Neuro Medications

Mannitol (Osmitrol)
Osmotic Diuretic

How Mannitol (Osmitrol) works:
Affects/Reduces ICP in two ways:
1. Plasma Expansion
2. Osmotic Effect

Plasma Expansion
reduces hematocrit and blood viscosity which increases CBF and cerebral oxygen delivery

Osmotic Effect
works by increasing plasma osmolality, induces diffusion of water from fluids back into plasma and extravascular space

Adverse Effects of Mannitol (Osmitrol):
Fluid and electrolyte imbalance
Thirst, dry mouth
Blurred Vision
Urinary Retention

Contraindications of Mannitol (Osmitrol):
Presence of Renal Disease
Severe Dehydration
Pulmonary Edema
Progressive Heart Failure
Elevated Serum Osmolality (amount of chemicals dissolved in the fluid portion of blood)

Nursing Considerations for Mannitol (Osmitrol)
Only administer IV
Careful monitoring of fluid and elyte bakance
Careful monitoring of body weight, I&O after admin.

Dexamethasone (Decadron)

How Dexamethasone (Decadron) works:
-Mode of action not completely known
-Thought to control vasogenic edema surrounding tumors and abcesses
-Theory- stabilizes cell membranes and inhibits synthesis of prostaglandins (inflammatory mediators)
-Improves neuronal function by improving CBF and restoring autoregulation

Adverse effects of Dexamethasone (Decadron):
Difficulty Sleeping
Increased Appetite
Increased Sweating
Mood Changes/Nervousness

Contraindications of Dexamethasone (Decadron):
Patients with head injuries
Systemic fungal infections
Sensitivity to the medication

Possible Complications of Dexamethasone (Decadron):
Increased risk for infection
GI bleed

Nursing Considerations for Dexamethasone (Decadron):
Closely monitor fluid intake
Closely monitor sodium and glucose levels
Concurrent administration of antacids, H2R Blockers, or PPIs to prevent GI ulcers and bleeding is recommended

Pentobarbital (Nembutal)
High-dose Barbituate

How Pentobarbital (Nembutal) works:
Reduces cerebral metabolic rate which decreases CBF resulting in decreased ICP
Reduces Cerebral Edema
Produces a more uniform blood supply to the brain
Used for patients with increased ICP who are not responsive to other treatment

Adverse Effects of Pentobarbital (Nembutal):
Impaired memory and concentration
Excitement, irritability, aggression

Nursing Considerations for Pentobarbital (Nembutal):
Close monitoring of ICP, blood flow, EEG during administration
Physician will order infusion to achieve a desired level of brain wave suppression (to control ICP)
Absence of spikes on EEG (called total burst suppression) means maximal therapeutic effect has been achieved

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