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Nervous System Flashcards

0
Q

muscarinic antagonists

A

atropine

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1
Q

muscarinic agonists (parasympathomimetic)

A

bethanechol

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2
Q

ganglionic-stimulating agents

A

nicotine

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3
Q

cholinesterase inhibitors (ChE)

A

physostigmine, neostigmine

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4
Q

neuromuscular-blocking agents

A

tubocurarine

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5
Q

adrenergic agonists (sympathomimetic)

A

epinephrine (adrenaline)

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6
Q

adrenergic antagonists (block alpha and beta receptors)

A

prazosin (alpha adrenergic antagonist), propanolol (beta adrenergic antagonist)

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7
Q

nicotine receptors

A

release of epinephrine from adrenal medulla; located at neuromuscular junction of skeletal muscle; causes skeletal muscle contraction

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8
Q

muscarinic receptors

A

decreased secretions from lungs, stomach, intestines, sweat glands; decrease in HR; smooth muscle contraction in bronchi and GI tract; miosis (sphincter contraction) and accommodation (ciliary contraction); voiding due to contraction of detrusor muscle and relaxation of trigone and sphincter muscles

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9
Q

alpha 1 receptors

A

mydriasis d/t radial muscle contraction; veins and arterioles are activated to constrict; decreased peripheral resistance and increased blood pressure; male sex organs are activated to promote ejaculation; contraction of prostatic capsule, trigone, and sphincter muscles

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10
Q

dopamine receptors

A

dilates blood vessels in the kidneys

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11
Q

beta 1 receptors

A

predominant receptor found on the heart; decreased HR, increased contraction force, and increased conduction through AV node; increased lipolysis; release of renin by the kidneys

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12
Q

beta 2 receptors

A

dilates bronchi; relaxes uterine smooth muscle; vasodilation of arterioles in heart, lungs, and skeletal muscle; slightly decreased peripheral resistance; increased glycogenolysis in the liver and muscles; skeletal muscle contraction

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13
Q

medications affecting the nervous system: general points

A

adaptive changes within brain with prolonged exposure; increased therapeutic effect; decreased side effects; tolerance and physical dependence; do not stop abruptly

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14
Q

Parkinson’s disease

A

treatment uses two main classes: medications that activate dopamine receptors (directly or indirectly) and medications that block acetylcholine receptors

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15
Q

seizure disorders

A

different types of seizures respond to different medications; usually require life-long management; medications must be discontinued slowly over 6 weeks to several months

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16
Q

schizophrenia

A

clinical course includes semi-remission punctuated by acute exacerbations; positive symptoms (agitation, delusions) medications: conventional antipsychotic [thorazine], atypical antipsychotic [clozapine]; negative symptoms (social withdrawal, poor self-care) medications: atypical antipsychotic [clozapine]; cognitive symptoms (difficulties with memory and learning); initial doses are high and given throughout the day; Maintenon doses given at bedtime

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17
Q

depression

A

symptom relief can take 1 to 3 weeks and possibly 2 to 3 months; three main groups: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs)

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18
Q

bipolar disorder

A

typically managed with mood stabilisers; antipsychotics and antidepressants may be used during acute episodes of mania or depression; lithium, valproic acid [Depakote], and carbamazepine [Tegretol]

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19
Q

cholinesterase inhibitors: expected action

A

prevents ACh degradation; increased transmission of nerve impulses by increased ACh

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20
Q

cholinesterase inhibitors: therapeutic uses

A

increased muscle strength by increasing ACh at neuromuscular junction in myasthenia gravis; reversal of nondepolarising neuromuscular blocking agents (tubocurarine)

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21
Q

cholinesterase inhibitors: adverse effects

A

excessive muscarinic stimulation; increased GI motility and secretions, bradycardia, and urinary urgency (side effect can be treated with atropine); cholinergic crisis: above plus respiratory depression from neuromuscular blockade

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22
Q

cholinesterase inhibitors: contraindications and precautions

A

pregnancy C; CI in obstruction of GI and GU systems; caution with seizures, asthma, bradycardia, hypotension, and peptic ulcer disease

