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Pharmacology 101 > Lecture 7 and 8 Nursing 100 > Flashcards

Lecture 7 and 8 Nursing 100 Flashcards

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1
Q

Parkinsonism (Pathophysiology)

A 
Chronic neurologic disorder
Degeneration of dopaminergic neurons
Imbalance of the neurotransmitters
Less dopamine 
Need to be a balance of ACh and dopamine
on and off periods
long term once developed
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2
Q

Parkinsonism (Characteristics)

A 
Tremors of head and neck and knees
Rigidity (increased muscle tone)
Bradykinesia (slow movement)
Postural changes
Head and chest thrown forward
Shuffling walk
Lack of facial expression
Pill-rolling motion of hands
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3
Q

Parkinsonism (Treatment)

A

MAO-B inhibitor- increases dopamine

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4
Q

Par. Treatment- Anticholinergic

A 
Dry the person out
Confusion
Block cholinergic receptors
Parasympatholytic- Benztropine (Cogentin)
Action: inhibit release of acetylcholine
Decrease tremors and rigidity
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5
Q

Par. Treatment- Dopaminergics

A

Convert to Dopamine
Carbidopa-levodopa (Sinemet)
Action: converted to dopamine
Increases mobility
Side effects
Fatigue, insomnia, dry mouth, blurred vision
Orthostatic hypotension- increased risk of falls
palpitations, dysrhythmias
Urinary retention, nausea, vomiting
Dyskinesia, psychosis (hallucinations, etc.),
severe depression- older white male (> 55yrs) predictable suicide

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6
Q

Carbidopa-Levodopa (Interactions)

A 
Inhibit MAO-B enzyme that interferes with dopamine
Decrease levodopa effect with:
Anticholinergics
Phenytoin- used for seizures
Tricyclic antidepressants
MAO inhibitors- interacts with food
Benzodiazepines
Phenothiazines 
Vitamin B6
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7
Q

Antiparkinosism Drugs (Interventions)

A

orthostatic hypotension- drink fluids; let feet dangle before standing
administer drug with low-protein foods
avoid vit B6, alcohol, and other depressants
mixed with alcohol increases effects
taper med off
suicidal- plan, where, how, etc < phenomenom
Monitor blood cell counts, liver and kidney (f)

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8
Q

Amantadine (Symmetrel)- Dopamine Agonist

A 
Stimulate dopamine receptors
Action:
Stimulates dopamine receptors
Use:
Early treatment as drug tolerance develops
Improvement of symptoms
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9
Q

Parkinsonism Treatments- COMT inhibitors

A

Inhibit COMT enzyme that inactivates dopamine

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10
Q

Parkinsonism Treatments- Dopamine agonists

A

Stimulate dopamine receptors

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11
Q

Alzheimer’s disease (Pathophysiology)

A

Progressive, degenerative disease
Neuritic plaques form- make transmission of signals more difficult
Neurofibrillary tangles are in neurons
Cholinergic neurotransmitter abnormality- ACh protects memory

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12
Q

Alzheimer’s disease (Characteristics)

A 
Loss of memory, logical thinking, judgment
Time disorientation
Personality changes
Hyperactivity
Tendency to wander
Inability to express oneself
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13
Q

Acetylcholinesterase Inhibitors (2 ex’s, action, and use)

A

Donepril (Aricept), Rivatstigmine (Exelon)
Action
Allow more acetylcholine in neuron receptors
Increase cognitive function
Use
Mild to moderate Alzheimer’s disease

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14
Q

Acetylcholinesterase Inhibitors (Side effects)

A 
Headache, dizziness
Depression
GI distress
Dehydration, dry mouth
Blurred vision
Insomnia
Hypertension, hypotension, dysrhythmias
Hepatotoxicity 
Orthostatic hypotension
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15
Q

Acetylcholinesterase Inhibitors (Interventions)

A 
Monitor vital signs
Maintain consistency in care
Monitor behavioral changes
Provide safety when wandering
Arise slowly to avoid dizziness
Monitor for GI bleeding
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16
Q

Stages of sleep

A

Rapid eye movement (REM)

Non–rapid eye movement (NREM)- 4 stages

17
Q

Insomnia

A

More common in females

Treatment: sedative-hypnotics

18
Q

Nonpharmacologic management (Insomnia)

A

No daytime naps, drink warm fluids
Avoid caffeine 6 hrs before bedtime
Avoid heavy meals/exercise before bedtime
Warm bath, read, listen to music

19
Q

Sedative- Hypnotics

A 
Sedatives: mildest form of CNS depression
Sedative hypnotics:
Barbiturates
Benzodiazepiness
Nonbenzodiazepines
Piperidinediones 
OTC:
Nytol, Sleep-Eze, Tylenol PM
Diphenhydramine (Benadryl)
20
Q

