Transcript Neurological Medications

Neurological Medications
 Review of central Nervous
System
 Description- Class
 Medications
 Side effects
 Implementation
Central Nervous System
 CNS- control center for the entire system, consists of
the brain and spinal cord. Concerned with regulation
and coordination of body activities
 Peripheral nervous system- contains the nerves
(afferent and efferent) which connect the CNS to all
other parts of the body. It is divided into the motor
nervous system which contains all the nerve fibers
that run between the CNS and skeletal muscles and
the Autonomic Nervous System which consists of all
the nerve fibers that run between the CNS and
smooth muscle, cardiac muscle, and glands. The ANS
produces a response only in involuntary muscles and
glands
Autonomic Nervous System
 Two divisions: (Involuntary)
 Sympathetic Nervous Systemconsists of ganglia and nerves that
supply the involuntary muscles
 Parasympathetic Nervous Systempromotes normal functioning of
digestion, urination, defecation, and
heart beats at normal resting state.
Adrenergic Drugs
 Mimic the activity of the sympathetic
nervous system.
 Used to treat hypotensive episodes,
bronchial asthma, cardiac arrest, heart
block, ventricular arrhythmias, allergic
reactions. Topically relieve nasal congestion
 Common adverse reactions include cardiac
arrhythmias, > B/P, and HA. Do not
produce slowed reaction to stimulus
 Dobutamine, Levophed (norepinephrine)
epinephrine, Triaminic
Adrenergic Drugs
 Adverse Reactions
cardiac arrhythmias such as
bradycardia and tachycardia, HA,
insomnia, nervousness, and increase
in blood pressure.
Management depends on drug used.
Adrenergic drugs are potentially
dangerous and great care must be
taken. Observe pt and report ASAP.
Adrenergic Blocking Agents
 Alpha-adrenergic blocking agentblock effects of alpha receptors
thereby inhibiting the normal
excitatory response of epi and norepi.
 Used to treat hypertension associated
with pheochromocytoma- a tumor of
the adrenal gland that produces
excess amounts of epi and norepi.
Beta-Adrenergic Blocking Agent
 Block beta receptors, resulting in a decrease in heart
rate. (Tenormin, Inderal)
 Used to treat hypertension, arrhythmias, angina
pectoris, and glaucoma.
 Adverse reactions include bradycardia, dizziness,
vertigo, and brochospasm
 Labetalol- used to treat hypertension. Only drug
considered alpha/beta adrenergic blocking. s/e include
Ha, fatigue, skin rash
 On initial dose of drug, take B/P and pulse in both
arms.
 If B/P significantly drops, withhold dose and contact
the physician
Antiadrenergic Agent
 Inhibit the release of norepinephrine
from certain nerve endings, they also
suppress the activity of the SNS.
 Used to treat hypertension and
arrhythmias
 Adverse reactions include < B/P,
arrhymthmias and headache
 Take blood pressure each time before
drug is given
Cholinergic drugs
 Mimic the activity of the parasympathetic
system, also called parasympathomimetic
drugs) blocks acetylcholine breakdown
important in nerve transduction
 Used to treat myasthenia gravis and
glaucoma, and to induce voiding in pts with
urinary retention (mestinon, prostigmin))
 Adverse reactions include nausea,
diarrhea, abd cramping, skin flushing,
arrhythmias, and muscle weakness
Myasthenia Gravis
 Disease characterized by great muscle
weakness (without atrophy) and
progressive fatigability
 S/S muscles of face and neck involved,
those of trunk and extremities secondary.
Onset gradual, worsen in evening. Pt c/o of
difficulty chewing, swallowing, and talking.
Expressionless faces and ptosis usually
present
Implementation
 With Initial drug regimen, always monitor
pt responses to drug. Frequently increased
or decreased early in therapy.
 Monitor for signs and symptoms of drug
overdose ( may be difficult to regulate)
 Elderly do not tolerate high doses of these
drugs.
 Drug underdose- may have rapid
fatigability and drooping of the eyelids
Cholinergic Crisis
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Muscle rigidity, clenching of jaw
Abdominal cramps
Nausea, vomiting, diarrhea
Increased salivation
Increased bronchial secretions
Hypertension
Miosis- abnormal contraction of pupils
Nursing Management
 Assess neuromuscular status including reflexes,
muscle strength, and gait
 Monitor pt for sis of overdose (cholinergic crisis) and
underdone (myasthenia crisis)
 Instruct pt to always take meds on time to prevent
weakness
 Instruct pt to take med before meals for best
absorption
 Instruct pt to wear medic-alert bracelet
 Explain that antimyasthenic therapy is lifelong
 Evaluate medication effectiveness based on
neuromuscular improvements and muscle strength
Nursing Management- Glaucoma
Instruct pt in instillation of eye drops
Prior to instilling drops, check label of bottle to see if drug is
for ophthalmic use
Eye drops (pilocarpine) adverse reaction may be a temporary
loss of vision acurity.
Instill the eye drops in the lower conjunctional sac
Administer eye drops with the hand holding the eye dropper
supported against the patient’s forehead.
If eye drops are ordered to be left at bedside, nurse must make
sure the medication is being used properly and at the right
time.
