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Pharm Flashcards

1
Q

Reticular Activating System

A

important for mood and memory and located in the brain stem

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2
Q

Limbic System

A

Identifies smells, memory, and emotional states
Important in activating fight or flight

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3
Q

Acetylcholine

A

important for learning, memory, and voluntary muscle movement

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4
Q

Norepinephrine

A

concentration helps to increase bloop pressure and HR

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5
Q

Epinephrine

A

adrenaline: fight or flight

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6
Q

Dopamine

A

pleasure

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7
Q

GABA

A

calming (reduces excitability)

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8
Q

Glutamate

A

memory and some excitability properties (this is over activated in seizures)

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9
Q

Serotonin

A

has to do with mood and sleep. Important with depression

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10
Q

Synapse

A

Neurotransmitters work at the synapse
This is where the chemical signals are passing onto the next cell

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11
Q

Blocking the reuptake

A

By blocking the reuptake, we allow our body to have a longer chance at metabolizing the neurotransmitters

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12
Q

Seizures

A

Abnormal brain activity in the nerve cells
May or may not be visible
Abnormal EEG patterns

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13
Q

Causes of Seizures

A

Hypoglycemia
Electrolytes (Na)
Medication Overdose
Medication /Alcohol withdrawal
Secondary
Idiopathic

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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

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15
Q

Generalized Seizure

A

Nonspecific area of brain
tonic-Clonic movement

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16
Q

Tonic

A

sustained muscle contraction, abnormal posture

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17
Q

Clonic

A

rapid rhythmic jerking movement

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18
Q

Status Epilepticus

A

seizure that does not stop or respond to drugs

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19
Q

Phenobarbital use and action

A

Takes three weeks to reach therapeutic level
generalized seizures
partial seizures

depress CNS
Inhibits conduction

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20
Q

Phenobarbital Route

A

IV, PO, IM

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21
Q

Phenobarbital Adverse Effects

A

CNS Depression/ Sedation
Stevens-Johnson syndrome
Status epilepticus with sudden withdrawal
BB warning suicidal ideation

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22
Q

Barbiturates Nursing Implications

A

Monitor for CNS depression
* MANY drug-to-drug interactions
– Opioids
– Steroids
– Oral birth control
– Oral anticoagulants
– Antidepressants
– Alcohol

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23
Q

Phenobarbital Patient Education

A
  • Do not stop suddenly
  • Have serum level monitored
  • May cause drowsiness
  • Barrier contraceptive
  • Wear medical alert bracelet
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24
Q

Diazepam and Lorazepam drug type

A

Benzodiazepines

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25
Q

Phenobarbital Drug Type

A

Barbiturate

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26
Q

Diazepam/Lorazepam Action

A

Increases GABA at receptor site

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27
Q

Diazepam/Lorazepam use

A

Seizures, Status Epilepticus
Broad range of other uses

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28
Q

Adverse Effects of Diazepam/Lorazepam + BB warning

A

Depression
Confusion
Bradycardia, hypotension

BB Warning: combined with opioids- life
threating respiratory depression

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29
Q

GABA analog example

A

Gabapentin

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30
Q

Use of GABA analog

A

Partial seizures
Off label uses:
– **Nerve pain (neuropathy)
– Fibromyalgia

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31
Q

Nursing Considerations GABA

A

can become a drug of abuse with opioids
don’t crush
take with food
Dont stop suddenly

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32
Q

Hydantoin Example

A

Phenytoin

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33
Q

Therapeutic Level of Phenytoin

A

10-20 mcg/mL

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34
Q

Phenytoin Use

A

Decreases nerve excitability
first line anti-epileptic drug
seizure prevention after brain injury

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35
Q

Phenytoin Adverse Effects

A

Gingival hyperplasia*
CNS depression
GI upset

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36
Q

Hydantoin Nursing Implication

A

Give with food
Alcohol & omeprazole increase effects
IV is tissue toxic
Avoid in pregnancy

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37
Q

Phenytoin Patient Education:

A
  • Do not stop suddenly
  • Take with food
  • Have serum level monitored
  • Good oral hygiene / Dental visits
  • Use barrier contraception
  • Wear medical alert bracelet
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38
Q

Iminostilbenes Example

A

Carbamazepine

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39
Q

Carbamazepine Action

A

Decreases action potentials
Used for Epilepsy

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40
Q

BB Warning Carbamazepine

A

aplastic anemia &
agranulocytosis

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41
Q

Carbamazepine Considerations

A

Respiratory Depression
Liver damage
drug to drug interactions with MAOIs and warfarin
give with food

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42
Q

Carbamazepine Pt. Education

A

Take with food
Do not stop suddenly
Avoid other CNS depressants
Use barrier contraception
Wear medical alert bracelet
Report bruising, bleeding, fatigue to MD

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43
Q

Levetiracetam

A

 Used commonly
 Treats a variety of seizures
 Adverse effects include CNS depression
 Contraindicated with pregnancy

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44
Q

Topiramate

A

Used for Seizures, migraines, weight loss
Adverse effects include CNS depression
Contraindicated with pregnancy

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45
Q

Valproate

A

Used to treat general or absence seizures
BB Warnings for pancreatitis, teratogenic,
alterations to clotting times
Use 2 forms of contraception
Monitor for bleeding

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46
Q

Acetazolamide

A

Used for treatment of seizures related to
increased fluid/ pressure around brain
Diuretic action

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47
Q

Lacosamide

A

Used for partial seizures
* Use caution with cardiac issues
* Contraindicated with pregnancy

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48
Q

Lamotrigine

A

Use with other meds for partial seizures
* BB Warning: Skin rash
* Contraindicated with pregnancy

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49
Q

Upper motor neuron damage

A

pastic paralysis and hyperreflexia

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50
Q

Lower motor neuron damage

A

laccidity of muscles and muscle atrophy

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51
Q

Changes in ANS with spinal cord injuries

A

Temperature regulation
Bowel / bladder function
Hypotension

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52
Q

Carisoprodol

A

Centrally Acting
Painful musculoskeletal conditions

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53
Q

Baclofen

A

Centrally acting
Relief of spasticity with MS, flexor
spasms, muscle rigidity

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54
Q

Dantrolene

A

Peripherally acting
Control upper motor spasticity d/t SCI,
CVA, cerebral palsy, MS
Prevent and treat malignant hyperthermia

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55
Q

Dantrolene Action

A

Interferes with the release of calcium in
the sarcoplasmic reticulum to
relax skeletal muscle

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56
Q

Cyclobenzaprine hydrochloride

A

Short Term use
Relief of muscle spasms

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57
Q

Tizanidine

A

Short term use
Spasticity

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58
Q

Dantrolene BB warning

A

Fatal liver impairment

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59
Q

Contraindications for Muscle Spasm drugs

A

Epilepsy
Pregnancy
Caution with other CNS drugs

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60
Q

Nociceptive Pain

A

pain R/T tissue injury

61
Q

Neuropathic pain

A

Produced by the nerves

62
Q

Nonpharmacologic Pain Management

A

Massage
Heat / Cold Therapy
Physical Therapy
Cognitive Therapy
Guided imagery

63
Q

Opioid Agonist Example

A

Morphine Sulfate
Codeine, Fentanyl, Hydromorphone

64
Q

Action of Opioid

A

Binds to pain receptors in brain, blocks pain impulse

65
Q

Use of opioids

A

Prevent or relieve moderate to severe pain (acute or chronic)
Antitussive (codeine)
Heart failure/pulmonary edema
Adjuncts to anesthesia

66
Q

Onset for Opioids IV vs Oral

A

IV: 10-20-minute onset
PO: 60-minute onset

67
Q

Opioid Complications

A

*Respiratory depression
*CNS depression
*Constipation

68
Q

Opioid Black box:

A

resp failure if used in combo with benzos or other CNS depressants and risk for abuse and dependence