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23
Q

cholinesterase inhibitors: interactions

A

tubocurarine: neostigmine reverse blockade; atropine: counteracts; succinylcholine: increased neuromuscular blockade

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24
cholinesterase inhibitors: education
wear medic-alert bracelet
25
cholinesterase inhibitors: prototypes
neostigmine, physostigmine
26
neuromuscular blocking agents: expected action
block ACh at neuromuscular junction (doesn't cross blood-brain barrier)
27
neuromuscular blocking agents: prototypes
nondepolarising: tubocurarine, pancuronium; depolarising: succinylcholine
28
neuromuscular blocking agents: therapeutic uses
control spontaneous respiration in ventilated patients; adjuncts to general anaesthesia; diagnose myasthenia gravis; succinylcholine for: electroconvulsive therapy (ECT), intubation, and endoscopy
29
neuromuscular blocking agents: adverse effects
hypotension from histamine release and ganglionic blockade; respiratory arrest; bradycardia and dysrhythmias; succinylcholine: low pseudocholinesterase activity causing apnea, malignant hyperthermia (dantrolene), pain, and hyperkalaemia
30
neuromuscular blocking agents: contraindications
pregnancy C; SCh: CI for hyperkalaemia (trauma, burns)
31
neuromuscular blocking agents: interactions
general anaesthetics; aminoglycosides and tetracyclines causing increased NM blockade; neostigmine and ChE inhibitors causing decreased nondepolarising and increased alpha depolarising
32
dopaminergics (anti-Parkinson's): expected action
levodopa taken up and converted to dopamine; carbidopa augments levodopa by preventing conversion to dopamine in intestine and periphery (increased DA in CNS)
33
dopaminergics (anti-Parkinson's): prototypes
levodopa, carbidopa, sinemet
34
dopaminergics (anti-Parkinson's): therapeutic uses
symptomatic relief from dyskinesias
35
dopaminergics (anti-Parkinson's): adverse effects
dyskinesias; discolouration of sweat and urine; nausea and drowsiness; orthostatic hypotension; psychosis (clozapine); activation of malignant melanoma
36
dopaminergics (anti-Parkinson's): contraindications and precautions
cardiac and psychiatric disorders; CI melanoma; 2 weeks from MAOI; pregnancy C
37
dopaminergics (anti-Parkinson's): interactions
proteins interfere with absorption and transport; conventional antipsychotics (haldol, compazine) decreased alpha; pyridoxine decrease alpha; MAOI cause hypertension; carbidopa, dopamine agonists, anticholinergics, COMT inhibitors and dopamine tea leaders increase therapeutic effects
38
COMT (catechol O-methyltransferase)
catechol O-methyltransferase; deactivates catecholamines (e.g. dopamine, norepinephrine, acetylcholine, epinephrine, serotonin, histamine, etc); found in post-synaptic cell membranes of adrenergic neurons where it degrades norepinephrine; also found in the gut
39
dopamine agonists (antiparkinson's): expected action
act directly on dopamine receptors
40
dopamine agonists (antiparkinson's): prototype
pramipexole, ropinirole, bromocriptine
41
dopamine agonists (antiparkinson's): therapeutic uses
monotherapy early; combined with levodopa in later stages
42
dopamine agonists (antiparkinson's): adverse effects
orthostatic hypotension; psychosis; sleep attacks; daytime sleepiness; dyskinesias; nausea
43
dopamine agonists (antiparkinson's): contraindications and precautions
pregnancy C; caution with liver and kidney impairment
44
dopamine agonists (antiparkinson's): interactions
levodopa can decrease motor-control fluctuations permitting lower dose; levodopa can also increases risk of orthostatic hypotension and dyskinesias
45
centrally acting anticholinergics (antiparkinson's): expected action
block ACh at muscarinic receptors which helps maintain ACh and dopamine balance
46
centrally acting anticholinergics (antiparkinson's): prototype
benztropine [Cogentin], trihexyphenidyl [Artane]
47
