[7] MIDTERMS | DRUGS ACTING ON THE CNS AND PNS Flashcards
- ____ are medicines that stimulate the brain, speeding up both mental and physical processes.
- They increase energy, ____, and elevate ____, heart rate and ____.
- They decrease ____, reduce appetite, improve confidence and concentration, and ____.
- CNS stimulants are medicines that stimulate the brain, speeding up both mental and physical processes.
- They increase energy, improve attention and alertness, and elevate blood pressure, heart rate and respiratory rate.
- They decrease the need for sleep, reduce appetite, improve confidence and concentration, and lessen inhibitions.
AMPHETAMINES
AMPHETAMINES
* Stimulates the release of neurotransmitters – ____ and ____
* Indications: ____, ADHD
* Can develop dependence
* Short-term (____ weeks)
* Avoid abrupt withdrawal
* Half Life: ____ hours
* S/E and A/R: ____, insomia, tachycardia, HPN, ____, dry mouth, ____, weight loss, diarrhea or constipation, and ____
AMPHETAMINES
* Stimulates the release of neurotransmitters – norepinephrine and dopamine
* Indications: narcolepsy, ADHD
* Can develop dependence
* Short-term (12 weeks)
* Avoid abrupt withdrawal
* Half Life: 9-13 hours
* S/E and A/R: restlessness, insomia, tachycardia, HPN, heart palpitations, dry mouth, anorexia, weight loss, diarrhea or constipation, and impotence
AMPHETAMINE-LIKE DRUGS
* Action: to increase child’s ____, ____ performance and to decrease ____, hyperactivity and ____
Example:
* ____ (Ritalin) – ADHD – Insomnia (Don’t give 6 hours before bedtime)
* ____ (Cylert) - narcolepsy
* ____ (Provigil) - newest
Nursing Responsibilities:
* Ritalin and Pemoline should be given ____ before meals (breakfast and lunch)
* Never give ____ sleep
* Instruct the patient to avoid ____
* Instruct the nursing mother to avoid taking CNS stimulants
* Explain to client that long-term use may lead to drug abuse
* Dry Mouth - ____
* WOF: ____ – involuntary twitching of eyes and mouth
AMPHETAMINE-LIKE DRUGS
* Action: to increase child’s attention span, cognitive performance and to decrease impulsiveness, hyperactivity and restlessness
Example:
* Methylphenidate (Ritalin) – ADHD – Insomnia (Don’t give 6 hours before bedtime)
* Pemoline (Cylert) - narcolepsy
* Modafinil (Provigil) - newest
Nursing Responsibilities:
* Ritalin and Pemoline should be given 30 to 45 minutes before meals (breakfast and lunch)
* Never give within 6 hours before sleep
* Instruct the patient to avoid driving
* Instruct the nursing mother to avoid taking CNS stimulants
* Explain to client that long-term use may lead to drug abuse
* Dry Mouth - sugarless gums
* WOF: Tourette Syndrome (Tics) – involuntary twitching of eyes and mouth
ANOREXIANTS
* Appetite ____
* S/E: nervousness, ____, irritability, ____, heart palpitations and HPN.
* Avoid: ____, ____
ANOREXIANTS
* Appetite suppresant
* S/E: nervousness, restlessness, irritability, insomnia, heart palpitations and HPN.
* Avoid: < 12 y/o, self-medication
ANALEPTICS
* Stimulate ____
* ____: Caffeine (____ - infusion/oral preparation) and ____ (newborn - used in respiratory distress)
* S/E: nervousness, restlessness, ____, twitching, palpitations and insomia, ____, GI irritation, ____
ANALEPTICS
* Stimulate respiration
* Methylxanthines: Caffeine (caffeine citrate - infusion/oral preparation) and Theophylline (newborn - used in respiratory distress)
* S/E: nervousness, restlessness, tremors, twitching, palpitations and insomia, diuresis, GI irritation, tinnitus
CNS DEPRESSANTS: Sedative-Hypnotics
- ____ – diminish physical and mental response at a lower dosages of certain CNS depressants but does not affect consciousness
- ____ – natural sleep
- SEDATION – diminish physical and mental response at a lower dosages of certain CNS depressants but does not affect consciousness
- HYPNOTIC – natural sleep
CNS DEPRESSANTS: Sedative-Hypnotics
Non-Pharma to Promote Sleep
* S – ____ – stimulants (6 hrs before sleep), daytime naps, nicotine/smoking, strenous activity before bedtime, heavy meals before bedtime
* L – Limit ____ / Listen to quiet music
* E – Encourage ____, ____
* E – Ensure ____ (cut lights > increase melatonin)
* P – Practice healthy lifestyle habits
Non-Pharma to Promote Sleep
* S – **SAY “NO” **– stimulants (6 hrs before sleep), daytime naps, nicotine/smoking, strenous activity before bedtime, heavy meals before bedtime
* L – Limit loud noises / Listen to quiet music
* E – Encourage warm bath, warm water/milk
