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A Nurse 233 Pharm 2 > Neuro System Week #1 > Flashcards

Neuro System Week #1 Flashcards

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1
Q

Types of local anesthesia

A

Topical anesthesia
Regional: Bier block Field blocking Nerve blocking Epidural Anesthesia Spinal Anesthesia

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2
Q

Parasympathetic

A

Increase secretion
Decreased heart rate & force of contraction
Increase intestinal motility
Constricts bronchi
No effect on peripheral blood vessels
Stimulates erection
Increases stomach motility & gastric acid secretion
Constricts pupil
Contracts bladder body & relaxes bladder sphincter

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3
Q

Sympathetic

A

Increases heart rate & force of contraction. (Decreases in parasympathetic)
Little/no effect on secretion (Increased in paras)
Dilates pupil (Constrict in paras)
Decreases stomach motility & gastric acid secretion. (Increase in paras)
Constricts peripheral blood vessels (Increase in paras)
Dilates bronchi. (constrict in paras)
Relaxes bladder body & constricts bladder sphincter (Contract in paras)
Stimulates ejaculation. (Stimulates erection)
Decreases intestinal mobility (Increased in paras)

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4
Q

When only a small area needs anesthesia OR client cannot tolerate anesthesia

A

Use: Local Anesthesia

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5
Q

Topical anesthesia

A

Application of a local anesthesia on the skin or mucus membrane

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6
Q

Topical, local anesthesia use for =>

A

Burns
Suturing wounds
Minor surgery
Dental procedures
Hemorrhoids

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7
Q

Bier Block Anesthesia

A

Injecting local anesthetic into upper of lower extremity

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8
Q

Field block anesthesia

A

Subcutaneous injection of local anesthetic around the margin of the surgical or procedure site
(Given to supply anesthetic to a specific area like hand or arm)

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9
Q

Nerve block anesthesia

A

Blocking a group of nerves called = plexus or ganglion, to a specific area

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10
Q

Spinal anesthesia

A

Injection of anesthetic into the cerebrospinal fluid = in the lumbar spine

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11
Q

Epidural anesthesia

A

Injection of local anesthetic into epidural space

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12
Q

General anesthesia has to balance in =>

A

Nerve blocked
Pt out of sleep
Pain is controlled

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13
Q

Amides = Ladocaine *

A

MoA = block nerve conduction by blocking the influx of sodium through sodium channels
Use = local anesthesia, topical (burns / sutures), mucus membrane, regional (IV), nerve block, epidural & spinal
AE: CNS depression = respiratory depression
LAST = Local Anesthetic Systemic Toxicity => large dose & accidental intravascular injection
Extreme SNC depression, restlessness, irritability, tremors, confusion, seizure activity, cardio excitement life threatening Arrhythmias
Intervention = monitor VS, hypotension = 1- lower HOB, if not 2 - epinephrine, pt report dizziness, paresthesia

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14
Q

Amides: Ladocaine Toxicity SAMS

A

S = slurrred or Difficult Speech
Paresthesias, numbness of lips / tongue
A = Altered Cardio System
Drowsiness/ dizziness/ hypotension, dysrhythmias = Bradycardia, Heart block
M = Muscle Twitching = tremors (الارتعاش)
S = Seizures
Confusion & respiratory depression

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15
Q

Inhaling Agents = isoflurane *

A

MoA= produces Amnesia (فقدان الذاكرة), musicale relaxation, hypnosis (التنويم المغناطيسي), blocks pain
AE = cardio & respiratory Depression, airway irritation, spasms (تشنجات), vomiting, Rare= immune mediated hepatotoxicity

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16
Q

General/ Barbiturate/ Intravenous Anesthesia
methohexital sodium

A

MoA= CNS Depression by amplifying the inhibitory neurotransmitter GABA
Use = hypnosis (تنويم مغناطيسي) & adjunct anesthesia
AE = Respiratory depression & decrease HR & BP
Intervention = monitor respiratory status, Inject Slowly, monitor VS before & during procedure
Contraindications = allergic to barbiturates
Precaution = hepatic/renal disease

