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pharm 140 > CNS part 3 > Flashcards

CNS part 3 Flashcards

1
Q

dopaminergic agents

A

increase effects of dopamine at receptor sites

more effective than anticholinergics

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2
Q

carbidopa-levodopa (sinemet) indications

A

Parkinson disease

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3
Q

carbidopa-levodopa (sinemet) action

A

levodopa: a dopamine precursor that relieves parkinsonian symptoms by being converted to dopamine in the braine
carbidopa: inhibits decarboxylation of peripheral levodopa which allows more intact levodopa to travel to the brain

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4
Q

carbidopa-levodopa (sinemet) contraindications

A 
glaucoma
hx melanoma
suicidal thoughts, bipolar disorder
renal, hepatic, respiratory disorders
peptic ulcer disease
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5
Q

carbidopa-levodopa (sinemet) adverse effects

A 
anxiety, nervousness
photophobia, blurred vision
flushing, sweating
hypotension, arrhythmia
anorexia, nausea, constipation
urinary retention
teratogenic
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6
Q

carbidopa-levodopa (sinemet) interactions

A

high protein meals, iron salts, antipsychotics, metoclopramide: decreased action/effect of carbidopa-levodopa

anticholinergics: increased response to carbidopa-levodopa
phenytoin: may antagonize antiparkinsonian action

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7
Q

carbidopa-levodopa (sinemet) interventions

A

monitor for s/s orthostatic hypotension
changes in client urine/sweat color
give quetiapine to relieve psychotic sx
give COMT inhibitor to increase half-life of levodopa and deliver more to the brain

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8
Q

carbidopa-levodopa (sinemet) pt teaching

A 
take with food to avoid GI distress
darkening of urine/sweat may occur
change positions slowly
avoid high protein foods
can take up to 6 months for full response
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9
Q

anticholinergic agents

A

oppose the effects of acetylcholine at receptor sites in the substantia nigra and the corpus striatum, thus helping to restore chemical balance in the area

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10
Q

benztropin (cogentin) indications

A

adjunctive therapy for parkinson disease

relief of symptoms of extrapyramidal disorders

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11
Q

benztropin (cogentin) action

A

acts as an anticholinergic in CNS to return balance to basal ganglia
peripheral anticholinergic effects help reduce drooling and other secondary effects of parkinsonism

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12
Q

benztropin (cogentin) contraindications

A

angle closure glaucoma
anhidrosis
arrhythmias
seizure disorders

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13
Q

benztropin (cogentin) adverse effects

A 
memory impairment, depression, hallucinations, fever
tachycardia, arrhythmias
dilated pupils, dry mouth
constipation, n/v/d, paralytic ileus
urinary retention, dysuria
sweating, heat stroke
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14
Q

benztropin (cogentin) interactions

A

amantadine, TCAs: may cause additive anticholinergic adverse reactions

cholinergics (donepezil, rivastigmine): may antagonize therapeutic effects

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15
Q

benztropin (cogentin) interventions

A

monitor vital signs
monitor for adverse effects especially in elderly pts
recognize s/s paralytic ileus (intermittent constipation and abdominal distention and pain)

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16
Q

benztropin (cogentin) pt education

A

take dose at bedtime
report s/s dysuria, retention
limit hot weather activity; risk of overheating

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17
Q

dopamine agonists

A

medications that mimic the actions of dopamine in the body to relieve symptoms related to low levels of dopamine

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18
Q

pramipexole (mirapex) indications

A

idiopathic parkinsonism

restless leg syndrome

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19
Q

pramipexole (mirapex) action

A

stimulates dopamine receptors

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20
Q

pramipexole (mirapex) contraindications

A

renal impairment
major psychotic disorder
hypotension

21
Q

pramipexole (mirapex) adverse effects

A 
sleep disorders, thought abnormalities, fever, pneumonia
chest pain, peripheral edema
vision problems
UTI
weight loss
arthritis, twitching
22
Q

pramipexole (mirapex) interactions

A

antipsychotics, dopamine antagonists: may diminish effects
diltiazem, ranitidine, verapamil: may decrease pramipexole clearance
alcohol: may increase sedative effects

23
Q

pramipexole (mirapex) interventions

A

monitor for nausea, drowsiness, sudden sleepiness, muscle weakness and prevent falls
monitor cardiac status
observe for abnormal muscle movement/dyskinesia

