Neuro Part 2 Pharm Speedrun

Mannitol, an osmotic diuretic, works by.....

Causing diuresis through osmosis

Contraindications and cautions of Mannitol all revolve around what type of issues?

Issues with fluid balance

Lithium and cardiac glycosides should not be used with what neurological medication?

Mannitol

Metabolic acidosis is possible with which neuro med?

Mannitol

This med "dehydrates" the brain by pulling fluid from the brain and putting it into the vascular spaces?

Mannitol

An in-line filter is required for administration of which neuro medication? It can also be given rapidly through IV for increased ICP.

Mannitol

Barbiturates can be used for what type of therapy to reduce ICP?

Coma Therapy

Memorization sentence for barbiturates.

Barbra the slow old lady, brings it down

-respiratory depression

-decrease in BP and HR

-hyponatremia and hypokalemia (electrolyte imbalances)

-withdrawal syndrome after abrupt discontinuation after prolonged come

-decreased brain activity

Barbiturate coma therapy should be a ____ resort due to its potential complications.

Last

Barbiturates Prototype

Pentobarbital

Pentobarbital Nursing Considerations

1) High doses via IV infusion

2) Continuous EEG and ICP monitoring to regulate infusion

Mechanical ventilation is required for what type of medication therapy?

Barbiturate coma therapy (Pentobarbital)

The most prevalent neurological disorder?

epilepsy

Antiepileptic (AED) Basic Info (3)

-monotherapy preferred

-the type of seizure, age, characteristics, and patient tolerance all guide drug selection

-not a cure

AED MOA

1) slow sodium and calcium back into neuron

2) suppress neuronal firing

3) enhance GABA

Common adverse effects of antiseizure meds

-CNS Suppression

-Gingival Hyperplasia

-Dermatological Reactions

-Liver Dmg

-GI Effects

-Bone Marrow Depression

Phenytoin, a barbiturate seizure medication that can also cardiac antiarrhythmic effects, can cause what type of adverse effects?

CNS effects (nystagmus, sedation, ataxia, double vision, cognitive impairment), skin rash, gingival hyperplasia, dysrhythmias, hypotension, endocrine effects (hirsutism, coarsening of facial features)

Cautions and Contraindications of Phenytoin

Elderly, sinus bradycardia, heart block, prego

Phenytoin Nursing Considerations

1. Folic acid supplements can decrease the occurrence of gingival hyperplasia

2. Avoid in patients with sinus bradycardia/sinoatrial block

3. Administer at slow IV rate

4. Stop medication if rash occurs

5. Monitor phenytoin level (10-20 ug/ml)

6. Maintain good oral hygiene - dental flossing and massaging gums, appointments

7. Do not stop abruptly and avoid alcohol

Phenytoin Black Box Warning

Cardiovascular risk with rapid infusion (no faster than 50mg/min)

Phenytoin therapeutic range

10-20

Phenobarbital, a barbiturate, controls seizures by aysinv CNS depression. Adversely effects are CNS related and toxicity related. The elderly, debilitated, or pregnant should be cautious of this medication. What drugs may cause drug interactions?

Oral contraceptives and warfarin (the effects of this drug will be decreased)

Phenobarbital Nursing Considerations

1. Avoid administering with other CNS depressants (alcohol, benzodiazepines, opioids)

2. Be aware of signs of toxicity - nystagmus, ataxia, clammy skin, respiratory depression, coma, pinpoint pupils, hypotension - can lead to death

—For toxicity or overdose, stop medication, assess ABCs!

Maintain respiratory function with ventilatory support; have resuscitation equipment available

3. Monitor for rash

4. Avoid activities that require alertness

5. Avoid alcohol and other CNS depressants

Ethosuximide is strictly used for what?

Absent seizures and epilepsy and is preferred for children

Ethosuximide has ____ and ____ effects.

CNS and GI effects

Ethosuximide therapeutic range

40-100 mcg/mL

Nursing Considerations for Ethosuximide

1. Evaluate for therapeutic blood levels

2. Administer with food to decrease GI effects

3. Administer low initial dose

5. Avoid hazardous activities

Controls seizure disorders and can cause hepatotoxicity, pancreatitis, and thrombocytopenia.

