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245 Cards in this Set

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  • Back
What is released when the axon terminal of a presynaptic neuron is excited?
Once a neurotransmitter crosses the synapse, what is it's next action?
It acts on the target cell, either inhibiting or exciting that cell
Some neurotransmitters are capable of both inhibition and excitation; What determines whether it will inhibit or excite the target cell?
the location of the neurotransmitter within the nervous system
What are examples of disorders caused by the excess or deficiency of neurotransmitters? (4)
- seizure disorders
- mental health problems
- pain
- anxiety
Neurotransmitters are classified into what 4 groups?
- amino acids
- biogenic amines
- neuropeptides
- acetylcholine
Seizures are classified into what 2 groups?
- generalized
- partial
What causes seizures?
abnormal electrical activity in the brain
How do generalized seizures manifest and spread in the brain?
begins in one part of the brain and rapidly spreads throughout the brain
What are 2 common types of generalized seizures?
- tonic-clonic seizures
- absence seizures
What type of seizure is characterized by intense muscle contractions and a loss of consciousness?
tonic-clonic seizure
What type of seizures are usually self-limiting and last only a few minutes?
tonic-clonic seizures
The disorder defined by seizures that continue for a protracted period of time or that recur frequently is called what?
status epilepticus
Tonic-clonic seizures are sometimes referred to as what (although the term is discouraged in a clinical setting)?
Grand Mal or Gran Mal Seizures
What is the greatest threat with status epilepticus?
What type of generalized seizure involves a period of unconsciousness lasting 3-5 seconds with no tonic-clonic movements present?
Absence seizure
What are partial seizures often referred to as?
focal seizures
What type of seizure involves only one area of the brain?
Partial (focal) seizure
What are 2 ways that partial seizures might exhibit in the body?
- a single muscle movement
- hallucinations (and other sensory alterations)

If a client is having a seizure, your primary action should be to use a tongue blade to ensure that the client doesn't swallow his/her tongue.
False - Your primary action should be to ensure the client's safety by preventing injury (ex. removing an item within the vicinity that may harm the client if they strike it). The idea that a person might swallow their tongue during a seizure has been proven false.
** How do anti-seizure agents work? **
Anti-seizure agents raise the seizure threshold within the brain; this is done by inhibiting excitatory activity in the motor cortex of the brain.
Anti-seizure drugs decrease excitatory activity in the brain. What are the three mechanisms by which this is accomplished?
- suppression of sodium influx
- suppression of calcium influx
- potentiation of gamma-aminobutyric acid (GABA) in the brain
How does the suppression of sodium to the brain help prevent seizures?
sodium carries electrical currents; therefore the blocking of sodium decreases those currents in the brain
How does the suppression of calcium assist in the treatment of seizures? (2)
- calcium carries electrical currents; suppression of calcium decreases electrical currents in the brain
- calcium is necessary for muscular contractions, therefore blocking calcium eases muscular contractions during a seizure
Anti-seizure agents __________ (block or potentiate) gamma-aminobutyric acid in the brain.
Anti-seizure drugs are also used in the treatment of what 2 types of disorders?
- mental health disorders
- chronic pain
How do Hydantoins work in the treatment of seizures?
- decrease excitability in the motor cortex of the brain by suppressing sodium influx
Would you expect to see an increase or decrease in the neuronal action potential when using Hydantoins?
Hydantoins are highly protein bound. What does mean for the half-life of the drug?
these drugs will have a long half-life
What is the biggest "problem" with Hydantoins?
they have a narrow therapeutic index (therefore toxicity is a major consideration)
What may happen if a Hydantoin is given in large doses or via IV too rapidly?
Cardiac Arrest
What type of monitoring would be done for a client who is prescribed a Hydantoin?
- Monitor therapeutic blood levels (routinely, ex. once a month)
- Monitor liver enzymes (mild hepatotoxicity, ex. every 6 months)
- Monitor seizure activity
- Special dental care may be indicated. - Gingival Hyperplasia is a risk
What are Hydantoins primarily used to treat?
- Generalized Seizures, but may be used for partial seizures
Despite the narrow therapeutic index of Hydantoins, they are still commonly used. Why?
They cause less drowsiness than some other anti-convulsants.
Dilantin, a Hydantoin, is used to treat seizures. However, what may occur is Dilantin reaches a toxic level within the blood?
It may actually cause seizures
How do Iminostilbenes work?
they suppress sodium influx through the sodium channels
What are 3 disorders that iminostilbenes are used to treat?
- generalized seizures
- partial seizures
- bipolar disorder

