Module 2A and 2B Neuropharmacology CNS/ANS drugs Flashcards
1
Q
Aids in withdrawal effects related to autonomic hyperactivity (diarrhea,
nausea, vomiting2B
A
CLONIDINE
CATAPRES
2
Q
opioid agonist that replaces opioids, prevents abstinence syndrome Part of
the 12 step self-help program
A
METHADONE
3
Q
Used for detoxification and maintenance, decreases craving,
administered SL, IM, IV, (for opioid)
A
BUPRENORPHINE
SUBUTEX
4
Q
An opioid antagonist that suppresses craving
and pleasurable effects of alcohol
A
naltrexone
5
Q
For alcohol aversion therapy
A
disulfiram
6
Q
Seizure precautions
A
(padded side
rails and suction equipment at bedside)
7
Q
Detoxification drugs
A
(Benzodiazepines) Chlordiazepoxide (Librium), diazepam
Valium), lorazepam (Ativan
8
Q
Succinylcholine nursing intervention
A
Test dose before adm, no resp. distress, proceed to adm
9
Q
When does alcohol withdrawal starts
A
within 4 to 12 hrs of the last intake of alcohol
10
Q
Withdrawing from a substance that has the potential to cause
addiction can cause abstinence syndrome. Manifestations of abstinence syndrome can be distressing and may lead to coma and death; occurs when clients abruptly withdraw from a substance to which they are physically dependent.
A
ABSTINENCE SYNDROME
11
Q
DOC for short procedures [less than 3 minutes] and for orthopedic manipulations; acts like acetylcholine but not inactivated by ACHe
A
Succinylcholine
12
Q
Nursing Intervention for Neuromuscular Blockers
A
Administer sedatives or general anesthetics before NMBs; Should be administered by personnel skilled in airway management; NMBs precipitates if mixed with alkaline solutions
13
Q
Directly activates DA receptors
First line drugs
A
DOPAMINE AGONISTS Pramipexole Ropinirole Bromocriptine
14
Q
● Competitive/ stabilizing drugs
● Compete with ACh to prevent muscle from contracting
A
( NON DEPOLARIZING BLOCKING DRUGS)
Atracurium, Cisatracurium, Doxacurium, Mivacurium, Pancuronium, Rocuronium, Vecuronium
15
Q
Relax skeletal muscles during surgery
Reduce intensity of muscle spasms in drug-induced seizures
Manage patients who are fighting the use of ventilator to help
with breathing
A
NEUROMUSCULAR BLOCKING DRUGS
16
Q
○ DOC for spasticity
○ Indicated for paraplegic/ quadriplegic patients with spinal cord
lesions
○ Most common adverse effect is transient drowsiness
A
Baclofen
17
Q
○ Most effective for spasticity of cerebral origin [i.e. cerebral palsy,
MS, spinal cord injury, stroke]
○ Used for treatment of malignant hyperthermia [complication of
anesthesia causing muscle rigidity and high fever]
A
Dantrolene Sodium ( DIRECT ACTING AGENTS)
18
Q
For treatment of acute muscle spasms caused by anxiety, pain and
trauma
Treat spasticity from conditions as MS and Cerebral Palsy
A
(CENTRALLY ACTING AGENTS) Carisoprodol Chlorphenesin Metaxalone Tizanidine
19
Q
Defined as involuntary contraction of a muscle or muscle
group; Often painful and decreases level of functioning
A
Muscle Spasm
20
Q
○ Partial seizures in adults
○ Treatment of pain from diabetic neuropathy
○ Tremors associated with MS, bipolar disorder and migraine
prophylaxis
Works to increase GABA in the brain
A
gabapentin
21
Q
Nursing intervention for carboxylic acid derivatives
A
Dilute the drug with a compatible diluent if injecting IV and give
over 1 hour, don’t exceed 20mg/min
22
Q
Carboxylic Acid Derivatives therapeutic level
A
50-100 mcg/mL
23
Q
for All partial and generalized seizures; Bipolar disorder; Migraine
A
(CARBOXYLIC ACID DERIVATIVES)
Valproate, Valproic Acid, Divalproex
24
Q
Diazepam therapeutic limit
A
5mg/min
25
Treatment for absence, atypical absence seizures
Clonazepam
26
DOC for acute management of status epilepticus
IV Lorazepam
27
○ is restricted to acute treatment of status epilepticus
○ Not recommended for long-term use due to high potential for
