Drugs acting on the nervous system Flashcards
1
Q
MAJOR NEUROTRANSMITTERS
A
- Gamma-aminobutyric acid (GABA)
- Serotonin
- Dopamine
- Norepinephrine
- Acetylcholine
2
Q
CLASSIFICATION OF NEUROTRANSMITTERS
A
Excitatory neurotransmitters
Inhibitory neurotransmitters
3
Q
Functions to prevent an action potential
A
Inhibitory neurotransmitters
4
Q
Function to activate receptors on the postsynaptic membrane and enhance the effects of the action potential
A
Excitatory neurotransmitters
5
Q
The most powerful inhibitory neurotransmitter
A
GAMA-AMINOBUTYRIC (GABA
6
Q
GAMA-AMINOBUTYRIC ACID (GABA) is produced by the neurons of?
A
spinal cord
cerebellum
basal ganglia
many areas of the cerebral cortex
7
Q
function is to reduce neuronal excitability throughout the nervous system
A
GAMA-AMINOBUTYRIC ACID (GABA)
8
Q
functions are closely related to mood and emotions
A
GAMA-AMINOBUTYRIC ACID (GABA)
9
Q
When GABA is abnormally low this can lead to?
A
Anxiety
10
Q
an inhibitory neurotransmitter that has been found to be intimately involved in emotion and mood
A
SEROTONIN (5-HYDROXYTRYPTAMINE, 5-HT)
11
Q
SEROTONIN (5-HYDROXYTRYPTAMINE, 5-HT) is produced by the neurons of?
A
brainstem
neurons that innervate the gastrointestinal tract (enteric nervous system)
platelets
12
Q
functions is to regulate body temperature, perception of pain, emotion, and sleep cycles
A
SEROTONIN (5-HYDROXYTRYPTAMINE, 5-HT)
13
Q
An insufficient secretion of _________ may result in decrease immune system function, as well as range of emotional disorders like depression, anger control problems, obsessive compulsive disorder and even suicidal tendencies.
A
SEROTONIN
14
Q
Regulates sleep, wakefulness and mood as well
as the delusions, hallucinations and withdrawal
of schizophrenia
A
SEROTONIN
15
Q
withdrawal of schizophrenia
A
SEROTONIN
16
Q
a neurotransmitter secreted by the neurons of the substantia nigra
A
DOPAMINE (DA)
17
Q
considered a special type of neurotransmitter because its effects are both excitatory and inhibitory
A
DOPAMINE (DA)
18
Q
Its function is to inhibit unnecessary movements, inhibits the release of prolactin, and stimulated the secretion of growth hormone
A
DOPAMINE (DA)
19
Q
Drugs and alcohol abuse can temporarily increase _______ level in the blood, leading to confusion and inability to focus
A
DOPAMINE
20
Q
__________ results from dopamine deficiency related to the
destruction of the ________________
A
DOPAMINE
SUBSTANTIA NIGRA
21
Q
Involved in regulation of cognition, emotional responses and motivation
A
DOPAMINE CONTAINING NEURONS
22
Q
Also known as noradrenaline (Nad)
A
NOREPINEPHERINE (NE)
23
Q
An excitatory neurotransmitter produced by the brainstem, hypothalamus, and adrenal glands and released into the bloodstream
A
NOREPINEPHERINE (NE)
24
Q
Its function is to increase the level of alertness and wakefulness, stimulates various process of the body
A
NOREPINEPHERINE (NE)
25
Is implicated in mood disorders such as depression and anxiety, in which case its concentration in the body is very low
NOREPINEPHRINE (NE)
26
Is also associated with control of arousal, attention, vigilance, mood, affect, and anxiety
NOREPINEPHRINE (NE)
27
Involved with thinking, planning, and interpreting
NOREPINEPHRINE (NE)
28
Abnormally high concentration may lead to impaired sleep cycle
NOREPINEPHRINE (NE)
29
An excitatory neurotransmitter secreted by neurons that innervate muscle cells, basal ganglia, preganglionic neurons of the autonomic nervous system and post ganglionic neurons of the parasympathetic and sympathetic nervous system.
