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Pharmacology > CNS and ANS > Flashcards

CNS and ANS Flashcards

1
Q

Cholingeric

A

acetylcholine, excitatory

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2
Q

Dopaminergic

A

dopamine, inhibitory

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3
Q

Noradrenergic

A

norepinephrine, excitatory, increases activity

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4
Q

Serotonergic

A

serotonin, sleep/wake/pain

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5
Q

Pain

A
  • tissue damage activates free endings (nocicepters) of peripheral nerves
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6
Q

Opioid analgesics

A
  • stimulate opiate receptors and bind to the receptors in CNS causing inhibition of ascending nerve pathways
  • Receptors: mu, kappa, and delta
  • used for severe to moderate acute pain, terminal malignancy
  • most schedule II, well absorbed orally
  • oral - significant first pass
  • contraindicated: allergy, increase ICP, respiratory problems, dependence, tolerance or addiction
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7
Q

Opioid analgesics - adverse/nursing

A
  • Adverse effects: sedation, respiratory depression, postural hypotension, flushing, N/V, constipation, urinary retention, and pupil constriction
  • monitor VS
  • use: for acute and chronic pain, MI, burns, trauma, post-op
  • Use in chronic pain only when other methods fail (such as terminal cancer pain)
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8
Q

Morphine

A
  • prototype for opiods
  • po, IM, IV, SQ, IT, epidural
  • sustained release or immediate release
  • effects: 15-20 min IV, 60 min po
  • oral: roxanol
  • fentanyl patch - anesthesia, epidural, IT (duragesic, transdermal) - works for 72 hrs (up to 24 hrs after removal of patch)

IM not given often - it’s erratic

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9
Q

Types of opioids

A
  • codeine - usually with acetaminophen
  • hydrocodone - vicodin and norco
  • meperidine (Demerol) - synthetic, may cause tremors, hallucinations, and seizures
  • tramadol (Ultram) - synthetic, low potential for tolerance - may use for chronic pain
  • oxycodone (OxyContin)
  • – popular drug of abuse
  • – w/aspirin - Percodan
  • – w/acetaminophen - Percocett

-hydromorphone (Dilaudid)

  • propoxyphene (Darvon)
  • – w/acetaminophen (Darvocett) – NOW REMOVED FROM MARKET
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10
Q

Nursing Implications of Opioids

A
  • MONITOR FOR SEDATION
  • alternate with non-narcotics
  • no alcohol use!
  • do not drive, operate machinery, or smoke
  • constipation is common
  • IR vs SR
  • may be used in PCA pumps
  • unlikely to cause addiction with acute pain
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11
Q

naloxone (Narcan)

A

(opioid antagonist)

  • given when too much opioid is administered
  • uses: reverse or block anesthesia, CNA and resp depression from narcotics
  • competes with opioid receptor sites in brain
  • adverse: increased HR/BP/resp and RETURN of pain
  • produces withdrawal symptoms
  • repeated injections may be needed
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12
Q

butorphanol (Stadol)

nalbuphine (Nubain)

A

(opioid agonist/antagonist)

  • agonist at some receptors and antagonist activity at others
  • reduced potential for abuse
  • never give to someone who has received opioid analgesics (due to antagonist activity)
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13
Q

methadone (Dolophine)

A
  • use: opioid addiction
  • longer acting than morphine, abuse, wean
  • use for cancer pain
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14
Q

Analgesic-Antipyretic-Anti-Inflammatory drugs

A
  • Action: inhibit the formation of prostaglandins in inflamed tissue, preventing the stimulation of pain
  • may have anti-inflammatory, antipyretic, or anti-platelet effects
  • NSAIDs
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15
Q

Aspirin (ASA)

A
  • prototype
  • mild to moderate pain, fever, inflammation, and decrease risk of thrombus
  • low dose ASA for MI, angina, stroke, primary prevention of MI, prevent thromboembolism in surgery patients
  • non-selective cyclooxygenase (COX) inhibitor
  • adverse: stomach irritation, bleeding
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16
Q