addiction
Diazepam (. BENZODIAZEPINES)
28
Adverse effects of this drug includes leukopenia, anemia and thrombocytopenia [fatal aplastic anemia]
carbamazepine
29
Carbamazepine (IMINOSTILBENES) therapeutic level
4-12 mcg/mL
30
Nursing intervention for carbamazepine
Do not drink grapefruit juice
31
Adverse reactions of this drug includes Rashes, hives and Steven-Johnson Syndrome [fatal inflammatory disease]
carbamazepine
32
○ Cornerstone of epilepsy therapy
○ Active against partial seizures and tonic-clonic seizures but not
absence seizures
○ Suppresses neuronal discharge by delaying recovery of sodium
channels
○ Has fewer side effects than phenytoin and phenobarbital
Carbamazepine
33
Phenobarbital therapeutic limit
60mg/min
34
T or F: IV phenobarbital is reserved for emergency treatment
T
35
Effective against partial seizures and generalized tonic-clonic
seizures but not absence seizures
○ Suppresses seizures by potentiating the effects of GABA
○ Can be used as daytime sedative “sleeping pills”
○ Able to suppress seizures without causing generalized CNS
depression
Phenobarbital
36
phenytoin therapeutic level
10-20 mcg/mL
37
Nursing intervention for phenytoin (IV push)
Watch out for PURPLE GLOVE SYNDROME; May precipitate with D5W; clear tubing first with PNSS
38
most commonly prescribed anticonvulsant drug; Stabilize nerve cells to keep them from getting overexcited by increasing efflux or decreasing influx of sodium ions; drug of choice for Control of tonic-clonic seizure and complex partial seizures; Status epilepticus and Prevention and treatment of seizures during neurosurgery
Phenytoin
39
Simple Partial, Complex Partial, Secondary Generalized Seizures
Tonic-clonic
valproic acid, phenobarbital, primidone, phenytoin, cabamazepine
40
for all types of seizzures
valproic acid
41
When px have seizures turn them to
Turn them at the side - they can choke at their own saliva
42
abnormal motor phenomenon
convulsions
43
Excitation spreads widely throughout
| both hemispheres of the brain
Generalized Seizures
44
Excitation undergoes limited spread from the
| focus to adjacent cortical areas
Partial Seizures
45
general term that applies to all types of epileptic events
seizures
46
Group of disorders characterized by excessive excitability of
neurons in the CNS
EPILEPSY
47
Nursing intervention on dopaminergic drugs
Avoid high-protein meals; Administer with food to prevent GI irritation [except
Levodopa]; If the patient receives a single-dose, the drug is better given
at bedtime
48
```
May cause
Orthostatic hypotension
Ventricular tachycardia
Bradycardia
Worsening angina
```
Bromocriptine
49
```
May cause
N&v
Orthostatic hypotension
Anorexia
Neuroleptic malignant syndrome
Arrhythmias
Confusion
```
Levodopa
50
When taking dopaminergic drugs, therapeutic level is reduced when taken with
pyridoxine [VIT B6], phenytoin,
| benzodiazepines, reserpine and papaverine
51
Use with antipsychotic reduces ____
effectiveness of levodopa
52
Levodopa + Maoi causes
Hypertensive crisis
53
Inhibits breakdown of dopamine; For newly
| diagnosed patients
MAO-B inhibitors
| Selegiline Rasagiline
54
Anti-viral but promotes release of dopamine; 2nd or 3rd line
| drug
DOPAMINE
RELEASER
Amantadine
55
Inhibits breakdown
of levodopa; Adjunct to
levodopa
COMT INHIBITORS
Entacapone
Tolcapone
56
Converted to Dopamine and activates dopamine
| receptors; First-line drug/ supplement to dopamine agonis
DOPAMINE
REPLACEMENT
Levodopa
Levodopa/Carbidopa
57
drugs that block receptors for ACh
Anticholinergic Agents
58
directly/indirectly cause activation of dopamine receptors
dopaminergic drugs
59
● Slowly progressive neurodegenerative disorder characterized by
tremor, rigidity, postural instability and slowed movement
● Affects the extrapyramidal system which influences movement
