Neurological Pharmacology
Developed by:
Dawn Johnson, RN, MSN, Ed
Property of:
www.careereducationalpathways.com
1-814-580-0913
Anticonvulsant Medications
Anticonvulsant Medications
Hydantoin class





Phenytoin (Dilantin)
Ethotoin (Peganone)
Mephenytoin (Mesantaoin)
Fosphenytoin IV (Celebyx)
Action: increases Na+ out of neurons
depressing abnormal stimulation
and discharge
Anticonvulsant Medications
Hydantoin class

Uses:


Seizures of all types without CNS depression
Side effects:
Drowsiness and dizziness
 n/v
 Gingival Hyperplasia-reddened gums that bleed easily
 Low platelet and WBC count
Toxicity:
 ataxia/slurred speech
 Diplopia/nystagmus
 Hypotension
 Pupils fixed/coma

Anticonvulsant Medications
Hydantoin class

Contraindications:



Bradycardia
Heart block
Considerations:






Dilantin level 10-20ug
Must take same brand; no abrupt discontinuation
Urine discoloration
If down tube feeding: shut off tf for 1 hour prior and 1 hour after
due to dilantin binds with protein in tube feedings
Give good oral hygiene/dental checks
IV: no dextrose; it precipitates


Give in large vein < or = 50mg/min
Cardiotoxic with low bp
Anticonvulsant Medications
Phenytoin-like class






Valproic acid (Depakene) (Depakote)
Carbamazepine (Tegretol)
Topiramate (Topamax)
Lamotrigine (Lamictal)
Zonisamide (Zonegran)
Felbamate (Felbatol)
Anticonvulsant Medications
Phenytoin-like class

Uses:



Absence/simple seizures
Trigeminal Neuralgia
Side effects:





Drowsiness and dizziness
Photophobia
Blood dyscrasias
Hepatoxicity can be life
threatening
Lamictal rash is life
threatening
Toxicity:
 ataxia/slurred speech
 Diplopia/nystagmus
 Hypotension
 Pupils fixed/coma
Anticonvulsant Medications
Phenytoin-like class

Contraindications:



Hepatic disease
Blood dyscrasias
Considerations:


Valproic acid is GI
irritant
Severe mouth/throat
irritation if chewed or
carbonated drinks

Considerations:


Sprinkles for on food for
children
Notify MD if s&s of
neutropenia:




Sore throat
Fever
Oral ulcers
S&s or plastic anemia:


Fatigue
Easy bleeding/bruising
Anticonvulsant Medications
Barbiturates class





Amobarbital (Amytal)
Pentobarbital (Nembutal)
Phenobarbital (Luminal)
Secobarbital (Seconal)
Primadone (Mysoline)
Anticonvulsant Medications
Barbiturates class

Uses:




Grand mal seizures
Partial seizures
Insomnia
Side effects:






Drowsiness
Decreased BP
Respiratory depression
Blood dyscrasias
Addiction
Have a hangover effect
Anticonvulsant Medications
Barbiturates class

Contraindications:




Hepatic disease
Addiction
Respiratory disease
Considerations:



Decreases oral contraceptive action
Hold with respirations <12
Check for s&s of withdrawal:


8-12 hours minor s&s
16 hours – 5 days: convulsions and delirium
Anticonvulsant Medications
Benzodiazepines




Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Lorazepam (Ativan)
Anticonvulsant Medications
Benzodiazepines

Uses:






Absence seizures
Partial seizures
ETOH withdrawal
Status epilepticus
Anxiety
Muscle spasms
Anticonvulsant Medications
Benzodiazepines

Side effects:






Drowsiness and
dizziness
Dependence
Blood dyscrasias
Vit k and d decreased
Increases digoxin level
Contraindications:

ETOH

Considerations:




Abrupt stop can bring
status epilepticus and
withdrawal
Check respiratory
depression
Check blood dyscrasias
IV diazepam


Push only <5mg/min in
large vein
Do not mix with other drugs
Anticonvulsant Medications
Succinimide class



Ethosuximide (Zarontin)
Methsuximide (Celontin)
Phensuximide (Milontin)
Anticonvulsant Medications
Succinimide class

Uses:


Absence seizures
Side effects:





Drowsiness and dizziness
Blood dyscrasias
GI: n/v, gingival hyperplasia, tongue swelling
Psychosis/mood swings
Hematuria common in phensuximide
Anticonvulsant Medications
Succinimide class