a pathologic condition in which any of the components of the blood are abnormal in structure, function, or quality (as seen in leukemia or hemophilia)
blood dyscrasia
Carbamazephine, an Iminostilbene, is commonly used for the treatment of seizures and bipolar disorder. What other disorder is it used to treat?
trigeminal neuralgia

a neurologic condition of the trigeminal facial nerve; characterized by facial pain
trigeminal neuralgia
Which iminostilbene drug is said to have fewer side effects, carbamazepine or oxcarbazepine?
Which is classified as a narcotic, barbituates or barbituate-like agents?
How do barbituates and barbituate-like agents exert their pharmacological effect?
They potentiate GABA and decrease the conduction of impulses in the ascending reticular formation of the brain
What are barbituates and barbituate-like agents used to treat?
- generalized and partial seizures
In addition to treating seizures, what is another use of barbituates and barbituate-like agents?

Barbituates (and barbituate-like agents) may be used in conjunction with other anti-convulsants.
True - For example, Dilantin (a Hydantoin) and Phenobarbital (a barbituate) are often given together to treat seizure disorders.
Why is non-adherence to the medication regimen so common for clients taking barbituate-like agents (ex. mephobarbital and primidone) for the treatment of seizure disorders?
because they are sedating (affects daily life)
What is the most common use of amobarbital, a barbituate?
given IV for status epilepticus
How do benzodiazepines exert their pharmacological effect?
they potentiate GABA and inhibit impulses subcortically in the limbic system, thalamus, and hypothalamus
In addition to treating status epilepticus, what are additional uses for benzodiazepines? (3)
- delirium tremens (DTs)
- anxiety
- sleep disorders
What is the logic behind a physician ordering diazepam in IV form (a benzodizepine) rather than dilantin for the treatment of status epilepticus in an emergency situation?
Diazepam is a safe alternative to halt seizures while lab work is conducted to check the blood level of Dilantin. Remember --- excess Dilantin can trigger seizures!
How do Valproic Acids exert their pharmacological effect?
they suppress sodium and calcium influx and by potentiating GABA
What are 3 common uses for Valproic Acids?
- Generalized, partial, and absence seizures
- Bipolar disorder
- Prevention of migraine headaches

Clients who are treated with a valproic acid (such as Depacon) must have blood tests done frequently to check magnesium levels in the blood.
FALSE - These clients should have liver enzymes drawn on a regular basis since Valproic acids are moderately hepatotoxic.
What type of sedation level would you expect to see with a Valproic Acid?
These drugs are minimally sedating

Valproic Acids are used very cautiously in children and the elderly.

