Module Neuro 1 Flashcards
baclofen (Lioresal) class
centrally acting muscle relaxant
baclofen (Lioresal) expected pharmacologic action
enhance inhibitory effects of GABA on receptors in the spinal cord, results in suppression of hyperactive reflexes
baclofen (Lioresal) adverse drug reactions
drowsiness, dizziness, weakness, fatigue
nausea, vomiting, constipation, urinary retention rare but possible
baclofen (Lioresal) nursing considerations
take oral doses with food to decrease gastric irritation
encourage fluids and dietary fiber to avoid constipation
centrally acting muscle relaxants - name prototype and others
baclofen (Lioresal)
carisoprodol (Soma)
chlorzoxazone (Parafon Forte)
cyclobenzaprine (Flexeril)
baclofen (Lioresal) contraindications
known hypersensitivity
use of MAOI antidepressants
centrally acting muscle relaxant interactions
avoid alcohol or other CNS depressants
serotonin syndrome can occur if cyclobanzaprine is given to patient on SSRIs, SSNRIs, or tricyclic antidepressants
baclofen (Lioresal) therapeutic use
spinal cord injury
multiple sclerosis
cerebral palsy
peripherally acting muscle relaxants prototype
dantrolene (Dantrium)
dantrolene (Dantrium) class
peripherally acting muscle relaxant
dantrolene (Dantrium) therapeutic use
prevent muscle spasms in CVA, stroke, spinal cord injury, MS, CP
prevent malignant hyperthermia
dantrolene (Dantrium) adverse drug reactions
weakness
drowsiness
dizziness
diarrhea
liver toxicity
dantrolene (Dantrium) nursing considerations
assess muscle strength during treatment
monitor for CNS effects
monitor for diarrhea
monitor liver function
dantrolene (Dantrium) contraindications
liver disease
dantrolene (Dantrium) precautions
cardiac disease
pulmonary disease
neuromuscular disorders
age over 35 years - increased risk for liver damage
dantrolene (Dantrium) interactions
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
baclofen (Lioresal) precautions
patients with:
severe mental illness
seizure disorders
stroke
older adults and children under 2 years
AEDs
anti-epileptic drugs
what are hydantoins?
help control tonic-clonic seizures and partial seizures
hydantoins - name prototype and others
phenytoin (Dilantin)
fosphenytoin (Cerebyx)
expected pharmacologic action of hydantoins
decrease neuronal activity by inhibiting influx of sodium through sodium channels
hydantoins - adverse drug reactions
drowsiness
CNS depression
gingival hyperplasia - abnormal tissue growth around gums
skin rash
abrupt discontinuation can lead to recurrence of seizures
hydantoins - nursing actions
monitor for drowsiness and CNS effects
observe gums for hyperplasia
monitor for rashes
phenytoin should be given with meals to prevent GI distress
what precautions should be taken when administering phenytoin IV?