PARKINSON’S DISEASE
60
doxapram nursing intervention
Never give more than 3 liters per minute because respiratory
| drive will be gone
61
Treatment of respiratory depression caused by drug overdose
| and COPD
Doxapram
62
Stimulate respiration (amphetamine)
Xanthine (analeptic)
63
Treatment of narcolepsy
Modafinil
64
■ Given to increase child’s attention span and cognitive
performance
■ Used to treat narcolepsy
Methylphenidate
65
Stimulate the release of NE and DA from the brain and SNS
: AMPHETAMINES
66
Characterized by falling asleep during normal waking activities
[driving/ talking]; Unable to move and may collapse
NARCOLEPSY
67
Dysregulation of the transmitters serotonin, norepinephrine,
| dopamine
ADHD [Attention Deficit/ Hyperactivity Disorder]
68
state in which abrupt discontinuation of
| drug use will precipitate a withdrawal syndrome
Physical Dependence
69
T or F: CHILDREN are much more sensitive to CNS drugs than adults
T
70
Impedes the entry of drugs into the brain
BLOOD BRAIN BARRIER
71
How many compounds does CNS has that serve as neurotransmitters
21
72
Used for psychiatric disorders, suppression of seizures, relief of
pain, production of anesthesia
CNS DRUGS
73
Process by which information is carried across the gap between
neuron and postsynaptic cell
Synaptic Transmission
74
Conducting an action potential down the axon of the neuron
Axonal Conduction
75
Study of drugs that alter processes controlled by the nervous
system
NEUROPHARMACOLOGY
76
Assess the ff in antinicotinic agents
Urine retention and bladder distention
Paralytic ileus
Respiratory adequacy
77
Adverse effects of Antinicotinic agents
● Prolong apnea
● Hyperkalemia
● Malignant hyperthermia
78
Causes sodium channels to open for prolonged depolarization
For rapid sequence tracheal intubation
A depolarizing agent
Succinylcholine
79
Rapid effect in less than 2 mins, will paralyze small muscles; Binds to ACh receptors but do not induce ion channel opening; Facilitates mechanical ventilator and tracheal intubation
Non-Depolarizing Agents
| Cisatracurium, Pancuronium, Cisatracurium, Pancuronium
80
○ Stimulate and block cholinergic function
○ Increase production of neurotransmitters
○ Increase BP, HR, but may also decrease BP- non-selective effect
○ CNS Stimulation - causes addiction
○ Not useful in clinical practice
a ganglionic blocker
NICOTINE
81
Adverse effects of cholinergic agonists
```
● D - Diarrhea
● U - Urination
● M – Miosis and Muscle Weakness
● B - Bronchorrhea
● B - Bradycardia
● E - Emesis
● L - Lacrimation
● S – Salivation/ Sweating
```
82
Adverse effects of Cholinergic blockers
```
A - Agitation
B - Blurred vision
C - Constipation, Confusion
D - Dry mouth
S - Stasis of urine and Sweating
```
83
For Parkinson’s like disorders
Benztropine
84
COPD, rhinorrhea as inhalation to brochodilate and decrease secretion
Ipratropium
85
Motion sickness, Post Op Nausea and Vomiting as patches
Scopolamine
86
Same as atropine but with less duration of action
Cyclopentolate,
| Tropicamide
87
For Mydriasis, Psychoplegia prior to an eye surgery or exam
Blocks M3 – reduced GI motility
Blocks M2 – SA and AV node, tachycardia
in high doses
Atropine
88
What to do to lessen n & v
Take on empty stomach
89
NEOSTIGMINE (Tensilon) Test
increased weakness
90
● Famous for milit
| ● Caused by overdose of cholinergic agonists
CHOLINERGIC CRISIS
91
Alzheimer’s disease to improve cognitive function
Donepezil,
Rivastigmine,
Galantamine
92
reverse effects of
| anesthesia
Neostigmine,
| Pyridostigmine
93
Overdose of atropine
Physostigmine
94
treatment of open glaucoma
Echothiophate
95
Famous for military use as nerve gases
INDIRECT ACTING REVERSIBLE cholinergic agonist
96
for acute post-operative and postpartum nonobstructive
urine retention, neurogenic atony of urinary bladder with urine
retention.
