Neurological Part 2

Question 1

selegiline (Eldepryl): class

Answer 1

Antiparkinson agent/ Monoamine Oxidase-B inhibitors (MAOI)

Question 2

selegiline (Eldepryl): other medications

Answer 2

rasagiline (Azilect)

Question 3

selegiline (Eldepryl): EPA

Answer 3

indirect-acting dopamine receptor agonist, inhibits the action of MAO-B, MAO-B inactivate dopamine

Question 4

selegiline (Eldepryl): Use

Answer 4

treat symptoms of Parkinson’s disease

Question 5

selegiline (Eldepryl): ADR

Answer 5

insomnia, take before morning meal

Question 6

selegiline (Eldepryl): contraindications

Answer 6

hypersensitivity, MAOIs, tricylics, SSRIs, food with tyramine can cause hypertension, herbal drugs can cause severe hypertension

Question 7

selegiline (Eldepryl): RN Interventions

Answer 7

last dose by noon, talk to doctor before taking new medications, educate about foods and herbs to avoid

Question 8

pramipexole (Mirapex): class

Answer 8

Direct-Acting Dopamine Receptor Agonist

Question 9

pramipexole (Mirapex): EPA

Answer 9

binds to dopamine receptors and causes a response similar to the body’s natural dopamine

Question 10

pramipexole (Mirapex): Use

Answer 10

relieves symptoms of Parkinson’s disease and restless leg syndrome

Question 11

pramipexole (Mirapex): ADRs

Answer 11

nausea, dizzy, muscle weakness, orthostatic hypotension, dyskinesias

Question 12

pramipexole (Mirapex): contraindications

Answer 12

teratogenic, older adults, renal dysfunction, ETOH and other CNS depressants increase risk for other adverse effects

Question 13

pramipexole (Mirapex): RN Interventions

Answer 13

nausea can lessen over time, avoid activities that need mental alertness, move slowly sitting/standing

Question 14

levodopa-carbidopa (Sinemet): class

Answer 14

dopamine replacement drugs

Question 15

levodopa-carbidopa (Sinemet): EPA

Answer 15

Levodopa-increases the availability of L-dopa, (the precursor to dopamine) = more dopamine! Carbidopa inhibits the breakdown of levodopa in peripheral tissues, so there is more dopamine available.

Question 16

levodopa-carbidopa (Sinemet): Use

Answer 16

relieves symptoms of Parkinson’s disease

Question 17

levodopa-carbidopa (Sinemet): ADRs

Answer 17

nausea, vomiting, darkening of urine and sweat, orthostatic hypotension, dyskinesia, psychosis, hallucinations, paranoia

Question 18

levodopa-carbidopa (Sinemet): contraindications

Answer 18

glaucoma, psychosis, existing renal dysfunction, vitamins B6 decrease action, MAOI can cause HTN crisis, high-protein diet can decrease action, anticholinergic increase response

Question 19

levodopa-carbidopa (Sinemet): RN Intervention

Answer 19

educate client on starting with low doses, can take 6 months for full response, monitor “on-off” phenomenon, don’t take with high-protein meals

Question 20

donepezil (Aricept): Class

Answer 20

Cholinesterase Inhibitor

Question 21

donepezil (Aricept): EPA

Answer 21

prevents the enzyme acetylcholinesterase from inactivating ACh = increase in ACh available in brain

Question 22

donepezil (Aricept): Use

Answer 22

improved cognitive function in clients with Alzheimer’s disease

Question 23

donepezil (Aricept): administration

Answer 23

given at bedtime with food

Question 24

donepezil (Aricept): ADR

Answer 24

nausea, CNS effects, insomnia, dizzy, bradycardia

Question 25

donepezil (Aricept): contraindications

Answer 25

GI bleeding, children, NSAIDs increases risk for GI bleed, caution with liver, renal, GI, or pulmonary disorders and seizures

Question 26

donepezil (Aricept): RN Interventions

Answer 26

take with food at bedtime, report adverse effects, safety alert: make sure caregivers are present if client is not able to remember instructions

Question 27

memantine (Namenda): class

Answer 27

NMDA Receptor Antagonist

Question 28

memantine (Namenda): EPA

Answer 28

blocks excess glutamate from stimulating NMDA receptors = decrease the influx of calcium into the neurons in the brain = reduces intracellular calcium to restore normal nerve transmission

Question 29

memantine (Namenda): Use

Answer 29

slow progression of Alzheimer's by preventing neuronal damage from high calcium

Question 30

memantine (Namenda): ADRs

Answer 30

CNS effects

Question 31

memantine (Namenda): contraindications

Answer 31

renal failure, liver disorders, seizure disorders, older adults, OTC antacids increase levels of memantine and could cause toxicity

Question 32

memantine (Namenda): RN Intervention

Answer 32

report presence of CNS effects

Question 33

interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): class

Answer 33

immunomodulators

Question 34

interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): EPA

Answer 34

inhibits the movement of leukocytes (product of body's defective autoimmune response) across the blood-brain barrier, stop leukocytes from damaging myelin sheath

Question 35

interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): use

Answer 35

slow progression of MS

Question 36

interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): ADR

Answer 36

flu-like symptoms, myelosuppression, liver toxicity, pain/redness at injection site

Question 37

interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): Contraindications

Answer 37

any drug that suppresses the immune system could increase risk for myelosuppression

Question 38

interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): RN Intervention

Answer 38

educate client on how to administer medication (rotate sites), pre-medicate with acetaminophen if flu-like symptoms occur, CBC and LFT monitored (report bleeding or jaundice)

Question 39

sumatriptan (Imitrex): class

Answer 39

Serotonin Agonists, triptans

Question 40

sumatriptan (Imitrex): EPA

Answer 40

reverses 5-HT/CGRP ration by activating 5-HT receptors which promote vasoconstriction and suppress the release of CGRP. this prevents inflammatory response from occurring

Question 41

sumatriptan (Imitrex): Use

Answer 41

relieve the symptoms of existing migraine or cluster headache

Question 42

sumatriptan (Imitrex): ADR

Answer 42

chest pressure or heaviness, may progress to angina pain caused by coronary vasospasm, CNS effects (tingling, vertigo)

Question 43

sumatriptan (Imitrex): contraindications

Answer 43

CAD, PVD, stroke, HTN, liver or kidney insufficiency, MAOIs taken in the last 2 weeks might cause sumatriptan toxicity, serotonin syndrome with other drugs, st. johns wort can cause toxicity

Question 44

sumatriptan (Imitrex): RN Intervention

Answer 44

immediately report chest pressure, tightness in back, jaw, or throat, educate on administration: nasal spray once in one nostril, one tablet, next after 2 hrs, no more than 2 doses in 24 hours