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Pharm > CNS medications > Flashcards

CNS medications Flashcards

1
Q

caffeine therapeutic effects

A

decreases drowsiness and fatigue

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2
Q

caffeine therapeutic uses

A

neonatal apena
& wakefulness

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3
Q

adverse effects of caffeine

A

palpations, dizziness, vasodilation, bronchodilation, tachycardia, diuresis & insomnia

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4
Q

therapeutic use of neostigmine and pyridostigmine

A

myasthenia gravis symptomatic relief of mm weakness by increase the force of contraction

s/s: ptosis difficulty swallowing and weak muscle

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5
Q

side effects of neostigmine & pyridostigmine

A
  • Excessive muscarinic stimulation \
  • tremors or muscle spasm
  • increased GI motility and tone, N/V, urinary urgency, increased secretions (saliva, GI)
  • bradycardia, sweating, miosis
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6
Q

nursing education for neostigmine & pyridostigmine

A

always assess for difficulty swallowing

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7
Q

2 categories for Parkinson’s disease

A

dopaminergic & anticholinergic agents

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8
Q

MOA for dopaminergic agents

A

stimulates dopamine by activating dopamine receptors

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9
Q

MOA for Anticholinergic agents

A

stops excess ACh by preventing activation of cholinergic receptors or blockage of muscarinic receptors

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10
Q

levodopa (dopar)

parkinsons

MOA

A

promotes dopamine synthesis (dopamine agonist)
& stimulates dopamine receptors directly

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11
Q

levodopa therapeutic use

A
  • 1st line drug for younger parkinson’s pt. due to most being able to tolerate the side effects
  • on-off phenomenon
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12
Q

side effects of Levopoda

A
  • drowsiness, dyskinesia (head bobbing and tics)
  • hypotension (dizziness, lightheadedness)
  • stimulation or dysrhythmias
  • Psychosis- not uncommon (hallucinations)
  • Clozapine (antipsychotic) can reduces these symptoms

Drug interactions:
* MAO inhibitors-
* hypertensive crisis

  • Pyridoxine (B6)
  • enhance destruction of Levodopa
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13
Q

nursing education of Levopoda

A
  • can give with food, but avoid high protein meals
  • can take months to show effect
  • on-off phenomenon
  • increase Na+ water consumption
  • taper off slowly
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14
Q

carbidpopa MOA

A

helps decrease peripheral degradation and allows levodopa to cross BBB

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15
Q

why shouldn’t patients take MAO inhibitors or pyridoxine (b6) when using levopoda?

A

MAO inhibitors can cause hypertensive crisis & b6 can cause destruction of the drug

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16
Q

Amantadine (symmetrel)

dopamine agonist

Adverse effects

A

CNS- confusion, lightheadedness, anxiety

atropine-like effects= blurred vision, urinary retention, dry mouth

skin discoloration–> livido reticularis

see response in 2-3 days, but diminish in 3-6 months

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17
Q

Benztropine (cogentin)
anticholinergic agents

Therapeutic use

A

stops tremors and muscle rigidity

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18
Q

adverse effects of Benztropine

A

Atropine like effects- dry mouth, blurred vision, mydriasis, urinary retention & constipation

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19
Q

Anti-epileptics/Anti-seizure
MOA

A

suppress sodium influx;

suppression of calcium influx;

antagonism of glutamate;

potentiation of GABA

Suppress discharge of neurons within a seizure focus

Suppress propagation of seizure activity from the focus to other areas of the brain

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20
Q

MOA of: phenytoin (dilantin)
**traditional anti-epileptic drug

A

Stabilizes neuronal membranes and limits seizure activity by selective inhibition of sodium channels

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21
Q

therapeutic use of phenytoin

A

All major seizures

Varied oral absorption

given IV for emergencies

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22
Q

adverse effects of phenytoin

A

CNS- Nystagmus- twitching eyes, Sedation, Ataxia (staggering gait), Diplopia (double vision or blurred vision),

Cognitive impairment or stroke like appearance

Skin- rash (measles like rash or Stevens Johnson Syndrome)

Gingival hyperplasia (tender swelling gums, bleeding)

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23
Q

patient/ nurse education for phenytoin

A

Half-life: 8 to 60 hours

Therapeutic level – 10-20 mcg/ml

Toxic level: 30-50 mcg/ml

Educate patient that they must take the drug every day and do not stop the drug suddenly

Childbearing age must use birth control or be switched to different Rx

Review adverse effects with patients and call clinic if they have any

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24
Q

drug interactions for phenytoin

A

oral contraceptives
warfin
glucocorticoids

can increase serum glucose levels

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25
Q

MOA: Carbamazepine (Tegretol)

Traditional anti-epileptic drugs

A

Stabilizes neuronal membranes and limits seizure activity by selective inhibition of sodium channels

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26
Q

therapeutic use of carbamazepine

A

for partial and generalized epilepsy

bipolar disorder

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27
Q

adverse effects of carbamazepine

A

Neurologic effects- nystagmus, ataxia

Hematologic effects- leukopenia, anemia, thrombocytopenia (Flu like Symptoms)

Hypo-osmolality- disorder of fluid and electrolyte balance

Dermatologic effects- rash, photosensitivity reactions

Contraindications: pregnancy (birth defects/Category X)

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28
Q

drug-drug interactions for carpbazepine

A

warfin, grapefruit juice

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29
Q

pt teaching for carpbazepine

A

monitor CBC before & after treatment

sunscreen

childbearing age must use birth control or a different

30
Q

benzodiazepines MOA

  • diazepam (valium)
  • Lorazepam (ativan)
A

Decrease anxiety by acting on the limbic system and other areas of the brain that help regulate emotional activity (anxiety & insomnia MOA)

