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					            Neuro Pharm
            Catherine A. Gibson,
                RN,BSN,MA


3/30/2011                          1
              Antiparkinson
 Increases the amount of dopamine (a
  neurotransmitter) at the synapse
• Reduces amount of acetylcholine.
• Decreases the S/S of Parkinson disease.
     Muscle tremors at rest Depression
     Rigidity                  Slurred speech
     Shuffling gait
     Pill rolling movement of hands
     Bradykinesia (slow movement)
     Mask-like facial expression

3/30/2011                                        2
             Antiparkinson
• Nursing Implication:
    Do not administer vitamin B6
     (pyridoxine) or foods containing vitamin
     B6; such as, yeast, liver, fish, molasses,
     muscle meats, whole grains, MVI.
    No high protein foods with sinemet.
    Before beginning sinemet/Levodopa;
     patient should be off MAOI
     antidepressants for at least two weeks.

3/30/2011                                     3
              Antiparkinson
• Side effects:
     Drowsiness          Blurred vision
     Dry mouth           (eye spasms may indicate
     Dysphagia            overdose)
     Nausea/vomiting      Rash
     Palpitations         Constipation
     Urinary retention    Report twitching
     Darkened urine
     Confusion


3/30/2011                                            4
            Antiparkinson
• Dosage:
    Tailored to the patient
    Start medication at the lowest possible
     dosage
    Side effects are dose related
    MD orders the lowest dose and
     increases dose as s/s increase.



3/30/2011                                      5
            Antiparkinson
Amatadine hydrochloride: (Symmetrel)
Action:
 Treats some parkinson disease and drug induced
  extrapyramidal reactions (EPS)
 Action in treatment of parkinson’s disease is
  unknown.
Side effects:
 Nausea/vomiting,vision changes, dysrhythmias,
  disorieintation, orthostatic hypotension,
  depression, fatigue.

3/30/2011                                      6
                  Antiparkinson
 Nursing Implications:
     Instruct patient
         to avoid alcohol and CNS depressant medications
         to not stop medication without consulting physician.
         Take medication as prescribed.
         Take medication after meals, if orthostatic hypotension has
          occurred.
         Not to stand or change positions abruptly.
Benztropine mesylate: (Cogentin)
Action:
     Blocks central cholinergic receptors.
     Treats mild cases of parkinsons and control of
      extrapyramidal reactions (EPS).

3/30/2011                                                           7
                  Antiparkinson
• Side effects:
       Dizziness
       Drowsiness
       Depression
       Orthostatic hypotension
       Palpitations
       Tachycardia
 Nursing implications: (what you need to monitor)
     Importance of following prescribed dosage
     Never stop drug abruptly
     Discontinue medication slowly


3/30/2011                                         8
                Antiparkinson
 Nursing implications: cogentin
     Avoid alcohol intake
     Administer with food
     Rise slowly to avoid orthostatic hypotension.
     Do not administer with antacids.
 Levodopa (L-Dopa): (dopar/Larodpa)
     Action: how it works is unknown
         increases balance between cholenergic and
          dopaminergic activity to allow more normal body
          movement and alleviate symptoms.
         Converted to dopamine by the central nervous
          system and acts as a neurotransmitter.

3/30/2011                                                   9
               Antiparkinson
    Side effects:
        Aggressive or psychotic behavior
        Involuntary grimacing
        Head and body movement
        Depression
        Suicidal tendencies
        Orthostatic hypotension
        Nausea/vomiting
        Dark urine
        Excessive and inappropriate sexual behavior

3/30/2011                                          10
             Antiparkinson
• Nursing Implications:
    Contraindicated in narrow angle
     glaucoma
    Monitor B/P if receiving antihypertensive
     drugs
    Monitor blood sugar if receiving
     hypoglycemic agens
    Change positions slowly and dangle legs
     before standing
3/30/2011                                   11
               Antiparkinson
• Nursing Implications: levodopa
    Protect drug from heat, light and
     moisture.
 Carbidopa-levodopa: (Sinemet)
    Action:(combination of carbidopa and
     levodopa)
        Increases levels of dopamine and
         levodopamine
        Improves modulation of voluntary nerve
         impulses transmitted to the motor cortex

3/30/2011                                           12
                Antiparkinson
     Side effects:
         Mental depression       Aggressive or psychotic
         Mental changes          behavior
         Nausea/vomiting
         Orthostatic hypotension
         Dizziness
         Uncontrollable body movements
     Nursing Implications:
         Give with food
         Give only as ordered
         Takes months to become effective


3/30/2011                                                   13
                Antiparkinson
     May cause drowsiness
     Get up slowly
     Lying down may effect blood glucose level and
     darken urine
 Selegiline hydrochloride: (Eldepryl)
     Action:
         Monoamine oxidase inhibitor: (MAOI)
         Used as an adjunct to levodopa and levodopa-
          carbidopa (used in combination (with) to improve
          effectiveness)
         Thought to slow parkinson’s disease and need for
          increased medication.

