Nursing Pharmacology Cns/cvs

Front 1

GABA

Back 1

Neurotransmitter

Effect : Most common inhibitory neurotransmitter

Clinical use : Seizure and anxiety

Front 2

Serotonin

Back 2

Neurotransmitter

Effect : inhibitory

Clinical use : Anxiety, bipolarism, depression

Front 3

Norepinephrine

Back 3

CNS Inhibitory/excitatory
Neurotransmitter

ANS excitatory

Clincal use: Depression, memory, panic attacks

Front 4

Dopamine

Back 4

Neurotransmitter

Involved in locomotion, attention, learning

Clinical use : Parkinson's and psychoses

Front 5

GAD

Back 5

Generalized anxiety disorder

Anxiety pesists for 6 months +

Excessive worry

Front 6

Panic disorder

Back 6

Anxiety by intense feelings of apprehension, terror, fear.

Front 7

Social anxiety

Back 7

Unreasonable and persist fear of crowds

Front 8

PTDS

Back 8

Post traumatic stress disorder

Situational anxiety develpod in response to a stress situation

Nightmares, hallucinationsm tachycardia

Front 9

Narcolepsy

Back 9

Sevvere daytime sleepiness, pt is unable to stay awake

Front 10

Valerian and Kava

Back 10

Herbal products that produce relaxation. Interacts with many hynotic drugs.

Front 11

Benzodiazepines
NonBenzodiazepines
Antidepressants
Barbiturates

Back 11

Major classification of drugs for sleep or anxiety disorders

Front 12

Category of drug of choice to treat GAD and short term insomnia

Back 12

Benzodiazepines

Front 13

Describe Benzodiazepines mechanism of action and primary clincal use

Back 13

MOA: Bind to GABA receptor and intensify its effect

Insomnia and Anxiety

Front 14

Bezodiazepines most common side effects and contraindications

Back 14

dizziness, ataxia, drowsiness, blurred vision, vertigo, sedation.

Category D pregnancy - Fetus malformation

C/I narrow angle glaucoma, chronic obstructive pulminary disease (COPD) or psychosis

Front 15

Define Nonbenzodiazepine MAO, S/E and C/I

Back 15

MAO:enhance GABA,however only binds to a specificGABA receptor

S/E: Nausea, dizziness, diarreah, depression, sleepwalking, amnesia.

C/I:Use w/ cation with patients wi repiratory impairment.

Should not be taken with food. Interactis with other CNS depressants (kava, valerian, melatonin)

Front 16

Barbiturates mechanism of actions and purpuse for its use in low, medium and high dosages.

Back 16

Binds to GABA receptorm enhancing HABA activity

Low dosage- anxiety
mediun - seizure/hypnotic
high - anesthesia

Front 17

Barbiturates S/E and C/I

Back 17

S/E hang over effect, lethargy, hallucinations, hepatic diseas, hypocalcemia, even coma and angioedema

C/I pts with renal, hepatic or cardiac impairment.CODP, hyperthyroidsm

D/I other cns depressants

Front 18

Dysthymic disorder

Back 18

Mild chronic depression lasting 2 years

Front 19

Cyclothymic disorder

Back 19

A typo of bipolar that alternates between depression and mania

Front 20

Depression symptoms

Whats Major depressive disorder

Back 20

Lack of energy, sleep disturbances, abnormal eating patterns, hopelessness

MJD : depression lasting for at least 2 weeks. Associated with low levels of nor-epinephrine, serotonin, and dopamine.

Front 21

Seasonal affective disorder

Back 21

Depression associated with the lack of exposure to sun light.

Front 22

Hypothyroidism

Back 22

Strongly associated to depression

Front 23

Alternative treatments for depression

Back 23

ECT electroconvulsive therapy
rTMS repetitive transcranial stimulation
VNS vagus nerve stimulation

Front 24

Primary classes of antidepressants

Back 24

Tricuclic antidepressants (TCA)

Selective Serotonin Reuptake inhibitor

Atypical antidepressants
(NSRI,...)

