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Pharmacology ASN MDC > Neurological System Part 1 > Flashcards

Neurological System Part 1 Flashcards

1
Q

Prototype (Centrally Acting Muscle Relaxants)

A

Prototype: Baclofen

Other Drugs: Carisoprodol, Chlorzoxazone, Cyclobenzaprine

For muscle spasms

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2
Q

Mechanism of Action (Centrally Acting Muscle Relaxants)

A

Mechanism: Enhances the inhibitory effects of GABA on receptors in the spinal cord, resulting in suppression of hyperactive reflexes.

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3
Q

Side Effects (Centrally Acting Muscle Relaxants)

A

Common: Drowsiness, dizziness, weakness, fatigue

Less Frequent: Nausea, vomiting, constipation, urinary retention

Withdrawal Effects: Anxiety, restlessness, visual hallucinations, seizures (with abrupt discontinuation)

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4
Q

Interventions (New Prescriptions)

A

Dosing: Start with the lowest effective dose and gradually increase to minimize adverse effects like dizziness and drowsiness.

Monitor: Encourage clients to drink plenty of fluids and increase fiber to avoid constipation.

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5
Q

Safety Alert (Discontinuation)

A

Alert: Taper dose over 1–2 weeks to prevent withdrawal effects such as seizures, hallucinations, and anxiety.

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6
Q

Administration (Baclofen)

A

Oral Doses: Gradually increase by 5 mg every 3 days, aiming for 20 mg three to four times per day. Administer with food or milk to prevent GI upset.

Intrathecal Infusion: Administered directly into the spine when oral doses are ineffective.

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7
Q

Client Instructions (Adverse Effects)

A

CNS Effects: Instruct clients that drowsiness and dizziness usually subside over time. Advise slow position changes if dizzy.

Constipation: Encourage increasing fiber and fluid intake to prevent constipation.

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8
Q

Contraindications and Precautions (Centrally Acting Muscle Relaxants)

A

Contraindications: Known hypersensitivity to the drug, concurrent use with MAOIs. Cyclobenzaprine is contraindicated within 2 weeks of MAOI use.

Precautions: Use cautiously in older adults, children, and clients with severe mental illness, seizure disorders, or cerebrovascular accidents.

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9
Q

Interactions (Cyclobenzaprine)

A

MAOI Interaction: Using cyclobenzaprine with MAOIs can result in hyperpyretic crisis and seizures.

Serotonin Syndrome: Risk when combined with SSRIs, SSNRIs, or tricyclic antidepressants.

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10
Q

Prototype (Peripherally Acting Muscle Relaxants)

A

Prototype: Dantrolene

For muscle spasms

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10
Q

Mechanism of Action (Peripherally Acting Muscle Relaxants)

A

Mechanism: Inhibits the release of calcium in skeletal muscle tissue, which is necessary for muscle contraction, leading to muscle relaxation and relief of spasticity.

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11
Q

Side Effects (Dantrolene)

A

Common: Muscle weakness, drowsiness, dizziness, diarrhea

Severe: Liver toxicity (more common with higher doses and long-term use)

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11
Q

Interventions (Dantrolene)

A

Monitor: Watch for CNS side effects (drowsiness, dizziness) and assist with ambulation.

Start with low doses: Gradually increase to minimize side effects.

Monitor liver function: Especially with long-term use or higher doses, and monitor for diarrhea.

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12
Q

Safety Alert (Dantrolene and Muscle Weakness)

A

Alert: Monitor muscle strength regularly to ensure that weakness doesn’t impair ambulation, which could lead to dangerous falls.

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13
Q

Administration (Dantrolene)

A

Oral: Most commonly used for spasticity.

IV: Use for treating malignant hyperthermia via IV bolus during life-threatening situations.

Preoperative use: Take orally 1–2 days before surgery for prevention of malignant hyperthermia in at-risk clients.

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14
Q

Client Instructions (Dantrolene)

A

Muscle Weakness: Report any weakness that interferes with daily activities.

Avoid driving: If feeling drowsy or dizzy.

CNS Depressants: Avoid alcohol and other CNS depressants.

Liver Damage: Report signs of liver damage, such as abdominal pain, jaundice, or yellowing of skin/eyes.

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15
Q

Contraindications and Precautions (Dantrolene)

A

Contraindications: Clients with liver disease.

Precautions: Use cautiously in clients with cardiac/pulmonary disease or
neuromuscular disorders.

Age Risk: Clients over age 35 are at increased risk for liver damage.

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16
Q

Interactions (Dantrolene)

A

Liver Toxicity: Increased risk in females over 35 who take estrogen.

CNS Depressants: Avoid using with other CNS depressants (e.g., alcohol), as it increases the risk of excessive sedation.

Cardiac Risks: May cause severe cardiac dysrhythmias when taken with calcium channel blockers.

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17
Q

Prototype (Hydantoins)

A

Prototype: Phenytoin

Other Medication: Fosphenytoin

For seizure

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17
Q

Mechanism of Action (Hydantoins)

A

Mechanism: Decreases neuronal activity by inhibiting sodium influx through sodium channels, slowing nerve impulses and preventing seizure activity. Prolongs the inactive state of neurons, reducing the frequency of seizures.

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18
Q

Side Effects (Hydantoins)

A

Common: Mild drowsiness, CNS depressant effects, gingival hyperplasia (especially in children/adolescents)

Serious: Skin rash, potential Stevens-Johnson syndrome, epidermal necrolysis

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19
Q

Interventions (Hydantoins)

A

Monitor: Drowsiness, CNS effects (may indicate toxicity).

Oral care: Check for gingival hyperplasia in children/adolescents.

Rash: Monitor for serious rashes like Stevens-Johnson syndrome and discontinue medication immediately if rash develops.

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20
Q

Administration (Hydantoins)

A

Oral: Give with meals to reduce gastrointestinal distress.