Nursing Implications of aspirin

A
  • toxicity: salicyism (toxic effects of overdose of salicyclic acid), tinnitus (ringing in the ears)
  • avoid other OTC preparations that contain ASA
  • stop use 2 weeks before and after invasive procedures
  • take with food, drink adequate fluids
  • high bound to blood albumin
  • do not give to kids - reye’s syndrome
  • watch for signs of bleeding
  • increased effects with alcohol, anticoagulants, opioids, and steroids
  • not for use in pregnancy
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17
Q

acetaminophen (tylenol)

A
  • antipyretic effects, no inflammatory or platelet effects
  • used to reduce pain and fever
  • may use with GI problems
  • additive effects with other opioids
  • adverse: hepatic failure with high dose and nephrotoxicity with overdose
  • overdose treatement: Mucomyst (po)
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18
Q

Nursing Implications of acetaminophen

A
  • read labels
  • no more than 4g (4000mg) per day
  • drug of choice for febrile children, elderly and impaired renal function, pregnancy
  • watch for duration of use
  • avoid alcohol
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19
Q

ibuprofen (Motrin, Advil)

A

(NSAIDs)

  • used to treat fever, pain, inflammation, arthritis, and menstrual cramps
  • has less GI upset than ASA
  • Same nursing imp. as ASA
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20
Q

Indomethacin (Indocin)

A

(NSAIDs)

  • strong anti-inflammatory effect
  • higher risk of side effects than Motrin
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21
Q

naproxen (Naprosyn, Aleve)

ketorolac (Toradol)

A

(NSAIDs)

Naprosyn is prescribed
Aleve is OTC

Toradol:

  • used for severe pain
  • given IV
  • duration of use 5 days - produces bleeding
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22
Q

celecoxib (Celebrex)

A

(selective COX-2 inhibitor)

  • blocks prostaglandins associated with pain and inflammation without gastric upset, with no GI bleeding
  • use for arthritis
  • Black box warning: increased risk for adverse cardiovascular event, risk of GI bleeding with long term use - patients should be advised
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23
Q

pregabalin (Lyrica)

A

(selective COX-2 inhibitor)

  • decreases number of pain signals sent out by damaged nerves
  • use: neuropathic pain, fibromyalgia, and partial seizures
  • adverse: tiredness, dizziness, N/V
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24
Q

allopurinol (Zyloprim)
colchicine
probenecid (Benemid)

A

(anti gout agents)

  • prevent uric acid formation
  • gout = body’s inability to metabolize uric acid
  • symptoms: hyperuricemia (> 6mg/dl), severe pain, inflammation and edema in musculoskeletal system
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25
Q

Nursing implications for anti-gout

A
  • obtain baseline serum data
  • give with food
  • increase fluids to 3000mL/day
  • rest and immobilize affected area
  • avoid alcohol
  • low purine diet: anchovies, sardines, game meats, organ meats and yeast
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26
Q

pentobarbital (Nembutal)

phenobarbital

A

(barbiturates)

  • depress CNS
  • treat seizures, promote anesthesia, promote sedation and sleep
  • considered the prototype drugs - limited use today
  • serious dependence and withdrawl
  • Adverse: hangover, drowsiness and decreased resp
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27
Q

diazepam (Valium)
alprazolam (Xanax)
lorazepam (Ativan)
midazolam (Versed)

A

(benzodiazepines)

  • release GABA substances - inhibit transmission of impulses in CNS
  • Use: sleep, decrease anxiety, preop, alcohol withdrawal
  • replaced barbiturates as drugs for insomnia - these are safer and lower potential for abuse
  • Valium = prototype
  • –decrease anxiety, break status epilecticus (ongoing seizures), alcohol withdrawl
  • Xanax/Ativan for anxiety
  • Versed = preop
  • –produced amnesia - used for conscious sedation
  • adverse: oversedation, hangover, decrease resp
  • caution in elderly
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28
Q

Nursing implications for benzodiazepines

A
  • safety!
  • assess resp rate
  • Flumazenil (Romazicon) - reversal for benzos
  • give with food
  • abstain from alcohol
  • taper off drugs
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29
Q

zolpidem (Ambien)
eszopiclone (Lunesta)
diphenhydramine (Benadryl)

