Spasticity medications — Medications
Diazepam, Baclofen, Dantrolene, OnabotulinumtoxinA (Botox)
Spasticity medications — Indications / Uses
• Medications do not cure cerebral palsy; they target spasticity and painful spasms • Diazepam: reduces spasms • Baclofen: reduces spasticity • Dantrolene: reduces tightness, cramps, and spasms • OnabotulinumtoxinA: provides localized relaxation by blocking acetylcholine release at the neuromuscular junction
Spasticity medications — Side Effects
• Drowsiness • Weakness • Sedation • Diazepam: paradoxical agitation
Spasticity medications — Adverse Effects
• Baclofen withdrawal can cause seizures • Dantrolene: hepatotoxicity • Dantrolene: respiratory depression from muscle weakness
Spasticity medications — Nursing Considerations
• Monitor and educate for drowsiness, weakness, and sedation • Assess mobility, fall risk, baseline function, swallowing/respiratory concerns, pain, and ability to participate in therapy • Reducing spasticity too much can impair an adapted movement pattern; the goal is improved function, not complete elimination of tone
Immunosuppressants — Medications
Cladribine, Mitoxantrone
Immunosuppressants — Indications / Uses
• Disease-modifying therapy intended to reduce relapse frequency/severity and slow progression • Suppress the immune system • Do not cure multiple sclerosis
Immunosuppressants — Adverse Effects
• Increased infection risk from immune suppression
Immunosuppressants — Nursing Considerations
• Monitor infection risk, liver function, blood counts, mental health, and vaccine status • Teach infection prevention • Avoid live vaccines unless approved • Report fever or new neurologic symptoms
Immunosuppressants — Labs / Monitoring
• Liver function • Blood counts
Immunomodulators — Medications
Interferon beta, Natalizumab, Glatiramer acetate
Immunomodulators — Indications / Uses
• Disease-modifying therapy intended to reduce relapse frequency/severity and slow progression • Modify immune-system activity • Do not cure multiple sclerosis
Immunomodulators — Adverse Effects
• Natalizumab: serious risk of progressive multifocal leukoencephalopathy (PML) • Interferons: can worsen depression or suicidal thoughts • Infection risk is a recurring safety concern
Immunomodulators — Nursing Considerations
• Teach infection prevention • Avoid live vaccines unless approved • Report fever or new neurologic symptoms • Monitor mental health, especially with interferons
Gabapentinoids — Medications
Pregabalin, Gabapentin
Gabapentinoids — Indications / Uses
• Neuropathic pain • Reduce calcium-channel-related neurotransmitter release, decreasing pain signaling • Pregabalin is also used for focal seizures
Gabapentinoids — Side Effects
• Dizziness • Drowsiness • Cognitive slowing • Weight gain • Peripheral edema • Pregabalin: blurred vision, nausea, dry mouth, and difficulty concentrating
Gabapentinoids — Adverse Effects
• Suicidal thoughts are a safety concern • Pregabalin: severe skin reactions, thrombocytopenia, rhabdomyolysis, respiratory depression, and PR-interval prolongation
Gabapentinoids — Nursing Considerations
• Do not stop abruptly • Monitor mood changes and fall risk • Pregabalin: avoid alcohol or other CNS depressants unless approved
Gabapentinoids — Labs / Monitoring
• Pregabalin: monitor renal function; dosing/monitoring are especially important with kidney impairment and in older adults
Sodium channel inhibitor — Medications
Carbamazepine
Sodium channel inhibitor — Indications / Uses
• Neuropathic pain • Decreases repetitive nerve firing through sodium-channel effects • Also used for focal and generalized tonic-clonic seizures
Sodium channel inhibitor — Adverse Effects
• Hyponatremia • Blood dyscrasias • Serious skin reactions • Multiple drug interactions
Sodium channel inhibitor — Nursing Considerations
• Do not stop abruptly • Report rash, fever, sore throat, unusual bleeding, mood changes, or suicidal thoughts • Tell the provider about oral contraceptive use because interactions can reduce effectiveness
Sodium channel inhibitor — Labs / Monitoring
• Sodium levels • Blood disorders/blood counts • Liver function
Tricyclic antidepressants (TCAs) — Medications
Amitriptyline
Tricyclic antidepressants (TCAs) — Indications / Uses
• Neuropathic pain • Reduces pain signaling by increasing serotonin and norepinephrine
Tricyclic antidepressants (TCAs) — Side Effects
• Anticholinergic effects • Dizziness and drowsiness are recurring neuropathic-medication safety concerns
Tricyclic antidepressants (TCAs) — Adverse Effects
• Cardiac concerns • Suicidal ideation is a recurring safety concern
Tricyclic antidepressants (TCAs) — Nursing Considerations
• Monitor fall risk and mood changes • Do not stop neuropathic-pain medications abruptly
SNRIs — Medications
Duloxetine
SNRIs — Indications / Uses
• Neuropathic pain • Reduces pain signaling by increasing serotonin and norepinephrine
SNRIs — Side Effects
• Dizziness, drowsiness, and cognitive slowing are recurring neuropathic-medication safety concerns
SNRIs — Adverse Effects
• Suicidal ideation is a recurring safety concern
