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Pharm > Drugs Affecting the Nervous System > Flashcards

Drugs Affecting the Nervous System Flashcards

1
Q

Chemical messengers of NS
Exert actions through receptors in postsynaptic membrane
Interaction of transmitter/receptor results in specific physiologic response
Rapid removal of transmitter needed to maintain precise control of neural transmission
Receptors named for type of neurotransmitter with which they interact

A

Basic concepts neurophysiology: communication neurotransmitters

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2
Q

Neurotransmitters, neuromodulators, neurotrophic or nerve growth factors

A

Chemical messengers of NS

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3
Q

Missing Ach in Alzheimers
Undersupply dopamine = Parkinson’s
GABA - major inhibitory NT; treatment of seizures

A

Review neurotransmitters

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4
Q

Simultaneous disruption of electrical activity/onset originate in bilateral hemispheres
Tonic–clonic seizure is most common major motor seizure: the 2 phases of seizure activity

A

Generalized Seizures

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5
Q

Begin in a specific area of cerebral hemisphere
With impaired consciousness (impaired awareness) or without impairment of consciousness (aware)

A

Focal Seizures

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6
Q

Chronic disorder of recurrent seizures

A

Epilepsy

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7
Q

When has Multiple seizures occur back to back with no recovery between them- hypotension, hypoxia, brain damage, and death (more sig implications result); med Emergency to get stop so no cardiac/resp probs or brain damage – diazepam (benzo - slow seizure activity) - not fine line on when given; vary between pats

A

Status epilepticus

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8
Q

alter movement of sodium, potassium, calcium, and magnesium ions; changes in movement of ions result in more stabilized and less excitable cell membranes; nerve membranes less excitable to decrease seizures; some later movement electrolytes, some enhance action GABA; whole goal: neurons less excitable

A

MoA: - Gen: anti-seizure (AS) meds

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9
Q

GI upset (n/v)
CNS depression (drowsiness, lethargy, fatigue) - less excitable; do more than want to see this and experience this; lot drugs cause CNS depression so aware and monitor for this
Confusion
Ataxia - rigid and clumsy like movements - gait; inability do fluid muscle movement esp with gait; diff with speech

A

Adverse Effects - Gen: anti-seizure (AS) meds

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10
Q

Hepatotoxicity - LFTs yearly; meds for long period time

A

Toxicity: - Gen: anti-seizure (AS) meds

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11
Q

CNS depressants (more than 1 worse), alcohol, many others (highly protein bound - compete for protein binding sites and higher levels of drug free to exert effect and higher risk for toxicty)

A

Drug-drug: - Gen: anti-seizure (AS) meds

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12
Q

Risk of birth defects with many anti-seizure meds; weigh benefit vs. risk - not have seizures all time - not have O2 deprivation
Risk severe seizure activity with abrupt withdrawal of medication - balance NT and through out balance and cause probs with pat - r/f major seizure
Monitor drug levels for toxicity - blood monitoring imp
Black box waring: Suicidal ideations - less NT activity - r/f depression and SI

A

Cautions: AS meds

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13
Q

Advise contraception, notify PCP if pregnancy occurs or want to be pregnant
Medications pregnancy cat C/D/X

A

Risk of birth defects with many anti-seizure meds; weigh benefit vs. risk - not have seizures all time - not have O2 deprivation

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14
Q

potentiates effects of GABA; drug of choice in acute care when having a seizure

A

MoA: - Benzodiazepines: Prototype: diazepam (Valium)

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15
Q

status epilepticus

A

Use: - Benzodiazepines: Prototype: diazepam (Valium)

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16
Q

IVP (2 mg/min) - not swallow since acute seizure; onset: 1-5 min; peak 30 min; duration: 60 min

A

Route: - Benzodiazepines: Prototype: diazepam (Valium)

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17
Q

respiratory depression, bradycardia, hypotension

A

AE: - Benzodiazepines: Prototype: diazepam (Valium)

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18
Q

Monitor cessation of seizure activity - if not might give second dose of med - wait 5 min until give 2nd dose, once activity stops monitor VS for certain period of time and not having any AE

