Neurological System Pharmacology

What is the guiding principle of neurological pharmacology?

Nurses administer medications to target manifestations of neurological conditions.

What does “Know” mean in the pharmacology framework?

Know the therapeutic class, prototype, and mechanism of action of the medication.

What does “Understand” mean in the pharmacology framework?

Understand how and where the medication works and how that leads to therapeutic and adverse effects.

What does “Apply” mean in the pharmacology framework?

Apply monitoring, assessment, administration, education, and evaluation to clinical practice.

What does ABCFOB stand for?

Airway, Breathing, Circulation, Fall risk, Organ damage, Bleeding.

What are therapeutic effects?

The intended beneficial effects of a medication.

What are adverse effects?

Undesired or harmful responses to a medication.

What is glutamate?

The primary excitatory neurotransmitter in the central nervous system.

What is GABA?

The primary inhibitory neurotransmitter in the brain.

What is glycine?

An inhibitory neurotransmitter primarily active in the spinal cord.

What is acetylcholine responsible for in the CNS?

Memory and cognition.

What is acetylcholine responsible for in the PNS?

Muscle contraction at the neuromuscular junction.

What is dopamine responsible for?

Smooth purposeful movement and reward system regulation.

What is norepinephrine responsible for?

Upregulating and stimulating body processes; can be excitatory or inhibitory.

What is cerebral palsy?

A permanent, non-progressive neuromuscular disorder caused by injury to developing brain tissue.

Is cerebral palsy progressive?

No, it is non-progressive.

What are the primary patient needs in cerebral palsy?

Management of muscle spasticity, dystonia, and balance difficulties.

What is the medication goal in cerebral palsy?

Reduce spasticity and improve mobility by enhancing inhibition or limiting excitation.

What neurotransmitters are targeted in cerebral palsy treatment?

GABA and glycine (enhanced), acetylcholine and calcium activity (limited).

How can cerebral palsy medications be explained to patients?

“These medications help your muscles relax.”

What are general safety considerations in cerebral palsy medication management?

Monitor for sedation, respiratory depression, fall risk, and organ toxicity.

What is the mechanism of action of Diazepam?

Enhances GABA activity in the CNS to provide systemic inhibition.

What are the desired effects of Diazepam?

Muscle relaxation and decreased spasticity.

What are the undesired effects of Diazepam?

Severe sedation and dependency.

What are the ABCFOB risks of Diazepam?

Airway and respiratory depression; CNS depression; fall risk; keep flumazenil available for overdose reversal.

What is the mechanism of action of Gabapentin (for cerebral palsy)?

Mimics GABA to quiet nerve signals and reduce excitability.

What are the desired effects of Gabapentin (for cerebral palsy)?

Reduced nerve-related pain and decreased muscle spasm.

What are the undesired effects of Gabapentin (for cerebral palsy)?

Dizziness and somnolence.

What are the ABCFOB risks of Gabapentin (for cerebral palsy)?

High fall risk; CNS depression; monitor renal function for accumulation.

What is the mechanism of action of Baclofen?

Mimics spinal GABA receptors to inhibit muscle contraction.

What are the desired effects of Baclofen?

Improved range of motion and reduced spasticity.

What are the undesired effects of Baclofen?

Muscle weakness and seizure risk if discontinued abruptly.

What are the ABCFOB risks of Baclofen?

Withdrawal seizures if stopped suddenly; intrathecal pump malfunction risk; CNS depression; fall risk.

What is the mechanism of action of Dantrolene?

Directly inhibits calcium release from the sarcoplasmic reticulum in skeletal muscle.

What are the desired effects of Dantrolene?

Reduced muscle contraction and localized muscle relaxation.

What are the undesired effects of Dantrolene?

Muscle weakness and gastrointestinal upset.

What are the ABCFOB risks of Dantrolene?

Hepatotoxicity; cardiovascular collapse; fall risk; monitor liver function tests.

What is the mechanism of action of Onabotulinumtoxin A?

Blocks acetylcholine release at the neuromuscular junction.

What are the desired effects of Onabotulinumtoxin A?

Targeted relaxation of stiff or spastic muscles.

What are the undesired effects of Onabotulinumtoxin A?

Localized pain, muscle weakness, and rare systemic spread.

What are the ABCFOB risks of Onabotulinumtoxin A?

Airway and swallowing compromise; monitor for breathing difficulty; injection site reactions; fall risk.

What is the mechanism of action of Trihexyphenidyl?

Blocks acetylcholine activity to reduce tremors and drooling.

What are the desired effects of Trihexyphenidyl?

Reduced tremor and decreased drooling.

What are the undesired effects of Trihexyphenidyl?

Dry mouth, blurred vision, urinary retention, constipation.

What are the ABCFOB risks of Trihexyphenidyl?

Cognitive impairment; lowered seizure threshold; tachycardia; glaucoma risk; fall risk.

What is multiple sclerosis (MS)?

A chronic, degenerative, progressive autoimmune disorder characterized by immune-mediated destruction of CNS myelin.

What happens to the nerve in multiple sclerosis?

Immune cells attack the myelin sheath, slowing or blocking nerve conduction.

What are common clinical manifestations of multiple sclerosis?

Weakness, visual changes, fatigue, sensory disturbances, and coordination problems.

What is the primary medication goal in multiple sclerosis?

Suppress or modulate the immune response to slow nerve damage and reduce relapse frequency.

How can MS treatment be explained to patients?

“We are calming your immune system so it stops attacking your nerve insulation.”

What are general considerations in MS pharmacotherapy?

