NEUROLOGIC DISORDER MEDS

BACLOFEN

• withdrawal manifestations → but NOT dependent

• start with low dose

• don’t stop abruptly → TAPER

• STORY → BACK in the day i used to have withdrawals when i didn’t have an energy drink a day. now days, i try not to depend on it. i usually take a low dose of caffeine so i don’t stop abruptly (fast).

DONEPEZIL

• FOR alzheimer’s disease

• GI side effects

• CNS effects → insomnia, dizzy, headache

• take w/ food at bedtime

• report bleeding changes

• NSAIDs increase bleeding risk 

• STORY → when i was DONE with my stair master workout, i felt dizzy (CNS) since i didn’t eat anything before. my stomach was hurting so bad, because i was on my period (bleeding). i ended up eating food at bedtime to help with my cramps. 

LEVODOPA / CARBIDOPA

• FOR parkinson’s disease

• dark urine & sweat

• orthostatic hypotension

• dyskinesias , tremors , twitches 

• AVOID high protein food

• STORY → when I used to work at a level 1 hospital , I had a patient who had Parkinson’s. He had dyskinesias, tremors and twitches due to his conditions. I had to take his vital signs orthostatic because he had hypotension. After working for so long, I started to sweat and had to go urine. My urine was dark which I thought was weird. I went to one of ,y mieses and they told me to avoid high protein.

PHENYTOIN

• FOR seizures

• gingival hyperplasia → regular dental check ups

• soft bristled brush

• don’t stop abruptly → TAPER to avoid seizures

• incompatible with dextrose

• avoid oral contraceptives

• STORY → plenton went to the dentist for his regular dental check up. they used a soft bristled brush to brush his teeth. they found he has gingival hyperplasia so they told him to avoid oral contraceptives. after the dentist he saw an ex friend named dextrose so he ran and didn’t stop abruptly to say hi. 

CARBAMAZEPINE

• FOR mood stabilizer

• CNS side effects (headache, ataxia → loss of coordination - tacky walk)

• CNS effects decrease over time

• SJS (steven johnson symptom) → gene testing w/ asian patients 

• report bruising & sore throat 

• can interfere with birth control 

• STORY → ms johnson was an asian lady who went on a walk in the cold weather and fell because she lost coordination. when she fell, she hit her head, so she laid ZEPINE because she was having a headache. the doctor told her, her headache was doing to decrease over time and to stop taking her birth control. she also had a huge bruise on her leg. she also report a sore throat after being in the cold for so long.

VALPROIC ACID

• FOR seizures

• neural tube defects (fetus)

• fatal liver toxicity / pancreatitis → report signs (jaundice, RUQ pain)

• give w/ food

• use enteric coated form

• STORY → a mom at my hospital had a baby named Valerie. Her baby was born with neural tube defects (fetus) and liver toxicity. I gave the food food, so she could cal down and an enteric pill.

KEPPRA 

• therapeutic range required

• TAPER to discontinue

• STORY → keppra went to the the required therapy because she was having problems with her boyfriend. they told her to slow down and discontinue her relationship.  

GABAPENTIN

• increase GABA synthesis

• SI risk (suicidal ideation risk)

• STORY → lady gaba was having mental health problems after increasing her weight. she had many suicidal thoughts because she felt fat.

DIAZEPAM

• FOR anxiety

• dependence

• antidote → flumazenil

• TAPER → can cause dependence if not taper

• use with caution w/ alcohol

• don’t take when pregnant

• CNS depressants

• STORY → my friends and I decided to throw a diazzle party. My bestie flumazemil was helping me plan it since she wasn’t going to drink. She was pregnant so she had to avoid the party or drink alcohol with caution if she was staying. However she got a headache and slowly (taper) left. I was left depending on my other friend to take care of my drunk self.

BUSPIRONE

• FOR anxiety

• paradoxical insomnia , anxiety

• give w/ food→ for nausea

• must be given regularly → not PRN

• report headache → can take OTC meds

• STORY → I used to drink bud light regularly after eating food to help with my anxiety but it just ended up making it worse. I would drink to the point, I would get headaches and had to go get OTC meds.

AMITRIPTYLINE

• FOR depression

• increased risk for suicide → especially kids/teens

• withdrawal potential

• risk for overdose

• if overdosed → prep for gastric lavage

• take at bedtime 

• levodopa/carbidopa risk for hypertension

• STORY →

FLUOXETINE

• FOR depression & premenopause disorder 

• sexual dysfunction

• report impotence/decreased libido → can’t keep erection / low interest in sex

• increase risk for suicide → especially kids/teens

• hyponatremia (low sodium) → especially older adults

• suicide risk → monitor 

• monitor for serotonin syndrome → too much serotonin from medications (hot, high, hyper (serotonin = keeps you cam and balanced)

• take early in the day

• STORY →

VENLAFAXINE

• FOR depression & anxiety

• suicide risk → especially kids/teens

• TAPER dose (2-4 weeks)

• STORY →

PHENELZINE

• FOR depression - not responding to other drugs

• suicide risk → especially kids/teens***

• AVOID tyramine***

• AVOID caffeine & chocolate

• monitor BP

• STORY →

BUPROPION HCL

• FOR depression & smoking censation

• psychosis , hallucinations

• suicide risk

• increased risk for seizures

• report thoughts of self harm

• AVOID alcohol

• STORY →

LITHIUM CARBONATE ***

• FOR bipolar disorder

• GI symptoms → often subside w/ time

• observe for toxicity → vomiting, ataxia (wobbly), seizure, ECG, hypotension, coma

• very narrow window → narrow therapeutic range → lead to toxicity

• drink 2-3L fluid / day

• AVOID caffeine → causes tremors

• SEVERAL drugs INCREASES

• LITHIUM TOXICITY RISK ***

• STORY →

CHLORPROMAZINE 

• FOR schizophrenia / psychosis → person’s mind doesn’t match reality 

• EPS , anticholinergic effects

• ED , reduced libido → get sleepy

• somnolence → may resolve 1-2 weeks

• dermatitis , photosensitivity → wear gloves

• STORY →

RISPERIDONE 

• FOR schizophrenia / psychosis

• agranulocytosis

• hyperglycemia , hyperlipidemia → monitor blood glucose & triglycerides

• constipation → monitor BM → take fiber, fluids fitness

• heat stroke

• STORY → when I used to work at the nursing home, I had many residents with psychosis (mentality not in real life). I had to get blood glucose because they were making hyperglycemic or hyperlipidic. Some of them were constipsted from laying down most of the day.