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17
Q

General Anesthesia/ Benzodiazepines (flumazenil =antagonist)
midazolam *

A

MoA = inhibits the effects of (GABA), Hypnotic producing = sleep & sedation
AE = Amnesia (memory loss since before injection), cardia / respiratory arrest
Intervention= give slowly (wait 2min before 2 dose), prep resuscitation equip, monitor VS
TERATOGENIC (pregnancy risk)

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18
Q

General Anesthesia/ Benzodiazepines (flumazenil =antagonist)
fentanyl **

A

MoA = like opioid, CNS depression
Use = supplement anesthesia,
AE = sedation & nausea, Respiratory & Cardiac depression , sedation
Intervention = monitor level of consciousness, nausea, VS, resuscitation equip handy
& Naloxone = reverse agent
Contraindications = substance abuse

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19
Q

General Anesthetic
diprivan (Propofol)

A

AE= Nausea, cough, itching, burning around site, confusion/ agitation, anxiety, muscle pain or discolored urine
Report = weak breathing, fast/ slow HR, seizures

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20
Q

Neuromuscular Blocking Agent
vecuronium (Norcuron)

A

MoA = suspend nerve impulse at neuromuscular junction = cause muscle paralysis
AE = anaphylaxis (حساسية مفرطة) & erythema
AE = sedation, nausea, respiratory/ circulatory depression
Prep resuscitation equip
Risk for substance abuse

21
Q

Seizure

A

Seizure = initiated by synchronous high frequency discharge from a group of hyper excitable neurons called focus
May be single event
May be chronic, recurrent pattern = called epilepsy

22
Q

Convulsion

A

Convulsion= tonic=clonic type of seizure characterized by spasmodic contractions of involuntary muscles

23
Q

Focus =

A

Focus = seizure

Focus = a group of hyper excitable neurons

24
Q

Focus may result from =

A

Congenital defects
Hypoxia at birth
Head trauma
Brain infection
Stoke
Cancer
Genetic disorder

25
Q

Seizure classification

A

Partial (Focal)= simple partial & complex partial
Generalized = Tonic-Clonic Absence (petit Mal) Atonic Myoclonic (muscle Twitching) Febrile (اهتياج)

26
Q

Partial seizure

A

1) partial seizure = simple & complex
2)begin in a specific area of brain
3) caused by brain lesion, brain injury, trauma, stroke, tumor
4) symptoms can be simple & sensory effect
OR more complex & abnormal movements & bizarre behavior
5) Movements = automatic repetitive inappropriate to situation

27
Q

partial seizure = simple & complex consciousness?

A

Simple = consciousness is Not impaired
Complex = Level of consciousness is decreased

28
Q

Partial Seizure Movements

A

1) Automatic
2) Repetitive
3) Inappropriate to the situation
*Chewing, swallowing
*Adverse movements

29
Q

Generalized

A

*Bilateral
*Symmetric
*No discernible point of origin in the brain
*Most common = Tonic-Clonic (major motor seizure & w/ aura)

30
Q

Generalized =tonic & clonic

A

*Tonic-clonic
Tonic= sustained muscle contraction (انقباض الجسم)
Clonic= rapid rhythmic & symmetric jerking (اهتزاز مع انبساط الجسم)

31
Q

Generalized = absence seizure

A

Absence = alteration in consciousness that lasts only a few seconds

32
Q

Generalized = Myoclonic seizure

A

Contraction of muscle or group of muscles

33
Q

Generalized = Akinetic

A

Akinetic = absence of movement

34
Q

Seizure classification = status epilepticus (حالة صرعية)

A

Tonic & clonic
Last for minutes
*hypotension Hypoxia Cardiac dysrhythmias
*causes: stopping AEDs, brain trauma/tumors Systemic/CNS infection alcohol withdrawal/drug overdose

35
Q

Anti-epileptic Drugs Effects

A

Effects:
*suppress discharge of neurons within a seizure focus
*suppress propagation of seizure activity from the focus to other areas of brain

