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NUR 408 Pharmacotherapeutics > Exam 2 Concepts > Flashcards

Exam 2 Concepts Flashcards

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1
Q

dark outer ring of the brain which is Latin for “bark”

A

cortex, roughly the size of a pillow case, which is responsible for human intellect and folded

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2
Q

lobes of the brain (4) and their function

A
  1. frontal: executive function
  2. parietal: sensory information, especially tactile (pressure, touch, pain)
  3. temporal: language and memory
  4. occipital: visualization
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3
Q

mental disorders in which the frontal lobe is at play

A

substance abuse

ADHD

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4
Q

limbic system function

A

controls learning, memory, emotions, and basic drives; hippocampus (memory), hypothalamus (homeostasis), and amygdala (emotion) all part of

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5
Q

how many neurons do we have in our brains?

A

86 billion and none of them touch

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6
Q

neurotransmitters (NTs) function, creation, and storage

A

NTs are signaling chemicals which the cell body of the nueron creates and the axon terminal stores within small vesicles

approximately 50 different types

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7
Q

action potential

A

an electrical charge which travels down the axon between cells of the myelin sheath and causes the release of NTs into the synapse

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8
Q

monoamines (3)

A
  1. Dopamine (DA)
  2. Norepinephrine (NE)
  3. Serotonin (5HT)
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9
Q

dopamine (DA)

A

NT which regulates mood, attention, energy, PLEASURE, MOTIVATION, and MUSCLE movements

ex. meds used to increase in clients with depression or ADHD

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10
Q

norepinephrine (NE)

A

NT involved in mood, attention, energy, and the FIGHT OR FLIGHT response

excessive amounts can cause anxiety or aggitation

ex. meds often used to increase in clients with depression or ADHD

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11
Q

serotonin (5HT)

A

NT which regulates mood, anxiety, SEXUAL DESIRE, and APPETITE

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12
Q

glutamate

A

main excitatory NT

“gas pedal”

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13
Q

GABA

A

main inhibitor NT
“brake pedal”

used in several meds to reduce anxiety, prevent seizures, and induce sleep

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14
Q

acetylcholine

A

NT which aids in regulation of attention and MEMORY

ex. often increased in pt’s w/Alzheimer’s dz

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15
Q

termination of a neuronal signal

A
  1. diffusion
  2. enzymatic degradation
  3. reuptake
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16
Q

NT diffusion

A

NTs float away from the synapse into the cerebrospinal fluid where they cannot activate postsynaptic receptors

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17
Q

NT enzymatic degradation

A

NTs broken apart by enzymes which end in “-ase”

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18
Q

NT reuptake

A

presynaptic terminal “pumps” suck NTs back into presynaptic terminal to be stored for future use

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19
Q

functions of psych medications (3)

A

change release of NTs
change enzymatic regulation
block reuptake

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20
Q

monoamine oxidase inhibitors (MAOIs)

A

prescribed for major depression, but usually not the first choice

think food AND drug interactions

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21
Q

MAOI food interactions

A

must AVOID foods w/tyramine (aged/fermented foods)

ex. cheeses, aged/processed meats, anything pickled, overripe fruit

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22
Q

MAOI drug interactions

A

pts must avoid drugs which increase monoamine NT levels

ex. other antidepressants, cold meds, meperidine (pain med), triptans (migraine meds)

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23
Q

MAOI mechanism of action

A

block monoamine oxidase which breaks down all three monoamines (DA, NE, 5HT) which increases their levels in the brain’s synapses

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24
Q

MAOI adverse effects

A

hypertensive crisis: tyramine or NE levels too high –> increased BP

serotonin syndrome: 5HT too high –> altered mental state, fever, sweating, clonus (involuntary rhythmic muscle contraction…foot test)

