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163 Cards in this Set

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CNS meds are used for what (medical purposes)?
Tx of psychiatric disorder, suppression of seizures, relief of pain, and production of anesthesia.
CNS meds are used for what (nonmedical purposes)?
stimulant, depressant, euphoriant, and other "mind-altering" abilities.
How many compounds are there in the CNS that serve as neurotransmitters (thought not proved)?
21 compounds.
How long does it take for CNS drugs to work in the body?
Doesn't work initially must work up in the body and brain b4 therapeutic effects kick in. So sometimes months.
The BBB does what in the CNS?
impedes entry of drugs into the brain - not fully developed at birth.
What are some initial side effects of CNS drugs?
n/v and muscle aches. Go away with time.
Production of psychotherapeutic drugs were what?
"happy accidents"
What happens to side effects after continued use of CNS drugs? Tolerance? Physical dependence?
Side effects are decreased along with tolerance being increased and physical dependence being increased
What drugs have more severe withdrawal symptoms? PNS or CNS drugs?
CNS drugs.
What is the Pathophysiology of Parkinsons disease?
damage to the extrapyramidal system.
Parkinsons disease is a what disorder?
Progressive chronic neurologic disorder. There is NO CURE!
Parkinsons happens generally in what age group?
Usually 60+ but can happen at any age. Rare in people younger than teens.
Over time Levadopa does what? Why is Carvadopa used with Levadopa?
becomes ineffective. It imporves the amount of Levadopa that is absorbed by the body.
What is the purpose of Dopaminergics (Levadopa/Carvadopa) if it doesn't treat Parkinsons?
They help with the improvement of ADLs and are monitored for the best therapy possible.
What is the word for movement disorders?
dyskinsias.
What is the Progression of Parkinsons disease? (6)
1. Lack of coordination 2. tremors 3. rigidity/weakness 4. bradykinesia 5. drooling/speech 6. mask like expressions
What is the symptom that is usually how Parkinsons is diagnosed?
tremors
When is Parkinsons not really noticable?
With intended movement but will shake otherwise.
What other problems do people with Parkinsons have? trouble walking? what?
Trouble maintaining posture and may fall forward.
What are some theories as to what causes Parkinsons? (6)
1. Viral infection 2. head injury 3. atherosclerosis 4. exposure to certain drugs 5. environmental factors 6. mitochondrial dysfunction
What are the most troubling effects of Parkinsons?
Dyskinesias
What drugs are they talking about when they say a theory about the cause of Parkinsons is exposure to drugs?
Many psych drugs.
What type of drug is Amantadine and what is it used for?
DA releasing agent. Can help with Levadopa Induced Dyskinesias
What type of dysfunction is associated with Parkinsons disease?
ACh and DA dysfunction
How long does it generally take Levadopa/Carvadopa and other Dopaminergics not to be therapeutic anymore for Parkinsons?
5 years.
Can dopamine cross the BBB?
No, hence the use of dopaminergics converting into dopamine after passing the BBB.
How long do therapeutic effects with Levadopa tend to take effect after starting on the med?
several months. Should question the diagnosis of Parkinsons if don't react to Levadopa.
What does Carbidopa help with when taking Levadopa as well?
effectiveness b/c it helps the body use Levadopa more readily and it also helps with n/v.
What is the trade name for Carbidopa?
Cinament.
What drug interactions are to be considered with Levadopa?
MAOIs (can cause hypertensive crisis), MAOBs (stop atleast 2 weeks b4).
What are some adverse effects to look out for in Dopaminergics?
anxiety, nervousness, n/v, orthostatic hypotension, benign darkening of urine & sweat, dyskinesias, headache, blurriness, arrhythmias, drooling, psychosis, hypotension.
What food interactions are involved with Levadopa?
high protein diet should be avoided b/c it interferes b/c of amino acids.
What are the trade names for Levadopa and Carbidopa combined?
Sinemet & Paracopa.
Dopamine Agonists what do they do alongside dopaminergics?
