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chapter 13 - ATI Testing

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Chronic Neurological Disorders
UNIT 2
chapter 13
MEDICATIONS AFFECTING THE NERVOUS SYSTEM
Chapter 13 Chronic Neurological Disorders
Overview
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Use medications for chronic neurologic disorders to manage symptoms and improve
quality of life.
Chronic neurologic disorders include myasthenia gravis, Parkinson’s disease, and seizure
disorder.
MEDICATION CLASSIFICATION: CHOLINESTERASE INHIBITORS
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Select Prototype Medication – Neostigmine (Prostigmin)
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Other Medications:
в—Їв—Ї
Ambenonium (Mytelase)
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Pyridostigmine (Mestinon)
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Edrophonium (Tensilon)
Purpose
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Expected Pharmacological Action
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Cholinesterase inhibitors prevent the enzyme cholinesterase (ChE) from inactivating
acetylcholine (ACh), thereby increasing the amount of ACh available at receptor
sites. Transmission of nerve impulses is improved at all sites responding to ACh as a
transmitter.
Therapeutic Uses
Treatment of
myasthenia gravis
NEOSTIGMINE
AMBENOMIUM
PYRIDOSTIGMINE
X
X
X
Diagnosis of
myasthenia gravis
Reversal of
nondepolarizing
neuromuscular
blocking agents
EDROPHONIUM
X
X
PN PHARMACOLOGY FOR NURSING
X
X
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Chronic Neurological Disorders
Complications
SIDE/ADVERSE EFFECTS
NURSING INTERVENTIONS/CLIENT EDUCATION
Excessive muscarinic stimulation as evidenced
by increased gastrointestinal (GI) motility,
increased GI secretions, bradycardia, and
urinary urgency
• Advise clients of potential side effects. If
effects become intolerable, instruct clients
to notify the provider.
• Treat side effects with atropine.
Cholinergic crisis (excessive muscarinic
stimulation and respiratory depression from
neuromuscular blockade)
• Monitor clients receiving atropine for
muscarinic effects.
• Assist with emergency respiratory care.
Contraindications/Precautions
в—Џв—Џ
в—Џв—Џ
Cholinesterase inhibitors are Pregnancy Risk Category C.
These medications are contraindicated in clients with obstruction of GI and genitourinary
(GU) system, peptic ulcer disease, asthma, and coronary insufficiency.
Interactions
MEDICATION/FOOD INTERACTIONS
NURSING INTERVENTIONS/CLIENT EDUCATION
Atropine counteracts the effects of neostigmine.
• Atropine is used to treat neostigmine
toxicity.
Neostigmine reverses neuromuscular blockade
caused by neuromuscular blocking agents
after surgical procedures and overdose.
• Monitor clients for return of respiratory
function. Support respiratory function
as necessary. If used to treat overdose,
provide mechanical ventilation until clients
have regained full muscle function.
Succinylcholine increases neuromuscular
blockade.
• Avoid concurrent use.
Nursing Administration
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Neostigmine may be given PO, IM, IV, or subcutaneously.
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Instruct clients to take medications as prescribed.
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Advise clients that dosage is very individualized, starts at very low doses, and is titrated
until desired muscle function is achieved.
Encourage clients to participate in self-dosage adjustments. Have clients:
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160
Keep records of medication administration and effects.
Recognize signs of inadequate dosing, such as difficulty swallowing, and signs of
overmedication, such as urinary urgency.
Modify dosage based on response.
Advise clients to wear a medical alert bracelet.
PN PHARMACOLOGY FOR NURSING
Chronic Neurological Disorders
Nursing Evaluation of Medication Effectiveness
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Depending on therapeutic intent, effectiveness may be evidenced by:
в—Їв—Ї
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Fewer episodes of fatigue
Improvement in strength as demonstrated by improved ability to chew, swallow, and
perform activities of daily living (ADLs) such as bathing, walking, eating, and dressing
MEDICATION CLASSIFICATION: ANTI-PARKINSON’S MEDICATIONS
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Select Prototype Medications:
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Dopaminergics – Levodopa (Dopar, Larodopa) or levodopa plus carbidopa (Sinemet)
в—Їв—Ї
Dopamine agonists – Pramipexole (Mirapex)
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Centrally acting anticholinergics – Benztropine (Cogentin)
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Dopamine releaser (Antiviral) – Amantadine (Symmetrel)
Other Medications:
в—Їв—Ї
Dopamine agonists – Ropinirole (Requip), bromocriptine (Parlodel)
в—Їв—Ї
Centrally acting anticholinergics – Trihexyphenidyl (Artane)
Purpose
в—Џв—Џ
Expected Pharmacological Action
в—Їв—Ї
These medications do not halt the progression of Parkinson’s disease (PD). However,
they do offer symptomatic relief from dyskinesias (bradykinesia, resting tremors, and
muscle rigidity) and an increase in the ability to perform ADLs by maintaining the
balance between dopamine and ACh in the extrapyramidal nervous system.
CLASSIFICATIONS
EXPECTED PHARMACOLOGICAL ACTION
Dopaminergics
• Levodopa crosses the blood-brain barrier and is taken up by
dopaminergic nerve terminals and converted to dopamine (DA). This
newly synthesized DA is released into the synaptic space and causes
stimulation of DA receptors.
• Use carbidopa to augment levodopa by decreasing the amount of
levodopa that is converted to DA in the intestine and periphery. This
results in greater amounts of levodopa reaching the CNS.
Dopamine agonists
• These agents act directly on DA receptors.
Centrally acting
anticholinergics
• These agents block ACh at muscarinic receptors, which assists in
maintaining balance between dopamine and ACh in the brain.
Antiviral
• Antivirals stimulate DA release, prevent dopamine reuptake, and may
block cholinergic and glutamate receptors.
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Therapeutic Uses
в—Їв—Ї
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Use levodopa as a first-line medication for PD treatment.
Use pramipexole as monotherapy in early-stage PD and use in conjunction with
levodopa in late-stage PD. It is used more often in younger clients who are better able
to tolerate daytime drowsiness and orthostatic hypotension.
Complications
SIDE/ADVERSE EFFECTS
NURSING INTERVENTIONS/CLIENT EDUCATION
Dopaminergics: levodopa (Usually dose dependent)
Nausea and vomiting,
drowsiness
• Administer with food in small doses, and at the start of
treatment.
Dyskinesias (head bobbing, tics,
grimacing, tremors)
• Administer a decreased dosage. The decrease may result in
resumption of PD symptoms.
Orthostatic hypotension
• Monitor the client’s blood pressure.
• Instruct clients about signs of orthostatic hypotension
(lightheadedness, dizziness). Instruct clients to change positions
slowly and to sit or lie down if symptoms occur.
Cardiovascular effects from
beta1 stimulation (tachycardia,
palpitations, irregular
heartbeat)
•
•
•
•
Psychosis (visual hallucinations,
nightmares)
• Administer antipsychotic medications as prescribed.
Discoloration of sweat and urine
• Advise clients that this is a harmless side effect.
Activation of malignant
melanoma
• Avoid use of medication in clients who have skin lesions that
have not been diagnosed.
Monitor the client’s vital signs.
Monitor ECG.
Notify the provider if symptoms occur.
Use cautiously in clients who have cardiovascular disorders.
Dopamine agonists: pramipexole
Sudden inability to stay awake
• Advise clients to notify the provider immediately if this occurs.
Daytime sleepiness
• Advise clients of the potential for drowsiness and to avoid
hazardous activities.
• Advise clients to avoid other CNS depressants such as alcohol.
Orthostatic hypotension
• Instruct clients about the signs of orthostatic hypotension
(lightheadedness, dizziness). Instruct clients to change
positions slowly and to sit or lie down if symptoms occur.
Psychosis (visual hallucinations,
nightmares)
• Administer an atypical antipsychotic medication if symptoms
occur.
Dyskinesias (head bobbing, tics,
grimacing, tremors)
• Decrease dosage of medication.