Contraindications:


Psychiatric history
Considerations:




Abrupt stop can bring on seizure
Check blood dyscrasias
Check tongue swelling/psych status
Teach oral care/dental checks
Anticonvulsant Medications
GABA agent class

Gabapentin (Neurontin)
Tiagabine (Gabitril)

Uses:




Partial seizures
Neuralgia
Nerve pain
Anticonvulsant Medications
GABA agent class

Side effects:



Contraindications:


Drowsiness and dizziness
Blood dyscrasias
MAO inhibitors
Considerations:

Check for blood dyscrasias
Anticonvulsant Medications
Misc

Oxacarbazepine (Trileptal)
Levetiracetam (Keppra)
Trimethadone (Tridione)

Uses:



Second line and adjunctive treatment for
seizures
Anticonvulsant Medications
Misc

Side effects:



Contraindications:


Drowsiness and dizziness
Blood dyscrasias
MAO inhibitors
Considerations:

Check for blood dyscrasias
Sedatives
Sedatives
Barbiturates class

Short acting:



Phenobarbital
(Nembutal)
Secobarbital (Seconal)
Intermediate acting:



Amobarbital (Amytal)
Aprobarbital (Alurate)
Butabarbital (Butisol)

Long acting:


Mephobarbital
(Mebaral)
Phenobarbital
(Luminal)
Sedatives
Barbiturates class

Uses:




Low dose: anxiety
Moderate dose: sleep, seizures
High dose: anesthesia
Side effects:







Drowsiness and dizziness
Decrease BP
Tolerance develops
Respiratory depression
Blood dyscrasias
Addiction
Low margin of safety:

Excessive dose will cause respiratory depression and coma
Sedatives
Barbiturates class


Contraindications:
 Hepatic disease
 Drug abuse history
 Suicidal history
 Respiratory disease
Considerations:
 reduces REM sleep
 Effectiveness on
insomnia without
daytime sedation

Considerations:
 Hold with respirations <12
 Decrease oral contraceptive
 Limit medication for
hoarding
 Tapered for withdrawal
 Check for s&s withdrawal:
 8-12 hours minor s&s
 16 hours – 5 days:
convulsions and delirium
Sedatives
Benzodiazepine





Estazolam (Prosom)
Flurazepam (Dalamane)
Quazepam (Doral)
Temazepam (Restoril)
Triazolam (Halcion)
Sedatives
Benzodiazepine

Uses:


Insomnia
Side effects:






Drowsiness and dizziness
Respiratory depression
Dependence
Blood dyscrasias
Greater margin of safety but with other CNS
depressants can be fatal
Herbs: Kava and valerian with increase the effects
Sedatives
Benzodiazepine

Contraindications:






Suicidal history
Drug abuse history
CNS depression
Elderly
NA Glaucoma
Uncontrolled pain

Considerations:





Limit to 7-10 days treatment
Withhold if systolic pressure
drops 20mm while standing
or respirations <12/min
Check neutropenia/aplastic
anemia
Antacids and smoking
decrease effects
No hazardous activity
Sedatives
dopamine and serotonin agonist


Buspirone (Buspar)
Uses:



Side effects:



Insomnia
Anxiety
Well tolerated
Dystonias; akisthesia
Contraindications:



Renal disease
Liver disease
MAO inhibitors

Considerations:


Does not cause
sedation, tolerance,
CNS depression, no
abuse potential
Takes several weeks
to take full effect
Sedatives
GABA Binder


Zolipidem (Ambien)
Uses:





Insomnia
Induces sleep


Side effects:




Daytime drowsiness
Confusion
Amnesia
Dependence in 10
days
Contraindications:



Liver disease
Lung disease
Apnea
Psych history
Elderly
Considerations:


Rapid effect
Take when pt in bed
due to fall risk
Sedatives
Antihistamines

Diphenhydramine




(Benadryl)
(Sominex)
Hydroxyzine

(Vistaril)
Promethazine



(Anergan 50)
(Phenergan)
Uses:



Insomnia
Allergic reaction
Side effects:


Drowsiness
Anticholinergic side effects
Sedatives
Antihistamines

Contraindications:






