medicines neurological ear eye musculoskeletal

1. Neurological (including anesthetics)
1. Anticonvulsants
a. action - modifies bioelectric activity at subcortical and cortical areas
b. examples
i. diazepam (Valium)
ii. magnesium sulfate
iii. phenytoin (Dilantin)
iv. phenobarbital (Luminal)
c. use: prevents seizures
d. adverse effects
i. blood dyscrasias
ii. gastric effects - nausea,vomiting
iii. CNS depression - dizziness, drowsiness
iv. phenytoin: ataxia, hirsutism, hypotension
e. contraindications
i. hypersensitivity
f. nursing interventions
i. give medication with food
ii. wiith phenytoin: monitor condition of oral mucosa, don't mix
with other IV fluids, monitor blood lab results, monitor urine
iii. renal, liver, and blood studies
iv. teach clients
 avoid alcohol
 notify physician of unusual symptoms
 carry medical alert information
 take medication on schedule; do not discontinue
 avoid driving and other potentially hazardous activities
 phenytoin: good oral hygiene, frequent dental visits
2. Antiparkinson agents
a. action
i. anticholinergics: block or compete at central acetylcholine receptors
ii. dopamine agonists: activation of dopamine receptors

2. iii. reinforce client education
 do not stop taking antiparkinsonian meds suddenly: may
precipitate parkinsonian crisis
 continue medical supervision
 avoid alcohol while on therapy
 take with meals
 caution with hazardous activities
 to change position slowly to prevent orthostatic
hypotension
 levodopa
o minimize Vitamin B6 in diet, because it hinders
drug's effectiveness
o do not take OTC medications without health
care provider's approval
o sweat and urine may be dark colored
o toxicity: personality changes, increased
twitching, grimacing, tongue protrusion
3. Cholinesterase inhibitors

3. a. action
i. prevents breakdown of acetylcholine at nerve endings
ii. facilitates transmission of impulses across myoneural junction
iii. strengthens muscle contractions including respiratory muscles
b. examples
i. edrophonium chloride (Tensilon) for diagnostic purposes
ii. neostigmine bromide (Prostigmin)
iii. ambenonium chloride (Mytelase)
c. use: treat myasthenia gravis
d. adverse effects
i. gastric irritation: nausea,vomiting, diarrhea
ii. hypersalivation
iii. CNS disturbances
iv. orthostatic hypotension
v. toxicity: pulmonary edema,respiratory failure, bronchospasm
e. contraindications
i. intestinal obstruction, renal obstruction
ii. peritonitis
f. nursing interventions
i. monitor client response to medication; may need to adjust
dosage
ii. monitor vital signs during period of dosage adjustment
iii. keep atropine sulfate available for overdosage
iv. administer medication with food
v. administer medication as per schedule
vi. teach client
 wear medic alert jewelry and ID
 change position cautiously; sit at first feeling of
faintness.
4. Antidepressants
a. action: increase norephinephrine at subcortical neuroeffector sites
b. examples
i. norepinephrine blockers (tricyclic, TCAs): amitriptyline (Elavil),
imipramine (Tofranil)
ii. monoamine oxidase inhibitors (MAOIs): isocarboxazid
(Marplan), phenelzine sulfate (Nardil)
iii. selective serotonin reuptake inhibitors: fluoxetine (Prozac),
sertraline (Zoloft)
c. use: treat melancholia, depression
d. adverse effects
i. norepinephrine blockers
 potentiate anticholinergics and CNS depressants
 orthostatic hypotension
 drowsiness, dizziness, confusion
 CNS stimulation
ii. MAOIs
 potentiate alcohol, barbiturates, antihistamines
 hypertensive crisis with ingestion of foods high in
tyramine (pickled herring, beer, wine, cheese,chocolate)
 orthostatic hypotension