3/30/2011                                                    14
                 Antiparkinson
     Action: Eldepryl
         May prolong life span of parkinson patients
     Side effects:
         Severe orthostatic hypotension
         Increased tremors
         Increased chorea
         Restlessness
         Grimacing
         Nausea/vomiting
         Slow urination
         Increased sweating/alopecia (loss of hair)


3/30/2011                                               15
               Antiparkinson
    Nursing Implications:
        Max dose 10 mg/day (>dosage increases
         adverse reactions)
        Avoid alcohol use
        Limit coffee use
         Administer with food
        Get up slowly (orthostatic hypotension)
        Notify MD of side effects
        Do not take over-the-counter cold
         medications
        Monitor blood pressure and respirations

3/30/2011                                          16
              Antiparkinson
     Do not take antacids or antidiarrheal agents
      within one hour of taking medication.
     Give with food
     Caution to rise slowly
     Monitor patients with narrow angle glaucoma
      and hypertension
     Causes drowsiness: CNS depressant
     Relieve dry mouth with ice chips, hard candy
      or cool drinks.
     Do not administer demerol (meperidine)

3/30/2011                                            17
                Antiparkinson
• Trihexyphenidyl: (Artane)
     Action:
         Controls symptoms in mild cases
         Controls extrapyramidal reactions (EPS) caused by
          drugs.
     Side effects:
         Skin rash             Urinary hesitancy
         Eye pain              Urinary retention
         Nervousness           Dry Mouth
         Headaches             Disorientation
         Tacycardia

3/30/2011                                                     18
           Anticonvulsant
• Uses:
  Treatment of generalized tonic-clonic
   seizures
  Emergent treatment of status
   epilepticus:
     Valium
    Non epileptic seizures associated with
       Reye’s syndrome or after head injury
    Migraines
    Trigeminal Neuralgia (Tic Doloureaux)
3/30/2011                                     19
       (dilantin/tegretol)
               Anticonvulsant
     Bell’s palsy
     Ventricular arrhythmias
         Uncontrolled by antiarrhythmias
 Nursing Implications:
     Medications should be taken at the same time
      every day to maintain therapeutic levels.
     Do not stop or d/c abruptly
     Take with or after meals to prevent GI distress
     Use soft tooth brush and good dental hygiene
         Dilantin causes hyperplasia (overgrowth) of gums.

3/30/2011                                                     20
            Anticonvulsant
• Side effects:
    Drowsiness/dizziness
    Depression/headache
    Slurred speech/ Ventricular fibrillation
    Nystagmus/hirsutism
    Nausea/vomiting
    Constipation/weight loss
    Anorexia/hepatitis
    Blood dyscrasia/lupus
3/30/2011                                       21
            Anticonvulsant
• Absorption decreased with antacids
  and calcium preparations.
• Periodic lab draws to monitor drug
  blood levels.
• Instruct not to discontinue meds
  abruptly
• Instruct not to drink alcohol

3/30/2011                              22
              Anticonvulsants
• Phenytoin: (Dilantin)
     Action:
         Reduces neuron hyperexcitability
         Inhibits seizure activity
         Reduces pain of trigeminal neuralgia
     Side effects:
         Sluggishness       Constipation
         Ataxia             Nausea/vomiting
         Slurred speech     Over growth of gingiva
         Nystagmus           Skin rash/hypotension
         Aplastic anemia/agranulocytosis (decreased WBC)

3/30/2011                                                   23
              Anticonvulsant
    Nursing interventions:
        Monitor B/P and pulse (report bradycardia)
         during or after IV administration
         Enforce Safety precautions if ataxic or
         drowsy.
        Give with food to reduce GI irritation
        Provide mouth care to prevent gingival
         overgrowth. (gingival hyperplasia)
        Monitor for drug interactions


3/30/2011                                             24
              Anticonvulsant
• Fosphenytoin: (cerebyx)
    Action:
        Used to control acute seizures
    Side effects: [same as for phenytoin
     (dilantin)]
    Nursing implications:
        Less irritation at IV site
        Do not exceed recommended IV
         administration rate.

