- 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.
- 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
- 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.
- To reduce anxiety
Abortive meds for migraines
- cafergot-combo of ergotamine and caffeine
Preventive meds for migraines
- serotonin antagonists
- Ca antagonists
- Give for autonomic dysreflexia
To give for bladder spasticity with spinal cord injury
- Baclofen, valium, Dantrium
For encephalitis caused by Herpes Simplex Virus
For encephalitis caused by fungal infections
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: