pharm final -new content Flashcards
the nueromuscular junction
Centrally acting muscle relaxants
baclofen, cyclobenzaprine, tizanidine, benzodiazepine, diazepam
centrally acting muscle relaxant actions
work in upper levels of CNS to interfere with reflexes that are causing muscle spasms- enhances the effects of GABA
centrally acting muscle relaxants adverse effects
-CNS: drowsiness, fatigue, weakness, confusion
-hypotension, cardiac dysrythmias
- dont abruptly withdrawal, can cause anxiety, restlessness, hallucinations, and seizures
centrally acting relaxants drug drug
-CNS depressants and alcohol
direct acting relaxants
-peripherally acting skeletal muscle relaxants:
-dantrolene- also used for malignant syndrome and hyperthermia
-botulism (botox)
direct acting relaxants actions
-dantrolene: acts within skeletal muscle fibers, interfering with the release of calcium from the muscle tubules and prevents muscle contraction)
-Botulism: toxins bind directly to the receptor sites of nerve terminals and inhibit the relese of Ach- causing local muscle paralysis
Narcotic agonists
drugs that react with opiod receptors
-cause analgesia (inability to feel pain). sedation, and dysphoria
-controlled substances with the potential for physical dependence and a rising problem of addiction
opioid receptors
Mu receptors: pain blocking receptors- also account for respiratory depression, euphoric, decreased GI, pupil constriction, and development of physical dependence
Drug names of opioids
morphine, hydromorphone, oxycodone (oxycoton, percaset), hyrdocodone, fentanyl, meperidine, tramadol
indications of opioid agonists
-acute pain
-analgesia before, during, after surgery
-relief of nonproductive cough (codeine)
cautions of opioids
-pulmonary disorders, respiratory dysfunction
-pregnancy, lactation, labor
opioids adverse effects
-respiratory depression with apnea, cardiac arrest, shock
-orthostatic hypotensionn
-lightheaded and dizziness
-GI: nausea, vomiting, constipation
-hallucinations
-pupil constriction
-GU: urinary retention, urethral spasm
BLACK BOX: risk of addiction and misuse can lead to overdose and death
opioid antagonists
-drugs that bind strongly to opioid receptors but do not activate them
-block the effects of the opioid receptors and are often used to block the effects of too many opioids in the system (effects include: respiratory depression, sedation, hypotension)
opioid antagonists
-naloxone (narcan): -reversal of the adverse effects of narcotics, diagnoses suspects acute narcotic overdose
-naltrexone: adjunct treatment of alcohol or opoioid dependence in adults
opiod antagonists adverse effects
-acute narcotic abstinence syndrome: nausea, vomiting, sweating, tachycardia, hypertension, tremulousness, anxiety
-tachycardia, BP changes, dysrythmias
Ergot derivatives: migraine headaches
used in the mainstay of migraine headache treatment before the development of triptans
Ergot derivatives: action
block alpha-adrenergic and serotonin receptor sites in the brain to cause vasoconstriction of cranial vessels, a decrease in cranial artery pulsation, and decrease in the hyperperfusion of the basilar artery bed
ergot derivatives drug names
dihyrdoergotamine: treatment of acute migraines in adults
ergotamine: prevention and abortion of migraines in adults
* both have ergotamine in name*
ergot derivatives adverse effects
-numbness and tingling
-chest pain and MI
-cardiac dysrythmias and pulselessness - because trying to get rid of pulses that contribute to mirgraine
-ergotism!!!- a syndrome which causes nausea, vomiting, severe thirst, hypoperfusion, chest pain, blood pressure changes, confusion, drug dependency, and drug withdrawal syndrome
ergot derivatives drug drug
beta blockers (peripheral ischemia and gangrene)
triptans actions
bind to selective serotonin receptor sites (activate) to cause vasoconstriction of cranial vessels
-sumatriptan, almotriptan, eletriptan
-all have triptan in the name!!
triptans indications
-acute migraines
-not for prevention tho!!
