| • Valproic acid is a | carboxylic acid derivative. |
| • Valproate is the name given to valproic acid after it has | converted to the active form in the body. |
| • Valproic acid is converted to valproate in the | GI tract; thus, this medication must be delivered orally. |
| • Valproic acid is used as an | anticonvulsant as well as vascular headache suppressant. |
| • Valproic acid has also been used to treat manic episodes associated with? | bipolar disorder, as an adjunct in schizophrenia, to treat tardive dyskinesia, to minimize aggression in children with attention-deficit/hyperactivity disorder (ADHD), and for organic brain syndrome mania. |
| • The mechanism of action by which valproate exerts its antiepileptic effects has not been established, but its action in epilepsy is believed to occur through | increased GABA concentrations in the brain, which decreases seizure activity. |
| • Valproic acid (valproate) also blocks the ???. These mechanisms make valproic acid a broad-spectrum anticonvulsant drug. | voltage-gated sodium channels and T-type calcium channels |
| • Valproate is believed to affect the function of the neurotransmitter GABA in the human brain, making it an alternative to? | lithium salts in treatment of bipolar disorder. |
| • Valproic acid mechanism of action includes?
However, several other mechanisms of action in neuropsychiatric disorders have been proposed
for valproic acid in recent years. | enhance neurotransmission of GABA (by inhibiting GABA transaminase, which breaks down GABA.) |
| is a barbiturate or barbituric acid derivative that acts a nonselective CNS depressant. | Phenobarbital |
| Phenobarbital is primarily used as a ??? but also has application as an ???. | sedative hypnotic;
anticonvulsant |
| Phenobarbital enables binding to ??? receptors, and it alters ??? through receptor channels. | Phenobarbital enables binding to inhibitory GABA subtype receptors, and it alters chloride currents through receptor
channels. |
| Phenobarbital also restricts ???. | glutamate-induced depolarizations |
| Phenobarbital In subhypnotic doses, it is used to treat all forms of ??? and namely? | epilepsy, status epilepticus, febrile seizures in children, sedation, and insomnia. |
| is an anticonvulsant chemically unrelated to existing antiepileptic drugs. Its chemical class name is (–)-(S)alpha-ethyl2-oxo-1-pyrrolidine acetamide. This agent is often used as monotherapy in partial seizures and as an adjunct to other medications in partial, primary generalized tonic–clonic, and myoclonic seizures. | Levetiracetam |
| is a hydantoin whose chemical structure is closely related to that of barbiturates.
is one of the drugs most commonly used to control epileptic seizures in the United States and around the world.
is prescribed to treat various types of convulsions and seizures, including generalized tonic–clonic (grand mal), complex partial (psychomotor, temporal lobe) seizures, status epilepticus, non-epileptic seizures associated with Reye syndrome or after head trauma, and Bell’s palsy. | Phenytoin |
| (clonazepam, chlorazepate, diazepam, lorazepam) are similar in pharmacologic action but have different potencies.
These medications are used as anticonvulsants, muscle relaxants, sedatives, and hypnotics, as well as for neurodegenerative disorders such as multiple sclerosis, ALS, and Parkinson’s disease | Benzodiazepines |
| The most common side effects seen with anticonvulsants are | drowsiness,
irritability,
nausea,
rash,
and
unsteadiness. |
| Some drugs with anticonvulsants may produce changes in?, and some patients may experience ???. | behavior and emotions;
thoughts of suicide |
| Anticonvulsants at high doses or with toxicity, patients can demonstrate | sedation,
slurring of speech,
sleep disturbances,
double vision, and
other symptoms |
| Of all the anticonvulsants, the drug that should be monitored most carefully, or that should be considered “high priority” is .
may accumulate in the cerebral cortex with chronic use and can cause atrophy of the cerebellum when administered at high doses. It inhibits the monoglutamate enzyme, thereby
causing folate deficiency and predisposing patients to megaloblastic anemia, agranulocytosis, and
thrombocytopenia. | phenytoin |
| is a known teratogen; it may produce craniofacial anomalies and a mild form of retardation in fetuses exposed to this drug. | Phenytoin |
| Due to the folate deficiency, it produces, has also been associated with drug-induced gingival enlargement, which may involve gingival bleeding and exudate, pronounced inflammatory response to plaque levels, and, in some instances, bone loss without tooth detachment. | phenytoin |
| has been known to cause hypertrichosis, rash, pruritus, exfoliative dermatitis, and autoimmune reactions such as drug-induced lupus, life-threatening skin reactions such as Stevens-Johnson syndrome, and toxic epidermal necrolysis. | Phenytoin |
| With any anticonvulsant medication, the dosage should be adjusted carefully, starting with? | low doses and increasing the amount given gradually until seizures are controlled, as long as there are no toxic effects. |
| Side effects such as ???,while mild; and
If what symptom that appear could be indications of toxicity or overdose. | acne and hirsutism (excessive growth of hair);
ataxia, slurred speech...
