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Pharm > CNS drugs > Flashcards

CNS drugs Flashcards

1
Q

CNS Stimulants

A

Amphetamine-like drugs

Analeptics

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2
Q

CNS Stimulants

A

amphetamine-like drugs:
methylphenidate
modafinil
armodafinil

Analeptics:
theophylline

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3
Q

Amphetamine-Like Drugs

A

methylphenidate

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4
Q

methylphenidate
ROUTE
AND SCHEDULE

A

PO,
transdermal patch,
schedule II

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5
Q

methylphenidate

MOA

A

increase dopamine & norepinephrine

Increase attention span & cognitive performance (memory, reading)

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6
Q

methylphenidate

INDICATION

A

ADHD,
narcolepsy

decrease impulsiveness, hyperactivity, and restlessness for ADHD

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7
Q

Amphetamine-Like Drugs
2
SCHEDULE IV

A

modafinil

armodafinil

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8
Q

modafinil
armodafinil- LESS RISK OF ABUSE
SCHEDULE

A

Schedule IV

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9
Q

modafinil
armodafinil- LESS RISK OF ABUSE

INDICATION

A

narcolepsy,
jet lag,
ADHD,
sleep apnea

Sleep apnea: periods of apnea when asleep requiring the patient to wake up and breath, either central (associated with CNS disorder) or obstructive (obesity)

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10
Q

Nursing
Amphetamines & Amphetamine-like drugs

methylphenidate
modafinil
armodafinil- LESS RISK OF ABUSE

A

Give early in the day (it’s a stimulant => insomnia)

Report irregular heartbeat, palpitation, HTN

Record height, weight, and growth of children (weight loss)

Avoid alcohol, caffeine, nicotine

Use sugarless gum to relieve dry mouth

Do not stop abruptly; taper off to avoid withdrawal symptoms

N/V, muscle weakness, HA, depression

Counseling must also be used

long term use causes dependence and abuse-disorder

Excreted in breast milk (avoid while breastfeeding)

May cause tics (report to provider)

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11
Q

Analeptics

A

theophylline

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12
Q

theophylline

MOA

A

stimulation of the brain stem

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13
Q

theophylline

INDICATION

A

(PO, IV)
IV:
neonatal apnea (stimulate respiration in newborns)

IV: Emergency respiratory depression
(caused by CNS depressant OD)

IV: Anesthetic recovery

IV/PO:
Bronchodilator
(for asthma, COPD, status asthmaticus)

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14
Q

theophylline

SIDE EFFECTS

A 
restlessness, 
tremors, 
twitching, 
insomnia, 
seizure
diuresis, 
tinnitus, 
tachycardia, 
palpitations, 
dysrhythmia
dependence, 
withdrawal symptoms
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15
Q

CNS DEPRESSANTS

A

Effects of CNS depressants

Barbiturates (-barbital)

Benzodiazepines (-pam, -lam)

Nonbenzodiazepine hypnotics
zolpidem

Anesthesia
Types
Types of anesthetics
Inhalation (nitrous oxide, -flurane)

IV (etomidate, propofol, ketamine)

Other IV drugs used for anesthesia
Benzodiazepine
Opioid

Neuromuscular blockers
Succinylcholine
vecuronium
Regional anesthesia (-caine)

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16
Q

CNS Depressants Action

A

Sedation
Hypnosis
Anesthesia

Not all drugs are used to achieve all levels (sedative, hypnotic, & anaesthetic)

anterograde amnesia: difficulty recalling events that occur after dosing

DT: delirium tremens: shaking, confusion, and hallucinations (look up CIWA assessment tool)

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17
Q

CNS Depressants Action

Sedation

A

Indication:
anxiety,
muscle spasm,
ETOH withdrawal (DTs)

Effect:
Diminish physical & mental responses

No effect on consciousness (no hypnotic effect)

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18
Q

CNS Depressants Action

Hypnosis

A

Indication:
induction of anesthesia,
insomnia

Effect:
sleep,
anterograde amnesia

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19
Q

CNS Depressants Action

Anesthesia

A

maintenance of anesthesia

Effect: 
loss of consciousness, 
loss of reflexes 
- blink, 
- gag, 
- ANS
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20
Q

CNS Depressants Action

SIDE EFFECTS/ADVERSE REACTIONS

A

Overdose:
Resp. depression,
severe low BP,
DEATH

Not all drugs are used to achieve all levels (sedative, hypnotic, & anaesthetic)

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21
Q

Barbiturates

Schedule

A

Schedule II, III, IV

22
Q

Barbiturates

MOA

A

GABA stimulation (an inhibitory neurotransmitter)

antiepileptic = anticonvulsant = anti-seizure
GABA: gamma-aminobutyric acid (an inhibitory neurotransmitter)
suicidal ideation, erectile dysfunction,

23
Q

Barbiturates

INDICATIONS

A

antiepileptic,
sedative,
hypnotic

24
Q

Barbiturates

SIDE EFFECTS

A

Resp depression,

bradycardia,

ataxia (FALL)

dependence & tolerance
(wean off to avoid withdrawal symptoms & seizure)

Only for short-term use (2 weeks or less)

REM rebound
(vivid dreams & nightmares),

hangover effect,

skin eruption,

constipation

paradoxical effects

Decreased effect of oral contraceptives (use a secondary method)

