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61 Cards in this Set

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CNS drugs
work on
treat
they are..
brain and spinal cord.
treat mental illness, seizures, pain and for anesthesia-
all are analgesics
Prostaglandins
bad-start pain receptors and increase inflammation- Cox1 and 2 help in this formation but Cox 1 prostag.work in the stomach where they promote the development of the mucous lining- a very good thing, whereas Cox 2 prost.cause pain/inflammation-
want to stop this-
lipid cmpd
Most OTC pain relievers
inhibit Cox enzymes which are necessary for prostaglandin formation.
Cox enzymes 1 & 2
responsible for the desired (Cox1-forms prostaglandins that promote mucus lining of stomach)and adverse effects (Cox2 is responsible for inflammation/pain of arthritis) of the drug:
for the formation of and inhibition of prostaglandins-
ASA & AIM NSAIDs & selective NSAID (Celebrex) inhibit COX
- relieves inflammation and pain-
- main inhibitors are NSAIDS they inhibit all COX (AIM, Aleve/ibuprofen/Motrin)but may cause PUD and dyspepsia
-new class of COX 2 inhibitors selectively block 2 only but may cause atherothrombosis (Celebrex, Vioxx)
Cox 1
"good" Cox - does good things, Peripheral action: gastric protection, maintains renal blood flow, causes platelet aggregation(clotting), promotes uterine contractions
Cox 1 - when blocked
the inhibition causes: gastric ulceration, acute renal failure, bleeding tendencies, relaxes uterine muscles so the new selective COX 2 inhibitors would be good but have many side effects, only one on market is Celebrex
Cox 2
Peripheral action: causes inflammation- responsible w/Cox1 for the formation of prosgtagladins which cause pain, swelling, inflammation
Cox 2 con't
central action: causes pain and fever
Cox 2 con't 2
when blocked: inhibition causes: reduced inflammation,reduced fever, reduced pain
blocked by NSAIDS and new NSAIDs that selectively block (Celebrex)
Cox 1 and Cox 2
only comes in combination
Non-Narcotic Analgesics
Salicylates
Para Aminophenol Derivatives
NSAID
Urinary tract analgesic (antiseptics)
see hint
PUNS
Paraaminophenol derivatives
urinary tract antiseptics
NSAIDs
Salicylates
Salicylates
Aspirin/acetylsalicylic acid
Para Aminophenol Derivatives
Tylenol/acetaminophen
NSAID
non-Steroidal Anti-Inflammatory Drug
Aleve/ibuprofen/motrin (AIM)
Urinary tract analgesic(antiseptics? Bactrim)
Pyridium/phenazopyridine
(pyromanic sets fire, pee on him)
Salicylates
Aspirin/acetylsalicylic acid
inhibits Cox 1 & 2
4 properties
anti-platlet effects last for life of platelet (7-10 days)(do not take 2 wks b4 & after surgery)
most common s.e.: GI, PUD,
another s.e.: renal failure
4 properties of Salicylates
analgesic (decreases pain)
anti-inflammatory
anti-pyretic (decreases fever)
anti-platelet
Aspirin toxicity
mild dizziness
tinnitus(most alarming s.e.)
N&V
often caused when used to treat rheumatoid arthritis because of the high dosage required- check creatine levels for renal fx

very acidic- to many cause Acidosis
enteric coatings on ASA will help stop ulcers but since ASA inhibits Cox, it is a systemic result so will not help with stomach ulcers-prevention but not stop-so red flag pts with chronic inflammatory disease
Reye's syndrome
if child under 18 has influenza or chickenpox, Aspirin can cause this and it can be fatal
kaopectate and Peptobismal both have aspirin
Para Aminophenol Derivatives


see hint
works centrally
max dose: 4 gm/day
mixed w.narcotic pain relievers
lrg doses -hepatoxicity esp. with alcohol
overdose antidote: mucomyst/acetylcysteine
PAD-Pad the tylenol-add the minophen
2 properties of PADs
1.analgesic
2.anti-pyretic