A
  • sleep agents
  • Ambien - short term use only
  • – reported problems with sleepwalking, doing things while sleepwalking and not remembering, rebound insomnia after stopping

Lunesta - longer term
—tastes funny

Benadryl - antihistamine
—drowsiness side effect for sleep aid

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30
Q

buspirone (BuSpar)

sertraline (Zoloft)

A

(anti-anxiety drugs)

  • episodic, situational anxiety and panic
  • used to reduce/relieve anxiety
  • cautions same as benzos
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31
Q

Nursing implications for anti-anxiety

A
  • assess signs/symps of severe anxiety
  • signs of depression/suicide
  • safety
  • avoid alcohol
32
Q

carisoprodol (Soma)
baclofen (Lioresal)
cyclobenzaprine (Flexeril)

A

(skeletal muscle relaxants)

  • depresses polysynaptic reflexes in the CNS
  • use: acute musculoskeletal pain, relieve musculoskeletal spasticity (trauma, MS, spinal injury), as an adjunct to other therapies
33
Q

Adverse reactions and Nursing implications for skeletal muscle relaxants

A

Adverse:
- drowsiness, dizziness, N/V, flaccid muscles, psychological/physical dependence

Nursing Imp:

  • assess muscular strength
  • check I&O
  • safety
  • physical therapy
34
Q

dantrolene (Dantrium)

A

(other relaxant)

  • interfere with the release of calcium from the sarcoplasmic reticulum, weakening the force of muscle contraction
  • use: malignant hyperthermia
  • also: spasticity with MS, cerebral palsy, and stroke
35
Q

anti-seizure drugs

A
  • used to treat seizures and epileps
  • decrease movement of ions into nerve cells, alternating activities of neurotransmitters
  • start with single dose - may need to add second drug
  • guide based on therapeutic levels
36
Q

phenytoin (Dilantin)

A

(anti-seizure)

  • prototype
  • stabilizes nerve membranes
  • used with all types of seizures accept absence
  • caution: severe kidney/liver disease, elderly
  • therapeutic range - 5-20mcg/ml
  • adverse: gingival hyperplasia, cardiovascular collapse with rapid IV dose
37
Q

Nursing implications of Dilantin

A
  • monitor serum levels
  • careful IV infusion
  • give with food
  • good oral hygiene
  • generic/trade brands not always the same
38
Q

other seizure drugs

A
  • phenobarbital sodium (luminol) - decline in use
  • benzodiazepines - ativan, valium, and clonazepam (Klonopin) - status epilecticus, severe recurrent seizures
  • carbamazepine (Tegretol)
  • ethosuximide (Zarontin)
  • lamotrigine (Lamictal)
  • valproic acid (Depakene/Depakote)
  • topiramate (Topamax)
39
Q

levodopa (Dopar)

carbidopa-levodopa (Sinemet)

A

(antiparkinsons drugs)

Dopaminergic drugs

  • drug goal: strengthen dopaminergic action or decrease cholinergic action
  • increase amount of dopamine concentration
  • adverse:
  • –early: N/V, anorexia, orthostatic hypotension, dizziness.
  • –late: involuntary movements, akinetic spells, anxiety, and depression
  • –use with caution with patients with narrow angle glaucoma, melanoma, GI, heart disease
40
Q

Nursing implications for antiparkinsons drugs

A
  • assess symptoms
  • skin assessment
  • wearing off effect
  • give with food
  • watch protein intake
  • darkening urine
  • safety
41
Q

trihexyphenidyl (Artane)

benztropine (Cogentin)

A

(anticholingeric - antiparkinsons)

  • counteract the cholingeric activity in brain
  • use alone in early Parkinson’s, young patients
  • caution: glaucoma, GI-GU obstructions, heart disease, elderly, very young

Nursing:

  • monitor I&O
  • taper drug
  • sit up slowly
  • watch heat, fiber/water
42
Q

migraines

A
  • pain associated with dilation of arteries of the scalp and face
  • HA with periodic attacks of nausea, pain, sensitivity to light
  • treatment: treat acute pain and prevention
  • prophylactic: use of beta blockers, calcium channel blockers, anticonvulsants and TCAs
43
Q

