pharm exam 4--extra crap Flashcards by malarie carroll

2 major divisions of the nervous system

CNS & PNS

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Receives and processes information, initiates action

CNS

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2 parts of CNS

brain & spinal cord

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Receives and processes sensory information

brain

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Conducts signals to and from the brain, controls reflex activities

spinal cord

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—transmits signals between the CNS and the rest of the body

PNS

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2 parts of PNS

sensory & motor neurons

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Carries signals to the CNS from the sensory organs

sensory neurons

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Carry signals from the CNS that control the activities of muscles and glands

motor neurons

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Consists of nerves that provide voluntary control over skeletal muscle

somatic nervous system

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Consists of nerves that provide involuntary control over the contraction of smooth muscle and cardiac muscle and glands

autonomic nervous system

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Activated under conditions of stress and produces a set of actions called the fight-or-flight response

Activation of this system will ready the body for an immediate response to a potential threat

Sympathetic nervous system

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Pupils dilate, inhibits salivation, dilates bronchioles, accelerates heart, increases HR, inhibits digestion, stimulates release of glucose, secretes epinephrine & norepinephrine, relaxes bladder, inhibits sex organs

sympathetic nervous system

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Activated under non-stressful conditions and produces symptoms called the rest-and-digest response

sympathetic nervous system

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Pupils constrict, stimulates salivation, constricts bronchioles, slows heart, stimulates digestion, stimulates gallbladder, contracts bladder, stimulates sex organs

parasympathetic nervous system

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Affords several mechanisms by which drugs may act

Synthesized in presynaptic nerve terminal from choline and acetyl coenzyme A

Ach in the synaptic cleft is rapidly destroyed by the enzyme acetylcholinesterase (AchE)

acetylcholine

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where is acetylcholine destroyed?

in the synaptic cleft

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cholinergic

Ach

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adrenergic

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primary neurotransmitter of the Parasympathetic nervous system

Ach

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2 types of cholinergic receptors which are classified after certain chemicals bind to them:

muscarininc

& nicotinic

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located on target tissues affected by postganglionic neurons in the parasympathetic nervous system; in parasympathetic target organs except the heart

Stimulation of smooth muscle and gland secretions

Muscarininc receptors

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located at the ganglionic synapse in both the sympathetic and parasympathetic nervous system

Stimulation of smooth muscle and gland secretions

nicotinic receptors

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Norepinephrine (adrenergic) receptors:

Alpha 1 & 2

Beta 1 & 2

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Primary neurotransmitter in the sympathetic nervous system

in all sympathetic target organs except the heart Constriction of BVs, dilation of pupils (increase BP)

alpha 1

at presynaptic adrenergic neuron terminals Activation inhibits the release of norepinephrine (decrease BP)

alpha 2

in heart and kidneys Increased heart rate and force of contraction of heart; increases release of renin

Beta 1

in all sympathetic target organs except the heart Inhibits smooth muscle (bronchodilation)

Beta 2

nerve carrying the impulse exiting the spinal cord

Preganglionic neuron

the connection made between the two outside of the CNS (blue bubble)

ganglionic synapse

nerve on the other side of the ganglionic synapse waiting to receive the impulse

postganglionic neuron

Class of neurons secreted in response to stress that include epinephrine, norepinephrine, and dopamine Adrenergic

catecholamines

used as an antihypertensive drug in patients diagnosed with schizophrenia

resperine

patients diagnosed with ADHD and for patients having difficulty staying awake

adderall

used as a local anesthetic in cases of nasal, mouth, and throat surgery

cocaine

mild stimulant, increases neuronal activity and arousal

caffeine

what are the 4 possible actions of sympathetic and parasympathetic nervous systems:

1. stimulate sympathetic nervous system 2. inhibits symapthetic nervous system 3. stimulates parasympathetic nervous system 4. inhibits parasympathetic nervous system

treatment of nasal congestion or hypotension

alpha 1

treatment of hypertension, reduce the release of NE

alpha 2

treatment of cardiac arrest, heart failure, and shock

beta 1

treatment of asthma and premature labor contractions

beta 2

Nasal decongestant, maintain BP—antihypotensive (increase BP) Pharm class: adrenergic agent Side effects are uncommon Overdose may cause hypertension and tachycardia

neo-synephrine (phenylephrine)

"i'm so anxious i really need to walk around the room"

neo-synephrine (phenylephrine)

Antihypertensive (decrease BP) Pharm: adrenergic-blocking drug Most commonly used in combination with other agents, such as beta blockers or diuretics Orthostatic hypotension, dizziness, drowsiness, light-headedness, reflex tachycardia from rapid fall in BP, nasal congestion, or inhibition of ejaculation Overdose may cause hypotension

Minipress (prozasin)

Stimulates urination, treatment of dry mouth Pharm class: muscarinic cholinergic receptor agent (parasympathomimetic) May increase smooth muscle tone and muscular contractions of the GI tract following general anesthesia Increased salivation, sweating, abdominal cramping, and hypotension

Duvoid, Urecholine (bethanechol)

Antidote for anticholinesterase poisoning, to increase heart rate, dilate pupils Pharm class: muscarinic cholinergic receptor blocker, anticholinergic Induces symptoms of fight-or-flight response May treat hypermotility diseases of the GI tract such as: irritable bowel syndrome, suppress secretions during surgical procedures, increase the heart rate in patients with bradycardia, dilate pupils during eye exams Dry mouth, constipation, urinary retention, and increased heart rate

