Neurological medications

In Class Review

• Increased hyperglycemia risk in patients with somatropin and diabetes.
• Liver is the primary site for drug metabolism.
• Monitor for adrenal insufficiency symptoms (hypoglycemia, hypotension, fatigue) when giving glucocorticoids to stressed clients.
• Apply pressure to puncta and nasolacrimal sac for 60 seconds after latanoprost administration to prevent systemic absorption.

Neurological Medications

• Lidocaine: Local anesthetic for local, epidural, and spinal anesthesia.
  • Adverse effects include CNS effects.
  • Monitor for respiratory arrest. Epinephrine can cause gangrene, while high doses can cause conduction disorders.
  • Check capillary refill distal to the insertion site.
• Methylphenidate: CNS stimulant for ADHD and narcolepsy.
  • Speeds everything up, with possible growth suppression.
  • Administer the last dose before 4 pm to prevent insomnia.
• Carbidopa-levodopa: Dopaminergic agent to relieve Parkinson’s symptoms and restless leg syndrome.
  • Adverse effects include dark urine/sweat and orthostatic hypotension.
  • Increases fall risk.
• Donepezil: Cholinesterase inhibitor to improve cognition in Alzheimer’s patients.
  • Adverse effects include insomnia, dizziness, bradycardia, syncope, and hypotension.
  • Increases fall risk.
• Sumatriptan: Serotonin agonist used to treat migraines.
  • Adverse effects include chest pressure and angina from excessive vasoconstriction, tingling, and vertigo.
• Alprazolam and Diazepam: Benzodiazepines that treat anxiety by enhancing inhibitory effects of GABA.
  • Adverse effects include CNS depression, paradoxical reactions (anxiety, insomnia, restlessness), and phlebitis.
  • Flumazenil is the antidote.
• Amitriptyline: Tricyclic antidepressant which blocks reuptake of norepinephrine and serotonin.
  • Adverse effects include CNS effects, orthostatic hypotension, anticholinergic effects, suicidal ideations, withdrawal, and cardiac toxicity.
  • Treat toxicity with activated charcoal and sodium bicarbonate.
• Fluoxetine: SSRI that selectively blocks serotonin reuptake and is the first-line treatment for depression.
  • Adverse effects include CNS stimulation (insomnia), weight gain, sexual dysfunction, serotonin syndrome, and GI bleed.
  • Increased risk of serotonin syndrome with excessive doses or when combined with MAOIs.
• Phenelzine: MAOI that blocks MAO enzymes in brain, increasing serotonin/dopamine/norepinephrine.
  • Adverse effects include orthostatic hypotension, CNS stimulation, and serotonin syndrome.
  • Phentolamine IV or nifedipine sublingually are antidotes.
  • Avoid foods containing tyramine.
• Lithium Carbonate: Treats bipolar disorder by altering sodium transport. Adverse effects include confusion, muscle weakness, memory impairment, polyuria, hypothyroidism, and tremors.
  • Muscle hyperirritability, EKG changes, blurred vision, coarse tremor, and incoordination indicate toxicity.
  • The therapeutic range is 0.8-1.2.

Medications for Infections

• Ciprofloxacin: Fluoroquinolone used for UTI, pneumonia, shigella, bronchitis, and otitis media.
  • Adverse effects include superinfection, SJS, kernicterus, and tendon rupture.
  • Immediately report muscle weakness/pain to avoid tendon problems.
• Metronidazole: Anti-infective for C-Diff, H. Pylori, and STDs; requires entering the invader to act.
  • Adverse effects include metallic taste, dark urine (harmless), peripheral neuropathy, and disulfiram-TR.
• Amphotericin B: Poylene used for fungal infections, specifically Candida.
  • Adverse effects include infusion reaction, renal toxicity, and anemia.
  • Monitor BUN/creatinine.
• Tetracycline: Affects protein synthesis and is used for G- infections like chlamydia, mycoplasmal, acne vulgaris, and rickettsial (typhus).
  • Adverse effects include teeth discoloration, photosensitivity, hepatotoxicity, superinfection, and long bone growth suppression.
  • Teratogenic.
• Nitrofurantoin: Urinary tract antiseptic that inhibits folic acid synthesis and only works in the urinary tract.
  • Adverse effects include brown urine (harmless), URI, permanent peripheral neuropathy, and pulmonary distress (dyspnea, chest pain, chills, cough).

