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HLTH 2511 > Module D > Flashcards

Module D Flashcards

1
Q

Components of the CNS

A

Brain: performs conscious thought,sensory perception, motor control and emotion

Spinal cord: performs impulses conduction to and from brain

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2
Q

Principles of Neurotransmission

A

-Communication occurs through chemical synapses
-neurotransmitters in CNS interact with one another
- the same neurotransmitter can cause both excitatory and inhibitory effects

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3
Q

Excitatory neurotransmission effects

A

Promote the release of NT from the nerve terminal- increases likelihood that the neuron will fire an action potential

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4
Q

Inhibitory Effect of Neurotransmission

A

Causes hyper polarization preventing the neuron from firing and inhibits the release of NT

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5
Q

What receptors do Fast and Slow NTs act on?

A

Fast NTs (such as GABA) act on ligand gated ion channels

Slow NTs (such as norepinephrine) act on G protein coupled receptors

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6
Q

CNS agents affect CNS processes by:

A
  1. Altering the synthesis, storage or release of NT
  2. Blocking the reuptake of the NT
  3. Inhibiting the degradation of NT
  4. Activating or blocking the receptor
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7
Q

Six main areas of functional processing

A
  1. Cognitive processing
  2. Memory
  3. Emotional processing
  4. Sensory processing
  5. Motor processing
  6. Autonomic processing
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8
Q

Cognitive processing

A
  • involves the cortex, which integrates the sensory information from experiences (memory) and produces thoughts and behaviours (influenced by emotions)
    -delirium is a general term referring to cognitive disorder (such as schizophrenia)
  • is affected by antipsychotics (used for major mental disorders), CNS stimulants (such as amphetamines) and sedative-hypnotics
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9
Q

Memory

A

-Involves various parts of the brain, depending upon the type of memory
- Disorders are called dementia and include Alzheimer’s and Parkinson’s
- is affected by benzodiazepines (BZs) which are a type of sedative-hypnotic drug

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10
Q

Emotional processing

A
  • involves the limbic system
  • disorders include anxiety states, mood disorders and schizophrenia
  • is affected by anxiolytic, anti-depressants and opioids
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11
Q

Sensory processing

A
  • involves neurons, that perceive, external stimuli such as touch small pain and hearing and transmit the information to the brain
  • Involves neuron that determine the level of consciousness
  • Disorders include sleep disorder, chronic pain syndrome, blindness, and deafness
  • Is affected by sedative-hypnotics, anti-depressants, opioids
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12
Q

Motor processing

A
  • involves neurons that allow for body movement
  • Is the main function of the cerebellum
  • disorders include Parkinson’s and degenerative myelinating neuron disorder
  • is affected by antispasmodics, muscle relaxants, and sedative-hypnotics
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13
Q

Autonomic processing

A
  • involves parts of the brain that integrated the feedback from the peripheral nervous system
  • Areas of the brain involved in autonomic processing are the hypothalamus and brainstem
  • disorders of the autonomic processing function include orthostatic hypotension and postural tachycardia syndrome
  • is affected by antidepressants and antipsychotics
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14
Q

Anxiety disorders

A

All functional processing pathways of the brain can be impacted.
- adaptive response of increase preparedness for an event can be debilitating
- The classification of anxiety determines the treatment. Many of the same treatments (antidepressants and sedatives) are used for multiple anxiety disorders.

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15
Q

Sleep and sleep disorders

A

Characterized into five stages
Stage 1-4: non-rapid eye movement
Stage 5: rapid eye movement (REM) which is critical for stable emotional status

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16
Q

Tolerance

A

Occurs due to chronic or long-term use of a drug.
Is a phamodynamic issue where the receptor is down regulate

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17
Q

What are the two types of dependence?

A

Physical dependence: occurs when the reason for the continued use of the drug is to avoid the unpleasant physical withdrawal symptoms. Reason for high relapse rate.

