Pharm Unit 5

- Tonic-Clonic (grand mal): most common, muscle spasms and jerkiness - Absence (petite mal) - rarer, usually occur in children, brief loss of consciousness (10 sec or less)

2 Common generalized seizure types and their characteristics

- Pediatrics - Adults

2 categories of ADHD

- behavior scales - vanderbilt assessment scale

2 diagnostic tests for ADHD

- Counseling - Recognition

2 ways to support parents with children diagnosed with ADHD

- methylphenidate (ritalin) - cataplexy: sodium oxybate (xyrem) - date rape drug

2nd line amphetamines used to treat Narcolepsy

- clonazepam - clorazepate dipotassium - diazepam

3 Benzodiazepine medications

- Amphetamines - Analeptics, caffeine - Anorexiants

3 categories of CNS Stimulants

- behavioral interventions (always start with) - Dexmethylphenidate (Focalin), Methylphenidate (Concerta, Ritalin) - Dextromamphetamine (Adderall), Lisdexamfetaine (Vyvanse) - SNRI: Strattera (atomoxetine)

4 Treatments for ADHD

- more common in men - often overlooked - 5-15 years from onset to diagnosis - sleepiness returns 1-2 hours after waking

4 characteristics of Narcolepsy

- distractibility - impulsivity - hyperactivity - inattention

4 manifestations of ADHD

- schedule II drug (same make up as cocaine) - high risk for addiction - fast onset - take before school and no later than 6pm (to prevent insomnia) - provide drug holidays, taper off when doing so - increases concentration

5 Characteristics of Methylphenidate (Ritalin)

1. give only with normal saline 2. give no faster than 50 mg/min 3. monitor EKG 4. may be a vesicant (blistering) if IV infiltrated 5. when given orally, there is an interaction with Ginko (reduces effectiveness and increases seizure risk)

5 items a nurse should know when administering Phenytoin (Dilantin)

- tachycardia, palpations, HT - restlessness, irritability, euphoria - insomnia, dysrhythmias, tremors - anorexia, dry mouth, weight loss, diarrhea - ED - psychosis (excess use)

6 side effects/adverse reactions for Amphetamines

- anticonvulsant - used best for tonic-clonic or partial seizures - narrow therapeutic index (10-20 mcg/mL) - category D drug (should not be taken while pregnant or planning to become pregnant) - herbal interaction of Ginko (more at risk of having seizure) - can cause severe local tissue damage (purple glove syndrome) - higher risk for bleeding if taken with anticoagulant

7 Phenytoin (Dilantin) characteristics

B. diazepam (valium)

A 6-year-old boy is admitted to the emergency department with status epilepticus. His parents report that his seizure disorder has been managed with phenytoin (dilantin) 50 mg PO BID for the past year. What drug should the nurse plan to administer in the emergency department. A. Phenytoin (dilantin) B. Diazepam (valium) C. Phenobarbital (luminal) D. Carbamazepine (tegretol)

D. Methylphenidate

A child has been diagnosed with ADHD. Which drug does the nurse anticipate the health care provider will prescribe? A. Zolmitriptan B. Doxapram C. Benzphetamine D. Methylphenidate

Psychomotor: repetitive behavior (chewing or swallowing motions), behavioral changes, motor seizures

A common partial seizure type and its characteristics

Gingival hyperplasia (bleeding gums) meticulous dental care is important while taking this drug

A common side effect of Phenytoin (Dilantin)

D. Determine the amount of medication the client has taken

A male client who resides in a long-term care facility has a seizure disorder that has been managed with phenobarbital (nembutal) for several years. Lately, he has become more difficult to arouse, and frequently tells the nurse that he wants to take a nap. What intervention should the nurse implement? A. carefully monitor the client's intake the output B. hold the medication and notify the healthcare provider C. continue to monitor the client closely for the next 24 hours D. determine the amount of medication the client has taken

B. 9 hours

A patient has been ordered a transdermal patch of methylphenidate. The nurse teaches the family to leave the patch on for how long? A. 2 hours B. 9 hours C. 20 hours D. 24 hours

Epilepsy

A seizure disorder where there are abnormal electric discharges from cerebral neurons.

- action: decreases calcium influx - use: absence of seizures

Action and use of Succinimide (ethosuximide)

- stimulate release of norepinephrine and dopamine - block reuptake of norepinephrine and dopamine - "feel good" drug

Actions of Amphetamines

- blood dyscrasias - systemic lupus erythematosus - psychosis, suicidal ideation - decrease in everything bone marrow related - risk for bleeding and infection

Adverse effects of Succinimide

- urine turns pink or brown - sedation - blood dyscrasias: aplastic anemia, leukopenia, anemia, thrombocytopenia, flu like symptoms (fever, pallor, sore throat) - gingival hyperplasia is a side effect

Anticonvulsant Odd Adverse Issues

1. By suppressing sodium influx 2. By suppressing calcium influx 3. By increasing the action of gamma-aminobutyric acid (GABA)

Antiseizure drugs work in one of these three ways

- careless mistakes - difficulty sustaining attention and organizing tasks - does not seem to listen

Characteristics of ADHD Inattention

- action: enhance GABA activity - use: tonic-clonic, partial, myoclonic seizures, status epilepticus - therapeutic range: 15-40 mcg/mL - side effects: sedation, tolerance - discontinuation: should be gradual

Characteristics of Barbiturates (Phenobarbital)

- loss of consciousness - involuntary, uncontrolled movements

Characteristics of Epilpesy

- use: tonic-clonic, partial seizures and psychiatric disorders - therapeutic serum range (very narrow range): 4-12 mcg/mL

Characteristics of Iminostilbene (Carbamazepine)

- increase amount of GABA - stay away from carbonated beverages - hepatotoxic (monitor liver level tests, avoid alcohol, tylenol) - will cause harm to fetus

Characteristics of Valproic Acid (depakene, depakote)

Abuse

Children with ADHD are at higher risk for what?