Cardiovascular Medications

• Captopril: ACE inhibitor to lower BP by stopping angiotensin II production in RAAS.
  • Adverse effects include hyperkalemia, dry cough, and angioedema.
• Metoprolol/Propanolol: Beta blocker to lower BP by reducing HR and contractility.
  • Adverse effects include bradycardia and heart failure.
  • Monitor Heart Rate before administering.
• Spironolactone: Potassium-sparing diuretic that increases salt excretion with less water loss.
  • Adverse effects include gynecomastia, irregular periods, and hyperkalemia.
  • Avoid salt substitutes.
• Digoxin: Cardiac glycoside that collects calcium in the heart, increasing contractility and lowering HR.
  • Adverse effects include dysrhythmia, toxicity (GI, fatigue, visual halos).
  • Take apical pulse for 1 minute and monitor potassium.
  • Hypokalemia increases toxicity risk.
• Nitroglycerin: Nitrate that causes vasodilation to lower preload and O2 demand, relaxing spasms.
  • Adverse effects include hypotension and tachycardia.
  • Contraindicated with sildenafil (Viagra).

Endocrine Medications

• Insulin Administration: Air into NPH, air into Regular, draw Regular, then draw NPH

Medications for Other Conditions

• Levothyroxine: Thyroid preparation for hypothyroidism and Addison’s disease.
  • Take in the morning on an empty stomach.
• Conjugated Equine Estrogen: Estrogen HRT for estrogen replacement therapy.
  • Adverse effects include thromboembolism (DVT, clots), nausea, HTN, and endometrial hyperplasia.
• Heparin: Factor Xa and thrombin inhibitor that prevents more clots from forming.
  • Adverse effects include thrombocytopenia and neuro injury.
  • Protamine is the antidote.
  • Monitor aPTT.
• Warfarin: Vitamin K antagonist that prevents DVT and PE from A-Fib, and prevents MI and TIA.
  • Adverse effects include hemorrhage and toxicity.
  • Avoid leafy greens with high vitamin K.
  • Vitamin K is the antidote, and report INR > 2-3.
• Ibuprofen/Aspirin: First-generation NSAIDs that inhibit COX 1 and COX 2.
  • Aspirin causes Reye’s Syndrome in kids with flu or varicella, leading to liver/brain damage and death.
  • Salicyclism causes toxicity with tinnitus, sweating, dizziness, headache, and tachypnea.
  • Contraindicated in PUD, bleeding disorders, and under 18 with flu or varicella.
• Acetaminophen: Nonopioid analgesic that only inhibits COX in the CNS, not peripherally.
  • Adverse effects include liver damage long-term and HTN in women.
  • Acetylcysteine is the antidote; do not exceed 4g a day.
• Albuterol: Beta-2 agonist that manages long-term asthma and prevents EIB.
  • Adverse effects include nervousness/restlessness/tremor, chest pain/palpitations.
  • Use before inhaling glucocorticoids to dilate the airway so the second medication can reach the lungs. It does not reduce inflammation
• Ipratropium: Anticholinergic that lowers secretions and relieves bronchoconstriction in COPD.
  • Adverse effects include increased intraocular pressure in narrow-angle glaucoma, dry mouth, and urinary retention.
  • No inhalants for 5 min.
• Diphenhydramine: First-generation antihistamine, also be taken for insomnia.
• Psyllium: Bulk-forming agent that stimulates peristalsis, adds bulk, and prevents constipation.
  • Increase fluid intake.
• Diphenoxylate/Atropine, Loperamide: Opioid antidiarrheal that decreases peristalsis.
  • Adverse effects include anticholinergic and arrhythmias.
  • Increase fluid intake.
  • Naloxone is the antidote.
• Testosterone HRT: androderm and delatestryl.
• Finasteride: 5-Alpha Reductase Inhibitor theats BPH.
  • Adverse effects include low libido and sperm, low PSA, gynecomastia.
  • Lifelong treatment, don't let women handle the medication (transdermal absorption).

