NEUROMUSCULAR MEDS Flashcards
What is the MOA of Levodopa?
crosses the BBB and converts to dopamine once it reaches the brain –> restores the balance btwn Ach and dopamine
What is the indication for Levodopa?
parkinson’s disease
What is the therapeutic effect of Levodopa?
reduction in symptom severity (improvement in carrying out ADL’s) –> does not cure or delay disease
What are the nursing considerations for Levodopa?
- administered orally
- therapeutic effect can take several months
- most effective drug for PD
- effectiveness of Levodopa decreases over time (symptoms controlled in first 2 yrs of treatment –> declines)
- ALONE: small fraction of med enters the brain –> given in combo
What is the other drug that is used with Levodopa?
Carbidopa (SINEMET) –> has no therapeutic effects
How does Carbidopa work with Levodopa?
delays the process of peripheral drug metabolism –> allows for more Levodopa to enter the brain
What is the risk of taking Levodopa alone?
only a small portion reaches the CNS –> requires high doses = more adverse effects
What are the adverse effects of Levodopa/Carbidopa (SINEMET)?
- N/V (activation of dopamine in CTZ)
- dyskinesias (tics, head bobbing, grimacing, rapid involuntary jerking, writhing movements)
- postural hypotension
- psychosis (visual hallucinations, vivid dreams, paranoia)
- CNS effects (anxiety, agitation, memory loss, cognitive impairment, issues with impulse control)
- darken sweat/urine
What are the precautions/CI of Levodopa/Carbidopa (SINEMET)?
hypersensitivity
What are the nursing considerations and assessments of Levodopa/Carbidopa (SINEMET)?
assess:
- parkinsonian and extrapyramidal symptoms before and during therapy (shuffling gait, bradykinesia, drooling, pill rolling, tremors, twisting motions, masked face, rigidity)
- blood pressure frequently during therapy
nursing considerations:
- pts should avoid high protein meals –> competes for absorption in gut
- pts should not transfer to a standing position abruptly
What are the 2 phenomenon of SINEMET?
- on/off phenomenon –> long term usage, sudden drop of symptoms (reversal symptoms recurrence), no connection to timing of doses
- wearing of phenomenon –> gradual wearing off, drugs need to be given frequently, may other drugs to prolong effect
What is the classification of Pramipexole (Mirapex)?
non-ergot dopamine receptor agonist
What is the MOA of Pramipexole (Mirapex)?
stimulates dopamine receptors in the striatum
What is the indication for Pramipexole (Mirapex)?
PD
What is the therapeutic effect of Pramipexole (Mirapex)?
improve ability to carry out ADL’s –> improvement in motor symptoms
NOTE: does not cure/delay PD
What are the adverse effects of Pramipexole (Mirapex)?
- nausea, dizziness, sleepiness, confusion, hallucinations
- sleep attacks (come on without warning)
- impulse control disorders (compulsive gambling, shopping, binge eating, hypersexuality)
What happens when Pramipexole (Mirapex) is taken with Levodopa?
increase risk of developing orthostatic hypotension, hallucinations and dyskinesias
What are the nursing considerations and assessments of Pramipexole (Mirapex)?
assess:
- monitor BP regularly
nursing considerations:
- warnings about potential to develop drowsiness (avoid sedating meds/alcohol while on pramipexole)
- avoid driving or engaging in dangerous activities (when starting the med)
- medication should be discontinued if pt experiences sleep attacks !!!
- used on its own in early PD
- used in combo with other PD drugs in advanced progression
- effects take several weeks to develop
- given orally
- alone –> no dyskinesia
What is the classification for Selegiline (Deprenyl)?
MAO-B inhibitor
What is a MAO-B?
an enzyme that inactivates dopamine in the striatum
What is the MOA of Selegiline (Deprenyl)?
selective inhibitor of MAO-B –> when used with Levodopa = suppresses the destruction of dopamine derived from Levodopa, reducing wearing off effect
What is the indication for Selegiline (Deprenyl)?
PD, depression
What is the therapeutic effect of Selegiline (Deprenyl)?
improvement in motor function, reduces wearing off effect
What are the adverse effects of Selegiline (Deprenyl)?
insomnia, hypertensive crisis (high doses - increased risk with younger people
- with Levodopa = worsen orthostatic hypotension, dyskinesias, psychiatric symptoms
What are the nursing considerations and assessments of Selegiline (Deprenyl)?
assess:
- gait and motor function –> effectiveness of treatment and identify dyskinesia (adverse effect)
- monitor behavioural changes and psychiatric symptoms
- BP (combo w/ Levodopa)
nursing considerations:
- discuss risk for falls
- not be taken with meperidine or SSRIs
- often recommended for newly diagnosed PD (first line drugs)
- used alone/combo with Levodopa
- administered orally
What is the MOA of Methylprednisolone (Solu-Medrol)?
mimics cortisol, potents anti-inflammatory and immunosuppressant, works rapidly (short term use)
What is the indication for Methylprednisolone (Solu-Medrol)?
exacerbation of MS (neurologic symptoms, increased disability, impairments in vision/strength/cerebellar function)
What is the therapeutic effect of Methylprednisolone (Solu-Medrol)?
anti-inflammatory and immunosuppressive effects
What are the nursing considerations and assessments of Methylprednisolone (Solu-Medrol)?
assess:
- signs of acute infection (fever, increased WBC, cough, soft tissue pain/swelling, UTI)
nursing considerations:
- IV or IM
- immunosuppressive –> can exacerbate infections
What is the classification of Interferon Beta drugs (Betaseron)?
immunomodulator
What is the MOA of Interferon Beta drugs (Betaseron)?
