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Pharm Neuro

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