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180 Cards in this Set
- Front
- Back
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a brief episode of abnormal electrical activity in nerve cells of the brain that may or may not be accompanied by visible changes in appearance or behavior
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seizure
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a tonic-clonic type of seizure characterized by spasmodic contractions of involuntary muscles
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convulsion
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What 2 drugs from test #1 can cause seizures?
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Demerol (in ppl with chronic renal failure)
Anti-anxiety drugs (benzos) |
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seizures that occur in a chronic, recurrent pattern
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epilepsy
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type of seizure when you "step out" for a minute or so
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absence seizure
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type of seizure that begins in a specific area of the brain and often indicates a localized brain lesion
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partial seizure
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type of seizure that is bilateral and symmetric and has no discernible point of origin in the brain
ex. tonic clonic hardest type to treat often preceded by an aura |
generalized seizure
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tonic-clonic seizures that occur in children
most common form of epilepsy |
febrile seizure
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a seizure that will not stop and the patient does not regain consciousness between seizures
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status epilepticus
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What is the life threatening problem in status epilepticus?
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the patient can lose his airway (b/c he has lost his protective reflexes)
this can cause a cardio-pulmonary arrest |
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Do children require higher or lower doses per kg of body weight of antiseizure drugs than adults?
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higher!
(b/c they are absorbed, metabolized, and excreted rapidly!) |
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Do older adults require higher or lower doses of antiseizure drugs than the average adult?
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lower
(b/c they have slower excretion...which can cause dizziness and drowsiness that leads to falls) |
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What are some causes of seizures?
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hypoglycemia
fever electrolyte imbalances drug overdoses withdrawal from alcohol head trauma stroke medication discontinuation |
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What is the pharmacological classification of Phenytoin (Dilantin)?
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hydantoin
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What is the therapeutic classification of Phenytoin (Dilantin)?
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antiarrhythmic
antiseizure anticonvulsant |
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What are the adverse effects of Phenytoin (Dilantin)?
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ataxia
gingival hyperplasia (an overgrowth of the gums where they become black and go over your teeth) agranulocytosis/aplastic anemia |
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a rare complication associated with anti-seizure medications that causes the skin to dissociate from the muscle fascia
cardinal symptom is a rash more common in blacks |
Steven Johnson syndrome
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Do NOT give Phenytoin (Dilantin) by IV in anything but ______________!
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normal saline (b/c it precipitates easily and can turn into crystal)
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Never give Phenytoin (Dilantin) faster than _________ by IV because you will shut down the action potentials in the heart.
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50 mg/min
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People taking what drug should not switch between generic and brand names?
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Phenytoin (Dilantin)
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What antiseizure drug is newer and has fewer side effects than Phenytoin (Dilantin)?
It is the most commonly prescribed anti-seizure drug for children. |
Keppra (Levetiracetam)
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What are the only adverse effects of Keppra (Levetiracetam)?
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dizziness
fatigue |
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What type of seizure is Keppra (Levetiracetam) particularly effective in?
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partial
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What is the therapeutic classification of Gabapentin (Neurotonin)?
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anticonvulsant
antiseizure analgesic adjunct |
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a drug that is used for seizures but mainly for phantom pain or fibromyalgia
used as a pain adjunct |
Gabapentin (Neurotonin)
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What is the pharmacological classification of Lorazepam (Ativan)?
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benzodiazepine
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What is the therapeutic classification of Lorazepam (Ativan)?
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sedative
anti-anxiety analgesic adjunct |
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the drug of choice for rapid control of tonic-clonic seizures
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Lorazepam (Ativan)
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What are 2 problems with Lorazepam (Ativan)?
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1. seizures often recur unless the dose is repeated or another, longer-acting drug (Phenytoin) is given
2. there is a risk of significant respiratory depression so airway management must be readily available |
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What pregnancy classification is Phenytoin (Dilantin)?
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C or D depending on the trimester
30% chance of causing fetal abnormalities! |
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What happens in diabetes when taking Phenytoin (Dilantin)?
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Phenytoin may inhibit the release of insulin and INCREASE blood sugar.