SNRIs — Nursing Considerations
• Monitor fall risk and mood changes • Do not stop neuropathic-pain medications abruptly
Parkinson medications — Medications
Levodopa, Carbidopa, Selegeline, Pramipexole
Parkinson medications — Indications / Uses
• Used to address dopamine-related motor dysfunction in Parkinson’s disease • Levodopa crosses the blood-brain barrier and is converted to dopamine • Carbidopa prevents levodopa from being converted outside the brain, allowing more levodopa to reach the CNS and reducing peripheral adverse effects • Selegeline: prevents dopamine breakdown
Parkinson medications — Side Effects
• Levodopa/carbidopa: nausea, dizziness, orthostatic hypotension, dyskinesias, and vivid dreams • Pramipexole: hallucinations, sudden sleep episodes, orthostatic hypotension, and impulse-control disorders such as gambling or compulsive shopping
Parkinson medications — Adverse Effects
• Selegeline: hypertensive crisis is a main concern
Parkinson medications — Nursing Considerations
• Teach consistent protein intake because protein can affect levodopa absorption and symptom control • Selegeline: requires a very specific diet and the client should speak with the provider before taking other medications • Monitor function, safety, medication timing, nutrition, fall risk, and medication complications
Sodium channel inhibitors — Medications
Phenytoin, Carbamazepine, Oxcarbazepine
Sodium channel inhibitors — Indications / Uses
• Focal seizures • Generalized tonic-clonic seizures • Keep sodium channels inactive to reduce repetitive neuronal firing
Sodium channel inhibitors — Side Effects
• Phenytoin: gingival hyperplasia • Oxcarbazepine: mood changes can occur • Neurologic effects are a monitoring concern
Sodium channel inhibitors — Adverse Effects
• Carbamazepine: hyponatremia, blood dyscrasias, serious skin reactions, and multiple drug interactions • Oxcarbazepine: hyponatremia • Mood changes or suicidal thoughts require reporting
Sodium channel inhibitors — Nursing Considerations
• Phenytoin has a narrow therapeutic range and requires monitoring • Do not stop abruptly • Avoid driving until cleared • Report rash, fever, sore throat, unusual bleeding, mood changes, or suicidal thoughts • Tell the provider about oral contraceptive use because interactions can reduce effectiveness
Sodium channel inhibitors — Labs / Monitoring
• Medication levels (especially phenytoin) • Liver function • Sodium levels • Blood disorders/blood counts
Voltage-gated calcium channel medication — Medications
Pregabalin
Voltage-gated calcium channel medication — Indications / Uses
• Focal seizures • Neuropathic pain • Reduces excitatory neurotransmitter release and stabilizes neuronal activity
Voltage-gated calcium channel medication — Side Effects
• Drowsiness • Dizziness • Edema • Blurred vision • Nausea • Dry mouth • Difficulty concentrating • Weight gain
Voltage-gated calcium channel medication — Adverse Effects
• Suicidal thoughts • Severe skin reactions • Thrombocytopenia • Rhabdomyolysis • Respiratory depression • PR-interval prolongation
Voltage-gated calcium channel medication — Nursing Considerations
• Do not stop abruptly • Avoid alcohol or other CNS depressants unless approved • Dosing and monitoring are especially important in kidney impairment and older adults
Voltage-gated calcium channel medication — Labs / Monitoring
• Renal function
Broad-spectrum antiseizure medication — Medications
Valproic acid
Broad-spectrum antiseizure medication — Indications / Uses
• Broad-spectrum use for several seizure types • Increases inhibitory GABA activity and also affects sodium and calcium channels
Broad-spectrum antiseizure medication — Adverse Effects
• Hepatotoxicity • Pancreatitis • Hyperammonemia • Thrombocytopenia • Teratogenicity • Suicidal thoughts
Broad-spectrum antiseizure medication — Nursing Considerations
• Major contraindication/caution patterns include severe liver disease, pancreatitis history, urea-cycle disorders, mitochondrial disorders, pregnancy risk, and blood disorders • Report abdominal pain, persistent vomiting, jaundice, unusual bruising/bleeding, severe fatigue, confusion, mood changes, or suicidal thoughts • Stress effective contraception and prescriber consultation before pregnancy
Broad-spectrum antiseizure medication — Labs / Monitoring
• Liver function • CBC • Medication levels
Benzodiazepines — Medications
Lorazepam
Benzodiazepines — Indications / Uses
• Rapidly enhance inhibitory GABA effects • Used to stop active seizure activity • Lorazepam is commonly used for status epilepticus
Benzodiazepines — Side Effects
• Sedation • Long-term use can cause cognitive or coordination problems
Benzodiazepines — Adverse Effects
• Respiratory/CNS depression may require airway support • Long-term use can lead to tolerance, dependence, and withdrawal
Benzodiazepines — Nursing Considerations
• After administration monitor level of consciousness, respiratory rate, oxygen saturation, airway patency, blood pressure, and cardiac rhythm • Prepare for airway support if needed • Do not combine with alcohol, opioids, or other CNS depressants