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