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Most drugs of this therapeutic classification cause some gastric irritation, nausea, or vomiting. They should be taken with food or fluid.
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antiseizure
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a chronic, progressive, degenerative disease characterized by abnormalities in movement and posture (tremor, bradykinesia, joint/muscular rigidity, and postural instability)
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Parkinson's disease
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People with Parkinson's disease have too much ________ and not enough _________.
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acetylcholine
dopamine |
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To treat Parkinson's disease, we give drugs that promote the level of _________ in the body.
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dopamine
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What is the pharmacological classification of Levodopa (L-dopa)?
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dopamine agonist
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What is the therapeutic classification of Levodopa (L-dopa)?
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antiparkinson
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How does Levodopa work?
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It is a precursor to dopamine. Unlike dopamine, it can penetrate the blood-brain barrier. Once it penetrates the CNS, then it is converted into dopamine.
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When should you give Levodopa (L-dopa)?
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at least 30 minutes before the patient's meal so they wont die from aspiration
*Make sure you give the medicine with a few crackers though to prevent nausea and vomiting. |
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What are the adverse effects of Levodopa?
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nausea and vomiting = most common
anxiety dizziness hallucinations memory loss blurred vision dry eye darkening of sweat or urine |
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Is Levodopa useful for drug-induced extrapyramidal reactions, such as those caused by phenothiazines (anti-psychotic drugs)?
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NO!
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What is one contraindication to Levodopa (L-dopa)?
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narrow-angle glaucoma...it can make patients with this blind!
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Does Levodopa affect acetylcholine?
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NO!
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What is the therapeutic classification of Carbidopa/Levodopa (Sinemet)?
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antiparkinson agent
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antiparkinson combination drug that is more commonly given because it treats both acetylcholine AND dopamine
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Carbidopa/Levodopa (Sinemet)
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What are the adverse effects of Carbidopa/Levodopa (Sinemet)?
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memory loss
dry mouth that can lead to dental caries orthostatic hypotension |
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Beneficial effects of __________ may not occur for a few weeks; do not stop taking them before they have a chance to work!
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antiparkinson drugs
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With what disease do you want to teach the patient to change the environment at his house (add bars to bathroom, remove throw rugs, etc.)?
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Parkinson's disease
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Why is surgery difficult to perform on people with Parkinson's disease?
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they are tremulous
it is also more difficult to maintain an airway on them |
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What is the pharmacological classification of Benztropine (Cogentin)?
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anticholinergic
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What is the therapeutic classification of Benztropine (Cogentin)?
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antiparkinson
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used for adjunctive treatment of all forms of Parkinson's disease
cannot be used alone blocks acetylcholine's activity in the CNS and restores natural balance of neurotransmitters |
Benztropine (Cogentin)
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With what disease do the drugs eventually stop working?
What are the other treatment options? |
Parkinson's disease
gamma-knife surgery stem cells |
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What are the 3 most common reasons to use skeletal muscle relaxants?
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trauma
multiple sclerosis (MS) spinal cord injury/cerebral palsy |
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allergic reaction to anesthetic gas that causes every skeletal muscle in your body to contract at the same time, and your body temp goes from normal to 108 F in about 10 minutes
you will die from the high metabolic demand if it is not reversed a defect in the skeletal muscles causes this reaction |
malignant hyperthermia
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What is the antidote/reversal agent for malignant hyperthermia?
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Dantrolene (Dantrium)
*the only peripherally acting muscle relaxant |
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What do you do for people who have had previous episodes of malignant hyperthemia and have surgery coming up?
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Give Dantrolene (Dantrium) prophylactically 1-2 days before surgery.
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What is the pharmacological classification of Diazepam (Valium)?
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benzodiazepine
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What is the therapeutic classification of Diazepam (Valium)?
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anti-seizure
anti-anxiety skeletal muscle relaxant |
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What is the important thing to remember about giving Diazepam (Valium) as a skeletal muscle relaxant?
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it is addicting and should only be used short term
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What is the therapeutic classification of Methocarbamol (Robaxin)?
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skeletal muscle relaxant
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the most commonly used skeletal muscle relaxant
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Methocarbamol (Robaxin)
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What are the adverse reactions of Methocarbamol (Robaxin)?