Nausea
• Advise clients to take medication with food.
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Chronic Neurological Disorders
SIDE/ADVERSE EFFECTS
NURSING INTERVENTIONS/CLIENT EDUCATION
Centrally acting anticholinergics: benztropine
Nausea, vomiting
• Advise clients to take medication with food but to avoid highprotein snacks.
Anticholinergic effects
(dry mouth, blurred vision,
mydriasis, urinary hesitancy or
retention, constipation)
• Advise clients to observe for symptoms and notify the
provider if they occur.
• Monitor I&O and check clients for urinary retention.
• Advise clients to chew sugarless gum, eat foods high in fiber,
and increase fluid intake to 2 to 3 L/day from beverage and
food sources.
Antihistamine effects (sedation,
drowsiness)
• Advise clients to avoid hazardous activities while taking the
medication.
Antiviral: amantadine
CNS effects (confusion,
dizziness, restlessness)
• Advise clients to avoid hazardous activities while taking the
medication.
Anticholinergic effects
(dry mouth, blurred vision,
mydriasis, urinary hesitancy or
retention, constipation)
• Advise clients to observe for symptoms and notify the
provider.
• Monitor I&O and check clients for hesitancy or urinary
retention.
• Advise clients to chew sugarless gum, eat high-fiber foods, and
increase fluid intake to 2 to 3 L/day from beverage and food.
Discoloration of skin, also called
livido reticularis
• Advise clients that discoloration of the skin will subside when
the medication is discontinued.
Levodopa plus carbidopa
Abnormal movements,
psychiatric disorders
• Advise clients of potential side effects and to notify the
provider if they occur.
Contraindications/Precautions
в—Їв—Ї
Levodopa
в– в– This medication is Pregnancy Risk Category C.
в– в– Contraindicated in clients with malignant melanoma.
в– в– Do not use within 2 weeks of MAOI use.
в– в– в—Їв—Ї
Use cautiously in clients who have heart disease, clients who have psychiatric
disorders, and older adult clients.
Pramipexole
в– в– This medication is Pregnancy Risk Category C.
в– в– Use cautiously in clients with liver and kidney impairment.
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Chronic Neurological Disorders
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Benztropine
в– в– в– в– Contraindicated in clients with narrow-angle glaucoma, myasthenia gravis, and
obstruction of the GI or GU system.
Use cautiously in older adults, debilitated clients, clients who have enlarged
prostate glands, hypertension, and renal and liver disease.
Interactions
MEDICATION/FOOD INTERACTIONS
NURSING INTERVENTIONS/CLIENT EDUCATION
Dopaminergics: levodopa
Proteins interfere with levodopa absorption and
transport across the blood-brain barrier. Highprotein meals decrease therapeutic effects.
• Proteins trigger an “off episode.”
• Advise clients to avoid high-protein meals
and snacks.
Conventional-antipsychotic agents
(chlorpromazine [Compazine], haloperidol
[Haldol]) decrease therapeutic effects.
• Avoid concurrent use.
• If clients experience levodopa-induced
psychosis, administer an atypical
antipsychotic agent.
Pyridoxine (vitamin B6) decreases therapeutic
effects.
• Advise clients to avoid vitamin preparations
that contain pyridoxine.
Concurrent use of MAOIs may result in
hypertensive crisis.
• Avoid concurrent use.
• Use these medications concurrently to
Carbidopa, dopamine agonists, anticholinergics,
increase the beneficial effects of levodopa,
Catechol O-methyltransferase (COMT) inhibitors,
but this increases the risk of adverse effects
and dopamine releasers increase therapeutic effects.
such as psychosis.
Dopamine agonists: pramipexole
Use with levodopa can decrease motor control
fluctuations and allow for lower dosage of
levodopa. Concurrent use can also increase the
risk of orthostatic hypotension and dyskinesias.
• Monitor clients for these interactions.
Levodopa plus carbidopa
Beneficial interactions include allowing for lower
dosage of levodopa, reduced cardiovascular
responses to dopamine in the periphery, and
decreased nausea.