Monoamine Oxidase Inhibitor (MOAIs)

Front 25

Whats the use of drugs of TCA category, S/E, D/I and MAO.

Back 25

Tricyclic antidepressants are used to treat depression.

MOA: blocks the reuptake of nor-epinephrine inhibitor

S/E: anticholinergic effects, orthostatic hypotension, acumulation in myocardium, dysrrhythmias.

Category D for pregnancy

D/I : Other CNS depressants, oral contraceptives decrease effects, avoid MAOI's

Front 26

Whats the use of drugs of SSRI category, S/E, D/I and MAO.

Back 26

Selective Serotonin Reuptake inhibitor, drug of choice to managa depression

MAO: blocks the uptake of serotonin, increasing amount of neurotransmitter available.

S/E Nausea, vomiting, insomnia, sexual dysfunction, hyperkinisia in kids. Cannot be stopped abruptly

D/I : Cardiac impaired pts, diabetics, or seizure disorder. Taking with MAOIs can result in serotonin syndrome

Front 27

Serotonin syndrome

Back 27

Reuptake of serotonin disease , causing mental status change, HTN, tremors, sweating, hyperpyrexia, ataxia. Resolves in 24 hours

Front 28

Whats the use of drugs of SNRI category, S/E, D/I and MAO.

Back 28

Selective nor-epinephrine re uptake inhibitors, atypical antidepressant.

MAO : Inhibits NE and serotonin in the CNS

S/E: Nausea, weight loss, CNS stimulation (like amphetamines), insomnia, sexual dysfunction

D/I: Serotonin syndrome is possible, MAOI's

Category C pregnancy

Front 29

Whats the use of drugs of MAOI's category, S/E, D/I and MAO.

Back 29

Monoamine oxidase inhibitors treats depression, but causes potentially serious adverse effects

Blocks the action of monoamine oxidase (neurotrans that destroys NE, dopamine and serotonin), enhancing their effects

Lowest safety margin out of the antidepressants..

S/E: Tachycardia, hypertensive crisis, blocks breakdown of dietary tyramine (found in beer, chocolate ..)

D/I Increase effects of diabetic, htn and cardiac drugs. Interacts with foods rich in tyramine.

Front 30

Lithium - Alkali metal ion salt

Back 30

Mood stabilizer used for bipolar disorder

Require Serum checkups

MOA : Acts by increasing the synthesis of serotonin.
C/I: cardiovascular/renal impairment, thyroid disease, diabetic patients

S/E : Initial : lethargy, nausea, polyuria, nocturia, tremors, confusion

Long term: kidney impairment, dysrhythmias, blood dyscresias.

D/I: Diuretics, salt depletion, NSAIDs increase lithium levels.

Should not be taken with caffeine beverages

Front 31

Psychosis

Back 31

Loss of contact with reality

Front 32

Delusions

Back 32

Firm ideas that are false and not found in reality. (believing to be Jesus)

Front 33

Hallucinations

Back 33

Seeing, hearing, feeling something not really there

Front 34

Schizophrenia

Back 34

Abnormal thoughts or thought process, disordered communication, occurs between 15 and 35 years old.

Symptoms associate with D2 receptors (dopamine)
Presents positive or negative symptons

Front 35

Describe the positive and negative symptoms of schizophrenia

Back 35

Positive : treatable with meds, hallucinations, paranoia, delusions, agitations, anxiety, Illusions.

Negative : Apathy, withdrawal, poor judgment, no functional speech.

Front 36

Anti-psychotic classes

Back 36

Phenothiazines and Nonphenothiazines

Front 37

Extrapyramidal symptoms EPS

Back 37

Adverse effects related to psychotic drugs

Acute dystonia, akathisia, parkinsonism, tardive dyskinesia.

Front 38

Whats the use of drugs of Phenothiazine category, S/E, D/I and MAO.