Note: While this is in theory, these drugs are known to be given to elderly clients with behavioral issues (ex. alzheimer's disease) and in children with behavioral disorder.
What are Succininides used to treat?
absence seizures
How do succininides exert their pharmacological effect?
reduce the synaptic nerve response to low-frequency repetitive stimulation
Miscellaneous anti-convulsants don't fit into any traditional anti-seizure categories. However, almost all of these misc. drugs all have something in common with one another. What is it?
Most of them act on GABA directly or indirectly
How does gabapentin, a misc. anti-convulsant medication, exert it's pharmacological effect?
it enhances GABA release
What are 5 common uses for gabapentin, a misc. anti-convulsant medication?
- adjunctive therapy for partial seizures
- bipolar disorder
- chronic pian
- chronic insomnia
- anxiety
How does lamotrigine, a misc. anti-convulsant medication, exert it's pharmacological effect?
modulates the excitatory action of asparate and glutamate (these are amino acids that excite the brain)
What is the primary use of lamotrigine, a misc. anti-convulsant medication?
adjunctive therapy for partial seizures
How does levetiracetam, a misc. anti-convulsant medication, exert it's pharmacological effect?
Mechanism of action unknown.
What is the primary use of levetiracetam, a misc. anti-convulsant medication?
adjunctive therapy for partial seizures
How does tiagabine, a misc. anti-convulsant medication, exert it's pharmacological effect?
blocks neuronal reuptake of GABA
What is the primary use of tiagabine, a misc. anti-convulsant medication?
adjunctive therapy for partial seizures
How does topiramate, a misc. anti-convulsant medication, exert it's pharmacological effect?
it potentiates GABA, suppresses sodium influx, and blocks glutamate (an amino acid that excites the brain)
What is the primary use of topiramate, an anti-convulsant medication?
adjunctive therapy for partial seizures
How does vigabatrin, a misc. anti-convulsant medication, exert it's pharmacological effect?
it inhibits the enzyme that degrades GABA
What is the primary use of vigabatrin, a misc. anti-convulsant medication?
used for generalized or partial seizures
What are 3 effects seen on the body when magnesium sulfate, a misc. anti-convulsant, is given parenterally?
- CNS depression
- Smooth muscle depression
- Skeletal muscle depression
Magnesium sulfate, a misc. anti-convulsant, has many uses. It is commonly used to control seizures in eclampsia (as seen in late pregnancy) and to halt preterm labor. Why do you think it is the drug of choice for these 2 specific disorders?
because it is a pregnancy category A drug
What should you assess when monitoring a client who is receiving magnesium sulfate, a misc. anti-convulsant?
- assess for depressed deep tendon reflexes
- assess drowsiness
- assess for muscle weakness
- assess for depressed respirations

***Don't forget that this drug is a serious drug! These things should be monitored consistently.***
What type of blood test (and how often) should be drawn on a client receiving magnesium sulfate?
Frequent blood tests for magnesium levels, at least every 4-6 hours
What should you watch for when giving sedating agents?
What should be monitored for agents with a narrow therapeutic index?
monitor therapeutic blood levels
What should be monitored for agents that are hepatotoxic?
monitor liver enzymes
Most anti-convulsants fall into what pregnancy categories?
C & D
Pregnant females receiving anti-convulsants receive additional supplements. Why?
because anti-convulsants increase the loss of folic acid in pregnant women
What should always be on hand when a client is receiving magnesium sulfate? Why?
Calcium Chloride - because it is the antidote to magnesium toxicity
The physiological basis of depression is thought to be a depletion of what?
neurotransmitters in the biogenic amines class in certain areas of the brain
What specific neurotransmitters are thought to be involved in depression? (3)
- serotonin 5 HT
- dopamine
- norepinephrine
Would you expect an increase in mood or decrease in mood when serotonin levels are low?
Low serotonin levels decrease mood (ex. cause depression)
What is the current theory surrounding the cause of low serotonin, dopamine, and norepinephrine levels?
- excessive reuptake by post-synaptic receptors or by excessive breakdown by monoamine oxidase (MAO)
What type of response would you expect to see in the body if epinephrine levels are low?
low energy levels
What type of response would you expect to see in the body if norepineprine levels are low?
inability to focus, lack of energy
In the treatment of depression, what is the first neurotransmitter targeted for treatment?

At what point would you receive a medication that targets all three?
- serotonin is usually the first neurotransmitter that is targeted

