Pharmacology- ATI Neuro P. 1

Two drug categories for sleep disorders
Non-benzodiazepines and Benzodiazepines

Name one benzodiazepine
Temazepam (restoril)

Therapeutic uses of Temazepam (Restoril)
reliefs insomnia (pt awakens multiple times during the night) anxiety, status epileptics, muscle spasms, moderate sedation

Administration of Temazepam(Restoril)
Oral, 30 mins before bedtime

Side effects of Temazepam (Restoril)
drowsiness, dizziness, paradoxical reaction (especially in older adults) tolerance, dependence, respiratory or CNS depression, toxicity, withdrawal

interventions of Temazepam (Restoril)
Monitor ambulation, severe sedation (Toxicity), paradoxical reaction, signs of dependence/tolerance, breathing function (respiratory depression). May need to be given flumazenil (Romazicon) for overdose. Taper to prevent withdrawal.

Pt instructions for Temazepam (Restoril)
Take 30 mins before bed. Ensure 8 hours of sleep. Don’t take with depressants (alcohol). Stop taking if paradoxical reaction occurs. Teach about tolerance, take as needed for short term (only). Take as prescribed. Call physician if underlying depression is not controlled. Instruct on tapering drug.

Contradictions/Precautions/Interactions of Temazepam (Restoril)
Contradictions: Pregnancy Category X, lactation, glaucoma, younger than 18.

Precautions: hepatic, renal dysfunction. Depression. Alcohol dependence. Chronic respiratory disorders. Sleep apnea. Neuromuscular disorders. Fall risks (elderly).

Interactions: severe sedation when taken with CNS depressants. Cimetidine increases levels. Smoking decreases effects. Kava and valerian increase effects.

Name one non-benzodiazepine
Zolpidem – ambien

Therapeutic uses of Zolpidem (ambien)
Short term insomnia

Administration of Zolpidem (ambien)
Oral available for immediate, extended, sublingual tab (intermezzo) and spray (zolpimist). At bed time, ensure 8 hours of sleep on empty stomach (for best effect).

Side effects of Zolpidem (ambien)
Daytime drowsiness, headaches, anxiety, dizziness, diplopia, confusion, amnesia, memory impairment, sleep driving (in larger doses)

Interventions of Zolpidem (ambien)
Monitor for adverse effects, fall precaution, and need to decrease dosage.

Pt instructions of Zolpidem (ambien)
Before bed 8 hours of sleep required (4 hours for sublingual tablets (intermezzo)). Take as prescribed. Report dizziness and vision changes. Don’t take with depressants. Don’t perform activities that require alertness while sedated.

Contradictions/Precautions/Interactions of Zolpidem (ambien)
Contradiction- suicidal ideation and during labor/delivery.

Precautions- hepatic, renal dysfunction. Older adults. Depression. Substance abusers. Chronic respiratory disorders. Sleep apnea. younger than 18.

Interactions- when taken with food, increased sedatives when taken with depressants.

Two categories for muscle spasms
Centrally acting and peripherally acting muscle relaxants

Name a centrally acting muscle relaxant
Baclofen (Lioresal)

Therapeutic use of Baclofen (Lioresal)
Relieves skeletal muscle spasms in spinal cord injury, multiple sclerosis, cerebral palsy (by enhancing inhibitory effects of GABA)

Administration of Baclofen (Lioresal)
Oral or intrathecal infusion (spinal). Low dose gradually increasing up to 20mg, 3-4 times daily. Give with food/milk. Don’t stop abruptly.

Side effect of Baclofen (Lioresal)
Drowsiness/Dizziness, Nausea, Constipation, Withdrawal symptoms. Oral- psychosis, seizures. Intrathecal- fever, confusion, rigidity (fatal)

Interventions of Baclofen (Lioresal)
Start with low dosage to minimize effects. Give with food/milk prevent GI symptoms. Monitor for constipation. Encourage fluids and fiber. Taper over 1-2 weeks.

Pt instructions of Baclofen (Lioresal)
Effects decrease with time. Change position if dizzy. Advise against activities that require mental alertness. Take with food/milk. Increase fiber/fluids. Don’t stop abruptly.

