1. CHAPTER 66: NEUROLOGICAL MEDICATIONS
PYRAMID POINTS
CHAPTER 66:
NEUROLOGICAL MEDICATIONS

2. PYRAMID POINTS I. Antimyasthenic Medications Description Side effects
Relieve muscle weakness by blocking acetylcholine breakdown at neuromuscular junction
Side effects
Sign of cholinergic crisis
Interventions
Assess neuromuscular status and medication effectiveness
Instruct client about the importance of taking medication on time
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3. PYRAMID POINTS continued … Tensilon test
Diagnosis of myasthenia gravis shows significant improvement in muscle tone 30 to 60 seconds after injection of Tensilon; muscle improvement lasts 4 to 5 minutes
In cholinergic crisis, muscle tone does not improve after injection of Tensilon
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4. PYRAMID POINTS II. Antiparkinsonian Medications Description
Restore the balance of acetylcholine and dopamine in the central nervous system (CNS)
Dopamine medications
Levodopa taken with monoamine oxidase (MAO) inhibitor can cause hypertensive crisis
Side effects include urinary retention
Interventions
Assess for risk of injury
Instruct client to take medication with food
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5. PYRAMID POINTS continued …
Assess for signs and symptoms of parkinsonism
Monitor for signs of dyskinesia
When administering, instruct client to avoid excessive vitamin B6 intake
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6. PYRAMID POINTS II. Antiparkinsonian Medications (continued)
Anticholinergic medications
Description
Block the cholinergic reception in the CNS, thereby suppressing the acetylcholine activity
Contraindicated in clients with glaucoma
Side effects include urinary retention
Interventions
Assess for risk of injury
Assess client’s bowel and urinary function
Instruct client to have routine eye examinations
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7. PYRAMID POINTS III. Anticonvulsant Medications Description
Depress abnormal neuronal discharges
Should be used with caution in clients taking anticoagulants, aspirin, sulfonamides, cimetidine (Tagamet), antipsychotic drugs
Interventions
Monitor liver and renal function tests and medication blood serum levels
Client education
Instruct about the importance of taking medication exactly as prescribed
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8. PYRAMID POINTS continued … Hydantoins
Phenytoin (Dilantin) also used to treat dysrhythmias
Side effects
Gingival hyperplasia
Interventions
When administering IV, dilute in normal saline
When administering IV, infuse no faster than
25 to 50 mg/min
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9. PYRAMID POINTS III. Anticonvulsant Medications (continued)
Barbiturates
Side effects include sedation, ataxia, dizziness
Benzodiazepines
Succinimides
Oxazolidinediones
Side effects include headache
Valproates
Iminostilbenes
Used to treat trigeminal neuralgia
Side effects
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10. PYRAMID POINTS IV. Central Nervous System Stimulants Description
Used to treat narcolepsy, attention-deficit/hyperactivity disorder (ADHD)
Side effects include insomnia
Interventions
Assess height, weight, growth of child
If given to child, instruct parents to notify school nurse
Monitor for calming effects within 3 to 4 weeks in children with ADHD
Monitor growth in child on long-term therapy with methylphenidate hydrochloride (Ritalin)
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11. PYRAMID POINTS V. Nonopioid Analgesics
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Contraindicated in clients with hypersensitivity, liver, renal disease
Children with flu symptoms should not take aspirin
Clients taking anticoagulants should not take aspirin, NSAIDs
Interventions
Assess for allergies
Monitor serum salicylate (aspirin) level when taking high doses of aspirin
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12. PYRAMID POINTS continued … Monitor for signs of bleeding
Instruct client to take with water, milk, food
Advise client to inform other health care professionals if taking high dose of aspirin
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13. PYRAMID POINTS V. Nonopioid Analgesics (continued)
Acetaminophen (Tylenol)
Contraindicated in clients with hepatic, renal diseases, alcoholism, hypersensitivity
Side effects include hepatotoxicity
Interventions
Assess for history of liver, renal dysfunction, alcoholism, malnutrition
Monitor for hepatic damage
Antidote is acetylcysteine (Mucomyst)
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14. PYRAMID POINTS VI. Opioid Analgesics Description Medications
Suppress pain impulses
Can produce euphoria, sedation, and physical dependence
Medications
Codeine sulfate
Can cause constipation
Meperidine hydrochloride (Demerol)
Used for acute pain, preoperative medication; can cause urinary retention
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15. PYRAMID POINTS continued … Morphine sulfate
Can cause respiratory depression, orthostatic hypotension, constipation
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16. PYRAMID POINTS VI. Opioid Analgesics (continued)
Medications (continued)
Oxycodone with aspirin (Percodan)
Should not be taken by client with allergy to aspirin
Propoxyphene hydrochloride (Darvon), propoxyphene napsylate (Darvon-N)
Methadone hydrochloride (Dolophine)
Hydrocodone (Hycodan)
Frequently used for cough suppression
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17. PYRAMID POINTS VI. Opioid Analgesics (continued)
Interventions for opioid analgesics
Morphine sulfate
Side effects include respiratory depression
Withhold if respiratory rate less than 12 breaths/min
Meperidine hydrochloride
Side effects include urinary retention
Contraindicated in clients with head injuries, increased intracranial pressure
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18. PYRAMID POINTS VII. Opioid Antagonists
Used to treat respiratory depression from opioid overdose
Interventions
Monitor blood pressure, pulse, and respirations frequently
Do not leave client unattended
Have resuscitation equipment available
Monitor for recurrent opioid overdose once effect of antagonist wears off
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19. PYRAMID POINTS VIII. Osmotic Diuretics Description Side effects
Inhibit reabsorption of water and electrolytes
Used for oliguria, to decrease intracranial pressure, and to decrease intraocular pressure
Side effects
Fluid and electrolyte imbalance
Cardiac dysrythmias
Interventions
Monitor vital signs
Monitor for signs of fluid and electrolyte imbalances
Monitor heart and lung sounds
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20. 1. Break the capsules so that they are easier to swallow.
The nurse is assisting in the care of a client being discharged on phenytoin (Dilantin), 100 mg, three times daily, for seizure control. When teaching the client about this medication, the nurse should be sure to include which of the following points?
1. Break the capsules so that they are easier to swallow.
2. Use a soft toothbrush while taking this medication.
3. If a dose is missed, just wait until the next one is due.
4. Sore throat is a common effect of the medication and is nothing to worry about.
Answer: 2
Rationale: Phenytoin is an anticonvulsant that can cause gingival hyperplasia, as well as bleeding, swelling, and tenderness of the gums. The client should use good oral hygiene, gum massage, and have regular dental checkups. The client should not skip medication doses, because this could precipitate a seizure. The client should report a sore throat, fever, glandular swelling, or any skin reaction, because this indicates hematological toxicity. Capsules should not be chewed or broken, and they must be swallowed.
Test-Taking Strategy: Use the process of elimination. Eliminate option 3, because the client should be encouraged to take medications on time. Choose among the remaining options, recalling that phenytoin can cause gingival hyperplasia. Review the side effects related to phenytoin if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Teaching and Learning
Content Area: Pharmacology
Reference: Hodgson, B., & Kizior, R. (2007). Saunders nursing drug handbook 2007 (p. 930). Philadelphia: W.B. Saunders.
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