Key Drugs to Know

• Muscle Spasms: Baclofen, Dantrolene: treats skeletal muscle relaxant for spinal cord injury, multiple sclerosis, cerebral palsy
  • Dantrolene also treats malignant hyperthermia.
    • Adverse effects include drowsiness, constipation, urinary retention, liver toxicity, and muscle weakness.
    • Psychosis and seizures are withdrawal symptoms, serotonin syndrome with SSRIs.
• Seizures:
  • Valproate: Valproic Acid: indicated for all seizure types, bipolar mania, migraine prevention
    • Adverse effects include hyperammonemia, rash.
    • High ammonia alters fatty acid metabolism (pancreatitis and liver toxicity).
  • Phenytoin: traditional AED indicated for tonic-clonic and partial seizures - Adverse effects include gingival hyperplasia, SJS. - Narrow therapeutic range: 10-20, >30=toxicity - Withdrawal seizures, cardiac dysrhythmias.
  • Carbamazepine: traditional AED which has indications for tonic-clonic and partial seizures, bipolar mood stabilizer, trigeminal neuralgia
    • Adverse effects include visual disturbance, bone marrow suppression, SJS, photosensitivity.
• Anesthesia:
  • Midazolam: Benzodiazapine which is indicated Sedation before anesthesia, conscious sedation
    • Adverse effects include amnesia, cardiac or resp arrest
    • Inject slowly, at least 2 minutes before the second dose.
  • Fentanyl: general anesthetic to suplemented general anesthesia
    • ADRs: nausea, resp/circulatory depression
    • HTN crisis with MAOI
• ADHD and Narcolepsy:
  • ** Amphetamine-dextroamphetamine (Adderall):** treats ADHD and narcolepsy - Adverse effects include speeds everything up, possible growth suppression - Give last dose no later than 4 pm - Can cause HTN crisis with MAOI.
• Parkinson's
  • Pramipexole: Direct Acting Dopamine Agonist, treats Parkinson’s symptoms, RLS.
    • Adverse effects include orthostatic hypotension, dyskinesias, weakness
    • Increases Fall Risk.
• Multiple Sclerosis
  • Interferon beta 1a and beta 1b
    • Adverse effects include flu-like, bone marrow suppression, hepatotoxicity
      • Monitor CBC, AST, ALT
• Anxiety:
  • Buspirone: Non-Benzodiazepine, binds to serotonin&dopamine receptors, increases norepinephrine metabolism.
    • Adverse effects include paradoxical effects, GI, mild CNS
      • Delayed effects, less risk of dependence
• Depression:
  • Venlafaxine: SNRI, blocks reuptake of norepi and serotonin.
    • Adverse effects include, GI, CNS stimulation, HTN, suicidal ideation, hyponatremia
  • Bupropion: Atypical Antidepressant, inhibit dopamine uptake.
    • Adverse effects include GI, weight loss, CNS, psychosis, seizures. Schizophrenia:
• Chlorpromazine Traditional Antipsychotic
  • blocks dopamine, ACTH,histamine, norepi.
    • Adverse effects include extrapyramidal side effects.
    • Risperidone Atypical Antipsychotic
      • mainly block serotonin receptors,but mild dopamine blockage -Adverse effects include CNS, diabetes, high cholesterol.
• Antibacterials: -Cephalexin (Cephalosporin)beta lactam for G+ cocci,later generations=more effective. - Adverse effects include C diff,candida (mouth ulcers), disulfram-like thrombophlebitis,penicillin cross allergy. - Take with food. -Aztreonam (Monobactam) narrow spectrum G-: LRI,UTI,abdominal/vaginal. - Adverse effects include thrombophlebitis, rash, abdominal distress.
  • **Imipenem (Carbapenem)**broad spectrum for serious infections resists beta-lactamase. - Adverse effects include thrombophlebitis, beta-lactam cross allergy, superinfection.
• Vancomycin:MRSA,C- diff. -Adverse effects include red man syndrome ,n/v!,nephrotoxicity, ototoxicity.
