Neurological Medications Flashcards
baclofen (Lioresal): class
centrally acting muscle relaxants
baclofen (Lioresal): use
drugs for muscle spams, spinal cord injuries, MS, CP
baclofen (Lioresal): ADRs
drowsiness/dizziness, weakness/fatigue is common, N/V, constipation and urinary retention is possible
baclofen (Lioresal): contraindications
ETOH, MAOIs, SSRI, caution in older adults, children, severe mental disorders, and CVAs
baclofen (Lioresal): RN interventions
Must be tapered to prevent withdrawal (seizures, spasticity/fever and muscle damage)
- take with food, fiber + hydration to decrease constipation, caution with things that need mental alertness, change position slowly
Dantrolene (dantrium): class
peripherally acting muscle relaxants/ direct-acting skeletal muscle relaxers
Dantrolene (dantrium): use
malignant hyperthermia, muscle spasms, spinal cord injuries
Dantrolene (dantrium): ADR
muscle weakness, drowsiness, dizzy, diarrhea, higher dose may lead to liver toxicity
Dantrolene (dantrium): contraindications
avoid w/ liver disease, older women on estrogen higher risk, ETOH, calcium channel blockers -> cardiac dysrhythmias
Dantrolene (dantrium): RN Interventions
call provider if prolonged diarrhea and muscle weakness, report abdominal pain or jaundice (liver failure)
phenytoin (Dilantin): class
traditional AEDs - hydantoins
phenytoin (Dilantin): use
tonic-clonic &partial seizures
baclofen (Lioresal): EPA
increases effects of GABA in spinal cord, suppression of hyperactive reflexes
dantrolene (Dantrium): EPA
acts directly on skeletal muscle by inhibiting calcium releases
phenytoin (Dilantin): EPA
suppress sodium uptake in neurons which reduces neuronal activity in seizure-generating cells of the brain
phenytoin (Dilantin): ADR
CNS depression, downiness, gingival hyperplasia, skin rash
phenytoin (Dilantin): contraindications
teratogenic, bradycardia/heart block, MANY drug interactions, oral contraceptives
phenytoin (Dilantin): RN interventions
Narrow therapeutic window (10-20), too much will lead to nystagmus, ataxia, sedation, blurred vision, Give slowly, educate on good dental hygiene, don’t stop abruptly
carbamazepine (Tegretol): class
Traditional AEDs: Iminostilbenes
carbamazepine (Tegretol): use
tonic-clonic & partial seizures, bipolar, trigeminal neuralgia pain
carbamazepine (Tegretol): EPA
inhibits sodium influx through sodium channels to decrease neuronal activity
carbamazepine (Tegretol): ADR
neurological effects - visual disturbances, HA, ataxia, nystagmus, blurred vision. Fluid retention. Skin rash (SJS). Photosensitivity. Bone marrow suppression = decreased blood counts
carbamazepine (Tegretol): contraindication
teratogenic, avoid in absence/myoclonic seizures, people with hematologic disorders or heart failure, MANY drug interactions
carbamazepine (Tegretol): RN interventions
give with food, monitor CBC, call provider about rash, decreased urine output or edema, avoid grapefruit juice, use condoms also if using oral contraceptives
valproic acid (Depakote, Depacon, Depakene): class
Traditional AEDs: Histone Deacetylase Inhibitor
valproic acid (Depakote, Depacon, Depakene): use
ALL seizure types, mania of bipolar
valproic acid (Depakote, Depacon, Depakene): EPA
effect influx of calcium and enhance inhibitory effects of GABA
valproic acid (Depakote, Depacon, Depakene): ADR
GI upset/indigestion, bone marrow suppression (blood stuff), skin rash, live toxicity
valproic acid (Depakote, Depacon, Depakene): contraindications
teratogenic, avoid if with liver disorder, thrombocytopenia, hyperammonemia, caution with other anticonvulsants
valproic acid (Depakote, Depacon, Depakene): RN Intervention
give with food, monitor lab values (blood and liver), call provider if rash, N/V, jaundice, confusion, bleeding, avoid getting pregnant
lidocaine (Xylocaine) - “amide” type: class
local anesthetics
lidocaine (Xylocaine): uses
anesthesia to direct body area, suturing, dental procedure, nerve blocks, epidural/spinal anesthesia
lidocaine (Xylocaine): EPA
blocks influx of sodium, prevents depolarization = no action potential activated
lidocaine (Xylocaine): ADR
only occur in high systemic absorption, stimulation or depression of CHS, most severe: respiratory depression, hypotension, cardiac dysrhythmias
lidocaine (Xylocaine): RN Intervention
monitor vital signs and respiratory rate, do not administer in eyes or broken skin
lidocaine (Xylocaine): contraindication
allergy, avoid viscous solution in children under 3 years, caution in clients with bradycardia
methohexital sodium (Brevital): class
