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PHARMACOLOGY > CNS & PNS > Flashcards

CNS & PNS Flashcards

1
Q

are medicines that stimulate the brain, speeding up both
mental and physical processes.

A

CNS STIMULANTS

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2
Q

CNS STIMULANTS INCREASE THE:

A

energy, improve attention and alertness, and elevate blood pressure, heart rate and respiratory rate.

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3
Q

CNS STIMULANTS DECREASE THE

A

sleep, reduce appetite,
improve confidence and concentration, and lessen
inhibitions

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4
Q

What drug is this:

Mecahanism:
Stimulates the release
of neurotransmitters –
norepinephrine and
dopamine

Indication:
1. Narcolepsy
2. ADHD -
methylphenidate
(note: do not give
5 hrs before
bedtime, the best
time to give is at
morning)

SE:
● Restlessness
● Insomnia
● Tachycardia
● HPN
● Heart palpitations
● Dry mouth
● Anorexia
● Weight loss
● Diarrhea or
constipation
● Impotence

Nursing Consideration:
● CAN DEVELOP
DEPENDENCE
● SHORT-TERM
(12 WEEKS)
● AVOID ABRUPT
WITHDRAWAL
● HALF LIFE: 9-13
HRS

A

AMPHETAMINES

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5
Q

What drug is this:

Mechanism: N/A

Indication:
● To increase
child’s attention
span, cognitive
performance
● To decrease
impulsiveness,
hyperactivity and
restlessness

SE/AE:
N/A

Nursing Consideration:

  1. Methylphenidate
    (Ritalin) – ADHD –
    CAUSES INSOMNIA!
    DON’T GIVE 6 HRS
    BEFORE BEDTIME.
  2. Pemoline (Cylert) -
    narcolepsy
  3. Modafinil (Provigil) -
    newest
A

AMPHETAMINE LIKE DRUGS

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6
Q

Nursing Cnsiderations of Amphetamine Drugs (7):

A
  1. RITALIN and Pemoline should be given 30 to 45 minutes before meals (breakfast and lunch)
  2. Never give within 6 hours before sleep
  3. Instruct the patient to avoid driving, (because it causes drowsiness)
  4. Instruct the nursing mother to avoid taking CNS stimulants
  5. Explain to clients that long-term use may lead to drug abuse.
  6. DRY MOUTH – ADVICE PX TO TAKE SUGARLESS GUMS
  7. WOF: TOURETTE SYNDROME (TICS) – INVOLUNTARY TWITCHING – EYES, MOUTH.
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7
Q

What drug is this:

Mecahnism:
Stimulates the release
of neurotransmitters –
norepinephrine and
dopamine

Clinical Use:
Appetite Suppresant

SE:
1. Nervousness
2. Restlessness
3. Irritability
4. Insomnia
5. Heart palpitations
6. HPN

Nursing Considerations:
● Avoid <12 yo.
● Avoid
self-medication
★ Not advisable to
people who are
dieting

A

ANOREXIANTS

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8
Q

What drug is this?

Mechanism:
Stimulates respiration
(bronchodilator)

Indication:
Newborn respiratory
distress (Theophylline &
Aminophylline)

SE:
● Nervousness
● Restlessness
● Tremors
● Twitching
● Palpitations &
insomnia
● Diuresis
● GI irritation
● Tinnitus

Nursing Consideration:
● Therapeutic level
of Aminophylline
& Theophylline
(10-20 mcg/mL)

A

ANALEPTICS

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9
Q

Give (1) drug related to Respiratory CNS Stimulants?