- Diazepam - Lorazepam - followed by IV phenytoin

Drugs you give in emergent seizure situation

Narcolepsy

Excessive daytime sleepiness, cataplexy (sudden bilateral weakness of skeletal muscles), vivid auditory or visual perceptions

Modafinil (Provigil) Increase wakefulness in patients with sleep disorders by stimulating CNS and augmenting serotonin action

Gold standard drug for Narcolepsy

Diazepam (Valium)

Gold standard treatment for status epilepticus

eat before taking and after it wears off

Medication education for stimulant administration

A. Administer the medication in the morning before the child goes to school

Methylphenidate HCl (Concerta) 18mg PO is prescribed for daily administration to a 10-year-old child with ADHD. In preparing a teaching plan for the parents of this newly diagnosed ADHD child, which instruction is most important for the nurse to provide the parents? A. Administer the medication in the morning before the child goes to school B. Plan to implement periodic interruption sin the administration of the drug C. Attempt to be consistent when setting limits on inappropriate behavior D. Seek professional counseling if the child's behavior continues to be disruptive

D. Mental depression

Methylphenidate should not be taken by a patient with a history of which condition? A. Renal failure B. Glaucoma C. Hypothyroidism D. Mental Depression

Weight loss

Most common side effect of Methylphenidate (Ritalin)

- take before meals - avoid caffeine and alcohol - record growth (height, weight) - don't stop abruptly, taper off to avoid w/d symptoms - chew sugar free gum to avoid dry mouth - you may have better outcomes when consuming more omega 3 fatty acids

Nursing Interventions for Methylphenidate (Ritalin)

- monitor serum drug levels - warn females to use additional contraceptives - use seizure precautions - advise not to drive when initiating drug therapy

Nursing interventions for Phenytoin (Dilantin)

- high fall and/or injury risk (educate pt on safety and fall prevention)

Patient problem for Phenytoin (Dilantin)

- restlessness, euphoria, insomnia - tachycardia, palpitations, HT - seizures - ED

Side effects of Anorexiants

True

T/F: 1/3 of individuals diagnosed with ADHD are also diagnosed with depression

False More common in pediatrics

T/F: Seizures are more common in adults

False Anorexiants should not be given to children under 12

T/F: You can give Anorexiants to an 8-year-old child

D. develops gingival hyperplasia

The healthcare provider prescribes the anticonvulsant carbamazepine (tegretol) for a client with a seizure disorder. The nurse should instruct the client to notify the healthcare provider if which condition occurs? A. urine turns pink or brown B. feels happy C. experiences a sore throat D. develops gingival hyperplasia

1. hemoglobin

The nurse prepares to administer carbamazepine 200 mg to a client. Which is the priority assessment for the nurse to make prior to administration? 1. hemoglobin 2. serum WBC 3. AST and ALT 4. C reactive protein and creatinine kinase

Theophyline

What Analeptic is used for neonatal apnea?

Doxapram

What Analeptic is used for post anesthesia is used for respiratory depression?

- ADHD - Narcolepsy - Reversal of respiratory distress

What are CNS stimulants used to treat?

Both could decrease

What can happen to renal and hepatic function when taking Phenytoin?

Growth

What do you need to monitor when a child is on a stimulant?

Methylphenidate (Ritalin) Because one of it's side effects is HT

What drug used to treat ADHD and Narcolepsy is contraindicated in patients with HT?

Caffeine (may increase effects)

What should you avoid when taking Methylphenidate?

A. The child is seen drinking a cola product

What would indicate to the nurse that the child taking methylphenidate requires more teaching? A. The child is seen drinking a cola product B. The child checks his weight twice a week C. The child takes the drug 45 minutes before a meal D. The child takes the drug before breakfast and lunch

D. Offer the child the medication before eating breakfast and after eating lunch

When providing client teaching about the administration of methylphenidate (ritalin) to the mother of a child diagnosed with ADHD, what instruction should the nurse include in the teaching plan? A. the doses should be given exactly 12 hours apart to sustain a therapeutic serum level B. Doses should be scheduled at mid-morning and mid-afternoon to achieve optimal benefit C. Give the medication on school days only and when the child appears to be anxious D. Offer the child the medication before eating breakfast and after eating lunch

D. Learning disabilities are often present in the child who has ADHD

When providing teaching to a group of parents regarding ADHD, which information will the nurse include? A. Children with ADHD have low intelligence. B. Children with ADHD have an infection in their spinal fluid. C. EEG results are typically normal in children with ADHD. D. Learning disabilities are often present in the child who has ADHD

SNRI: Strattera

Which ADHD medication has a black box warning for high risk of suicide and substance abuse?

- increase child's attention span and cognitive performance - decrease impulsiveness, hyperactivity, and restlessness

Why are methylphenidate (ritalin) and dexmethylphenidate (focalin) given?