general anesthetics: barbiturates
methohexital sodium (Brevital): EPA
enhances inhibitory effects of GABA and causes significant CNS depression
methohexital sodium (Brevital): Use
rapid induction of anesthesia and hypnosis
methohexital sodium (Brevital): ADR
respiratory depression & hypotension
methohexital sodium (Brevital): RN intervention
resuscitation and emergency equipment close by, airway maintenance supplies, IV fluids, vasopressors, monitor IV site for extravasation
midazolam (Versed): class
adjuncts to anesthesia/ conscious sedation: Benzodiazepines
midazolam (Versed): EPA
enhance inhibitory effects of GABA = CNA depression, hypnosis and amnesia
midazolam (Versed): use
conscious sedation, sedation prior to general anesthesia, supplement inhaled anesthesia
midazolam (Versed): ADR
amnesia, large dosages have potential for cardiac and respiratory areest
midazolam (Versed): RN intervention
educate on amnesia effects, monitor vital signs and respiratory signs, have resuscitation equipment nearby
midazolam (Versed): contraindications
teratogenic, greater CNS depression when given with others, Herbal products may increase or decrease effects
fentanyl (Duragesic): class
adjuncts to anesthesia/ conscious sedation: opioids
fentanyl (Duragesic): EPA
pain receptor agonists that cause analgesia and sedation, Narcotic
fentanyl (Duragesic): ADR
sedation, respiratory depression, hypotension, nausea
fentanyl (Duragesic): contraindication
history substance abuse, teratogenic, caution with intracranial pressure, older adults, young children, caution with liver, respiratory, or kidney disorders, do not give with MAOIs, given with other CNS depressants = excessive respiratory depression
fentanyl (Duragesic): RN Interventions
monitor vital signs, have resuscitation equipment on hand, educate to report nausea, schedule II controlled substance, have reversal! NALOXONE
amphetamine/ dextroamphetamine sulfate (Adderall): class
CHS stimulant: Amphetamines
amphetamine/ dextroamphetamine sulfate (Adderall): EPA
increases norepinephrine and dopamine in brain and PNS = more alert, energy, improved mood, increased ability to focus/attention span
amphetamine/ dextroamphetamine sulfate (Adderall): use
ADHA, Narcolepsy
amphetamine/ dextroamphetamine sulfate (Adderall): ADRs
insomnia, nervousness, hypertension, tachycardia, palpitations, weight loss, appetite suppressant effect, large doses may show paranoid schizophrenia
amphetamine/ dextroamphetamine sulfate (Adderall): RN Interventions
give in the AM, monitor weight in children, drug “holidays,” schedule II - high risk for abuse, can lead to dependence, taper, monitor vitals, educate to avoid caffeine, report severe symptoms
amphetamine/ dextroamphetamine sulfate (Adderall): contraindications
avoid in clients with cardio problems, severe hypertension, hyperthyroidism, never take with MAOIs
methylphenidate (Ritalin, Concerta): class
CNS Stimulant: Amphetamine-related
methylphenidate (Ritalin, Concerta): EPA
same as amphetamines, increase norepinephrine and dopamine in brain and PNS = more alert, improved mood, attention
methylphenidate (Ritalin, Concerta): Use
ADHD, Narcolepsy
methylphenidate (Ritalin, Concerta): ADR
insomnia, nervousness, hypertension, tachycardia, palpitations, weight loss, appetite suppressant effect, large doses may show paranoid schizophrenia, Toxicity: psychosis, dysrhythmias, seizures
methylphenidate (Ritalin, Concerta): RN Interventions
same as amphetamines, applying patch: press in place for 30 seconds, remove after 9 hours, do not touch drug side with fingers
methylphenidate (Ritalin, Concerta): Contraindications
same as amphetamines, do not use with history of psychosis/depression, not in children under 6 years
modafinil (Provigil): class
CNS Stimulant: Non-amphetamine
modafinil (Provigil): EPA
precise mechanism unknown. Thought to block reuptake of norepinephrine
modafinil (Provigil): Use
ADHD, narcolepsy, shift-work sleepiness, obstructive sleep apnea
modafinil (Provigil): ADR
common= nausea and diarrhea, headache, tachycardia, hypertension, rare = SJS
modafinil (Provigil): RN Intervention
- administer in AM or 1 hour before work
- take with food to minimize GI effects
- monitor for CNS effects
- report rash immediately
- use other contraception
- lower abuse potential but can lead to psychological dependence
modafinil (Provigil): contraindications
- avoid in clients with valvular heart disease
- caution with cardio problems, hypertension, renal or hepatic failure
- No with methylphenidate
- interacts with oral contraceptives