bethanicol
97
Increase muscle tone in bladder and GIT
Bethanechol
98
Constricts pupil, decrease IOP for acute glaucoma
Pilocarpine
99
Not as susceptible to AChE, used locally to constrict pupil and
decrease IOP
Carbachol
100
Non-specific cholinergic effect, decreases CO, HR, BP, increase GI
activity
Acetylcholine
101
transmission of cholinergic signals
Nn
102
affects muscle contraction 9receptor)
Nm
103
affect skeletal muscles (receptor)
nicotinic
104
may increase potassium and decrease heart rate (receptor)
M2 (heart)
105
M1 (GU) and M3 (lungs, glands)
– may increase calcium activity
106
stimulate smooth muscle and slows HR
muscarinic
107
Check apical pulse (<60 bpm alert!); for : mild to moderate hypertension
prazosin
108
Hypertension – with vasodilation
Carvedilol, Labetalol
109
Glaucoma, decrease
| intraocular pressure
Timolol (1st gen
110
Propranolol (1st gen)
Hypertension, Angina,
| Migraine
111
(-olol)
beta Blockers
112
Decrease heart rate
Decreases blood pressure
Useful for treating mild to moderate hypertension, angina pectoris
and myocardial infarction
BETA BLOCKERS
113
A decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg
or more in DBP, and/or
An increase in the HR of 20 beats/minute or more from supine to
standing indicates orthostatic hypotension
ORTHOSTATIC HYPOTENSION
114
Alpha blockers examples
(zosin)
Terazosin
Doxazosin
Prazosin
115
Blocks alpha and beta receptor blocker
ADRENERGIC BLOCKERS
116
non catecholamines aerosol use
15 min before exercise
117
cathecolamines iM adm area
lateral deltiod area
118
non cathecolamines inhalation adm
wait 2 minutes between doses
119
Normal mean arterial pressure
> 65
120
Don’t adm in the same IV line as other drugs
catecholamines
121
give cardiac glycosides if ordered first
cathecolamines
122
for Asthma/ COPD; B2
albuterol
123
For Increases heart rate, force of contraction in heart failure, shock; b1
Dobutamine
124
antidote for epinephrine
phentolamine Mesylate (Regitine)
125
For anaphylaxis, asthma, cardiac stimulation, induction
| and maintenance of mydriasis during intraocular surgery; a vasopressor; adrenergic
epinephrine
126
receptor for treatment of Asthma, premature labors of contraction
Beta 2
127
Receptor for treating Heart failure, cardiac arrest, shock
beta 1
128
Receptor for treating Hypertension
alpha 2
129
receptor for treating Hypotension, nasal congestion, dilation of pupils
alpha 1
130
Has a catechol ring and amines
Catecholamines
131
stimulates the release of norepinephrine from terminal nerve
| endings.
Indirect-Acting Sympathomimetic
132
directly stimulates the adrenergic receptor.
Direct-Acting Sympathomimetic
133
stimulate adrenergic receptors
sympathomimetic
134
drugs that produces a response
agonists
135
Increases salivation
parasympa NS
136
Relaxes smooth muscles of the
| GI
Sympa NS
137
Dilates blood vessels
parasympa NS
138
Increases heart rate
sympa NS
139
Constricts bronchioles, increase
| secretions
parasympa NS
140
Dilates pupils
SNS
141
inactivates acetylcholine before reaching
| organ cells
Acetylcholinesterase:
142
Receptor organ cells of PNS
nicotinic, muscarinic
143
terminal Neurotransmitter of PNS
Acetylcholine
144
Location of PNS
cranio sacral
145
Rest and digest response (NS)
Parasympathetic system
146
location of SNS
thoracolumbar (thoracic and lumbar area)
147
receptor Organs of SNS
alpha and beta receptors
148
Terminal Neurotransmitter of SNS
Norepoinephrine
149
Fight or flight response (NS)
SYMPATHETIC NERVOUS SYSTEM
150
3 types of Termination of the synaptic transmission
(a) Reuptake of into nerve terminal - absorbed back to the
nervous terminal
(b) Enzymatic degradation
(c) Diffusion away from the gap
151
Synaptic Transmission
| 5 processes
(1) Synthesis of your neurotransmitter
○ (2) Storage of transmitter in the vesicles
○ (3) Release neurotransmitter because of the response of the
action potential
○ (4) Action at the receptor
○ (5) Termination of the synaptic transmission
152
Voluntary; Innervates the skeletal muscles
SOMATIC NS
153
Involuntary; Controls and regulates the heart, GI, respiratory system, bladder,
eyes and glands
AUTONOMIC NS/ VISCERAL SYSTEM
154
2 branches of ANS
sympathetic/adrenergic and parasympathetic/cholinergic
155
2 branches of efferent/motor PNS
ANS and SMS
156
2 branches of PNS
afferent/sensory and efferent/motor
157
2 parts of CNS
brain and spinal cord
158
2 Types of Nervous System
CNS and PNS
159
A decrease of 20 mm Hg or more in SBP, a decrease of 10 mm Hg
or more in DBP, and/or
An increase in the HR of 20 beats/minute or more from supine to
standing indicates orthostatic hypotension
160
Conducting an action potential down the axon of the neuron
Axonal Conduction
