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Pharm Neuro
| Question | Answer |
|---|---|
| What is a seizure? | A disturbance of electrical activity in the brain. Affects consciousness, motor activity and sensation |
| Epilepsy | Chronic seizure activity |
| Convulsion | Involves involuntary violent spasms of skeletal muscles |
| Causes of seizures | Infectious disease, trauma, pediatric disorders (febrile), neoplastic disease, medications, drug abuse, withdrawl, idiopathic. Metobolic disorders- fluid and lyte imb. Hypoglycemia Vascular disease-cerebral hypoxia, ischemia |
| Risk of anti-seizure meds during pregnancy | Category C or D contribute to folate deficiency that can cause neural tube defects like spina bifida |
| Spina bifida | The more you see the more disability |
| What quality of life can seizures affect | there is an increased risk for injury, severe limit to lifestyle-cant drive Chronic depression r/t imbalance of dopamine and seritonin. |
| Partial seizure | Involves one area of brain begins with aura |
| Complex partial seizure | psychomotor or temporal lobe seizure Altered consciousness Aura Sensory, motor, or autonomic symptoms |
| Generalized seizures | Involve entire brain 3 types- absence, atonic, tonic-clonic |
| Absence seizure | staring los of responsiveness slight motor activity |
| Atonic seizure | Drop attack Stumble and fall No muscle tone |
| Tonic-clonic seizure (Grand mal) | Aura Tonic contractions Cry out, incontinence Postictal state follows- drowsey,fuzzy |
| Febrile seizures | Common in children and infants Related to seizure |
| Reflex/Myoclonic epilepsies | Jerky movements of trunk muscles similar to Maro reflex in infants |
| Status Epilepticus | Repeted seizure Usually tonic-clonic Hypoxia-hypoglycemia may dev. Hyperthermia Acidosis- related to lactic acid Lasts a long time |
| Why would hypoxia and hypoglycemia develop | During the seizure you use alot of oxygen but lack air movement which causes cells to burn through glucose |
| Pharmacotherapy | Choice of med depends on: Type of seizure history Pathological processes causing seizures Indiviualized to each individual |
| How to determine dosage | How the meds control seizures The side effects caused Serum drug levels |
| Why is compliance with seizure medication so important? | If you skip a dose it will cause you to have a seizure. You can also do drug levels to make sure pt is compliant. |
| When changing medications what is it important to do? | You must wean slowly from one med to another usually over the course of 1-2 weeks. While tapering one drug the other is increased. |
| Things a pt with seizure meds should do- | Keep a journal If resp under 12 hold med Avoid hazerdous activity till effect of drug is known (this can take a few weeks) |
| What do you report on seizure meds | Dizziness visual changes N, V, D, rash jaundice Take with food if Gi upset occurs |
| Goal of anti-seizure pharmacotherapy | Suppress neuron activity by altering the movement of these ions: chloride sodium calcium GABA-gamma aminobutyric acid |
| Drugs that potentiate(increase) GABA which calms nerves down | Barbiturates Benzodiazepines |
| Barbiturates | Low margin of safety Can cause CNS depression High potential for dependance Can OD if drink alcohol |
| Phenobarbital (Luminal) | Barbiturate Commonly prescribed Inexpensive Long acting Low incidence of AE Causes drowsiness-take at bed time Easy to adjust in liqid form for children |
| Things to be aware of in barbiturates | Adverse effects- sedation, respiratory dep Precautions- impaired hepatic or renal Perg cat-D Decrease in effectiveness of hormonal contraceptives- use more than one barrier method Depleation of vitamins D, B6 and K |
| Benzodiazepines | Schedule IV drugs Uses: Absence seizures Myoclonic seizures In conjuction with other seizure meds |
| Examples of Benodiazepines | epam's clonazepam(Klonopin)-longterm for seizures lorazepam(Ativan)-also used for anxiety diazepam(Valium)-also for anxiety Valium-can be given Iv during satus eplepticus till other drugs start to work. |
