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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
Benzodiazepine Antidote
**Flumazenil (Romazicon)** Inhibits effects of the benzodiazepines at the GABA receptors Short t1/2 (about an hour)
26
Nonbenzodiazepines
* **Zolpidem** (Ambien, Intermezzo) * **Chloral hydrate** * **Antihistamines** (Phenergan, Benadryl) * **Eszopiclone** (Lunesta) * **Zalepon** (Sonata) * **Melatonin receptor agonist** (Rozerem)
27
Stages of General Anesthesia
Analgesia Excitement or Delirium Surgical Mudullary paralysis
28
Balanced Anesthesia
* Hypnotic the night before * Premedication * Short-acting barbiturates * Inhaled gas * Muscle rexant as needed
29
Anesthetics Volatile Liquids
**(-ane)** * **Halothane** (Fluothane) * Enflurane (Ethrane) * Isoflurane (Forane) * Desflurane (Suprane) * Sevoflurane (Ultane)
30
Anesthetics Gases
* Nitrous oxide * Cyclopropane/ether (flammable no longer used)
31
Anesthetics IV
* **Thiopental** sodium (Pentothal) wisdom teeth * Droperidol (Innovar) * Etomidate (Amidate) * Ketamine (Ketalar) used for brief sedation
32
Anesthetics Benzodiazepines
**Midazolam** (Versed)
33
Anesthetics Sedative-Hypnotic
Propofol (Diprovan) MJ died
34
Local Anesthesia Uses
* Should NOT be absorbed systemically * Topical administration * Infiltration * Field block * Nerve block * IV regional anesthesia * Pain pump
35
Local Anesthetics Esters, Amides, and Spinal
**(-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
Pain Scale with meds administered
**1-3** Mild pain (tylenol) **4-6** Moderate pain (ASA + codeine) **7-10** Severe pain (morphine)
37
Legislation for Narcotic Analgesics
* Harrison Narcotic Act of 1914 * Controlled Substances Act of 1970
38
Opiods
Morphine and Codeine (Supress pain and resp. in the medulla)
39
Synthetic Narcotics
* **Meperidine** (Demerol)-not a cough suppressant; not good for long-term medication * **Hydromorphine** (Dilaudid) * **Fentanyl**- transdermal and lolipop (EOL) * **Tramadol** (Ultram) * **Tapentadol** (Nucynta)
40
Narcotics Side/Adverse Effects & Contraindications
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
Narcotic Agonist-Antagonists
Composition of mixed narcotic agonist-antagonists * Nalbuphine HCl (Nubain) most commonly used * Butorphanol tartrate (Stadol) * Buprenorphine (Buprenex) * Pentazocine (Talwin) * Morphine-naltrexone (Embeda)
42
Narcotic-Addicted People
* Suboxone clinics * Methadone Tx program (Weaning/Maintenance program)
43
Opiod Antagonists
**Naloxone (Narcan)** Naltrexone HCl (ReVia)
44
Headaches: preventative Tx
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
Headache Tx
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
Addictive states
Intoxication Detoxification Withdrawal syndrome Cessation and maintaining abstinence
47
Stimulants
* **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
Other drugs of abuse
* **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
Special needs for Drug-Abusing Clients
* 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
Chemical Impairment in Nurses
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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