orthostatic hypotension

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25
tricyclic antidepressants (TCAs)
drugs which help treat major depression, neuropathic pain, and anxiety disorders ex. diabetes neuropathic pain tx think LESS selective than SNRIs
26
TCA mechanism of action
block NE and 5HT REUPTAKE pumps which increases NE and 5HT levels in synapses
27
TCA adverse effects
anti-cholinergic: block muscarinic cholinergic receptors --> can't see, spit, pee, sh*t cardiotoxicity: fatal cardiac dysrhythmias w/overdose; children and pt w/suicidal ideation at risk orthostatic hypotension
28
selective serotonin reuptake inhibitors (SSRIs)
first line of drugs for depression and may also be used for anxiety
29
SSRI mechanism of action
serotonin reuptake pumps blocked which increases 5HT
30
SSRI adverse effects (5)
"5 s's" 1. S tomach trouble 2. S lowed metabolism (weight gain) 3. S exual dysfunction 4. S uicidal ideation 5. S edating (EXCEPT fluoxitine)
31
serotonin norepinephrin reuptake inhibitors (SNRIs)
prescribed for major depression; duloxetine for neuropathic pain and venlafaxine for anxiety disorders.
32
SNRIs mechanism of action
blocked reuptake of NE and 5HT; MORE selective than TCAs
33
SNRI adverse effects
similar to SSRIs plus HTN, especially if dose is high
34
bupropion
prescribed for depression, smoking cessation, and ADHD inhibits NO and DA reuptake (NE 5HT effect!!!-->no weight gain)
35
trazadone
prescribed for depression, but mainly used for insomnia weak SRI w/ strong sedative and anticholinergic effects
36
important note about anti-depressants
takes 2-3 weeks for them to kick into action black box warning for suicidal thoughts, especially pts <18yo
37
mood stabilizer challenges
treating from above and below medication adherence, esp w/mania self-medication w/other substances
38
mood stabilizer medications
lithium anti-epileptic atypical anti-psychotics
39
lithium benefits and difficulty
pro: highly effective, lowers suicide risk con: NARROW therapeutic index of 1.5mEq/L
40
signs of lithium toxicity
A taxia C oarse tremors N ausea/vomiting E ars ringing "tinnitus" HOLD the drug and call provider
41
client teaching w/lithium
take w/food to prevent GI upset maintain fluid and salt intake avoid strenuous exercise knows signs of toxicity
42
normal side effects of lithium
mild nausea/diarrhea fine hand tremors polyuria/polydipsia (frequent urination and thirst) weight gain
43
anti-anxiety "anxiolytic" medications
``` benzodiazepines buspirone anti-depressants beta blockers certain anti-histamines ```
44
uses of benzodiazepines
``` anxiety insomnia muscle spasms seizures alcohol w/drawal ```
45
benzodiazepine mechanism of action
increase GABA activity "break pedal" which decreases neuronal firing, similar to alcohol EXTREMELY addictive d/t rapid onset and short half life
46
benzodiazepine side effects
ataxia sedation impaired memory
47
benzodiazepine precautions
hx of drug abuse liver dz elderly d/t possible fall risk pt must be weaned off benzos after long term use
48
buspirone mechanism of action
not entirely understood, but binds strongly to 5HT and loosely to DA
49
benefits and difficulty w/buspirone
pros: no abuse potential, not CNS depressant, no major w/drawal sx con: long period of onset (weeks)
50
buspirone food interactions
must AVOID grapefruit juice b/c it is a cyp inhibitor which increases drug levels in the blood--> toxicity
51
anti-psychotic medications
FGAs "typical" | SGAs "atypical"
52
uses of FGAs
schizophrenia aggitation/aggression nausea/vomiting intractable hiccups
53
signs of schizophrenia
``` "4 D's" D istress D anger D eviant D ysfunction ```
54
schizophrenia symptoms
positive: hallucinations, delusions, disorganized speech, bizarre behavior negative: flat affect, alogia (absence of thought), avolition (lack of motivation), anhedonia (no pleasure), social isolation
55
FGA mechanism of action
block all dopamine receptors to reduce dopamine activity in the brain
56
dopamine pathways (4)
mesolimbic: positive sx mesocortical: negative sx nigrostriatal: extrapyramidal sx tuberoinfundibular: endocrine issues ex. gynecomastia, galactorrhea, amenorrhea
57
FGA side effects