Can decrease amount of Levadopa needed therefore decreasing dyskinesias from Levadopa & increases amount of time Levodopa is available.
Some AE of Dopamine agonists?
Hallucinations, daytime sleepiness, and postural hypotension.
What do COMT inhibitors do for dopaminergics?
allow a larger amount of Levadopa to reach the brain.
What are some examples of COMT inhibitors? Only used with Levadopa NOT ALONE!
entacapone and Comptan along with (entacapone+levadopa+carbidopa=stalevo)-not for people who need more flexibility in regimen
MAOB inhibitors what are some examples?
resagiline (caution in liver impaired and increases risk of malignant melanoma- caution with levadopa) and selegiline (2nd or 3rd line drug for PD MAY DELAY DISEASE PROGRESSION! Avoid foods with tyramine)
What do MAOB inhibitors do?
Used in early stages of PD for mild tremors. Delay dyskinesias or with severe.
What do Centrally Acting Anticholinergic Drugs do for PD?
Help alleviate symptoms (usually in younger) that happen when there's an imbalance - LESS EFFECTIVE THAN LEVADOPA! NO ELDERLY - confusions, hallucinations.
What are some examples of Centrally Acting Anticholinergic Drugs?
trihexphenidyl (Artan) & benztropine (Cogentin)
What are some Nursing Considerations when thinking about PD?
Assess motor symptoms & ADL interference. Caution in Pts with cardiac disease and psych disorders. Do not abruptly stop!
What are some examples of Dopamine Agonists?
Pramipexole (can promote compulsive disorders- used in early PD or with Levadopa in advanced PD)!! ropinirole and apomorphine. (PD). cabergoline and bromocriptine as well. Tolcapone is also used for PD but AE are more SEVERE! liver failure and even death!!! ONLY when other drugs don't work.
Antiepileptic Agents... What are some kinds of seizures (seizure generation) (5)?
1. tonic clonic 2. absence seizures 3. myoclonic seizures 4. febrile seizures 5. status epilepticus
Which one is the most severe if not treated right away and if noone is with that person?
Tonic clonic.
What are some causes of seizures? What are these called?
injury, drugs, and environmental exposure, congenital defects, and cancer. 2ndary seizures.
What happens physiologically when a seizure is happening?
excessive electrical energy from neve cells within the brain.
Some description of the types of seizures...
Petit mal (Tonic Clonic) 3-5 seconds. Myoclonic (2ndary)sparatic muscle spasms. Febrile - self limiting, high fever. Status epilepticus- can last long 30min. can die generally if someones not with.
Most severe seizure?
Status epilepticus
What is the difference between simplex partial and complex partial seizures?
simplex partial - motor function delayed (staring) in children too.... complex-impairment of location. UNRESPONSIVE. ask their name.
What are some drugs used for Antiepileptic phases?
Hydantions is the group of drugs Phenytoin (Dilantin) being the prototype & Depakote
What is the significance of Hydantoins? What does it do physiologically?
It was the first drug to suppress seizures without depressing the entire CNS! they stabalize nerve cells.
Use for Phenytoin?
Tonic clonic seizures and partial seizures.
What are some AE of Phenytoin?
ataxia, dysarthria, slurred speech, dizziness, headache, fatigue, dermatitis, gum overgrowth, cardiac dysrhythmias and hypotension.
Some drug to drug interactions with Phenytoin?
antacids decrease absorption, tube feeding, alcohol. increases metabolism of carbamazepine, oral contraceptives, and coumatin. INCREASES LEVELS OF PHENYTOIN - Flucanazole, Prozac.
What is Carbamazepine (Tegretol) & Lamotrigine (Lamictal) used for besides seizures?
Bipolar disorder
Carbamazepine (Tegretol) is indicated for what types of seizures?
refractory seizures (partial seizures) and tonic clonic seizures.
What are some AE that come with Carbamazepine (Tegretol)? Drug to drug interactions?
ataxia, vertigo, headache, dizziness, anemia, n/v, sleepy, bld disorders, Stevens Johnson Syndrome....NO IN PREEXISTING HEMATOLOGIC DISORDER PTS! Alcohol, phenobarbital and grapefruit juice.
