pharm final- neuro Flashcards
Phenytoin (Dilantin) class
hydantoins
Phenytoin (Dilantin) MOA
Stabilize nerve membranes
Decrease conduction through nerve pathways
Phenytoin (Dilantin) SE
Adverse effects: gingival hyperplasia, hyperglycemia, bad acne, rash over abdominal/chest area
Overdose/toxicity: nystagmus (abnormal movement of the eyes), blurred vision, diplopia, slurred speech, dizziness, lethargy, coma, fever, respiratory depression
Phenytoin (Dilantin) nursing implications
Metabolized in the liver, avoid alcohol Narrow therapeutic index: levels should be 10-20 mcg/ml IV loading dose: 15-20 mg/kg IV: no faster than 50mg/min or may have bradycardia, cardiac arrest, hypotension, v-fib Cardiac suppressant Only given with .9NS or will precipitate Very irritating-watch IV site Onset 10-20 minutes, duration 24 hours TAKE WITH FOOD
Xanax (alprazolam) class
benzodiazepines
Xanax (alprazolam) MOA
increase effects of GABA
Xanax (alprazolam) SE
CNS depression, constipation, hypotension, urinary retention, blurred vision, urinary retention
Xanax (alprazolam) nursing implications
antianxiety Cause physical dependence Withdrawal if abruptly stopped Metabolized by liver Smaller amounts for elderly patients
Versed (midazolam) class
benzodiazepines
Versed (midazolam) MOA
increase effects of GABA
Versed (midazolam) SE
CNS depression, constipation, hypotension, urinary retention, blurred vision, urinary retention
Versed (midazolam) nursing implications
IV only, conscious sedation Cause physical dependence Withdrawal if abruptly stopped Metabolized by liver Smaller amounts for elderly patients
flumazenil (Romazicon) uses
versed antidote
Low respirations, 02
Haldol (haloperidol ) class
nonphenothiazine
antipsychotic
for psychotic reactions/ICU psychosis
tardive dyskinesia
15% to 20% in patients during long-term use
Twisting, writhing worm-like movements of tongue and face.
Lip smacking
Fly catching
Interferes with swallowing, chewing, speaking
Treatment: decrease dosage
Symptoms irreversible if left untreated
akathesia
Characterized by pacing, squirming brought on by an uncontrolled need to be in motion
Treated with beta blockers
Develops within first two months of treatment
acute dystonia
Develops within first few days of therapy
Severe spasm of muscles of tongue, face, neck or back
Oculogyric crisis: involuntary upward deviation of the eyes (medical emergency)
Treated with Benadryl
parkinsonism
Bradykinesia, drooling, tremor, rigidity Shuffling gait, stooped posture Cogwheeling or pill rolling Develops within first month of therapy Treated with Symmetrel, Cogentin-PRN No Levodopa
Thorazine (chlorpromazine) class
phenothiazine
antipsychotic
Thorazine (chlorpromazine) SE
EPS tardive dyskinesia akathesia acute dystonia parkinsonism
Thorazine (chlorpromazine) nursing implications
Newer drugs more expensive but less side effects
Elderly: 30-50% less of a dose
Drugs metabolized by the liver
Oral: liquid form dilute prior to giving to reduce taste
Maintenance therapy
Promote compliance (usually lifetime treatment)
Manage side effects
Caffeine negates effects of drugs
Avoid alcohol
Therapeutic responses develop slowly
Should not abruptly stop taking meds
lithium (lithium salts) class
Mood Stabilizers- Antimanic Drugs
lithium (lithium salts) SE
As levels rise: lethargy, slurred speech, muscle weakness, polyuria
Toxic levels: Clonic movements, hyporeflexia, seizures, hypotension, renal toxicity, pulm toxicity
lithium (lithium salts) nursing implications
Multiple drug interactions
Watch drug levels
Monitor symptoms
Give with food or milk to enhance absorption
Maintain adequate fluid intake
Monitor sodium intake (Too much salt decreases the effects of the lithium)
Limit caffeine (can also decrease the effects of lithium)
No ETOH