Back 38

Antipsychotic drugs used in the treatment of schizophrenia

Also used in treating: Nausea and vomiting, tourettes syndrome, organic brain syndrome.

MOA : blocks post-synaptic dopamine receptors.

S/E : Extrapyramidal syndrome, anticholinergic effects, blurred vision, dry ass, glaucoma. Tachycardia, laryngospasms, respiratory depression, seizures.

Front 39

Whats the use of drugs of Nonphenothiazine 2nd generation category, S/E, D/I and MAO.

Back 39

Drug of choice in the treatment of schizophrenia

Lower incidence of EPS

MO: dopamine antagonist

A/E : Increased salivation, constipation, impotence, hyperglacemia, glactorrhea,

D/I SSRIs and other CNS depressants

Front 40

Whats the use of drugs of DSS category, S/E, D/I and MAO.

Back 40

Antipsychotic. Dopamine System Stablizers work on both agonist and partial antagonist dopamine receptor

Lower incidence of S/E than phenothiazines and nonphenothiazines

Interacts with grapefruit juice

Front 41

Degenerative diseases of CNS

Back 41

Alzheimer's, Huntington's, Parkinson's, MG, Multiple Sclerosis

Front 42

Medications can cause Parkinson's like symptoms called

Back 42

Secondary PD symptoms

Front 43

Parkinson's symptoms

Back 43

Tremors, muscle rigidity, bradykinesia, postural instability.

Caused by an insufficient amount of dopamine produced by substantia nigra

Front 44

Drugs used in the treatment of PD

Back 44

Dopamine Replacement Agents, Dopamine Agonists, COMT inhibitors, others

Front 45

Idiopathic pain

Back 45

non-specific pain of unknown origin

Front 46

Drugs used in conjunction with altered patterns of sleep

Back 46

sedative-hypnotic

Front 47

Azaspirones

Back 47

• Chemically related to barbituates, benzodiazepines or other anxiolytic agents

Front 48

How long (average) antidepressants take to start working ?

Back 48

• All must be taken for 2 to 4 weeks before depressive symptoms improve

Front 49

This class of antidepressants can be taken with food and may cause weight gain

Back 49

SSRI's

Front 50

Valproic acid

Back 50

• Rapidly distributed with 90+% protein bound
• Treats acute manic symptoms

Front 51

Main antipsychotic adverse effects

Back 51

• Extrapyramidal reactions ( p. 331)
• Antimuscarinic or anticholinergic side effects
• Dermatologic
• Endocrine
• Non-reversible bone marrow depression
• Neuroleptic malignant syndrome

Front 52

PD facts

Back 52

• Parkinson’s disease: a chronic disorder of CNS; muscle tremors, bradykinesia, muscle weakness with rigidity, alteration in posture & equilibrium
• Symptoms caused by a dopamine deficiency in extrapyramidal system within basal ganglia.
• Drugs used to increase levels of dopamine (dopaminergic) or inhibit acetylcholine (anticholinergic )

Front 53

Levodopa

Back 53

Most known efficient drugs in the treatment of Parkinson's

Front 54

 Epilepsy

Back 54

a group of neurological disorders characterized by recurrent episodes of convulsive seizures, sensory disturbances, abnormal behavior, loss of consciousness, or any combination of these.

Front 55

 Seizure

Back 55

the excessive stimulation of neurons in the brain leading to a sudden burst of abnormal neurons activity results in temporary changes in brain function.

Front 56

 Convulsion

Back 56

characterized by spasmodic contractions of voluntary muscles.

Front 57

 Secondary epilepsy:

Back 57

usually in infants and children and are developmental defects, metabolic disease, or injury at birth. Some can be acquired such as head injury, infection or disease (stroke).

