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Nursing Pharmacology > C8- Central Nervous System (stimulants/ benzo / barbiturates) > Flashcards

C8- Central Nervous System (stimulants/ benzo / barbiturates) Flashcards

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1
Q

Your brain communicates with electrical impulses that signal a release of ____________?

A

Neurotransmitter

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2
Q

Neurotransmitters bind to targeted ______?

A

Cells

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3
Q

The chemicals used to suppress or stimulate effectors at the nerve synapse are?

A

Neurotransmitters

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4
Q

A neurotransmitter must be released by?

A

A nerve

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5
Q

When will the neurotransmitter be released into the synapse?

A

When the nerve is stimulated and need to react with a specific receptor site

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6
Q

NT is synthesized from substances that enter or may enter neuron in what form?

A

Intact

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7
Q

Neurotransmitters are stored where?

A

In storage vesicles

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8
Q

Neurotransmitters are released by what kind of impulse?

A

Electrical

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9
Q

Neurotransmitters have specific _________?

A

Messages

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10
Q

After NT communication, what three things happen to the NT?

A

NT inactivated
NT reabsorbed (reuptake)
NT diffuse AWAY from synapse

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11
Q

CNS medications influence which two things in the CNS?

A

Neurotransmitter concentration
Electrical activity

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12
Q

CNS medications pass which barrier? Because it passes through this barrier what are these meds soluble with? What conditions must be careful taking these medications?

A

BLOOD BRAIN BARRIER
Lipid-soluble
Pregnancy lactation category D or X

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13
Q

CNS drugs work _______ to block or mimic neurotransmitters?

A

DIRECTLY

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14
Q

Drugs work_______ by influencing neurotransmitter synthesis, formation, storage, release, reuptake, destruction.

A

Indirectly

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15
Q

What break down the Neurotransmitters in the synapse?

A

Neurotransmitter enzymes

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16
Q

Anti enzyme drugs interact with what? Which allows for what?

A

Interacts with the enzyme allowing for more neurotransmitters

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17
Q

Norepinephrine/Noradrenaline (concentration NT) affects what?

A

Attention and responding actions in the brain
Fight or flight response
Contracts blood vessels
Increases blood flow

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18
Q

Dopamine (pleasure neurotransmitter) effect? What drug type blocks receptors of dopamine?

A

Feelings of pleasure, addiction
Movement
Motivation
people repeat behaviors that lead to dopamine release
Antipsychotics block DA receptors

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19
Q

Serotonin (mood NT) affects? What type of drug elevates serotonin?

A

Mood
Well-being and happiness
Sleep cycle
Digestive system regulation
Affected by:
-exercise
-light exposure
Antidepressants elevate 5HT

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20
Q

GABA (calming NT) effects: What type of drugs regulate GABA sites?

A

Firing nerves in CNS = calming
Motor control
Vision
Improve focus (high levels)
Cause anxiety (low levels)
Benzodiazepines work on GABA sites

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21
Q

Acetylcholine (learning NT) involved in

A

Thought
Learning
Memory
Attention
Awakening
Activates:
-muscle action in the body

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22
Q

MAOI (monoamine oxidase) inactivates what neurotransmitters?

A

NE (norepinephrine)
DA (Dopamine)
5HT (Serotonin)

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23
Q

Insomnia is:

A

Chronic inability to sleep or remain asleep

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24
Q

Anxiety is defined as

A

A feeling of tension, nervousness, apprehension or fear that usually involves unpleasant reaction to a stimulus

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25
Q

Depression is defined as

A

Abnormal emotional state characterized by exaggerated feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness that are out of proportion to reality

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26
Q

Bipolar disorder is defined as

A

Manic depressive haracterized by alternate episodes of mania, depression or mixed mood

One or the other present at a given time

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27
Q

What is psychosis?

