Unit 1: Medication List for Neurological Disorders Flashcards
Anticholinergic: Benztropine
- block cholinergic activity in the CNS
- reduction of rigidity and tremors
- used in Parkinson’s disease
- Side Effects: blurred vision, dry eyes, constipation, dry mouth, confusion, depression, and weakness
Anticoagulant: Warfarin (Coumadin)
- prevents clot extension and formation
- prophylaxis treatment of venous thrombosis, PE, AFib w/ embolization
- Side Effects: bleeding
- Nursing: assess for signs of bleeding and hemorrhage (bleeding gums, nosebleed, unusual bruising, tarry black stools, hematuria, fall in hematocrit and BP)
Antihistamine: Meclizine
- management/prevention of motion sickness and vertigo
- has central anticholinergic, CNS depressant, and antihistaminic properties
- decreases excitability of the middle ear labyrinth
- decreases conduction in middle ear vestibular-cerebellar pathways
- Side effects: drowsiness, fatigue, blurred vision, dry mouth, constipation
Anti-platelet: Aspirin
- produce analgesia
- reduces inflammation and fever
- mild to moderate pain
- decreases platelet aggregation
- decreases incidence of Transient ischemic attacks (TIA)
- Side Effects: GI bleeding, allergic reactions (anaphylaxis), dyspepsia (indigestion/abdominal discomfort), epigastric distress, nausea
- Nursing: prolongs bleeding time for 4-7 days, and in large doses may cause prolonged prothrombin time; avoid alcohol consumption; pts who have asthma, allergies, nasal polyps are at increased risk for developing hypersensitivity reactions
Antiemetic: Ondansetron (Zofran)
-prevention of nausea and vomiting
-decreases severity and incidence of nausea and vomiting
-Side Effects:
>Serotonin Syndrome (mental status changes, autonomic instability [tachycardia, labile BP, dizziness, diaphoresis, flushing, hyperthermia]
>Steven Johnsons Syndrome and Toxic epidermal necrolysis (both caused by rash)
>Neuromuscular symptoms (tremor, rigidity, myoclonus, hyperreflexia, incoordination)
>GI symptoms: nausea, vomiting, diarrhea
Antispasmodic: Baclofen
- depresses CNS to reduce pain and inhibit reflexes at the spinal level to decrease muscle spasm
- decreases muscle spasticity
- Side effects: Seizures, dizziness, drowsiness, fatigue, weakness, nausea
Beta Blocker: Metoprolol (Lopressor)
-decreases HR and BP
-unlabeled use: migraine prophylaxis, tremors, aggressive behavior, ventricular arrhythmias/tachycardia
-Side Effects: bradycardia, heart failure, pulmonary edema, fatigue, weakness, erectile dysfunction
-Nursing:
>Monitor BP, EKG and Pulse frequently during dose adjustment and during therapy
>Monitor vital signs and EKG q 5-15 min during and for several hours after administration
>If HR <40 bpm (w/ cardiac output also decreased) administer atropine IV
Calcium Channel Blockers
- block calcium entry into cells of vascular smooth muscle and myocardium
- dilate coronary arteries in both normal and ischemic myocardium and inhibit coronary artery spasm
- used to prevent vasospasm
- prevents migraine headaches
- Side effects: constipation, dizziness, tachycardia, fatigue, flushing, nausea
Diuretics: Furosemide (Lasix)
-causes diuresis and subsequent mobilization of excess fluid (edema)
-increases excretion of water, sodium, chloride, magnesium, potassium, and calcium
-Side Effects: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic acidosis, aplastic anemia, agranulocytosis,
>erythema multiforme, Steven-Johnsons syndrome, toxic epidermal necrolysis (assess for skin rash)
Dopamine Agonists: Ropinirole (Requip)
- stimulates dopamine receptors in the brain
- management of S/S of idiopathic Parkinson’s Disease
- decreased tremor and rigidity
- Side Effects: sleep attacks, dizziness, syncope, orthostatic hypotension
Dopamine Replacement: Levodopa/Carbidopa (Sinemet)
- compensates for lack of dopamine
- treatment of bradykinesia, tremors, and rigidity in Parkinson’s Disease
- Side Effects: nausea/vomiting, orthostatic hypotension, constipation, arrhythmias, dyskinesia’s (uncontrolled, muscle movement), and dry mouth
Glutamate Inhibitor: Riluzole (Rilutek)
- decreases glutamate levels
- used in treatment of Amyotrophic Lateral Sclerosis (ALS)
Glutamate Inhibitor: Edaravone (Radicava)
- improved functional ability
- used to treat Amyotrophic Lateral Sclerosis (ALS)
- Side effects: hypersensitivity reactions, headache, contusion, gait abnormality
- Nursing: monitor for S/S of hypersensitivity reactions (redness, wheals, erythema multiforme, urticaria, decreased BP, dyspnea) with each infusion
Laxative-Stimulant: Docusate (Colace)
- prevention of constipation
- softer fecal mass
- Side Effects: mild cramps, diarrhea
