neurologic disorder in class Flashcards
what do anti epileptics do? MOA
suppress the discharge of neurons & _____ finish
what are goals for treating epilepsy
reduce seizures for a normal life, try to eliminate seizures
t/f monitoring plasma drug levels is important for many AED therapy
T
which of the follwoing is true about AEB drugs
1. cause cns depression
2. safe to fetus in preggo
3. only parenteral route
4. used as monotherapy
5. should not be stopped abruptly
- cause cns depression
- should not be stopped abruptly
pt works day shifts and night shifts for newly diagnosed seizure disorder. what is important teaching
to take the meds at the same time no matter what shift they work
pt started phenytoin. which is correct
a) if my urine turns orange i know the drug is working
b) will use soft toothbrush and make dental appt
c) will gargle after each use of drug
d. take med only when feel a seizure coming
b) will use soft toothbrush and make dental appt
– it affects the gums
(called digital hyperplasia)
what might the nurse see if the phenytoin level is 27mcg/ml?
A) breakthrough seizures
B) nystagmus
C) pinpoint pupils
D) unclear thinking
E) hyperactivity, restlessness
F) diplopia
G) sedation
therapeutic level is 10-20
nystagmus , unclear thinking , diplopia , sedation
they look drunk
T/F: carbamazepine is often preferred b/c it is better tolerated than phenytoin
pt has been taking carbamazepine and calls nurse line about a small rash on the lower leg. is this a concern?
this is a concern, do not take the next dose and come in for an appointment today
we are worried about stevens johnson syndrome
pt has been taking carbamazepine and complains of flu like symptoms including sore throat and malaise. nurse notes several tiny bruises on the patients arms. What could this be?
thrombocytopenia
what are the implications for the pt taking carbamazepine taking:
-oral contreceptives
-warfarin
-eating grapefruit
-oral contraceptives are less effective
-warfarin decreases the effect so more at risk for clots
-no grapefruit b/c metabolism of the drug will be inhibited
which of the following offer broad spectrum effectiveness for seizures
A) phenytoin
b. carbamazepine
c. valproic acid
valproic acid (depakote)
V is for Variety
match AED to nursing implication:
Valproic acid, phenytoin, Carbamazepine, topiramate & lamotrigine
with
suicidal ideation
monitor for gingival hyperplasia
hepatotoxicity & pancreatitis
monitor for changes in blood counts
*valproic acid – hepatotoxicity & pancreatitis
*phenytoin - monitor for gingival hyperplasia
*carbamazepine – monitor for changes in blood counts
*topiramate & lamotrigine – suicidal ideation
do you mix IV Phenytoin with
Dextrose solution or Normal Saline solution
can only be mixed in normal saline
T/F: phenobarbital, phenytoin, carbamazepine are associated with fetal harm
T/F: phenytoin works to stop absence seizures
True fetal harm
False no absence
which of the following may pose the least risk of ADRs and dependence
Phenobarbital
Levetiracetam (Keppra)
Pregabalin (Lyrica)
Phenytoin (Dilantin)
Levetiracetam (Keppra)
a pt with depression newly diagnosed with epilepsy
what is an AED that you need to monitor more
lamotrigine
non drug therapies for seizures
vagus nerve stim
ketogenic diet
neurosurgery
drugs used to Stop an attack
nonspecific analgesic (aspirin like)
migrane specific drugs (serotonin 1b/1d receptor agonist [triptans] and ergot alkaloids)
drugs to prevent migranes
beta blocker, tricycle antideppresants, antiepileptic drugs
pt is using tripants experiencing migranes. they want to try using opiods is this recommended?
no, because you would be taking more and more
this is only used when no other medications are not effective
what is considered first line therapy to eliminate a migraine:
A) aspirin
B) sumatriptan
C) ergotamine
D) estrogen supplements
sumatriptin – migraine specific
5 migraines per month. what will the nurse recommend
daily use of a beta blocker like propranolol
are ergotamines safe during pregnancy
no
can you mix triptans and ergotamines?
no, they cannot be taken concurrently
overdose on ergotamines what happens
severe tissue ischemia secondary to constriction of peripheral arteries
drugs for parkinsons do what
restore balance of dopamine and acetylcholine
activate dopamine and block receptors for aacetylcholine
benztropine MOA
decrease amount of acetylcholine
pramipexole MOA
stimulate dopamine receptors
levodopa/Carbidopa MOA
increase amount of dopamine in the brain
selegiline MOA
inhibits MAO-B, thus decreasing the breakdown of dopamine and leaving more dopamine in the brain
what drug is used in early treatment of parkinsons
Pramixepelos
ADRS for Levodopa/Carbidopa
nausea vomiting
dyskinesia
psychosis and other CNS effects like anxiety, memory impairment
hypotension
what drug used in the treatment of parkinsons is known to have and ADR of the on-off phenomenon?
Carbidopa/Levodopa (Sinemet)
we might have to stop it and restart it
