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Pharm > Ch 17-20 > Flashcards

Ch 17-20 Flashcards

1
Q

major groups of CNS stimulants

A

caffeine/amphetamines/anorexiants

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2
Q

medically approved uses of cns stimulants

A

ADHD in children, narcolepsy, reversal of respiratory distress, migraines, cluster headaches

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3
Q

long term use of cns stimulants leads to?

A

depenence/tolerance: need larger doses for same response. diminshed psychoactive effects after repeated use. feeds into addiction.

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4
Q

cns stimulants are recommended short term or long term?

A

short term

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5
Q

PATHO of adhd

A

dysregulation of serotonin, NE, dopamine.

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6
Q

ADHD primarily what age? what gender?

A

primarily children before age 7 and it’s 3-7x more common in boys.

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7
Q

characteristic behaviors of adhd

A

inattentiveness, inability to concentrate, restlessness, fidgety, hyperactivity, inability to complete tasks, impulsivity

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8
Q

narcolepsy

A

fall asleep during normal wake cycles. may have sleep paralysis: paralysis of voluntary muscles, inability to move: may collapse

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9
Q

amphetamines stimulate?

A

release of NT NE and dopamine from brain and SNS

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10
Q

amphetamines typically cause?

A

euphoria, alertness, may cause sleeplessness, restlessness, tremors, irritability

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11
Q

amphetamines are prescribed for?

A

narcolepsy, occassionally ADHD if amphetamine like drugs are ineffective

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12
Q

continued use of amphetamines causes?

A

increased HR, palpitations, cardiac dysrhythmias, increased BP

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13
Q

amphetamine like drugs for ADHD and narcolepsy are meant to?

A

increase a child’s attention span, cognitive performance, decrease impulsiveness, restlessness, hyperactivity

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14
Q

prototype drug for ADHD/narcolepsy?

A

methylphenidate (Ritalin)

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15
Q

methylphenidate/Ritalin

A

prototype amphetamine like drug for ADHD/narcolepsy.
CSS III
given to correct hyperactivity for adhd: increases attention span and controls narcolepsy

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16
Q

anorexiants

A

appetite suppressants, not commonly used: lipase inhibitors preferred.

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17
Q

examples of anorexiants

A

benzphetamine HCL (Didrex), diethylpropion HCl (Tenuate), phentermine HCl (Suprenza), phentermine-topiramate (Qsymia), phendimetrazine (Bontril)

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18
Q

lipase inhibitors

A

replaced anorexiants as drug of choice for weight loss
decrease GI absorption of dietary fats, excreted in feces: weight loss.
side eff of oily spotting, steatorrhea, abdominal pain, flatus with discharge, fecal urgency/incontinence, headache, N/V, may cause hypoglycemia in DM

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19
Q

analeptics

A

CNS stimulants most affecting brainstem and spinal cord, may affect cerebral cortex.
primarily used to stimulate respirations
sub group: xanthines/methylxanthines (mainly caffeine and theophylline)

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20
Q

adverse rxn/side eff of analeptics

A

nervousness, restlessness, tremors, twitching, palpitations, insomnia, diuresis, GI upset

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21
Q

caffeine

A

analeptic. stimulates CNS: large doses stimulate respirations. given to newborns with resp distress. side eff: tremors, twitching, palpitations, diuresis, gi irritation, rarely tinnitus, insomnia

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22
Q

theophylline

A

analeptic. used to relax bronchioles, can also stimulate resps in newborns

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23
Q

respiratory stimulants drug of choice

A

doxapram (Dopram).
treats resp depression from drug overdose, pre/post anesthetic, COPD.
used w caution in neonatal apnea. given IV: onsent of 20-40 sec, peak action 2 mins.
has infrequent side eff.
signs of overdose: HTN, tachycardia, tremores, spasticity, hyperactive reflexes. mechanical ventilation is most effective.

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24
Q

cns depressants

A

cause varying degrees of reduction in functional activity (CNS depression). degree of depression depends on drug and amount of drug.

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25
Q

classifications of cns depressants

A

sedative hypnotics, general anesthetics, analgesics, opioid analgesics, nonopioid analgesics, anticonvulsants, antipsychotics, antidepressants.
assess vitals/sleep etc. plan for pt to sleep 6-8 hrs. tell pt to avoid caffeine/alcohol 6 hrs before sleep

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26
Q

sedative-hypnotics

A

ordered to treat sleep disorders. 1. mildest form of cns depression is sedation: diminshed physical/mental responses (does not effect consciousness).

