we will discuss now some nursing considerations so as nurses we do play a critical role in ensuring the safe and effective administration of neurologic medication and just from the overview that you had so far you can understand that those uh medications can have powerful effects on the nervous system and even small errors in their use can lead to Serious consequences so our responsibility extends Beyond just giving the medication we must really carefully monitor those patients to educate them and ensure the best possible outcomes so let's look into those nursing consideration and um evaluate them from a perspective of what is the commonality among all those medications across the board um and we uh give some specific examples for some of them so first and foremost we will look into monitoring for the CNS um effects for the central nervous system effects of those medications uh that's kind of the purpose of of the medication right so many of those neurological medications directly impact brain function which means that they can cause dizziness and drowsiness and confusion and impair coordination and just listen to those words dizziness drowsiness confusion and impair coordination that is especially important when we are talking about our elderly patients that absolutely they're the more more vulnerable to false and cognitive side effects so we need to advise our patients as well on avoiding driving or oper operating heavy machinery until they have known how the medication affects them uh and for drugs like benzoins muscle relaxants and sedatives uh that excessive drowsiness could indicate over medication or potential toxicity so we need to um let the the patients know and educate them on that as well as uh caregivers now in terms of assessing for contraindications not all patients can safely take any medication and this applies for um neurological medication as well um conditions like liver or kidney failure or disease can slow the metabolism and clearance of those uh drugs and they can lead to an accumulation and toxicity uh so we need to evaluate for that um cardiac issues such as high blood pressure or arhythmia may be exacerbated by stimulants or by vasoconstrictive medication uh patients with a history of substance abuse may be at a high risk of dependence with medications like benzo aspin and stimulant so all those elements we need to consider them um before administering a medication like that to the patients and keep in mind that us nurses are The Gatekeepers the providers may not look into all those tiny elements that are so important actually for the patient so you will need to inquire uh about those elements and and uh bring it back to the provider if there is anything that needs to be changed uh we need to educate patients on how to properly use those medications so they need very clear instructions on how to take the medication correctly they should know the importance of taking the medication at the right time for example we discussed levodopa Carbidopa that should be taken before meals because if I they are taking it with meals or after a meal the absorption will be impaired on the other uh hand dzil is best taken at night because it has a potential for causing dizziness U now we need to educate them about common side effects and when to seek medical attentions for example if a patient is taking venito in and no this is some gum swelling they should report that immediately um also we need to emphasize the importance of adherance this is probably the most important element when we are talking medication and pharmacology uh the inability of patients to keep up with their treatments uh because missing doses of a drug um for example anti-epileptics can trigger a seizure so we don't want that to happen and we need to explain that in terms that will make them understand it um another element will be how to taper the medication properly this is probably one of the most uh dangerous mistakes uh when a medication is abruptly stopping um and benzo aspin and backen must be um for that reason must be tapered gradually to prevent control symptoms uh which can include seizure hallucinations and rebound anxiety um levodopa and Carbidopa as well should not be discontinued suddenly as it can cause severe rigidity and immobility in Parkinson patients it's like kind of the opposite of what they this medication is doing um in some situation uh some steroids may be um associated in the treatment of patients with neurologic conditions and um especially for neurologic inflammation for example dexamethasone um this should be tapered as well to avoid adrenal insufficiency um why I'm saying that because those are part of the very important uh questions that can be asked in enlex in enlex you'll be asked very critical uh elements and questions that are uh very common so um we do not stop suddenly a medication uh we can um advise them and encourage them to um Li to do some lifestyle modifications so those medication are powerful but however lifestyle changes can increase the treatment Effectiveness and can improve their overall well-being in terms of diet um remember that patients taking levodopa should avoid um high protein meals um as proteins interferes with the absorption of the medication in terms of exercise regular physical activity can improve symptoms of Parkinson's disease reduce migraine frequency and enhance mood in patients with neurologic disorders while sleep hygiene proper sleep is essential we all know that especially uh for patients that have neurologic conditions um I cannot emphasize uh enough stress management anxiety and stress can exacerbate any neurologic symptoms so techniques like meditation and yoga and therapy can be beneficial just to summarize a little bit those elements as a final thought um we are the first line of defense in preventing medication errors and making sure that our patients are safety so we need to monitor for side effects assess for contraindication providing all necessary education sometimes more than once ensure proper uh tapering when needed and encouraging healthy habits can make very significant impacts on patient outcomes and quality of life we'll start looking now into some specific ific medication therapies we'll start with uh Parkinson disease um let's do a little bit of a of a short introduction of Parkinson disease that you didn't study yet however um you should have a little bit of understanding of the disease in order to understand the medication so Parkinson disease is a neurod degenerative disorder U neuro related to nervous system degenerative means it becomes worse and worse in time um it's a um decreasing function of that um organ or system um and that that this condition occurs uh due to the loss of dopamine producing