Pharm Session 6:

Hey guys, here is the last notes session before the second test. It goes over anti-epileptic, sedatives and hypnotics. So benzodiazepines, barbiturates, and the anti-epileptics. There is a good deal missing from these, but I will follow up with my next post which is the filled out study guide. The first section is questions that were presented in the class so try to answer them before you scroll down to see the answer. Again thank you so much for reading, an happy studying!

-Peter

That is the name of the alert list of medications for elders?

  • BEERS list

Tolerance to barbs does not produce a cross tolerance to? What do they develop a tolerance to?

  • opiates
  • they do develop the cross tolerance to benzos, anesthetics, alcohol

Patient is in a coma and on barbiturates, family wants to decrease the dose to see if he is responsive, what do you say as the nurse?

  • it decreases the brain’s need for 02 to facilitate healing by suppressing its metabolism.

If the drug (benzos) works on the cerebellum it can also affect?

  • coordination

The lipid solubility of benzo meds produces what effects?

  • cross BBB, into the CNS
  • there are levels of lipid solubility

What types of procedures use conscious sedation?

  • colonoscopy

Immediate nursing priority when a pt is on a long acting benzo chronically?

  • safety, so fall risk and such due to the sedation 

Unconscious patient brought into the ED with suspected benzo OD why do we also give NARCAN?

  • it could be a “mixed bag”
  • Narcan is the antidote for opiates

____(drug class we mentioned specifically)___ and anti-epileptics can both cause permanent long term side effects (pandora’s box)

  • antiarrhythmics

What is the nursing priority for education when discharging a patient on seizure meds?

  • avoid stopping or running out

What should a seizure patient do if they become pregnant?

  • stay on the meds
    • the risk of seizures is greater than the risk to the fetus from the drug. 

Patient on tegratol complaining of vertigo, what should the RN do first

  • ensure patient safety

Sedatives out you to sleep

  • hypnotics

tranquilizers calm you down

  • usually becomes a sedative at high doses

Barbiturates classified by duration of action

  • ultra short – 15 minute onset and peak of 3-4 hours (insomnia)
  • intermediate – 30 to 45minute onset and peak of 6- 8 hr (sedative)
  • long – 90 minute onset, and peak of 10-12 hours (for epilepsy)

OTC sedatives:

  • diphenhydramine (benadril)
  • Doxylamine succinate (Unisom)
  • Hydroxyzine (Vistrail)
  • Hot milk is useful

Eplilepsy and seizures

  • effects a lot of people
    • the children and the old at higher risk
  • EPSP – EXCITATORY postsynaptic potential
  • IPSP – INHIBITORY postsynaptic potential
  • drugs for this
    • ↓ NA, Ca, innflux, or K efflux
    • block glutamate receptors  
  • one med can exacerbate the other med
  • give on a strict schedule
  • all cause CNS depression
    • stopping electrical activity in the brain (sleepy, coordination, attention)
  • Goal is to reduce, but may not be able to eliminate seizures
    • trial and error
  • Catagoies
    • traditional: Phenytoin (Dilantin)
    • Newer: Levetiracetam (Keppra)

Phenytoin (Dylantin)

  • For tonic clonic seizures
    • blocks Na channels selectively
    • take often (tid)
    • low therapeutic index
      • half life is variable even in the same patient: 8-60 hr
    • S/E: gingival hyperplasia, CV effects, cognition issues, steven johnson syndrome and toxic epidermal necrolysis (like being burned inside out)
      • toxicity: CNS and ventricular depression
      • Pregnancy: Newborns bleed, and there are cranio-facial defects
    • decreases effect of oral contraceptive, warfarin, glucocorticoids
    • levels increase of dilantin when taken with
      • Diazepam, cimetidine, isoniazid, ETOH,
    • stimulates CYP450 system

Carbamazepine (tegretol)

  • for epilepsy
    • grapefruit juice inhibits metabolism

valproic Acid

  • seizures, bipolar, migraine
    • S/E liver failure, pancreatitis, Teratogenic

Phenobarbital is the only barbiturate approved for seizures

Gabapentin

  • not used by itself for seizures
  • used for pn, RLS, and fibromyalgia

Levetiracetam (Keppra)

  • used in kiddos
    • for partial, generalized tonic clonic, and myclonic

Mag sulfate

    • anticonvulsant, in pre, and eclampsia pts
      • IM is extremely painful so only use IV
      • needs to have a loading dose first
      • check deep tendon reflexes
  • stop admin if reflexes reduce to 1-0

status epilepticus

  • last half hour or longer
    • increased BP, HR and temp
    • hypoglycemic, and acidotic
    • keep O2 up
    • IV benzos
    • after use long acting AED
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