| diazepam(Valium) | Interacts- Precipitates when mixed with other meds in same tubing or syringe. *Never mix* *Fluse tubing with NORMAL saline prior and after giving* Muscle relaxer IVP may cause-apnea,hypotension,bradycardia,cardiac arrest |
| Other GABA potentiating agents | gabapentin(Neurontin) antiseizure,nerve pain primidone(Mysoline) topiramate(Topamax)-sometimes mental health and migraines Pregabalin(Lyrica)-Turns into Gaba-controled drug-more for neuropathy |
| Drugs that suppress sodium influx (Sodium channel blockers) | Hydantoins and phenytoin Na channels desensitized-dec neuron activity ex- phenytoin (Dilantin) |
| phenytoin (Dilantin) | Used mainly for seizures Sometimes used in cardiac to stop dysrythmias |
| Examples of phenytoin like drugs | carbamazipine(Tegretol)- seizure, little mental ability valproic acid(Depakene, Depakote)-seizures lamotrigine(Lamictal)-mental health(bipolar) |
| phenytonin (Dilantin) | Req a loading dose Has a dysrhythmic effect(on cardiac monitor while IV) DO NOT GIVE IM *When IV prime with ns follow with ns* Infuse 50mg per min or slower in large vein if given too fast heart will stop |
| valproic acid (Depakene) | Many drug interactions Used in migrane prevention and bipolar disorder |
| Nursing considerations | Monitor for toxicity- Dizziness,ataxia(difficulty walking), diplopia(blurred vision),lethargy Blood dyscrasias r/t alteration of vit K metab Urine color may change liver toxicity |
| Drugs that suppress calcium influx (Calcium channel blockers) | Succinimides -act by delaying calcium influx into neurons Raise seizure threshold-muscles and nerves do not react quickly Interact with other seizure meds that lower seizure threshold Ex- ethosuximide(Zarontin)-not for bp |
| Pt ed for drugs that suppress calcium influx | Report-change in mood,depression,suicidal ideation, signs of infection,weight loss, anorexia Do not perform hazardous activities before effect is known Do not d/c abruptly take with food if gi upset Sympt of overdose |
| Degenerative diseases of the central nervous system | Multiple etiologies Medications are only used to treat the symptoms but do not cure the diseases |
| Parkinsons Characteristics | Progressive destruction of substantia nigra (too little dopamine too much AcH) No cure |
| Symptoms of Parkinsons | Tremors Muscle twitching and blepharospasms(eye twitching) are eary symptoms muscle rigidity bradykinesia postural instability |
| Parkinsonism | Not Parkinsons but mimic symptoms Usually side effect of psychiatric drugs Also called EPS's |
| Anti-parkinsonism Drugs | Dopaminergic drugs tell nerves to make more dopamine. amantadine(Symmetrel)-does not turn in too dopamine bromocriptine(Parlodel)-does not turn into dopamine carbidopa-levodopa(Sinemet)-turns into dopamine |
| What are anti-parkinsonism drugs used for? | Given for side effects of parkinsons or pshchiatric meds |
| Anti-parkinsonism drug effects | Restore balance of dopamine and AcH in the brain(boosts dopamine) S/E- involuntary movements, anxiety,pshc problems,blurred vision,n,v,hepatotoxicity Interactions-Caffine,MAOI,anesthetics,phenothiazines (mental health),pyridoxine(vitamins) |
| Nursing considerations of anti-parkinsonism drugs | VS, dysrhythmias Provide safety monitor mental health monitor glucose in DM monitor kidney and liver function May cause darkining of urin and perspiration |
| levodopa(Larodopa) | Crosses blood brain barier Becomes dopamine comb with carbidopa to slow met of med so it works better and longer can take 6 months to have full effect Do not withdrawl abruptly S.E. uncontrolled movements,anxiety |
| levodopa(Larodopa) drug interactions | Pyridoxine(Vit B6) phenytoin(Dilantin) antihypertensives |
| Anticholinergics for Parkinsons | 2nd half if increasing dopamine doesent work Improves balance of AcH and dopamine Many side effects Ex- trihexyphenidyl(Artane) benztropine(Cogentin) |
| Side effects of anticholinergics | Dry mouth,nose and throat Constipation Drowsiness flushing and overheating Confusion and memory loss Blurred vision |
