Unit 6 - CNS Flashcards
a disorder that responds well to complimentary and alternative medicine ( CAM)
Anxiety
a perception of a threat to a person’s well-being or security
anxiety
- can be caused by secondary reasons: such as meds (adrenergic agonists)
Type of Anxiety:
- a healthy response
- is not disabling or consistent
- does not require pharmacotherapy
situational anxiety (healthy)
Type of Anxiety:
- panic disorder
- generalized anxiety disorder (GAD)
- social anxiety disorder
- obsessive-compulsive disorder (OCD)
- post-traumatic stress disorder
anxiety disorders (unhealthy)
characterized by them being chronic and interfering with ADL’s
anxiety disorders
Type of Anxiety Disorder:
intense and immediate (fight or flight response), history of 1 month of worrying about having a panic attack
panic disorder
Type of Anxiety Disorder:
have to have spent 6 months or longer with some sort of excessive fear or worry of something in your life
generalized anxiety disorder (GAD)
Type of Anxiety Disorder::
fear of crowds or being ridiculed in public, considered a type of phobia
social anxiety disorder
Type of Anxiety Disorder:
spending at least 1 hour every day either thinking or doing the obsession/compulsion
1. regarding thoughts (obsessive)
2. regarding behaviors (compulsive)
OCD
Type of Anxiety Disorder:
has to do with a previous life experience/traumatic life event, intense feelings of helplessness, have to have occurred longer than a month (ex. sexual assault, natural disasters, war)
PTSD
what determines a sleep disorder
it had to have occurred for 30 days or longer and affecting ADL’s
Type of Sleep disorder:
it takes you longer than 30 min. to fall asleep
sleep-onset insomnia
Type of Sleep disorder:
where a person wakes up in the middle of the night and can’t fall back to sleep
sleep-maintenance insomnia
Type of Sleep disorder:
where a person prematurely wakes up or too early and can’t get back to sleep
sleep-offset insomnia
Type of Sleep disorder:
you’re sleeping at night, but you feel really sleepy throughout the day
non-restorative sleep
there’s some sort of other problem related to insomnia (ex. pain, medications) = you want to try and treat the underlying cause
secondary insomnia
you just fall asleep at the drop of the hat, usually from a stimulus
narcolepsy
T/F: anxiety and insomnia are interrelated
T
nurse’s first choice to treat anxiety & insomia
complimentary alternative method (counseling, yoga, herbal supplements, etc.)
Anxiety/Insomnia Prescription drugs:
drugs that relieve anxiety
anxiolytics
Anxiety/Insomnia Prescription drugs: the class related to relaxation & calming during daytime activities (ex. going in a procedure during the day and need to be relaxed for it)
sedatives
Anxiety/Insomnia Prescription drugs:
they help induce sleep for night time sleeping
hypnotics (etc. ethynol)
nonprescription drugs that are used to treat anxiety & insomnia
antihistamines (diphenhydramine)
drugs used to treat anxiety
- benzodiazepines
- non-benzodiazepines
- antidepressants
prototype for benzodiazapines class
lorazepam
what does “pam” usually indicate
benzodiazepine
FYI: Lorazepam combines with gaba receptors = calms the CNS down = decrease CNS functioning = calms people down and helps them to sleep
:)
What drug:
anti-anxiety, sedation, anesthesia induction and maintenance, seizures (status epilepticus), sedation for mechanical ventilation, alcohol withdrawal symptoms
Lorazepam
should a pregnant girl take Lorazepam
NO!
can Lorazepam cause orthostatic hypotension?
yes
the effect is the opposite of what we intended it to have
paradoxical reactions
Important potential interactions for Lorazepam
increased effect with other CNS depressants
4 important side effects for Lorazepam
- drowsniness
- excessive sedations
- impaired motor coordination
- confusion
Patient teaching for Lorazepam
- don’t take with other CNS depressants (ex. alcohol, other sleeping pills)
- don’t take if pregnant/notify doctor
- keep in a secure place/out of reach of children/med abusers
Nursing considerations for Lorazepam
- aspirate prior to IV injection (cause gangrene if not in vein) , also give very slowly with IV!!
