status wait 5 to 7 days between dosage increases
106
pramipexole (Mirapex) contraindications
allergy pregnancy and lactation
107
pramipexole (Mirapex) precautions
renal dysfunction compulsive behavior older adults psychotic disorder
108
pramipexole (Mirapex) interactions
alcohol increases risk of adverse effects antipsychotics decrease therapeutic effect cimetidine increases levels
109
Antiparkinson Agent/MAOB inhibitors prototype and others
selegiliine (Eldepryl or Zelapar ODT) rasagiline (Azilect)
110
therapeutic use of MAOB inhibitors
parkinson's symptoms major depression
111
MAOB inhibitors expected pharmacologic action
inhibits monoamine oxidase enzyme, which prevents it from inactivating dopamine
112
MAOB inhibitors adverse drug reactions
insomnia hypertension if interacting with other drugs irritation of oral mucous membranes if given in orally disintegrating form
113
MAOB inhibitors considerations
monitor for adverse effects monitor BP inspect tongue and mouth for irritation levodopa dosage can be reduced if given with MAOB inhibitors no food or drink within 5 minutes of ODT administration
114
MAOB inhibitors contraindications
hypersensitivity concurrent meperidine
115
MAOB inhibitors precautions
peptic ulcers
116
MAOB inhibitors interactions
opioids, MAOIIs, SSRIs can cause fever and hypertension herbals can cause hypertension
117
cholinesterase inhibitor prototype and others
donepezil (Aricept) rivastigmine (Exelon) galantamine (Razadyne)
118
expected pharmacologic action of cholinesterase inhibitors
prevents acetylcholinesterase enzyme from inactivating acetylcholine
119
therapeutic use of cholinesterase inhibitors
improve cognitive function in Alzheimer's patients
120
cholinesterase inhibitor adverse drug reactions
nausea CNS - insomnia, dizziness, headache bradycardia
121
cholinesterase inhibitor cosiderations
give with food monitor weight monitor for signs of GI bleed fall prevention for dizziness give at bedtime
122
cholinesterase inhibitor contraindications
GI bleeding donepezil allergy being a child
123
cholinesterase inhibitor precautions
liver, renal, cardiac, GI, pulmonary disorders hyperthyroidism seizures
124
cholinesterase inhibitor interactions
use with NSAIDs can cause GI bleed anticholinergic drugs such as antihistamines decrease effects
125
NMDA receptor antagonist prototype
there is currently only one NMDA receptor antagonist memantine (Namenda)
126
NMDA receptor antagonist therapeutic use
slow the decline of cognitive and physical functioning in Alzheimer's
127
memantine (Namenda) expected pharmacologic action
block excess glutamate from stimulating NMDA receptors decrease influx of calcium into neurons prevent neuronal damage from high levels of calcium
128
memantine (Namenda) adverse drug reactions
dizziness, headache confusion constipation
129
memantine (Namenda) considerations
monitor for CNS effects maintain safety if dizziness or confusion occurs provide fiber supplements and stool softener for constipation
130
memantine (Namenda) contraindications
renal failure allergy
131
memantine (Namenda) precautions
liver or kidney disorders seizure disorders older adults
132
memantine (Namenda) interactions
antacids increase levels, possible toxicity
133
what kind of drugs treat multiple sclerosis?
immunomodulators and immunosuppressants
134
immunomodulators expected pharmacologic action
inhibits movements of leukocytes across blood-brain barrier to prevent them from damaging myelin sheath
135
immunomodulator prototype and others
TWO PROTOTYPE DRUGS interferon beta 1a (Avonex or Rebif) interferon beta 1b (Betaseron) glatiramer acetate (Copaxone) natalizumab (Tysabri)
136
immunomodulator adverse drug reactions
headache, fever, chills, myalgia decreased blood cell production liver toxicity subQ injection site irritation
137
immunomodulator considerations
start low dose acetaminophen for flu-like symptoms liver function tests
138
immunomodulator administration schedule
Avonex administered IM once a week Rebif administered subQ 3x a week Betaseron subQ every other day
139
immunomodulator contraindications
allergic reaction to interferon beta, albumin, mannitol
140
immunomodulator precautions
suicidal ideation liver disorder alcohol abuse age under 18 years seizures mental health disorders
141
immunomodulator interactions
immunosuppressants
142
serotonin agonist therapeutic use
relieve symptoms of migraine or cluster headache
143
serotonin agonist prototype and others
sumatriptan (Imitrex) zolmitriptan (Zomig)
144
serotonin agonist expected pharmacologic action
promote vasoconstriction and suppress release of CGRP that causes inflammatory response
145
serotonin agonist adverse drug reactions
chest pressure - vasoconstriction in lungs and esophagus anginal pain CNS - tingling and vertigo
146
serotonin agonist considerations
monitor vitals after first dose in case of vasospasm maximum daily dose of nasal spray sumatriptan is 40 mg do not give more than 2 subQ doses in 24 hours do not give more than 200 mg orally in 24 hours
147
serotonin agonist contraindications
coronary artery disease, angina, MI, hypertension peripheral vascular disease older adults stroke MAOI in last 2 weeks use of another triptan in 24 hours
148
serotonin agonist precautions
liver or kidney insufficiency seizure disorders high blood pressure serotonin syndrome fertility impairment
149
serotonin agonist interactions
St John's wort can cause toxicity MAO inhibitors within 2 weeks can cause sumatriptan toxicity can cause serotonin syndrome if taken with another serotonin agonist