Succinimides (another antiepileptic) what is the prototype?
Ethosuxamide (Zarontin)
What are the types of seizures Ethosuxamide (Zarontin) helps with?
absent seizures ONLY. Few AE & No alcohol with use. n/v can be controlled with food with administration.
Some Newer Antiepileptic Drugs? What is one of them?
Lamotrigine (Lamictal)
What is Lamotrigine (Lamictal) used for? what kind of seizures? What besides seizures?
Broad spectrum agent - partial, generalized, absent, tonic clonic, myoclonic.. Bipolar.
What are some AE of Lamotrigine (Lamictal)?
life threatening rash (DISCONTINUE IMMEDIATELY) n/v, headache, dizziness, Stevens Johnson Syndrome, blurred vision, sm risk of cleft lip or cleft palate in fetus.
Other drugs for treating absence seizures?
Valproic Acid (Depakene or Depakote). NO IN PTS WITH PREEXISTING LIVER DYSFUNCTION!
Some AE of Valproic Acid (Depakene or Depakote)?
pancreatitis, hepatotoxicity, GI effects, sedation..
What is Valproic Acid essentially used for?
Absence seizures but also used widely for all major seizure types along with bipolar and prevention of migraine.
Drug to drug interactions of Valproic acid (Depakene or Depakote)?
phenobarbital, phenytoin - toxicity may result and topamiramate.
(2) Benzodiazepines in Seizure?
1. Diazepine (Valium) and 2. Clonazepam (Klonopin).
Nursing considerations when considering seizure meds?
Blood counts, ADLs interfered, teach Pt and family.
Definition of Pain?
Sensory and emotional experience associated with actual or potential tissue damage. Whatever Pt believes it is.
Drugs used to relive pain? What categories - not specific.
Narcotics, opiod receptors/ narcotic agonists.
what do some of these include?
morphine, fentanyl, codeine, oxycodone, and propoxyphene.
Starting with Opiod/Narcotic Agonists PO IM SubQ IV epidural..?
Morphine.
Some AE of Morphine?
neurotoxicity, sedations, miosis, euphoria, dysphoria, emesis, elevation of intraocular pressure, respiratory depression, constipation, ortho hypo, urinary retention, cough suppression, biliary colic, hallucinations (NO IN PTS WITH GALLBLADDER PROBLEMS)
What are the Indications for Morphine?
relief of severe, acute, or chronic pain, analgesic but not in cardiac pts.
Drug to drug interactions with morphine?
phenothiazines, MAOIs, barbituate general anesthetics, CNS depressants, and hypotensive drugs.
Toxicity with Morphine? treatment.
antagonist ordered when 8 or below respiratory rate.
Opiod Agonists - Antagonist some examples?
Pentazocin (Talwin)
What is the use for Pentazocin (Talwin)?
adjunct for general anesthesia or pain during delivery.
Caution in who when taking Pentazocin (Talwin)?
Hx of CAD and acute MIs.
Compare Pentazocin (Talwin) to Morphine... which ones safer? why?
Pentazocin b/c it has less abuse potential.
drug to drug interactions with Pentazocin (Talwin)..?
barbitual and general anesthetics increase effects of ortho hypo and increase sedation.
What are some AE of Pentazocin (Talwin)?
withdrawal, increased cardiac work, CV effects, acute MI, Resp. depression, headache, hallucinations, urinary retention/spasms.
Opiod/Narcotic Antagonists? some examples? What can it do?
Naloxone (Narcan).. reverse most effects of opiod agonists including resp. depression, coma and analgesia. Also used for relief of opiod induced constipation and reversal of postop opiod effects.
Nursing Considerations when talking about Opiod/Narcotic Antagonist and Agonists?
Pt may falsify pain. chk BP, RR, HR, all b4, 30 min after, and 1hr after. Keep assessing!!