A

DOXAPRAM (DOPRAM)

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10
Q

Define Doxapram drug:

A

MOA:
N/A

Indication:
● Treat respiratory
depression caused
by drug overdose
● pre-postanesthetic
respiratory depression
● COPD

SE:
1. HPN
2. Tachycardia
3. Trembling
4. Convulsions

Nursing Considerations
★ Route: IV
★ To prevent respi
collapse /
depression
during post op:
instruct patient to
cough & do deep
breathing
exercises

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11
Q

A class of drugs that slow down brain activity, which can cause a person to feel calm and relaxed

A

CNS DEPRESSANTS

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12
Q

Diminish physical and mental response at a lower dosages of certain CNS depressants but does not affect consciousness

A

SEDATION

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13
Q

Termed as Natural Sleep

A

HYPNOTIC

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14
Q

NON PHARMA TO PROMOTE SLEEP:

S -
L -
E- -
E -
P -

A

● S – SAY “NO” – stimulants (6 hrs before sleep), daytime naps, nicotine/smoking, strenuous activity before bedtime, heavy meals before bedtime

● L – Limit loud noises / Listen to quiet music

● E – Encourage warm bath, warm water/milk

● E – Ensure soothing activities / quiet environment (cut lights > increase melatonin)

● P – Practice healthy lifestyle habits

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15
Q

Finite episodes of brain dysfunction resulting from
abnormal discharge of cerebral neurons.

A

SEIZURE

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16
Q

(5) Sedative Hypnotics

A
  1. Barbiturates
  2. Benzodiazepines
  3. Nonbenzodiazepines
  4. Piperidinediones
  5. Chloral Hydrate
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17
Q

A heterogenous symptom complex – a chronic
disorder characterized by multiple seizures

A

EPILEPSY

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18
Q

(2) Types of Seizure

A
  1. Focal Seizure
  2. Generalized Seizure
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19
Q

Seizure is a product of focal lesion/electrical abnormality in some parts of the cerebral cortex

A

Focal Seizure

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20
Q

(2) Types of Focal Seizure

A

1.Simple Partial Seizure
2. Complext Partial Seizure

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21
Q

Arise from the local part of the brain, manifestation depends on the focus (e.g. somatosensory – tingling of contralateral face/side of body, visual – seeing flashes of light, auditory – hearing ringing noise, motor.

A

Simple Partial Seizure

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22
Q

Like simple partial but with impairment of consciousness, awareness and
memory.

A

Complex Partial Seizure

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23
Q

Seizure manifestation indicates bilateral and diffuse cerebral cortical involvement.

A

Generalized Seizure

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24
Q

This composed of:

  1. Long-Acting
  2. Intermediate Acrting
  3. Short Acting
  4. Ultrashort Acting
A

Barbiturates (Barbital)

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25
Q

About Long Acting (Barbiturates)

A

● Phenobarbital
● Mephobarbital
- used to control seizures in epilepsy

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26
Q

About Intermediate Acting (Barbiturates)

A

● Amobarbital (Amytal)
● Aprobarbital (Alurate)
● Butabarbital (Butisol)
- sleep sustainers for maintaining long period of sleep
- causes drowsiness / hangover

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27
Q

About Short Acting (Barbiturates)

A

● Secobarbital (Seconal)
● Pentobarbital (Nembutal)
- induce sleep for those difficulty falling asleep

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28
Q

About Ultrashort Acting (Barbiturates)

A

● Thiopental Na (Pentothal)
- general anesthetics
- for procedure sedation

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29
Q

Nursing Responsibilities (Barbiturates/Effects/Sleep/Medications)

A

● Barbiturates – short term use only! (2 weeks or less)
● Abrupt withdrawal
● Raise bedside rails .
● Check skin for rashes.
● Administer IV pentobarbital at a rate of less than 50 mg/min.
● Do not mix pentobarbital w/ other medications.
● Deep IM in gluteus medius.
● Teach clients to use non pharma ways to induce sleep.
● Instruct to avoid alcohol and antidepressant, antipsychotic and narcotics – morphine sulfate!.
● WOF: respiratory depression / cns depression; hepatotoxicity esp. when combined with acetaminophen!

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30
Q

What drug class is this:

Action:
● Increase the action of
inhibitory neurotransmitter
GABA > neuron excitability is
reduced!
● FLURAZEPAM (DALMANE) –
first — used to treat
insomnia

SE:
Triazolam (Halcion) – A/R:
loss of memory (anterograde
amnesia/memory impairment);
should not be taken longer than
7-10 days.