tylonal - pain and fever
Non-Steroidal Anti-Inflammatory Drugs
NSAIDS (non selective)
non-selective Cox inhibitors
Aleve/ibuprofen/Motrin AIM
Block 1 & 2 Cox
4 properties:analgesic, anti-inf.antiplat, anti-py.
adverse: GI, PUD, Renal failure, slight bleeding tendencies (better for menstrual cramps)
NSAIDS
4 properties (same as ASA)
anti-inflammatory
analgesic
anti-pyretic
better anti-infl, than ASA, better for sprained ankels, etc
anti-platelet (only last as long as it is in bloodstream)
Selective Cox inhibitors
Celebrex/celecoxib
block COX 2
2 properties: analgesic, anti-inflammatory
rare side effects
have cardiac issues
Celebrex-
Cox 2,
2 prop.,
Cardiac issues
All NSAIDS are useful in treating
Rheumatoid arthritis
Menstrual cramps
post-op pain
Anti-inflammatory
Selective COX 2 inhibitors (Celebrex/celecoxib) NSAIDS-(AIM)
Salicylates- Aspirin/acetylsalicylic acid
non-narcotic analgesic
ASA
Tylenol/acetymenophen
Motrin
Aleve
ibuprophen
Celebrex
anti-pyretic
ASA
Tylenol
AIM (aleve,ibuprofen,motrin)
anti-platlet
AIM
ASA
NSAIDs
AIM
Celebrex
least effective treating pain from inflammation
Tylenol
Most appropriate to prevent heart attacks/strokes
ASA
blood thinner
most effective in treating pain in a chronic inflammatory condition
NSAIDs- more powerful than ASA & not acidic, less GI problems - if intigent then NSAIDs are expensive so give ASA
choice to treat headache in alcoholic patient
NSAIDs
if there is no hepatic problems then could take tylenol
choice for a pt with renal failure
tylenol-affects liver not kidney
Urinary Tract Analgesics
Pyridium/phenAZOpyrindine - AZO standard drug ( take with food, drink, milk or after meals)
calms -lidocaine effect
no anti-infective property
often comb. w/urinary antiseptics like Bactrim (has some pryridium in it)
turns urine orange-red, may be mistaken for blood
Narcotic Agonist Analgesics
or Opioids - Morphine & demorals
Morphine/morphine sulfate
actions: relieves pain by binding to opiate receptor sites in the brain and spinal cord, blocks pain
alters pain perception
causes decreased GI motility (can cause fecal impaction), euphoria, sedation, pupil constriction, drowsiness, respiratory depression (danger below 12 so monitor pt)
Opioids-problems
if on an opioid more than 2 days then pt will need a stool softner, will cause impacts,
watch for physical dependence
give high fiber food
Morphine one of most difficult drugs to rehab from
Give tylenol to child
tylenol every 4 hrs
motrin every 6 hrs
Nursing implications of Opioids
1.do not admin if resp.<12
2.may cause physical depend.
3.prevent constipation
4.give on fixed sch. or b4 pain is moderate/pca Pump
5.used to treat acute or cancer related pain(most used in patches or PCA pump)
6. overdose is treated w/opioid/narcotic antagonist-
Narcan/naloxone
Narcan/naloxone

see hint
1.competes w/Morphine at recepter sites
2.dose may be repeated every 2-3 min
3. contraindicated in persons chemically dependent-causes withdrawal
Narc-stops Opioids
Nursing assessments/interventions for Opioids
1.respirations & vital signs
2.constipation
3.flatulence
4.pain scale 5 or below good
Mixed Agonist-Antagonist Opioids


see hint
Stadol/butorphanol
1.decreases pain w/out respiratory depression and GI effects
2. is not as effective in treating moderate to severe pain as agonists
3. equal in effectiveness to Tylenol/NSAIDs
Is "stad all?" just 2?-all mixed up
Anti-anxiety- narcotic analgesic-Opioid
Valium & Dalmine

hint
Class:Benzodiazepine/Valium/
diazepam
anti-anx & muscle relax

Dalmane should not be used in elderly due to long half-life (pt will sleep long time)
most common s.e: Sedation
should be D/C slowly
VD - Valium & Dalmine
Val
Dal
Barbiturates- narcotic antianxiety - Opioid
Luminal/pentobarbital
treats anxiety, seizures
supresses REM sleep
raises seizure threshold
less safe than benzodiazepines (Valium)(antianxiety & muscle relaxant used with antidepresants and SSRI's
barbituates a-luminate your mind
pento-barbit-al
Narcotic analgesics - Opioids
Morphine-pain reliever
Stadal-pain reliever
Valium-Benzodiazepine-Dalmine -anti-anxiety
Luminal- barbituate
Dexadrine-amphetamine
Analgesics-Opioids
main use: pain relief
bind opioid recepters
all addictive
Amphetamines-narcotic analgesic-opioid
nervous system stimulant
acts: increases prod. of neuroreceptors (norepinephrine, dopamine, serotonin_
actions: causes euphoria, mental alertness, decreases fatigue, sympathetic NS stimulation
causes in adults: hyperactivity, restlessness, agitation, diff. concentrating
used to treat: narcolepsy, ADHD, obesity
overdose may cause convulsions, increase HR
causes in children: sedation
Used for ADHD
Do not use amphetamines with:


see hint
MAO inhibitors - blocks the blocker, causes hypertensive crisis, doubles the epinephrine, stimulates sympethetic response which MAO inhibitors break down epinephrine, synergenic response
Amp cannot play with Maoi, cause Maoi keeps blocking amp, makes him have a adrenaline rush, makes him have a hypertensive crisis, but makes him sympathetic
Nursing implications of amphetamines

see hint
1. caffeine is similar w/out extreme
s.e. potentiates (enhances) amphetamines
2.contraindicated if have heart disease, HTN, glaucoma due to its adreneric(mimics norepinephrine-bronchiodilators- nasal decongestants) effects
produce tolerance and dependance
HTN is hypertension
Contraindicated (amphetamines) with
MAO inhibitors
decongestants
heart failure pts
coffee
glaucoma pts
Psychotropic agents:
Antidepressants
in general:
1.used to treat depressed mood, feelings of sadness, emotional upset & chronic pain
2. exact cause and cure is unknown
3.depression is attributed to decreased amts of the neurotransmitters norepinephrine and serotonin in the brain and neurotransmitter receptor function (increase)
4. 3 classes -all take 2 wks or more to become theraputic
Antidepressants

hint
Tricyclic agents: Elavil/amitriptyline
SSRIs- Prozac/fluozetine
MAO inhibitors
St. Johns Wort
Msst
Tricyclic agent

see hint
Elevil/amitriptyline
typical-andrenic uptake inhibitor
more side eff. than new agents -used to treat chronic pain
s.e.: sedation, orthostatic hypotension, major wgt gain(leds to non-compliance)
anticholinergic effects:
most serious s.e.: cardiac toxicity/cardiac arrythmias:do EKG b4 admin.
lethal overdose w/ 5-10 day supply-do not give many to pt
use cautiously w/: sympathomimetics, MAO inhibitors and anticholinergics (antimuscarinic and antinicotinic agents)
all synergestic-all cause sympathetic response
will Elevate you tri-ways
to hang yourself,to have heart problems,to gain wgt---
how typical -reuptake with Eleval and you will have plenty side effects
SSRI- Selective Serotonin Reuptake Inhibitors
antidepressant

see hint
Prozac/fluozetine-reuptakes from the synopsys cavity btw the neursotransmitters and receptors to allow serotonin to linger in the synopse cavity longer
Pro zac dates Sera tonin
Prozac/fluozetine
antidepressant
less serious side effects than tricyclics
very effective in treating major depression
s.e.: sexual dysfuntions 70%(no1 reason for non-compliance), wgt gain/loss, nausea, headaches, insomnia
do not mix w/MAOI
Prozac/fluozetine problems


see hint
Serotonin Syndrome:
usually begins w/first few days of therapy
usually caused by drug interactions with other serotonergics/MAOI
S&S- ALTERED MENTAL STATUS, INCOORDINATION, FEVER
Poor(pro) zac he is having problems with Sara Tonin(seretonin)after just a few dates, she is interacting w/Maoi and she altered her state, and became incoordinated
MAO inhibitors-antidepressant

see hint
*last ditch effort drug
as effective as other antidepressants but more dangerous
often used in atypical depression
adverse & main s.e.: CNS stimulation, hypotension (this does not subside), wgt gain, sexual dysfunction
do not eat foods containing tyramine will cause hypertensive crisis
& watch for OTC drug interactions with decongestants that decrease blood pressure
Maoi, is depressed and dangerous. his "last ditch effort"caused CNS stimulation, hypotension, & sexual problems, he gained wgt so had to quit eating old foods "with tyramine", that made his bl pressure go hygh.
maybe he will get a cold, the decongestant will make his blood pressure fall.
Atypical depression: treated by MAO inhibitors

see hint
bulimia, panic attacks, obsessive-compulsive disorders
may be given with anti-anxiety
Maoi can mix with antianna- val and dal
Tyramine foods not to eat when taking MAO inhibitors
aged cheeses, red wine, beer, sausages like bologna, pepperoni, salami and aged fish or meat
St. John's Wort
is an SSRI antidepressant

see hint
adverse eff: photosensitivity, increases the metabolism of many drugs (warfarin/Coumadin, oral contraceptives, antiepilemics) synergenic effects with MAOIs SSRIs, TCAs
ssri poor old st. john he's depressed
he got a bad sunburn,went to war with coumadin, took birth control pills by mistke, and had an anti-epilemic seizure