Contradictions/Precautions/Interactions of Baclofen (Lioresal)
Contradictions- Allergy to baclofen, pt taking MAOI’s within past 2 weeks (may have hypertensive crisis), pt with cerebral palsy taking cyclobenzaprine.

Precautions- Elderly, child under 2, mental illness, seizure disorders, stroke or a cerebral vascular accident.

Interactions- CNS depressant increase sedation, pt with DM may require increase in insulin or anti-diabetics

Name a peripherally acting muscle relaxants
Dantrolene -Dantrium

Therapeutic use of Dantrolene (Dantrium)
Relaxes skeletal muscle spasm, cerebrovascular accident, stroke, spinal cord injury, multiple sclerosis, cerebral palsy, prevent and treat malignant hyperthermia (MH)

Administration of Dantrolene (Dantrium)
Oral and IV. For prevention of MH give 1-2 days pre-op. IV form to treat MH.

Side effect of Dantrolene (Dantrium)
Muscle weakness, drowsiness/dizziness, diarrhea, liver toxicity

Interventions of Dantrolene (Dantrium)
Assess muscle strength, monitor for CNS effects (drowsiness), diarrhea (early in treatment), liver function tests.

Pt instructions of Dantrolene (Dantrium)
Inform provider about muscle weakness, diarrhea and liver dysfunction (ab pain, jaundice), avoid driving (activities that require mental alertness) and CNS depressants

Contradictions/Precautions/Interactions of Dantrolene (Dantrium)
Contradictions- liver disease
Precautions- Cardiac, pulmonary disease and neurological disorders. Pt older than 35 b/c liver damage increases after this age.
Interactions- Estrogen use increase his for liver toxicity in women older than 35. CNS depressants- excessive sedation. IV- calcium channel blockers increase risk for severe cardiac dysrhythmias.

Three categories for Seizure Disorders
Hydantoins, Iminostilbenes, Valproic Acid

Name one hydantoin
Phenytoin -Dilantin

Therapeutic use of Phenytoin (Dilantin)
Tonic clonic, partial seizures

Action- Inhibits the influx of sodium through channel. Decreasing discharge of neurons around areas of activity.

Administration of Phenytoin (Dilantin)
Give with meal. Inject slowly using correct dilution (cardiac collapse can occur if given to quickly b/c of the influx of sodium to neurons in the brain/heart). Monitor vital signs during administration. Monitor plasma levels,

Side effects of Phenytoin (Dilantin)
Drowsiness, gingival hyperplasia (abnormal growth around gums, skin rashes (epidermal necrolysis, sevens-johnson syndrome), withdrawal (possible seizures)

interventions of Phenytoin (Dilantin)
Monitor vital signs, for toxicity and rash, refer and teach about oral hygiene. Gradually reduce dosage.

Pt instructions of Phenytoin (Dilantin)
Not to drive or other hazardous activities. If CNS effects occur instruct provider, regular check ups, good dental hygiene, instruct provider if rash occurs, don’t stop taking abruptly.

Contradictions/Precautions/Interactions of Phenytoin (Dilantin)
Contradictions- Category D, skin rash, bradycardia or heart block, allergy to hydantoins, seizures b/c low blood sugar (diabetic)
Precautions- liver/kidney disease, cardiac/respiratory dysfunction, DM, elderly, alcohol use disorder

Interactions- IV phenytoin incompatible with dextrose and other solutions. Alcohol increase or decrease phenytoin levels. Depressants increase effects. Decrease efficacy of oral contraceptives.

Name three Valproic Acid
Depakote, Depacon, Depakene

Therapeutic use of Valproic Acid
Treats all seizures types, controls mania in bipolar disorder, prevents migraine headaches,

Action: Inhibits influx of sodium through sodium channels. Inhibits influx of calcium through calcium channels. Enhances inhibitory effects of GABA.

Administration of Valproic Acid
Orally or IV. Enteric-coated given with food (to prevent GI symptoms) Dilute IV with at least 50ml and don’t mix other drugs. Depakote can be sprinkled on food before consuming.

Side effect of Valproic Acid
Bruising, bleeding, prolonged bleeding time, decreased platelets (r/t done marrow suppression). GI symptom (common when first taking the drug), skin rash, neural tube defect, hyperammonemia, pancreatitis, liver toxicity.

