Neurological Part 2 Flashcards
selegiline (Eldepryl): class
Antiparkinson agent/ Monoamine Oxidase-B inhibitors (MAOI)
selegiline (Eldepryl): other medications
rasagiline (Azilect)
selegiline (Eldepryl): EPA
indirect-acting dopamine receptor agonist, inhibits the action of MAO-B, MAO-B inactivate dopamine
selegiline (Eldepryl): Use
treat symptoms of Parkinson’s disease
selegiline (Eldepryl): ADR
insomnia, take before morning meal
selegiline (Eldepryl): contraindications
hypersensitivity, MAOIs, tricylics, SSRIs, food with tyramine can cause hypertension, herbal drugs can cause severe hypertension
selegiline (Eldepryl): RN Interventions
last dose by noon, talk to doctor before taking new medications, educate about foods and herbs to avoid
pramipexole (Mirapex): class
Direct-Acting Dopamine Receptor Agonist
pramipexole (Mirapex): EPA
binds to dopamine receptors and causes a response similar to the body’s natural dopamine
pramipexole (Mirapex): Use
relieves symptoms of Parkinson’s disease and restless leg syndrome
pramipexole (Mirapex): ADRs
nausea, dizzy, muscle weakness, orthostatic hypotension, dyskinesias
pramipexole (Mirapex): contraindications
teratogenic, older adults, renal dysfunction, ETOH and other CNS depressants increase risk for other adverse effects
pramipexole (Mirapex): RN Interventions
nausea can lessen over time, avoid activities that need mental alertness, move slowly sitting/standing
levodopa-carbidopa (Sinemet): class
dopamine replacement drugs
levodopa-carbidopa (Sinemet): EPA
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.
levodopa-carbidopa (Sinemet): Use
relieves symptoms of Parkinson’s disease
levodopa-carbidopa (Sinemet): ADRs
nausea, vomiting, darkening of urine and sweat, orthostatic hypotension, dyskinesia, psychosis, hallucinations, paranoia
levodopa-carbidopa (Sinemet): contraindications
glaucoma, psychosis, existing renal dysfunction, vitamins B6 decrease action, MAOI can cause HTN crisis, high-protein diet can decrease action, anticholinergic increase response
levodopa-carbidopa (Sinemet): RN Intervention
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
donepezil (Aricept): Class
Cholinesterase Inhibitor
donepezil (Aricept): EPA
prevents the enzyme acetylcholinesterase from inactivating ACh = increase in ACh available in brain
donepezil (Aricept): Use
improved cognitive function in clients with Alzheimer’s disease
donepezil (Aricept): administration
given at bedtime with food
donepezil (Aricept): ADR
nausea, CNS effects, insomnia, dizzy, bradycardia
donepezil (Aricept): contraindications
GI bleeding, children, NSAIDs increases risk for GI bleed, caution with liver, renal, GI, or pulmonary disorders and seizures
donepezil (Aricept): RN Interventions
take with food at bedtime, report adverse effects, safety alert: make sure caregivers are present if client is not able to remember instructions
memantine (Namenda): class
NMDA Receptor Antagonist
memantine (Namenda): EPA
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
memantine (Namenda): Use
slow progression of Alzheimer’s by preventing neuronal damage from high calcium
memantine (Namenda): ADRs
CNS effects
memantine (Namenda): contraindications
renal failure, liver disorders, seizure disorders, older adults, OTC antacids increase levels of memantine and could cause toxicity
memantine (Namenda): RN Intervention
report presence of CNS effects
interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): class
immunomodulators
interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): EPA
inhibits the movement of leukocytes (product of body’s defective autoimmune response) across the blood-brain barrier, stop leukocytes from damaging myelin sheath
interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): use
slow progression of MS
interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): ADR
flu-like symptoms, myelosuppression, liver toxicity, pain/redness at injection site
interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): Contraindications
any drug that suppresses the immune system could increase risk for myelosuppression
interferon beta-1a (Avonex & Rebif) & interferon beta-2a (Betaseron): RN Intervention
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)
sumatriptan (Imitrex): class
Serotonin Agonists, triptans
sumatriptan (Imitrex): EPA
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
sumatriptan (Imitrex): Use
relieve the symptoms of existing migraine or cluster headache
sumatriptan (Imitrex): ADR
chest pressure or heaviness, may progress to angina pain caused by coronary vasospasm, CNS effects (tingling, vertigo)
sumatriptan (Imitrex): contraindications
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
sumatriptan (Imitrex): RN Intervention
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
