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CNS Flashcards

1
Q

cognitive symptoms

A

difficulty w/ attention and applying information to make decisions

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2
Q

blood-brain barrier

A
  • lipid drugs can pass
  • water-soluble can’t pass very easily
  • not fully present at birth
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3
Q

barbiturates safety concerns

A
  • habit-forming
  • low therapeutic index
  • benzodiazepines are more commonly used because they are safer and more effective
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4
Q

barbiturates drug effects

A

dose-dependent!
- low: sedative
- high: hypnotic, lower RR
- enzyme inducer (metabolism of other drugs)

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5
Q

barbiturates increased metabolism of…

A
  • C hloramphenicol
  • WA rfarin
  • S teroids
  • T olbutamide & Theophylline
  • G riseofulvin
    (Cause WASTaGe)
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6
Q

Barbiturates SE

A
  • A taxia
  • B ehavioural disturbance
  • C oma & decreased Concentration
  • D epression, Drowsiness, Diplopia
    (ABCD)
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7
Q

Barbiturates AE

A
  • CV: vasodil, hypotn
  • CNS: drowsiness, lethargy, vertigo
  • Resp: depression, cough
  • MS: ataxia
  • GI: N/V, constipation
  • Hem: thrombocytopenia, agranulocytosis
  • Neuro: decreased REM
  • SJS
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8
Q

Barbiturate Toxicity/OD

A
  • resp depression/arrest
  • CNS depression: coma/death
  • treated symptomatically but not reversible (oxygenation, fluids, charcoal)
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9
Q

High (near toxic) doses of barbiturates used for

A
  • induced coma
  • anesthesia induction
  • uncontrollable seizures
  • must be in a controlled environment
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10
Q

OTC Hypnotics

A
  • sleep aids contain antihistamines (CNS depressant)
  • Doxylamine (unisom)
  • Diphenhydramine (Sominex)
  • Acetaminophen/Diphenhydramine (Extra Strength Tylenol PM
  • ZQuil
  • use w/ alcohol can be fatal (resp depress)
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11
Q

Benzodiazepines indications

A
  • acute seizures
  • alcohol withdrawal
  • agitation
  • moderate/conscious sedation
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12
Q

Benzos MOA

A
  • depress CNS
  • affect hypo/thalamicm limbic systems
  • Benzo receptors (GABA)
  • Don’t suppress REM as much
  • Don’t increase metabolism of drugs
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13
Q

Benzos contraindications

A
  • NA glaucoma
  • pregnancy
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14
Q

Benzos AE

A
  • HA
  • drowsiness
  • dizziness/vertigo
  • cognitive impairment
  • lethargy
  • fall hazard (older pt)
  • REM rebound
  • hangover effect
    (these are mild and infrequent)
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15
Q

Benzos toxicity/OD

A
  • Somnolence (extremely tired)
  • Confusion
  • Coma
  • decreased reflexes
  • w/other CNS depressants: hypotn and resp depress
  • symptomatic/supportive treatment
  • antidote: Flumazenil
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16
Q

Classifications of stimulants

A
  • Amphetamines (i.e. Adderall)
  • Serotonin agonists (Sumatriptan for migraines)
  • Sympathomimetics (stim adrenergic receptors)
  • Xanthines (caffeine)
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17
Q

CNS stimulants therapeutic uses

A
  • anti-ADD
  • antinarcoleptic
  • anorexiant
  • antimigraine
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18
Q

Drugs for ADHD

A
  • CNS stimulats b/c they increase NT like dopamine, serotonin, epi
  • Amphetamines: methylphenidate (Ritalin) and dextroamphetamine (Adderall)
  • Nonamphetamines: modafinil (Provigil)
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19
Q

