Anticonvulsants
During a seizure, there is an imbalance of which two neurotransmitters? Which one is increased and which one is decreased?
decrease GABA + increase glutamate
What is a migraine aura?
a group of visual or sensory disturbances that occur shortly before a migraine
What are the goals for treating someone with schizophrenia?
Suppress acute episodes
Prevent exacerbations
Maintain the highest functioning level
Do Benzodiazepines or Barbiturates have a safety ceiling? What does a safety ceiling mean?
Benzodiazepines maintain a safety ceiling; therefore, there’s a limit to how much they can depress the nervous system.
Barbiturates don’t have a safety ceiling, which raises the risk of fatal respiratory depression
Besides pain reduction, what else can morphine be used for? Name 2
Sedation, drowsiness
Anxiolysis (↓ anxiety)
Euphoria (sense of well-being)
Dyspnea relief
Cough suppression (antitussive)
↓ Myocardial O₂ demand (beneficial in MI)
What relationship does phenytoin have with protein?
Highly protein-bound
What is the mechanism of action of Sumatriptan?
5-HT1B agonist:
Binds to receptors on cranial blood vessels
Causes vasoconstriction → counters the vasodilation linked to migraines → relieves headache
5-HT1D agonist:
Binds to receptors on the trigeminal nerve
Inhibits the release of neuropeptides that cause inflammation
Reduces pain signal transmission
What is the difference between Haloperidol (Typical Antipsychotic, aka first-generation) and Clozapine (Atypical Antipsychotic, aka second-generation)?
Haloperidol blocks D2 dopamine receptors
Clozapine blocks BOTH serotonin (5-HT2A) AND dopamine (D2)
What's the half-life of Phenobarbital?
Extremely long half-life: 2–6 days
Takes 2–3 weeks to reach steady state
What are some safety warnings someone should be educated on when receiving morphine? Name 3
DO NOT drive, operate machinery, or perform dangerous activities (causes drowsiness)
AVOID alcohol completely (dangerous interaction, can be fatal)
DO NOT take other medications without checking with MD/pharmacist (especially sedatives, sleep aids)
Change positions slowly (sit before standing) - prevents falls from dizziness
Call for help before getting out of bed (fall risk)
Keep out of reach of children and pets (fatal if accidentally ingested)
What are two parts of the IV safety protocol for administering phenytoin?
Max infusion rate: 50 mg/min (25 mg/min for the elderly)
Only use 0.9% sodium chloride
Requires a 0.22-micron in-line filter
Use a large vein (≥20 gauge)
What are three serious adverse effects of Sumatriptan?
Cardiovascular: coronary vasospasm, heart attack, irregular heartbeats
Neurological: stroke, TIA, serotonin syndrome
What are the symptoms of Tardive Dyskinesia?
Involuntary movements: tongue, lips, neck, trunk, limbs
"Fly-catching" tongue motions, facial/jaw movements
Early sign: Fine worm-like tongue movements
What parts of the medical history should be reviewed before starting someone on Alprazolam?
Respiratory disorders (COPD, asthma, sleep apnea) - HIGH RISK
Hepatic function (liver disease affects metabolism)
Renal function
Glaucoma (type: narrow-angle vs. open-angle)
•History of substance abuse or addiction (alcohol, drugs)
Depression, bipolar disorder, psychotic disorders
Myasthenia gravis
Pregnancy/breastfeeding status
Previous benzodiazepine use and response
What are some absolute contraindications to morphine? Name 3
1. Breathing problems or severe asthma (when the patient isn't being closely watched)
•WHY: Morphine slows down breathing. If someone already can't breathe well, morphine could make them STOP BREATHING completely.
2. Blocked intestines (paralytic ileus)
•WHY: Morphine slows down the gut. If the intestines are already blocked or not moving, morphine makes it WORSE and can cause dangerous buildup.