• Monitor clients for therapeutic effects.
Nursing Administration
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164
Instruct family members to assist clients with the medication at home.
Instruct clients about the possible sudden loss of the effects of medication and to notify the
provider if symptoms occur.
Inform clients that effects may not be noticeable for several weeks to several months.
PN PHARMACOLOGY FOR NURSING
Chronic Neurological Disorders
в—Џв—Џ
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Instruct clients that a medication “holiday” may be prescribed, but will take place in an
inpatient setting.
Advise clients to avoid high-protein meals and snacks.
Nursing Evaluation of Medication Effectiveness
в—Џв—Џ
Depending on therapeutic intent, effectiveness may be evidenced by:
в—Їв—Ї
в—Їв—Ї
Improvement of symptoms as demonstrated by absence of tremors, and reduction of
irritability and stiffness.
Increase in ability to perform ADLs.
MEDICATION CLASSIFICATION: ANTIEPILEPTICS (AEDs)
в—Џв—Џ
Select Prototype Medications:
в—Їв—Ї
в– в– Phenobarbital (Luminal)
в– в– Primidone (Mysoline)
в—Їв—Ї
Phenytoin (Dilantin)
в—Їв—Ї
Carbamazepine (Tegretol)
в—Їв—Ї
Ethosuximide (Zarontin)
в—Їв—Ї
Valproic acid (Depakote)
в—Їв—Ї
Gabapentin (Neurontin)
в—Їв—Ї
в—Џв—Џ
Barbiturates:
Benzodiazepines:
в– в– Diazepam (Valium)
в– в– Lorazepam (Ativan)
Other Medications:
в—Їв—Ї
Lamotrigine (Lamictal)
в—Їв—Ї
Oxcarbazepine (Trileptal)
Purpose
в—Џв—Џ
Expected Pharmacological Action
в—Їв—Ї
AEDs control seizure disorders by various mechanisms, which include:
в– в– в– в– в– в– Slowing the entrance of sodium and calcium back into the neuron and, thus
extending the time it takes for the nerve to return to its active state.
Suppressing neuronal firing, which decreases seizure activity and prevents
propagation of seizure activity into other areas of the brain.
Decreasing seizure activity by enhancing the inhibitory effects of gamma butyric
acid (GABA).
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Chronic Neurological Disorders
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Therapeutic Uses
MEDICATION
THERAPEUTIC USES
Phenobarbital
• Use for partial seizures and generalized tonic-clonic seizures.
• This medication is not effective against absence seizures.
Phenytoin
• Use for all major forms of epilepsy except absence seizures.
• Use IV route for status epilepticus.
• Use for dysrhythmias with QT prolongation.
Carbamazepine
• Use for the treatment of partial (simple and complex) seizures,
tonic-clonic seizures, bipolar disorder, and trigeminal and
glossopharyngeal neuralgias.
Ethosuximide
• Use only for absence seizures.
Valproic acid
• Use for partial, generalized, and absence seizures; bipolar disorder;
and migraine headaches.
Gabapentin
• Use as a single agent for control of partial seizures.
• This medication is also used for neuropathic pain and the prevention
of migraine headaches.
Diazepam or
lorazepam
• Use IV route for status epilepticus.
Complications
SIDE/ADVERSE EFFECTS
NURSING INTERVENTIONS/CLIENT EDUCATION
Barbiturates: phenobarbital
CNS effects in adults manifest as drowsiness,
• Advise clients to observe for symptoms and
sedation, confusion, and anxiety. In children, CNS
to notify the provider if they occur.
effects manifest as irritability and hyperactivity.
• Advise clients to avoid hazardous activities,
such as driving.
Toxicity (nystagmus, ataxia, respiratory
depression, coma, pinpoint pupils, hypotension,
death)
166
• Stop medication. Administer oxygen and
assist with emergency care.
• Monitor the client’s vital signs.
