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Pharmacology > CNS > Flashcards

CNS Flashcards

1
Q

Caffeine MOA

A

reversible blockade of adenosine receptors

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2
Q

Caffeine use

A

neonatal apnea, wakefulness

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3
Q

Caffeine adverse effects

A

palpitations, dizziness, vasodilation, bronchodilation, diuresis, insomnia

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4
Q

Caffeine implications

A

Other CNS stimulants
- methylphenidate
- dextroamphetamine
- amphetamine

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5
Q

Neostigmine & Pyridostigmine MOA

A

prevent ach inactivation = increased mm strength

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6
Q

Neostigmine & Pyridostigmine class

A

cholinesterase inhibitor

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7
Q

Neostigmine & Pyridostigmine use

A

myasthenia gravis (ptosis, difficulty swallowing, weak mm)

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8
Q

Neostigmine & Pyridostigmine adverse effects

A

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

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9
Q

Parkinson’s disease 2 drug categories

A

Dopaminergic agents + anticholinergic agents

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10
Q

Dopaminergic agents MOA

A

stimulate dopamine by activating dopamine receptors

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11
Q

Anticholinergic agents MOA

A

stops excess ach by preventing activation of cholinergic receptors or blockage of muscarinic receptors

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12
Q

Levodopa MOA

A

promotes dopamine synthesis

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13
Q

Carbidopa MOA

A

helps decrease peripheral degradation and allows levodopa to cross BBB

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14
Q

Levodopa/Carbidopa use

A

parkinson’s disease
- treatment of choice
- levodopa 1st choice for younger patients
- “on/off” phenomenon common

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15
Q

Levodopa/carbidopa adverse effects

A

GI: n/v, dark sweat + urine
Neuro: drowsy, dyskinesia
CV: postural hypotension, dysrhythmias
Psychosis: hallucinations
- Clozapine can reduce

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16
Q

Levodopa/carbidopa interactions

A

B6 enhances destruction of levodopa

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17
Q

Levodopa/carbidopa implications

A
  • 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
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18
Q

Amantadine MOA

A

dopamine agonist, promotes dopamine release and prevents reuptake

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19
Q

Amantadine use

A

parkinson’s disease - second line drug

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20
Q

Amantadine adverse effects

A

CNS: confusion, lightheadedness, anxiety
Atropine-like: blurry vision, urinary retention, dry mouth
Skin discoloration

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21
Q

Benzotropine MOA

A

anticholinergic agent - blocks muscarinic receptor in striatum and cholinergic receptors

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22
Q

Benztropine use

A

parkinson’s disease - stops tremors and mm rigidity

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23
Q

Benztropine adverse effects

A

n/v, dry mouth, blurry vision, urinary retention, constipation, mydriasis

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24
Q

Phenytoin MOA

A

stabilizes neuron membranes and limits seizure activity by selective inhibition of sodium channels

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25
Q

Phenytoin Use

A

all major seizures

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26
Q

Phenytoin route

A

varied oral absorption, IV for emergencies

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27
Q

Phenytoin adverse effects

A

CNS: nystagmus, eye twitch, sedation, ataxia, diplopia, cognitive impairment
Skin: rash
Gingival hyperplasia (tender swelling gums, bleeding)
Dysrhythmias
Teratogen

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28
Q

Phenytoin interactions

A
  • decrease efficacy of oral contraceptives, warfarin, glucocorticoids
  • increase levels when taken with diazepam, isoniazid, cimetidine, alcohol, valporic acid
  • can increase glucose levels
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29
Q

Phenytoin implications

A
  • 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
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30
Q

Carbamazepine MOA

A

limits seizure activity by selective inhibition of sodium channels

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31
Q

Carbamazepine use

A

Epilepsy - partial and generalized
Bipolar disorder

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32
Q

Carbamazepine adverse effects

A

Neurologic: nystagmus, ataxia
Hematologic: leukopenia, anemia, thrombocytopenia
Hypo-osmolity
Dermatologic: rash, photosensitivity
Teratogenic - category X

