Neurological System Part 1

Centrally Acting Muscle Relaxant

Baclofen

Other medications that centrally acting muscle relaxants

Carisoprodol, Cyclobenzaprine

Therapeutic Use for Baclofen

Enhances the inhibitory effects of GABA receptors, suppressing hyperactive reflexes in spine

Adverse effects of baclofen

dizziness, weakness, constipation

Why should you increase fluids and fiber intake on baclofen

Reduce constipation in patients

How can you administer baclofen

Orally, IV

What’s one risk of abruptly stopping IV baclofen

muscle damage and damage to organs

Interactions with other medications for baclofen

MAOIs - cause CNS depression

Contraindications for Baclofen

hypersensitivity, severe mental illness

What is the MOA for peripherally acting muscle relaxants

inhibits calcium, which reduces muscle contractions

What is the name for peripherally acting muscle relaxants?

Dantrolene

Adverse effects for Dantrolene

weakness, drowsiness, diarrhea

Why should a nurse monitor liver function when on dantrolene

to know if liver failure is present

What should a nurse say when educating a patient about dantrolene

Report any muscle weakness, diarrhea

contraindications for dantrolene

liver disease

Interactions with other medications on Dantrolene

estrogen for increased risk of liver toxicity, CNS depressants for sedation

how can dantrolene cause liver toxicity

It stresses liver metabolism, leading to more of the drug in the body

What are Hydantoins?

Traditional ASMs are used for tonic-clonic seizures

What is the prototype name for a Hydantoin

phenytoin

What is Phenytoin MOA?

Suppresses sodium intake in neurons that are hyperactive

Adverse effects for Phenytoin

Gingival hyperplasia, rash, CNS depression effects

Why shouldn’t patients on phenytoin abruptly stop the use

can lead to recurrence of seizures

Why should you monitor phenytoin levels when administering it IV?

The therapeutic level is narrow, 10-20 mcg/ml, and can cause cardiac collapse

What can rash tell you about patients on phenytoin

Stevens-Johnson syndrome developed

Contraindications for Phenytoin (think low respirations)

bradycardia, heart block

Interactions with other drugs for Phenytoin

CNS depressants and dextrose solutions

What do anticonvulsants do? (think similar to phenytoin)

treat partial and tonic-clonic seizures

What is the prototype name for Anticonvulsants?

Carbamazepine

MOA for Carbamazepine (think activity of neurons)

inhibits sodium intake through sodium channels, decreasing discharge of neurons

Adverse reactions to Carbamazepine (think neurological effects)

skin rash, headache, blurred vision

Why should you monitor a patient’s CBC when on Carbamazepine

to monitor for bone marrow suppression

Why should you give Carbamazepine with food

to reduce gastric irritation

What should a nurse tell a patient to report if they are on Carbamazepine (think adverse effects)

decreased urine output, edema, CNS effects, sunburn

Contraindications for Carbamazepine

heart failure, pregnancy

interactions with Carbamazepine

grapefruit juice, MAOIs, antifungals, many other drugs

Which anticonvulsant treats all seizures and bipolar disorder mania?

Valproic Acid

What is the MOA for Valproic Acid (think cell activity)

inhibits sodium intake through sodium channels, decreasing discharge of neurons

What can valproic acid also affect, changing it’s therapeutic effect?

influx of calcium, enhancing effects of GABA

Adverse Drug reactions for Valproic acid

liver toxicity, pancreatitis