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Pharmacology N322 > Neuro 1 > Flashcards

Neuro 1 Flashcards

1
Q

CNS neurotransmitters

A

Dopamine
Acetylcholine
Serotonin
Norepi

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2
Q

ANS (fight or flight)

Sympathetic

A

Adrenergic

  • Alpha 1,2, Beta 1,2 receptors
  • Neurotransmitters
  • Epi, Norepi

Dopaminergic

  • can’t cross BBB without fat taxi
  • dopamine

locate all throughout body

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3
Q

ANS (rest and digest)

Parasympathetic

A 
Receptors
-Muscarinic and nicotinic
-Located all throughout body.
Neurotransmitter:
Acetycholine
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4
Q

adrenergic agonist

A

Drugs that stimulate and mimic the actions of the sympathetic nervous system.
Primary response: vasoconstriction and CNS stimulation

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5
Q

Alpha/beta-adrenergic receptors

A

Control stimulation and blockade, vasoconstriction and vasodilation of blood vessels, and increased and decreased production of various substances.

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6
Q

Beta-adrenergic agonist

A

Bronchial, GI, and uterine smooth muscle relaxation, glycogenolysis, and cardiac stimulation

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7
Q

Dopaminergic receptor

A

Cause the vessels of the renal, mesenteric, coronary, and cerebral arteries to dilate.

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8
Q

Benzodiazepines MOA

A

Multiple areas of CNS depression in the brain. Increases the action of GABA

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9
Q

Benzo reversal

A

Flumazenil

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10
Q

why do we use Temezapam, midazolam, and (lorazepam, alprazolam)

A

Temezapam-Typically sleep. 30 mins before bed

Lorazepam, alprazolam-anxiety, ptsd, sometimes sleep.

Midazolam-Conscious sedation, has amnesiac effect.

Benzos used for anxiety, sleep disorders, muscle relaxation, ETOH withdrawal, seizures.

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11
Q

Benzo like drugs MOA

A

Bind to benzo receptors and share some of the same properties. Enhance GABA indirectly.
Ben Likes it Fast (don’t last long.)

Less addictive

Zolpidem (ambien)

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12
Q

Benzo like risk

A

Sleep activity, fall risk, amnesia like symptoms.

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13
Q

Barbituates MOA

A

CNS depression.
used for induction of sleep, suppression of seizures, and gen anesthesia.

bind to GABA and enhance inhibitory effects.

Barb likes it slow, long lasting effects

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14
Q

Barbituate reversal agent

A

None

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15
Q

3 types barbs

A

Sodium thiopental (pentothal): Gen Anesthesia

Phenobarbital: seizures or anxiety.

secobarbital: sleep

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16
Q

Barb nursing considerations.

A

• Severe respiratory depression
o Fatal with overdose.
o Will attempt to pump stomach (usually too late)
o Give activated charcoal
Sodium bicarb
o Try to treat symptoms until out of the system

• CV: Hypotension, Tachycardia, Flash Pulmonary edema
o Will flood with fluids for hypotension.
o Flash pulmonary edema—SOB instantly, extremely restless, sats low, crackles (could be audible), will give furosemide (diuretic)

• Risk for abuse/addiction

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17
Q

Centrally activated muscle relaxants

A

most effects are believed to come from sedative type effects and not direct muscle relaxation. Acts in the CNS to enhance GABA

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18
Q

CAMR therapeutic use

A

Muscle spasms

Baclofen- (back)
-back pain/spasms, MS, CP, wheel chair bound)

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19
Q

CAMR nursing implications

A

• CNS Depression:
o Don’t want them to drive, don’t take with alcohol, Safe environment when taking first time (don’t know how it will affect you), if chronic use, have to taper off.
• Muscle Weakness
• Can cause constipation and urinary retention

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20
Q

Peripherally acting muscle relaxant MOA

A

acts directly on skeletal muscles by preventing release of calcium in the skeletal muscle

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21
Q

PAMR drug

A

 dantrolene (Dantrium)
 The initial dose is 2.5 mg/kg, repeated every 5 minutes until reversal of the reaction occurs or a total dose of 10 mg/kg (or 20 mg/kg, according to some practitioners) is reached.

22
Q

PAMR therapeutic use

A
  • Spasticity
  • Treatment of Malignant Hyperthermia or Neuroleptic Malignant Syndrome

NMS—MH but cause is antipsychotic and not general anesthesia.

May be given for acute spinal cord injuries.

