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CNS Drugs p2 Flashcards

1
Q

partial seizures

A
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2
Q

simple partial

A

no loss of consciousness, minute symptomes, thumbs twitching, numbness
20-60s

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3
Q

complex partial

A

impaired consciousness, lack of responsiveness, motionless/ fixed gaze
45-90s

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4
Q

generalized-tonic clonic/ grand mal

A

major convulsions, muscle rigidity (tonic) followed by jerking (clonic)

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5
Q

post ictal phase

A

post seizure “feeling like getting hit by a truck”

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6
Q

generalized- petit mal/ abscence seizures

A

LOC, mild motor activity, eye blinking, no motor activity

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7
Q

status epilepticus

A

recurrent seizures, lasting 15 up minutes

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8
Q

unclassifies seizures

A

febrile seizures like after a high fever

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9
Q

antiepileptic meds MOA

A

enhancement of GABA
inhibition of glutamate
suppress sodium influx
suppress calcium influx
promote potassium efflux

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10
Q

goal seizure treatment

A

reduce seizures to a level that allows the patient to live as normal a life as possible
balance desire for complete seizure control with acceptable side effects

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11
Q

seizure treatment consideration

A

trial period, dosage adjustment, monitor plasma drug levels, promote patient adherence, monitor for suicide risk

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12
Q

Hydantoins

A

class of antiepileptics
prototype: phenytoin (dilantin)

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13
Q

Dilantin/phenytoin MOA

A

selective inhibition of sodium channels

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14
Q

therapeutic uses of dilantin/phenytoin

A

seizures, epilepsy, cardiac dysrhythmias

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15
Q

dilantin/phenytoin kinetics

A

Absorption: slow onset w/ PO and IM
distribution: HIghly protein bound
half life increases as dose increases
Low dose: half life 6-24 hrs
therapeutic dose: half life 20-60 hrs

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16
Q

phenytoin/ dilantin therapeutic levels

A

closely reltated to serum drug level
10-20 mcg/ml
effects can be achieved at lower standard range

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17
Q

phenytoin CNS side effects

A

Dizziness, ataxia (lack of balance/ coordination), blurred vision, slurred speech, tremor, mental confusion, sedations, nystagmus, cognitive impairment

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18
Q

Phenytoin other side effects

A

Dermatological reactions like IV infiltrate
cardiovascular collapse if given too quickly
live damage
gingival hyperplasia

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19
Q

phenytoin cautions

A

dysrhythmias like sinuc bradycardia, sinoatrial block 2/3 degree heart block
Diabetes( drug can cause increased blood sugar)
Wean off
pregnancy
monitor dose, small changes can cause large serum concentration change
dilute only in NS
avoid PO administration with enteral tube feedings
many drugs interact, include alcohol

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20
Q

patient education for phenytoin

A

shaking suspension thoroughly
teach good dental hygeine
take with food
blood sugar
reduce effectiveness of birth control pills

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21
Q

succinimides

A

class of antiepileptics
prototype: ethosuximide (Zarontin)

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22
Q

ethosuximide indications

A

used to treat absence seizures

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23
Q

ethosuximide

A

administered: oral
metabolized: liver
excreted: kidneys
peak: 3-7 hrs
half life: 30-60 hrs