4. iii. selective serotonin reuptake inhibitors
 may interact with tryptophan
 insomnia
 headache
 sexual dysfunction
 gastric irritation
e. contraindications
i. acute schizophrenia
ii. mixed mania and depression
iii. suicidal tendencies
iv. narrow angle glaucoma
f. nursing interventions
i. monitor effect of medication
ii. maintain suicide precautions especially as depression lifts
iii. give SSRIs in morning; TCAs at bedtime
iv. teach client
 do not take OTC medication without physician approval
 avoid hazardous activities
 effect of medication may take up to four weeks
 MAOIs: teach client to avoid food containing tyramine;
monitor client for hypertensive crisis
 SSRIs and MAOIs should not be given concurrently or
close together
5. Antimanic agents
a. action: reduces adrenergic neurotransmitter levels in cerebraltissue
b. examples
i. antimanic agents: lithium carbonate (Lithane)
ii. alternative antimanic agents: carbamazepine (Tegretol),
clonazepam (Klonopin)
c. use: control of manic phase of mood disorders; bipolar disorder
d. adverse effects
i. metallic taste
ii. hand tremors
iii. excess voiding and extreme thirst
iv. slurred speech
v. disorientation
vi. cogwheel rigidity
vii. renal failure
viii. respiratory depression
e. nursing interventions
i. monitor blood levels
ii. avoid concurrent administration of adrenergic drugs
iii. evaluate client's response to medication
iv. teach client
 effect of medication may take severalweeks
 high intake of fluids and normal sodium
 toxicity signs: diarrhea, vomiting, weak muscles,
confusion etc.
 take medication with meals
6. Antipsychotics

5. a. action blocks dopamine hydrochloride receptors in the CNS and
sympathetic nervous system
b. examples
i. phenothiazines: chlorpromazine (Thorazine), thioridazine
(Mellaril)
ii. benzisoxazole: risperidone (Risperdal)
iii. thioxanthenes: chlorprothixene (Taractan)
iv. butyrophenones: haloperidol (Haldol)
c. use: treatment of psychotic symptoms in schizophrenia, psychosis,
Tourette's syndrome, bipolar disorder
d. adverse effects
i. excessive sedation
ii. jaundice
iii. orthostatic hypotension
iv. urinary retention
v. anorexia
vi. dry mouth
vii. hypersensitivity reactions (such as photoallergic reaction,
impotence, cardiac toxicity)
viii. blood dyscrasias - agranulocytosis
ix. extrapyramidal side effects:dystonia, pseudoparkinsonism,
akathisia, akinesia, tardive dyskinesia
x. neuroleptic malignant syndrome: fever,muscle rigidity,
agitation, confusion, deliruim, respiratory failure
e. nursing interventions
i. assess client's response to therapy
ii. monitor for signs of infection, liver toxicity, extrapyramidal
symptoms
iii. monitor blood work if long-term therapy
iv. monitor vital signs
v. give medication at bedtime
vi. teach client
 avoid alcohol use
 avoid driving or other hazardous activities
 avoid exposure to direct sunlight
 good oral hygiene
 report extrapyramidal symptoms or signs of infection to
physician
 drink plenty of water
7. Hypnotics
a. action: depress CNS
b. examples
i. barbiturates: pentobarbital (Nembutal), secobarbital (Seconal):
physical dependency may result with long term use
ii. acetylinic alcohol: ethchlorvynol (Placidyl)
iii. chloral derivatives: chloral hydrate (Noctec)
c. uses: insomnia, sedation
d. adverse reactions
i. respiratory depression
ii. hypotension

6. iii. barbiturate toxicity: hypotension, pulmonary constriction, cold
and clammy skin, cyanosis of lips, insomnia, hallucinations,
delirium
e. contraindications
i. hypersensitivity
ii. pregnancy
f. nursing interventions
i. monitor client response to medication
ii. teach client
 take medication exactly as prescribed
 avoid alcohol and other depressant use
 avoid driving and other hazardous activities while under
the influence
8. Antianxiety (Anxiolytic)
a. action: depress CNS
b. examples
i. benzodiazepines: alprazolam (Xanax), chlordiazepoxide
(Librium):physical dependency and withdrawl finsings after long
term use
ii. azapirones: buspirone (Buspar)
c. uses: anxiety, sleep disorders, alcohol withdrawl
d. adverse reactions
i. CNS disturbances: dizziness drowsiness, lethargy, orthostatic
hypotension
ii. skin rash
iii. blood dyscrasias
e. contraindications
i. hypersensitivity
ii. acute narrow angle glaucoma
iii. liver disease
f. nursing interventions
i. notify health care provider if systolic BP drops 20mm Hg
ii. administer with food or milk
iii. teach client
 take medication as prescribed
 do not take OTC medication without health care
provider's approval
 use caution when driving or hazardous activities
 action potentiated with alcohol or sedatives
 never abruptly stop taking benodiazepine
 with chlordiazepoxide- avoid excessive sunlight
Managing musculoskeletal conditions
1. Skeletal muscle relaxants
a. use: relax muscles, treat spasm disorders b

