Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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?
|
bradykinin
|
|
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 |
antiprostaglandins
|
|
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) |
NSAIDS
|
|
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?
|
- PUD
- GI Bleed - impaired renal function (Crt > 2.0) - ASA contraindicated in children |
|
Which four drugs does ASA interact with?
|
- warfarin (Coumadin)
- ETOH - 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?
|
- TINNITUS
- 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 |
True
|
|
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
|
Glucasamine/Chondroitin
|
|
True or False:
It is recommended that patients take ASA and NSAIDS with water and food to minimize GI irritation |
True
|
|
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?
|
Colchine
|
|
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?
|
- CAD
- PVD - HTN - 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?
|
Feverfew
|
|
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?
|
5-20mg/dL
|
|
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 |
True
|
|
Which Antiseizure drug is often used in neonates with seizures?
|
Phenobarbital
|
|
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?
|
Levodopa
|
|
When are dopaminergic drugs contraindicated?
|
- narrow-angle glaucoma
- hemolytic anemia - angina - TIA |
|
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?
|
Levodopa
|
|
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?
|
Decrease:
- 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?
|
Flexeril
|
|
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 |
True
|
|
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
- ADHD - 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
|
Guarana
|
|
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?
|
NSAIDS
|
|
High doses of which vitamin may slow progression of AD?
|
vitamin E
|
|
What is the current DOC for AD?
|
donepezil (Aricept) (well-tolerated)
|