A

Any major mental disorder of organic or emotional origin gross impairment in reality

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28
Q

Psychosis is characterized by these 3 things

A

Regressive behavior
Inappropriate mood and affect
Diminished impulse control

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29
Q

Symptom of _______ includes delusions and hallucinations

A

Psychosis

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30
Q

Parkinson’s disease is defined as

A

A slowly progressing degenerative neurological disorder

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31
Q

What characterizes someone with Parkinson’s?

A

Resting tremor
Pill rolling of fingers
Mask like faces
Shuffling gait
Forward flexion of the trunk
Loss of postural reflexes
Muscle rigidity no weakness

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32
Q

What is seizure disorder?

A

Hyper excitation of neurons in the brain leading to a sudden, violent involuntary series of contraction by a group of muscles

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33
Q

Grand mal seizures are also called:

A

Tonic clonic

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34
Q

Grand mal seizures are described as?

A

Generalized involuntary muscular contraction and cessation of respiration followed by tonic and clonic spasms of muscles

35
Q

What is another term for a petit mal seizure?

A

Absence seizure

36
Q

What happens to the body during a petit mal seizure?

A

Sudden momentary loss of consciousness. Sometimes accompanied by minor spasms of the neck or upper extremities (symmetric twitching to face or loss of muscle tone)

37
Q

What is a psychomotor seizure>

A

Temporary impairment of consciousness characterized by psychic symptoms, loss of judgment, automatic behavior and abnormal acts

38
Q

What two CNS stimulants are used for treatment of ADHD/ADD?

A

Methylphenidate
Amphetamine/dextroamphetamine

39
Q

What is ADHD/ADD? What neurotransmitters are affected?

A

Dysregulation of transmitters (serotonin, norepinephrine, dopamine)

40
Q

When does ADHD/ADD start affecting people?

A

Usually occurs in children before 7 years

41
Q

What are some characteristics of ADD/ADHD

A

Inattentiveness (inability to concentrate)
Restlessness
Hyperactivity
Impulsivity
Inability to complete tasks
Poor coordination

42
Q

What effects do stimulants induce on the body/mental state?

A

Induce a feeling of increased energy and alertness, increase feelings of well-being.

43
Q

What do stimulants do to the CNS?

A

Can cause an increase in dopamine that affects the brain reward system.
Increase in
HR
BP
Respiration

44
Q

What are the medically approved uses for stimulants?

A

ADD/ADHD
Narcolepsy
Reversal of respiratory distress

45
Q

Amphetamines action-

A

Act on cerebral cortex

46
Q

Amphetamines prototype drug name?

A

Amphetamine/dextroamphetamine
(Adderall)

47
Q

Amphetamines action-

A

Elevates Norepinephrine and dopamine by stimulating their release.

Inhibits reuptake of NE & DA

48
Q

Side effects of amphetamines?

A

Tachycardia
HTN
Insomnia
Restlessness
Anorexia
Dry mouth
Weight loss
Growth retardation (children)

49
Q

Excess use of amphetamines can lead to?

A

Psychosis/Mania

50
Q

What increases the effects of amphetamines?

A

Caffeine
oral anticoagulants
tricyclic antidepressants
monoamine oxidase inhibitors

51
Q

What do amphetamines decrease the effects of?

A

antihypertensives

52
Q

What should nurses assess/evaluate in regards to amphetamines?

A

HR & BP
attention span
behavior (calm not manic)
height and weight in children (compare to growth charts)
peripheral circulation (numbness/tingling, cool, pale, painful)

53
Q

What should nurses teach in regards to amphetamines?

A

take with meals
avoid caffeine and alcohol
report palpitations and tachycardia/irregular hr
sugarless gum or hard candy for dry mouth
do not stop abruptly (withdrawl/depression)

54
Q

What are the prototype drugs for Sedative/anxiolytics/hypnotics?

A

Lorazepam
Phenobarbital

55
Q

What are some non pharmacological methods to help with insomia?

