Pharm Test 3 Flashcards
Neuro Meds
1
Q
This type of drug has an inhibitory effect on CNS, but DOES NOT cause sleep
A
Sedatives (but can become a hypnotic if given in high enough doses)
2
Q
This type of drug does cause sleep
A
Hypnotic
3
Q
Sedatives cause a reduction in….
A
- Nervousness
- Excitability
- Irritability
4
Q
Long-acting benzodiazepine
A
Lorazepam (Ativan)
5
Q
Short-acting benzodiazepine
A
Alprazolam (Xanax)
6
Q
Non-benzodiazepine approved for long-term therapy
A
Lunesta and Ambien
7
Q
Drug effects of benzodiazepines
A
- Calming on the CNS
- Induce skeletal muscle relaxation
- Induce sleep
8
Q
Benzodiazepines are indicated for…
A
- Sedation
- Sleep induction
- Relief of agitation
- Alcohol withdrawal treatment
9
Q
Adverse effects of benzodiazepines
A
Headache, drowsiness, lethargy Dizziness/vertigo Fall hazard** "Hangover" effect Withdrawal effect = rebound insomnia
10
Q
Symptoms of an overdose of benzodiazepines
A
Somnolence Confusion Coma Diminished reflexes *Does not cause hypotension/respiratory depression
11
Q
Flumazenil is the antidote for…
A
Benzodiazepines
12
Q
A patient taking benzodiazepines should avoid…
A
Cimetidine
MAOIs
Grapefruit juice**
13
Q
Habit forming drug that in low does can cause a sedative effect, and in high doses can cause hypnotic effect
A
Barbituates
14
Q
Suffix for barbituates
A
-barbital
15
Q
Barbituates are indicated for…
A
Sedation
Anticonvulsant
Anesthesia
16
Q
Adverse effects of barbituates
A
CNS: drowsiness, lethargy, vertigo, “hangover”, paridoxical restlessness
Respiratory: Resp. depression, apnea, bronchospasm, cough
GI: N/V/D, constipation
Cardio: Vasodilation, hypotension
Hypersensitivity reaction, reduced REM sleep
17
Q
An overdose of a barbituate is characterized by….
A
Respiratory depression/arrest CNS depression (sleep, coma, death)
18
Q
Activated charcoal, ventilation, fluids, and pressor support are overdose treatments for…
A
Barbituates
19
Q
A patient taking barbituates should avoid…
A
Alcohol, antihistamines, benzodiazepines, opioids, tranquilizers (additive effects)
Reduction in anticoagulation effects (clot potential)
Increased metabolism of birth control (unexpected pregnancy potential)
20
Q
Used to relieve pain associated with skeletal muscle spams
A
Muscle relaxants
21
Q
Direct-acting muscle relaxant
A
Dantrolene (Dantrium)
22
Q
Baclofen (Lioresal), Cyclobenzaprine (Flexeril), Dantrolene (Dantrium), and Metaxalone (Skelaxin) are examples of…
A
Muscle relaxants
23
Q
Muscles relaxants work best when combines with…
A
Physical therapy
24
Q
Can also be used for malignant hyperthermia crisis
A
Dantrolene
25
Adverse effects of muscle relaxants center around...
CNS depression (euphoria, light headedness, dizziness, drowsiness, fatigue, muscle weakness)
26
When administering a CNS depressant it is important to obtain baseline...
Supine and standing blood pressures
27
Hypnotics are administered...
30-60 minutes before bed
28
Can cause REM rebound and feeling tired the next day
Benzodiazepines
29
Excitatory neurotransmitters
Dopamine, norepinephrine, epinephrine
30
CNS stimulants are indicated for...
1. ADHD
2. Anorexiant (Weight loss)
3. Analeptic
4. Narcolepsy
5. Migraine headaches
31
Common adverse effects seen with CNS stimulants include...
