week 7 cns pns p2

methylphenidate (Ritalin)

cns stimulant drug

blocks dat and nat transporters, and inc synaptic level

methylphenidate moa

attention, impulse control, and executive function

methylphenidate enhances 3

adhd, narcolepsy

methylphenidate 2 indications

depression, augmentation, fatigue

methylphenidate off label 3

Allergy, Marked anxiety, agitation, glaucoma, Cardiac disease, Pregnancy

methylphenidate c/i 6

Seizures, Hypertension, History of drug dependence, alcoholism

methylphenidate caution 4

insomnia, dec apetite, nervous, irritability, ha, gi upset, inc hr and bp

common s/e methylphenidate 7

cardiac death, psychosis, growth suppression, raynaud’s phenomenon, priapism

methylphenidate serious s/e 5

a. BP, pulse & growth

b. early in day

c. crush

d. drug holidays

methylphenidate nsg cons

a. monitor 3

b. take in what time

c. do not

d. used to assess need and reduce s/e

epilepsy

chronic neurologic condition ● sudden discharge of excessive electrical energy from nerve cells located within the brain

Duration, Fracture, bruises, Risk for aspiration , Level of Consciousness

look out for 5 in seizure

Hydantoins ● Barbiturates ● Benzodiazepines ● Succinimides ● Iminostilbene ● Valproic Acid

6 types of anti epileptics

Inhibit sodium influx, stabilize cell membranes, reduce repetitive neuronal firing seizures

hydantoins moa

antidysrhythmic

hydantoin Acts as an — by increasing threshold in cardiac tissue

general sedation , non addicting, teratogenic

hydantoin Has slight effect on —and is 2

phenytoin

the first antiseizure drug

tonic-clonic (grand mal), partial seizure, status epilepticus, seizure prophylaxis

hydantoin: phenytoin indication 4

antiarrhythmic (Class B)

hydantoin: phenytoin off label use

gingival hyperplasia, drowsy, dizzy, ataxia, gi upset, hirsutism, rash

common s/e hydantoin:phenytoin 7

sjs, purple glove syndrome, hepatoxicity, blood dys, cardiac arryth, teratogenicity

serious s/e phenytoin 6

purple glove syndrome

is a rare but serious complication associated with IV phenytoin (Dilantin) administration

stop immed, elevate limb, warm compress, wound care

PGS management 4

10-20 mcg/mL

hydantoin phenytoin therapeutic range

a. serum level, liver func, cbc

b. 50

c. oral hygiene

d. abrubt discont

nsg cons phenytoin

a. monitor 3

b. use iv slowly mcg/min

c. educate on

d. avoid

phenytoin

potent enzyme inducer

phenobarbital- Status ep, primidone- seizure prophylaxis

2 barbiturates and indication

inc act of gaba

moa barbi

15-40 mcg/mL

Therapeutic serum range of Phenobarbitals

Seizure control ● Status epilepticus ● Sedation and preoperative anesthesia

barbiturates indication 4

insomnia, anxiety

2 off label for barbi

drowsy, ataxia, cog dulling, depression, gi upset, hyperact

6 common s/e barbi

respi depress, hypotension, sjs, blood dys, agra, hepatox, dependence, thrombo

serious s/e barbi 8

a. respi stat

b. iv adm

c. avoid alc

d. consistent dosing sched

e. labs

g. bedtime

nsg cons barbi

a. asess

b. slow

c. educ pt on

d. maintain

e. monitor

f. give at

clonazepam- absent and myoclonic seizure, clorazepate- partial, diazepam-stat epi, lorazepam

4 benzos and indi

ETHOSUXIMIDE (ZARONTIN)

succinamide drug

absent seizure

ETHOSUXIMIDE (ZARONTIN) indi

bm depression

for other drug methsuximide: causes

Inhibits T-type calcium channels , Reduces abnormal electrical activity

succinamide moa

gaba

succinamides does not affect

gi upset, dec apetite, drowsy, hiccups, gum/tongue swell, fatigue

common s/e succinamides 6

Mood/behvior changes ● Stevens-Johnson Syndrome ● Blood dyscrasias ● Lupus-like syndrome ● Hepatotoxicity ● Respiratory issues

succinimides serious s/e 6

40-100 mcg/mL

succinimides therapuetic level

a. cbc, renal, liver

b. behavioral changes

nsg cons succinimides

a. labs 3

b. assess for

Valproic Acid ● Phenytoin Acid

succinimides 2 drug drug interactions

CARBAMAZEPINE (TEGRETOL)

