Neurological System Flashcards
Centrally Acting muscle relaxants prototype and other drug names
baclofen (Lioresal)
Others: carisoprodol (Soma), cyclobenzaprine (Flexeril)
centrally acting muscle relaxants EPA
inhibits effects of GABA in the spinal cord = suppression of hypertensive reflexes
centrally acting muscle relaxants therapeutic uses
spinal cord injuries, MS, CP
centrally acting muscle relaxants administration
Administered PO (Baclofen also through intrathecal pump)
centrally acting muscle relaxants ADRs
most common = drowsiness/dizziness, weakness/fatigue
Also possible = N/V, constipation, and urinary retention
centrally acting muscle relaxants contraindications and interactions
ETOH (alc), MAOIs, SSRI/SNRI/tricyclic antidepressants
Use caution with older adults, children, severe mental disorder, and CVAs
centrally acting muscle relaxants RN intervention and client education
Take w/ food to decrease GI upset
Educate regarding activities requiring mental alertness
Change positions slowly
For clients with long term use (weeks to months) MUST BE TAPERED to prevent withdrawl (seizures/hallucinations)
*Intrathecal abrupt stop causes - rebound spasticity/fever and muscle damage
peripherally acting muscle relaxants prototype
dantrolene (Dantrium)
peripherally acting muscle relaxants EPA
acts directly on skeletal muscle by inhibiting calcium release (necessary for muscle contraction)
peripherally acting muscle relaxants therapeutic uses
spinal cord injuries, MS, CP, CVA, and malignant hyperthermia
peripherally acting muscle relaxants administration
PO and IV
peripherally acting muscle relaxants ADRs
muscle weakness, drowsiness/dizziness and diarrhea
At higher/more frequent doses: liver toxicity
peripherally acting muscle relaxants contraindications and interactions
avoid in clients w/ liver disease. Women age >35 y.o. Using estrogen have higher risk for liver toxicity. Avoid ETOH. Possibility of severe cardiac dysrhythmias in clients taking calcium channel blockers
peripherally acting muscle relaxants RN interventions and client education
Monitor for ADRs - CNS effects, diarrhea, liver function (check liver function tests - LFTs)
Client education regarding changing positions slowly - assist w/ ambulation
Client should call provider: prolonged diarrhea, muscle weakness
Education regarding activities requiring mental alertness
Client should report abdominal pain or jaundice
Traditional AEDs Hydanoins prototype and other drug names
phenytoin (Dilantin)
Others: fosphenytoin (Cerebyx)
hydantoins EPA
suppress sodium uptake in neurons thus reducing neuronal activity in seizure-generating cells of the brain
hydantoins therapeutic uses
tonic-clonic and partial seizures
hydantoins administration
PO and IV - slowly
hydantoins ADRs
CNS depression/mild drowsiness. Gingival hyperplasia. Skin rash
hydantoins contraindications and interactions
teratogenic. Avoid in clients w/ skin rash, bradycardia/heart block. MANY drug interactions (including oral contraceptives)
hydantoins RN intervention and client education
Monitor for CNS effects
Narrow therapeutic window!!!
- Serum level should be 10-20
- Monitor blood - lab draw
- Serum >20 - nystagmus, ataxia, sedation, blurred/double vision
Do NOT give IV too quickly! Cardiac collapse!