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seizures
anaphylaxis dizziness anorexia nausea brown/black/green urine |
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When do you go from sedation to analgesia?
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when you lose your protective reflexes!
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What is the most common cocktail given for a surgery?
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anesthetic gas
opiate (Fentanyl) for pain benzo (to produce amnesia) |
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What drugs are used to keep patients from moving during surgery?
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neuromuscular blocking agents
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What is the therapeutic classification of Pavulon (Pancuronium)?
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neuromuscular blocking agent
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Pavulon (Pancuronium) must be given by someone who can:
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intubate (b/c the drug paralyzes your muscles and stops your breathing)
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What is the therapeutic classification of Succinylcholine (Anectine)?
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neuromuscular blocking agent
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neuromuscular blocking agent that is used in children because it doesn't last very long
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Succinylcholine (Anectine)
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one of the drugs that can trigger malignant hyperthermia
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Succinylcholine (Anectine)
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What are 2 disorders treated with CNS stimulants?
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ADHD
narcolepsy |
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What is the therapeutic classification of Amphetamine (Dexedrine)?
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CNS stimulant
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What is the therapeutic classification of Methylphenidate (Ritalin)?
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CNS stimulant
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What is the therapeutic classification of Strattera (Atomoxetine)?
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CNS stimulant
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prototype drug given to treat ADHD and narcolepsy
works by causing the release of ___________ from nerve endings |
Amphetamine (Dexedrine)
norepinephrine |
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What is the controlled substance schedule and pregnancy category of Amphetamine (Dexedrine)?
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Schedule II
Pregnancy category C |
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What are the adverse effects of Amphetamine?
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hyperactivity
insomnia restlessness tremor palpitations tachycardia anorexia |
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Use of amphetamines with __________ or ____________ may result in hypertensive crisis.
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MAO inhibitors (Nardil)
Meperidine (Demerol) |
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What is the most commonly prescribed amphetamine?
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Methylphenidate (Ritalin)
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the alternate to Ritalin
used to treat ADHD but not narcolepsy |
Strattera (Atomoxetine)
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How does Strattera (Atomoxetine) work?
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it inhibits the reuptake of norepinephrine in nerve synapses
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Contraindications of Strattera (Atomoxetine) include:
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MAO inhibitors
narrow angle glaucoma |
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What are the adverse effects of Strattera (Atomoxetine)?
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dizziness
fatigue mood swings insomnia N/V dry mouth constipation dysmenorrhea decreased libido *rarely it can cause severe liver injury |
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What is the chemical in caffeine that causes you to be more alert?
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xanthine
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Why should children have a drug free period from amphetamines?
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so they can can weight and grow (the drugs decrease their appetite)
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What are the contraindications for the use of CNS stimulants?
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cardiovascular disorders (angina, dysrhythmias, hypertension)
glaucoma hyperthyroidism |
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What is the main neurotransmitter of the sympathetic nervous system?
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norepinephrine (adrenaline)
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Which NS increases blood pressure and cardiac output?
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sympathetic
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Which NS increases blood flow to the brain, heart, and skeletal muscles?
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sympathetic
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Which NS increases the rate of cellular metabolism?
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sympathetic
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Which NS increases the breakdown of muscle glycogen for energy?
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sympathetic
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Which NS increases blood sugar?
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sympathetic
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Which NS increases your ability to think clearly?
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sympathetic
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Which NS increases muscle strength?
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sympathetic
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Which NS increases your rate of blood coagulation?
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sympathetic
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Which NS increases your rate and depth of respirations?
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sympathetic
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Which NS causes pupil dilation?
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sympathetic
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Which NS causes increased sweating?
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sympathetic
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Which NS causes dilation of blood vessels in the skin?
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parasympathetic
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Which NS causes decreased heart rate?
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parasympathetic
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Which NS causes increased secretion of saliva and motility of the GI tract?
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parasympathetic
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Which NS causes bronchoconstriction?
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parasympathetic
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Which NS causes pupil constriction?
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parasympathetic
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Which NS causes contraction of bladder muscle?