...nystagmus (a vision condition in which the eyes make repetitive, uncontrolled movements.)...
...and blurred vision occur, notify the primary provider immediately |
| Avoid ???, as it can lead to serious side effects.
Always ??? anticonvulsant medications slowly. | sudden withdrawal;
taper |
| Anticonvulsants: Patients or their caregivers should be instructed regarding how to | recognize signs of blood or skin disorders and advised to seek immediate medical attention if symptoms of fever, sore throat, rash, mouth ulcers, bruising, or bleeding develop. |
| Anticonvulsants: Instruct patients to take medications either? | after meals, or at least with food. |
| Anticonvulsants: Encourage patients and their families to learn about? | the disorder being treated, the medication, and its
potential side effects or drug interactions. |
| is a blanket term for chronic, progressive diseases or disorders
characterized by selective and often symmetrical loss, or death of, neurons in the motor, sensory, or cognitive systems. | Neurodegeneration |
| If the cerebral cortex is involved, typically diseases such as | Alzheimer disease, Pick disease, and Lewy body dementias occur. |
| Cellular destruction or malformation in the basal ganglia is generally encountered in | Parkinson’s disease or Huntington disease. |
| Degeneration occurring in the brain stem and cerebellum are characteristic of such disorders as | Freidreich ataxia, multiple system atrophy, or spinocerebellar ataxia. |
| When the motor areas are affected, diseases such as | ALS and spinal muscular atrophy are seen. |
| Many of the causes of neurodegenerative disorders are not know, many of these diseases are associated with | gene mutations. |
| is a disorder in which nerve cells in the areas of the brain that involve muscle movement (corpus striatum and substantia nigra) are affected.
This disease is considered both chronic and progressive, meaning that once it develops, it does not go away, and symptoms generally get worse over time.
In this disease, nerve cells that produce a neurochemical called dopamine die or become damaged. | Parkinson's Disease (PD) |
| sends signals to the brain and normally acts to counter signals sent via acetylcholine (both then affect GABA), thereby coordinating movement. | Dopamine |
| Symptoms that are characteristic of PD include? | tremors in the face, jaw, hands, arms, and legs.; Stiffness of the extremities and trunk, slow movements, and altered coordination. |
| As symptoms worsen with progression of the disease, the patient may eventually?
What may be an early sign? | lose the abilities to walk and speak; have difficulty chewing or swallowing; develop depression; and/or lose the ability to perform simple tasks.
Sleep disturbances |
| Parkinson's disease: Before motor symptoms have begun, and may | include insomnia, excessive daytime sleepiness,
restless leg syndrome, sleep apnea, and nocturia. |
| The drug classes as PD agents are of two types: | (1) those that increase dopamine in the nerves; and
(2) those that decrease acetylcholine in the nerves. |
| as what, upon crossing the blood-brain barrier, is converted to dopamine, thus offering replacement therapy? | levodopa |
| Other dopamine agonists that may be prescribed for PD are? | pramipexole and ropinirole |
| Other drugs used (for Parkinson's disease) are the , the action of which enhances the effect of levodopa; | monoamine oxidase B (MAO-B) inhibitor selegiline |
| which decrease or block acetylcholine (other drug used in Parkinson's disease. | the catechol-o-methyltransferase (COMT) inhibitor entacapone;
and the anticholinergics benzatropine and amantadine, |
| is a catecholamine combination; Administration of dopamine itself is ineffective in the treatment of PD, as this agent does not cross the blood–brain barrier. However, levodopa, the metabolic precursor of dopamine, does cross the blood–brain barrier and is converted to dopamine in the brain. | Carbidopa-Levodopa |
| Carbidopa-Levedopa therefore serves to supplement existing dopamine in affected neurons. Levodopa is rapidly ??? to dopamine in extracerebral tissues so that only a small portion of a given dose is transported unchanged to the CNS. | decarboxylated |
