Module 7: Neurological System

Phenytoin (Dilantin)

Indication:

Seizures

therapeutic serum level—10-20 mcg/mL

Phenytoin (Dilantin)

Mechanism of Action:

Blocks sodium channels

Phenytoin (Dilantin)

Side Effects:

Hypotension if IV, CNS depression, liver toxicity, gingival hyperplasia, bone marrow suppression, skin reactions—can be severe.

Valproic Acid

Indication:

Seizures

do not take during pregnancy > harmful to fetus.

Valproic Acid

MOA:

Blocks Na channels and increases GABA

Valproic Acid

Side Effects:

GI side effects-Guillain-Barré Syndrome (GBS)

Carbamazepine

Indication:

Seizures

Carbamazepine

MOA:

Blocks Na channels / Stabilizes nerve endings by altering sodium channels / First generation Anti-seizure

Carbamazepine

Side Effects:

CNS effects: double vision, sedation, staggering gait, and headache; rash, Stevens-johnson syndrome,hyponatremia, BMS

Levodopa/Carbidopa

Indication:

Parkinson’s disease.

Levodopa/Carbidopa

MOA:

combines to prevent early conversion outside the brain

Levodopa/Carbidopa

Side Effects:

Involuntary movements (with higher doses).

Selegiline

Indication:

Parkinson’s disease.

Selegiline

MOA:

Monoamine Oxidase Type B Inhibitors; they block the MAO enzyme that wants to inactivate dopamine.

Selegiline

Side Effects:

Insomnia, dizziness, ortho hypotension. Caution with foods that contain tyramine and when taking sympathomimetics as these can cause severe hypertension. Can increase effect of opioids.

Donepezil

Indication:

Alzheimer’s disease.

Donepezil

MOA:

Cholinesterase Inhibitors / indirect acting cholinergic agonists; works centrally in brain to prevent breakdown of Ach.

Donepezil

Side Effects:

Excess SLUDGE effect, nausea, diarrhea, insomnia, bradycardia.

Pyridostigmine

Indication:

Myasthenia Gravis.

Pyridostigmine

MOA:

Cholinesterase Inhibitor / Acetylcholinesterase (AChE) Inhibitors > more acetylcholine available.

Pyridostigmine

Side Effects:

SLUDGE effects, bradycardia.

Mannitol

Indication:

Traumatic Brain Injury & Increased Intracranial Pressure; reduces intracranial and intraocular pressure by drawing fluid out of tissues / lowers intracranial pressure.

Mannitol

MOA:

Osmotic diuretic; elevating osmolarity in the renal tubules, preventing water reabsorption. The increased osmotic pressure draws water into the renal tubules from surrounding tissues, leading to increased excretion of water, electrolytes, and waste products.

Mannitol

Side Effects:

Dehydration (due to increased urine output), hyponatremia (electrolyte imbalances, particularly low sodium levels), hypotension, possible gastrointestinal issues (such as nausea or diarrhea), risk of headache or dizziness in some individuals.

Thrombolytics (Alteplase, Reteplase)

Indication:

Treatment for Ischemic Stroke (to dissolve the clot; treatment should be delivered within 4.5 hours of symptom onset).

Thrombolytics (Alteplase, Reteplase)

MOA:

Thrombolytic Agents; break down the thrombus that has been formed by stimulating the plasmin system (activating plasminogen to plasmin, which in turn breaks down fibrin threads in a clot to dissolve a formed clot).

Thrombolytics (Alteplase, Reteplase)

Side Effects:

Bleeding, hypersensitivity – rash, flushing, bronchospasm, and anaphylactic reaction.

Clopidogrel (Plavix)

Indication:

Ischemic stroke treatment (Antiplatelet agents

Clopidogrel (Plavix)

MOA:

Antiplatelet agent.

Clopidogrel (Plavix)

Side Effects:

Bleeding risks.

Parkinson Disease

Pathophysiology/Causes:

Dopaminergic neurons degenerate in substantia nigra which causes a loss of available dopamine. There is an imbalance between dopamine and acetylcholine.Degenerations leads to brain cell’s inability to perform normal inhibitory actions (motor neuron suppression)

Parkinson Disease

Symptoms/Manifestations:

Tremors- especially at rest, Rigidity of muscle, Bradykinesia (trouble moving/walking),Stooping/ hunching over, Masked Face, Dizziness/ Fainting, Loss of automatic movements, Writing changes: hard to write, may appear small, Loss of smell, Trouble Sleeping, Soft of low voice, slurring

Parkinson Disease

Treatment:

Meds —> Dopamine agonists and MAO inhibitors

Guillain-Barré Syndrome (GBS)

Pathophysiology/Causes:

An acute onset autoimmune demyelinating peripheral neuropathy. When your body's own immune system attacks your own peripheral nerves. Destroys the protective covering of the peripheral nerves (myelin sheath), preventing the nerves from transmitting signals to the brain.

Guillain-Barré Syndrome (GBS)

Etiology:

Idiopathic, but it's usually preceded by an infectious illness (2/3 patients report having influenza-like illness, linked to infection with viruses like Epstein-Barr virus). It's thought that this immune attack is initiated to fight an infection and that some chemicals on infecting bacteria and viruses resemble those on nerve cells, which, in turn, also become targets of attack.

Guillain-Barré Syndrome (GBS)

Risk Factors:

Preceded by an infectious illness (influenza-like illness, Epstein-Barr virus); rare - vaccinations may increase risk - especially flu vaccine.

Guillain-Barré Syndrome (GBS)

Symptoms/Manifestations:

Very rapid, progressive limb weakness results and loss of tendon reflexes. Symptoms resulting from nerve degeneration: poor coordination and mobility, difficulty moving eyes and face, difficulty chewing and swallowing (dysphasia), urinary incontinence, difficulty breathing.

Guillain-Barré Syndrome (GBS)

Treatment:

Plasmapheresis (removes the circulating immune complexes; shown to decrease morbidity and shorten the course of the disease); Intravenous immunoglobulin therapy (IVIG) (infusion of antibodies that bring your immune system under control by decreasing the harmful antibodies that are attacking your nerves; shows a positive impact on the speed of recovery