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Pharmacology Exam 3 KS > Central Nervous System > Flashcards

Central Nervous System Flashcards

1
Q

Definition of Seizure

A

Abnormal or uncontrolled neuronal discharges in the brain

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2
Q

Defintion of Convulsion

A

“involuntary violent spasm of large muscles of face, neck, arms or legs.

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3
Q

Definition of Eclampsia.

A

“severe hypertensive disorder of pregnancy characterized by seizures, com, and perinatal mortality.”

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4
Q

Epilepsy is

A

when someone has Chronic seizures.

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5
Q

An involuntary violent spasm of large muscles of face, neck, arms, and legs is a ________.

A

Convulsion

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6
Q

An Abnormal or uncontrolled neuronal discharges in the brain is a ____________.

A

Seizure.

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7
Q

severe hypertensive disorder of pregnancy, characterized by seizures, coma, and perinatal mortality is the definition of ________.

A

Eclampsia.

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8
Q

Difference between simple and complex partial (focal) epileptic seizures

A

simple= Olfactory and visual hallucinations, intense emotions, twitching of arms, legs and face;

Complex = Preceding aura and postictal confusion, no response to verbal comands.

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9
Q

Difference between Absense, Atonic, and Tonic-Clonic seizures

A

Absence (petit mal)
• Lasting a few seconds
• Seen most often in children (child stares into space, does not respond to verbal stimulation, may have fluttering eyelids or jerking)
• Misdiagnosed often (especially in child) as ADD or daydreaming

Atonic (drop attacks)
• Falling or stumbling for no reason
• Lasting a few seconds

Tonic-clonic (grand mal)
• Preceeded by aura
• Intense muscle contraction (tonic phase) followed by alternating contraction and relaxation of muscles (clonic phase)
• Crying at beginning as air leaves lungs; loss of bowel/bladder control; shallow breathing with periods of apnea; usually lasting 1–2 minutes

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10
Q

disorientation after a seizure is called

A

postictal state

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11
Q

myoclonic seizures are:

A

large jerking movements of a major muscle group. Think: myo (single muscle) and clonic (like grand mal/tonic-clonic.)

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12
Q

status epilepticus seizures are:

A

a medical emergecy, they are continuous seizue activity which can lead to coma and death.

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13
Q

True or False: Tonic Clonic Seizures are such a bad problem, that doctors usually start the pts on large doses of meds to make them go away fast.

A

False. The meds have really bad side effects (suidical thoughts/tendencies)and so they are usually put on a very small dose and titer up to a workable value over the course of like a month. It takes a while.

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14
Q

Three possible MOAs of seizure medications

A
  1. Stimulating an influx of Cl ions; 2. delaying influx of Na+; and 3. Delaying an influx of Ca2+ ions
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15
Q

True or False: Seizure Meds that work with Na+ ions blocks the channels

A

False. They just desensitize them.

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16
Q

What’s a side effect you’re going to want to look out for teens on this medication (and adults, too)?

A

Suicidal behavior. (This is prevalent in adults, too, of course, but adults also have problems with kidney/liver failure. teens are already super hormonal/anxty… so it’s pertinent to watch for suidical tendencies even more closely.)

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17
Q

Patient teaching of Barbituates and Gaba Agents

A
  • Use reliable contraception
  • Immediately report pregnancy
  • Report excessive signs of bleeding
  • Report drowsiness and bone pain
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18
Q

Drugs that potentiate the gaba action include:

A

Barbiturates, Benzodiazepines, Miscellaneous GABA agents

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19
Q

Hydantoins are used to treat what forms for epilepsy?

A

All forms except absence seizures

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20
Q

Phenytoin related drugs are used to treat what types of seizures?

A

Absence Seizures

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21
Q

True or False. If the pt hasn’t had a seizure in 2 years, they can stop taking the medication.

A

False. If they are free after 3 years, they can start taking less of their medication. Then if after taking less of their medication they are still taking less of their medication, they are still seizure free, they can take even, less… etc etc. Resume if seizures resume.

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22
Q

Pts coming off of seizure meds should be aware of

A

rebound seizure

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23
Q

Parkinsons disease is a progressive ______ of dopamine.

A

loss.

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24
Q

Symptoms known as Parkinsonism include:

A 
	Tremors
	Muscle rigidity
	Bradykinesia
	Postural instability
	Affective flattening
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25
Q

Drug Therapy for Parkinsonism

A

 Restores dopamine function
 Blocks acetylcholine
 Extrapyramidal side effects (EPS)

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26
Q

ROLE OF THE NURSE:

DOPAMINERGIC DRUG THERAPY

A
  • Contraindicated in narrow-angle glaucoma
  • Monitor for hypotension and tachycardia
  • Look for symptoms of drug toxicity
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27
Q

DOPAMINERGICS CLIENT TEACHING

A
  • Increase fiber and fluids
  • Avoid food and drugs high in pyridoxine
  • May take several months for full effect
  • Abruptly stopping the drug may cause Parkinsonism crisis
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28
Q

