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Neuro Meds Flashcards

1
Q

benzotropine class

A

anticholinergic

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2
Q

purpose of benzotropine

A

oppose effects of Ach at receptor dits

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3
Q

Why would you give a patient benzotropine?

A
  1. To treat parkinsonism
  2. No longer respond to levedopa
  3. Reverse/Relieve EPS
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4
Q

What are the adverse effects of benzotropine?

A
  1. CNS effects (disorient,
    , memory loss, agitated
  2. Anticholinergic effects( dry mouth, GI upset, blurred vision, urinary retention)
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5
Q

What should the nurse do after administering benzotropine?

A
  1. Monitor HR and BP
  2. Assess for constipation & urinary retention
  3. Monitor renal & liver fx tests
  4. Watch for CNS effects
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6
Q

What education should a nurse provide to a patient receiving benzotropine?

A
  1. Avoid heat (decreased sweating –> body overheats)
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7
Q

Why cant levodopa be given alone?

A

Levodopa converts to dopamine before crossing blood brain barrier

Dopamine cannot cross BBB

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8
Q

What class is levodopa/carbidopa in?

A

dopaminergics

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9
Q

Purpose of dopaminergics

A
  1. Promote dopamine synthesis/receptor activation/prevent dopamine breakdown
  2. Relieves dyskinesias symptoms
  3. increase ADL performance
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10
Q

Why would you give a patient levodopa/carbidopa?

A

to treat Parkinson’s disease

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11
Q

Can levodopa/carbidopa be given as a long term treatment for Parkinson’s?

A

No. Effects wear off after 5 years of treatment

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12
Q

What manifestations may a patient display if taking levodopa/carbidopa?

A
  1. Dyskinesias
  2. Orthostatic hypotension
  3. Tachycardia, Plapation
  4. Orange pee & urine
  5. Psychosis
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13
Q

What should the nurse inform the patient about levodopa/carbidopa?

A
  1. Avoid High protein foods.
  2. Avoid foods high in VitB6
  3. May take weeks for the drug to take effect
  4. Do not take with MAOIs or Haldol
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14
Q

After a nurse administers levodopa/carbidopa, what should she do?

A
  1. Monitor BP
  2. Monitor ECG
  3. Administer 2nd generation antipsychoticfor psychosis
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15
Q

Why must you use 2nd generation antipsychotics instead of 1st generation with levodopa/carvedopa?

A

1st generation blocks dopamine receptors

Block dopamine receptors prevents therapeutic use of drug

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16
Q

What drug class is atropine in?

A

Anticholinergic Agents

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17
Q

What is the purpose of anticholinergic agents?

A

Block Ach receptors and PSNS

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18
Q

Why would a nurse administer atropine to a patient?

A
  1. Treat Parkinson’s symptoms
  2. Restore HR & BP
  3. Relieve N/V
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19
Q

What should the nurse inform the patient about atropine?

A
  1. Avoid OTC meds that stimulate cardiac system (ie. cough/cold meds)
  2. Stay hydrated
  3. Avoid heat exposure
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20
Q

What should the nurse do after administering atropine?

A
  1. Observe for CNS effects
  2. Monitor VS and cardiac status
  3. Assess abdomen
  4. Assess bowel and bladder patterns
  5. Monitor renal fx
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21
Q

What drug class is bethanecol in?

A

Direct acting cholinergic agonist

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22
Q

Why would a nurse administer bethanechol?

A

to treat non-obstructive urinary retention

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23
Q

If a patient is taking bethanechol, what side effects should the nurse expect?

A 
PSNS stimulation symptoms:
sweating
tearing
urinary urgency
bradychardia
hypotension
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24
Q

What patients should not receive bethanecol?

