Patho/Pharm 2 (CH 3) - Neurological Drugs PT 1

central acting muscle relaxant

baclofen

baclofen MOA

directly stimulates increase in GABA inhibitory features

- supresses hyperactive reflexes

- NOT DIRECT on skeletal muscle

priority use for baclofen

- relief splacisity in cerebral palsy

- spinal cord injuries

- Multiple sclerosis

GIVEN via: PO/IV/ and MAINLY INTRATHECAL PUMP

pt education w/ baclofen

- drowsy/dizzy/fatigue

- urinary retention (RARE)

- N/V

- constipation

- REPORT TO PROVIDER if mild laxatives not alleviate constipation

- ABRUPT withdrawel symptoms via PO = SEIZURES / visual hallucinations

- ABRUPT withdrawal symptoms via intrathecal = RHABDOMYLOSIS/ CONFUSION/ RESTLESSNESS

nursing priority for baclofen

- take w/food and milk

- increase fluids

- reposition pt's slowly (prevent dizziness/drowsiness)

- seizure precautions

- strict I/O (urinary rentention s/s)

- tirtate dose up slowly for first time use

- mild laxatives

- DO NOT STOP ABRUPTLY (TAPER OFF 1-2WEEK TIME FRAME)

pt contraindications when taking baclofen

- hypersensitivity

- hx/active use of monoamine/oxydiase/MOAIs (synergic INCREASES CNS effects)

CAUTION W/ (can still take if needed):

- older adults

- children

- mentally ill pts

- hx seizures/CVA

baclofen abrupt intrathecal complications

abrupt stop may cause:

- rebound muscle splasicity FOLLOWED BY FEVER

- muscle damage + hyperactive --> rhabdomylosis (toxins produced) which cause organ failure

dantrolene MOA

peripheral acting muscle relaxant

- blocks Ca+ in skeletal muscle to reduce skeletal muscle spasms

primary use for dantrolene

- cerebral palsy

- cardiovascular accident/stroke

- spinal cord injuries

- multiple sclerosis

- prevent AND treat malignant hyperthermia

- GIVEN VIA: PO

treatment for malignant hyperthermia

DANTROLENE

- malignant hyperthermia is caused by Ca+ problems in skeletal muscle causing excessive muscle use

- dantrolene is a Ca+ skeletal muscle blocker relaxing symptoms of malignant hyperthermia

pt education taking dantrolene

- muscle weakness

- drowsiness/dizziness

- diarrhea

- liver toxicity (in high doses + long term therapy)

- caution w/ women >35 years old taking estrogen medications

nursing priorities for dantrolene

- monitor/educate s/s of CNS depression (dizziness/drowsiness)

- diarrhea monitoring

- s/s liver toxicity

- LFTs

- LOW DOSE to start --> titrate up if needed

- for malignant hyperthermia PO 1-2days perioperatively

liver toxicity pt education

s/s =

- abdominal pain

- ascites

- N/V

- jaundice

- pain w/ eating

- fever/confusion can occur as well

contraindications for dantrolene

- active liver dysfunction

- HIGH risk > 35y/o (women >35 taking estrogen HIGH risk liver toxicity)

- hx heart, lung, and neuromuscular disorders

- taking/on CNS depressants

- Ca+ channel blockers (severe cardiac dysrhythmias)

Ca+ channel blockers

verapamil

nifedipine

Phenytonin MOA

traditional ASM, decreases neural activity of seizure generating cells

- inhibits Na+ going through Na+ channels

primary use for phenytonin

- simple partial + complex partial seizure

- tonic clonic seizures (PRIMARY USE)

GIVEN VIA: PO, IM, IV

simple partial seizure

a partial seizure, starting from a focus and remaining localized, that does not produce loss of consciousness

complex partial seizure

in epilepsy, a type of seizure that doesn't involve the entire brain and therefore can cause a wide variety of symptoms

phenytonin pt education

- mild drowsiness combined w/ CNS depressants

- gingival hyperplasia w/ CHILDREN + TEENS

- occasional SKIN RASH (STEVENS-JOHNSONS SYNDROME)

nursing priorities for phenytonin

- THERAPUETIC RANGE = 10 - 20mcg/dL

- CNS/neuro checks (depression toxicity)

- gum assessments in children/teens

- rash monitoring

- PO take w/ food

- IV MAX DOSE = 50mg/min

- 25mg/min in eldery

- IV increases risk cardiac collaspe is pushed too fast

nursing interventions for phenytonin usage

- IV MAX DOSE = 50mg/min

- 25mg/min in elderly

- IV increases risk cardiac collaspe is pushed too fast

- constant drug level checks

- DO NOT STOPE MED ABRUPTLY (unless SJ syndrome shows)