Glaucoma
Peptic ulcer
MAOIs
BPH
COPD
Children can have CNS over stimulation and
decrease response at the same time leading
to heat stroke, seizures and can easily
overdose
Sedatives
Antihistamines

Considerations:







No hazardous activity
Do not mix with ETOH/CNS depressants
Sugarless candy for dry mouth
Monitor BP and pulse
Check urinary function
Z track vistaril
Use with other antihistamine products
including topicals increase effect
Sedatives
Misc



Meprobamate (Equanil)  Side effects:
 Drowsiness
(Milltown)
 Respiratory depression
Chloral hydrate
 Contraindications:
(Noctec)
 Elderly
Uses:



Insomnia
Preoperative sedation
Anxiety


Uncontrolled pain
Considerations:


Give chloral hydrate after
meal due to GI irritant
Mix with fluids due to
poor taste
Anxiolytics
Anxiolytics
Benzodiazepines








Alprozolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Halezepam (Paxipam)
Lorazepam (Ativan)
Oxazepam (Serax)
Anxiolytics
Benzodiazepines

Uses:



Insomnia
Anxiety
Side effects:






Drowsiness and dizziness
Respiratory depression
Dependence
Blood dyscrasias
Vit K and D decreased
Increases digoxin level
Anxiolytics
Benzodiazepines

Contraindications:



NA Glaucoma
Suicide history
Considerations:






Check respiratory depression
No hazardous activity
Do not mix with ETOH/CNS depressants
Check blood dyscrasias
Caution with herbs: kava, valerian, chamomile, hops
due to CNS depression
IV diazepam/lorazepam:



IV push <5mg/min in large vein
Can not mix with other drugs
Rapid acting
Benzodiazepine Antagonist




Flumazenil (Romazicon)
Uses: benzodiazepine toxicity/overdose
Side effects: seizures
Contraindications:



Status epilepticus
ICP
Considerations:




IV: 0.2mg, 0.3mg 0.5mg over 30 secs q minute prn
Effects last one hour: watch 2 hours after last dose
Seizure precautions
Does not reverse respiratory depression
CNS Stimulants
CNS Stimulants
Anorexiants class



Bensphetamine (Didrex)
Diethylpropion (Proprioan)
Sibutramine (Meridia)
CNS Stimulants
Anorexiants class

Uses:





Narcolepsy
ADHD
ADD
Obesity
Side effects:







Restlessness, insomnia
Palpitations
Dysmennorhea
Tachycardia
Reverse HTN treatment
Decrease seizure threshold
Dependence and abuse
CNS Stimulants
Anorexiants class

Contraindications:









NA glaucoma
Hyperthyroid
CV disease
Drug abuse history
<12yrs old
Agitation
Anxiety
Tourettes syndrome
Considerations:



Give on empty stomach
Take 6hrs before bed
No OTCs can have fatal reaction
CNS Stimulants
Amphetamines





Ampehtamine SO4 (Adderall)
Dexroamphetamine (Dexadrine)
Dexmethylphenidate (Focalin)
Pemoline (Cylert) (PemADD)
Methylphenidate




(Ritalin)
(Concerta)
(Metadate)
(Methylin)
CNS Stimulants
Amphetamines

Uses:




ADHD
Obesity
Narcolepsy
Side effects:



Restlessness,
insomnia,
hyperactivity,
talkative
Palpitations
Tachycardia

Side effects:








Arrythmias
Low BP, CV collapse
Dry mouth
n/v
Impotence
Libido change
Growth suppression
Dependence and
abuse
CNS Stimulants
Amphetamines

Contraindications:







Glaucoma
Hyperthyroid
CV disease
Drug abuse history
Agitation
Anxiety
Tourettes sydrome

Considerations:








Empty stomach
1st dose wakening
Last dose 6hrs before bed
ADD/ADHD benefits in 3-4
wks
Avoid caffeine, colas,
chocolate, tea
No OTC fatal reaction
No abrupt discontinuation
Withdrawal:

HA, N/V, myalgia,
depression, fatigue, hunger
CNS Stimulants
Amphetamine



Doxapram (Dopram)
Uses: stimulate respirations post anesthesia
Side effects:









Arrythmias
Low BP, CV collapse
Dry mouth
n/v
Impotence
Libido change
Growth suppression
Dependence and abuse
Considerations:

Check respiratory status while administering: rate, depth, lung
sounds, ABGs
THE END