Front 58

Major classes of antiepiletic drugs

Back 58

 Barbiturates:
 Benzodiazepines:
 Hydantoins: (Depakene)
 Iminostilbenes:
 Succinimides:
 Miscellaneous

Front 59

 Barbiturates

Back 59

 Used for controlling tonic-clonic and partial seizures.
 Used in STATUS EPILEPTICUS and used for controlling febrile seizures.
 Side effects are sedation, and tolerance,in pediatrics the most common adverse effects are irritability, hyperactivity, depression, sleep disorders, and cognitive abnormalities.
 Therapeutic effects are seen at serum drug levels of 15 to 40 micrograms/ml. It has a long half life and therefore only dosed q 24 hours.

Front 60

 Benzodiazepines

Back 60

: Used as first-line agents in the treatment of status epilepticus and as second-line agents

Front 61

Hydatoin

Back 61

Phenytoin: Is used as of tonic-clonic and partial seizures.
 Common side effects: lethargy, abnormal movements, mental confusion, and cognitive changes
 Therapeutic drug levels are 10 to 20 micrograms/ml.
 Toxic levels can cause nystagmus, ataxia, dysarthria, and encephalopathy.
 Long term use: gingival hypertrophy, acne, hirsutism, and hypertrophy of subcutaneous facial tissue (Dilantin facies”) and osteoporosis (Vit D supplement) Vitamin K and folic acid.

Front 62

 Pain Physiology has four phases

Back 62

 Transduction
 Transmission
 Perception
 Modulation

Front 63

Muscle spasms

Back 63

Treated with muscle relaxants that work in the brain

Central acting or direct acting

Examples of Central acting


 Baclofen (lioresal)
 Cyclobenzaprine (Flexeril)
 Metaxalone (Skelaxin)
 Tizanidine (Zanaflex)

Front 64

Muscle relaxants

Back 64

Similar to TCA's

S/E include muscle weakness

Front 65

ADHD

Back 65

presents in children and may extend into adulthood

For diagnoses purpose, pt must have 6 of the common symptoms

Front 66

Drugs used in the treatment of ADHD

Back 66

Amphetamines (adderall)

CNS stimulant, sympathomimetic, increase attention and alertness, also used for narcolepsy. Stimulates the release of epinephrine and dopamine.

S/E loss of appetite
A/E: irritability,insomnia, palpitations

Front 67

ADHD non stimulants

Back 67

SNRI

frontal lobe concentration stimulation

OD causes sympathetic stimulation

Front 68

Narcolepsy

Back 68

Day dreaming, drowsiness.

CNS stimulants are prescribed for treatment. Contraindications include caffeine

S/E Euphoria, dry mouth, nausea, insomnia

Front 69

Methylxanthines

Back 69

Used in the treatment od COPD

Ability to relax bronchial smooth muscle

Caffeine is a type of Methylxanthine

Front 70

Nociceptors

Back 70

Pain receptors located throughout the body, initiate pain transmission. Analgesic worn on these receptors to relief pain.

Front 71

Opiods and non opiods

Back 71

are drugs that relief pain by interacting with mu, kappa and delta receptors in the CNS

Front 72

Opiods

Back 72

Relief moderated-high pain levels.

Cause analgesia, decreased GI motility, euphoria, miosis, dependence, resp. depression, sedation

May cause severe ICP and nausea/vomit

Prototype:Morphine

Front 73

NSAID's

Back 73

Nonsteroidal anti-inflammatory drugs

used in the treatment of mild-moderate pain

Works by unhibiting pain mediator in the peripheral site (cycloxygenase)

S/E ulcerations, dyspepsia, anorexia, vomiting

Front 74

Tramadol

Back 74

Analgesic drugs that produce CNS depression without respirator issues

Front 75

Palliative care

Back 75

used for cancer patient to help the management of extreme pain

Front 76

Opiods antagonists

Back 76

used in OD cases, reverse respiratory depression, compete with mu and kappa receptors

Front 77

Mu and kappa receptors

Back 77

Pain receptors, NSAIDs, tramadol, work on these receptors to produce analgesic

Front 78

Mild Migraines treatment

Back 78

Usually treated with NSAIDs and caffeine

Front 79

Treatment for Moderate-severe migraines

Back 79

Serotonin receptor agonists (5HT1) causing vasodialation of cranial vessels

Front 80

General anesthesia

Back 80

Causes loss of consciousness to entire body, loss of sensation

Analgesia, relaxation, hypnosis, amnesia, loss of reflexes

Front 81

Regional anesthesia

Back 81

Loss of sensation w/o LOC(loss of consciousness) - works in an entire limb.

