Neurological System Part 1

Baclofen, carisoprodol, chlorzoxazone,, cyclobenzaprine

Centrally Acting Muscle Relaxants

Action: treat painful muscle spasms related to spinal cord injury, multiple sclerosis, cerebral palsy, or spasms due to musculoskeletal injury or other acute musculoskeletal disorders

Adverse effects:

• drowsiness/dizziness

• weakness & fatigue

• N/V

• constipation

• urinary retention

Nursing interventions:

• take oral doses with food/milk

• drink plenty of fluids

• increase fiber intake

• taper over 1-2 weeks

Contraindications:

• MAOI’s

• children, severe mental illness, seizure disorder, or CVA

Dantrolene

Peripherally Acting Muscle Relaxants

Action: ease skeletal muscle spasms that occur as a result of CVA or stroke, SCI, MS or CP and treat/prevent malignant hyperthermia.

Adverse effects:

• muscle weakness

• drowsiness/dizziness

• diarrhea

• liver toxicity

Interventions:

• monitor LFT’s

• fall risk

Contraindications:

• liver disease patients

• females older than 35 using estrogen

• concurrent administration of CNS depressants

Phenytoin

Class: Antiseizure Medication

Action: help control tonic-clonic seizures as well as partial seizures

Adverse effects:

• mild drowsiness

• gingival hyperplasia (children/adolescents)

• skin rash (serious)

Interventions:

• monitor excess drowsiness

• monitor rash or gingival hyperplasia

Contraindications:

• pregnancy

• skin rash, bradycardia, heart block, previous allergy, seizures caused by low blood sugar

• liver, respiratory, kidney, cardiac dysfunction or DM

Carbamazepine

Traditional Antiseizure Medications

Action: treats partial seizures and tonic-clonic seizures. Also, mood stabilizer for clients with bipolar disorder

Adverse effects:

• visual disturbances

• headache

• ataxia

• nystagmus

• blurred vision

• decreased excretion of water

• skin rash

• steven’s johnson syndrome

• bone marrow suppression

Interventions:

• monitor WBC & CBC

• observe skin

• protect from sun

Contraindications:

• pregnancy

• cardiac/hepatic disease

• hx of alcoholism

• grapefruit juice

• oral contraceptive effectiveness i decreased

Valproic Acid

Class: anticonvulsant

Action: treats all types of seizures / controls mania that occurs with bipolar disorder / prevent migraine headaches

Adverse effects:

• GI upset

• bone marrow suppression

• skin rash

• liver toxicity

Interventions:

• CBC

• hyperammonemia

• LFT’s

Contraindications:

• pregnancy

• liver disorder

• thrombocytopenia

• hyperammonemia

• anticonvulsants

• kidney disease

• children under 2

Oxcarbazepine

Class: Anticonvulsant

Action: treats seizures, neuralgia, pain from nerve, migraines, bipolar disordera

Adverse effects:

• dizziness

• drowsiness

• changes in vision

• headaches

• ataxia

• steven-johnson syndrome

• hypothyroidism

• dec bone mineral density (long-term use)

• leukopenia

Interventions:

• monitor sodium

• WBC & CBC

Contraindications:

• allergy to carbamazepine

Lidocaine

Class: local anesthesia

Action: used when only a small area of the body requires anesthesia or client is not able to tolerate general anesthesia

Adverse effects:

• restlessness

• irritability

• tremors

• confusion

• convulsions

• respiratory depression

• hypotension (spinal anesthesia)

Interventions:

• monitor V/S

Contraindications:

• previous allergy

• children under age of 3

• bradycardia

• heart block

Barbiturates

Class: general aesthetics

Action: rapid induction of anesthesia and hypnosis for brief procedures requiring more than 15 minutes of anesthesia

Adverse effects:

• decrease in BP & HR

• respiratory depression

• death

Interventions:

• sensitivity

• hectic/renal disease

Benzodiazepines

Class: Anesthetics

Action: general anesthesia because of their ability to provide sedation before the administration of general anesthesia

Adverse effects:

• memory loss

• cardiac/respiratory arrest

Interventions:

• amnesia occurs

• monitor V/S

• resuscitation equipment

Contraindications:

• pregnancy, delivery, lactation

• sensitivity

• acute-angle glaucoma

• neuromuscular, cardiac, pulmonary, or renal disorders

Amphetamines/dextroamphetamine sulfate

Class: amphetamines

Action: treat ADHD in both adults & children / narcolepsy

Adverse effects:

• insomnia

• nervousness

• hallucinations

• hypertension

• tachycardia

• palpitations

• weight loss

• appetite suppression

Interventions:

• administered during day

• monitor v/s closely

Contraindications:

• allergy

• moderate/severe hypertension, CV disease, hyperthyroidism

• cardiac defects

Methylphenidate

Class: CNS Stimulant

Action: treat ADHD & narcolepsy

Adverse effects:

• insomnia

• nervousness

• tachycardia

• hypertension

• palpitations

• weight loss

Interventions:

• same as amphetamines

Contraindications:

• medication misuse hx

• allergy hx

• cardiac dysrhythmias

• structural heart defects

Modafinil

Class: non-amphetamines

Action: promote wakefulness in clients who are experiencing narcolepsy, shift-work sleepiness, obstructive sleep apnea

Adverse effects:

• nausea

• diarrhea

• headache

• tachycardia

• hypertension

• steven’s-johnson syndrome

Interventions:

• take with food

• monitor v/s

• monitor rash/blistering

Contraindications:

• valvular heart disease

• CV disease, hypertension, hepatic/renal impairment

• hx substance/alcohol use disorder

• pregnancy

Levodopa/Carbidopa

Class: dopamine-replacement drugs

Action: help relieve the manifestations of parkinson’s disease and when combined with cardioids to make it possible to reduce the dosage of levodopa & prevent some of its adverse effects

Adverse effects:

• N/V

• hypotension

• darken sweat/urine

• dyskinesias

Interventions:

• fall risk

Contraindications:

• angle-closure glaucoma

• hx of melanoma, psychosis, suicidal thoughts

• renal, hepatic, respiratory or endocrine disorders, wide-angle glaucoma, PUD, depression, bipolar disorder

Pramipexole

Class: direct-acting dopamine receptor agonists

Action: help relieve manifestations of parkinson’s disease & restless leg syndrome

Adverse effects:

• nausea

• GI issues

• orthostatic hypotension

• dyskinesias

• drowsiness & sleep attacks

• muscle weakness

Interventions:

• give with food

• fall risks

• monitor muscle weakness, drowsiness

• observe for abnormal movements

Contraindications:

• allergy hx

• major psychotic disorder

• renal dysfunction

• liver dysfunction

• glaucoma

Selegiline

Class: Antiparkinson agent/MAOI

Action: treat manifestations of parkinson’s disease and are often adjunct to levodopa/carbidopa

Adverse effects:

• insomnia

• hypertensive crisis from tyramine intake

• irritation of oral mucous membranes

Interventions:

• insomnia

• monitor BP

• menu selections of tyramine

• inspect tongue & oral cavity

Contraindications:

• hypersensitivity

• hx of PUD

• tyramine intake

Donepezile

Class: Cholinesterase inhibitors

Action: improve cognitive function in clients with mild to moderate alzheimer’s disease and have been known to lightly delay progression of alzheimer’s

Adverse effects:

• nausea

• GI issues

• insomnia

• dizziness

• headache

• bradycardia

• syncope

• loss of consciousness

Interventions:

• give with food

• monitor weight loss

• observe for GI bleeding

Contraindications:

• hypersensitivity

• hx of GI bleed

• cardiac, GI or pulmonary disorders

• hyperthyroidism

• hx of seizures

Meantime

Class: NMDA Receptor Antagonists

Action: treat moderate to severe alzheimer’s disease. They slow the decline of cognitive and physical functioning

Adverse effects:

• headaches

• dizziness

• increase confusion

• constipation

Interventions:

• monitor dizziness, headache, confusion

Contraindications:

• renal/liver failure

Interferon Beta-1a and beta-1b

Other: glatiramer acetate, natalizumab, ocrelizumab, dimethyl fumarate, fingolimod hydrochloride

Class: immunomodulators

Action: treat relapsing-remitting multiple sclerosis

Adverse effects:

• flu-like manifestations (headache, fever, chills, myalgia, muscle aches

• liver toxicity

• injection site pain, redness, tenderness

Interventions:

• recommend acetaminophen for flu-like symptoms

• liver functions tests

• monitor for local reactions after injections

Contraindications:

• hypersensitivity

• suicidal tendencies

• pre-existing or hx of liver disorders/alcohol misuse

• hx of seizures or thyroid disorder

• younger than 18

Sumatriptan

class: serotonin agonists'

actions: help relieve the manifestations of an existing migraine or cluster headache

adverse effects:

• chest pressure (heaviness)

• angina pain

• vasoconstriction of blood vessels in lungs

Interventions:

• migraine is common side effect

• monitor v/s closely

Contraindications:

• hx of CAD, angina, or previous MI

• liver/kidney insufficiency