23
Q

PAMR nuring considerations

A

• CNS Depression
o Advise of CNS depression effects.
• Can cause fatal liver damage if used long term
• Muscle Weakness
• Administration: IV or oral
• May be used prophylactically for patients w/ hx or family hx of ___MH_

24
Q 
Hydrodantoines functions
(seizures)
A
  1. Increase seizure threshold (nerves less excitable)
  2. Limit the spread (suppress transmission of impulses)
  3. Decrease the speed of transmission.

most through Na channel.

25
Q

Hydrodantoins drug

A

-toin
phenytoin (dilantin) most common
fosphenytoin (cerebyx)

Block Na channel to suppress threshold

26
Q

hydantoins therapeutic use

A

Control tonic-clonic seizures and partial seizures

Not used for absent seizures.

27
Q

hydantoins nursing considerations

A 
o	 CNS affects  (confused)
o	Nystagmus
o	Dysarthria -difficulty articulating, slurred speech
o	Ataxia – drunk walking.
o	Blurred vision.
•	Long term effects: 
o	Gingival hyperplasia (puffy gums)
o	Soft tooth brush and mouth care
o	Acne

• CNS depression: can increase sedative effects, slowed thinking
o Higher risk of suicide
• Pregnancy: Category D–can cause cleft palate, facial and heart malformations
o Seizure meds usually cause birth defects.
Teach about Toxicity, especially loved ones so they can recognize. Low protein level can lower phenytoin levels, increase risk for toxicity.

28
Q

Hydantoins IV infusion

A

Can cause cardiac arrhythmias (bradycardia), hypotension, More with rapid infusion.
Give no more than 50 mg/min
o Filter tubing and incompatible w/ dextrose (can’t hang with lactated ringers)

Tends to be hard on veins, if given for a long time may want to insert central line. Can infiltrate (eats surrounding tissue)
o Also give PO

29
Q

hydantoins skin complication

A

o DRESS (drug rash with eosinophilic and systemic symptoms):
Look at CBC, eosinophils will be high, Allergic rxn.
Fever, rash, eventually organ failure.
o Stevens Johnson Syndrome (and the worse Toxic epidermal necrolysis):
o Higher risks for Asian population
o Looks like chemical burns, happen internally and externally
o Difficult to treat, high risk of infection.

If there is a rash, you should be worried.

30
Q

iminostilbenes drug

A

-zepine

Carbamazepine (tegetrol)
ess effect on cognitive function – that is why it is often chosen over Dilantin
 Can still have symptoms similar to “toxic” effects of Dilantin if dose increased too early

31
Q

iminostilbenes therapeutic use

A
  • Partial seizures, Tonic-Clonic Seizures, Bipolar disorder, Trigeminal Neuralgia
  • Do not use in patients w/ Absent or Myoclonic seizure as it can worsen them
32
Q

iminostilbenes Nursing complications

A

• Bone Marrow Suppression: Labs, pancytopenia*
• Side effects SE: same as phenytoin , birth defects
• CNS symptoms decrease with time. Monitor w/ dose adjustments
• Not recommended for patient w/ heart failure d/t concern for water retention (effects ADH) Hyponatremia, causes water retention*
• Many drug interactions including grapefruit juice (p450 inhibitor)
o P450 enzymes—break down foreign molecules, medications
i. Some drugs induce p450 enzyme (breaks down more, faster rate) will need more drug.
ii. Iminostilbenes are p450 inducers, fight with grapefruit juice (inhibitor)
iii. Also have p450 inhibitor

33
Q

Valproic Acid nursing implications

A

Gi issues, LIVER TOXCITY (Fatal!), elevated ammonia levels causing confusion, pancreatitis, gets itchy rash, jaundice
o Monitor AST and ALT, look for jaundice, itchy rash
o Monitor amylase and lipase
o With food, minimizes the GI issues.
Teratogenic-4 x more likely to cause congenital defects

34
Q

 levetiracetam (Keppra) use

A

wide use of various seizure disorders with minimal interactions or side effects. Some include CNS. Considered safer in pregnancy. Besides Depakote, probably the #1 prescribed medication. No IV form.

35
Q

what happens if lidocaine is absorbed systemically?

A

If absorbed systemically: CV effects include: __bradycardia, hypotension, death__; CNS effects include: initial excitation (tremors, restlessness) and eventual depression leading to respiratory depression/arrest, increased risk of seizures.
o Use epinephrine to prevents systemic absorption., usually won’t go systemic unless injected into vein or using a lot. Confusion is also side effect.
o Encourage patient to report symptoms.