Interventions of Valproic Acid
Monitor bleeding time and bruising. give with food. monitor for rash, give folic acid (if pregnant), assess for decreased LOC, monitor blood for ammonia levels, serum amylase, liver function tests (before and during treatment). Pt taking lowest dosage.

Pt instructions of Valproic Acid
Report bleeding/bruising, rash, nausea, ab pain, jaundice, anorexia. Instruct to take with food. Advise provider if pt become pregnant.

Contradictions/Precautions/Interactions of Valproic Acid
Contradictions- category D, lactation, liver disease, other anti-convulsants, thrombocytopenia, hyperammonemia.

Precautions- Kidney disease, elderly, children under 10.

Interactions-Increase blood level of phenytoin. Topiramate increases risk for hyperammonemia.

Name one iminostilbenes
Carbamazepine – Tegretol

Pt instructions of Carbamazepine (Tegretol)
Partial, tonic-clonic seizures, mood stabilizers in bipolar disorders, reduces pain in trigeminal neuralgia (one-sided facial pain: CN #5)

Administration of Carbamazepine (Tegretol)
Give with food, taken as directed, IV suspension should not mix with other drugs.

Interventions of Carbamazepine (Tegretol)
CNS effects should decrease with time. No hazardous activities, if visual disturbances to ataxia occur. Report fever, brushing, rashes, fluid retention. Use sunscreen.

Side effect of Carbamazepine (Tegretol)
visual disturbance, headaches, ataxia, fluid retention, bone marrow suppression, decrease blood cell production, skin rash (epidermal necrolysis/stevens-johnson syndrome), photosensitivity.

Contradictions/Precautions/Interactions of Carbamazepine (Tegretol)
Contradictions- Category D, absence/myoclonic seizures, hematologic disorders, heart failure, use of MAOI’s (within 2 last weeks) hypersensitivity to TCA’s. Coadministration of nefazodone and NNRTI’s.

Precautions- cardiac or hepatic disease, positive to HLA-B*1502 gene. Alcohol disorder.

Interactions- Drinking grapefruit juice increase plasma levels. May cause false pregnancy test and decrease efficacy of oral contraceptives.

Name four types of anesthesias
local anesthesia, general anesthesia- barbiturate, general anesthesia- benzodiazepine, general anesthesia- opioids.

Name one local anesthesia
Prototype lidocaine -xylocaine

Name three general anesthesia
Thiopental – Pentothal, midaozolam- versed, fentanyl -sublimaze

Therapeutic uses of Prototype lidocaine (xylocaine)
Relieved pain in mucous membrane, burns and suturing of wounds. Relieves regional anesthesia (IV). Blocks nerves near surgical field, epidural or spinal anesthesia.

Administration of Prototype lidocaine (xylocaine)
Avoid eyes, broken skin (b/c toxicity). Correct concentration and form for specific procedure. Epinephrine lidocaine increase time of anesthesia but may cause gangrene in end-artery sites (vasoconstrictive effects), some may contain preservatives (contraindication)

Side effects of Prototype lidocaine (xylocaine)
Hypotension (spinal anesthesia), CNS stimulant/depressant effects.

Interventions of Prototype lidocaine (xylocaine)
Monitor vital signs (during and after procedure), for hypotension (administer ephedrine or phenylephrine if continues) Monitor for CNS effect and respiratory status.

Pt instructions of Prototype lidocaine (xylocaine)
Report dizziness/paresthesia, breathing, difficulty breathing.

Contradictions/Precautions/Interactions of Prototype lidocaine (xylocaine)
Contradictions- Allergy to amide type of anesthetics, sepsis/severe trauma, bradycardia or heart blocking.

Precautions- elderly, MG, respiratory depression, history of malignant hyperthermia

Interactions- beta blockers increase lidocaine levels, phenytoin increase risk for cardiac effects, procainamide increases risk for CNS and cardiac effects (arrest)

Therapeutic uses of Thiopental (Pentothal)
Rapid induction of anesthesia and hypnosis for brief procedures, adjunction with other procedures more than 15 mins.

Action: Depresses CNS significantly enhances inhibitory effects of GABA.

Administration of Thiopental (Pentothal)
Available for IV injection or infusion only. Assure vein/intra-atterial extravasation doesn’t occur, causing tissue/artery damage.