Barbiturates

A

Ultrashort-acting
Used as a general anesthetic
Example: thiopental sodium (Pentothal)
Short-acting
Induce sleep
No residual drowsiness
Examples: pentobarbital (Nembutal), secobarbital (Seconal)
Intermediate-acting
Induce and sustain sleep
Residual drowsiness (hangover effect)
Examples: amobarbital (Amytal), butabarbital (Butisol)
Long-acting
Used to control seizures
Example: phenobarbital

21
Q

Benzodiazepines

Ex, Action, Use

A

GABA= calming «targeted in antianxiety and insomnia meds
Temazepam (Restoril)
Action: Interacts with neurotransmitter GABA to reduce neuron excitability
Use: reduce anxiety, treat insomnia

22
Q

Non benzo’s

Ex, Action

A

Zolpidem (Ambien), Eszopiclone (Lunesta)

Action: neurotransmitter inhibition

23
Q

Zolpidem (Ambien)

A

gets people to sleep; crazy time before sleep- no memory

24
Q

Eszopiclone (Lunesta)

A

not as problematic; metallic taste- makes things taste weird

25
Q

Sedative-Hypnotics (General side effects)

A 
Residual drowsiness (hangover)
Drug dependence
Drug tolerance
Excessive depression
Respiratory depression
Withdrawal symptoms
26
Q

Secobarbital (Seconal)

Action, Use, Side-effects, interactions

A

Barbituate
Action: depression of CNS
Use: short-acting to treat insomnia
Side effects
Hangover, dizziness, paradoxical excitement in elderly, respiratory distress, laryngospasm
Interactions
Decreased respirations with alcohol, CNS depressants, and MAOIs

27
Q

Sedative- Hypnotics

Interactions, Interventions

A 
Alcohol, CNS depressants
Nursing interventions
First use nonpharmacologic methods
Take 15-45 min before bedtime
Report hangover effect
Be attentive to safety
Avoid alcohol, other CNS depressants
Monitor BP, R, withdrawal symptoms
28
Q

Epilepsy

A

Seizure disorder

Abnormal electric discharges from cerebral neurons

29
Q

Epilepsy (Characteristics)

A

Loss of consciousness

Convulsive movements

30
Q

Epilepsy (Cause)

A

Unknown
Secondary to trauma, anoxia, infection, stroke
Isolated seizures due to fever, electrolyte, or acid-base imbalance

31
Q

Generalized Seizure Classification

A

Grand mal (tonic-clonic)
Most common
Generalized alternating
muscle spasms and jerkiness

32
Q

Petit mal Seizure Classification

A

Brief loss of consciousness (10 seconds or less)

Usually occurs in children

33
Q

Partial Seizure Classification

A 
Psychomotor
Repetitive behavior
Chewing or swallowing motions
Behavioral changes
Motor seizures
34
Q

Anticonvulsants (Action)

A

Suppress abnormal neuron firing
Suppress Na influx
Phenytoin (Dilantin)
Suppress Ca influx
Valproic acid (Depakane), divalproex (Depakote)
Enhance action of GABA- inhibitory neurotransmitter: calm; antianxiety
Clonazepam (Klonopin), gabapentin (Neurontin)
Inhibit GABA degradation- inhibit breakdown so there is more; usually enzyme is inhibited
Vigabatrin (Sabril)

35
Q

Hydantoins

Ex, Contradictions, therapeutic serum level, side effect/adverse reactions

A

Phenytoin (Dilantin)
Contraindications
Pregnancy (teratogenic)
Therapeutic serum level
10-20 mcg/ml
Side effect/adverse reactions
Gingivitis, gingival hyperplasia, nystagmus
HA, diplopia, dizziness, slurred speech, decreased coordination, alopecia
Thrombocytopenia, Stevens-Johnson syndrome

36
Q

Steven-Johnson Syndrome

A

Rash

37
Q

Phenytoin (Dilantin) Drug interactions

A

Increased effects with cimetidine (Tagamet), INH, sulfonamides
Decreased effects with folic acid, antacids, calcium, sucralfate, antineoplastics, antipsychotics, primrose, ginkgo
Decreased effects of anticoagulants, oral contraceptives, antihistamines, dopamine, theophylline

38
Q

Hydantoins Nursing Interventions

A

Shake suspension well (5 min)
Monitor serum drug levels
Safety: Protect from environmental hazards, driving
Warn females taking oral contraceptives to use additional contraception
Avoid certain herbs, alcohol, and other CNS depressants
Warn client not to discontinue abruptly
Need frequent oral hygiene and dental check-ups
Monitor glucose level in diabetics
Teach client to take drug at same time every day
Warn of harmless pinkish red or brown urine

Pharmacology 101 (15 decks)

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