7. 2. Nonsteroidal antinflammatory drugs (NSAIDS)
a. action: interferes with prostaglandin synthesis
b. examples: ibuprofen (Motrin), indomethacin (Indocin)
i. first generation (COX-1 inhibitor) - salicylates (aspirin - Bayer,
Ecotrin), ibuprofen(Motrin, Advil), naproxen (Naprosyn)
ii. second generation (COX-2 inhibitor)- celecoxib (Celebrex)
c. use: rheumatoid arthritis, osteoarthritis, dysmenorrhea
d. adverse effects
i. gastric disturbances- lessened with administration of COX-2
inhibitors
ii. skin rash
iii. blood dyscrasias/bleeding
iv. CNS disturbances
v. nephrotoxicity
e. contraindications
i. hypersensitivity
ii. asthma
iii. renal disease
iv. liver disease
f. nursing interventions
i. administer one hour before or two hours after meals

8. ii. monitor blood work, vital signs
iii. monitor response to medication
3. Antigout agents
a. action: increases excretion of uric acid and decreases uric acid formation
b. examples
i. allopurinol (Zyloprim)
ii. colchicine (Novocolchine)
iii. probenecid (Benemid)
c. use: prevent gout attacks
d. adverse effects
i. gastric effects:nausea and vomiting, indigestion
ii. blood dyscrasias
iii. liver damage
iv. skin rash
v. gi disturbances
e. contraindications: hypersensitivity
f. nursing interventions
i. increase fluid intake to prevent renal calculi
ii. monitor fluid intake and output
iii. administer with meals
iv. monitor blood work, including serum uric levels, and electrolyte
levels
v. instruct client
I. lose weight if needed
II. avoid high purine foods (organ meats, sardines, shellfish,
etc.)
III. avoid fermented beverages such as beer, ale, wine
Ophthalmic Agents:
1. Miotics - constrict the pupil of the eye,pullingthe irisawayfromfiltratingangle andimproving
outflowof aqueous humor
Examples:
 Pilocapine Hcl
 Physostigmine
 Timolol maleate (Timoptic)
S/E
 Twitchingof eyelids(inc.cholinergicstimulation)
 Brow ache

9.  HA (vasodilation)
 Conjunctival pain
 Contact dermatitis
2. Anticholinergics:dilate the pupil (mydriasis) byrelaxingciliarymuscle &sphinctermuscle of the
iris,paralyze accommodation(cycloplegia)
Examples:
 Atropine Sulfate
 Tropicamide (Mydriacly)
 Scopolamine
S/E
 Dry mouth(decsalivation)
 Flushing,fever(CNSeffect)
 Blurredvision(pupillarydilation)
 Skinrash
 Tachycardia (decvagal stimulation)
 Ataxia(CNSeffect)
AVOIDTO GLAUCOMA PT
3. Mydriatrics:dilate pupil (mydriasis)bycausingcontractionof the dilatormuscle of iriswith
minimal effectonciliarymuscle whichlessensthe effectonaccommodation
Examples:
 Phenylephrine Hcl (Neo-Synephrine)
S/E
 Brow ache
 HA (vasoconstrictoreffect)
 Blurredvision(pupillarydilation)
 Tachycardia (inc.sympatheticstimulation)
 HTN (vasoconstrictoreffect)
4. Carbonicanhydranase inhibitor:decreasethe flow of aqueoushumorincontrol of intraocular
pressure
Example:
o Acetazolamide(Diamox)
S/E
 Diuresis(incsecretionof Na& H20 renal tubules)
 Paresthesia(F-Eimbalance)
 N/V
 CNSeffect

10. 5. Osmoticagents:administeredsystematicallytodecrease bloodosmolality,whichmobilizesfluid
fromthe eye toreduce volume of intraocularfluid
Example:
 Glycerin(glycerol)
 Mannitol (Osmitrol)
S/E
 HA (cerebral dehydration)
 N/v(F-Eimbalance)
NursingCare
 Instructthe patientregarding:effectsdrugs,propermethodapplication&needmedical
supervision
 Provide care formydriatrics:
 Cautionthatvisionwill be Blurredtemporarily
 Sunglasseswillrelieve photophobia
 Avoidhazardoussports
 Assessof worseningof S/E
 Diet:Richdense-nutrientssuchasfruits,vegetables,whole grains&legumes
Ophthalmic / Eye Medication
Administration of Eye Medication
Objectives
To provide an eye medication the client requires to treat an infection or other reason.
Considerations
The eye is the most sensitive organ to which the nurse applies medications. Care must be
taken to prevent instilling medication directly into cornea.
Instilling wrong concentration may cause local irritation of the eyes as well as systemic
effects
Equipment
Medication bottle with eye dropper or ointment tube
Cotton ball or tissue
Eye patch or tape (optional)
PROCEDURE RATIONALE
* Clean the eyelid /lashes if necessary using a cotton soak in
sterile saline. Wiping from inner to outer canthus, one cotton for each
eyes.
Eye Drops
- Squeeze prescribed dose in the Eyedropper. Ensure correct dosage