centrally acting anticholinergics (antiparkinson's): adverse effects
nausea (take with food); atropine-like effects (e.g. dry mouth, blurred vision, mydriasis, constipation); antihistamine effects (e.g. sedation, drowsiness)
48
centrally acting anticholinergics (antiparkinson's): contraindications and precautions
CI in narrow-angle glaucoma
49
antiviral (antiparkinson's): expected action
stimulate dopamine release; prevent dopamine reuptake; may block cholinergic and glutamate receptors
50
antiviral (antiparkinson's): prototype
amantadine
51
antiviral (antiparkinson's): therapeutic uses
Parkinson's disease
52
antiviral (antiparkinson's): adverse effects
CNS effects; discolouration of skin (temporary); atropine-like effects
53
antiepileptic medications: barbiturates
phenobarbital [Luminal]
54
antiepileptic medications: hydantoins
phenytoin [Dilantin]
55
antiepileptic medications: benzodiazepines
diazepam [Valium], lorazepam [Ativan], carbamazepine [Tegretol], ethosuximide [Zarontin], valproic acid [Depakote], gabapentin [Neurontin]
56
antiepileptic medications: other medications
lamotrigine [Lamictal], oxcarbazepine [Trileptal], clozanepam [Klonopin]
57
antiepileptic medications: mechanisms
slow ca2+ and na+ reentry to neuron; potentiating inhibitory effect of GABA; suppress neuron firing
58
barbiturate (antiepileptic): therapeutic uses
partial seizures and generalised tonic-clonic seizures; not effective against absence seizures
59
barbiturate (antiepileptic): prototype
phenobarbital [Luminal]
60
barbiturate (antiepileptic): adverse effects
CNS effects (e.g. adults as sedation and anxiety, kids as irritability and hyperactivity); toxicity: nystagmus, ataxia, respiratory depression, pinpoint pupils
61
barbiturate (antiepileptic): contraindications and precautions
pregnancy D; CI with intermittent porphyria
62
hydantoins (antiepileptic): therapeutic uses
effective against all major forms except absence seizures
63
hydantoins (antiepileptic): prototype
phenytoin [Dilantin]
64
hydantoins (antiepileptic): adverse effects
CNS effects; skin rash; teratogenic; gingival hyperplasia; cardiovascular;endocrine effects; vitamin D metabolism
65
hydantoins (antiepileptic): contraindications and precautions
CI: sinus bradycardia, SA blocks, second and third degree AV blocks
66
hydantoins (antiepileptic): interactions
oral contraceptives; warfarin; glucocorticoids, decrease alpha of these; EtOH, diazepam, cimetidine, valproic acid: increase phenytoin levels; carbamazepine, phenobarbital, chronic EtOH: decrease phenytoin levels; CNS depressants (e.g. barbiturates, EtOH): additive effects with concurrent use
67
hydantoins (antiepileptic): education
use IV route for status epilepticus; antidysrhythmics
68
carbamazepine (antiepileptic): therapeutic uses
partial seizures; tonic-clonic seizures; bipolar disorder; trigeminal neuralgia
69
carbamazepine (antiepileptic): prototype
tegretol
70
carbamazepine (antiepileptic): adverse effects
skin disorders; cognitive function is minimally affected but CNS effects can occur; blood dyscrasias; teratogenic; hypoosmolarity (increased ADH secretion)
71
carbamazepine (antiepileptic): contraindications and precautions
CI: marrow suppression, bleeding disorders
72
carbamazepine (antiepileptic): interactions
grapefruit juice (inhibits metabolism and increases carbamazepine); phenytoin and phenobarbital: decrease carbamazepine; oral contraceptives and warfarin: carbamazepine stimulates hepatic enzymes which decrease levels of these medications
73
ethosuximide (antiepileptic): therapeutic uses
indicated only for absence seizures
74
ethosuximide (antiepileptic): prototype
zarontin
75
ethosuximide (antiepileptic): adverse effects
GI effects (take with food); CNS effects (fatigue, dizziness)
76
valproic acid (antiepileptic): therapeutic uses
partial, generalised, and absence seizures; bipolar disorder; migraines
77
valproic acid (antiepileptic): prototype
depakote
