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CNS Flashcards

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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
Q

Tardive Dyskinesia

A
  • AE of antipsychotics
  • involuntary contraction of oral and facial muscles
  • wavelike movements of extremities
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26
Q

Neuroleptic Malignant Syndrome (NMS)

A
  • AE of antipsychotics
  • life-threatening
  • high fever
  • unstable BP
  • myoglobinemia (myoglobin in blood)
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27
Q

Extrapyramidial symptoms

A
  • 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)
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28
Q

GABA

A
  • 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
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29
Q

Seizure

A
  • episode of abnormal electrical activity in brain
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30
Q

Convulsion

A
  • involuntary spasmodic contractions (any muscles in body)
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31
Q

Epilepsy

A
  • chronic recurring pattern of seizures
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32
Q

Seizure disorder

A
  • not always epilepsy
  • may be caused by trauma, poisoning, fever, withdrawal, etc.
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33
Q

Status epilepticus

A
  • multiple seizure with no recovery in between
  • results in hypotension, brain damage, death
  • can be caused by an abrupt discontinuation of anticonvulsants
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34
Q

Antiepileptics

A
  • aka anticonvulsants
  • control or prevent seizures
  • minimize AE and drug induced toxicity
  • lifelong therapy
  • may be a combination of drugs
  • serum must be measured
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35
Q

Serum concentrations of antiepileptics

A
  • 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
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36
Q

Antiepileptic AE

A
  • necessitate a med change
  • long-term phenytoin may cause ginivial hyperplasia (skin grows over teeth), acne, hirsutism, Dilantin facies (skin thickens)
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37
Q

Antiepileptic contraindications

A
  • birth control
  • Carbamazepine: avoid grapefruit
38
Q

DRESS

A
  • Drug Reaction with Eosiniphilia and Systemic Symptoms
  • rash
  • fever
  • eosiniphilia
  • seen with antiepileptics
39
Q

Phenytoin (Dilantin) drug class and nursing implications

A
  • antiepileptic
  • IV administration:
    slow through large-gauge catheter
    diluted in NS
    filter
    saline flush
    stop if rash (DRESS)
40
Q

Levetiracetam (Keppra) drug class and nursing implications

A
  • antiepileptic
  • adjunct for partial seizures
  • CNS AE but generally fine
  • no interactions
41
Q

Nursing Implications of antiepileptics

A
  • 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
Q

Anti-parkinson drugs

A
  • drugs that stimulat substantia nigra to increase dopamine and inhibit acetylcholine
43
Q

Carbidopa/Levodopa (Sinemet)

A
  • for parkinson’s
  • crosses BBB
  • converted into dopamine in brain
  • Carbidopa helps prevent breakdown of Levodopa
44
Q

Carbidopa/Levodopa AE

A
  • Neuroleptic malignant syndrome
  • dyskinesia
  • depression
  • suicidal ideation
  • hallucinations
  • intense urges
45
Q

Selegiline (Eldepryl, Emsam, Zelapar) drug class and MOA

A
  • Anti-Parkinson Drugs
  • block breakdown of dopamine
46
Q

Selegiline AE

A
  • hypertn crisis in foods high in tyramine
    (aged cheese, meats, overripe bananas, avacados, fermented soy like miso)
47
Q

Amantadine (Symmetrel) drug class and effects

A
  • Anti-Parkinson’s
  • reduces tremors
  • reduces muscle rigidity
48
Q

Amantadine AE

A
  • CHF
  • peripheral edema
  • suicidal ideation
  • incontrollable, intense urges
49
Q
  • acute seizures
  • alcohol withdrawal
  • agitation
  • moderate/conscious sedation
A

Benzodiazepines indications

50
Q
  • sedative-hypnotic or anxiolytic
  • long-acting
  • intermediate-acting
  • short-acting
A

Benzo types

51
Q
  • depress CNS
  • affect hypo/thalamicm limbic systems
  • Benzo receptors (GABA)
  • Don’t suppress REM as much
  • Don’t increase metabolism of drugs
A

Benzos MOA

52
Q
  • NA glaucoma
  • pregnancy
A

Benzos contraindications

53
Q
  • HA
  • drowsiness
  • dizziness/vertigo
  • cognitive impairment
  • lethargy
  • fall hazard (older pt)
  • REM rebound
  • hangover effect
    (these are mild and infrequent)
A

Benzos AE

54
Q
  • Somnolence (extremely tired)
  • Confusion
  • Coma
  • decreased reflexes
  • w/other CNS depressants: hypotn and resp depress
  • symptomatic/supportive treatment
  • antidote: Flumazenil
A

Benzos toxicity/OD

55
Q
  • Amphetamines (Dextroamphetamine aka Adderall)
  • Serotonin agonists (Sumatriptan for migraines)
  • Sympathomimetics (stim adrenergic receptors)
  • Xanthines (caffeine)
A

Classifications of stimulants

56
Q
  • anti-ADD
  • antinarcoleptic
  • anorexiant
  • antimigraine
A

CNS stimulants therapeutic uses

57
Q
  • CNS stimulats b/c they increase NT like dopamine, serotonin, epi
  • Amphetamines: methylphenidate (Ritalin) and dextroamphetamine (Adderall)
  • Nonamphetamines: modafinil (Provigil)
A