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
hydantoins contraindications
pregnancy - teratogenic
skin rash
bradycardia
heart block
hydantoin allergy
seizures caused my low blood sugar
hydantoins precautions
liver or kidney disease
cardiac dysfunction
diabetes mellitus
respiratory dysfunction
history of alcoholism = high risk of toxicity
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
carbamazepine (Tegretol) class
anticonvulsant
carbamazepine (Tegretol) therapeutic use
partial seizures
tonic-clonic seizures
mood stabilizer for bipolar
reduces trigeminal neuralgia pain
carbamazepine (Tegretol) adverse drug reactions
visual disturbances
ataxia
headache
skin rash
photosensitivity
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
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
carbamazepine (Tegretol) precautions
cardiac or hepatic disease
alcoholism
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
valproic acid class
anticonvulsant
valproic acid brand names
Depakote, Depacon, Depakene
valproiic acid therapeutic use
all seizure types
controls mania in bipolar
prevents migraines
valproic acid adverse drug reactions
brusing, bleeding, decreased platelets
GI symptoms
skin rash
neural tube defect in pregnancy
hyperammonemia
pancreatitis
liver toxicity
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
valproic acid contraindications
pregnancy and lactation
liver disorders
concurrent use of other anticonvulsants
valproic acid precautions
kidney disease
older adults
children younger than 2 years
valproic acid expected pharmacologic action
inhibiting influx of sodium through sodium channels
may enhance inhibitory effects of GABA
local anesthetics - prototype and others
lidocaine (Xylocaine)
procaine (Novocain)
benzocaine (Americaine)
local anesthetic expected pharmacologic action
blocks influx of sodium through sodium channels
prevents depolarization
prevents action potentials from being activated
local anesthetics adverse drug reactions
CNS stimulation - restlessness, irritability, tremors, confusion, convulsions
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
lidocaine contraindications
previous allergy
viscous lidocaine should not be used in children under 3
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
Barbituates - General Anesthetics - Intravenous anesthetics
name the prototype drug and others
methohexital sodium (Brevital) is the prototype
propofol (Diprivan) most widely used
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
general anesthesia barbiturate adverse drug reactions
respiratory depression
cardiovascular toxicity - tachycardia or hypotension
suicide or abuse
general anesthesia barbiturate nursing considerations
monitor vitals
IV injection should be slow
resuscitation equipment should be kept on hand
contraindications for general anesthesia barbiturates
known sensitivity
use precaution with hepatic and renal disease because they can prolong the effects of the drug
general anesthesia barbiturate interactions
potentiates CNS effects of other CNS depressants
giving with general benzodiazepine anesthetics will prolong anesthesia
general anesthesia benzodiazepines - name prototype and others
midazolam (Versed) is prototype
diazepam (Valium)
therapeutic use of general anesthetic benzodiazepines
sedation before general anesthesia
conscious sedations with induction of amnesia
supplement to inhalation anesthesia for surgeries
general anesthetic benzodiazepine adverse drug reactions
amnesia from time prior to injection
cardiac or respiratory arrest
general anesthetic benzodiazepine nursing considerations
monitor vitals
inject IV bolus slowly and wait at least 2 minutes between doses
resuscitation equipment on hand
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
general anesthetic benzodiazepine contraindications
pregnancy and lactation risk
benzo sensitivity
acute angle-closure glaucoma
use caution for neuromuscular, cardiac, pulmonary, or renal disorders
general anesthetic benzodiazepine interactions
enhances effects of anticonvulsants
herbal products can increase or decrease effects of midazolam
name the prototype drug for the general anesthesia neuroleptic-opioid combination class
fentanyl (Duragesic or Actiq)
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
fentanyl (Duragesic) adverse reactions
sedation
nausea
respiratory or circulatory depression
fentanyl nursing consiiderations
monitor LOC
monitor for nausea
monitor vitals
resuscitation equipment on hand
naloxone (Narcan) on hand
fentanyl contraindications
substance abuse
childbirth
fentanyl precautions
patients who have increased ICP
older adults and young children
patients with cardiac or respiratory disorders
patients with liver or kidney disorders
fentanyl interactions
MAOI antidepressants can cause hypertensive crisis
other CNS depressants increase risk for sedation and respiratory depression
what kind of drugs are used to treat ADHD and narcolepsy?