A
  1. Patients with urinary obstruction
  2. Patients with PUD
  3. Patients with Asthma or COPD
  4. Patients with hyperthyroidism
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25
How will the nurse know if bethanechol has been effective?
If the patient is peeing
26
What should the nurse know about administering bethanecol?
Give 1-2 hours before or after meals
27
SNS Neurotransmitters
Epinephrine and Norepinephrine
28
PSNS Neurotransmitter
Acetylcholine
29
What is the action of Alpha 1 receptors when activated?
Vasoconstriction
30
What is the action of Alpha 2 receptors when activated?
1. Vasodilation | 2. Insulin release
31
What is the action of Beta 1 receptors when activated?
1. Increased HR 2. Conduction 3. Contraction
32
What is the action of Beta 2 receptors when activated?
1. Vasodilation | 2. Bronchodilation
33
What is the action of muscarinic receptors when activated?
stimulates visceral organs
34
What is the action of nicotinic receptors when activated?
SkM contractions
35
What is the function of Muscarinic Agonist & Antagonist?
1. stimulate/prevent bladder contraction | 2. treat urinary frequency/retention
36
What is the function of Direct Cholinergic Agonist?
to act directly on cholinergic receptors to stimulate the PSNS
37
What is the function of Indirect Cholinergic Agonist?
to inhibit aceytlcholine esterase No AchEsterase, Ach can bind to sites
38
What is the function of Anticholinergic Agents?
block muscarinic receptor sites | mimic SNS symptoms
39
PSNS neurotransmitters
acetocholyine
40
SNS neurotransmitters
Norepinephrine/Epinephrine
41
CNS neurotransmitters
1. Dopamine 2. Gamma-aminobutryic acid 3. Serotonin
42
What drug class is lorazepam and diazepam in?
Benzodiazepienes
43
A patient is in the ER. He has is currently addicted to alcohol . What medication does the nurse anticipate giving for alcohol withdrawal?
Chlordiazepoxide
44
When would you administer lorazepam/diazepam?
A patient has 1. Anxiety Disorder 2. Panic disorder 3. Seizure disorders 4. Insomnia 5. Muscle Spasm 6. Before surgery
45
What should the nurse inform the patient about lorazepam/diazepam?
1. Do not abruptly stop talking 2. Take with food 3. Avoid alcohol or other CNS depressants
46
What should the nurse be aware of when administering lorzepam or diazepam?
1. Signs of toxicity | 2. Signs of CNS depression/respiratory suppression
47
If a patient is experiencing benzodiazepine toxicity, what medication should the nurse administer as an antidote?
Flumazenil
48
Why should benzodiazepine be avoided in patients with sleep apnea/respiratory depression/ glaucoma?
Benzos can worsen theses complications
49
Can benzodiazipnes be given long term?
No. They can only be used short term for dependence
50
What drug class is phenobarbital in?
Barbituates
51
What Is the purpose of barbiturates?
inhibit neuronal impulse and depress motor output
52
To reduce anxiety, what should the nurse administer?
Low dose phenobarbital
53
To induce anesthesia, sedation, and treatment of seizures, what should the nurse administer?
High dose of phenobarbital
54
When administering phenobarbitals, what should the nurse monitor for:
1. Respiratory & CNS depression 2. Signs of overdose 3. Impaired mobility 4. Oversedation and confusion 5. Stevens-Johnson syndrome (Redness/inflammation/allergic rxn)
55
How do non-barbituarates act in the CNS?
binds to serotonin & dopamine receptors to reduce anxiety but not completely sedative/anticonvulsant/muscle-relaxant
56
What drug class is buspirone in?
Non-barbiturates
57
If a client is being administered buspirone, what disorders are they expected to have?
1. Panic Disorder 2. Anxiety Disorder 3. OCD 4. PTSD
58
What education should the nurse provide when administering buspirone?
1. Avoid St. John's wort 2. Take with food 3. No grapefruit juice 4. Drug takes 1-3 weeks to become in effect
59
Can tolerance/dependence/withdrawl effects occur with non barbituates?
Yes, but rarely occurs
60
Why shouldn't MAOIs be administered with buspirone?
it increases risk for hypertensive crisis
61
What drug is not recommended for patients that are breastfeeding?
Buspirone
62
For short term insomnia, what drugs should be administered?
Zolpidemmor Diphenhydramine
63
To decrease need for narcotics before/after surgery, what drug is administered?
Hydroxyzine
64
When administering antidepressants, what should the nurse be sure to educate the patient about?
Takes 2-4 weeks for drug to be effective | During this time, suicide is high risk, so monitor closely
65
How do SSRIs work?
Block serotonin reuptake thus increasing serotonin effects
66
What are the prototypes for SSRIs?
escitalopram | sertraline
67
What are the therapeutic uses for escitalopram and sertraline?
1. Major depressive disorder 2. Anxiety 3. OCD 4. PTSD 5. Bulimia
68
What are major adverse effects of SSRIs (escitalopram/sertraline) that the nurse should monitor?
1. Overstimulation of CNS 2. Sexual dysfunction 3. Hyponatrimia 4. Serotonin syndrome 5. Weight loss then weight gain
69
Major patient education points for SSRIs?
1. Take in morning (it is a stimulant so won't be able to sleep at night) 2. Avoid caffeine or stimulant medications 3. Avoid St. John's wort
70
What is the major contraindication of SSRIs?
Do NOT take with another SSRI/MAOI/TCA/Lithium as this increases risk for Serontonin Syndrome
