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Pharm- Exam 3 Dashaye > CNS > Flashcards

CNS Flashcards

1
Q

what is the prototype for barbiturates?

A

Phenobarbital

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2
Q

what is the purpose for phenobarbital

A

Sedatives
Stop seizure activity

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3
Q

What is the routes for Phenobarbital?

A

Po.IM,IV

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4
Q

What is the moa for phenobarbital?

A

Stimulate the inhibitory neurotransmitter gamma-aminobutyric acid (GABA)

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5
Q

Who should be considered when giving phenobarbital?

A

Do not use < 1month of age
Harmful to fetus during pregnancy
Avoid use in geriatric population

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6
Q

What should the pt. be taught who is on barbiturates?

A

Do not discontinue abruptly
CNS depressants can enhance depression
OCP- estrogen-containing may be ineffective

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7
Q

What are the adverse effects of phenobarbital?

A

Addiction
Suicidal thoughts
GI upset
Rashes
OD
Respiratory depression

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8
Q

what are benzodiazepines used for?

A

*Anxiety
* Sedative
* Stop seizure activity
* Insomnia
* Pre-anesthetic

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9
Q

What is the prototype for benzodiazepines?

A

Lorazepam

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10
Q

What is moa for lorazepam?

A

Bind to specific neurotransmitter gamma-aminobutyric acid (GABA) to potentiate GABA

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11
Q

What are the routes for lorazepam?

A

PO,IM,IV,PR

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12
Q

What reaction can occur in children and the elderly if lorazepam is taken? what impairment occurs with the medication?

A

Paradoxical reactions in children and elderly
Hepatic impairment

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13
Q

What should you teach a pt on lorazepam?

A

Coordination may be impaired
Assistance to get OOB
No alcohol for 24-48 hours

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14
Q

What is the black box warning for benzodiazepines?

A

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma and death

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15
Q

What are the adverse effects of Lorazepam?

A

IV- resp depression
* PO- sedation, drowsiness, resp depression (dose-dependent, hypotension, and unsteadiness
* Addiction
* OD- CNS depression

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16
Q

What is a CNS stimulant used for?

A

ADHD

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17
Q

What is the prototype for cns stimulants?

A

Methylphenidate

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18
Q

what is the MOA for a cns stimulant

A

Stimulates brain. Thought to block the reuptake of norepinephrine and dopamine into presynaptic neuron

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19
Q

How old should you be when taking methylphenidate?

A

Over 6 years of age

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20
Q

What is contraindicated with methylphenidate?

A

MAOIs

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21
Q

What should the pt be taught who is on cnc stimulants

A

CV risks
Increase in BP and heart rate
Psychotic or manic symptoms
Avoid alcohol

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22
Q

What does a CNS help to do?

A

Improve focus

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23
Q

What are some adverse effects of methylphenidate?

A

Growth suppression
insomnia
headache
abdominal pain
Raynaud’s
priapism
gynecomastia

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24
Q

What is another name for the prototype phenytoin?

A

Dilantin

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25
Q

What is Dilantin used for?

A

Seizures
* Tonic clonic
* Psychomotor (temporal lobe)
* After neuro surgery

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26
Q

what is the route for Dilantin?

A

PO

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27
Q

What is the MOA for phenytoin

A

Interferes with sodium channels in the brain causing a reduction of sustained high-frequency neuronal discharges

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28
Q

what should be considered with this medication?

A

Fetus Harm
narrow therapeutic drug level
hepatic and renal impairment
elderly
pt. with heart block

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29
Q

what is some pt education for Dilantin?

A

May take weeks for desired effect* Do not stop abruptly* Avoid other CNS depressants* Monitor glucose in diabetics

30
Q

what should you monitor when on Dilantin?

A

Cardiac

31
Q

Adverse effects of Dilantin?

A

High levels can cause confusion, delirium, psychosis orencephalopathy* Dermatological reactions (severe

32
Q

What is the black box warning on Dilantin?

A

When giving IV do not exceed 50mg/min in adults and 1-3 mg/kg/min in peds. May cause severe hypotension and cardiac arrhythmia.

33
Q

What is levetiracetam used for ?

A

Seizures
* Partial seizures
Decrease seizure activity

34
Q

what is the MOA for levetiracetam?

A

UNKONWN

35
Q

What are some considerations for levetiracetam?

A

12 years of age or older* Monitor plasma levels in pregnancy* Immediate release solution can be used after 1month of age* Renal impairment

36
Q

What should the pt be taught while on levetiracetam?