PN PHARMACOLOGY FOR NURSING
Chronic Neurological Disorders
SIDE/ADVERSE EFFECTS
NURSING INTERVENTIONS/CLIENT EDUCATION
Hydantoins: phenytoin
CNS effects (nystagmus, sedation, ataxia,
cognitive impairment, double vision)
• Monitor for symptoms and notify the provider
if symptoms occur.
Gingival hyperplasia (softening and overgrowth
of gum tissue, tenderness, and bleeding gums)
• Advise clients to maintain good oral hygiene
(dental flossing, massaging gums).
Skin rash
• Instruct clients to stop the medication and
notify the provider.
Teratogenic (cleft palate, heart defects)
• Avoid use in pregnancy.
Cardiovascular effects (dysrhythmias,
hypotension)
• Monitor clients receiving IV therapy for
adverse CV effects.
Endocrine and other effects (coarsening of facial
features, hirsutism, and interference with vitamin
D metabolism)
• Instruct clients to report changes.
• Encourage clients to consume adequate
amounts of calcium and vitamin D.
Carbamazepine
Cognitive function is minimally affected, but
CNS effects (nystagmus, double vision, vertigo,
staggering gait, headache) can occur.
• Administer in low doses initially and then
gradually increase dosage.
• Instruct clients to administer the dose at
bedtime.
Blood dyscrasias (leukopenia, anemia,
thrombocytopenia)
• Obtain the client’s baseline and perform
ongoing monitoring of CBC and platelet
count.
• Observe clients for signs of bruising and
bleeding of gums.
Hypo-osmolarity (Carbamazepine promotes
secretion of ADH, which inhibits water excretion
by the kidneys and places clients who have heart
failure at risk for fluid overload.
• Monitor serum sodium periodically.
• Monitor clients for edema, decrease in urine
output, and hypertension.
Skin disorders (dermatitis, rash, Stevens-Johnson
syndrome)
• Treat mild reactions with anti-inflammatory or
antihistamine medications.
• Instruct clients to notify the provider of
severe reaction. The medication should be
discontinued.
Ethosuximide
GI effects (nausea, vomiting)
• Administer with food.
CNS effects (sleepiness, lightheadedness,
fatigue)
• Administer low initial dosage.
• Advise clients to avoid hazardous activities,
such as driving.
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SIDE/ADVERSE EFFECTS
NURSING INTERVENTIONS/CLIENT EDUCATION
Valproic acid
GI effects (nausea, vomiting, indigestion)
• Advise clients to take medication with food.
Enteric-coated formulation can decrease
symptoms.
Hepatotoxicity (anorexia, abdominal pain,
jaundice)
• Check baseline liver function and monitor
liver function periodically.
• Advise clients to observe for signs (anorexia,
nausea, vomiting, abdominal pain, jaundice),
and notify the provider if symptoms occur.
• Administer in lowest effective dose.
Pancreatitis as evidenced by nausea, vomiting,
and abdominal pain
• Advise clients to observe for symptoms and
to notify the provider immediately if these
symptoms occur.
• Monitor amylase levels.
• Medication should be discontinued if
pancreatitis develops.
Thrombocytopenia
• Advise clients to observe for symptoms such
as bruising, and to notify the provider if these
occur.
• Monitor the client’s platelet counts.
Gabapentin
CNS effects (drowsiness, nystagmus)
• Administer low initial dosage.
• Advise clients to avoid hazardous activities,
such as driving.
Diazepam
Respiratory depression
• Monitor the client’s vital signs.
• Have resuscitation equipment ready.
• Administer oxygen.
Anterograde amnesia
• Monitor clients for memory loss.
• Notify the provider if symptoms occur.
Contraindications/Precautions
в—Џв—Џ
Phenobarbital, phenytoin, carbamazepine and valproic acid are Pregnancy Risk Category D.
в—Џв—Џ
Barbiturates are contraindicated in clients with intermittent porphyria.
в—Џв—Џ
168
Phenytoin is contraindicated in clients with sinus bradycardia, sinoatrial blocks, secondand third-degree AV block, or Stokes-Adams syndrome.