3. Allergic to morphine
•WHY: Could cause a life-threatening allergic reaction (anaphylaxis).
4. Taking MAO inhibitor antidepressants (or stopped within the last 14 days)
•WHY: DANGEROUS drug interaction - can cause severe high blood pressure, fever, seizures, coma, or death.
5. Severe alcohol intoxication or alcohol withdrawal (delirium tremens)
•WHY: Both morphine and alcohol slow breathing and brain function. Together = potentially fatal. Withdrawal is already unstable; morphine complicates treatment.
What is the mechanism of action for Valproic Acid?
Increases GABA levels by inhibiting enzymes that break it down → calms nerve activity
Blocks sodium channels → stabilizes nerve membranes
Blocks T-type calcium channels → linked to absence seizures
What are the three High-Risk Populations for receiving Sumatriptan?
Men over 40
Postmenopausal women
Patients with multiple cardiac risk factors (high cholesterol, obesity, diabetes, smoking)
What labs require monitoring with Clozapine?
Absolute Neutrophil Count (ANC)
White Blood Cell (WBC)
What are two major side effects and two serious side effects of phenobarbital (4 total)?
Major Side Effects:
SEVERE SEDATION (limits use)
Cognitive impairment, drowsiness
Ataxia, dizziness, nystagmus
Respiratory depression (dose-dependent)
Serious Effects:
Stevens-Johnson syndrome
Megaloblastic anemia (folate deficiency)
Osteomalacia (vitamin D deficiency)
Hepatotoxicity
Life-threatening WITHDRAWAL (seizures, delirium, death)
Paradoxical excitement (children, elderly)
Physical dependence, tolerance
What are 3 reasons someone should call a healthcare provider when receiving morphine?
Difficulty breathing, slow or shallow breathing
Severe drowsiness, difficulty waking up, confusion
Chest pain, irregular heartbeat
Severe constipation, inability to have bowel movement >3 days
Inability to urinate or difficulty urinating
Rash, hives, swelling, difficulty breathing (allergic reaction)
Severe nausea/vomiting that won't stop
Thoughts of harming yourself
What labs require monitoring with Valproic Acid?
LFTs (AST, ALT)— baseline, then frequently during the first 6 months
Ammonia levels — if mental status changes (can affect brain function)
Pancreatic enzymes (amylase, lipase) — if abdominal pain develops
CBC — monitor platelets (risk of thrombocytopenia)
What are 5 pre-administration nursing assessments for receiving Sumatriptan?
Cardiovascular screening (first priority): History of HTN, high cholesterol, smoking, diabetes, family cardiac issues. Ask about chest pain or irregular heartbeats
Baseline data: Blood pressure, Pain assessment: location, intensity (0–10), quality, associated symptoms (nausea, photosensitivity)
Safety checks: Review medications — currently on SSRIs, SNRIs, or ergotamines? Verify pregnancy status (medication risks)
Antipsychotics have a black box warning for what patient population?
Older Adults with Dementia:
• ↑ Mortality risk with ALL antipsychotics
• NOT approved for dementia-related psychosis
• AVOID FGAs and SGAs in this population
What are 5 areas that require monitoring while someone is receiving phenobarbital?
Seizure activity (frequency, type, duration)
Sedation level, cognitive function
Respiratory rate (watch for depression)
Therapeutic drug levels (q2-4 weeks initially)
CBC, LFTs every 6-12 months
Folate, vitamin D levels annually
Signs of toxicity: severe sedation, ataxia, nystagmus, slurred speech
Fall risk (especially elderly)
What are the 8 points of the baseline assessment for people who are going to receive morphine? name 5
Before FIRST Dose:
1. Pain Assessment (Comprehensive):
2. Respiratory Assessment (CRITICAL!):
3. Vital Signs:
4. Neurological/Mental Status:
5. Gastrointestinal:
6. Medical History Review:
7. Current Medications:
8. Laboratory Values (if available):