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33
Q

Carbamazepine implicatiosn

A
  • monitor CBC
  • Sunscreen
  • Childbearing age must use birth control or switch medication
  • monitor serum sodium and edema
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34
Q

Carbamazepine interactions

A
  • decrease efficacy of oral contraceptives and warfarin
  • grapefruit juice effect
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35
Q

Levetiracetam MOA

A

unknown

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36
Q

Levetiracetam use

A

Seizures
- myoclonic seizures in adults/adolescents >12
- focal-onset seizures in adults/children >4
- generalized seizures in adults/children >6

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37
Q

Levetiracetam adverse effects

A

possible renal injury in high doses, drowsiness, asthenia, agitation, anxiety, psychosis, depression, hallucination, depersonalization

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38
Q

Levetiracetam implication

A

monitor renal function, assess for drowsiness

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39
Q

Benzodiazepine meds

A

Lorazepam, diazepam

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40
Q

Benzodiazepine moa

A

decrease anxiety by acting on limbic system

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41
Q

Benzodiazepine use

A

manage status epilepticus, tonic-clonic seizures, anxiety, insomnia

42
Q

Benzodiazepine adverse effects

A

sedation, mm relaxation

43
Q

Benzodiazepine implications

A

risk for abuse in general population

44
Q

General seizure information

A
  • 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
45
Q

Diazepam MOA

A

enhance GABA receptors

46
Q

Diazepam use

A

anxiety, sedative/hypnotic, mm relaxant, amnestic, anticonvulsant

47
Q

Diazepam adverse effects

A

cardiac and respiratory depression

48
Q

Diazepam implications

A

increase risk for respiratory depression when taken with opioid analgesics

49
Q

Lidocaine MOA

A

block impulses on axon by blocking sodium channels

50
Q

Lidocaine anesthesia types

A
  • local anesthetic
  • infiltration anesthesia
  • Nerve block anesthesia
  • IV regional anesthesia
  • epidural anesthesia
  • spinal anesthesia
  • administer by injection
51
Q

Local anesthetics end in

A

caine

52
Q

Lidocaine routes/forms

A

cream, ointment, jelly solution, aerosol, patch

53
Q

Lidocaine drug

A

procaine - injection only

54
Q

Lidocaine use

A
  • suppresses pain w/o generalized CNS depression
  • used with vasoconstriction
  • prolongs anesthesia + reduces toxicity
55
Q

Lidocaine adverse effect

A
  • CNS excitation followed by depression
  • bradycardia + heart block
  • spinal headache
  • urinary retention
56
Q

Lidocaine implications

A

patient should void urine within 8 hrs

57
Q

Propofol & Ketamine class

A

general anesthetic

58
Q

Propofol & Ketamine MOA

A

blocks impulses on axon by blocking sodium channels

59
Q

Propofol & Ketamine route

A

inhaled or IV

60
Q

Propofol & Ketamine use

A
  • induction/maintenance of anesthesia
  • propofol used in ICU for sedation for intubation & mechanically ventilated adults
61
Q

Propofol & Ketamine adverse effects

A

respiratory depression, hypotension, high risk for bacterial infection

62
Q

Propofol & Ketamine implications

A

monitor RR and BP closely

63
Q

Mu opioid receptor moa

A

analgesia, respiratory depression, euphoria, sedation

64
Q

Kappa opioid receptor moa

A

analgesia, sedation

65
Q

Strong Opioid agonist drugs

A

morphine, fentanyl, meperidine, methadone

66
Q

Strong opioid agonist Moa

A

reduce pain by binding to opiate receptor sites in PNS + CNS - mimic endorphins

67
Q

Morphine route

A

IV, sustained release

68
Q

Fentanyl route

A

PO, IV, transdermal
100x stronger than morphine

69
Q

Methadone specific use

A

relieve pain and treat opioid addicts

70
Q

Strong opioid agonist uses

A

analgesia, sever/chronic/acute pain, sedation, cough suppression, dilate blood vessels