| For this reason (only a small portion of a given dose is transported unchanged to the CNS), large doses of levodopa are required for adequate therapeutic effect, but their administration may be accompanied by nausea and other adverse reactions, Because its decarboxylase-inhibiting activity is limited to extracerebral tissues, administration of ??? with levodopa makes more levodopa available for transport to the brain | carbidopa |
| There is an increased risk of upper gastrointestinal bleeding in patients with a history of ??? who are being treated with carbidopa–levodopa formulations, just as when they are treated with levodopa alone. | peptic ulcer disease |
| Side effects of Carbidopa-Levedopa | Dark brown, red, or black discoloration of urine, saliva, and sweat may also be seen; other side effects include anorexia, constipation, dry mouth, back and shoulder pain, dyspnea, fatigue, depression, psychosis, and bradykinetic episodes (“on-off” phenomenon), among other. |
| Carbidopa–levodopa has been found to pass into ???, so it is contraindicated for use during pregnancy or while ???. | breastfeeding |
| Carbidopa-Levedopa is also contraindicated in patients with ??? as it can affect intraocular pressure, which must be monitored during therapy. | chronic wide-angle glaucoma, |
| Overdose with carbidopa–levodopa is rare, but treatment is the same as the management of ???:
General supportive measures are employed along with emergent gastric lavage.
Intravenous fluids should be administered cautiously, and a satisfactory airway maintained.
Cardiac telemetry monitoring should be instituted, and the patient carefully observed for arrhythmias. | acute overdosage with levodopa |
| Parkinson's Disease (PD): Assess: Monitor the patient for any known PD symptoms such as" | tremors, “pill rolling” (a rhythmic, muscle contraction and relaxation involving to-and-fro movements of the fingers), drooling, akinesia, rigidity of extremities or trunk, or a shuffling gait. |
| Parkinson's Disease (PD): Assess: Obtain baseline vital signs and track the patient’s blood pressure and respirations.
Notify the primary provider if there are episodes of , or changes in heart rate and rhythm. | orthostatic hypotension |
| Parkinson's Disease (PD): Assess: Be aware of any changes in the patient’s? | affect, mood, and behavior; watch for onset of depression; and perform a complete suicide assessment. |
| Parkinson's Disease (PD): Assess: ??? may occur and indicate toxicity.
Monitor renal, hepatic, and hematopoietic tests, as well as those for diabetes and acromegaly, in long-term use | Muscle twitching or uncontrolled spasms of the eyelids |
| Parkinson's Disease (PD): Administer: Carbidopa–levodopa is given orally as ???.
When administering the medication to the patient, ???, although they may be broken in half if necessary. | disintegrating tablets;
do not crush or let the patient chew the extended-release tablets |
| Parkinson's Disease (PD): Administer: Ask patients to take the medication ??? if GI symptoms occur;
limit ???, as this can decrease the absorption of the drug.
Do not initiate the drug until ??? have been discontinued for a minimum of 2 weeks. | with meals;
protein intake;
nonselective monoamine oxidase inhibitors |
| Parkinson's Disease (PD): Administer: If the patient was previously on levodopa, discontinue it for at least ??? before changing to carbidopa–levodopa. | 12 hours |
| Parkinson's Disease (PD): Administer: is required by the body for utilization of energy from the foods we eat, production of red blood cells, and proper functioning of nerves. | Pyridoxine (B6) |
| Parkinson's Disease (PD): Evaluate: Determine the therapeutic response of ??? based on the patient’s
decrease in “inner restlessness” or slowness of movement (akathisia/bradykinesia), tremors, rigidity, and improved mood. | antiParkinson’s medications |
| Parkinson's Disease (PD): Patient/Family Education: When educating the patient and family members, remind them that the patient should ??? side effects are noted, report them
to the primary provider immediately—especially such symptoms as twitching or blepharospasms. Which may indicate overdose. | change positions or rise slowly to prevent orthostatic hypotension; |
| Parkinson's Disease (PD): Patient/Family Education: Explain to the patient that ???, which could stain clothing.