Osmotic Diuretic: Mannitol
- mobilization of excess fluid
- reduction of intraocular or intracranial pressure
- increased urinary excretion of toxic materials
- Side effects: hyponatremia, hyperkalemia (high potassium), acute kidney injury
- Nursing Implications: assess BUN and Creatinine, monitor electrolytes
NSAID: Acetaminophen (Tylenol)
- treatment of mild pain and fever
- Side Effects: hepatotoxicity
NSAID: Ibuprofen (Advil)
- decreases pain and inflammation
- reduced fever
- treatment of mild to moderate pain; inflammatory disorders, and moderate to severe pain w/ opioid analgesics
- Side Effects: anaphylaxis, GI bleed, hepatitis, stroke, MI, HF, constipation, dyspepsia, vomiting, headache, exfoliative dermatitis, Steven-Johnsons syndrome, toxic epidermal necrolysis
Carbamazepine (Tegretol)
- Decreases incidence of seizures (Tonic-clonic)
- Side Effects: suicidal thoughts, hepatotoxicity, pancreatitis, agranulocytosis, aplastic anemia (body stops producing enough new blood cells), thrombocytopenia (low platelets), ataxia (impaired balance or coordination), drowsiness, allergy, dizziness, blurred/double vision, nausea, behavioral changes, hepatitis
- Nursing: monitor for visual changes; monitor liver function; monitor CBC; do not crush or chew sustained release capsules
Gabapentin (Neurontin)
- Decreases incidence of seizures
- unlabeled use: prevention of migraine headaches and neuropathic pain
- Side Effects: suicidal thoughts, anaphylaxis, angioedema, multiorgan hypersensitivity reactions, rhabdomyolysis, confusion, depression, dizziness, drowsiness/somnolence, weight gain, ataxia, fatigue
- Nursing: monitor for increased appetite and weight gain; monitor for dizziness, ataxia
Lamotrigine (Lamictal)
- Decreased incidence of seizures
- used for absence, tonic-clonic, atonic, and myoclonic seizures
- Side Effects: somnolence, dizziness, nausea, rash, ataxia, headache, suicidal thoughts, hepatic failure, photosensitivity, multi-organ hypersensitivity reaction, aseptic meningitis
- Nursing: monitor for dizziness; nausea/vomiting; rash can be life-threatening when given w/ valproic acid (Depakote)
Levetiracetam (Keppra)
- Decreased incidence and severity of seizures
- used for tonic-clonic seizures
- unlabeled use: status epilepticus
- Side Effects: fatigue, ataxia, loss of appetite, cough/runny nose, suicidal thoughts, rash, agranulocytosis, hypersensitivity reactions, aggression, agitation, anger, anxiety, depression, dizziness, personality disorder
- Nursing: monitor for ataxia, monitor for loss of appetite
Phenytoin (Dilantin)
- diminished seizure activity
- treatment/prevention of tonic-clonic seizures
- unlabeled use: termination of ventricular arrhythmias
- Side Effects: gingival hyperplasia, nystagmus, hirsutism (excessive hair growth on unexpected areas of the body [face, chest, neck, back]), ataxia, folate deficiency, drug-induced lupus, rash, myelosuppression (bone marrow activity decreased)
- Nursing: serum levels monitored; total serum levels: 10-20 mcg/ml; Dilantin (free) levels 90% bound to protein [1-2 mcg/mL]; at high doses can develop nystagmus; increases levels and prolongs half-life of Coumadin; monitor CBC; monitor for gingival hyperplasia (care w/ teeth brushing)
Valproate (Valproic acid, Depakote)
- suppression of seizure activity
- decreased frequency of migraine headaches
- used for myoclonic, absence, and tonic-clonic seizures
- Side Effects: tremors, hair loss, elevated liver enzymes, liver failure, pancreatitis, amenorrhea (absence of menstruation), thrombocytopenia, suicidal thoughts, agitation, dizziness, headache, insomnia, sedation, visual disturbances, nausea, vomiting, diarrhea, indigestion, hypothermia
- Nursing: monitor for tremor; monitor for hair loss; monitor liver function; monitor CBC; monitor coagulation
Dexamethasone and Methylprednisolone
- steroid
- suppress inflammation and the normal immune response
- can cause hyperglycemia; check glucose levels
- Side Effects: more common when used long term/high-doses: peptic ulceration, thromboembolism, depression, euphoria, hypertension, anorexia, nausea, adrenal suppression, hirsutism, petechiae, muscle wasting, decreased wound healing, ecchymoses, cushingoid appearance (moon face, buffalo hump)
- Nursing: stopping medication suddenly can cause adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia)
Statins
- lipid-lowering agents
- lower blood lipids
Alteplase (tPA)
tissue plasminogen activator
- lysis of thrombus
- lysis of PE and DVT
- Side Effects: intracranial hemorrhage, GI bleeding, retroperitoneal bleeding. GU tract bleeding, bleeding, anaphylaxis