NURSING CONSIDERATIONS:
● Avoid alcohol,
antidepressants,
antipsychotics
● Asking the patient to
urinate before taking the
drug – causes urinary
retention!
● No OTC drugs
● Caution in driving
● Antidote for flurazepam
overdose: Flumazenil

A

BENZODIZEPINES (PAM/LAM)

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31
Q

BENZODIAZEPINES -PAM/LAM

What are the (5) drugs of this?

A
  1. Temazepam
    (Restoril)
  2. Estazolam
    (ProSom)
  3. Quazepam
    (Doral)
  4. Diazepam
    (Valium)
  5. Lorazepam
    (Ativan)
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32
Q

NONBENZODIAZEPINES HAVE (2) Drugs

A
  1. Zolpidem (Ambien)
  2. Chloral Hydrate
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33
Q

This Nonbenzodiazepines have action of:

Induces sleep and decrease nocturnal awakenings

A

CHLORAL HYDRATE

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34
Q

This Nonbenzodiazepines have action of:

● Short term treatment of Insomnia (<10 days)
● Duration of Action: 6-8 hours
● Metabolized in the liver
● Excreted in the urine

A

ZOLPIDEM (AMBIEN)

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35
Q

Termed as:

*first anesthetic - nitrous oxide “laughing gas”

A

ANESTHESIA

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36
Q

● A hypnotic – given at night before surgery

● Premedication (narcotic and benzodiazepine) & anticholinergic (Atropine) – given 1 hr before surgery > to
decrease secretions > prevent aspiration!

● A short acting nonbarbiturate - Propofol

● An inhaled gas

● A muscle relaxant – PRN! – as needed!

A

BALANCED ANAESTHESIA

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37
Q

(3) Types of Anesthesia

A
  1. General
  2. Regional
  3. Local
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38
Q

● Loss of sensation induced in a part of the body by
infiltration or topical application of local anesthetics
near the nerve

A

LOCAL ANESTHESIA

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39
Q

● A state of unconsciousness, amnesia, immobilization,
reflex inhibition, and skeletal muscle relaxation (partial
or complete)

● Usual methods: Inhalational, Intravenous, or
Combined (MOST COMMON)

A

GENERAL ANESTHESIA

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40
Q

● A state of where there is loss of sensation and blockade
of major nerves

● Usual methods: Neuraxial (subarachnoid “spinal”
or epidural), Peripheral (plexus blockade)

A

REGIONAL ANESTHESIA

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41
Q

(4) STAGES OF GENERAL ANESTHESIA

A

1ST: ANALGESIA/INDUCTION

2ND: EXCITEMENT/DELIRIUM

3RD: SURGIAL STAGE:

4TH: MEDULLARY PARALYSIS

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42
Q

What stage of anesthesia includes the following:

● Decreased pain awareness
● Sometimes with amnesia
● Impaired consciousness but not lost

A

1ST: ANALGESIA/INDUCTION

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43
Q

What stage of anesthesia includes the following:

● Excitation
● Amnesia
● Enhance reflexes
● Uncontrolled movement
● Irregular respiration
● Urinary incontinence

A

2ND: EXCITEMENT/DELIRIUM

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44
Q

What stage of anesthesia includes the following:

● Unconscious
● No pain reflex
● Regular respiration

● Maintained BP
○ Plane 1: light anesthesia
○ Plane 2: loss of blink reflex, regular respiration. Surgical
procedures can be performed. NONBENZODIAZEPINES
○ Plane 3 – Deep anesthesia: Shallow breathing; assisted by
ventilator!
○ Plane 4 – Diaphragmatic breathing only! VENTILATOR IS
REQUIRED! CAUSES CARDIOVASCULAR IMPAIRMENT!

A

3RD – SURGICAL STAGE

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45
Q

What stage of anesthesia includes the following:

TOO DEEP > OVERDOSAGE > CIRCULATORY/RESPI COLLAPSE > DEATH!

A

4TH: MEDULLARY PARALYSIS

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46
Q

3RD SURGICAL STAGE:

WHAT IS PLANE 1 ABOUT?

A

Plane 1: light anesthesia

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47
Q

3RD SURGICAL STAGE:

WHAT IS PLANE 2 ABOUT?

