Week 7 - Neuro Part 1

Question 1

Centrally Acting Muscle Relaxants - Baclofen (Lioresal) - Use

Answer 1

• muscle spasms - spinal cord injury - MS - multiple sclerosis

Question 2

Baclofen (Lioresal) - Adverse Effects

Answer 2

• drowsiness, fatigue - N&V - constipation - urinary retention

Question 3

Baclofen (Lioresal) - Client Instructions

Answer 3

• take with food or milk, increase fiber

Question 4

Peripherally Acting Muscle Relaxants - Dantrolene (Dantrium) - Use

Answer 4

• muscle spasms in: stroke, MS, cerebral palsy - used for malignant hyperthermia

Question 5

Dantrolene (Dantrium) - Education

Answer 5

• avoid alcohol - report jaundice

Question 6

Hydantoins - Phenytoin (Dilantin) - Use

Answer 6

• tonic-clonic seizures - partial seizures - 10-20 is therapeutic range, more than 20 = toxic

Question 7

Phenytoin (Dilantin) - Adverse Effects

Answer 7

• drowsiness - gingival hyperplasia - skin rash (Stevens-Johnson Syndrome)

Question 8

Phenytoin (Dilantin) - Education

Answer 8

• soft toothbrush

Question 9

Traditional Antiepileptic Drugs - Carbamazepine (Tegretol) - Use

Answer 9

• partial seizures - tonic-clonic seizures - Bipolar Disorder - pain in trigeminal neuralgia

Question 10

Carbamazepine (Tegretol) - Education

Answer 10

• sunscreen

Question 11

Valproates - Valproic Acid (Depakote, Depacon, Depakene) - Use

Answer 11

• all seizure types - mania in Bipolar Disorder - migraine headaches

Question 12

Valproic Acid (Depakote, Depacon, Depakene) - Adverse Effects

Answer 12

• bruising, bleeding, decreased platelets - neural tube defects - hyperammonemia - liver toxicity, may be fatal

Question 13

Local Anesthesia - Lidocaine (Xylocaine) - Use

Answer 13

• local anesthesia - IV regional anesthesia

Question 14

Lidocaine (Xylocaine) - Adverse Effects

Answer 14

• hypotension - CNS depressing effects, respiratory arrest

Question 15

General Anesthesia / Barbiturate - Methohexital Sodium (Brevital) - Use

Answer 15

• rapid induction of anesthesia and hypnosis for brief procedures - used with other agents for procedures longer than 15 mins

Question 16

Methohexital Sodium (Brevital) - Adverse Effects

Answer 16

• respiratory depression - cardiovascular toxicity - suicide

Question 17

General Anesthesia - Benzodiazepine - Midazolam (Versed) - Use

Answer 17

• sedation before general anesthesia

Question 18

Midazolam (Versed) - Adverse Effects

Answer 18

• amnesia - cardiac or respiratory arrest

Question 19

General Anesthesia / Opioids - Fentanyl (Duragesic) - Use and Adverse Effects

Answer 19

• supplement to general anesthesia

Question 20

Adderall, Ritalin and Modafinil (Provigil, not an amphetam) can also be used for narcolepsy

Answer 20

Modafinil (Provigil) adverse effects: Stevens-Johnson, oral contraception less effective, so change to different form of contraception

Question 21

Dopamine-Replacement Drugs - Levodopa / Carbidopa (Sinemet) - Use

Answer 21

• Parkinson’s symptoms

Question 22

Levodopa / Carbidopa (Sinemet) - Adverse Effects

Answer 22

• darkening of urine and sweat - psychosis, hallucinations - orthostatic hypotension - dyskinesias (abnormal muscle movements)

Question 23

Levodopa / Carbidopa (Sinemet) - Education

Answer 23

• if taken with food, avoid high protein foods - take it before getting out of bed

Question 24

Direct-Acting Dopamine Receptor Agonists - Pramipexole (Mirapex) - Use

Answer 24

• Parkinson’s - Restless Leg Syndrome

Question 25

Receptor Agonists - Pramipexole (Mirapex) - Adverse Effects

Answer 25

• muscle weakness -

Question 26

Monoamine Oxidase-B - Selegiline - Use

Answer 26

• Parkinson’s Disease adjunct to Levodopa / Carbidopa - Major Depression, transdermal patch (Emsam)

Question 27

Monoamine Oxidase-B - Selegiline - Adverse Effects

Answer 27

• insomnia - hypertension

Question 28

Monoamine Oxidase-B - Selegiline - Education

Answer 28

• take last dose by noon to prevent insomnia - report any new medications, herbs or supplements to provider due to interaction

Question 29

Cholinesterase Inhibitors - Donepezil (Aricept) - Use

Answer 29

• for cognitive function in mild - moderate Alzheimer’s disease

Question 30

Donepezil (Aricept) - Adverse Effects

Answer 30

• GI and CNS effects - Bradycardia

Question 31

NMDA Receptor Antagonist - Memantine (Namenda) - Use

Answer 31

• slows decrease in functioning for moderate - severe Alzheimer’s - mild/moderate vascular dementia

Question 32

Memantine (Namenda) - Adverse Effects

Answer 32

• CNS effects: dizziness, headache, increased confusion

Question 33

Immunomodulators - Interferon Beta-1A (Avonex, Rebif); Beta-1B (Betaseron) - Use

Answer 33

Beta-1A: MS (relapsing-remitting type) / Beta-1B: MS (relapsing and relapsing-remitting types)

Question 34

Immunomodulators - Interferon Beta-1A (Avonex, Rebif); Beta-1B (Betaseron) - Adverse Effects

Answer 34

• flu-like symptoms (decrease with prolonged treatment) - myelosuppression - liver toxicity - pain & redness at subcutaneous injection site

Question 35

Immunomodulators - Interferon Beta-1A (Avonex, Rebif); Beta-1B (Betaseron) - Education

Answer 35

• rotate injection sites

Question 36

Serotonin Agonist - Sumatriptan (Imitrex) - Use

Answer 36

• migraines or cluster headaches

Question 37

Sumatriptan (Imitrex) - Adverse Effects

Answer 37

• chest pressure or heaviness can progress to angina pain caused by coronary vasospasm - CNS effects: tingling sensation, vertigo