The Neurological System Part 2

Diazepam

other: alprazolam, lorazepam, chlodiazepoxide, clorazepate, oxazepam

class: benzodiazepine

action: treats anxiety and anxiety disorders

adverse effects:

• dizziness

• drowsiness

• lethargy

• confusion

• anxiety

• hypotension

• tachycardia

• respiratory depression

Interventions:

• fall precautions

• evaluate memory

• check for tolerance and dependence

• taper dosage over 1-2 weeks

• flumazenil = antidote

Contraindications:

• pregnancy

• older adults, children under 18 yrs

• renal/hepatic impairment, mental health disorders, SI, chronic respiratory disorders, neuromuscular disorders

Buspirone

class: non-benzodiazepine

action: treats short-term treatment of certain anxiety disorders such as generalized anxiety disorder

adverse effects:

• paradoxical effects = insomnia, anxiety, restlessness

• GI upset, nausea

• headache, dizziness, and lightheadedness

interventions:

• monitor paradoxical effects

• monitor GI effects

• fall precautions

• it can take 2-4 weeks to have therapeutic effects

contraindications:

• previous hypersensitivity

• grapefruit juice, erythromycin, ketoconazole can increase blood levels of buspirone

Amitriptyline

others: imipramine, dose pin, nortriptyline, amoxapine, and trimipramine

class: tricyclic antidepressants

action: help improve mood and increase activity while reducing morbid feelings and restoring appetite and sleep

adverse effects:

• drowsiness

• sedation

• orthostatic hypotension

• tachycardia

• anticholinergic effects

• increase risk of SI

• high risk overdose = life-threatening dysrhythmias, confusion, seizures

interventions:

• fall precautions

• monitor orthostatic v/s

• eval inc. depression & SI

• taper over 1-2 weeks

• overdose = gastric lavage, activated charcoal, and sodium bicarbonate

• increase fiber & fluid intake

• do not stop abruptly

• take at bedtime to avoid daytime drowsiness

contraindications:

• previous allergy

• children younger than 12

• rx acute MI

• cardiac dysrhythmias

• hx of seizures

• cautiously = angle-closure glaucoma, prostatic hypertrophy, hx urinary retention, ECT, liver/renal disorders, SI, schizophrenia, hematologic/respiratory disorders, DM, alcoholism

Fluoxetine

other: citalopram, escitalopram oxalate, paroxetine, sertraline

class: selective serotonin reuptake inhibitors (SSRI’s)

action: treat major depression disorders / bipolar disorder, panic disorders, OCD, premenstrual dysphoric disorder, bulimia nervous

adverse effects:

• insomnia

• nervousness

• sexual dysfunction

• headache

• weight gain

• hyponatremia

• inc. ADH = inc. excretion of sodium

• risk for suicide

interventions:

• monitor insomnia & nervousness

• eval for increase in depression & SI

• initiate suicide precautions

• closely monitor serum sodium levels & watch for = lethargy, abdominal cramps, diarrhea, nausea

contraindications:

• hypersensitivity to SSRI’s

• taking MAOI’s = increases risk for serotonin syndrome = mental confusion, difficulty concentrating, fever, agitation, anxiety, hallucinations, incoordination, hyperreflexia, diaphoresis, tremors

• caution = DM, PUD, liver disease, hyponatremic patients

Venlafaxine

other: desvenlafaxine, duloxetine

class: serotonin/norepinephine reuptake inhibitors (SNRI’s)

action: treating major depression, social anxiety disorder, generalized anxiety disorder

adverse effects:

• nausea/vomiting

• anorexia

• headache

• hypertension

• insomnia

• nervousness

interventions:

• monitor nausea & GI effects

• check for weight loss

• monitor for insomnia & nervousness

• taper over 2-4 weeks

• withdrawal = anxiety, tremors, headache, tachycardia, nausea, tinnitus, vertigo

contraindications:

• hx hypersensitivity to SNRIs, SI, concurrent use of MAOI’s

• caution = liver/kidney disease, glaucoma, cardiac disorders, hypertension

• phenelzine = serotonin syndrome

phenelzine

other: isocarboxazid, tranylcypromine, selegiline transdermal

class: monoamine oxidase inhibitors (MAOI’s)

action: depression that hasn’t responded to other safer classes of antidepressants or have depression associated with bipolar disorder

adverse effects:

• orthostatic hypotension

• constipation

• n/v

• GI manifestations

• SI

tyramine-containing foods:

• cheese, sour cream

• bananas, figs, raisins

• eggplant, avocados, beets, sauerkraut

• aged, process and smoked meat, liver'

• some types of cured or canned fish, caviar, shrimp

• broad beans pods, soy beans, tofu

• spoiled food, processed foods, broths, large amounts of nuts

• alcoholic beverages

• chocolate, caffeine-containing beverages, wine

interventions:

• monitor for orthostatic hypotension

• teach to rise slowly

• give list of foods/drinks to avoid

• hypertensive crisis = IV phentolamine or sublingual nifedipine

contraindications:

• hypersensitivity

• tyramine-free diet

• SI, renal failure, liver disorders, cardiac disease, clients older than 60 or younger than 6

• pt taking SSRI, hx of glaucoma or alcohol or medication addiction

bupropion hydrochloride

class: atypical antidepressant

action: treat depression, as well as seasonal affective disorder also called SAD. Also may be an adjunct for smoking cessation

adverse effects:

• nausea / vomiting

• weight loss

• increased risk for seizures

• insomnia

• agitation

• tremor

• headache

• psychosis

• hallucination

• delusions as well SI

interventions:

• give with food

• weigh clients weekly

• monitor for CNS effects

contraindications:

• hypersensitivity

• use cautiously with clients who have renal/liver dysfunction, cardiac disease, schizophrenia, bipolar disorder, diabetes mellitus, hx of alcohol use disorder

Lithium carbonate

class: mood stabilizing medications’

action: helps control acute mania and acute manic episodes associated with bipolar disorder and is used prophylactically to prevent recurrence of mania or depression

adverse effects:

• therapeutic = GI manifestations, transient fatigue, headache, confusion, muscle weakness, polyuria, memory impairment, fine hand impairment

• higher levels = muscle hyperirritability, ECG changes, incoordination, ataxia, blurred vision, seizures, significant hypotension, coma to death

interventions:

• monitor for early, transient adverse effects

• fluid intake & output

• monitor for manifestations of hypothyroidism

• monitor for serum sodium

contraindications:

• pregnancy risk, lactation

• renal insufficiency or moderate-severe cardiac disorders

• dehydrated, low serum sodium level, taking diuretics, low-salt diet

• client with hx of angiodema

• avoid taking NSAID’s to reduce risk of lithium toxicity

• precautions = hx of seizure/thyroid disorders, diabetes mellitus, problems with urinary retention, suicidal ideation

Divalproex sodium

class: antiseizure medication

action: treat seizures as well as control the mania and depression associated with bipolar disorder / prevent migraines

Chlorpromazine

other: haloperidol, fluphenazine, thiothexane

class: conventional antipyschotics

action: help suppress manifestations of schizophrenia, such as hallucinations, delusions, paranoia

adverse effects:

• extrapyramidal effects

• acute dystonia

• tardive dyskinesia

• parkinson's-like manifestations = muscle rigidity, tremors, sluggish movement

• anticholinergic effects

interventions:

• intiate tx with beta blocker/benzodiazepine

• instruct client to wear with sunscreen when exposed to sunlight

• monitor for anticholinergic effects

• monitor vital signs for risk of dysrhythmias

• periodic ECG’s & potassium measurements

contraindications:

• previous allergy to phenothiazine

• in alcohol withdrawal

• have bone marrow suppression

• experiencing CNS depression

• pregnant or lactating

• cautiously = COPD, glaucoma, DM, hypertension, prostatic hypertrophy, thyroid, cardiac, liver disorders

Risperidone

other: clozapine, olanzapine, quetiapine, aripiprazole, ziprasidon, lumateperone

class: atypical antipsychotics

action: treat wide range of manifestations of schizophrenia, bipolar disorders, and help manage the irritability associated with autism

adverse effects:

• drowsiness

• insomnia

• dizziness

• weight gain

• onset of diabetes or worsening

• increase cholesterol levels

• EPS = dystonia, akathisia, parkinson-like manifestations

interventions:

• monitor for adverse effects

• fall precautions

• monitor weight, blood glucose, cholesterol & triglyceride levels

• monitor for EPS

contraindications:

• allergic to it

• lactating

• severe CNS disorders

• certain ECG abnormalities

• psychosis related to dementia in older adults

• increase CVA or stroke

Latanoprost

class: prostaglandin analogs

action: provide topical therapy for lowering IOP for client who have open-angle glaucoma or ocular hypertension

adverse effects:

• changes in pigmentation of iris & eyelid

• changes in eyelashes

• keratitis

• macular edema

• intraocular inflammation

intervention:

• instill one drop in affected eye once daily in evening

• monitor for inflammation or irritation

contraindications:

• known allergy to latanoprost or preservative benzalkonium chloride

betaxolol

other: timolol

class: beta-adrenergic blockers

actions: lower IOP in client who have open-angle glaucoma

adverse effects:

• stinging

• burning

• eye discomfort

• cardiac or respiratory effects such as bradycardia, hypotension, bronchospasm

interventions:

• stinging, burning, eye discomfort = normal

• measure clients pulse immediately prior to administration

contraindications:

• heart block, bradycardia, or cardiogenic shock

• caution = taking systemic beta blockers propranolol, hx renal/liver disorders, diabetes mellitus, airway disorder

• do not give timolol = heart block or heart failure, COPD, asthma, or acute bronchospasm

Pilocarpine

class: cholinergic agonists

action: provide topical therapy to lowering IOP in glaucoma

adverse effects:

• decrease visual acuity

• frontal headache

• urinary urgency

• bradycardia

• constriction of bronchioles

interventions:

• administer mild analgesic for headache

• hold pressure on punctuation for 60 seconds immediately

contraindications:

• acute inflammatory eye disorder or retinal detachment

• chronic respiratory disorders or hypertension

echothiophate

class: cholinesterase inhibitors

action: helps lower IOP in glaucoma

adverse effects:

• decrease visual acuity

• myopia

• long-term use = cataracts

• urinary urgency, bradycardia, constriction of bronchioles

interventions:

• safety measures for nighttime ambulation

• pressure on for 60 seconds

• observer for opacity behind pupil

contraindications:

• hx of retinal detachment

• caution = hx cardiac or chronic respiratory disease, hyperthyroidism, urinary tract blockage, parkinson’s disease