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28 Cards in this Set

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Epilepsy

- Disorder of recurrent seizures


- Anticonvulsants prevent and control most epileptic seizures


- Goal of drug therapy is to reduce seizure activity with lowest level of drug


- Start 1 at a time, slowly increase dose, may need multiple drugs

Seizures

Disorganized, rapid-firing, electrical activity


Generalized seizures - produced by the entire brain


1. Grand Mal - unconsciousness, convulsions, muscle rigidity


2. Absence - Brief loss of consciousness


3. Myoclonic - Sporadic (isolated), jerking movements


4. Clonic - Repetitive, jerking movements


5. Tonic - Muscle stiffness, rigidity


6. Atonic - Loss of muscle tone

Generalized Seizures: First Line Generations

Mechanism of Action: Generally unknown


Cause a decrease in voltage, frequency, and spread of electrical impulses


Side Effects: ataxia, dizziness, drowsiness, loss of coordination


Adverse Effects: Bleeding


Examples: Dilantin (phenytoin), Tegretol (carbamepine), Depakote (valproic acid)


Note: Can't stop abruptly, no alcohol consumption

Anticonvulsants: First Line Specifics


Phenytoin (Dilantin)

- Narrow therapeutic index, teratogenic


Side Effects: hyperplasia of gums, diplopia, hypotension


Adverse Effect: Neutropenia, aplastic anemia (Low WBCs and RBCs)


Interactions: Increase Effects of anticoagulants, decrease absorption with antacids

Anticonvulsants: First Line Specifics


Carbamazepine

- Used for bipolar disorder and alcohol withdrawal


Adverse Effects: Neutropenia, thrombocytopenia (low platelets)


No grapefruit juice - causes increased levels of the drug

Anticonvulsants: First Line Specifics


Valproic Acid (Depakote)

Mechanism of Action: attributed to increased GABA (calming effect)


Adverse Effects: hepatotoxicity, pancreatitis

Anticonvulsants: First Line for Absence Seizures

Mechanism of Action: Depresses motor cortex and increases the CNS threshold to stimuli


Side Effects: GI (anorexia, n/v), sensitivity to light, drowsiness


Adverse Effects: Pancytopenia (Low blood cells)


Example: Zarontin (ethosuximide)


Note: Also use valproic acid (Depakote) for absence seizures

Anticonvulsants: Second Line: Benzodiazepines

Mechanism of Action: Potentiate GABA, generally useful for all seizures


Side Effects: ataxia, GI distress, sedation


Adverse Effects: Severe CNS depression


Examples: clonazepam, diazepam, lorazepam (Ativan)


Note: Do not stop abruptly, Antagonist: Romazicon (for when patient stops breathing - risk they will start seizing again)

Anticonvulsants: Second Line: Barbiturates

Mechanism of Action: Nonspecific CNS depressant. Potentiates GABA. Useful for all seizures.


Side Effects: Sedation, GI distress, drowsiness


Adverse Effects: Respiratory depression


Examples: phenobarbitol


Note: May cause physical dependence

Antidepressants

Tricyclic (TCA), SSRIs, Atypical, MAOIs


Take 2-8 weeks to work

Antidepressants: Tricyclic (TCAs)

Mechanism of Action: Inhibit reuptake of NE, dopamine, and serotonin


Side Effects: Sedation, blurry vision, dry mouth


Adverse Effects: Arrythmias


Example: Elavil (amitriptyline)


Note: Effective but sedating - give at bedtime

Antidepressants: SSRIs

Mechanism of Action: Prevent serotonin reuptake, thus increasing the amount of serotonin


Side Effects: Insomnia, GI, tremors, decreased sexual activity


Adverse Effects: Serotonin Syndrome --> toxicity


Examples: Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram)


Note: Most commonly prescribed

Antidepressants: Atypical

Mechanism of Action: Unique, work differently by changing dopamine, NE, serotonin


Side Effects: Dizziness, headaches


Adverse Effects: Seizures


Examples: Bupropion (Wellbutrin), trazadone (Desyrel), venlafaxine (Effexor)


Note: Wellbutrin may be marketed as Zyban for smoking cessation

Antidepressants: Monoamine Oxidase Inhibitors (MAOIs)

