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Pharmacology > CNS Stimulants & Depressants / Drugs for Pain Mngt & Abuse (ch 20,21,26,9) > Flashcards

CNS Stimulants & Depressants / Drugs for Pain Mngt & Abuse (ch 20,21,26,9) Flashcards

1
Q

Central Nervous System Components

A

Brain and Spinal Cord

Respirations controlled by pons and medulla

Neurotransmitters are norepinepherine, serotonin, dopamine

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2
Q

Action of CNS Stimulants

A

Provoke release of neurotransmitters

Decrease the reuptake of neurotransmitters

Inhibit postsynaptic enzymes

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3
Q

CNS Stimulants and Uses

A

“The Uppers”

Amphetamines

Caffeine

Used medically for ADHD, Narcolepsy, Obesity, Reversal of respiratory distress

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4
Q

Amphetamines

Uses and Side Effects

A

Uses:

  • decrease hyperactivity and impulsiveness of ADHD
  • increase wakefulness in narcolepsy

Side Effects:

  • Sleeplessness, restlessness, tremors, irritability, anorexia, impotence
  • CV problems: tachycardia, palpations, dysrythmias, hypertension
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5
Q

Amphetamines

ADHD Drugs

A

Give bid meds with breakfast and lunch, any later than lunch may cause sleeping issues

  • Methylphenidate (Ritalin, Concerta, Daytrana)
  • Amphetamine sulfate (Adderall)
  • Dextroamphetamine sulfate (Dexedrine) (obesity too)
  • Methamphetamine HCl (Desoxyn)
  • Atomozetine (Strattera)
  • Lisdexamfetamine dimesylate (Vyvanse)
  • Guanfacine (Intuiv)
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6
Q

Amphetamines

Narcolepsy Drugs

A

Schedule II- reguire Rx every month

tid

  • Modafinil (Provigil)
  • Armodafinil (Nuvigil)
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7
Q

Amphetamines

Anorexiants

A

Part of a total strategy!!

Do not use longer than 12 wks!

  • Dextroamphetamine sulfate (Dexadrine)- off mkt, not indicated
  • Phenylpropanolamine- off mkt, may cause an increased risk of hemorrhagic stroke
  • Sibutramine (Meridia)- off mkt, adverse CV effects
  • Phentermine (Fastin)-Schedule IV
  • Phentermine + topiramate (Qnexa)
  • Orlistat (Xenical, Alli)-long term use, poop everything out.
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8
Q

Amphetamines

Analeptics

Purpose, Side Effects, Interactions

A

Purpose: Stimulate respirations

Side Effects: restlessness, tremors, twitching, palpations, insomnia, diuresis.

Interactions: oral contraceptives, psychostimulants, sympathomimetics agents, fluroquinolones, lithiums, MAOIs

Xanthines: Caffeine (preferred in newborns), Theophylline (rarely used in adults)

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9
Q

Amphetamines

Respiratory CNS Stimulant

A

Uses:

  • Resp depression from drug overdose
  • Postanesthetic resp depression
  • Occasionally COPD
  • Doxapram (Dopram)
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10
Q

CNS Depressants

Effects

A

“The Downers”

Sedative-hypnotics

General and local anesthesia

Narcotic and nonnarcotic anelgesics

Anticonvulsants

Antipsychotics

Antidepressants

**The bigger the dose, the bigger effect**

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11
Q

Stages of Sleep

A

Non-rapid eye movement (NREM)

(4 stages)

Rapid eye movement (REM)

(dream sleep)

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12
Q

Nonpharmacologic methods of promoting sleep

A
  • Arise at a specific hour in the morning
  • Take few or no daytime naps
  • Avoid caffeine at 6 hours before bedtime
  • Avoid heavy meals or strenuous activity before bedtime
  • Take a warm bath, read, or listen to music before bed
  • Decrease exposure to loud noises
  • Avoid drinking lots of fluids before bed
  • Drink warm milk before bed
  • Backrub
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13
Q

Sedative-Hypnotics

A

Supress cerebral cortex

Sedation-Hypnosis-Anesthesia-Coma

Side Effects include: Hangover (interrupt REM), dependence, tolerance, and withdrawal symptoms

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14
Q

Long-Acting Bariturates

A

(-barbital)

For short-term use

Phenobarbital (Long term use for epilepsy)

Mephobarbital

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15
Q

Intermediate-acting Barbiturates

A

(-barbitol)