A

Plane 2: loss of blink reflex, regular respiration. Surgical
procedures can be performed. NONBENZODIAZEPINES

48
Q

3RD SURGICAL STAGE:

WHAT IS PLANE 3 ABOUT:

A

Plane 3: Deep anesthesia: Shallow breathing; assisted by
ventilator!

49
Q

3RD SURGICAL STAGE:

WHAT IS PLANE 4 ABOUT:

A

Plane 4: –

  1. Diaphragmatic breathing only!
  2. VENTILATOR IS
    REQUIRED!
  3. IT CAUSES CARDIOVASCULAR IMPAIRMENT!
50
Q

Termed as:

Gas or volatile liquids administered as gas

A

INHALATION ANESTHETICS

51
Q

Inhalation Anesthetics (8) Drugs?

A

● Halothane
● Methoxyflurane
● Enflurane
● Isoflurane
● Desflurane
● Sevoflurane
● Nitrous oxide
● Cyclopropane

(HEMEIDSNC)

52
Q

A/R for Inhalation Anesthetics

A

● Myocardial Depression
● Respiratory depression
● Nausea/Emesis
● Hypotension
● Dysrhythmias
● Hepatic dysfunction

53
Q

Watch Out For (Inhalation Anesthetics)

A

VERY IMPORTANT:

  1. MALIGNANT
    HYPERTHERMIA!!!

● TOXICITY
● Hepatotoxicity (Halothane)
● Nephrotoxicity
(Methoxyflurane)
● Proconvulsivant (Enflurane)
● Malignant Hyperthermia (all
but Nitrous oxide, rare, life
threatening inherited
susceptibility)
● Expansion of trapped gas in
a body cavity (Nitrous oxide)

54
Q

Medication Management for (Inhalation Anesthetics)

Given to patients with hyperthermia toxicity

A

DANTROLENE

Given to patients with hyperthermia toxicity

55
Q

Termed as General Anesthesia

A

INTRAVENOUS ANESTHETICS

56
Q

Drug under IV Anesthetics are:
1. Thiopental sodium (pentothal)
2. Methohexital sodium (brevital)
3. Ketamine HCl (ketalar)

A/R:
Respiratory and Cardiovascular effects

WOF:
(?)

A

INFECTIONS

57
Q

Drug under IV Anesthetics are:

  1. Midazolam/Prpofol

ACTION
(?)

A/R:
Respiratory and Cardiovascular effects

WOF:
(?)

A

ACTION: INTUBATION/MINOR SURGERIES

WOF: INFECTIONS
1. Propofol supports microbial growth.

58
Q

A Solution, liquid spray, ointment, cream, and gel applied to mucous membrane; broken or unbroken skin surface, burns

A

TOPICAL ANESTHETICS

59
Q

What is the go to anesthesia drug for used in: (IMPORTANT)

  1. Local Anesthetics
  2. Dental Procedures
  3. Sutures
  4. Diagnostics
  5. Lumbar Puncture
  6. Thoracentesis
A

LIDOCAINE

60
Q

A Local anesthesia injected into subarachnoid space 3rd to 4th lumbar space – children! 1st LS (adult)

● S/E and A/R: respiratory distress (spread too high in spinal column > respiratory muscle), headache (decrease in
CSF pressure), hypotension (sympathetic blockade)

● Nerve block: spinal block (subarachnoid space); epidural block (dura mater); caudal block (near the sacrum); saddle
block (lower end of spinal column)

● Nurse role:
1. Complete the pre-operative orders
2. Including the pre-medications

A

SPINAL ANESTHESIA

61
Q

What subarachnoid space ___ to ____ (?) space is spinal anesthesia given

A

3rd to 4th lumar space

62
Q

Also called “ANTIEPILEPTICS”

● ACTION: to suppress the abnormal electrical impulses from the seizure focus to other cortical areas, PREVENTING
SEIZURES!!

