Meds for Neuro

Mannitol (Osmitrol)

  • is used to decrease cerebral edema during increased ICP.
  • It is an osmotic diuretic, which means the blood will be drawn from interstitial areas to vascular space and then be eliminated in the urine excretion.
  • Electrolytes are also drawn into blood and excreted, so monitor for electrolyte imbalance
  • Hyponatremia is a life threatening side effect, causes seizures and death.
  • Maintain strict I&O.
  • Can have rebound ICP’s about 12 hours after drug administration

Dobutamine (Dubutrex) and Norepinephrine (Levophed) – cardiac stimulants used to maintain cerebral perfusion during increased ICP.

Dexamethasone (Decadron)

  • Corticosteroid used to decrease inflammation surrounding a brain tumor
  • Used in medical management of meningitis.
  • Used post craniotomy for cerebral edema
  • Administer IV q 6 hours for 24-72 hours, change to oral a.s.a.p., taper dosage over 5-7 days
  • As with any steroid, fluid retention, increased sugar, lowed immune system
  • Common side effect nasal irritation, cardiovascular edema, hyperglycemia, cataract, oral candidiasis, impaired would healing
  • If using with Mannitol (makes electrolytes be excreted) (by the way the two together are contraindicated according to the book) add potassium-rich foods or supplement to diet.
  • Use good oral hygiene to prevent oral candidiasis

Phenytion (Dilantin)

  • Anticonvulsant – to reduce risk of seizures
  • Especially after supratentorial neurosurgical procedure (prone to seizures)
  • Used to prevent grand mal and complex partial seizures
  • During Ictal phase of seizure give ativan (lorazepam), then start dilantin
  • Life threatening side effects are cardiovascular collapse, Agranulocytosis, aplastic anemias, dermatitis (bullous, exfoliative, or purpuric), Steven-Johnson syndrome.
  • Common side effects gingival hyperplasia (swollen gums), give good mouth care.  Self care pt should brush, floss and massage gums after each meal.
  • Other side effect in power point; headache, dizziness, confusion, ataxia, slurred speech, depression, bleeding gums
  • Decreases the effects of oral anticoagulants, corticosteroids, antihistamines, and oral contraceptive
  • Therapeutic level is narrow; therapeutic level is 10-20 mcg/ml, toxic level is 30-50 mcg/ml, lethal level is 100 mcg/ml.  Therapeutic levels not reached for at least 7-10 days
  • Do not stop drug abruptly, may precipitate status epilepticus.
  • Tell patients to inform all healthcare providers they are on this med.

Diazepam (Valium)

  • To reduce anxiety

Antiseizure medications

  • Tegretol
  • Klonopin
  • Keppra
  • Luminal
  • Dilantin-Phenytoin
  • Topamax
  • Depakote

Abortive meds for migraines

  • Triptans
  • Lilitrex
  • amerge
  • maxalt
  • ergotamine
  • cafergot-combo of ergotamine and caffeine

Preventive meds for migraines

  • Inderal
  • Lopressor
  • elavil
  • valproate
  • flunarzine
  • serotonin antagonists
  • Ca antagonists

Apresoline

  • Give for autonomic dysreflexia

To give for bladder spasticity with spinal cord injury

  • Baclofen, valium, Dantrium

For encephalitis caused by Herpes Simplex Virus

  • Acyclovir

For encephalitis caused by fungal infections

  • Amphotericin

For complications of vasospasms after hemorrhagic stroke

  • Calcium channel blockers – Nimotop, Verapamil, Nifedipine
  • OR triple H-therapy hemodilution, hypertension, hypervolemia (fluid volume expanders)

Methylpredinisolone (Solu medoral)

  • Give high doses of this steroid within 8 hours of spinal cord injury.
  • Has shown to improve outcomes at 6 weeks, 6 months, and 1 year

For shoulder pain after a stroke give:

  • Lamictal
  • Amitriptyline

2 Responses to Meds for Neuro

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