C8- Central Nervous System (stimulants/ benzo / barbiturates) Flashcards
Your brain communicates with electrical impulses that signal a release of ____________?
Neurotransmitter
Neurotransmitters bind to targeted ______?
Cells
The chemicals used to suppress or stimulate effectors at the nerve synapse are?
Neurotransmitters
A neurotransmitter must be released by?
A nerve
When will the neurotransmitter be released into the synapse?
When the nerve is stimulated and need to react with a specific receptor site
NT is synthesized from substances that enter or may enter neuron in what form?
Intact
Neurotransmitters are stored where?
In storage vesicles
Neurotransmitters are released by what kind of impulse?
Electrical
Neurotransmitters have specific _________?
Messages
After NT communication, what three things happen to the NT?
NT inactivated
NT reabsorbed (reuptake)
NT diffuse AWAY from synapse
CNS medications influence which two things in the CNS?
Neurotransmitter concentration
Electrical activity
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?
BLOOD BRAIN BARRIER
Lipid-soluble
Pregnancy lactation category D or X
CNS drugs work _______ to block or mimic neurotransmitters?
DIRECTLY
Drugs work_______ by influencing neurotransmitter synthesis, formation, storage, release, reuptake, destruction.
Indirectly
What break down the Neurotransmitters in the synapse?
Neurotransmitter enzymes
Anti enzyme drugs interact with what? Which allows for what?
Interacts with the enzyme allowing for more neurotransmitters
Norepinephrine/Noradrenaline (concentration NT) affects what?
Attention and responding actions in the brain
Fight or flight response
Contracts blood vessels
Increases blood flow
Dopamine (pleasure neurotransmitter) effect? What drug type blocks receptors of dopamine?
Feelings of pleasure, addiction
Movement
Motivation
people repeat behaviors that lead to dopamine release
Antipsychotics block DA receptors
Serotonin (mood NT) affects? What type of drug elevates serotonin?
Mood
Well-being and happiness
Sleep cycle
Digestive system regulation
Affected by:
-exercise
-light exposure
Antidepressants elevate 5HT
GABA (calming NT) effects: What type of drugs regulate GABA sites?
Firing nerves in CNS = calming
Motor control
Vision
Improve focus (high levels)
Cause anxiety (low levels)
Benzodiazepines work on GABA sites
Acetylcholine (learning NT) involved in
Thought
Learning
Memory
Attention
Awakening
Activates:
-muscle action in the body
MAOI (monoamine oxidase) inactivates what neurotransmitters?
NE (norepinephrine)
DA (Dopamine)
5HT (Serotonin)
Insomnia is:
Chronic inability to sleep or remain asleep
Anxiety is defined as
A feeling of tension, nervousness, apprehension or fear that usually involves unpleasant reaction to a stimulus
Depression is defined as
Abnormal emotional state characterized by exaggerated feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness that are out of proportion to reality
Bipolar disorder is defined as
Manic depressive haracterized by alternate episodes of mania, depression or mixed mood
One or the other present at a given time
What is psychosis?
Any major mental disorder of organic or emotional origin gross impairment in reality
Psychosis is characterized by these 3 things
Regressive behavior
Inappropriate mood and affect
Diminished impulse control
Symptom of _______ includes delusions and hallucinations
Psychosis
Parkinson’s disease is defined as
A slowly progressing degenerative neurological disorder
What characterizes someone with Parkinson’s?
Resting tremor
Pill rolling of fingers
Mask like faces
Shuffling gait
Forward flexion of the trunk
Loss of postural reflexes
Muscle rigidity no weakness
What is seizure disorder?
Hyper excitation of neurons in the brain leading to a sudden, violent involuntary series of contraction by a group of muscles
Grand mal seizures are also called:
Tonic clonic
Grand mal seizures are described as?
Generalized involuntary muscular contraction and cessation of respiration followed by tonic and clonic spasms of muscles
What is another term for a petit mal seizure?
Absence seizure
What happens to the body during a petit mal seizure?
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)
What is a psychomotor seizure>
Temporary impairment of consciousness characterized by psychic symptoms, loss of judgment, automatic behavior and abnormal acts
What two CNS stimulants are used for treatment of ADHD/ADD?
Methylphenidate
Amphetamine/dextroamphetamine
What is ADHD/ADD? What neurotransmitters are affected?
Dysregulation of transmitters (serotonin, norepinephrine, dopamine)
When does ADHD/ADD start affecting people?
Usually occurs in children before 7 years
What are some characteristics of ADD/ADHD
Inattentiveness (inability to concentrate)
Restlessness
Hyperactivity
Impulsivity
Inability to complete tasks
Poor coordination
What effects do stimulants induce on the body/mental state?
