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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
MOA: Carbamazepine (Tegretol) Traditional anti-epileptic drugs
Stabilizes neuronal membranes and limits seizure activity by selective inhibition of sodium channels
26
therapeutic use of carbamazepine
for partial and generalized epilepsy bipolar disorder
27
adverse effects of carbamazepine
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)
28
drug-drug interactions for carpbazepine
warfin, grapefruit juice
29
pt teaching for carpbazepine
monitor CBC before & after treatment sunscreen childbearing age must use birth control or a different
30
benzodiazepines MOA - diazepam (valium) - Lorazepam (ativan)
Decrease anxiety by acting on the limbic system and other areas of the brain that help regulate emotional activity (anxiety & insomnia MOA)
31
therapeutic use of benzodiazepines
management of status epilepticus tonic clonic seizures lasting > 20-30 min anxiety insomina
32
general seizure info
- neuro surgery (best succes rate) - vagal nerve stimulation - keto diet
33
benzodiazepines MOA
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
benzodiazepines drugs
lorazepam (Ativan) alprazolam temazepam (restoril) midazolam (versed)
35
therapeutic use of diazepam
anxiety sedative/hypnotic muscle relaxant amnestic (amnesia) anticonvulsant
36
adverse effect of diazepam
cardiac and respiratory depression
37
nurse education of diazepam
increased risk for respiratory depression when taken with opioid
38
MOA of local anesthetics
blocks impulses along axon through blocking sodium channels
39
therapeutic use of: lidocaine (xylocaine) procaine (novocain)
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
adverse effects of lidocaine
CNS excitation followed by depression Cardiac- bradycardia & heart block Spinal headache Urinary retention
41
nurse education for Lidocaine
should void within 8 hr
42
general anesthetics propofol
Used for induction & maintenance of anesthesia Propofol used in ICU for sedation for intubation & mechanically ventilated adults
43
adverse effects of profofol
respiratoy depression and hypotension
44
nurse education for profofol
monitor RR & BP
45
opioid agonists MOA
reduce pain by binding to opiate receptor sites in the peripheral nervous system & CNS
46
strong opioid drugs: morphine, fentanyl, meperidine, methadone
analgesia severe, chronic & acute pain sedation, cough suppression
47
adverse effects of strong opioid drugs
respiratory depression constipation hypotension
48
nurse education for strong opioids
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
moderate to strong opioids
Acetaminophen and Hydrocodone Oxycodone
50
meperidine pt edu
Administration >48 hours increase risk for neurotoxicity and seizures
51
morphine adverse effects
decreased rate and depth of breathing, pupil constriction & coma
52
therapeutic use of morphine
dilates the smooth mm of the GI and GU tracts dilates the peripheral blood vessels
53
naloxone (narcan) MOA
blocks the effects of opioid agonist
54
naloxone therapeutic use
reversal of opioid overdose reversal of postoperative opioid effects reversal of neonatal respiratory depression
55
NSAIDS MOA
inhibition of COX
56
therapeutic use of NSAIDS
anti-inflammatory effects, pain relief, reduce fever
57
what organ can be affected by NSAIDS
kidney
58
MOA of acetaminophen
pain control & fever
59
what organ is affected by acetaminophen
liver
60
pain medication quick facts
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
codine action
mild to moderate pain- cough suppressant
62
meperidine
metabolizes to normeperidine, which is a toxic metabolite
63
Merperidine Adverse effects
tremors, palpation, tachycardia drug accumulation= renal failure
64
adverse effects of naloxone
feeling nervoud, restless, irritable body aches, dizziness or weakness, diarrhea, stomach pain or nausea, fever chills
65
adverse effects of NSAIDS
GI upset/ ulcers, acute renal failure & bleeding
66
general seizure saftey
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
general seizure info
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
neostigmine & pyridostigmine MOA
reversible cholinesterase inhibitor
69
amantadine MOA
dopamine agonists promotes dopamine release and prevents reuptake
70
benztropine MOA
blocks muscarinic receptors in the striatum and cholinergic receptors
71
benztropine MOA
blocks muscarinic receptors in the striatum and cholinergic receptors

Pharm (11 decks)

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