Overview
This lecture covers critical nursing considerations for neurologic medications, with a focus on safe administration, patient education, Parkinson’s disease therapies, and anti-epileptic drugs.
General Nursing Considerations for Neurologic Medications
- Neurologic drugs can strongly affect the central nervous system (CNS), so careful monitoring is crucial.
- Common CNS side effects: dizziness, drowsiness, confusion, impaired coordination; elderly patients are at higher risk for falls.
- Advise patients to avoid driving or using heavy machinery until drug effects are known.
- Excessive drowsiness in drugs like benzodiazepines or muscle relaxants may indicate toxicity.
- Assess for contraindications: liver/kidney disease can increase toxicity risk; cardiac issues or history of substance abuse also impact safety.
- Nurses must thoroughly assess history and communicate concerns to providers.
- Provide clear instructions about medication timing (e.g., levodopa/carbidopa before meals, donepezil at night).
- Educate about side effects and when to seek help (e.g., report gum swelling with phenytoin).
- Stress the importance of medication adherence, especially with anti-epileptics to prevent seizures.
- Taper medications gradually (e.g., benzodiazepines, baclofen, steroids) to avoid withdrawal or serious effects.
- Recommend lifestyle changes (diet, exercise, sleep, stress management) to improve outcomes.
Parkinson’s Disease Medication Overview
- Parkinson’s disease involves dopamine deficiency causing tremors, rigidity, slow movements, and postural instability.
- Goal: increase dopamine or mimic its effect with medications.
Key Medications for Parkinson’s Disease
- Levodopa/carbidopa: Gold standard; levodopa converts to dopamine in the brain, carbidopa prevents peripheral breakdown.
- Take before meals; avoid high-protein foods for better absorption.
- Monitor for dyskinesia (involuntary movements), on/off episodes, and orthostatic hypotension.
- Pramipexole: Dopamine agonist; used in early disease or with levodopa.
- Watch for hallucinations, impulse control disorders, and excessive sleepiness.
- Selegiline (MAOI): Inhibits dopamine breakdown; used to extend levodopa effect.
- Avoid foods high in tyramine (aged cheese, wine) to prevent hypertensive crisis.
- General side effects: nausea, vomiting, confusion, hallucinations, orthostatic hypotension.
- Swallowing difficulty may require medication in liquid or crushed forms.
Anti-Epileptic Drug (AED) Overview
- AEDs stabilize neuron activity to prevent and control seizures.
Key Medications for Seizure Disorders
- Phenytoin: Blocks sodium channels; used for tonic-clonic and partial seizures.
- Side effects: sedation, ataxia (loss of coordination), gingival hyperplasia.
- Monitor serum levels (10–20 mcg/mL); slow IV administration; ensure oral hygiene.
- Carbamazepine: Blocks sodium channels; treats seizures, bipolar disorder, trigeminal neuralgia.
- Side effects: drowsiness, dizziness, bone marrow suppression (risk for infection, anemia).
- Monitor CBC; avoid grapefruit juice.
- Valproic acid: Increases GABA; used for seizures, bipolar disorder, migraine prevention.
- Side effects: hepatotoxicity, GI distress, pancreatitis.
- Monitor liver function; educate about withdrawal risk.
- All AEDs can cause sedation, dizziness; never stop them abruptly.
- Oral contraceptives may be less effective; advise alternative birth control.
- Avoid alcohol; encourage healthy sleep and stress management.
Key Terms & Definitions
- CNS (Central Nervous System) — brain and spinal cord; target of many neurologic drugs.
- Dyskinesia — involuntary, abnormal movements, often from long-term levodopa use.
- On/off episodes — fluctuations in effectiveness of Parkinson’s medication.
- Orthostatic hypotension — sudden drop in blood pressure upon standing.
- MAOI (Monoamine Oxidase Inhibitor) — class of drugs that prevent dopamine breakdown.
- Gingival hyperplasia — overgrowth of gum tissue, common with phenytoin.
- Bone marrow suppression — reduced production of blood cells, risk with carbamazepine.
- Hepatotoxicity — liver toxicity, a risk with valproic acid.
- Ataxia — lack of muscle coordination.
Action Items / Next Steps
- Review tables 24.1, 24.2, 24.3 (dopaminergic, anticholinergic, adjunctive agents) in Tucker’s pharmacology book, pp. 422–429.
- Review table 23.2 on anti-epileptic drugs, p. 401 in Tucker’s pharmacology book.
- Continue to ATI pharmacology resources for further review.