Psychological dependence: continued drug use to receive the pleasurable effects or escape reality. increased dopamine levels promote drug reinforcement

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18
Q

Treatments for sleep disorder and how they are selected

A

The classification of sleep disorders ( such as insomnia, narcolepsy, hypersomnia) determine what treatment is appropriate.

Treatments for sleep disorders include benzodiazepines (BZs) and other sedative-hypnotic agents and antidepressants.

BZs and other hypnotics which cause decrease sleep latency (time needed to fall asleep) and increased sleep duration.
- many of the older sleep disorder, treatments affect their normal sleep pattern (decrease REM) and cause emotional disturbance
- newer sleep agents have less impact on sleep architecture but do not work on all sleep disturbances

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19
Q

Sedative Hypnotic Drugs

A

Anxiolytic effect; calming or relaxing effect so that anxiety is reduced

High doses cause hypnosis or sleep

Hypnotics includr BZs, barbiturates some antihistamines and other secative-hypnotic

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20
Q

Benzodiazepines
- example
-pharmacokinetics
- mechanism of action
- pharmacological effects
- advantages and disadvantages

A

Valium (diazepam) - long acting BZ
Ativan (lorazepam) - oral form medium duration
Versed (midazolam) - IV only and is short acting BZ

Pharmacokinetics: lipid solubility determines the degree of absorption onset is fast administration oral, or IV. Normal doses are sedative - large doses are hypnotic

Mechanism of action: promotes binding to the GABA at it receptor inhibiting uptake of adenosine which inhibits the release of ACh resulting in decreased arousal

Pharmacological effect: anxiolytic, amnesia, hypnosis, skeletal muscle relaxant

Advantages: lack of respiratory and cardiac depression, safe, small doses can relieve anxiety with minimal sedation
Disadvantage: motor incoordination, dizziness, decrease cognitive ability

Antagonists: Anexate (flumazenil) is a competitive BZ receptor antagonist is used to treat BZ overdose and reverse BZ sedation

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21
Q

Barbiturates

A

Recognize by their - TAL ending
Lots of OD and ER

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22
Q

Examples of other sedative- hypnotic drugs

A

Ambien (zolpidem)
Starnoc (zaleplon)
Lunesta (eszopiclone)
Noctec (chloral hydrate): used as an anxiolytic/hypnotic in peds. Mild hypnotic and little resp depressant or CV affects and longer half life than BZ

23
Q

Anaesthesia and the three types

A

Anaesthesia: loss of all sensation

  1. General Anaesthesia: loss of sensation accompanied by a loss of consciousness
  2. Local anesthesia: known as regional anaesthesia provides loss of sensation without loss of consciousness.
  3. Surgical anesthesia: condition in which the perception and the reaction of pain or blocked to surgery can be performed without pain to the patient
24
Q

Local anaesthetic agents
Type
Mechanism of action
Pharmacological effect
Classifications
Adverse effect

A

Block nerve conduction, or transmission and peripheral or spinal nerves to block sensation to particular region of body.

Types: spinal ( c-section, lumbar puncture, pelvic lower limb) epidural (c-section, lumbar puncture pelvic, lower limb), peripheral nerve blocks, topical (oral nasal laryngeal rectal skin), infiltration(ABGa, suturing), iontophoresis (dentistry)

Mechanism of action: bind to sodium ion channels, inhibit depolarization, and the conduction of action potential in the nerve

Pharmacological Effects: work best on nerves that are firing or being affected by their procedure such as pain nerves affected by suturing.

Classification
1. Amides: lidocaine and bupivacaine, prototype of the local anesthetics and are most widely used, administered perineally or tropically, more intense, local, and anaesthetic effect than cocaine, fastest onset of action, often combined with epinephrin to prolong its effect.

