Pharm Flashcards
1
Q
Reticular Activating System
A
important for mood and memory and located in the brain stem
2
Q
Limbic System
A
Identifies smells, memory, and emotional states
Important in activating fight or flight
3
Q
Acetylcholine
A
important for learning, memory, and voluntary muscle movement
4
Q
Norepinephrine
A
concentration helps to increase bloop pressure and HR
5
Q
Epinephrine
A
adrenaline: fight or flight
6
Q
Dopamine
A
pleasure
7
Q
GABA
A
calming (reduces excitability)
8
Q
Glutamate
A
memory and some excitability properties (this is over activated in seizures)
9
Q
Serotonin
A
has to do with mood and sleep. Important with depression
10
Q
Synapse
A
Neurotransmitters work at the synapse
This is where the chemical signals are passing onto the next cell
11
Q
Blocking the reuptake
A
By blocking the reuptake, we allow our body to have a longer chance at metabolizing the neurotransmitters
12
Q
Seizures
A
Abnormal brain activity in the nerve cells
May or may not be visible
Abnormal EEG patterns
13
Q
Causes of Seizures
A
Hypoglycemia
Electrolytes (Na)
Medication Overdose
Medication /Alcohol withdrawal
Secondary
Idiopathic
14
Q
Partial Seizure
A
-Specific area
– Symptoms range from
simple motor and sensory
manifestations to bizarre
behavior (chewing, vacant stare, pill rolling)
– Consciousness not
impaired
15
Q
Generalized Seizure
A
Nonspecific area of brain
tonic-Clonic movement
16
Q
Tonic
A
sustained muscle contraction, abnormal posture
17
Q
Clonic
A
rapid rhythmic jerking movement
18
Q
Status Epilepticus
A
seizure that does not stop or respond to drugs
19
Q
Phenobarbital use and action
A
Takes three weeks to reach therapeutic level
generalized seizures
partial seizures
depress CNS
Inhibits conduction
20
Q
Phenobarbital Route
A
IV, PO, IM
21
Q
Phenobarbital Adverse Effects
A
CNS Depression/ Sedation
Stevens-Johnson syndrome
Status epilepticus with sudden withdrawal
BB warning suicidal ideation
22
Q
Barbiturates Nursing Implications
A
Monitor for CNS depression
* MANY drug-to-drug interactions
– Opioids
– Steroids
– Oral birth control
– Oral anticoagulants
– Antidepressants
– Alcohol
23
Q
Phenobarbital Patient Education
A
- Do not stop suddenly
- Have serum level monitored
- May cause drowsiness
- Barrier contraceptive
- Wear medical alert bracelet
24
Q
Diazepam and Lorazepam drug type
A
Benzodiazepines
25
Phenobarbital Drug Type
Barbiturate
26
Diazepam/Lorazepam Action
Increases GABA at receptor site
27
Diazepam/Lorazepam use
Seizures, Status Epilepticus
Broad range of other uses
28
Adverse Effects of Diazepam/Lorazepam + BB warning
Depression
Confusion
Bradycardia, hypotension
BB Warning: combined with opioids- life
threating respiratory depression
29
GABA analog example
Gabapentin
30
Use of GABA analog
Partial seizures
Off label uses:
– **Nerve pain (neuropathy)
– Fibromyalgia
31
Nursing Considerations GABA
can become a drug of abuse with opioids
don't crush
take with food
Dont stop suddenly
32
Hydantoin Example
Phenytoin
33
Therapeutic Level of Phenytoin
10-20 mcg/mL
34
Phenytoin Use
Decreases nerve excitability
first line anti-epileptic drug
seizure prevention after brain injury
35
Phenytoin Adverse Effects
Gingival hyperplasia*
CNS depression
GI upset
36
Hydantoin Nursing Implication
Give with food
Alcohol & omeprazole increase effects
IV is tissue toxic
Avoid in pregnancy
37
Phenytoin Patient Education:
* Do not stop suddenly
* Take with food
* Have serum level monitored
* Good oral hygiene / Dental visits
* Use barrier contraception
* Wear medical alert bracelet
