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Pathopharmacology > Neuro Meds > Flashcards

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
Q

How will the nurse know if bethanechol has been effective?

A

If the patient is peeing

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26
Q

What should the nurse know about administering bethanecol?

A

Give 1-2 hours before or after meals

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27
Q

SNS Neurotransmitters

A

Epinephrine and Norepinephrine

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28
Q

PSNS Neurotransmitter

A

Acetylcholine

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29
Q

What is the action of Alpha 1 receptors when activated?

A

Vasoconstriction

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30
Q

What is the action of Alpha 2 receptors when activated?

A
  1. Vasodilation

2. Insulin release

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31
Q

What is the action of Beta 1 receptors when activated?

A
  1. Increased HR
  2. Conduction
  3. Contraction
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32
Q

What is the action of Beta 2 receptors when activated?

A
  1. Vasodilation

2. Bronchodilation

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33
Q

What is the action of muscarinic receptors when activated?

A

stimulates visceral organs

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34
Q

What is the action of nicotinic receptors when activated?

A

SkM contractions

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35
Q

What is the function of Muscarinic Agonist & Antagonist?

A
  1. stimulate/prevent bladder contraction

2. treat urinary frequency/retention

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36
Q

What is the function of Direct Cholinergic Agonist?

A

to act directly on cholinergic receptors to stimulate the PSNS

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37
Q

What is the function of Indirect Cholinergic Agonist?

A

to inhibit aceytlcholine esterase

No AchEsterase, Ach can bind to sites

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38
Q

What is the function of Anticholinergic Agents?

A

block muscarinic receptor sites

mimic SNS symptoms

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39
Q

PSNS neurotransmitters

A

acetocholyine

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40
Q

SNS neurotransmitters

A

Norepinephrine/Epinephrine

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41
Q

CNS neurotransmitters

A
  1. Dopamine
  2. Gamma-aminobutryic acid
  3. Serotonin
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42
Q

What drug class is lorazepam and diazepam in?

A

Benzodiazepienes

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43
Q

A patient is in the ER. He has is currently addicted to alcohol . What medication does the nurse anticipate giving for alcohol withdrawal?

A

Chlordiazepoxide

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44
Q

When would you administer lorazepam/diazepam?

A

A patient has

  1. Anxiety Disorder
  2. Panic disorder
  3. Seizure disorders
  4. Insomnia
  5. Muscle Spasm
  6. Before surgery
45
Q

What should the nurse inform the patient about lorazepam/diazepam?

A
  1. Do not abruptly stop talking
  2. Take with food
  3. Avoid alcohol or other CNS depressants
46
Q

What should the nurse be aware of when administering lorzepam or diazepam?

A
  1. Signs of toxicity

2. Signs of CNS depression/respiratory suppression

47
Q

If a patient is experiencing benzodiazepine toxicity, what medication should the nurse administer as an antidote?

A

Flumazenil

48
Q

Why should benzodiazepine be avoided in patients with sleep apnea/respiratory depression/ glaucoma?

A

Benzos can worsen theses complications

49
Q

Can benzodiazipnes be given long term?

A

No. They can only be used short term for dependence

50
Q

What drug class is phenobarbital in?

A

Barbituates

51
Q

What Is the purpose of barbiturates?

A

inhibit neuronal impulse and depress motor output

52
Q

To reduce anxiety, what should the nurse administer?

A

Low dose phenobarbital

53
Q

To induce anesthesia, sedation, and treatment of seizures, what should the nurse administer?

A

High dose of phenobarbital

54
Q

When administering phenobarbitals, what should the nurse monitor for:

A
  1. Respiratory & CNS depression
  2. Signs of overdose
  3. Impaired mobility
  4. Oversedation and confusion
  5. Stevens-Johnson syndrome (Redness/inflammation/allergic rxn)
55
Q

How do non-barbituarates act in the CNS?

A

binds to serotonin & dopamine receptors to reduce anxiety but not completely sedative/anticonvulsant/muscle-relaxant

56
Q

What drug class is buspirone in?

A

Non-barbiturates

57
Q

If a client is being administered buspirone, what disorders are they expected to have?

A
  1. Panic Disorder
  2. Anxiety Disorder
  3. OCD
  4. PTSD
58
Q

What education should the nurse provide when administering buspirone?

A
  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
Q

Can tolerance/dependence/withdrawl effects occur with non barbituates?

A

Yes, but rarely occurs

60
Q

Why shouldn’t MAOIs be administered with buspirone?

A

it increases risk for hypertensive crisis

61
Q

What drug is not recommended for patients that are breastfeeding?

62
Q

For short term insomnia, what drugs should be administered?

A

Zolpidemmor Diphenhydramine

63
Q

To decrease need for narcotics before/after surgery, what drug is administered?

A

Hydroxyzine

64
Q

When administering antidepressants, what should the nurse be sure to educate the patient about?

A

Takes 2-4 weeks for drug to be effective

During this time, suicide is high risk, so monitor closely

65
Q

How do SSRIs work?

A

Block serotonin reuptake thus increasing serotonin effects

66
Q

What are the prototypes for SSRIs?

A

escitalopram

sertraline

67
Q

What are the therapeutic uses for escitalopram and sertraline?

A
  1. Major depressive disorder
  2. Anxiety
  3. OCD
  4. PTSD
  5. Bulimia
68
Q

What are major adverse effects of SSRIs (escitalopram/sertraline) that the nurse should monitor?

