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52 Cards in this Set
- Front
- Back
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What is the mechanism of action for centrally-acting muscle relaxants?
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act in the CNS, no direct action on muscle or neuromuscular junction
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What is the mechanism of action for centrally-acting spasmolytics?
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act in the CNS
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What is the mechanism of action for peripherally-acting spasmolytics?
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direct action on the skeletal muscle fibers
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What are the key pharmacotherapeutics for central muscle relaxants?
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acute musculoskeletal disorders
supportive for fibromyalgia and tentanus |
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What are the key pharmacotherapeutics for centrally-acting spasmolytics?
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CHRONIC musculoskeletal/neuropathic disorders
eg. MS, traumatic cord lesions, cerebral palsy, focal dystonic movements, Meige's syndrome, StiffMan syndrome |
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What are the key pharmacotherapeutics for peripherally-acting spasmolytics?
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Malignant hyperthermia
upper motor neuron disorders heat stroke rigors associated with amphotericin B spasticity from spinal cord and cerebral injuries |
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What are the adverse effects of centrally-acting muscle relaxants?
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Serious:arrthythmias, seizures, MI
dry mouth, blurred vision, fatigue, headache, confusion, nervousness |
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What are the adverse effects of centrally-acting spasmolytics?
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Serious: CNS depression, CV collapse, resp. failure, seizures
hypotension, constipation, increased urinary frequency, insomnia |
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What are the adverse effects of peripherally-acting spasmolytics? (normal administration)
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Serious: fatal hepatitis, seizures, plerual effusion w/ pericarditis
muscle weakness, drooling, slurred speech |
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What are the adverse effects of peripherally-acting spasmolytics? (IV administration)
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edema
itching thrombophlebitis redness |
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Teaching plan for centrally-acting muscle relaxants
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-assess degree of sedation
-self-help interventions -contact provider for severe headaches, confusion, hallucinations, sudden/increased weakness -no OTC drugs -don't stop abruptly |
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Teaching plan for centrally-acting spasmolytics
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-change positions slowly
-avoid alcohol -assess degree of sedation -contact provider for severe headache, confusion, hallucinations, sudden/increased weakness -never double the dose -diabetics should monitor blood glucose -never stop abruptly -teach aseptic technique if giving intrathecally |
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Teaching plan for peripherally-acting spasmolytics
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-photosensitivity
-assess degree of sedation -don't crush/chew extended release pills -signs/symptoms of hepatitis |
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What are the signs and symptoms of hepatitis?
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-jaundice in skin/eyes/palms/soles
-pain in upper right quadrant -bleeding/bruising -itching at surface from bilirubin -tired -anorexia |
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What are the monitoring guidelines for centrally-acting muscle relaxants?
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-Has synergistic effects when given with other CNS depressants
-Patient's safety -If taking prolonged, use a 1-2 week taper to discontinue |
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What are the monitoring guidelines for centrally-acting spasmolytics?
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-neurologic, cardiac function and muscle strength/spasticity
-patient's safety -labs: liver, renal, blood glucose -age (elderly) -synergistic effects -hallucinations/psychosis |
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What are the monitoring guidelines for peripheral spasmolytics?
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-Lactulose intolerance
-safety -alcohol consumption -elderly |
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What are the patient instructions for intrathecal baclofen?
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-Aseptic technique
-How to assess integrity of the cathetar and infusion system |
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What is the action of dopamine in movement?
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inhibition
sends info to parts of brain that control movement and coordination |
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What is the action of acetylcholine in movement?
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excitatory
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What neurotransmitter's neurons have degenerated in Parkinson's Disease?
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dopamine
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What is the mechanism of action for carbidopa-levodopa?
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crosses BBB, converted into dopamine
changes dopa-ach balance to improve nerve impulse control |
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What is the mechanism of action for dopamine agonists?
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selectively stimulate dopamine receptors to increase how much dopamine is available to the body
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What is the mechanism of action for anticholinergic drugs?
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decrease how much ACh is available to the body by blocking the receptors
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What are the adverse effects of dopaminergic drugs?
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bradykinetic episodes (on-off phenom)
orthostatic hypotension abnormal movements |
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What are the adverse effects of dopamine agonists?
