Neurological Drugs - Part 1 PDF

Neurological Drugs - Part 1 Neurological disorders cause physical, cognitive, emotional and behavioral symptoms like pain, confusion, mood changes and/or coordination difficulties. The goal of therapy is to correct alterations in the nervous system and nervous system medications provide ways to do...

Neurological Drugs - Part 1 Neurological disorders cause physical, cognitive, emotional and behavioral symptoms like pain, confusion, mood changes and/or coordination difficulties. The goal of therapy is to correct alterations in the nervous system and nervous system medications provide ways to do that, and also help clients manage symptoms.  Muscle Relaxants Meds for Seizure Disorders ADHD Neuro Parkinson’s Conditions Alzheimer’s Multiple Sclerosis Migraines MUSCLE RELAXANTS Classifications: Centrally acting types Peripherally acting types USES: relief of painful conditions like back spasms, trauma, spinal cord injury, as well as control of spasticity of chronic conditions like MS, CP  CENTRALLY ACTING RELAXANTS PROTOTYPE - baclofen works in the CNS to reduce muscle hyperactivity (GABA agonist) Has CNS depressant effects (dizzy, drowsy, orthostatic hypotension, etc.) can be given intrathecally (into the spine with a pump) don’t take with MAOIs, alcohol, other CNS depressants (hypotension, CNS depression)  PERIPHERALLY ACTING RELAXANTS PROTOTYPE - dantrolene acts directly on skeletal muscles by inhibiting calcium release (needed for muscle contraction) Has high potential for liver toxicity Causes CNS depressant effects, so avoid alcohol, other CNS depressants Contraindications: clients older than 35 taking estrogen, clients taking a calcium channel blocker SEIZURE DISORDERS Classifications: Traditional AEDS New AEDS (antiepileptics)  AEDs: Hydantoins PROTOTYPE - phenytoin Suppresses the sodium intake in hyperactive neurons to control tonic-clonic seizures (grand mal) Has CNS depressant effects Gingival hyperplasia is an expected side effect Adverse reaction: skin rash - possible Stevens-Johnson Syndrome (SJS) Reduces effectiveness of oral contraceptives IV - inject SLOWLY; monitor blood levels (10-20 mcg/ml)  AEDs: Other PROTOTYPE - carbamazepine (Tegretol) Same mode of action as phenytoin Used for partial seizures (also as a mood stabilizer for bipolar disorder) Side effects: neuro (visual disturbances, headache, ataxia, nystagmus, blurred vision), fluid retention, skin rash (SJS) Monitor for bone marrow suppression (CBC, fever, sore throat, easy bruising) Decreases effectiveness of oral contraceptives ADHD Classifications: Amphetamines (ADHD) Methylphenidate ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental disorder that affects both children and adults. It is characterized by signs such as difficulty with focus, hyperactivity, and impulsivity.  Amphetamines/ADHD PROTOTYPE - amphetamine/dextroamphetamine Increases release of norepinephrine and dopamine CNS stimulant: improved mood, focus, attention span, less impulsivity, distractibility Side effects: weight loss (monitor weight closely in children), tolerance/dependence, risk of toxicity (psychosis) Schedule II controlled substance Stopping abruptly can lead to abstinence syndrome (severe exhaustion, hypersomnia, depression) Contraindication: MAOI (can cause hypertensive crisis)  methylphenidate/ADHD, narcolepsy PROTOTYPE - methylphenidate (Ritalin, Concerta) Same action and effects as amphetamine (CNS stimulant) PARKINSON’S (PD) Classifications: Dopamine replacement/dopaminergic Dopamine receptor agonists MAO-B inhibitors Parkinson’s disease (PD) occurs when brain cells that make dopamine, a chemical that coordinates movement, stop working or die. Because PD can cause tremor, slowness, stiffness, and walking and balance problems, it is called a “movement disorder.” But non-movement symptoms also can be part of Parkinson’s. PD is a lifelong and progressive disease  Dopamine Replacement Drugs (PD) PROTOTYPE - levodopa/carbidopa levodopa - absorbed in the intestine; brain converts it to dopamine, which powers normal movement but decreases in Parkinson's disease (PD). Carbidopa prevents levodopa from turning into dopamine before it gets to the brain and limits levodopa's side effects Adverse eff: may darken sweat/urine, dsykinesias (early on), orthostatic hypotension Can take up to 6 months to achieve therapeutic response Clients must avoid high-protein foods  Dopamine Receptor Agonists (PD) PROTOTYPE - pramipexole Bind to dopamine receptors to mimic dopamine Side effects similar to L/C - also drowsiness (“sleep attacks”) Muscle weakness - causing risk for falls  MAO-B inhibitors (PD) Monamine oxidase type B PROTOTYPE - selegiline Used as adjunct to L/C to manage symptoms of PD MAO-B inactivates dopamine; so MAO-B inhibitor makes more dopamine available to the brain; enhances effectiveness of L/C Major adverse effects: insomnia, ingesting foods that contain tyramine (aged cheeses, processed meats) can cause hypertensive crisis when high doses are given Interacts with many different types of drugs ALZHEIMER’S (AZ) Classifications: Cholinesterase inhibitors NMDA receptor agonists Alzheimer's disease, the most common cause of dementia, is the biological process that begins with the appearance of a buildup of proteins in the form of amyloid plaques and neurofibrillary tangles in the brain. This causes brain cells to die over time and the brain to shrink. AZ leads to serious memory loss and the inability to do everyday tasks. There is no cure.  Cholinesterase Inhibitors/AZ PROTOTYPE - donepezil (Aricept) Increases the amount of acetylcholine available in the brain (there is a decrease in acetyl in Alzheimer’s) Side effects: GI symptoms (including GI bleeding), CNS effects like insomnia, dizzy, headache. Syncope/bradycardia are adverse effects. Monitor HR Make sure a caregiver is present when giving instructions!  NMDA receptor antagonist/AZ PROTOTYPE - memantine Reduces intracellular calcium which restores normal nerve transmissions - prevents damage from high levels of CA CNS effects - dizzy, headache, confusion, constipation Make sure a caregiver is present when giving instructions MULTIPLE SCLEROSIS (MS) Classification: Immunomodulators MS is an autoimmune disease that causes breakdown of the protective covering (myelin sheath) of nerves. It can cause numbness, weakness, trouble walking, vision changes and other symptoms. Note: other drugs are used to manage symptoms. There is no cure for MS.  Immunomodulators/MS PROTOTYPES - interferon beta-1a (Avonex, Rebif), interferon beta-1b (Betaseron) Inhibit the movement of leukocytes across the blood- brain barrier (defective autoimmune response), protecting the myelin sheath from damage Given by injection Monitor blood counts (thrombocytopenia and neutropenia) Don’t give with any other drug that suppresses the immune system (prednison) MIGRAINES Classification: Serotonin agonists (triptans) Note: this is one of many drug types used for migraines. Others include beta blockers, tricyclic antidepressants, antiepileptics, estrogens, analgesics.  Serotonin Agonists/Migraine PROTOTYPES - sumatriptan (Imitrex) Promotes vasoconstriction and suppression of the inflammatory response that occurs with migraines Side effects - chest heaviness, anginal pain (normal) Monitor vitals closely after the first dose (risk of vasospasm of the coronary arteries) Contraindicated for clients with coronary artery disease, MI, severe hypertension, peripheral vascular disease (because of the vasoconstriction action) St. John’s wart may cause sumatriptan toxicity