3/30/2011                                   25
                Anticonvulsant
• Gabapentin: (Neurontin)
     Action
         Unique gabapentin-specific binding site in the brain
         Used in combination with other seizure meds to
          control partial seizures
     Side effects:
         Somnolence (sleepy)
         Dizziness
         Ataxia (after starting medication or increasing dose)
         Weight gain
         Edema
         Vomiting
         Constipation
         Rhinitis/pharyngitis
3/30/2011                                                        26
                Anticonvulsant
• Nursing Implications:
     Safety precautions because of drowsiness
     Give with food to prevent GI distress
     Encourage rest periods if fatigued
 Topiramate: (topamax)
     Action:
         Blocks voltage dependent sodium and calcium
          channels
         Blocks excitatory receptors



3/30/2011                                               27
              Anticonvulsant
    Side effects:
        Somnolence          Weight loss
        Abnormal thinking   Dysmenorrhea
        Dizziness           Nausea
        Agitation           Dyspepsia
        Confusion           URI
        Ataxia
        Nystagmus
        Nephrolithiasis
        Anorexia

3/30/2011                                   28
                Anticonvulsant
     Nursing Implications:
         Safety precautions if drowsy
         Notify MD if confused, agitation or abnormal thinking
          occurs.
         Give with food to prevent GI upset
         Do not chew or cut tablet: has a very bitter taste.
         Maintain adequate hydration to prevent kidney
          stones
         Renders oral contraceptives ineffective. Use barrier
          contraceptives.
         Avoid use of alcohol due to increased CNS depression



3/30/2011                                                    29
                Anticonvulsant
• Valproates: (depakote/depakene)
     Uses:
         Generalized tonic-clonic seizures
         Absence seizures
         Atonic/myoclonic seizures
     Side Effects:
         Confusion          Indigestion
         Dizziness          Nausea/vomiting
         Headaches          Anorexia
         Visual disturbances/ Constipation
         Diarrhea/rash/pancreatitis
         ataxia

3/30/2011                                      30
             Anticonvulsant
• Nursing Implications:
     Monitor hepatic function (labs)
     Assess location, duration and characteristics of
      seizure activity
     Institute seizure precautions
     Abrupt d/c of medication, may lead to status
      epilepticus.
 Ethosuximide: Zarontin
     Absence seizures myoclonic seizures
     Psychomotor seizures
     Side effects: same
3/30/2011                                            31
                Anticonvulsant
• Felbamate: (felbatol)
     Uses:
         Treatment of seizures in children
         Generalized tonic-clonic seizures in adults
         Treat hard to treat seizures
     Side effects:
         Irritabililty      can cause hepatic failure
         Insomnia           and aplastic anemia
         Amprexoa
         Nausea/vomiting
         Headache

3/30/2011                                                32
                Anticonvulsant
• Sedative/hypnotic: Barbiturate
     Phenobarital: (luminal)
• Primidone: (Mysoline)
     Action:
         Depresses CNS and raises seizure threshold
         Used as anticonvulsant
     Side effects:
         Drowsiness             Rash
         Respiratory depression Photosensitivity
         Nausea/Vomiting        Muscle aches
         Diarrhea               IV route: Larngospasms
         Constipation                     Bronchospasms
                                           Hypotension

3/30/2011                                                  33
              Anticonvulsant
    Nursing Intervention:
        Safety precaution if drowsy
        Monitor respiratory rate and B/P
        Monitor for drug interaction
        Do not stop drug abruptly without
         consulting physician
        Avoid alcohol use
        Avoid excessive sunlight



3/30/2011                                    34
              Anticonvulsant
• Carbamazepine: (Tegretol)
    Action:
        Slows transmission of impulses in CNS
        Prevents seizures
        Reduces pain of trigeminal neuralgia
    Side effects:
        Drowsiness     B/P increase or decrease
        Ataxia         Heart failure
        Blurred vision Urinary retention
        Rash/hepatitis Blood dyscrasias

3/30/2011                                          35
              Anticonvulsant
    Nursing Intervention:
        Safety Precautions if drowsy
        Monitor B/P
        Avoid use of alcohol
        Avoid excessive sunlight
        Do not change dosage or stop abruptly
         without MD guidance
        Report sore throat, fever, excessive
         bruising, bleeding or jaundice.


