Unit 6 Pharm – Flashcards
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Phenytoin (Dilantin) anticonvulsant S/E
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sedating, liver impairment, *gingival hyperplasia. SUICIDAL THOUGHTS, ataxia, diplopia, nystagmus, hypotension, nausea, STEVEN JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, hypertrichosis, rash
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gabapentin (Neurotonin) anticonvulsant S/E
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SUICIDAL THOUGHTS, confusion, depression, dizziness, drowsiness, RHABDOMYOLYSIS, ataxia
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carbamazepine (Tegretol) anticonvulsant S/E
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SUICIDAL THOUGHTS, ataxia, drowsiness, STEVENS JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, AGRANULOCYTOSIS, APLASTIC ANEMIA, THROMBOCYTOPENIA
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Diazepam (Valium) anticonvulsant S/E
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dizziness, drowsiness, lethargy, RESPIRATORY DEPRESSION,
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(clonazepam) Klonopin anticonvulsant S/E
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SUICIDAL THOUGHTS, behavioral changes, drowsiness, ataxia
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Antileptics
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Antiseizure and Anticonvulsants
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What are the extrapyramidal symptoms?
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Akathisia, dystonia, bradykinesia, tremors, and tardive dyskinesia
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What is dopamine?
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A neurotransmitter that contributes to memory, pleasurable reward, behavior, cognition, and attention
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What is acetylcholine?
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Neurotransmitter used at the neuromuscular junction that activates muscle or motor function: arousal, attention, sensation
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What is convulsing/seizures
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Abnormal electroal activity in the brain: leads to motor activity abnormalities or sensory, convulsions, loss of conciousness, etc. Lasts a few seconds to minutes.
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Systemic causes of seizures
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Metabolic or electric abnormalities, tumors or infarctions, trauma, hematomas, etc. Needs to be controlled or it will lead to permanent brain damage.
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What are the 5 antiepilectic medications?
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Hydratoins Barbituates Benzodiazepines Succinimides Other meds
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Primary indication of antiepileptic medications.
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Reduce seizure activity. There is no cure for seizures.
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Major side effects of antiepilectics.
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Sedation and dizziness .
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Hydratoins function
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Stabilizes nerve membranes. For treatment of seizures. S/E: *gingival hyperplasia*, sedation, liver impairment. Education: proper oral care. monitor Dilantin therapeutic level.
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Hydrations - phenytoin (Dilantin)
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10-20 mcg/mL level Early Dilantin toxicity symptoms: Ataxia, Fast, uncontrollable eye movements or double vision. Dizziness, drowsiness, or confusion. Lack of coordination of fingers, hands, arms, legs, or body. Slurred speech. Nausea or vomiting. Late Dilantin toxicity symptoms: Suicidal thoughts, acute hepatic failure, stephens -johnsons syndrome, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, drug reaction eosinophilia and systematic symptoms (dress).
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Pramipexole (Mirapex)
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Ind: For management of PD MOA: Stimulates dopamine receptors in the striatum of the brain S/e: SLEEP ATTACKS, dizziness, hallucinations, weakness, dry mouth Interacts: Levodopa
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Ropinirole (Requip)
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Ind: management of s/s of idiopathic PD MOA: Stimulates dopamine receptors in the brain S/e: SLEEP ATTACKS, dizziness, syncope Interacts: Levodopa
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Apomorphine (Apokn)
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Ind: Acute, intermittent treatment of hypomotility MOA: Stimulation of specific dopamine receptors improves motor function S/e: CARDIAC ARREST, dizziness, hallucinations, rhinorrhea, n/v
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Carbidopa-levodopa (Sinemet, Dopar)
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The only combination Advantage: precursor of dopamine, crosses the BBB, and is converted into dopamine NRSG ED: Diet, protein, vitamin B6, NO calcium, exercise
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What are the acetylcholine medications for Parkinson's disease called?
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Anticholinergics
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Benztropine (Cogentin)
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Ind: Adjunct treatment of all forms of PD ; antipsychotic side effects alleviation MOA: Blocks cholinergic activity in the CNS, which is partially responsible for the symptoms of PD S/e: decreases GI motility and secretions, confusion, memory loss
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T/F: Anticholinergics help more with symptoms such as tremors rather than slowed movement.
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True
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Trihexyphenidyl (Artane)
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Ind: Adjunct in the management of parkinsonian syndrome of many causes, including drug-induced parkinsonism
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What symptoms might you experience with depletion of dopamine?