Atro-pen (atropine)

Injury to tissues which may be described as somatic pain (sharp, localized) or visceral pain (generalized, dull, throbbing, or aching sensation)

nociceptive pain

Results from injury to the nerves and described as burning, shooting, or numb pain (more difficult to manage)

neuropathic pain

Free nerve endings located throughout the body

nociceptors

reassess pain ___ min to ___ after tx

30 min - 1 hour

Substances that produce numbness or stupor-like symptoms; natural or synthetic drug related to morphine, may refer to hallucinogens, CNS stimulants, marijuana, and other illegal drugs

narcotics

Medications used to relieve pain

analgesics

early tx of opioid dependence

buprenorphine (subtex)

mixed opioid agonist-antagonist; sublingual route

buprenorphine (subtex)

later maintenance of opioid dependence

suboxone

Patients are allowed to self-medicate with opiate medication by pressing a button Safe levels of scheduled pain medication are delivered with an infusion pump Set to only give a certain amount of medication Can still overdose Always assess your patient’s pain with a numeric scale or smiley face scale

PCA pumps

Muscles of the head and neck become very tight because of stress, causing steady and lingering pain

tension headache

Characterized by throbbing or pulsating pain, sometimes preceded by auras

migraine

Sensory cue that let the patient know that a migraine attack is coming soon Ex) jagged lines, flashing lights, special smells, tastes, or sounds

aura

selective for 5-HT receptor subtypes; act by constricting certain blood vessels in brain

triptans

interact with adrenergic, dopaminergic, and serotonin receptors; promote vasoconstriction, stop ongoing migraines

ergot alkaloids

If someone is taking a large amount of a narcotic:

assess respirations, open up the airway

Opioid analgesic (CNS depressant) Pharm class: opioid receptor agonist Used for symptomatic relief of acute and chronic pain after nonnarcotic analgesics have failed Dysphoria (restlessness, depression, anxiety), hallucinations, constipation, nausea, dizziness, and itching sensation Overdose: Decreased respirations, BP, heart rate (cardiac arrest, respiratory depression)

Morphine (astramorph PF, duramorph)

Used to treat acute opioid overdose and misuse (reverses morphine) Pharm class: opioid receptor antagonist Reversal of the effects of opioids may result in rapid loss of analgesia, increased BP, tremors, hyperventilation, nausea, vomiting, and drowsiness Will immediately cause opioid withdrawal symptoms in patients physically dependent on opioids

Narcan (naloxone)

Antimigraine, helps dilate vessels in the head Pharm class: triptan; serotonin receptor drug; vasoconstrictor of intracranial arteries Dizziness, drowsiness, or a warming sensation Works best when combined with a narcotic Should be used with caution in patients with recent MI, hypertension, or diabetes Toradal

Imitrex (sumatriptan)

Non-narcotic, nonopiod analgesic Patients usually don’t want it because they don’t like the feeling of it; Don’t get the full loopy/narcotic effect they are used to Used to treat inflammation and fever NSAID

Toradal

Work by blocking sodium channels—temporarily suspending nerve conduction and preventing pain signals from reaching the CNS Occurs when sensation is lost to a limited part of the body without loss of consciousness

local anesthesia

Block flow of sodium into neuron Delays nerve impulses and reduces neural activity Produces unconsciousness Produces lack of responsiveness to painful stimuli Requires different classes of drugs that cause loss of sensation to the entire body, usually resulting in loss of consciousness

general anesthesia

allows a lower dose of inhalation anesthetic, thus making the procedure safer for the patient

balanced anesthesia

stage 3 of anesthesia, in which major surgery occurs

Surgical anesthesia

Stages of general anesthesia

Stage I: loss of pain Stage II: excitement and hyperactivity Stage III: surgical anesthesia Stage IV: paralysis of the medulla

Act within a few seconds Used alone or in combination with inhalation agents: balanced anesthesia

IV anesthetics

State where patients are conscious, though insensitive to pain and unconnected with surroundings Patient may hear and see what’s going on but has no ability to move or speak

neuroleptanalgesia

Anesthetic (local/topical), antidysrhythmic, sodium channel blocker Most frequently used injectable local anesthetic Acts by blocking neuronal pain impulses, may be for spinal and epidural anesthesia

Lidocaine (xylocaine)

General anesthetic, inhalation gaseous drug Ideal for short surgical or dental procedures because the patient remains conscious and can follow instructions while experiencing full analgesia Laughing gas

nitrous oxide

General anesthetic (what MJ overdosed on) Has an almost immediate onset of action and is used effectively for conscious sedation Provides faster onset and deeper sedation

Diprivan (propofol)

Skeletal muscle paralytic drug; neuromuscular blocker Complete loss of consciousness Can cause respiratory depression, malignant hyperthermia, apnea, circulatory collapse ET tubes are used for mechanical ventilation during surgery

succycholine (anectine)

Vasoconstrictor (increases BP), sometimes mixed with lidocaine

epinephrine

Used during surgery Cause paralysis without loss of consciousness, which means without a general anesthetic, patients would be awake and without the ability to move

neuromuscular blockers

A rapid-onset short-acting barbiturate general anesthetic Slows the activity of your brain and nervous system Used to help you relax before you receive general anesthesia with an inhaled medication

Thiopental (pentothal)/ Sodium pentothal