Induce a feeling of increased energy and alertness, increase feelings of well-being.
What do stimulants do to the CNS?
Can cause an increase in dopamine that affects the brain reward system.
Increase in
HR
BP
Respiration
What are the medically approved uses for stimulants?
ADD/ADHD
Narcolepsy
Reversal of respiratory distress
Amphetamines action-
Act on cerebral cortex
Amphetamines prototype drug name?
Amphetamine/dextroamphetamine
(Adderall)
Amphetamines action-
Elevates Norepinephrine and dopamine by stimulating their release.
Inhibits reuptake of NE & DA
Side effects of amphetamines?
Tachycardia
HTN
Insomnia
Restlessness
Anorexia
Dry mouth
Weight loss
Growth retardation (children)
Excess use of amphetamines can lead to?
Psychosis/Mania
What increases the effects of amphetamines?
Caffeine
oral anticoagulants
tricyclic antidepressants
monoamine oxidase inhibitors
What do amphetamines decrease the effects of?
antihypertensives
What should nurses assess/evaluate in regards to amphetamines?
HR & BP
attention span
behavior (calm not manic)
height and weight in children (compare to growth charts)
peripheral circulation (numbness/tingling, cool, pale, painful)
What should nurses teach in regards to amphetamines?
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)
What are the prototype drugs for Sedative/anxiolytics/hypnotics?
Lorazepam
Phenobarbital
What are some non pharmacological methods to help with insomia?
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
What are physical signs of anxiety?
tachycardia/palpitations
dry mouth
sweating/weakness
What are some psychological signs of anxiety?
Fear/apprehension
dread/uneasiness
What are some non pharmacological methods to anxiety?
Relaxation techniques
psychotherapy
support groups
Hypnotics help with what?
induce sleep (CNS depressant)
Sedatives help with what?
Induce a sense of calm and decrease anxiety (CNS Depressant)
The three types of sedative-hypnotics are?
benzodiazepines (common)
barbiturates
benzodiazepine-like medications (common)
Anxiolytics help with what?
decrease intensity or frequency of anxiety
What is the pharmacological action of sedative/hypnotics/anxiolytics?
enhance the action of (GABA) in the CNS
What are the therapeutic uses of sedative/hypnotics/anxiolytics?
insmonia
induction of anesthesia
anxiety disorders
panic disorder
seizure disorder
muscle spasm
alcohol withdrawal
tranq/antipsychotic
The distinction between sedative/hypnotics/anxiolytics is often a matter of _________?
Dosage!
What is the action of Barbiturates?
Depress CNS Motor and sensory centers
What is the long acting barbiturate?
Phenobarbital
it is also used for seizures.
Uses of phenobarabital
insomnia relief
suppresion of seizures
preop sedation
general anesth.
acute mania
anxiety
What are some cautions regarding barbiturates?
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
REM Rebound is
A significant increase in the percentage of time spent in REM over normal levels
Nurses should monitor these in regards to barbiturates?
sedation/respiration
liver function tests
pain levels
drug interactions
What might be important to teach about regarding barbiturates?
may cause drowsiness
avoid alcohol/sedatives
do not stop abruptly
avoid pregnancy/breastfeeding
barrier birth control (inactivates estrogen BC)
What pregnancy category are barbiturates?
D- DO NOT USE
Example of Benzodiazepines?
Lorazepam
Action of benzodiazepines
enhance GABA receptors
(NOT direct GABA agonists)
Uses for benzodiazepines?
anxiety (major use)
insomnia
seizures
alcohol withdrawl
muscle spasms
preop med
conscious sedation.
Benzodiazepines are relatively safer than barbiturates? T or F
true
Side effects of benzodiazepines
CNS Depression/sedation
drowsiness/hangover
decreased reaction time
confusion
anterograde amnesia
hypotension- IV doses
Contraindications of benzodiazepines
allergies
psychosis
glaucoma
shock/coma
alcohol intox
pregnancy
children/elderly
renal/hepatic disfunction
IV administration of benzodiazepines include?
SLOW IV push
1 min/ 5 mg
Reversal agent of benzodiazepines?
Flumazenil
Flumazenil action
antagonizes the effects of benzodiazepines on CNS such as
sedation
impairment of recall
psychomotor impairment
Uses of flumazenil
reversal of sedation
benzodiazepine overdose
(does not work with opiates)
What should the nurse monitor after administering flumazenil
respritory status until risk of re-sedation is unlikely
120 mins - T1/2= 54 mins