- No more than 50mg/min
- Monitor vital signs
Educate regarding activities requiring mental alertness
Educate about good oral hygiene! Regular dental check-ups, soft-bristled toothbrush, flossing
Educate to call provider if rash occurs
Do not stop abruptly!! Risk for seizure recurrance
traditional AEDs iminostilbenes prototype
carbamazepine (Tegretol)
iminostilbenes EPA
similar to hydantoins. Inhibits sodium influx through sodium channels = decreased neuronal activity
iminostilbenes therapeutic uses
tonic-clonic and partial seizures, mood stabilizer (bipolar), for trigeminal neuralgia pain
iminostilbenes administration
PO (immediate or ER)
iminostilbenes ADRs
neurological effects - visual disturbances, HA, ataxia, nystagmus, blurred vision. Fluid retention. Skin rash (SJS). Photosensitivity. Bone marrow suppression = decreased blood counts
iminostilbenes contraindications and interactions
teratogenic. Avoid in absence/myoclonic seizures, clients w/ hematologic disorders or heart failure. MANY drug interactions
iminostilbenes RN intervention and client education
Give w/ meals to decrease GI upset
Monitor CBC - will look at WBC and RBC
- Educate pt on s/sx infections/bleeding
Monitor skin and educate about photosensitivity
- PTs of asian decent w/ HLA-B*1502 - increased risk of skin reactions
Monitor for CNS effects
Educate pt to call provider if decreased urine output, edema, or SOB
Pt should avoid grapefruit juice
Educate child-bearing age clients to use back up protection if on oral contraception
traditional AEDs histone deacetylase inhibitor prototype
valproic acid (Depakote, Depacon, Depakene)
histone deacetylase inhibitor EPA
similar to phenytoin and carbamazepine. May also effect influx of calcium and enhance inhibitory effects of GABA
histone deacetylase inhibitor therapeutic uses
ALL seizure types. Mania (bipolar). Prevent migraine HA
histone deacetylase inhibitor administration
PO or IV (must be diluted)
histone deacetylase inhibitor ADRs
common - GI upset/indigestion. Bone marrow suppression (bruising, bleeding, prolonged bleeding time, decreased platelets). Skin rash. liver toxicity. Hyperammonemia (drowsy or altered mental state)
histone deacetylase inhibitor contraindications and interactions
teratogenic. Avoid in liver disorder, thrombocytopenia (low platelets), and hyperammonemia. Caution with other anticonvulsants
histone deacetylase inhibitor RN intervention and client education
Give with food to decrease GI upset
Monitor lab values:
- Platelet, bleeding time
- Ammonia
- LFTs - must obtain baseline
Monitor for and educate client to report: rash, N/V, abdominal pain, anorexia, Jaundice, Confusion and decreased mental status, Bruises, bleeding
Clients should avoid getting pregnant. If pregnant client MUST take folic acid supplement (prevent spinabifida)
local anesthetics prototype and other drug names
lidocaine (Xylocaine) - “amide” type
Others - “ester” type: procaine (Novocain), benzocaine (Americaine)
local anesthetics therapeutic uses
anesthesia to direct body area - suturing, dental procedures, nerve blocks, epidural/spinal anesthesia
local anesthetics adminstration
Topical, IV, oral solution (viscous)
local anesthetics EPA
blocks influx of sodium through sodium channels preventing depolarization = no action potential activated
local anesthetics ADRs
only occurs in systemic absorption of high doses - stimulation or depression of CNS. Most severe = respiratory depression, hypotension, and cardiac dysrhythmias
local anesthetics contraindications and interactions
Allergy to lidocaine or smide-type anesthetics. Avoid viscous solution in children < 3y.o. Caution in clients with bradycardia/heart block
local anesthetics RN interventions and client education
Monitor VS before, during, after
Monitor respiratory status
Monitor restlessness, tremors, dizziness, paresthesias
Monitor for hypotension with spinal anesthetics
Do not administer in eyes or broken skin
general anesthetics barbituates prototype and other drug names
methohexital sodium (Brevital) - 88propofol (Diprivan)
barbituates EPA
Enhances inhibitory effects of GABA and causes significant CNS depression
barbituates therapeutic uses
rapid induction of anesthesia and hypnosis
barbituates administration
IV only
barbituates ADRs
Respiratory depression and hypotension
barbituates contraindications and interactions
Caution in clients with hepatic or renal disease
Given with other CNS depressants = more CNS depression
barbituates RN intervention and client education
Close monitoring of VS, before during, and after
Close monitoring of respiratory status
resuscitation/emergency equipment close by! Airway maintenance supplies, IV fluids, vasopressors
Monitor IV site for extravastion