36
Q

Anti-epileptic Drugs MOA

A

Suppress of sodium influx
Suppress of calcium influx
Antagonism of glutamate
Potentiation of GABA

37
Q

Antiepileptic

A

Phenytoin = inhibit sodium channels

Phenobarbital = inhibit the conduction of impulses= depress CNS & cerebral cortex & cerebellar funct

Carbamazepine = suppress high frequency neuro discharge & around seizure foci

Valproic acid = increase GABA effects = decrease electrical activity

Ethosuximide = suppress neurons in thalamus (responsible for generating absence seizure)

38
Q

Gabapentin & Pregabalin

A

gaba = use for neuro pain

39
Q

Name 3 Anti-epileptic Drugs = caution ⚠️ & use

A

High Voltage ⚡️⚡️⚡️
Use = management of tonic- clonic & partial seizure activity
Drugs= phenytoin. = selective inhibitor of sodium channels
carbamazepine = suppress high frequency neuro discharge
Valproic acid = block sodium & it’s channels to prevent neuron firing

40
Q

Anti-epileptic Drugs = watch for ⚠️ ? What cause treatment failure?

A

High Voltage ⚡️⚡️⚡️
What for ⚠️ = Dilantin: gingival hyperplasia, bradycardia, rash
Tegretol: visual problems, leukemia, anemia, thrombocytopenia
Valproic acid: GI upset, hepatotoxicity, pancreatitis
Noncompliance = responsible for treatment failure

41
Q

Phenytoin Warning ⚠️⚠️

A

Do NOT give to pregnant women (birth defects)
Do NOT abruptly withdraw (will trigger seizure)

42
Q

Phenytoin MOA, USE, CONSIDERATION, INTERACTIONS

A

MOA = inhibition of sodium channels
Use = tonic-clonic seizure & partial seizure
AE = gingival hyperplasia, Steven Johnson syndrome
CONSIDERATION = therapeutic level = 10 - 20 mcl/mL & patient education, teratogenic, withdrawal trigger seizure
INTERACTIONS = warfarin, oral contraceptives/ 📉increase affect w/ diazapam, alcohol, Valproic acid

43
Q

Barbiturates = *phenobarbital = MOA, USE, CONSIDERATION, INTERACTIONS

A

MOA = inhibit conduction of impulses
USE = sedative & antiepileptic = p & gen tonic clonic seizures
AE = CNA depression, sedation, drowsiness, congestive impairment
= children = irritability & hyperactivity
CONSIDERATION = teratogenic & withdrawal

44
Q

Carbamazepine => MOA, USE, CONSIDERATION, INTERACTIONS

A

MOA => suppress high frequency
Use => epilepsy, bipolar disorder, trigeminal neuralgia
A/E => neurological effects = nystagmus & ataxia
BBW=> DECREASE ⬇️ blood cell production ( aplastic anemia & agranulocytosis)
=> Teratogenic = birth defects
Derma=> Rash & photosensitivity reactions & SJS (Steven Johnson syndrome)

45
Q

Ethosuximide => USE MOA & A/E

A

Use => drug choice for absence seizure
MOA = suppress neurons in thalamus
A/E => hematologic effects = anemia, leukopenia. & anorexia or weight loss

46
Q

Gabapintin & pregablin USE?

A

Used for neuro pain

47
Q

Causes of drug therapy failure? *5

A

Non compliance, inadequate drug dose
Incorrect diagnosis or med for seizure type
Too frequent changes or premature withdrawal
Drug overdose, use of alcohol or recreational drugs
Severe electrolyte imbalance

48
Q

Management of generalized convulsive status epilepticus?

A
  • cont series of tonic clonic 20 to 30 min
    Goals = maintain ventilation & correct hypoglycemia
    Terminate seizure = benzodiazepine lorazepam = first line management
    = diazepam if lorazepam isn’t available
    Long term suppression = phenytoin (oin)

A Nurse 233 Pharm 2 (1 decks)

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