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24
Q

Ethosuximide MOA

A

inhibiting the influx of calcium ions

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25
ethosuximide cautions
increased suicidal thoughts
26
ethosuximide side effects
drowsiness, dizziness, lethargy, nausua, blood disorders
27
ethosuximide drug interactions
known to interact with some of the other antiepileptic drugs
28
ethosuximide maximizing therapeutic effects
monitor drug levels at the start of therapy and when changing doses
29
ethosuximide minimizing adverse effects
assess CBC, UA, and LFT taper dose gradually if needed to discontinue drug
30
ethosuximide education
take with milk/food if GI upset use birth control rash, joint pain, fever, sore throat, bleeding or bruising, drowsiness, dizziness, blurred vision/ pregnancy
31
keppra as adjunct therapy
for epilepsy adverse effects: drosiness, dizziness, headache, infection educate: carefule due to increased accidental injuries in pediatric patient, increased behavioral changes
32
tegretol/ carbamazepine MOA
suppress influx of sodium
33
tegretol/ carbamazepine therapeutic uses
seizures, bipolar disorder, neuralgias
34
tegretol/ carbamazepine side effects
leukopenia, anemia, thrombocytopenia, birth defects
35
tegretol/ carbamazepine drug/food interactions
lots of drug, grapefruit
36
valproic acid/ depakote MOA
block influx of sodium and calcium increases GABA influence
37
valproic acid/ depakote therapeutic uses
seizures, bipolar disorder, migraines
38
valproic acid/ depakote
hepatotoxicity, teratogenic effect, pancreatitis
39
gabapentin/ neurontin MOA
Unknown, think helps release GABA
40
gabapentin/ neurontin therapeutic uses
seizures off label: neuropathic pain, migraine, fibromyalgia
41
gabapentin/ neurontin side effects
well tolerated dizziness, ataxia, fatigue, peripheral edema
42
Barbiturates
class of antiepileptics prototype: phenobarbital
43
Phenobarbital MOA
CNS depressant, stimulates effects of GABA
44
phenobarbital Therapeutic uses
tonic-clonic, focal seizures used for sedation induction of sleep
45
phenobarbital tolerance
does not occur to antiepileptic effects like it does for sedative effects
46
barbiturate serum therapeutic range
20-40 mcg/ml
47
phenobarbital pregnancy
class D
48
phenobarbital adverse effects
resp depression, CNS depression, sedation, dependency, ataxia, many drug interaction
49
benzodiazepines sedatives
P: lorazepam (ativan) alprazolam (xanax) chlordiazepoxide (librium) diazepam (valium) midazolam (versed)
50
benzodiazepines hypnotic
flurazepam (dalmane) temazepam (restoril) triazolam (Halcion)
51
Benzodiazepines Indications
anxiety, sleep promotions, antiepileptic effects, alcohol withdrawal, panic disorder, induction of general anesthesia, preoperative sedation, conscious sedation
52
Benzodiazepines Mechanism of action
bind to specific receptors to produce their effect BZ1- related to sleep BZ2- related to memory, motor, sensory, and cognitive increase effects of GABA
53
benzodiazepines kinetics
Absorption: easily absorbed from GI tract, readily absorped when given IM distribution: highly protein bound, mostly fast, some medium metabolism: lived excretion: kidneys
54
lorazepam and oxazepam metabolism
to inactive substance while other benzo diasepines to active substance
55
Benzodiazepines side effects
well tolerated, mild drowsiness, atazia and confusion especially in older adults, rare effects in CNS depression
56
benzodiazepines cautions
prolonged use can cause tolerance/ dependence do not give with other CNS depressant drugs, alcohol, narcotics, barbiturates pregnancy X
57
Anxiety pathogenesis
Drugs, disease processes, paulty neuro regulation, psychiatric illness
58
NT in emotion
GABA Glutamate
59
Anxiety classification
generalized anxiety disorder panic disorder phobia OCD PTSD
60
Anxiety diagnosis
complete history including med that may worsen/ cause anxiety symptoms medical association w/ anxiety recognize signs/ symptoms
61
anxiety relieving durgs
selective serotonin reuptake inhibitors tricyclic antidepressants monoamine oxidase inhibitors benzodiazepines
62
Medications that can cause anxiety
antibiotics, antidepressants, antihypertensives, antoseizure, bronchodilators, hallucinogens, hormones, NSAIDs, stimulants, sympathomimetics
63
sleep disorders
narcolepsy, sleep apnea, sleep walking, night terrors, primary (not caused by alternative things) insomnia, secondary (drug/ other reasons) insomnia
64
to do before starting sleeping meds
develop regular bedtime/ wakeup, avoid naps, exercise but not within 1 hr of bedtime avoid alcohol 3-4 hrs before bed avoid stimulant 8 hrs before bed warm bath before sleep in cool room
65
sedatives
substance that moderates activity and exitement while inducing a calming effects
66
hypnotic
substance that causes drowsiness and facilitates the onset and maintenance of natural sleep
67
Barbiturates
class of sedative-hypnotic and anxiolytic P- phenobarbital secobarbital
68
Eszopiclone (lunesta)
benzodiazepine-like hypnotic can be used for long term use induces sleep quickly, prevents waking up in the middle of night schedule IV controlled substances
69
Eszopiclone (lunesta) MOA
binds with BZ1 receptor and enhances GABA
70
Eszopiclone (lunesta) side effects
bitter aftertaste sleep driving, headache, dizziness, dry mouth
71
Melatonin
hormones that regulates our circadian clock low doses can reset circadian clock higher doses have hypnotic effects
72
melatonin indications
insomnia and jet lag
73
melatonin side effects
short term/low dose: minimal to no effects short term/high dose: hangover, headache, nightmares
74
ramelteon (rozerem)
melatonin receptor agonist MOA: high affinity for melatonin receptors approved for chronic insomnia, no risk for abuse or tolerance side effects: same as melatonin, sleep driving
75
zolpidem (ambien)
short term use only (7-10 days) does not cause insomnia rebound effect when discontinued rapid onset side effects: daytime drowsiness, dizziness, sleep driving. Schedule IV, tolerance/ dependency possible

Pharm (6 decks)

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