Instruct the patient to take the medication as prescribed and advise the patient that discontinuing the medication abruptly ???. | his or her urine, sputum, or perspiration may darken;
could initiate Parkinson’s crisis. |
| Parkinson's Disease (PD): Patient/Family Education: If a patient needs to discontinue the medication, do so by? | tapering the medication gradually. |
| Parkinson's Disease (PD): Patient/Family Education: Encourage patients to ???, maintain mobility and function and to lessen muscle spasms | continue physical activity or therapy |
| Parkinson's Disease (PD): Patient/Family Education: Remind them that improvement may not be seen for ??? after initiation of carbidopa–levodopa therapy and that they may experience the ??? | two to four months:
“on-off phenomenon.” |
| is an anti-Parkinson’s agent that acts as a dopamine receptor agonist in idiopathic PD; it is also used for the treatment of restless leg syndrome (RLS). | Ropinirole |
| Although the precise mechanism of ropinirole’s action as a treatment for Parkinson’s disease is unknown, it is believed to be related to the drug’s ability to? | stimulate these receptors in the striatum. |
| Side effects of Ropinirole medication are? | like those associated with other anti-Parkinson’s drugs. |
| Ropinirole should be avoided in ???, and precautions should be taken with patients who experience ??? | pregnancy;
dysrhythmias, cardiac disease, hepatic disease, renal disease, psychosis, or affective disorder. |
| Symptoms of Ropinirole overdose include | confusion, agitation, chest pain, drowsiness, facial muscle movements, grogginess, increased jerkiness of movement, symptoms of low blood pressure
(dizziness, lightheadedness) upon standing, nausea, and vomiting. |
| Ropinirole: Assess: Obtaining a baseline of the patient’s vital signs, and watching for possible changes during treatment,
especially issues with ???. | hypertension or hypotension |
| Ropinirole: Assess: One symptom to be aware of with ropinirole is ???. | “sleep attacks” or narcolepsy;
Sudden drowsiness or falling asleep without warning, especially during hazardous activities. |
| Ropinirole: Assess: Monitor the patient’s mental status for any changes in affect, mood, or behavior; watch for signs of
???. | depression; and perform a complete suicide assessment |
| Ropinirole: Assess: If the patient is on long-term therapy, provide testing for conditions such as ???, as these conditions may worsen with use of ropinirole. | diabetes mellitus and acromegaly |
| Ropinirole: Assess: Monitor and report the therapeutic response for the patient, noting ??? | any improvement in movement and other symptoms of Parkinson’s disease. |
| Ropinirole: Administer: Continue administering the medicine as ordered, unless or until the patient is ??? | NPO (nothing by mouth) prior to any surgery. |
| Ropinirole: Administer: Adjust the dosage according to the patient’s response to medication and taper gradually when
discontinuing. If the patient experiences GI symptoms, the medication should be ???.
The extended-release tablets should not be ??? | taken with meals to reduce nausea;
chewed, crushed, or divided. |
| is an anticholinergic agent that works by blocking acetylcholine. The action of acetylcholine is normally balanced by dopamine; in PD, however, because dopamine is depleted, decreasing the acetylcholine helps rebalance dopamine/acetylcholine actions on GABA neurons. | Benztropine |
| Benztropine helps in decreasing muscle rigidity, perspiring, and production of saliva, and works to improve ambulation in patients with ???.
Benztropine is used to treat symptoms of ??? as well as to diminish the involuntary movements. | Parkinson’s disease |
| Potential side effects of benztropine are related to its anticholinergic activity and include ???.
This medication is contraindicated in ???. | drowsiness, dizziness, blurred vision, constipation, flushing, nausea, nervousness, and dry mouth;
children younger than three years and in persons with tardive dyskinesia |
| Benztropine: Assess: As with all medications, vital signs will be monitored while a patient is on benztropine, especially upon initiation of the drug. ??? is vital. | Blood work including monitoring of kidney and liver function |
| Benztropine: Administer: Benztropine may be administered ???.
If the medication is ordered only once a day, it is recommended that it be taken at ??? to avoid daytime drowsiness.
