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Module D

Terms in this set (32)

Ergotamine
ergot derivative anti-migraine drug

work by narrowing or constricting blood vessels in the brain

not used as commonly as triptans

tablet form Ergotamine tartrate with caffeine (Cafergot)
Adverse effects
Sudden numbness or weakness, especially on one side of the body
Muscle pain in arms/legs
Leg weakness
Tachycardia or bradycardia
Cyanosis of the fingers or toes
Headache
Confusion
Problems w vision and speech
Phenytoin (Dilantin)
anti-epileptic drug AED
"anti-convulsant"

"narrow spectrum"

Indications:
Used to control and prevent seizures
Maintain reasonable quality of life
Also used to minimize AE and drug-induced toxicity
Administration
10-20 mcg/mL

Slow IV push (50mg/min adults)
Normal saline only
Very caustic (corrodes live tissue)

Highly protein bound = low albumin levels results in increased blood levels; occurs in malnourishment and renal failure

Long half-life (missed dose typically does not cause seizure)

Monitor for AE, especially suicidal thoughts/ideation
S/S of toxicity: nystagmus, ataxia, dysarthria, ecnephalopathy

Safer admin w Fosphenytoin IV 150 mg PE/min
Patient teaching
AED therapy is usually life-long

Long-term therapy may cause gingival hyperplasia (excessive gum tissue growth), acne, hirsutism, and Dilantin facies

Requires great dental care! Recommended dentist visit every 3 months instead of 6

Numerous AE; may need a change in medication

Do not abruptly DC! Taper off. Can cause severe withdrawal seizures
(Levetiracetam) Keppra
anti-epileptic drug AED
"anti-convulsant"
Used to treat and prevent seizures

"broad spectrum"
Administration
Available PO and IV
Narrow therapeutic dug level
12-46 mcg/mL


Check liver and renal function prior to admin!

No drug interactions!
Patient teaching
May cause "neuropsychiatric changes" ie. agitation, depression, anxiety, behavior changes
Con't pt teaching for anti-epileptics
§ Lowest dose to prevent seizures and decrease side effects
§ Taking meds on time/all the time is key to seizure free medication; consistent drugs levels are important!
§Take with full glass of water or a bit of food to decrease nausea sx
§ Sedating effects
§ Suicidal thoughts
§ No alcohol or caffeine
§ Nausea/GI s/s is common
§ No sudden stopping - rebound seizures!
§Medical Alert bracelet and daily journal
Levodopa-carbidopa (Simenet)
anti-Parkinson's drugs
Dopamine replacement

Most common monotherapy, although often combined w other meds

Indications:
Parkinson disease treatment
Drug of choice for later stages
Goals of therapy
§ Reduce bradykinesia (slow movement)
§ Reduce tremor/rigidity
§ Enhance ability to carry out ADL's (varies based on the stage of the patient's disease)
§ Minimize side effects, including involuntary movements
Adverse effects
"On-off" works well then suddenly stops being effective

Dysrhythmias
Hypotension
Chorea
Muscle cramps
GI distress; best to admin with empty stomach, away from high protein meal (30 mins prior or 1 hr after)

Can activate malignant melanoma! Assess skin and refer to derm if needed
Toxicity
...
Anticholinergics
anti-Parkinson's drugs
Blocks acetylcholine/cholinergic effects
Anti-tremor properties

Indications:
Parkinson's disease
Goals of therapy
decrease tremors

§ Reduce tremor/rigidity
§ Enhance ability to carry out ADL's (varies based on the stage of the patient's disease)
§ Minimize side effects, including involuntary movements
Adverse effects
Confusion
Urinary retention
Visual blurring
Palpitations
Increased intra-ocular pressure
Toxicity
...
Benzodiazepines
anti-anxiety meds

"-pam"
Valium (Diazepam), Lorazepam

Indications:
Acute anxiety (anxiety attack, panic)
Also insomnia, muscle spasms, seizures, ETOH withdrawal, sedation for procedures
Adverse effects
CNS depression
Hypotension
Habit-forming
Increased risk for falls w elderly
"Hang-over" effect
Paradoxical effect, especially w elderly (increased anxiety and s/s)

Tolerance can develop
Dependence can develop after only 2-4 weeks; high potential for abuse

Hypotension and respiratory/cardiac arrest w IV admin

OD: confusion, hypotension, depressed reflexes, coma, somnolence
Antidote for Valium (Diazepam) is Flumazenil (Romazicon)
SSRIs (selective serotonin reuptake inhibitors)
anti-depressant medication
Second generation antidepressant

Increase levels of neurotransmitter serotonin
Adverse effects
Initial AE usually stop after 2-3 weeks:
Nausea
Diaphoresis
Tremor
Fatigue
Drowsiness

Additional AE:
Insomnia
Weight gain
Bruxism (teeth grinding)
Sexual dysfunction (anorgasmia)
Withdrawal syndrome
Serotonin syndrome!
Serotonin syndrome
§ Can occur after ingestion of one pill
§ Rapid onset of tremors
§ Restlessness
§ Shivering
§ Diaphoresis
§ Diarrhea

§ Later - myoclonus, ocular clonus, muscle rigidity, tachycardia, pyrexia, AMS, coma

§Renal failure due to rhabdomyolysis
Interactions
...
Patient teaching
Anti-depressant are not considered "first line therapy" for depression. Psychotherapy is also important

May take 6-8 weeks for therapeutic effects to begin

Initial AE will go away after 2-3 weeks

Many patient have issues with adherence due to various undesirable side effects

Will be tapered off towards end of treatment
MOAIs (monoamine oxidase inhibitors)
anti-depressant medications
First generation antidepressants

inhibit MAO enzyme to prevent breakdown of dopamine, serotonin, and norepinephrine

Not used as often for depression tx (common w Parkinson's tx)
Adverse effects
Danger - Can cause a hypertensive crisis! Do not combine w tyramine containing foods
Interactions
Lots of drug interactions!
OTC cough and cold medications
SSRIs, increased risk of serotonin syndrome
Sympathomimetic drugs
Patient teaching
Do not take w tyramine containing foods such as aged cheeses, red wine, avocado, smoked sausage, etc.
Can cause hypertensive crisis

Consult with doctor/physician before taking with another medication due to high interaction potential
Zolpidem (Ambien)
anti-insomnia medication

Non-benzodiazepine; less risk for dependence/tolerance, may still occur
Adverse effects
Watch for sleep walking!
Daytime drowsiness

Weakness, light-headed
Headache
Loss of coordination
"Drugged" feeling
Dry mouth
Sore throat
Nausea
Nasal irritation, stuffy nose
Constipation, diarrhea
Administration
Max:
5mg for women
5-10mg for men

Take at bedtime with no food
Do not crush or chew

Short half-life = less daytime sleepiness
Patient teaching
Safe environment!
Make sure you have someone around when you start taking the medication for safety purposes

Take at bedtime with no food
Taking too late at night could cause daytime sleepiness

Do not take when you didn't get a full night's sleep the night before
Avoid tasks requiring mental alertness until drug response is known

Do not abruptly DC, should wean off
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