A

ANTICONVULSANTS

63
Q

(5) Classifications of Seizures

A
  1. Absence (Petit Mal)
  2. Tonic
  3. Myoclonic
  4. Infantile/Epileptic Spasms
  5. Generalized tonic-clonic
64
Q

Short lapses of consciousness that causes a blank stare

A

Absence (Petit Mal)

65
Q

Sudden tonic adduction of limbs with head flexion

A

Infantile/Epileptic Spasms

66
Q

Stiffening of muscles

A

Tonic

67
Q

A brief sudden jerks like a startle reaction

A

Myoclonic

68
Q

Grand mal seizure, easily recognized TONIC = STIFF / CLONIC = JERKING

A

Generalized tonic-clonic

69
Q

Under Anticonvulsant Drugs:

Drug:
(?) what drug is this?

INDICATION
1. First anticonvulsant;
1938
2. Focal seizure, Status
epilepticus (1st line
prophylaxis)

AE
1. Gingival
Hyperplasia

NOTE:
Route: IV, PO – (Do No
Administer IM - Causes
Tissue Damage)

A

HYDANTOINS –
PHENYTOIN
(DILANTIN)

70
Q

(10) Nursing Responsibilities for PHENYTOIN

A
  1. Shake the suspension well
  2. Instruct client not to drive
  3. No alcohol and antidepressants
  4. Medic alert ID
  5. Not to abruptly stop the drug therapy
  6. No OTC
  7. W/food or milk
  8. Inform about the adverse reaction
  9. INSTRUCT CLIENT ABOUT PINKISH RED URINE / REDDISH BROWN
  10. USE SOFT TOOTHBRUSH
71
Q

(6) Anticonvulsant Drugs

A
  1. HYDANTOINS - PHENYTOIN (DILANTIN)
  2. BARBITURATES (PHENOBARBITAL)
  3. SUCCINIMIDES
  4. OXAZOLIDINONES/OXAZOLIDINEDIONE
  5. IMINOSTILBENES (CARBAMAZEPINE)
  6. VALPROATE (VALPROIC ACID)
72
Q

Under Anticonvulsant Drugs:

Drug:
(?) what drug is this?

INDICATION
● Treatment for: Partial,
Grand Mal and Status
Epilepticus.

● Status Epilepticus -
Life Threatening
seizures that last for
more than 5 minutes

AE
Teratogenic

NOTE:
Gradual discontinuance

A

BARBITURATES (PHENOBARBITAL)

73
Q

Under Anticonvulsant Drugs:

Drug:
(?) what drug is this?

INDICATION
● Used for ABSENCE OR
PETIT-MAL SEIZURES
● Brief seizures that
last for less than 20
seconds
● Common in children
and indicated by a
BLANK STARE

AE
N/A

NOTE:
● ETHOSUXIMIDE —succinimide
of choice for absence seizure

● OTHER EXAMPLES -
Methsuximide and
Phensuximide

A

SUCCINIMIDES

74
Q

Under Anticonvulsant Drugs:

Drug:
(?) what drug is this?

INDICATION
● Used to treat PETIT-MAL SEIZURE

AE
N/A

NOTE:
● OXAZOLIDONES
● TRIMETHADIONE
● PARAMETHADIONE

A

OXAZOLIDINONES/
OXAZOLIDINEDIONE

75
Q

Under Anticonvulsant Drugs:

Drug:
(?) what drug is this?

INDICATION
● Grand mal and
partial seizures
● Bipolar disease
● Trigeminal
Neuralgia
● Alcohol withdrawal

AE
N/A

NOTE:
● PO

A

IMINOSTILBENES (CARBAMAZEPINE)

76
Q

Under Anticonvulsant Drugs:

Drug:
(?) what drug is this?

INDICATION
● Petit-mal
● Grand mal
● Mixed types of
seizures

AE
HEPATOTOXIC

NOTE:
● N/A

A

VALPROATE
(VALPROIC ACID)

77
Q

BENZODIAZEPINES (3) Drugs

A
  1. Clonazepam
  2. Clorazepate Dipotassium
  3. Diazepam
78
Q

BENZODIAZEPINES

DRUG: (?)

Treatment for: PETIT-MAL SEIZURE

A

Clonazepam

79
Q

BENZODIAZEPINES

DRUG: (?)

Treatment for: PARTIAL SEIZURE

A

CLORAZEPATE DIPOTASSIUM

80
Q

BENZODIAZEPINES

DRUG: (?)