Drugs for ADHD

58
Q
  • adjunct for schizophrenia
  • eating disorders
  • personality d/o
  • migraines
  • chronic pain/sleep d/o
  • premenstrual syndrome (PMS)
  • hot flashes (menopause)
A

Misc indications for antidepressants

59
Q
  • sedation
  • impotence
  • ortho hypo
  • in older pt: dizziness, constipation, delayed micturition, edema, muscle tremors
A

TCA AE

60
Q
  • 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
A

Antipsychotics

61
Q
  • AE of antipsychotics
  • involuntary contraction of oral and facial muscles
  • wavelike movements of extremities
A

Tardive Dyskinesia

62
Q
  • AE of antipsychotics
  • life-threatening
  • high fever
  • unstable BP
  • myoglobinemia (myoglobin in blood)
A

Neuroleptic Malignant Syndrome (NMS)

63
Q
  • 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)
A

Extrapyramidial symptoms

64
Q
  • episode of abnormal electrical activity in brain
A

Seizure

65
Q
  • involuntary spasmodic contractions (any muscles in body)
A

Convulsion

66
Q
  • chronic recurring pattern of seizures
A

Epilepsy

67
Q
  • not always epilepsy
  • may be caused by trauma, poisoning, fever, withdrawal, etc.
A

Seizure disorder

68
Q
  • multiple seizure with no recovery in between
  • results in hypotension, brain damage, death
  • can be caused by an abrupt discontinuation of anticonvulsants
A

Status epilepticus

69
Q
  • aka anticonvulsants
  • control or prevent seizures
  • minimize AE and drug induced toxicity
  • lifelong therapy
  • may be a combination of drugs
  • serum must be measured
A

Antiepileptics

70
Q
  • 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
A

Serum concentrations of antiepileptics

71
Q
  • necessitate a med change
  • long-term phenytoin may cause ginivial hyperplasia (skin grows over teeth), acne, hirsutism, Dilantin facies (skin thickens)
A

Antiepileptic AE

72
Q
  • birth control
  • Carbamazepine: avoid grapefruit
A

Antiepileptic contraindications

73
Q
  • antiepileptic
  • IV administration:
    slow through large-gauge catheter
    diluted in NS
    filter
    saline flush
    stop if rash (DRESS)
A

Phenytoin (Dilantin)

74
Q
  • antiepileptic
  • adjunct for partial seizures
  • CNS AE but generally fine
  • no interactions
A

Levetiracetam (Keppra) drug class and nursing implications

75
Q
  • 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
A

Nursing Implications of antiepileptics

76
Q
  • for parkinson’s
  • crosses BBB
  • converted into dopamine in brain
  • (1) helps prevent breakdown of (2)
A

Carbidopa/Levodopa (Sinemet)

77
Q
  • Neuroleptic malignant syndrome
  • dyskinesia
  • depression
  • suicidal ideation
  • hallucinations
  • intense urges
A

Carbidopa/Levodopa AE

78
Q
  • Anti-Parkinson Drugs
  • block breakdown of dopamine
A

Selegiline (Eldepryl, Emsam, Zelapar) drug class and MOA

79
Q
  • hypertn crisis in foods high in tyramine
    (aged cheese, meats, overripe bananas, avacados, fermented soy like miso)
A

Selegiline AE

80
Q
  • Anti-Parkinson’s
  • reduces tremors
  • reduces muscle rigidity
A

Amantadine (Symmetrel) drug class and effects

81
Q
  • CHF
  • peripheral edema
  • suicidal ideation
  • incontrollable, intense urges
A

Amantadine AE

82
Q

Haloperidol (Haldol) drug classes and uses

A
  • antipsychotic
  • for Tourette’s and schizophrenia
83
Q

Risperidone (Risperdal) drug class and effects

A
  • antipsychotic
  • for schizo, acute manic episodes, and irritability in autism
84
Q

Carbamazepine drug class

A
  • antiepileptic
85
Q

Alprazolam (Xanax)

A
  • used as an anxiolytic
  • GAD, panic disorder, anxiety w/ depression
  • AE: confusion, ataxia, headache
  • Interactions: alcohol and contraceptives

Intermediate-acting benzo

86
Q

Diazepam (Valium)

A
  • 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
Q

Lorazepam (Ativan)

A
  • can be given IV push for an agitated pt
  • continuous for agitated pt w/ mechanical ventilation
  • treat/prevent alcohol withdrawal

Intermediate-acting benzo

88
Q

Eszopiclone (Lunesta)

A
  • hypnotic
  • FDA approved for long term use
  • 8 hours of sleep

short/intermediate-acting NONbenzo

89
Q

Zolpidem (Ambien)

A
  • lower incidence of daytime sleepiness compared to benzos

short-acting NONbenzo

90
Q

Amphetamines contraindications

A
  • recent use of an MAOI
  • CV structural abnormalities

Pharm 4 (4 decks)

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