What are some AE of Naloxone (Narcan)?
acute narcotic abstinence syndrome, n/v, sweating, tachycardia, decrease in BP, hypotension, hypertension, and pulmonary edema.
When considering Pentazocin (Talwin) against Morphine again..
Pentazocin may have less abuse potential than Morphine but Pentazocin is much less effective against pain than morphine!
Drugs for headache. Not always drugs needed. What option first?
quiet room, cold cloth, little interruptions.
When taking headaches into consideration what do you do first? Thinking about meds.
1st work on preventative then abortive therapy and nondrug measures.
Abortive Therapy - primary used for this (MED)?
NSAIDS. like Excedrin Migraine or aspirin with metochlopramide.
Another abortive therapy that needs prescribed. ?
Sumatriptan (Imatrex)
Opiod Analgesics if headache is severe include?
Meperidine (Demerol) & butorphanol nasal spray (Stadol MS) --- preferred.
Migraines are caused by what? Vasoenlargement? Vasoconstriction?
Vasoenlargement.
Serotonin Receptor Agonists - Triptans..
Sumatriptan (Imatrex) SubQ PO or inhalation.
What are the indications for Sumatriptan (Imitrex)?
acute migraine, treatment of cluster headaches.
What are some AE of Sumatriptan (Imitrex)?
dizziness, vertigo, weakness, myalgia, BP alterations, tightness or pressure in chest, tingling, burning sensations, numbness, coronary vasospasm.
Precautions with Sumatriptan (Imitrex)?
elderly, CAD, Ergot cont. drugs, MAOIs (no within 2wks) and prego.
Nursing considerations with Opiod analgesics or opiod antagonists?
Baseline! Other drugs? what works? quiet, no disturbance, side rails up, LABS, pain level, discussion.
What are psychotherapeutic agents not used for?
Not in elderly Pts for the treatment of dementia.
What is Haldol referred to as? Used in Pts with what symptoms?
chemical restraints. elderly-aggitated, schizo, hyperactivity, combative.... etc.
What happens to people with schizophrenias brain matter after time?
it decreases. decreasing the ability to comprehend reality.
What are some symptoms of schizo? "within own mind"
disordered thinking, learning and memory, decreased attention, exaggeration of normal function, no motivation, lack of hygiene, socially withdrawn, speech abnormalities, hallucinations, delusions, aggitated, tense, paranoia.
What is cause of schizo?
biochemical abnormality -genetic.
Schizo is a brain disease there is a how many yr increase in brain deficit?
5 yrs so (-20%).
Classifications of Antipsychotic drugs? (2) What are the prototypes?
Typical-Haloperidol and Atypical - Clozapine (fewer neurological effects/depression).
What are some AE of Haloperidol?
hypotension, anticholinergic effects,.. early EPRs, rare-convulsions, and impotenence. Risk of serious dysrhythmias.
Types of Extrapyramidal effects that are associated with the use of antipsychotics?
pseudoparkinsonism, dystonia, akathisia, tardive dyskinesia, neuroleptic malignant syndrome -SERIOUS! rigid hi fever in/out conciousness, coma, BP up and down.
Clozapine (Clozaril) AE?
fatal aganulocytosis, psychosis, sedation, weight gain, ortho hyp, dry mouth, blurred vision, urinary retention, constipation, and tachycardia. Low risk of EPRs.
What should you do when treating someone with antipsychotics? Nursing considerations
Monitor WBC & ANC... NO IN DEMENTIA PTS! Don't use with other drugs that can suppress bone marrow function.
Some AE of antipsychotic/neuroleptic drugs in general?
sedation, weakness, tremors, drowsiness, EPRs, dry mouth, nasal congestion, constipation..
Contraindications for antipsychotic/neuroleptic drugs?
CNS depression, circulatory problems, PD, bone marrow suppression, CV disease, severe hypotension (60/40), seizure disorders, and diabetes.
Drug to drug interactions in antipsychotic/neuroleptic drugs in general?
beta blockers, alcohol, CNS depressants, mesoridazine, and thioridazine & anticholinergic agents unless prescribed.