Front 82

MAC - Monitored anesthesia care

Back 82

used in diagnostic procedures and minor surgeries

Front 83

Stage III

Back 83

Stage III - surgical anesthesia required for most procedures

Front 84

Drugs used in anesthesia

Back 84

Barbiturates (rapid anesthesia, short duration)
Opioids (pain relief)
Benzodiazepines (Relaxation)
Ketamine/Propolol (maintain anesthesia), depress limbic system

Front 85

Inhalation anesthesia

Back 85

Nitrous oxide, GABA receptors agonist, opioid agonist

Front 86

Local anesthetics

Back 86

surface anesthesia - sprayed on
infiltration anesthesia - injected in deeper skin layers
nerve block - surrounding a peripheral nerve, causes regional anesthesia
epideral anesthesia - obstratic
spnial anesthesia - injected in spinal cord, abdomnal anesthesia

Front 87

Give examples of local anesthetics

Back 87

Ester(Novacaine) and Amide (Lidocaine)

Decrease amount of sodium entering neuron, depressing depolarization, preventing conduction

epinephrine is added many times to limit blood loss and decrease anesthesia systemic absorption

C/I Cardiac impairment

Front 88

Preoperative drugs

Back 88

anticholinergic are given to decrease salication and glands excretion

Front 89

Post operative drugs

Back 89

Opiods and antiemedics

Front 90

Main lipoproteins

Back 90

VLDL primary carrier of triglycerides, transporting it for storage
LDL reduced sized of VLDL
HDL transports excess cholesterol back to liver (reverse cholesterol transport) for excretion via bile

Front 91

HDL

Back 91

Good cholesterol, assis in reverse cholesterol transport, lowering VDLD thus lowering LDL

Front 92

HTN drugs - main categories

Back 92

Diuretics
Adrenergic drugs (CNS and peripheral)
ACE inhibitors
Vasodialators
CCB (Calcium channel blockers)
Angiotensin II receptor blocker

Front 93

Diuretics

Back 93

Inhibit Na reabsorption and K+and Na reabsorption

Front 94

CNS acting antihypertensive drugs

Back 94

Central stimulations - stimulates alpha 2, decreasing cardiac output and dilating vessels

Peripheral - block beta 1 receptors and reduce renin

Front 95

ACE drugs

Back 95

Treatment of hypertension, drug of choice for heart failure patients.

S/E dizziness, orthostatic hypotension, dry non productive cough, metallic taste, andgioedema

Pregnancy contraindicated

All the "prils" like Lisinopril, Captopril

Front 96

Angiotensin receptor blocker (ARB)

Back 96

bind to angiotensin at the receptor, advantages over ACE by not causing cough, push fluid and water to maintain blood volume

Front 97

Calcium channel blocker (CCB)

Back 97

Inhibit movement of calcium ions across cell membrane

most affective in african-americans and elderly

Serum digoxin may increase while on this med

Front 98

Direct Vasodialators

Back 98

Causes direct visodialation, used in hypertensive emergencies.

Hyperstat

Bio-product maybe toxic to the body, dangerous on hypoglacemic pts

Front 99

Nursing implications for patients taking HTN drugs

Back 99

Monitor BP/HR
Weight patient daily -
Change positions slowly (due to orthostatic hypotention)

Front 100

Coagulation drugs

Back 100

block formation of thrombus, embolus and fibrin.

may cause excessive bleeding

Common med : Heparin

Front 101

Anticoagulation drug

Back 101

Warfarin

Inhibit vitamin K clotting factors that are produced in the intestinal walls

Front 102

Anti-platelet

Back 102

Affects the cyclooxygenase pathway, making the platelets "slippery", preventing coagulation

