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2020 Pharmacology I > PME Nervous System Part 1 > Flashcards

PME Nervous System Part 1 Flashcards

1
Q

autonomic nervous system (ANS)

A
  • responds to stress or danger
  • maintains regulatory body functions
  • affects cardiac and smooth muscle and glands
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2
Q

neurotransmitters in the ANS and receptors they stimulate

A
  • acetylcholine | cholinergic receptors
  • epinephrine | adrenergic receptors
  • norepinephrine | adrenergic receptors
  • dopamine
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3
Q

ANS agonists

A

stimulate function, enhance effects of neurotransmitter

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4
Q

antagonists

A

block effects of neurotransmitter

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5
Q

drugs that being with “anti-“ and end with “-ase”

A

block degradation of neurotransmitter

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6
Q

ANS receptor subtypes

A

location determines subtype

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7
Q

cholinergic subtypes

A
  • nicotinic
  • muscarinic
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8
Q

adrenergic subtypes

A
  • Alpha1, 2
  • Beta1, 2
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9
Q

goals of CNS meds

A
  • depress or increase activity of CNS
  • regulate amounts of CNS neurotransmitters
  • stimulate or block autonomic receptors
  • treat psychiatric disorders
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10
Q

CNS depressant types to treat sleep disorders

A
  • benzodiazepines
  • non-benzodiazepines
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11
Q

benzodiazepines therapeutic use

A
  • relieve insomnia
  • decreased repeated awakenings at night
  • relieve anxiety
  • treat status epilepticus
  • relax muscle spasms
  • help with moderate sedation
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12
Q

benzodiazepines

A
  • usually end in “-pam”
    • temazepam
    • diazepam
    • lorazepam
    • flurazepam
  • prototype
    • temazepam
  • others for sleep
    • triazolam
    • flurazepam
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13
Q

MOA of benzodiazepines

A
  • enhance inhibitory effects of GABA
  • promote sleep via sedation
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14
Q

side effects of benzodiazepines

A
  • drowsiness
  • dizziness
  • confusion
  • anxiety
  • tolerance: develops over weeks
  • withdrawal
    • can cause paranoia, panic attacks, muscle twitching, hallucinations
    • taper dose
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15
Q

nursing interventions for benzodiazepines

A
  • oversee nighttime ambulation, especially for older adults
  • watch for S of toxicity
  • monitor for paradoxical reactions, especially in older adults
  • monitor for S of dependence and tolerance
  • taper to prevent withdrawal
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16
Q

s/sx of benzodiazepine toxicity

A
  • weakness
  • slurred speech
  • ataxia: defective muscle coordination
  • uncoordinated muscle movements
  • respiratory depression
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17
Q

administering benzodiazepines

A

give oral preparations 30 min HS

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18
Q

patient education for temazepam

A
  • take about 30 min HS and ensure 8 hr for sleep
  • do not take with ETOH or other depressants
  • stop taking and notify provider if paradoxical reaction occurs
19
Q

contraindications and precautions for benzodiazepines

A
  • contra
    • pregnancy (Category X)
    • lactation
    • glaucoma
    • children < 18 yo
  • caution
    • renal or hepatic impairment
    • suicidal ideation
    • ETOH dependence
    • neuromuscular disorders
    • chronic respiratory disorders
    • sleep apnea
20
Q

interactions with benzodiazepines

A
  • other CNS depressants: severe sedation and respiratory depression
  • kava kava and valerian root: ↑ sedation
  • cimetidine: ↑ benzodiazepine levels
  • smoking: ↓ effects of benzodiazepines
21
Q

non-benzodiazepines

A
  • use: short-term Tx of insomnia
  • prototype: zolpidem (Ambien)
  • other
    • zaleplon (Sonata)
    • eszopiclone (Lunesta)
22
Q

MOA of non-benzodiazepines

A

enhance inhibitory effects of GABA

23
Q

SE of non-benzodiazepines

A
  • daytime drowsiness
  • headache
  • anxiety
  • dizziness
  • diplopia
  • confusion in older adults
  • amnesia: ambulating, eating, driving
24
Q

nursing interventions for non-benzodiazepines

A
  • monitor for adverse effects
  • take precautions to prevent falls, especially in older adults
  • monitor for need to ↓ dose
25
Q

administering non-benzodiazepines

A
  • oral form for immediate or extended-release
  • oral spray: direct absorption via nasal mucosa
  • give HS, ensure 8 hr for sleep
  • give on empty stomach for full effect
26
Q