38
Iminostilbenes Example
Carbamazepine
39
Carbamazepine Action
Decreases action potentials
Used for Epilepsy
40
BB Warning Carbamazepine
aplastic anemia &
agranulocytosis
41
Carbamazepine Considerations
Respiratory Depression
Liver damage
drug to drug interactions with MAOIs and warfarin
give with food
42
Carbamazepine Pt. Education
Take with food
Do not stop suddenly
Avoid other CNS depressants
Use barrier contraception
Wear medical alert bracelet
Report bruising, bleeding, fatigue to MD
43
Levetiracetam
Used commonly
Treats a variety of seizures
Adverse effects include CNS depression
Contraindicated with pregnancy
44
Topiramate
Used for Seizures, migraines, weight loss
Adverse effects include CNS depression
Contraindicated with pregnancy
45
Valproate
Used to treat general or absence seizures
BB Warnings for pancreatitis, teratogenic,
alterations to clotting times
Use 2 forms of contraception
Monitor for bleeding
46
Acetazolamide
Used for treatment of seizures related to
increased fluid/ pressure around brain
Diuretic action
47
Lacosamide
Used for partial seizures
* Use caution with cardiac issues
* Contraindicated with pregnancy
48
Lamotrigine
Use with other meds for partial seizures
* BB Warning: Skin rash
* Contraindicated with pregnancy
49
Upper motor neuron damage
pastic paralysis and hyperreflexia
50
Lower motor neuron damage
laccidity of muscles and muscle atrophy
51
Changes in ANS with spinal cord injuries
Temperature regulation
Bowel / bladder function
Hypotension
52
Carisoprodol
Centrally Acting
Painful musculoskeletal conditions
53
Baclofen
Centrally acting
Relief of spasticity with MS, flexor
spasms, muscle rigidity
54
Dantrolene
Peripherally acting
Control upper motor spasticity d/t SCI,
CVA, cerebral palsy, MS
Prevent and treat malignant hyperthermia
55
Dantrolene Action
Interferes with the release of calcium in
the sarcoplasmic reticulum to
relax skeletal muscle
56
Cyclobenzaprine hydrochloride
Short Term use
Relief of muscle spasms
57
Tizanidine
Short term use
Spasticity
58
Dantrolene BB warning
Fatal liver impairment
59
Contraindications for Muscle Spasm drugs
Epilepsy
Pregnancy
Caution with other CNS drugs
60
Nociceptive Pain
pain R/T tissue injury
61
Neuropathic pain
Produced by the nerves
62
Nonpharmacologic Pain Management
Massage
Heat / Cold Therapy
Physical Therapy
Cognitive Therapy
Guided imagery
63
Opioid Agonist Example
Morphine Sulfate
Codeine, Fentanyl, Hydromorphone
64
Action of Opioid
Binds to pain receptors in brain, blocks pain impulse
65
Use of opioids
Prevent or relieve moderate to severe pain (acute or chronic)
Antitussive (codeine)
Heart failure/pulmonary edema
Adjuncts to anesthesia
66
Onset for Opioids IV vs Oral
IV: 10-20-minute onset
PO: 60-minute onset
67
Opioid Complications
*Respiratory depression
*CNS depression
*Constipation
68
Opioid Black box:
resp failure if used in combo with benzos or other CNS depressants and risk for abuse and dependence
69
Administration of Opioids
IV: Dilute and push slow (5ml/5mins)
Pre/Post pain assessment
PO with or without food
70
Opioid Reversal Agent
Naloxone
71
Patient Education for Opioids
Chronic pain- take around the clock
Take only as prescribed
High fiber diet
Encourage fluids (2-3L/day)
Stool softeners PRN
Do not crush or chew pills
Dispose of narcotics properly
Do not drive on narcotics
72
Opioid Agonist / Antagonist example
Butorphanol
73
Action of butorphanol
activate some receptors and block some receptors, blocking pain sensation with lower risk for abuse.