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Decreased muscle movement and coordination
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Amantadine (Symmetrel)
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Ind: Symptomatic initial and adjunct treatment of PD MOA: Potentiates the action of dopamine in the CNS S/e: dizziness, insomnia, hypotension
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Diphenhydramine (Benadryl)
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Ind: PD and dystonic reactions from meds MOA: Significant CNS depressant and anticholinergic properties S/e: Drowsiness, anorexia, dry mouth
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Tolcapone (Tasmar)
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Ind: Management of PD w/ levodopa in pt's w/out severe movement abnormalities who don't respond to other treatment MOA: Inhibitor of the enzyme catechol-O -methyltransferase, preventing the breakdown of levodopa S/e: HEPATOTOXICITY, headache, sleep disorder, constipation, diarrhea, dyskinesia, dystonia
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What do adjunct antiparkinsonism agents?
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Reduce the breakdown of dopamine
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Selegiline (Eldepryl) contraindicates with which drug?
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Levodopa/carbidopa
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Entacapone (Comtan)
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Ind: Management of PD in pt's who fail to respond to levodopa MOA: Inactivation of MAO leading to increased amounts of dopamine in the CNS S/e: SEROTONIN SYNDROME, nausea
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carisoprodol (Soma) muscle relactant MOA
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MOA: Skeletal muscle relaxation, probably due to CNS depression.
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cyclobenzaprine (Flexeril) muscle relactant MOA
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MOA: Reduces somatic muscle activity at the level of the brainstem. S/e: dizziness, drowsiness, dry mouth
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dantrolene (Dantrium) muscle relactant MOA
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MOA: Acts directly on skeletal muscle, causing relaxation by decreasing calcium release from sarcoplasmic reticulum in muscle cells. Prevents intense catabloic process associated with malignant hyperthermia. Major s/e: malignant hyperthermia
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Baclofen (Lioresal) muscle relactant MOA
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MOA: Inhibits reflexes at the spinal level
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carisoprodol (Soma) muscle relactant diagnosis
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acute pain, impaired bed mobility, risk for injury
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dantrolene (Dantrium) muscle relactant diagnosis
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impaired physical mobility, acute pain, risk for injury
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Baclofen (Lioresal) muscle relactant diagnosis
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impaired wheelchair mobility, risk for injury
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carisoprodol (Soma) muscle relactant nursing management
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Notify HCP if allergic reaction, change positions slowly to minimize orthostatic hypotension, limited to acute relief of musculoskeletal discomfort, don't use with alcohol, take as directed
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cyclobenzaprine (Flexeril) muscle relactant nursing management
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contact HCP if signs of serotonin syndrome occur or urinary retention occurs, good oral hygiene, drink extra fluids or take stool softener if constipation occurs, don't take with alcohol. May cause dizziness or drowsiness, take as directed
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dantrolene (Dantrium) muscle relactant nursing management
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Don't take more meds than prescribed, if dose is missed do not take unless remembered within an hr, may cause dizziness ; drowsiness, avoid alcohol, notify HCP if rash, yellow eyes or skin, dark urine, clay colored body, bloody or back stool, nausea, weakness, malaise, fatigue, diarrhea persists
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Baclofen (Lioresal) muscle relactant nursing management
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take as directed, avoid abrupt withdrawals, may cause dizziness or drowsiness, change positions slowly to minimize orthostatic hypotension, don't take with alcohol or CNS depressants, notify HCP if urge to urinate, painful urination, constipation, nausea, headache, insomnia, tinnitus, depression, confusion persists, report symptoms of hypersensitivity
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cyclobenzaprine (Flexeril) muscle relactant diagnosis
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acute pain, impaired physical mobility, risk for injury
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Bromocriptine (Parlodel)
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Ind: Parkinsonism (as a supplement to levodopa) MOA: Activates dopamine receptors in the CNS, decreases prolactin secretion S/e: PULMONARY FIBROSIS, MI, dizziness, drowsiness, orthostatic hypotension, nausea Interacts: Additive neurologic effects w/ levodopa
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What is the most serious side effect of dopamine agents?
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Choeiform (rapid, jerky, involuntary) movements
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T/F: Dopamine crosses the blood brain barrier.