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parasympathetic
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Which NS causes decreased platelet aggregation, decreased inflammation, and dilation of blood vessels?
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parasympathetic
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What are the 4 types of adrenergic receptors?
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Alpha receptors (1&2)
Beta 1 Beta 2 Dopamine |
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What do alpha receptors control?
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sex and vessels
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What do beta 1 receptors control?
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heart
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What do beta 2 receptors control?
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lungs
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What do dopamine receptors control?
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gut and kidneys
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What are the 2 types of receptors in the parasympathetic NS?
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muscarinic
nicotinic |
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What is the main neurotransmitter of the parasympathetic NS?
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acetylcholine
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CPP = ___________ - ___________
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MAP
ICP |
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BP = ______ X ________
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CO
SVR |
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CO = _______ X ________
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HR
SV |
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drugs that produce effects similar to those produced by the stimulation of the sympathetic NS
often used as emergency drugs in the treatment of acute CV, respiratory, and allergic disorders |
adrenergic
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Adrenergic drugs = ________ drugs
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RESCUE!
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What is the therapeutic effect of Albuterol, and what are its adverse effects?
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therapeutic = bronchodilation
adverse = chest pain and palpitations |
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Contraindications of Albuterol:
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hypersensitivity to adrenergic amines
hypersensitivity to fluorocarbons (some inhalers) USE CAUTIOUSLY IN: cardiac disease hypertension hyperthyroidism diabetes glaucoma seizure disorders geriatric patients (increase risk of adverse effects) pregnancy breastfeeding children under 2 |
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Excess inhaler use may lead to:
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tolerance and paradoxical bronchospasm
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How does Albuterol work?
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it binds to beta 2 receptors in the smooth muscle airways and causes relaxation of the smooth muscle with subsequent bronchodilation
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Albuterol increases ____ and ____ but decreases _____.
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CO and HR
SV |
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What are times that we might need adrenergic (rescue)drugs?
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asthma
shock trauma anaphylaxis nose bleeds |
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What pharmacological classification is Pseudoephedrine (Sudafed)?
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adrenergic
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What therapeutic classification is Pseudoephedrine (Sudafed)?
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decongestant
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What are the contraindications for Pseudoephedrine (Sudafed)?
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hypertension
severe coronary artery disease concurrent MAO inhibitor therapy people with known alcohol intolerance |
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What are the adverse effects of Pseudoephedrine (Sudafed)?
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seizures
cardiovascular collapse anxiety palpitations anorexia |
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With epinephrine, what is the concentration for the inhalation route?
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1% (1:100)
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With epinephrine, what is the concentration for the subcutaneous route?
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0.5% (1:200)
0.1% (1:1000) |
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With epinephrine, what is the concentration for the intramuscular route?
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0.1% (1:1000)
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With epinephrine, what is the concentration for the intravenous route?
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0.01% (1:10,000)
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With epinephrine, what is the concentration for the intradermal route?
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0.001% (1:100,000)
*in combination with local anesthetics |
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the most common form of sub-Q epinephrine
used to treat anaphylaxis by acting as a vasoconstrictor |
Epi-pen
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What are the uses of epinephrine?
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bronchodilation
profound bradycardia/hypotension cardiac arrest anaphylaxis nasal agent for hemostasis |
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Do not mix Sudafed or inhalers with ___________ because they will make your blood pressure go too high
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appetite suppressants
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What should an asthmatic do after using his inhaler?
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use a peak flow meter and then go to the ER
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If you're diabetic and you use an adrenergic drug, your blood sugar will _____________.
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increase (it will be harder to control)
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this drug is not an adrenergic drug, but it is used in cardiac arrest, just like epinephrine
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Vasopressin
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What are the 7 deadly costs (secondary health problems) associated with the use of adrenergic drugs?
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decreased renal perfusion
cardiac dysrhythmias increased myocardial oxygen requirement decreased liver perfusion hyperglycemia, hypokalemia, hypophosphatemia (not enough ATP) severe hypertension and reflex bradycardia tissue necrosis after extravasation |
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Epinephrine is a vesicant, which means:
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it is irritating to the vasculature
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What happens if you treat a heart attack with epinephrine?