neurons in the brain dopamine is essential for coordinating movements and when those levels are low the patient will experience that in coordinated type of movements they will have Tremors or muscle rigidity uh pinia which is the slow movement uh and postural instability and uh this is a progress Ive condition that will significantly affect their mobility and as a result of that their independence and as a result of that their quality of life and that's why the medication is so important so let's look what we can um do to help them in terms of medication and medication only keep in mind this is a farm class this is not a pathophysiology type of class or not Med search where we discussing the disease we discuss only medication but I want you to have a little bit of background on the condition to understand the medication so since Parkinson is caused by dopamine deficiency the treatment should focus first of all on replenishing those dopamine or mimicking it its effect giving something that is similar to that so as a goal standard keep in mind goal standard levodopa Carbidopa is the medication and I say it in one word because they come as a one uh pill how it works so levodopa is a dopamine precursor that crosses the blood brain barrier and it's converted into dopamine becomes dopamine once it passes at the brain level on the other hand the sidekick Carbidopa it's added to prevent levodopa from breaking down before reaching the brain it's it's kind of keeping um all the people that are all the people keeping all the uh enzymes in the um surrounding environment from uh destroying uh levodopa before reaching its Target and Performing its Mission so in terms of clinical benefits it improves the Tremor the stiffness and movement uh initiation uh in terms of some nursing consideration for this medication only um patients should avoid high protein meals as proteins competes with levodopa for absorption so the uh medication should be taken should be taken before meals allow for absorption and eat maybe 20 30 minutes later um definitely not take the medication after the meal because the absorption will be almost inexistent we need to monitor for discinesia those will be involuntary movements as a different to differentiate them from Tremors those are like kind of they look like ticks they look like really out of control of the patient and usually this is how the patient will report it will say I don't understand why my uh limbs are doing those movements which is this is a very common side effect for long-term use meaning P patients that are taking for 10 15 years and watch for the onoff episodes where the medication Effectiveness fluctuates they may be on the medication and suddenly the symptoms become worse the family or the patient will report that uh we still need to keep the medication because they can go through those on and off second medication that we are giving for Parkinson is pramipexol um and um this is a dopamine Agonist um in other words it mimics the dopamine um activity by directly stimulating those receptors in the brain uh usually it's used for early stages um of the disease or as an add-on to uh levodopa to reduce the fluctuations in terms of side effects we can see hallucinations or impulse control disorders as gambling or compulsive shopping um and excessive daytime sleeping sometimes um and and we need to instruct the U caregivers and the patient to report that as soon as they observe that uh cogin and other medication in the same family but cogin is kind of like the um most common used in this family uh is a monoamine oxidos inhibitor um in terms of how they work they prevent the breakdown of dopamine in the brain so prolongate its effects so if you look in the list you see that lopa is the actually supplementing the dopamine that the body is not producing efficiently uh pramipexol is something that is acting as dopamine but not as efficient is kind of a supplement now another element that I'm adding I'm adding celin that is stopping the breakdown of dopamine so if I have low levels at least to keep them on as long as possible possible uh so it's also used in early Parkinson's to delay the need for levodopa or as an add-on therapy later um very important as a key word for you whenever you hear monoamino oxid as Inhibitors think tyramine Foods tyramine is uh one of the um amino acids in our body uh that we actually um receive it with food as well um is very frequent in age cheese and red wine and cured meats uh they're very high in this kind of protein so those patients that are on a monoamine oxida inhibitor they need to avoid as much as possible those Foods because that it it can result in what is called the hypertensive crisis there is a reaction and um it they will end up having very high blood pressure if they consume that together with the medication on the other hand they can uh monine oxid as Inhibitors can cause insomnia so it is taken in the morning so uh if we need to uh summarize some common side effects of the Parkinson's medication um we can say that they can cause nausea and vomiting usually with levodopa um and um disas involuntary movements uh developed with prolonged levodopa use hallucination and confusion more common with dopamine agonists and in elderly patients and uh don't forget about orthostatic hypotension that's a risk for our patient it's a sudden uh drop in the blood pressure when standing up that's why we need to advise the patient to rise slowly and stay hydrated uh in terms of some nursing considerations um timing is crucial we need to encourage the patients to take the medication on time every day to avoid what we call quote unquote wearing off the symptoms um monitor for Effectiveness if they experience any sudden movement problems there those may need adjusted uh we need to educate them on on off episodes um they may notice that their medication works well at sometimes and suddenly wears off it's common should be reported and observed um about dietary adjustments remember about limiting the protein intake and there is uh that's always a tricky element because your elderly you want them to have proteins on the other hand if they have Parkinson's disease and they are on this medication we need to see what kind of proteins we can give them and as well to limit the amount to improve absorption and prevent side effects if they are on mono Amin oidas uh if they have any swallowing difficulties because swallowing is an active um um voluntary movement uh and because of that Parkinson may affect that as well and as the disease progresses it may become difficult so crushing tablets or using a liquid form uh formulation for the medication may be needed at some point um you hear a lot about dizziness and um orthostatic hypotension that