• Acyclovir Purine Analog: herpes simplex/ herpes zoster. -Adverse effects include itching, headache,vertigo,nephrotoxicity. -OTC lotion may alter effectiveness.
• Losartan(ARB):Lowers BP blocks angiotensin II receptors in RAAS. -Adverse effects include hyperkalemia,angioedema,insomnia.
• Carvedilol Alpha-Beta Blocker:alpha/beta blockers, increases vasodilation. -Adverse effects include exacerbation of asthma,postural hypotension. -One min apical pulse, hold if BP remains <60. -Hydrochlorothiazide(Thiazide Diuretic):reduces salt levels by increasing urine output. -Adverse effects include dehydration, hypokalemia, high uric acid. -Potassium Diet.
• Furosemide (Loop Diuretic):loop diuretic, lowers salt through increase urine output. -Adverse effects include ototoxicity ,hypokalemia(muscle cramps)high uric acid. -Potassium rich diet
• Atorvastatin (HMG-CoA Reductase Inhibitor):lowers LDL and VLDL,increases. -LPL,HDL(good cholesterol)
  • Adverse effects include hepatotoxicity, myopathy, rhabdomyolysis -No grapefruit, monitor creatinine kinase.
• Glipizide(Sulfonylurea ) stimulates insulin release.
• Metformin (Biguanide) increasing insulin sensitivity.
• Pioglitazone (Thiazolidinedione) lowering insulin resistance.
• Acarbose(Alpha-glucosidase Inhibitor) lowers glucose absorption in Gl.
• Sitagliptin (Gliptin)* inhibits enzyme that activates incretin -Propylthiouracil (Anti thyroid ) hyperthyroidism, Grave's -Takes(3-12 weeks to work, can cause a rash. -lodine-131(Anti thyroid) hyperthyroid (Grave's) and thyroid cancer by killing thyroid tissues. -Adverse effects include hypothyroid, bone marrow suppression,rediation sickness w/ high doses.
• Fludrocortisone(Mineralocorticoid) treats adrenocortical insufficiency(Addison's). -Adverse effects include HTN edema hypocakemia.
• Ethinyl estradiol+drospirenone( Oral Contraceptives) prevents ovulation. -Adverse effects includethromboembolism, uterine bleeding breast cancer exacerbation,hyperkalemia hypertension.
• Ethinyl Estradiol+progesterone; treats endometrial hyperplasi and lowers risk of uterine cancer
• Leuprolide GnRH Agonisttreats enclometriosis. -Adverse effects include menopausal symptoms, osteoporosis.
• Progesterone: Endometriosis and endometrial hyperplasia: Adverse effects include thromboembolism, blood cancer,breakthrough bleeding,nausea,Edema.
• Clomiphene ( LH AND FSH Stimulant) promotes ovulation:
  • Adverse effects include vasomotor symptoms visual disturbance ovarian hyperstimulation ruptured overian cyst multiple gestation.
• *Human Chorionic gonadotropin Ovulation Stimulant)**.Promotes ovulation Adverse effects include Ovarian Hyperstimulation ruptured overian cysts CNS.
• Cabeergoline Antiypersprolactinemia* inhibits prolactin regulates menses:
  • Adverse effects include G I,CNS effects fibrosis, valcular disorders.
• .Oxytocin,induces labor:
  • Adverse effects include hypertensive crisis.water intoxication seizures. -Methylergonovine Ergot Alkaloid
  • cause contractions stops uterine hemorrhage: -Adverse effects include cramps ,HTN crisis,cva ,arrhythmia seizure. -Factors Vill and IX Antihemophilic Factor) replaces clotting factors to stop active bleeding: -Adverse effects include allergy,creutzfeldt-Jakob disease(fatal brain).
• Desmopressin Antidiuretic Hormone) stimulates factor vill release controls trauma bleeding. -Adverse effects include fluids retention seizures. -Clopidogel Antiplatelet AlDP Inhibitor Prevents clotting to reduce risk of Mt, CVA Tia . -Adverse effects include thrombotic thrombocytopenia purpura. -Alteplase Thrombolytic) dissolves existing clots: -Antidote amiocaprocic acid -Lie flat during infusion avoid invasive procedure during infusion gives ford MIT and cva. : - Adverse effects include low sperm, headache/dizzy, hypotension, fainting.