A

Arise at a specific hour
take a few daytime naps
avoid caffeine
avoid heavy meals/ exercise before bed
take a warm bath
read
avoid drinking large amounts of fluids before bed

56
Q

What are physical signs of anxiety?

A

tachycardia/palpitations
dry mouth
sweating/weakness

57
Q

What are some psychological signs of anxiety?

A

Fear/apprehension
dread/uneasiness

58
Q

What are some non pharmacological methods to anxiety?

A

Relaxation techniques
psychotherapy
support groups

59
Q

Hypnotics help with what?

A

induce sleep (CNS depressant)

60
Q

Sedatives help with what?

A

Induce a sense of calm and decrease anxiety (CNS Depressant)

61
Q

The three types of sedative-hypnotics are?

A

benzodiazepines (common)
barbiturates
benzodiazepine-like medications (common)

62
Q

Anxiolytics help with what?

A

decrease intensity or frequency of anxiety

63
Q

What is the pharmacological action of sedative/hypnotics/anxiolytics?

A

enhance the action of (GABA) in the CNS

64
Q

What are the therapeutic uses of sedative/hypnotics/anxiolytics?

A

insmonia
induction of anesthesia
anxiety disorders
panic disorder
seizure disorder
muscle spasm
alcohol withdrawal
tranq/antipsychotic

65
Q

The distinction between sedative/hypnotics/anxiolytics is often a matter of _________?

A

Dosage!

66
Q

What is the action of Barbiturates?

A

Depress CNS Motor and sensory centers

67
Q

What is the long acting barbiturate?

A

Phenobarbital
it is also used for seizures.

68
Q

Uses of phenobarabital

A

insomnia relief
suppresion of seizures
preop sedation
general anesth.
acute mania
anxiety

69
Q

What are some cautions regarding barbiturates?

A

Dependence/withdrawl (Schedule 2)
cross tolerance (requires higher dose over time)
multiple drug interations (accelerate metabolism of drugs)
respiratory depression
renal/hepatic impairment
REM rebound when D/C’d

70
Q

REM Rebound is

A

A significant increase in the percentage of time spent in REM over normal levels

71
Q

Nurses should monitor these in regards to barbiturates?

A

sedation/respiration
liver function tests
pain levels
drug interactions

72
Q

What might be important to teach about regarding barbiturates?

A

may cause drowsiness
avoid alcohol/sedatives
do not stop abruptly
avoid pregnancy/breastfeeding
barrier birth control (inactivates estrogen BC)

73
Q

What pregnancy category are barbiturates?

A

D- DO NOT USE

74
Q

Example of Benzodiazepines?

A

Lorazepam

75
Q

Action of benzodiazepines

A

enhance GABA receptors
(NOT direct GABA agonists)

76
Q

Uses for benzodiazepines?

A

anxiety (major use)
insomnia
seizures
alcohol withdrawl
muscle spasms
preop med
conscious sedation.

77
Q

Benzodiazepines are relatively safer than barbiturates? T or F

A

true

78
Q

Side effects of benzodiazepines

A

CNS Depression/sedation
drowsiness/hangover
decreased reaction time
confusion
anterograde amnesia
hypotension- IV doses

79
Q

Contraindications of benzodiazepines

A

allergies
psychosis
glaucoma
shock/coma
alcohol intox
pregnancy
children/elderly
renal/hepatic disfunction

80
Q

IV administration of benzodiazepines include?

A

SLOW IV push
1 min/ 5 mg

81
Q

Reversal agent of benzodiazepines?

A

Flumazenil

82
Q

Flumazenil action

A

antagonizes the effects of benzodiazepines on CNS such as
sedation
impairment of recall
psychomotor impairment

83
Q

Uses of flumazenil

A

reversal of sedation
benzodiazepine overdose
(does not work with opiates)

84
Q

What should the nurse monitor after administering flumazenil

A

respritory status until risk of re-sedation is unlikely
120 mins - T1/2= 54 mins

Nursing Pharmacology (11 decks)

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