IMINOSTILBENES drug

partial & gen tonic clonic epilepsy, pain, trigeminal pain, bipolar

4 indic for carbamazepin

schizoaffective disorder

carbamazepine off label use

blocks voltage-gated sodium channels , modulate GABA & Ca channels , reduces synaptic transmission

carbamazepine moa

drowsy, anticholi, rash, photosens, ataxia

common s/e carbamazepine 5

aplastic anemia, agra, sjs, hyponatremia, hepatox, suicidal ideation

carbamazepine serious s/e 6

4-12 mcg/mL

carbamazepin serum level

a. 1 hr

b. cbc, liver/renal, electrolytes

c. rash

carbamazepin nsg cons

a. hrs spcace

b. labs 3

c. assess

absence/partial/gen seizure, bipolar, migraine prophylaxis

valproic acid indic 3

inc gaba, modu na ca channel, reduce seizure freq

valproic acid moa

gi upset, drowsy, inc/dec weight, hair thin, men irreg

valproic acid common s/e 5

hepatox, pancreatitis, thrombo, leuko, suicidal ideation, terato

serious s/e valproic 6

50-100 mcg/mL

valproic serum level

a. cbc, ammonia level

b. sign of toxicity

c. take w/ food

d. crush

e. abrupt discont

valproic nsg cons

a. labs

b. assess

c. meals?

d. do not

e. avoid

benztropine, biperiden, procycline

3 anticholinergic drugs

blocks ach

anticholi moa

narrow angle glaucoma, myasthenia gravis

anticholi c/i 2

Tachycardia ● Hyper/Hypotension ● Hepatic dysfunction ● Lactation & pregnancy

anticholi 4 caution

Sedation ● Anorexia ● Dry mouth ● Confusion & constipation ● Urinary retention ● Blurred vision

6 anticholi effects

myadiasis, dry skin, flushed skin/vasodi, delirium/halluci, hyperthermia, urinary retention

Anticholinergic Toxicity Symptoms 6

Physostigmine

treatment for anticholi

increase acetylcholine levels

physostigmine moa

cardiac monitor

physostigmine caution

Rivastigmine, iv, activated charcoal, benzo, na carbonate

alternative treatment for anticholi 5

ileus

waatch out for - in anticholi treatment

parkinson

dopaminergic agents indic

Levodopa ● Amantadine ● Pramipexole

3 dopaminergic agents

inc dopamine level

dopaminergic agent moa

Allergy ● Angle closure glaucoma ● History of suspicious skin lesions ● Lactating women

c/i dopa agents

anxiety, hypotension, dysphagia, bizarre breathing, bm depression

5 c/i dopa agents

a. rebal, hepatic fxn

b. 30-60

c. IV apomorphine antiemetic treatment

d. extended release tabs

e. dyskinesia, impulse control

nsg cons dopa agents

a. check 2

v. levadopa/carbidopa mins b4 meals

c. route

d. not be crushed

e. adv fx 2

apomorphine

direct dopamine agonist; given subcutaneously (not PO). Usually with trimethobenzamide to ↓ nausea/vomiting

bromocriptine

direct dopamine agonist; may work longer than levodopa.

ropinirole

– dopamine agonist; also for restless leg syndrome

rotigotine

dopamine agonist; given transdermally (good if swallowing is difficult), = transdermal patch

Rasagiline

MAO-B inhibitor → prevents dopamine breakdown in CNS

a. maoi

b. vit b6 & phenytoin

c. antipsychotics

d. rasagiline

drug drug interactions dopa agents

a. risk of hypertensive crisis; stop 14 days before starting dopaminergic

b. ↓ levodopa effectiveness

c. ↓ effect

d. avoid tyramine-rich foods, St. John’s wort, meperidine, some analgesics