Neurologic And Psychiatric

Front 1

acetylcholine

Back 1

main NT of the parasympathetic nervous system. the levels of this NT decreases in pts with Alzheimer's disease.
- binds to cholinergic receptors (muscarinic and nicotinic).
- decrease in ACh receptors in myesthenia gravis
- C. botulinum toxin blocks ACh release therefore causing paralysis.

Front 2

norepinephrine

Back 2

"fight or flight" monoamine released by the adrenal medulla.
- catecholamine released by nerves in the sympathetic branch of the ANS.
- cocaine and amphetamines increase release of this, block reuptake of this, and inhibit MAO, causing overstimulation of postsynaptic neurons.
- decrease in this with depression

Front 3

Dopamine (DA)

Back 3

MOA associated with reward mechanisms in the brain, motor activity, mood, memory, cognition.
parkinson disease results from destruction of _ secreting neurons
- drugs used to increase secretion of this is associated with onset of schizo
- increase with alcohol, nicotine, cocaine, opium, heroin.

Front 4

serotonin

Back 4

MOA involved in mood, appetite, sleep induction, emotion.
- LSD and ecstasy attach to __receptor sites causing psychomimetic effects (causing hallucinations).

Front 5

too little serotonin

Back 5

depression, decrease in anger control, OCD, decrease in appetite control (especially starchy foods), difficulty sleeping

Front 6

too much serotonin

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schizophrenia results in elevated ___

Front 7

GABA

Back 7

gamma-aminobutyric acid

Front 8

GABA

Back 8

most neurons in the CNS have GABA receptors.
- major inhibitory neurotransmitter: acts like a break to excitatory NT that lead to anxiety - people with too little ___ tend to suffer from anxiety disorders.

Front 9

GABA

Back 9

important in preventing over-excitability or stimulation such as seizure activity.

Front 10

increased GABA activity

Back 10

barbiturates and benzodiazepines.

Front 11

glutamate

Back 11

most common excitatory NT
- learning and memory
- amyotrophic lateral sclerosis (ALS): excessive production of this
- one mechanism of brain damage when this becomes a neurotoxin
- possible role in schizophrenia and Alzheimer's disease

Front 12

Drugs that act as CNS stimulants

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amphetamines, amphetamine-like drugs (Ritalin, Concerta), analeptics

Front 13

analeptics

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produce generalized stimulation on brain and spinal cord, causing decrease in fatigue and increase repsonsiveness to external stimuli; stimulates breathing (caffeine, theophylline)
- anorexiants (control of suppress appetite)
- anti-migraine drugs (ergot alkaloids, serotonin receptor agonist)

Front 14

ADHD

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involves dysregulation in neuropathways that utilize 5HT, NE and DA.

Front 15

ADHD

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characterized by: intelligence not affected, hyperactivity, inattentiveness, impulsivity
Dx: before age 7 s/s must last for at least 6 months
- most children with __ respond well to pharmacological treatment, usually methylphenidate.

Front 16

methylphenidate (Ritalin)

Back 16

increase wakefulness and alertness, decrease fatigue, elevates mood, augments self-confidence and initiative, euphoria, talkativeness, increase motor activity, decrease appetite, weight loss, actions of NE: increase respirations, increase heart rate, increase force of cardiac contraction, vasoconstriction, tachycardia, dysrhythmias, HTN, anginal pain.

Front 17

methylphenidate (Ritalin)

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nursing considerations: baseline assessment, monitor for therapeutic and adverse effects, additive effect with other CNS stimulants, MAO inhibitors and ephedra increase effect --> hypertensive crisis.
- caution in pts with HTN, seizure disorder, history of drug dependence, give 30-45 min. before meals, do not give drug in late afternood or evening, prolonged use: monitor CBC, monitor weight/height of child, pt teaching for parents and child, counseling must be utilized in conjunction with medications (the stimulant decreases negative behavior, but does not produce positive behavior).

Front 18

cluster headaches

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unilateral non-throbbing pain; often around eye occur in a series of clusters (one or more per day), onset during sleep.
- duration: 15-90 minutes/episodes

Front 19

tension headaches

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dull band of pain around the entire head, onset during time of stress, duration 30 mins - 7 days/episode.