* E – Ensure soothing activities / quiet environment (cut lights > increase melatonin)
* P – Practice healthy lifestyle habits
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: BARBITURATES
Long-Acting
* ____ and ____
* Used to control seizures in ____
Intermediate-Acting
* ____ (Amytal)
* Aprobarbital (Alurate)
* ____ (Butisol)
* ____ for maintaining long period of sleep
* Causes drowsiness/hangover
Short-Acting
* ____ (Seconal)
* ____ (Nembutal)
* Induce sleep for those with ____
Ultrashort-Acting
* ____ (Pentothal)
* General anesthetics
Sedative-Hypnotics: BARBITURATES
Long-Acting
* Phenobarbital and Mephobarbital
* Used to control seizures in epilepsy
Intermediate-Acting
* Amobarbital (Amytal)
* Aprobarbital (Alurate)
* Butabarbital (Butisol)
* Sleep sustainers for maintaining long period of sleep
* Causes drowsiness/hangover
Short-Acting
* Secobarbital (Seconal)
* Pentobarbital (Nembutal)
* Induce sleep for those with difficulty falling asleep
Ultrashort-Acting
* Thiopental Na (Pentothal)
* General anesthetics
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics:
1. ____
2. ____
3. Nonbenzodiazepines
4. ____
5. ____ - induces sleep and decrease nocturnal awakenings
Sedative-Hypnotics:
1. Barbiturates
2. Benzodiazepines
3. Nonbenzodiazepines
4. Piperidinediones
5. Chloral Hydrate - induces sleep and decrease nocturnal awakenings
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: BARBITURATES
Nursing Responsibilities
* ____ – short term use only! (____ or less)
* Abrupt withdawal
* Raise ____
* Check skin for rashes.
* Administer ____ at a rate of less than ____ mg/min.
* Do not mix ____ with other medications.
* Deep IM in ____.
* Teach client to use ____ to induce sleep.
* Instruct to avoid alcohol and antidepressant, antipsychotic and narcotics – ____
* WOF: ____ depression / ____ depression; ____ esp. when combined with acetaminophen
Sedative-Hypnotics: BARBITURATES
Nursing Responsibilities
* Barbiturates – short term use only! (2 weeks or less)
* Abrupt withdawal
* Raise bedside rails
* Check skin for rashes.
* Administer IV pentobarbital at a rate of less than 50 mg/min.
* Do not mix pentobarbital with other medications.
* Deep IM in gluteus medius.
* Teach client to use non pharma ways to induce sleep.
* Instruct to avoid alcohol and antidepressant, antipsychotic and narcotics – morphine sulfate
* WOF: respiratory depression / CNS depression; hepatotoxicity esp. when combined with acetaminophen
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: BENZODIAZEPINES
* Action: increase the action of inhibitory neurotransmitter ____ > neuron excitability is reduced
* ____ – first; used to treat insomia
* ____ – A/R: loss of memory (anterograde amnesia / memory impairment); should not be taken longer than 7-10 days
* Temazepam (Restoril), Estazolam (ProSom), Quazepam (Doral)
* ____ (Valium), ____ (Ativan)
Sedative-Hypnotics: BENZODIAZEPINES
* Action: increase the action of inhibitory neurotransmitter GABA > neuron excitability is reduced
* Flurazepam (Dalmane) – first; used to treat insomia
* Triazolam (Halcion) – A/R: loss of memory (anterograde amnesia / memory impairment); should not be taken longer than 7-10 days
* Temazepam (Restoril), Estazolam (ProSom), Quazepam (Doral)
* Diazepam (Valium), Lorazepam (Ativan)
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: BENZODIAZEPINES
Nursing Responsibilities
* Avoid ____, antidepressants, antipsychotics
* ____ before taking the drug – causes ____
* No ____
* Caution in driving
* Antidote: ____
Sedative-Hypnotics: BENZODIAZEPINES
Nursing Responsibilities
* Avoid alcohol, antidepressants, antipsychotics
* Urinate before taking the drug – causes urinary retention
* No OTC drugs
* Caution in driving
* Antidote: Flumazenil
CNS DEPRESSANTS: Sedative-Hypnotics
Sedative-Hypnotics: NONBENZODIAZEPINES
* ____ (Ambien)
* Short term treatment of Insomnia (< ____ )
* Duration of Action: ____
* Metabolized in the ____
* Excreted in the ____
Sedative-Hypnotics: NONBENZODIAZEPINES
* Zolpidem (Ambien)
* Short term treatment of Insomnia (< 10 days)
* Duration of Action: 6-8 hours
* Metabolized in the liver
* Excreted in the urine
First anesthetic
Nitrous Oxide or “Laughing Gas”
ANESTHESIA
BALANCED ANESTHESIA
* A ____ – given at night before surgery
* ____ (narcotic and benzodiazepine) and ____ (Atropine) – given ____ before surgery > to decrease secretions > prevent aspiration
* A short acting nonbarbiturate - ____
* An ____
* A ____ – PRN! – as needed!