- a combination medication will be given if other medications prove untherapeutic OR if the client is suffering from severe depression
How long does it take for most anti-depressants to begin improving symptoms?
about 4 weeks
What might occur if a person accumulates too much serotonin, dopamine, or norepinephrine when taking anti-depressants?
symptoms are aggression, excessive behavior, etc. due to a build up of these agents
What is the overall goal of anti-depressants?
to increase the transmission of the neurotransmitters thought to be lacking
What often happens to clients who begin taking antidepressants in regards to compliance?
These drugs often exert many side effects in the first 2 weeks, but can take an average of 4 to begin working. This results in low compliance with many clients.
How do Tricyclic and Tetracyclic Anti-depressants exert their therapeutic effect?
they reduce the reuptake of serotonin 5HT and norepinephrine by the pre-synaptic region
What are (6) problems associated with Tricyclic and Tetracyclic anti-depressants?
- sedation
- lowered seizure threshold
- heart block with large doses
- orthostatic hypotension
- anti-cholinergic effects
- increased appetite and weight gain
What are the dosage recommendations for TCAs (Tricyclic and Tetracyclic antidepressants)?
- if taking one dose a day, take @ bedtime
- if taking more than one a day, smaller doses during the day and a larger dose at bedtime
What population group should avoid taking amitriptyline, a TCA drug? Why?
The elderly. This is the most sedating of the TCA medication.
In addition to treating depression, amitriptyline, a TCA drug, is also used to treat what other disorder? Why?
used for IBS (irritable bowel syndrome) because of it's high anti-colinergic effects
What is the primary disorder treated with clomipramine, a TCA drug?
In addition to treating depression, what are 2 other disorders that can be treated with imipramine, a TCA drug? Why?
enuresis and stress incontinence because of it's high anti-colinergic effects
How do MAOIs (Monoamine Oxidase Inhibitors) exert their therapeutic effect?
By inhibiting MAO (monoamine oxidase) which allows for increase levels of serotonin 5HT, dopamine and norepinephrine
Which anti-depressant drug would be considered a "last ditch effort" in the treatment of depression? Why?
MAOIs because the have many negative side effects
What could result if there was a drug-drug or food-drug reaction with a MAOI?
Blood pressure could rise to a dangerous level
What are (5) negative side effects of MAOIs?
- drug/drug and food/drug interactions
- lower seizure threshold
- anti-cholinergic effects
- orthostatic hypotension
- increase appetite and weight gain
What disorder may result from the concomitant use of meperidine (Demerol) with MAOIs?
hyperpyrexia (extremely high fever)
How do Selective Serotonin Reuptake Inhibitors (SSRIs) exert their therapeutic effect?
increase the level of serotonin 5HT by decreasing presynaptic neuronal reuptake
Why do SSRIs typically have fewer side effects than other anti-depressants?
Because of their selective nature (only act on serotonin)
What are 3 notable side effects with SSRIs?
- loss of appetite
- weight loss
- decreased sexual function
What specific SSRI is known to cause aggression in certain individuals, especially adolescents?
fluxetine (Prozac)
How does bupropion, a misc. anti-depressant medication, exert it's therapeutic effect?
inhibits neuronal reuptake of serotonin 5HT, norepinephrine, and dopamine
Bupropion, a misc. anti-depressant medication, is similar in structure to what other medication group?
In addition to treating depression, what is another popular use for bupropion, a misc. anti-depresant medication?
smoking cessation
How does duloxetine (Cymbalta), a misc. anti-depressant medication, exert it's therapeutic effect?
inhibits the reuptake of serotonin and norepinephrine
How does mirtazepine, a misc. anti-depressant, exert it's therapeutic effect?
increases neuronal release of serotonin and norepinephrine
In addition to treating depression, what additional disorder can be treated with mirtazepine, a misc. anti-depressant?
What is a known side-effect of mirtazepine, an anti-depressant medication?
causes weight gain and can raise serum lipid levels
How does trazodone (Desyrel), an misc. anti-depressant, exert it's therapeutic effect?
inhibits presynaptic neuronal reuptake of serotonin and some serotonin precursors
In addition to treating depression, what additional disorder can be treated with trazodone, a misc. anti-depressant? Why?
chronic insomnia - because it causes drowsiness
How does venlafazine, a misc. anti-depressant, exert it's therapeutic effect?
reuptake of serotonin at lower levels, but also inhibits the reuptake of norepinephrine and dopamine at higher doses
Misc. anti-depressants have ________ (fewer or greater) adverse effects on sexual functioning.
How long should a nurse tell a client it will take to see therapeutic effects when taking an anti-depressant?
4-6 weeks
Why would you monitor clients (especially teen-agers) for signs of suicidal ideation while on anti-depressants?
Clients with untreated depression may not have the energy to commit suicide, however they may carry out a plan when the anti-depressant becomes effective.
How long should therapy accompany the use of anti-depressants?
at least 6 months to a year
How do anti-manic agents, such as lithium carbonate, exert their therapeutic effects?
decreases manic episodes by blocking the release of dopamine and norepinephrine
Lithium carbonate, an anti-manic agent, may cause what negative side effect? What diet changes must be made to help prevent this side effect?
- may cause hyponatremia

