1. Neurological Pharmacology
Developed by:
Dawn Johnson, RN, MSN, Ed

2. Property of:

3. Anticonvulsant Medications

4. Anticonvulsant Medications Hydantoin class
Phenytoin (Dilantin)
Ethotoin (Peganone)
Mephenytoin (Mesantaoin)
Fosphenytoin IV (Celebyx)
Action: increases Na+ out of neurons depressing abnormal stimulation and discharge

5. Anticonvulsant Medications Hydantoin class
Uses:
Seizures of all types without CNS depression
Side effects:
Drowsiness and dizziness
n/v
Gingival Hyperplasia-reddened gums that bleed easily
Low platelet and WBC count
Toxicity:
ataxia/slurred speech
Diplopia/nystagmus
Hypotension
Pupils fixed/coma

6. Anticonvulsant Medications Hydantoin class
Contraindications:
Bradycardia
Heart block
Considerations:
Dilantin level 10-20ug
Must take same brand; no abrupt discontinuation
Urine discoloration
If down tube feeding: shut off tf for 1 hour prior and 1 hour after due to dilantin binds with protein in tube feedings
Give good oral hygiene/dental checks
IV: no dextrose; it precipitates
Give in large vein < or = 50mg/min
Cardiotoxic with low bp

7. Anticonvulsant Medications Phenytoin-like class
Valproic acid (Depakene) (Depakote)
Carbamazepine (Tegretol)
Topiramate (Topamax)
Lamotrigine (Lamictal)
Zonisamide (Zonegran)
Felbamate (Felbatol)

8. Anticonvulsant Medications Phenytoin-like class
Uses:
Absence/simple seizures
Trigeminal Neuralgia
Side effects:
Drowsiness and dizziness
Photophobia
Blood dyscrasias
Hepatoxicity can be life threatening
Lamictal rash is life threatening
Toxicity:
ataxia/slurred speech
Diplopia/nystagmus
Hypotension
Pupils fixed/coma

9. Anticonvulsant Medications Phenytoin-like class
Contraindications:
Hepatic disease
Blood dyscrasias
Considerations:
Valproic acid is GI irritant
Severe mouth/throat irritation if chewed or carbonated drinks
Considerations:
Sprinkles for on food for children
Notify MD if s&s of neutropenia:
Sore throat
Fever
Oral ulcers
S&s or plastic anemia:
Fatigue
Easy bleeding/bruising

10. Anticonvulsant Medications Barbiturates class
Amobarbital (Amytal)
Pentobarbital (Nembutal)
Phenobarbital (Luminal)
Secobarbital (Seconal)
Primadone (Mysoline)

11. Anticonvulsant Medications Barbiturates class
Uses:
Grand mal seizures
Partial seizures
Insomnia
Side effects:
Drowsiness
Decreased BP
Respiratory depression
Blood dyscrasias
Addiction
Have a hangover effect

12. Anticonvulsant Medications Barbiturates class
Contraindications:
Hepatic disease
Addiction
Respiratory disease
Considerations:
Decreases oral contraceptive action
Hold with respirations <12
Check for s&s of withdrawal:
8-12 hours minor s&s
16 hours – 5 days: convulsions and delirium

13. Anticonvulsant Medications Benzodiazepines
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Lorazepam (Ativan)

14. Anticonvulsant Medications Benzodiazepines
Uses:
Absence seizures
Partial seizures
ETOH withdrawal
Status epilepticus
Anxiety
Muscle spasms

15. Anticonvulsant Medications Benzodiazepines
Side effects:
Drowsiness and dizziness
Dependence
Blood dyscrasias
Vit k and d decreased
Increases digoxin level
Contraindications:
ETOH
Considerations:
Abrupt stop can bring status epilepticus and withdrawal
Check respiratory depression
Check blood dyscrasias
IV diazepam
Push only <5mg/min in large vein
Do not mix with other drugs

16. Anticonvulsant Medications Succinimide class
Ethosuximide (Zarontin)
Methsuximide (Celontin)
Phensuximide (Milontin)

17. Anticonvulsant Medications Succinimide class
Uses:
Absence seizures
Side effects:
Drowsiness and dizziness
Blood dyscrasias
GI: n/v, gingival hyperplasia, tongue swelling
Psychosis/mood swings
Hematuria common in phensuximide