BALANCED ANESTHESIA
* A hypnotic – given at night before surgery
* Premedication (narcotic and benzodiazepine) and anticholinergic (Atropine) – given 1 hr before surgery > to decrease secretions > prevent aspiration
* A short acting nonbarbiturate - Propofol
* An inhaled gas
* A muscle relaxant – PRN! – as needed!
ANESTHESIA
STAGES OF GENERAL ANESTHESIA
1. ____ - decreased pain awareness,sometimes with amnesia, impaired consciousness but not lost
2. ____ - excitation, amnesia, enhanced reflexes, uncontrolled movement, irregular respiration, urinary incontinence
3. ____ - unconscious, no pain reflex, regular respiration, maintained BP
4. ____ - too deep > overdosage > circulatory/respiratory collapse > death
STAGES OF GENERAL ANESTHESIA
1. Analgesia/Induction - decreased pain awareness,sometimes with amnesia, impaired consciousness but not lost
2. Excitement/Delirium - excitation, amnesia, enhanced reflexes, uncontrolled movement, irregular respiration, urinary incontinence
3. Surgical Stage - unconscious, no pain reflex, regular respiration, maintained BP
4. Medullary Paralysis - too deep > overdosage > circulatory/respiratory collapse > death
ANESTHESIA
INHALATION ANESTHETICS
* ____ or ____ administered as gas
* A/R: ____, hypotension, dysrhythmias, ____
* ____, methoxyflurane, ____, isoflurane, ____, sevoflurane, nitrous oxide, ____
* WOF: ____
* MGT: ____
INHALATION ANESTHETICS
* Gas or volatile liquids administered as gas
* A/R: respiratory depression, hypotension, dysrhythmias, hepatic dysfunction
* Halothane, methoxyflurane, enflurane, isoflurane, desflurane, sevoflurane, nitrous oxide, cyclopropane
* WOF: Malignant Hyperthermia
* MGT: Dantrolene
ANESTHESIA
IV ANESTHETICS
* As general anesthesia
* ____ (Pentothal), ____ (Brevital), ____ (Ketalar)
* ____ - intubation/minor surgeries
* Adverse Reactions: ____
* WOF: Infections - ____ supports microbial growth
IV ANESTHETICS
* As general anesthesia
* Thiopental sodium (Pentothal), Methohexital Sodium (Brevital), Ketamine HCl (Ketalar)
* Midazolam/Propofol - intubation/minor surgeries
* Adverse Reactions: respiratory and cardiovascular effects
* WOF: Infections - Propofol supports microbial growth
ANESTHESIA
TOPICAL ANESTHETICS
* ____, broken or unbroken ____, ____
* Solution, liquid spray, ointment, cream, and gel
* Local Anesthetics: Lidocaine for dental procedures, sutures, and diagnostics such as lumbar punctures and thorcentesis
TOPICAL ANESTHETICS
* Mucous membrane, broken or unbroken skin surface, burns
* Solution, liquid spray, ointment, cream, and gel
* Local Anesthetics: Lidocaine for dental procedures, sutures, and diagnostics such as lumbar punctures and thorcentesis
ANESTHESIA
SPINAL ANESTHESIA
* Local anesthesia injected into ____ (children) or ____ (adults)
* S/E and A/R: ____ (spread too high in spinal column > respiratory muscle), ____ (decrease in CSF pressure), ____ (sympathetic blockade)
* Nerve block: spinal block ( ____ ), epidural block ( ____ ), caudal block ( ____ ), saddle block ( ____ )
* Nurse role: complete the pre-operative orders including pre-medications
SPINAL ANESTHESIA
* Local anesthesia injected into subarachnoid space 3rd to 4th lumbar space (children) or 1st lumbosacral space (adults)
* S/E and A/R: respiratory distress (spread too high in spinal column > respiratory muscle), headache (decrease in CSF pressure), hypotension (sympathetic blockade)
* Nerve block: spinal block (subarachnoid space), epidural block (dura mater), caudal block (near the sacrum), saddle block (lower end of spnal cord)
* Nurse role: complete the pre-operative orders including pre-medications
