[7] MIDTERMS | DRUGS ACTING ON THE CNS AND PNS

Question 1

• ____ 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 ____.

Answer 1

• 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.

Question 2

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 ____

Answer 2

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

Question 3

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

Answer 3

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

Question 4

ANOREXIANTS
* Appetite ____
* S/E: nervousness, ____, irritability, ____, heart palpitations and HPN.
* Avoid: ____, ____

Answer 4

ANOREXIANTS
* Appetite suppresant
* S/E: nervousness, restlessness, irritability, insomnia, heart palpitations and HPN.
* Avoid: < 12 y/o, self-medication

Question 5

ANALEPTICS
* Stimulate ____
* ____: Caffeine (____ - infusion/oral preparation) and ____ (newborn - used in respiratory distress)
* S/E: nervousness, restlessness, ____, twitching, palpitations and insomia, ____, GI irritation, ____

Answer 5

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

Question 6

CNS DEPRESSANTS: Sedative-Hypnotics

• ____ – diminish physical and mental response at a lower dosages of certain CNS depressants but does not affect consciousness
• ____ – natural sleep

Answer 6

• SEDATION – diminish physical and mental response at a lower dosages of certain CNS depressants but does not affect consciousness
• HYPNOTIC – natural sleep

Question 7

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

Answer 7

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

Question 7

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

Answer 7

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

Question 8

CNS DEPRESSANTS: Sedative-Hypnotics

Sedative-Hypnotics:
1. ____
2. ____
3. Nonbenzodiazepines
4. ____
5. ____ - induces sleep and decrease nocturnal awakenings

Answer 8

Sedative-Hypnotics:
1. Barbiturates
2. Benzodiazepines
3. Nonbenzodiazepines
4. Piperidinediones
5. Chloral Hydrate - induces sleep and decrease nocturnal awakenings

Question 9

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

Answer 9

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

Question 10

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)

Answer 10

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)

Question 11

CNS DEPRESSANTS: Sedative-Hypnotics

Sedative-Hypnotics: BENZODIAZEPINES

Nursing Responsibilities
* Avoid ____, antidepressants, antipsychotics
* ____ before taking the drug – causes ____
* No ____
* Caution in driving
* Antidote: ____

Answer 11

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

Question 12

CNS DEPRESSANTS: Sedative-Hypnotics

Sedative-Hypnotics: NONBENZODIAZEPINES
* ____ (Ambien)
* Short term treatment of Insomnia (< ____ )
* Duration of Action: ____
* Metabolized in the ____
* Excreted in the ____

Answer 12

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

Question 13

First anesthetic

Answer 13

Nitrous Oxide or “Laughing Gas”

Question 14

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!

Answer 14

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!

Question 15

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

Answer 15

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

Question 16

ANESTHESIA

INHALATION ANESTHETICS
* ____ or ____ administered as gas
* A/R: ____, hypotension, dysrhythmias, ____
* ____, methoxyflurane, ____, isoflurane, ____, sevoflurane, nitrous oxide, ____
* WOF: ____
* MGT: ____

Answer 16

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

Question 17

ANESTHESIA

IV ANESTHETICS
* As general anesthesia
* ____ (Pentothal), ____ (Brevital), ____ (Ketalar)
* ____ - intubation/minor surgeries
* Adverse Reactions: ____
* WOF: Infections - ____ supports microbial growth

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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

Question 20

ANTICONVULSANTS

ANTICONVULSANTS
* Also called “____”
* Action: to suppress the abnormal ____ from the seizure focus to ____, preventing seizures

Actions:
* Suppress ____ and ____ influx
* Increase the action of ____

Answer 20

ANTICONVULSANTS
* Also called “antiepileptics”
* Action: to suppress the abnormal electrical impulses from the seizure focus to other cortical areas, preventing seizures

Actions:
* Suppress Na and Ca influx
* Increase the action of GABA

Question 21

ANTICONVULSANTS

Classification of Seizures (5)

Answer 21

1. Tonic-Clonic
2. Tonic
3. Clonic
4. Absence (Petit Mal)
5. Myoclonic

Question 22

ANTICONVULSANTS

Suppress Na Influx:
* ____ (Dilantin)
* Fosphenytoin
* Oxcarbazepine
* ____

Suppress Ca Influx:
* ____
* Ethosuzimide

Enhance the Action of GABA
* Barbituates
* Benzodiazepines

Answer 22

Suppress Na Influx:
* Phenytoin (Dilantin)
* Fosphenytoin
* Oxcarbazepine
* Valproic Acid

Suppress Ca Influx:
* Valproic Acid
* Ethosuzimide

Enhance the Action of GABA
* Barbituates
* Benzodiazepines

Question 23

ANTICONVULSANTS

HYDANTOINS: Phenytoin (Dilantin)
* First anticonvulsant (____)
* Teratogenic
* Therapeutic Range = ____
* IV, PO, no ____ (tissue damage)

S/E and A/R
* ____
* Slurred speech
* ____
* ____
* Thrombocytopenia
* Leukopenia
* Hyperglycemia
* ____

Answer 23

HYDANTOINS: Phenytoin (Dilantin)
* First anticonvulsant (1938)
* Teratogenic
* Therapeutic Range = 10-20 mcg/mL
* IV, PO, no IM (tissue damage)

S/E and A/R
* Gingival hyperplasia
* Slurred speech
* Confusion
* Depression
* Thrombocytopenia
* Leukopenia
* Hyperglycemia
* N/V, constipation

Question 24

# ANTICONVULSANTS **BARBITUATES: Phenobarbital** * For partial, ____, and ____ * Teratogenic * Gradual ____

Answer 24

**BARBITUATES: Phenobarbital** * For partial, **grand mal**, and **status epilepticus** * Teratogenic * Gradual **discontinuance**

Question 25

# ANTICONVULSANTS **SUCCINIMIDES** * Used for ____ or ____ → blank stare → children * ____ - succinimide of choice * Methsuximide and Phensuximide

Answer 25

**SUCCINIMIDES** * Used for **absence** or **petit-mal seizures** → blank stare → children * **Ethosuxinimide** - succinimide of choice * Methsuximide and Phensuximide

Question 26

# ANTICONVULSANTS **BENZODIAZEPINES** * ____ - petit-mal * ____ - partial seizure * ____ - acute status epilepticus (severe seizure); IV

Answer 26

**BENZODIAZEPINES** * **Clonazepam** - petit-mal * **Clorazepate** - partial seizure * **Diazepam** - acute status epilepticus (severe seizure); IV

Question 27

# ANTICONVULSANTS **IMINOSTILBENES: Carbamezapine** * ____ and ____ * ____, ____, alcohol withdrawal * PO

Answer 27

**IMINOSTILBENES: Carbamezapine** * **Grand mal** and **partial seizures** * **Bipolar Disease**, **trigeminal neuralgia**, alcohol withdrawal * PO

Question 28

# ANTICONVULSANTS **VALPROATE: Valproic Acid** * Petit-mal, grand mal, mixed type of seizures * Hepatotoxic

Question 29

# ANTICONVULSANTS **NURSING RESPONSIBILITIES: Phenytoin** * Shake the suspension well * Instruct the client not to drive * No ____ and ____ * Medic alert ID * Not to abruptly stop the drug therapy * No OTC * With food or milk * Instruct the client about the ____ urine * Inform about the adverse reaction * Use ____

Answer 29

**NURSING RESPONSIBILITIES: Phenytoin** * Shake the suspension well * Instruct the client not to drive * No **alcohol** and **antidepressants** * Medic alert ID * Not to abruptly stop the drug therapy * No OTC * With food or milk * Instruct the client about the **pinkish red/reddish brown** urine * Inform about the adverse reaction * Use **soft toothbrush**

Question 30

# DRUGS FOR PARKINSON'S DISEASE **ANTICHOLINERGIC - inhibit the release of Acetylcholine** * **Benztropine** (Cogentin) * Biperiden (Akineton) * **Trihexyphenidyl** (Artane) * Diphenhydramine HCl (Benadryl)

Answer 30

**ANTICHOLINERGIC - inhibit the release of Acetylcholine** * **Benztropine** (Cogentin) * Biperiden (Akineton) * **Trihexyphenidyl** (Artane) * Diphenhydramine HCl (Benadryl)

Question 31

# DRUGS FOR PARKINSON'S DISEASE **DOPAMINERGICS** ____ - does not cross the blood-brain barrier * Converted to dopamine; most effective in diminshing the symptoms of ____ * S/E: nausea, vomiting, **dyskinesia**, hypotension, **psychosis**, cardiac dysrhythmias ____ - alternative drug comined with Levodopa

Answer 31

**DOPAMINERGICS** **Levodopa** - does not cross the blood-brain barrier * Converted to dopamine; most effective in diminshing the symptoms of **Parkinson's Disease** * S/E: nausea, vomiting, **dyskinesia**, hypotension, **psychosis**, cardiac dysrhythmias **Carbidopa** - alternative drug comined with Levodopa

Question 32

# DRUGS FOR PARKINSON'S DISEASE **CARBIDOPA-LEVODOPA: Nursing Responsibilities** * Monitor VS especially BP * ____ * Asess for s/sx of Parkinsonism * Low ____ food

Answer 32

**CARBIDOPA-LEVODOPA: Nursing Responsibilities** * Monitor VS especially BP * **ECG** * Asess for s/sx of Parkinsonism * Low **protein** food

Question 33

# DRUGS FOR PARKINSON'S DISEASE **DOPAMINE AGONISTS** - stimulate the dopamine receptors ____ (Symmetrel) * Antiviral that acts on the dopamine receptors * S/E: orthostatic hypotension, confusion, ____, constipation ____ (Parlodel) * Acts directly on CNS, CVS, and GIT * S/E: orthostatic hypotension, palpitations, chest pain, edema, ____, ____, ____

Answer 33

**DOPAMINE AGONISTS** - stimulate the dopamine receptors **Amantadine HCl** (Symmetrel) * Antiviral that acts on the ***dopamine receptors*** * S/E: orthostatic hypotension, confusion, **urinary retention**, constipation **Bromocriptine** (Parlodel) * Acts directly on ***CNS, CVS, and GIT*** * S/E: orthostatic hypotension, palpitations, chest pain, edema, **nightmares**, **delusions**, **confusion**

Question 34

# DRUGS FOR PARKINSON'S DISEASE **DOPAMINE AGONISTS: Nursing Responsibilities** * Report any signs of ____, seizures, or ____ * Assess for ____ * Avoid alcohol * Monitor VS especially ____ and HR * Not to ____ stop the drug

Answer 34

**DOPAMINE AGONISTS: Nursing Responsibilities** * Report any signs of **skin lesions**, seizures, or **depression** * Assess for **orthostatic hypotension** * Avoid alcohol * Monitor VS especially **BP** and HR * Not to **abruptly** stop the drug

Question 35

# DRUGS FOR PARKINSON'S DISEASE **MAO-B INHIBITORS** * Prolongs the action of ____ * ____ (Eldepryl)

Answer 35

**MAO-B INHIBITORS** * Prolongs the action of **Levodopa** * **Selegiline HCl** (Eldepryl)

Question 36

# DRUGS FOR PARKINSON'S DISEASE **COMT INHIBITORS** * Inactivates ____ * ____ (Tasmar) - can cause liver damage * ____ (Comtan)

Answer 36

**COMT INHIBITORS** * Inactivates **dopamine** * **Tolcapone** (Tasmar) - can cause liver damage * **Entacapone** (Comtan)

Question 37

**DRUG FOR ALZHEIMER'S DISEASE: Acetylcholinesterase or Cholinesterase Inhibitors** * Improve the cognitive function of clients with ____ Alzheimer's disease * ____ (Cognex) - 1st * ____ (Aricept) * ____ (Exelon)

Answer 37

**DRUG FOR ALZHEIMER'S DISEASE: Acetylcholinesterase or Cholinesterase Inhibitors** * Improve the cognitive function of clients with **mild to moderate** Alzheimer's disease * **Tacrine** (Cognex) - 1st * **Donepezil** (Aricept) * **Rivastigmine** (Exelon)

Question 38

# DRUGS FOR MYASTHENIA GRAVIS **ACETYLCHOLINESTERASE INHIBITORS OR CHOLINESTERASE INHIBITORS** * ____ (Prostigmin) - 1st drug * ____ (Mestinon) - increases muscle strength * ____ (Mytelase) * ____ (Tensilon) - used to distinguish myasthenia crisis from cholinergic crisis * S/E and A/R: GI disturbances, increased salivation, ____, ____, HPN

Answer 38

**ACETYLCHOLINESTERASE INHIBITORS OR CHOLINESTERASE INHIBITORS** * **Neostigmine** (Prostigmin) - 1st drug * **Pyridostigmine Bromide** (Mestinon) - increases muscle strength * **Ambenonium Chloride** (Mytelase) * **Edrophonium Chloride** (Tensilon) - used to distinguish myasthenia crisis from cholinergic crisis * S/E and A/R: GI disturbances, increased salivation, **tearing**, **miosis**, HPN

Question 39

# DRUGS FOR MYASTHENIA GRAVIS **MESTINON: Nursing Responsibilities** * Administer IV ____ * ____ as antidote for cholinergic crisis * Take the drug ____ meals * Assess for the effectiveness of the drug therapy * Avoid: ____ – can lead to paralysis

Answer 39

**MESTINON: Nursing Responsibilities** * Administer IV **undiluted** * **Atropine sulfate** as antidote for cholinergic crisis * Take the drug **before** meals * Assess for the effectiveness of the drug therapy * Avoid: **Baclofen (Lioresal)** – can lead to paralysis

Question 40

# DRUGS FOR MULTIPLE SCLEROSIS - SKELETAL MUSCLE RELAXANT **Centrally-Acting Skeletal Muscle Relaxants** * ____ * Suppress ____ reflexes * Decrease pain and increase range of motion * Have a ____ effect

Answer 40

**Centrally-Acting Skeletal Muscle Relaxants** * **Spasmolytics** * Suppress **hyperactive** reflexes * Decrease pain and increase range of motion * Have a **sedative** effect

Question 41

# DRUGS FOR MULTIPLE SCLEROSIS - SKELETAL MUSCLE RELAXANT **Drugs for Skeletal Muscle Spasticity (3)** **Drugs for Muscle Spasms (3)**

Answer 41

**Drugs for Skeletal Muscle Spasticity (3)** * Baclofen (Lioresal) * Dantrolene (Dantrium) * Diazepam (Valium) **Drugs for Muscle Spasms (3)** * Carisoprodol (Soma) * Methocarbamol (Robaxin) * Orphenadrine citrate (Norflex)

Question 42

# DRUGS FOR MULTIPLE SCLEROSIS - SKELETAL MUSCLE RELAXANT **S/E and A/Rs:** * Drowsiness * ____ * Lightheadedness * Nausea * Vomiting * ____ * ____

Answer 42

**S/E and A/Rs:** * Drowsiness * **Dizziness** * Lightheadedness * Nausea * Vomiting * **Diarrhea** * **Abdominal cramps**

Question 43

# DRUGS FOR MULTIPLE SCLEROSIS - SKELETAL MUSCLE RELAXANT **NURSING RESPONSIBILITIES** * Monitor ____ levels * Do not abruptly stop the medication * Not to ____ or operate ____ * Avoid alcohol and CNS depressants * C/I with ____ ; ____ * Take with food

Answer 43

**NURSING RESPONSIBILITIES** * Monitor **serum liver enzyme** levels * Do not abruptly stop the medication * Not to **drive** or operate **dangerous machinery** * Avoid alcohol and CNS depressants * C/I with **pregnant women** ; **nursing mothers** * Take with food

Question 44

# PSYCHIATRIC AGENTS **ANTIPSYCHOTICS** * A.K.A. ____ * Action: blocks ____ * S/E: ____, dry mouth, ____, orthostatic hypotension * E.g. ____ (Haldol), ____ (Thorazine)

Answer 44

**ANTIPSYCHOTICS** * A.K.A. **major tranquilizers** * Action: blocks **dopamine** * S/E: **blurred vission**, dry mouth, **photosensitivity**, orthostatic hypotension * E.g. **Haloperidol** (Haldol), **Chlorpromazine** (Thorazine)

Question 45

# PSYCHIATRIC AGENTS **ANTIPSYCHOTICS: Extrapyramidal Symptoms** * ____ - pill-rolling, mask-like face, propulsive gait * ____ - restless leg syndrome * ____ - poor muscle tone

Answer 45

**ANTIPSYCHOTICS: Extrapyramidal Symptoms** * **Pseudoparkinsonism** - pill-rolling, mask-like face, propulsive gait * **Akathisia** - restless leg syndrome * **Dystonia** - poor muscle tone

Question 46

# PSYCHIATRIC AGENTS **ANTIPSYCHOTICS** **A/R**: * ____ - irreversible * ____ - low WBC → risk for infection → fever → report * Hepatotoxicity **Nursing Considerations**: * Give pc * Rise ____ * Avoid ____ * HR and BP * Report ____ and ____

Answer 46

**ANTIPSYCHOTICS** **A/R**: * **Tardive Dyskinesia** - irreversible * **Aggranulocytosis** - low WBC → risk for infection → fever → report * Hepatotoxicity **Nursing Considerations**: * Give pc * Rise **slowly** * Avoid **sunlight exposure** * HR and BP * Report **fever** and **body malaise**

Question 47

# PSYCHIATRIC AGENTS **ANXIOLYTICS** * AKA: ____, anti-anxiety * ACTION: ____ → stimulates the action of GABA * Examples: ____ (Valium), ____ (Serax), ____ (Librium), ____ (Xanax) * S/E: dizziness, drowsiness, dry mouth, sedation Nursing Considerations: * Give ac * Ask patient to avoid ____ and ____ * Administer separately.

Answer 47

**ANXIOLYTICS** * AKA: **Minor tranquilizers**, anti-anxiety * ACTION: **decrease R.A.S** → stimulates the action of GABA * Examples: **Diazepam** (Valium), **Oxazepam** (Serax), **Cholorodiazepoxide** (Librium), **Alprazolam** (Xanax) * S/E: dizziness, drowsiness, dry mouth, sedation Nursing Considerations: * Give ac * Ask patient to avoid **caffeine** and **alcohol** * Administer separately.

Question 48

# PSYCHIATRIC AGENTS **ANTIDEPRESSANTS: Tricyclics (TCA)** * ____ (Tofranil) - 1st antidepressant * ____ (Elavil) * ACTION: prolongs norepinephrine's action * S/E: ____; cardiovascular effects Nursing Considerations: * After meals * Therapeutic effects: ____ weeks * BP/HR

Answer 48

**ANTIDEPRESSANTS: Tricyclics (TCA)** * **Imipramine** (Tofranil) - 1st antidepressant * **Amititriptylline** (Elavil) * ACTION: prolongs norepinephrine's action * S/E: **anticholinergic**; cardiovascular effects Nursing Considerations: * After meals * Therapeutic effects: **2-4** weeks * BP/HR

Question 49

# PSYCHIATRIC AGENTS **ANTIDEPRESSANTS: MAO Inhibitors** * Most sensitive; least used * ____ (Parnate), ____ (Nardil), and ____ (Marplan) * ACTION: ____ of norepinephrine * S/E: hypertensive crisis Nursing Considerations: * After meals * Report headache * Avoid ____

Answer 49

**ANTIDEPRESSANTS: MAO Inhibitors** * Most sensitive; least used * **Tranylcypromine** (Parnate), **Phenelzine** (Nardil), and **Isocarboxazid** (Marplan) * ACTION: **prevents destruction** of norepinephrine * S/E: hypertensive crisis Nursing Considerations: * After meals * Report headache * Avoid **tyramine-containing food**

Question 50

# PSYCHIATRIC AGENTS **ANTIDEPRESSANTS: Selective Serotonin Reuptake Inhibitor (SSRI)** * ____ (Prozac) * ACTION: prolongs ____ action * S/E: restlessness, ____, insomnia * Nursing Consideration: avoid ____

Answer 50

**ANTIDEPRESSANTS: Selective Serotonin Reuptake Inhibitor (SSRI)** * **Fluoxetin** (Prozac) * ACTION: prolongs **serotonin** action * S/E: restlessness, **agitation**, insomnia * Nursing Consideration: avoid **bedtime doses**

Question 51

# PSYCHIATRIC AGENTS **MOOD STABILIZER/ANTIMANIC AGENTS: Lithium Carbonate (Eskalith/Lithane)** * ACTION: ____; reduce the release of ____ * S/E: ____, excessive tears and urination, ____ * WOF: ____ (persistent vomiting, profuse diarrhea, lethargy) * Therapeutic Range: ____ (0.6-1.2 mEq/L) * Toxic Range: ____ **Nursing Considerations**: - Best taken ____ meals. - Therapeutic effects: ____ - Increase fluid intake ( ____ ) and sodium ( ____ ). - ____ (osmotic diuretic) administered if toxicity occurs **CARBAMAZEPINE (Tegretol)** * Other agent - for bipolar disorder * WOF: ____ → infection → fever

Answer 51

**MOOD STABILIZER/ANTIMANIC AGENTS: Lithium Carbonate (Eskalith/Lithane)** * ACTION: **idiopathic**; reduce the release of **norepinephrine** * S/E: **NAVDA**, excessive tears and urination, **fine hand tremors** * WOF: **lithium toxicity** (persistent vomiting, profuse diarrhea, lethargy) * Therapeutic Range: **0.5-1.5 mEq/L** (0.6-1.2 mEq/L) * Toxic Range: **1.5-2.0 mEq/L** Nursing Considerations: - Best taken **after** meals. - Therapeutic effects: **10-14 days** - Increase fluid intake (**3 L/day**) and sodium (**3 g/day**). - **Mannitol** (osmotic diuretic) administered if toxicity occurs **CARBAMAZEPINE (Tegretol)** * Other agent - for bipolar disorder * WOF: **Agranulocytosis** → infection → fever