Mechanism of Action: Inhibit monoamine oxidase (MAO) from removing NE, serotonin, and dopamine from the brain


Side Effects: Multiple


Adverse Effects: food and drug interactions


Examples: Parnate, Nardil


Note: diet restrictions, HTN results when mixed with certain foods, avoid food high in tyramine (processed meat, aged cheese, red wine, pickled foods)

Nursing Process for Antidepressants

Obtain med/drug history


Monitor drug levels


Monitor client's response


Educate and monitor for side effects


Pediatric: May increase risk for suicidal thoughts, may suppress growth (Effexor)


Pregnancy considerations: Category C or D

Antianxiety/Anxiolytics

Benzodiazepines


-zepam -alprazolam



SSRIs and venlafaxine (Effexor)


-Milder side effects

Antipsychotics: Generalized Therapy

Mechanism of Action: Block Dopamine receptors. Impulse transmission decreases. CNS relaxes.


Side effects: Many. Sedation, agitation, tremors, blurry vision


Adverse effects: Multiple on CNS, ANS, and cardiac. Tardive dyskinesia, Neuroleptic Malignant Syndrome

What to monitor for in antipsychotics

Extrapyramidal symptoms (EPS)


- Tardive dyskinesia (TD) - tongue rolling/protrusion, sucking/smacking of lips, abnormal facial or body movement


- More common in long term use


Neuroleptic Malignant Syndrome


- Rare dysfunction of autonomic nervous system


- Increase in HR and RR, high fever 105-106

Antipsychotics: Mood Stabilizers

Mechanism of Action: Alters NE and serotonin synthesis, used for bipolar


Side Effects: Dizzinesss, sedation, headache


Adverse Effects: Toxicity, Increase in reflexes, HR, HTN, Decreased LOC


Examples: Lithium, Abilify


Note: Teratogenic, Narrow therapeutic window, Maintain hydration, avoid alcohol

Parkinsonism

Signs and symptoms, not disease itself


Tremors, slow movement


-Imbalance of dopamine and acetylcholine


For therapy:


-Acetylcholine needs to be blocked, more dopamine is needed


Focus on parasympathetic nervous system

Parkinsonism medications

Anticholinergics


Dopaminergics


- levadopa


- carbidopa-levadopa


Dopamine Agonists


- amantadine


MAO-B inhibitor


- selegiline


COMT inhibitor


- entacapone

Parkinsonism: Dopaminergics: Levodopa

- Most effective

- Can cross the blood-brain barrier


- Short half-life


- Need to take the drug 3-4 times a day


Side effects: dyskinesia, orthostatic hypotension, cardiac dysrhythmias, and psychosis

Parkinsonism: Domaminergics: Carbidopa - Levodopa

2 medications in 1


Allows more conversion of dopamine


1:10 ratio 1 part carbidopa to 10 parts levodopa


Side effects: dystonic movement (involuntary abnormal movement), and psychotic behavior



Parkinsonism: Dopamine Agonists: Amantadine

Given in early treatment, delays the need for levodopa


Effective in drug-induced parkinsinism also, with fewer side effects than anticholinergics

Parkinsonism: Dopamine Agonists: Bromocriptine

Used in early treatment for Parkinsinism


Can be given with levodopa therapy


Side effect: amnesia



Parkinsonism: MAO-B inhibitor: Selegiline

Inhibits the catabolic enzymes of dopamine


It Increases the action of dopamine


Given in the early phase of Parkinson's disease


When used less levodopa is needed


Side effects: confusion, dry mouth

Parkinsonism: COMT inhibitor: Entacapone

Inhibits the COMT enzyme


the concentration of levodopa is increased


Used in combination with levodopa-carbidopa


When used less levodopa is needed


Side Effects: dyskinesia, dystonia, headache

Alzheimer's Agents

Thought to be the result of deficient Ach


Medication therapy aimed at preventing breakdown of Ach in CNS


Palliative, not curative


Acetylcholinesterase (AChE) Inhibitors


Prevent the breakdown of Ach


Mild: Aricept, Exelon


Mild/Moderate: Namenda


Side Effects: Increased parasympathetic action