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140 Cards in this Set

  • Front
  • Back
In the ascending pathway, after substance P is released in the spinal cord, where does it travel?
to the thalamus and then to the cerebral cortex
In the descending pathway which two endogenous "opioid-like" substances are activated to diminish pain?
- enkephalins
- betaendorphins
What is the strongest pain-producing substance?
The experience of pain between administering pain meds
Breakthrough pain
Pain related to tissue injury:

Somatic (bones, joints, muscle)
Visceral (visceral organs)
Nociceptive pain
Pain related to peripheral nerve injury
Neuropathic pain
Which opioid agonist:

produces neurotoxic metabolite with chronic usage, large doses, or renal failure and is contraindicated in Cancer pain.
meperidine (Demerol)
Which opioid agonist:

is used for severe pain and in withdrawal to opiates (i.e. heroin)
methadone (Dolophine)
These drugs Inhibit the release of substance P - thereby inhibiting the transmission of pain signals to the brain
Opioid Agonists - originate from the opium poppy plant
These pain killers bind to opioid receptors in the brain, spine, peripheral tissues; closes "gate"
Opioid Agonists
Which neurological drugs are indicated for:

- abdominal cramping
- pulmonary edema
- unproductive cough
Opioid Agonists
When are opioid agonists contraindicated (use cautiously)?
- resp depression
- chronic lung disease
- liver/kidney disease
- prostatic hypertrophy
- increased ICP
- head injury
- labor
What are some adverse effects to Opioid Agonist use?
- CNS depression
- N/V
- constipation
- papillary constriction
- urinary retention
- euphoria
- cough suppression
What are two life-threatening effects of Opioid Agonists?
- Respiratory Depression
- Sedation
The following are examples of which neurological drugs:

- Codeine
- proproxyphene (Darvon) schedule IV for moderate pain
- oxycodone (Oxycontin)
- methadone (Dolophine)
- tramadol (Ultram)
Opioid Agonist PO drugs
Which opioid agonist drug:

- has minimal risk for dependency/respiratory depression
- not a scheduled drug
tramadol (Ultram)
The following are examples of which neurological drugs:

- Morphine (MS-Contin) prototype
- hydromorphone (Dilaudid)
Opioid Agonist PO/Parenteral drugs
The following are examples of which neurological drugs:

- Heroin (schedule I)
- sublimaze (Fentanyl)
- meperidine (Demerol)
Opioid Agonist Pareteral drugs
Which opioid agonist can be given:

- parenterally
- transdermal (Duragesic patch)
- lozenge (Actiq)
sublimaze (Fentanyl)
Why are opioid agonists contraindicated with increased ICP?
opioid agonists increased CO2 by slowly respirations, this leads to brain vessel dilation, increasing ICP even further
Why must opioid agonists be used with caution in labor?
they may cause respiratory depression of neonate
What important principle applies to Vicodin and Breakthrough pain?
Do not administer Tylenol to a patient on Vicodin with breakthrough pain because it already contains acetaminophen (overdose would strain liver)
Which neurological drug group has a low potential for abuse, and is less likely to produce respiratory depression?
Opioid Agonist/ Antagonist
What important implication applies to the administration of Opioid Agonists/ Antagonists to someone addicted to opioids?
They may precipitate withdrawal symptoms
The following are examples of which neurological drugs:

- pentazocine (Talwin)
- nalbuphine (Nubain)
- butorphanol (Stadol)
Opioid Agonist/ Antagonist
The following are examples of which neurological drugs:

- naloxone (Narcan)
Opioid Antagonist
Which neurologic drug:

competes with opioids for receptor sites in the brain - displacing opioids that are already occupying these sites
Opioid Antagonists
When are opioid antagonists indicated?
- respiratory depression
- sedation associated with opioid administration
What is the onset of action for Narcan?
begins to work within minutes
What important implication concerns Narcan's half-life?
Because of Narcan's short half-life, repeated doses may be necessary (Morphine has a half-life of 3 hours, Narcan's is 1-2 hours)
Prostaglandins are synthesized through the arachidonic acid pathway by an enzyme called ______
cyclooxygenase (COX)
Which neurologic drug:

- suppresses inflammation
- decreases pain
- reduces fever
This enzyme:

- produces prostaglandins in the GI tract that decrease gastric secretion, increase mucus/bicarbonate secretion, & increase blood supply
- produces prostaglandins in the kidneys that cause vasodilation - increase blood flow
- produce prostaglandins (thromboxane 2) that causes platelet aggregation
COX - 1 (good one)
This enzyme:

- produces prostaglandins that are responsible for pain and inflammation
COX - 2 (bad one)
These drugs:

inhibit the synthesis of prostaglandin in both the central and peripheral nervous systems; by blocking prostaglandins adverse effcts of GI bleeding, gastric ulceration, & renal impairment may occur
ASA and NSAIDS [COX 1 & COX 2 inhibitors]
What are some indications for NSAIDS?
- osteoarthritis
- rheumatoid arthritis
- musculoskeletal disorders
- menstrual cramps
- mild to moderate pain
The following are examples of which neurological drugs:

- ibuprofen (Advil)
- naproxen (Naprosyn)
- oxaprozin (Daypro)
- indomethacin (Indocin)
- ketorolac (Toradol)
- nabumetone (Relafen)
Which NSAID:

produces pain relief similar to opioids (i.e. morphine) without the adverse effects associated with opioids.
ketorolac (Toradol)
Why is ketorolac (Toradol) indicated for short-term use (no longer than 5 days)
Due to risks of bleeding
When are NSAIDS & ASA contraindicated?
- GI Bleed
- impaired renal function (Crt > 2.0)
- ASA contraindicated in children
Which four drugs does ASA interact with?
- warfarin (Coumadin)
- glucocorticoids
- ibuprofen
What tx is given for Acute ASA poisoning, in which respiratory depression occurs secondary to acidosis
alkalinizing the urine (this promotes the renal excretion of ASA
What are some symptoms of ASA toxicity?
- fever
- vision changes
- CNS depression
- hyperventilation (associated w/ acidosis)
How soon must ASA be stopped prior to dental care?
7-10 days
Which neurologic drug:

only blocks the synthesis of prostaglandins in the CNS - thereby reducing fever and pain but dose not suppress inflammation?
acetaminophen (Tylenol)
Which neurologic drug:

does not produce adverse effects in the GI tract & kidneys like ASA & NSAIDS
acetaminophen (Tylenol)
Which neurologic drug is indicated for moderate pain without inflammation?
acetaminophen (Tylenol)
What primary disorder is acetaminophen (Tylenol) contraindicated with?
liver impairment (Tylenol is metabolized in the liver)
True or False:

Unlike ASA, acetaminophen (Tylenol) is safe to use in children
What is the max daily dose of acetaminophen for an adult?
4g/4000mg in a 24 hr period
The following are examples of which neurological drugs:

- celecoxib (Celebrex)
- meloxicam (Mobic)
- refecoxib (Vioxx)
COX 2 inhibitors
What are some indications for COX 2 inhibitors?
- osteoarthritis
- rheumatoid arthritis
- acute pain
- dysmenorhheal
What are some contraindications for COX 2 inhibitors?
- GI ulceration/bleeding
- renal impairment
- pregnancy
- allergies to sulfa
What are some adverse effects to COX 2 inhibitors
GI upset
Which drug do COX 2 inhibitors interact with?
warfarin (coumadin)
Which herbal supplement is used to treat athritis
chondroitin from animal cartilage
Which two supplements are often taken together but aren't recommended by the American College of Rheumatology and Arthritis foundation
True or False:

It is recommended that patients take ASA and NSAIDS with water and food to minimize GI irritation
The following are examples of which neurological drugs:

- allopurinol (Zyloprim)
- Colchine
- probenecid (Benemid)
Gout and Hyperuricemia drugs
Which Gout and Hyperuricemia drug prevents or treats clients with increased uric acid; preventing formation of uric acid?
allopurinol (Zyloprim)
Which Gout and Hyperuricemia drug is the DOC for acute attacks of gout?
Which Gout and Hyperuricemia drug increases excretion of uric acid in urine?
probenecid (Benemid)
Concerning Gout and Hyperuricemia drugs:

What is the target range of water intake to prevent kidney stones formed from uric acid?
2-3 quarts
Concerning Gout and Hyperuricemia drugs:

How long must allopurinol be taken to decrease uric acid levels?
1-3 weeks
How often can Colchine be taken for acute gout pain?
q 1 hour, stop if N/V/D occurr
The following are examples of which neurological drugs:

- aalmotriptan (Axert)
- eletriptan (Relpax)
- frovatriptan (Frova)
- naratriptan (Amerge)
- rizatriptan (Maxalt)
- sumatriptan (Imitrex)
- zolmitriptan (Zomig)
Selective serotonin 5-H1 receptor agonists (to treat Migraines)
What is the MOA of selective serotonin 5-H1 receptor agonists?
relieve migraines by constricting vessels
When are selective serotonin 5-H1 receptor agonists contraindicated?
- angina
- MI
- uncontrolled hypertension
What 3 routes is sulmatriptan (Imitrex) given through?
- PO
- SC
- nasal spray
The following are examples of which neurological drugs:

- dihydroergotamine mesylate (DHE 45)
- ergotamine tartrate (Ergomar)
Ergot preparations
What is the MOA for Ergot preparations?
relieves migraines by constricting vessels
When are Ergot preparations contraindicated?
- renal/hepatic disease
- pregnancy
What are the signs of ergot toxicity?
- tingling
- coldness
- numbness
- weakness to arms/legs
What nursing implication applies to administration of SS 5-H1, if an Ergot prep has been given?
Must wait 24 hours after Ergot prep is administered to give SS-5H1
What action do the following drugs have concerning migraines?