triptans adverse effects
-blood pressure alterations
-angina–avoid in clients with coronary artery disease
triptains drug drug
-ergot derivatives increase risk of angina due to prolonged vasoconstriction
calcitonin gene related peptide (CGRP inhibitors)
-rimegepant and ubrogepant: treats acute migraine by blocking CGRP receptor (CRGP causes major vasodilation)
-erenumab-aooe: prevention of migraines in adults because it is a monoclonal antibody that targets the CGRP receptor or CGRP directly (ergotamine prevents as well)
anesthetic agents
-drugs that are used to cause complete or partial loss of sensations
general anesthetics
-general anesthetics: CNS depressants, produce loss of pain sensation and consiousness
local anesthetics
-local anesthetics: used to kill loss of pain sensation and feeling in a designated area of the body
- does NOT produce the systemic effects associated with severe CNS depression
Stages of anesthesia: 1
the analgesia stage: loss of pain sensation with the client still conscious and able to communicate
stages of anesthesia: 2
the excitement stage: period of excitement and often combative behavior with many signs of sympathetic stimulation (tachycardia, increased RR, BP changes)
stages of anesthesia: 3
surgical anesthesia: relaxation of skeletal muscles, return of regular respirations, and progressive loss of eye refluxes and pupil dilation
stages of anesthesia: 4
medulla paralysis: very deep CNS depression with loss of respiratory and vasomotor center stimuli in which death can occur rapidly (anesthesia has become too intense and the situation is critical)
adminstering general anesthesia: induction
period from the beginning of anesthesia until stage3 is reaches (NMJ blockers are used during induction to facilitate intubation)
administering gen anesthesia: maintenance
period from stage 3 until the surgical procedure is complete
administering gen anesthesia: recovery
-period from discontinuation of the anesthetic until the client has regained consiousness
-continuous monitoring for any adverse effects of the drus used while ensuring support of the clients vital functions as necessary is imperative during recovery
balanced anesthesia: preop meds
anticholinergics: decrease secretions and facilitate intubation and prevent bradycardia associated w neural depression (glycopyrrolate, atropine)
balanced anesthesia: preop meds
sedative-hypnotics:
-relax the client, facilitate amnesia, decrease sympathetic stimulation
-include barbituates and benzodiazepines that increase GABA
balanced anesthesia: preop meds
antiemetics: decrease nausea and vomitting associated with slowing of GI activity: ondansetron
balanced anesthesia: preop meds
antihistamines: to decrease the chance of allergic reaction and help dry secretions
balanced anesthesia: preop meds
opioids: aid in pain reductions and sedation
general anesthetics
barbituates: methohexital sodium
-induce rapid anesthesia and are then maintained w inhaled drug (volatile liquids and gas anesthetics)
general anesthetics
non-barbiturates: midazolam, ketamine, etomidate, propofol
general anesthetics
gas anesthetics: nitrous oxide
-anesthetic gases enter the bronchi and alveoli and rapidly pass into the capillary system– quickly pass into the brain and cause severe CNS depression
general anesthetics
Volatile Liquids: desflurane, enflurane, isoflurane (all end in flurane) sevoflurane!!- has the least side effects
-liquids that are unstable at room temperature and release gases that are inhaled by the client
ketamine (nonbarbiturate)
-30 second onset of action, 45 min recovery period
-crosses blood brain barrier
-associated with bizarre state of unconsciousness in which the client appears to be awake but is unconscious and cannot feel pain- may experience hallucinations, dreams, phsycosis
-casues sympathetic stimulations with increases in BP and HR
propofol (nonbarbiturate)
-used for short procedures
-short acting 25-100 min with rapid 30-60 sec onset
-produces less hangover effect and quicker recovery
-often causes local burning on injection
-can cause bradycardia and hypotension
-also used for sedation in clients receiving mechanica ventilation
-white liquid that looks like milk- milk of amnesia
local anesthetic agents
-lidocaine, bupivacaine, benzocaine, tetracaine
-actions: causes temporary interruption in the production and conduction of nerve impulses
-affects the permeability of nerve membranes to sodium ions and stops the nerve from depolarizing
-indications: infiltrations anesthesia, peripheral nerve block, spinal anethesia, relief of local pain
local anethestic agents
epinephrine: sometimes added to lidocaine in order to increase the length of time that the affected area is numb
-closely monitor the sites distal to the inject site for lack of circulations- can cause gangrene due to vasoconstrictive effects of the “caines”
hypothalamus
-“master gland” of the endocrine system
-coordinating center for the nervous and endocrine responses to internal and external stimuli
-regulates body temp, thirst, hunger, water retention, blood pressure, respirations, reproduction, and emotional reactions
hypothalamus releasing hormones
-growth-hormone releasing hormone (GHRH)
-thyrotropin releasing hormone (TRH)
-gonadotropin releasing hormone_GnRH)
-corticotropin releasing hormone (CRH)
-prolactin realeasing hormone (PRH)
hypothalamus inhibiting hormones
Growth hormone release-inhibiting factor (somatostatin)
-prolactin inhibiting factor (PIF)
posterior pituitary gland hormones
anti-diuretic hormone (ADH)- also reffered to as vasopressin and acts on the kidneys to increase retentions of water in order to decrease the osmolarity of the blood volume
OXYTOCIN: stimulates uterine smooth muscle contraction in late phases of pregnany and causes milk release or let down reflex in lactating women
anterior pituitary gland hormones
-growth hormones- cell growth
-adrenocorticotropic hormone (ACTH)
-follicle-stimulating hormone- estrogen/progesterone/ testosterone
-luteinizing hormone- estrogen/progesterone/testosterone
-prolactin- milk production
-thryroid stimulating hormone
diabetes insipidus
defiecency in the amount of posterior pituitary ADH and may result from pituitary disease or injury (trauma, surgery, tumor)
-two types: neurogenic and nephrogenic
diabetes insipidus
production of a large amount of dilute urine containing no glucose- blood become concentrated and blood glucose levels are higher than normal
-S/S polyuria, polydispia (thirst), dehyrdation
diabetes insipidus treatment
-desmopressin- neurogenic diabetes
-synthetic ADH
syndrome of inappropriate ADH
-excessive secretion of ADH causing fluid retention, dilution of the blood and al of the blood elements, and serious issues with water balance and fluid volume
-treated with drugs that block the ADH or vasopressin receptors, so water is no longer retained and urine is producted
-fluid balance needs to be closely monitored