adjuncts to anesthesia/conscious sedation benzodiazepines prototype and other drug names
midazolam (Verses)
Others: diazepam (Valium), lorazepam (Ativan)
benzos EPA
enhance inhibitory effects of GABA = CNS depression, hypnosis, and amnesia
benzos therapeutic uses
conscious sedation, sedation PRIOR to general anesthesia, supplement inhaled anesthesia. Many others (active seizure, anxiety)
benzos administration
PO, IV, IM
benzos ADRs
amnesia. Large dosages have potential for cardiac and respiratory arrest
benzos RN intervention and client education
Educate on amnesia effects
Monitor VS and respiratory status before, during, and after administration
Have resuscitation equipment nearby
benzos contraindications and interactions
Teratogenic
Greater CNS depression when given w/ other CNS depressants (use caution)
Herbal products may increase or decrease the effects of midazolam
adjuncts to anesthesia/conscious sedation opioids prototype and other drug names
fentanyl (Duragesic, Actiq)
Others: morphine, hydromorphone (Dilaudid)
opioids EPA
pain receptor agonists that cause analgesia and sedation. Narcotic
opioids administration
IV, transdermal, oral lozenge
opioids ADRs
sedation. Respiratory depression and hypotension. Nausea
opioids contraindications and interactions
clients with hx of substance abuse. Teratogenic during OB delivery. Caution in clients with increased intracranial pressure, older adult, young children, debilitation clients. Caution with liver, respiratory, or kidney disorders
Do NOT give with MAOIs
Given with other CNS depressants = excessive sedation/respiratory depression
opioids RN interventions and client education
Monitor VS, respiratory status, and LOC before during, and after administration
Have resuscitation equipment on hand = Naloxone
Educate client to report nausea
Schedule II controlled substance
CNS stimulants amphetamines prototype and other drug names
amphetamine/dextroamphetamine sulfate (Adderall)
Others: methamphetamine hydrochloride (Desoxyn)
amphetamines EPA
Increase norepinephrine and dopamine in brain and PNS = more alert, energy, improved mood (euphoria). When used in ADHD - increased ability to focus/attention span
amphetamines therapeutic use
ADHD, narcolepsy
amphetamines administration
PO (regular and ER)
amphetamines ADRs
due to CNS stimulation. Insomnia, nervousness, hypertension, tachycardia/palpitations. Weight loss (appetite suppressant effect). Large doses can cause symptoms resembling paranoid schizophrenia
amphetamines RN intervention and client education
Give in AM
Monitor weight in children
Drug “holiday”
Schedule II - high risk for abuse
Can develop tolerance, psychological and physical dependance
Taper - withdrawal symptoms = depression and fatigue
Monitor VS - HR and BP
Educate to avoid caffeine
Educate client on symptoms to report
Palpitations, anorexia
amphetamines contraindications and interactions
avoid in clients with cardiovascular problems, severe hypertension, hyperthyroidism. Nerve take iwth MAOIs
CNS stimulant amphetamine related prototype and other drug names
methylphenidate (Ritalin, Concerta)
Others: dexmethylphenidate (Focalin)
amphetamine related EPA
Increase norepinephrine and dopamine in brain and PNS = more alert, energy, improved mood (euphoria). When used in ADHD - increased ability to focus/attention span
amphetamine related therapeutic use
ADHD, narcolepsy
amphetamine related administration
PO (reular and ER), transdermal
amphetamine related ADRs
due to CNS stimulation. Insomnia, nervousness, hypertension, tachycardia/palpitations. Weight loss (appetite suppressant effect). Large doses can cause symptoms resembling paranoid schizophrenia. Toxicity symptoms = psychosis, dysrhythmias, seizures
amphetamine-related RN intervention and education
Same as amphetamines
Applying patch: press in place for 30 sec, remove after 9 hours, do not touch drug side with fingers
amphetamine related contraindications and interactions
Same as amphetamines
Do not use in clients with hx of psychosis/depression
Children younger than 6 y.o. Should not take (unless benefits outweigh risk)
CNS stimulants non-amphetamines prototype and other drug names
modafinil (Provigil)
Others: armodafinil (Nuvigil)
non-amphetamines EPA
precise mechanism unknown. Thought to block reuptake of norepinephrine
non-amphetamines therapeutic uses
ADHD, narcolepsy. Also shift-work sleepiness and OSA
non-amphetamines administration
PO
non-amphetamines ADRs
common = nausea and diarrhea. HA, tachycardia, HTN. Rare = SJS
non-amphetamines RN intervention and client education
Administer in AM for ADHD/narcolepsy
Administer 1hr prior to shift it for sleepiness
Take w/ food to minimize GI effects
Monitor for CNS effects (BP, HR)
