Nervous system medications Flashcards
Anticonvulsants/Antiepileptic Drugs:
- seizures: sudden muscle contractions that happen without conscious control
- Etiology: disease or disorders, head injuries
- epilepsy, brain tumour, stroke
Epilepsy:
- condition characterised by the continued recurrence of seizures
- affects 1% of the population
- excitability of nerve cells are altered and become uncontrolled and unpredictable
Managment of epilepsy:
- membranes of excitatory nerve cells can be stabilised by adjusting sodium, potassium and calcium levels
- Adjusting neurotransmitter levels
Aanticonvulsant/Antiepileptic drugs:
Adverse effects:
- GI disturbance - altered appetite
- headaches
- mental confusion
- allergic skin rash
Nursing considerations:
- medications must be taken at regular intervals
- cannot drive until medical clearance
- avoid bath and hot showers - can provoke seizures
Barbiturates:
Action:
- long duration of action and sedative effect on the brain
Uses:
- status epilepticus - prevent and control grand mal seizures
- may treat seizures caused by tetanus, fever or drugs
Adverse reactions:
- dizziness, drowsiness, lethargy, headache, rash
- diarrhoea, nausea, vomiting
Benzodiazepines:
Action:
- CNS depressants, suppress electrical discharge in seizures
Uses:
- treat minor motor seizures
- limited use in seizure prevention because of tolerance and sedative effect
Examples:
- Diazepam (Valium)
Adverse reactions:
- Hypotension, tachycardia, hypersalivation
- clumsiness, confusion, depression, headache
- fatigue, insomnia, vertigo, anorexia
Hydantoins:
Action:
- work primarily on the motor cortex
- stop the spread of seizure activity by increasing or decreasing Na+ ion movement across the motor cortex during the generation of nerve impulses
Uses:
- grand mal and psychomotor seizures, status epilepticus, migraines
Examples:
- Phenytoin (Dilantin) - less sedation than barbiturates
Adverse reactions:
- dizziness, drowsiness, inattentiveness
- hallucinations, poor memory, slurred speach
- constipation, nausea, vomiting, change in focus
Parkinson’s Disease:
Neurological disease causing:
- tremor of extremities, and head
- difficulty coordinating fine muscle movement
- Hyperkinesia - problems initiating movement
- postural changes
- skeletal muscle rigidity
- progressive decrease in neuronal functioning
- tends to be irreversible
- occurs in 1% or people aged over 60
- cause unknown
Anti-Parkinson’s medications:
- current drugs cannot cure the condition or slow progression
Classes of drugs: - drugs that raise dopamine (DA) levels or stimulate DA receptors
- drugs with central anticholinergic activity
- other drugs used for symptomatic relief
Drugs enhancing brain DA:
Levodopa:
- first line of treatment
- requires large doses
Adverse effects:
- nausea, depression, agitation, delusions, confusion
- hypotension, increased tremor
Nursing considerations:
- ‘on-off’ syndrome - periods of norma movement preceding increased severity of symptoms
- controlled release may be useful during the day
Carbidopa:
- used with levodopa to slow breakdown of levodopa
- no therapeutic action itself
- CNS adverse effects due to more levodopa reaching the brain
Pramipexole:
- binds to dopamine D3 receptor
- used with levodopa to improve motor functions and reduce ‘off’ time
- adverse effects - sudden sleepiness, compulsive behaviours
Anticholinergic drugs:
- useful in early stages of disease
- improve functional capacity
- reduces tremor
- examples - benztropine, benzhexol
Parkinson disease patient education:
- all medications must be taken exactly as prescribed
- take after meals to reduce stomach upset
- urine, swear and saliva may darken after exposure to air
- avoid overexertion during hot weather
Sleep:
Two phases of sleep:
- non-rapid eye movement (non-REM)
- rapid eye movement (REM)
Factors that can disrupt sleep:
- disrupted sleep cycles
- obstructive sleep apnea
- anxiety and depression
- alcohol and drug use
- environmental factors
- pain
Drugs used to promote sleep:
- sedatives
- hypnotics
