PHARM 4 EVERYTHING

What class is Levodopa and what is it used for?

Dopamine precursor; antiparkinson agent | Parkinson motor symptoms: tremor, rigidity, bradykinesia

How does Levodopa work?

Crosses the BBB and is converted into dopamine; only a small amount reaches the brain

What are the major side effects of Levodopa?

N/V; dyskinesia; orthostatic hypotension; hallucinations, vivid dreams, paranoia, impulse-control problems; harmless dark sweat/urine

What do you assess/monitor for a patient on Levodopa?

Assess mobility/ADLs, BP, dyskinesia, hallucinations, wearing-off and on/off episodes; monitor kidney/liver function

What do you teach a patient taking Levodopa?

Take without food when possible; if GI upset, use a non-protein meal; avoid high-protein meals near dose; rise slowly; report loss of effect, palpitations, hallucinations, new twitching

NCLEX clue: Parkinson patient improves movement but develops involuntary movements or dark urine — which drug?

Levodopa — Levo lets dopamine LEVEL UP so the patient can move.

What class is Carbidopa/Levodopa (Sinemet) and what is it used for?

Dopamine precursor + peripheral decarboxylase inhibitor | Parkinson disease

How does Carbidopa/Levodopa (Sinemet) work?

Carbidopa blocks peripheral decarboxylase so more levodopa reaches the brain and lower doses can be used

What are the major side effects of Carbidopa/Levodopa (Sinemet)?

Same levodopa effects: N/V, dyskinesia, orthostatic hypotension, hallucinations/psychosis, impulse-control changes

What do you assess/monitor for a patient on Carbidopa/Levodopa (Sinemet)?

Monitor symptom control, on/off and wearing-off, BP, mental status and dyskinesias

What do you teach a patient taking Carbidopa/Levodopa (Sinemet)?

Take consistently; do not stop abruptly; avoid high-protein meals near dosing; report sudden loss of effect

NCLEX clue: Combination pill described as a 'crossing guard' that gets levodopa to the brain — which drug?

Carbidopa/Levodopa (Sinemet) — Carbidopa guards Levodopa so more can cross into the brain.

What class is Selegiline (Zelapar) and what is it used for?

Selective MAO-B inhibitor; adjunct antiparkinson drug | Adjunct for Parkinson disease

How does Selegiline (Zelapar) work?

Selectively inhibits MAO, increasing dopamine availability

What are the major side effects of Selegiline (Zelapar)?

Oral irritation; nausea; constipation/dry mouth; headache; insomnia or profound somnolence; dyspepsia; orthostatic hypotension/dizziness; hypertension; serotonin syndrome; hallucinations/psychosis; compulsive behaviors; dyskinesia

What do you assess/monitor for a patient on Selegiline (Zelapar)?

Monitor oral mucosa, BP, sleep attacks/somnolence, serotonin syndrome, hallucinations, compulsive behavior and dyskinesia

What do you teach a patient taking Selegiline (Zelapar)?

Take before breakfast; report severe dizziness, hallucinations, compulsive behavior or serotonin-syndrome symptoms

NCLEX clue: Parkinson adjunct with MAO inhibition and risk for serotonin syndrome — which drug?

Selegiline (Zelapar) — Selegiline SAVES dopamine from being destroyed.

What class is Pramipexole (Mirapex) and what is it used for?

Dopamine-receptor agonist | Early Parkinson disease alone; advanced disease with carbidopa/levodopa

How does Pramipexole (Mirapex) work?

Directly activates dopamine receptors

What are the major side effects of Pramipexole (Mirapex)?

Nausea; dry mouth/constipation; headache; insomnia; sudden sleep attacks; dyspepsia; orthostatic hypotension; dyskinesia; hallucinations; impulse-control disorders/compulsive behaviors

What do you assess/monitor for a patient on Pramipexole (Mirapex)?