Nursing considerations...
Baseline. Talk with Pt when? etc. check on Pt, Teach to stay on and make sure they get and take meds.
Affective disorder vs Depression
Affective disorder - ups and downs and Depression is long lasting severe and long lasting sadness.
Physical symptoms of depression are?
no sleep - too much sleep, decrease in ADLs, decrease in energy/appetite.
Diagnosis of depression needs to include what?
more than 5 symptoms, last more than 2 wks, and a change from previous level.
Actions of antidepressant therapy?
inhibits effects of MAO, neurotransmitters and regulation of receptor sites. increases serotonin and norepi amts.
Classifications of Antidepressants?
Tricyclic antidepressants (depression and bipolar), MAO inhibitors, & selective serotonin reuptake inhibitors
Drug to drug interactions with antidepressants?
monoamine oxidase inhibitors, sympathomimetic drugs, and CNS depressants.
Drugs of ez. kind? TCAs? SSRIs?
TCAs imipramine(Tofranil) & SSRIs Fluoxetine(Prozac) ---very popular.
AE of TCAs?
sedation, ortho hypo, CV effects,seizures, anticholinergic effects, cardiac toxicity, may increase risk of suicide, sedation, seizures, hypomania.
What are some precautions in TCAs? --imipramine (Tofranil).
CV disease, angloglaucoma, urinary retention.. drug.. MAOIs, Some GI meds, another antidepressant, and oral anticoagulants.
Indications for SSRIs Fluoxatine (Prozac) besides depression?
OCD, panic disorders, bulemia, PTSD, social phobias..
AE of SSRIs? drug to drug?
nausea, agitation, insomnia, sexual dysfunction. Avoid MAOIs and other Serotonergic drugs, TCAs, Lithium & monitor warfarin closely. NO IN IMPAIRED RENAL OR HEPATIC FUNCTION!
What can TCAs MAOIs and SSRIs also be used for besides depression?
eneuresis.
Serotonin/Norepi Reuptake Inhibitors?
duloxetine (Cymbalta).
Indications for duloxetine (Cymbalta)?
antidepressant, decrease pain, generalized anxiety disorder, fibromyalgia.
AE of duloxetine (Cymbalta)?
increase in BP, medriasis, nausea, dry mouth, insomnia.
Precautions in duloxetine (Cymbalta)?
narrow angloglaucoma, and alcoholics.
drug to drug in duloxetine (cymbalta)?
alcohol, MAOIs (stop 2wks b4), other SSRIs. .. Has advantage over SSRIs.
MAOI examples? USUALLY LAST SOURCE FOR DEPRESSION!!! Risk of hypertensive crisis! USES?
Isocarboxazide (Marplan), Phenelzine (Nardile) and Tranylcypromidine (Parnate). For use in atypical depression, bulemia, OCD
Food interactions with MAOIs?
tyramine containing foods like veg. cheese, alcohol, dairy etc.
drug to drug for MAOIs?
Avoid OTC and Rx agenst not approved by prescriber!
AE of MAOIs?
CNS stimulation, anxiety, insomnia, agitation, mania, ortho hypo, hypertensive crisis from dietary tyramine.
Nursing considerations for antidepressants?
Baseline> Hx for med reason, how working? Teach AE. Dont mix meds! discuss risk of suicide (just beg) Serotonin syndrome. LABS, assessments.
What are the characteristics of Bipolar?
extreme times of depression (no sleep, eat, guilt, suicidal thoughts) to hyperactivity almost to mania(talk fast, decrease in sleep) fast and disruptive. Affects social behavior and unwise financial decisions.
What is the cause of Bipolar?
biochemical imbalance/unstable neurons - disruption in neuronal growth. inability to reestablish stability.CAN ACHIEVE STABILITY c Meds.
Drugs for Bipolar?
Lithium, Valproic Acid, Carbamazepine, Velbutrin.
Mood stabalizers for bipolar?
lithium, valproic acid, carbamazepine.
Lithium is used for what?
