ans cns learnign objecftives Flashcards
Anxiety and
sleep
Drug names lorazepam/fluoxetine
How does the
drug work? Binds to GABA receptors & F-inhibit reuptake of serotonin
Nursing considerations in using the drug
Risk for suicide
Watch elderly close
watch respirations
discontinue if adverse effects
Seizures
Drug names
phenytoin/lorazepam/phenobarbituate
How does the
drug work?
interferes with sodium channels in brain
alters cerebellar function to depress actions of sensory cortex
Nursing considerations in using the drug
narrow theraputic levels
may cause fetal harm
may cause depression
Depression
Drug names : fluoxetine /amitriptyline/ tranylcypromine
How does the
drug work?
inhibit reuptake of serotonin & inhibits reuptake of norepinephrine
Nursing considerations in using the drug
administer at bedtime
contradicted with MAOI
Bipolar disorder
Drug names
lithium
How does the
drug work?
alters sodium transport in nerve and muscle cells
Nursing considerations in using the drug
narrow therapeutic range
serum levels
manic episode may normalize in 1-3 week
ADHD
Drug names
methylphenidate
How does the
drug work?
Thought to block reuptake of norepinephrine and dopamin
Nursing considerations in using the drug
DO NOT CRUSH
do not after 4pm
high calorie food
Psychosis
Drug names
haloperidol/ risperidone
How does the
drug work?
Block dopamine receptors in the brain
Nursing considerations in using the drug
Monitor elderly patient with dementia-related psychosis closely for cardiovascular events and pneumonia
monitor lithium intake fot neurotoxicity
Parkinson’s
Disease
Drug names : carbidopa/levodopa
How does the
drug work?
restore the balance of dopamine and acetylcholine
Nursing considerations in using the drug
Use caution with positional changes and operating heavy equipment
contraindicated with MAOI
Identify the major types of anxiety disorders.
Generalized anxiety disorder
- Social anxiety disorder
- Specific phobias
- Separation anxiety disorder
Use the Nursing Process to care for patients receiving drug therapy for treatment of CNS disorders
Assessment
- Is it appropriate to give this medication?
- Assessment consists of subjective vs. objective data
- Diagnosis
- Anxiety r/t unmet security and safety needs AEB change in economic status
- Planning
- Patient will identify and verbalize symptoms of anxiety each day when symptoms are present.
- Implementation
- Administer anti-anxiety medication, demonstrate breathing exercises, etc.
- Evaluation
- Is the medication working?
Identify the common degenerative diseases of the CNS.
Parkinsons
huntingtons/alzheimers
Identify drugs used for treatment of attention deficit-hyperactivity disorder.
CNS Stimulants (methylphenidate)
Identify symptoms of attention deficit-hyperactivity disorder.
Hyperactivity
* Inability to concentrate
* Difficulty with self-control
* Lack of emotional control
Explain the symptoms associated with extrapyramidal side effects of antipsychotic drugs.
an inability to sit still, involuntary muscle contraction, tremors, stiff muscles, and involuntary facial movements.
Identify drugs used for treatment of psychoses.
Halosideral/Risperdal
Seroquel Zyprexa Clozaril others
Identify drugs used for treatment of mood disorders.
lithium
SSri-fluoxtine
amitriptlyne
Identify the two major categories of mood disorders and their symptoms.
Depression-Diminished interest / Weight loss insomnia/hypersomnia/Agitation/fatigue
BipolarRapid speech
* Hyperactivity
* Flight of ideas
* Grandiosity
* Poor judgement
* Aggression/hostility
* Risky sexual behavior
Compare the terms epilepsy, seizures, and convulsions.
E-recurring seizures not caused by another known condition
C- sudden, violent, irregular movement of a limb or of the body
S-Sudden, uncontrolled electrical disturbance in the brain.
Identify drugs used for treatment of anxiety disorders.