IV: Do not inject more than 50 mg/min (or 25 mg/min for older adults). Monitor for cardiac collapse and dysrhythmias during IV administration.

Therapeutic Range: Maintain phenytoin levels between 10-20 mcg/mL. Monitor regularly to avoid toxicity.

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20
Q

Safety Alert (Hydantoins)

A

Abrupt discontinuation: Can result in seizure recurrence or status epilepticus.

Rash Alert: Epidermal necrolysis or Stevens-Johnson syndrome can occur—discontinue immediately if rash develops.

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21
Q

Client Instructions (Hydantoins)

A

Avoid: Driving or mental alertness activities if drowsiness occurs.

Oral Care: Regular dental checkups, use a soft-bristled toothbrush, floss, and massage gums to prevent gingivitis.

Blood Levels: Periodic monitoring may be required to check therapeutic range.

Report: Rashes or severe side effects immediately.

Do not stop suddenly: Taper to avoid seizures.

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22
Q

Side Effects (Carbamazepine)

A

Common: Visual disturbances, headache, ataxia, nystagmus, blurred vision, fluid retention

Serious: Skin rash (Stevens-Johnson syndrome, epidermal necrolysis), bone marrow suppression, photosensitivity reactions

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23
Q

Interactions (Hydantoins)

A

Incompatibility: IV phenytoin is incompatible with many other medications and dextrose solutions.

Increased Phenytoin Levels: Diazepam, isoniazid, cimetidine, valproic acid.

Decreased Levels: Phenobarbital, carbamazepine.

Alcohol: May increase or decrease phenytoin levels.

Oral Contraceptives: Phenytoin reduces effectiveness—recommend alternative birth control methods.

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23
Q

Contraindications and Precautions (Hydantoins)

A

Contraindications: Pregnancy (teratogenic risk), skin rash, bradycardia, heart block, low blood sugar seizures, allergy to hydantoins.

Caution: Use carefully in clients with liver/kidney disease, cardiac dysfunction, diabetes, respiratory dysfunction, or alcoholism. Risk of toxicity in older adults and clients in a weakened state.

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24
Q

Drug Class (Carbamazepine)

A

Anticonvulsants / Antiseizure Medication (ASM)

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25
Q

Mechanism of Action (Carbamazepine)

A

Mechanism: Inhibits sodium influx through sodium channels, decreasing the neuronal discharge in areas of increased activity. This helps prevent seizures and stabilize mood in bipolar disorder.

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26
Q

Interventions (Carbamazepine)

A

Monitor: CNS effects, skin rashes, fluid retention.

Labs: Baseline and periodic blood counts to check for bone marrow suppression, particularly white blood cell count (WBC).

Dose: Start with a low dose and gradually increase. Administer the larger dose at bedtime to reduce daytime side effects.

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27
Q

Safety Alert (Carbamazepine)

A

Bone marrow suppression: Watch for low WBCs; obtain baseline and periodic blood counts.

Rash: Monitor for Stevens-Johnson syndrome, especially in clients of Asian descent (test for HLA-B*1502 gene).

Fluid retention: Can cause heart failure symptoms—report decreased urine output, edema, and shortness of breath.

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28
Q

Administration (Carbamazepine)

A

With Meals: Take with food to reduce gastric upset.

Sustained Release: Swallow whole, chewable tablets can be crushed.

Oral Suspension: Do not mix with other suspensions. Keep plasma levels consistent; administer with a sip of water if NPO.

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29
Q

Client Instructions (Carbamazepine)

A

CNS Effects: Inform clients that visual disturbances and incoordination should lessen over time; avoid driving or hazardous activities until effects are known.

Sun Protection: Use sunscreen and protective measures due to photosensitivity.

Fluid Retention: Report signs of heart failure (edema, decreased urine output, shortness of breath).

Rash: Report any rash immediately.

Bone Marrow Suppression: Report fever, sore throat, easy bruising.

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30
Q

Contraindications and Precautions (Carbamazepine)

A

Contraindications: Pregnancy risk (teratogenic), hematologic disorders, heart failure, absence or myoclonic seizures.

Caution: Clients with cardiac/hepatic disease, alcoholism, or positive for HLA-B*1502 gene (risk for Stevens-Johnson syndrome).

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31
Q

Interactions (Carbamazepine)

A

Increases Plasma Levels: Grapefruit juice, antifungals, erythromycin, isoniazid, some antiretrovirals, valproic acid, verapamil, niacin, loratadine, nefazodone, and MAOIs.

Decreases Plasma Levels: Phenytoin, barbiturates, rifampin, cisplatin, theophylline.

Oral Contraceptives: Decreased effectiveness—use alternative birth control methods.

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32
Q

Drug Class (Valproic Acid)

A

Class: Anticonvulsants / Antiseizure Medication (ASM)

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33
Q

Mechanism of Action (Valproic Acid)

A

Mechanism: Inhibits sodium influx through sodium channels and decreases neuron discharge. May also affect calcium influx and enhance the inhibitory effects of GABA.

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33
Q

Prototype (Valproic Acid)

A

Prototype: Valproic Acid

Other Medications: Valproate, Divalproex Sodium

An Antiseizure

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34
Q

Contraindications and Precautions (Valproic Acid)

A

Contraindications: Pregnancy risk (teratogenic), liver disorder, thrombocytopenia, hyperammonemia, concurrent anticonvulsant use.

Caution: Clients with kidney disease, older adults, and children under 2 years old.

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34
Q

Side Effects (Valproic Acid)

A

Common: GI upset, indigestion

Serious: Bruising, bleeding, prolonged bleeding time, decreased platelets, skin rash, liver toxicity, hyperammonemia

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35
Q

Administration (Valproic Acid)

A

Oral/IV: Can be given orally or IV. For GI issues, use enteric-coated tablets.

With Food: Administer with food to minimize gastric distress.

