Week 2 & 3 - Nervous System

Question 1

• for Alzheimer’s disease
• prevents the inactivation of acetylcholine (learning); inc acetylcholine = inc cognition
• ADR: syncope
• NC: monitor pt safety/fall precautions; give medication at bedtime (peak); teach pt and caregiver that pt may not remember taking the med due to disease; inc risk of GI bleeding with NSAIDS

Answer 1

Cholinesterase Inhibitor: donepezil

Question 2

• Anti-epileptics (AEDs)
• slows firing activity by inhibiting Na and Ca from returning to the neuron; inc inhibitory effect of GABA to prevent seizure activity
• may give alternate route if NPO with MD order
• very narrow therapeutic range (10-20) > toxicity concerns, esp for older, malnourished
• ADR: gingival hyperplasia, purple glove syndrome
• NC: pregnancy is contraindication; don’t take with milk/antacids (dec gut absorption); steven johnson syndrome (burning feeling) = emergent

Answer 2

AED Hydantoin: phenytoin

Question 3

• for Parkinson’s disease
• combo drg: Carbidopa helps keep the gut from utilizing Levodopa so more can reach the nervous system, remaining neurons uptake Levodopa, convert it to dopamine and use it
• levodopa: synthetic dopamine, give body more dopa
• more dopa for movement
• SE: darkened sweat or urine; orthostatic/postural hypotension
• ADR: dyskinesia (movement disorder - can mean toxicity)
• NC: don’t take with high protein foods (dec absorption)

Answer 3

Dopamine-replacement: carbidopa/levodopa

Question 4

• for ADHD
• CNS stimulant - allows release of norepinephrine and dopamine and block their return to the neuron allowing more to be available to the nervous system; serotonin (happy/sleep) rises
• serotonin syndrome (tachy, inc BP, dilated pupil); opposite effect - ramps up body instead or relax

Answer 4

Amphetamines: dextroamphetamine sulfate

Question 5

dry mouth, blurred vision, odd taste in mouth, lack of appetite

Answer 5

CNS stimulants

Question 6

• for ADHD
• CNS stimulant - blocks reuptake of dopamine so more is available; may also trigger sympathomimetic response
• ADR: neuroleptic malignant syndrome (fever, muscle rigidity, autonomic instability, changes in LOC) w/in few weeks of med
• NC: drg interactions (antidepressants, St. John’s Wort, anti-hypertensive); may worsen pts experienced psychosis; abuse potential

Answer 6

CNS stimulants: methylphenidate

Question 7

• for narcolepsy (selective loss of orexin in hypothalamus which is important for regulator sleep/wake behavior)
• non-amphetamine (inhibit stimulants that speed up body’s system)
• CNS stimulant - improve daytime alertness; obstructive sleep apnea and shift work sleep disorder - inhibits release of GABA; inc release of glutamate
• ADR: agranulocytes (dec neutrophils) - fever, sore throat, flu-like sx
• NC: take on empty stomach to inc absorption

Answer 7

Non-amphetamine: modafinil

Question 8

• for migraine (most migraine pain is from dilatation of middle cerebral artery)
• receptor agonist to induce vasoconstriction
• metabolism through hepatic: give lower doses)
• ADR: higher w/ subq dosing, vasoconstriction leading to HTN, MI, death
• NC: know when was the last dose (drug can’t be stacked or it’ll inc cardiovascular risk); pt c/o chest pain after dose = notify MD, EKG, tele, vital signs; never give IV

Answer 8

Serotonin Agonist: sumatriptan

Question 9

constrict pupils, stimulate saliva, dec HR, constrict airways, stimulate digestive activity, stimulate gallbladder, stimulate activity of intestines, contract bladder

Answer 9

Parasympathetic NS

Question 10

dilate pupil, inhibit saliva, inc HR, relax airways, inhibit digestive activity, inhibit gallbladder, secrete adrenaline/noradrenaline, relax bladder

Answer 10

Sympathetic NS

Question 11

• fight or flight
• produced in stressful situations
• inc HR and blood flow, leading to physical boost hightened awareness

Answer 11

Adrenaline/Epinephrine

Question 12

• concentration
• affects attention and responding actions in the brain
• contract blood vessels, increasing blood flow

Answer 12

Noradrenaline/Norepinephrine

Question 13

• pleasure
• feelings of pleasure, alos addiction, movement, and motivation
• ppl repeat behaviors that lead to dopamine release

Answer 13

Dopamine

Question 14

• mood
• contributes to well-being and happiness
• helps sleep cycle and digestive system regulation
• affected by exercise

Answer 14

Serotonin

Question 15

• calming
• calms firing neves in the CNS
• high lvls improve focus, low lvs cause anxiety
• contributes to motor control and vision

Answer 15

Gaba

Question 16

• learning
• involved in thought, learning, and memory
• activates muscle action in the body
• associated with attention and awakening

Answer 16

Acetylcholine

Question 17

• memory
• involved in learning and memory, regulates development and creation of nerve contacts

Answer 17

Glutamate

Question 18

• euporia
• release during exercise, excitement, and sex
• producing sense of well-being and pain reduction

Answer 18

Endorphins