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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
classifications of cns depressants
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
26
sedative-hypnotics
ordered to treat sleep disorders. 1. mildest form of cns depression is sedation: diminshed physical/mental responses (does not effect consciousness). 2. increased dose leads to hypnotic/sleeping effect 3. with high doses, anesthesia may be achieved.
27
why are barbiturates less frequently prescribed now?
they are sedative-hypnotics with potential for mental and physical dependency.
28
short acting hypnotics are useful for?
useful in achieving sleep as they do not have lingering side effects
29
intermediate acting hypnotics are useful for? may cause?
useful for sustaining sleep. may cause residual hangover feeling
30
hypnotic therapy should be short or long term?
short term: to prevent dependence and drug tolerance
31
discontinuing a high dose of hypnotic after a long time can?
lead to withdrawal. doses should be tapered and should not be used in patients with respiratory compromise or pregnancy
32
categories of sedative hypnotics
barbiturates, benzodiazepines, nonbenzos, melatonin agonists
33
barbiturate classifications
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
t/f: drug interactions rarely occur with barbiturates
false. many occur. alcohol, narcotics, and other sedative-hypnotics concurrently can cause significant CNS depression
35
benzodiazepines background info
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
benzo action
increase action of inhibitory NT GABA (gamma aminobutyric acid) to GABA receptors. reduce neuron excitability.
37
benzo overdose
reversal agent/antagonist = flumanezil (Romazicon)
38
alprazolam (Xanax) drug type
benzo.
39
alprazolam (Xanax) pharmacokinetics
well absorbed thru GI. rapidly metabolized in liver to active metabolites. half life 11-16 hrs
40
alprazolam (Xanax) pharmacody
binds receptors in limbic system and reticular formation, increases GABA to receptors, stabilizes neuronal membranes
41
alprazolam (Xanax) pharmacot
anxiety/panic disorders
42
alprazolam (Xanax) CI
hypersensitivity, sleep apnea, psychotic rxns, resp depression, acute alcohol intoxication, recent resp depressions
43
alprazolam (Xanax) adverse rxn
depression, impaired coordination
44
alprazolam (Xanax) SE
drowsiness, lethargy, dizziness, memory impairment, headache, blurred vision, paradoxical rxns
45
alprazolam (Xanax) drug/food/lab rxn
decreases resp when taken with alcohol and other cns depressants
46
alprazolam (Xanax) NI
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
alprazolam (Xanax) pt ed
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
nonbenzo sedative hypnotic
ambien (Zolpidem Tartrate)
49
ambien (Zolpidem Tartrate) pharamcok
only give PO
50
ambien (Zolpidem Tartrate) pharmad
causes cns depression and NT inhibition
51
ambien (Zolpidem Tartrate)pharmat
insomnia
52
ambien (Zolpidem Tartrate) CI
breastfeeding, hypersensitivity, resp depression, recent resp depressants
53
ambien (Zolpidem Tartrate) adverse rxn
tolerance, hypotension, angioedema, dysrhythmias, suicidal ideation, psychological or physiological dependence
54
ambien (Zolpidem Tartrate) se
hot flashes, hangover, n/v, irritability, dizziness, ataxia, visual disturbances, mental depression, anxiety, erectile dysfunction, drowsiness, lethargy, headache
55
ambien (Zolpidem Tartrate) drug/food/lab
decreases resp with alc, other cns depressants
56
ambien (Zolpidem Tartrate) NI
assess if pt has taken it previously, ensure safety, place bed alarm, obtain drug hx for other cns depressants/alc
57
ambien (Zolpidem Tartrate) pt ed
safety measures, dont drink alc while taking, dont drive after taking
58
melatonin agonist drug
ramelteon (Rozerem)
59
ramelteon (Rozerem) pharmakin
quick onset, short half life
60
ramelteon (Rozerem) pharmad
first FDA approved hypnotic not classed as controlled substance. stimulates same receptor as endogenous melatonin
61
ramelteon (Rozerem) pharmath
insomnia, anxiolytics
62
ramelteon (Rozerem) CI
severe hepatic dysfx
63
ramelteon (Rozerem) adverse rxn
headache, daytime sleepy, dizzy, tired, nausea, worse insomnia
64
ramelteon (Rozerem) drug/food/lab
may decrease testosterone, may increase prolactin
65
ramelteon (Rozerem) NI
assess pt sleeping hx and need for med
66
ramelteon (Rozerem) pt ed
dont drink alc when taking. does not pose risk for abuse/tolerance does not cause rebound insomnia/withdrawal
67
sedative hypnos and older adults
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
nonpharma methods for sleep
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
seizure
abnormal electric discharges from cerebral neurons characterized by loss/disturbance of consciousness
70
convulsion
involuntary paroxysmal muscular contractions
71
dx of seizure/convulsions
EEG, CT, MRI
72
emergency managmeent of seizure
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
2 types of seizures
primary (idiopathic) - 75% | secondary - brain trauma, anoxia, infection, CVA
74
epilepsy
chronic, lifelong disorder. majority have their 1st seizure before 20 yo.
75
seizures not associated with epilepsy
can result from fever, alc/drugs, hypoglycemia, electrolyte imbalance, metabolic imbalance, when conditions are treated seizures cease.
76
classes of seizures
generalized/partial
77
generalized seizures
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
partial seizures
one hemisphere of brain. no loss of consciousness in simple partial. loss of consciousness with complex partial. types: simple, psychological, complex

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