- 2500 - 3000 mL of fluid intake per day and an adequate sodium intake should be included in diet
Lithium carbonate, an anti-manic agent, has a very ________ (narrow/wide) therapeutic index.
What pregnancy category does Lithium carbonate fall in?
Pregnancy category D
Drugs used to treat anxiety and sleep disorders include what (3) types?
- anxiolytics
- hypnotics
- somnifacients
What are the (3) primary uses of drugs that are used to treat anxiety and sleep disorders?
1. relieve anxiety
2. produce sedation (ex. for before surgeries and procedures)
3. induce sleep
Are drugs used to treat anxiety and sleep disorders (anxiolytics, hypnotics, and somnifacients) analgesic?
No, however they may be used in adjunction with analgesics to potentiate the effects of both
How do benzodiazepines produce CNS depression?
by potentiating GABA and inhibiting impulses subcortically in the limbic system, thalamus and hypothalamus
What are 4 uses of benzodiazepines?
- treat anxiety
- treat insomnia
- sedation before surgeries and procedures
- treatment of DTs
Benzodiazepines are controlled substances; what schedule are they?
Can benzodiazepines cause physiological or psychological dependence?
What is chlordiazepoxide (Librium), a benzodiazepine, most often used to treat?
What is diazepam (Valium), a benzodiazepine, most often used to treat? What is the IV form good for? What is an additional use for this drug?
Most often used to treat anxiety. IV form is good for seizures. Additionally used to treat DTs.
What is lorazepam (Ativan), a benzodiazepine, most often used to treat? What is the IV form good for? What is an additional use for this drug?
Most often used to treat anxiety. IV form is good for seizures. Additionally used to treat DTs.
What is alprazolam (Xanax), a benzodiazepine, most often used to treat?
What is flurazepam (Dalmane), a benzodiazepine, most often used to treat?
What is temazopam (Restoril), a benzodiazepine, most commonly used to treat?
What 2 benzodiazepines are often used in IV form for status eptilipticus?
- Valium
- Ativan
What 2 benzodiazepines are commonly used to treat insomnia in the elderly?
flurazepam (Dalmane) & temazopam (Restoril)
What is the primary use of midazolam (Versed), a benzodiazepine?
given for sedation before surgery and some diagnostic procedures
What are 2 adverse reactions of midazolam (Versed), a benzodiazepine? What precautions are in place because of this?
- short-term amnesia
- severe respiratory depression

