Neuro 2 Flashcards
Common Neurotransmitters
Dopamine
Serotonin
Epinephrine
Noepinephrine
Beta-Blockers
-olol
timolol & betaxolol
Beta-Blocker Action
Used for Glaucoma
-decreases aqueous humor production
-Block B1&B2
-Will decrease pressure in the eye
Alpha2 Agonist
-nidine
brimonidine
Alpha2 Agonist action & side effects
facilitates outflow and decreases production by stimulating alpha receptors
Does not cross the blood-brain barrier
SE: hypotension, drowsiness, and fatigue
Carbonic Anhydrase Inhibitors
-zolamide
dorzolamide
Carbonic Anhydrase Inhibitors characteristics
-decreases aqueous production
-chemically related to sulfa antibiotics
-can be given as a diuretic
Prostaglandin
-prost
Latanoprost & bimatoprost
Prostaglandin Characteristics
-considered just as effective as beta-blockers - have fewer side effects
-facilitates outflow by stimulating prostaglandin F receptors
-SE: eye discoloration and eyelash growth
Cholinergic Agonist
-pilocarpine
Pilocarpine
-used to decrease pressure and used for eye surgeries
-Miosis or constriction of the pupil (pin-point pupils)
-SE: decreased visual acuity
Cholinesterase Inhibitors
-Echothiopate
-inhibit breakdown of acetylcholine
-same ocular effects as pilocarpine
Benzodiazepines
-pam & -lam
-lorazapam, alprazolam, diazepam
-most common meds for anxiety
-highly addictive
Benzo Reversal Agent
Flumazenil
Benzo Characteristics
Non-benzos
-buspirone
-boost serotonin and dopamine
Buspirone characteristics
-does not cause sedation or interact with other CNS stimulants
-cannot take prn - takes 2-4 weeks to onset
-SE: paradoxical anxiety, blurred vision, HA, nausea
-Serotonin Syndrome
-safer than benzos
Buspirone Interactions
CYP3A4
-do not take with grapefruit juice
-no tolerance, dependence, or withdrawal
MAOI (Monoamine Oxidase Inhibiter)
-stops breakdown of monoamines which include 5-HT, Dopamine, and NE
-phenelzine
-selegiline
-used for depression
MAOI side effects
-CNS stimulation
-Orthostatic Hypotension
-Hypertensive crisis from Tyramine
-interacts with NUMEROUS other meds
TCA (Tricyclic Antidepressants)
-work by improving 5-HT and NE availability
-migraines, insomnia, neuropathic pain syndromes
-can be used for bedwetting and OCD
-Amitriptyline
-doxepin
Amitriptyline (TCA)
-avoid using
-no reversal agent
-cardiac toxicity - overdose is lethal
-symptoms worsen with alcohol
-Orthostatic hypotension, drowsiness = take at night
-contraindicated w/ other CNS depressants, MAOI, anticholinergics
-monitor for sucidial ideation
TCA Overdose
-Anticholinergicgic syndrome
-3 ‘Cs’ = coma, convulsions, cardiac conduction abnormalities
-QRS > 0.12 sec is a predictor of toxicity
SSRI (Selective Serotonin Reuptake Inhibitor)
-block reuptake of 5-HT
-fluoxetine, citalopram, escitalopram, paroxetine, sertaline
-used for major depression
-also used for other mental conditions
SSRI Nursing Considerations
SE: sexual dysfunction (drug holidays) and weight gain
-increased risk of suicide with initial treatment
- take in the morning with insomnia
-elevated risk of GI bleed with NSAIDs
-Hyponatremia: syndrome of inappropriate anti-diuretic hormone
-do not take paroxetine with pregnancy
Serotonin Syndrome
-too much serotonin
-can happen 2-73 hours after starting treatment
SE: delirium, anxiety, tachycardia, hyperreflexia, and tremors
-treat symptoms
Discontinuation Syndrome
-Happens after stopping quickly
SE: flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances
SNRI
-blockade of 5-HT, NE, and slightly blocks dopamine reuptake
-venlafaxine, duloxetine
-used for major depression and generalized anxiety disorder
SE: same as SSRI with nausea, HTN, and anorexia
bupropion use
-Atypical depressant
-used to treat depression, smoking addiction, and used as an adjunct to combat sexual side effects of other antidepressants
-can lower seizure threshold
-drug interaction: azole antifungals
SE: appetite suppression
what is Mirtazapine?
-atypical depression
-promotes release of serotonin and norepinephrine in the brain
Mirtazapine therapeutic effects
-used for depression and bipolar disorder
-activates histamine receptor activity (causes sedation) = take at night
-may give to older patients who need to gain weight
-may use for sexual dysfunction
-SE: appetite stimulant
what is trazodone?
-atypical depression
-serotonin antagonist reuptake inhibiter
trazodone therapuetic effects
used for depression or insomnia
-strong sedative and only taken at night
-SE: priapism (prolonged erection)
-minimal anticholinergic effects
Lithium
-mood stabilizer for bipolar disorder
-used for bipolar disorder w/ euphoric mania
-also used with schizophrenia, ETOH, bulimia, and for children with chronic neutropenia
-monitor blood levels (initial range 0.8-1.4) (maintenance range 0.4-1)
Lithium Side Effects
L-leukocytes
I- increased
T- tremors
H - low thyroid
I - increased
U - urination-
M - mothers contraindicated
Lithium Drug Interactions
No Ace in the Hold
-NSAIDs
-Diuretics
-Ace inhibitors
Lithium Education
-consistent diet in water and sodium intake
-report anytime they get sick
-exercise
Typical Antipsychotics
-chlorpromazine, haloperidol
-block NE, ACh, Dopamine, and Histamine receptors
-produce tranquil effect
-used for schizophrenia, manic bipolar, and hiccups (Thorazine)
Typical Antipsychotics implications
-cardiac arrhythmias: prolonged QT
-Anticholinergic effect
-sedation
-weight gain
-hyperprolactinemia - breast growth and discharge, ED in males
-Neuroleptic Malignant Syndrome: high fever, unstable BP, LOC
EPS symptoms
-Akathisia: give benzos
Dystonia: diphenhydramine
-Tardive Dyskinesia: benztropine and diphenhydramine
-Parkinson-like symptoms: changing doses of dopamine
Atypical Antipsychotics
-block dopamine and 5HT
-risperidone, clozapine, olanzapine, quetiapine
-improve symptom control in psychosis
Atypical implications
-weight gain
-metabolic syndrome can lead to more cardiac problems
-EPS symptoms with higher doses
-CNS effect
-Agranulocytosis
