Neurological

Pharmacology
 Anticonvulsant Medications

Anticonvulsants (also commonly known as

antiepileptic drugs or as antiseizure drugs) are
a diverse group of pharmacological agents used
in the treatment of epileptic seizures.
 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: Toxicity:
 Absence/simple seizures  ataxia/slurred

 Trigeminal Neuralgia speech

 Diplopia/nystagmus
 Side effects:
 Hypotension
 Drowsiness and dizziness
 Pupils fixed/coma
 Photophobia
 Blood dyscrasias
 Hepatoxicity can be life
threatening
 Lamictal rash is life
threatening
 Anticonvulsant Medications
Phenytoin-like class
 Contraindications:  Considerations:
 Hepatic disease  Sprinkles for on food
 Blood dyscrasias for children
Notify MD if s&s of
 Considerations: 

neutropenia:
 Valproic acid is GI  Sore throat
irritant  Fever
 Severe mouth/throat  Oral ulcers
irritation if chewed or  S&s or plastic anemia:
carbonated drinks  Fatigue
 Easy bleeding/bruising
 Barbiturates class
A barbiturate is a drug that acts as
a central nervous system depressant, and
can therefore produce a wide spectrum
of effects, from mild sedation to death.
 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
 Benzodiazepines
Benzodiazepines (BZD, BDZ, BZs), sometimes
called "benzos", are a class of psychoactive
drugs whose core chemical structure is the
fusion of a benzene ring and a diazepine ring.

Benzodiazepines enhance the effect of the neurotransmitter

gamma-aminobutyric acid (GABA) at the GABAA receptor,
resulting in sedative, hypnotic (sleep-inducing), anxiolytic
(anti-anxiety), anticonvulsant, and muscle relaxant properties.
 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:
 Drowsiness and dizziness
 Blood dyscrasias
 Contraindications:
 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:
 Drowsiness and dizziness
 Blood dyscrasias
 Contraindications:
 MAO inhibitors
 Considerations:
 Check for blood dyscrasias
Sedatives
 Sedatives
Barbiturates class
 Short acting:  Long acting:
 Phenobarbital  Mephobarbital
(Nembutal) (Mebaral)
 Secobarbital (Seconal)  Phenobarbital
 Intermediate acting: (Luminal)
 Amobarbital (Amytal)
 Aprobarbital (Alurate)
 Butabarbital (Butisol)
 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:  Considerations:
 Hepatic disease  Hold with respirations <12

 Drug abuse history  Decrease oral contraceptive

 Suicidal history  Limit medication for

 Respiratory disease
hoarding
 Tapered for withdrawal

 Check for s&s withdrawal:

 Considerations:
 8-12 hours minor s&s
 reduces REM sleep
 16 hours – 5 days:
 Effectiveness on

insomnia without convulsions and

daytime sedation 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:  Considerations:
 Suicidal history  Limit to 7-10 days treatment
 Drug abuse history  Withhold if systolic pressure
 CNS depression drops 20mm while standing
or respirations <12/min
 Elderly
 Check neutropenia/aplastic
 NA Glaucoma
anemia
 Uncontrolled pain
 Antacids and smoking
decrease effects
 No hazardous activity
 Sedatives
dopamine and serotonin agonist
 Buspirone (Buspar)  Considerations:
 Uses:  Does not cause
 Insomnia sedation, tolerance,
 Anxiety CNS depression, no
abuse potential
 Side effects:
 Takes several weeks
 Well tolerated to take full effect
 Dystonias; akisthesia
 Contraindications:
 Renal disease
 Liver disease
 MAO inhibitors
 Sedatives
GABA Binder
 Zolipidem (Ambien)  Contraindications:
 Uses:  Liver disease
 Insomnia  Lung disease
 Induces sleep  Apnea
 Side effects:  Psych history
 Daytime drowsiness  Elderly
 Confusion  Considerations:
 Amnesia  Rapid effect
 Dependence in 10  Take when pt in bed
days due to fall risk
 Sedatives
Antihistamines
 Diphenhydramine  Uses:
 (Benadryl)  Insomnia
 (Sominex)  Allergic reaction
 Hydroxyzine  Side effects:
 (Vistaril)  Drowsiness
 Promethazine  Anticholinergic side effects
 (Anergan 50)
 (Phenergan)
 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  Side effects:
(Equanil) (Milltown)  Drowsiness
 Respiratory depression
 Chloral hydrate
(Noctec)  Contraindications:
Elderly
 Uses: 

 Uncontrolled pain
 Insomnia
 Preoperative sedation  Considerations:
 Anxiety  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:  Side effects:
 ADHD  Arrythmias
 Obesity  Low BP, CV collapse
 Narcolepsy  Dry mouth
 Side effects:  n/v
 Restlessness,  Impotence
insomnia,
 Libido change
hyperactivity,
talkative  Growth suppression
 Palpitations  Dependence and
abuse
 Tachycardia
 CNS Stimulants
Amphetamines
 Contraindications:  Considerations:
 Glaucoma  Empty stomach
 Hyperthyroid  1st dose wakening
 CV disease  Last dose 6hrs before bed
 Drug abuse history  ADD/ADHD benefits in 3-4
wks
 Agitation
 Avoid caffeine, colas,
 Anxiety
chocolate, tea
 Tourettes sydrome
 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