Used for second line or moderate-severe pain or in pregnancy
74
Opioid Antagonist
Naloxone
75
Naloxone action
Reverses analgesia, displaces opioids at receptor site
76
Nursing Considerations for Naloxone
Only reverses Opioid agonists
*Short half life may need multiple doses
Immediate withdrawal symptoms will occur
77
Patients lose sensation in this order with local anesthesia
o Temperature
o Touch
o Proprioception
o Muscle Tone
78
Local Anesthetics Example
Lidocaine
79
Lidocaine Adverse Effects
Vary based on route
*Increased effect with epinephrine
Burning or pain at application site
N/V
Shivering
80
Lidocaine: Field Block
Barrier around surgical site
Tooth Extraction
81
Lidocaine: Topical
Ointment or drop to skin/mucous membrane
Sunburn cream
Sore throat spray
82
Lidocaine: Nerve Block
Blocking a large nerve plexus
Epidural
Spinal Block
83
Nursing Considerations for Lidocaine
Topical application works in 20 minutes
If using a –caine (Lidoderm) patch, apply to most painful area after removing old patch and washing site
Do not use heating pad over –caine patch
Monitor EKG/cardiac assessment for larger doses
Ensure gag reflex has returned if used as oral spray
84
Goals of General Anesthesia
Amnesia: Memory loss
Analgesia: Absence of pain
Hypnosis: unconsciousness
Immobility: Muscle relaxation
85
Balanced Anesthesia
Using several drugs to reach the anesthetic goal
86
Induction of Anesthesia
Patient becomes unconscious
Inhaled or IV anesthetics
Pt may have received benzodiazepine pre-op
87
Maintenance of Anesthesia
During procedure
Continuous Inhaled or IV anesthetic
May receive anti-emetics, opioids, or neuromuscular blocking agents
88
Emergence phase of Anesthesia
Procedure ends
Medication wears off or reversal agent given
89
Benzodiazepine used for anesthesia
Midazolam
90
Analgesics used for anesthesia
Fentanyl or other opioids
91
Inhaled Anesthetics to induce hypnosis
Isoflurane
92
IV anesthesia to induce hypnosis
Propofol
93
Neuromuscular Blocking Agents/Muscle blocker
Vecuronium
94
Isoflurane Adverse Effects
CV and Resp depression
Airway irritation
*Malignant Hyperthermia
95
Isoflurane Antidote
Dantrolene
96
Propofol action
Causes depression of the CNS, block perception of pain
97
Propofol use
Rapid Induction of anesthesia (<1min)
Amnesia
Euphoria
Hypnosis
10-minute recovery time
Can be used in mechanical ventilation (gets/min)
98
Contraindications to propofol
Allergies to soy, eggs, or preservatives
IV burns
99
Vecuronium action
Suspends nerve impulses, leading to paralysis
100
Use of Vecuronium
Anesthetic paralysis
Muscle relaxation
Intubation & mechanical ventilation
101
Vercuronium Considerations
Risk for return of weakness after presumed recovery- monitor closely
102
Antidote to Midazolam
Flumazenil
103
Action of Midazolam
Produce amnesia
Reduce anxiety
Sedation
High doses can cause Hypnosis
104
Anxiety
Most common mental health disorder with an unknown cause. Possibly due to imbalanced neurotransmitters
105
First line drug for anxiety
SSRI
106
Diazepam for Anxiety
Used for acute anxiety because there is immediate relief
Habit forming
Increase effects of neurotransmitters
Facilitate binding of GABA to decrease excitability
1-5 minute onset
Use low dose
Caution with elderly because they have lower tolerance with kidney function
107
Diazepam Adverse Effects/Considerations
CNS depressants
BB resp failure if used with other CNS depressants and risk for abuse and dependence
IV undiluted and push slow 5mg/5min
108
Reversal Agent of Diazepam
flumazenil
109
Pathophysiology of Depression
Changes in corticoreleaseing factor (CRF) and activation of the hypothalamic-pituitary-adrenal axis
Monoamine neurotransmitter dysfunction
Low of norepinephrine and serotonin
Neuroendocrine Factors:
Down regulation (decreased sensitivity of corticoid receptors)
Other factors:
Genetic and environmental
Disruption in sleeping patterns
Decreased hypothalamic function
110
Imipramine Drug and Action
TCA that blocks the reuptake of norepi and serotonin at the presynaptic nerve endings
111
Black Boxes for Imipramine
More toxic in overdose than other antidepressants
suicide is the leading cause of death in adolescents increased risk of suicide in children and young adults (18-24)
112
Administration of Imipramine
PO given at bedtime to reduce daytime serotonin
Start with small dose and increase slowly
Pre/post mood assessment
113
Fluoxetine
SSRI
114
Adverse Effect of Fluoxetine
Serotonin Syndrome
115
Serotonin Syndrome Sx
too much serotonin in the body. Serotonin builds up in the body. Combining an anti-depressant with something else that messes with serotonin (migraine, or dietary supplement, or st. johns wart)
116
Monoamine Oxidase Inhibitors
Phenelzine
117
Phenelzine Action
increases serotonin, epinephrine, norepinephrine and dopamine in the CNS
118
Adverse Effects of Phenelzine
Hypertensive Crisis!
