Pharm Test 3 Flashcards
Neuro Meds
This type of drug has an inhibitory effect on CNS, but DOES NOT cause sleep
Sedatives (but can become a hypnotic if given in high enough doses)
This type of drug does cause sleep
Hypnotic
Sedatives cause a reduction in….
- Nervousness
- Excitability
- Irritability
Long-acting benzodiazepine
Lorazepam (Ativan)
Short-acting benzodiazepine
Alprazolam (Xanax)
Non-benzodiazepine approved for long-term therapy
Lunesta and Ambien
Drug effects of benzodiazepines
- Calming on the CNS
- Induce skeletal muscle relaxation
- Induce sleep
Benzodiazepines are indicated for…
- Sedation
- Sleep induction
- Relief of agitation
- Alcohol withdrawal treatment
Adverse effects of benzodiazepines
Headache, drowsiness, lethargy Dizziness/vertigo Fall hazard** "Hangover" effect Withdrawal effect = rebound insomnia
Symptoms of an overdose of benzodiazepines
Somnolence Confusion Coma Diminished reflexes *Does not cause hypotension/respiratory depression
Flumazenil is the antidote for…
Benzodiazepines
A patient taking benzodiazepines should avoid…
Cimetidine
MAOIs
Grapefruit juice**
Habit forming drug that in low does can cause a sedative effect, and in high doses can cause hypnotic effect
Barbituates
Suffix for barbituates
-barbital
Barbituates are indicated for…
Sedation
Anticonvulsant
Anesthesia
Adverse effects of barbituates
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
An overdose of a barbituate is characterized by….
Respiratory depression/arrest CNS depression (sleep, coma, death)
Activated charcoal, ventilation, fluids, and pressor support are overdose treatments for…
Barbituates
A patient taking barbituates should avoid…
Alcohol, antihistamines, benzodiazepines, opioids, tranquilizers (additive effects)
Reduction in anticoagulation effects (clot potential)
Increased metabolism of birth control (unexpected pregnancy potential)
Used to relieve pain associated with skeletal muscle spams
Muscle relaxants
Direct-acting muscle relaxant
Dantrolene (Dantrium)
Baclofen (Lioresal), Cyclobenzaprine (Flexeril), Dantrolene (Dantrium), and Metaxalone (Skelaxin) are examples of…
Muscle relaxants
Muscles relaxants work best when combines with…
Physical therapy
Can also be used for malignant hyperthermia crisis
Dantrolene
Adverse effects of muscle relaxants center around…
CNS depression (euphoria, light headedness, dizziness, drowsiness, fatigue, muscle weakness)
When administering a CNS depressant it is important to obtain baseline…
Supine and standing blood pressures
Hypnotics are administered…
30-60 minutes before bed
Can cause REM rebound and feeling tired the next day
Benzodiazepines
Excitatory neurotransmitters
Dopamine, norepinephrine, epinephrine
CNS stimulants are indicated for…
- ADHD
- Anorexiant (Weight loss)
- Analeptic
- Narcolepsy
- Migraine headaches
Common adverse effects seen with CNS stimulants include…
Palpitation Tachycardia Hypertension Angina **Speed up body systems
ADHD Drugs
Amephetamines (Adderall)
Methylphenidate (Ritalin, Concerta)
Atomoxetine (Strattera)
**Can cause suicidal thinking and behavior
Modafinil (Provigil) is used in the treatment of…
Narcolepsy
Drug used to support weight loss
Anorexiant
Sibutramine (Meridia)
Anorexiant
Suffix for antimigraine drugs
- triptan
Sumatriptan (Imitrex) and Zolmitriptan (Zomig) are used to treat….