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False
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Hydratoins - Fosphenytoin (Cerebyx)
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Anticonvulsant - diminishes seizure activity by altering ion transport. May also decrease synaptic transmission. S/E: *Stevens-Johnsons Syndrome, toxic epidermal necrolysis, drug reaction with esophylia and systematic symptoms (DRESS)* diziness, drowziness, nystagmus, pruritus, ataxia. SHORT TERM (>5 days) parenternal management of generalized, compulsive status epilepticus when use of phenytoin is not feasible. Treatment and prevention of seizures during neurosurgery when use of phenytoin is not feasible.
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What are the two primary goals for treating Parkinson's disease?
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Reduce symptoms and slow its progression
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What do anticholinergics do?
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Block the signaling of acetylcholine to help restore the balance of dopamine to acetylcholine
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Epilepsy can be:
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Congenital: injury at birth Acquired: tumors, injury, or environments It affects social life, education, relationships, and occupation.
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What is epilepsy?
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seizure disorder that relates to a structural abnormality of the brain
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Antiepileptic - Barbituates
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CNS depression - inhibit impulse conduction and depress cerebral cortex. Theraputic level: 5-12 mcg/mL level Major S/E: Physical dependance, depression, confusion, drowsiness, sedation, withdrawl symptoms.
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Phenobarb (Luminal)
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Anticonvulsants in tonic-clonic (grand mal), partial, and febrile seizures in children. Preoperative sedative and in other situations in which sedation may be required. Hypnotic (short term). Produces all levels of CNS depression. S/E: *Serum sickness, angioedema, larygospasm*, hangover.
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Patient Education for anticonvulsants
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oral care, never omit doses, wear medic-alert tag.
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Which drug choice is used for long term treatment?
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(Sinemet) carbidopa, levodopa because it is the pst effective ; it does not harm critical brain cells in people with PD
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Which drug has the longest effect?
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bromocriptine (Parlodel)
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Primidone (Mysoline)
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Decreases neuronal excitability for prevention of seizures. S/E: *suicidal thoughts*, ataxia, drowsiness, vertigo, anorexia.
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Why do we give anticonvulsants?
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toxicity prevention
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Methsuximide (Celontin)
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MOA: Suppresses abnormal brain activity w/ absence seizures S/e: CNS depression, anorexia, bone marrow suppression, pancytopenia, alopecia
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Carbamazepine (Tegretol)
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MOA: Decreases synaptic transmission in the CNS by affecting sodium channels in neurons Ind: Treatment of tonic-clonic, mixed, and complex-partial seizures
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Ethosuximide (Zarontin)
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Ind: Absence seizures (petit mal) MOA: Elevates the seizure threshold, suppresses abnormal brain activity w/ absence seizures S/e: INCREASED FREQUENCY OF TONIC-CLONIC (GRAND MAL) SEIZURES, SUICIDAL THOUGHTS, ALLERGIC REACTION
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Gabapentin (Neurontin)
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Ind: Partial seizures (adjunct treatment) MOA: not known S/e: SUICIDAL THOUGHTS, RHAMBDOMYOLYSIS, confusion, depression, dizziness, drowsiness
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Levetiracetam (Keppra)
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Ind: Partial onset seizures, primarily generalized tonic-clonic seizures MOA: Appears to inhibit burst firing w/out affecting normal neuronal excitability
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Cause of congenital epilepsy?
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Injury at birth
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4 Main Drugs for Partial Seizures
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Carbamazepine (Tegretol), Gabapentin (Neurontin), Levetiracetam (Keppra), Pregabalin (Lyrica)
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T/F: Most skeletal muscle relaxants work in the brain and spinal cord.
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True
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What happens to your muscles when you experience hyperventilation?
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Muscle cells are tense, constricted, and possibly hypoxic
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What happens to your nerve cells when you experience hyperventilation?
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Irritable, and over-excited due to low threshold of excitability
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Baclofen (Lioresal)
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Ind: Management of pain, treatment of reversible spasticity due to MS or spinal cord lesions MOA: inhibits reflexes at the spinal level S/e: SEIZURES, dizziness, drowsiness, fatigue, weakness, nausea
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Selegiline (Eldepryl)
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Ind: Management of PD (w/ levodopa) in pt's who fail to respond to levodopa alone MOA: Inactivation of MAO leads to increased amounts of dopamine available in the CNS S/e: SEROTONIN SYNDROME, nausea
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Cause of acquired epilepsy?