Ergot alkaloids

A

(main class of antimigraine drugs)

  • reduce extracranial blood flow
  • ergotamine tartare (Ergomar)
  • –with caffeine (Cafergot)
  • –sublingual or inhaled
  • – adverse: N/V, cramps, confusion, decreased circulation to extremities
  • – contraindicated with pregnancy, severe HTN and CAD
44
Q

sumatriptan (Imitrex)

zolmitriptan (Zomig)

A

(antimigraine drugs)

  • triptans/serotonin agonists
  • stimulate receptors on the basilar artery to vasoconstrict the vessels of the dura mater
  • adverse: nausea, HTN, dizziness, weakness
  • contraindications: CAD, HTN, do not give within 24 hours of ergot alkaloids
45
Q

General anesthesia

A
  • state of profound CNS depression - complete loss of sensation, consciousness, pain, perception and memory
  • Balanced anesthesia: allows anesthesiologist to not have to use too much of the potent general anesthetics - using many different types
  • IV - used for rapid induction and maintenance
  • – etomidate (Amidate)
  • – propofol (Diprivan)
  • – fentanyl citrate (sublimaze)
  • Inhalant
  • – enflurane (Ethrane)
  • – nitrous oxide
  • Neuromuscular blocking agents - to keep patient from moving
  • –atracurium (Tracrium)
  • – vecuronium (Norcuron)
46
Q

Moderate or conscious sedation

A
  • does not cause complete loss of consciousness or respiratory arrest
  • use: procedural areas including peds
  • drugs:
  • –Versed - benzos
  • – Fentanyl, Morphine - opioids
  • more rapid recovery
  • must have advanced life support certification to administer and monitor
  • intubation capabilities must be available
47
Q

lidocaine (Xylocaine)

buprivacaine (Marcaine)

A
  • local anesthesia
  • no paralysis of resp function
  • elimination of pain sensation
  • –topical
  • –infiltration
  • – field block
  • –nerve block
  • –spinal/epidural/intrathecal
48
Q

amphtamine (Adderall)
methylphenidate (Ritalin)
dextroamphetamine (Dexedrine)
atomoxetine (Strattera)

A
  • CNS stimulants
  • use: ADHD (for kids, it has the opposite effect - rather than stimulating, it calms), narcolepsy, weight reduction
  • adverse: nervousenss, irritability, HA
  • caution: anxiety, glaucoma, pregnancy, HTN, dependence
  • tolerance and psychological dependence
49
Q

substance abuse

A
  • self administration of a drug for prolonged time periods or in excessive amounts which can lead to psychological or physical dependence
  • for alcohol abuse - Antabuse is used
  • anxiety, sedative, hypnotics - taper to withdraw
  • for opioids - methadone
  • CNS stimulants: amphetamines, nicotine, cocaine
  • hallucinogens
50
Q

chloropromazine (Thorazine)
fluphenazine (Prolixin)
trifluoperazine (Stelazine)

A

(antipsychotics)

  • actions: occupy or block dopamine receptors
  • use: schizophrenia, acute mania, psychotic depression, N/V
  • caution: elderly

Thorazine is prototype
Phernergan fits in this category

51
Q

Adverse and Nursing Imp of antipsychotics

A

Adverse:

  • excessive sedation, slurred speech, impaired mental processess
  • –extrapyramidal symptoms (EPS)

Nursing:

  • assess behavior
  • watch for adverse effects
  • photosensitivity
  • safety
  • Phernergan - highly sedative
52
Q

haloperidol (Haldol)
clozapine (Clorazil) - prototype
risperidone (Risperdal)
olanzapine (Zyprexa)

A

(nonphenothaizines)

  • used to control flat affect and hallucinations, schizophrenia, and Touretts syndrome
  • adverse: agranulocytosis, seizures, decrease BP, EPS symptoms (Haldol)
53
Q

Nursing Imp for nonphenothaizines

A
  • determine baseline WBC
  • VS
  • assess for constipation
  • administer with food
  • watch photosensitivity
  • do not take with other CNS depressants
54
Q