Administer the medication at ??? each day to maintain constant blood levels. | either with food or an empty stomach;
bedtime;
the same time |
| Benztropine: Patient/Family Education: Teach the patient and family members that the medication should be taken ???;
do not ??? the drug without consulting a primary provider, as doing so could lead to serious side effects or worsening of symptoms. | exactly as directed;
increase, decrease, or abruptly discontinue; |
| Benztropine: Patient/Family Education: Do not use ??? without consulting a primary provider, as these substances could worsen side effects of the drug or affect the drug’s efficacy. | alcohol, prescription or over-the-counter sedatives, or CNS depressants |
| Benztropine: Patient/Family Education: The patient who is taking benztropine may experience ??? until their response to the drug is known. | drowsiness, dizziness, confusion, or blurred vision, so encourage patients not to drive, climb stairs, or operate machinery |
| Benztropine: Patient/Family Education: The medication should be used with caution in ???, as it can make the patient more
susceptible to heat stroke due to the drug’s side effect of decreasing perspiration; maintain adequate fluids and reduce exercise activity where possible. | hot weather |
| is used as prophylaxis or treatment of influenza type A, extrapyramidal symptoms, Parkinsonism, and Parkinson’s disease.
causes release of dopamine from the neurons, thereby rebalancing actions with acetylcholine. | Amantadine |
| Amantadine: Assess: Closely monitor the patient’s ???;
also obtain baseline serum ??? levels prior to beginning treatment. Be aware of ??? before initiation of
treatment, and the potential reactions. | intake and output ratios, reporting any frequency or hesitancy;
BUN and creatinine:
patient allergies |
| Amantadine: Assess: Monitor hematologic status for signs of ???. | leukopenia or agranulocytosis |
| Amantadine: Assess: Watch the patient for signs of congestive heart failure (CHF), such as ??? | weight gain, dyspnea, crackles, and jugular vein distention. Monitor respiratory status, noting rate, quality, and presence of wheezing or tightness in the chest. |
| Amantadine: Assess: Monitor closely for signs of toxicity such as? | confusion, behavioral changes, hypotension, or seizures. |
| Amantadine: Administer: Administer the medication in ??? to prevent CNS symptoms such as headache, dizziness,
fatigue, and drowsiness. | divided doses |
| Amantadine: Administer: The patient should take amantadine after meals for ???, and at least four hours before bedtime to prevent ???. | better absorption and to decrease possible GI
symptoms;
insomnia |
| Amantadine: Evaluate: Document the patient’s response to the medication. The patient should be observed for the presence (or absence) of ??? | tremors and a shuffling gait as seen in Parkinson’s disease. |
| Amantadine: Patient/Family Education: Teach patients that when repositioning themselves or beginning to rise from a lying or sitting position, they should do so slowly to prevent ???.
To avoid injury, they should also avoid any hazardous activities, including driving or climbing stairs, if ??? | orthostatic hypotension;
dizziness or blurred vision occurs. |
| Amantadine: Patient/Family Education: If a dose is missed, the patient should be advised to take the medication if it is still within ??? after the missed dose. | four hours |
| Amantadine: Patient/Family Education: If shortness of breath, sudden weight gain, dizziness, poor concentration, dysuria, or behavioral changes manifest, what to do next? | notify the primary provider immediately. |
| Amantadine: Patient/Family Education: Explain to patients that they should avoid ??? while taking this medication, as adverse effects may occur. | alcohol |
| is a neurogenerative disorder that is the most common form of dementia, a general term for loss of memory and other intellectual abilities serious enough to interfere with daily life.
is distinguished by the loss of nerve cells and synapses in the cerebral cortex and subcortical regions of the brain as well as the appearance of plaques and tangles, which make this disease unique.
is an irreversible, progressive brain disease that slowly destroy memory, reasoning, judgment, communication, and the ability to carry out simple tasks and activities of daily living. | Alzheimer ('s) disease (AD) |
| The loss of nerve cells and synapses in the cerebral cortex and subcortical regions of the brain results in? | profuse deterioration of the affected regions, including degeneration of the temporal and parietal lobes, and parts of the frontal cortex and cingulate gyrus. |
| Food and Drug Administration (FDA) has approved four medications for the treatment of Alzheimer disease: | donepezil, galantamine, memantine, and rivastigmine. |
| Three of the FDA-approved medications for Alzheimer's Disease (AD) are in the same drug class— namely, ??? inhibitors.