PN PHARMACOLOGY FOR NURSING
Chronic Neurological Disorders
в—Џв—Џ
в—Џв—Џ
Carbamazepine is contraindicated in clients with bone marrow suppression or bleeding
disorders.
Valproic acid is contraindicated in clients with liver disorders and children less than 3В yr of
age.
Interactions
MEDICATION/FOOD INTERACTIONS
NURSING INTERVENTIONS/CLIENT EDUCATION
Phenytoin
Phenytoin causes a decrease in the effects of
oral contraceptives, warfarin (Coumadin), and
glucocorticoids because of the stimulation of
hepatic drug-metabolizing enzymes.
• Inform clients of interaction, and provider
may need to adjust the dosage of oral
contraceptives. Suggest use of an alternative
form of birth control.
• Monitor for therapeutic effects of warfarin
with PT and INR. Provider may adjust
dosage.
Alcohol, diazepam (Valium), cimetidine
(Tagamet), and valproic acid decrease phenytoin
levels.
• Advise clients to avoid alcohol use.
• Monitor phenytoin serum levels.
Carbamazepine (Tegretol), phenobarbital, and
chronic alcohol use increase phenytoin levels.
• Encourage clients to avoid use of alcohol.
Additive CNS depressant effects can occur
with concurrent use of CNS depressants
(barbiturates, alcohol).
• Advise clients to avoid concurrent use of
alcohol and other CNS depressants.
Carbamazepine
Carbamazepine causes a decrease in the effects
of oral contraceptives and warfarin (Coumadin)
because of the stimulation of hepatic drugmetabolizing enzymes.
• Inform clients of interaction and provider
may need to adjust the dosage of oral
contraceptives. Suggest use of an alternative
form of birth control.
• Monitor for therapeutic effects of warfarin
with PT and INR.
• Provider may adjust dosage.
Grapefruit juice inhibits metabolism, and thus
increases carbamazepine levels.
• Advise clients to avoid intake of grapefruit
juice.
Phenytoin and phenobarbital decrease the
effects of carbamazepine.
• Avoid concurrent use.
Valproic acid
Concurrent use with valproic acid increases the
levels of phenytoin and phenobarbital.
PN PHARMACOLOGY FOR NURSING
• Monitor phenytoin and phenobarbital levels.
• Adjust dosage of medications as prescribed.
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Chronic Neurological Disorders
Nursing Administration
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в—Џв—Џ
в—Џв—Џ
в—Џв—Џ
в—Џв—Џ
в—Џв—Џ
в—Џв—Џ
в—Џв—Џ
Monitor therapeutic serum levels. Be aware of therapeutic levels for medications prescribed.
Notify the provider of results.
Advise clients taking antiepileptic medications that treatment provides for control of
seizures, not cure of disorder.
Encourage clients to keep a seizure frequency diary to monitor effectiveness of therapy.
Advise clients to take medications as prescribed and not to stop medications without
consulting the provider. Sudden cessation of medication may trigger seizures.
Advise clients to avoid hazardous activities (driving, operating heavy machinery) until
seizures are fully controlled.
Advise clients who are traveling to carry extra medication to avoid interruption of
treatment in locations where their medication is not available.
Advise clients of childbearing age to avoid pregnancy, because medications may cause birth
defects and congenital abnormalities.
Advise clients that phenytoin has a narrow therapeutic range, and strict adherence to the
medication regimen is imperative to prevent toxicity or therapeutic failure.
Nursing Evaluation of Medication Effectiveness
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170
Depending on therapeutic intent, effectiveness may be evidenced by:
в—Їв—Ї
Absence or decreased occurrence of seizures
в—Їв—Ї
Ability to perform ADLs
в—Їв—Ї
Absence of injury
PN PHARMACOLOGY FOR NURSING
Chronic Neurological Disorders
APPLICATION EXERCISES
1. Clients who take phenytoin must perform good oral hygiene. Why is oral hygiene important for
these clients?
2. A client has been diagnosed with absence seizures. The nurse should recognize that which of the
following medications are used to treat this type of seizure? (Select all that apply.)
