Module 5A - nervous system meds

seizure

• uncontrolled convulsions, nerves firing at synapses uncontrollably

• prolonged state causes brain damage from decreased O2 in the brain

phenytoin indications

prevents tonic-clonic and partial seizures

phenytoin ADRs

• drowsiness (decreases with long-term use)

• gingival hyperplasia

• skin rash

• withdrawal symptoms

phenytoin nursing care

• administer with meals

• monitory lab levels (10-20 mcg/ml) - levels greater than 30 can be toxic

phenytoin pt teaching

• avoid alcohol

• use second from of birth control (preg catagory x)

• dental checkups q6 months + good dental care

• do not stop abruptly

• report rash

• do not drive/perform hazardous activities if experiencing CNS side effects

benzodiazepines indications/antidote

treats active seizures/IV flumazenil

benzo ADRs

• drowsiness

• confusion

• hypotension

• resp depression

• sedation

• pregnancy category x

benzo nursing intervention

• monitor in post ictal state

• protect pt

• monitor for over sedation

• monitor airway

carbamazepine ADRs

• visual disturbance

• blurred vision

• ataxia

• fluid retention

• photosensitivity

• bone marrow suppression

carbamazepine pt teaching

• monitory WBC and CBC during therapy

• take with meals, take with sip of water if pt is NPO

• monitor i/o

• report fever, sore throat, easy bruising

• no grapefruit juice

• pregnancy category x

carbamazepine nursing care

if blood values are below normal range, hold drug and notify provider

succinylcholine MOA

depolarizing neuromuscular blocker that mimics acetylcholine in the NMJ, causing muscle paralysis

succinylcholine nursing care

always give pain medication and put pt to sleep before paralyzing

malignant hyperthermia

• reaction to anesthesia

• s/s: increased end-tidal CO2, tachycardia, tachypnea, muscle rigidity, dark urine, hyperkalemia, hypotension, fever of 104

dantrolene

antidote and treatment for malignant hyperthermia

oxybutynin indication

treats overactive bladder

oxybutynin ADRs

• anticholinergic effects - blind as a bat, hot as a desert, mad as a hatter, dry as a bone, red as a beet

• common SE - dry mouth, consitpation, blurred vision, drowsiness, dizziness

bethanechol indication

helps pts pee - treats urinary retention

bethanechol ADRs

hypotension, bradycardia, fecal incontinence, salivation, bronchoconstriction, dizziness

cholinergic effects

SLUDGE

• salivation

• lacrimation

• urination

• defecation

• gi distress

• emesis

baclofen indications/MOA

• relief of spasticity related to cerebral palsy, spinal cord injury, and multiple sclerosis

• centrally acting muscle relaxant

baclofen ADRs

• drowsiness

• dizziness

• n/v

• constipation

• urinary retention

• withdrawal symptoms: psychosis, seizures

baclofen pt teaching

• drug must be tapered - do not stop abruptly

• give food or milk to help with GI upset

• get up slowly

• increase fluid and fiber intake while on medication

• avoid alcohol

donepezil MOA/indication

• cholinesterase (enzyme that breaks down acetylcholine) inhibitor

• treats symptoms of alzheimer’s and slows progression → does not cure pt

neostigmine indications

long-term management of myasthenia gravis

neostigmine ADRs

• monitor for excessive muscarinic stimulation and cholinergic crisis

• can lead to paralysis of respiratory muscles and result in death

atropine

donzepil/neostigmine antidote

don/neo ADRs

• gi symptoms

• n/v

• insomnia

• dizziness/syncope

• ha

• bradycardia

• cholinergic effects

don/neo nursing care

• give with food to decrease gi upset

• monitory for s/s of gi bleed

• give at bedtime

• monitor HR

carbidopa/levodopa MOA/indications

• dopamine replacement

• used to treat parkinsons → doesn’t cure, only manages symptoms

• therapeutic effects may take several months

carbidopa/levodopa ADRs

• n/v

• darkening of urine and sweat

• dyskinesias

• tremors

• twitching

• psychosis

• hallucinations

• paranoia

• dizziness

carb/levo pt teaching

• sweat/urine color change normal

• monitor for orthostatic hypotension

• give med before meals

• take with food/avoid high protein foods (decreases absorption)

• report dyskinesia