NSG 470: Pharmacology Flashcards
t-PA
Gold Standard IV medication that works by dissolving the clot and improving blood flow to the brain cells.
Requirements for receiving t-PA?
Only for Ischemic Strokes
Goal is to give within 60 mints of arriving to the ED.
Less than 3 hours from onset of symptoms.
Age >18
Pre-stroke status of no deficits
SBP <185 and diastolic < 110
Not a minor stroke or rapidly resolving symptoms (use NIHSS)
No prior intracerebral hemorrhage, AVM, aneurysm, or tumor
No major surgery past 14 days
No GI or urinary bleeding past 21 days
No stroke or head trauma past 3 months
Nursing interventions for t-PA?
Check for bleeding
Neuro checks around the clock
Vital signs
Labs
Monitor glucose
Prevent injury (bedrest)
Avoid unnecessary venipunctures, IV sticks, Foley insertion
Avoid IM injections
Neuro checks around the clock (checking their neuro status using the NIH stroke scale)
Blood pressure medication if needed for hypertension
Most patients will go to ICU to be monitored
Pharmacological TIA treatment?
Dual Anti-Platelets (short-term): Aspirin and Plavix
Statin: Atorvastatin
Levodopa (Dopar)/ Carbidopa (Sinemet)
Levodopa is a precursor to dopamine and is converted in the CNS and PNS. Thus, increasing dopamine supply to the basal ganglion.
Gold standard anti-PD agent.
Carbidopa decreases peripheral metabolism of levodopa, leaving more available for the brain. Sinemet (Levodopa/Carbidopa) combination works only on CNS: blocks conversion in CNS only.
Tolerance is common
Short half-life (90-120 minutes)
Timing of doses is critical/dosed 3-6 times daily
On-Off phenomenon/Wearing off phenomenon
Increased tremors
Dyskinesias (difficult movements)
Administer per schedule: 1-2 hrs. after meals
What are the side effects of Levodopa and Carbidopa?
Increased Restlessness (major S/E: requires dose reduction)
Dyskinesia
Orthostatic hypotension
Mental disturbances: hallucinations
Insomnia: reduce bedtime dose
What us the On-Off phenomenon/ wearing off phenomenon?
Increased tremors
Dyskinesias (difficult movements)
As Parkinsons disease progresses, the brains levodopa plasma concentration decreases, causing levodopa medications to wear off temporarily and symptoms to return.
Dopamine Agonists for PD?
Bromocriptine (Paradol)
Ropinirole (Requip)
Pramipexole (Mirapex)
What is the S/Es of dopamine agonists?
orthostatic hypotension
dyskinesia
hallucinations
Anti-Cholinergics for PD?
Benztropine (Cogentin)
Trihexyphenidyl (Artane)
What is the S/Es of anti-cholinergic used for PD?
Dry mouth
Constipation
Urinary Retention
Confusion
COMPTs (Catechol O-methyltransferase Inhibitors) for PD?
Entacapone (Comtan)
Action: Decrease the breakdown of Levodopa
Best results if used with a dopaminergic & dopamine agonist agent.
Nursing considerations for COMPT inhibitors?
Monitor for dyskinesia when given with levodopa
Diarrhea is common
Dark colored urine is normal
Anti-Viral’s for PD?
Amantadine (Symmetrel)
Action: stimulate release of dopamine & prevents its reuptake -> leaving it available in blood
ORIGINALLY A DRUG USED TO TREAT INFLUENZE
What are some nursing considerations for Anti-viral used for PD?
Anxiety
Confusion
Anticholinergic effects
Advise patient that skin may become discolored