  1. increased dose leads to hypnotic/sleeping effect
  2. with high doses, anesthesia may be achieved.
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27
Q

why are barbiturates less frequently prescribed now?

A

they are sedative-hypnotics with potential for mental and physical dependency.

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28
Q

short acting hypnotics are useful for?

A

useful in achieving sleep as they do not have lingering side effects

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29
Q

intermediate acting hypnotics are useful for? may cause?

A

useful for sustaining sleep. may cause residual hangover feeling

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30
Q

hypnotic therapy should be short or long term?

A

short term: to prevent dependence and drug tolerance

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31
Q

discontinuing a high dose of hypnotic after a long time can?

A

lead to withdrawal. doses should be tapered and should not be used in patients with respiratory compromise or pregnancy

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32
Q

categories of sedative hypnotics

A

barbiturates, benzodiazepines, nonbenzos, melatonin agonists

33
Q

barbiturate classifications

A

ultrashort-acting (Thiopental sodium/Pentothal as general anesthetic)
short-acting (used for sedation preoperatively, VS must be closely monitored)
intermediate-acting (useful for sustaining sleep or maintaining long sleep when taken approx 1 hr before onset of sleep. not for ppl who have trouble falling asleep: VS must be monitored closely)
long-acting(control seizures in epilepsy)

34
Q

t/f: drug interactions rarely occur with barbiturates

A

false. many occur. alcohol, narcotics, and other sedative-hypnotics concurrently can cause significant CNS depression

35
Q

benzodiazepines background info

A

introduced in 60s as antianxiety med.
sedative hypnotics for inducing sleep for several weeks longer than other sedative hypnos.
should not be used more than 3-4 weeks (short term).
schedule IV according to controlled substances act.

36
Q

benzo action

A

increase action of inhibitory NT GABA (gamma aminobutyric acid) to GABA receptors. reduce neuron excitability.

37
Q

benzo overdose

A

reversal agent/antagonist = flumanezil (Romazicon)

38
Q

alprazolam (Xanax) drug type

A

benzo.

39
Q

alprazolam (Xanax) pharmacokinetics

A

well absorbed thru GI. rapidly metabolized in liver to active metabolites. half life 11-16 hrs

40
Q

alprazolam (Xanax) pharmacody

A

binds receptors in limbic system and reticular formation, increases GABA to receptors, stabilizes neuronal membranes

41
Q

alprazolam (Xanax) pharmacot

A

anxiety/panic disorders

42
Q

alprazolam (Xanax) CI

A

hypersensitivity, sleep apnea, psychotic rxns, resp depression, acute alcohol intoxication, recent resp depressions

43
Q

alprazolam (Xanax) adverse rxn

A

depression, impaired coordination

44
Q

alprazolam (Xanax) SE

A

drowsiness, lethargy, dizziness, memory impairment, headache, blurred vision, paradoxical rxns

45
Q

alprazolam (Xanax) drug/food/lab rxn

A

decreases resp when taken with alcohol and other cns depressants

46
Q

alprazolam (Xanax) NI

A

monitor for safety, assess renal fx, obtain alc hx, monitor for tolerance/dependence, obtain drug hx for other cns depressants, obtain baseline vitals and monitor vitals

47
Q

alprazolam (Xanax) pt ed

A

avoid other cns depressants. teach non pharma therapies. advise not to drive or anything else that requires coordination until knowing how med affects pt. tell dr about other meds. do not stop med without telling dr (withdrawal)

48
Q

nonbenzo sedative hypnotic

A

ambien (Zolpidem Tartrate)

49
Q

ambien (Zolpidem Tartrate) pharamcok

A

only give PO

50
Q

ambien (Zolpidem Tartrate) pharmad

A

causes cns depression and NT inhibition

51
Q

ambien (Zolpidem Tartrate)pharmat

A

insomnia

52
Q

ambien (Zolpidem Tartrate) CI

A

breastfeeding, hypersensitivity, resp depression, recent resp depressants

53
Q

ambien (Zolpidem Tartrate) adverse rxn

A

tolerance, hypotension, angioedema, dysrhythmias, suicidal ideation, psychological or physiological dependence

