Comprehensive Pharmacology and Treatment Strategies for Seizures, Parkinson's, and Psychiatric Disorders

Hydantoins

Phenytoin (Dilantin)

Iminostilbenes

Carbamazepine (Tegretol)

Valproates

Valproic Acid (Depakote, Depakene)

Levetiracetam

Keppra

Acetylcholinesterase Inhibitors

(AChE Inhibitors) Neostigmine, Pyridostigmine

Anticholinergics

Benztropine (Cogentin)

Sinemet

Combination medication for Parkinson's disease

Amantadine

Medication used for Parkinson's disease

Aricept

Medication for Alzheimer's disease

Gingko

Supplement contraindicated with psyche meds

St Johns Wort

Supplement contraindicated with psyche meds

Kava Kava

Supplement contraindicated with psyche meds

TCAs

Tricyclic Antidepressants

SSRI

Selective Serotonin Reuptake Inhibitors

SNRI

Serotonin-Norepinephrine Reuptake Inhibitors

Atypicals

Atypical Antidepressants

MAOIs

Monoamine Oxidase Inhibitors

Lithium

Mood stabilizer medication

Traditional/Typical Antipsychotics

Haldol

Atypical Antipsychotics

Seroquel, Risperdal, Clozapine

BZD

Benzodiazepines such as Valium, Xanax, Ativan, Librium

BuSpar

Medication for anxiety

Ciprofloxacin

Anti-infective for eyes

TMP Polymyxin

Anti-infective for eyes

Erythromycin

Anti-infective for eyes

Ketorolac

Anti-inflammatory for eyes

Pataday

Anti-inflammatory for eyes

Pilocarpine

Cholinergic agent for glaucoma

Timolol

Beta-adrenergic blocker for glaucoma

Latanoprost

Prostaglandin analogue for glaucoma

Acetazolamide

Carbonic anhydrase inhibitor for glaucoma

Amoxicillin

Systemic medication for ears

Cipro/Ofloxacin

Topical medication for ears

Carbamide Peroxide

Cerumenolytic for ears

Tretinoin

Topical anti-acne medication

Isotretinoin

Systemic anti-acne medication

Therapeutic level of Phenytoin

10 - 20 mcg/mL

Toxic level of Phenytoin

20 - 25 mcg/mL

Therapeutic level of Phenobarbital

20 - 40 mcg/mL

Therapeutic level of Valproate

50 - 100 mcg/mL

Therapeutic level of Carbamazepine

8 - 12 mcg/mL

Therapeutic level of Lithium

0.5 to 1.5 mEq/L

Toxic level of Lithium

1.5 to 2 mEq/L

Signs of toxicity

Ataxia, Nystagmus, Diplopia, Lethargy, Comatose state, N/V/D, Seizures, Dysrhythmias, Tremors, Tinnitus

Gingival hyperplasia

Overgrowth of gums that bleed easily

Phenytoin (Dilantin)

What patient teaching is needed to prevent it? Use a soft tooth brush to prevent gum irritation and bleeding.

Febrile seizure prevention in children

Prophylaxis = Phenobarbital or diazepam. Contraindicated = Valporic acid (Due to hepatotoxicity).

Cholinergic crisis

Causes? Cholinergic crisis = Excessive cholinesterase inhibition.

Myasthenic crisis

Causes? Myasthenic crisis = Undermedication or acute illness.

Cholinergic crisis symptoms

S/S? Cholinergic crisis = SLUDGE (Salivation, lacrimation, urination, diarrhea, GI cramping, and emesis).

Myasthenic crisis symptoms

Myasthenic crisis = Muscle weakness (Respiratory muscles).

Cholinergic crisis occurrence

When do they occur? Cholinergic crisis = Overmedication.

Myasthenic crisis occurrence

Myasthenic crisis = Undermedication.

Cholinergic crisis treatment

Treatment (Atropine Vs Neostigmine)? Cholinergic crisis = Atropine.

Myasthenic crisis treatment

Myasthenic crisis = Neostigmine.

Antidepressants full effect

Length to achieve full effect? 6 Weeks.

Antidepressants and psychotherapy

Need for psychotherapy? Antidepressants used in conjunction with psychotherapy.

Suicide risk with antidepressants

When risk increases for suicide? Higher risk of suicide in adult and pediatric populations.

Foods to avoid with MAOIs

Foods to avoid with MOAIs? Tyramine-containing foods (Cheese, wine, beer, etc.).

Antidepressants in treatment

Place in treatment of depression? Last line of treatment.

Antidepressants and behavioral health meds

Use with other behavioral health meds? Avoid use due to drug interactions → HTN.