Lithium carbonate (Eskalith)

A

(mood stabilizing drugs)

  • use: bipolar, treat/prevent manic episodes
  • caution: significant cardiac/renal disease, hyponatremia, pregnancy, leukemia
  • interacts with Haldol, Tegretol, thiazide diuretics
  • therapeutic level: 0.5-1.2mEq/L
55
Q

Adverse and Nursing Imp of mood lithium

A

Adverse:
- metallic taste, twitching, diarrhea, thirst

Nursing:

  • assess mood
  • monitor Na+ levels
  • increase fluid intake, monitor use of diuretics
  • take with food
  • avoid changes in salt intake
56
Q

Antidepressants

A
  • used: for depressed mood, feelings of sadness and emotional upset
  • depression occurs in all age groups
  • 3 types
  • –Tricyclic antidepressants (TCA)
  • –Selective Serotonin Reuptake Inhibitors (SSRIs)
  • –Monoamine Oxidase Inhibitors (MAO)
57
Q 
amitriptyline hydrochloride (Elavil)
imipramine hydrochloride (Tofranil) - prototype
A
  • TCA
  • decrease reuptake of serotonin and norepinephrine
  • adverse: sedation, orthostatic hypotension, decreased GI motility, dry mouth, cardiac arrythmias, urinary retention
  • caution: suicidal, adverse effects mimic panic

Nursing:

  • do not give concurrently with SSRIs
  • take in PM
  • do not take with St. John’s Wort
58
Q

fluoxetine (Prozac)
citalopram (Celexa)
proxetine (Paxil)
sertraline (Zoloft)

A
  • SSRIs
  • increase available serotonin
  • use: depression, OCD, bulimia
  • adverse: anxiety, nausea, decreased appetite, weight loss, HA
  • caution: risk of suicide, those taking MAOIs, anticoagulants
59
Q

phenelzine sulfate (Nardil)

A
  • MAO Inhibitors
  • prevent the metabolism of neurotransmitter molecules
  • adverse: orthostatic hypotension, weight gain, edema, toxicity, hypertensive crisis with tyramine foods (cheese, beer, chocolate, yogurt, smoked meats)
  • many drug interactions
60
Q

other antidepressants

A
  • burpropion (Wellbutrin, Zyban)
  • –Wellbutrin also used for smoking cessation, has CNS stimulant effects - causes agitation, anxiety, insomnia
  • –do not use Wellbutrin with seizure patients - lowers threshold - seizures more likely
  • venlafine (Effexor) - not to be used during pregnancy
  • duloxetine (Cymbalta) - not be used with alcohol dependency - liver damage
  • mirtazapine (Remeron) - causes weight gain, drowsiness
61
Q

Nursing Implications for antidepressants

A
  • therapeutic effects - 2-4 weeks
  • assess depression, suicide precautions
  • encourage diet and exercise
  • watch with children/adolescents
  • recommend counseling/support groups
62
Q

adrenergic agents

A
  • mimic SNS
  • widespread action, used in emergencies
  • adverse: arrhythmias, HTN, palpitations, angina, nervouseness
  • interactions: TCAs, MAOIs
63
Q 
epinephrine HCL (Adrenaline) - prototype
norepinephrine (Levophed)
dopamine HCL (Intropin)
phenylephrine (Neo-Synephrine)
albuterol (Proventil)
Isoproterenol (Isuprel)
A
  • Adrenaline used anaphylaxis and cardiac emergencies
  • Levophed - stimulates alpha - causes peripheral vasoconstriction - “leave em dead, Levophed” - last ditch effort
  • Intropin - results dependent on size of dose
  • – Low: increased renal perfusion
  • – Med: increased cardiac output
  • – High: increased BP

Neo-Synephrine
- alpha, vasoconstrictor, nasal decongestant

albuterol
- beta, bronchodilator

Isuprel
- beta, used in shock

64
Q

Nursing Imp for adrenergic drugs

A
  • extreme care with calculations of meds
  • monitor VS, ECG, urine output, cardiac output
  • allergies, carry epi pen at all times
  • tolerance can develop
65
Q

antiadrenergic drugs

A
  • block SNS - whole or part
  • –decrease BP, increase renal perfusion
  • suppress pathological responses to activity, stress
66
Q

phentolamine mesylate (Regitine) - prototype
prazosin (Minipress)
tamsulosin (Flomax)

