CNS Stimulants, Antiepileptics

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Pharmacology

CNS Stimulant Uses

ADHD, Antimigraine

ADHD Medications

Amphetamines
Methylphenidate (synthetic)
Automoxetine (strattera)

Amphetamines

Adderall
-promotes release of norepinephrine and dopamine
-Partially habit reuptake of both neurotransmitters

Methylphenidate

Concerta, Ritalin
-Synthetic amphetamine derivative
-similar action as above

Atomoxetine

Strattera
-Norepinephrine Reuptake Inhibitor
-Non Stimulant Drug
-Nonadditive

ADHD Medication Contraindications

-Known drug allergy
-Previous conditions
(anxiety, agitation, tourette syndrome, glaucoma)
-MAOI's (Monoamine oxidase inhibitor)
*15 day break between MAOIs and ADHD Drugs.

ADHD Medication Adverse Effects

side effects are dose related
-Increased HR & BP
-Angina, Anxiety, Insomnia, Headache, tremor, blurred vision, increased metabolic rate, GI distress, dry mouth

Adverse Effects of Atomoxetine

Lower incidence of insomnia and lower abuse potential
- May cause suicidal thinking and behavior

ADHD interatctions

Many! But be aware of other drugs that effect BP, HR, dysrhythmias, anxiety, and insomnia

CNS Stimulant Antimigraine Medications

All meds ending in "triptan"

How Antimigraine medications work

Serotonin Agonists
-Stimulates serotonin receptors in the brain
--causes vasoconstriction
--reduces production of inflammatory neuropeptides

Abortive therapy

Taken once a migraine starts and is not used to preventative medication

Antimigraine Med contraindications

-Serious Cardiovascular Disease
-Use with other Triptans or Ergot Alkaoids

Antimigraine medications adverse effects

-Coronary Vasospasm (coronary arteries spasm and can close)
-Tingling, flushing, congestion feeling in head or chest.
-Malaise, Fatigue
-Pregnancy category C.

What is a seizure?

A brief episode of excessive excitability of neurons in the CNS.

Epilepsy

Chronic, recurrent pattern of seizures

Status Epilepticus

Multiple seizures happen without enough time in-between for the brain to recover.

Goals of Antiepileptic drug therapy

-To control or prevent seizures while maintaining reasonable quality of life.
-To minimize adverse effects and drug induced toxicity

Antiepileptic Drug Nursing Need to knows

-Start low and go slow
-Never abruptly stop medications
--Withdrawal Symptoms

How Antiepileptic Drugs Work

-Reduce nerve's ability to be stimulated
--by singling out the problem nerve
-Suppress transmission of impulses from one nerve to the next
-decrease speed of nerve impulse conduction within a neuron

Traditional Antiepileptic drugs

-Barbituates
-Hydantoins
-Iminostilbenes
-Valproic Acid

Newer Antiepileptic drugs (AED's)

-Gabapentin
-Lamotrigine (Lamictal)
-Levetiracetam (keppra)
-Pregabalin (Lyrica)
-Topiramate (topamax)
Not As Common Newer AED's
-Zonisamide (Zonegran)
-Lacosamide (Vimpat)

The Barbituates

-Phenobarbital
-Primidone

The Hydantoins

-Phenytoin
-Fosphenytoin

The Iminostilbenes

-Carbamazepine (tegertol)
-Oxcarbazepine (Trileptal)

The Valproic Acid

-Depakene
-Depakote

Phenobarbital
-Use
-Mechanism of Action
-Route & Dose
-Contraindications
-Theraputic levels

Phenobarbital
-Side Effects
-Interactions

Phenobarbital monitoring & patient education

-Rarely used in the US for seizure control
-Avoid Hazardous activities ; Driving
-Assess patient's age
--peds vs. elderly
-Red flags: when to call MD

Phenytoin (dilantin)
-Use
-Mechanism of action
-Route & Dose
-Contraindications
-Therapeutic Levels

Phenytoin (dilantin)
-Side Effects
-Long Term Effects
-Toxic Levels

Phenytoin (dilantin)
-Drug interactions

-Highly protein bound - more risk of toxicity (ask anna about)
---Problem-low albumin levels (ask anna about)
-Induces P-450 enzymes
-Decreases the effecrs of oral BC, Warfarin, glucocorticoids
-Increases levels of diazepam, isoniazid, cimetidine, alcohol and valproic acid.

Phenytoin (dilantin)
-Teaching and monitoring

-CBC monitors drug level closely for the first year
-Gingival Hyperplasia

Gingival Hyperplasia
-how to prevent

swelling of the gums
-Good Oral Care: Brushing, flossing, massaging gums
-Frequent dental appointments

Carbamazepine (tegretol)
-use
-mechanism of action
-route & dose
-Contraindications
-Therapeutic levels

Carbamazepine (tegretol)
-Side Effects
-Warning
-Interactions

Carbamazine (tegretol)
-Monitoring & Teaching

-CBC baseline & throughout treatment
-Test baseline vision
-Administer with meals to minimize GI effects
-No grapefruit juice (increases drug levels leading to toxicity).

Oxcarbaepine (trileptal)
-Use
-mechanism of action
-route & dose
-contraindications
-Side Effects
-Other

Valproic Acid (depakene, depakote, depacon)
-Use
-Mechanism
-Route & Dose
-Contraindications

urea cycle disorder
-disorder processing amonia

Valproic Acid
-Side Effects
-Interations

Valproic Acid
-Teaching and monitoring

Assess baseline liver function & amylase levels
Teach to watch for signs of Pancreatitis & Hepatotoxicity
Anorexia, nausea, vomiting, abdominal pain, jaundice
Take medications with food to minimize GI symptoms

Ethosuximide (nursing info)

-Drug of choice used only for absence of seizures.
-Generally Devoid of significant adverse effects and interactions
-initially may cause drowsiness dizziness and lethargy

Gabapentin (neurontin)
-Use
-Mechanism of action
-Route & Dose
-Contraindications
-Side Effects
-Interactions

Status Epilepticus:
-Management
-Goals of treatment

-Continuous series of tonic clonic seizures
-Goals of threatment
--maintain ventilation
--correct hypepoglycemia
--Terminate seizures

Status Epilepticus:
How Seizures are terminated?
-what med and what route.

-IV benzodiazepanes (lorazepam, or diazepam)
*Side Effects- Apnea, Hypotension, somnolence
-Rectal Diazepam

Therapeutic Considerations with AED's

-Monitoring plasma drug levels
-Promoting patient adherence
-Withdrawing antiepileptic drugs
-Suicide Risk -antiepileeptic drugs

Nursing facts about AED's

Separate sheet.

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