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Pharmacology > Ch. 9: CNS problems > Flashcards

Ch. 9: CNS problems Flashcards

1
Q

Sedative Hypnotic medications actions and uses:

A

relaxes the patient and allows him or her to sleep

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2
Q

Hypnotic agent produces what in the patient?

A

Sleep

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3
Q

Psychotherapeutic Agents

A 
Antianxiety Medications
Antidepressants
Antipsychotic Drugs
Antimanic Drugs
Sedative-Hypnotic Medications
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4
Q

Antianxiety Agents

A

Anxiety is common, problematic when it interferes with a person’s ability to perform activities of daily living

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5
Q

Action of antianxiety drugs

A

produce a calming effect

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6
Q

Uses of antianxiety drugs

A

Relieve anxiety, tension, and fear

May be used to manage alcohol withdrawal symptoms; used preoperatively; used to relieve muscle spasm

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7
Q

Antianxiety agents patient and family teaching

A

Dosing; appointments and follow-up; adverse reactions; safety with storage; drug and alcohol interactions
Habit-forming: should be used for the shortest time possible

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8
Q

Typical antipsychotic drugs actions and uses

A

antipsychotic agents act by blocking the action of dopamine in the brain
Used in the treatment of severe mental illness
May be used in combination with major tranquilizers

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9
Q

Expected side effects/adverse reactions of antipsychotic drugs

A

headache, drowsiness, nausea, constipation and dry mouth/(EPS)–pseudo-Parkinsonism, acute dystonia, akathisia, and tardive dyskinesia

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10
Q

Drug interactions of antipsychotic drugs

A

acetaminophen, diuretics such as furosemide or hydrochlorothiazide, certain calcium channel blockers, and several antidiabetic agents

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11
Q

Atypical antipsychotic drugs actions and uses

A

block dopamine 2 or other subtypes of dopamine receptor as well as certain subtypes of serotonin; used primarily for schizophrenia but also can be used for bipolar illnesses and schizoaffective disorder

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12
Q

Atypical antipsychotics side effects/adverse reactions

A

Insomnia, drowsiness, sexual side effects, dizziness, orthostatic hypotension, constipation and dry mouth

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13
Q

Atypical antipsychotic drug interactions

A

Drugs that decrease dopamine, alcohol

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14
Q

Antidepressants and Mood stabilizers

A 
Tricyclics 
MAOIs
SSRIs
SNRIs
Atypical antidepressants
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15
Q

Selective Serotonin Reuptake Inhibitors actions and uses

A

Act by inhibiting CNS neuronal uptake of serotonin
Used short-term for treatment of outpatients with diagnosis listed as a category of Major Depressive Disorders in the DSM- V
Used long-term for dysthymic and minor depressive disorders

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16
Q

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) actions and uses

A

inhibit the reuptake of both serotonin and norepinephrine increasing the concentration of both neurotransmitters available to postsynaptic receptors

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17
Q

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) side effects/adverse reactions

A

nausea, dry mouth, loss of appetite, fatigue, drowsiness, sexual side effects/epistaxis (nosebleeds), gastrointestinal bleeding, and liver damage

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18
Q

SNRIs drug interactions

A

any drug that affects serotonin or norepinephrine, St. John’s wort

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19
Q

Tricyclic antidepressants actions and uses

A

Believed to inhibit the reuptake of norepinephrine and or/serotonin
To treat endogenous depression; mild depression due to exogenous causes

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20
Q

Tricyclic antidepressants side effects/adverse reactions

A

dry mouth, drowsiness, constipation, nausea and orthostatic hypotension/cardiac dysrhythmias, heart failure and seizures

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21
Q

Tricyclic antidepressants drug interactions

A

sedatives

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22
Q

Monoamine Oxidase Inhibitors actions and uses

A 
Monoamine oxidase: naturally occurring enzyme found in the mitochondria of cells; located in nerve endings, kidneys, liver, and intestines; normally acts as catalyst to inactivate dopamine, norepinephrine, epinephrine, and serotonin
MAO inhibitors (MAOIs) block inactivation of these biogenic amines, resulting in increased concentrations at neuronal synapses and antidepressant effects
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23
Q