A

alpha adrenergic blocking agents

  • block alpha 1 receptor sites
  • Regitine used for phenochromocytoma - tumor in adrenal glands
  • Flomax used for Benign prostatic hyperplasia (BPH)
  • Minipress used for hypertension
  • also used for Reynaud’s - discoloration of fingers/toes
  • adverse: tachycardia, hypotension
67
Q

Nursing implications for alpha adrenergic blocking agents

A
  • monitor VS
  • supine with IV Regitine
  • change positions slowly
  • taper doses
  • give with food
  • take same time everyday
68
Q

propranolol (Inderal) - prototype
atenolol (Tenormin)
carvedilol (Coreg)

A

beta adrenergic blocking agents

  • can block beta 1 and/or beta 2
  • block beta 1: decrease in HR, decrease in contraction and conduction
  • –cardioselective beta blockers only block beta 1
  • block beta 2: bronchoconstriction of smooth muscles

Inderal - prototype, nonselective
Tenormin - cardioselective
Coreg - alpha-beta

  • uses: angina, post MI, dysrhythmias
69
Q

Nursing Implications for beta blockers

A
  • monitor VS esp HR
  • watch for symptoms of hypoglycemia
  • change position slowly
  • taper dose
  • avoid hot tubs, hot showers, saunas
  • interacts with alcohol
70
Q

acetylcholine - prototype
bethanechol (Urecholine)
metoclopramide (Reglan)

A

(parasympathetic drugs)

  • direct acting cholinergic drugs
  • Urecholine - urinary retention
  • Reglan - delayed gastric emptying
  • action: decrease HR, increase GI muscle tone, increase bladder tone, relax sphincters, increase resp secretions, constrict pupils
  • use: glaucoma, GI reflux, neurogenic bladder, N/V with chemo
71
Q

Adverse and Nursing Implications for parasympathetic drugs

A

Adverse:
- bradycardia, hypotension, HA, restlessness, coma

Caution:
- CAD, MI, heart block, intestinal obstruction, resp disorders

Nursing:

  • monitor HR, rest rate
  • watch for GI problems
  • can exacerbate peptic ulcers
  • atropine sulfate - antidote
72
Q

neostigmine (Prostigmine)
edrophonium (Tensilon)
donepezil (Aricept)

A

(indirect acting cholingerics)

  • inhibit action of acetylcholinesterase and prolongs the effects of acetylcholine
  • use: myasthenia gravis, glaucoma, bladder distension, paralytic ileus
  • Prostigmin - urinary retention and myasthenia gravis
  • Tensilon - diagnosis of MG
  • Aricept - alzheimers
73
Q

Adverse and Nursing Implications for indirect acting cholingerics

A

Caution:
- bradycardia, parkinson’s intestinal/bladder obstructions, resp disorders, ulcerative colitis

Adverse:
- hypotension, bradycardia, intestinal spasm, resp arrest, vasodilation

Nursing:

  • watch for signs of neurotoxicity
  • monitor resp rate
  • assess for abdominal cramping
  • measure urinary output
74
Q

atropine sulfate - prototype
oxybutynin (Ditropin)
tolterodine (Detrol)

A

(anticholinergic drugs)

  • block parasympathetic nerve impulses by competing withe acetylcholine for sites on muscarinic receptors
  • drugs used for urinary frequency
  • use: GI disorders that have increased motility, bradycardia, relieve spastic bladder, decreased saliva
75
Q

Adverse and Nursing Implications for anticholingeric drugs

A

Caution:
- glaucoma, heart disease, paralytic ileus

Adverse:
- dry mouth, constipation, tachycardia, difficult urination, blurred vision, and confusion

Nursing:

  • monitor pulse, BP, urine output
  • encourage fluids
  • provide ice chips

Pharmacology (7 decks)

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