C
Sertraline and citalopram
Lorezopam
SSRI-
maybe fluextine
Identify indications, side effects, and potential drug interactions associated with the use of herbal supplements
allergic reactions, rashes, asthma, headaches, dizziness, agitation, dry mouth, seizures, fatigue, tachycardia, nausea, vomiting, and diarrhea
Identify considerations and implications of using central nervous system medications across the lifespan
younger kids could get addicted much easier due to less of knowledge of drugs
older people have much greater risk of toxic effects happening
Identify the side effects and special considerations associated with central nervous system drug therapy
park
phen
antisp
lith
moai
depres
meth
benzo
phone
antiparksinsons-dizziness/drowsiness
phenytoin-TEN and SJS
antipsychotics- tardive dyskenia / NMS
lithium-toxicity-diahria vomit bleeding
MAOI-severe hypertension
Antidepressents-increased suicide
meth-inc bp and hr
benzo-resp depression
coma/death
phenobarbital-suical thoughts
Give examples of when, how, and to whom central nervous system drugs may be administered
anxiety, panic, acute stress reactions, and sleep disorders
pill capsule or liquid form
Cite the classifications and actions of central nervous system drugs
barbituates
benzodiapzipenes
stimulate
tricyclic
SSRI
MAOI
Antimania
antipsychotics
anticovulsants
antiparkinsons
barbituates-depressant-seizures
benzodiapzipenes-depressant-anxiety,sedation
stimulate-adhd
tricyclic antidepressant-
SSRI-antidepresent
MAOI- antidepressants
Antimania-bipolar
antipsychotics-schizophrenia
anticovulsants- seizures
antiparkinsons
A
Define the autonomic nervous system.
a control system that acts largely unconsciously and regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal
Identify the two fundamental divisions of the nervous system.
the central nervous system (CNS) and the peripheral nervous system (PNS)
Compare and contrast the actions of the sympathetic and parasympathetic nervous systems
P_______S
Con eyes dilate
sec mouth inhbit
con lungs dialate
dec heart increase
sec stomach inhibit
sec intestines inhibit
go bladder realx
go reproductive inhibit
store pancreas release glucose
d. Explain how medications that mimic and block the sympathetic and parasympathetic nervous systems have opposite effects and similar effects on organ tissue.
Where sympathetic will dilate one action, the parasympathetic will inhibit the other reaction
for each one reaction. the other one will have the opposite reaction.
e. Identify situations in which autonomic nervous system medications may be administered.
cardiovascular, respiratory, urinary tract, and gastrointestinal disorders.
f. Explain the mechanism of drug action, therapeutic effects, uses, adverse and toxic effects, and antidotes to overdose for each of the drug classes:
parasympathomimetics
Contract smooth muscle
PNS stimulation
Blood vessels: vasodilation
Decreased heart rate & BP
Lungs: bronchoconstriction
GI: increase motility
Bladder: contraction
Pupil: constriction
Example: betanechol (direct-acting)
donepezil (indirect-acting)
f. Explain the mechanism of drug action, therapeutic effects, uses, adverse and toxic effects, and antidotes to overdose for each of the drug classes:
, anticholinergics,
Relax smooth muscle
Blood vessels: vasoconstriction to nonessential organs
Increased heart rate & BP
Salivation
Lacrimation
Urinary retention
Drowsiness/dizziness
GI upset
Eyes (blurred vision/dry eyes)
Use caution in elderly d/t constipation &
confusion
Example: atropine
f. Explain the mechanism of drug action, therapeutic effects, uses, adverse and toxic effects, and antidotes to overdose for each of the drug classes:
sympathomimetics
Primarily stimulates heart with increased heart rate and contractility
Primarily relaxes smooth muscles
Blood vessels: vasodilation
Lungs: bronchodilation
GI: decreased motility
Liver: glyconeogenesis
Uterus: relaxatio
f. Explain the mechanism of drug action, therapeutic effects, uses, adverse and toxic effects, and antidotes to overdose for each of the drug classes:
adrenergic antagonists.
Relax smooth muscle
Vasodilation
Decreased blood pressure
Bladder: increase blood flow
“Selective Beta blocker” used to decrease heart rate and blood pressure
bronchoconstriction
Identify the classifications and actions of autonomic nervous system drugs
Nicotnic agonist-nictone patch
musc agon-pilocarpine
musc antan-atropine
aplh1 agonist- pseudoephedrine
alph2 antagon-tamsulosen
Beta1
anon-dobutamine
antag-metoplrol
beta2
anon-albetorl
antag-propanolol
Identify the side effects and special considerations associated with autonomic nervous system drugs
Atr
Psudo
tam
dob
met
alb
pro
Atropine- overdose includes urine termination, dizziness, abnormal heartbeat and difficulty breathing—also dry mouth
pseudoephedrine-increased BP
- Urinary retention
- Nervousness
- Difficulty sleepin
tamsulosin- hypotension
dobutamine-increase in bp/hr too much
labored breathing/dizziness
metotprlol-
shortness of breath, bradycardia, fatigue,depression
albuterol
hypersensitivity,bronchospams, increase hr/bp
propanolol-
bromchocontriction
hypotension
bradycardia
Include considerations and implications of using autonomic nervous system drugs across the lifespan
As patients get older, they are going to need bp and other vital sign medications more. Also with decreased metabolism it will sit in system for longer
Include evidence-based concepts when using the nursing process related to medications that affect the autonomic nervous system
Asess-many type of medications stimulate or inhibit specific ANS receptors- assessing which ones will help specific problems
Plan-
atient will adhere to the drug regimen.
