complex neurological meds

complex neurological meds

mannitol (osmotic diuretic)

— used to reduce intracranial pressure and cerebral edema

— osmotic diuretic; monitor serum osmolality (<320)

— MOA → pulls water from brain tissue into bloodstream via osmotic gradient

— common indications → TBI, intracranial hemorrhage, cerebral edema, acute ICP

— monitor → neuro status, I&Os, serum osmolality, BUN / creatinine

— major risks → dehydration, electrolyte imbalance, acute kidney injury, rebound ICP

— contraindications → anuria (cant pee), dehydration, uncontrolled intracranial bleeding

alteplase (tPA)

— GOLD STANDARD (clot buster)

— MOA → converts plasminogen to plasmin, which breaks down fibrin clots

— must be given within 3-4.5 hours of symptoms onset

— DO NOT give if they’re at bleeding risk or contraindicated

— higher bleeding risk

— shorter half time → 5 mins

— given in 60 min infusion

tenecteplace (TNK) — better

— MOA → tPA with enhanced (high) fibrin specify

— easier to administer → IV bolus, given over 5-10 seconds

— has longer half-life → 20 mins

— lower bleeding risk

propofol

— MOA → potentiates GABA, leading to enhanced neuronal inhibition (slows things)

— onset → 30-60 seconds IV admin (FAST) & lasts 5-15 mins

— preferred sedative for neuro patients (like a quick nap)

• short half life (rapid onset & offset) → quick wake up for neuro checks

— cerebral benefits → may reduce intracranial pressure & cerebral metabolic rate

— common uses → intubated patients, management of status epilepticus & ICP management

— used only for intubated/ventilated patients requiring continuous monitoring

— assess sedation level (RASS/SAS scale) & vital signs/ETCO2

— change IV tubing every 12 hours

— monitor triglycerides if infusion lasts longer than 48 hours

— watch for signs of propofol infusion syndrome

— propofol infusion syndrome (PRIS) → high dose or prolonged use (>48 hr) of infusions

• manifestations → severe metabolic acidosis, rhabdomyolysis, arrhythmias, cardiac & renal failure, hyperkalemia

• prevention → limit propofol dose & duration, monitor lactase, CK & tryglycerides

• treatment → discontinue propofol immediately, provide supportive care & consider ECMO for severe cases

diazepam/valium → benzodiazepines

— for seizure disorder alcohol withdrawal

— MOA → CNS depressant (enhances inhibitory effects of GABA)

• confusion & anxiety (paradoxical)

• antidote — flumazenil

• monitor SE

• TAPER

• monitor for dependence

• AVOID other CNS depressants

buspirone → non benzodiazepine

— short term treatment for anxiety

— MOA → binds to serotonin + dopamine & increases norepinephrine metabolism

— non sedating, not a CNS depressant → no risk for tolerance or abuse

• paradoxical insomnia, anxiety → report

• GI upset (nausea) → given with food

• dizziness/headache → report, can take OTC meds

• change positions slowly & dont drive until stable

amitriptyline

— for depression

• increased risk for suicide especially in kids/teens → educate about this

• sedation → take at bedtime & change positions slowly

• anticholinergic effect → dry mouth (chew gum or suck candy)

• if overdose → prep for gastric lavage

• take as prescribed & TAPER

• increase FFF (fiber, fluids, fitness)

fluoxetine → SSRI

— for depression, premenstrual depression

— blocks re-uptake of serotonin floating around in the brain = better mood

— produces CNS excitation

• sexual dysfunction

• report impotence/decreased libido (less interested in having sex)

• weight gain

• serotonin syndrome

• increased suicide risk → especially in kids/teens

• hyponatremia (sodium) → especially in older adults

venlafaxine → SNRI

— for major depressive disorder, social anxiety & GAD

— block uptake of both serotonin & norepinephrine without major impact on other receptors & neurotransmitters

• potential withdrawal → TAPER (2-4 weeks)

• increased risk for suicide → in kids/teens — monitor & educate about it

• report thoughts of harm

• N/V → take with food

• AVOID → MAIOs (increases SS) & grapefruit

• don’t give if they’re having suicide ideation (has a plan to do it)

phenelzine → MAOIs

— for major depression that is not responding to other drugs

• orthostatic hypotension → change positions slowly

• report extreme CNS SE

• educate to AVOID TYRAMINE, chocolate & caffeine

bupropion

— for depression, SAD, smoking cessation

• CNS effects (agitation, tremors, headaches)

• psychosis, hallucinations

• increased risk for suicide (educate) & seizures (especially with alcohol)

• take exactly as prescribed → DON’T DRINK

lithium → mood stabilizer

— helps control acute mania & manic episodes with bipolar disorders

• fine motor tremors → worse with stress — AVOID caffeined

• watch for toxicity

• maintain sodium intake → hyponatremia can lead to toxicity

• very narrow window → 0.6-1.2 (1.5 , 2.0 , 2.5 = coma)

• biweekly serum levels until stable

• report neck swelling → could be issue with thyroid

• MED RECONCILIATION → many drugs increase lithium toxicity

chlorpromazine

— schizophrenic symptoms (hallucinations, delusions & disorganized thoughts)

• REPORT MUSCLE RIGIDITY

• EPS, anticholinergic effects

• ED, reduced libido

• NMS

• wear gloves !

• mouth checks for noncompliance

• encourage fluids

• benzo for anxiety

• wear sunscreen & sunglasses

• report sudden fever

rsperidone

— schizophrenic symptoms (hallucinations, delusions & disorganized thoughts)

• agranulocytosis → sore throat

• heat stroke → educate

• monitor weight

valproic acid

— for seizures

• bruising/bleeding, decreased platelets

• GI side effects → give with food

• neutral tube defects

• use ER form

• report signs of liver toxicity