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pharm 140 > cns drugs part 1 > Flashcards

cns drugs part 1 Flashcards

1
Q

limbic system

A

responsible for emotions, expression, learning, memory

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2
Q

amygdala

A

can signal a threat and set off a fear response/anxiety

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3
Q

hippocampus

A

processes threats and traumatic stimuli

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4
Q

panic disorder

A

intense anxiety and feelings of immediate apprehension, fearfulness, terror or doom

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5
Q

nonpharm tx of anxiety

A

CBT
counseling
biofeedback
meditation

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6
Q

sedatives

A

depress CNS
benzos
barbiturates
anthihistamines

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7
Q

hypnotics

A

induce sleep

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8
Q

SSRIs (Prozac) pregnancy

A

category C

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9
Q

SSRIs (Prozac) indications

A

depression
OCD
bulimia
panic disorder

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10
Q

SSRIs (Prozac) pharmacokinetics

A

given PO
metabolized in liver
excreted in urine, feces

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11
Q

SSRIs (Prozac) action

A

blocks the reuptake of 5HT (serotonin) and increases levels of 5HT in the synaptic cleft

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12
Q

SSRIs (Prozac) contraindications

A

hypersensitivity
pregnancy
hepatic impairment
suicidal or severely depressed patients

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13
Q

SSRIs (Prozac) side effects

A 
headache, mania, insomnia
n/v/d, constipation
urinary urgency
cough, dyspnea, URI
rash
increased IOP
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14
Q

SSRIs (Prozac) interactions

A

aspirin, NSAIDs, anticoagulants: risk of bleeding
MAOIs
other SSRIs: serotonin syndrome
TCAs

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15
Q

SSRIs (Prozac) interventions

A

look for s/s hyponatremia
monitor for insomnia, increased depression, suicidal ideation
taper gradually to prevent w/d

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16
Q

SSRIs (Prozac) pt teaching

A

full effect in >4 wks
take in AM to avoid sleep disruption
report dizziness, headache, increased depression/anxiety

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17
Q

TCAs (imipramine/Toframil) indications

A

depression
chronic pain
bed wetting in kids >6 y/o

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18
Q

TCAs (imipramine/Toframil) action

A

inhibits presynaptic reuptake of norepinepherine and serotonin

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19
Q

TCAs (imipramine/Toframil) contraindications

A

CV disorders
urinary retention
seizure disorders
thyroid drugs

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20
Q

TCAs (imipramine/Toframil) black box warning

A

may increase suicidal tendencies

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21
Q

TCAs (imipramine/Toframil) adverse effects

A

seizures, stroke, confusion, hallucinations, ataxia, extrapyramidal reactions
MI, arrhythmias, precipitation of HF
tinnitus, blurred vision, black tongue
paralytic ileus, urinary retention/freqency
bone marrow depression
unstable blood sugar
alopecia

22
Q

TCAs (imipramine/Toframil) interactions

A

barbiturates, CNS depressants: may increase CNS depression
clonidine: HTN
other antidepressants: increased effect
MAOI: seizures, fever, death
QTc prolonging drugs (quinidine, etc): arrhythmias

23
Q

TCAs (imipramine/Toframil) interventions

A

monitor for s/s withdrawal if stopping l/t therapy
stop drug several days before surgery
monitor for mood changes, suicidal tendencies
monitor WBCs

24
Q

TCAs (imipramine/Toframil) pt teaching

A 
recognize and report s/s serotonin toxicity
take at bedtime 
avoid alcohol
do not stop drug suddenly
sun protection
25
Q

monoamine oxidase

A

enzyme that degrades serotonin in synapse

higher levels of serotonin can remain active in the synapse when MAO is inhibited

26
Q

MAOIs (phenelzine/Tardil) indications

A

depression

27
Q

MAOIs (phenelzine/Tardil) action

A

irreversibly inhibits MAO, allowing norepinepherine, 5HT and dopamine to accumulate in the synaptic cleft