Patient’s vital signs will be within the desired range
implement- give drug. make sure to give medications when patient is right
evaluate- document wether patient is doing as well an presribed
L
Provide examples of the scheduled categories for controlled substances.
1- no accepted medical use
2-high potential for abuse
3-low potential for dependance
4-low potentialfor abuse
5-lowest potential for abuse
Identify the impact of medication legislation on drug therapy and nursing.
to establish a legal framework for the safe and effective distribution of prescription drugs
Identify the process involved in development of new medications, including investigational new medication application, phases of investigational medication studies, and informed consent.
Step 1: Discovery & Development.
Step 2: Preclinical Research.
Step 3: Clinical Drug Development Process
.
Step 4: FDA Review.
Step 5: Post-market Monitoring.
Analyze the ethical aspects of medication administration.
always work for the patent and fight for their right no matter where they are
Explain the effect of socio-cultural factors in regard to a patient’s response to and compliance with medication therapy.
Patients with strong belief in the harm of medications were found 4 times more likely to have poor medication adherence than those with weak belief in the harm of medications
nurses need to have knowledge of all culture and beliefs. some cultures and beliefs don’t allow certain types of medications
Summarize the nurse’s role in educational management of medication therapy.
Nurses need to explain side affects and adverse affects to the patient. This allows for patient education so the patient knows what will happen to their body when they take the drugs
Explain the relationship between plasma concentration and half-life of a medication.
Half-life (t1/2) refers to the time required for plasma concentration of a drug to decrease by 50%
Differentiate among adverse medication reactions: side effects, toxic effect, allergic reaction, idiosyncratic reaction, and teratogenic reaction.
Side affects- non inteefdned affects- can be predictable
toxic afects- its ability to cause harmful effects
ido-an abnormal susceptibility to a drug peculiar to the individua
terat-drug is a teratogen if its administration to the pregnant mother, directly or indirectly,
Compare the action of agonist and antagonist medications.
agonist-work with the receptor-stimulate
antagonist-work againts-inhibit
Identify the significance of the following terms in the measurements of medication concentrations in the body: minimum effective concentration (MEC), minimum toxic concentration (MTC), plateau or steady-rate concentration, peak concentration, and trough concentration.
MEC- is the minimum plasma concentration of a drug needed to achieve sufficient drug concentration at the receptors to produce the desired pharmacologic response,
MTC- represents the minimum blood level at which a toxic effect occurs
plateau C-At steady state, the amount of drug administered on each dosing occasion is matched by an equivalent amount of drug leaving the body between each dose.
Pc–when drug is highest in blood
t-when blood is lowest in blood
Compare the significance of the chemical name, generic name, and brand name of a medication.
Chemical name-they tell us about the elements present
generic name-generic names are a shorthand version of the drug’s chemical name, structure, or formula- all the same
brand name-brand names are usually catchy, often related to the drug’s intended use, and relatively easy to remember
Discuss the process of pharmacokinetics
absorption-Occurs when a medication enters the body and travels from
site of administration into the body’s circulatio
distribution-Movement of the drug within the body (blood/plasma to intra/extracellular compartments)
metabolism-Breakdown of drugs so they can be eliminated more easily
excretion-Process of elimination of waste
Describe the process of pharmacodynamics
- Agonist
Activates receptors - Antagonist
Blocks receptor
Therapeutic window
Peak drug level
through level
therapeutic index
Consider pharmacodynamic differences across lifespan
target cell sites and changing numbers of protein receptors. Immature systems and changing body compositions mean that drugs affect children differently.
body composition, immature systems, and genetics. Total body water, fat stores, and protein levels change throughout childhood and greatly influence the effectiveness of drugs in the pediatric population.
As you get older. your body has less to fight off the drug with, so it will stay in system for longer
Differentiate among prescription drugs, over-the- counter drugs, herbals, and dietary supplements
OTC
-Do not require a prescription
* Regulated through FDA
* Prescribed meds may be available OTC in smaller doses
Dietary-
Includes vitamins, minerals, enzymes, and botanicals
* Not regulated by FDA
Prescription
-requires perscriprion
regulated FDA
larger doses
need doctor order
