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- Enhances cognition - slows progression
- Does not cure
- Lab
• LFT, BUN/creatinine
- Contraindications
• NSAID use, CDV (relative), seizures
• Adverse effects:
- H/A, depression, fatigue, afib, HTN or Hypotension, vasodilation, wt. gain/loss, bruising, bradycardia
• Interactions:
- Bethanechol- incr. cholinergic effects
- NSAIDs - incr. bleeding • Adverse effects
- Less motor side effects then First generation (TD, akathisia, NMS)
- Agranulocytosis
• Potentially lethal- strict monitoring of WBC's
- Most common
• Drowsiness, sedation, hypotension, hypersalivation, tachycardia, dizziness, weight gain
Agranulocytosis
• WBC count < 2000
• Signs of infection
- Low grade fever, malaise, sore throat
• Treatment
- Stop antipsychotic medication
- Protective isolation • Expected effects
- Fine hand tremors, polyuria, mild thirst, mild nausea, general discomfort, weight gain. drowsiness, dizziness, headache.
• Dehydration Raises lithium level
• Contraindications
- Diuretics
- Cardiovascular disease, pregnancy, brain damage, renal or thyroid disease
• Complete baseline PE, labs including renal function, LFT, EKG. • Aged cheeses
- Cheddar, blue, Swiss
- Dishes made with cheese-lasagna, pizza
• Aged or fermented meats, fish or poultry
- Caviar, chicken or beef pate', bouillon
• Brewer's yeast, peanuts, MSG
• Fava beans, tofu, banana peel, over ripe fruit, avocado sauerkraut, or soybeans
• Red Wines
- Burgundy, sherry, vermouth
• Smoked or pickled meats, fish or poultry
- Herring, sausage, corned beef, salami, • Adverse effects: hemolytic anemia, agranulocytosis, orthostatic/postural hypotension, palpitations, syncope, bradycardia, CNS changes, on-off phenomenon (Sinemet), uncontrolled body movements
• Interactions: Hydantoins-increases metabolism of Sinamet, Haldol-blocks absorption of dopamine, non-selective MAOI-hypertensive crisis
• Laboratory Indications: LFTs, CBC, Bun/Creatinine Interferon is a naturally occurring glycoprotein with antiviral, antiproliferative, and immunomodulatory actions.
Therapeutic use
-Reduces the frequency and severity of MS attacks
-Reduces the number and size of MRI-detectable lesions
-Delays progression of disability
Adverse Effects
-Seizures, depression, insomnia, neutropenia, anemia, TTP, flu like symptoms
Flu like symptoms generally subside over time-take acetaminophen for discomfort.
• Labs: CBC, LFTs, electrolytes
• Nursing: give dose afternoon or evening at the same time 48 hours apart
Rotate sites-use ice prior to injection to decrease discomfort, warm moist packs may reduce post injection irritation, may use antihistamine like benadryl if itching occurs at injection site
• Steroids to decrease inflammation • Mechanism of action: suppresses neuronal discharge
• Adverse effects:
- visual distrubance, ataxia, vertigo, H/A, fatigue
- Bone marrow suppression
- Teratogenic to fetus
- Water retention, urinary retention
- Hypertension or hypotension
- Jaundice
• Labs: LFTs, CBC, BUN/Creatinine, electrolytes, Tegretol levels (nml 4-12 mcg/ml)
• Drug interaction: inactivates oral birth control, reduces warfarin efficacy, grapefruit juice increases levels
• Nursing: check VS frequently, assess seizure activity/duration/timing, • Mechanism of Action: inhibition of Sodium channels; suppressing neuronal response (suppression of seizure)
• Adverse effects:
- Gingival hyperplasia
- Skin rash
- Hirsutism (excessive hair growth)
- Teratogenic in pregnancy
- Cardiovascular effects: hypotention, tachycardia
• Labs: LFTs, BUN/creatinine, Dilantin level 10-20 mcg/ml, glucose
• Nursing implications: Monitor VS, no abrupt withdrawal, with meals, take at same time each day, no ETOH, oral hygiene, not with antacids, reduce effectiveness of oral birth control pills
• Dilantin toxicity-ataxia, nystagmus, diplopia, sedation, cognitive impairment
• Special IV administration: mix only with NS, will be slightly yellow in color, should be no sediment in solution • Mechanism of action: suppression of seizure through sodium channels
• Adverse effects
- GI effects
- Hepatotoxicity: liver failure
- Pancreatitis
- Teratogenic effects
- Leukopenia, thrombocytopenia, peripheral edema
- Sedation
- Pancreatitis
- Tremor
- alopecia
• Lab: LFT, CBC, electrolytes, glucose
• Nursing considerations: give at bedtime if possible, give with food, sprinkles may be put in pudding, etc, do not chew, no abrupt withdrawal, avoid ETOH,
• Dosing: if missed take within 6 hours of next scheduled dose then space out remaining doses • Mechanism of action: unknown, effects GABA
• Adverse effects: fatigue, somnulence, dizziness, ataxia, nystagmus, peripheral edema, confusion, hypertension, leukopenia
• Lab: BUN/creatinine, CBC
• Nursing implications: monitor VS, cautious use with antacids( > 2 hours apart), avoid ETOH, avoid abrupt discontinuation
• Also used for PVD pain 