** Only given in health care settings that can provide continuous monitoring**
What benzodiazepine is commonly used for colonoscopies?
midazolam (Versed)
What antidote may be given if coma or respiratory depression occurs with the administration of a benzodiazepine? How long does it take for this antidote to work if given IV?
flumazenil (Romazicon) - should work within 1-2 minutes
If a client is benzodiazepine dependent, what may occur with the administration of flumazenil (Romazicon)?
withdrawal syndrome
Buspirone (BuSpar), a non-benzodiazepine anxiolytic, is used to treat what?
anxiety alone (NOT depression)
How does Buspirone (BuSpar), a non-benzodiazepine anxiolytic, exert it's therapeutic effect?
binds to serotonin and dopamine receptors in the CNS resulting in decreased transmission of these neurotransmitters
Why must the prescribing doctor be very cautious when prescribing a non-benzodiazepine anxiolytic (such as BuSpar)?
because these agents will enhance depression if a client is already depressed. They should only be used in clients with high anxiety absent of depression.
What nursing consideration should be implemented for a client on a non-benzodiazepine anxiolytic (such as BuSpar)?
Monitor for extrapyramidal side effects, including abnormal movements such as those seen in Parkinson's disease (dystonia, and tardive dyskinesia)
Any drug that reduces _________ in the brain may induce Parkinson like side effects.
Do Non-Benzodiazepine Somnifacients potentiate or inhibit GABA?
Would a benzodiazepine or a non-benzodiazepine somnifacient have less residual effects?
non-benzodiazepine somnifacient
Which is thought to cause less physiological/psychological dependence - benzodiazepines or non-benzodiazepine somnifacients?
non-benzodiazepine somnifacients
Are non-benzodiazepine somnifacients controlled substances?
Yes, schedule IV
Zaleplon (Sonata), a non-benzodiazepine somnifacient, is used to treat what? Briefly describe it's action.
Used for insomnia - has a short half-life so can be taken late in the night
Zolpidem tartrate (Ambien), a non-benzodiazepine somnifacient, is used to treat what? Briefly describe this drug.
Used to treat insomnia - has a greater half-life than others, so 7-8 hours must be devoted to sleep
Eszopiclone (Lunesta) is similar to what other non-benzodiazepine somnifacient?
zolpidem tartrate (Ambien)
What hormone helps control the sleep-wake cycle?
What are 2 examples of melatonin receptor agonists?
melatonin and ramelteon (Rozerem)
What receptor sites does melatonin work on? What receptor sites does ramelteon (Rozerem) work on?
melatonin - works on melatonin type 1 receptor sites

ramelteon (Rozerem) - works on melatonin type 1 and type 2 receptor sites
How long before getting into bed should you take a non-benzodiazepine somnifacient?
- you should take these right before getting into bed
What occurs to the action of non-benzodiazepine somnifacients if taken with food in the stomach?
- decreases bioavailability
What is a side-effect of zolpidem tartrate (Ambien) if a person is awakened during sleep?
short-term amnesia
Why should alcohol be avoided when taking non-benzodiazpine somnifacients?
- alcohol increases the action of the drug and can cause psycho-motor impairments
Drugs used for psychosis and agitation __________ (increase/decrease) dopamine and serotonin levels.
Agents used for psychosis and agitation may be used to treat what 2 disorders?
- Anxiety (high levels)
- Bi-Polar Disorder (during manic phase)
What should the nurse monitor for when giving an agent used for psychosis and agitation?
- monitor for a decrease in alertness
- monitor for anti-cholinergic effects
- monitor for abnormal movement disorders (tardive dyskinesia, dystonia, akathisia, pseudoparkinsonism)
What are 2 drugs that may be given to decrease the effects of abnormal movement disorder cause by the administration of a drug to treat psychosis? What side-effect must be closely monitored if these drugs are given?
benztropine (Cogentin) or trihexiphenidyl (Artane), however you need to monitor for anti-cholinergic effects
How do narcotic analgesics (opiods) exert their therapeutic effect?
bind with opiate receptors in the central nervous system altering the perception of and the emotional response to pain
Activation of cells in the brain containing _______ also occurs with some opioids.
Besides reducing pain, what are 4 additional uses of opioids?
- suppress cough
- slow respiratory rate
- decrease peristalsis
- pre-medication before surgery
What are 3 types of non-opioid analgesics?
- non-steroidal anti-inflammatory agents (NSAIDS)
- acetaminophen
- salicylates
What 3 drug types may be given in adjunction to analgesics in the treatment of chronic pain?
skeletal muscle relaxants
What should a nurse specifically include when assessing pain? (8)
- location
- intensity
- quality
- pattern
- precipitating factors
- alleviating factors
- associated symptoms
- coping mechanisms

Treatment of acute and chronic pain is not different.
False - medication regimens differ for each type

Studies have shown that pain control in the US is inadequate.