Treatment for:
Acute Status Epilepticus (Severe)

ROUTE: IV

A

DIAZEPAM

81
Q

__________ disease
1. increase acetylcholine (ACh)
2. decrease dopamine

A

Parkinson’s disease

82
Q

(5) class for parkinson’s disease drugs

A
  1. Anticholinergic
  2. Dopaminergics
  3. Dopamine Agonists
  4. Mao-B Inhibitor
  5. COMT inhibitors
83
Q

What class of Parkinson’s disease is this?

CLASS: ?

DRUG:
● Benztropine (Cogentin) - Common drug of choice
● Biperiden (Akineton)
● Trihexyphenidyl (Artane)
● Diphenhydramine Hcl (Benadryl)

ACTION: DRUGS THAT INHIBITS THE RELEASE OF ACETYLCHOLINE

A

ANTICHOLINERGIC

84
Q

What drug is this under dopaminergics?

Drug: (?)

Action:
● Does not cross blood
brain barrier (BBB)
● Converted into
dopamine
● Most effective in
diminishing symptoms
of parkinson’s disease

S/E:
● Nausea
● Vomiting
● Dyskinesia
(involuntary muscle
movement)
● Hypotension
● Psychosis
● Cardiac dysrhythmias

NURSING RESPONSIBILITIES:
● Monitor VS, especially
BP
● ECG
● Assess for signs and
symptoms of
Parkinsonism
● Administer low-protein
foods

A

LEVODOPA

85
Q

What drug is this under under dopaminergics?

Drug: (?)

Action: Alternative drug
combined with levodopa

NURSING RESPONSIBILITIES:
● Monitor VS, especially
BP
● ECG
● Assess for signs and
symptoms of
Parkinsonism
● Administer low-protein
foods

A

CARBIDOPA

86
Q

This type of parkinsonian drug Stimulate the dopamine receptors

A

Dopamine Agonists

87
Q

What drug is this under dopamine agnoists?

DRUG: (?)

Action: Antiviral that acts
on the dopamine receptors

SE:
● ORTHOSTATIC
HYPOTENSION
● Confusion
● Urinary retention
● Constipation

NURSING RESPONSIBILITIES:
● Report any signs of
skin lesions, seizures,
or depression
● Assess for
ORTHOSTATIC
HYPOTENSION
● Avoid alcohol
● Monitor VS especially
BP and HR
● Not to abruptly stop the
drug

A

AMANTADINE HCL
(SYMMETREL)

88
Q

What drug is this under dopamine agnoists?

DRUG: (?)

Action:
● Acts directly on
CNS, CVS, and GIT

SE:
● ORTHOSTATIC
HYPOTENSION
Palpitations
● Chest pain
● Edema
● NIGHTMARES
● Delusions
● Confusion

NURSING RESPONSIBILITIES:
● Report any signs of
skin lesions, seizures,
or depression
● Assess for
ORTHOSTATIC
HYPOTENSION
● Avoid alcohol
● Monitor VS especially
BP and HR
● Not to abruptly stop the
drug

A

BROMOCRIPTINE
(PARLODEL)

89
Q

This type of parkinsonian drug

● Prolongs the action of LEVODOPA
● SELEGILINE HCL (ELDEPRYL)
● Nursing Avoid foods high in tyramine

A

MAO-B INHIBITOR

90
Q

This type of parkinsonian drug:

● Inactivates DOPAMINE
● TOLCAPONE (TASMAR) - can cause liver damage
● ENTOCAPONE (COMTAN)

A

COMT INHIBITORS

91
Q

What is the (1) drug for alzheimer’s disease

A

ACETYLCHOLINESTERASE/CHOLINESTERASE INHIBITORS

92
Q

1ST DRUG OF CHOICE FOR ALZHEIMERS

A

TACRINE (COGNEX)

93
Q

ACETYLCHOLINESTERASE/CHOLINESTERASE INHIBITORS

what does it do in alzheimers?