Side effects of Thiopental (Pentothal)
Respiratory depression and cardiovascular toxicity (tachy or hypotension).

Interventions of Thiopental (Pentothal)
Monitor respiratory status and vital signs

Pt instructions of Thiopental (Pentothal)
They will be frequently monitored.

Contradictions/Precautions/Interactions of Thiopental (Pentothal)
Contradictions- allergies to barbiturates. hepatic porphyria/ paradoxical excitation with depressants, status asthmaticus,

Precautions- Hepatic/Renal/Cardiac disease, MG, severe anemia, chronic respiratory disorders

Interactions- used w/ depressant may cause respiratory depression. use w/ probenecid increases length of anesthesia. Herbs- kava kava and valerian sedative properties, incompatibilities with other solutions, use with other benzondiazepines results in prolonged anesthesia.

Therapeutic uses of midaozolam (versed)
sedation before anesthesia, conscious sedation with induction of amnesia during procedures, supplement to inhalation anesthesia for surgeries.

Administration of midaozolam (versed)
IM in conscious sedation, give IV or infusion for induction of anesthesia or conscious sedation. No bolus for neonates. May be given with opioid for conscious sedation.

Side effects of midaozolam (versed)
Amnesia, cardiac or respiratory arrest.

Interventions of midaozolam (versed)
Monitor vitals and for amnesia, inject IV slowly and wait 2 mins before giving a second dose. have resuscitation equipment close. ensure someone is with them at discharge.

Pt instructions of midaozolam (versed)
Advise patient that memory loss is b/c the drug. Someone with them at discharge. Frequent monitoring will occur.

Contradictions/Precautions/Interactions of midaozolam (versed)
Contradictions- Category D, lactation, obstetric delivery, sensitivity to benzodiazepines, glaucoma

Precautions- parkinsron disease/ other neuromuscular disorders, cardiac/pulmonary/renal disorders

Interactions-CNS Depressants anticoagulants increase sedation, cimetidine may cause toxicity, smoking decrease sedative effects, herbals may increase or decrease effects

Therapeutic uses of fentanyl (sublimaze)
supplement to general anesthesia, uses with droperidol & nitrous oxide for neuroleptanesthesia, used with skeletal muscle relaxant as anesthesia for high risk patient in selected situations.

Administration of fentanyl (sublimaze)
IV or stick lozenge between gum and cheek (no longer than 15 mins)

Side effects of fentanyl (sublimaze)
sedation, nausea, respiration/circulatory depression

Interventions of fentanyl (sublimaze)
monitor LOC, nausea, vital signs, have opioid antagonist naloxone (narcan) and resuscitation equipment available.

Pt instructions of fentanyl (sublimaze)
Drowsiness is expected, report nausea, frequent monitoring will be assessed.

Contradictions/Precautions/Interactions of fentanyl (sublimaze)
Contradictions- substance abuse, obstetric delivery, MS,

Precautions- pt with increased intercranial pressure, elderly, children, debilitated patients, cardiac/respiratory disorders, liver/kidney disorders

Interactions- MAOI’s given within 2 weeks (hypertensive crisis) CNS depressants increase sedation (respiratory depression)

Three types of drugs that treat ADHD and Narcolepsy
Amphetamines, methylphenidate, non-amphetamines

Name one amphetamines
Adderall

Name three methylphenidate
Ritalin, Concentra, Daytrana

Name one non-amphetamines
Modafinil -Provigil

Therapeutic uses of Amphetamines (Adderall)
ADHD, narcolepsy, obesity

Administration of Amphetamines (Adderall)
regular tab and extended release. take as recommended.

Side effects of Amphetamines (Adderall)
insomnia, weight loss, suppressed growth in children, hypertension, tachycardia, heart palpitations, toxicity, tolerance, withdrawals

Interventions of Amphetamines (Adderall)
Morning dose, monitor weight, drug holidays (for children), monitor vital signs, dosage (toxicity), drug use carefully, signs of depression

Pt instructions of Amphetamines (Adderall)
Avoid caffeine, take as early as possible, report anorexia, weightless, eat larger meal when hungry, report cardiovascular effects (hypertension), take as directed, potential for abuse, taper dosage.