25
Q

Barbiturates

CONTRAINIDCATIONS

A

pregnancy,

with other sedative-hypnotics (alcohol, opioids)

26
Q

Barbiturates

SCHEDULE / ACTION

A

Long-acting:

schedule IV

27
Q

Barbiturates

IS THERE A REVERSAL

A

NO REVERSAL AGENT

OFTEN REPLACED BY BENZOSSS

28
Q

Barbiturates

THERAPEUTIC RANGE

A

Narrow therapeutic range

29
Q

Benzodiazepines

MOA

A

MOA: GABA stimulation, Schedule IV

30
Q

Benzodiazepines

INDICATIONS

A

Sedative (anxiolytic) => preventing alcohol withdrawal symptoms (DTs)

Epilepsy (antiepileptic)

Spasms (centrally acting

muscle relaxant)

Insomnia (hypnotic)

anesthesia induction (sedative/hypnotic)

31
Q

Benzodiazepines

ROUTES

A

Routes: PO, IM, IV

32
Q

Benzodiazepines

DRUGSSS

A

lorazepam

diazepam

chlordiazepoxide

  • Prophylaxis for alcohol withdrawal,
  • scheduled & PRN,
  • long onset of action,
  • safest Benzodiazepine

alprazolam
temazepam

clonazepam

midazolam
- pre-operative

33
Q

Benzodiazepines withdrawal symptoms

A 
anxiety, 
insomnia, 
diaphoresis, 
tremor, 
delirium, 
HTN, 
seizure
34
Q

Anesthesia
Anesthetics Types & Routes
GENERAL

A

Inh/IV

General CNS depression

loss of consciousness,

amnesia

analgesia,

complete muscle paralysis,

loss of reflexes/ANS

35
Q

Anesthesia
Anesthetics Types & Routes
REGIONAL

A

Injection close to a nerve

No loss of consciousness, no amnesia

Regional effects:
analgesia,

muscle paralysis,

loss of reflexes/ANS

36
Q

Anesthesia
Anesthetics Types & Routes
LOCAL

A

Local analgesia
(dental procedures, minor surgeries)

Injection/topical

37
Q

Inhalation Anesthetics

A 
Inhaled gas: 
nitrous oxide (NO)

Inhaled volatile liquids:
isoflurane

38
Q 
Inhaled gas: 
nitrous oxide (NO)

Inhaled volatile liquids:
isoflurane

A

Fast induction
& fast reversal/recovery

no metabolism;
eliminated by ventilation

39
Q 
Inhaled gas: 
nitrous oxide (NO)

Inhaled volatile liquids:
isoflurane

REVERSAL AGENT

A

Reversal agent: deep breathing; intubation/ventilation

40
Q 
Inhaled gas: 
nitrous oxide (NO)

Inhaled volatile liquids:
isoflurane
ADVERSE EFFECTS

A

“Anesthesia awareness” (under-sedation)

Overdose:
respiratory depression,
hypotension,
brady-dysrhythmia

SIDE EFFECTS
HA,
confusion
N/V

Shivering/chills

malignant hyperthermia

dantrolene IV to treat malignant hyperthermia, watch for liver failure

malignant hyperthermia: severe adverse reaction to inhaled anesthesia and succinylcholine => severe temperature increase, severe muscle rigidity, death
dantrolene IV to treat malignant hyperthermia

41
Q

IV Anesthetics

A

etomidate
propofol
ketamine

42
Q

etomidate
propofol
ketamine

A

Rapid onsets and short durations of action

43
Q

propofol

A

high risk of infection,

use vial within 6hrs

44
Q

propofol

CONTRAINDICATION

A

Contraindication: allergy to egg/soybean

45
Q

ketamine

SIDE EFFECT

A 
Side effect 
(paradoxical effects)

cause hallucination,
delirium,
confusion

46
Q

Other Drug used as IV Anesthetics

A

Benzodiazepines (-pam, -lam)
midazolam (Versed)
flumazenil to reverse

Opioid
morphine,
fentanyl
naloxone to reverse

Neuromuscular blocker (paralytics)

succinylcholine,
vecuronium

No analgesic effect

No sedative effect

succinylcholine has no reversal,
but very short-acting

neostigmine (cholinesterase-inhibitor) to reverse vecuronium

47
Q

Regional Anesthesia

A

Anesthetic agent injected around nerves
(spine, local nerves)

no LOC
(loss of consciousness)

may need benzodiazepines
or
opioids for
sedative effect

48
Q

Regional Anesthesia

MOA

A

Prevent conduction of nerve impulses at injection site

Motor,
Sensory,
Autonomic

49
Q

Regional Anesthesia

ROUTES

A

Routes for regional anesthesia:

injection close to a nerve

50
Q

Regional Anesthesia

SODIUM CHANNEL BLOCKER:

A

procaine

lidocaine

51
Q

Regional Anesthesia

bottom notes

A

LOC: loss of consciousness
Reduces complication & expedites recovery, ambulation
We will use “sodium-channel-blocker” for seizure (phenytoin) and dysrhythmia but these are all similar yet different
Routes:
Epidural larger dose further away from the spine
Spinal (intrathecal/subarachnoid) smaller dose right beside the spine
Local conduction block (topical or superficial injection)

Pharm (7 decks)

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