78
valproic acid (antiepileptic): adverse effects
GI effects (take with food); hepatotoxicity; thrombocytopenia; pancreatitis as evidenced by nausea, vomiting, and abdominal pain
79
valproic acid (antiepileptic): contraindications and precautions
avoid children younger than 3 (hepatotoxicity); liver disorders
80
valproic acid (antiepileptic): interactions
phenytoin and phenobarbital: concurrent use increases these medications
81
gabapentin (antiepileptic): therapeutic uses
single agent used for partial seizures; neuropathic pain; prevents migraines
82
gabapentin (antiepileptic): prototype
neurontin
83
gabapentin (antiepileptic): adverse effects
CNS effects (drowsiness, nystagmus)
84
benzodiazepines (antiepileptic): therapeutic uses
status epilepticus
85
benzodiazepines (antiepileptic): prototype
diazepam [Valium]
86
benzodiazepines (antiepileptic): adverse effects
respiratory depression; anterograde amnesia; teratogenic
87
muscle relaxants and antispasmodics: centrally acting muscle relaxants
diazepam [Valium], baclofen [Lioresal], cyclobenzaprine [Flexeril], metaxalone [Skelaxin]
88
muscle relaxants and antispasmodics: peripherally acting muscle relaxants
dantrolene [Dantrium]
89
diazepam (muscle relaxant and antispasmodic): expected action
acts in CNS to enhance GABA and produce sedation; acts in CNS to depress spasticity of muscles
90
diazepam (muscle relaxant and antispasmodic): prototype
diazepam [Valium]
91
diazepam (muscle relaxant and antispasmodic): therapeutic uses
relief of spasticity related to cerebral palsy and/or MS; anxiety and panic disorders; EtOH withdrawal; insomnia; status epilepticus; anaesthesia induction; relief of spasm related to injury
92
diazepam (muscle relaxant and antispasmodic): adverse effects
CNS depression; physical dependence from long-term use
93
diazepam (muscle relaxant and antispasmodic): interactions
CNS depressants (EtOH, opioids, antihistamines, barbiturates): addictive CNS depressive effect an with concurrent use
94
diazepam (muscle relaxant and antispasmodic): contraindications and precautions
pregnancy D; caution with impaired liver or renal function
95
centrally acting (muscle relaxant and antispasmodic): expected action
acts in CNS to depress spasticity of muscles
96
centrally acting (muscle relaxant and antispasmodic): prototype
baclofen, cyclobenzaprine, metaxalone
97
centrally acting (muscle relaxant and antispasmodic): therapeutic uses
relief of muscle spasm related to injury; relief of spasticity related to cerebral palsy or multiple sclerosis
98
centrally acting (muscle relaxant and antispasmodic): adverse effects
CNS depression; physical dependence from long-term use; metaxalone: hepatotoxicity; baclofen: nausea, urinary retention, constipation
99
centrally acting (muscle relaxant and antispasmodic): contraindications and precautions
caution in patients with impaired liver or renal function; baclofen: pregnancy C
100
centrally acting (muscle relaxant and antispasmodic): interactions
CNS depressants (EtOH, opioids, antihistamines): additive CNS depressants effects with concurrent use
101
cue (muscle relaxant and antispasmodic):
response
102
peripherally acting (muscle relaxant and antispasmodic): expected action
only peripherally acting muscle relaxant; inhibits muscle contraction by preventing release of calcium in skeletal muscles
103
peripherally acting (muscle relaxant and antispasmodic): prototype
dantrolene [Dantrium]
104
peripherally acting (muscle relaxant and antispasmodic): therapeutic uses
relief of spasticity related to cerebral palsy or multiple sclerosis; treatment of malignant hyperthermia
105
peripherally acting (muscle relaxant and antispasmodic): adverse effects
CNS depression; hepatic toxicity
106
local anaesthetics: expected action
decreases pain by blocking local conduction of pain impulses
107
local anaesthetics: amide type
lidocaine
108
local anaesthetics: ester type
tetracaine, procaine
