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Neuro 1 Flashcards

1
Q

Benzodiazepines purpose

A

Relieve insomnia

Decrease repeated awakenings during the night

Relieve anxiety

Treat status epilepticus

Relax muscle spasms

Help with moderate sedation

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2
Q

Common benzodiazepines

A

End in “Pam”

Temazepam (Restoril)

Diazepam

Lorazepam

Flurazepam

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3
Q

How benzodiazepines work

A

Enhance effects of Gamma-immunobuteric acid (GABA)

Cause sedation

Fall asleep quicker

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4
Q

benzodiazepines: side effects

A

Drowsiness, dizziness, confusion, anxiety

Tolerance develops over weeks

Withdrawal: paranoia, panic attacks, muscle twitching, hallucinations

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5
Q

benzodiazepines monitoring

A

Overseeing ambulation for older adults

Toxicity: weakness, slurred speech, ataxia, uncoordinated muscle movements, respiratory depression

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6
Q

Ingesting benzodiazepines

A

PO 30 min before sleep

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7
Q

benzodiazepines contraindications

A

Preg category X

Glaucoma

Children under 8

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8
Q

benzodiazepines precautions

A

Renal or hepatic impairment

Suicidal ideation

Alcohol dependence

Neuromuscular disorders

Chronic respiratory disorders

Sleep apnea

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9
Q

benzodiazepines interactions

A

Taking with other CNS depressants (alcohol, opioids)- sedation risk

Kava kava and valerian - sedation risk

Cimetidine- increase levels

Smoking- decrease effectiveness

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10
Q

Non-benzodiazepines treatment

A

Short term

insomnia

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11
Q

Non-benzodiazepines drugs

A

Zolpidem (Ambien)

Other:

Zaleplon (Sonata)

Eszopiclone (Lunesta)

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12
Q

Non-benzodiazepines side effects

A

Daytime drowsiness, headache, anxiety, dizziness, diplopia, confusion in older adults

Amnesia ⬇️

Ambulating, eating, driving

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13
Q

Non-benzodiazepines: admin

A

Oral for immediate or extended release

Oral spray

Admin on empty stomach

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14
Q

Non-benzodiazepines contraindications

A

Children under 18

Suicidal ideation

Labor and delivery

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15
Q

Non-benzodiazepines precautions

A

Older adults

History of depression

Chronic respiratory disorders

Sleep apnea

Hepatic or renal dysfunction

SMALLER DOSES: hepatic and renal disease

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16
Q

Types of drugs for muscle spasms

A

Centrally acting

Peripherally acting

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17
Q

Centrally acting muscle relaxants: use

A

Spinal cord injury

Multiple sclerosis

Cerebral palsy

Musculoskeletal injury or other disorders

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18
Q

Centrally acting muscle relaxants: drugs

A

Baclofen (Lioresal)

Carisoprodol (Soma)

Chlorzoxazone (Paraflex, Parafon Forte)

Cyclobenzaprine (Flexeril)