CNS stimulants
amphetamines, methylphenidate, non-amphetamines
amphetamines prototype and others
amphetamine/dextroamphetamine sulfate (Adderall)
methamphetamine hydrochloride (Desoxyn)
expected pharmacological action of amphetamines
increase release of norepinephrine and dopamine
increase alertness and energy
can inhibit appetite
amphetamine/dextroamphetamine sulfate (Adderall) adverse reactions
insomnia and nervousness
weight loss
hypertension, tachycardia, heart palpitations
toxicity can cause psychosis
dependence and abuse
withdrawal - depression
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
Adderall client instructions
avoid caffeine
take as early in day as possible
time large meals when appetite is greatest
do not stop abruptly
Adderall contraindications
amphetamine allergy
hypertension
heart disease
structural cardiac defects in children
drug abuse history
MAOI use in last 14 days
glaucoma
Adderall precautions
mild hypertension
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
CNS stimulant category prototype drug and others
methylphenidate (Ritalin or Concerta)
dexmethylphenidate (Focalin)
expected pharmacologic action of methylphenidate (Ritalin)
increasing norepinephrine and dopamine release
increases energy and alertness
methylphenidate (Ritalin) adverse drug reactions
insomnia, nervousness
weight loss
hypertension and heart palpitations
dependence and abuse
withdrawal depression
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
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
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
methylphenidate (Ritalin) precautions
hypertension
hyperthyroidism
methylphenidate (Ritalin) innteractions
hypertension if used within 2 weeks of MAOI
increase chance of cardiac effects if taken with other stimulants
non-amphetamine prototype and others
modafinil (Provigil)
armodafinil (Nuvigil)
remember vigil like vigilant = alert
expected pharmacologic action of non-amphetamines
unknown, may block reuptake up norepinephrine
modafinil (Provigil) adverse reactions
nausea and diarrhea
headache
tachycardia and hypertension
rash - stevens-johnson syndrome
modafinil (Provigil) considerations
take with food
monitor vitals for cardiac effects
discontinue if rash develops
modafinil (Provigil) interactions
decrease levels of oral contraceptives
methylphenidate can cause delayed absorption
modafinil (Provigil) contraindications
valvular heart disease
pregnancy
modafinil (Provigil) precautions
heart disease
hypertension
hepatic or renal impairment
substance abuse history
mania or psychosis
older adults or children younger than 16
dopamine replacement drugs prototype
levodopa/carbidopa (Sinemet)
therapeutic use of levodopa/carbidopa (Sinemet)
relieves parkinson’s symptoms
expected pharmacologic action of levodopa/carbidopa (Sinemet)
drug converts to dopamine and is used
levodopa/carbidopa (Sinemet) adverse reactions
nausea
vomiting
postural hypotension
dyskinesias
levodopa/carbidopa (Sinemet) considerations
fall prevention measures
gradually increase dose to reduce adverse effects
take with food
avoid high-protein foods
levodopa/carbidopa (Sinemet) contraindications
glaucoma
melanoma
psychosis
suicidal ideation
levodopa/carbidopa (Sinemet) precautions
renal, hepatic, endocrine, respiratory disorders
wide-angle glaucoma
peptic ulcers
depression or bipolar
levodopa/carbidopa (Sinemet) interactions
first gen antipsychotics and B6 decrease action
MAOI within 2 weeks causes hypertensive crisis
anticholinergic drugs increase response
Direct-acting dopamine receptor agonist prototype and others
pramipexole (Mirapex)
ropinirole (Requip)
therapeutic use of pramipexole (Mirapex)
restless leg syndrome
parkinson’s symptoms
pramipexole (Mirapex) adverse reactions
nausea
drowsiness
muscle weakness
orthostatic hypotension
dyskinesias
pramipexole (Mirapex) expected pharmacologic action
bind to dopamine receptors and mimic dopamine
pramipexole (Mirapex) considerations
monitor LOC
monitor nausea
monitor muscle weakness and prevent falls
monitor cardiac status
wait 5 to 7 days between dosage increases
pramipexole (Mirapex) contraindications
allergy
pregnancy and lactation
pramipexole (Mirapex) precautions
renal dysfunction
compulsive behavior
older adults
psychotic disorder
pramipexole (Mirapex) interactions
alcohol increases risk of adverse effects