71
Q

Strong opioid agonist adverse effects

A

respiratory depression, constipation, n/v, hypotension

72
Q

Strong opioid agonist implications

A
  • must assess RR before giving (<12 bpm HOLD medication)
  • monitor all s/e
  • increase fiber
  • constipation affects elderly more
73
Q

Moderate to strong opioid agonists

A

Oxycodone, hydrocodone, codeine

74
Q

Moderate to strong opioid agonist MOA

A

reduce pain by binding to opiate receptor sites in PNS and CNS

75
Q

Moderate to strong opioid agonists facts

A
  • no ceiling effect of opioid analgesia
  • dose can be increased to overcome tolerance
76
Q

Moderate/strong opioid agonist use

A

analgesia, severe/chronic/acute pain, sedation, cough suppression, vasodilation

77
Q

Moderate to strong opioid agonist adverse effects

A

respiratory depression, constipation, n/v, hypotension

78
Q

Moderate to strong opioid agonist implications

A
  • must assess RR before giving (<12 bpm HOLD medication)
  • monitor all s/e
  • increase fiber
  • constipation affects elderly more
79
Q

Meperidine facts

A
  • strong opioid agonist
  • metabolized to normeperidine
    = normeperidine is a toxic metabolite
80
Q

Meperidine use

A

analgesia, severe/chronic/acute pain, sedation, cough suppression, vasodilation

81
Q

Adverse effects

A

CV: tremors, palpitations, tachycardia
Renal failure
CNS: excitation, delirium, neurotoxic, seizures

82
Q

Merepidine implications

A
  • administration for >48hrs increases risk of seizures/neurotoxic
  • recent decline in use
83
Q

Morphine Use

A
  • dilate GI smooth mm
  • peripheral vasodilation
  • decreased pre-load
  • shortness of breath
  • pulmonary edema
  • left sided heart failure
84
Q

Morphine adverse effects

A
  • respiratory depression, coma, miosis (pinpoint pupils)
  • periodic, irregular breathing
  • may trigger asthmatic attack
  • flushing, orthostatic hypotension
85
Q

Morphine implications

A
  • respiratory depression last about 4-5 hours
86
Q

Naloxone class

A

opioid antagonist

87
Q

Naloxone MOA

A

blocks effect of opioid agonist

88
Q

Naloxone use

A
  • opioid overdose
  • reverse postoperative opioid effect
  • reverse neonatal respiratory depression
89
Q

Naloxone adverse effects

A
  • nervous, restless, irritable
  • body aches
  • dizzy/weak
  • d/n/stomach pain
  • fever, chills, goosebumps
90
Q

Naloxone implications

A

stops overdose of opioids

91
Q

NSAIDS meds

A

ibuprofen, celecoxib

92
Q

NSAIDS MOA

A

inhibition of enzyme cyclooxygenase (COX)

93
Q

NSAIDs use

A

anti-inflammatory, pain relief, reduce fever

94
Q

NSAIDs adverse effects

A

Gastric upset/ulceration, acute renal failure, bleeding

95
Q

NSAIDs vs. acetaminophen

A

NSAIDs:
- anti-inflammatory
- not hepatotoxic
- caution in patients with renal disease

Acetaminophen: potentially hepatotoxic

96
Q

Acetaminophen MOA

A

anti-pyretic: acts directly on heat-regulating center in hypothalamus

97
Q

Acetaminophen use

A

pain, fever, drug of choice for kids with fever/flu symptoms

98
Q

Acetaminophen adverse effects

A

Liver failure, increased when taken with ETOH

99
Q

Acetaminophen interactions

A

warfarin (increase INR), loop diuretics (decreased efficacy)

100
Q

Acetaminophen implications

A
  • metabolized by liver, excreted by kidneys
  • potential liver damage
  • excessive alcohol worsens hepatotoxicity
  • does not affect inflammation or platelet function like ibuprofen
101
Q

Dosing guidelines for clinical use of opioids

A
  • 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

Pharmacology (9 decks)

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