- if pt. is smoker = they will require larger doses
- monitor ambulation
Is diazepam (valium) a prototype
yes
uses for diazepam
- GAD
- seizures
- alcohol withdrawal
What drug:
control anxiety, preoperative sedation, skeletal muscle relaxant, treat status epilepticus
diazepam
contraindications of diazepam
- narrow-angle glaucoma
- pregnancy
- depressed vitals
does Diazepam have similar pt. teachings & nursing consideration as lorazepam
yes
can you take diazepam with food
yes
can you abruptly stop taking diazepam
no, you should ween off of them
antidote to benzodiazepines
flumazenil
does flumazenil have a long or short half-life
short
drugs used to treat insomnia
- benzodiazepines
- non-benzodiazepines
- antidepressents
- barbiturates
FYI: the meds for insomnia tend to reduce REM sleep = allow us to sleep at night, but not as deep as we could get = often tired throughout the day = nurses need to encourage use of non-pharmacologic measures for sleep
:)
is zolpidem (ambian) a diazepine
no, it’s a non-benzodiazapine
is zolpidem a non-diazepine prototype
yes
what is zolpidem used for
sleep/insomnia treatment
nursing considerations for zolpidem
- give right before going to sleep
- avoid giving it with food (food prolongs action)
- pt’s will always be at fall risk when on this med
pt/family teaching for zolpidem
- watch out for sleep behaviors (walking, eating, etc.)
- never take with alcohol/CNS depressents!
- non-pharm measures for sleeping
what is temazepan (resturil) used for
sleep/insomnia
does temazepam have similar characteristics as other benzodiazepines
yes
is phenobarbitol given commonly for sleep
no
T/F: barbituates tend to commit suicide
TRUE!
problem with phenobarbitol
- it’s a barbituate = suicide?
- develops tolerance easily to CNS effects = takes more to help fall asleep (respiratory system doesn’t develop this tolerance = unsafe)
what is phenobarbitol used for
- short-term treatment of insomnia
- seizures
nursing considerations for a patient taking sedative/hypnotics
- give med immediately prior to sleep
- teach family to watch for night-time behaviors (sleepwalking, eating, etc.)
- never take with alcohol
- non-pharmacologic techniques to improve sleep
disease caused by destruction of neurons and there’s anatomical changes within brain and decrease in acetylcholine
alzheimer’s disease
Degenerative brain disease that usually starts with some forgetfulness progressing to minor memory loss and confusion. Unfortunately, the disease progresses to profound irreversible mental impairment. It is not a normal aspect of aging.
alzheimer’s disease
symptoms of what disease:
- increasing and persistent forgetfulness
- difficulties with abstract thinking
- difficulty finding the right word
- disorientation
- loss of judgement
- difficulty performing familiar tasks/ADLs
- personality changes/mood swings
alzheimer’s disease
drugs for the treatment of alzheimer’s disease
indirect acting cholinergics (anticholinesterases)
prototype of indirect acting cholinergics (anticholinesterases)
donepezil (aricept)
T/F: indirect acting cholinergics (anticholinesterases) can stop the progression of alzheimer’s disease
FALSE! They can slow it down, but not stop it
why do we even give indirect acting cholinergics (anticholinesterases)
- improve ADLS
- improve behavior
- improve cognition
what drug:
improved memory, function and behavior through elevating acetylcholine concentration in CNS
donepezil
important adverse effects of donepezil
- GI issues (A, N, V, D, cramping) (because we’re stimulating PNS of ANS)…most will go away with continued use
nursing considerations for donepezil
- monitor for cognitive function (can pt. be responsible enough to take their own meds)
- monitor for GI bleeding, especially if on NSAIDS
- monitor for respiratory function, especially for asthma or COPD pt’s
- walk through ANS (cholinergic = decrease in bronchoconstrition)
- monitor for safety issues/depression
pt. teaching for donepezil
- does not cure/prevent disease, just slows it down
- report GI bleeding
- encourage to take with food/milk to decrease GI upset
a disorder in children ages 4-17, and can last into adulthood. It can lead to difficulties in school, jobs, and interpersonal relationships
ADHD
why do kids usually get diagnoses with ADHD so early in life
because ti’s very noticeable when they start school
2 kinds of meds used for ADHD
stimulants & non-stimulants
are stimulants or non-stimulants more common
stimulants
T/F: stimulants are sympathomimetic drugs