54
Q

ambien (Zolpidem Tartrate) se

A

hot flashes, hangover, n/v, irritability, dizziness, ataxia, visual disturbances, mental depression, anxiety, erectile dysfunction, drowsiness, lethargy, headache

55
Q

ambien (Zolpidem Tartrate) drug/food/lab

A

decreases resp with alc, other cns depressants

56
Q

ambien (Zolpidem Tartrate) NI

A

assess if pt has taken it previously, ensure safety, place bed alarm, obtain drug hx for other cns depressants/alc

57
Q

ambien (Zolpidem Tartrate) pt ed

A

safety measures, dont drink alc while taking, dont drive after taking

58
Q

melatonin agonist drug

A

ramelteon (Rozerem)

59
Q

ramelteon (Rozerem) pharmakin

A

quick onset, short half life

60
Q

ramelteon (Rozerem) pharmad

A

first FDA approved hypnotic not classed as controlled substance. stimulates same receptor as endogenous melatonin

61
Q

ramelteon (Rozerem) pharmath

A

insomnia, anxiolytics

62
Q

ramelteon (Rozerem) CI

A

severe hepatic dysfx

63
Q

ramelteon (Rozerem) adverse rxn

A

headache, daytime sleepy, dizzy, tired, nausea, worse insomnia

64
Q

ramelteon (Rozerem) drug/food/lab

A

may decrease testosterone, may increase prolactin

65
Q

ramelteon (Rozerem) NI

A

assess pt sleeping hx and need for med

66
Q

ramelteon (Rozerem) pt ed

A

dont drink alc when taking. does not pose risk for abuse/tolerance
does not cause rebound insomnia/withdrawal

67
Q

sedative hypnos and older adults

A

identify cause of insomnia first, use nonpharma methods first. barbiturates may cause inc cns dpression/confusion, should not be used for sleep. short/intermediate acting benzos ie estazolam (ProSom), temazepam (Restoril), and triazolam (Halcion) safer than barbs.
avoid long acting benzos.
dont take more than 4x/week to reduce risk of SE and dependence.
if using: use bed alarm (confusion/falls) for non benzos. monitor for hangover, light headed, dizzy, confusion. ensure pt empties bladder before taking hypnotic. warn pt about caution while driving and watch for lasting effects of drug

68
Q

nonpharma methods for sleep

A

avoid naps, wake at same time every day, avoid heavy meals/strenuous exercise before bed, avoid caffeine/alc/nicotine within 6hrs of sleep, take warm bath/quiet music/soothing activity before bed, decrease light, avoid use of electronics

69
Q

seizure

A

abnormal electric discharges from cerebral neurons characterized by loss/disturbance of consciousness

70
Q

convulsion

A

involuntary paroxysmal muscular contractions

71
Q

dx of seizure/convulsions

A

EEG, CT, MRI

72
Q

emergency managmeent of seizure

A

dont insert anything into mouth.
remove anything around pt that may cause injury.
document time seizure started, when it ended.
document characteristics of seizure to help identify type of seizure.
iv ativan then phenytoin.
if seizures continue, iv midazolam (Versed) or propofol (Diprivan)

73
Q

2 types of seizures

A

primary (idiopathic) - 75%

secondary - brain trauma, anoxia, infection, CVA

74
Q

epilepsy

A

chronic, lifelong disorder. majority have their 1st seizure before 20 yo.

75
Q

seizures not associated with epilepsy

A

can result from fever, alc/drugs, hypoglycemia, electrolyte imbalance, metabolic imbalance, when conditions are treated seizures cease.

76
Q

classes of seizures

A

generalized/partial

77
Q

generalized seizures

A

convulsive/nonconvulsive. both hemispheres are involved.
types:
Tonic clonic aka grand mal: entire cerebral cortex
tonic: stiff/rigid, fall to ground
clonic: massive muscle spasm and loss of consciousness
absence aka petit mal: very brief loss of consciousness
atonic: sudden loss of muscle tone

78
Q

partial seizures

A

one hemisphere of brain. no loss of consciousness in simple partial. loss of consciousness with complex partial.
types: simple, psychological, complex

Pharm (20 decks)

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