ACETYLCHOLINE (Ach)
30
Its function is to regulate skin cycle, essential for muscle functioning
ACETYLCHOLINE (Ach)
31
Its main function is to stimulate muscle contraction
ACETYLCHOLINE (Ach)
32
Plays a role in sleep and wakefulness
ACETYLCHOLINE (Ach)
33
Benzodiazepine
ANXIOLYTIC AGENTS
34
State of apprehension, tension, or uneasiness that stems from anticipation of danger, the source of which is largely unknown or unrecognized
ANXIETY
35
A normal emotion. It’s your brain’s way of reacting to stress and alerting your potential danger ahead
ANXIETY
36
Occasional anxiety is ok, but occasional disorder is different
ANXIETY
37
Are group of mental illnesses that cause constant and overwhelming anxiety and fear
ANXIETY DISORDERS
38
TWO CLASSIFICATIONS OF ANXIETY
1. Primary anxiety
2. Secondary anxiety
39
The cause is not by medical condition or drugs
PRIMARY ANXIETY
40
The cause is related to selected drugs, medical, or psychiatric disorders
SECONDARY ANXIETY
41
TYPES OF ANXIETY DISORDERS
1. Situational
2. Generalized
3. Panic
4. Phobias
5. OCD
6. PTSD
42
Anxiety experienced by people faced with a stressful environment
SITUATIONAL ANXIETY
43
Is beneficial because it motivates people to accomplish tasks in a prompt manner
SITUATIONAL ANXIETY
44
Difficult to control, your excessive anxiety, unrealistic worry and tension with little or no reason that lasts 6 months or more
GENERALIZED ANXIETY DISORDER
45
Symptoms include: restlessness, fatigue, muscle tension, nervousness, inability to focus or concentrate, and sleep disturbance
GENERALIZED ANXIETY DISORDER
46
Most common type of stress disorder
GENERALIZED ANXIETY DISORDER
47
Characterized by intense feelings of immediate apprehension, fearfulness, terror or impending doom accompanied by increased autonomic nervous system activities that brings panic attack
PANIC DISORDER
48
During panic attack, you may break out in sweat, have chest pain, and have a pounding heartbeat (palpitations) that will last less than 10 mins.
PANIC DISORDER
49
Fearful feelings attached to situations or objects
PHOBIAS
50
Involves recurrent, intrusive thoughts or repetitive behaviors that interfere with normal activities or relationships
OBSESSIVE COMPULSIVE DISORDER (OCD)
51
A type of situational anxiety that develops in response to re-experiencing a previous life event
POST TRAUMATIC STRESS DISORDER
(PTSD)
52
Cognitive behavioral therapy
Counselling
Biofeedback techniques
Meditation and other complimentary therapies
Relaxation technique
Psychotherapy
Support group
NON PHARMACOLOGICAL STRATEGIES FOR
ANXIETY
53
Drugs of choice for various anxiety disorders and short term insomnia
BENZODIAZEPINES
54
Drugs of choice for various anxiety disorders and short term insomnia
BENZODIAZEPINES
55
Also used as anti-convulsants, sedativehypnotics, pre-operative drugs and anxiolytics
BENZODIAZEPINES
56
Enhance the action of GABA, an inhibitory neurotransmitter within the CNS.