69
Q

Administration of Opioids

A

IV: Dilute and push slow (5ml/5mins)
Pre/Post pain assessment
PO with or without food

70
Q

Opioid Reversal Agent

A

Naloxone

71
Q

Patient Education for Opioids

A

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
Q

Opioid Agonist / Antagonist example

A

Butorphanol

73
Q

Action of butorphanol

A

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
Q

Opioid Antagonist

A

Naloxone

75
Q

Naloxone action

A

Reverses analgesia, displaces opioids at receptor site

76
Q

Nursing Considerations for Naloxone

A

Only reverses Opioid agonists
*Short half life may need multiple doses
Immediate withdrawal symptoms will occur

77
Q

Patients lose sensation in this order with local anesthesia

A

o Temperature
o Touch
o Proprioception
o Muscle Tone

78
Q

Local Anesthetics Example

A

Lidocaine

79
Q

Lidocaine Adverse Effects

A

Vary based on route
*Increased effect with epinephrine
Burning or pain at application site
N/V
Shivering

80
Q

Lidocaine: Field Block

A

Barrier around surgical site
Tooth Extraction

81
Q

Lidocaine: Topical

A

Ointment or drop to skin/mucous membrane
Sunburn cream
Sore throat spray

82
Q

Lidocaine: Nerve Block

A

Blocking a large nerve plexus
Epidural
Spinal Block

83
Q

Nursing Considerations for Lidocaine

A

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
Q

Goals of General Anesthesia

A

Amnesia: Memory loss
Analgesia: Absence of pain
Hypnosis: unconsciousness
Immobility: Muscle relaxation

85
Q

Balanced Anesthesia

A

Using several drugs to reach the anesthetic goal

86
Q

Induction of Anesthesia

A

Patient becomes unconscious
Inhaled or IV anesthetics
Pt may have received benzodiazepine pre-op

87
Q

Maintenance of Anesthesia

A

During procedure
Continuous Inhaled or IV anesthetic
May receive anti-emetics, opioids, or neuromuscular blocking agents

88
Q

Emergence phase of Anesthesia

A

Procedure ends
Medication wears off or reversal agent given

89
Q

Benzodiazepine used for anesthesia

A

Midazolam

90
Q

Analgesics used for anesthesia

A

Fentanyl or other opioids

91
Q

Inhaled Anesthetics to induce hypnosis

A

Isoflurane

92
Q

IV anesthesia to induce hypnosis

A

Propofol

93
Q

Neuromuscular Blocking Agents/Muscle blocker

A

Vecuronium

94
Q

Isoflurane Adverse Effects

A

CV and Resp depression
Airway irritation
*Malignant Hyperthermia

95
Q

Isoflurane Antidote

A

Dantrolene

96
Q

Propofol action

A

Causes depression of the CNS, block perception of pain

97
Q

Propofol use

A

Rapid Induction of anesthesia (<1min)
Amnesia
Euphoria
Hypnosis
10-minute recovery time
Can be used in mechanical ventilation (gets/min)

98
Q

Contraindications to propofol

A

Allergies to soy, eggs, or preservatives
IV burns

99
Q

Vecuronium action

A

Suspends nerve impulses, leading to paralysis

100
Q

Use of Vecuronium

A

Anesthetic paralysis
Muscle relaxation
Intubation & mechanical ventilation

101
Q

Vercuronium Considerations

A

Risk for return of weakness after presumed recovery- monitor closely

102
Q

Antidote to Midazolam

A

Flumazenil

103
Q

Action of Midazolam

A

Produce amnesia
Reduce anxiety
Sedation
High doses can cause Hypnosis

104
Q

Anxiety

A

Most common mental health disorder with an unknown cause. Possibly due to imbalanced neurotransmitters