ANTICHOLINERGICS CLIENT TEACHING

A
  • Relieve dry mouth with frequent drinks or sugarless hard candy
  • Take with food or milk to prevent GI upset
  • Avoid alcohol
  • Wear dark glasses; avoid bright sunlight
  • Do not stop taking abruptly
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29
Q

NURSING CONSIDERATIONS WITH

ACHE INHIBITORS

A
  • Assess baseline vitals
  • Monitor for hypotension
  • Monitor for change in mental status or mood
  • Monitor for dizziness, insomnia, anorexia
  • Clients with narrow-angle glaucoma should not take revastigmine (Exelon)
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30
Q
  • Assess baseline vitals
  • Monitor for hypotension
  • Monitor for change in mental status or mood
  • Monitor for dizziness, insomnia, anorexia
  • Clients with narrow-angle glaucoma should not take revastigmine (Exelon)
A

• Take with food or milk to avoid GI upset
• Take as prescribed
• Teach signs and symptoms of overdose
o Severe nausea/vomiting, sweating, salivation, hypotension
o Bradycardia, convulsions, increased muscle weaknesses (including respiratory muscles)

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31
Q

True or False: Some drugs are more effective than others.

A

False. All of these drugs have equal efficacy.

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32
Q

ANTIPARKINSONISM AGENTS

A

• Restore balance of dopamine and acetylcholine in brain

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33
Q

Possible causes of Alzheimers Disease

A

 Genetic defects
 Chronic inflammation
 Excess free radicals
 Environmental factors

but really it’s unknown…

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34
Q

Structural Damage in Brain consist of

A

 Amyloid plaques

 Neurofibrillary tangles

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35
Q

 Symptoms of Alzheimers result from progressive damage to neurons in the _____ of the brain, which requires ______ as a neurotransmitter

A

hippocampus, acetylcholine

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36
Q

Symptoms of Alzheimer’s Disease

A

 Impaired memory and judgment
 Confusion and disorientation
 Inability to recognize family and friends
 Aggressive behavior
 Depression
 Psychoses, including paranoia and delusions
 Anxiety

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37
Q

MOA of Barbiturates

A

changing the action of GABA

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38
Q

MOA of Hydantoins

A

to densitize sodium channels

39
Q

MOA of Phenytoin like drugs

A

to desensitize sodium channels

40
Q

MOA of Succinimides

A

suppress calcium influx

41
Q

MOA of Dopaminergic drugs

A

Increases biosynthesis of dopamine within nerve terminals

42
Q

MOA of Dopaminergic Adjunct Agents

A

Cause dopamine release from nerve terminals

43
Q

MOA of Anticholinergics

A

block acetylcholine; inhibit overactivity in brain

44
Q

MOA of ACHE Inhibitors

A

to prevent breakdown of acetylcholine; enhance transmission in neurons

45
Q

MOA of diazepam (Valium),

A

changing the action of GABA

46
Q

MOA of Penobarbital (Luminal)

A

changing the action of GABA

47
Q

MOA of phenytoin (Dilantin),

A

to densitize sodium channels

48
Q

MOA of Fosphenytoin (Cerebyx)

A

to densitize sodium channels

49
Q

MOA of Valproic acid (Depakene, Depakote)

A

to desensitize sodium channels

50
Q

MOA of ethosuximide (Zarontin)

A

suppress calcium influx

51
Q

MOA of levodopa (Larodopa),

A

Increases biosynthesis of dopamine within nerve terminals

52
Q

MOA of Amantadine (Symmetrel)

A

Cause dopamine release from nerve terminals

53
Q

MOA of Ropinirole (Requip)

A

Activate dopamine receptors (dopamine agonists)

54
Q

MOA of benztropine mesylate (Cogentin)

A

block acetylcholine; inhibit overactivity in brain

55
Q

MOA of donepezil hydrochloride (Aricept)

A

to prevent breakdown of acetylcholine; enhance transmission in neurons

56
Q

The drug categories that work by desensitizing sodium channels are:

A

Hydantoins (Phenytoin) , Phenytoin-like drugs,

57
Q

Examples of Benzodiazepines

A

diazepam (Valium),
clonazepam (Klonopin)
Lorazepam (Ativan)
Clorazepate (Tranxene)

58
Q

Examples of Barbituates

A

Penobarbital (Luminal)
Amobarbital (Amytal)
Secobarbital (Seconal)
Pentobarbital (Nembutal)

59
Q

Examples of Hydantoins

A

phenytoin (Dilantin), Fosphenytoin (Cerebyx)

60
Q

Examples of Phenytoin like drugs

A

Valproic acid (Depakene, Depakote) Tegretol)

61
Q

Examples of Succinimides

A

ethosuximide (Zarontin)

62
Q

Examples of Dopaminergic drugs

A

levodopa (Larodopa), levodopa and carbidopa (Sinemet)

63
Q

Examples of Dopaminergic Adjunct Agents

A

Amantadine (Symmetrel)

64
Q

Examples of Anticholinergics

A 
benztropine mesylate (Cogentin)
Triexyphenidyl hydrochloride (Artane)
65
Q

Examples of Immunomodulators

A

Interferon Beta

Glatiramer acetate

66
Q

Examples of ACHE Inhibitors

A

donepezil hydrochloride (Aricept)

67
Q

ACHE Inhibitors are used to treat

A

Alzheimers Disease

68
Q

Immunomodulators are used to treat

A

Multiple Sclerosis (MS)

69
Q

the drug Levodopa is more effictive when combined with the drug

A

carbidopa… (the drug Sinemet is Levodopa and Carbidopa combined for that reason.)