BENZODIAZEPINES
57
categorized as scheduled IV drugs
BENZODIAZEPINES
58
refers to an aromatic compound, one having a carbon ring structure attached to different atoms or to another carbon ring
“BENZO”
59
EXAMPLES OF BENZODIAZEPINES
- Chlorodiazepoxide (Librium)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Medazolam (Versed)
- Halazepam (Paxipam)
60
rapid onset time 15-30 minutes to reach peak serum levels
MIDAZOLAM (Versed)
61
take 1 to 3 hours to reach peak serum levels
HALAZEPAM (Paxipam)
62
First and most widely used benzodiazepines
1. CHLORDIAZEPOXIDE (LIBRIUM)
2. DIAZEPAM (VALIUM)
63
Used also for its sedative effect
Given PO, IV, IM
CHLORDIAZEPOXIDE (LIBRIUM)
64
- Mild to moderate anxiety
- Control alcohol withdrawal syndrome
- If given IV it should monitored carefully owing a rapid onset of CNS and possible respiratory depression
LORAZEPAM (ATIVAN)
65
- For anxiety, muscle spasm, seizure disorders
- For pre-operative sedation/use as induction
agents for general anesthesia
- Treatment for alcohol withdrawal symptoms
DIAZEPAM (VALIUM)
66
- If given IV, it should be monitored carefully owing a rapid onset of CNS and possible respiratory depression
- Promote central muscle relaxation
DIAZEPAM (VALIUM)
67
Lipid soluble
Absorbed readily in the GI tract
Highly protein bound
Excreted in the urine
PHARMACOKINETICS OF BENZADIAZEPINES
68
Must be prescribed no more that 3-4 weeks
PHARMACODYNAMICS OF BENZODIAZEPINES
69
o Sedation, drowsiness, dizziness, confusion
o Lethargy, ataxia, headache, dry mouth
o Blurred vision, urinary incontinence
o Memory problems, muscle weakness
SIDE EFFECTS OF BENZODIAZEPINES
70
o Acute hyperexcited states, hallucinations
o Increased muscle spasticity, renal impairment,
respiratory impairment due to hypersalivation
o Congenital defects among women who are pregnant
ADVERSE REACTIONS OF BENZODIAZEPINES
71
Antidote for Benzodiazepines such as:
- diazepam (valium)
- lorazepam (Ativan)
- midazolam (versed)
Must be administered intravenously (IV).
FLUMAZENIL (ROMAZICON)
72
1. Assess client’s need for antianxiety drugs, including intensity and duration of symptom
2. Identify factors that precipitate anxiety or insomnia, physical symptoms, excessive CNS
stimulation, excessive daytime sleep
3. Assess for the likelihood of drug abuse and dependence and identify coping mechanism
used in managing previous episodes of stress
and anxiety
4. Used cautiously to patient with a suicidal
potential, because it may increase the risk of
suicide
5. Benzodiazepines are contraindicated in narrow
angle glaucoma
BENZODIAZEPINES: NURSING CONSIDERATIONS
73
6. Used cautiously to patient with impaired renal or
liver function
7. Assess for common side effects related to CNS
depression such as drowsiness and dizziness
because these increase a client’s risk of injury
and may indicate a need for dose reduction
8. Benzodiazepines are used illegally for
recreation, most often by adolescents, young
adults, and opioid or cocaine addicts
9. Benzodiazepines cross the placenta and
excreted in breast milk, they are not
recommended in pregnant or nursing women
10. Used cautiously in elderly clients, because
metabolism and excretion are slowed may lead
to overdose
11. Assess elderly for over sedation, confusion,
dizziness, and impaired mobility
BENZODIAZEPINES: NURSING CONSIDERATIONS
74
1. Used caution when driving or operating heavy
machinery until the effect of the medication is
known. Benzodiazepines can cause drowsiness,
impair mental and physical functioning
2. Take the medication as directed. Do not exceed
the ordered dosage
3. Avoid alcohol and other CNS depressants,
because they may cause increased drowsiness.
4. Do not stop taking medications suddenly,
because withdrawal symptoms may occur
5. Store medication safely out of reach of children
6. Inform that the effective response is 1 to 2
weeks
BENZODIAZEPINES: CLIENT HEALTH TEACHINGS
75
Treat major depression by enhancing mood
ANTIDEPRESSANT
76
Often prescribe to phobia, OCD, panic, and
anxiety
ANTIDEPRESSANT
77
Beneficial in treating psychological and physical signs of pain, especially in clients without major depressive disorder
ANTIDEPRESSANT
78
- The most important warning about antidepressants.