Misc indications for antidepressants

A
  • adjunct for schizophrenia
  • eating disorders
  • personality d/o
  • migraines
  • chronic pain/sleep d/o
  • premenstrual syndrome (PMS)
  • hot flashes (menopause)
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20
Q

types of antidepressants

A
  • Monoamine oxidase inhibitor (MAOI)
  • Selective Srotonin Reuptake Inhibitors (SSRI)
  • Serotonin-norepi reuptake inhibitors (SNRI)
    (others are SARI, NDRI, alpha2 adrenoreceptor antagonist)
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21
Q

Tricyclin Antidepressant

A
  • TCAs
  • second line (behind SSRIs)
  • adjunct therapy with other antidepressants
  • Amitriptyline
  • Block reuptake of NT, so they accumulate
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22
Q

TCA AE

A
  • sedation
  • impotence
  • ortho hypo
  • in older pt: dizziness, constipation, delayed micturition, edema, muscle tremors
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23
Q

Antimania drugs

A
  • mood stabiliziers
  • Lithium was the 1st
  • contraindicated in renal/CV dz, dehydration, Na depletion, diuretics (risk of toxicity)
  • serum range of lithium 0.8-1.2
  • lithium toxicity. (1.5)
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24
Q

Antipsychotics

A
  • Haloperidol (Haldol) for Tourette’s and schizo
  • Haldol contraindicated in Parkinson’s, dementia with Lewy bodies (d/t blocking of dopamine receptors)
  • Risperidone (Risperdal) for schizo, acute manic episodes, and irritability in autism
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25
Tardive Dyskinesia
- AE of antipsychotics - involuntary contraction of oral and facial muscles - wavelike movements of extremities
26
Neuroleptic Malignant Syndrome (NMS)
- AE of antipsychotics - life-threatening - high fever - unstable BP - myoglobinemia (myoglobin in blood)
27
Extrapyramidial symptoms
- AE of antipsychotics - involuntary motor symptoms similar to in Parkinson's - akathisia (distressing motor restlessness) - acute dystonia (painful muscle spasms) - treated w/ anticholinergic meds (benzotropine and trihexyphenidyl)
28
GABA
- Gamma aminobutyric acid - amino acid/NT in brain - inhibitory - reduce neuron excitability in NS - some antiseizure drugs enhance this effect - Gabapentin is anticonvulsant and treats nerve pain
29
Seizure
- episode of abnormal electrical activity in brain
30
Convulsion
- involuntary spasmodic contractions (any muscles in body)
31
Epilepsy
- chronic recurring pattern of seizures
32
Seizure disorder
- not always epilepsy - may be caused by trauma, poisoning, fever, withdrawal, etc.
33
Status epilepticus
- multiple seizure with no recovery in between - results in hypotension, brain damage, death - can be caused by an abrupt discontinuation of anticonvulsants
34
Antiepileptics
- aka anticonvulsants - control or prevent seizures - minimize AE and drug induced toxicity - lifelong therapy - may be a combination of drugs - serum must be measured
35
Serum concentrations of antiepileptics
- concentrations of phenytoin, phenobarbital, carbamazepine, levetiracetamm, primadone correlate with seizure control and toxicity - concentrations of valproic acid, ethosuximide, and clonazepam do not correlate as well
36
Antiepileptic AE
- necessitate a med change - long-term phenytoin may cause ginivial hyperplasia (skin grows over teeth), acne, hirsutism, Dilantin facies (skin thickens)
37
Antiepileptic contraindications
- birth control - Carbamazepine: avoid grapefruit
38
DRESS
- Drug Reaction with Eosiniphilia and Systemic Symptoms - rash - fever - eosiniphilia - seen with antiepileptics
39
Phenytoin (Dilantin) drug class and nursing implications
- antiepileptic - IV administration: slow through large-gauge catheter diluted in NS filter saline flush stop if rash (DRESS)