Monitor BP, sleep attacks, hallucinations, dyskinesias and impulse-control changes

What do you teach a patient taking Pramipexole (Mirapex)?

May take with meals; rise slowly; avoid alcohol/caffeine/OTC cough-cold products as instructed; report sleep attacks or gambling/shopping/sexual compulsions

NCLEX clue: Dopamine agonist + sudden sleep or new compulsive behavior — which drug?

Pramipexole (Mirapex) — Pramipexole PRESSES the dopamine receptor directly.

What class is Donepezil (Aricept) and what is it used for?

Cholinesterase inhibitor | Mild to severe Alzheimer symptoms

How does Donepezil (Aricept) work?

Prevents acetylcholinesterase from breaking down acetylcholine

What are the major side effects of Donepezil (Aricept)?

SLUDGE: salivation, lacrimation, urination, diarrhea/defecation, gastric upset, emesis; bradycardia, fainting and falls

What do you assess/monitor for a patient on Donepezil (Aricept)?

Monitor cognition/ADLs, HR, fainting, weight, hydration, GI losses and falls

What do you teach a patient taking Donepezil (Aricept)?

Take consistently; report fainting, very slow pulse, severe vomiting/diarrhea; understand it does not cure or stop progression

NCLEX clue: Improves memory/reasoning or quality of life but does not stop disease progression — which drug?

Donepezil (Aricept) — Donepezil means the memory is not DONE yet - but it does not cure Alzheimer's.

What class is Rivastigmine and what is it used for?

Cholinesterase inhibitor | Alzheimer symptoms

How does Rivastigmine work?

Prevents acetylcholine breakdown in the CNS

What are the major side effects of Rivastigmine?

SLUDGE; diarrhea, dehydration, dyspepsia, N/V; bradycardia, fainting and falls

What do you assess/monitor for a patient on Rivastigmine?

Monitor HR, hydration, weight, GI effects, cognition and patch skin if used

What do you teach a patient taking Rivastigmine?

Rotate patch sites; remove old patch before a new one; report severe GI effects or fainting

NCLEX clue: Alzheimer drug available as a transdermal patch with cholinergic effects — which drug?

Rivastigmine — Rivastigmine RAISES acetylcholine and may ride on a patch.

What class is Memantine (Namenda) and what is it used for?

NMDA-receptor antagonist | Moderate to severe Alzheimer symptoms; may be combined with donepezil

How does Memantine (Namenda) work?

Blocks NMDA receptors and prevents excessive calcium accumulation in neurons

What are the major side effects of Memantine (Namenda)?

Presentation notes minimal adverse effects; monitor dizziness/confusion clinically

What do you assess/monitor for a patient on Memantine (Namenda)?

Assess cognition, function, safety, kidney function and response when combined with donepezil

What do you teach a patient taking Memantine (Namenda)?

Take consistently; it may slow decline or improve symptoms but does not cure disease

NCLEX clue: NMDA antagonist; donepezil + memantine may have a potentiated benefit — which drug?

Memantine (Namenda) — Memantine puts a MEMbrane-like block on too much NMDA calcium.

What class is Cyclobenzaprine and what is it used for?

Centrally acting skeletal-muscle relaxant | Acute muscle spasm and improved ROM

How does Cyclobenzaprine work?

Acts centrally to reduce muscle spasm; not effective for CNS-origin spasticity

What are the major side effects of Cyclobenzaprine?

Drowsiness, dizziness, sedation; dry mouth, blurred vision, urinary retention, constipation; tolerance/dependence; serotonin syndrome with antidepressants

What do you assess/monitor for a patient on Cyclobenzaprine?

Assess sedation, falls, anticholinergic effects and serotonin syndrome

What do you teach a patient taking Cyclobenzaprine?

Avoid alcohol/driving; use short term; increase fluids/fiber; report agitation, fever or tremor

NCLEX clue: Acute spasm - not spasticity - and causes anticholinergic effects — which drug?