IV Administration: Dilute in at least 50 mL of diluent, and do not mix with other medications.

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36
Q

Safety Alert (Valproic Acid)

A

Hepatic & Pancreatic Failure: Monitor closely for signs of liver toxicity (e.g., jaundice) and pancreatitis (e.g., abdominal pain, nausea, vomiting).

Pregnancy: Avoid during pregnancy due to risk of neural tube defects (e.g., spina bifida). If pregnant, take folic acid to reduce the risk.

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37
Q

Client Instructions (Valproic Acid)

A

Report: Rash, nausea, vomiting, abdominal pain, jaundice, unexplained bruising, bleeding.

For caregivers: Watch for confusion or changes in consciousness (signs of hyperammonemia) and contact the provider.

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37
Q

Interventions (Valproic Acid)

A

Monitor: Platelet count, bleeding time, ammonia levels, liver function (baseline and periodic tests).

Look for: Unexpected bruising, blood in urine or stool, hyperammonemia (vomiting, confusion, decreased consciousness).

Report: Elevated serum amylase (pancreatitis risk), jaundice, and abdominal pain.

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38
Q

Interactions (Valproic Acid)

A

Increases Levels of: Phenytoin, phenobarbital

Increased Risk of Hyperammonemia: When taken with topiramate.

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39
Q

Prototype (Second- and Third-Generation ASMs) antiseizure medication

A

Prototype: Oxcarbazepine

Other Medications: Gabapentin, Lamotrigine, Topiramate, Levetiracetam, Zonisamide, Brivaracetam, Cenobamate

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40
Q

Mechanism of Action (Oxcarbazepine)

A

Mechanism: Binds to sodium channels, inhibiting the release of glutamate (an excitatory neurotransmitter), reducing seizures.

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41
Q

Side Effects (Oxcarbazepine)

A

Common: Dizziness, drowsiness, vision changes, headache, ataxia

Serious: Stevens-Johnson syndrome, hypothyroidism, decreased bone mineral density, leukopenia

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42
Q

Safety Alert (Oxcarbazepine)

A

Hyponatremia: Monitor sodium levels, especially in clients using diuretics or sodium-depleting medications.

Abrupt Discontinuation: May lead to increased seizure frequency or status epilepticus.

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43
Q

Interventions (Oxcarbazepine)

A

Monitor: Sodium levels, white blood cell count, and complete blood count.

Start with low dose: Gradually increase the dosage, dividing it into two daily doses.

Genetic Testing: Test for the HLA-B*1502 gene in clients of Asian descent to avoid severe skin reactions.

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44
Q

Administration (Oxcarbazepine)

A

Route: Administer orally as a tablet or liquid.

Dosing: Divide the total daily dose into two doses.

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45
Q

Client Instructions (Oxcarbazepine)

A

Sun Protection: Always use protection against sun exposure.

Birth Control: Use additional forms of contraception, as oxcarbazepine reduces the effectiveness of oral contraceptives.

Skin Reactions: Report any skin reactions immediately.

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46
Q

Contraindications and Precautions (Oxcarbazepine)

A

Contraindications: Allergy to carbamazepine.

Precautions: Use cautiously with clients who are at risk for hyponatremia.

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47
Q

Interactions (Oxcarbazepine)

A

Increases Phenytoin Levels: Concurrent use with phenytoin may cause elevated serum phenytoin levels.

Decreased Oxcarbazepine Levels: May occur when used with phenytoin, phenobarbital, or carbamazepine.

Oral Contraceptives: Oxcarbazepine reduces the effectiveness of oral contraceptives.

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48
Q

Prototype (Local Anesthesia)

A

Prototype: Lidocaine (Amide-type)

Other Medications: Procaine, Benzocaine (Ester-type)

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49
Q

Mechanism of Action (Local Anesthesia)

A

Mechanism: Blocks the influx of sodium through sodium channels, preventing depolarization and blocking the initiation of action potentials.

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50
Q

Side Effects (Local Anesthesia)

A

CNS Stimulation: Restlessness, irritability, tremors, confusion, convulsions

CNS Depression: Respiratory depression

Cardiac Effects: Hypotension, life-threatening cardiac conduction disorders (at high doses)

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51
Q

Safety Alert (Local Anesthesia)

A

Cardiac Risks: High doses of lidocaine can cause life-threatening conduction disorders.

Systemic Absorption: CNS stimulation followed by depression can occur with systemic absorption of high doses.

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52
Q

Administration (Lidocaine)

A

Application: Avoid application to eyes or broken skin due to risk of systemic absorption and toxicity.

Epinephrine Addition: Extends anesthetic effect but may cause vasoconstriction—monitor for lack of circulation in distal areas (e.g., fingers, toes).

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52
Q

Interventions (Local Anesthesia)

A

Monitor: Vital signs during and after procedures, particularly for signs of CNS stimulation (restlessness, tremors) or hypotension (especially with spinal anesthesia).

Treatment: If hypotension occurs, lower the head of the bed and have ephedrine or phenylephrine available.

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53
Q

Client Instructions (Local Anesthesia)

A

Report: Dizziness, abnormal sensations (paresthesia), and breathing difficulties during or after the procedure.

Monitoring: Expect careful monitoring of vital signs during and after the procedure.

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54
Q

Interactions (Lidocaine)

A

Increases Lidocaine Levels: Beta blockers, cimetidine, quinidine

Cardiac Risk: Increased risk of cardiac effects with phenytoin.

Increased CNS/Cardiac Effects: With concurrent use of procainamide and lidocaine.

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54
Q

Contraindications and Precautions (Lidocaine)

A

Contraindications: Allergy to lidocaine or amide-type anesthetics.

Precautions: Avoid viscous lidocaine in children under 3 years old.

Cardiac Risk: Clients with bradycardia or heart block may experience cardiac arrest when using lidocaine.