Front 20

migraine headaches

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migraines afflict about 30 million people in US.
- may occur at any age. usually begin between the ages of 10-40. diminishes after age 50. some ppl experiences several a month, while others have only a few migraines throughout their lifetime. approximately 75% of __sufferers are women. (more than just a headache), pain is accompanied by N/V, photophobia, phonophobia, osmophobia, sleep disruption, duration 4-72 hours/episode.
PHASES: prodrome, aura, H/A, resolution, recovery (not all migraines are associated with aura).

Front 21

patho of migraine headaches

Back 21

neurovascular disorder, inflammation and dilation of cerebral blood vessels, plasma 5HT reduced, blood vessels press on nerves, release of substance-P (a NT involved in pain transmission), possible genetic link and numerous triggers

Front 22

migraine triggers

Back 22

environmental factors (weather, altitude, time zone changes), foods that contain tyramine (aged cheese, red wine), nitrates, phenylethylamine, monosodium glutamate, aspartame, caffeine
anxiety, stress, hormonal changes in women, hunger, lack of sleep, fatigue, perfume, fragrances, flickering lights, glare

Front 23

sumatriptan (imitrex)

Back 23

triptan; selective 5HT receptor agonist; antimigraine.
- indications: abort acute migraine, treat cluster headaches.
- routes: intranasal, PO, SQ
MOA: selective stimulation of a sub-group of 5HT receptors found in small, peripheral nerves that innervate intravasculature--> intracranial vascular constriction
- prevents release of inflammatory neuropeptides --> decrease perivascular inflammation, relief of migraine pain associated symptoms
SE: generally well-tolerated, some pt. experience unpleasant chest symptoms, "heavy arms" or "chest pressure" (transient and not related to ischemic heart disease)
- coronary vasospasm (rare): EKG changes have been observed in pts with CAD, other effects: vertigo, malaise, tingling, intranasal formulation has a bad/unusual taste.

Front 24

sumatriptan (immitrex)

Back 24

nursing considerations: baseline assessment, monitor for therapeutic and adverse effects, pts should be forewarned of "chest" side effects; unusual taste of nasal preparation, do not give to pts at risk for CAD until CAD has been ruled out; contraindicated in pts with history of MI, uncontrolled HTN, TIA, stroke.
- additive effect if given with ergot alkaloids or other vasoconstrictive medications
- MAO inhibitors suppress degradation of ____
- teratogenic: avoid during pregnancy
- pt teaching for intranasal and SQ administration

Front 25

CNS depressants

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barbiturates
- sedative-hypnotic drugs depress CNS function
- agents that cause sedation result in diminished physical and mental function
- agents that promote sleep are called hypnotics

Front 26

Barbiturates

Back 26

phenobarbital

Front 27

phenobarbital

Back 27

barbiturate, sedative-hypnotic, anticonvulsant
- route: PO, IM, IV
indications: seizure prophylaxis, first-line drug for management of status epilepticus, mild sedative to relieve anxiety and insomnia (although benzo are favored)
MOA: potentiates the effects of GABA and mimics the effects of GABA in the CNS.
therapeutic effects: suppression of seizures, depression of CNS activity, sedation, relief of anxiety.

Front 28

phenobarbital

Back 28

side effects: drowsiness, lethargy, vertigo, sedation
- causes sedation through actions on the RAS
- although phenobarbital causes sedation, it suppresses seizures at doses that produce only moderate CNS disruption
- tolerance to sedation develops if taken long-term for seizure prophylaxis
- respiratory depression, death by OD, potential for dependence and addiction, paradoxical CNS hyperactivity (children), depression (adults), agitation/confusion (elderly).

Front 29

phenobarbital

Back 29

nursing considerations: baseline assessment
- monitor for therapeutic and adverse effects
- stimulates hepatic drug-metabolizing enzymes, causing increase metabolism (and therefore decrease decrease effectiveness) of other drugs
- interferes with vitamin K and vitamin D metabolism
- additive effect with other CNS depressants (alcohol, benzodiazepines, opiods, etc.)
- caution with hepatic and respiratory disease
- avoid abrupt withdrawal after prolonged use, aboid during pregnancy, patient safety (side rails up, call light with in reach)

Front 30

zolpidem (Ambien)

Back 30

sedative-hypnotic, non-benzodiazepine
ROUTE: PO
indication short-term management (7-10 days) of insomnia
MOA: binds to a sub-type of benzodiazepine receptors --> potentiates GABA --> decreased sleep latency and awakenings, prolongs sleep duration.