MAOIs side effects/adverse reactions

A

constipation, headache, dizziness, drowsiness, dry mouth/liver damage, a variety of blood disorders, thoughts of suicide

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24
Q

MAOIs drug interactions

A

SSRIs, SNRIs, and St. John’s Wort

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25
Q

Mood stabilizers actions and uses

A

Exact mechanism of lithium’s action is unknown; alters sodium transport at nerve endings and enhances uptake of serotonin and norepinephrine by the cells (inactivates these neurotransmitters)
Mood-stabilizing drug
Used to treat patients with bipolar disorder who are in acute manic phase; prevents recurrent manic episodes

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26
Q

Mood stabilizers side effects/adverse reactions

A

mild weight gain, increased thirst, increased urine output, dry skin/hypothyroidism, renal failure and diabetes insipidus

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27
Q

Mood stabilizers drug interactions

A

Diuretics, NSAIDS, antidepressants, and antipsychotic drugs

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28
Q

Excitatory neurotransmitters

A

ACh, epinephrine, and norepinephrine

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29
Q

Inhibitory neurotransmitters

A

Dopamine, types of serotonin, and GABA

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30
Q

Parkinson’s Disease

A

imbalance of excitatory and inhibitory neurotransmitters

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31
Q

Alzheimer’s and Parkinson’s Disease

A

result from degenerative changes that occur within nerves

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32
Q

PD is a CNS disorder

A

not enough dopamine, imbalance between excitatory and inhibitory reduced

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33
Q

PD symptoms

A

tremors, stooped posture, difficulty stopping motion, difficulty chewing, swallowing, and drooling

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34
Q

PD complications

A

Depression, anxiety, hallucinations, and delusions

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35
Q

PD drugs increase dopamine levels

A

to improve motor symptoms

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36
Q

Increased dopamine supply results in

A

hallucinations/delusions

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37
Q

Most common neurodegenerative disease

A

Parkinson’s

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38
Q

PD drugs

A

COMT inhibitors and Monoamine Oxidase type B (MAO-B)

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39
Q

Dopamine Agonists

A

increased levels of dopamine to restore balance between ACh and dopamine action

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40
Q

Carbidopa/Levidopa

A

Sinemet, Rytary; 1st line treatment for PD patients older than 70 years

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41
Q

Parmipexole, roprinrol, and rotigotine

A

Mirapex, Mirapex ER, Requip, Neupro; 1st line treatment for PD patients between 50 and 70 years

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42
Q

Levodopa

A

is synthesized in the brain and converted to natural dopamine

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43
Q

COMT inhibitors

A

Entacapone (Comtan), tolcapone (Tasmar)

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44
Q

Selective MAO-B

A

breaks down dopamine; rasagiline (Azilect), safinamide (Xadago), selegiline (Eldepryl, Ensam, Zelapan)

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45
Q

Dyskinesia

A

involuntary muscle movements common in patients on long-term carbidopa/levidopa therapy

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46
Q

Delirium

A

psychosis and hallucinations, caused by dopamine agonists

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47
Q

Neuroleptic Malignant Syndrome

A

symptoms of agitation, coma, muscle rigidity, tremors, high fever, and an unstable BP

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48
Q

COMT and MAO-B inhibitors

A

added to the regimen of dopamine agonists, further complications of dopamine will preciptate

