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Neurological Pharmacology

Learn about various anticonvulsant medications, including Hydantoin, Phenytoin-like, Barbiturates, Benzodiazepines, Succinimide, GABA Agents, and more, their uses, contraindications, side effects, and considerations. Developed by Dawn Johnson, RN, MSN, Ed.

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Neurological Pharmacology

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  1. Neurological Pharmacology Developed by: Dawn Johnson, RN, MSN, Ed

  2. Property of: www.careereducationalpathways.com 1-814-580-0913

  3. Anticonvulsant Medications

  4. Anticonvulsant MedicationsHydantoin class • Phenytoin (Dilantin) • Ethotoin (Peganone) • Mephenytoin (Mesantaoin) • Fosphenytoin IV (Celebyx) • Action: increases Na+ out of neurons depressing abnormal stimulation and discharge

  5. Anticonvulsant MedicationsHydantoin class • Uses: • Seizures of all types without CNS depression • Side effects: • Drowsiness and dizziness • n/v • Gingival Hyperplasia-reddened gums that bleed easily • Low platelet and WBC count Toxicity: • ataxia/slurred speech • Diplopia/nystagmus • Hypotension • Pupils fixed/coma

  6. Anticonvulsant MedicationsHydantoin class • Contraindications: • Bradycardia • Heart block • Considerations: • Dilantin level 10-20ug • Must take same brand; no abrupt discontinuation • Urine discoloration • If down tube feeding: shut off tf for 1 hour prior and 1 hour after due to dilantin binds with protein in tube feedings • Give good oral hygiene/dental checks • IV: no dextrose; it precipitates • Give in large vein < or = 50mg/min • Cardiotoxic with low bp

  7. Anticonvulsant MedicationsPhenytoin-like class • Valproic acid (Depakene)(Depakote) • Carbamazepine (Tegretol) • Topiramate (Topamax) • Lamotrigine (Lamictal) • Zonisamide (Zonegran) • Felbamate (Felbatol)

  8. Uses: Absence/simple seizures Trigeminal Neuralgia Side effects: Drowsiness and dizziness Photophobia Blood dyscrasias Hepatoxicity can be life threatening Lamictal rash is life threatening Toxicity: ataxia/slurred speech Diplopia/nystagmus Hypotension Pupils fixed/coma Anticonvulsant MedicationsPhenytoin-like class

  9. Contraindications: Hepatic disease Blood dyscrasias Considerations: Valproic acid is GI irritant Severe mouth/throat irritation if chewed or carbonated drinks Considerations: Sprinkles for on food for children Notify MD if s&s of neutropenia: Sore throat Fever Oral ulcers S&s or plastic anemia: Fatigue Easy bleeding/bruising Anticonvulsant MedicationsPhenytoin-like class

  10. Anticonvulsant MedicationsBarbiturates class • Amobarbital (Amytal) • Pentobarbital (Nembutal) • Phenobarbital (Luminal) • Secobarbital (Seconal) • Primadone (Mysoline)

  11. Anticonvulsant MedicationsBarbiturates class • Uses: • Grand mal seizures • Partial seizures • Insomnia • Side effects: • Drowsiness • Decreased BP • Respiratory depression • Blood dyscrasias • Addiction • Have a hangover effect

  12. Anticonvulsant MedicationsBarbiturates class • Contraindications: • Hepatic disease • Addiction • Respiratory disease • Considerations: • Decreases oral contraceptive action • Hold with respirations <12 • Check for s&s of withdrawal: • 8-12 hours minor s&s • 16 hours – 5 days: convulsions and delirium

  13. Anticonvulsant MedicationsBenzodiazepines • Clonazepam (Klonopin) • Clorazepate (Tranxene) • Diazepam (Valium) • Lorazepam (Ativan)

  14. Anticonvulsant MedicationsBenzodiazepines • Uses: • Absence seizures • Partial seizures • ETOH withdrawal • Status epilepticus • Anxiety • Muscle spasms

  15. Side effects: Drowsiness and dizziness Dependence Blood dyscrasias Vit k and d decreased Increases digoxin level Contraindications: ETOH Considerations: Abrupt stop can bring status epilepticus and withdrawal Check respiratory depression Check blood dyscrasias IV diazepam Push only <5mg/min in large vein Do not mix with other drugs Anticonvulsant MedicationsBenzodiazepines