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it increases the size of the heart attack
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drugs that decrease or block the effects of sympathetic nerve stimulation and adrenergic drugs
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antiadrenergic
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What is the #1 indication for using an antiadrenergic drug?
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hypertension
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What is the pharmacological classification of Clonidine (Catapres)?
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alpha2 agonist
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What is the therapeutic classification of Clonidine (Catapres)?
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anti-hypertensive
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What is a side effect of Clonidine (Catapres) that you should watch out for?
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orthostatic hypotension
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If you miss a dose of Clonidine (Catapres), what might happen?
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rebound hypertension
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What are the off-label uses of Clonidine (Catapres)?
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alcohol withdrawal (DT)
test anxiety |
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What is the pharmacological classification of Tamsulosin HCL (Flomax)?
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alpha blocker
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What is the therapeutic classification of Tamsulosin HCL (Flomax)?
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anti-hypertensive
BPH |
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When do you take Clonidine (Catapres) and when do you take Tamulosin HCL (Flomax)?
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Clonidine in the A.M.
Flomax at night |
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All of the drugs in this pharm class end in "-olol":
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beta blocking
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What are the clinical indications for Propanolol (Inderal)?
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hypertension
angina pectoris dysrhythmias MI hypertrophic subaortic stenosis migraine prophylaxis |
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Which beta blocker works better in whites?
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Metoprolol (Lopressor)
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Which beta blocker works better in blacks?
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Labetalol (Normadyne)
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What is one contraindication to the use of beta blockers?
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asthma
*blocking beta 1 and beta 2 would cause bronchoconstriction |
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Which drug blocks beta 1 and not beta 2, therefore you can give it to an asthmatic?
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Labetalol (Normadyne)
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What are some of the adverse reactions of alpha-blocking drugs?
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papitations
weakness dizziness |
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What are some of the adverse effects of beta-blocking drugs?
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bradycardia
fatigue dizziness |
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What is the problem with diabetics and beta blockers?
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they could drop their blood sugar and not know it (hypoglycemic unawareness)
*only reliable symptom is sweaty palms |
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drugs that stimulate the parasympathetic nervous system in the same way that acetylcholine does
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cholinergic
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the disease where there is not enough acetylcholine at the neuromuscular junction
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myasthenia gravis
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What is the pharmacological classification of Neostigmine (Prostigmin)?
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cholinergic
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prototype cholinergic drug that is used as the antidote for Pancuronium and Anectine and also for the long term treatment of myasthenia gravis
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Neostigmine (Prostigmin)
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cholinergic drug used to diagnose people with myasthenia gravis
also used as the rescue drug for myasthenia gravis |
Edrophonium (Tensilon)
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What is the #1 symptom of myasthenia gravis?
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ptosis of one eyelid
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the maintenance drug of choice for myasthenia gravis
MAKE SURE YOU GIVE ON TIME |
Pyridostigmine (Mestinon)
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cholinergic drug that is used to treat Alzheimer's disease
|
Donepezil (Aricept)
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What are some signs of cholinergic drug underdosage (myasthenic crisis)?
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increased muscle weakness
difficulty breathing |
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What are some signs of cholinergic drug overdosage (cholinergic crisis)?
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abdominal cramps
diarrhea difficulty breathing muscle weakness |
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Avoid taking _____________ at the same time as cholinergic drugs because it may decrease your level of acetylcholine.
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St. John's wort
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drugs that block the action of acetylcholine on the parasympathetic nervous system
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anticholinergic
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Why do we give Atropine instead of Epinephrine for bradycardia?
|
because the cost is not as high on the heart
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What are the uses for Atropine?
|
bradycardia
before surgery to increase heart rate reversal of nerve gas |
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drug used for the maintenance of asthma
|
Ipratropium (Atrovent)
|
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What is the pharmacological classification of Ipratropium (Atrovent)?
|
anticholinergic
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What is the pharmacological classification of Scopolamine?
|
anticholinergic
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drug used to treat seasickness
|
Scopolamine
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What are some adverse effects of anticholinergic drugs?
|
tachycardia
fever heat stroke constipation dry mouth |