Contradictions/Precautions/Interactions of Amphetamines (Adderall)
Contradictions- allergies to amphetamines, hypertension, cardiovascular disease, structural cardiac defects (children), hyperthyroidism, history of drug abuse, glaucoma

Precautions- mild hypertension

Interactions-pt taking MAOI’s w/in past 2 weeks (hypertension), increase chance of cardiac effect, ascorbic acid/ammonium chloride decrease elimination, sodium bicarbonate (vitamin c) increases effects

Therapeutic uses of Methylphenidate (Ritalin)
ADD/ADHD and narcolepsy

Administration of Methylphenidate (Ritalin)
Oral, use as directed, transdermal don’t leave for more than 9 hours on new areas of skin.

Side effects of Methylphenidate (Ritalin)
Insomnia, nervousness, anorexia, weight loss, growth suppression, hypertension, tachycardia, heart palpitations, tolerance, dependance and withdrawal

Interventions of Methylphenidate (Ritalin)
Give dose early, monitor weight/height and depression, drug holidays, vital signs, use of drug carefully, taper dose,

Pt instructions of Methylphenidate (Ritalin)
avoid caffeine, as early as possible, report anorexia, weight loss, eat larger meals when hungry, cardiovascular symptoms, take as directed, potential for abuse, taper drug.

Contradictions/Precautions/Interactions of Methylphenidate (Ritalin)
Contradictions- allergies to amphetamines, cardiac arythmies, structural cardiac defects, psychosis, depression, drug abuse, mania, agitation, children under 6, glaucoma, motor tics, Tourettes syndrome
Precautions- hypertension, hyperthyroidism
Interactions- MAOI’s within 2 weeks, increase cardiac effects with other stimulants

Therapeutic uses of Modafinil (Provigil)
Promotes wakefulness, narcolepsy, shift-work sleepiness, obstructive sleep apnea,

Action: Unclear, possibly ability to block re-uptake of norepinephrine.

Administration of Modafinil (Provigil)
Give in the morning and 1 hr before work shift work sleepiness.

Side effects of Modafinil (Provigil)
Nausea, diarrhea, CNS effects, tachycardia, hypertension, rashes, decreased effectiveness of contraceptives

Interventions of Modafinil (Provigil)
give with food, monitor CNS effects, monitor for rash (discontinue if occurs) ask about contraceptives.

Pt instructions of Modafinil (Provigil)
take with food as necessary, report headaches/nervousness/dizziness/chest pain/rashes, pt should use back up contraceptives for up to 30 days after discontinuing med.

Contradictions/Precautions/Interactions of Modafinil (Provigil)
Contradictions- heart valvular disease
Precautions- cardiovascular disease, hypertension, hepatic/renal impairment, drug/alcohol abuse, mania, psychosis, elderly or children under 16, pregnancy category C
Interactions- causes increase levels of warfarin, back up contraceptives (+30 days after)

Name three drug types for Parkinson Disease
Dopamine replacement drugs, direct acting dopamine receptors agonists, indirect acting dopamine receptor agonists/MAO Inhibitors,

Name a Dopamine replacement drug
Levodopa/Carbidopa (Sinemet)

Name a Direct acting dopamine receptors agonists
Pramipexole -Mirapex

Name a Indirect acting dopamine receptor agonists/MAO Inhibitors
Selegiline (Eldepryl, Zelapar ODT)

Therapeutic uses of Levodopa/Carbidopa (Sinemet)
Relieves symptoms of Parkinsons, addition of Carbidopa allows for reduced dose of levodopa and prevents some adverse effects

Action: Crosses blood brain barrier and taken up by the dopaminergic nerves converted to dopamine.

Administration of Levodopa/Carbidopa (Sinemet)
Low dosage to reduce side effects, can take up to 6 months for full response, monitor for loss of drug effect and “on-off” episodes and report it to provider.

Side effects of Levodopa/Carbidopa (Sinemet)
Nausea, vomiting, darken urine/sweat, orthostatic hypotension, dyskinesias, tremors, twitching and other movements, symptoms of psychosis (hallucination, paranoia), “on/off episodes”

Interventions of Levodopa/Carbidopa (Sinemet)
75 mg of carbidopa (GI symptoms), observe urine output, monitor risk for falls, administer amantadine (decrease dyskinesias) lower dose for dyskinesia, increase bedtime dose for dystonia in morning, give 4 dosages instead of 3 when symptoms present between dosages.