71
The patient is currently taking escitalopram but the HCP has decided to have her take sertraline. What nursing action should the nurse take and why?
Wean the patient off of escitalopram, wait 2-4 weeks, then administer sertraline This is done to prevent serotonin syndrome
72
What are S/S of Serotonin Syndrome?
confusion, fever, agitation, anxiety, hallucinations, diaphoresis, tremors, hypertension
73
When should the nurse expect S/S of Serotonin Syndrome and what should occur if she notices these S/S?
Within 2-72 hrs of administering SSRI Stop immediately if she notices these symptoms
74
How do tricyclic antidepressants (TCA) work on CNS? What do they do?
Block reuptake of norepinephrine serotonin, increasing their effects reduce symptoms of panic and anxiety
75
What are the prototypes for TCA?
amitriptyline | imipramine
76
If a patient is being administer amitriptyline/imipramine, what disorder would the nurse expect the patient to have?
Depression
77
What are therapeutic uses for TCAs?
``` Depression (main) Depressive episodes in Bipolar diorder Neuropathic pain Fibromyalgia Insomnia Anxiety Disorder ```
78
Which drug is the last choice of treatment for depression?
TCA (amitriptyline/imipramine)
79
What interventions should the nurse complete after administering TCAs and why?
1. Give at bedtime (cause orthostatic hypotension and sedation) 2. Monitor HR/BP /cardiac monitor especially if there is a pre-existing heart t condition (causes cardiac toxicity) 3. Monitor for seizure onset (lowers seizure threshold)
80
What should the nurse tell the patient about the effectiveness of TCAs (amitriptyline/imipramine)?
Drug takes 4-8 weeks to show effectiveness; need close suicide monitoring
81
Why shouldn't TCA be given concurrently with St. Johns Wort or other antidepressants?
Causes serotonin syndrome (too much serotonin)
82
What drug should be administered if other depression drugs aren't workin?
Phenelzine, MAOI
83
What is the major side effect of MAOIs?
Hypertensive crisis
84
What should the nurse educate the patient about when on MAOIs (phenelzine)?
1. Dont eat foods high in tyramine or caffeine 2. Takes 3-4 weeks to be therapeutic 3. Avoid OTC decongestants
85
What are the S/S of hypertensive crisis?
Headache, stiff neck, N/V, tachycardia/chest pain, sever hypertension
86
What are the prototypes for atypical antidepressants?
duloxetine | bupropion
87
A patient wants to quit smoking, what medication should the nurse anticipate administering?
Bupropin
88
What are atypical antidepressants mainly used for?
Mild depression
89
A patient is experiencing neuropathic pain. What drug should the nurse anticipate administering?
duloxetine
90
A patient is taking atypical antidepressants, what interventions should the nurse anticipate and why?
1. Increase fluid & fiber (drug causes constipation) 2. Monitor weight (drug causes weight loss) 3. Monitor liver toxicity
91
What are important patient education points for atypical antidepressants (bupropion, duloxetine)?
1. don't take with MAOI 2. don't take if hx of seizure 3. Do not crush/chew/ cut pills
92
What medication is most commonly used for bipolar disorder and why?
Lithium carbonate controls manic episodes
93
What are therapeutic uses of lithium carbonate?
alcohol disorder bulimia psychotic disorder bipolar disorder treatment
94
What are major adverse effects of lithium carbonate?
1. Renal toxicity 2. Polyuria/thirst 3. Hypothyroidism (weight gain, cold intolerance) 4. Electrolyte imbalance (sodium)
95
What should be administered to counteract hypothyroidism with lithium carbonarte?
levothyroxine
96
What are key nursing interventions for lithium carbonate?
1. Give with food/milk 2. Inc fluid intake 3. Monitor kidney fx 4. encourage sodium adequate diet* 5. Avoid NSAIDs/diuretics/anticholinergic drugs 6. Monitor for lithium toxicity
97
Explain how a patient may become lithium toxic
Lithium carbonate needs enough sodium to be excreted If there is low sodium in the body, lithium cannot be excreted thus remaining and causing issues
98
Therapeutic lithium level
0.5 - 1.2 mEq/L
99
What are S/S of lithium toxicity
1. Hand tremor/confusion/seizure/coma 2. N/V/D 3. Tinnitus 4. Hypotension 5. Muscle weakness 6. GI distress
100
If the patient shows signs of lithium toxicity, what should the nurse do?
1. STOP medication and report to physician
101
What interventions should the nurse complete if lithium levels are above 2.5?
Administer emetic, gastric lavage, hemodialysis to prevent renal disorder
102
Patient education for lithium carbonate
1. Cat D 2. Levels should be monitored every 2-3 days then once every 1-3 months 3. Takes 7-14 days for therapeutic effect 4. Increase fluid and sodium diet intake
103
Positive symptoms
hallucinations, delusions, irritability, etc
104
Negative symptoms
flat affect, depression, etc
105
Typical antisphyscotics treat positive or negative symptoms?
Postive symptoms
106
Atypical antipsychotics treat positive or negative symptoms?
Positive and Negative symptoms
107
What are the prototypes for typical antipsychotic?
chlorpromazine, haloperidol
108
What are the therapeutic uses for typical antipsychotics?
1. Schizophrenia 2. Bipolar diroder (positive symptoms) 3. Tourettes 4. N/V in renal failure

Pathopharmacology (6 decks)

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