```
Palpitation
Tachycardia
Hypertension
Angina
**Speed up body systems
```
32
ADHD Drugs
Amephetamines (Adderall)
Methylphenidate (Ritalin, Concerta)
Atomoxetine (Strattera)
**Can cause suicidal thinking and behavior
33
Modafinil (Provigil) is used in the treatment of...
Narcolepsy
34
Drug used to support weight loss
Anorexiant
35
Sibutramine (Meridia)
Anorexiant
36
Suffix for antimigraine drugs
- triptan
37
Sumatriptan (Imitrex) and Zolmitriptan (Zomig) are used to treat....
Migraines
38
Imitrex is administered
SubQ
39
Drugs that stimulate respiration in neonates
Analeptics
40
Doxapram (Dopram) and Methylxanthines are...
Analeptics
41
The last daily dose of an ADHD medication should be administered...
4-6 hours before bedtime
42
Tyramine containing foods
Beer, Wine, Aged Cheeses
43
When taking migraine medications (serotonin agonists), educate patients to...
1. Avoid tyramine containing foods
2. Use correct administration technique (SQ, wafer, spray)
3. Keep a journal to monitor therapeutic response
44
Drugs that control or prevent seizures while maintaining a reasonable quality of life
Antieleptic Drugs (Anticonvulsants)
45
Therapeutic level of Phenytoin (Dilantin)
10-20 mEq/mL
46
Phenytoin (Dilantin) is in this class of Antieleptic Drugs
Hydantoins
47
Common adverse effects of Phenytoin (Dilantin)
```
CNS depression (Ataxia)
Ginigival hyperplasia **
```
48
Therapeutic level of Phenobarbital (Luminal)
15-40 mEq/mL
49
Phenobarbital is in this class of Antieleptic Drugs
Barbituates
50
Common adverse effects of Phenobarbital (Luminal)
Tissue necrosis at injection site
| Withdrawal syndrome
51
Benzodiazepine that can be given for generalized seizures
Diazepam (Valium)
52
Therapeutic level of Ethosuximide (Zarontin)
40-100 mEq/mL
53
Contraindications to Ethosuximide (Zarontin)
Porphyria (build-up of chemicals in the body)
Renal/live impairment
Pregnancy
54
Common adverse effects of all Antieleptic Drugs
CNS depression
Bone marrow suppression
Dermatological reactions
55
Nursing interventions for Antieleptic Drugs
Administer with food, monitor labs, DON'T discontinue abruptly (rebound seizures)
56
Goals of Antiparkinsonian drug therapy
1. Increase levels of dopamine
2. Antagonize or block Ach
3. Slow the progression of the disease
57
Avoid tyramine containing foods with this type of Antiparkinsonian Drug
Indirect-Acting Dopaminergic (can cause severe hypertension)
58
A selective MAO-B Inhibitor that increases the levels of dopaminergic stimulation in the CNS
Selegiline
59
Used as an adjunct with carbadopa-levadopa
Selegiline (decreases required dose of levadopa)
60
When used prophylactically, this drug can DELAY development of DEBILITATING PD for 9-18 years
Selegiline
61
Adverse effects of Selegiline
```
Nausea
Lightheadedness, dizziness, Confusion
Abdominal pain
Insomnia
Dry mouth
Hypertensive crisis (if used in doses higher than 10 mg/day)
```
62
An indirect-acting dopamine-receptor agonist used early in PD that causes the release of dopamine from storage sites, but blocks the reuptake by nerve endings
Amantadine (Symmetrel)
63
An indirect-acting dopamine-receptor agonist that inhibits COMT and prolongs the duration of action of levodopa
Tolcapone (Tasmar) and Entacapone (Comtan)
64
Adverse effects of COMT inhibitors
GI upset
Dyskinesia
Urine discoloration**
65
Non-dopamine Dopaminergic Receptor Agonists (NDDRA)
Bromocriptine (Parlodel) - also used in the treatment of prolactin imbalances
Ropinirole (Requip) - also used for Restless Leg Syndrome
Apomorphine (Apokyn)
66
Crosses the blood-brain barrier and is converted to dopamine, but requires large doses to work
Levodopa
67
Does not cross the blood-brain barrier and prevents the breakdown of levodopa in periphery
Carbidopa
68
Used to treat tremors and muscle rigidity caused by excessive cholinergic activity, but DOES NOT relieve bradykinesia
Anticholinergic Therapy
69
Anticholinergic drugs used to treat PD
Benztropinemesylate (Cogentin)
| Diphenhydramine (Benadryl)
70
Anticholinergic therapy can result in....