Pt instructions of Levodopa/Carbidopa (Sinemet)
take with food, avoid high proteins (decreases absorption), warn about darkening urine, move slowly, inform provider of dyskinesia and symptoms of psychosis develops.

Contradictions/Precautions/Interactions of Levodopa/Carbidopa (Sinemet)
Contradictions- narrow angle glaucoma, history of melanoma, psychosis, suicidal thoughts,

Precautions-elderly, renal/hepatic/endocrine/respiratory, wide angle glaucoma, peptic ulcer disease, depression/bipolar disorder

Interactions- traditional antipsychotics and preparations with vitamin B decrease action, MAOI’s hypertensive crisis, high proteins decrease action, anticholinergic drugs increase response.

Therapeutic uses of Pramipexole (Mirapex)
Relieves symptoms of PD and restless leg syndrome,

Administration of Pramipexole (Mirapex)
3 hours before bed, increasing dose blood 4-7 days between each increase.

Side effects of Pramipexole (Mirapex)
GI symptoms, drowsiness, “sleep attacks” muscle weakness, orthostatic hypotension, dyskinesias,

Interventions of Pramipexole (Mirapex)
Monitor for nausea, drowsiness/sleepiness/muscle weakness and fall risk. Monitor cardiac status. Observe abnormal muscle movement. Monitor CPK (muscle damage).

Pt instructions of Pramipexole (Mirapex)
Nausea lessenes over time, take with food, avoid driving or activities that require mental alertness, avoid CNS depressants (alcohol) taken before bedtime, report muscle weakeness, orthostatic hypertension and notify if they occur, taper drug over 1 week.

Contradictions/Precautions/Interactions of Pramipexole (Mirapex)
Contradictions- allergy to pramipexole or ropinirole
Precautions- renal dysfunction, compulsive behaviors, children
Interactions-Cimetidine increase levels, CNS depressants increase adverse effects.

Therapeutic uses of Selegiline (Eldepryl, Zelapar ODT)
symptoms of parkinson as an adjunct to Levodopa, major depression (transdermal patch)

Administration of Selegiline (Eldepryl, Zelapar ODT)
give with levodopa <-- so dosage may be reduced, give before morning meal, don't eat or drink for 5 mins before and after administration

Side effects of Selegiline (Eldepryl, Zelapar ODT)
Insomnia, hypertension, orthostatic hypotension, irritation of oral mucous membrane, hallucinations

Interventions of Selegiline (Eldepryl, Zelapar ODT)
Monitor for insomnia, Monitor other drugs, BP, orthostatic BP and pulse, Inspect tongue and oral cavity for irritation, Monitor for hallucinations,

Pt instructions of Selegiline (Eldepryl, Zelapar ODT)
Take last dose before noon, notify provider before taking new drugs, instruct on foods to avoid and herbs, rise slowly from lying or sitting position, report irritation to providers, educate patient to report hallucinations

Contradictions/Precautions/Interactions of Selegiline (Eldepryl, Zelapar ODT)
Contradictions-uncontrolled hypertension, suicidal ideation, receiving meperidine for pain, concurrent use of MOAI’s.
Precautions-hypertension, bipolar disorders, psychosis, lactation
Interactions- MOAI’s can cause high fevers, hypertension, rigidity, foods containing tyramine (hypertension), herbal drug and anti-hypertensive drugs (hypotension)

Name two types of drugs for Alzheimer’s Disease
Cholinesterase Inhibitors, NMDA Receptors Antagonists

Name a Cholinesterase Inhibitors
donepezil (aricept, aricept ODT)

Name a MDA Receptors Antagonists
Memantine (namenda)

Therapeutic uses of donepezil (aricept, aricept ODT)
improved cognitive function in patients with mild to moderate alzheimer’s disease

Administration of donepezil (aricept, aricept ODT)
give at bedtime daily with or without food,

Side effects of donepezil (aricept, aricept ODT)
nausea, CNS effects, insomnia/dizziness, headaches, bradycardia,

Interventions of donepezil (aricept, aricept ODT)
given with food to decrease GI effects, monitor weight, for dark stool, coffee ground emesis, fall risk, heart rate

Pt instructions of donepezil (aricept, aricept ODT)
with food at bedtime, report vomiting, severe diarrhea, weight loss, GI bleeding, report GI symptoms and LOC.