Monitor for infection risk, immune suppression, liver dysfunction, mood changes, and infusion reactions.

What serious viral infection is associated with certain MS therapies?

Progressive multifocal leukoencephalopathy (PML).

What virus is associated with PML?

JC virus.

What must be monitored before and during certain MS therapies to reduce PML risk?

JC virus status and new neurological changes.

What is the mechanism of action of Interferon beta?

Modulates immune response and prevents immune cells from attacking myelin.

What are the desired effects of Interferon beta?

Reduced relapse frequency and slowed disease progression.

What are the undesired effects of Interferon beta?

Flu-like symptoms, depression, injection site reactions.

What are the ABCFOB risks of Interferon beta?

Monitor LFTs and CBC; suicide risk screening; monitor for Stevens-Johnson syndrome; infection monitoring.

What is the mechanism of action of Glatiramer acetate?

Acts as a myelin decoy to distract immune cells away from attacking actual myelin.

What are the desired effects of Glatiramer acetate?

Reduced relapse rate.

What are the undesired effects of Glatiramer acetate?

Post-injection flushing, chest tightness, palpitations.

What are the ABCFOB risks of Glatiramer acetate?

Monitor for immediate post-injection reaction; injection site reactions; monitor liver function; fall risk if dizziness occurs.

What is the mechanism of action of Natalizumab?

Blocks immune cell migration across the blood-brain barrier into the CNS.

What are the desired effects of Natalizumab?

High-efficacy relapse reduction and slowed progression.

What are the undesired effects of Natalizumab?

Fatigue, headache, infusion reactions.

What are the ABCFOB risks of Natalizumab?

Black box warning for PML; monitor JC virus status; monitor for new neurological deficits; infection risk.

What is the mechanism of action of Cladribine?

Selectively depletes T and B lymphocytes to reset immune function.

What are the desired effects of Cladribine?

Long-term remission and reduced relapse activity.

What are the undesired effects of Cladribine?

Lymphopenia and increased infection risk.

What are the ABCFOB risks of Cladribine?

Monitor CBC for severe lymphopenia; teratogenic; require dual contraception for 6 months after last dose; infection monitoring.

What is the mechanism of action of Mitoxantrone?

Cytotoxic agent that directly suppresses overactive immune cells.

What are the desired effects of Mitoxantrone?

Slows rapid disease progression in severe MS.

What are the undesired effects of Mitoxantrone?

Hair loss, nausea, and potential heart damage.

What are the ABCFOB risks of Mitoxantrone?

Black box cardiotoxicity; lifetime max dose 140 mg/m²; obtain echocardiogram and assess LVEF before every dose; bone marrow suppression risk.

What is neuropathy?

Nerve dysfunction commonly caused by diabetes, vitamin B12 deficiency, or chemotherapy.

What are common symptoms of neuropathy?

Burning pain, tingling, numbness, and hypersensitivity.

What is the medication goal in neuropathy?

Reduce abnormal nerve signaling and decrease pain intensity.

How can neuropathy treatment be explained to patients?

“We are reducing the intensity of the bad nerve signal.”

What are general safety considerations in neuropathy medications?

Monitor for sedation, fall risk, suicide risk, liver toxicity, and severe skin reactions.

What is the mechanism of action of Pregabalin (neuropathy)?

Modulates calcium channels to decrease glutamate release and reduce nerve excitability.

What are the desired effects of Pregabalin (neuropathy)?

Reduced burning and neuropathic pain.

What are the undesired effects of Pregabalin (neuropathy)?

Weight gain, peripheral edema, drowsiness.

What are the ABCFOB risks of Pregabalin (neuropathy)?

Respiratory depression; renal impairment monitoring; Stevens-Johnson syndrome; suicide risk; fall risk.

What is the mechanism of action of Carbamazepine (neuropathy)?

Blocks sodium channels to prevent repetitive pain signal firing.

What are the desired effects of Carbamazepine (neuropathy)?

Relief of trigeminal neuralgia pain.

What are the undesired effects of Carbamazepine (neuropathy)?

Blurred vision, dizziness, urinary retention.

What are the ABCFOB risks of Carbamazepine (neuropathy)?

Black box bone marrow suppression; Stevens-Johnson syndrome; NO GRAPEFRUIT JUICE; monitor CBC and liver function.

What is the mechanism of action of Amitriptyline?

Blocks reuptake of norepinephrine and serotonin to dull pain perception.

What are the desired effects of Amitriptyline?

Improved sleep and decreased chronic neuropathic pain.

What are the undesired effects of Amitriptyline?

Dry mouth, sedation, blurred vision.

What are the ABCFOB risks of Amitriptyline?

Cardiotoxicity and arrhythmias; orthostatic hypotension; fall risk; suicide risk.

What is the mechanism of action of Duloxetine?

Increases serotonin and norepinephrine to reduce pain perception.

What are the desired effects of Duloxetine?

Reduced diabetic neuropathy pain and chronic pain.

What are the undesired effects of Duloxetine?

Nausea, sweating, dry mouth.

What are the ABCFOB risks of Duloxetine?

Liver toxicity; serotonin syndrome; Stevens-Johnson syndrome; bleeding risk; suicide risk.

What defines seizure disorders?

Excessive CNS excitability leading to involuntary motor or behavioral manifestations.

What is an aura?

A sensory warning that occurs before a seizure.

What is tonic activity?

Sustained muscle contraction during a seizure.

What is clonic activity?

Rhythmic jerking movements during a seizure.

What does ictal mean?

Occurring during a seizure.