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55
Q

Mechanism of Action (Short-Acting Barbiturates)

A

Mechanism: Causes significant CNS depression and enhances the inhibitory effects of GABA, inducing rapid anesthesia and hypnosis.

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55
Q

Prototype (Short-Acting Barbiturates)

A

Prototype: Methohexital Sodium

Other Medication: Propofol (widely used, but linked to misuse)

Class: General Anesthetics – Barbiturates / Intravenous Anesthetics

Induce General anesthesia and hypnosis

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56
Q

Side Effects (Short-Acting Barbiturates)

A

Common: Decreased heart rate and blood pressure

Serious: Hypotension, tachycardia (compensatory), respiratory depression, apnea, overdose leading to death

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57
Q

Interventions (Short-Acting Barbiturates)

A

Monitor: Vital signs before, during, and after anesthesia; monitor for hypotension and respiratory depression.

Slow IV Administration: Administer slowly to minimize risks.

Constant Observation: Keep resuscitation equipment nearby.

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58
Q

Safety Alert (Short-Acting Barbiturates)

A

Respiratory Risk: Monitor respiratory status carefully for decreased respirations or apnea, which can occur due to CNS depression.

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59
Q

Client Instructions (Short-Acting Barbiturates)

A

Reassurance: Inform clients they will be closely monitored before, during, and after the procedure to ensure safety.

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60
Q

Administration (Short-Acting Barbiturates)

A

Route: IV injection or infusion only.

Patency Check: Ensure IV line is in the vein to avoid extravasation, which can cause severe damage to surrounding tissue.

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61
Q

Contraindications and Precautions (Short-Acting Barbiturates)

A

Contraindications: Known sensitivity to the medication.

Precautions: Use cautiously in clients with hepatic or renal disease, as these conditions can prolong the effects of the drug.

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62
Q

Prototype (Benzodiazepines)

A

Prototype: Midazolam

Other Medication: Diazepam

A General anesthetic

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62
Q

Interactions (Short-Acting Barbiturates)

A

Increased CNS Effects: Occurs when used with other CNS depressants, increasing the risk of respiratory depression and hypotension.

Duplicate Therapy: Using benzodiazepines like midazolam may prolong anesthesia unnecessarily.

62
Q

Mechanism of Action (Benzodiazepines)

A

Mechanism: Enhances the inhibitory effects of GABA, causing CNS depression and promoting sedation and hypnosis (sleep induction).

63
Q

Side Effects (Benzodiazepines)

A

Common: Amnesia (memory loss from injection to reversal)

Serious: Risk of cardiac or respiratory arrest (especially with higher doses for anesthesia)

64
Q

Safety Alert (Benzodiazepines)

A

Cardiac/Respiratory Arrest: Potential for arrest during anesthesia—ensure resuscitation equipment is available and monitor heart and respiratory rates closely.

65
Q

Administration (Benzodiazepines)

A

Routes: Administer IM into a large muscle, orally for children, or by IV bolus (titrated for sedation depth).

Conscious Sedation: Combine with opioids for conscious sedation.

Neonates: Do not give IV bolus doses to neonates.

65
Q

Interventions (Benzodiazepines)

A

Monitor: Vital signs before, during, and after the procedure.

Amnesia: Inform clients they will not recall the procedure and may have memory loss for several hours afterward.

Slow IV Administration: Administer IV bolus slowly, allowing 2 minutes between doses.

66
Q

Client Instructions (Benzodiazepines)

A

Reassurance: Inform clients they will be monitored frequently before, during, and after the procedure for safety.

Amnesia: Warn clients they will likely not remember the procedure.

67
Q

Contraindications and Precautions (Benzodiazepines)

A

Contraindications: Pregnancy, delivery, lactation (teratogenic), acute angle-closure glaucoma, sensitivity to benzodiazepines.

Precautions: Use cautiously in clients with neuromuscular, cardiac, pulmonary, or renal disorders.

68
Q

Interactions (Benzodiazepines)

A

CNS Depressants: Enhanced effects with concurrent CNS depressants (e.g., anticonvulsants).

Midazolam Toxicity: May occur with concurrent use of cimetidine.

Herbal Products: May increase or decrease the effects of midazolam.

69
Q

Prototype (Opioids for General Anesthesia)

A

Prototype: Fentanyl

Used as a part of general anesthetic regimen

70
Q

Safety Alert (Opioids for General Anesthesia)

A

Naloxone Availability: Always have naloxone ready to reverse opioid-induced respiratory depression. Monitor respiratory status carefully.

71
Q

Side Effects (Opioids for General Anesthesia)

A

Common: Sedation (desired effect during anesthesia), nausea

Serious: Respiratory depression, circulatory collapse

72
Q

Mechanism of Action (Opioids for General Anesthesia)

A

Mechanism: Narcotic agonists that provide analgesic and sedative effects, valuable as adjuncts to general anesthesia.

73
Q

Interventions (Opioids for General Anesthesia)

A

Monitor: Vital signs and level of consciousness before, during, and after the procedure.

Nausea: Administer antiemetics as needed to prevent vomiting.

Resuscitation Equipment: Keep nearby in case of respiratory depression.

74
Q

Administration (Fentanyl)

A

Forms: Available as IV or stick lozenge.

Lozenge: Place between cheek and gum, and instruct clients to suck for 15 minutes or longer—do not chew.

75
Q

Client Instructions (Opioids for General Anesthesia)

A

Expect: Drowsiness as part of the medication’s effect.

Report: Any nausea immediately so antiemetics can be given.

76
Q

Contraindications and Precautions (Fentanyl)

A

Contraindications: History of substance use disorder, obstetric deliveries (teratogenic, risk of neonatal respiratory depression).

Precautions: Use cautiously in clients with increased intracranial pressure, older adults, young children, and those with cardiac, respiratory, liver, or kidney disorders.

