47 terms

CNS Stimulants, Antiepileptics

CNS Stimulant Uses
ADHD, Antimigraine
ADHD Medications
Methylphenidate (synthetic)
Automoxetine (strattera)
-promotes release of norepinephrine and dopamine
-Partially habit reuptake of both neurotransmitters
Concerta, Ritalin
-Synthetic amphetamine derivative
-similar action as above
-Norepinephrine Reuptake Inhibitor
-Non Stimulant Drug
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.
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
-Valproic Acid
Newer Antiepileptic drugs (AED's)
-Lamotrigine (Lamictal)
-Levetiracetam (keppra)
-Pregabalin (Lyrica)
-Topiramate (topamax)
Not As Common Newer AED's
-Zonisamide (Zonegran)
-Lacosamide (Vimpat)
The Barbituates
The Hydantoins
The Iminostilbenes
-Carbamazepine (tegertol)
-Oxcarbazepine (Trileptal)
The Valproic Acid
-Mechanism of Action
-Route & Dose
-Theraputic levels
-Side Effects
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)
-Mechanism of action
-Route & Dose
-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)
-mechanism of action
-route & dose
-Therapeutic levels
Carbamazepine (tegretol)
-Side Effects
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)
-mechanism of action
-route & dose
-Side Effects
Valproic Acid (depakene, depakote, depacon)
-Route & Dose
urea cycle disorder
-disorder processing amonia
Valproic Acid
-Side Effects
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)
-Mechanism of action
-Route & Dose
-Side Effects
Status Epilepticus:
-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.