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Pharm 1 Neuro
| Question | Answer |
|---|---|
| hypnotics | any drug that aids in sleep reduces amount of time it takes to fall asleep |
| Sleep Disorders | Benzodiazepines; Non-Benzodiazepines |
| Benzo- "pam" "lam" | Temazepam (restoril) Triazolam (halcion) Flurozepam (dalmane) |
| Benzo- action | enhances inhibitory effects of GABA |
| Benzo- SE | CNS DEPRESSION drowsiness, confusion, dizziness, anxiety |
| Paradoxical reaction | reactions that are opposite of anticipated effect |
| Benzo- w/drawal Signs | paranoia, panic attacks, muscle twitches, hallucinations |
| Benzo- Interventions | Monitor: sleep *risk for falls paradoxical reactions signs of dependency |
| Benzo- Toxicity | Respiratory distress; muscle weakness, uncoordinated muscle movements, ataxia, slurred speech |
| Benzo- Admin | 30 mins a hs- ensure full 8hrs/sleep/night Avoid CNS depressants |
| Non-benzo | short term tx of insomnia immediate onset |
| Non-benzo- action | enhances inhibitory effects of GABA |
| non-benzo- SE | daytime drowsiness, dizziness, headaches, amnesia during sleep, diplopia, confusion |
| non-benzo- RX | Zolpidem (ambien) Zaleplon (sonata) Eszopiclone (lunesta) |
| non-benzo- Interventions | monitor: adverse effects fall risk Amnesia - suggest decreased dose |
| non-benzo- admin | PO hs empty stomach for full effect |
| non-benzo- caution | liver / renal disease d/t decreased metabolism & secretion |
| Zolpidem | (ambien) sedative/hypnotic |
| Temazepam | (restoril) sedative/hypnotic |
| peripherally acting muscle relaxant- action | decreases muscle tissue contractions by inhibiting Ca release |
| Peripheral muscle relaxant- causes | spasms r/t spinal cord injuries, CP, MS prevents & tx malignant hyperthermia |
| dantrolene (dantrium) | peripheral muscle relaxant |
| Peripheral muscle relaxant- SE | muscle weakness* drowsiness, dizziness diarrhea* liver toxicity |
| Peripheral muscle relaxant- intervention | monitor: strength continuously w/ therapy CNS SE diarrhea- caution for early onset assess for liver toxicity |
| liver toxicity signs | juandice acute severe abdominal pain |
| Peripheral muscle relaxant- tx | muscle spasms spasticity hyperthermia |
| Peripheral muscle relaxant- admin | PO: spasticity IV: malignant hyperthermia |
| Pre-op use of dantrolene (dantrium) | 1-2 days a sx to prevent hyperthermia |
| Peripheral muscle relaxant- caution | episodes prolong diarrhea/ early onset juandice, abdominal pain |
| Peripheral muscle relaxant- DO NOT USE | IV admin w/ concurrent Ca channel blockers (cardiac dysrhythmias) |
| baclofen (lioresal) | centrally acting muscle relaxant |
| Carisoprodol (soma) | centrally acting muscle relaxant |
| cyclobenzaprine (flexeril) | centrally acting muscle relaxant |
| Chlorzoxazone (paraflex; parafon forte) | centrally acting muscle relaxant |
| centrally acting muscle relaxant- action | enhances inhibitory effects of GABA on Spinal Cord |
| central muscle relaxants- cause | relieve spasms r/t spinal cord injuries, MS, CP, musculoskeletal injuries |
| central muscle relaxants- tx | muscle spasms |
| central muscle relaxants- SE | drowsiness, dizziness nausea, constipation |
| central muscle relaxants- w/drawal symptoms | anxiety, restlessness, visual hallucinations, seizures w/ abrupt d/c |
| central muscle relaxants- admin | gradual increase to 20mg 3-4x/day from low dose take w/ food increase fiber/fluids |
| baclofen (flexeril) carisoprodol (soma) (flexeril) discontinuation policy | taper dose over 1-2 weeks to avoid w/drawal |
| central muscle relaxants- intrathecal admin-tx | malignant hyperthermia caution *abrupt d/c may cause rebound spasticity w/ fever & muscle damage leading organ failure, damage or death |
| central muscle relaxants- contraindications | use of MAOI's w/in 2 weeks of use may increase glucose levels *hypertensive crisis w/ (flexeril) use |
| central muscle relaxants- pt advisories | drowisness subsides over time food/milk w/ admin decreases GI distress change positions slowly |
| hydantoins | aid in the control of tonic-clonic & partial seizures |
| partial seizures- effect | effects 1 part or brain & 1 part of the body |
| tonic clonic- effects | effects entire body |
| Anti-eplileptics (AEDs) | hydantoin iminostilbenes valporic acid |
| seizure disorders med class(s) | Anti-eplileptics (AEDs) |
| phenytoin (dilantin) | hydantoin anti-eplileptic |
| ethotoin (peganone) | hydantoin anti-eplileptic |
| fosphenytoin (cerebyx) | hydantoin anti-eplileptic |
| hydantoin- action | causes neg neuron charge by inhibiting influx of Na in Na channels |