| Drug holiday | Meds eventually lose effectiveness Tapper off med Stay off for a period of time resume at much lower dose Drug becomes effective again |
| Alzheimers Characteristics | Impaired memory, confussion, aggressivess, depression, psycoses, anxiety Dementia Unable to perform tasks that require AcH (Not enough Ach getting to cells) Hippocampus-learning and memory |
| Alzheimers etiology | Early onset is genetic (10% of cases) and is more rapid Chronic inflammation/oxidative damage -amyloid plaques(goo on nerves) -neurofibrillary tangles(wind up and tangle) |
| What is the differance between Alzhiemers and dementia | Alzhiemers is nerve based and Demitia is vascular |
| Meds for Alzhiemers | Action-Inhibit AchE and increase Ach effect Slows progression of Alzheimers Side effects-N,V,D Also called Acetocholinase inhibitors Indirect parasympathomimetic |
| Examples of Alzheimers meds | donepezil hydrochloride(Aricept) Reminyl,Exelon,Cognex Nemenda |
| Why is aggitation a side effect | The meds keep the nerves firing longer so they can get past the plaques and tangles which can cause more anxiety |
| Nursing considerations for alzheimers | Monitor pt condition Agitation may require -antipsycotics -anti-anxiety meds -mood stabilizers |
| Alzheimers pt drug edcation | Meds will not cure Goals are to improve function ADL's Behavior Cognition Contraindications-Glaucoma,renal or hepatic disease,COPD,history of GI bleed |
| donepezil(Aricept) | Stabalizes memory for a period of time Administer HS(at bedtime)unless keeps them awake SE-N,V,D,darkened urine,insomnia,syncope,depression,HA, irritability,muscle cramps,arthritis, inc libido,many drug interactions *Do not stop abruptly pt will crash |
| Attention Deficit Hyperactivity Disorder (ADHD) | Poor attention span Poor behavior control Inc motor activitytalk excessively anxiety,mood swings |
| ADHD Meds | CNS stimulants- Reverse symptoms schedual II drug Action-heighten alertness,inc focus AE-insomnia,weight loss,anorexia,nervousness depression,N,abdominal pain Nursing considerations- give in am Preg cat C Can give with food |
| methylphenidate(Ritalin) | S.E.-irr heart beat, HTN, Liver toxicity, A.E.-dependance Contraindications- Hyperthiroidism,psycosis, glaucoma, motor tics, CV disease, HTN, DM, seizures Many interactions-MAOI's Check BP regularly |
| Other ADHD meds | Dosed less frequantly because they tend to get sold pemoline(Cylert) amphetamine mixture(Adderall) atamoxetine(Strattera)-non-CNS stimulant |
| Pt education ADHD meds | Keep behavior diary Report-increase motor behavior, change in sesorium, sadness,rapid pulse, palpitations, dizziness, bruising,SOB Take in am with food, avoid caffine Weekly weight & report any loss Taper prior to drug holiday Take last dose before 1 |
| Migraines | Symptoms- Throbbing, pulsating, one side of head, may have aura,N, V, photophobia Triggers- MSG, nitrates, red wine, perfumes, caffine, chocolate, aspartame, aged cheese, beer, pickled foods, tyramine containing foods |
| Abortive drugs for Migraines | Act on serotonin receptor sites -ergot alkaloids(found in european mines) Triptans They constrict intracranial blood vessels Avilable po,im, intranasal,SL,supp,SQ |
| Examples of Migraine drugs | sumatriptan(Imitrex) safer ergotamine tartrate (Ergostat)- Can be SL, only so many per day or week or will poision |
| Migrane prevention(prophylaxis) | beta blockers calcium channel blockers antidepressants anti-seizure drugs (anything used for hypertension in a much lower dose) |
| sumatriptan(Imitrex) | Constricts intracranial blood vessels, usually does not inc systemic blood vessels Best if taken at the begining of attack AE-cardiac ischimia,MI,seizures Peg cat C Use cautiously in pt with heart disease,DM Interact with MAOI,SSRI's, *test at office |
| Antianxiety meds | Mediate GABA (inhibitory neurotransmitter) AE-sedation, orthostatic hypotension, dry mouth, blurred vision Interactions- alcohol, digoxin |
| Examples of anxiety meds | Benzodiazepines -Alprazolam(Xanax) -Diazepam(Valium) -Lorazepam(Ativan) buspirone(BuSpar)-not addicting Beta blockers |
Created by:
dhoehne
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