Valproic Acid

Drug interactions with valproic acid

increases levels of phenobarbital and phenytoin

Assess liver before and periodically, should not be used for children younger than 2, discontinue if pancreatitis develops, monitor platelet counts.

Valproic Acid

Controls seizures. Can cause blood disorders, rash, and hypo-osmolarity.

Carbamazepine

Drug interactions for Carbamazepine

-oral contraceptives and warfarin (inc effects)

-grapefruit juice (metabolism)

-phenytoin and phenobarbital (dec effects)

Administer largest portion of dose at bedtime, monitor CBC and platelets, observe for bruising, bleeding, infection, and discontinue if rash develops.

Carbamazepine

Lamotrigine

possibility of depression. aseptic meningitis, and SJS (rash)

Levetiracetam

Suicidal ideation

Topiramate

Reduced sweating, increased body temp, metabolic acidosis, angle-closure glaucoma

DI: Phenytoin and Carbamazepine (decrease lvls)

Oxcarbazepine

Hyponatremia and multi-organ hypersensitivity reactions (liver and kidney)

drug interactions include oral contraceptives and phenytoin

Oxcarbazepine Nursing Considerations

1. Administer low initial dosage

2. Treat mild skin reactions with anti-inflammatory of antihistamine meds

3. Discontinue if skin reaction is severe

4. Monitor for hyponatremia - headache, confusion, nausea, drowsiness

4. Monitor blood sodium levels

5. Use caution when administered with a diuretic

6. Discontinue med if manifestations of multiorgan hypersensitivity - fever, rash, lymphadenopathy, hepatorenal syndrome, hematologic abnormalities

Gabapentin

peripheral edema (diminishing over time)

Pregabalin

Adverse Effects: CNS effects(somnolence, dizziness, headache, cognitive effect, blurred vision), weight gain, dry mouth, peripheral edema, hypersensitivity reactions (angioedema)

Drug Interactions: benzodiazepines, alcohol, and opioids intensify the depressive effects

Pregabalin - Nursing Considerations

1. Blurred vision can develop early in therapy but resolves with continued use

2. Monitor daily weight and report significant increase to provider

3. Discontinue med if manifestations of angioedema occur

Client Education

§ Avoid driving if experiencing a high degree of drowsiness

§ Chew gum or suck on hard candy to increase salivation

§ Monitor weight at home

§ Contact your provider immediately if you develop signs of a hypersensitivity reaction

Benzodiazepines (Diazepam)

Therapeutic Use: Anxiety disorders, seizure disorders, insomnia, muscle spasm, alcohol withdrawal, panic disorder, anesthesia/preop sedation

Caution: elderly, debilitated, impaired renal or liver function

Contraindications: allergy, sleep apnea, respiratory depression, lactation

Drug Interactions: CNS depressants

Diazepam AE

Adverse Effects/Complications:

1. CNS Depression -

2. Paradoxical Response - insomnia, excitation, anxiety, rage; notify provider and discontinue med if occur

3. N/V, Anorexia

4. Respiratory Depression - especially with IV admin

5. Physical Dependance - taper over several weeks

6. Controlled substance - schedule IV

7. Acute Toxicity - drowsiness, lethargy, confusion, resp depression, cardiac arrest

◦Antidote: Flumazenil**

Diazepam Antidote

Antidote: Flumazenil**

Nonbenzodiazepines (Zolpidem)

Therapeutic Use: short-time management of insomnia

Cautions/Contraindications: elderly, debilitated, impaired renal or liver function, lactation

Adverse effects: daytime sleepiness, lightheadedness and headache

Drug Interactions: CNS depressants

Client Teaching:

•Take medication, allowing for at least 8 hours of sleep

•Take on an empty stomach for more rapid absorption

Melatonin Agonists (Ramelteon)

Therapeutic Use: management of chronic insomnia when falling asleep is difficult; does not help with sleep maintenance

Caution: elderly, liver function

Contraindications: lactation, severe forms of liver disease, depression, apnea, and COPD

Adverse Effects: sleepiness, dizziness, fatigue, hormonal effects - amenorrhea, decreased libido, infertility, and galactorrhea

Drug Interactions: high-fat meals can prolong absorption, CNS depressants

§ Take medication 30 min prior to bedtime

§ Take on an empty stomach and avoid high-fat foods before taking med