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49
Q

Take carbidopa/levidopa

A

on an empty stomach

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50
Q

Antihypertensive agents with dopamine agonists

A

can cause severe hypotension

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51
Q

Phenelzine (MAO inhibitors) with dopamine agonists

A

can cause hypertensive crisis

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52
Q

Iron decreases the effects of

A

carbidopa/levodopa

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53
Q

B6 increases metabolism of

A

levodopa

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54
Q

Reglan decreases effectiveness of

A

dopamine agonists

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55
Q

Dopamine agonists with sedatives

A

worsen drowsiness

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56
Q

Akinesia

A

loss of movement

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57
Q

Tardive Dyskinesia

A

abnormal and involuntary body movements

58
Q

Dystonia

A

impairment of muscle tone

59
Q

Monitor all patients closely for behaviors of

A

psychosis and depression

60
Q

COMT is metabolized by

A

the liver

61
Q

Epinephrine or methyldopa may increase

A

heart rate, dysrhythmias, BP

62
Q

MAO-Bs, selegiline and rasagililne are safe to take with

A

COMT drugs

63
Q

MAO-B inhibitors

A

an enzyme made in many body areas that breaks down many substances, neurotransmitters; suppresses the actions of MAO-B, allows dopamine levels to increase and decrease symptoms of PD

64
Q

Side effects of MAO-B inhibitors

A

dry mouth, nausea, constipation and lightheadedness. Confusion and hallucinations in older adults

65
Q

Tyramine rich foods

A

should be avoided e.g., avocados, aged cheese, beer, soy sauce, red wine, sauerkraut

66
Q

MAO-B drug interactions

A

opiates and methadone=hypertensive crisis
tricyclic antidepressants=hyperthermia, tremors, seizures, or delirium
amphetamines, decongestants and cough medicines=hypertensive crisis
ginseng, ephedra, ma huang, St Johns Wort= hypertensive crisis

67
Q

N-methyl-D-asparate (NMDA) blockers

A

Early onset of AD are memory issues, progressive diseases with memory problems, medication may offer a temporary improvement in symptoms

68
Q

Cholinesterase inhibitors

A

increased ACh levels, reduced ACh in AD, binds to ACh-esterase, delays memory loss, increases ADLs

69
Q

Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne)

A

cholinesterase inhibitor drugs

70
Q

Side effects of cholinesterase inhibitor drugs

A

Mild diarrhea, drowsiness, headache, loss of appetite, GI discomfort, joint pain, muscle cramping

71
Q

Adverse reactions of cholinesterase inhibitor drugs

A

Hallucinations, dysrhythmias, GI bleeding, infection, incontinence

72
Q

Cholinesterase drug interactions

A

Drugs that prolong the QT interval=torsade de pointes(ventricular tachycardia, fatal)

73
Q

Cholinesterase with dextromethorphan, quinidine, fluconazole and Tensilon

A

increase risk for adverse effects

74
Q

Before administering cholinesterase inhibitor drugs

A

obtain baseline weight, decreases appetite

75
Q

With cholinesterase inhibitor drugs, observe for

A

decrease in hematocrit and hemoglobin

76
Q

Monitor blood levels on cholinesterase drugs

A

BUN and liver function

77
Q

Alzheimer’s Disease Assessment Scale

A

cognitive testing for AD

78
Q

Take Donepezil (Aricept)

A

at bedtime

79
Q

Take galantamine (Razadyne) and rivastigamine (Exelon)

A

at the same time everyday, 2x daily with food

80
Q

NMDA

A

block entrance of calcium into neurons, Memantine (Namenda, Ebixa)
can be taken with Aricept, Exelon, and Razadyne to increase cholinergic agoinsts

81
Q

Side Effects of NMDA

A

Headaches, dizziness, constipation

82
Q

Adverse Reactions of NMDA

A

Somnolence, shortness of breath, incontinence, weight loss

83
Q

Drug Interactions with NMDA

A

drugs that increase urine pH, increase side effects/adverse reactions eg., carbonic anhydrase inhibitors (acetazolamide, quinidine, and dextromethorphan)