70
Q

The Phenytoin-like drug Tegretol is used to treat _____.

A

Tonic-Clonic and Partial seizures.

71
Q

Phenytoin-like drugs are better than Phenytoin because:

A

They have lesser side effects (newer… less cognitive effects… less sleepy.) Side effects are mostly GI.

72
Q

Phenytoin-like drugs are used for what type of seizure?

A

Absence seizures

73
Q

Hydantoins (including phenytoin) are used for what type of seizures?

A

all types except Absence seizures

74
Q

If you have an overdose of Benzodiazepines, give ______.

A

flumazenil (Romazicon)

75
Q

A major side effect of Benzodizazepines, Barbitrates, Hydantoins, is

A

severe respiratory depression

76
Q

Nursing Implications of Benzodiazepines

A

Avoid alcohol, OTC drugs, and herbal medications
Avoid nicotine
Avoid driving and hazardous activities
Rebound seizures if discontinued abruptly
Take with food
Drug often used illegally

77
Q

laryngospasm is a side effect of what type of drug?

A

Barbituate

78
Q

True or False: toxicity to Benzodiazepines leads to Stevens-Johnson syndrome.

A

False. An adverse effect of BARBITUATES is Steven-Johnsons Syndrome.

79
Q

True or False. Hydantoin can be mixed with other IV fluids, as long as it they are clear.

A

False. It’s rarely IV compatible. Needs it’s only Normal Saline IV.

80
Q

True or False. Benzodiazepines are used as a maintenance drug for epileptic seizures.

A

False. They are used DURING Tonic-Clinic Seizures.

81
Q

Side Effects Barbituates

A 
Somnolence, Agranulosis, Stevens-Johnson syndrome
CNS depression (respiratory depression)
dependence, drowsiness, vitamin deficiencies, laryngospasm
82
Q

Side effect Hydantoins

A

CNS depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, and hypotension

83
Q

Nursing Implications Hydantoins

A

Monitor serum-drug levels
Monitor for signs of toxicity
Monitor for blood dyscrasias and bleeding disorders
Monitor liver and kidney function
Fatal hepatotoxicity can occur
Patients with hypersensitivity to hydantoin products should be cautious.
Rash, seizures due to hypoglycemia, sinus bradycardia, and heart block

84
Q

Nursing Implications - Phenytoin like drugs

A

Monitor serum-drug levels
Monitor for signs of toxicity
Monitor for blood dyscrasias and bleeding disorders
Monitor liver and kidney function
Fatal hepatotoxicity can occur
Patients with hypersensitivity to hydantoin products should be cautious.
Rash, seizures due to hypoglycemia, sinus bradycardia, and heart block

85
Q

Side Effects of Phenytoin like drugs

A

limited CNS depression, visual disturbances, ataxia, vertigo, headache
gastrointestinal effects, hepatotoxicity, pancreatitis

86
Q

Side effects of Succinimides

A 
Drowsiness, headache, fatigue, dizziness
Depression or euphoria
Nausea, vomiting, weight loss
Abdominal pain
Life threatening reactions:
Severe mental depression with suicide intent
Stevens-Johnson syndrome 
Very rare but serious side effects: systemic lupus erythematosis, leukopenia, aplastic anemia, Stevens-Johnson syndrome 
Blood dyscrasias
87
Q

Nursing Implications for Succinimides

A

Do not abruptly withdraw medication
Use with caution with antiseizure medications, phenothiazines, and antidepressants
Patient teaching:
• Immediately report mood changes or suicidal thoughts
• Avoid driving and hazardous activities
• Do not suddenly stop taking
• Take with food
• Report symptoms of fever or sore throat
• Report weight loss and anorexia

88
Q

True or False. Pts should take Succinimides on an empty stomach to avoid side effects.

A

False. Take with food.

89
Q

What drugs do you measure the serum levels?

A

Phenytoin (Hydantoins) and Phenytoin-like drugs

90
Q

Side effects of Dopaminergic Drugs

A

dizziness, light-headedness, sleep dysfunction, fatigue, nausea, vomiting, constipation, orthostatic hypertension, dystonia, dyskinesia

91
Q

Side effects of Anti-cholinergics

A

dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia, glaucoma
paralytic ileus, cardiovascular collapse

92
Q

Paralytic ileux and cardiovasucalr collapse are side effects of what type of drug?

A

anticholinergics

93
Q

side effects of immunomodulators

A

flushing, chest pain, weakness, infection, pain, nausea, joint pain, anxiety, muscle stiffness

94
Q

side effects of ACHE Inhibitors

A

nausea/vomiting, dizziness and headache, bronchoconstriction, liver injury (tacrine(Cognex))

Pharmacology Exam 3 KS (4 decks)

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