A
  1. Overstimulation of CNS
  2. Sexual dysfunction
  3. Hyponatrimia
  4. Serotonin syndrome
  5. Weight loss then weight gain
69
Q

Major patient education points for SSRIs?

A
  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
Q

What is the major contraindication of SSRIs?

A

Do NOT take with another SSRI/MAOI/TCA/Lithium as this increases risk for Serontonin Syndrome

71
Q

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?

A

Wean the patient off of escitalopram, wait 2-4 weeks, then administer sertraline

This is done to prevent serotonin syndrome

72
Q

What are S/S of Serotonin Syndrome?

A

confusion, fever, agitation, anxiety, hallucinations, diaphoresis, tremors, hypertension

73
Q

When should the nurse expect S/S of Serotonin Syndrome and what should occur if she notices these S/S?

A

Within 2-72 hrs of administering SSRI

Stop immediately if she notices these symptoms

74
Q

How do tricyclic antidepressants (TCA) work on CNS? What do they do?

A

Block reuptake of norepinephrine serotonin, increasing their effects

reduce symptoms of panic and anxiety

75
Q

What are the prototypes for TCA?

A

amitriptyline

imipramine

76
Q

If a patient is being administer amitriptyline/imipramine, what disorder would the nurse expect the patient to have?

A

Depression

77
Q

What are therapeutic uses for TCAs?

A 
Depression (main)
Depressive episodes in Bipolar diorder
Neuropathic pain
Fibromyalgia
Insomnia
Anxiety Disorder
78
Q

Which drug is the last choice of treatment for depression?

A

TCA (amitriptyline/imipramine)

79
Q

What interventions should the nurse complete after administering TCAs and why?

A
  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
Q

What should the nurse tell the patient about the effectiveness of TCAs (amitriptyline/imipramine)?

A

Drug takes 4-8 weeks to show effectiveness; need close suicide monitoring

81
Q

Why shouldn’t TCA be given concurrently with St. Johns Wort or other antidepressants?

A

Causes serotonin syndrome (too much serotonin)

82
Q

What drug should be administered if other depression drugs aren’t workin?

A

Phenelzine, MAOI

83
Q

What is the major side effect of MAOIs?

A

Hypertensive crisis

84
Q

What should the nurse educate the patient about when on MAOIs (phenelzine)?

A
  1. Dont eat foods high in tyramine or caffeine
  2. Takes 3-4 weeks to be therapeutic
  3. Avoid OTC decongestants
85
Q

What are the S/S of hypertensive crisis?

A

Headache, stiff neck, N/V, tachycardia/chest pain, sever hypertension

86
Q

What are the prototypes for atypical antidepressants?

A

duloxetine

bupropion

87
Q

A patient wants to quit smoking, what medication should the nurse anticipate administering?

88
Q

What are atypical antidepressants mainly used for?

A

Mild depression

89
Q

A patient is experiencing neuropathic pain. What drug should the nurse anticipate administering?

A

duloxetine

90
Q

A patient is taking atypical antidepressants, what interventions should the nurse anticipate and why?

A
  1. Increase fluid & fiber (drug causes constipation)
  2. Monitor weight (drug causes weight loss)
  3. Monitor liver toxicity
91
Q

What are important patient education points for atypical antidepressants (bupropion, duloxetine)?

A
  1. don’t take with MAOI
  2. don’t take if hx of seizure
  3. Do not crush/chew/ cut pills
92
Q

What medication is most commonly used for bipolar disorder and why?

A

Lithium carbonate

controls manic episodes

93
Q

What are therapeutic uses of lithium carbonate?

A

alcohol disorder
bulimia
psychotic disorder
bipolar disorder treatment

94
Q

What are major adverse effects of lithium carbonate?

A
  1. Renal toxicity
  2. Polyuria/thirst
  3. Hypothyroidism (weight gain, cold intolerance)
  4. Electrolyte imbalance (sodium)
95
Q

What should be administered to counteract hypothyroidism with lithium carbonarte?

A

levothyroxine

96
Q

What are key nursing interventions for lithium carbonate?

A
  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
Q

Explain how a patient may become lithium toxic

A

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
Q

Therapeutic lithium level

A

0.5 - 1.2 mEq/L

99
Q

What are S/S of lithium toxicity

A
  1. Hand tremor/confusion/seizure/coma
  2. N/V/D
  3. Tinnitus
  4. Hypotension
  5. Muscle weakness
  6. GI distress
100
Q

If the patient shows signs of lithium toxicity, what should the nurse do?

A
  1. STOP medication and report to physician
101
Q

What interventions should the nurse complete if lithium levels are above 2.5?

A

Administer emetic, gastric lavage, hemodialysis to prevent renal disorder

102
Q

Patient education for lithium carbonate

A
  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
Q

Positive symptoms

A

hallucinations, delusions, irritability, etc

104
Q

Negative symptoms

A

flat affect, depression, etc

105
Q

Typical antisphyscotics treat positive or negative symptoms?

A

Postive symptoms

106
Q

Atypical antipsychotics treat positive or negative symptoms?

A

Positive and Negative symptoms

107
Q

What are the prototypes for typical antipsychotic?

A

chlorpromazine, haloperidol

108
Q

What are the therapeutic uses for typical antipsychotics?

A
  1. Schizophrenia
  2. Bipolar diroder (positive symptoms)
  3. Tourettes
  4. N/V in renal failure

Pathopharmacology (6 decks)

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