Bipolar yes. but what for in it? maintenance therapy, depression, migraine, alcoholism. WATCH FOR DEHYDRATION. LABS
Nursing considerations with lithium and other bipolar meds?
how long? use to episodes? control or no? can be with meals.
AE of lithium?
GI upset, polyuria, nocturia, thirst, renal toxicity, decrease in WBCs, goiter, hypothyroidism, teratogenesis.
Contraindications in lithium? drug to drug?
renal and cardiac disease, bld discrasias, prego, lactating. ... No diuretics, NSAIDS (switch to acetaminophen) carbamazepine, haloperadole increases toxicity.
Lamotrigine (Lamictal) is also used as a biplar agent? tell me about it..
alone or with other mood stabalizing agents AE: headache, dizziness, double vision, (rare) life threatening rashes.
Sedative Hypnotic drugs?
Benzodiazepines --- (Valium) diazepam.. Benzodiazepine like drugs ---- lorazepam (Ativan) & alprazolam (Xanax).
What do these do?
reduce anxiety, promote sleep, and induce muscle relaxation.
some indications for sedative hypnotic drugs?
aggitation, hyperexitability, preop, alcohol withdrawal, anxiety disorders, muscle spasms.
precautions in sedative hypnotic drugs?
allergy, acute narrow angloglaucoma, shock, acutely intoxicated, pregnancy, psychosis.
AE in sedative hypnotic drugs?
anticholinergic effects, sedation, drowsiness, depression, lethargy, blurred vision, confusion, dry mouth, constipation, n/v, hypotension, urinary retention.
Another Sedative Hypnotic drug type..
Barbiturates (long lasting).. Phenobarbital (Solfoton, Luminal) .. can induce coma, hypnosis, seizures, sedation... etc.
Some AE in Phenobarbital?
CNS depression, drowsiness, sedation, physical dependence, vertigo, ataxia, n/v, constipation, Resp, depression, suicide. HI ABUSE POTENTIAL!
drug to drug interactions and contraindications in phenobarbitals?
alcohol, antihistamines, phenytoin, MAOs, anticoagulants, digoxxin, corticosteroids.... No in hepatic or nephritis impairment, Resp distress/dysfunction!
diazepam (Valium) should be used with caution in? and What's severe even at therapeutic levels?
COPD, OSA, liver disease, and snoring Pts... Severe in IV can cause hypotension, resp arrest, cardiac arrest.
Benzodiazepine like drugs? examples?
Zolpidem, Zaleplon, and Eszopiclone - highly effective hypnotics. 1st 2 short term Tx of insomnia 3rd no time limit for insomnia.
CNS stimulants.. ADHD..
Amphetamines, Amphetamine mixture, and Ritalin, Adderall, Adderall XXR, Concerta...
To be diagnosed you have to present what for ADHD?
6 symptoms for 6 mo. in 2+ settings.
Problems with ADHD?
problems in school, home, relationships in child or adults. Tx with stimulants, CNS stim, and behavioral modification techniques. inattentive, easily distracted, miss details, forget, switch activities frequently, cant focus, get bored fast..
AE in CNA stimulants?
CNS stimulation, weight loss, and CV effects, headache, blurry vision, nervousness, insomnia, restlessness, dysrhythmias, chest pain, hypertension, psychosis, paranoia, halllucinations.
CNS stimulants? example..
methophenadate (Ritalin),---abuse/tolerance potential. NO CAFFEINE.
Downside of CNS stimulants?
cannot elevate mood without affecting other CNS functions - not like antidepressant..
CNS stimulants can also be used for what besides ADHD?
narcolepsy.
Do not give CNS stimulants to which Pts?
Pts already with anxiety, aggitation, tense, CV conditions, seizure disorder, or drug dependency, prego.. DONT STOP ABRUPTLY! limit or no caffeine. give in evening.
Drug to drug interactions with CNS stimulants?
anticonvulsants, phenobarbituates, phenytoin, premadone, coumadin, SSRIs, TCAs, MAOIs(2wks after), mthophenadate.