Anticonvulsants
List teaching points you will tell your patient starting on a new anti-seizure med.
What can cause drowsiness, GI upset, increased risk for falls, take med consistently and same time every day, ataxia (incoordination).
An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient? A. Carbidopa-levodopa (Sinemet) B. Donepezil (Aricept) C. Rivastigmine (Exelon) D. Tacrine (Cognex)
What is A? Rationale: This patient is exhibiting signs of Parkinson’s disease and should be treated with carbidopa-levodopa. The other drugs are used to treat Alzheimer’s disease.
Should not be taking with other CNS (central nervous system) depressants, or alcohol and can cause suicidal ideation.
What are anti-seizure or anti-epileptic drugs.
Seizure pads, oxygen and suction set up, call light within reach, bed in lowest position with side rails up.
What are seizure precautions.
The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL (normal). What action will the nurse take? A. Administer the dose since the patient is not toxic and continue to monitor. B. Contact the provider to discuss decreasing the phenytoin dose. C. Report drug toxicity to the providers.
What is A? Rationale: Drowsiness is a common side effect of phenytoin and is not cause for alarm. The patient’s drug level is normal, since 10-20 mcg/mL is the therapeutic range. The nurse should administer the dose. It is not necessary to decrease the dose. Continue to monitor.
The spouse of a patient newly diagnosed with mild, unilateral symptoms of Parkinson’s disease (PD) asks the nurse what, besides medication, can be done to manage the disease. The nurse will A. counsel the spouse that parkinsonism is a normal part of the aging process in some people. B. recommend exercise, nutritional counseling, and group support to help manage the disease. C. tell the spouse that the disease will not progress if mild symptoms are treated early. D. tell the spouse that medication therapy can be curative if drugs are begun in time.
What is B? Rationale: PD is a progressive disorder. Nonpharmacologic measures can lessen symptoms and help patients and families cope with the disorder. Although the aging process may contribute to the development of PD, it is not necessarily a normal part of aging. Treatment may slow the progression but does not arrest or cure the disease.
How do you instruct your patient to take this drug for myasthenia gravis: pyridostigmine Bromide (Mestinon)
Early in the morning and before meals to assist with muscle weakness and impaired swallowing.
Bradycardia, abdominal pain, nausea, drooling and severe weakness. These are symptoms of what kind of crisis?
Cholinergic Crisis. This can be caused by an overdose of pyridostigmine bromide (Mestinon) used for Myasthenia Gravis.
Good oral hygiene is important to teach because gum hyperplasia can occur.
What is phenytoin (Dilantin)
Agitation, muscle rigidity, tremors, high fever and unstable B/P.
What is neuroleptic malignant syndrome when COMT inhibitors and MAO-B inhibitors are added to dopamine agonist (Carbidopa-Levodopa) in Parkinson's.
What teaching points are you going to discuss with a patient who takes dimethyl fumarate (Tecfidera) a neurologic drug to decrease inflammation on nerves for MS?
Take with food to decrease GI upset and flushing, and watch for signs and symptoms of infection including regular blood work (WBC's).
A autoimmune disease that affects the myelin sheath of the neuron which reduces nerve function.
What is Multiple Sclerosis
A 25 year-old female patient will begin taking phenytoin for epilepsy. The patient tells the nurse she is taking oral contraceptives (OCPs). Which response will the nurse give? Two correct answers.
A. “Continue taking OCPs because phenytoin can increase risk of birth defects.” B. “You should use a backup method of contraception along with OCPs.” C. “You should stop taking OCPs because of drug-drug interactions with phenytoin.” D. “You should take low-dose aspirin while taking these medications to reduce your risk of stroke.”
What is A and B? Rationale: Female patients who take oral contraceptives and anticonvulsants should be advised to use a backup method of contraception because of reduced effectiveness of OCPs. Patients should be cautioned to consult with a provider if considering pregnancy because of the teratogenic effects of anticonvulsants. Patients should not stop taking OCPs and do not need to take precautions against stroke.
The provider added a MAO-B drug rasagiline (Azilect) to a Parkinson's med regimen. You instruct the patient to avoid foods high in tyramine. What are these foods?
What are Cured or smoked meats, fish and cheeses, Avocadoes, beer or wine, sauerkraut, sour cream , soy sauce, or yogurt.
When and how should a dopamine agonist medication for Parkinson's be taking?
30-60 minutes before a meal on an empty stomach to promote absorption with 6-8 oz. of water and never with high protein foods.
What is included in your baseline assessment before giving an anti-seizure medication?
VS, med reconciliation, baseline labs, mental status, any chance you are you pregnant, describe seizure activity, any aura or postictal events, and duration of seizure.
Rash or bradycardia or tachycardia.
What is notify the provider immediately. Rash can progress to Stevens-Johnsons Syndrome and bradycardia or tachycardia can occur.
The nurse is helping to develop a plan of care for a patient who has advanced Alzheimer’s disease. The patient will be taking a new medication. Which is a realistic goal for this patient? A. Demonstrate improved cognitive function. B. Exhibit improved ability to provide self-care. C. Receive appropriate assistance for care needs and delay impaired cognitive function. D. Show improved memory for recent events.
What is C? Rationale: For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress. The most realistic care plan for a patient with advanced AD is that they will receive appropriate and safe care.
Taking a dopamine agonist like pramipexole or carbidopa/levodopa and a anti-hypertensive drug may cause what?
What is hypotension
Is a progressive fatal neurodegenerative disease that affects the motor nerves of the brain and spinal cord and looses the ability to move, speak, eat and breath.
What is amyotrophic lateral sclerosis (ALS)