Unit 1: Medication List for Neurological Disorders

Question 1

Anticholinergic: Benztropine

Answer 1

• 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

Question 2

Anticoagulant: Warfarin (Coumadin)

Answer 2

• 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)

Question 3

Antihistamine: Meclizine

Answer 3

• 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

Question 4

Anti-platelet: Aspirin

Answer 4

• 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

Question 5

Antiemetic: Ondansetron (Zofran)

Answer 5

-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

Question 6

Antispasmodic: Baclofen

Answer 6

• 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

Question 7

Beta Blocker: Metoprolol (Lopressor)

Answer 7

-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

Question 8

Calcium Channel Blockers

Answer 8

• 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

Question 9

Diuretics: Furosemide (Lasix)

Answer 9

-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)

Question 10

Dopamine Agonists: Ropinirole (Requip)

Answer 10

• 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

Question 11

Dopamine Replacement: Levodopa/Carbidopa (Sinemet)

Answer 11

• 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

Question 12

Glutamate Inhibitor: Riluzole (Rilutek)

Answer 12

• decreases glutamate levels

- used in treatment of Amyotrophic Lateral Sclerosis (ALS)

Question 13

Glutamate Inhibitor: Edaravone (Radicava)

Answer 13

• 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

Question 14

Laxative-Stimulant: Docusate (Colace)

Answer 14

• prevention of constipation
• softer fecal mass
• Side Effects: mild cramps, diarrhea

Question 15

Osmotic Diuretic: Mannitol

Answer 15

• 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

Question 16

NSAID: Acetaminophen (Tylenol)

Answer 16

• treatment of mild pain and fever

- Side Effects: hepatotoxicity

Question 17

NSAID: Ibuprofen (Advil)

Answer 17

• 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

Question 18

Carbamazepine (Tegretol)

Answer 18

• 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

Question 19

Gabapentin (Neurontin)

Answer 19

• 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

Question 20

Lamotrigine (Lamictal)

Answer 20

• 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)

Question 21

Levetiracetam (Keppra)

Answer 21

• 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

Question 22

Phenytoin (Dilantin)

Answer 22

• 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)

Question 23

Valproate (Valproic acid, Depakote)

Answer 23

• 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

Question 24

Dexamethasone and Methylprednisolone

Answer 24

• 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)

Question 25

Statins

Answer 25

• lipid-lowering agents

- lower blood lipids

Question 26

Alteplase (tPA)

Answer 26

tissue plasminogen activator

• lysis of thrombus
• lysis of PE and DVT
• Side Effects: intracranial hemorrhage, GI bleeding, retroperitoneal bleeding. GU tract bleeding, bleeding, anaphylaxis