pt education for non-benzodiazepines

A
  • take HS with 8 hr to sleep
  • do not take extra doses
  • report dizziness or vision changes
  • do not take with ETOH or other CNS depressants
  • be aware that amnesia, memory impairment, and sleep driving may occur
27
Q

contraindications and precautions for non-benzodiazepines

A
  • contra
    • children < 18 yo
    • suicidal ideation
    • L&D
  • caution
    • older adults
    • prone to substance abuse
    • Hx of depression
    • chronic respiratory disorders
    • sleep apnea
    • hepatic or renal dysfunction
28
Q

interactions with non-benzodiazepines

A
  • ETOH
  • other CNS depressants
  • take on empty stomach
29
Q

types of CNS depressants for muscle spasms

A
  • centrally acting muscle relaxants
  • peripherally acting muscle relaxants
30
Q

centrally acting muscle relaxants

A
  • relieve muscle spasms due to
    • spinal cord injury
    • multiple sclerosis
    • cerebral palsy
    • MSK injury or other disorders
  • prototype: baclofen
  • other
    • carisoprodol
    • chlorzoxazone
    • cyclobenzaprine
31
Q

MOA of centrally acting muscle relaxants

A

enhance inhibitory effects of GABA

32
Q

side effects of centrally acting muscle relaxants

A
  • drowsiness and dizziness early in therapy
  • nausea
  • constipation
  • withdrawal
    • anxiety
    • restlessness
    • visual hallucinations
    • Sz
33
Q

administering centrally acting muscle relaxants

A
  • oral
    • start with low dose, gradually ↑
    • give oral dose with food or milk
    • encourage fluids, ↑ fiber
    • D/C drug: taper dose over 1-2 wks
  • intrathecal infusion
    • directly into spine via needle attached to pump
    • do not stop abruptly
34
Q

pt education for centrally acting muscle relaxants

A
  • drowsiness and other CNS effects will ↓ with time
  • change position slowly if dizzy
  • do not drive or use heavy machinery if drowsy
  • take with food or milk
  • ↑ fiber and fluid intake
  • report constipation
  • do not stop abruptly: taper over 1-2 wks
35
Q

contraindications and precautions for centrally acting muscle relaxants

A
  • contra
    • allergy to drug
    • cyclobenzaprine
      • use of MAOI in past 2 wks
      • cerebral palsy
  • caution
    • older adults
    • children
    • severe mental illness
    • Sz disorder
    • CVA
36
Q

interactions with centrally acting muscle relaxants

A
  • ETOH and other CNS depressants: ↑ sedation
  • DM: ↑ insulin or oral antidiabetics for ↑ BG
  • hypertensive crisis: cyclobenzaprine + MAOI
37
Q

peripherally acting muscle relaxants

A
  • use: relax skeletal muscle spasms r/t
    • CVA
    • spinal cord injury
    • multiple sclerosis
    • cerebral palsy
  • prevent and treat malignant hyperthermia
  • prototype: dantrolene
38
Q

MOA for peripherally acting muscle relaxants

A
  • inhibit release of Ca
  • block contraction of muscles
39
Q

SE of peripherally acting muscle relaxants

A
  • muscle weakness
  • drowsiness
  • dizziness
  • diarrhea
  • liver toxicity
40
Q

nursing interventions for peripherally acting muscle relaxants

A
  • assess muscle strength frequently
  • monitor for CNS effects (drowsiness)
    • start oral dantrolene at low doses and gradually ↑
  • monitor for diarrhea, especially early in Tx
  • monitor LFTs
41
Q

administering peripherally acting muscle relaxants

A
  • oral or IV
  • for prophylaxis of MH, orally for 1-2 days before
  • use IV to treat MH
42
Q

pt education for peripherally acting muscle relaxants

A
  • report
    • muscle weakness
    • prolonged diarrhea
  • avoid
    • driving, other activities that require alertness
    • CNS depressants
  • potential liver damage
43
Q

contraindications and precautions for peripherally acting muscle relaxants

A
  • contra: liver dz
  • cardiac dz
  • pulmonary dz
  • neuromuscular disorder
  • pts > 35 yo
44
Q

interactions with peripherally acting muscle relaxants

A
  • estrogen: ↑ risk of liver toxicity in women > 35 yo
  • CNS depressants: ↑ risk of severe sedation
  • IV use: calcium channel blockers ↑ risk for severe cardiac dysrhythmia

2020 Pharmacology I (21 decks)

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