Overview
This lecture covers essential neurological drugs for nursing exams, focusing on mechanisms, key side effects, safe administration, and critical teaching points for patient care.
Anticonvulsants: Phenytoin (Dilantin)
- Used for long-term seizure prevention (e.g., epilepsy); therapeutic range is 10–20 mcg/mL.
- Levels <10 risk seizures; >20 risk toxicity—both require HCP notification.
- Routine blood level and liver function monitoring are required.
- Early toxicity signs: ataxia (unsteady gait), hand tremor, slurred speech.
- Adverse effects needing immediate reporting: suicidal thoughts, new/painful rash (Stevens-Johnson syndrome).
- Normal side effects: gingival hyperplasia (overgrown gums)—teach oral care, use soft toothbrush, inform dentist.
- Decreases effectiveness of oral contraceptives —use alternative birth control.
- Do not stop abruptly; taper off to avoid withdrawal seizures.
- Take at the same time daily; do not administer with tube feedings (hold feeds 1–2 hours before/after, flush with 30–50 mL tap water).
- Flush IV lines with normal saline pre- and post-administration.
- Not associated with metallic taste, facial bleeding, or photosensitivity.
Anticonvulsants: Levetiracetam
- Used for seizure prevention (esp. post-brain tumor/surgery/trauma).
- Fewer drug interactions than phenytoin.
- Common side effects: drowsiness, fatigue; avoid driving initially.
- Report: new anxiety, mood changes, depression, rash/blistering (Stevens-Johnson syndrome).
Cholinesterase Inhibitors: Neostigmine, Pyridostigmine (for Myasthenia Gravis)
- Increase secretions to improve muscle strength and mobility.
- Excess can cause cholinergic crisis: salivation, sweating, diarrhea, urinary incontinence, miosis.
- Antidote for crisis: atropine (anticholinergic).
- Contraindicated in asthma due to increased secretions/bronchoconstriction.
- Effectiveness: improved vision and reduced cramping.
Migraine Medications: Sumatriptan, Ergotamine
- Cause cerebral vasoconstriction to relieve migraines.
- Contraindicated in CAD and uncontrolled HTN (risk of stroke, MI).
- Report angina or pale extremities immediately.
Parkinson's Medications: Carbidopa/Levodopa
- Levodopa increases dopamine; carbidopa prevents its breakdown.
- Adverse effects: hallucinations, orthostatic hypotension (teach slow position changes).
- Toxicity: dyskinesia (involuntary movements)—report immediately.
- Takes 2–6 weeks to take effect; do not stop abruptly.
- Normal: red/brown urine, sweat, or saliva.
- Avoid high-protein meals (interferes with absorption).
- Effectiveness: improved movement/ambulation, not memory.
Anticholinergics: Benztropine, Atropine
- Reduce secretions and treat tremors in Parkinson’s and extrapyramidal symptoms.
- Side effects: dry mouth, blurred vision, urinary retention, constipation—“can’t see, can’t pee, can’t spit, can’t poop.”
- Contraindicated in glaucoma, BPH, and urinary retention.
- Teach: hydrate, avoid overheating, report urinary retention, rise slowly.
Osmotic Diuretic: Mannitol
- Lowers intracranial and intraocular pressure.
- Monitor for heart failure (edema, crackles, pulmonary edema).
- Give IV only; monitor LOC every hour.
Neuromuscular Blockers: Succinylcholine
- Used for intubation/paralysis (mechanical ventilation).
- Does not cause sedation; always sedate with benzodiazepine before use.
- Life-threatening adverse effect: malignant hyperthermia (muscle rigidity, high fever).
- Interventions: notify HCP, prepare dantrolene, begin cooling, give oxygen.
- Screen for personal/family anesthesia reactions and alcoholism prior to use.
Key Terms & Definitions
- Therapeutic range — safe and effective drug blood level window.
- Ataxia — unsteady gait or movement.
- Gingival hyperplasia — gum overgrowth.
- Cholinergic crisis — excessive secretions due to too much cholinergic medication.
- Stevens-Johnson syndrome — severe skin reaction with rash/blistering.
- Dyskinesia — involuntary muscle movements.
- Malignant hyperthermia — muscle rigidity and high temperature post-anesthesia.
- Osmotic diuretic — medication removing excess fluid by drawing it into blood vessels.
Action Items / Next Steps
- Review key drug mechanisms, adverse effects, contraindications, and patient teaching for each class.
- Commit all critical lab values, side effects, and high-yield tips to memory.
- Complete assigned readings or practice questions on neurological drugs.
- Prepare for next lecture/topic as directed by instructor.