Neurological System Part 1

Mechanism of Action:

Temazepam (Restoril)

Increases GABA in the CNS, promoting sedation/sleep (CNS depression)

Therapeutic Uses:

Temazepam (Restoril)

-Insomnia

-Anxiety

-Seizures, muscle spasms

-Alcohol withdrawal

Adverse Effects:

Temazepam (Restoril)

-Amnesia, confusion

-Respiratory depression

Patient Education:

Temazepam (Restoril)

-Do not combine with other CNS depressants or alcohol

-Do not discontinue suddenly

-Take 30 minutes before bedtime

-Smoking decreases effects

Nursing Considerations:

Temazepam (Restoril)

-High risk of addiction (not for long-term use)

-Gradually decrease use

Antidote for Benzodiazepines

Flumazenil

Non-benzodiazepines are ______ addictive than benzodiazepines

less

Mechanism of Action:

Zolpidem (Ambien)​

Increases GABA in the CNS, promoting sedation/sleep (CNS Depression)

Therapeutic Uses:

Zolpidem (Ambien)​

Short-term treatment of insomnia

Adverse Effects:

Zolpidem (Ambien)​

-Somnolence

-Confusion

-Anterograde amnesia

Patient Education:

Zolpidem (Ambien)​

-Do not combine with other CNS depressants or alcohol

-Take 30 minutes before bedtime

Nursing Considerations:

Zolpidem (Ambien)​

-Smaller doses for renal/hepatic impairment

-Precautions to prevent falls

Mechanism of Action:

baclofen (Lioresal)​

Enhance the effects of GABA in the CNS, reducing muscle spasticity

Therapeutic Uses:

baclofen (Lioresal)​

Spasticity in:

-Spinal cord injuries

-Cerebral palsy

-Multiple sclerosis

-Muscle injury

Adverse Effects:

baclofen (Lioresal)​

-Drowsiness/dizziness, nausea

-Constipation

-Urinary retention

Patient Education:

baclofen (Lioresal)​

-Increase fiber and fluid to prevent constipation

-Do not discontinue suddenly

Nursing Considerations:

baclofen (Lioresal)​

-Taper to prevent withdrawal symptoms

Mechanism of Action:

dantrolene (Dantrium)​

Acts directly on skeletal muscle to prevent calcium release, which inhibits muscle contraction

Therapeutic Uses:

dantrolene (Dantrium)​

Spasticity in:

-Spinal cord injuries

-Cerebral palsy

-Multiple sclerosis

-Muscle injury

+Malignant hypothermia

Adverse Effects:

dantrolene (Dantrium)​

-Diarrhea

-Hepatotoxicity

Patient Education:

dantrolene (Dantrium)​

-Report signs of hepatotoxicity, diarrhea, etc.

-Risk for falls (muscle weakness)

Nursing Considerations:

dantrolene (Dantrium)​

-Monitor liver function (hepatotoxicity)

Mechanism of Action:

Anti-Epileptic Drugs - Hydantoins, Iminostilbenes, Valproic Acid

Decreases the neuronal activity of seizure-generating cells in the brain by inhibiting the influx of sodium through sodium channels

Therapeutic Uses:

phenytoin (Dilantin)

Prevents tonic-clonic (grand mal) and partial seizures​

Therapeutic Uses:

carbamazepine (Tegretol)​

-Partial seizures

-Tonic-clonic seizures

-Bipolar disorder (mood stabilizer)

Therapeutic Uses:

valproic acid (Depakote)

-All types of seizures

-Mania associated with bipolar disorder

-Prevention of migraine headache

Adverse Effects:

phenytoin (Dilantin)

-Gingival hyperplasia

-Stevens-Johnson Syndrome (rash)

-Diplopia

Adverse Effects:

carbamazepine (Tegretol)​

-Visual disturbances

-Fluid retention

-Bone marrow suppression

-Rash

Adverse Effects:

valproic acid (Depakote)

-Hepatotoxicity

-Pancreatitis

-Blood dyscrasias (bleeding, etc.)