```
Drowsiness, confusion, disorientation
Constipation, N/V
Urinary retention
Blurred vision, dilated pupils, photophobia
Dry skin
Decreased salivation/dry mouth
```
71
Drugs that stimulate the parasympathetic nervous system (mimic the effects of Ach)
Cholinergic Drugs
72
Adverse effects of Cholinergic drugs (SLUDGE)
```
Salivation
Lacrimation
Urinary incontinence
Diarrhea
Gastrointestinal cramps
Emesis
```
73
Direct-acting cholinergic drugs
Acetylcholine
Carbachol
Pilocarpine
Bethanechol
74
Direct-acting cholinergic drug used to increase tone and motility of the bladder and GI tract
Bethanechol
75
Used to reverse anticholinergic poisoning
Physotigmine
| Pyridostigmine
76
Used in the diagnosis/treatment of Myasthenia Gravis and to treat mild-moderate ALzheimer's disease
Indirect-acting cholinergic drugs
77
Indirect-acting cholinergic drugs include...
Donapezil (Aricept)
Tacrine (Cognex)
Galantamine (Razadyne)
Rivastigmine (Exelon)
78
Avoid taking these when taking cholinergic drugs (can cause decreased cholinergic effects)
Anticholinergics
Antihistamines
Sympathomimetics
79
Nursing interventions for cholinergic drugs
Do NOT stop abruptly or adjust dosages unless indicated by doctor (OD can be life-threatening)
Encourage Myasthenia Gravis patients to take 30 minutes before meals
Therapeutic effects of Alzheimer's drugs may take up to 6 weeks to occur
80
Antidote for cholinergic drugs
Atropine
81
Instruct patient taking cholinergic drugs to notify doctor if...
Weakness
Abdominal cramps
Diarrhea
Difficulty breathing
82
Urination should occur how long after bethanechol administration?
60 minutes
83
Competitive antagonists that block Ach at the muscarinic receptors in the parasympathetic nervous system
Cholinergic Blocking Drugs
84
Examples of Anticholinergic Drugs
Atropine
Scopolamine
Ipratropium
85
Antidote for an Atropine overdose
Physostigmine
86
A patient taking an anticholinergic should avoid these drugs...
Antihistamines
Phenothiazines
Tricyclic antidepressants
MAOIs
87
Nursing interventions for anticholinergics
```
Take EXACTLY as prescribed
Enforce need for adequate fluids
Overdoses can be life-threatening
Apply pressure to inner canthus if administering ophthalmic
Dry mouth may occur
```
88
Elderly taking anticholinergics should be especially careful to avoid...
High temperatures (increased risk for heat stroke)
89
A patient taking an anticholinergic should report the following to the doctor...
```
Urinary hesitance/retention
Constipation
Palpitations
Tremors
Confusion, sedation or amnesia
EXCESSIVE dry mouth
Fever
```
90
Effects of anticholinergic drugs include...
Decreased heart rate in small doses (increased in high)
Decreased muscle rigidity and tremors
Drowsiness, disorientation, hallucinations (high doses)
Urinary retention
Decreased intestinal/gastric secretion
Dilated pupils (mydriasis) and decreased accommodation (cycloplegia)
Decreased salivation, sweating
Decreased bronchial secretions and dilated airways