T, so they increase fight or flight = improve alertness & focusing
can ADHD last into adulthood
yes
T/F: non-stimulant drugs are like antidepressents
true
Classification of non-stimulant to treat ADHD
selective norepinephrine re-uptake inhibitor = increase norepinephrine in system
is amphetamine a prototype of a stimulant of non-stimulant
stimulant
uses of amphetamine
- ADHD
- narcolepsy
- weight-loss
drug of choice for ADHD treatment
amphetamine
what drug:
stimulates the CNS to improve alertness, awakeness, mood, and attention. Causes a paradoxical sedation effect in ADHD
amphetamine (dextroamphetamine)
contraindications of ampethamine
- hyperthyroidism = increase HR (drug already increases HR)
- diabetes = increase BS (drug already increases HR)
- bipolar = can potentially throw someone into a manic episode
interactions for amphetamine
- alkaline drugs decrease elimination
- acidic drugs increase excretion
- caffeine increase CNS stimulation
nursing considerations for amphetamine
- assess for therapeutic effects (not toxic), side effects (BP, HR)
pt. teaching for amphetamine
- monitor for med abuse = out of reach
- diabetics: monitor BS
- monitor for adverse effects of insomnia
- can decrease growth in children = monitor growth
- chew gum, drink water for dry mouth
- avoid caffeine
prototype for non-stimulant drug for ADHD
atomoxatine
atomoxatime is only a problem with what other kinds of drugs
highly protein bound drugs
T/F: atomoxatine takes a while for therapeutic affects, fpeak is 1-2 hours, onset 2-4 weeks
T, this drug is similar to antidepressant mechanisms = takes a couple weeks to show alleviation/therapeutic effect of ADHD symptoms
what drug:
improves attentiveness and decrease distraction and forgetfulness
atomoxatine
use of MAOI’s
- MAOI is a type of depressents
- MAOI breaks down norepinephrine = norepinephrine re-uptake inhibitor - excessive norepinephrine
BLACK BOX WARNING for atomoxatine
increase suicidal thoughts
what drugs should you not take with atomoxatine
MAOIs
common side effects of atomoxatine
- headache
- N, V, A
- insomnia
nursing considerations for atomoxatine
- monitor/encourage LFTs
- monitor therapeutic/adverse effects
- black box warning: suicidal thoughts
- monitor CV status, BP, HR
pt. teaching for atomoxatine
- teach what happens when liver gets sick: chronic N&V, jaundice, urine gets darker (brown), stools get lighter (grey)
- make position changes slowly
- know how med will affect them
Q: Which receptors do benzodiazepines work on?
GABA
Q: What is the most common adverse effect of lorazepam and diazepam?
Drowsiness
Q: What should the nurse warn the patient about who has received a new prescription of zolpidem? A. nightmares B. sleep walking and sleep eating C. inability to stay asleep D. bed-wetting
B. sleep walking and sleep eating
Q: Which of the following is NOT a nursing consideration for a patient taking donepezil?
A. monitor cognitive function
B. monitor for depression and anxiety
C. monitor for constipation
D. monitor for GI bleeding, especially with use of NSAIDS
C. monitor for constipation
Q: What is a common adverse effect of donepezil? A. sleepiness B. increased blood sugar C. urinary retention D. nausea
D. nausea
Q: Which is NOT a common adverse effect of amphetamine/dextroamphetamine? A. insomnia B. bleeding gums C. anorexia D. irritability
B. bleeding gums
Q: Which of the following is an important teaching point for patients taking atomoxatine? A. report suicidal thoughts B. report yeast infection of the mouth C. report ringing in the ears D. report joint pain
A. report suicidal thoughts
Q: At what point might a client get diagnosed with an anxiety disorder and be offered treatment with medications?
if the symptoms have been chronic and are interfering with the client’s ability to function
Q: Which of the following is NOT currently used in the treatment of anxiety/insomnia? A. narcotics, such as morphine B. anxyolitics C. antihistamines (diphenhydramine) D. Herbs
a. narcotics, such as morphine
Q: Which medication is used as the antidote for benzodiazepine overdose?
flumazenil
name 2 benzodiazapines
name 1 benzodiazapine antidote
lorazepam, diazepam
agonist: flumezanil
name 4 meds to help with sleep/anxiety
- benzodiazepines (lorazepam, diazepam)
- zolpidem
- temazepam
- phenobrarbitol
name 1 med to help with cognition
cholinergic agonist: donepezil
name 2 meds to help with ADHD
- atomoxatine
- amphetamine (dextramphetamine)
can you abruptly stop taking benzos
NO! They must be weened!