77
Q

Interactions (Fentanyl)

A

CNS Depressants: Increased risk of sedation and respiratory depression when used with other CNS depressants.

MAOIs: Risk of hypertensive crisis when taken with MAOI antidepressants—ensure clients are not on MAOIs before administration.

78
Q

Prototype (Amphetamines)

A

Prototype: Amphetamine/Dextroamphetamine Sulfate

Other Medications: Lisdexamfetamine Dimesylate, Methamphetamine Hydrochloride, Dextroamphetamine Sulfate

CNS Stimulant for ADHD and Narcolepsy

79
Q

Safety Alert (Amphetamines)

A

Hypertensive Crisis Risk: If combined with MAOIs, may result in hypertensive crisis. Ask about MAOI use in the last 2 weeks before prescribing.

79
Q

Mechanism of Action (Amphetamines)

A

Mechanism: Increases the release of norepinephrine and dopamine, enhancing alertness, energy, mood, and focus. Increases blood pressure, pulse, and respiratory rate.

80
Q

Side Effects (Amphetamines)

A

Common: Insomnia, nervousness, hypertension, tachycardia, palpitations, weight loss

Serious: Growth suppression in children, risk of misuse and dependence, withdrawal symptoms (depression, fatigue), toxicity (psychosis, dysrhythmias, seizures)

81
Q

Interventions (Amphetamines)

A

Monitor: Weight, height (in children), blood pressure, pulse, and signs of misuse.

Medication Holidays: Consider for children to avoid growth suppression.

Withdrawal: Taper doses slowly to avoid withdrawal symptoms like depression and fatigue.

82
Q

Administration (Amphetamines)

A

Forms: Available as regular tablets and extended-release formulations.

Extended Release: Instruct clients not to crush or chew the extended-release form to avoid increased side effects.

83
Q

Client Instructions (Amphetamines)

A

Avoid Caffeine: Potentiates stimulant effects.

Timing: Take medication early in the day, no later than 4:00 p.m., to prevent insomnia.

Report: Weight loss, palpitations, or cardiovascular symptoms to the provider.

Taper: Do not stop abruptly; taper slowly under provider supervision.

84
Q

Contraindications and Precautions (Amphetamines)

A

Contraindications: Allergy to amphetamines, moderate to severe hypertension, cardiovascular disease, hyperthyroidism, structural cardiac defects in children

Precautions: Clients with mild hypertension (monitor blood pressure closely), history of medication misuse (risk of dependence)

85
Q

Interactions (Amphetamines)

A

Increases Cardiac Effects: Stimulants, digoxin, beta blockers, tricyclic antidepressants

Decreases Effects: Ascorbic acid, ammonium chloride

Increases Effects: Sodium bicarbonate, acetazolamide

Dangerous Combination: MAOIs—risk of hypertensive crisis

86
Q

Drug Class (Methylphenidate)

A

Class: CNS Stimulant for ADHD and Narcolepsy

87
Q

Prototype (Methylphenidate)

A

Prototype: Methylphenidate

Other Medication: Dexmethylphenidate

88
Q

Mechanism of Action (Methylphenidate)

A

Mechanism: Increases norepinephrine and dopamine release, improving alertness, energy, and mood, while decreasing appetite and increasing blood pressure, pulse, and respiratory rate.

89
Q

Side Effects (Methylphenidate)

A

Common: Insomnia, nervousness, hypertension, tachycardia, palpitations

Serious: Weight loss, growth suppression in children, psychosis, dysrhythmias, seizures, potential for misuse and dependence, withdrawal (depression, fatigue)

90
Q

Safety Alert (Methylphenidate)

A

Hypertensive Crisis Risk: Ensure no recent MAOI use (within 2 weeks) due to risk of hypertensive crisis.

91
Q

Administration (Methylphenidate)

A

Oral: Give sustained-release forms whole, do not crush or chew.

Transdermal Patch: Apply in the morning, press for 30 seconds, rotate sites daily, and remove after 9 hours to avoid excessive dosing.

91
Q

Interventions (Methylphenidate)

A

Monitor: Weight and height in children, vital signs (BP, pulse), and signs of misuse.

Medication Holidays: Consider for children to avoid growth suppression.

Withdrawal: Taper doses gradually to avoid withdrawal symptoms.

92
Q

Client Instructions (Methylphenidate)

A

Avoid Caffeine: Potentiates stimulant effects.

Timing: Take the medication early in the day (last dose before 4 p.m.).

Report: Unexpected weight loss or cardiovascular symptoms to the provider.

Taper Gradually: Do not stop abruptly.

93
Q

Interactions (Methylphenidate)

A

Increases Cardiac Effects: When used with other stimulants or tricyclic antidepressants.

Dangerous Combination: MAOIs—risk of hypertensive crisis.

93
Q

Contraindications and Precautions (Methylphenidate)

A

Contraindications: History of medication misuse, allergy to methylphenidate, cardiac dysrhythmias, structural heart defects, psychosis or depression.

Precautions: Use cautiously in children under 6, clients with mild hypertension, or hyperthyroidism (monitor blood pressure closely).

94
Q

Prototype (Non-Amphetamines CNS Stimulant )

A

Prototype: Modafinil

Other Medication: Armodafinil

CNS Stimulant for ADHD and Narcolepsy

95
Q

Mechanism of Action (Non-Amphetamines CNS Stimulant)

A

Mechanism: Unclear, but thought to involve blocking the reuptake of norepinephrine, prolonging its action.

96
Q

Administration (Non-Amphetamines CNS Stimulant)

A

Narcolepsy/Sleep Apnea: Administer in the morning.

Shift-Work Sleepiness: Take 1 hour before work.