31
Q

therapeutic use of benzodiazepines

A

management of status epilepticus

tonic clonic seizures lasting > 20-30 min

anxiety
insomina

32
Q

general seizure info

A
  • neuro surgery (best succes rate)
  • vagal nerve stimulation
  • keto diet
33
Q

benzodiazepines MOA

A

work in the CNS by enhancing GABA receptors

Decrease anxiety by acting on the limbic system and other areas of the brain that help regulate emotional activity

34
Q

benzodiazepines

drugs

A

lorazepam (Ativan)
alprazolam
temazepam (restoril)
midazolam (versed)

35
Q

therapeutic use of diazepam

A

anxiety
sedative/hypnotic
muscle relaxant
amnestic (amnesia)
anticonvulsant

36
Q

adverse effect of diazepam

A

cardiac and respiratory depression

37
Q

nurse education of diazepam

A

increased risk for respiratory depression
when taken with opioid

38
Q

MOA of local anesthetics

A

blocks impulses along axon through blocking sodium channels

39
Q

therapeutic use of:
lidocaine (xylocaine)
procaine (novocain)

A

supresses pain w/o generalized CNS depression

used w/ vasoconstrictors like epinephrine to decrease local blood flow

prolongs anesthesia & reduces the risk of toxicity

40
Q

adverse effects of lidocaine

A

CNS excitation followed by depression

Cardiac- bradycardia & heart block

Spinal headache

Urinary retention

41
Q

nurse education for Lidocaine

A

should void within 8 hr

42
Q

general anesthetics propofol

A

Used for induction & maintenance of anesthesia

Propofol used in ICU for sedation for intubation & mechanically ventilated adults

43
Q

adverse effects of profofol

A

respiratoy depression and hypotension

44
Q

nurse education for profofol

A

monitor RR & BP

45
Q

opioid agonists MOA

A

reduce pain by binding to opiate receptor sites in the peripheral nervous system & CNS

46
Q

strong opioid drugs: morphine, fentanyl, meperidine, methadone

A

analgesia

severe, chronic & acute pain

sedation, cough suppression

47
Q

adverse effects of strong opioid drugs

A

respiratory depression
constipation
hypotension

48
Q

nurse education for strong opioids

A

shallow & slow RR if below 12 BPM, hold drug

avoid alcohol

Increase fiber and use a stool softener while on Opioids

Constipation effects elderly more often

wean off 7-10 days

avoid with head injury

49
Q

moderate to strong opioids

A

Acetaminophen and Hydrocodone
Oxycodone

50
Q

meperidine pt edu

A

Administration >48 hours increase risk for neurotoxicity and seizures

51
Q

morphine adverse effects

A

decreased rate and depth of breathing, pupil constriction & coma

52
Q

therapeutic use of morphine

A

dilates the smooth mm of the GI and GU tracts
dilates the peripheral blood vessels

53
Q

naloxone (narcan) MOA

A

blocks the effects of opioid agonist

54
Q

naloxone therapeutic use

A

reversal of opioid overdose

reversal of postoperative opioid effects

reversal of neonatal respiratory depression

55
Q

NSAIDS MOA

A

inhibition of COX

56
Q

therapeutic use of NSAIDS

A

anti-inflammatory effects, pain relief, reduce fever

57
Q

what organ can be affected by NSAIDS

A

kidney

58
Q

MOA of acetaminophen

A

pain control & fever

59
Q

what organ is affected by acetaminophen

A

liver

60
Q

pain medication quick facts

A

Pain status should be evaluated prior to opioid administration and about 1 hour after for PO and 10-15 minutes after IV administration.

Opioid analgesics must be adjusted to accommodate individual variation.

opioids should be administered on a fixed schedule. Ie: Q4 hours instead of PRN

20 days or more, physical dependence may develop.

Taper drug slowly over 7-10 days and monitor for withdrawal symptoms

61
Q

codine action

A

mild to moderate pain- cough suppressant

62
Q

meperidine

A

metabolizes to normeperidine, which is a toxic metabolite

63
Q

Merperidine Adverse effects

A

tremors, palpation, tachycardia

drug accumulation= renal failure

64
Q

adverse effects of naloxone

A

feeling nervoud, restless, irritable

body aches, dizziness or weakness, diarrhea, stomach pain or nausea, fever chills

65
Q

adverse effects of NSAIDS

A

GI upset/ ulcers, acute renal failure & bleeding

66
Q

general seizure saftey

A

Take AED’s exactly as prescribed & monitor plasma levels

Seizure frequency chart

avoid driving & wear medic alert bracelet

Forewarn about CNS depression/ sedation

Never stop abruptly – must be weaned possibly a period of 6 weeks to months

Phenytoin – with meals, shake bottle well, good oral hygiene.

Carbamazepine (Tegretol) – Take with meals, forewarn about hematologic abnormalities (fever, sore throat, weakness, petechiae), do NOT take with grapefruit juice.

67
Q

general seizure info

A

Neurosurgery (best success rate)

Vagal nerve stimulation
Ketogenic diet

All patients with a dx of seizures but be given education on seizure precautions

Diagnosis and drug selection-specific drugs for specific types

Drug evaluation has a trial period

68
Q

neostigmine & pyridostigmine MOA

A

reversible cholinesterase inhibitor

69
Q

amantadine MOA

A

dopamine agonists

promotes dopamine release and prevents reuptake

70
Q

benztropine MOA

A

blocks muscarinic receptors in the striatum and cholinergic receptors

71
Q

benztropine MOA

A

blocks muscarinic receptors in the striatum and cholinergic receptors

Pharm (11 decks)

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