Children and the elderly are often treated properly for pain.
False - medications are often given in doses too small or too infrequent in the children and elderly especially

Analgesia is most effective if given once pain has reached it's severity.
False- it is more effective if given before the pain becomes severe
Which would be better managed by scheduled doses of analgesics, acute or chronic pain?
chronic pain
If respiratory depression is a concern with opioids, why is it given around the clock for chronic pain?
because respiratory depression is not likely to occur in the presence of pain
What is the recommended pain medication for a person with terminal cancer? Why?
Morphine because it has a wide dosage range (no dosage ceiling)
What is meperidine (Demerol), not recommended for chronic pain?
because after only a few days use, it is converted to normeperidine which is a CNS toxin (causes confusion, excitement, seizures, hallucinations)
Why is PCA (patient controlled analgesia) used?
it is shown to better control pain
Is codeine a mild or strong opioid agonist?
Fentanyle transdermal systems (Duragesic patches), opioid agonists, are commonly used to treat what 2 disorders? Briefly describe.
- chronic pain
- cancer

*slow onset, continual relief*
Are hydromophone (Dilaudid) and methadone (Dolophine) stronger or weaker than morphine?
Is meperidine (Demerol) long or short-acting?
Is oxycodone (OxyContin), an analgesic, long-acting or short-acting? Why does it have a bad reputation?
It is long acting; it has a bad reputation because abusers smash/shoot-up the medication (causing respiratory depression)
What specific analgesic was considered the pain medication of choice for the elderly for many years? What problem is associated with this?
(propoxyphene) Darvon - very mild; not effective for any pain that exceeds mild
What synthetic agent is used to treat pain, but is not controlled and therefore appealing to doctors?
tramadol hydrochloride (Ultram)
How does tramadol hydrochloride (Ultram) exert it's therapeutic effect?
binds with opiate receptors and increases levels of norepinephrine and serotonin
Tramadol hydrochloride (Ultram) should be used cautiously with what 2 things? Why?
- antidepressants
- St. John's wort

- Because it already increases the level of serotonin, and excessive serotonin can cause serotonin syndrome (extreme agitation)
Why are opioid agonists/antagonists thought to have a lower addiction potential?
because of their antagonistic properties
Opioid Agonists/Antagonists are less likely to cause what?
respiratory depression
Opioid Agonist/Antagonists may cause what if given to a client who is opioid dependent?
withdrawal symptoms
Opioid Antagonists, such as naloxone (Narcan) and naltrexone (Trexan), are used for what?
opioid overdoses
Are opioid antagonists long or short-acting? What implication might this have on a person who is overdosing on methadone or heroin?
They are short acting; therefore they must receive multiple doses until the heroin/methadone leaves their system

Most people are not allergic to opioids, therefore it is not a common nursing consideration
False- allergies to opioids are not uncommon; additionally, you will always check for allergies when administering ANY medication
Why should opioids not be given to a person with a head trauma?
opioid medications can mask symptoms of a head trauma
Why should you not give an opioid to a person in shock?
because opioids can decrease blood pressure

Opioids should not be given when a persons respiratory rate is borderline low
False -

they should not be given when a person has SEVERE respiratory depression; many times pain medication is withheld unnecessarily
Can opioids be used in a client with a history of addiction?
Yes, they may be used cautiously; however you should never deny such a person pain control if they are in pain
Opioids should be used cautiously with clients that have what 2 conditions?
- urinary retention
- asthma
What side-effect is very likely to occur with opioid use?
Centrally acting skeletal muscle relaxants are used for what disorder?
muscle spasticity
What causes muscle spasticity?
direct injury to the muscle or damage to the area of the CNS that controls muscle activity
How do centrally acting skeletal muscle relaxants exert their therapeutic effects?
interfere with the reflexes that cause spasticity
Muscle relaxants are sometimes given concomitantly with what?
What special nursing consideration is applied to baclofen (lioresal), a centrally acting skeletal muscle relaxant?
it needs to be discontinued by tapering over a 1-2 week period to avoid psychosis and hallucinations
All patients taking centrally acting skeletal muscle relaxants should be monitored for what 2 things?
- muscle weakness
- drowsiness
Parkinson's disease is a degenerative disorder of the CNS cause by what?
destruction of the neurons in the substantia nigra that produce the neurotransmitter dopamine
Neurons in the substantia nigra supply dopamine to the ______ ______ which controls balance, posture, and involuntary muscle movement.
corpus striatum
Why does the lack of dopamine in the corpus striatum result in tremors, muscle rigidity, postural instability, and bradykinesia (as seen in Parkinsons)?
because acetylcholine excessively stimulates the corpus striatum
What 2 types of drugs are commonly used to treat Parkinson's Disease?
- Dopaminergic Drugs
- Anti-Cholinergic drugs