97
Q

Side Effects (Non-Amphetamines CNS Stimulant)

A

Common: Nausea, diarrhea, headache, tachycardia, hypertension

Serious: Rash (risk of Stevens-Johnson syndrome)

98
Q

Safety Alert (Non-Amphetamines CNS Stimulant)

A

Stevens-Johnson Syndrome: A rare but serious complication involving red/purple rash, blisters, skin sloughing, and possible internal organ damage. Immediate discontinuation and treatment are required.

99
Q

Client Instructions (Non-Amphetamines CNS Stimulant)

A

With Food: To minimize gastrointestinal distress.

Report: Headache, nervousness, dizziness, palpitations, or any rash/blistering immediately.

Birth Control: Use barrier methods as non-amphetamines reduce the effectiveness of oral contraceptives.

99
Q

Interventions (Non-Amphetamines CNS Stimulant)

A

Monitor: Vital signs for CNS effects (hypertension, tachycardia).

With Food: To prevent nausea and diarrhea.

Rash: Discontinue immediately if rash or blistering occurs.

100
Q

Contraindications and Precautions (Non-Amphetamines CNS Stimulant)

A

Contraindications: History of valvular heart disease.

Precautions: Use cautiously in clients with cardiovascular disease, hypertension, liver or kidney impairment, or history of substance misuse. Not recommended for children under 16 or during pregnancy.

101
Q

Interactions (Non-Amphetamines CNS Stimulant)

A

Decreases Effectiveness of: Oral contraceptives.

Increases Levels of: Warfarin, phenytoin.
Concurrent Use Risks: Diazepam, phenytoin, propranolol, tricyclic antidepressants—may decrease metabolism and increase effects.

102
Q

Prototype (Dopamine-Replacement Medications)

A

Prototype: Levodopa/Carbidopa

For Parkinson’s disease

103
Q

Mechanism of Action (Dopamine-Replacement Medications)

A

Mechanism: Levodopa crosses the blood-brain barrier and converts to dopamine in dopaminergic neurons, replenishing dopamine levels in the CNS. Carbidopa enhances levodopa’s effects by preventing its breakdown in the periphery.

104
Q

Side Effects (Dopamine-Replacement Medications)

A

Common: Nausea, vomiting, orthostatic hypotension, darkened urine/sweat

Serious: Dyskinesias (movement disorders)

105
Q

Safety Alert (Dopamine-Replacement Medications)

A

Orthostatic Hypotension: Monitor blood pressure lying, sitting, and standing. Assist clients with ambulation to prevent falls. Watch for a significant drop in systolic or diastolic pressure.

106
Q

Interventions (Dopamine-Replacement Medications)

A

Monitor: For dyskinesias and adjust dosage or timing if necessary.

Orthostatic Hypotension: Advise slow movements and assist with ambulation.

“On/Off” Phenomenon: Adjust dosing to regulate muscle control throughout the day.

107
Q

Administration (Dopamine-Replacement Medications)

A

Initial Dose: Start with a low dose and increase gradually.

Timing: Immediate-release tablets work within 30 minutes but wear off quickly, extended-release work over 4-6 hours but take longer to start.

6 Months: Full therapeutic response may take up to 6 months.

108
Q

Client Instructions (Dopamine-Replacement Medications)

A

With Food: Take with food if necessary but avoid high-protein meals, as they can reduce absorption.

Darkened Urine/Sweat: Inform that this is harmless.

Dizziness: Move slowly from sitting/lying to standing to avoid dizziness.

108
Q

Contraindications and Precautions (Dopamine-Replacement Medications)

A

Contraindications: Angle-closure glaucoma, history of melanoma, psychosis, suicidal thoughts.

Precautions: Use cautiously with older adults, and clients with renal, hepatic, respiratory, or endocrine disorders, wide-angle glaucoma, peptic ulcer disease, depression, or bipolar disorder.

109
Q

Interactions (Dopamine-Replacement Medications)

A

Decreases Effectiveness: First-generation antipsychotics (haloperidol), vitamin B6 (pyridoxine).

Delays Absorption: High-protein meals.

Increases Response: Anticholinergic medications.

MAOIs: Risk of hypertensive crisis if taken within 2 weeks of each other.

109
Q

Prototype (Direct-Acting Dopamine Receptor Agonists)

A

Prototype: Pramipexole

Other Medication: Ropinirole

For Parkinson’s disease

110
Q

Mechanism of Action (Direct-Acting Dopamine Receptor Agonists)

A

Mechanism: Mimics the effects of dopamine by directly binding to dopamine receptors, producing a response similar to the body’s natural dopamine.

111
Q

Side Effects (Direct-Acting Dopamine Receptor Agonists)

A

Common: Nausea, orthostatic hypotension, dyskinesias, drowsiness, “sleep attacks”

Serious: Muscle weakness, risk of falls

112
Q

Safety Alert (Direct-Acting Dopamine Receptor Agonists)

A

Falls Risk: Clients with muscle weakness from this medication are at a higher risk for falls. Implement fall-prevention measures, especially for older adults.

113
Q

Interventions (Direct-Acting Dopamine Receptor Agonists)

A

Monitor: Nausea (give with food), drowsiness, muscle weakness, and abnormal movements (dyskinesias).

Prevent Falls: Assist with ambulation if needed, and monitor for orthostatic hypotension (measure BP sitting and standing).

114
Q

Administration (Direct-Acting Dopamine Receptor Agonists)

A

Start Low: Begin with a low dose and gradually increase every 5-7 days.

Restless Leg Syndrome: Administer 2-3 hours before bedtime.

115
Q

Client Instructions (Direct-Acting Dopamine Receptor Agonists)

A

With Food: Take with food if nausea occurs.

Avoid Alcohol: To prevent increased drowsiness.

Report: Muscle weakness, lack of energy, and abnormal movements to the provider.

Move Slowly: To prevent orthostatic hypotension, and taper doses slowly when discontinuing.

116
Q

Contraindications and Precautions (Direct-Acting Dopamine Receptor Agonists)

A

Contraindications: Allergy to the medication.

