Neurological Pharmacology Approach

Question 1

Anatomy and Physiology Review

Answer 1

-brain/spinal cord/cranial nerve function
-lobes:
frontal, occipital, parietal, temporal
-afferent and efferent pathways
-12 cranial nerves

Question 2

Increased Intracranial Pressure (ICP)

Answer 2

Monro-Kellie hypothesis:

• ICP stable as long as volume added is balanced by volume displaced
• 3 components inside enclosed skull: brain tissue, blood, cerebrospinal fluid
• expansion by one causes rise in ICP if volume of other two remains constant

Question 3

Manifestations of ICP

Answer 3

1) change in LOC
2) headache
3) pupillary changes
4) nausea/vomiting
5) papilledema
6) seizures
7) irregular respirations
8) late: changes in VS

Question 4

Examples of Alterations

Answer 4

• hypercarbia
• hypoxia
• aneurysm
• arteriovenous malformation
• cerebral edema
• hematoma
• tumor
• hydrocephalus
• increase in brain volume
• cerebral edema
• increase in CSF

Question 5

Diuretics

Answer 5

• osmotic diuretics (Mannitol)
• withdraw fluid from normal tissue
• works within 20 min
• may cause rebound cerebral edema
• loop diuretics (furosemide)
• reduce rate of CSF production

Question 6

Corticosteroids

Answer 6

• dexamethasone (Decadron)
• stabilize cell membranes
• most effective in managing effects of brain tumors

Question 7

Blood Pressure Control

Answer 7

• avoid hypotention and hypertension
• keep systolic BP < 160 mm Hg
• high BP may be required in management of vasospasms associated w/ subarachnoid hemorrhage

Question 8

Control Cerebral Metabolism

Answer 8

• treat fever
• seizure prophylaxis
• sedation
• propofol (newer agent): short-acting neuromuscular blockade
• always sedate

Question 9

Control Cerebral Metabolism
Barbiturate coma (pentobarbital)

Answer 9

• decreases metabolism
• decreases cerebral edema
• better cerebral blood flow
• best used early to manage ICP refractory to standard treatment
• related total nursing care