Cholinergic blocking drugs
 Inhibit the activity of acetylcholine by blocking the
cholinergic receptors in the CNS
 Side effects include dry mouth and drying of
secretions of resp tract (encourage to take frequent
sips of water), >pulse, blurred vision, restlessness,
constipation
 Contraindicated in glaucoma pts and COPD ( can
develop dry, thick mucous secretions
 Atropine- used preoperatively to reduce secretions of
the upper respiratory tract
 Use with elderly during hot weather may result in heat
exhaustion (prostration) These drugs decrease
sweating
Anticholinergic Drugs
 Used in treatment of peptic ulcer disease
(Quarzan,Robinul)
 Pylorospasm- secondary to lesions of the stomach and
duodenum
 Renal colic (pain in region of kidney and toward the
thigh)
 Preanesthetic sedation ( Atropine)
 Third degree Heart block (Atropine) – always place on
a cardiac monitor
 If while taking an anticholinergic, experiences
photophobia, place in semi darkened room
 May be used as antidote for cholinergic toxicity
(Cogentin and atropine)
Nursing Management
 Monitor Vital signs
 Assess for rigidity and tremors
 Instruct pt to check with physician before
taking any OTC meds
 Instruct pt to minimize dry mouth by
increasing fluid intake and by using ice
chips , hard candy, and gum
 Increase fluid and fiber to prevent
constipation
 Routine eye exams to assess for intraocular
pressure
Anticoagulants
 Used to prevent clot extension and
formation. Do not dissolve clots
 Usually initiated with heparin because
of rapid onset of action
 Maintenance therapy consists of
warfarin
 Lovenox-low molecular wt heparin
may be used after surgery or with
prolonged bedrest to prevent DVT
Antiparkinsonian Medications
 Parkison’s is a progressive disease of
the nervous system caused by
deficiency of dopamine.
 S/S fine tremors, rigidity of some
muscle groups and weakness of
others, slurred speech, mask-like
facial expression and shuffling,
unsteady gait.
Levodopa- most effective drug
 Levadopa converts to dopamine and
restores the balance of neurotransmitters
acetylcholine and dopamine in the CNS,
and decreases the s/s of Parkinson’s
 Contraindicated in cardiac, renal , and
psychiatric patients
 Side effects include choreiform and
dystonic movements, dizziness, confusion,
mood swings
Choreiform- Definition
 Involuntary twitching of the muscles such
as facial grimacing, protruding tongue,
exaggerated chewing motions and head
movements, and jerking movements of the
arms and legs.
 Observe daily for the development of
dystonic reactions and report to physician if
observed, dosage adjustment or change to
a different medication may be required.
Levadopa- continued
 Some patients with Parkinson’s have
difficulty communicating and will not
tell the nurse that problems are
occurring.
 Carbidopa is given with levadopa
either as one medication or as two
separate drugs. If given together,
teach patient that carbidopa must be
given with levadopa.
Nursing Management
Assess Vital signs
Assess for risk of injury
Instruct pt to take with food of N/V occurs
Assess daily for dystonic movements
Instruct pt taking Sinemet to eat reduced
protein diet, high-protein foods interfere
with medication transport to CNS
 Change positions slowly
 Inform pt urine may change color
 Instruct pt to report side effects and s/s of
dyskinesia
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Anticonvulsants
 Seizure- abnormal disturbance in the
electrical activity in one or more areas of
the brain
 Epilepsy- permanent, recurrent seizure
disorder
 Anticonvulsants- act to reduce the
excitability of the nerve cells of the brain
( depress abnormal neuronal discharges)
and prevent the spread of seizures
Anticonvulsants
 Phenytoin (Dilantin)
 Side effects are reddened gums that
bleed easily, slurred speech,
confusion, HA, elevated blood
glucose, and depression
 Other anticonvulsants include
Tegretol, Depakote, and Neurontin
Nursing Management
 Monitor serum levels to assess for toxicity
 Instruct pt on importance of good oral
hygiene and regular dental exams
 Instruct pt to consult physician before
taking other medications
 Oral tube feedings may interfere with the
absorption of oral dilantin and diminish the
medication's effectiveness, feedings should
be scheduled as far as possible from the
drug administration
Benzodiazepines
 Used to treat tonic-clonic seizures
and status epileptics
 Valium used to treat status
epilepticus
 Includes Klonopin, Tranxene, Valium
and Ativan
Narcotic Analgesics
 Suppress pain impulse but can also
suppress respirations
 Includes codeine, Diludid, Demerol,
Percocet, Percodan, Darvon, Stadol,
Nubain, Ultram,
Methodone,Hydrococone, Oxycodone
 Meperidine (Demerol) can increase
intracranial pressure in head injuries
Narcotic Antagonists
 Used to treat respiratory depression from
narcotic overdose
 Includes Narcan, revex, and reVia
 Monitor B/P, respiration rate, and pulse
every 5 mins, tapering to every 15 mins,
then every 30 mins
 Place pt on cardiac monitor
 Have resuscitation equipment available
 Do not leave patient unattended
 Monitor pt closely, when antagonist wears
off, may again display s/s of overdose