109
local anaesthetics: adverse effects
CNS excitation: treat with midazolam [Versed] or diazepam; hypotension; bradycardia; heart block; cardiac arrest; allergic reactions (more likely with esters); decreased uterine contractibility; spinal headache (lay flat for 12 hours); freely cross placenta; urinary retention (call after 8 hours)
110
local anaesthetics: contraindications and precautions
CI in dysrhythmias and/or heart block; caution with liver and kidney dysfunction, heart failure and myasthenia gravis
111
general inhalation anaesthetics: expected action
loss of consciousness; loss of sensation; relaxation of muscles; amnesia
112
general inhalation anaesthetics: prototype
halothane [Fluothane], isoflurane [Forane], nitrous oxide
113
general inhalation anaesthetics: adverse effects
hepatotoxicity; gastric aspiration; hypotension; malignant hyperthermia (treatment: medications, ice or saline infusion, and dantrolene); respiratory and cardiovascular depression
114
general inhalation anaesthetics: interactions
CNS depressants: additive effect; opioids: constipation and urinary retention
115
general inhalation anaesthetics: education
succinylcholine: used as a muscle relaxant; encourage early ambulation; assist with lung expansion
116
peripherally acting (muscle relaxant and antispasmodic): contraindications and precautions
pregnancy C; caution with impaired liver and renal function
117
peripherally acting (muscle relaxant and antispasmodic): interactions
CNS depression: additive effects
118
intravenous anaesthetics (key points): medications
barbiturates: thiopental [Pentothal]; ketamine [Ketalar]; benzodiazepines: diazepam [Valium], midazolam [Versed], lorazepam [Ativan]; propofol [Diprivan]
119
intravenous anaesthetics (key points): therapeutic uses
adjunct to inhalation anaesthesia; induction and maintenance of anaesthesia; amnesia; midazolam and an opioid result in conscious sedation; ketamine can be used with children
120
intravenous anaesthetics: adverse effects
respiratory and cardiovascular depression: propofol: bacterial infection (use opened vial with 6 hours); ketamine: psychologic reaction (premedicate with diazepam to decrease risk)
121
intravenous anaesthetics: contraindications and precautions
ketamine should be avoided with psychiatric disorders
122
intravenous anaesthetics: interactions
CNS depressants and stimulants: additive effects: opioid analgesics: constipation and urinary retention
123
intravenous anaesthetics: education
midazolam [Versed]: inject over more than 2 minutes; propofol [Diprivan]: inject into large vein and prep site with lidocaine
124
antipsychotics (conventional): expected action
dopamine, acetylcholine, histamine, and norepinephrine receptors in brain and periphery are blocked; symptom inhibition related to dopamine blockade in brain
125
antipsychotics (conventional): prototype
⬇️ n: chlorpromazine [Thorazine], ⬆️ n: haloperidol [Haldol]; others: fluphenazine, molindone, perphenazine, thiothixene
126
antipsychotics (conventional): therapeutic uses
tourette's syndrome; delusional disorder; bipolar disorder; dementia; schizophrenia; schizoaffective disorder; Huntington's chorea
127
antipsychotics (conventional): adverse effects
agranulocytosis; sedation; photosensitivity; anticholinergic effects; orthohypotension; neurone doctrine effects; seizures; parkinsonism; sexual dysfunction; dysrhythmias; dystonia; akathisia; tardive dyskinesia; neuroleptic malignant syndrome
128
antipsychotics (conventional): interactions
anticholinergics: increase n; CNS depressants: additive effects; levodopa: counteracts antipsychotics by stimulating dopamine receptors
129
antipsychotics (conventional): education
consider depot preparations; protect liquid prep from the sun; early EPS symptoms with anticholinergics, beta blockers, and benzodiazepines

Pharmacology Exam - Flashcards (2 decks)

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