40
Levetiracetam (Keppra) drug class and nursing implications
- antiepileptic - adjunct for partial seizures - CNS AE but generally fine - no interactions
41
Nursing Implications of antiepileptics
- health history and current drugs - liver function study (they are metabolized in liver) - CBC - baseline vitals - pt monitor response to drug, occurance of seizures, AE - wear medical alert tag - don't discontinue abruptly (status epilepticus) - driving recommendations
42
Anti-parkinson drugs
- drugs that stimulat substantia nigra to increase dopamine and inhibit acetylcholine
43
Carbidopa/Levodopa (Sinemet)
- for parkinson's - crosses BBB - converted into dopamine in brain - Carbidopa helps prevent breakdown of Levodopa
44
Carbidopa/Levodopa AE
- Neuroleptic malignant syndrome - dyskinesia - depression - suicidal ideation - hallucinations - intense urges
45
Selegiline (Eldepryl, Emsam, Zelapar) drug class and MOA
- Anti-Parkinson Drugs - block breakdown of dopamine
46
Selegiline AE
- hypertn crisis in foods high in tyramine (aged cheese, meats, overripe bananas, avacados, fermented soy like miso)
47
Amantadine (Symmetrel) drug class and effects
- Anti-Parkinson's - reduces tremors - reduces muscle rigidity
48
Amantadine AE
- CHF - peripheral edema - suicidal ideation - incontrollable, intense urges
49
- acute seizures - alcohol withdrawal - agitation - moderate/conscious sedation
Benzodiazepines indications
50
- sedative-hypnotic or anxiolytic - long-acting - intermediate-acting - short-acting
Benzo types
51
- depress CNS - affect hypo/thalamicm limbic systems - Benzo receptors (GABA) - Don't suppress REM as much - Don't increase metabolism of drugs
Benzos MOA
52
- NA glaucoma - pregnancy
Benzos contraindications
53
- HA - drowsiness - dizziness/vertigo - cognitive impairment - lethargy - fall hazard (older pt) - REM rebound - hangover effect (these are mild and infrequent)
Benzos AE
54
- Somnolence (extremely tired) - Confusion - Coma - decreased reflexes - w/other CNS depressants: hypotn and resp depress - symptomatic/supportive treatment - antidote: Flumazenil
Benzos toxicity/OD
55
- Amphetamines (Dextroamphetamine aka Adderall) - Serotonin agonists (Sumatriptan for migraines) - Sympathomimetics (stim adrenergic receptors) - Xanthines (caffeine)
Classifications of stimulants
56
- anti-ADD - antinarcoleptic - anorexiant - antimigraine
CNS stimulants therapeutic uses
57
- CNS stimulats b/c they increase NT like dopamine, serotonin, epi - Amphetamines: methylphenidate (Ritalin) and dextroamphetamine (Adderall) - Nonamphetamines: modafinil (Provigil)
Drugs for ADHD
58
- adjunct for schizophrenia - eating disorders - personality d/o - migraines - chronic pain/sleep d/o - premenstrual syndrome (PMS) - hot flashes (menopause)
Misc indications for antidepressants
59
- sedation - impotence - ortho hypo - in older pt: dizziness, constipation, delayed micturition, edema, muscle tremors
TCA AE
60
- Haloperidol (Haldol) for Tourette's and schizo - Haldol contraindicated in Parkinson's, dementia with Lewy bodies (d/t blocking of dopamine receptors) - Risperidone (Risperdal) for schizo, acute manic episodes, and irritability in autism
Antipsychotics
61
- AE of antipsychotics - involuntary contraction of oral and facial muscles - wavelike movements of extremities
Tardive Dyskinesia
62
- AE of antipsychotics - life-threatening - high fever - unstable BP - myoglobinemia (myoglobin in blood)
Neuroleptic Malignant Syndrome (NMS)
63
- AE of antipsychotics - involuntary motor symptoms similar to in Parkinson's - akathisia (distressing motor restlessness) - acute dystonia (painful muscle spasms) - treated w/ anticholinergic meds (benzotropine and trihexyphenidyl)
Extrapyramidial symptoms
64
- episode of abnormal electrical activity in brain