Front 31

zolpidem (Ambien)

Back 31

side effects: daytime drowsiness, dizziness, HA, muscle pain, severe anaphylactic and anaphylactoid reactions have been reported, somnambulistic episodes.

Front 32

zolpidem (Ambien)

Back 32

nursing considerations: baseline assessment, utilization of nonpharm strategies, can intensify effects of other CNS depressants, rapid onset: take just before bedtime
- short-term therapy is not associated with significant tolerance or physical dependence; withdrawal symptoms minimal/absent, pt. safety considerations.

Front 33

seizure disorders

Back 33

the clinical manifestation of a sudden abnormal, uncontrolled, electrical discharge from a group of neurons in the cerebral cortex.
- a symptom of underlying CNS dysfunction

Front 34

epilepsy

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a condition for which no underlying correctable cause for seizure can be found

Front 35

phenytoin (Dilantin)

Back 35

anticonvulsant, hydantoin
- most widely used AED
ROUTE: PO, IM, IV
MOA: inhibits entry of sodium into hyperactive neurons leading to suppression of seizure-generating neurons
Indication: antiepileptic
side effects: drowsiness, lethargy, HA, gingivitis, gingival hyperplasia (swelling, tenderness, bleeding)
- nystagmus (sign of toxicity)-A rapid, involuntary, oscillatory motion of the eyeball.
- HA, diplopia, dizziness, slurred speech, decreased coordination
- aplastic anemia, stevens-johnson syndrome (rare skin rash characterized by inflammation, red macules, papules, tubercles)

Front 36

phenytoin (Dilantin)

Back 36

nursing considerations: therapeutic serum level: 10-20 mcg/mL
- contraindicated in pregnancy (teratogenic), use contraception
- drug interactions: MANY!!!
- increase effects with cimetidine, INH, sulfonamides
- decrease effects with folic acid, antacids, calcium, sucralfate, antineoplastics, antipsychotics, primrose, gingko.
decrease effects of anticoagulants, oral contraceptives, antihistamines, dopamine, theophylline
- monitor IV site (vesicant - blister), shake suspension well, monitor serum drug levels, CBC, safety: protect from environmental hazards, advise pt not to d/c abruptly, need frequent oral hygiene and dental check-ups, teach pt. to take drug at same time everyday, usually in PM.

Front 37

antipsychotics

Back 37

haloperidol (Haldol)
- aka neuroleptics
- typical and atypical

Front 38

halperidol (haldol)

Back 38

high-potency neuroleptic, antipsychotic
- indications: actue psychosis, schizophrenia, tourette's disorder, emergency sedation of severely agitated/delirious patients
ROUTE: IM, PO
MOA: blocks DA receptors in CNS--> tranquilizing, sedating effects
side effects: extrapyramidal effects occur frequently (from central DA blockade)
anticholinergic effects (muscarinic cholinergic blockade)

Front 39

halperidol (haldol)

Back 39

nursing considerations:
- baseline assessment, monitor for therapeutic effects
CONTRAIND: parkinson's disease, narrow angle glaucoma, cns depression.
drug interactions with anti-Parkinson agents, anticholinergics, CNS depressants, do not abruptly withdraw long-term therapy.
- patient safety considerations.

Front 40

atypical antipsychotics

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clinically superior to conventional agents, fewer EPS side effects, increased risk of weight gain and diabetes, can cause sedation and orthostatic hypotension like conventional agents

Front 41

Risperidone (Risperdal)

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atypical antipsychotic
-indications: schizophrenia,a cute bipolar disorder mania, PTSD, NOT indicated for dementia-related psychosis
- ROUTE: PO, IM
MOA: powerful antagonist to a subgroup of 5HT receptors, less powerful antagonist to DA receptors, does not block cholinergic receptors
SE: EPS symtomatology (low at recommended dosages), neuroleptic malignant syndrome, hyperglycemia-->DM, weight gain
Black Box Warning!!! - increased risk of death in elderly pts with dementia-related psychosis
NURSING CONsiderations:
-baseline, monitor therapeutic and adverse effects, monitor blood glucose levels, interacts with alcohol and other CNS depressants, may decrease effects of dopamine agoinsts, may potentiate antihypertensives, pt safety