84
Q

Memantine increases risk for

A

renal impairment

85
Q

Obtain baseline before administering Memantine

A

creatine and BUN, liver enzymes

86
Q

UTIs can increase levels of

A

Memantine

87
Q

Monitor vitals for AD patients with

A

heart disease

88
Q

For AD patients, report

A

ataxia, dizziness

89
Q

Epilepsy

A

neurons of the brain become hyperexcitable, trigger electrical signals when not needed

90
Q

Seziures

A

body’s response to inappropriate brain signals

91
Q

Covulsion

A

sudden contraction of many muscle groups without conscious control

92
Q

Subtypes of seizures

A

partial or generalized

93
Q

Traditional AEDs

A

phenytoin, carbamazepine, ethosuximide, phenobarbital, and valproic acid

94
Q

Phenytoin

A

prevent the spread of neuron excitation by binding to sodium channels

95
Q

Phenytoin prodrug

A

Fosphenytoin (Cerebyx), converted to phenytoin in the body

96
Q

Carbamazepine

A

limits the spread of neuron excitation by altering sodium channels to prevent or slow refiring or neurons
controls epilepsy in children, mood stabilizer

97
Q

Ethosuximide

A

increases seizure threshold by altering calcium channels on the neuron membranes
for absent seizures, likely to cause birth defects

98
Q

Phenobarbital

A

barbituate class, increases seizure threshold, ehances action of GABA, CNS depression
oldest drug to control seizures, sedative agent, longest duration, not for absent seizures

99
Q

Phenobarbital can also be used short-term for

A

insomnia and anxiety

100
Q

Phenobarbital Prodrug

A

Primidone

101
Q

Valproic Acid

A

increases seizure threshold by increasing activity of GABA

combined with divalproex sodium to increased duration, decreases dosing frequency

102
Q

Side effects of Phenytoin

A

gum hyperplasia, abdominal discomfort

103
Q

Side effects of Carbamazepine

A

constipation, nausea, vomiting, ataxia, itching, burning, rash, muscle weakness

104
Q

Side effects of Ethosuximide

A

dyspepsia, nausea, vomiting, dizziness, drowsiness and fatigue

105
Q

Side effects of Phenobarbital and Primidone

A

drowsiness, ataxia, blurred vision, dizziness, mental status changes
-more apparent in the beginning of medication therapy

106
Q

Side effects of Valproic Acid

A

drowsiness, muscle weakness, nausea, diarrhea and menstural irregularities. Anorexia, double vision, blurred vision and sometimes insomnia

107
Q

Adverse reactions of Phenytoin

A

teratogen (birth defects), blood cell problems of anemia, decreased WBC counts, increased risk for infection

108
Q

Adverse reactions of Carbamazepine

A

Anemia, decreased WBC count, increased risk for infection, decreased platelet counts with increased risk for bleeding, tachycardia, A-fib, and severe hypertension

109
Q

Adverse reactions of Phenobarbital

A

severe CNS depression, can cause respiratory depression, bone marrow depression, cognitive impairment, exfoliative dermatitis, liver impairment and coma

110
Q

Adverse reactions of Valproic Acid

A

amnesia and heart rhythm irregularities, hearing loss and GI bleeding

111
Q

Drug interactions of traditional AEDs

A

Aspirin, acetaminophen, oral contraceptives, proton pump inhibitors, and drugs for diabetes
drugs used to manage psychiatric problems and warfarin

112
Q

Newer AEDs

A

Oxcarbazapine, Lamotrigine, Lacosamide, and Topiramate

113
Q

Adjuvant therapy

A

“added on” therapy

114
Q

Oxcarbazapine

A

blocks sodium channels increase seizure threshold, controls partial seizures

115
Q

Expected Side Effects/Adverse reactions of newer AEDs

A

Drowsiness, dizziness, headache, nausea
Double vision and blurred vision
Hyponatremia

116
Q

Drug interactions of newer AEDs

A

aspirin, acetaminophen, oral contraceptives, proton pump inhibitors, drugs for psychiatric problems, HIV and diabetes

