CNS Flashcards
Caffeine MOA
reversible blockade of adenosine receptors
Caffeine use
neonatal apnea, wakefulness
Caffeine adverse effects
palpitations, dizziness, vasodilation, bronchodilation, diuresis, insomnia
Caffeine implications
Other CNS stimulants
- methylphenidate
- dextroamphetamine
- amphetamine
Neostigmine & Pyridostigmine MOA
prevent ach inactivation = increased mm strength
Neostigmine & Pyridostigmine class
cholinesterase inhibitor
Neostigmine & Pyridostigmine use
myasthenia gravis (ptosis, difficulty swallowing, weak mm)
Neostigmine & Pyridostigmine adverse effects
SLUDGE and the Killer B’s
- salivation, lacrimation, urination, diaphoresis/diarrhea, GI cramping, emesis, bradycardia, bronchospasms
DUMBELS
- diaphoresis/diarrhea, urination, miosis, bradycardia, bronchospasm, bronchorrhea, emesis, lacrimation
Parkinson’s disease 2 drug categories
Dopaminergic agents + anticholinergic agents
Dopaminergic agents MOA
stimulate dopamine by activating dopamine receptors
Anticholinergic agents MOA
stops excess ach by preventing activation of cholinergic receptors or blockage of muscarinic receptors
Levodopa MOA
promotes dopamine synthesis
Carbidopa MOA
helps decrease peripheral degradation and allows levodopa to cross BBB
Levodopa/Carbidopa use
parkinson’s disease
- treatment of choice
- levodopa 1st choice for younger patients
- “on/off” phenomenon common
Levodopa/carbidopa adverse effects
GI: n/v, dark sweat + urine
Neuro: drowsy, dyskinesia
CV: postural hypotension, dysrhythmias
Psychosis: hallucinations
- Clozapine can reduce
Levodopa/carbidopa interactions
B6 enhances destruction of levodopa
Levodopa/carbidopa implications
- take w/food to decrease n/v
- avoid high-protein food
- administer w/o food if possible
- benefits may take weeks-months
- educate on “on-off”
- must taper off
Amantadine MOA
dopamine agonist, promotes dopamine release and prevents reuptake
Amantadine use
parkinson’s disease - second line drug
Amantadine adverse effects
CNS: confusion, lightheadedness, anxiety
Atropine-like: blurry vision, urinary retention, dry mouth
Skin discoloration
Benzotropine MOA
anticholinergic agent - blocks muscarinic receptor in striatum and cholinergic receptors
Benztropine use
parkinson’s disease - stops tremors and mm rigidity
Benztropine adverse effects
n/v, dry mouth, blurry vision, urinary retention, constipation, mydriasis
Phenytoin MOA
stabilizes neuron membranes and limits seizure activity by selective inhibition of sodium channels
Phenytoin Use
all major seizures
Phenytoin route
varied oral absorption, IV for emergencies
Phenytoin adverse effects
CNS: nystagmus, eye twitch, sedation, ataxia, diplopia, cognitive impairment
Skin: rash
Gingival hyperplasia (tender swelling gums, bleeding)
Dysrhythmias
Teratogen
Phenytoin interactions
- decrease efficacy of oral contraceptives, warfarin, glucocorticoids
- increase levels when taken with diazepam, isoniazid, cimetidine, alcohol, valporic acid
- can increase glucose levels
Phenytoin implications
- half life: 8-60 hrs
- therapeutic level: 10-20 mcg/mL
- toxic level: 30-50 mcg/mL
- educate they must take every day and taper off
- teratogenic
Carbamazepine MOA
limits seizure activity by selective inhibition of sodium channels
Carbamazepine use
Epilepsy - partial and generalized
Bipolar disorder
Carbamazepine adverse effects
Neurologic: nystagmus, ataxia
Hematologic: leukopenia, anemia, thrombocytopenia
Hypo-osmolity
Dermatologic: rash, photosensitivity
Teratogenic - category X
Carbamazepine implicatiosn
- monitor CBC
- Sunscreen
- Childbearing age must use birth control or switch medication
- monitor serum sodium and edema
Carbamazepine interactions
- decrease efficacy of oral contraceptives and warfarin
- grapefruit juice effect
Levetiracetam MOA
unknown
Levetiracetam use
Seizures
- myoclonic seizures in adults/adolescents >12
- focal-onset seizures in adults/children >4
- generalized seizures in adults/children >6
Levetiracetam adverse effects
possible renal injury in high doses, drowsiness, asthenia, agitation, anxiety, psychosis, depression, hallucination, depersonalization
Levetiracetam implication
monitor renal function, assess for drowsiness
Benzodiazepine meds
Lorazepam, diazepam
Benzodiazepine moa
decrease anxiety by acting on limbic system
Benzodiazepine use
manage status epilepticus, tonic-clonic seizures, anxiety, insomnia
Benzodiazepine adverse effects
sedation, mm relaxation
Benzodiazepine implications
risk for abuse in general population
General seizure information
- treatment goal/options: neurosurgery, vagal n stimulation, ketogenic diet
- educate on seizure precautions
- drug evaluation has trial period
- take AEDs exactly as prescribed
- monitor plasma levels
- seizure frequency chart
- avoid driving and wear medical bracelet
- warn about CNS depression/sedation
- always taper
- phenytoin: with meals, shake bottle well, good oral hygiene
- carbamazepine: take with meals, warn about hematologic abnormalities, do NOT take with grapefruit juice
Diazepam MOA
enhance GABA receptors
Diazepam use
anxiety, sedative/hypnotic, mm relaxant, amnestic, anticonvulsant
Diazepam adverse effects
cardiac and respiratory depression
Diazepam implications