A

Improve the cognitive function of clients with mild to moderate Alzhemier’s disease

94
Q

(3) ACETYLCHOLINESTERASE/CHOLINESTERASE INHIBITORS FOR ALZHEIMERS

A
  1. TACRINE (COGNEX)
  2. DONEPEZIL (AGRICEPT)
  3. RIVASTIGMINE (EXELON)
95
Q

A Chronic neuromuscular disease that causes muscle weakness and fatigue

A

Myasthenia Gravis

96
Q

Drug of choice for Myasthenia Gravis

A

NEOSTIGMINE (PROSTIGMIN)

97
Q

(4) Drugs of Myasthenia Gravis

A
  1. NEOSTIGMINE (PROSTIGMIN) -
  2. PYRIDOSTIGMINE BROMIDE (MESTINON)
  3. AMBENONIUM CHLORIDE (MYTELASE)
  4. EDROPHONIUM CHLORIDE (TENSILON)
98
Q

PYRIDOSTIGMINE BROMIDE (MESTINON)

(ACTION) ?

A

Increases muscle strength

99
Q

EDROPHONIUM CHLORIDE (TENSILON)

A

Used to distinguish myasthenia crisis from cholinergic crisis

100
Q

________ Crisis - LOW TO NO STIMULATION at neuromuscular junction by ACh

_________ Crisis - EXCESSIVE STIMULATION at neuromuscular junction by ACh

A
  1. Myasthenia Crisis
  2. Cholinergic Crisis
101
Q

(5) Nursing Responsibilities for: (MESTINON)

A

● Administer IV undiluted

● ATROPINE SULFATE as antidote for cholinergic crisis

● Take drug BEFORE MEALS

● Assess for effectiveness of drug therapy

● AVOID BACLOFEN (LIORESAL) AS IT MAY CAUSE PARALYSIS

102
Q

An autoimmune disorder that attacks the myelin sheath of nerve fibers in the brain and spinal cord, which results
in lesions called plaques

● Cause is unknown

● Common manifestation of MS are motor, sensory, neurologic, cerebellar, and emotional problem

● Motor symptoms: weakness or paralysis of the limbs, muscle spasticity, and diplopia

● Sensory abnormalities: numbness, tingling, blurred vision, vertigo, and tinnitus

● Cerebellar signs: nystagmus, ataxia, dysarthria, dysphagia

● Severe FATIGUE

A

MULTIPLE SCLEROSIS

103
Q

This relaxant:

● Spasmolytics
● Suppress hyperactive reflexes
● Decrease pain and increase range of motion
● Have a sedative Effect

A

SKELETAL MUSCLE RELAXANT (CENTRALLY ACTING)

104
Q

(3) DRUGS FOR SKELETAL MUSCLE SPASTICITY

A
  1. Baclofen (Lioresal)
  2. Dantrolen (Dantrium)
  3. Diazepam (Valium)
105
Q

(3) DRUGS FOR MUSCLE SPASMS

A
  1. Carisoprodol (Soma)
  2. Methocarbamol (Robaxin)
  3. Orphenadrine Citrate (Norflex)
106
Q

NURSING RESPONSIBILITES FOR DRUGS IN:

  1. SKELETAL MUSCLE SPASTICITY
  2. MUSCLE SPASMS
A

● TAKE WITH FOOD

● Monitor SERUM LIVER ENZYME LEVELS

● Do not abruptly stop medication

● Advise px not to drive or operate
dangerous machinery

● Avoid alcohol and CNS depressants

● C/I WITH PREGNANT WOMEN AND NURSING MOTHERS

107
Q

PSYCHIATRIC AGENTS

Drug: (?)

Action: Blocks Dopamine
A.k.a Major Tranquilizers

SE:
● Blurred Vision
● Dry Mouth
● Photosensitivity
● Orthostatic Hypertension
● Tardive Dyskinesia
- Involuntary
movements;
irreversible
● Agranulocytosis
- Low WBC that can
increase risk for
infection
- Report immediately
● Hepatotoxicity

EXTRAPYRAMIDAL
SYMPTOMS (EPS)

● PSEUDOPARKINSONISM
- Pill-rolling tremors,
mask-like face,
propulsive gait

● AKATHISIA
- Restless leg syndrome

● DYSTONIA
- Poor in muscle tone

A

ANTIPSYCHOTICS

  1. HALOPERIDOL
  2. CHLOROPROMAZINE
108
Q

(5) NURSING CONSIDERATIONS FOR ANTIPSSYCHOTICS:

A
  1. Give AFTER MEALS
  2. Rise slowly
  3. Avoid SUNLIGHT EXPOSURE
  4. Monitor HR and BP
  5. Report fever and body malaise
109
Q

PSYCHIATRIC AGENTS

Drug: (?)