  16. Anticonvulsant MedicationsSuccinimide class • Ethosuximide (Zarontin) • Methsuximide (Celontin) • Phensuximide (Milontin)

  17. Anticonvulsant MedicationsSuccinimide class • Uses: • Absence seizures • Side effects: • Drowsiness and dizziness • Blood dyscrasias • GI: n/v, gingival hyperplasia, tongue swelling • Psychosis/mood swings • Hematuria common in phensuximide

  18. Anticonvulsant MedicationsSuccinimide class • Contraindications: • Psychiatric history • Considerations: • Abrupt stop can bring on seizure • Check blood dyscrasias • Check tongue swelling/psych status • Teach oral care/dental checks

  19. Anticonvulsant MedicationsGABA agent class • Gabapentin (Neurontin) • Tiagabine (Gabitril) • Uses: • Partial seizures • Neuralgia • Nerve pain

  20. Anticonvulsant MedicationsGABA agent class • Side effects: • Drowsiness and dizziness • Blood dyscrasias • Contraindications: • MAO inhibitors • Considerations: • Check for blood dyscrasias

  21. Anticonvulsant MedicationsMisc • Oxacarbazepine (Trileptal) • Levetiracetam (Keppra) • Trimethadone (Tridione) • Uses: • Second line and adjunctive treatment for seizures

  22. Anticonvulsant MedicationsMisc • Side effects: • Drowsiness and dizziness • Blood dyscrasias • Contraindications: • MAO inhibitors • Considerations: • Check for blood dyscrasias

  23. Sedatives

  24. Short acting: Phenobarbital (Nembutal) Secobarbital (Seconal) Intermediate acting: Amobarbital (Amytal) Aprobarbital (Alurate) Butabarbital (Butisol) Long acting: Mephobarbital (Mebaral) Phenobarbital (Luminal) SedativesBarbiturates class

  25. SedativesBarbiturates class • Uses: • Low dose: anxiety • Moderate dose: sleep, seizures • High dose: anesthesia • Side effects: • Drowsiness and dizziness • Decrease BP • Tolerance develops • Respiratory depression • Blood dyscrasias • Addiction • Low margin of safety: • Excessive dose will cause respiratory depression and coma

  26. Contraindications: Hepatic disease Drug abuse history Suicidal history Respiratory disease Considerations: reduces REM sleep Effectiveness on insomnia without daytime sedation Considerations: Hold with respirations <12 Decrease oral contraceptive Limit medication for hoarding Tapered for withdrawal Check for s&s withdrawal: 8-12 hours minor s&s 16 hours – 5 days: convulsions and delirium SedativesBarbiturates class

  27. SedativesBenzodiazepine • Estazolam (Prosom) • Flurazepam (Dalamane) • Quazepam (Doral) • Temazepam (Restoril) • Triazolam (Halcion)

  28. SedativesBenzodiazepine • Uses: • Insomnia • Side effects: • Drowsiness and dizziness • Respiratory depression • Dependence • Blood dyscrasias • Greater margin of safety but with other CNS depressants can be fatal • Herbs: Kava and valerian with increase the effects

  29. Contraindications: Suicidal history Drug abuse history CNS depression Elderly NA Glaucoma Uncontrolled pain Considerations: Limit to 7-10 days treatment Withhold if systolic pressure drops 20mm while standing or respirations <12/min Check neutropenia/aplastic anemia Antacids and smoking decrease effects No hazardous activity SedativesBenzodiazepine

  30. Buspirone (Buspar) Uses: Insomnia Anxiety Side effects: Well tolerated Dystonias; akisthesia Contraindications: Renal disease Liver disease MAO inhibitors Considerations: Does not cause sedation, tolerance, CNS depression, no abuse potential Takes several weeks to take full effect Sedativesdopamine and serotonin agonist

  31. Zolipidem (Ambien) Uses: Insomnia Induces sleep Side effects: Daytime drowsiness Confusion Amnesia Dependence in 10 days Contraindications: Liver disease Lung disease Apnea Psych history Elderly Considerations: Rapid effect Take when pt in bed due to fall risk SedativesGABA Binder

  32. Diphenhydramine (Benadryl) (Sominex) Hydroxyzine (Vistaril) Promethazine (Anergan 50) (Phenergan) Uses: Insomnia Allergic reaction Side effects: Drowsiness Anticholinergic side effects SedativesAntihistamines

  33. SedativesAntihistamines • Contraindications: • Glaucoma • Peptic ulcer • MAOIs • BPH • COPD • Children can have CNS over stimulation and decrease response at the same time leading to heat stroke, seizures and can easily overdose

