T4 NEURO DRUGS

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BHAVES
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127343
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T4 NEURO DRUGS
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2012-01-23 14:52:41
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T4 NEURO DRUGS
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  1. CNS STIMULANTS
    • ANALEPTICS - stimulate the respiratory Center
    • AMPHETAMINES- ADHD
    • ANOREXANTS - Suppress the Appetite
    • USES: ADHD, drug induced respiratory depression , narcolepsy, sleep, apnea, exogenous obesity
    • ADVERSE REACTIONS: CNS Stimulation, hyperactivity, tachycardia, palpitations, insomnia
    • CONTRAINDICATIONS: Most Anorexiants are Pregnancy Category X
    • PRECAUTIONS: Ampethamines & Anorexiants - Abuse & Addiction
    • AMPHETAMINES - Adderall, Ritalin
    • ANALEPTICS - Nuvigil, Provigil
    • ANOREXIANTS -
    • MISC DRUGS - Strattera
    • Obtain & record clients Baseline VS & weight
    • Administer CNS Stimulant early in the day
    • Instruct client to Avoid coffee tea or Cola if Taking CNS Stimulants
    • Monitor clients with ADHD started on atomoxetine (STRATTERA) for suicide ideation
    • Given in the morning 30-45 minutes before breakfast & before lunch; a journal of the child's behavior pattern is kept
    • In Narcolepsy, a record of the times per day that sleepiness occurs is kept
  2. ANTICONVULSANTS
    • USES FOR THE ANTICONVULSANTS
    • LORAZEPAM (ATIVAN), is the drug of choice for status epilepticus
    • ADV. REACTIONS OF ANTICONVULSANTS
    • CNS REACTIONS: Somnolence (sleepiness), nystagmus
    • GI SYSTEM REACTIONS: gingival hyperplasia (gum tissue overgrowth)
    • CONTRAINDICATIONS & PRECAUTIONS FOR ANTICONVULSANTS
    • Carbamazepine (Tegretol) should not be given within 14 days of monamine oxidase inhibitor (MAOI) antidepressant
  3. HYDANTOINS
    All hydantoins may cause hypotension, drowsiness, sedation, gingival hyperplasia (Dilantin only) blood dyscrasias, elevated glucose
    • Phenytoin (Dilantin)
    • Most commonly prescribed anticonvulsant
    • Administered Orally with Meals
    • IV is diluted in NS because dextrose causes medication to crystalize
    • Rapid IV administration may cause hypotension & Dysrhythmias
    • Decreases effectiveness of Birth Control Pills
    • Oral Tube feedings may interfere absorption of Orally administered; If on continous feedings higher doses of the drug may be necessary
    • Instruct clients taking Phenytoin (Dilantin) to use a soft bristled toothbrush
    • Phenytoin (Dilantin) may cause urine to turn Pinkish-red or reddish-brown color
    • Monitor Serum Glucose levels in Clients with Diabetes Mellitus (DM)

    • NURSING CONSIDERATIONS
    • Usually taken for Life
    • Status Epilepticus may result from abrupt discontinuation
    • IV administration of Lorazepam (Ativan) or diazepam (Valium) may cause Respiratory Depression
    • Instruct Client to Avoid Alchol & over the counter Medications (OTC)
    • Wear Medic-Alert Bracelet
    • Should use Caution when driving or performing activities that requires alertness
    • Follow up visit with Periodic Blood Studies related to determining Toxicity
    • Instruct client to report symptoms which may indicated a Blood Dyscrasia Anticonvulsants may cause Nausea & Vomiting; stress importance of Adequate Nutritional Intake
    • Monitor S/S of liver dysfunction for Clients in Tegretol:dark urine clay colored stools, unusual bleeding
  4. SUCCINIMIDES - CBC & Liver Function Tests
    May Cause drowsiness, gingival hyperplasia
  5. BARBITURATES
    Use with extreme caution with Valproic acid, may cause phenobarbital toxicity
    May Cause Somnolence, Respiratory Depression
  6. CARBOXYLIC ACID DERIVATIVES -
    Use with Extreme caution with Phenobarbital (Luminal) mau cause Phenobarbital Toxicity
    May Cause Blood Dyscrasias, hepatotoxicity (monitor CBC & liver enzymes)
  7. OXAZOLIDINEDIONES
    Tridone - used for absence seizulre & epilepsy may cause Blood Dyscrasias
  8. BENZODIAZEPINES
    Klonopin Valium Ativan - may cause sedation, drowsiness, Blood Dyscrasias
  9. MISC ANTICONVULSANTS PREPARATIONS
    • Carbamazepine (Tegretol) - Used for Trigeminal & Posthertic Neuralgia
    • Gabapentin (Neurontin) used for Postherpetic Neuralgia