antipsychotics decrease therapeutic effect
cimetidine increases levels
Antiparkinson Agent/MAOB inhibitors prototype and others
selegiliine (Eldepryl or Zelapar ODT)
rasagiline (Azilect)
therapeutic use of MAOB inhibitors
parkinson’s symptoms
major depression
MAOB inhibitors expected pharmacologic action
inhibits monoamine oxidase enzyme, which prevents it from inactivating dopamine
MAOB inhibitors adverse drug reactions
insomnia
hypertension if interacting with other drugs
irritation of oral mucous membranes if given in orally disintegrating form
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
MAOB inhibitors contraindications
hypersensitivity
concurrent meperidine
MAOB inhibitors precautions
peptic ulcers
MAOB inhibitors interactions
opioids, MAOIIs, SSRIs can cause fever and hypertension
herbals can cause hypertension
cholinesterase inhibitor prototype and others
donepezil (Aricept)
rivastigmine (Exelon)
galantamine (Razadyne)
expected pharmacologic action of cholinesterase inhibitors
prevents acetylcholinesterase enzyme from inactivating acetylcholine
therapeutic use of cholinesterase inhibitors
improve cognitive function in Alzheimer’s patients
cholinesterase inhibitor adverse drug reactions
nausea
CNS - insomnia, dizziness, headache
bradycardia
cholinesterase inhibitor cosiderations
give with food
monitor weight
monitor for signs of GI bleed
fall prevention for dizziness
give at bedtime
cholinesterase inhibitor contraindications
GI bleeding
donepezil allergy
being a child
cholinesterase inhibitor precautions
liver, renal, cardiac, GI, pulmonary disorders
hyperthyroidism
seizures
cholinesterase inhibitor interactions
use with NSAIDs can cause GI bleed
anticholinergic drugs such as antihistamines decrease effects
NMDA receptor antagonist prototype
there is currently only one NMDA receptor antagonist
memantine (Namenda)
NMDA receptor antagonist therapeutic use
slow the decline of cognitive and physical functioning in Alzheimer’s
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
memantine (Namenda) adverse drug reactions
dizziness, headache
confusion
constipation
memantine (Namenda) considerations
monitor for CNS effects
maintain safety if dizziness or confusion occurs
provide fiber supplements and stool softener for constipation
memantine (Namenda) contraindications
renal failure
allergy
memantine (Namenda) precautions
liver or kidney disorders
seizure disorders
older adults
memantine (Namenda) interactions
antacids increase levels, possible toxicity
what kind of drugs treat multiple sclerosis?
immunomodulators and immunosuppressants
immunomodulators expected pharmacologic action
inhibits movements of leukocytes across blood-brain barrier to prevent them from damaging myelin sheath
immunomodulator prototype and others
TWO PROTOTYPE DRUGS
interferon beta 1a (Avonex or Rebif)
interferon beta 1b (Betaseron)
glatiramer acetate (Copaxone)
natalizumab (Tysabri)
immunomodulator adverse drug reactions
headache, fever, chills, myalgia
decreased blood cell production
liver toxicity
subQ injection site irritation
immunomodulator considerations
start low dose
acetaminophen for flu-like symptoms
liver function tests
immunomodulator administration schedule
Avonex administered IM once a week
Rebif administered subQ 3x a week
Betaseron subQ every other day
immunomodulator contraindications
allergic reaction to interferon beta, albumin, mannitol
immunomodulator precautions
suicidal ideation
liver disorder
alcohol abuse
age under 18 years
seizures
mental health disorders
immunomodulator interactions
immunosuppressants
serotonin agonist therapeutic use
relieve symptoms of migraine or cluster headache
serotonin agonist prototype and others
sumatriptan (Imitrex)
zolmitriptan (Zomig)
serotonin agonist expected pharmacologic action
promote vasoconstriction and suppress release of CGRP that causes inflammatory response
serotonin agonist adverse drug reactions
chest pressure - vasoconstriction in lungs and esophagus
anginal pain
CNS - tingling and vertigo
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
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
serotonin agonist precautions
liver or kidney insufficiency
seizure disorders
high blood pressure
serotonin syndrome
fertility impairment
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