A

Monitor for suicidality* Do not stop abruptly

37
Q

What are some adverse effects for levetiracetam?

A
  • Behavioral abnormalities: psychotic symptoms, suicidal ideation, irritability, aggressive behavior* Somnolence* Irritability* Anaphylaxis* Steven-Johnson Syndrome
38
Q

What is gabapentin used for?

A

Seizures
* Partial seizures
Neuropathic pain

39
Q

Gabapentin MOA?

A

Unknown

40
Q

What is gabapentin Route?

A

PO

41
Q

what pt. should you consider when giving gabapentin?

A

Elderly
Fetus during pregnacy (harmful)
Pts. 3-12 can have cns adverse effects

42
Q

What should pt. know who is taking gabapentin?

A

Do not take antacids within 2 hours* Sedation* Suicidality* Do not stop abruptly

43
Q

What are some adverse effects when taking gabapentin?

A

*Behavioral abnormalities: psychotic symptoms, suicidal ideation, irritability, aggressive behavior
* Somnolence
* Irritability

44
Q

Carbidopa/Levodopa is apart of what classification?

A

Antiparkinson

45
Q

What is levodopa and carbidopa used for?

A

Parkinson’s Disease* Restless leg syndrome

46
Q

What is the purpose of carbidopa/levodopa?

A

Carbidopa prevents levodopa from being broken downbefore crossing the BBB and then it can covert todopamine in brain.

47
Q

What are some things to consider when giving carbidopa/levodopa?

A

for pt 18 and over
contraindicated with MAOIs
can fall asleep during task
high protein diet lowers absorption

48
Q

what should the pt know about carbidopa and levodopa?

A

Do not take antacids within 2 hours* Sedation* Suicidality* Do not stop abruptly

49
Q

True or false
Carbidopa and levodopa make the progression of symptoms faster.

A

False
Slow progression of symptoms

50
Q

What are some adverse effects of carbidopa and levodopa?

A

Neuroleptic malignant syndrome (NMS)* Hallucinations* Psychotic behavior* Intense gambling & sexual urges and to spend money, binge eat

51
Q

A person taking carbidopa and levodopa is at risk for what?

A

Melanoma

52
Q

the prototype selegiline is for what indication?

A

Parkinson’s disease

53
Q

what is the route for selegiline?

A

PO

54
Q

what is selegiline MOA?

A

Blocks the breakdown of dopamine by inhibiting MAO-B

55
Q

What can large doses of selegiline do?

A

Large doses may inhibit MAO-A (metabolism of tyramine in the GItract)

56
Q

what should a patient on selegiline be taught?

A

Dietary Restrictions

57
Q

What are some side effects of selegiline?

A

Dose dependent* Large doses may cause a hypertensive crisis if consuming food with tyramine* Drowsiness* Orthostatic changes* Hallucinations* Sudden urge

58
Q

What are the indications of Amantadine?

A

Parkinson’s Disease Medication induced extrapyramidal symptoms* Influenza A

59
Q

What is the route for amantadine?

A

PO

60
Q

what is the MOA for amantadine?

A

Unknown but it is an antiviral drug that acts on dopamine receptors

61
Q

What is important to consider for amantadine?

A

renal impairment and suicidal ideations

62
Q

When taking amantadine what should the pt be educated on?

A

Do not use with CNS depressants Do not take OTC cold medications* Worsening depression

63
Q

What are some adverse effects of amantadine?

A

Parkinson crisis
heart failure
peripheral edema
impaired thinking

64
Q

What is the prototype for cholinesterase inhibitors?

A

Donepezil(aricept)

65
Q

What are the indications for donepezil?

A

Mild to moderate and severe dementia

66
Q

What is the route for Aricept?

A

PO

67
Q

What is the MOA for Donepezil?

A

Prevent the breakdown of acetylcholine by acetylcholinesterase (AChE) and increases the availability of acetylcholine at cholinergic synapses

68
Q

Who benefits from Donepezil?

A

*1 in 12 patients benefit
* Benefits are modest and only last a short time

69
Q

Patient education for donepezil?

A

NVD
Dizziness and headache

70
Q

What is important about administration of donepezil?

A

Drug Interactions
* Anticholinergics
* 1st generation antihistamines
* Tricyclic antidepressants

71
Q

What does donepezil help with?

A

improvement in cognitive function

72
Q

Adverse effects of Donepezil?

A

Bronchoconstriction
Bradycardia

Pharm- Exam 3 Dashaye (4 decks)

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