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Tumors, injury, or environments
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Valproic Acid
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MOA: Stimulates GABA activity while reducing electrical brain activity, leading to stabilizing nerve cell membranes Cont: allergy & hepatic or renal impairment Primary s/e: sedation & drowsiness
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Benzodiazepines
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MOA: Potentiates the GABA, stabilizing the cell membrane RX: Anxiety disorders
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Clonazepam (Klonopin)
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Ind: Prophylaxis of petit mal, lennox-gastaut, akinetic, and myoclonic seizures MOA: Produces sedative effects in the CNS, probably by stimulating inhibitory GABA receptors S/e: SUICIDAL THOUGHTS, behavioral changes, drowsiness Interacts: Levodopa, barbiturates
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Diazepam (Valium)
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Ind: Treatment of status epilepticus/uncontrolled seizures MOA: Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter S/e: RESPIRATORY DEPRESSION, dizziness, drowsiness, lethargy Interacts: Levodopa, barbiturates
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Lorazepam (Ativan)
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Ind: Anxiety disorder, decreases preoperative anxiety and provides amnesia MOA: Depresses the CNS, probably by potentiating GABA S/e: APNEA, CARDIAC ARREST, dizziness, drowsiness, lethargy
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Botulinum (Botox)
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MOA: Inhibits the release of acetylcholine, resulting in local decrease in muscle activity
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Generalized epilepsy
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Bilateral epileptiform activity w/ bilateral motor manifestations and impaired conciousness
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Myoclonic seizures
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Isolated muscle jerking
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Tonic seizures
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Stiffening of body but no jerking
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Tonic-clonic (grand mal) seizures
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Tonic: body becomes rigid, patient often falls Clonic: generalized convulsing bilateral jerking of muscles
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Absence seizures
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Activity ceases, pt stares and pales for a few seconds
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Atypical seizures
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Other EEG changes
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Partial epilepsy
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Epileptiform activity originating from only one area of the cortex
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Simple seizures
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No loss of consciousness i.e. Jackinsonian
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Complex seizures
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Loss of consciousness i.e. Temporal lobe epilepsy
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Secondary generalized seizures
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Focal seizure that spreads to generate epileptic activity in both hemisphere i.e. evolves to tonic-clonic (w/ loss of consciousness
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Typical seizures (petit mal)
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EEG: 3 Hz Spike and wave
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A pt who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within therapeutic range?
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12 mcg/mL
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A child is experiencing febrile seizures for which phenobarbital is ordered to be given intravenously. The dose is administered at 10 am. The nurse understands that a second dose of the drug may be given as soon as which time?
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1400
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Which drug would the nurse expect to be ordered as the drug of choice for the treatment of myoclonic seizures?
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Clonazepam
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When describing the action of levodopa, what should the nurse include?
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Levodopa acts like a replacement therapy
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An older pt is to receive a centrally acting skeletal muscle relaxant. What should the nurse prescribe?
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Carisoprodol
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Signs and symptoms of what would necessitate discontinuation of dantrolene therapy?
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Hepatic dysfunction
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A pt with malignant hyperthermia is scheduled for surgery. What agent should the nurse administer?
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Dantrolene
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Identify the prototype centrally acting skeletal muscle relaxant: carisoprodol, cyclobenzaprine, dantrolene, baclofen
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Baclofen
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What agent would a nurse expect to administer intravenously for a partial seizure?
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Levetiracetam (keppra)
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What drug classification is Sertraline (Zoloft)?
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SSRI
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What drug classification is Levofloxacin (Levaquin)?
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Florouquinolones
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What drug classification is Haloperidol (Haldol)?
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Antipsychotics
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What drug classification is Promethazine (Phenergan)?
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Antihistamines
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What drug classification is Methotrexate (Rheumatrex)?
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Metabolic inhibitor
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What drug classification is Alprozolam (Xanax)?
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Benzodiazepines
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What drug classification is Ibuprofen or Naproxen?
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NSAIDs
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What adverse reaction, if observed in a client prescribed phenytoin (Dilantin), would indicate that the pt may be developing early and late phenytoin toxicity?
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Lethargic and ataxia
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What is the MOA of Soma (Carisoprodol)?
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Interneuronal activity inhibitors
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What is the drug of choice for long term effectiveness in the treatment of PD?
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Amantadine (Symmetrel)
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What is the primary purpose of an anticonvulsant?
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Relieve spasticity
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T/F: Phenytoin (Dilantin) works by reducing the spread of seizure activity in the brain.
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True
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What drugs are used for the management of epilepsy?
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Tegretol, Klonopin, Dilantin