Migraines
Imitrex is administered
SubQ
Drugs that stimulate respiration in neonates
Analeptics
Doxapram (Dopram) and Methylxanthines are…
Analeptics
The last daily dose of an ADHD medication should be administered…
4-6 hours before bedtime
Tyramine containing foods
Beer, Wine, Aged Cheeses
When taking migraine medications (serotonin agonists), educate patients to…
- Avoid tyramine containing foods
- Use correct administration technique (SQ, wafer, spray)
- Keep a journal to monitor therapeutic response
Drugs that control or prevent seizures while maintaining a reasonable quality of life
Antieleptic Drugs (Anticonvulsants)
Therapeutic level of Phenytoin (Dilantin)
10-20 mEq/mL
Phenytoin (Dilantin) is in this class of Antieleptic Drugs
Hydantoins
Common adverse effects of Phenytoin (Dilantin)
CNS depression (Ataxia) Ginigival hyperplasia **
Therapeutic level of Phenobarbital (Luminal)
15-40 mEq/mL
Phenobarbital is in this class of Antieleptic Drugs
Barbituates
Common adverse effects of Phenobarbital (Luminal)
Tissue necrosis at injection site
Withdrawal syndrome
Benzodiazepine that can be given for generalized seizures
Diazepam (Valium)
Therapeutic level of Ethosuximide (Zarontin)
40-100 mEq/mL
Contraindications to Ethosuximide (Zarontin)
Porphyria (build-up of chemicals in the body)
Renal/live impairment
Pregnancy
Common adverse effects of all Antieleptic Drugs
CNS depression
Bone marrow suppression
Dermatological reactions
Nursing interventions for Antieleptic Drugs
Administer with food, monitor labs, DON’T discontinue abruptly (rebound seizures)
Goals of Antiparkinsonian drug therapy
- Increase levels of dopamine
- Antagonize or block Ach
- Slow the progression of the disease
Avoid tyramine containing foods with this type of Antiparkinsonian Drug
Indirect-Acting Dopaminergic (can cause severe hypertension)
A selective MAO-B Inhibitor that increases the levels of dopaminergic stimulation in the CNS
Selegiline
Used as an adjunct with carbadopa-levadopa
Selegiline (decreases required dose of levadopa)
When used prophylactically, this drug can DELAY development of DEBILITATING PD for 9-18 years
Selegiline
Adverse effects of Selegiline
Nausea Lightheadedness, dizziness, Confusion Abdominal pain Insomnia Dry mouth Hypertensive crisis (if used in doses higher than 10 mg/day)
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)
An indirect-acting dopamine-receptor agonist that inhibits COMT and prolongs the duration of action of levodopa
Tolcapone (Tasmar) and Entacapone (Comtan)
Adverse effects of COMT inhibitors
GI upset
Dyskinesia
Urine discoloration**
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)
Crosses the blood-brain barrier and is converted to dopamine, but requires large doses to work
Levodopa
Does not cross the blood-brain barrier and prevents the breakdown of levodopa in periphery
Carbidopa
Used to treat tremors and muscle rigidity caused by excessive cholinergic activity, but DOES NOT relieve bradykinesia
Anticholinergic Therapy
Anticholinergic drugs used to treat PD
Benztropinemesylate (Cogentin)
Diphenhydramine (Benadryl)
Anticholinergic therapy can result in….
Drowsiness, confusion, disorientation Constipation, N/V Urinary retention Blurred vision, dilated pupils, photophobia Dry skin Decreased salivation/dry mouth
Drugs that stimulate the parasympathetic nervous system (mimic the effects of Ach)
Cholinergic Drugs
Adverse effects of Cholinergic drugs (SLUDGE)
Salivation Lacrimation Urinary incontinence Diarrhea Gastrointestinal cramps Emesis
Direct-acting cholinergic drugs
Acetylcholine
Carbachol
Pilocarpine
Bethanechol
Direct-acting cholinergic drug used to increase tone and motility of the bladder and GI tract
Bethanechol
Used to reverse anticholinergic poisoning
Physotigmine
Pyridostigmine
Used in the diagnosis/treatment of Myasthenia Gravis and to treat mild-moderate ALzheimer’s disease
Indirect-acting cholinergic drugs
Indirect-acting cholinergic drugs include…
Donapezil (Aricept)
Tacrine (Cognex)
Galantamine (Razadyne)
Rivastigmine (Exelon)
Avoid taking these when taking cholinergic drugs (can cause decreased cholinergic effects)
Anticholinergics
Antihistamines
Sympathomimetics
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
Antidote for cholinergic drugs
Atropine
Instruct patient taking cholinergic drugs to notify doctor if…
Weakness
Abdominal cramps
Diarrhea
Difficulty breathing
Urination should occur how long after bethanechol administration?
60 minutes
Competitive antagonists that block Ach at the muscarinic receptors in the parasympathetic nervous system
Cholinergic Blocking Drugs
Examples of Anticholinergic Drugs
Atropine
Scopolamine
Ipratropium
Antidote for an Atropine overdose
Physostigmine
A patient taking an anticholinergic should avoid these drugs…
Antihistamines
Phenothiazines
Tricyclic antidepressants
MAOIs
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
Elderly taking anticholinergics should be especially careful to avoid…
High temperatures (increased risk for heat stroke)
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
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