um comes with the risk of fall uh and fault prevention and Mobility support is encouraged with this uh patients as all so if I need to do some kind of a final thoughts on it and to very much simplify the Parkinson medication to be easy to remember remember the goal is to increase dopamine um and I have three main types of medication I have leopa gold sander turns into dopamine in the brain Carbidopa helps it get it there most effective at reducing Tremors however it can cause involuntary movements pexel dopamine Agonist mimics dopamine used in early disease and or with levodopa reduced onoff effects but it can cause hallucination drowsiness and impulse control issues cogin blocking monamine oxidos inhibitor um um enzyme and um it can extend effect of levodopa however it needs to be used avoiding foods high in tyramine as age cheese and uh wine for any kind of additional information please review the summarizing table of the most used drug in those categories that you can find them um that is summarized in table 24.1 uh for dopaminergic agents uh this is in uh on page uh 422 in your Tuckers pharmacology book uh table 24.2 for anticholinergic agents um and 24.3 for any adjunctive medications on page 429 the same way that we describe medication for Parkinson's Disease we will look now into the seizure disorder medication so um this is also known as anti-epileptic drugs or aeds they help stabilize the neuron activity by modifying ion channels and neurotransmitter levels and um they're used to control seizures to prevent complication and to improve overall the quality of life for our patients so what would be some key medications um in the management of seizures um different medication work in various way to prevent this excessive electrical activity in the brain um when we are looking at phenin um the phenin is blocking the voltage gated sodium channels and by doing that is preventing neurons from releasing any kind of impulse um is used tonic clonic or grand M and partial seizures and there's a side very common side effects would be sedation dizzus a taxia taxia means a lack of coordination and gum overgrowth gingival gingival hyperplasia um for nursing considerations you will need to make sure that you monitor serum drug level to ensure that therapeutic Effectiveness um is there and to on the other hand prevent toxicity the normal range is between 10 and 20 uh millam per per milliliter and I'm telling you this because n enlex May test knowledge on uh phenin level uh we need to encourage good oral hygiene to prevent gum overgrowth and um IV in administration of this medication should be down very slowly to avoid any cardiac arthas carbom maspin um is a mood stabilizing um um antiepileptic drug it's similar to phenin it blocks the same sodium channels um that stabilize ing the neuron firing and is used in seizure disorders bipolar disorder and trigeminal neuralgia and as a common side effects will be drowsiness dizziness and bone marrow suppression so um remember that element of bone marrow suppression here is a complication so there is a risk for low white blood cells anemia and trombocytopenia um as nursing consideration will'll monitor the CBC complete blood count for bone marrow suppression periodically those patients will need to avoid grapefruit juice which increases toxicity risk because it's blocking that um uh cytochrom um um enzyme in the liver uh so questions about grapefruit juice um are also common in your inkli because this is widely used by your elderly population uh so patients on carbamazapine cannot are not allowed to uh drink grapefruit juice it's only grapefruit juice that is doing that and no other citrus type of juices patients should report any fever or sign of infection immediately because that can be a sign of bone Mar suppression uh another medication will be the valproic acid that is increasing the Gaba for seon control uh it increases um this inhibitor and neurotransmitter uh is using seizures also in bipolar and uh disorder and migraine prevention and there common side effects here it comes the hepatotoxicity please remember that also valproic acid can cause GI distress and pancreatitis in terms of nursing consideration we need to because of the hepatotoxicity we need to assess liver function test regularly um monitor for abdominal pain and jaundice those will be signs of liver dysfunction or pancreatitis and we need to educate patients on not stopping it abruptly because it can produce and withdrawal that can trigger seizures um so if I need to summarize the common side effects um those will be sedation and dizziness uh pretty much all of them can have it as a side effect especially at the beginning of the treatment uh gingival hyperplasia will be uh with fenin and requires good oral hygiene and regular Dental visit uh hepatotoxicity for valproic acid requires frequent um liver function test and Bone maros suppression for carbamazapine that can Co cause low um white blood cells um as well as anemia um they will have increase risk for infections so in terms of um nursing consideration for this type of medication we need to monitor for serum drug levels remember that element for phenin it's 10 to 20 milligrams um or micrograms for um per milliliter that can cause um toxicity axian stmas and confusion whenever the levels are over uh 20 uh micrograms per per milliliter um carbamazapine and um valproic acid also have some narrow therapeutic ranging however we are um not um doing the same type of close monitoring as we do for fenin we need to educate patients on medication adherance uh never stop anti-epileptic medication abruptly because they can trigger um withdrawal seizures take the medication at the same time daily to maintain the St stable blood levels remember the halftime that we discussed in the um in module one uh and encourage those patients to have medical alert bracelets um in case that something happens and they cannot provide information to the people around them also in terms of assessing for drug interactions and lifestyle adjustments many anti-epileptic medications will interact with oral contraceptives and they will reduce their effectiveness so they may need to uh use alternative birth control methods um alcohol should be avoid uh it increases the sedation and seizure risk and we need to encourage a healthy sleep routine and Stress Management because sleep deprivation can trigger um seizures as well so those are the elements that are the most um common and important regarding um seizure anti-seizure medication there is a summarizing table of most used drugs in this category that you can review it's table 23.2 um that you can find it on page 401 in uh t pharmacology as well you can um preview those in uh your ATI um pharmacology book