Front 42

lorazepam

Back 42

ativan
- anxiolytic, sedative-hypnotic, anticonvulsant, skeletal muscle relaxant, ROUTES: PO, IM, IV
indications: control anxiety; preoperative sedation
MOA: potentiaties GABA by binding to benzo receptors
SE: sedation, drowsiness, lethargy, difficulty concentration, confusion, anterograde amnesia, resp depression (IV only), profound HTN (IV only), rare: paradoxical responses - insomnia, excitation, esp in elderly/debilitated, additive effects with concurrent CNS depressants, TCAs, MAO inhibitors
NC: baseline, injectable form requires refrig, take PO with food to avoid stomach upset, phlebitis, thrombosis, ensure patent IV site, inject slowly.
- Emergency equipment must be readily available (IV administration), avoid during pregnancy.

Front 43

TCA

Back 43

potent inhibitors of neuronal reuptake of NE and serotonin, intensifying their effects, also block numerous other receptors

Front 44

SSRIs

Back 44

block reuptake of 5HT
- increase concentration in synaptic cleft and increase postsynaptic activity; minimal effect on other transmitters and receptors

Front 45

MAO inhibitors

Back 45

inactivate the enzyme MAO, permitting NT molecules to escape degradation --> increase NE and 5HT available for release into synaptic cleft

Front 46

serotonin/norepinerphrine reuptake

Back 46

inhibitors block neuronal reuptake of serontonin and NE with minimal effect on other transmitters or receptors

Front 47

amitriptyline

Back 47

TCA used for various forms of depression, OCD, bipolar, migraine headache prophylaxis, pain adjuvant therapy

Front 48

amitriptyline

Back 48

inhibits neuronal reuptake of NE and 5HT, also blocks cholinergic , histaminergic, muscarinic,alpha1-adrenergic receptors (blood vessels)
SE: sedation, drowsiness, orthostatic hypotension, anticholinergic effects: blurred vision, dry mouth, urinary retention, constipation, sexual dysfunction, cardiac toxicity (rare) increases risk of dysrhythmias, increase appetite, increase weight
BBW: antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders

Front 49

amitriptyline (Elavil)

Back 49

contraindictaions: acute recovery following MI, caution with Hx seizures, urinary retention, glaucoma, cardiovascular disease
NC: effects may not be felt for 2 weeks, supervise patient at risk for suicide, to minimize suicidal attempt by OD, supply of no more than one week at a time, sedation effects - should be taken at night, pt safety.

Front 50

fluoxetine (prozac)

Back 50

indication: depression, panic disorder, OCD, premenstrual disphoric d/o, bulimia nervosa
MOST WIDELY PRESCRIBED IN USA
route: PO
SE: increased risk of suicide
*serotonin sydrome: altered mental status, incoordination, hyperflexia, sweating, tremor, fever, death , more likely if combined with TCA or MAO.
NC: max therapeutic reponse may take >or= 4 weeks of therapy.
-supervise pt at risk for suicide
- caution for pts at risk for bleeding or history of ulcers
**drug interactions: warfarin, MAOs, TCAs, lithium

Front 51

MAOI

Back 51

- PO,
pt must be able to comply with strict adherence to dietary restrictions because hypertensive crisis can occur by eating a lot of tyramine. (tyramine promotes the release of NE from sympathetic neurons, dietary tyramine is inactivated by intestinal and hepatic MAO)
BBW - increased risk of suicidal thoughts
mech of action: irreversibly binds to MAO, inhibiting its effects
WHEN A PT IS TAKING MAOI:
1) when MAO is inhibited increases the level of NE in nerve terminals
2) inhibition of hepatic MAO leads to tyramine entering the systemic circulation
3) when tyramine reaches peripheral sympathetic nerves it stimulates release of accumulated NE (fight or flight monoamine)

Front 52

MAOI

Back 52

drug interactions: sympathomimetic agents, TCAs and SSRIs (serotonin syndrome), antihypertensive drugs, meperidine
NC: given to pts who can only comply with dietary guidelines, inform pts the hazards of ingesting tyramine, hypertensive crisis (HA, NV, palpitations, tachycardia), give SL nifepidine.