Educate pt of childbearing age to use barrier contraceptives instead of oral contraceptive
Lower abuse potential but can lead to psychological dependence
non-amphetamines contraindications and interactions
Avoid in pt with vascular heart disease. Caution in clients with cardiovascular problems, hypertension, renal, or hepatic failure. Interacts with oral contraceptives. Do not take with methylphenidate
Antiparkinsons agent/MAOIs prototype and other drug names
selegiline (Elderpryl)
Other drugs: rasagiline (Azilect)* Monotherapy
MAOIs EPA
indirect-acting dopamine receptor agonist
Inhibits the action of the of the enzyme MAO-B in the brain and other parts of the body
MAO-B inactivates dopamine
MAOIs therapeutic uses
treat symptoms of Parkinson’s disease (PD)
MAOIs administration
PO, take before morning meal
MAOIs ADRs
insomnia
MAOIs contraindications an dinteractions
Hypersensitivity
MAOIs, tricyclic, or SSRIs (can cause high fever, HTN, rigidity)
Food containing tyramine can cause HTN
Herbal drugs can cause severe HTN
MAOIs RN intervention and client education
Instruct pt to take last dose of the day before noon to avoid insomnia
Notify provider before taking any new drugs
Instruct about foods and herbs to avoid
direct acting dopamine receptor agonist prototype and other drug names
pramipexole (Mirapex)
Others: ropinirole (Requip)
direct acting dopamine receptor agonists EPA
Binds to dopamine receptors and causes a response similar to the body’s natural dopamine
direct acting dopamine receptor agonist therapeutic uses
Relieves symptoms of PD and restless leg syndrome
direct acting dopamine receptor agonist administration
PO
direct acting dopamine receptor agonist ADRs
nausea, drowsiness, muscle weakness, orthostatic hypotension, and dyskinesias
direct acting dopamine receptor agonist contraindications and interactions
Pregnancy and lactation
Older adults
Renal dysfunction
ETOH and other CNS depressants increase risk for adverse effects
direct acting dopamine receptor agonist RN intervention and client education
Nausea can lessen over time
Instruct pt to avoid driving or performing activities that require mental alertness if drowsiness occurs
Move slowly from a sitting/standing position
dopamine replacement drugs prototype
levodopa-caridopa (Sinemet)
dopamine replacement drugs EPA
Levodopa increases the availability of L-dopa, the precursor to dopamine, creating more dopamine. Carbidopa inhibits the breakdown of levodopa in peripheral tissues, so there is more dopamine available. Carbidopa does not cross the blood-brain barrier
dopamine replacement drugs therapeutic uses
relieves symptoms of PD
dopamine replacement drugs administration
PO, taken multiple times a day
Available in IR and ER
dopamine replacement drugs ADRs
N/V, darkening urine and sweat, orthostatic hypotension, dyskinesias, and psychosis, hallucinations, paranoid (rare)
dopamine replacement drugs contraindications and interactions
glaucoma, psychosis, existing renal dysfunction, vitamin B6 decreases action, MAOI antidepressants can cause HTN crisis, high-protein meals decrease action, anticholinergic drugs increase response
dopamine replacement drugs RN intervention and client education
Educate pt that administration starts with low doses to reduce adverse effects
Can take up 6 months for full response
Monitor for “on-off” phenomenon
Don’t take with high protein meals
cholinesterase inhibitors prototype
donepezil (Aricept)
cholinesterase inhibitors EPA
Prevents the enzyme acetylcholinesterase from inactivating ACh, thus increase the amount of ACh available at receptor sites in the brain
cholinesterase inhibitors therapeutic uses
Improved cognitive function in clients with mild to moderate Alzheimer’s disease
cholinesterase inhibitors adminstration
PO (tablets, orally disintegrating tablets and syrup), given at bedtime with food
cholinesterase inhibitors ADRs
Nausea, CNS effects (insomnia, dizziness, headaches) and bradycardia
cholinesterase inhibitors contraindications and interactions
GI bleeding, children, NSAIDs increase risk for GI bleed, use with caution in clients with liver, renal, cardiac, GI, or pulmonary disorders and seizures
cholinesterase inhibitors RN intervention and client education
Instruct pt to take with food at bedtime to decrease GI upset
Instruct client or caregiver to report adverse effects to provider
Safety alert-make sure caregivers are present if client is not able to remember instructions
NMDA receptor antagonist prototype
memantine (Namenda)
NMDA receptor antagonist EPA
Blocks excess glutamate from stimulating NMDA receptors, decreasing the influx of calcium into neurons in the brain. Reduces intracellular calcium to restore normal nerve transmissions. Reduces calcium.