3/30/2011                                        36
              Anticonvulsant
• Diazepam: (valium)
     Action:
        Depresses CNS
        Inhibits impulse conduction
     Side effect:
        Drowsiness        Constipation
        Rash              Respiratory depression
        Nausea/vomiting Physical and psychologi-
        Diarrhea           cal dependence
         Hypotension/phlebitis

3/30/2011                                       37
              Anticonvulsant
    Nursing Implications:
        Safety precautions if drowsy
        Monitor infusion site for extravasation
         (infiltration into tissues)
        Monitor B/P
        Give with food to decrease GI distress
        Do not stop or change dosage without
         consulting MD




3/30/2011                                          38
              Anticonvulsant
• Clonazepam: (Klonopin)
    Action:
        Raises seizure threshold
    Side effects:
        Drowsiness      Nocturia
        Ataxia          Blurred vision
        Agitation       Dry mouth
        Rash             Elderly excitement
        Edema           Toxicity causes lethargy,
        Agitation        confusion, coma

3/30/2011                                            39
                Anticonvulsant
    Nursing Interventions:
        Safety measures if drowsy
        Do not stop medication abruptly
             Can cause restlessness, incomnia and status
               epilepticus
 Lorazepam: (ativan)
    Used to treat Status epilepticus
    Used in conjunction with other
     anticonvulsants.

3/30/2011                                                   40
                 Cholinergic
• Increases the neurotransmitter
    – acetylcholine
• speed up the impulses at the
  neuromuscular junction (snapse)
• Parasympathomimetic:(produces similar
  effect of stimulating parasympathetic)
     GI motility
     Contraction of skeletal muscles
     Relieves muscle weakness by blocking
      acetylcholine breakdown at the synapse

3/30/2011                                      41
                   Cholinergic
• Drugs:
     Mestinon (pyridostigmine)
     Prostigmin (Neostigmine)
      (used to treat postop ileus, bladder distention
      and myasthenia gravis)
     Tensilon (edrophonium)
         Used to diagnose myasthenia gravis
 Uses:
     Muscle relaxant antagonist
     Used to treat myasthenia gravis
3/30/2011                                           42
               Cholinergic
• Nursing Implications:
    Monitor therapeutic response
     (including muscle strength, hand grasp,
     gait, absence of labored breathing)
    Does not cure the disease; just relieves
     symptoms.
    Must be taken on time to prevent
     weakness.
    Monitor vital signs and I&O Q8H
3/30/2011                                   43
                 Cholinergic
 Nursing Implications:
    Side effects to Watch for:
        Bradycardia
         Decreased B/P
         Bronchospasms
        Headache
        Dizziness
        Convulsions
        Respiratory depression

3/30/2011                         44
                Cholinergic
• Nursing Implication:
     D/C if toxicity occurs
     Administer medication AC (on empty stomach)
     Do not crush sustained release capsules
     Should wear a medic alert bracelet
     Do not administer sedatives or tranquilizers
      especially to patients with myasthenia gravis.
     Overdosage causes cholinergic crisis. (GI
      disturbances)
     Should avoid any medication that causes
      respiratory or cardiac depression
3/30/2011                                          45
                   Steroids
• Uses: (glucocorticosteroids)
    Treatment of cerebral edema caused by
     head injuries
        Decreases inflammation
    Treat of allergic reactions
    Treat of Collagen Diseases
    Decrease intensity and duration of acute
     exacerbations in multiple sclerosis and
     Bell’s palsy
3/30/2011                                  46
                  Steroids
• Drugs:
     Decadron (dexamethasone)
     Solu Medrol (methylprednisolone)
     Solu Cortef (hydrocortisone)
 Side effects:
     Fluid retention(wt gain) Sweating
     Tachycardia        Mood changes
     Flushing          Headache
     Nausea/vomiting/diarrhea/abd distention