- This should be included at the beginning of drug package inserts and drug information sheets. This warning to applies to children who are at risk for suicidal ideation.
BLACK BOX WARNING
79
1. Tricyclic antidepressants (TCAs)
2. Selective serotonin reuptake inhibitors (SSRIs)
3. Monoamine oxidase inhibitors (MAOIs)
4. Atypical antidepressants including the serotonin norepinephrine reuptake inhibitors (SNRIs) and other atypical antidepressants
FOUR PRIMARY CLASSES OF ANTIDEPRESSANT DRUGS
80
Examples of ATYPICAL ANTIDEPRESSANTS
- DULOXETINE (CYMBALTA)
- VENLAFAXINE (EFFEXOR)
81
They inhibit the reabsorption of serotonin and norepinephrine and elevate mood by increasing the level of serotonin, norepinephrine, and dopamine in the central nervous system
- DULOXETINE (CYMBALTA)
- VENLAFAXINE (EFFEXOR)
82
Inhibit the reuptake of both norepinephrine and serotonin into presynaptic nerve terminals
TRICYCLIC ANTIDEPRESSANTS (TCAs)
83
Used mainly for major depression and occasionally for milder situational depression
TRICYCLIC ANTIDEPRESSANTS (TCAs)
84
Approved treatment for OCD
CLOMIPRAMINE (ANAFRANIL)
85
Used for treatment of childhood enuresis
CLOMIPRAMINE (ANAFRANIL)
86
Example of TCAs
- Amitriptyline (Elavil)
- Amoxapine (Asendin)
- Imipramine (Tofranil)
87
o Orthostatic hypotension – most common
o Drowsiness, sedation, dizziness, dry mouth,
constipation, urine retention, blurred vision and
mydriasis
SIDE EFFECTS OF TCAs
88
o Cardiac dysrhythmias – the most serious
adverse effects
o Heart block, MI
o Bone marrow depression, seizures
o Angioedema of the face, tongue or generalized
ADVERSE EFFECTS OF TCAs
89
o Cardiac dysrhythmias – the most serious adverse effects
o Heart block, MI
o Bone marrow depression, seizures
o Angioedema of the face, tongue or generalized
ADVERSE EFFECTS OF TCAs
90
1. Therapeutic effects of TCAs may take 2 to 4
weeks to occur
2. Monitor the client closely for symptoms of
suicidal ideation throughout the treatment
3. TCAs is contraindicated in client in the acute
recovery phase of an MI, with heart block or with
history of dysrhythmias, because of their effects
on cardiac tisse
4. Carefully monitor clients with epilepsy, TCAs lower the seizure threshold
NURSING CONSIDERATIONS FOR TCAs
91
5. Clients with urinary retention, narrow angle
glaucoma or prostatic hypertrophy may not be
good candidates for TCAs because of
anticholinergic side effects.