105
Q

First line drug for anxiety

A

SSRI

106
Q

Diazepam for Anxiety

A

 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
Q

Diazepam Adverse Effects/Considerations

A

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
Q

Reversal Agent of Diazepam

A

flumazenil

109
Q

Pathophysiology of Depression

A

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
Q

Imipramine Drug and Action

A

TCA that blocks the reuptake of norepi and serotonin at the presynaptic nerve endings

111
Q

Black Boxes for Imipramine

A

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
Q

Administration of Imipramine

A

PO given at bedtime to reduce daytime serotonin
Start with small dose and increase slowly
Pre/post mood assessment

113
Q

Fluoxetine

A

SSRI

114
Q

Adverse Effect of Fluoxetine

A

Serotonin Syndrome

115
Q

Serotonin Syndrome Sx

A

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
Q

Monoamine Oxidase Inhibitors

A

Phenelzine

117
Q

Phenelzine Action

A

increases serotonin, epinephrine, norepinephrine and dopamine in the CNS

118
Q

Adverse Effects of Phenelzine

A

Hypertensive Crisis!

Tyramine containing foods. The patient has to change their whole diet! Anything aged meats, cheeses, beer. This is hard.

119
Q

Bupropen drug and action

A

Atypical Antidepressant inhibits the reuptake of norepinephrine, serotonin and dopamine

120
Q

Bupropen BB

A

serious neuropsychiatric effects when administered for smoking cessation

121
Q

Lithium

A

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
Q

Nursing Implications for lithium

A

Do not give with diuretics because they need to maintain lithium

123
Q

Acute Psychosis

A

 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
Q

Delusion

A

Falsed fixed beleif

125
Q

First generation antipsychotics

A

Haloperidol
Typical treatment for psychosis

126
Q

Haloperidol action

A

blocks postsynaptic dopamine receptors in the brain

127
Q

Schizophrenia

A

Haloperidol treats this

128
Q

EPS (Extra Peramedal symptsoms)

A

Tardive dyskinesia
Akathisia
dystonia
drug induced parkinsonism’s

129
Q

Tardive dyskinesia

A

drug induced movement disorder in which the person develops facial movements like tics

130
Q

Akathisia

A

feeling that your muscles are quivering and you have an inability to sit still

131
Q

dystonia

A

movement disorder that causes muscles to contract involuntarily

132
Q

Haloperidol Adverse Effects

A
  • EPS
  • Prolonged QT (get baseline EKG)
  • Agranulocytosis
133
Q

Haloperidol Considerations

A
  • Need baseline EKG
  • IM given in ventrogluteal with 1.5 inch needle
  • Monitor for orthostatic hypotension
     Avoid with herbals, antacids, other CNS depressants
134
Q

Second Generation Antipsychotics

A

Clozapine

135
Q

Clozapine Action

A

block dopamine receptors in the brain

136
Q

Clozapine Black Box Warning

A

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
Q

Cataplexy

A

condition that brings bouts of paralysis or muscle weakness

138
Q

Hypnagogic Hallucinations

A

happen immediately before falling asleep. An experience of transitional state from wakefulness to sleep

139
Q

Sleep paralysis

A

unable to move while falling asleep or upon waking.

140
Q

Dextroamphetamine

A

Amphetomine

141
Q

Dextroamphetamine Action

A

facilitate initiation and transmission of nerve impulses that excite other cells

142
Q

Dextroamphetamine Use

A

management of ADHD and narcolepsy

143
Q

Dextroamphetamine BB

A

high abuse potential and may cause sudden death due to cardiovascular event. WE ARE GONNA WANT AN EKG

144
Q

Dextroamphetamine Considerations

A

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
Q

Methylphenidate

A
  • Action: acts on CNS like amphetamine
  • Use: management of ADHD and narcolepsy
146
Q

Methylphenidate BB

A

risk of drug dependence amphetamine-related drugs

147
Q

Methylphenidate Considerations

A

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
Q

Atomoxetine

A

SSRI second line treatment for people with ADHD and narcolepsy

149
Q

Drug of choice for alcohol withdrawal

A

Benzodiazapine (caution with glaucoma)

Adults (6 decks)

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