- propanolol (Inderal)
- nifedipine (Procardia)
- imipramine (Tofranil)
These are used as migraine prophylactics
What herb is thought to be effective in reducing the incidence and severity of migraine headaches?
What important nursing implication applies to the chronic use of analgesics, triptans, opioids, or ergotamine for migraine tx?
Rebound headaches are more likely to occurr
The following are examples of which neurological drugs:

- phenytoin (Dilantin)
- fosphenytoin (Cerebyx)
- carbamazepine (Tegretol)
- gabapentin (Neurontin)
- lamotrigine (Lamictal)
- levetiracetam (Keppra)
- phenobarbital (a barbituate)
- valproic acid (Depakote)
Antiseizure Drugs
What are the 2 MOAs for Antiseizure drugs?
1) decreasing the movement of sodium and calcium ions into nerve channels

2) potentiation of the activity of certain neurotransmitters such as GABA (an inhibitory neurotransmitter)
What is the drug of choice for status epilepticus
IV benzodiazepines

ex) lorazepam (Ativan)
diazepam (Valium)
Which antiseizure drugs are used to tx bipolar disorders?
- carbamazepine (Tegretol)
- valproate acid (Depakote)
Which antiseizure drugs are used to tx neuropathic pain?
- carbamazepine (Tegretol)
- valproate acid (Depakote)
- gabapentin (Neurontin)
When are antiseizure drugs contraindicated (caution with use)?
- hepatic/renal impairment
- CNS depression
Which antiseizure drug is usually the DOC?
phenytoin (Dilantin)
What implication applies to the administration of Dilantin via IV?
Dilute with NS, give 50mg/min (DO NOT EXCEED)
What is the serum drug level range for Dilantin?
What are some adverse effects of Dilantin use?
- CNS depression
- gingival hyperplasia
- skin rash
What is the pregnancy category of Dilantin?
Pregnancy category X
Which antiseizure drug can be diluted in D5 & NS and given faster than phenytoin, converting to phenytoin in the bloodstream?
fosphenytoin (Cerebyx)
Which antiseizure drug is associated with causing hematologic disorders?
carbamazepine (Tegretol)
What disorder can occur if clients don't maintain good oral care with phenytoin (Dilantin)?
Gingival hyperplasia
True or False:

Anticonvulsants are generally teratogenic
Which Antiseizure drug is often used in neonates with seizures?
The following are examples of which neurological drugs:

- levodopa (Larodopa)
- carbidopa (Lodosyn)
- amantidine (Symmetrel)
- bronocriptin (Parlodel)
- pergolide (Permax)
- pramipexole (Mirapex)
- ropinirole (Requip)
- selgiline (Eldepryl)
- tolcapone (Tasmar)
Dopaminergic Antiparkinsons drugs
What is the general MOA of Dopaminergic drugs?
increase the amount of dopamine in the brain
Which dopaminergic drug replaces dopamine in the brain?
levodopa (Larodopa)
Which dopaminergic drug blocks an enzyme that inactivates dopamine in the striatum?
Monamine Oxidase Inhibitors [MAO-B Inhibitors]

- selegiline (Eldepryl)
Which domaminergic drug triggers the release of dopamine?
amantadine (Symmetrel)
Which dopaminergic drugs stimulate dopamine receptors in the brain?
Dopamine Agonists
- bromocriptin (Parlodel)
- pergolide (Permax)
- pramipexole (Mirapex)
- ropinirole (Requip)
Which dopaminergic drug inhibits metabolism of dopamine in the brain by inhibiting a substance called COMT?
COMT Inhibitors
- entacapone (Comtan)
- tolcapone (Tasmar)
When are dopaminergic drugs indicated?
tx of idiopathic or acquired parkinsonism
Which dopaminergic drug is considered the conerstone of Parkinsons tx?
When are dopaminergic drugs contraindicated?
- narrow-angle glaucoma
- hemolytic anemia
- angina
Why are pts not given straight dopamine instead of levodopa?
because exogenous dopamine cannot cross the BBB, levodopa is converted once it reaches brain
With dopaminergic drug is used in combination with levodopa to prevent the breakdown of levodopa in the intestines and allow more of it to reach the brain?
carbidopa (Lodosyn) - no therapeutic effects when used alone; doesn't cross BBB
What some adverse effects to Levodopa?
- N/V
- dyskinesia
Which dopaminergic drug is the only one that replaces dopamine?
The following are examples of which neurological drugs:

- benztropin (Cogentin)
- diphenhydramine (Benadryl)
- trihexyhenidyl (Trihexy)
Anticholinergic drugs
What is the MOA of anticholinergics as relates to Parkinson's disease?
decrease the effects of aCH, used to treat tremors and muscle rigidity caused by excess cholinergic activity
What symptoms do anticholinergic drugs have on Parkinson's pts?
- salivation
- spasticity
- tremors
When are anticholinergic drugs contraindicated?
- glaucoma
- GI obstruction
- prostatic hypertrophy
- myasthenia gravis
Which mineral supplement should NOT be given with Levodopa?
Fe supplements
When should selegiline (Eldepryl) be given?
Eldepryl should be given in the morning and at noon to decrease CNS stimulation and allow client to sleep at night
The following are examples of which neurological drugs:

- baclofen (Lioresal)
- carisoprodol (Soma)
- cyclobenazaprine (Flexeril)
- dantrolene (Dantrium)
- diazepam (Valium)
- metaxalone (Skelaxim)
- methocarbamol (Robaxin)
- orphenadrine citrate (Norflex)
- rizanidine (Zanaflex)
Skeletal Muscle Relaxants
When are skeletal muscle relaxants contraindicated?
- Caution with CNS depression
- renal/hepatic impairment
- respiratory depression
Which skeletal muscle relaxant is contraindicated with CV disorders?
What is the side effect to skeletal muscle relaxant use?
CNS depression
Which skeletal muscle relaxant is available PO & intrathecal implanted pump
baclofen (Lioresal)
Which skeletal muscle relaxant is also used to treat malignant hyperthermia?
dantrolene (Dantrium)
True or False:

skeletal muscle relaxants may be given with milk or food to diminish GI upset
Why can IV diazepam (Valium) only be mixed with NS?
Valium precipitates with other fluids
The following are examples of which neurological drugs:

- amphetamine
- dextroamphetamine (Dexedrine)
- amphetamine mixture (Adderall)
- methylphenidate (Ritalin, Concerta, Metadate)
CNS stimulants [Amphetamines]
What is the MOA of CNS stimulants?
promote the release and inhibit reuptake of norepinephrine and dopamine in the brain
What are some expected effects of CNS stimulant [Amphetamine] use?
- euphoria
- increased mental alertness & capacity for work
- decreased fatigue
- prolonged wakefulness
What are some indications for CNS stimulant [Amphetamine] use?
- narcolepsy
- caffeine (a xanthine derivative used in NoDoz and as a respiratory stimulant in neonates)
What are some contraindications to CNS stimulant [Amphetamine] use?
- CV disorders
- anxiety
- agitation
- glaucoma hyperthyroidism
- Hx of drug abuse
What are some side effects of CNS stimulant [Amphetamine] use?
- stimulate SNS
- CNS stimulation
- restlessness
- hyperactivity
- agitation
- nervousness
- difficulty concentrating
- confusion
- overdose can induce convulsions/psychotic behavior
What schedule are Amphetamines and amphetamine related drugs?
Schedule II
Which CNS stimulant is indicated for treatment of ADHD?
atomoxetine (Strattera)
What herbal CNS stimulant, originating from South America with caffeine as its main ingredient is falsly thought to aid in weight loss
What should be monitored in children taking amphetamines for ADHD?
weight loss
The following are examples of which neurological drugs?

- donepezil (Aricept)
- rivastigmine (Exelone)
- tacrine (Cognex)
- galantamine (Reminyl)
Cholinesterase Inhibitors (Alzheimers medications)
What is the MOA of cholinesterase inhibitors?
they prevent the breakdown of acetylcholine by acetylcholinesterase; increasing the availability of acetylcholine at cholinergic synapses
When are cholinesterase inhibitors indicated?
- Mild to moderate symptoms of Alzheimers disease

- Slow the progression of AD but does not cure it
What is the side effect of cholinesterase inhibitors?
Cholinergic effects
The following are examples of which neurological drugs?

- memantine hydrochloride (Namenda)
N-methyl-D-aspartate Receptors (NMDA) Antagonist
What is the MOA of NMDA antagonists?
blocks NMDA receptors which, when activated by the excitatory amino acid glutamine, is thought to contribute to AD
Research has indicated that long-term use of which drugs may help protect against AD?
High doses of which vitamin may slow progression of AD?
vitamin E
What is the current DOC for AD?
donepezil (Aricept) (well-tolerated)