  34. SedativesAntihistamines • Considerations: • No hazardous activity • Do not mix with ETOH/CNS depressants • Sugarless candy for dry mouth • Monitor BP and pulse • Check urinary function • Z track vistaril • Use with other antihistamine products including topicals increase effect

  35. Meprobamate (Equanil) (Milltown) Chloral hydrate (Noctec) Uses: Insomnia Preoperative sedation Anxiety Side effects: Drowsiness Respiratory depression Contraindications: Elderly Uncontrolled pain Considerations: Give chloral hydrate after meal due to GI irritant Mix with fluids due to poor taste SedativesMisc

  36. Anxiolytics

  37. AnxiolyticsBenzodiazepines • Alprozolam (Xanax) • Chlordiazepoxide (Librium) • Clonazepam (Klonopin) • Clorazepate (Tranxene) • Diazepam (Valium) • Halezepam (Paxipam) • Lorazepam (Ativan) • Oxazepam (Serax)

  38. AnxiolyticsBenzodiazepines • Uses: • Insomnia • Anxiety • Side effects: • Drowsiness and dizziness • Respiratory depression • Dependence • Blood dyscrasias • Vit K and D decreased • Increases digoxin level

  39. AnxiolyticsBenzodiazepines • Contraindications: • NA Glaucoma • Suicide history • Considerations: • Check respiratory depression • No hazardous activity • Do not mix with ETOH/CNS depressants • Check blood dyscrasias • Caution with herbs: kava, valerian, chamomile, hops due to CNS depression • IV diazepam/lorazepam: • IV push <5mg/min in large vein • Can not mix with other drugs • Rapid acting

  40. Benzodiazepine Antagonist • Flumazenil (Romazicon) • Uses: benzodiazepine toxicity/overdose • Side effects: seizures • Contraindications: • Status epilepticus • ICP • Considerations: • IV: 0.2mg, 0.3mg 0.5mg over 30 secs q minute prn • Effects last one hour: watch 2 hours after last dose • Seizure precautions • Does not reverse respiratory depression

  41. CNS Stimulants

  42. CNS StimulantsAnorexiants class • Bensphetamine (Didrex) • Diethylpropion (Proprioan) • Sibutramine (Meridia)

  43. CNS StimulantsAnorexiants class • Uses: • Narcolepsy • ADHD • ADD • Obesity • Side effects: • Restlessness, insomnia • Palpitations • Dysmennorhea • Tachycardia • Reverse HTN treatment • Decrease seizure threshold • Dependence and abuse

  44. CNS StimulantsAnorexiants class • Contraindications: • NA glaucoma • Hyperthyroid • CV disease • Drug abuse history • <12yrs old • Agitation • Anxiety • Tourettes syndrome • Considerations: • Give on empty stomach • Take 6hrs before bed • No OTCs can have fatal reaction

  45. CNS StimulantsAmphetamines • Ampehtamine SO4 (Adderall) • Dexroamphetamine (Dexadrine) • Dexmethylphenidate (Focalin) • Pemoline (Cylert) (PemADD) • Methylphenidate • (Ritalin) • (Concerta) • (Metadate) • (Methylin)

  46. Uses: ADHD Obesity Narcolepsy Side effects: Restlessness, insomnia, hyperactivity, talkative Palpitations Tachycardia Side effects: Arrythmias Low BP, CV collapse Dry mouth n/v Impotence Libido change Growth suppression Dependence and abuse CNS StimulantsAmphetamines

  47. Contraindications: Glaucoma Hyperthyroid CV disease Drug abuse history Agitation Anxiety Tourettes sydrome Considerations: Empty stomach 1st dose wakening Last dose 6hrs before bed ADD/ADHD benefits in 3-4 wks Avoid caffeine, colas, chocolate, tea No OTC fatal reaction No abrupt discontinuation Withdrawal: HA, N/V, myalgia, depression, fatigue, hunger CNS StimulantsAmphetamines

  48. CNS StimulantsAmphetamine • Doxapram (Dopram) • Uses: stimulate respirations post anesthesia • Side effects: • Arrythmias • Low BP, CV collapse • Dry mouth • n/v • Impotence • Libido change • Growth suppression • Dependence and abuse • Considerations: • Check respiratory status while administering: rate, depth, lung sounds, ABGs

  49. THE END

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