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Pharm > Neuro 1 > Flashcards

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
Q

Centrally acting muscle relaxants: interactions

A

diabetes: may need to increase insulin as drug can increase blood glucose (baclofen)

Use of cyclobenzaprine (Flexeril) with MAOI can cause hypertensive crisis

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26
Q

Peripherally acting muscle relaxants: use

A

Cerebrovascular incident

Spinal cord injury

Multiple sclerosis

Cerebral palsy

Prevent&attest malignant hyperthermia: side effect of anesthesia

27
Q

Peripherally acting muscle relaxants: prototype drug

A

Dantrolene (Dantrium)

28
Q

How Peripherally acting muscle relaxants work

A

Inhibit release of calcium

Block contraction of muscles

29
Q

Peripherally acting muscle relaxants: side effects

A

Muscle weakness

Drowsiness, dizziness

Diarrhea

Liver toxicity (increased dose and long therapy)

30
Q

Peripherally acting muscle relaxants: nurse interventions

A

Assess muscle strength

Monitor CNS side effects: drowsiness

Monitor for diarrhea

Monitor liver function

31
Q

Peripherally acting muscle relaxants: med admin

A

Oral or IV

Prophylaxis of malignant hyperthermia: PO 1-2 day postoperative

IV: malignant hyperthermia

32
Q

Peripherally acting muscle relaxants: contraindication

A

Liver disease

33
Q

Peripherally acting muscle relaxants: precautions

A

Cardiac disease

Pulmonary disease

Neuromuscular disorders

Patients older than 35

34
Q

Drug therapy for seizure disorders

A

Anti-epileptic drugs (AEDs)

  • Hydantoin
  • Iminostilbenes
  • Valproic acid
35
Q

Drug therapy for seizure disorders: Hydatoins

A

Tonic-clinic seizures (involve entire body)

Partial seizures (affect one part of brain and one part of body)

36
Q

Hydantoins types

A

Phenytoin (Dilantin)

Other:

Ethotoin (Peganone)

Fosphenytoin (Cerebyx)

37
Q

Hydantoins purpose

A

Inhibit influx of sodium through sodium channels

Decrease discharge of neurons around areas of increased activity

38
Q

Hydantoins: side effects

A

Mild drowsiness

Gingival hyperplasia

Skin rash

Withdrawal symptoms

39
Q

Hydantoins: nursing intervention

A

Give with meals

Inject IV slowly (no more than 50mg/min)

Monitor vitals

Monitor plasma (10-20 mcg/mL)

40
Q

Hydantoins: client education

A

Don’t drive or perform hazardous activities

Dental checkups

Report rash

Don’t stop taking abruptly

41
Q

Hydantoins: contraindications

A

Preg category D

Skin rash

Bradycardia or heart block

Seizures caused from low blood sugar

42
Q

Hydantoins: precautions

A

Liver or kidney disease

Cardiac dysfunction

Diabetes

Older adults

Alcoholism

Debilitated patients

Respiratory dysfunction

43
Q

Hydantoins: interactions

A

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
Q

Imonstilbenes: treatment

A

Partial seizures

Tonic-clinic seizures

Bipolar disorder

Trigeminal neuroalgia

45
Q

Imonstilbenes: drug

A

Carbamazepine (Tegretol)

46
Q

Imonstilbenes: how they work

A

Inhibit influx of sodium through sodium channels

Decrease discharge neurons around areas of increased activity

47
Q

Imonstilbenes: side effects

A

visual disturbances

Decreased excretion of water

Skin rash (epidermal necrolysis, Stevens-Johnson syndrome)

Bone marrow suppression

48
Q

Imonstilbenes: nursing intervention

A

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
Q

Imonstilbenes: admin

A

With meals

Sustained release taken whole

Don’t mix suspension with other suspensions

Maintain therapeutic levels

50
Q

Imonstilbenes: client education

A

CNS effects

No driving

Prevent falls

Rash

Decreased urine output, edema, shortness of breath

Bone marrow suppression

Limit sun

51
Q

Imonstilbenes: contraindications

A

Preg category risk D

Absence and myoclonic seizures

Hematologic disorders

Heart failure

52
Q

Imonstilbenes: precautions

A

Cardiac or hepatic disease

HBLA B 1502 gene

Alcoholism

53
Q

Imonstilbenes: interactions

A

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
Q

Valproic acid

A

All seizure types

Mania with bipolar

Migraine headache prevention

55
Q

Valproic acid: drug

A

Valproic acid

Depakote, Depacon, Depakene

56
Q

Valproic acid: how it works

A

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
Q

Valproic Acid: side effects

A

GI upset

Indigestion

Bruising, bleeding, decreased platelets

Skin rash

Liver toxicity

Hyperammonemia

58
Q

Valproic Acid: nurse intervention

A

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
Q

Valproic Acid: med admin

A

Orally or IV

Enteric Coated w/food

Dilute IV w/50mL

Depakote sprinkles can be sprinkled on food

60
Q

Valproic Acid: client teaching

A

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
Q

Valproic Acid: contraindications

A

Preg risk category C

Liver disorder

Thrombocytopenia

Hyperammonemia

Taking other anticonvulsants

62
Q

Valproic Acid: precautions

A

Kidney disease

Older adults

Children under 10

63
Q

Valproic Acid: interactions

A

Blood levels of phenytoin and phenobarbital increase

Topiramate (Topamax) increase risk for hyperammonemia

Pharm (8 decks)

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