    • NURSING CONSIDERATIONS
    • Anticonvulsant Dosage is started low & gradually increased
    • Plasma Serum Levels of anticonvulsants are measured regularly
  10. THERAPEUTIC SERUM RANGE FOR COMMON ANTICONVULSANTS
    • Carbamezepine (Tegretol) 3-14 mcg/mL
    • Clonazepam (Klonopin) 20-80 ng/mL
    • Ethosuximide (Zarontic) 40-100 mcg/mL
    • Phenobarbital (Luminal) 15-40 mcg/mL
    • Phenytoin (Dilantin) 10-20 mcg/mL
  11. ANTIPARKINSONISM DRUGS - Parkinsonism is aterm that referes to agroup of sysmptoms involving motor movement: Tremors rigidity & bradykinesia (slow movement)
  12. DOPAMINERGIC DRUGS
    • The Dopamine agonists which are MAOIs selegiline (Eldepryl, Zelapar) & Rasagiline(Azilect) should not be used with the opioid meperidine (Demerol) because of antimetabolite conversion -> stupor, rigidity & hyperthermia
    • AMANTADINE(SYMMETREL) - used for PD - May cause lightheadedness, dizziness, orthostatic hypotension (check B/P & pulse)
    • LEVODOPA - may cause dizziness dark sweat or urine
    • RASAGILINE (Azilect) used in the Tx for PD Do not administer with Demerol
    • SELEGELINE (Eldeprul, Emsam, Zelapar)- Do not administer with Demerol
  13. ADVERSE REACTIONS OF CHOLINERGIC BLOCKING DRUGS(ANTICHOLINERGICS)
    • May cause dry mouth, blurred vision, dizziness, orthostatic hypotension (check B/P & Pulse)
    • Other adverse reactions include Urinary Retention
    • CONTRAINDICATIONS: Glaucoma, Prostatic Hypertrophy, Myasthenia Gravis
    • BENZTROPINE (Cogentin) used for PD drug induced extra-pyramidal syndrome
    • BIPERIDEN (Akineton)
    • DIPHENHYDRAMINE (Benadryl) also allergies
  14. COMT INHIBITORS
    • TOLCAPONE - is a potent COMT inhibitor that is associated with Liver damage & Liver Failure
    • TOLCAPONE (Tasmar) - used to treat PD that is not responsive to levodopa/carbidopa; may cause Liver Failure
  15. DOPAMINE RECEPTOR AGONISTS
    • Apomorphine (Apokyn) is used for on/off phenomenon antiemetic therapy must be iniated with this drug to Vomiting
    • Adverse Effects: Nausea Vomiting, Postural Hypotension Abnormal involuntary movements
    • Apomorphine (Apokyn) used for PD off episode - may cause Profound Hypotension, nausea vomiting
    • Nursing Considerations:
    • Antiparkinsonism drugs if effective should decrease severity of Symptoms
    • Parlodel interferes with Oral Contraceptives another method of Birth Control should be used
    • Offer frequent sips of water, ice chips, or hard candy
    • Neurologic changes cause changes in peristalsis & dilation of the bowel -> Chronic Constipation
    • Stress importance for a diet high in Fiber & fluids
    • Monitor liver function tests & observe client for signs of liver dysfunction: Persistent Nausea fatigue, lethargy, anorexia, jaundice, dark urine, clay colored stools, unusual bleeding, pruritus and RUQ tenderness
    • Instruct client to rise slowly from sitting or lying
    • Do not abruptly d/c use of the antiparkinsonism drugs, a neuroleptic malignant like syndrome may occur
    • Avoid the use of Alcohol
    • Instruct the client taking levodopa to avoid vitamin B6 (Pyridoxine), this vitamin may interfere with the action of levodopa (found in whole grains, fortified cereals, liver & green vegetables
  16. "ON-OFF" PHENOMENON
    • The on-off phenomenon is when the therapeutic effects of the drug have decreased and the adverse effects have increased
    • Or the use of a drug holiday
  17. CHOLINERGIC DRUGS
    • ACh called Direct acting cholinergics & are used in the Tx of Urinary Retention & Neurogenic bladder
    • AChE are called indirectacting cholinergics or Anticholinesterase muscle stimulants & are used to treat Myasthenia Gravis & Glaucoma
    • Drugs used to treat MG act indirectly to inhibit the activity of AChE & promote muscle contraction
    • Adverse Reactions: Nausea Diarrhea
    • Atropine - an antidote for overdosage of cholinergic drugs
    • Nx Considerations:
    • Assess the client with MG for the presence or Absence of Symptoms prior to each drug dose because the dosage frequency & interval has to be increased or decreased early in therapy depending on the clients repsonse
    • Many clients with MG learn to adjust dosage according to needs
  18. CHARACTERISTICS OF MYASTHENIC & CHOLINERGIC CRISIS
    • Myasthenic Crisis - Restlessness, Dyspnea, Increase Salivation/Tearing (RDIST)
    • Cholinergic Crisis - Abdominal Cramps, Blurred Vision, Facial Muscle Twitching (ACBVFMT)

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