Neuro 1 Flashcards
Benzodiazepines purpose
Relieve insomnia
Decrease repeated awakenings during the night
Relieve anxiety
Treat status epilepticus
Relax muscle spasms
Help with moderate sedation
Common benzodiazepines
End in “Pam”
Temazepam (Restoril)
Diazepam
Lorazepam
Flurazepam
How benzodiazepines work
Enhance effects of Gamma-immunobuteric acid (GABA)
Cause sedation
Fall asleep quicker
benzodiazepines: side effects
Drowsiness, dizziness, confusion, anxiety
Tolerance develops over weeks
Withdrawal: paranoia, panic attacks, muscle twitching, hallucinations
benzodiazepines monitoring
Overseeing ambulation for older adults
Toxicity: weakness, slurred speech, ataxia, uncoordinated muscle movements, respiratory depression
Ingesting benzodiazepines
PO 30 min before sleep
benzodiazepines contraindications
Preg category X
Glaucoma
Children under 8
benzodiazepines precautions
Renal or hepatic impairment
Suicidal ideation
Alcohol dependence
Neuromuscular disorders
Chronic respiratory disorders
Sleep apnea
benzodiazepines interactions
Taking with other CNS depressants (alcohol, opioids)- sedation risk
Kava kava and valerian - sedation risk
Cimetidine- increase levels
Smoking- decrease effectiveness
Non-benzodiazepines treatment
Short term
insomnia
Non-benzodiazepines drugs
Zolpidem (Ambien)
Other:
Zaleplon (Sonata)
Eszopiclone (Lunesta)
Non-benzodiazepines side effects
Daytime drowsiness, headache, anxiety, dizziness, diplopia, confusion in older adults
Amnesia ⬇️
Ambulating, eating, driving
Non-benzodiazepines: admin
Oral for immediate or extended release
Oral spray
Admin on empty stomach
Non-benzodiazepines contraindications
Children under 18
Suicidal ideation
Labor and delivery
Non-benzodiazepines precautions
Older adults
History of depression
Chronic respiratory disorders
Sleep apnea
Hepatic or renal dysfunction
SMALLER DOSES: hepatic and renal disease
Types of drugs for muscle spasms
Centrally acting
Peripherally acting
Centrally acting muscle relaxants: use
Spinal cord injury
Multiple sclerosis
Cerebral palsy
Musculoskeletal injury or other disorders
Centrally acting muscle relaxants: drugs
Baclofen (Lioresal)
Carisoprodol (Soma)
Chlorzoxazone (Paraflex, Parafon Forte)
Cyclobenzaprine (Flexeril)
How Centrally acting muscle relaxants work
Enhance inhibitory effects of GABA
Centrally acting muscle relaxants: side effects
Drowsiness and dizziness early in therapy
Nausea
Cobsitipation
Withdrawal symptoms: anxiety, restlessness, visual hallucinations, seizures
Centrally acting muscle relaxants: nurse intervention
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
Centrally acting muscle relaxants intrathecal infusion
Directly into spine via needle attached to pump
Do not stop abruptly
Centrally acting muscle relaxants: contraindications
use of MAOI within past 2 weeks
Cerebral palsy
Centrally acting muscle relaxants: precautions
Older adults
Children
Severe mental illness
Seizure disorders
Cerebrovascular Accident
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
Peripherally acting muscle relaxants: use
Cerebrovascular incident
Spinal cord injury
Multiple sclerosis
Cerebral palsy
Prevent&attest malignant hyperthermia: side effect of anesthesia
Peripherally acting muscle relaxants: prototype drug
Dantrolene (Dantrium)
How Peripherally acting muscle relaxants work
Inhibit release of calcium
Block contraction of muscles
Peripherally acting muscle relaxants: side effects
Muscle weakness
Drowsiness, dizziness
Diarrhea
Liver toxicity (increased dose and long therapy)
Peripherally acting muscle relaxants: nurse interventions
Assess muscle strength
Monitor CNS side effects: drowsiness
Monitor for diarrhea
Monitor liver function
Peripherally acting muscle relaxants: med admin
Oral or IV
Prophylaxis of malignant hyperthermia: PO 1-2 day postoperative
IV: malignant hyperthermia
Peripherally acting muscle relaxants: contraindication
Liver disease
Peripherally acting muscle relaxants: precautions
Cardiac disease
Pulmonary disease
Neuromuscular disorders
Patients older than 35
Drug therapy for seizure disorders
Anti-epileptic drugs (AEDs)
- Hydantoin
- Iminostilbenes
- Valproic acid
Drug therapy for seizure disorders: Hydatoins
Tonic-clinic seizures (involve entire body)
Partial seizures (affect one part of brain and one part of body)
Hydantoins types
Phenytoin (Dilantin)
Other:
Ethotoin (Peganone)
Fosphenytoin (Cerebyx)
Hydantoins purpose
Inhibit influx of sodium through sodium channels
Decrease discharge of neurons around areas of increased activity
Hydantoins: side effects
Mild drowsiness
Gingival hyperplasia
Skin rash
Withdrawal symptoms
Hydantoins: nursing intervention
Give with meals
Inject IV slowly (no more than 50mg/min)
Monitor vitals
Monitor plasma (10-20 mcg/mL)
Hydantoins: client education
Don’t drive or perform hazardous activities
Dental checkups
Report rash
Don’t stop taking abruptly
Hydantoins: contraindications
Preg category D
Skin rash
Bradycardia or heart block
Seizures caused from low blood sugar
Hydantoins: precautions
Liver or kidney disease
Cardiac dysfunction
Diabetes
Older adults
Alcoholism
Debilitated patients
Respiratory dysfunction
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
Imonstilbenes: treatment
Partial seizures
Tonic-clinic seizures
Bipolar disorder
Trigeminal neuroalgia
Imonstilbenes: drug
Carbamazepine (Tegretol)
Imonstilbenes: how they work
Inhibit influx of sodium through sodium channels
Decrease discharge neurons around areas of increased activity
Imonstilbenes: side effects
visual disturbances
Decreased excretion of water
Skin rash (epidermal necrolysis, Stevens-Johnson syndrome)
Bone marrow suppression
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
Imonstilbenes: admin
With meals
Sustained release taken whole
Don’t mix suspension with other suspensions
Maintain therapeutic levels
Imonstilbenes: client education
CNS effects
No driving
Prevent falls
Rash
Decreased urine output, edema, shortness of breath
Bone marrow suppression
Limit sun
Imonstilbenes: contraindications
Preg category risk D
Absence and myoclonic seizures
Hematologic disorders
Heart failure
Imonstilbenes: precautions
Cardiac or hepatic disease
HBLA B 1502 gene
Alcoholism
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
Valproic acid
All seizure types
Mania with bipolar
Migraine headache prevention
Valproic acid: drug
Valproic acid
Depakote, Depacon, Depakene
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
Valproic Acid: side effects
GI upset
Indigestion
Bruising, bleeding, decreased platelets
Skin rash
Liver toxicity
Hyperammonemia
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
Valproic Acid: med admin
Orally or IV
Enteric Coated w/food
Dilute IV w/50mL
Depakote sprinkles can be sprinkled on food
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
Valproic Acid: contraindications
Preg risk category C
Liver disorder
Thrombocytopenia
Hyperammonemia
Taking other anticonvulsants
Valproic Acid: precautions
Kidney disease
Older adults
Children under 10
Valproic Acid: interactions
Blood levels of phenytoin and phenobarbital increase
Topiramate (Topamax) increase risk for hyperammonemia
