Pharm Neuro

Neurological Medications

Heather Miller, MSN, RN

• Explain the expected therapeutic effects of neurological medications. 

• Summarize the pharmacological action of neurological medications. 

• Monitor for common adverse effects of neurological medications. 

• Apply the concepts of safe medication administration and dosage calculation when administering neurological medications. 

• ​Reinforce client education regarding neurological medication prescriptions.

• Determine if the neurological medication is appropriate for the client.

• Monitor for potential interactions that can cause adverse or life-threatening effects when administering neurological medications. 

Objectives

• Neurotransmitters – released by ANS

  • Epinephrine

  • Norepinephrine

  • Acetylcholine

  • Dopamine

• Agonist vs Antagonist

Neurologic System

• Baclofen - treats painful muscle spasms by suppressing hyperactive reflexes

  • Drowsiness, constipation, urinary retention, withdrawal

  • Hydrate/increase fiber, safety with activity

  • Take with food; change positions slowly

  • MAOIs cause hypertensive crisis

Muscle Relaxant

• Phenytoin - decreases neuronal activity of seizure-generating cells in brain

  • Gingival hyperplasia, skin rash, seizure

  • Take with meals, monitor plasma levels (10-20 mcg/mL); toxicity

  • Blood draws, dental checkups, safety with activity

  • Decreases oral contraceptive efficacy; caution with ETOH, liver & kidney disease (toxicity)

Anticonvulsants

• Carbamazepine - partial seizures, tonic-clonic

  • visual disturbance, neuro, bone marrow suppression, skin rash

  • Lowest dose; monitor CBC & skin; protect from sun; with food

  • Sunscreen; report decreased urination, edema, SOB

  • Teratogenic; avoid grapefruit juice; decrease oral contraceptive efficacy

• Valproic Acid - all seizures

  • GI upset, bruising, bleeding, prolonged bleed time, decreased platelets

  • Monitor labs, unusual bruises or prolonged bleed

  • Teratogenic; caution with liver & kidney disease

• Gabapentin - treats seizures, migraines, neuralgia/nerve pain

  • CNS - somnolence, ataxia, HA, fatigue, drowsy

  • Withdrawal if stopped abruptly

  • ETOH & other CNS depressants increase drowsiness and respiratory problems

  • Caution with COPD, mental health/substance abuse

Open Ended

A client is prescribed phenytoin for a recurrent convulsive disorder. The nurse teaches the client that the common adverse reactions are ________.

Open Ended

List 3 pieces of information to provide a client regarding taking carbemazepine for tonic-clonic seizures.

​Supporting Anesthesia

• Lidocaine - local anesthetic (skin, mouth, rectal); adjunct with regional anesthesia

  • CNS stimulation (restless, confusion, convulsion) --> CNS depression (drowsiness); hypotension (spinal)

  • Monitor VS

  • Interacts with beta blockers

​ADHD

• Amphetamine/Dextroamphetamine

  • increases norepi & dopamine = more alert & energy

  • decreases impulsivity

• Insomnia, HTN, tachycardia, palpitations

• Take during day; monitor height & weight, BP and pulse

• Not for hypertensive, hyperthyroid, med misuse

• No MAOIs or Vitamin C

​ADHD

• Methylphenidate

  • increases norepi & dopamine = more alert & energy

  • decreases impulsivity

• Insomnia, HTN, tachycardia, weight loss, suppressed growth

• Take during day; monitor height & weight, BP and pulse

• Not for hypertensive, hyperthyroid, med misuse; caffeine

• No MAOIs or stimulants

Poll

When administering an amphetamine (methylphenidate), the nurse first checks to see if the client is taking or has taken a monoamine oxidase inhibitor (MAOI) because __________.

• a lower dosage of the amphetamine may be needed

• a higher dosage of the amphetamine may be needed

• the amphetamine can be substituted as the antidepressant drug

• the amphetamine is not given within 14 days of the MAOI

Multiple Choice

A nurse is reinforcing teaching with a parent of a child who has attention-deficit/hyperactivity disorder (ADHD) and is prescribed methylphenidate. Which statement by the parent indicates a need for further teaching?

• “I will give the medication early in the day to help prevent trouble sleeping.”

• “I’ll make sure my child avoids drinking coffee, tea, or energy drinks.”

• “I can give my child chocolate milk with the morning dose to help it go down easier.”

• “I will monitor my child’s weight regularly while taking this medication.”

Dopamine Replacement

• Levodopa/Carbidopa - replaces dopamine in neurons; relieves Parkinson's s/s

  • Nausea, vomiting, dark sweat or urine, dyskinesias, orthostatic hypotension

  • Safety d/t hypotension - change positions slowly; low dose

  • Avoid high-protein foods and MAOIs

  • No with angle-closure glaucoma, psychosis

Dopamine Receptor Agonist

• Pramipexole - acts as natural dopamine

  • Nausea, vomiting, muscle weakness, dyskinesias, orthostatic hypotension

  • Safety d/t hypotension - change positions slowly; low dose

  • Take with food; report abnormal movements

  • Caution with major psychosis, renal dysfunction, & older

Multiple Choice

Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse reactions to the medication. Which of the following indicates that the client is experiencing an adverse reaction?

• Pruritis

• Tachycardia

• Impaired voluntary movements

• Hypertension

Cholinesterase Inhibitor

• Donepezil - stops inactivation of acetylcholine = improved cognitive function

  • Nausea, insomnia, dizziness, bradycardia, syncope

  • Safety & assistance

  • Take with food at HS; report severe diarrhea & wt loss

  • Avoid NSAIDs

NMDA Antagonist

• Memantine - blocks glutamate to decrease Ca+ influx = restores normal nerve transmission, slows progression & improves function

  • Dizziness, headache, constipation

  • Safety, increase fiber or take laxative

  • With or without food; monitor nutritional intake

  • Caution with liver & renal disorder (decreased metabolism & excretion)

  • No antacids or meds increasing urine pH

Multiple Choice

The nurse administered donepezil (Aricept) to a patient. Which finding indicates that the medication is therapeutic?

• Relaxation

• Alert

• Increased cognition

• Increased urination

Beta Adrenergic Blocker

• Timolol - decreases IOP -> aqueous humor production

  • Tingle, burning; systemic - heart, lungs

  • Take pulse before administering

  • Admin techniques

  • No heart or lung conditions

  • No beta blockers or calcium channel blockers

Cholinergic Agonist

• Pilocarpine - decreases IOP; increases acetylcholine available = constricts pupils, enhances aqueous humor drainage

  • Decreased visual acuity - blurred, limited distance & night vision

  • Stimulates muscarinic receptors/antagonizes effects of anticholinergics

  • Retinal detachment

  • Caution with chronic respiratory disorder & hypertension

Dropdown

A nurse is reviewing the medical history of a client who has glaucoma and a new prescription for timolol ophthalmic drops. Which of the following conditions should the nurse identify as a contraindication to this medication?​

Select answer

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Select answer