NMDA receptor antagonist therapeutic use
Slows progression of Alzheimer’s disease by preventing neuronal damage from high levels of calcium
NMDA receptor antagonist administration
PO (tablet or liquid)
NMDA receptor antagonist ADRs
CNS effects (dizziness, headache, increased confusion)
NMDA receptor antagonist contraindications and interactions
renal failure, liver disorders, seizure disorders, and older adults
*OTC antacids increase levels of memantine and could cause possible toxicity
NMDA receptor antagonist RN intervention and client education
Instruct client/caregiver to report presence of CNS effects
immunomodulators prototype and other drug names
interferon beta-1a (Avonex and Rebif) and interferon beta-2a (Betaseron)
immunomodulators EPA
inhibits the movement of leukocyte, a product of the body’s defective autoimmune response, across the blood-brain barrier. Inhibiting leukocytes from damaging myelin sheath of neurons
immunomodulators therapeutic uses
slow progression of MS
immunomodulators administration
IM weekly, or SQ daily for 3 days each week
immunomodulators ADRs
Flu-like symptoms (will decrease with prolonged treatment), myelosuppression, liver toxicity, and pain/redness at injection site
immunomodulators contraindications and interactions
Any drug that suppresses the immune system (ex Prednisone) - could increase the risk for myelosuppression
immunomodulators RN intervention and client education
Educate client on how to administer medication
Rotate sites
Instruct client to pre-medicate with acetaminophen if flu symptoms occur
CBC and LFTs will be monitored before treatment begins and then periodically after
Instruct client to report easy bruising, bleeding, or fatigue
Instruct client to report abdominal tenderness, anorexia, and jaundice
serotonin agonists prototype
sumatriptan (Imitrex)
serotonin agonists EPA
reverse 5-HT (serotonin)/CGRP ratio by activating 5-HT receptors, which promote vasoconstriction and suppress the release of CGRP. This prevents inflammatory response from occuring
serotonin agonists therapeutic uses
relieve symptoms of existing migraine or cluster HA
serotonin agonists administration
PO, SQ, or by nasal spray
serotonin agonists ADRs
chest pressure or “heaviness: may progress to angina pain caused by coronary vasospasm. CNS effects (tingling and vertigo)
serotonin agonist contraindications and interactions
CAD, PVD, stroke, HTN, liver or kidney insufficiency. MAOIs taken w/in 2 weeks (can cause sumatriptan toxicity), use of another triptan w/in 24 rs, serotonin agonist with sumatriptan can cause serotonin syndrome, st johns wort can cause toxicity
serotonin agonists RN interventions and client education
instruct client at once if they experience chest pressure or tightness/heaviness in back, jaw, or throat
Instruct client to report CNS symptoms
Educate pt on how to administer medication
Nasal spray one in a single nostril and repeat after 2 hrs if need
Take one oral tablet and repeat after 2 hrs if needed
Give one SQ injection and repeat once after 1 hr if no relief; no more than 2 doses in 24 hrs
The maximum dose is 200mg in 24 hrs