24
Q

pramipexole (mirapex) pt teaching

A

avoid alcohol and CNS depressants
take before bedtime if taking once daily
taper gradually to avoid w/d
change positions slowly

25
Q

baclofen (lioresal)

A

centrally acting skeletal muscle relaxant

26
Q

baclofen (lioresal) indications

A

muscle spasm/pain caused by injury, MS, cerebral palsy

27
Q

baclofen (lioresal) action

A

appears to reduce transmission of impulses from the spinal cord to skeletal muscle
this in turn decreases the frequency and amplitude of muscle spasms in pts with spinal cord lesions

28
Q

baclofen (lioresal) contraindications

A

concurrent use with MAOIs
age extremes
seizure disorders
stroke

29
Q

baclofen (lioresal) adverse effects

A 
drowsiness, dizziness, seizures, psychosis
n/v, constipation
urinary retention
peripheral edema
pneumonia
diaphoresis
30
Q

baclofen (lioresal) interactions

A

alcohol/CNS depressants/opioids: can increase sedation

31
Q

baclofen (lioresal) interventions

A

administer low dose and gradually increase to minimize adverse effects
give with food to prevent GI upset
taper gradually to avoid w/d
encourage fluids/fiber if constipation occurs

32
Q

baclofen (lioresal) pt teaching

A

change positions slowly
take with food to avoid GI upset
increase fluid/fiber intake
do not stop abruptly to avoid w/d

33
Q

pyridostigmine (mestinon) indications

A

indirectly acting cholinergic agonist used to treat myasthenia gravis
antidote for neuromuscular blockers

34
Q

pyridostigmine (mestinon) action

A

reversible cholinesterase inhibitor that increases the levels of acetylcholine, facilitating transmission at the neuromuscular junction

35
Q

pyridostigmine (mestinon) contraindications

A 
GI/GU obstruction
bronchial asthma
arrhythmias
epilepsy
peptic ulcer
pregnancy/lactation
36
Q

pyridostigmine (mestinon) adverse effects

A 
headache, syncope
cardiac arrest, thrombophlebitis
increased peristalsis
urinary urgency
muscle cramps, tingling in extremities
bronchoconstriction, bronchial secretions
37
Q

pyridostigmine (mestinon) interactions

A

anticholinergics, corticosteroids, general or local anesthetics: may antagonize cholinergic effects

beta blockers: bradycardia

38
Q

pyridostigmine (mestinon) interventions

A

stop all other cholinergics before giving this drug

administer antidote if needed

39
Q

pyridostigmine (mestinon) antidote

A

atropine sulfate

is the antidote for mestinon

40
Q

pyridostigmine (mestinon) pt education

A

take as prescribed and on time
carry ID stating pt has myasthenia gravis
may be taking drug for life

41
Q

donepezil (aricept) indications

A

mild to moderate alzheimer’s disease

42
Q

donepezil (aricept) action

A

reversible cholinesterase inhibitor that causes elevated acetylcholine levels in the cortex
this in turn slows the neuronal degradation of alzheimer’s disease

43
Q

donepezil (aricept) contraindications

A 
renal/hepatic impairment
cardiac/respiratory disorders
seizures
hyperthyroidism
GI bleeding
44
Q

donepezil (aricept) adverse effects

A

insomnia, dizziness, headache
bradycardia
nausea, GI upset
rash

45
Q

donepezil (aricept) interactions

A

NSAIDs: risk of GI bleeding

anticholinergic drugs: decrease effect of aricept

46
Q

donepezil (aricept) nursing dx

A

acute pain r/t GI effects

decreased cardiac output r/t BP changes and arrhythmias

47
Q

donepezil (aricept) interventions

A

give with food if GI upset
monitor weight and vitals
monitor and report s/s GI bleeding
monitor for bradycardia (potential for vagotonic effects)

48
Q

donepezil (aricept) pt teaching

A

take with food at bedtime to minimize GI effects
report LOC to provider
drug does not alter underlying degenerative disease; treats symptoms
avoid OTC cold/sleep remedies

49
Q

memantine (namenda)

A

adjunctive therapy with aricept to slow memory loss in alzheimer’s pts
antagonizes N-methyl-D-aspartate receptors and decreases symptoms

interacts with OTC antacids; possible toxicity

pharm 140 (18 decks)

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