Patient Education:

phenytoin (Dilantin)

-Oral care related to gingival hyperplasia

-Decreases effects of oral contraceptives

Patient Education:

carbamazepine (Tegretol)​

-Take at bedtime

-Avoid grapejuice

Patient Education:

valproic acid (Depakote)

-Take the lowest effective dose

-Monitor for bone marrow suppression (CBC)

-Supplement folic acid (risk for NTD in fetus)

Nursing Considerations:

phenytoin (Dilantin)

-Monitor serum level

-Taper dosage

The therapeutic range of phenytoin (Dilantin) is

10-20 mcg/mL

Nursing Considerations:

carbamazepine (Tegretol)​

-Interacts with grapefruit juice

-Monitor CBC for bone marrow suppression

Nursing Considerations:

valproic acid (Depakote)

-Monitor CBC (Thrombocytopenia)

-Monitor s/s of hyperammonemia

Mechanism of Action:

lidocaine (Xylocaine)

Blocks conduction of pain impulses in circumscribed area

Therapeutic Uses:

lidocaine (Xylocaine)

-Decrease pain in skin, mucous membranes, at IV insertion sites

-Decrease pain in minor surgeries

Adverse Effects:

lidocaine (Xylocaine)

-Hypotension

-Cardiac dysrhythmias

-Allergic reaction

Patient Education:

lidocaine (Xylocaine)

-Report diziness or paresthesia

-Report difficulty breathing or allergic reactions

Nursing Considerations:

lidocaine (Xylocaine)

-Monitor VS

-Monitor CNS effects

Mechanism of Action:

thiopental (Pentothal)​

Significant CNS depression and enhances the inhibitory effects of GABA

Therapeutic Uses:

thiopental (Pentothal)​

-Rapid induction of anesthesia

-Hypnosis for brief procedures

Adverse Effects:

thiopental (Pentothal)​

-Decrease HR/BP/respirations

-Respiratory depression

Patient Education:

thiopental (Pentothal)​

-Avoid using other CNS depressants

Nursing Considerations:

thiopental (Pentothal)​

-Inject only into vein (damages tissues)

-Monitor respirations + VS

Mechanism of Action:

fentanyl (Sublimaze) ​

Narcotic Agonist - binds to opioid receptors in the brain and spinal cord, producing analgesic (pain-relieving) effects

Therapeutic Uses:

fentanyl (Sublimaze) ​

-Analgesia

-Sedation

Adverse Effects:

fentanyl (Sublimaze) ​

-Nausea

-Cardiac/Respiratory Depression

Patient Education:

fentanyl (Sublimaze) ​

-Monitor respirations + VS

-Avoid using other CNS depressants

Nursing Considerations:

fentanyl (Sublimaze) ​

-Avoid MAOI's (hypertensive crisis)

-Monitor respiratory depression

Antidote for Opioids

naloxone (Narcan)

Mechanism of Action:

succinylcholine (Anectine) ​

Blocks acetylcholine at neuromuscular junction, causing skeletal muscle paralysis. (Depolarizes muscles)

Therapeutic Uses:

succinylcholine (Anectine) ​

-Rapid muscle relaxation (paralysis) for procedures

-Used adjunct to anesthesia during surgery/intubation

Adverse Effects:

succinylcholine (Anectine) ​

-Respiratory arrest

-Malignant Hyperthermia

Patient Education:

succinylcholine (Anectine) ​

-Muscle pain expected after surgery

Nursing Considerations:

succinylcholine (Anectine) ​

-Monitor for malignant hyperthermia

Signs and Symptoms:

Malignant Hyperthermia

-Muscle rigidity

-Fever

Treatment of Malignant Hyperthermia

-100% oxygen

-Cooling measures

-Muscle relaxant (e.g. dantrolene)

Method of Action:

Adderall, Methylphenidate

Increases the release of the neurotransmitters norepinephrine and dopamine in the brain and PNS

Therapeutic Uses:

Adderall, Methylphenidate

-ADHD

-Narcolepsy

Adverse Effects:

Adderall, Methylphenidate

-Decreased appetite​

-Weight loss

-Insomnia​

-Dysrhythmias, hypertension

Patient Education:

Adderall, Methylphenidate

-Take in the morning after/right before meals

-Avoid other stimulants (caffeine)

Nursing Considerations:

Adderall, Methylphenidate

-Taper dose when d/c

-Monitor for weight loss

Mechanism of Action:

levodopa/carbidopa (Sinemet)​

Dopamine agonist - binds to dopamine receptors, mimicking the effects

Therapeutic Uses:

levodopa/carbidopa (Sinemet)​

Relieve symptoms of Parkinson's disease

Adverse Effects:

levodopa/carbidopa (Sinemet)​

-Dyskinesia

-Tics

-Dysrhythmias

-Dark urine

-Psychosis

Patient Education:

levodopa/carbidopa (Sinemet)​

-Avoid high protein meals (Absorption)

Nursing Considerations:

levodopa/carbidopa (Sinemet)​

-Normal darkening of urine/sweat

-High protein meals decease effectiveness

Mechanism of Action:

selegiline (Eldepryl)​

By inhibiting MAO, dopamine is not inactivated, and more is available to the brain

Therapeutic Uses:

selegiline (Eldepryl)​

-Adjunct to levodopa/carbidopa

-Major depression

-Decreases symptoms of Parkinson's

Adverse Effects:

selegiline (Eldepryl)​

-Hypertensive crisis

Patient Education:

selegiline (Eldepryl)​

-Avoid tyramine-containing foods

Nursing Considerations:

selegiline (Eldepryl)​

-Monitor BP (hypertensive crisis)

Mechanism of Action:

benztropine​

Acetylcholine Antagonist - Binds to acetylcholine receptors, preventing acetylcholine from binding

Therapeutic Uses:

benztropine​

-Decrease tremors and muscle rigidity

Adverse Effects:

benztropine​

-Dry mouth​

-Dry eyes, blurry vision​

-Urinary retention​

-Constipation​

Patient Education:

benztropine​

-Chew gum

-Increase fiber and fluid intake

-Wear sunglasses

Nursing Considerations:

benztropine​

-Monitor adverse effects

Mechanism of Action:

donepezil (Aricept)​

Stops acetylcholinesterase from inactivating acetylcholine​ and increases acetylcholine in the brain​

Therapeutic Uses:

donepezil (Aricept)​

-Improve cognitive function in Alzheimer's

-Slightly delay progression of Alzheimer's

Adverse Effects:

donepezil (Aricept)​

-Insomnia

-Bradycardia, syncope

-Diarrhea, weight loss

Patient Education:

donepezil (Aricept)​

-Take at bedtime with food to minimize GI symptoms

-Do not combine with other CNS depressants

Mechanism of Action:

sumatriptan (Imitrex)​

Activates 5-HT receptors, which promote vasoconstriction and suppress the release of CGRP. This prevents the inflammatory response from occurring

Therapeutic Uses:

sumatriptan (Imitrex)​

-Prevents migraines

-Analgesics for existing headache

-Vasoconstriction/inflammation

Adverse Effects:

sumatriptan (Imitrex)​

-Heavy chest pressure, angina

-Tingling

-Vertigo

Patient Education:

sumatriptan (Imitrex)​

-Risk for falls (vertigo)

-Report severe angina

Nursing Considerations:

sumatriptan (Imitrex)​

-Monitor VS for coronary vasospasm

-Interacts with MAOIs

-St. Johns Wort (toxicity)

Signs and symptoms of ethanol withdrawal:

Elevated B/P, HR, RR, and temp

N/V​

Insomnia, restlessness​

Tremors​

Agitation, irritability, depression​

Alcohol Withdrawal Medications

Benzodiazepines, carbamazepine, clonidine/beta blockers

Alcohol Abstinence Medications

Disulfiram (Antabuse)​, Naltrexone (Vivitrol, Revia), Acamprosate​

Signs and symptoms of opioid withdrawal

-Diaphoresis

-Hypertension, tachycardia

-Arthralgia

-Anxiety

-N/V

-Malaise

Opioid Withdrawal Medications

Methadone, clonidine, Buprenorphine

What drug is similar to methadone, but safer

Buprenorphine

Nicotine withdrawal/abstinence Medications

NRT, Bupropion (Wellbutrin)​, Varenicline (Chantix)

Benzodiazepines usually end in

"-zepam" or "-zolan"

temazepam (Restoril) class

Benzodiazepine

How to remember non-benzodiazepines

-Usually start with or have a Z

-"Z-drugs"

zolpidem (Ambien) class

Non-benzodiazepine

zaleplon (Sonata) class

Non-benzodiazepine