Cyclobenzaprine — Cyclobenzaprine stops the muscle's SPASM cycle.

What class is Baclofen and what is it used for?

Centrally acting antispasticity drug | Spasticity from MS, cerebral palsy, stroke or spinal-cord lesions

How does Baclofen work?

Acts in spinal cord to suppress hyperactive reflexes

What are the major side effects of Baclofen?

Sedation; weakness; dizziness; abrupt withdrawal can cause severe rebound symptoms

What do you assess/monitor for a patient on Baclofen?

Assess muscle tone, function, sedation and safety; taper rather than stopping abruptly

What do you teach a patient taking Baclofen?

Avoid alcohol/driving until effects known; do not stop suddenly

NCLEX clue: Spasticity drug acting in the spinal cord; main lecture effect is sedation — which drug?

Baclofen — Baclofen BACKS OFF hyperactive spinal reflexes.

What class is Diazepam (Valium) and what is it used for?

Benzodiazepine; GABA enhancer | Spasticity

How does Diazepam (Valium) work?

Enhances GABA-mediated inhibition

What are the major side effects of Diazepam (Valium)?

Sedation, dizziness, respiratory depression, dependence and withdrawal

What do you assess/monitor for a patient on Diazepam (Valium)?

Monitor respirations, sedation, falls and dependence; taper after long use

What do you teach a patient taking Diazepam (Valium)?

Avoid alcohol/opioids and driving; take exactly as prescribed; do not stop abruptly

NCLEX clue: Benzodiazepine used for spasticity; sedation is the main adverse effect — which drug?

Diazepam (Valium) — Diazepam DIALS DOWN tight muscles and the whole CNS.

What class is Dantrolene and what is it used for?

Direct-acting skeletal-muscle relaxant | Spasticity orally; malignant hyperthermia IV

How does Dantrolene work?

Acts directly on skeletal muscle to reduce contraction

What are the major side effects of Dantrolene?

Dose-related hepatotoxicity; muscle weakness

What do you assess/monitor for a patient on Dantrolene?

Monitor LFTs, muscle strength and respiratory status; stop/report liver injury

What do you teach a patient taking Dantrolene?

Report jaundice, dark urine, RUQ pain or severe weakness

NCLEX clue: Only direct-acting relaxant in this lecture; IV for malignant hyperthermia — which drug?

Dantrolene — Dantrolene DAMPENS muscle directly - but can damage the liver.

What class is Phenytoin (Dilantin) and what is it used for?

Traditional AED; sodium-channel inhibitor; narrow therapeutic index | Seizure prevention

How does Phenytoin (Dilantin) work?

Inhibits sodium channels in hyperactive neurons

What are the major side effects of Phenytoin (Dilantin)?

Headache/drowsiness/irritability at therapeutic levels; toxicity >20 mcg/mL: nystagmus, sedation, ataxia, diplopia, cognitive impairment; gingival hyperplasia; rash/DRESS; teratogenicity

What do you assess/monitor for a patient on Phenytoin (Dilantin)?

Monitor level 10-20 mcg/mL, neurotoxicity, gums, rash, behavior, liver function; seizure precautions; give with food

What do you teach a patient taking Phenytoin (Dilantin)?

Excellent oral hygiene; take consistently; do not stop abruptly; report rash or loss of seizure control

NCLEX clue: Nystagmus + ataxia + overgrown gums — which drug?

Phenytoin (Dilantin) — Phenytoin gives FUNNY gums and eyes that flick.

What class is Phenobarbital and what is it used for?

Barbiturate AED; GABA potentiator | Seizure control

How does Phenobarbital work?

Potentiates GABA and depresses CNS activity

What are the major side effects of Phenobarbital?

Sedation, respiratory depression, hypotension, dependence; teratogenicity and interactions

What do you assess/monitor for a patient on Phenobarbital?