36
Q

Fentanyl Use

A

 Conscious sedation
adjunct to general anesthesia
 may be given in conjunction with benzo for moderate sedation
 SE: severe respiratory depression; hypotension, sedation
 Antidote: __Naloxone__

37
Q

amphetamines side effects

A

Euphoria:
o Need to wean, can cause depression w/ sudden stop
o High doses can cause psychosis or even seizures
• Insomnia, nervousness: should be taken in the morning, not after 4 pm
• Dry mouth: good oral care, higher risk of cavities
• Weight loss:
• CV effects: tachycardia, HTN, RR: BP goes up.

• Do Not take w/ MAOI

38
Q

methylphenidate (ritalin) uses

A

 Same indications, effects, and nursing implications as amphetamines
 Effects slightly milder then Adderall
 Sometimes used for adults to improve energy (cancer patients)

39
Q

Dopamine replacement drugs MOA

A

Reduces symptoms by increasing dopamine production

40
Q

Levodopa/carbidopa (sinemet)

A

Most favorable
 Levodopa—L, lipid soluble form of dopamine to cross BBB
 Carbidopa—helps stop breakdown of dopamine
o This is why given together, levodopa takes a long time to cross BBB
 Don’t want them on high protein diet, compete with same receptor, can cause toxicity.

41
Q

Levodopa/carbidopa Therapeutic use

A

• Used to slow the progression of the symptoms, not the disease, nothing to stop parkinson’s.

42
Q

Levodopa/carbidopa Nursing implications

A
  • GI upset: Nauseous., take with food, if can tolerate better absorbed on empty stomach
  • BP: Tendency for orthostatic HTN
  • Palpitations: feel like heart is racing. (also give in cardiac patients to increase BP) Get a baseline EKG as a baseline before giving. Want to make sure they don’t have cardiac issues.
  • Cyclic dosing effect: Usually last about 4 hours, have to take it several times, take it during the day. Don’t care about bradykinesia during the night unless it is endstage. Can be taken up to 10 times a day.

o Will be doing great and then plummet, people tend to know what will occur for them. There are some extended release—don’t usually start with this because we don’t know how they will react.

  • Movement disorders: Teaching: will have lots of spasms. Can give amantadine-less movement disorders.
  • Psychosis: High levels of dopamine can cause schizophrenia, so it can also cause psychosis. When dopamine levels raise, can increase addictive behaviors.
43
Q

selegiline (Eldepryl or Zelapar ODT) MAOI

Therapeutic use

A
  • Some MAOI’s are nonselective and can be used for Depression type symptoms
  • With Parkinson’s it is considered a first line treatment. Can be used as monotherapy, but is often used as an adjunct with levodopa therapy
44
Q

selegiline (Eldepryl or Zelapar ODT) MAOI

Nursing implications

A

• MAOI’s in general have a possible interaction with Tyramine products. “Cheese Effect”:
o Can cause hypertensive crisis.
o Tyramine regulates BP
o Wine, beer, processed meats, cheese, yogurt.

  • Do not give w/ meperidine (Demerol)—causes rigidity
  • Can cause insomnia
  • Hypotension: if given w/ HTN meds, diuretics, anesthetics
45
Q

 Selegiline (Eldepryl or Zelapar ODT)

MOA

A

Prevent the metabolic breakdown of catecholamines such as dopamine, norepinephrine, and epinephrine. Drugs used for Parkinson’s are MAO-B selective

46
Q

Dopamine modulatore MOA

Amantadine (symmetrel)

A

appears to work by causing the release of dopamine and other catecholamines from their storage sites in the presynaptic fibers of nerve cells within the basal ganglia that have not yet been destroyed by the disease process

47
Q

Dopamine modulatore MOA
Amantadine (symmetrel)
Therapeutic use

A

• Used in first 6-18 months of dx when there are still some intact neurons ***
o 80% of dopamine must be depleted before symptoms of Parkinson’s are noticed.
• Given in conjunction w/ Carbidopa/Levodopa for dyskinesias

48
Q

Anti-cholinergic
benadryl, benztropine

Side effects

A

a. Hot as a hare
b. Dry as a bone
c. Blind as a bat
d. Red as a beet
e. Mad as a hatter
f. Can’t pee, can’t see, can’t spit, Can’t shit
• Tachycardia

49
Q

Cholinergic Side Effects

A 
SLUDGEMM
o	 Salivation
o	Lacrimation
o	Urination
o	Defecation
o	GI upset/cramps
o	Emesis
o	Muscle twitching
o	Pupils (pinpoint)

bronchospasms–don’t give to COPD

50
Q

Meds to avoid with cholinergics

A

NSAIDS

51
Q

Take with or without food?

A

With food, causes nausea

52
Q

Cholinergic drug

A

Donepezil

donny has alzheimers

Pharmacology N322 (11 decks)

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