- inhibits migration of proinflammatory leukocytes across the BBB (cannot reach neurons of the CNS)
- suppresses T-helper cell activity
- naturally occurring as glycoprotein
What is the indication for Interferon Beta drugs (Betaseron)?
MS
What is the therapeutic effect of Interferon Beta drugs (Betaseron)?
decreases the frequency and severity of relapse, reduce the size and number of lesions and delay progression of disability
What are the adverse effects of Interferon Beta drugs (Betaseron)?
- flu-like symptoms (decreases overtime, minimized by low doses and gradually increases = antipyretic)
- hepatotoxicity
- myelosuppression (suppress bone marrow function = low blood cells)
- injection site reaction (pain, erythema, rash, itching)
- depression and suicidal ideation
What are the CI of Interferon Beta drugs (Betaseron)?
- hypersensitivity
- pts with previous suicide attempts/depression (use cautiously)
- pts with liver disease and alcoholism (use cautiously)
What are the nursing considerations and assessments of Interferon Beta (Betaseron)?
assess:
- MS symptoms during therapy
- liver function tests + CBC = prior to treatment, 1/3/6 months
- signs of depression
nursing considerations:
- educate pt about likelihood of experiencing flu-like symptoms and offer tylenol for relief
- educate pt about signs of depression, suicidal ideation, worsening anxiety
- should not combine w/ alcohol or other hepatotoxic meds
- should not take with other immunosuppressants
- IM/SC
What are the classifications of Mitoxantrone (Novantrone)?
immunosuppressant, cytotoxic drugs (kills cells in body)
What is the MOA of Mitoxantrone (Novantrone)?
- binds w/ DNA = inhibits DNA/RNA synthesis –> causing breakage of DNA strands
- more lethal to rapidly dividing cells (hair, skin, mucosa, bone marrow)
- suppresses production of immune system cells and decreases immune system destruction of myelin
What are the indication for Mitoxantrone (Novantrone)?
MS, used to treat cancer
What is the therapeutic effect of Mitoxantrone (Novantrone)?
delays MS pts going into relapse, delays disability progression, decrease lesions
What are the adverse effects of Mitoxantrone (Novantrone)?
- myelosuppression (toxic to bone marrow = low blood cells, high risk of infection)
- cardiotoxicity (affects left ventricular EF = HF, occur months to yrs after treatment has ended)
- teratogenic (potential for fetal harm)
- hair loss, N/V, mouth sores
What are the CI of Mitoxantrone (Novantrone)?
hypersensitivity
precautions in pts with cardiac diseases or active infections
What are the nursing considerations and assessments of Mitoxantrone (Novantrone)?
assess:
- bone marrow depression (bleeding, bruising d/t decreased platelets)
- signs of infections (decreased neutrophils)
- signs of anemia (decreased RBC)
- GI symptoms
- mouth sores
- fluid/electrolytes
- I/Os
- appetite
- nutrition
- baseline EKG, chest xray, echo (EF and cardiac status prior to starting therapy and during
- signs of HF (crackles, edema, SOB, chest pain)
nursing considerations:
- administer antiemetics prophylactically
- careful w/ IV administration
- monitor pt IV site carefully (d/c = pain, swelling, redness)
What is the classification of Gabapentin (Neurontin)?
GABA analog (antiseizure agent)
What is the MOA of Gabapentin (Neurontin)?
- does not directly affect GABA receptors
- may enhance GABA release = increasing GABA-mediated inhibition of neuronal firing
What is the indication for Gabapentin (Neurontin)?
- off-label uses (relief of neuropathic pain)
- postherpetic neuralgia`
What are the adverse effects of Gabapentin (Neurontin)?
very well tolerated
- somnolence
- dizziness
- ataxia
- fatigue
- nystagmus
- peripheral edema
NOTE: mild to moderate and often diminished with continued drug use
- mood changes, suicidal ideation
What is the CI of Gabapentin (Neurontin)?
hypersensitivity
What are the nursing considerations and assessment of Gabapentin (Neurontin)?
assess:
- signs of CNS depression
- improvement of neuropathic pain
- changes in mood, depression, suicidal ideation
nursing considerations:
- caution w/ other CNS depressants (can cause resp. depression) –> opioids, benzodiazepines, anticholinergics, etoh
- withdrawal symptoms w/ abrupt d/c (high risk of seizure) –> slow taper required
-
What is the classification of Baclofen (Lioresel)?
skeletal muscle relaxant
What is the MOA of Baclofen (Lioresel)?
acts within SC to suppress hyperactive reflexes involved in the regulation of muscle movement
NOTE: mimic actions of GABA on spinal neurons –> structural analog of the inhibitory NT GABA
What is the indication of Baclofen (Lioresel)?
relieve muscle spasticity with MS and SCI
What is the therapeutic effect of Baclofen (Lioresel)?
relieve muscle spasticity (decreases flexor/extensor spasms and suppresses resistance to passive movement
What are the adverse effects of Baclofen (Lioresel)?
- drowsiness, dizziness, weakness, fatigue (CNS depressants)
- N/V
- constipating, urinary retention
- orthostatic hypotension
What are the nursing considerations and assessments of Baclofen (Lioresel)?
asses:
- intrathecal route –> infusion system closely
nursing considerations:
- extreme caution with other CNS depressants
- overdose or combo with other CNS depressants –> respiratory depression
- overdose –> resp. depression (NO ANTIDOTE)
- monitor for withdrawal symptoms (hallucinations, seizures, paranoid ideation) = doses tapered over 1-2 weeks for d/c of therapy
- intrathecal route has a higher risk of severe withdrawal symptoms (fever, muscle rigidity, exaggerated rebound spasticity, multiorgan failure, death)
- PO, intrathecal (placed directly into the spinal fluid of the back)