  1. Esters: example cocaine short duration of action, addictive system side effects basal construction effects use for bronchoscopy

Adverse effects : CNS stimulation, then inhibition, cardiovascular effects, potential of neuromuscular blockers, allergic reaction

25
Types of general anaesthetics
1. Inhalation agents: generally consist of nitrous oxide and a host of volatile liquid and parent drug of which is halothane 2. Intervenous agents: January used in combination with other drugs.
26
Minimal Alveolar concentration (MAC)
The potency of inhalation anaesthetics as expressed in terms of the inspired concentration of the anaesthetic required to produce anaesthetics in half of the subjects
27
Blood/gas partition coefficient
Measure of the amount of anaesthetics solubility in the blood
28
Factors of achieving surgical anesthesia
1. Solubility of gas - determines the rate and which the anaesthetic molecular dissolve into the blood 2. Alveolar anesthesia partial pressure or concentration - increase concentration of inspired anaesthetic gas results and increased alveoli partial pressure promoting the transfer of gas into blood, therefore increasing rate of induction 3. Pulmonary ventilation - increase ventilation leads to an increase in alveoli, partial pressure and therefore increase arterial partial pressure. 4. Pulmonary blood flow - increase results in exposure of more blood to the anaesthetic therefore arterial partial pressure rises slower
29
Mechanism of action of inhaled anesthesia
Bind to Pacific amino acid residues in the transmembrane portion of the gamma-aminobutyric acid (GABAA) receptor chloride ion channel. Increasing chloride influx and potassium efflux from neurons Causing hyperpolarization of neuronal membranes and reduce membrane excitability also reduces, sodium and calcium influx and prevent nerve firing and the release of neurotransmitters
30
Pharmacological effects of inhaled anaesthetic
Cardiovascular: decrease cardiac output or decrease systemic, vascular resistance and can promote arrhythmia ( except nitrous oxide NO) Respiratory: depress respiratory system to some degree by decreasing tidal volume respiratory response to apnea and hypoxia are depressed by inhalation anaesthetics bronchodilation occurs with some of the halogenated agents but no NO
31
Pharmacokinetics effects of inhaled anaesthetic
Enter through the lungs and exert their effects on the brain via blood exit the body via lungs
32
Difference between the nitrous oxide and halogenated inhaled anaesthetics
Less potent and does not cause loss of consciousness produces more analgesia
33
IV anesthesia Advantage use examples
More useful than inhaled, fast acting, eliminate the need for specialized equipment, fast recovery Pre-anesthetic sedation , induction of anaesthesia, analgesia, intraoperative anesthesia Barbiturates (pentothal - thiopental) Benzodiazepines (midazolam) Opioid analgesic anesthesia (fentanyl) Diprivan (propofol) Amidate (etomidate) ketamar (ketamine)
34
Anti-psychotic drugs Classification adverse effect advantages
Also known as neuroleptics used to treat major psychosis (such as schizophrenia) Two major classifications: typical (halperidol) atypical (clozapine) Adverse effect : Motor abnormalities Muscarinic and alpha 1 adrenergic blockade Advantages : Fewer extrapyramidal side effects (fewer motor abnormalities) greater effects on the negative symptoms of schizophrenia
35
Mood disorder
Depressive characterized by depressed mood, loss of interest or pleasure in life sleep disturbance Bipolar characterized by recurrent fluctuations in mood energy behaviour
36
Antidepressants
Treatment consists of one of the following: 1. Tricyclic antidepressants (TCAs)- lots of side effects and cardiac arrhythmias 2. Selective serotonin reuptake inhibitors (SSRIs) - most commonly used antidepressant because of good effects and fewer side effects than TCAs 3. Selective norepinephrine reuptake inhibitors 4. Monamine oxidase inhibitors (MAOs) - these have serious interactions with other drugs and with food and interiors, overdose side effects of hypertension Used for anxiety disorders, sleep disorders and chronic pain syndrome
37
Mood stabilizer
Used for bipolar disorder Lithium depresses, both manic and depressive symptoms Have a low TI, which can easily result in overdose symptoms of cardiac arrhythmias and neurotoxicity
38
CNS Stimulants