Seizure
65
- involuntary spasmodic contractions (any muscles in body)
Convulsion
66
- chronic recurring pattern of seizures
Epilepsy
67
- not always epilepsy - may be caused by trauma, poisoning, fever, withdrawal, etc.
Seizure disorder
68
- multiple seizure with no recovery in between - results in hypotension, brain damage, death - can be caused by an abrupt discontinuation of anticonvulsants
Status epilepticus
69
- aka anticonvulsants - control or prevent seizures - minimize AE and drug induced toxicity - lifelong therapy - may be a combination of drugs - serum must be measured
Antiepileptics
70
- concentrations of phenytoin, phenobarbital, carbamazepine, levetiracetam, primadone correlate with seizure control and toxicity - concentrations of valproic acid, ethosuximide, and clonazepam do not correlate as well
Serum concentrations of antiepileptics
71
- necessitate a med change - long-term phenytoin may cause ginivial hyperplasia (skin grows over teeth), acne, hirsutism, Dilantin facies (skin thickens)
Antiepileptic AE
72
- birth control - Carbamazepine: avoid grapefruit
Antiepileptic contraindications
73
- antiepileptic - IV administration: slow through large-gauge catheter diluted in NS filter saline flush stop if rash (DRESS)
Phenytoin (Dilantin)
74
- antiepileptic - adjunct for partial seizures - CNS AE but generally fine - no interactions
Levetiracetam (Keppra) drug class and nursing implications
75
- health history and current drugs - liver function study (they are metabolized in liver) - CBC - baseline vitals - pt monitor response tod drug, occurance of seizures, AE - wear medical alert tag - don't discontinue abruptly (status epilepticus) - driving recommendations
Nursing Implications of antiepileptics
76
- for parkinson's - crosses BBB - converted into dopamine in brain - (1) helps prevent breakdown of (2)
Carbidopa/Levodopa (Sinemet)
77
- Neuroleptic malignant syndrome - dyskinesia - depression - suicidal ideation - hallucinations - intense urges
Carbidopa/Levodopa AE
78
- Anti-Parkinson Drugs - block breakdown of dopamine
Selegiline (Eldepryl, Emsam, Zelapar) drug class and MOA
79
- hypertn crisis in foods high in tyramine (aged cheese, meats, overripe bananas, avacados, fermented soy like miso)
Selegiline AE
80
- Anti-Parkinson's - reduces tremors - reduces muscle rigidity
Amantadine (Symmetrel) drug class and effects
81
- CHF - peripheral edema - suicidal ideation - incontrollable, intense urges
Amantadine AE
82
Haloperidol (Haldol) drug classes and uses
- antipsychotic - for Tourette's and schizophrenia
83
Risperidone (Risperdal) drug class and effects
- antipsychotic - for schizo, acute manic episodes, and irritability in autism
84
Carbamazepine drug class
- antiepileptic
85
Alprazolam (Xanax)
- used as an anxiolytic - GAD, panic disorder, anxiety w/ depression - AE: confusion, ataxia, headache - Interactions: alcohol and contraceptives | Intermediate-acting benzo
86
Diazepam (Valium)
- anxiety - alcohol withdrawal - status epilepticus - preop sedation - adjunct for muscle spasms - Contraindications: hepatic dysfunction - AE: headache, confusion, slurred speech - Interactions: alcohol and contraceptives | Long-acting benzo
87
Lorazepam (Ativan)
- can be given IV push for an agitated pt - continuous for agitated pt w/ mechanical ventilation - treat/prevent alcohol withdrawal | Intermediate-acting benzo
88
Eszopiclone (Lunesta)
- hypnotic - FDA approved for long term use - 8 hours of sleep | short/intermediate-acting NONbenzo
89
Zolpidem (Ambien)
- lower incidence of daytime sleepiness compared to benzos | short-acting NONbenzo
90
Amphetamines contraindications
- recent use of an MAOI - CV structural abnormalities

Pharm 4 (4 decks)

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