A

Nursing: - Benzodiazepines: Prototype: diazepam (Valium)

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19
Q

Stabilize nerve membranes throughout CNS-less excitability

A

MoA: - Hydantoins: Prototype: phenytoin (Dilantin)

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20
Q

see general; gingival hyperplasia (overgrowth of gum tissue)

A

AE: - Hydantoins: Prototype: phenytoin (Dilantin)

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21
Q

Many - highly protein bound, hepatic enzyme inducer; warfarin - increased risk for bleeding

A

Drug-Drug: - Hydantoins: Prototype: phenytoin (Dilantin)

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22
Q

therapeutic blood level: monitor levels; see next slide for IV administration; teach and maintain good oral hygiene - more bacteria in mouth - increased risk for dental probs

A

Nursing: - Hydantoins: Prototype: phenytoin (Dilantin)

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23
Q

Intravenous push: use large vein and large catheter; do not exceed 50 mg/min
Intravenous infusion: only dilute in NS; use with particular kind of filter - so not percipitate
Follow with normal saline flush to decrease risk of local venous irritation
Monitor IV site for inflammation and extravasation
More sig AE: Monitor cardiac rhythm (bradycardia) and affect blood pressure; on cardiac monitor and monitor BP frequently during IV infusion

A

Phenytoin IV admin

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24
Q

Enhances action of GABA neurotransmitter to slow down activity in brain and less excitability

A

MoA: - Barbiturates: Prototype: phenobarbital (Luminal)

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25
Q

See general; general AE resolve over time

A

AE: - Barbiturates: Prototype: phenobarbital (Luminal)

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26
Q

respiratory depression, coma (particularly sig and higher risk with IV route, be cautious)

A

Toxic: - Barbiturates: Prototype: phenobarbital (Luminal)

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27
Q

therapeutic blood level: monitor levels; admin once daily dosing at HS due to sedating effects - more sedating than other drugs so take HS if only taking qday

A

Nursing: - Barbiturates: Prototype: phenobarbital (Luminal)

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28
Q

Increases levels of GABA in brain

A

MoA: - Miscellaneous: Prototype: valproic acid

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29
Q

See general; weight gain; increased bleeding time; toxic: pancreatitis

A

AE: - Miscellaneous: Prototype: valproic acid

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30
Q

Many - Highly protein bound; warfarin - increased bleeding: monitor bleeding times if taking with this, labs likely drawn frequently

A

Drug-Drug: - Miscellaneous: Prototype: valproic acid

31
Q

Do not crush or chew extended release (ER) - available immediate and ER forms

A

Nursing: - Miscellaneous: Prototype: valproic acid

32
Q

Focused neuro: LOC and orientation; assessments related to AE
Consider Pregnancy status, drug-drug interactions (CNS depressants)
Labs: drug levels (if appropriate), kidney/liver if toxicity suspected

A

Assessment

33
Q

Risk for injury

A

Nursing Diagnosis

34
Q

The client will have an absence of seizure activity
The client will understand drug therapy, adverse effects, safety measures

A

Expected Outcomes

35
Q

Reduce risk for falls
Seizure precautions: padding around bed rails, suction available, O2 ready and available; keep them as safe as possible
Counsel women of childbearing age
Lab monitoring for therapeutic levels (if appropriate); below: not problematic if not having seizures; get to make sure not becoming toxic; care if above: at risk for toxicity
Educate:

A

Nursing care plan: interventions

36
Q

Seizure disorder will need med therapy for lifetime
Discontinue drug slowly; abrupt withdrawal may precipitate seizures; take as directed; call if having certain AE
Caution with driving until effects of medication known - CNS depression and impact driving and seizure
Lab monitoring - AS drugs q3months once stable; start more often

A

Educate:

37
Q

Therapeutic response
Monitor for Adverse effects
Teaching

A

Nursing care plan: eval

38
Q

Absence of seizure activity

A

Therapeutic response

39
Q

CNS depression, confusion, ataxia
GI effects
Signs of toxicity
Med specific

A

Monitor for Adverse effects

40
Q

More sensitive to sedating effects, monitor closely
Children 2 months – 6 years absorb and metabolize quickly; may require larger dose per kilogram to maintain therapeutic levels

A

Child - Lifespan considerations: anti-seizure meds

41
Q

Medic Alert identification
Consider lifestyle changes (work [impacts financial status], transportation, etc.)