• Sildenafil (PDE-5 Inhibitor) treats erectile dysfunction: - Adverse effects include priapism (persistent erection), headache, CNS hearing/ vision loss.
  • Oxybutynin Anticholinergic urge incontinent,Anticholinergic effects. .
  • Bethanechol Cholinergic treats urinary retention by causing bladder contraction.
• • Epoetin, alfare blood cells.
• • Filiarastim white blood cells.
• • Opreivekin:platelets
• Pain Musculoskeletal 4Question*.
• Tramadol Centrally Acting Non Opiod:treats Nonopioids .Binds to opioids - receptors and blocks: norepinephine and serotonin. Adverse effects include cons,urinary retention
• Butorphanol or Pentazoaine Opioid Agonist Antagonist,is used for Moderateto- sever pain,anesthesia,adjuct. -Adverse effects include limited resps depression sedation.
• *Allopurinot Antihyperuricemic treats hyperuricemia from gout/cancer/chemo.
• -Adverse effects include hypersensitivity, metallic taste, cataracts.
• Methotrexate AntineoplasticDMARD(Traditional):folate antagonist that interferes w/Band T lymphocytes.
• Adverse effects includes myelosuppresion pulmonary fibrosis. Avoid and report anything unusual: can reactivate TB infection Adverse effects includes SJS,reactivate TB injection site reaction no vaccines!!
• Raloxifene (SERM)* postmenopausal osteoporosis osteoporosis low risk of breast cancer : -Adverse effects include high risk of DVT hot flashes stroke -Adverse effects of bisphosphonates can include espohapitis
• Dysphagia muscle,joint,Eye Paim and vision changes-sit up for 30min
• **Theophyiline Methylxanthino * is used treat chronic asthma by blocking phosphodiasterase and relaxing bronchial smooth muscles
• Amoxicillin * Penicillin beta-lactam board spectreum of ear and threat UTI .
• • Adverse effects includes supennfectiow C.Dift and candidia penicillin. Adverse effects includes ventricular dysrhymia oto toxity superinfection Contraindicatow history of prolonged OT syndrone. -Nephrotoxicily Olo toxixly dizziness. -Supertufectiow SJS kernicteas Blood Dyscasias -Nephrolithiasis Distram -Chloroquine (Avimalarials):malaria amabiasis Secondline for RA aud see -Adverse effects visual menfestators take 1 2 wk before travel while there and take for weeks after
• ** Ketocoarzcle.Azole* ** cutaneous lufections disseminated eccidiomyeasis (desert soil) Lhistoplamases (poopsoll** Adverse enects localiritation,hepatotesity -The patient should gives with the food and acidicarbonated dunks help with absorptian Low potassium. -AlisKiren Direct Ronin'mhibiton lowers as binding to ronin and desabling angiogenesis in & RAAS.
• • Adverse effects includes hyperkalenia of distress tough avgioca ema
• • Ferratogenic
• • **Doxazesin Aphai Blocken
• • Doxazosin block alpho of receptor and in areas perpheral Vasudation Othostolic hypotensions Reflex tachyardia dizziness
• • • • Clonidine rentially Acting Apho a aganist
• . Stimulates alphal receptor docks nerepinethrine.
• . -Adverse effects includes cos affect xerostanion rebrand UT
• • Hydratacine Direct Aching Vosed. later Lawas By by alting artentes Adverse effects includes reflex tachycarda Lypis symptoms
• .Oobutamine Sympathom.me Mimis sns increases urme output lowertheart workload Adverse effects includes tachycardia dysthythmia angina paan.
• **
• • Mulrinon phosphodiestrase inhibiton increases comp contractility and card.ar actrat
• *Combrozil (p.orate**mcreases LPL and itde Lower 10 and L10L Adverse effects includes gallstones hepatotoxicity myopacity
• Hydrocorisone(Glucocorteodeacute end chronic adrenocortical insufficiency( Addison's)