Precautions: Use cautiously with clients with psychotic disorders, renal or liver dysfunction, older adults, and those with compulsive behaviors. Safety during pregnancy or lactation is not established.

117
Q

Interactions (Direct-Acting Dopamine Receptor Agonists)

A

Increases Levels: Cimetidine.

Decreases Effects: Metoclopramide, phenothiazine antipsychotics (chlorpromazine).

Increases Risk for Drowsiness: Alcohol and other CNS depressants.

118
Q

Drug Class (MAO-B Inhibitors)

A

Class: Antiparkinson Agent / Monoamine Oxidase-B Inhibitors

119
Q

Mechanism of Action (MAO-B Inhibitors)

A

Mechanism: Inhibits the enzyme monoamine oxidase B, which inactivates dopamine. By blocking MAO-B, dopamine is not broken down, increasing its availability in the brain and improving Parkinson’s symptoms.

120
Q

Safety Alert (MAO-B Inhibitors)

A

Hypertensive Crisis: If clients experience headache, nausea, vomiting, or blood pressure spikes, measure BP immediately as this may indicate a hypertensive crisis.

120
Q

Prototype (MAO-B Inhibitors)

A

Prototype: Selegiline

Other Medication: Rasagiline

121
Q

Side Effects (MAO-B Inhibitors)

A

Common: Insomnia, oral mucosa irritation (orally-disintegrating tablet)

Serious: Hypertensive crisis (at high doses when interacting with foods containing tyramine or ephedrine medications)

122
Q

Interventions (MAO-B Inhibitors)

A

Monitor: For insomnia, blood pressure (hypertension), and oral mucosa irritation.

Tyramine: Help clients avoid foods high in tyramine (aged cheese, processed meats) and caffeine.

Medication Review: Evaluate other medications for interactions.

123
Q

Administration (MAO-B Inhibitors)

A

Orally-Disintegrating Tablets: Place on top of the tongue, avoid eating/drinking for 5 minutes before or after.

Timing: Administer in the morning, no later than noon, to prevent insomnia.

124
Q

Client Instructions (MAO-B Inhibitors)

A

Timing: Take the last dose of the day by noon to prevent insomnia.

Report: Any irritation in the mouth or tongue.

New Medications: Inform the provider before starting any new prescription, over-the-counter, or herbal medications due to the risk of interaction and hypertensive crisis.

125
Q

Contraindications and Precautions (MAO-B Inhibitors)

A

Contraindications: Hypersensitivity to the medication.
Precautions: Use cautiously in clients with a history of peptic ulcer disease.

126
Q

Interactions (MAO-B Inhibitors)

A

Dangerous Combinations: Meperidine (Demerol), opioids, tricyclic antidepressants, SSRIs, and other MAOIs—may cause fever, muscle rigidity, and hypertensive crisis.

Food Interactions: Avoid foods with tyramine (aged cheeses, processed meats) and herbal supplements like ephedra, St. John’s wort, and ginseng due to risk of severe hypertension.

Blood Pressure Medications: Antihypertensives and diuretics may cause hypotension when taken together.

127
Q

Prototype (Cholinesterase Inhibitors)

A

Prototype: Donepezil

Other Medications: Rivastigmine, Galantamine

For Alzheimer’s disease

128
Q

Mechanism of Action (Cholinesterase Inhibitors)

A

Mechanism: Inhibits acetylcholinesterase, increasing acetylcholine availability at receptor sites in the brain, improving cognitive function in Alzheimer’s disease.

129
Q

Side Effects (Cholinesterase Inhibitors)

A

Common: Nausea, vomiting, diarrhea, dizziness, insomnia, headache

Serious: Bradycardia (which may lead to syncope)

130
Q

Safety Alert (Cholinesterase Inhibitors)

A

Syncope: Bradycardia can lead to fainting episodes. If heart rate drops below 60/min, place the client on bed rest and notify the provider.

131
Q

Interventions (Cholinesterase Inhibitors)

A

Monitor: For gastrointestinal bleeding, CNS effects, and bradycardia.

With Food: Give the medication with food to reduce nausea.

Assist: With ambulation due to dizziness and risk of syncope.

132
Q

Administration (Cholinesterase Inhibitors)

A

Oral: Donepezil is given at bedtime, with or without food. Available as tablets, disintegrating tablets, and syrup.

Patch: Rivastigmine is available as a weekly transdermal patch.

133
Q

Client Instructions (Cholinesterase Inhibitors)

A

Take with Food: To reduce nausea and gastrointestinal discomfort.

Report: Vomiting, severe diarrhea, weight loss, gastrointestinal bleeding, dizziness, or any episodes of fainting.

134
Q

Contraindications and Precautions (Cholinesterase Inhibitors)

A

Contraindications: Children, history of gastrointestinal bleeding, or allergy to donepezil.

Precautions: Use cautiously with clients with cardiac, GI, or pulmonary disorders, hyperthyroidism, or seizure history.

135
Q

Interactions (Cholinesterase Inhibitors)

A

Decreases Effects: Anticholinergic medications (e.g., antihistamines).

Increases Risk of GI Bleeding: NSAIDs (e.g., aspirin, ibuprofen).

Safety: Use acetaminophen for mild pain to avoid increased bleeding risk from NSAIDs.

136
Q

Prototype (NMDA Receptor Antagonist)

A

Prototype: Memantine

For Alzheimer’s disease

137
Q

Mechanism of Action (NMDA Receptor Antagonist)

A

Mechanism: Blocks excess glutamate from stimulating NMDA receptors, reducing calcium influx into neurons. This helps prevent neuronal damage and may slow the progression of Alzheimer’s disease.

138
Q

Side Effects (NMDA Receptor Antagonist)

A

Common: Headache, dizziness, increased confusion

Other: Constipation

139
Q

Safety Alert (NMDA Receptor Antagonist)

A

CNS Effects: Clients with Alzheimer’s may not recognize dizziness or confusion. Caregivers should monitor for these side effects and report them to the provider.