A

Adult - Lifespan considerations: anti-seizure meds

42
Q

More susceptible to adverse effects, toxicity
Dose adjustments for reduced liver/kidney function

A

Older adult - Lifespan considerations: anti-seizure meds

43
Q

PD: dopamine; CM: tremors, shuffling gait, drooling, mask like facial expression, anticholinergic effects because AcH levels higher than dopamine
AD: neuronal death because of amyloid plaque- lack AcH; memory impairment, loss motor func and speech

A

Recall the pathophysiology of Parkinson’s disease and Alzheimer’s disease with special attention to levels of neurotransmitters. Recall common clinical manifestations of Parkinson’s disease and Alzheimer’s disease

44
Q

No cure for Parkinson’s disease or Alzheimer’s disease
Medications used for treatment take several months to take effect
Medications help alleviate manifestations of Parkinson’s disease
Medications slow progression of disease in Alzheimer’s dementia – earlier more benefit

A

Special considerations

45
Q

Improvement in several months

A

Medications help alleviate manifestations of Parkinson’s disease

46
Q

Improvement in 4-6 weeks

A

Medications slow progression of disease in Alzheimer’s dementia – earlier more benefit

47
Q

Restores dopamine concentration in brain (combo); Levodopa - active part, broken down in periphery, not liver like norm, if given on own body break down quickly and faster than get to BBB to restore dopamine levels; Carbidopa - given to prevent breakdown Levodopa before body can use it, lower doses Levodopa can be given - major AE higher doses: huge GI effects (n/v)

A

MoA: - Dopaminergic agent: Prototype: Levodopa/Carbidopa (Sinemet)

48
Q

Parkinson’s disease - main stage disease treatment

A

Indication: - Dopaminergic agent: Prototype: Levodopa/Carbidopa (Sinemet)

49
Q

antihypertensives (inc. hypotension); CNS dep (increase sedation)

A

Drug-drug: - Dopaminergic agent: Prototype: Levodopa/Carbidopa (Sinemet)

50
Q

CV disease, asthma, urinary obstruction, peptic ulcer disease

A

Caution: - Dopaminergic agent: Prototype: Levodopa/Carbidopa (Sinemet)

51
Q

(low BP and anticholinergic effects): orthostatic hypotension, dry mouth, constipation, urinary retention, confusion, agitation, insomnia

A

AE - Dopaminergic agent: Prototype: Levodopa/Carbidopa (Sinemet)

52
Q

maintain compliance; Abrupt cessation may cause parkinsonism crisis - acute exacerbation: severe presentation of Parkinson’s disease; take as prescribed and do not double doses - can build up tolerance over time - start lowest dose so careful in how increase med - once increase med lower doses never effective again

A

Nursing: - Dopaminergic agent: Prototype: Levodopa/Carbidopa (Sinemet)

53
Q

Enhances the effects of acetylcholine in neurons in cerebral cortex that have not been damaged

A

MOA: - Alzheimer’s Disease: Cholinesterase Inhibitor (cholinergic agonist): Prototype: donepezil (Aricept)

54
Q

Alzheimer’s disease - first line treatment and delay progression

A

Indication: - Alzheimer’s Disease: Cholinesterase Inhibitor (cholinergic agonist): Prototype: donepezil (Aricept)

55
Q

n/v/d, insomnia or drowsiness (more common), bradycardia/AV block

A

AE: - Alzheimer’s Disease: Cholinesterase Inhibitor (cholinergic agonist): Prototype: donepezil (Aricept)

56
Q

Assess BP/HR; monitor mental status; give at bedtime unless insomnia occurs; Teach - not to increase or decrease dose abruptly; Risk cholinergic crisis (too much AcH and cause it; risk present but rarely seen but NT missing); earlier start the better; once increase no turning back

