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Unit 11: Drugs that affect the CNS Nancy Pares, RN, MSN NURS 1950 Metropolitan Community College
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Obj. 1: Describe the general cause of seizures and the two major clinical findings associated with seizures. Seizures ◦ Abnormal or uncontrolled neuronal discharges in the brain ◦ affect Consciousness Motor activity Sensation ◦ Symptom of an underlying disorder-not a disease itself
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Obj 2: Factors that precipitate seizures Infectious diseases Trauma Metabolic disorders Vascular diseases Pediatric disorders Neoplastic diseases
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Drugs as cause of seizures High dose of local anesthetics Drug abuse Withdrawal from alcohol Withdrawal from sedative-hypnotics
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Convulsion Involuntary violent spasm of large muscles of the face, neck, arms and legs Not synonymous with seizure
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Obj. 3: Name and describe major types of epileptic seizures Signs and symptoms ◦ Related to the area of the brain with abnormal activity Types-based on International Classification ◦ Partial (focal) ◦ Generalized ◦ Special epileptic syndromes
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Simple partial (focal) seizures Occur in limited portion of brain Point of origin: abnormal focus or foci Clients experience ◦ Feeling that is vague ◦ Hallucinations with all senses ◦ Extreme emotions ◦ Twitching of arms, legs or face
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Complex partial (focal) seizures Altered levels of consciousness Involve sensory, motor, autonomic symptoms Aura commonly precedes seizure No memory of seizure
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Generalized seizures Travel throughout the entire brain Subcatagories ◦ Absence ◦ Atonic ◦ Tonic-clonic
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Absence seizures Common in children Subtle symptoms ◦ Staring ◦ Transient loss of consciousness ◦ Eyelid fluttering ◦ Myclonic jerks
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Atonic seizures Usually last only a few seconds Characterized by stumbling or falling
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Tonic clonic Most common Usually preceded by aura Tonic phase ◦ Intense muscle contractions ◦ Hoarse cry at onset ◦ Loss of bowel/bladder control ◦ Shallow breathing
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Tonic clonic, cont Clonic phase ◦ Alternating contraction and relaxation of muscles Postictal state (post seizure) ◦ Drowsiness, disorientation, deep sleep
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Special epileptic syndromes Febrile seizures Myoclonic seizures Status epilepticus
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Febrile seizures Last one –two minutes Tonic clonic motor activity Common in 3-5 year olds Occur with rapid rise in body temperature Affect 5% of all children
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Myoclonic seizures Large jerking body movements Quick contraction of major muscles Stumbling and falling Similar to normal infantile Moro reflex
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Status epilepticus Medical emergency Continuously repeating seizure Common with generalized tonic-clonic Continuous muscle contractions ◦ May compromise airway ◦ May cause hypoglycemia, hypothermia, acidosis ◦ May produce lactic acid
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Obj. 4, 5, 6,and 7 (inclusive) The choice of drug depends upon ◦ Type of seizure ◦ Client history and diagnostic studies ◦ Pathologic process causing seizures
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Barbiturates and GABA Agents GABA= gamma aminobutyric acid ◦ Primary neuro transmitter of brain. Drugs that potentiate GABA action ◦ Barbiturates ◦ Benzodiazepines ◦ Misc. agents
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Barbiturates Prototype: phenobarbital (Luminal) ◦ Mechanism of action Changing the action of GABA ◦ Primary use Controlling seizures ◦ Adverse effects Dependence, drowsiness, vitamin deficiencies, laryngeospasm
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Benzodiazepines Prototype: diazepam (Valium) ◦ Mechanism of action Similar to barbiturates, but safer ◦ Primary use Short term seizure control ◦ Adverse effects Drowsiness and dizziness
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Miscellaneous GABA Agents Prototype: valproic acid (Depakene) Mechanism of action: ◦ similar to benzo’s and barbiturates Primary use ◦ Adjunct therapy Adverse effects: ◦ Sedation, drowsiness, GI upset, prolonged bleeding time
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Hydantoins Prototype: phenytoin (Dilantin) Mechanism of action: ◦ Desensitize sodium channel blockers Primary use ◦ Treatment of all types of seizures, except absence seizures Adverse effects: ◦ CNS depression, gingival hyperplasia, skin rash, cardiact dysrhythmias, and hypotension