increase risk for respiratory depression when taken with opioid analgesics
Lidocaine MOA
block impulses on axon by blocking sodium channels
Lidocaine anesthesia types
- local anesthetic
- infiltration anesthesia
- Nerve block anesthesia
- IV regional anesthesia
- epidural anesthesia
- spinal anesthesia
- administer by injection
Local anesthetics end in
caine
Lidocaine routes/forms
cream, ointment, jelly solution, aerosol, patch
Lidocaine drug
procaine - injection only
Lidocaine use
- suppresses pain w/o generalized CNS depression
- used with vasoconstriction
- prolongs anesthesia + reduces toxicity
Lidocaine adverse effect
- CNS excitation followed by depression
- bradycardia + heart block
- spinal headache
- urinary retention
Lidocaine implications
patient should void urine within 8 hrs
Propofol & Ketamine class
general anesthetic
Propofol & Ketamine MOA
blocks impulses on axon by blocking sodium channels
Propofol & Ketamine route
inhaled or IV
Propofol & Ketamine use
- induction/maintenance of anesthesia
- propofol used in ICU for sedation for intubation & mechanically ventilated adults
Propofol & Ketamine adverse effects
respiratory depression, hypotension, high risk for bacterial infection
Propofol & Ketamine implications
monitor RR and BP closely
Mu opioid receptor moa
analgesia, respiratory depression, euphoria, sedation
Kappa opioid receptor moa
analgesia, sedation
Strong Opioid agonist drugs
morphine, fentanyl, meperidine, methadone
Strong opioid agonist Moa
reduce pain by binding to opiate receptor sites in PNS + CNS - mimic endorphins
Morphine route
IV, sustained release
Fentanyl route
PO, IV, transdermal
100x stronger than morphine
Methadone specific use
relieve pain and treat opioid addicts
Strong opioid agonist uses
analgesia, sever/chronic/acute pain, sedation, cough suppression, dilate blood vessels
Strong opioid agonist adverse effects
respiratory depression, constipation, n/v, hypotension
Strong opioid agonist implications
- must assess RR before giving (<12 bpm HOLD medication)
- monitor all s/e
- increase fiber
- constipation affects elderly more
Moderate to strong opioid agonists
Oxycodone, hydrocodone, codeine
Moderate to strong opioid agonist MOA
reduce pain by binding to opiate receptor sites in PNS and CNS
Moderate to strong opioid agonists facts
- no ceiling effect of opioid analgesia
- dose can be increased to overcome tolerance
Moderate/strong opioid agonist use
analgesia, severe/chronic/acute pain, sedation, cough suppression, vasodilation
Moderate to strong opioid agonist adverse effects
respiratory depression, constipation, n/v, hypotension
Moderate to strong opioid agonist implications
- must assess RR before giving (<12 bpm HOLD medication)
- monitor all s/e
- increase fiber
- constipation affects elderly more
Meperidine facts
- strong opioid agonist
- metabolized to normeperidine
= normeperidine is a toxic metabolite
Meperidine use
analgesia, severe/chronic/acute pain, sedation, cough suppression, vasodilation
Adverse effects
CV: tremors, palpitations, tachycardia
Renal failure
CNS: excitation, delirium, neurotoxic, seizures
Merepidine implications
- administration for >48hrs increases risk of seizures/neurotoxic
- recent decline in use
Morphine Use
- dilate GI smooth mm
- peripheral vasodilation
- decreased pre-load
- shortness of breath
- pulmonary edema
- left sided heart failure
Morphine adverse effects
- respiratory depression, coma, miosis (pinpoint pupils)
- periodic, irregular breathing
- may trigger asthmatic attack
- flushing, orthostatic hypotension
Morphine implications
- respiratory depression last about 4-5 hours
Naloxone class
opioid antagonist
Naloxone MOA
blocks effect of opioid agonist
Naloxone use
- opioid overdose
- reverse postoperative opioid effect
- reverse neonatal respiratory depression
Naloxone adverse effects
- nervous, restless, irritable
- body aches
- dizzy/weak
- d/n/stomach pain
- fever, chills, goosebumps
Naloxone implications
stops overdose of opioids
NSAIDS meds
ibuprofen, celecoxib
NSAIDS MOA
inhibition of enzyme cyclooxygenase (COX)
NSAIDs use
anti-inflammatory, pain relief, reduce fever
NSAIDs adverse effects
Gastric upset/ulceration, acute renal failure, bleeding
NSAIDs vs. acetaminophen
NSAIDs:
- anti-inflammatory
- not hepatotoxic
- caution in patients with renal disease
Acetaminophen: potentially hepatotoxic
Acetaminophen MOA
anti-pyretic: acts directly on heat-regulating center in hypothalamus
Acetaminophen use
pain, fever, drug of choice for kids with fever/flu symptoms
Acetaminophen adverse effects
Liver failure, increased when taken with ETOH
Acetaminophen interactions
warfarin (increase INR), loop diuretics (decreased efficacy)
Acetaminophen implications
- metabolized by liver, excreted by kidneys
- potential liver damage
- excessive alcohol worsens hepatotoxicity
- does not affect inflammation or platelet function like ibuprofen
Dosing guidelines for clinical use of opioids
- evaluate pain before opioid admin and 1 hr after PO and 10-15 min after IV
- adjust opioid analgesics to accommodate individual variation
- should be administered on fixed schedule
- 20+ days physical dependence may develop
- taper drug over 7-10 days and monitor