Help sleeping

Amobarbital (Amytal)

Aprobarbital (Alurate)

Butabarbital (Butisol)

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16
Q

Short-acting Barbiturates

A

(-barbital)

Help falling asleep

Pentobarbital (Nembutal)

Secobarbital (Seconal)

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17
Q

Barbiturates

A

Long-acting, Intermediate-acting & Short-acting

*Controlled substance II or III

**Interact with kava kava and valerian

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18
Q

Barbiturates: Contraindications

A
  • Allergy
  • History of addiction to any other sedative/hypnotic
  • Liver or kidney dysfunction
  • Resp. distress or depression
  • Pregnancy
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19
Q

Barbiturates: Adverse Effects

A
  • Resp. depression
  • Hangover

**Do not mix with alcohol, antidepressants, antipsychotics, or narcotics!!

**Do not withdraw abruptly

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20
Q

Benzodiazepines

A

The drug of choice to treat anxiety!

  • Do not cause much sedation
  • Less likely to cause physical dependence (C IV)
  • Indications: anxiety disorders, alcohol withdrawal, hyperexcitability and agitation, seizures, induction of anesthesia, preop sedation, conscious sedation
  • Act by potentiating GABA (gamma aminobutyric acid) (inhibitory transmitter that diminishes anxiety)
  • Well absorbed from the GI tract, lipid soluble (can cross the blood-brain barrier), metabolized by the liver
  • Should be used short term bc it can cause a rebound interrupting REM sleep.
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21
Q

Benzodiazepines: Contraindications

A
  • Allergy
  • Psychosis
  • Acute narrow-angle glaucoma
  • Conditions which could be exacerbated by the depressant effect of the drug
  • Patients with decreased liver/kidney function
22
Q

Benzodiazepines: Adverse Effects

A
  • CNS effects
  • Use with caution with African Americans
  • Additive effect with alcohol or narcotics
23
Q

Benzodiazepines: Anxiolytics

A

(-am)

Diazepam (Valium)

Chlordiazepoxide (Librium) (the oldest)

Lorazepam (Ativan)

Aprazolam (Xanax) (most abused today)

Oxazepam (Serax)

Chlonazepam (Klonopin)

Flunitrazepam (Rohypnol) (Date-rape drug, 7:10 times stronger than Valium)

24
Q

Benzodiazepines: Hypnotics

A

(-am)

Flurazepam (Dalmane) long t1/2

Temazepam (Restoril)

Triazolam (Halicion)

25
Q

Benzodiazepine Antidote

A

Flumazenil (Romazicon)

Inhibits effects of the benzodiazepines at the GABA receptors

Short t1/2 (about an hour)

26
Q

Nonbenzodiazepines

A
  • Zolpidem (Ambien, Intermezzo)
  • Chloral hydrate
  • Antihistamines (Phenergan, Benadryl)
  • Eszopiclone (Lunesta)
  • Zalepon (Sonata)
  • Melatonin receptor agonist (Rozerem)
27
Q

Stages of General Anesthesia

A

Analgesia

Excitement or Delirium

Surgical

Mudullary paralysis

28
Q

Balanced Anesthesia

A
  • Hypnotic the night before
  • Premedication
  • Short-acting barbiturates
  • Inhaled gas
  • Muscle rexant as needed
29
Q

Anesthetics

Volatile Liquids

A

(-ane)

  • Halothane (Fluothane)
  • Enflurane (Ethrane)
  • Isoflurane (Forane)
  • Desflurane (Suprane)
  • Sevoflurane (Ultane)
30
Q

Anesthetics

Gases

A
  • Nitrous oxide
  • Cyclopropane/ether (flammable no longer used)
31
Q

Anesthetics

IV

A
  • Thiopental sodium (Pentothal) wisdom teeth
  • Droperidol (Innovar)
  • Etomidate (Amidate)
  • Ketamine (Ketalar) used for brief sedation
32
Q

Anesthetics

Benzodiazepines

A

Midazolam (Versed)

33
Q

Anesthetics

Sedative-Hypnotic

A

Propofol (Diprovan) MJ died

34
Q

Local Anesthesia Uses

A
  • Should NOT be absorbed systemically
  • Topical administration
  • Infiltration
  • Field block
  • Nerve block
  • IV regional anesthesia
  • Pain pump
35
Q

Local Anesthetics

Esters, Amides, and Spinal

A

(-caine)

Esters:

  • Benzocaine (Unguentine)
  • Procaine (Novacain) short-acting
  • Tetracaine (Pontocaine) long-acting

Amides:

  • Bupivacaine (Marcaine) long-acting
  • Dibucaine (Nupercainal)
  • Levobupivacaine (Chirocaine)
  • Lidocaine (Xylocaine, EMLA) mod acting
  • Mepivacaine (Carbocaine) mod acting

Spinal:

  • Montior resp. and BP
  • Can cause a terrible headache due to CSF leakage
36
Q

Pain Scale with meds administered

A

1-3 Mild pain (tylenol)

4-6 Moderate pain (ASA + codeine)

7-10 Severe pain (morphine)

37
Q

Legislation for Narcotic Analgesics

A
  • Harrison Narcotic Act of 1914
  • Controlled Substances Act of 1970
38
Q

Opiods

A

Morphine and Codeine

(Supress pain and resp. in the medulla)

39
Q

Synthetic Narcotics

A
  • Meperidine (Demerol)-not a cough suppressant; not good for long-term medication
  • Hydromorphine (Dilaudid)
  • Fentanyl- transdermal and lolipop (EOL)
  • Tramadol (Ultram)
  • Tapentadol (Nucynta)
40
Q

Narcotics

Side/Adverse Effects & Contraindications

A

Side Effects:

  • Resp depression
  • Constipation (slows down breathing and gut)
  • Orthostatic hypotension (dilates blood vessels)
  • Naiive vs tolerant and dependent (large vs small doses)
  • WIthdarwal Symptoms

Contraindications:

  • Clients with head injuries/increased intracranial pressure
  • Clients with resp disorders
  • Clients with shock or hypotension
41
Q

Narcotic Agonist-Antagonists

A

Composition of mixed narcotic agonist-antagonists

  • Nalbuphine HCl (Nubain) most commonly used
  • Butorphanol tartrate (Stadol)
  • Buprenorphine (Buprenex)
  • Pentazocine (Talwin)
  • Morphine-naltrexone (Embeda)
42
Q

Narcotic-Addicted People

A
  • Suboxone clinics
  • Methadone Tx program (Weaning/Maintenance program)
43
Q

Opiod Antagonists

A

Naloxone (Narcan)

Naltrexone HCl (ReVia)

44
Q

Headaches: preventative Tx

A

Arterial spasm at the base of the brain causing vasodilation

  • Beta-Adrenergic blockers (Propranolol, Atenolol)
  • Anticonvulsants (Valproic acid, Sodium valporate, Topiramate)
  • Tricyclic antidepressants (Amitryptylline, Imipramine)
45
Q

Headache Tx

A

Depends on the intensity of the pain

  • Analgesics (mild pain)- ASA Acetaminophen, NSAIDS
  • Opiod Analgesics- Demerol, Stadol
  • Ergot Derivatives- Ergotamine + Caffeine = Cafergot (do not give with beta blockers or CPY3A4; pregnancy category X)
  • Triptans: Do not give with ergotamines, SSRIs, or MAOIs (psychiatric drugs)
46
Q

Addictive states

A

Intoxication

Detoxification

Withdrawal syndrome

Cessation and maintaining abstinence

47
Q

Stimulants

A
  • Nicotine: Activates the nicotinic receptors. Most addicting drug. Tx: Nicotine replacement therapies (Chantix)
  • Cocaine: Makes dopamine and norepinephrine more available activating the brain reward system
  • Amphetamines: (Meth, crystal meth, crank) Similar to cocaine. Tx difficult.
  • Caffeine: myocardial stimulant
48
Q

Other drugs of abuse

A
  • Cannibis-THC
  • Psychadelic Agents- bath salts (category I)
  • Inhalants- gasoline, nail polish remover, paint thinner, hair spray, pesticide, dust off, nitrous oxide, amyl nitrate
49
Q

Special needs for Drug-Abusing Clients

A
  • Cross tolerance ma necessitate more anesthesia
  • Use of opiods at home may necessitate more pain meds
  • Increases susceptability to cardiac/resp depression
  • Increased risk for bleeding, liver damage, infection
  • Withdrawal symptoms may be delayed
  • Addictive Tx is not priority-pain relief is!
  • Develop written agreement
50
Q

Chemical Impairment in Nurses

A

10-20% of nurses have a substance abuse problem.

3-6% demonstrate impaired practice

Nurse Practice Act derivatives

Pharmacology (5 decks)

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