Pharm Unit IIIb, Neuro & Pain

What is donepezil used to treat?

Alzheimer's dementia

timolol side effects

stinging, dry eyes, blurred vision, systemic effects (bradycardia)

Nursing notes for timolol:

report blurred vision and dry eyes to HCP, monitor pulse for bradycardia, delay insertion of contacts for 15 mins after administration, have patient bring in every time to demonstrate they can use proper technique for administration of eye gtts.

timolol uses:

for POAG, occasionally for emergency treatment of closed-angle glaucoma

antidote medications

acetylcysteine, naloxone

nursing administration for donepezil?

notify the HCP is pulse is below 60 bpm, GI effects usually subside, give med at HS, avoid anticholinergics

nursing administration for memantine

monitor for side effects as they may not be able to communicate them, avoid alcohol.

How does donepezil help patients with Alzheimer's dementia?

prevent the breakdown of acetylcholine, allow acetylcholine to accumulate in cholinergic synapses

Side effects of donepezil

nausea, vomiting, loss of appetite, increased frequency of bowel movements, headache, constipation, confusion and dizziness.

What is memantine used to treat?

Alzheimer's disease

Prostaglandin action

Promote fever, inflammation, pain

How can memantine help patients with Alzheimer's dementia?

decrease symptoms. believed to work by regulating glutamate, which, if there are excessive amount of glutamate in the brain, causes brain cell death.

outermost sheath of the anterior eyeball, is transparent so that light can enter the eye. The cornea has no blood vessels; it receives its nutrition from the aqueous humor and its oxygen supply by diffusion from the air and surrounding vascular structures. There is a thin layer of epithelial cells on the external surface of the cornea that is resistant to infection

Cornea

the clear fluid between the cornea and the lens. It is how the cornea receives nutrition.

Aqueous humor

diaphragm that surrounds the pupil and gives the eye its color—blue, green, hazel, brown, or gray. The sphincter muscle within the iris encircles the pupil and is innervated by the parasympathetic nervous system

Iris

aka nocieption, is an individual’s awareness of the feeling or sensation of pain

Pain perception

donepezil drug class?

Acetylcholinesterase Inhibitor

memantine drug class?

NMDA receptor inhibitor

person's ability to endure pain

Pain tolerance

Opioid Analgesics side effects?

dependence, withdrawal syndrome, sedation, euphoria, respiratory depression nausea and vomiting, constipation

cornea

outermost sheath of the anterior eyeball, is transparent so that light can enter the eye. has no blood vessels; it receives its nutrition from the aqueous humor and its oxygen supply by diffusion from the air and surrounding vascular structures. There is a thin layer of epithelial cells on the external surface of the it is resistant to infection

Aqueous humor

the clear fluid between the cornea and the lens. It is how the cornea receives nutrition.

Ciliary muscle

connected to zonular fibers that create tension the change the shape of the lens based on news. Contraction changes based on the ability of the lens to assume a more biconvex shape when tension on the ligaments is relaxed, and ciliary muscle contraction. It is innervated by parasympathetic nerve fibers.

Iris

a diaphragm that surrounds the pupil and gives the eye its color—blue, green, hazel, brown, or gray. The sphincter muscle within the iris encircles the pupil and is innervated by the parasympathetic nervous system

NSAIDs

nonsteroidal anti-inflammatory drugs

What kinda medications are NSAIDs

medication that exerts analgesic, antipyretic, and anti-inflammatory actions

pain threshold

the point at which a person feels pain

acute pain

pain that is felt suddenly from injury, disease, trauma, or surgery

chronic pain

episode of pain that lasts for 3 months or longer; may be intermittent or continuous

Opioid Agonists

medications such as morphine, meperidine, codeine, oxycodone, hydromorphone, and fentanyl

opioid agonist action

block pain sensation, stimulate analgesic effects

Opioid patient teaching

hold for resp. rate below 12/min, increase fluid/fiber, monitor for constipation, monitor for orthostatic hypotension, avoid hazardous activity

Opioid Antagonists

Naloxone, naltrexone

NSAID examples

-aspirin (ASA)

-ibuprofen (Motrin, Advil)

-indomethacin (Indocin)

-ketorolac (Toradol)

-naproxen (Aleve)

-meloxicam (Mobic)

Mnemonic for NSAID examples

Affluent Idiots Insulted Korean Newborns Mockingly.

NSAID S/E

GI: pain, bleed, dyspepsia

GU: impaired kidney function

Salicylism & ASA toxicity with ASA use

NSAID Nursing Administration

Give with food, milk or full glass of water

Stop ASA one week prior to surgery

IV IBU---hydrate to prevent kidney damage

Ketorolac (Toradol) short term use only r/t S/E

Timolol brand name?

Timoptic

Timolol action

beta blocker; decreases aqueous humor production in the eye

Application of eye drops

Wash hands

Wipe secretions

Pull down lower lid

Instill gtts into the conjunctival sac

Apply pressure to inner canthus 1-2 mins

timoptic side effects

stinging, dry eyes, blurred vision, systemic (bradycardia)

Brimonidine brand name?

Alphagan P

Brimonidine SE

stinging, dry mouth, red sclera, dilated pupils

Latanoprost (Xalatan) Side Effects

-increased pigmentation of iris, lids, and lashes

-stinging

-blurred vision

Nursing Administration for eye gtts

-Clean hands/gloves

-wipe away exudate

-do not rub eyes

-Apply gtts in sac & apply pressure to inner canthus

-no contacts for 15 mins after gtts

Nursing administration ear gtts

-Clean hands/gloves

-Warm solution to room temp

-side laying

-massage tragus

donepezil side effects

N/V, dyspepsia; headache; bradycardia; B/P changes

Memantine side effects

depression, headache, confusion, hypertension, ataxia

latanoprost drug class

Prostaglandin analog

latanoprost action:

reduce IOP by increasing aqueous humor outflow through

latanoprost uses

for open angle glaucoma

latanoprost nursing administration

do not rub eyes, report blurred vision and migraine to HCP, delay insertion of contacts for 15 mins after administration, use proper technique for administration of eye gtts

ciprofloxacin with HC action

the antibiotic and steroid action will decrease pain, inflammation, and edema

ciprofloxacin with HC uses

Otitis externa

things said during class about timolol:

Bring in every time so patient demonstrates correctly how to use it. side effects: stinging and burning when put in! HAVE to have pressure applied to inner canthus. Need to wait to put contact in at least 15 mins

ciprofloxacin with HC side effects

CNS (dizziness, tremors, restlessness), rash

What OTC med doesn't reduce inflammation

tylenol (acetaminophen)

ciprofloxacin with HC nursing administration

use proper technique for administration of ear gtts, warm the solution, dry ears after swimming and bathing

Antidote for Acetaminophen

acetylcysteine

andidote for opioid agonists

naloxone

pt taking naproxen, what 3 actions:

pain relief

anti inflammatory

antipyretic

antipyretic definition

drug that has the ability to lower body temperature

antiemetic definition

prevents or treats nausea and vomiting

Patient's respiration is 10/min requesting Dilantin (phenytoin), what would be the nurse's action?

hold and notify, assess why 10? raise HOB, ambulate, (non pharm things)

Brimonidine, Latanaprost, Timolol, way to remember side effects.

B-L-T. "Tastes so good it makes your eyes water

Donepezil and Memantine, way to remember use

You'll need to DM to remember those Alzheimer's meds.