- gradually stop med over a couple weeks

SJ syndrome (from phenytoin)

- fever

- massive skin damage/peeling off

- internal organ damage

- sepsis

DISCONTINUE THE MEDICATION IMMEDIATLY IF RASHING OCCURS

phenytonin toxicity s/s

- hystamus (rapid fluttering of the eyes)

- ataxia (drunk walk/ uncoordinated)

- sedation

- blurred/double vision

priority pts when monitoring phenytonin

- Category D pregnancy

- Hx resp, liver, and cardiac dysfunction

- diabetes (increases insulin resistance)

- older adults

- hx alcohol abuse

- actively on contraceptives (lower phenytoin levels)

(DECREASE phenytoin levels)

- w/ phenybartibital

- w/ carbamezepine

contraindications for phenytonin

- skin rashing

- heart block pts

- seizure induced via low blood sugars

med interactions:

(SYNGERGIC = phenytonin toxicity)

- diazapem

- isoniazid

- cimetidine

- valporic acid

carbamazepine MOA

traditional ASM, lowers amount of Na+ going into Na+ channels

- slows down neuron discharge

priority use for carbamazepine

- all subtypes of partial seizures (focal, focal-aware, focal-impaired)

- tonin clonic seizures

- bipolar mood stabilizer

- trigimineal neuralgia

GIVEN VIA: PO

pt education taking carbamazepine

- CNS effects (headache, axtaxia, hystamus, blurred vision)

- FLUID RETENTION

- SJ syndrome

- photosensitivity (WEAR SUNSCREEN)

- BONE MARROW SUPRESSION

- educate immunocompromised, anemia, thrombocytopenia

- take w/ meals (sustained release med GI distress)

nursing priorities for carbamazepine

- monitor fluid retention (ESPECIALLY W/ HX OF CARDIAC/KIDNEY DYSFUNCTION)

- administer low dose and SLOW

- take w/ meals (sustained release med GI distress)

- monitot Na+ levels (hyponatrermia s/s)

- monitor CBC levels/ and bruising s/s

- monitor signs of rash

- HLA-B*1502 gene testing

- THERAPUTIC DOSE = 4-12mcg/dL

hyponatremia s/s

N/V

Muscle cramps

Confusion

Muscular twitching,

coma

Seizures

Headache

priority pts taking carbamazepine

- category D pregnancy

- hx cardiac, hepatic disease

- hx alcohol abuse

(MEDS DECREASE EFFECTIVENESS):

- oral contraceptives

- phenytonin

- rifampin

- theothyline

- barbiturates

- cisplastin

pt contraindications w/ carbamazepine

- hx of hematologic disorders

- hx/active heart failure pts

- HLA-B*1502 gene in asian decent (increases risk for SJ)

(SYNERGIC MEDS):

- antifungals

- grapefruit

- erythromycin

- isonizid

- antiretrovirals

- MOAIs

- valporic acid

valporic acid MOA

traditional ASM

- inhibits influx of Ca+ and Na+ into channesl

- enhances inhibitory effects of GABA

primary use for valporic acid

- ALL TYPES of seizures

- controls mania induced bipolar episodes

- PREVENTATIVE for migraines

GIVEN VIA: PO, IV

pt education taking valporic acid

- liver toxicity

- hyperammonemia leading to hepatitis

- prancreatitis

- bone marrow supression

- GI distress/indigestion w/ PO

- take w/ food

BB WARNING - hepatitis/pancreatitis leads to SEVERE DEATH IN 6 MONTHS if untreated

nursing priorities for valporic acid

- PO sustained release DO NOT crush

- IV MUST be diluted

- DO NOT MIX IV MED w/ other meds

- REPORT hyperammonemia immediately

- s/s hepatitis/pancreatitis

- LFTs

- amylase tests (pancreatitis rise in amylase)

- platelets, bleeding time, and ammonia levels

- skin monitoring

hyperammonemia s/s

- episodes of N/V, confusion, LOC

pancreatitis s/s

- abdominal pain

- N/V

- fever

- jaundice

- weight loss

- skin bruising

priority pts on valporic acid

- pregnancy (must take folic acid supplements to prevent fetal deformaties)

- children < 2y/o

- active kidney disease

- older adults

contraindications when on valporic acid

- hx/active liver disorders

- thrombocytopenia

- hyperammonemia levels

- w/ other anticonvulstants

(MED INTERACTIONS)

