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

Neurological Pharmacology

Developed by:Dawn Johnson, RN, MSN,

Ed

Property of:

www.careereducationalpathways.com1-814-580-0913

Anticonvulsant Medications


Hydantoin class

Phenytoin (Dilantin) Ethotoin (Peganone) Mephenytoin (Mesantaoin) Fosphenytoin IV (Celebyx) Action: increases Na+ out of

neurons depressing abnormal stimulation and discharge


Hydantoin 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 countToxicity: ataxia/slurred speech Diplopia/nystagmus Hypotension Pupils fixed/coma


Hydantoin 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


Phenytoin-like class

Valproic acid (Depakene) (Depakote)

Carbamazepine (Tegretol) Topiramate (Topamax) Lamotrigine (Lamictal) Zonisamide (Zonegran) Felbamate (Felbatol)


Phenytoin-like class 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


Phenytoin-like class

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


Barbiturates class

Amobarbital (Amytal) Pentobarbital (Nembutal) Phenobarbital (Luminal) Secobarbital (Seconal) Primadone (Mysoline)


Barbiturates class Uses:

Grand mal seizures Partial seizures Insomnia

Side effects: Drowsiness Decreased BP Respiratory depression Blood dyscrasias Addiction Have a hangover effect


Barbiturates 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


Benzodiazepines

Clonazepamzepam (Klonopin) Clorazepate (Tranxene) Diazepam (Valium) Lorazepam (Ativan)


Benzodiazepines

Uses: Absence seizures Partial seizures ETOH withdrawal Status epilepticus Anxiety Muscle spasms


Benzodiazepines 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


Succinimide class

Ethosuximide (Zarontin) Methsuximide (Celontin) Phensuximide (Milontin)


Succinimide 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


Succinimide class

Contraindications: Psychiatric history

Considerations: Abrupt stop can bring on seizure Check blood dyscrasias Check tongue swelling/psych status Teach oral care/dental checks


GABA agent class

Gabapentin (Neurontin) Tiagabine (Gabitril)

Uses: Partial seizures Neuralgia Nerve pain


GABA agent class

Side effects: Drowsiness and dizziness Blood dyscrasias

Contraindications: MAO inhibitors

Considerations: Check for blood dyscrasias


Misc

Oxacarbazepine (Trileptal) Levetiracetam (Keppra) Trimethadone (Tridione)

Uses: Second line and adjunctive treatment

for seizures


Misc

Side effects: Drowsiness and dizziness Blood dyscrasias

Contraindications: MAO inhibitors

Considerations: Check for blood dyscrasias

Sedatives

Sedatives Barbiturates class

Short acting: Phenobarbital

(Nembutal) Secobarbital (Seconal)

Intermediate acting: Amobarbital (Amytal) Aprobarbital (Alurate) Butabarbital (Butisol)

Long acting: Mephobarbital

(Mebaral) Phenobarbital

(Luminal)


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


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

SedativesBenzodiazepine

Estazolam (Prosom) Flurazepam (Dalamane) Quazepam (Doral) Temazepam (Restoril) Triazolam (Halcion)


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


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

Sedativesdopamine and serotonin

agonist 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

SedativesGABA Binder

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

SedativesAntihistamines

Diphenhydramine (Benadryl) (Sominex)

Hydroxyzine (Vistaril)

Promethazine (Anergan 50) (Phenergan)

Uses: Insomnia Allergic reaction

Side effects: Drowsiness Anticholinergic side

effects


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


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

SedativesMisc

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

Anxiolytics

AnxiolyticsBenzodiazepines

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


Uses: Insomnia Anxiety

Side effects: Drowsiness and dizziness Respiratory depression Dependence Blood dyscrasias Vit K and D decreased Increases digoxin level


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

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

CNS Stimulants

CNS StimulantsAnorexiants class

Bensphetamine (Didrex) Diethylpropion (Proprioan) Sibutramine (Meridia)


Uses: Narcolepsy ADHD ADD Obesity

Side effects: Restlessness, insomnia Palpitations Dysmennorhea Tachycardia Reverse HTN treatment Decrease seizure threshold Dependence and abuse


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

CNS StimulantsAmphetamines

Ampehtamine SO4 (Adderall) Dexroamphetamine (Dexadrine) Dexmethylphenidate (Focalin) Pemoline (Cylert) (PemADD) Methylphenidate

(Ritalin) (Concerta) (Metadate) (Methylin)


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


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 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

THE END

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

Documents

discharge slide

ed slide

low bp slide

hangover effect slide

life threatening toxicity

dilantin level

life threatening lamictal

oral contraceptive action