18. Anticonvulsant Medications Succinimide class
Contraindications:
Psychiatric history
Considerations:
Abrupt stop can bring on seizure
Check blood dyscrasias
Check tongue swelling/psych status
Teach oral care/dental checks

19. Anticonvulsant Medications GABA agent class
Gabapentin (Neurontin)
Tiagabine (Gabitril)
Uses:
Partial seizures
Neuralgia
Nerve pain

20. Anticonvulsant Medications GABA agent class
Side effects:
Drowsiness and dizziness
Blood dyscrasias
Contraindications:
MAO inhibitors
Considerations:
Check for blood dyscrasias

21. Anticonvulsant Medications Misc
Oxacarbazepine (Trileptal)
Levetiracetam (Keppra)
Trimethadone (Tridione)
Uses:
Second line and adjunctive treatment for seizures

22. Anticonvulsant Medications Misc
Side effects:
Drowsiness and dizziness
Blood dyscrasias
Contraindications:
MAO inhibitors
Considerations:
Check for blood dyscrasias

23. Sedatives

24. Sedatives Barbiturates class
Short acting:
Phenobarbital (Nembutal)
Secobarbital (Seconal)
Intermediate acting:
Amobarbital (Amytal)
Aprobarbital (Alurate)
Butabarbital (Butisol)
Long acting:
Mephobarbital (Mebaral)
Phenobarbital (Luminal)

25. Sedatives Barbiturates class
Uses:
Low dose: anxiety
Moderate dose: sleep, seizures
High dose: anesthesia
Side effects:
Drowsiness and dizziness
Decrease BP
Tolerance develops
Respiratory depression
Blood dyscrasias
Addiction
Low margin of safety:
Excessive dose will cause respiratory depression and coma

26. Sedatives Barbiturates class
Considerations:
Hold with respirations <12
Decrease oral contraceptive
Limit medication for hoarding
Tapered for withdrawal
Check for s&s withdrawal:
8-12 hours minor s&s
16 hours – 5 days: convulsions and delirium
Contraindications:
Hepatic disease
Drug abuse history
Suicidal history
Respiratory disease
Considerations:
reduces REM sleep
Effectiveness on insomnia without daytime sedation

27. Sedatives Benzodiazepine
Estazolam (Prosom)
Flurazepam (Dalamane)
Quazepam (Doral)
Temazepam (Restoril)
Triazolam (Halcion)

28. Sedatives Benzodiazepine
Uses:
Insomnia
Side effects:
Drowsiness and dizziness
Respiratory depression
Dependence
Blood dyscrasias
Greater margin of safety but with other CNS depressants can be fatal
Herbs: Kava and valerian with increase the effects

29. Sedatives Benzodiazepine
Contraindications:
Suicidal history
Drug abuse history
CNS depression
Elderly
NA Glaucoma
Uncontrolled pain
Considerations:
Limit to 7-10 days treatment
Withhold if systolic pressure drops 20mm while standing or respirations <12/min
Check neutropenia/aplastic anemia
Antacids and smoking decrease effects
No hazardous activity

30. Sedatives dopamine and serotonin agonist
Buspirone (Buspar)
Uses:
Insomnia
Anxiety
Side effects:
Well tolerated
Dystonias; akisthesia
Contraindications:
Renal disease
Liver disease
MAO inhibitors
Considerations:
Does not cause sedation, tolerance, CNS depression, no abuse potential
Takes several weeks to take full effect

31. Sedatives GABA Binder Zolipidem (Ambien) Uses: Side effects:
Insomnia
Induces sleep
Side effects:
Daytime drowsiness
Confusion
Amnesia
Dependence in 10 days
Contraindications:
Liver disease
Lung disease
Apnea
Psych history
Elderly
Considerations:
Rapid effect
Take when pt in bed due to fall risk

32. Sedatives Antihistamines
Diphenhydramine
(Benadryl)
(Sominex)
Hydroxyzine
(Vistaril)
Promethazine
(Anergan 50)
(Phenergan)
Uses:
Insomnia
Allergic reaction
Side effects:
Drowsiness
Anticholinergic side effects

33. Sedatives Antihistamines
Contraindications:
Glaucoma
Peptic ulcer
MAOIs
BPH
COPD
Children can have CNS over stimulation and decrease response at the same time leading to heat stroke, seizures and can easily overdose