- w/ phenytonin increases phenytoin levels

- w/ phenobacterial meds increase med levels

- topiramte increases risk of hyperammonemia

oxycarbazepine MOA

2nd/3rd generation ASM similar to the structure of carbamazepine

- Anticonvulsant binds to Na+ channels used w/ adjunct therapy for seizures

- blocks glutamine release (excitatory neurotransmitters)

primary use for oxycarbazepine

- mood disorders

- migraines

- neuralgia (nerve pain)

GIVEN VIA: PO

pt education taking oxycarbazepine

- allergy to carbamepizine can causes hypersensitivity to this med

- hyponatremia

- SJ syndrome

- dizziness/drowsiness

- blurred vision

- ataxia

- LONG TERM USE CAUSES HYPERTHYROIDISM

- photosensitivity

nursing priorities for oxycarbazepine

- monitor electrolyte levels (especially if on diuretics)

- monitor s/s of SJ syndrome (rashing)

- TITRATE IV med slowly in LOW DOSES

- monitor WBC

- WITHHOLD MED IF ANY CBC levels are out of range / notify provider

- - HLA-B*1502 gene testing

contraindications for ozycarbazepine

- therapy w/diuretics = SEVERE hyponatremia INCREASING RISK of seizures

(MED INTERACTIONS):

- phenytonin (increases risk phenytonin toxicity)

- phenobarbtial decreases effectiveness

- carbamazepine (decreases effectiveness)

- med can decrease effectiveness of oral contraceptives

lidocaine MOA

local anesthetic blocks Na+ influx in Na+ channels

- prevents depolarization

primary use for lidcaine

- SMALL areas ONLY

- body anesthesia

- minor surgeries

- clients who are unable to tolerate general anesthesia

GIVEN VIA: LOCAL IV, EPIDURAL SPACE (LABOR)

pt education taking lidocaine

- HIGH doses = LIFE THREATENING cardiac dysrhythmias

- hypotension in SPINAL ANAESTHESIA

SYSTEMIC ABSORPTION=

- high seizure risk

- respiratory distress

- restlessness

- tremors

- confusion

- CNS depression (rare)

- paraesthesia

nursing priorities for lidocaine

- frequent vitals/ monitor hypotension

- EPI or phenylephrine @ the ready

- frequent neuro checks

- respiratory assessments

contraindications for lidocaine use

- hx hypersensitivity

- hx hypersensitivity w/ similar anesthesia

- viscous lidocaine NEVER w/ children < 3y/o

- bradycardia

- heart block

- cardiac arrest UPON HOSPITAL ASMISSION

priority pts taking lidocaine

(MED INTERACTIONS:)

- beta blockers (increase lidocaine levels)

- cimetidine (increase lidocaine levels)

- quinidine (increase lidocaine levels)

- phenytonin (increase cardiac effects)

- procainamide (increases CNS + cardiac effects)

methohexital sodium MOA

general anesthesia, rapidly introduces anesthesia and hypnosis,

- increases GABA inhibitory effects

primary use for methohexital sodium

- "propofol" #1 COMMON INDUCING ANESTHESIA

- for inducing anesthesia in surgeries

- most misused med to induce sleep

pt education on methohexital sodium

in LARGE DOSES =

- hypotension

- tachycardia

- resp depression

- apnea/death

- extravasation (very common in poor venous access)

nursing priorities for methohexital sodium

- monitor IV site (PRIORITIZE IV PATENCY)

- PRIORITIAZE CENTRAL LINES w/ large bore IVs are next choice (18-20' gauge)

- frequent vitals

-stop infusion w/ s/s of infiltration

- recitation @ THE READY

contraindications for methohexital sodium

- Allergy to barbiturates

- CAUTION W/ HX HEPATIC/RENAL DISORDERS

(SYNERGIC MEDS):

- CNS depressants

- benzodiazepines (duplicate therapy) (ex: moazolam)

moazolam MOA

benzodiazapine anesthesia

- CNS depressant

- Increases GABA inhibitory effects

primary use for moazolam

- general anesthesia

- sedation

- hypnotic

GIVEN VIA: PO, IV, IM

pt education taking moazolam

- respiratory arrest

- cardiac arrest

- amnesia (memory loss)

nursing priorities for moazolam

- monitory vitals frequently

- slow IV push w/ 2min pauses between doses

- recitation @ the ready

- PRIOTIZE CAUTION W/ PTs hx of neuromuscular, cardiac, pulm, renal disorders

cardiac arrest s/s

- sudden collaspe/LOC

- gasping for air/SOB

- no pulse

- heart palaptions

contraindications w/ moazolam

(MED INTERACTIONS):

- anticonvulsants (SYNGERIC CNS effects)

- cimetidine (increases med toxicity)

- HERBAL PRODUCTS can lower or raise effects of meds

- pregnancy

- delivery

- lactation