``` anticholinergic EPS orthostatic hypotension sedation neuroendocrine photosensitivity ```
58
extrapyramidal symptoms d/t FGA
acute dystonia akathisia parkinsonism tardive dyskinesia
59
neuroleptic malignant syndrome
``` F ever E levated WBCs and CPK V ital signs unstable E ncephalopathy R igidity ``` extremely fatal
60
uses of SGAs
schizophrenia bipolar disorder late stage dementia w/psychotic features
61
SGA mechanism of action
block all dopamine AND serotonin receptors to reduce dopamine activity in the brain in areas w/too much and increases dopamine in areas w/too little
62
SGA benefit and difficulties
pro: lower extrapyramidal sx cons: metabolic syndrome, expensive (2-3 times more so than FGAs) while equally effective
63
metabolic syndrome
may lead to diabetes central obesity, HTN, high blood sugar, dyslipidemia (bad cholesterol) mainly caused by clozapine (also causes destrcution of WBCs) and olanzapine
64
uses of CNS stimulants
ADHD | narcolepsy
65
CNS stimulants mechanism of action
block reuptake of NE and DA to increase levels at the synapses to increase executive function
66
CNS stimulant side effects
A ddiction/abuse A norexia A rrhythmias A wake at night (insomnia) *do NOT combine w/alcohol-->increased BPx2
67
atomoxetine benefits and risks
pros: NE reuptake inhibitor ONLY, low abuse potential cons: long period of onset, increased risk of suicide, weight loss, liver toxicity * not as effective as other CNS stimulants, but option fo pts w/hx of abuse
68
alcohol cessation medication uses
to help facilitate withdrawal | maintain abstinence
69
alcohol withdrawal
``` w/in hrs of last drink: INCREASE all vital signs hallucination illusion N/V seizures tremors ``` d/t brain compensation for constant GABA increase--> overstimulation w/glutamate
70
delirium tremens
``` rare, 2-3 days after last drink: severe disorientation hallucinations severe HTN cardiac dysrhythmias ```
71
seizure precautions
pad bedrails have O2 ready have suction regulator in case pt begins vomiting; prevent aspiration
72
disulfiram
causes N/V, sweating, hypotension, headache, palpations w/ANY alcohol ingestion to decrease alcohol temptation must avoid hidden alcohol in sauces, cough syrup, etc contraindicated for pts w/CV issues
73
naltrexone
opioid antagonist which reduces the pleasure derived from alcohol reduced cravings, reduced buzz
74
opioid toxicity
C oma P inpoint pupils R espiratory depression !!!!
75
naloxone
powerful opioid antagonist which reverse opioid toxicity short half life, pain/withdrawal MUST monitor pt, usually given multiple doses
76
opioid withdrawal sx
``` N/V/D yawning rhinorrhea sweating irritability tremor goosebumps muscle spasms/kicking movements "kicking the habit" ```
77
methadone
opioid agonist | doses gradually reduced to aid w/withdrawal sx
78
buprenorphine
PARTIAL opioid agonist | doses gradually reduced to aid w/withdrawal sx
79
nicotine addiction
HIGHLY lipid soluble so it reaches brain instantaneously and binds to nicotinic N acetylcholine receptors
80
nicotine N receptors
CV: increased BP and cardiac work GI: increase motility CNS: increased alertness, memory, cognition, decreased appetite, pleasure activated
81
nicotine withdrawal
begins w/in 24h and can last months abrupt discontinuation best tolerated cravings, irritability, insomnia, impaired concentration, weight gain
82
nicotine patches
slower, steadier release of nicotine ONLY which is not carcinogenic itself CAUTION: increased absorption w/inflammed skin, open wounds, heating pad
83
varenicline
partial nicotinic agonist to decrease reward of nicotine side effects: N, mood changes, suicidal ideation!!
84
activated charcoal mechanism of action
binds to certain drugs to prevent absorption of the drug and allow them to be excreted lipid soluble drugs such as TCAs, benzos, opioids, NSAIDs, antihistamines, etc
85
activated charcoal administration
pt must be awake and alert to avoid aspiration give anti-nausea beforehand !! mix in 6-8oz water can be w/juice or chocolate to improve taste NEVER milk *must be taken w/in 1 hr of drug ingestion

NUR 408 Pharmacotherapeutics (22 decks)

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