| hydantoin- SE | mild drowsiness, CNS effects *skin rash- indicative of serious reaction gingival hyperplasia- abnormal tissue growth around gums |
| hydantoin- w/drawal symptoms | |
| status eplilepticus | (prolonged seizures)occurs from abrupt d/c of hydantoin following prolong use |
| hydantoin- intervention | excessive drosiness indicative of toxicity gingiva in children/teens(hyperplasia/overgrowth) rash- stevens-johnson syndrome |
| hydantoin rash | indicative of epidermal necrolysis or steven johnson syndrome. symptoms include: fever, damage to skin & internal organs, sepsis. D/C IMMEDIATELY |
| hydantoin- admin | take w/ meals IV- inject slowly; no more than 50mg/min monitor VS continuously -detect dysrhythmias & hypotension plasma levels 10-20mcg/ml nystagmus, ataxia, sedation, blurred vision |
| phenytoin- overdose | results in cardiac arrest; dysrythmias, hypotension. therapuetic levels 10-20mcg/ml |
| hydantoin- caution | CNS depression may indicate need for decreased dose routinely dental check-ups appearance of rash |
| gingiva- care | routine check-ups soft toothbrush massage gums floss |
| hydantoin- contraindications | preexisting skin rash heart block, bradycardia seizures d/t hypoglycemia pregnancy |
| Intraveneous phenytoin- interactions | incompatible w/ dextrose increased levels w/ diazepam, valporic acid increase sedative effects w/ CNS depressants levels decreased w/ phenobarbital & carbamazepine use reduces oral contraceptives |
| iminostilbenes- uses | treat partial & clonic tonic seizures stabilized mood associated w/ bi-polar disorder reduces pain r/t trigeminal neuralgia |
| trigeminal neuralgia | periodic one sided fascial pain from stimulation to 5th cranial nerve |
| carbamazepine (tegretol) | iminostilbene anti-epileptic drug |
| iminostilbenes- action | inhibit influx of Na through channels decreasing discharge around active neurons |
| iminostilbenes- intervention | monitor: visual disturbances; cns effects nystagmus, blurred/double vision decreases h2o extretion |
| iminostilbenes- SE | bone marrow suppression h20 retention nystagmus, ataxia, blurred/dble vision skin rash- epidermal necrolysis, steven johnson syndrome |
| Bone marrow suppression | iminostilbene dose adjustment necessary if CBC <3,000/mm3 |
| iminostilbenes- admin | begin w/ low dose highest slit dose to be given at hs (min. SE during day) obtain base line CBC w/ diff take whole PO w/ sip of h20 & food DO NOT MIX oral suspension |
| iminostilbenes- caution | Rash-immediate notify report decrease urine output, SOB, edema avoid direct sunlight- use sunscreen Asians- test HLA-B*1502 gene d/t increase risk of severe skin reactions |
| bonemarrow suppression signs/symptoms | fever sore throat easy bruising |
| carbamazoprine- contraindication | hemtalogic disorders heart failure absence & myoclonic seizures pregnancy-causes false + grapefuit juice- increases plasma levels |
| carbamazoprine- interactions | grapefruit juice antifungals, erythromycin increase levels phenytoin, barbituates, rifampin decrease levels |
| cholinesterase inhibitors- tx | mild-moderate alzheimer's disease (improves cognitive function) |
| donepezil (aricept) | cholinesterase inhibitors |
| rivastigmine (exelon) | cholinesterase inhibitors |
| galantamine (razadyne) | cholinesterase inhibitors |
| cholinesterase inhibitors- action | increases acetylcholine available at receptor sites in brain by preventing acetylcholinesterase from inactivating acetylcholine |
| cholinesterase inhibitors- SE | GI issues; nausea CNS effects; insomnia, dizziness, headaches bradycardia, syncope |
| cholinesterase inhibitors- admin | take w/ food to minimize nausea (gi effects) take at hs |
| cholinesterase inhibitors- caution | GI bleeds loss of concousiness during ambulation w/ bradycardia cns stimulated effects- insomnia & dizziness |
| cholinesterase inhibitors- reports | vomiting, severe diarrhea, insomnia, dizziness loss of conciousness |
| cholinesterase inhibitors- precautions | hyperthyroidism, seizures anticholinergic rx decrease effects of donepezil |
| NMDA receptor antagonist- tx | slows decline in cognitive function in alzheimer's |
| memantine (namenda) | NMDA receptor antagonist |
| NMDA receptor antagonist- action | block excess glutamate from receptors- decreases overstimulation and Ca & neuronal damage |
| NMDA receptor antagonist- SE | CNS effects; dizziness, headaches, confusion constipation |
| NMDA receptor antagonist- admin | w/w/o food increase dietary fibers & fluids |
| NMDA receptor antagonist- caution | glucose levels, hx seizure disorders DO NOT give to renal failure |
Created by:
chelsi04
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