Monitor respirations, sedation, seizure control and dependence; taper gradually

What do you teach a patient taking Phenobarbital?

Avoid alcohol/driving; take exactly as prescribed; do not stop abruptly

NCLEX clue: Traditional AED that increases GABA and is more sedating — which drug?

Phenobarbital — Phenobarbital puts the brain's firing to BED.

What class is Oxcarbazepine (Trileptal) and what is it used for?

Newer AED; sodium-channel inhibitor | Seizure prevention

How does Oxcarbazepine (Trileptal) work?

Blocks overactive sodium channels

What are the major side effects of Oxcarbazepine (Trileptal)?

Dizziness, drowsiness, diplopia, nystagmus, headache, ataxia; hyponatremia; SJS/TEN, DRESS; teratogenicity

What do you assess/monitor for a patient on Oxcarbazepine (Trileptal)?

Monitor sodium, CNS safety, thyroid function, rash and interactions

What do you teach a patient taking Oxcarbazepine (Trileptal)?

Do not stop abruptly; report confusion, headache, cramps or rash; avoid pregnancy

NCLEX clue: Seizure drug with hyponatremia and serious skin-reaction risk — which drug?

Oxcarbazepine (Trileptal) — OXcarbazepine knocks sodium LOW.

What class is Carbamazepine (Tegretol) and what is it used for?

AED; sodium-channel inhibitor | Partial seizures and trigeminal-neuralgia pain

How does Carbamazepine (Tegretol) work?

Decreases synaptic transmission by blocking sodium channels

What are the major side effects of Carbamazepine (Tegretol)?

CNS effects, serious rash and blood dyscrasias are important class concerns

What do you assess/monitor for a patient on Carbamazepine (Tegretol)?

Give with food; monitor CBC, liver function, sodium, rash and seizure control

What do you teach a patient taking Carbamazepine (Tegretol)?

Avoid grapefruit juice and alcohol; take exactly as directed; give oral suspension separately from other liquids

NCLEX clue: Facial pain/trigeminal neuralgia + grapefruit interaction — which drug?

Carbamazepine (Tegretol) — Carbamazepine calms CARVED facial pain - skip grapefruit.

What class is Pregabalin (Lyrica) and what is it used for?

Calcium-channel-binding AED/neuropathic-pain agent | Focal seizures; neuropathic pain

How does Pregabalin (Lyrica) work?

Binds CNS calcium channels and inhibits neurotransmitter release

What are the major side effects of Pregabalin (Lyrica)?

SJS; thrombocytopenia; suicidal thoughts; respiratory depression; prolonged PR; rhabdomyolysis/myopathy; weight gain; misuse potential

What do you assess/monitor for a patient on Pregabalin (Lyrica)?

Monitor behavior, respirations, platelets, CK, muscle pain/weakness, weight and ECG risk

What do you teach a patient taking Pregabalin (Lyrica)?

Avoid CNS depressants; do not double missed doses or stop abruptly; report pregnancy plans

NCLEX clue: Focal-seizure/nerve-pain drug with weight gain, muscle injury and respiratory risk — which drug?

Pregabalin (Lyrica) — Pregabalin protects painful nerves, but watch breathing and muscles.

What class is Valproic Acid (Depakene) and what is it used for?

Broad-spectrum AED; GABA augmenter | Seizures; also used clinically for bipolar and migraine prevention

How does Valproic Acid (Depakene) work?

Increases GABA; also suppresses sodium and calcium channels

What are the major side effects of Valproic Acid (Depakene)?

N/V; edema; alopecia; rash/DRESS; visual changes; weight gain; CNS effects; hepatotoxicity; pancreatitis; thrombocytopenia/leukopenia; serious teratogen

What do you assess/monitor for a patient on Valproic Acid (Depakene)?

Monitor LFTs, ammonia, CBC/platelets, pancreatitis symptoms, toxicity and suicidal ideation