28
Q

MAOIs (phenelzine/Tardil) contraindications

A

hepatic impairment
HF
pregnancy (C)
dye used in myelography

29
Q

MAOIs (phenelzine/Tardil) adverse effects

A

anxiety, insomnia, suicidal thoughts, twitching, drowsiness
HTN, orthostatic hypotension
n/v/d, constipation, urinary retention
weight gain

30
Q

MAOIs (phenelzine/Tardil) interactions

A

antihypertensives: may cause hypotension
demerol: fever
SSRIs: serotonin syndrome
TCAs: HTN

31
Q

MAOIs (phenelzine/Tardil) food interactions

A

foods containing tyramine
chocolate
caffeine
all cause HTN

32
Q

MAOIs (phenelzine/Tardil) interventions

A

monitor BP carefully
monitor for insomnia, agitation, increased depression, seizures
give IV nitroprusside if HTN crisis

33
Q

MAOIs (phenelzine/Tardil) pt teaching

A

change positions slowly
avoid foods containing tyramine
take with food if GI upset
DM pts – monitor glucose

34
Q

atypical antidepressants

A

trazodone (sedating)

mirtazapine (remeron)

35
Q

benzodiazepines (diazepam) indications

A

seizures
anxiety
muscle spasm
ETOH w/d

36
Q

benzodiazepines (diazepam) action

A

acts in limbic system to potentiate the effects of GABA

may act in spinal cord to produce muscle relaxation

37
Q

benzodiazepines (diazepam) contraindications/precautions

A 
pregnancy (D, teratogenic)
coma
age extremes
addiction risk
chronic respiratory disorders
38
Q

benzodiazepines (diazepam) adverse effects

A

sedation, drowsiness, amnesia, confusion
BP changes, arrhythmias
dry mouth, constipation, n/v
urinary retention, decreased sex drive

39
Q

benzodiazepines (diazepam) interactions

A

CNS depressants: increased sedation, resp depression

cimetidine: increases benzo levels
smoking: decreases effects
digoxin: increases dig levels
cardizem: CNS depression, increased benzo effects

40
Q

benzodiazepines (diazepam) interventions

A

fall risk assessment
taper dosage to avoid withdrawal
monitor vitals
assess for s/s dependence, tolerance, w/d

41
Q

benzodiazepines (diazepam) reversal

A

IV flumazenil to reverse sedation

flumazenil = antidote to bdz

42
Q

benzodiazepines (diazepam) pt teaching

A 
cautious ambulation to avoid falls
amnesia may occur
tolerance occurs with time
taper slowly to avoid w/d
do not drink alcohol
43
Q

hydroxyzine (vistaril)

A

antihistamine used to treat anxiety
CNS depressant in subcortical areas
rapid feeling of calmness without impairing mental alertness

44
Q

zolpidem (ambien)

A

short-term treatment of insomnia
give immediately before bedtime; works fast
interacts with GABA-benzodiazepine receptors

45
Q

barbiturates

A

anxiolytics-hypnotics

habit forming

46
Q

barbiturates (phenobarbitol) indications

A

insomnia
seizures
preanesthetic

47
Q

barbiturates (phenobarbitol) actions

A

inhibits conduction in the ascending RAS
alters cerebral function
depresses motor output

48
Q

barbiturates (phenobarbitol) adverse effects

A 
drowsiness, confusion, ataxia
bradycardia, hypotension
n/v/d, constipation
hypoventilation, apnea
rash, stevens-johnson syndrome
49
Q

barbiturates (phenobarbitol) interactions

A

CNS depressants: increased CNS depression
MAOIs: increase serum levels of phenobarbitol
anticoagulants, digoxin, TCAs, oral contraceptives, acetaminophen, beta blockers, doxycycline: decreased effect of drugs

50
Q

barbiturates (phenobarbitol) interventions

A

fall risk
assess for dependence
monitor respirations
do not mix IV drugs in solution with anything else
IV push slowly to decrease adverse CV effects
taper slowly

51
Q

barbiturates (phenobarbitol) pt education

A

taper gradually to avoid w/d
tolerance/dependence can develop
oral contraceptives may be less effective
with or without food

pharm 140 (18 decks)

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