Contradictions/Precautions/Interactions of donepezil (aricept, aricept ODT)
Contradictions- GI bleeding, allergy to donepezil, jaundice, children
Precautions- liver/renal/ cardiac/GI or pulmonary disorders, hyperthyroidism, seizures,
Interactions- use of NSAIDS increase risk for GI bleeding, anticholinergic (antihistamines) drugs decrease effects

Therapeutic uses of Memantine (namenda)
Slows decreasing in functioning for moderate/severe Alzheimer’s and mild/moderate vascular dementia

Administration of Memantine (namenda)
Give with or without food,

Side effects of Memantine (namenda)
CNS effects, dizziness, headaches, increased confusion, constipation

Interventions of Memantine (namenda)
Monitor for these effects, keep safe if dizziness occurs, monitor constipation

Pt instructions of Memantine (namenda)
Report CNS effects, increase fluids and fiber in diet, report constipation

Contradictions/Precautions/Interactions of Memantine (namenda)
Contradictions- renal failure, allergy to memantine,
Precautions- liver/renal/seizures disorders, elderly
Interactions- over the counter antacids (vitamin C) increases ph of urine (possible toxicity) , other NMDA antagonists may increase levels.

Name a type of drug for Multiple Sclerosis
Immunomodulators

Name a two immunomodulators
Interferon Beta-1a (avonex, rebif) Beta 1b (betaseron)

Therapeutic uses of Immunomodulators
Interferon Beta-1A: multiple sclerosis (relapsing-remitting type)

Beta 1B:Multiple sclerosis (relapsing-relapsing-remitting types)

Administration of immunomodualtors
1A: IM weekly, subq- 3 days each week, 48 between injections.

1B: Give SC every other day, use within others after reconstituting

side effects of immunomodulators
Flu-like symptoms, myelosuppresion, liver toxicity, pain/redness at subq injection site,

interventions of immunomodulators
Start with low dose to higher, medicate with NSAID’s if symptoms are expected. Monitor CBC (before and after treatment), liver function test, and injection site.

Pt instructions of immunomodulators
Pre-medicate with NSAID’s, report easy bruising/bleeding/fatigue, ab tenderness, anorexia, jaundice, instruct to rotate injection site, cool compression prior to injection and warm moist after, report skin ulcers

Contradictions/Precautions/Interactions of immunomodulators
allergies to interferon beta, human albumin or mannitol,
precaution: suicidal tendencies, history of liver disorders, alcohol abuse, children under 18, seizures, mental health/ thyroid disorders
Interactions: any drug that surppreses the immune system increase risk for myelosuppression,

Name a type of drug for migraine headaches
Serotonin Agonist

Name a serotonin agonist
Sumatriptan (limitrex)

Therapeutic uses of Sumatriptan (limitrex)
Relieves symptoms of existing migraines or cluster headaches,

Administration of Sumatriptan (limitrex)
administration is orally, subq, or nasal,

Nasal: 5-20 mg, maximum dose is 40 mg in 24 hours
Subq: No more than 2 in 24 hours,
Oral: max dose of 200mg in 24 hours

Side effects of Sumatriptan (limitrex)
Chest pressure, angina pain (coronary vasospasm), CNS effects (tingling ,sensation and vertigo)

Interventions of Sumatriptan (limitrex)
Monitor for chest pressure, vital signs and CNS effects.

Pt instructions of Sumatriptan (limitrex)
notify provider of chest pressure and CNS symptoms

Contradictions/Precautions/Interactions of Sumatriptan (limitrex)
Contradictions- CAD, PVD, elderly, stroke, use of MAOI’s (past 2 weeks) use of another triptan within 24 hours

Precautions- liver/kidney insufficiency, CAD risk factors, seizures disorders, BP elevation, serotonin syndrome, chest tightness, fertility impairment

Interactions- MAOI (within 2 weeks) ergotamine triptan patients use of 24 hours or sumatriptan increase chance of angina, serotonin agonist can cause serotonin syndrome, herbal- st. Johns can cause toxicity.

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