Example Aspirin

Front 103

Thrombolytics

Back 103

Convert plasminogen to plasmin, breaking down clots

According to the professor "the good stuff"

Generally administered in the ER, given within 4 hours of stroke, may prevent arterial blockage from happening

Front 104

Nursing considerations when patients are taking anticoagulant drugs

Back 104

Monitor lab tests Hgb, HCT, PT, aPIT, INR
Careful with Vitamin K due to its influence in clotting formation

Front 105

Hematopoetic drugs

Back 105

Used in the treatment of Anemia

Front 106

Reasons for anemia

Back 106

Iron deficientcy, bone marrow depression, folic-acid

Front 107

Iron pharmacology

Back 107

Iron is important in the formation of RBC's
do not take with milk, take with orang juice

Front 108

Cyanocobalamin

Back 108

Vitamin B12, important in there treatment of pernicious anemia and megaloblastic anemia

Front 109

Erythropoietic drugs

Back 109

Stimulates production of blood cell on bone marrow

(erythropoetin is naturally produced in the kidneys, stimulating RBCs productions. Patients w renal failure take this meds to maintain optimal RBC count)

Front 110

Colony stimulating factors

Back 110

stimulates blood cell production by bone marrow following bone marrow transplant or chemotherapy

Filgrastin (Neupogen)

Front 111

Crystalloid

Back 111

clear fluids given in IV

Front 112

Types of crystalloids

Back 112

NS - Normal Saline o.9 % Na
Lactated ringers - lactate is converted by the liver to bicarbonate, to reduce acidic level after surgery (electrolyte replenisher )
D5W - 5 % dextrose
Plasma-lyte (electrolyte replenisher )

Front 113

Concentration of crystalloids

Back 113

Isotonic 0.9 %
Hypotonic 0.45%
Hypertonic 10 % dextrose

Front 114

Colloids

Back 114

Drugs that pull fluid from edema to vascular bed

Front 115

Blood products administration

Back 115

must be administered by 2 accredited professionals (2 RNs)

May be only given with NS

If A/E occur, stop infusion
O- blood type maybe given to anyone

Front 116

Potassium adm for electrolyte imbalanced

Back 116

Potassium (k+) 3.5 to 5.0 mEql/L must be diluted, otherwise it can stop the heart

Front 117

Renal system responsibilities

Back 117

Formation of urine, electrolyte balance, erythropoetin, excretion of products

Front 118

Beta-Blockers produce a significant decrease in blood pressure by decrease cardiac out put
True or False

Back 118

False, it decreases de effect of endogenous substances

Front 119

Vitamin K is antidote for __________

Back 119

Warfarin

Front 120

Vitamin K will affect action of digoxin & lasix

Back 120

False

Front 121

Aldactone/ is an example of______

Back 121

Potassium Sparing

Front 122

Vasodilation and faster heart rate
True or False

Back 122

False

Front 123

carbamazepine

Back 123

treatment of seizures and maniac episodes

GABA enhancers and sodium channel stabilizers

Front 124

Phentolamine

Back 124

used in hypertensive crisis

Front 125

The pain gate control theory proposes

Back 125

There is a mechanism of transmission of pain in the spinal cord

Front 126

The nocirepectors are located in which receptors

Back 126

Sensory receptors and relate to pain

Front 127

Anesthetic agents

Back 127

Barbiturates
Benzodiazepines
Opioids
Miscellaneous agents

Front 128

Ketamine and propolol

Back 128

Intravenous general anesthesia

Ketamine S/E HTN, and tachycardia.Respiratory depression

Dellirium, hallucinations (Emergence phenomina)
Administer drug slowly

Front 129

Nitrous oxide

Back 129

Inhaled anesthesia

Stage II anesthesia, anxiety, excitement
nausea, vomiting, lethargy.

Caffeine or adrenergic agents may exacerbate dysrhythmia

Must monitor patients pulmonary function