Tyramine containing foods. The patient has to change their whole diet! Anything aged meats, cheeses, beer. This is hard.
119
Bupropen drug and action
Atypical Antidepressant inhibits the reuptake of norepinephrine, serotonin and dopamine
120
Bupropen BB
serious neuropsychiatric effects when administered for smoking cessation
121
Lithium
o First line treatment of bi-polar
o Treats manic cycle
o Stimulates neuronal growth, reducing brain atrophy in people with long-standing mood disorders
122
Nursing Implications for lithium
Do not give with diuretics because they need to maintain lithium
123
Acute Psychosis
Also called confusion or delirium
Sudden onset over hours to days
May be precepted by physical disorders (infection or metabolic disorders)
May be superposed on chronic paranoia
124
Delusion
Falsed fixed beleif
125
First generation antipsychotics
Haloperidol
Typical treatment for psychosis
126
Haloperidol action
blocks postsynaptic dopamine receptors in the brain
127
Schizophrenia
Haloperidol treats this
128
EPS (Extra Peramedal symptsoms)
Tardive dyskinesia
Akathisia
dystonia
drug induced parkinsonism’s
129
Tardive dyskinesia
drug induced movement disorder in which the person develops facial movements like tics
130
Akathisia
feeling that your muscles are quivering and you have an inability to sit still
131
dystonia
movement disorder that causes muscles to contract involuntarily
132
Haloperidol Adverse Effects
* EPS
* Prolonged QT (get baseline EKG)
* Agranulocytosis
133
Haloperidol Considerations
* Need baseline EKG
* IM given in ventrogluteal with 1.5 inch needle
* Monitor for orthostatic hypotension
Avoid with herbals, antacids, other CNS depressants
134
Second Generation Antipsychotics
Clozapine
135
Clozapine Action
block dopamine receptors in the brain
136
Clozapine Black Box Warning
increased risk of seizure activity if dosage is increased
risk of fatal agranulocytosis
risk of hyperglycemia in patients who take clozapine
administration of clozapine to elderly patients with dementia. Risk of death is increased in these patients
137
Cataplexy
condition that brings bouts of paralysis or muscle weakness
138
Hypnagogic Hallucinations
happen immediately before falling asleep. An experience of transitional state from wakefulness to sleep
139
Sleep paralysis
unable to move while falling asleep or upon waking.
140
Dextroamphetamine
Amphetomine
141
Dextroamphetamine Action
facilitate initiation and transmission of nerve impulses that excite other cells
142
Dextroamphetamine Use
management of ADHD and narcolepsy
143
Dextroamphetamine BB
high abuse potential and may cause sudden death due to cardiovascular event. WE ARE GONNA WANT AN EKG
144
Dextroamphetamine Considerations
o Take first thing in the morning and last dose 6 hours before bedtime
o Take 30-45 minutes before meals (decreases appetite)
o Do not crush
o Perform drug holidays as needed to maintain normal growth and development (stop taking over the weekend or through the summer)
145
Methylphenidate
- Action: acts on CNS like amphetamine
- Use: management of ADHD and narcolepsy
146
Methylphenidate BB
risk of drug dependence amphetamine-related drugs
147
Methylphenidate Considerations
Take first thing in the morning and last dose 6 hours before bedtime
o Take 30-45 minutes before meals (decreases appetite)
o Do not crush
o Perform drug holidays as needed to maintain normal growth and development (stop taking over the weekend or through the summer)
148
Atomoxetine
SSRI second line treatment for people with ADHD and narcolepsy
149
Drug of choice for alcohol withdrawal
Benzodiazapine (caution with glaucoma)