Head trauma can cause Parkinson's Disease
What is the overall goal of the many drugs used to treat Parkinson's disease?
They all aim to raise the dopamine levels in the brain

Anti-Parkinson medications should be given within a 1 hour window to avoid a worsening of symptoms.

They should be administered ON TIME
Abrupt discontinuation of anti-Parkinson medications can lead to what?
Parkinsonian crisis
Foods high in what can decrease the effects of anti-Parkinson medications?
pyridoxine (vitamin B6)
Why should a person receiving anti-Parkinson medications change positions slowly?
to avoid faintness or dizziness (to avoid falls)
What are 5 examples of effects that may be seen in anti-cholinergic drugs (and should be monitored)?
1. blurred vision
2. dry mouth
3. urinary retention
4. constipation
5. tachycardia
What Dopaminergic drug is most affected by B6 intake?
levodopa (L-Dopa)
Alzheimer's Disease is a degenerative process that occurs in the ______ ______.
cerebral cortex
Although Alzheimer's is a CNS disorder, we currently can only treat the ________ nervous system.
What 3 things occur to the cerebral cortex that can be attributed to the development of Alzheimer's Disease?
- cerebral cortex decreases in size
- amyloid protein plaques are formed (on the neurons)
- neurons become tangled
What occurs in the parasympathetic nervous system that can be attributed to the development of Alzheimer's Disease?
- the enzyme active in producing acetylcholine is decreased
What are 4 common symptoms of Alzheimer's disease?
- memory impairment
- language impairment
- confusion
- agitation
As Alzheimer's disease progresses, what 3 essential functions of daily living are lost?
- ability to walk
- ability to feed self
- ability to maintain continence
Although Alzheimer's disease can be seen in middle age, it most typically occurs to those over what age?
Currently, how many medications are available to decrease the symptoms of Alzheimer's disease?
How does donepezil (Aricept), a drug to treat Alzheimer's disease, exert it's therapeutic effect? What stage of Alzheimer's does it work on?
increases levels of acetylcholine; works on early stages
How does mermantine HCL (Namenda), a drug to treat Alzheimer's disease, exert it's therapeutic effect? What stage of Alzheimer's does it work on?
blocks activation of receptors for N-methyl-D-asparate receptors in the CNS; works on early to middle stages
CNS stimulants are used to treat what disorders?
- ADD and ADHD
- narcolepsy (and other sleep disorders)
- obesity
How do CNS stimulants exert their therapeutic effect?
stimulate the cortical area of the brain and the reticular activating system
What effect does CNS stimulants have on children?
has a paradoxical calming effects on children
What type of adult may benefit from a CNS stimulant?
an adult with ADD
Why are CNS stimulants used to treat obesity?
they cause an increase in metabolism

CNS drugs can be used for post-stroke victims.
True- they are used in hopes to enhance attention and concentration
What is a major concern with children who are on CNS stimulants, such as Ritalin or Concerta.
They diminish appetite greatly
Are CNS stimulants controlled substances?
yes, physical and psychological dependence can occur
What are 4 major nursing consideration in regards to CNS stimulants?
- monitor for nervousness and insomnia
- monitor for nausea, anorexia, and marked weight loss
- monitor for increase in blood pressure
- monitor growth milestones for children
Methylphenidate (Ritalin, Concerta), a CNS stimulant, is used for what disorders?
- narcolepsy
Modafinil (Provigil), a CNS stimulant, is commonly used for what 2 disorders?
- used for sleep disorders that cause hypersomnia
- may also be used after neurological events, such as stroke, to increase alertness
Sibutramine HCL (Meridia), a CNS stimulant, is used commonly to treat what disorder?
Pemoline (Cylert), a CNS depressant, is used to treat what?