34. Sedatives Antihistamines
Considerations:
No hazardous activity
Do not mix with ETOH/CNS depressants
Sugarless candy for dry mouth
Monitor BP and pulse
Check urinary function
Z track vistaril
Use with other antihistamine products including topicals increase effect

35. Sedatives Misc Side effects: Meprobamate (Equanil) (Milltown)
Drowsiness
Respiratory depression
Contraindications:
Elderly
Uncontrolled pain
Considerations:
Give chloral hydrate after meal due to GI irritant
Mix with fluids due to poor taste
Meprobamate (Equanil) (Milltown)
Chloral hydrate (Noctec)
Uses:
Insomnia
Preoperative sedation
Anxiety

36. Anxiolytics

37. Anxiolytics Benzodiazepines
Alprozolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Halezepam (Paxipam)
Lorazepam (Ativan)
Oxazepam (Serax)

38. Anxiolytics Benzodiazepines
Uses:
Insomnia
Anxiety
Side effects:
Drowsiness and dizziness
Respiratory depression
Dependence
Blood dyscrasias
Vit K and D decreased
Increases digoxin level

39. Anxiolytics Benzodiazepines
Contraindications:
NA Glaucoma
Suicide history
Considerations:
Check respiratory depression
No hazardous activity
Do not mix with ETOH/CNS depressants
Check blood dyscrasias
Caution with herbs: kava, valerian, chamomile, hops due to CNS depression
IV diazepam/lorazepam:
IV push <5mg/min in large vein
Can not mix with other drugs
Rapid acting

40. Benzodiazepine Antagonist
Flumazenil (Romazicon)
Uses: benzodiazepine toxicity/overdose
Side effects: seizures
Contraindications:
Status epilepticus
ICP
Considerations:
IV: 0.2mg, 0.3mg 0.5mg over 30 secs q minute prn
Effects last one hour: watch 2 hours after last dose
Seizure precautions
Does not reverse respiratory depression

41. CNS Stimulants

42. CNS Stimulants Anorexiants class
Bensphetamine (Didrex)
Diethylpropion (Proprioan)
Sibutramine (Meridia)

43. CNS Stimulants Anorexiants class
Uses:
Narcolepsy
ADHD
ADD
Obesity
Side effects:
Restlessness, insomnia
Palpitations
Dysmennorhea
Tachycardia
Reverse HTN treatment
Decrease seizure threshold
Dependence and abuse

44. CNS Stimulants Anorexiants class
Contraindications:
NA glaucoma
Hyperthyroid
CV disease
Drug abuse history
<12yrs old
Agitation
Anxiety
Tourettes syndrome
Considerations:
Give on empty stomach
Take 6hrs before bed
No OTCs can have fatal reaction

45. CNS Stimulants Amphetamines
Ampehtamine SO4 (Adderall)
Dexroamphetamine (Dexadrine)
Dexmethylphenidate (Focalin)
Pemoline (Cylert) (PemADD)
Methylphenidate
(Ritalin)
(Concerta)
(Metadate)
(Methylin)

46. CNS Stimulants Amphetamines
Uses:
ADHD
Obesity
Narcolepsy
Side effects:
Restlessness, insomnia, hyperactivity, talkative
Palpitations
Tachycardia
Side effects:
Arrythmias
Low BP, CV collapse
Dry mouth
n/v
Impotence
Libido change
Growth suppression
Dependence and abuse

47. CNS Stimulants Amphetamines
Considerations:
Empty stomach
1st dose wakening
Last dose 6hrs before bed
ADD/ADHD benefits in 3-4 wks
Avoid caffeine, colas, chocolate, tea
No OTC fatal reaction
No abrupt discontinuation
Withdrawal:
HA, N/V, myalgia, depression, fatigue, hunger
Contraindications:
Glaucoma
Hyperthyroid
CV disease
Drug abuse history
Agitation
Anxiety
Tourettes sydrome

48. CNS Stimulants Amphetamine
Doxapram (Dopram)
Uses: stimulate respirations post anesthesia
Side effects:
Arrythmias
Low BP, CV collapse
Dry mouth
n/v
Impotence
Libido change
Growth suppression
Dependence and abuse
Considerations:
Check respiratory status while administering: rate, depth, lung sounds, ABGs

49. THE END