6. Tricyclics must be given with extreme caution to
client with asthma, cardiovascular disorders,
gastrointestinal disorders, alcoholism and other
psychiatric disorders including schizophrenia
and bipolar disorders
7. Most TCAs are pregnancy category C or D, so
they are used during pregnancy or lactation only
when medically necessary
8. Oral contraceptive may decrease the efficacy of
tricyclics
NURSING CONSIDERATIONS FOR TCAs
92
9. Cimetidine (Tagamet) interferes with their
metabolism and excretion
10. Tricyclic affect the efficacy of clonidine
(catapres) and guanethidine (Ismelin)
11. The nurse should observe clients for the effects
of drugs that enhance the effects of TCAs such
as antidysrhythmics, antihistamine,
antihypertensive, and CNS depressants
12. Carbamazepine (Tegretol), Phenytoin (Dilantin),
and rifampin (rifadin) because it will increase the
rate of TCAs metabolism and excretion
13. Cigarette smoking diminishes the effects of
TCAs
NURSING CONSIDERATIONS OF TCAs
93
1. Be aware that it may take several weeks or more
to achieve the full therapeutic effect of the drug
2. Keep all scheduled follow up appointments with
your health care provider
3. Sweating along with anticholinergic side effects
may occur
4. Take the medication exactly as prescribes and
reports side effects if they occur
5. Avoid using alcohol and other CNS depressants
CLIENT HEALTH TEACHINGS FOR TCAs
94
6. Do not take other prescription drugs, OTC
medications, or herbal remedies without
notifying your heath care provider
7. Change positions slowly to avoid dizziness
8. Do not drive or engage in hazardous activities
until the drug’s sedative effect is known
9. Take the drug at bedtime if sedation occurs
10. Immediately discuss with your healthcare provider an intention or desire to become pregnant, because these drugs must be withdrawn over several weeks and not discontinued abruptly
CLIENT HEALTH TEACHINGS FOR TCAs
95
Drugs that slow the reuptake of the serotonin
into presynaptic nerve terminals
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
(SSRIs)
96
They are the drug of choice in the treatment of
depression because of their favorable side effect
profile
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
(SSRIs)
97
Its function is to increase level of serotonin in the synaptic gap induce complex neurotransmitter
changes in presynaptic and postsynaptic
neurons in the brain. Presynaptic receptors
become less sensitive and postsynaptic receptor
become more sensitive.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
(SSRIs)
98
Is a natural neurotransmitter in the CNS, found in high concentrations in certain neurons in hypothalamus, limbic system, medulla and spinal cord.
SEROTONIN
99
Is important to several body activities including
the cycling between NREM and REM sleep, pain
perception and emotional states
SEROTONIN
100
Its chemical name is 5-hydorxytryptamine (5-HT)
SEROTONIN
101
Major depression
OCD
Panic, phobias, PTSD
SSRIs treats the following
102
- Citalopram (Celexa)
- Escitalopram oxalate (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
DRUG EXAMPLES OF SSRIs
103
o Nausea, headache, nervousness, anxiety
o Insomnia, somnolence, dizziness, fatigue
o GI disturbances, anorexia
o Increased heart rate and hypertension
(sympathomimetic effects)
o Dry mouth, blurred vision, urinary retention, and
constipation (anticholinergic effects)
o Sedation
SIDE EFFECTS/ADVERSE EFFECTS OF SSRIs
104
Sexual dysfunction
most common side effects of SSRIs
105
Steven-Johnson syndrome
serious adverse effects of SSRIs
106
A rare but serious disorder that affects the skin,
mucous membrane, genitals and eyes
STEVEN-JOHNSON SYNDROME
107
Usually caused by an unpredictable adverse
reaction to certain medications
STEVEN-JOHNSON SYNDROME
108
May occur when the client is takin in another medication that affects the metabolism, synthesis or reuptake of serotonin, causing serotonin to accumulate in the body
SEROTONIN SYNDROME (SES)
109
Symptoms can begin as early as 2 hours after taking first dose or as late several weeks after the initiating pharmacotherapy
SEROTONIN SYNDROME (SES)
110
o Mental status changes (confusion, anxiety, restlessness)
o Hypertension, tremors
o Sweating, hyperpyrexia, or ataxia
SIGNS AND SYMPTOMS OF SES
111