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orthostatic hypotension
hallucinations psychic disturbances |
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What are the adverse effects of anticholinergic drugs?
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can't see, pee, spit, sh*t
anti-cholinergic overdose |
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What are the adverse effects of COMT inhibitors?
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dyskinesia
nausea increased daytime sleepiness dystonia orthostatic hypotension hallucinations |
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What is the mechanism of action for COMT inhibitors?
eg. Tolcapone (Tasmar) |
inhibits the enzyme that degrades dopamine in the periphery of the body
more dopamine is available |
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What are the key monitoring tests for dopaminergic drugs?
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recent use of MAOI's
current signs/symp of Parkinsons (to watch for progression) improvement in ADLs decreased muscle rigidity and tremors blood pressure |
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What is the anticipated outcome for patients receiving riluzole?
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slows progression of ALS by delaying loss of muscle and limb function for several months
only delays time before endotracheotomy |
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What are the adverse effects of riluzole?
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resemble progression of ALS
neutropenia, hepatotoxicty hypertension worsening of spasticity tachy weight loss ab pain athralgia |
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What is the role of nursing during a seizure?
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Keep patient safe: get anything out of way, protect head by putting pillow or blanket underneath
Leave them alone!! |
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What are the key pharmacotherapeutics for phenytoin (Dilantin)?
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generalized and psychomotor seizures
seizures after neurosurgery status epilepticus |
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What are the key pharmacotherapeutics for carbamazepine (Tegretol)?
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partial seizures with complex symptomatology
generalized tonic-clonic seizures mixed seizures |
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What are the key pharmacotherapeutics for valproic acid?
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absence seizures
tonic-clonic seizures myoclonic seizures partial seizures mania migranes |
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What are the key pharmacotherapeutics for phenobarbital?
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generalized tonic-clonic seizures
status epilepticus preanesthesia induce sleep |
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What are the key adverse effects of phenytoin (Dilantin)?
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Stevens-Johnson syndrome
gingival hyperplasia nystagmus |
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What are the key adverse effects of carbamazepine (Tegretol)?
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potentially fatal blood dyscrasias
aplastic anemia agranulocytosis thrombocytopenia hepatitis |
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What are the key adverse effects of valproic acid?
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elevated ammonia levels
platelet disorders pancreatitis liver toxicity GI problems tremors weight gain |
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What are the key lab tests for phenytoin (Dilantin)?
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serum phenytoin
albumin protein blood work |
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What are the key lab tests for carbamazepine (Tegretol)?
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serum peak and trough levels
CBC liver function |
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What are the key lab tests for valproic acid?
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serum concentration
liver function |
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What are the key lab tests for phenobarbital?
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serum concentration
liver hepatic |
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How do you know if someone is having an overdose or a seizure of primidone (Mysoline)?
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OD-check drug level
seizure-check phenobarbital level, because this drug is a precursor) |
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What are AEDs that are also used for mental health?
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carbamazepine (Tegretol)
valproic acid gabapentin (Neurontin) BZOs |
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What are therapeutic uses of CNS stimulants?
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narcolepsy, ADHD, anorectic adjunct therapy in obesity
obesity neonatal apnea asthma drowsy/fatigue migranes post-anesthesia respiratory depression |
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What are the contraindications of dextroamphetamine?
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advanced arteriosclerosis
symptomatic CV disease moderate to severe hypertension hyperthyroidism known hypersensitivity glaucoma history of drug abuse |
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What are the contraindications of sibutramine?
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CNS appetite suppressing drugs
anorexia and bulimia untreated/poorly controlled hypertension severe hepatic disease/renal impairment MAOIs organic causes of obesity closed angle glaucoma seizures choleithiasis |
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What are the contraindications of caffeine?
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Anxiety and panic disorder
insomnia seizures cardiac disease, angina, hypertension, cardiac dys diabetes mellitus, hyperthyroidism, peptic ulcer hepatic disease/impairment |
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What are the adverse effects of dextroamphetamine?
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sudden death
stroke MI hearing voices, suspicious for no reason, manic CNS stimulant effects elevated blood glucose occular irritation, mydriasis itching inability to ejaculate/decreased libido |
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What would you monitor in a child who is taking dexoamphetamine?
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growth, because the drug can suppress it
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