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19
Q

How Centrally acting muscle relaxants work

A

Enhance inhibitory effects of GABA

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20
Q

Centrally acting muscle relaxants: side effects

A

Drowsiness and dizziness early in therapy

Nausea

Cobsitipation

Withdrawal symptoms: anxiety, restlessness, visual hallucinations, seizures

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21
Q

Centrally acting muscle relaxants: nurse intervention

A

Start with low dose

Give with food

Increase fluid and fiber intake

If discontinue after several weeks, taper over 1-2 weeks to prevent withdrawal

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22
Q

Centrally acting muscle relaxants intrathecal infusion

A

Directly into spine via needle attached to pump

Do not stop abruptly

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23
Q

Centrally acting muscle relaxants: contraindications

A

use of MAOI within past 2 weeks

Cerebral palsy

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24
Q

Centrally acting muscle relaxants: precautions

A

Older adults

Children

Severe mental illness

Seizure disorders

Cerebrovascular Accident

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25
Centrally acting muscle relaxants: interactions
diabetes: may need to increase insulin as drug can increase blood glucose (baclofen) Use of cyclobenzaprine (Flexeril) with MAOI can cause hypertensive crisis
26
Peripherally acting muscle relaxants: use
Cerebrovascular incident Spinal cord injury Multiple sclerosis Cerebral palsy Prevent&attest malignant hyperthermia: side effect of anesthesia
27
Peripherally acting muscle relaxants: prototype drug
Dantrolene (Dantrium)
28
How Peripherally acting muscle relaxants work
Inhibit release of calcium Block contraction of muscles
29
Peripherally acting muscle relaxants: side effects
Muscle weakness Drowsiness, dizziness Diarrhea Liver toxicity (increased dose and long therapy)
30
Peripherally acting muscle relaxants: nurse interventions
Assess muscle strength Monitor CNS side effects: drowsiness Monitor for diarrhea Monitor liver function
31
Peripherally acting muscle relaxants: med admin
Oral or IV Prophylaxis of malignant hyperthermia: PO 1-2 day postoperative IV: malignant hyperthermia
32
Peripherally acting muscle relaxants: contraindication
Liver disease
33
Peripherally acting muscle relaxants: precautions
Cardiac disease Pulmonary disease Neuromuscular disorders Patients older than 35
34
Drug therapy for seizure disorders
Anti-epileptic drugs (AEDs) - Hydantoin - Iminostilbenes - Valproic acid
35
Drug therapy for seizure disorders: Hydatoins
Tonic-clinic seizures (involve entire body) Partial seizures (affect one part of brain and one part of body)
36
Hydantoins types
Phenytoin (Dilantin) Other: Ethotoin (Peganone) Fosphenytoin (Cerebyx)
37
Hydantoins purpose
Inhibit influx of sodium through sodium channels Decrease discharge of neurons around areas of increased activity
38
Hydantoins: side effects
Mild drowsiness Gingival hyperplasia Skin rash Withdrawal symptoms
39
Hydantoins: nursing intervention
Give with meals Inject IV slowly (no more than 50mg/min) Monitor vitals Monitor plasma (10-20 mcg/mL)
40
Hydantoins: client education
Don't drive or perform hazardous activities Dental checkups Report rash Don't stop taking abruptly
41
Hydantoins: contraindications
Preg category D Skin rash Bradycardia or heart block Seizures caused from low blood sugar
42
Hydantoins: precautions
Liver or kidney disease Cardiac dysfunction Diabetes Older adults Alcoholism Debilitated patients Respiratory dysfunction
43
Hydantoins: interactions
Incompatible in solution with many other drugs w/dextrose solutions Diazepam, isoniazid, cimetidine, valproic acid increase levels of phenytoin phenobarbital and carbamazepine decrease phenytoin levels Phenytoin decrease effectiveness of oral contraceptives
44
Imonstilbenes: treatment
Partial seizures Tonic-clinic seizures Bipolar disorder Trigeminal neuroalgia
45
Imonstilbenes: drug
Carbamazepine (Tegretol)
46
Imonstilbenes: how they work
Inhibit influx of sodium through sodium channels Decrease discharge neurons around areas of increased activity
47
Imonstilbenes: side effects
visual disturbances Decreased excretion of water Skin rash (epidermal necrolysis, Stevens-Johnson syndrome) Bone marrow suppression
48
Imonstilbenes: nursing intervention
Begin with low dose Split daily dose, large dose at bedtime WBC &a complete blood count Observe patients skin Test Asian decent for HLA-B 1502 gene
49
Imonstilbenes: admin
With meals Sustained release taken whole Don't mix suspension with other suspensions Maintain therapeutic levels
50
Imonstilbenes: client education
CNS effects No driving Prevent falls Rash Decreased urine output, edema, shortness of breath Bone marrow suppression Limit sun
51
Imonstilbenes: contraindications
Preg category risk D Absence and myoclonic seizures Hematologic disorders Heart failure
52
Imonstilbenes: precautions
Cardiac or hepatic disease HBLA B 1502 gene Alcoholism
53
Imonstilbenes: interactions
Plasma levels increase with grapefruit juice False negative pregnancy test Plasma levels can increase with antifungals, erythromycin, isoniazid, some antiretrovirals, valpronic acid, verapamil, niacin, loratidine, nefazodone, MAIOs Plasma levels decrease with phenytoin, barbiturates, rifampin, cisplatin, theophylline
54
Valproic acid
All seizure types Mania with bipolar Migraine headache prevention
55
Valproic acid: drug
Valproic acid | Depakote, Depacon, Depakene
56
Valproic acid: how it works
Inhibits sodium through sodium channels Decrease discharge of neurons around areas of increased activity Inhibits reflux of calcium through calcium channels Enhanced inhibitory effects of GABA
57
Valproic Acid: side effects
GI upset Indigestion Bruising, bleeding, decreased platelets Skin rash Liver toxicity Hyperammonemia
58
Valproic Acid: nurse intervention
Monitor for patients signs and symptoms of hepatitis and pancreatitis Monitor bleeding and platelet count Liver function Symptoms of hepatitis Take lowest effective dose
59
Valproic Acid: med admin
Orally or IV Enteric Coated w/food Dilute IV w/50mL Depakote sprinkles can be sprinkled on food
60
Valproic Acid: client teaching
Report rash, nausea, abdominal pain, jaundice, anorexia, bruises, unexpected bleeding Women who became pregnant- take folic acid to prevent neural tube defects cause spina bifida
61
Valproic Acid: contraindications
Preg risk category C Liver disorder Thrombocytopenia Hyperammonemia Taking other anticonvulsants
62
Valproic Acid: precautions
Kidney disease Older adults Children under 10
63
Valproic Acid: interactions
Blood levels of phenytoin and phenobarbital increase Topiramate (Topamax) increase risk for hyperammonemia

Pharm (8 decks)

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