CNS drugs Flashcards by Abby Hurst

CNS Stimulants

Amphetamine-like drugs

Analeptics

How well did you know this?

Not at all

Perfectly

CNS Stimulants

amphetamine-like drugs:
methylphenidate
modafinil
armodafinil

Analeptics:
theophylline

How well did you know this?

Not at all

Perfectly

Amphetamine-Like Drugs

methylphenidate

How well did you know this?

Not at all

Perfectly

methylphenidate
ROUTE
AND SCHEDULE

PO,
transdermal patch,
schedule II

How well did you know this?

Not at all

Perfectly

methylphenidate

MOA

increase dopamine & norepinephrine

Increase attention span & cognitive performance (memory, reading)

How well did you know this?

Not at all

Perfectly

methylphenidate

INDICATION

ADHD,
narcolepsy

decrease impulsiveness, hyperactivity, and restlessness for ADHD

How well did you know this?

Not at all

Perfectly

Amphetamine-Like Drugs
2
SCHEDULE IV

modafinil

armodafinil

How well did you know this?

Not at all

Perfectly

modafinil
armodafinil- LESS RISK OF ABUSE
SCHEDULE

Schedule IV

How well did you know this?

Not at all

Perfectly

modafinil
armodafinil- LESS RISK OF ABUSE

INDICATION

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)

How well did you know this?

Not at all

Perfectly

Nursing
Amphetamines & Amphetamine-like drugs

methylphenidate
modafinil
armodafinil- LESS RISK OF ABUSE

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)

How well did you know this?

Not at all

Perfectly

Analeptics

theophylline

How well did you know this?

Not at all

Perfectly

theophylline

MOA

stimulation of the brain stem

How well did you know this?

Not at all

Perfectly

theophylline

INDICATION

(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)

How well did you know this?

Not at all

Perfectly

theophylline

SIDE EFFECTS

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

How well did you know this?

Not at all

Perfectly

CNS DEPRESSANTS

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)

How well did you know this?

Not at all

Perfectly

CNS Depressants Action

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)

How well did you know this?

Not at all

Perfectly

CNS Depressants Action

Sedation

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

Effect:
Diminish physical & mental responses

No effect on consciousness (no hypnotic effect)

How well did you know this?

Not at all

Perfectly

CNS Depressants Action

Hypnosis

Indication:
induction of anesthesia,
insomnia

Effect:
sleep,
anterograde amnesia

How well did you know this?

Not at all

Perfectly

CNS Depressants Action

Anesthesia

maintenance of anesthesia

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

How well did you know this?

Not at all

Perfectly

CNS Depressants Action

SIDE EFFECTS/ADVERSE REACTIONS

Overdose:
Resp. depression,
severe low BP,
DEATH

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

How well did you know this?

Not at all

Perfectly

Barbiturates

Schedule

Schedule II, III, IV

Barbiturates

MOA

GABA stimulation (an inhibitory neurotransmitter)

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

Barbiturates

INDICATIONS

antiepileptic,
sedative,
hypnotic

Barbiturates

SIDE EFFECTS

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)

Barbiturates | CONTRAINIDCATIONS

pregnancy, with other sedative-hypnotics (alcohol, opioids)

Barbiturates | SCHEDULE / ACTION

Long-acting: | schedule IV

Barbiturates | IS THERE A REVERSAL

NO REVERSAL AGENT | OFTEN REPLACED BY BENZOSSS

Barbiturates | THERAPEUTIC RANGE

Narrow therapeutic range

Benzodiazepines | MOA

MOA: GABA stimulation, Schedule IV

Benzodiazepines | INDICATIONS

Sedative (anxiolytic) => preventing alcohol withdrawal symptoms (DTs) Epilepsy (antiepileptic) Spasms (centrally acting muscle relaxant) Insomnia (hypnotic) anesthesia induction (sedative/hypnotic)

Benzodiazepines | ROUTES

Routes: PO, IM, IV

Benzodiazepines | DRUGSSS

lorazepam diazepam chlordiazepoxide - Prophylaxis for alcohol withdrawal, - scheduled & PRN, - long onset of action, - safest Benzodiazepine alprazolam temazepam clonazepam midazolam - pre-operative

Benzodiazepines withdrawal symptoms

``` anxiety, insomnia, diaphoresis, tremor, delirium, HTN, seizure ```

Anesthesia Anesthetics Types & Routes GENERAL

Inh/IV General CNS depression loss of consciousness, amnesia analgesia, complete muscle paralysis, loss of reflexes/ANS

Anesthesia Anesthetics Types & Routes REGIONAL

Injection close to a nerve No loss of consciousness, no amnesia Regional effects: analgesia, muscle paralysis, loss of reflexes/ANS

Anesthesia Anesthetics Types & Routes LOCAL

Local analgesia (dental procedures, minor surgeries) Injection/topical

Inhalation Anesthetics

``` Inhaled gas: nitrous oxide (NO) ``` Inhaled volatile liquids: isoflurane

Fast induction & fast reversal/recovery no metabolism; eliminated by ventilation

``` Inhaled gas: nitrous oxide (NO) ``` Inhaled volatile liquids: isoflurane REVERSAL AGENT

Reversal agent: deep breathing; intubation/ventilation

``` Inhaled gas: nitrous oxide (NO) ``` Inhaled volatile liquids: isoflurane ADVERSE EFFECTS

“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

IV Anesthetics

etomidate propofol ketamine

Rapid onsets and short durations of action

propofol

high risk of infection, | use vial within 6hrs

propofol | CONTRAINDICATION

Contraindication: allergy to egg/soybean

ketamine | SIDE EFFECT

``` Side effect (paradoxical effects) ``` cause hallucination, delirium, confusion

Other Drug used as IV Anesthetics

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

Regional Anesthesia

Anesthetic agent injected around nerves (spine, local nerves) no LOC (loss of consciousness) may need benzodiazepines or opioids for sedative effect

Regional Anesthesia | MOA

Prevent conduction of nerve impulses at injection site Motor, Sensory, Autonomic

Regional Anesthesia | ROUTES

Routes for regional anesthesia: | injection close to a nerve

Regional Anesthesia | SODIUM CHANNEL BLOCKER:

procaine | lidocaine

Regional Anesthesia | bottom notes

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)