These drugs work to curb the breakdown of acetylcholine, a chemical in the brain that is important for memory and learning, by inhibiting an enzyme, acetylcholinesterase, that is responsible for the metabolism of acetylcholine; as a result, concentrations acetylcholine increase in the brain and symptomatic improvement is seen. | cholinesterase |
| While these drugs (Cholinesterase or Alzheimer's Disease) may reduce symptoms for approximately half the people taking them for a limited time, on average ??? , the medications do not slow the progression of Alzheimer disease overall, and their effects are, for the most part, temporary. | 6 to 12 months |
| is the only cholinesterase inhibitor approved by the FDA for all stages (mild, moderate, and severe) of AD. | Donepezil |
| Donepezil: Assess: When initiating medication for AD treatment, obtain the patient’s ???. | baseline vital signs and then monitor them regularly, especially blood pressure for signs of hypertension; |
| Donepezil: Assess: Continually assess GI (Gastrointestinal) status for signs of ??? and add bulk to the diet and increase fluids for issues with ???. | vomiting or constipation; constipation; |
| Donepezil: Assess: Monitor GU (Genitourinary) status for urinary frequency; monitor ???. | serum creatinine levels; |
| Donepezil: Assess: Be aware of any mental status changes such as ???. Assist the patient with ambulation during the onset of therapy, as ??? may occur. | affect, mood, and behavioral changes, and appearance of hallucinations or confusion; dizziness |
| Donepezil: Administer: Instruct the patient to take the medication with ???. | a full glass of water and note that it may be taken without regard to meals. |
| Donepezil: Administer: Patients should not ??? the extended-release capsules; instead, they ??? | crush, chew, or divide;
should swallow the capsules whole or open them and sprinkle their contents on applesauce before swallowing. |
| also known as Lou Gehrig disease or motor neuron disease is a progressive neurodegenerative disease with varied etiology characterized by rapidly progressive weakness, muscle atrophy and fasciculations, muscle spasticity, and difficulty speaking, swallowing, and breathing. | Amyotrophic Lateral Sclerosis |
| The defining feature of ALS (Amyotrophic Lateral Sclerosis) is the ??? | death of both upper and lower motor neurons in the motor cortex of the brain, the brain stem, and the spinal cord. |
| an anti-glutamate agent, is the first FDA-approved drug for the treatment of patients with ALS. | Riluzole |
| Riluzole: Assess: Evaluate the patient for clinical improvement in neurologic function. Monitor hepatic studies such as ???, by ???And signs of ???. | AST, ALT, GGT, and bilirubin, along with liver function tests (LFTs);
obtaining baseline lab values and then performing follow-up lab work every month for three months, then every three months to adequately track liver function (riluzole is metabolized in the liver).;
neutropenia. (i.e., neutrophils numbering less than 500 cells/mm3 ) |
| Where is riluzole metabolized? | Liver |
| Riluzole: Administer: Give the medication ???; note that a ??? will decrease riluzole’s absorption. | one hour before or two hours after meals;
high-fat meal |
| Riluzole: Patient/Family Education: Explain to patients the reason they are being given this medication and the expected results.
Remind them that ???. | there is no current cure for ALS |
| Riluzole Patient/Family Education: Other medications that may be used for ALS, or other neurodegenerative disorders, include
??? to reduce excess saliva production, ??? and ??? for discomfort. | antidepressants such as amitriptyline; muscle relaxants such as diazepam or baclofen, and pain medications |
| these medications, along with proper nutrition, physical and occupational therapy, and use of braces, a wheelchair, or other orthopedic measures, are meant to ??? | maximize functioning, provide optimal general health to the patient, and prolong life |
| An individual strains or overstretches a tendon or muscle during strenuous activity and experiences pain and, in the case of muscle injuries, ???. | spasm |
| a condition characterized by widespread muscle and joint pain. | Fibromyalgia |
| is defined as a sudden involuntary contraction of one or more muscle groups and is usually an acute condition associated with muscle strain or sprain. | Muscle spasm |
| Is a state of increased muscular tone with amplification of the tendon reflexes and is often associated with disease states, illness, or injury such as multiple sclerosis, stroke, and spinal cord injury.
Can severely limit functioning due to weakness, spasms, and loss of dexterity | Spasticity |
| Muscular dysfunction (Muscular spasm, fibromyalgia): Assess: | While patients are on medications, monitor their vital signs such as blood pressure (both reclined and standing), pulse, and respiratory rate.
Due to the medications’ effects on the liver, monitor hepatic laboratory results such as AST, ALT, bilirubin, creatinine, LDH, and alkaline phosphorus
Assess the patient for relief of symptoms of pain and/or muscle spasms. |
| Muscular dysfunction (Muscular spasm, fibromyalgia): Administer: | Give oral medications with food or milk to prevent possible GI symptoms.
Instruct the patient that medications may be crushed if the patient is unable to swallow the medication whole. |