Phenytoin (Dilantin)
Ethosuximide (Zarontin)
Gabapentin (Neurontin)
Carbamazepine (Tegretol)
Valproic acid (Depakote)
3. A nurse is caring for a client who is taking valproic acid (Depakote) to prevent seizures. What
laboratory values should the nurse plan to monitor for this client?
4. A client who has Parkinson’s disease is prescribed levodopa/carbidopa (Sinemet) and pramipexole
(Mirapex). For which of the following should the nurse monitor this client?
A. Urinary hesitancy
B. Watery diarrhea
C. Weight gain
D. Orthostatic hypotension
5. A client with Parkinson’s disease has a new prescription for levodopa (Dopar). Which of the
following findings should the nurse watch for in this client? (Select all that apply.)
Hallucinations
Memory loss
Mania
Paranoid ideas
Nightmares
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APPLICATION EXERCISES ANSWER KEY
1. Clients who take phenytoin must perform good oral hygiene. Why is oral hygiene important for
these clients?
Gingival hyperplasia, an overgrowth of gum tissue, may occur in clients who take
phenytoin. Bleeding gums, and swelling and tenderness of tissue, may result. The client
should brush well, floss between teeth, and perform gum massage to minimize this
adverse reaction.
NCLEXВ® Connection: Pharmacological Therapies, Adverse Effects/Contraindications/Side
Effects/Interactions
2. A client has been diagnosed with absence seizures. The nurse should recognize that which of the
following medications are used to treat this type of seizure? (Select all that apply.)
Phenytoin (Dilantin)
X Ethosuximide (Zarontin)
Gabapentin (Neurontin)
Carbamazepine (Tegretol)
X Valproic acid (Depakote)
Use ethosuximide and valproic acid to treat absence seizures. Phenytoin is effective
against all major forms of seizures except absence seizures. Use gabapentin as a single
agent for control of partial seizures. Use carbamazepine for the treatment of partial
(simple and complex) seizures, tonic-clonic seizures, bipolar disorder, and trigeminal and
glossopharyngeal neuralgias.
NCLEXВ® Connection: Pharmacological Therapies, Expected Actions/Outcomes
3. A nurse is caring for a client who is taking valproic acid (Depakote) to prevent seizures. What
laboratory values should the nurse plan to monitor for this client?
Severe hepatotoxicity and pancreatitis may occur in the client taking valproic acid. The
nurse should plan to monitor periodic liver function tests and amylase values. The nurse
should also reinforce teaching about manifestations of hepatotoxicity (nausea, anorexia,
abdominal pain, and jaundice) and pancreatitis (abdominal pain, nausea, vomiting, and
weight loss) for the client to report to the provider.
NCLEXВ® Connection: Pharmacological Therapies, Adverse Effects/Contraindications/Side
Effects/Interactions
172
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Chronic Neurological Disorders
4. A client who has Parkinson’s disease is prescribed levodopa/carbidopa (Sinemet) and pramipexole
(Mirapex). For which of the following should the nurse monitor this client?
A. Urinary hesitancy
B. Watery diarrhea
C. Weight gain
D. Orthostatic hypotension
Orthostatic hypotension is an adverse effect of both levodopa/carbidopa and pramipexole.
When both medications are prescribed, the incidence of orthostatic hypotension is very
high. Memory loss, diarrhea, and weight gain are not adverse effects of either medication.
NCLEXВ® Connection: Pharmacological Therapies, Adverse Effects/Contraindications/Side
Effects/Interactions
5. A client with Parkinson’s disease has a new prescription for levodopa (Dopar). Which of the
following findings should the nurse watch for in this client? (Select all that apply.)
X Hallucinations
Memory loss
Mania
X Paranoid ideas
X Nightmares
Psychotic behaviors which may occur in clients taking levodopa include visual
hallucinations, paranoid ideas, and vivid dreams or nightmares. Memory loss and mania
are not manifestations seen in clients taking this medication.
NCLEXВ® Connection: Pharmacological Therapies, Adverse Effects/Contraindications/Side
Effects/Interactions
PN PHARMACOLOGY FOR NURSING
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