Indirect-acting adrenergics that increase the release of norepinephrine and dopamine Used for attention-deficit/hyperactivity disorders, narcolepsy and obesity All CNS stimulants can have adverse cardiac effects as well as decreases in growth and weight gain in children
39
Pain
5th vital sign Pain can be caused by actual potential tissue damage, and this tissue damage can be caused the stimulus ( temperature or chemicals) or by pathological processes. Treatment or analgesia depends upon intensity and duration and location since the type of pain is carried by different types of neurons.
40
Pain pathway
Primary afferent never fibres that transmit pain information to the dorsal horn of the spinal cord and release the neurotransmitters substance P and glutamate.
41
Ascending vs descending pain pathways
Ascending pain pathways of spinal tract have 2 main anatomical functional pathways 1. Sensory alerts a person to pain. 2. Emotional causes a person to experience that discomfort of pain. Descending and inhibitory pathways are activated and release endogenous met-enkephalins, serotonin and norep, inhibiting the transmission of pain
42
Three major components of the nervous system
1. Peripheral nerves (reception): the peripheral nerve fibres end with nociceptors, which are receptors that detect actual or potential tissue damage. 2. Spinal cord (transmission): fibres that transmit pain message enter the spinal cord in an area, called the dorsal horn. They then released NTs that activate other nerve cells in the spinal cord which process the information and then transmit it to the brain. 3. Brain (perception): thalamus is sorting station of the brain and forward the message to cortex (identified and localizes the pain), the system (associated with the emotions of pain), cortex (assigns meaning to the pain)
43
Opioid
3 endogenous opioid peptides that bind to the opioid receptors and block pain transmission. 1. Enkephalins 2. B-endorphines 3. Dynorphins Morphine is the protype of the opioids and all potencies are compared to it.
44
Use of opioids
- Treatment of moderate to severe pain, either pre or post- op - Inducing and maintaining anaesthesia during surgery - acute pulmonary edema to relieft anxiety, reduced perception of shortness of breath and reduction of preload and afterload - Extreme shortness of breath - nebulized morphine is used in end stage of COPD disease and in terminally ill patients - diarrhea
45
Opioids mechaism of action
Bind to MU, delta and kappa opioid receptors in the brain and spinal cord G-coupled protein receptors Inhibit adenylyl cyclase, decreasing cAMP and therefore decreasing Ca++ conductance resuling in - decreased release of NTs (substance P and glutamate) in the primary afferent nerves -decreasing depolarization of the ascending pathways neurons in spinal cord.
46
Pharmacological Effects of Opioids
CNS: Mu receptor activation, resulting in analgesia, euphoria or dysphoria, respiratory depression and physical and psychological dependence Delta and kappa receptors contributing to analgesia Sedation due to dopaminergic, serotonin and norepinephrine effects Mitosis of the pupil (helps in diagnosis opioid OD Cough supression Physical dependence/tolerance CVS: Vasodilation, partially due to histamine release, which can cause hypotension In pt with angina or coronary artery disease (CAD) morphine will decrease preload & afterload and decrease the work of the heart which is a benefit in this situation RESP: Depression of medullary centres (decreased response yo PaCO2 without any increase in hypoxic drive , which can result in respiratory and metabolic acidosis and cause increased cerebral blood flow Bronchoncontriction due to histamine release Decreased cough reflex OTHER: Constipation and urinary retention Immune suppression
47
Morphine
Used for severe,acute pain ( trauma,MI,cancer) and for chronic pain where it is administered in a long-acting oral form
48
Dilaudid (hydromorphone)
Used after heart surgery. Has fewer paychotic gastrointestinal and cardiovascular effects than morphine
49
Sublimaze (fentanyl)
Very powerful analgesic Benefits include: fast onset of action, less hangover effects and less cardiovascular impact than morphine. A long acting transdermal patch can be used for severe or chronic pain
50
Sufenta (sufentanil)
Same as fentanyl
51
Ultiva (remifentanil)
Same as fentanyl
52
Demerol (meperidine)
Short term treatment of acute pain (obstetric or postsurgical limited gastrointestinal GI problems
53
Oxycontin (oxycodone)
Used for treatment of chronic pain

HLTH 2511 (4 decks)

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