11. - Place a tissue below the lower lid Cotton or tissue absorbs medication that escapes eye
- Gently press downward with thumb or forefinger against bony orbit.
- Exposes lower conjunctival sac by pulling down on cheek.
- Prevents pressure and trauma to eyeball and prevents fingers from touching eye.
- While client looks up, drop prescribed dose into center of the conjunctival sac.
Prevent damage directly to the cornea. Reduces stimulation of blink reflex.
- While client closes and move eyes, place finger on either side of the nasolacrimal duct for 1
minute. Prevents overflow of medication into nasal passage and possible systemic effect.
Eye Ointment
- Separate client’s eyelids and grasp lower lid, exert downward pressure over the cheek.
- Instruct patient to look up
- Apply ointment along inside edge of the lower eyelid from inner to outer canthus.
Distributes medication without traumatizing eye
- Wipe excess medication Promtes comfort and facilitate cleanliness
Eye Irrigation
Have patient sit or lie with head tilted toward side of affected eye
Clean from inner toward outer canthus to prevent debris entering lacrimal ducts
Expose lower conjunctival sac, hold irrigator about 2.5 cm (1‖) from eye, direct flow from
inner to outer canthus
Irrigate until solution is clear or all of the solution has been used
Use only enough force to remove secretions gently
Avoid touching any part of eye
Dry area with cotton balls or gauze sponge
Chart irrigation, appearance of eye, drainage, and patient’s response
Otic ( Ear ) Medication
Includes instillations and irrigations
Instillations:
To soften earwax
To reduce inflammation
To treat infection
To relive pain
Irrigations:

12. To remove cerumen or pus
To apply heat
To remove a foreign body or object
Administration of Ear Medication
Objectives
To soften earwax so that it can be readily removed at
a later time
To provide local therapy to reduce inflammation,
destroy infective organism.
To relieve pain
Equipment
Medication bottle with dropper
Cotton tipped applicator
Cotton ball
- Warm medication by running warm water over the bottle. Prevents nausea and vertigo that may
occur if the medication is too cold
- Place the client in side- lying position with the affected ear facing up. The nurse should
stabilize the client’s head with his or her hand. Provide easy access to ear for instillation of
Infants: draw the auricle gently downward and backward.
Adults / Children : lift pinna upward and backward Straightening of ear canal provides direct
access to deeper external ear structures.
- Instill the medicine into the ear canal holding the dropper 1 cm above ear canal
Forceful instillation of medicine into occluded canal can cause injury to eardrum.
- Ask the client to maintain the position for 2-5 minutes. Apply gentle massage or pressure to
tragus of ear with finger. Allows complete distribution of medication. Pressure and massage
moves medication inward.
Guidelines for Removing Excessive/ Impacted Cerumen
Place 5 to 10 drops of the cerumen-softening solution into the ear canal, and allow it to
remain for at least 15 minutes.
Prepare a warm (not hot) solution of plain water or other solution as directed by your doctor.
Eight ounces of solution should be sufficient to clean out the ear canal.
To catch the returning solution, hold a container under the ear being cleaned. An emesis
basin is ideal because it fits the contour of the neck.
Tilt the head down slightly on the side where the ear is being cleaned.
Gently pull the earlobe down and back to expose the ear canal as shown in drawing A.
Place the open end of the syringe into the ear canal with the tip pointed slightly upward
toward the side of the ear canal, as shown in the drawing. Do not aim the syringe into the
back of the ear canal. Make sure the syringe does not obstruct the outflow of solution.
Squeeze the bulb gently—not forcefully—to introduce the solution into the ear canal and to
avoid rupturing the eardrum. (Note: Only health professionals trained in aural hygiene should use
forced water sprays [e.g., Water Pik] to remove cerumen.)

13. Do not let the returning solution come into contact with the eyes.
If pain or dizziness occurs, remove the syringe and do not resume irrigation until a doctor is
consulted.
Make sure all water is drained from the ear to avoid predisposing to infection from water-
clogged ears.
Rinse the syringe thoroughly before and after each use, and let it dry.
Store the syringe in a cool, dry place (preferably, in its original container) away from hot
surfaces and sharp instruments.
Do this procedure twice daily for no longer than 4 consecutive days.