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Phenytoin-like Drugs Prototype drug: valproic acid (Depakene) Mechanism of action: ◦ Desensitize sodium channels Primary use: ◦ Absence seizures Adverse effects: ◦ Limited CNS depression, visual disturbances, ataxia, vertigo, HA, GI, hepatotoxicity, pancreatitis
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Succinimides Prototype: ethosuximide (Zarontin) Mechanism of action ◦ Suppress calcium influx Primary use ◦ Absence seizures Adverse effects: ◦ Rare, but include drowsiness, dizziness, lethargy ◦ Rare, but serious: lupus, leukopenia, aplastic anemia, Stevens-Johnson syndrome
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Nurse’s role in pharmacological management Barbiturates: ◦ Monitor for liver and kidney function ◦ Category D in pregnancy ◦ Depletion of nutrients ◦ Alcohol and ginko biloba interactions ◦ Client teaching Use reliable contraception Immediately report pregnancy Report excessive bleeding,drowsiness, bone pain Avoid alcohol and gingko biloba
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Benzodiazepines-schedule IV drug Monitor for drug abuse potential Pregnancy risk (category D) Contraindicated in narrow angle glaucoma Liver and kidney function monitored Respiratory depression In event of overdose ◦ Give flumazenil (Romazicon)
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Status epilepticus Give IV valium and ativan Do not mix with other drugs in IV line Client teaching ◦ Avoid ETOH, OTC drugs, herbal preps, nicotine, driving and hazardous activities ◦ Rebound seizures if d/c abruptly ◦ Take with food ◦ These drugs most often used illegally
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Hydantoin and Phenytoin-like drugs Monitor serum drug levels, liver and kidney function Monitor for bleeding disorders Fatal hepatotoxicity can occur Contraindicated ◦ Hx of heart block or seizures due to low BS Client teaching ◦ Routine labs; report s/s of toxicity, bleeding, pregnancy, hypoglycemia
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Succinimides Monitor for liver and kidney function Pregnancy category C Adverse reactions: ◦ Drowsiness, HA, euphoria, n/v, weight loss, abd. Pain Life threatening reactions: ◦ Mental depression with suicide intent ◦ Blood dyscrasias and Stevens-Johnson syndrome
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Succinimides Symptoms of overdose ◦ CNS depression, stupor, ataxia, coma Client teaching ◦ Report mood changes or suicidal thoughts ◦ Avoid driving and hazardous activities ◦ Take with food ◦ Do not stop abruptly ◦ Report weight loss and anorexia
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General client teachings for epilepsy Start with smallest dose of med Add additional drugs, if needed Monitor serum drug levels Withdrawal of meds ◦ Seizure free for three years ◦ Done gradually ◦ Resume meds if seizures return ◦ Knowledge of rebound seizures
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Nursing diagnosis for epilepsy Disturbed sensory perception RT seizure activity Risk for injury RT seizure activity Deficient knowledge RT disease/drugs Noncompliance RT drug regime Noncompliance RT serum lab testing
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Goals in epilepsy treatment Absence/reduction in number of seizures No injury during seizure Understanding of disease Understanding of drug regimen Compliance with lab testing
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Obj. 13: define sedative and hypnotic Sedative: ◦ An agent that calms nervousness, irritability and excitement Hypnotic ◦ An agent that induces sleep
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Obj. 16: Name the conditions that may cause muscle spasticity. Results from damage to the motor area of the cerebral cortex Conditions: ◦ Cerebral palsy ◦ severe head injury, spinal cord injury or lesions ◦ stroke ◦ dystonia
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Obj. 17: Goals of drug therapy for muscle spasms Goals of muscle relaxants ◦ Minimize discomfort ◦ Increase ROM ◦ Improve ability to function independently
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Obj. 18: Name the musculoskeletal relaxants Centrally acting muscle relaxants ◦ Prototype: cyclobenzaprine (Flexeril) ◦ Mechanism of action Inhibits upper motor neuron activity Alters simple spinal reflexes, causes CNS depression ◦ Primary Use Treat localized spasms ◦ Adverse effects CNS depression, hepatic toxicity, physical dependence, anticholinergic effects
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Obj. 18: cont Direct acting antispasmodics ◦ Prototype: dantrolene (Danantrium) ◦ Mechanism of action Interferes with release of calcium ions in skeletal muscle ◦ Primary use Relieve dystonias and leg cramps ◦ Adverse effects Hepatic toxicity, muscle weakness, drowsiness, diarrhea
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Obj. 19 Nursing process for CNS drugs Assessment ◦ Monitor pain, LOC, vital signs ◦ Monitor muscle tone, ROM, degree of spasms ◦ Monitor labs Nursing Dx ◦ Pain ◦ Impaired physical mobility ◦ Risk for injury ◦ Deficient knowledge
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Obj. 19 cont Goals ◦ Decrease pain ◦ Increase range of motion (ROM) ◦ Reduce muscle spasms ◦ No adverse effects of drugs ◦ Knowledge of drug regimen
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