3/30/2011                                       47
                   Steroids
• Nursing Implications:
     Weigh daily (monitor for weight gain)
     Monitor I&O (monitor for fluid retention)
     Monitor for signs of infection. (Medication
       mask infections)
     May cause potassium depletion
     Do not d/c abruptly; can cause adrenal crisis
     Monitor for abdominal pain, coffee ground
       emesis, bloody or tarry stools. (at risk for
       psychotic behavior, peptic ulcers, GI bleed and
       cataract formation)
     Must be stopped gradually.
3/30/2011                                            48
           Polio Vaccine
• TOPV- Sabin
  Uses: prevents polio
  Nursing Intervention:
    Only given PO
    Do not administer within 1 month of other
     live vaccines
    Provide written record of administration
There have been reported rare cases
   of polio occuring after receiving the
   live virus.
3/30/2011                                49
             Polio Vaccine
• Poliovirus Vaccine Inactivated (IPV)
  (Salk vaccine)
    Contains types 1,2,3 poliovirus
    Indicated over 18 years, if never been
     immunized
    Given SQ 1 ml (4 doses) first two doses
     1 month apart; then several months in
     between for the remaining doses.
    Uses: prevents polio
3/30/2011                                  50
             Polio Vaccine
• Nursing Implications: (IPV)
    Check for allergies
    Do not give if pregnant
 Side Effects: (TOPV/IPV)
    Arthralgia    Fever
    Skin rash      Headache
    Enlarged lymph glands
    Itching       Malaise
    Abdominal pain
3/30/2011                       51
    Skeletal Muscle Relaxant
• Drugs:
    –   Baclofen
    –   Diazepam (valium)
    –   Flexeril
    –   Robaxin
• Uses:
     Treatment of spasticity in multiple sclerosis,
      and spinal cord lesions.
     Decreases spasticity


3/30/2011                                              52
    Skeletal Muscle Relaxant
• Nursing Implications:
     Observe for drowsiness, dizziness, ataxia
     Monitor patient with history of seizures; lowers
      seizure threshold
     Lower dose maybe required in patients with
      renal impairment.
 Side effects: hyperglycemia
     Dizziness    Weakness        Headache Ataxia
     Drowsiness   Confusion       Insomnia
     Fatigue      Depression      Nasal congestion
3/30/2011                                           53
            Narcotic Analgesic
• Demerol (meperidine)
• Morphine
• Nursing implications:
    Monitor respirations:
    Do not administer if respirations <12
     min
    Check for allergies
 Uses: treat moderate to severe pain
  associated
3/30/2011                                    54
            Narcotic Analgesics
• Side effects:
    Slowed repirations
    Drowsiness
    Nausea/vomiting
    Addictive




3/30/2011                         55
                Antiviral
• Used in the management of herpes
  viral infections and chicken pox
• Inhibits viral replication (growth)
• Drug: acyclovir
• Nursing Implications:
    Monitor B/P and pulse during therapy
    Monitor I&O and daily weight
    Monitor for s/s CHF
3/30/2011                                   56
            Vascular Headache
               Suppressant
• Drug:
     Imitrex
     Cafergot
     Ergot
• Uses: migraine and cluster headaches
    – CNS stimulant for migraines
    – Promotes vasoconstriction of carotid arteries
• Side effects:
       Dizziness    Weakness Transient hypertension
       Anxiety      Malaise     Dysphagia
       Drowsiness   Alternation in vision
       Fatigue      Coronary vasospasm
       Flushing      Chest pressure


3/30/2011                                              57
            Vascular Headache
               Suppressant
• Nursing Implication:
    Should not be given within 2 weeks of
     receiving MAOI.
    Concurrent use of lithium or SSRI
     antidepressants can cause:
        weakness
        hyperreflexia
        Incoordination
    Should be used only during an acute
     migraine attack (not a preventative)
3/30/2011                                    58
            Vascular Headache
               Suppressant
• Nursing Interventions:
    Report symptoms:
        Dizziness
        Drowsiness
        Tingling
        Flushing
        Fatigue
        Feeling sick
     Avoid use of alcohol (aggrevates
     headache)

3/30/2011                                59
            Other Medications
• Adrenocorticotropic hormone:
  (ACTH)
    Used to treat an acute exacerbation of
     multiple sclerosis
    Administered intravenous (IV) as a drip
 Mannitol: Osmotic diuretic
    Used to treat cerebral edema and ICP
    Administered IVP

3/30/2011                                   60
            Other Medications
• Non narcotic: Toredol
     Anti inflammatory
     Used in combination with analgesics for pain
      control
     Do not exceed the max 24 hour dose.
     Side effects:
         Abnormal thinking   GI bleeding
         Dizziness           Diarrhea
         Euphoria             Dry mouth
         Headache             Dyspepsia
         Asthma               Nausea/vomiting
         dyspnea

3/30/2011                                            61
            Other Medications
• Antimicrobial: (antibiotics)
    – Used in the treatment of meningitis.
• Plasmaphoresis: used in the short
  term treatment of myasthenia
  gravis.
• Review Drug calculations



3/30/2011                                    62

				
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