140
Q

Interventions (NMDA Receptor Antagonist)

A

Monitor: For CNS effects such as dizziness, headache, and confusion.

Constipation: Monitor bowel movements and provide fiber supplements or laxatives as needed.

141
Q

Administration (NMDA Receptor Antagonist)

A

Forms: Memantine is available as oral tablets or liquid.

With or Without Food: Can be given with or without food.

142
Q

Client Instructions (NMDA Receptor Antagonist)

A

Report: Any dizziness, headaches, or increased confusion to the provider.

Constipation: Adjust diet as needed to manage constipation and report if severe.

143
Q

Contraindications and Precautions (NMDA Receptor Antagonist)

A

Contraindications: Do not give to clients with renal failure.

Precautions: Use cautiously with clients with liver/renal disorders, seizure history, and older adults. Dosage adjustments may be needed.

144
Q

Interactions (NMDA Receptor Antagonist)

A

Interacts With: Antacids like sodium bicarbonate and medications that increase urine pH, which may raise memantine levels and cause toxicity.

145
Q

Prototype drug for Immunomodulators

A

Prototype Medications: Interferon beta-1a, Interferon beta-1b

Other Medications: Glatiramer acetate, Natalizumab, Ocrelizumab, Dimethyl fumarate, Fingolimod hydrochloride

For Multiple Sclerosis

146
Q

Mechanism of Action (Immunomodulators)

A

Mechanism: Inhibit the movement of leukocytes across the blood-brain barrier, protecting the myelin sheath of neurons from autoimmune damage.

147
Q

Side Effects (Immunomodulators)

A

Common: Flu-like symptoms (fever, headache, chills, myalgia)

Serious: Myelosuppression, liver toxicity, injection site reactions

148
Q

Interventions (Immunomodulators)

A

Start Low: Begin therapy with a low dose and gradually increase.

Monitor: Liver function tests and blood counts regularly.

Manage Flu-like Symptoms: Recommend acetaminophen for flu-like effects.

148
Q

Safety Alert (Immunomodulators)

A

Myelosuppression: Monitor for thrombocytopenia and neutropenia, as these increase the risk of bleeding and infection.

Hepatotoxicity: Watch for abdominal tenderness, anorexia, jaundice, and other signs of liver damage.

149
Q

Administration (Immunomodulators)

A

Form: Oral, IM, IV, or subcutaneous

Self-Administration: Rotate injection sites, apply cool compress before and warm compress after injections.

150
Q

Client Instructions (Immunomodulators)

A

Flu-like Symptoms: Pre-medicate with acetaminophen.

Report: Unexplained bruising, bleeding, fatigue, and any injection site reactions.

Injection Site Care: Rotate sites, use cool compress before and warm compress after injections.

151
Q

Contraindications and Precautions (Immunomodulators)

A

Contraindications: Allergies to interferon beta, human albumin, or mannitol

Precautions: Suicidal tendencies, liver disorders, alcohol misuse, seizures, thyroid disorders, or age under 18.

151
Q

Interactions (Immunomodulators)

A

Interaction: Avoid concurrent use with other immunosuppressants like prednisone due to increased risk of bone marrow suppression.

152
Q

Mechanism of Action (Serotonin Agonists)

A

Mechanism: Activates 5-HT receptors, promoting vasoconstriction and suppressing the release of CGRP, preventing the inflammatory response and reversing the 5-HT/CGRP ratio.

153
Q

Prototype for Serotonin Agonists

A

Prototype Medication: Sumatriptan

Other Medications: Zolmitriptan

For Migraine Headache

154
Q

Side Effects (Serotonin Agonists)

A

Common: Chest pressure, heaviness, tingling sensations, vertigo

Serious: Vasospasm of coronary vessels, anginal pain

155
Q

Safety Alert (Serotonin Agonists)

A

Chest Heaviness/Angina: Heaviness in the chest could be benign, but it could also indicate coronary vasospasm leading to anginal pain. Monitor vital signs and be cautious of cardiac ischemia.

Excessive Vasoconstriction: Do not exceed the maximum daily dose to avoid compromised blood flow to vital organs.

156
Q

Administration (Serotonin Agonists)

A

Forms: Oral, nasal spray, subcutaneous injection

Dosing: Oral doses should not exceed 200 mg in 24 hours, nasal doses 40 mg, and subcutaneous injections should not exceed two doses in 24 hours.

156
Q

Interventions (Serotonin Agonists)

A

Monitor: Vital signs closely after the first dose to detect any vasospasm or coronary issues.

Reassure Clients: Chest pressure is common but should be monitored. Report any unresolved chest pain immediately.

157
Q

Client Instructions (Serotonin Agonists)

A

Chest Pain: Report chest pressure, tightness, or heaviness in the back, jaw, or throat immediately.

CNS Effects: Report symptoms like tingling or vertigo during the next doctor visit.

158
Q

Contraindications and Precautions (Serotonin Agonists)

A

Contraindications: History of coronary artery disease, angina, MI, severe hypertension, peripheral vascular disease, or stroke

Precautions: Liver or kidney insufficiency

159
Q

Interactions (Serotonin Agonists)

A

MAO Inhibitors: Risk of toxicity if taken within 2 weeks of sumatriptan

Ergotamine/Other Triptans: Increased risk of angina if taken within 24 hours

Serotonin Syndrome: Risk with concurrent use of serotonin agonists for other disorders

Herbal Interactions: St. John’s wort increases toxicity risk.

160
Q

What are the only Immunosuppressants used for MS?

A

The only immunosuppressant currently available and approved to treat Multiple Sclerosis include mitoxantrone, which was originally used in the treatment of cancer, and cladribine.

Pharmacology ASN MDC (2 decks)

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