A.K.A. Minor Tranquilizers;
Anti Anxiety

SE:
● Dizziness
● Drowsiness
● Dry mouth
● Sedation

NURSING CONSIDERATION:
● Give BEFORE MEALS
● Ask patient to avoid
CAFFEINE and ALCOHOL
● Administer separately

A

ANXIOLYTICS

110
Q

ANTIDEPRESSANTS:

DRUG: (one?) (two?) (three?)

ACTION: PROLONGS NOREPINEPHRINE’S
Action

SE:
● Anticholinergic
● Cardiovascular effects

NURSING CONSIDERATION:
● Give After meals
● Therapeutic Effect: 2-4
Weeks
● Monitor BP; HR
● Given to treat major
depression

A
  1. TRICYCLICS (TCA)
  2. IMIPRAMINE (TOFRANIL) -
    1ST ANTIDEPRESSANT
  3. AMITRIPTYLINE (ELAVIL)
111
Q

ANTIDEPRESSANTS:

DRUG: (?)

ACTION: PREVENTS DESTRUCTION OF NOREPINEPHRINE

SE: HYPERTENSIVE
CRISIS (avoid MAO +
TYRAMINE rich foods)

NURSING CONSIDERATION:
● After meals
● Report headache
● Avoid TYRAMINE-containing
foods

A

MAO INHIBITORS

  1. Tranylcypromine (Parnate)
  2. Phenelzine (Nardil),
  3. Isocarboxazid (Marplan)
112
Q

TYRAMINE RICH FOODS (5)

A
  1. Aged cheese (cheddar, swiss, blue cheese)
  2. Cured or Processed meats (salami, bologna, bacon, corned beef)
  3. Alcoholic beverages (beer, red wine)
  4. Pickled or fermented foods (tofu, kimchi, pickles)
  5. Sauces (soy sauce, shrimp sauce, fish sauce, miso
113
Q

ANTIDEPRESSANTS: THE MOST SAFEST ANTIDEPRESSANT!!

DRUG: (?)

ACTION Prolongs serotonin action

SE:
● Restlessness
● Agitation
● Insomnia

NURSING CONSIDERATION:
● Avoid BEDTIME DOSES

A

SELECTIVE SEROTONIN REUPTAKE INHIBITOR

  1. FLUOXETINE (PROZAC)
  2. Sertraline (Zoloft)
  3. Citalopram (Celexa)
  4. Escitalopram (Lexapro)
  5. Paroxetine (Paxil)
114
Q

ANTIMANIC AGENTS (MOOD STABILIZER)

DRUG: (?)

ACTION: Idiopathic; reduces the
release of Norepinephrine
treatment for BIPOLAR DISORDER

SE: NAVDA, excessive tears & urination fine hand tremors

Nursing Considerations:
● Take AFTER MEALS
● WOF: lithium toxicity
(persistent vomiting; profuse
diarrhea, lethargy)
● THERAPEUTIC RANGE:
0.5-1.5 mEd/L (0.6-1.2
mEq/L)
● TOXIC RANGE: 1.5-2.0
mEq/L
● Therapeutic effects last for
10-14 DAYS
● Increase FLUID INTAKE
(3L/day) and SODIUM
INTAKE (3g/day)
● MANNITOL (osmotic
diuretic) administered if
lithium toxicity occurs

A

LITHIUM CARBONATE
(ESKALITH, LITHANE)

115
Q

ANTIMANIC AGENTS (MOOD STABILIZER)

DRUG: (?)

ACTION: Treatment of Bipolar Disorder

NURSING CONSIDERATION: WOF: Agranulocytosis which
increases risk for infection
and fever

A

CARBAMAZEPINE

116
Q
A

PHARMACOLOGY (6 decks)

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