117
Q

Lamotrigine

A

thought to block sodium channels on neuron membranes

partial seizures, tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome

118
Q

Side Effects of Lamotrigine

A

Drowsiness, abdominal pain, and usual disturbances
Ataxia, dry mouth, dizziness
-clearance rate is lower among black patients

119
Q

Adverse Reactions of Lamotrigine

A

Stevens-Johnson syndrome and toxic epidermal necrolysis
interacts with folic acid formation
not recommended during pregnancy

120
Q

Drug Interactions of Lamotrigine

A

Aspirin, acetaminophen, oral contraceptives, proton pump inhibitors, cardiac drugs, drugs for psychiatric problems, drugs for HIV disease, drugs for tuberculosis and drugs for diabetes

121
Q

Lamotrigine has 3 different

A

“starter kits”

122
Q

Lacosamide

A

amino acid with an unknown mechanism of action, appears to control seizures by acting at sodium channels

  • monotherapy
  • partial seizures
  • “add on” drug
123
Q

Side effects of Lacosamide

A

headaches, dizziness, blurred vision, fatigue, nausea and ataxia

124
Q

Adverse reactions of Lacosamide

A

due to euphoria, can cause psychological dependence

pain at injection site rapid lowering of blood pressure, and heart rhythm problems

125
Q

Drug interactions of Lacosamide

A

cardiac drugs, antihypertensive drugs, drugs f or psychiatric problems, drugs for HIV disease, antifungal drugs, and drugs for tuberculosis

126
Q

Before giving Lacosamide, assess patient’s

A

blood pressure, can cause severe hypotension

127
Q

Topiramate

A

appears to reduce seizures by preventing the spread of excitation in the brain

  • acts at sodium channels
  • enhances GABA
  • Monotherapy for partial seizures, tonic-clonic seizures and seizures associated with Lennox-Gaustaut syndrome
  • “add on” drug
128
Q

Side effects of Topiramate

A

abdominal pain, nausea, dizziness, drowsiness, fatigue, taste changes, anorexia, and paresthesias

129
Q

Adverse Reactions of Topiramate

A

memory impairment, electrolyte imbalances, decreases levels of phosphorus and calcium
metabolic problem, acidosis and elevated ammonia concentrations
encephalopathy from too high ammonia levels

130
Q

Unexplained lethargy, vomiting, changes in mental status, and low core body temperature manifest from

A

encephalopathy from toxic ammonia levels in blood

131
Q

Drug Interactions with Topiramate

A

Aspirin, acetaminophen, oral contraceptives, cardiac drugs, diuretics, antihypertensives, antifungals, drugs for psychiatric problems, drugs for HIV disease, drugs for tuberculosis, drugs that affect blood clotting, and drugs for diabetes

132
Q

MS

A

occurs 2x as often in women than men

133
Q

Corticosteroids for MS

A

may help symptoms, but do not alter the course of the disease

134
Q

Biological Response Modifiers (BRMs)

A

used to RRMS, modify the patient’s immune response to abnormal trigger for immunity, and inflammation

135
Q

Sub Q Beta inferon:

A

Avonex, Betaseron, Extaria, Plegridy, Rebif, glatiramer(Copaxone, Glatopa)

136
Q

Oral Beta inferon:

A

Fingolimod (Gilenya), teriflunomide (Aubagio)

137
Q

Monoclonal Antibodies for MS

A

antibodies attack and inactivate or destroy lymphocytes that destroy myelin or that produce cytokines that trigger the immune system to destroy myelin

  • risk for infection, increase in WBCs
  • Given on IV infusions
138
Q

Specific Neurologic Drugs for MS

A 
Dimethyl fumarate (Tecfidera) and dalfaprimide (Ampyra)
-must be taken daily
139
Q

Tecfidera

A

reduces inflammation in the CNS

140
Q

Ampyra

A

blocks potassium channels in affected nerves

141
Q

What vitamin should you avoid while taking Antiparkinsonian agents?

A

B6, pyroxamine

Pharmacology (10 decks)

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