TCA overdose

Overdose = Lethal arrhythmias and seizures. Tx = Activated charcoal within 2 hours of ingestion, speed elimination of drug through urine, and management of seizures/arrhythmias.

Smoking cessation medication

Which med can help with smoking cessation? Atypical antidepressants = Bupropion (Wellbutrin).

Washout period

What is a washout period? Must wait 14 days after being taken off MAOIs to use TCAs.

4 D's for lithium toxicity risk factors

4 D's For risk factors for lithium toxicity? Dehydration, Decreased renal function, Diet low in sodium, Drugs interactions (NSAIDs/Thiazide diuretics).

Typical antipsychotics side effects

SE/AE? Typical = Sedation, hypotension, qt prolongation, dizziness, seizures, anticholinergic effects, ortho hypo, and photosensitivity.

Atypical antipsychotics side effects

Atypical = Blood dyscrasia (Clozapine), sedation, photosensitivity, seizures, weight gain, hyperglycemia, anticholinergic effects, ortho hypo, sexual dysfunction, and qt prolongation (Less risk of TD, EPS, NMS due to weak affinity for D2).

First line therapy for atypical antipsychotics

What is first line therapy? Atypical = Clozapine (Clozaril).

EPS

What is it? Extrapyramidal syndrome = Side effect from antipsychotics that causes movement and muscle control issues.

EPS occurrence

Why does it occur? Due to blockage of dopamine.

Pseudoparkinsonism

Stooped posture, shuffling gait, rigidity, and tremors

Acute dystonia

Facial grimacing, involuntary upward eye movement, muscle spasms of tongue, face, neck, back, and laryngeal

Akathisia

Restless, trouble standing still, pacing, and feet in constant motion

Tardive dyskinesia

Protrusion of tongue, sucking and smacking movements of lips, chewing motion, facial dyskinesia, and involuntary movements of the body

Neuroleptic malignant syndrome

Side effect due to antipsychotic drugs

Symptoms of neuroleptic malignant syndrome

Altered mental status, seizures, muscle rigidity, fevers > 105 degrees, BP fluctuations, tachycardia, rhabdomyolysis, renal failure, respiratory failure, coma

Treatment for neuroleptic malignant syndrome

Stop antipsychotics, hydration, reduce fever, muscle relaxants, benzodiazepines

Benzodiazepine withdrawal

Develops due to abrupt stopping of BZD → Occurs within 2 - 10 days of last dose

Symptoms of benzodiazepine withdrawal

Tremor, agitation, nervousness, sweating, insomnia, anorexia, muscle cramps

Correct administration of eye meds

Wash hands/wear gloves, remove contact lenses (replace after 15 minutes), pull and pinch bottom eyelid, in conjunctival sac (drops = squeeze drops into sac/topical = apply thin layer into sac)

Correct administration of ear meds

Adult = pull pinna up and out; Child = pull pinna down and out

Prevention of ear infections

Dry ears after swimming, use custom earplugs, and avoid meds that are not useful for treating ear infections (antihistamines/decongestants)

Signs and symptoms of Steven Johnson syndrome

Large blisters in oral mucosa, anal mucosa, pharynx, eyes, and viscera

Treatment for Steven Johnson syndrome

Stop medication → IVF/electrolytes → Nutritional support → Pain management (opioids)

Intertriginous dermatitis

For rubbing of skin surfaces and moisture (sweating); removes moisture

Incontinence associated dermatitis

For contact with urine/fecal matter, which cause irritation; protects from moisture (barrier cream = locks in moisture)

Location of intertriginous dermatitis

Skin folds

Location of incontinence associated dermatitis

Buttocks, groin, sacrum, coccyx

Conditions treated with barrier cream

Diaper rash, skin breakdown, conditions caused by urine or fecal matter

Mechanism of antiseizure meds

Blocks sodium and calcium; enhances GABA

Are antiseizure meds curative?

No

Reversal meds for benzodiazepine overdose

Activated charcoal (conscious)/gastric lavage (unconscious) within 20 minutes; antidote = flumazenil (Romazicon) IV (BZD antagonist)

Patient education on taking AChE inhibitors

Take before meals; take doses at the same time

Key nursing interventions for cholinergic crisis

Monitor + S/S (Tx = atropine)

Wearing off phenomenon for Parkinson's disease

Medications begin to lose effectiveness

Role of symmetrel

Stimulates dopamine receptors

Gold standard treatment for Parkinson's

Carbidopa-Levodopa (Sinemet)

Key administration points for carbidopa-levodopa

Take 30 minutes before meals; cannot take with protein