1. Assess the client’s needs for antidepressants by
noting the intensity and duration of symptoms
and identifying factors that led to depression
such as life events, and health changes
2. Obtain a careful drug history, including the use
of CNS depressants, alcohol, and other
antidepressants, especially MAOI therapy,
because this may interact with SSRIs
3. Assess for hypersensitivity to SSRIs
NURSING CONDSIDERATIONS FOR SSRIs
112
4. Ask the client about suicidal ideation, because
the drugs may take several weeks before full
therapeutic benefit is obtained
5. Obtain a history of any disorder of sexual
function, because this drugs have a high
incidence of side effects of this nature
6. Note a history of eating disorders, because
SSRIs commonly cause weight gain, which may
contribute to noncompliance in clients with
distortions and concerns about body image
NURSING CONDSIDERATIONS FOR SSRIs
113
1. SSRIs may take up to 5 weeks to reach their
maximum therapeutic effectiveness
2. Do not take any prescription, OTC drugs, or
herbal products without notifying your health
care provider
3. Keep all follow-up appointments with your
healthcare provider
4. Report side effects, including nausea, vomiting,
diarrhea, sexual dysfunction and fatigue
CLIENT HEALTH TEACHINGS FOR SSRIs
114
5. Do not drive or engage in hazardous activities
until the drugs sedative effect is known
6. Do not stop taking drug suddenly after long term
use because withdrawal symptoms may occur
7. Take most SSRIs in the morning with food to
avoid GI upset and insomnia. Lexapro and Zoloft
maybe taken in the morning and evening. Take
Rameron at bedtime because it usually causes
excessive drowsiness, especially at lower dose
8. Exercise and restrict calorie intake to avoid
weight gain
CLIENT HEALTH TEACHINGS FOR SSRIs
115
It inhibits monoamine oxidase, the enzyme that
terminates the action of neurotransmitters such
as dopamine, norepinephrine, epinephrine, and
serotonin
MONOAMINE OXIDASE INIBITORS
116
These drugs are reserved for clients who have
not responded to TCAs or SSRIs because of
their low safety margin
MONOAMINE OXIDASE INIBITORS
117
It limits the breakdown of norepinephrine dopamine and serotonin in the CNS neurons
MONOAMINE OXIDASE INIBITORS (MAOIs)
118
The first drugs approved to treat depression in 1950
MONOAMINE OXIDASE INIBITORS (MAOIs)
119
Isocarboxasid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Example drugs of MAOIs
120
o Orthostatic hypotension, headache, insomnia,
and diarrhea – most common
o Drowsiness, insomnia, blurred vision, constipation, anorexia, dry mouth, urine retention
SIDE EFFECTS: TCAs
121
1. A client taking MAOIs must refrain from foods
that contain tyramine
2. Assess cardiovascular status, because these
agents may affect blood pressure
3. Phenelzine (Nardil) is contraindicated in
cardiovascular disease, heat failure, hepatic or
renal dysfunction and paranoid schizophrenia
4. Obtain a CBC, because MAOIs can inhibit
platelet function
NURSING CONSIDERATIONS FOR MAOIs
122
5. Assess for the possibility of pregnancy, because
these agents are pregnancy category C and
enters breast milk
6. Use MAOIs with caution in epilepsy because
they may lower the seizure threshold
7. Take a careful drug history; common drugs that
may interact with a MAOIs include other MAOIs,
insulin, caffeine-containing products, other
antidepressants, meperidine (Demerol) and
possibly opioids and methylpoda (Aldomet).
There must be at least 14 days interval between
the use of MAOIs and other drugs
8. Some clients may not achieve the full
therapeutic benefits of MAOIs for 4 to 8 weeks
NURSING CONSIDERATIONS FOR MAOIs
123
1. Strictly observe dietary restriction for food
containing tyramine
2. Do not take any prescription, OTC drugs, or
herbal products without notifying your healthcare
provider
3. Avoid caffeine
4. Wear a medical alert bracelet identifying the
MAOIs medication
5. Be aware that it may take several weeks or more
to obtain the full therapeutic effects of drugs
6. Keep follow-up appointments with your
healthcare provider
7. Do not drive or engage in hazardous activities
until the drug’s sedative effect is known
8. It may be taken at bedtime if sedation occurs
9. Observe for and report signs of impending
stroke or myocardial infarction (MI)
CLIENT HEALTH TEACHINGS FOR MAOIs