A

Nursing: - Alzheimer’s Disease: Cholinesterase Inhibitor (cholinergic agonist): Prototype: donepezil (Aricept)

57
Q

are drugs that reduce or eliminate pain by depressing nerve function in the central and/or peripheral nervous system

A

Anesthetics

58
Q

involves complete loss of consciousness and loss of body reflexes so adequately perform surgery, including respiratory muscles (requires ventilatory support to avoid brain damage); endotracheal tube

A

General anesthesia

59
Q

allows patient to relax and tolerate procedure but maintains respiratory function and response to stimuli; colonoscopy/EGD; breathing on own
Registered nurses may be trained to administer moderate sedation
Must have advanced cardiac life support (ACLS) training

A

Moderate sedation (conscious sedation, procedural sedation)

60
Q

Ensure life support equipment readily available prior to start of procedure
Ensure patent IV for administering drugs
Gather supplies to administer drugs intravenous push (IVP): Syringes, alcohol prep, flushes, drug vials
Monitor patient’s level of consciousness and pain during procedure
Monitor patient’s vital signs during procedure
Alert provider of concerning changes in patient status
Monitor LOC and VS following procedure
Standard protocols on how often monitor after procedure - VS and LOC - waking up after

A

Nurse role: moderate sedation

61
Q

Trained intensive care registered nurses
Assist with intubation of patient
Manage sedation to keep patient comfortable and tolerant of endotracheal tube
Taper drugs prior to extubating (removing endotracheal tube)

A

Nurse role: medically-induced coma

62
Q

Gather supplies to administer drugs IVP (i.e.; midazolam, rocuronium)
Administer drugs as directed by anesthesia provider
Sequence: benzodiazepine/some kind sedative - sedate and make them more comfy, then paralytic - paralyze muscles so stop breathing so can insert ET tube in right spot and once there attach ambu back attached to ventilator

A

Assist with intubation of patient

63
Q

Cont give Intravenous infusions of midazolam and fentanyl - comfy and tolerate presence of ventilator

A

Manage sedation to keep patient comfortable and tolerant of endotracheal tube

64
Q

Moderate sedation for diagnostic procedures, induction of anesthesia (surgery), sedation of intubated patients, decrease anxiety prior to procedure

A

Indications: - Benzodiazepines (Anesthetic): Prototype: midazolam (Versed)

65
Q

(IVP in acute care to help with sedation): 1-5min/<30 min/2-6 hours

A

Onset/peak/duration - Benzodiazepines (Anesthetic): Prototype: midazolam (Versed)

66
Q

CNS depressants, opioids

A

Drug-drug: - Benzodiazepines (Anesthetic): Prototype: midazolam (Versed)

67
Q

respiratory depression, CNS depression, disorientation, amnesia, restlessness, bradycardia, hypotension

A

AE: - Benzodiazepines (Anesthetic): Prototype: midazolam (Versed)

68
Q

Assume patient will remember things said/done during sedation/anesthesia

A

Nursing: - Benzodiazepines (Anesthetic): Prototype: midazolam (Versed)

69
Q

Bind to ACh receptors at neuromuscular junction, blocking action of ACh; induces paralysis of skeletal muscle and beneficial for sedation (peripheral to central); paralytic drug

A

MoA: - Neuromuscular Blocking Drugs: Prototype: Rocuronium

70
Q

Endotracheal intubation; surgery

A

Indication: - Neuromuscular Blocking Drugs: Prototype: Rocuronium

71
Q

(IV): 1-2 min/4 min/30 min - quickly relaxed so hooked up quickly to ventilator imp

A

Onset/peak/duration - Neuromuscular Blocking Drugs: Prototype: Rocuronium

72
Q

muscle damage, hyperkalemia, cardiovascular collapse (more likely with larger dose, prolonged administration when at highest risk)

A

AE: - Neuromuscular Blocking Drugs: Prototype: Rocuronium

73
Q

Administer prescribed sedation prior to neuromuscular blocking agent/paralytic drug

A

Nursing: - Neuromuscular Blocking Drugs: Prototype: Rocuronium

Pharm (30 decks)

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