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93 Cards in this Set
- Front
- Back
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Adrenergic =
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Symapthetic
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Cholinergic =
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Parasympathetic
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What does Adrenergic stimulation do to the Heart and how does it do it?
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Increase Heart rate, force & velocity by NE stimulation on the B1 receptor sites.
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What does Adrenergic stimulation do to the Lungs and how does it do it?
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Dialates the lungs by NE stimulation on the B2 receptor sites.
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What does Adrenergic stimulation do to the Bladder and how does it do it?
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Relaxes the depressor muscle by NE stimulation on the B2 receptor sites, and contracts the sphincter by NE stimulation on the Alpha receptor sites.
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What does Cholinergic stimulation do to the Heart and how is it done?
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Decreases Heart rate, force and velocity by AcH stimulation on the Muscarinic and Nicotinic receptor sites.
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What does Cholinergic stimulation do to the Lungs and how is it done?
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Constricts the lung and increases bronchial secretions by AcH stimulation on the Muscarinic and Nicotinic receptor sites.
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What does Cholinergic stimulation do to the Bladder and how is it done?
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Detrussor muscle contracts and sphincter relaxes by AcH stimulation on the Muscarinic and Nicotinic receptor sites.
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What does Adrenergic stimulation do to the GI tract and how is it done?
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Decreases motility by NE stimulation the B2 receptor sites and contracts the sphincters by NE stimulation on the alpha sites.
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What does Cholinergic stimulation do to the GI tract and how is it done?
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Increases motility by AcH stimulation the Muscarinic/Nicotinic receptor sites and relaxes the sphincters by AcH stimulation on the Muscarinic/Nicotinic sites.
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What do the H1 neurotransmitters do?
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Stimulates alergic reations and causes drowsiness.
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What do the H2 neurotransmitters do?
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Stimulates the stomach to create stomach acids.
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Describe the normal process of AcH breakdown?
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After AcH is used on the postsynaptic cell it is released into the synaptic cleft. So that we don't have an overload of AcH, Acetylcholinesterase (CE) is activated and breaks down/digests the AcH.
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Describe the normal process of Monoamine breakdown?
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After an Monoamine (MA) is used it returns to the presynaptic cell and is reuptaked. Within the presynaptic cell is a chemical called Monoamine Oxidase (MAO) that breaks down MA into it's various elements and returned to the processing center that can reuse those elements to make MA again.
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Describe the Negative Feedback System of Neurtransmitter regulation?
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The presynaptic cell has a special counter that is used to determine the number of NT let loose into the synaptic cleft. So the NT is released into cleft, goes to the post synaptic receptor site then released and returned to a counter receptor site on the presynaptic cell. Once an adequate number of NT is counted the system turns off.
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Name the monoamines.
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Dopamine (DA); Norepinephrine (NE); Serotonin (5-HT); Histamine (H1,H2).
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Name the Animo Acids.
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Gamma-aminobutyric acid (GABA); Glutamate (NMDA, AMPA)
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Name the Cholinergics.
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Acetylcholine (AcH)
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Name the neurotransmitters that are associated with Anxiety.
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Increased NE, Serotonin; Decrease in GABA
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Name the neurotransmitters that are associated with depression.
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Decrease in DA, serotonin & NE
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Name the neurotransmitters that are associated with Schizophrenia.
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Increase in dopamine & serotonin
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Name the neurotransmitters that are associated with Alzheimer's.
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Deficiency in AcH; Increased action on NMDA glutamate receptor sites.
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Frontal lobes of the cerebral cortex are responsible for?
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planning, & execution of movement
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Pre-frontal lobes of the cerebral cortex are responsible for?
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motivation, problem solving, insight & judgement.
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Limbic system is responsible for?
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Emotion, learning, memory and olfactory center.
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Amygdala of the Limbic System is responsible for?
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emotions
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Hippocampus of the Limbic System is responsible for?
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Memory
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Cerebellum is responsible for?
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Balance & hand-eye coordination.
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Reticular Activating System is responsible for?
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Modulating awareness and consciousness. Allows for both sleep and attentiveness
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Basal ganglia is responsible for?
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Involved with movement; mediating hallucinations & delusions; processing emotions and memory; Part of the extrapyramidal system.
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What is the Extrapyramidal System?
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System responsible for smooth and rthymic movement; does not initiate movement which is done in the pyramidal system.
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Where are the pathways for the EPS found?
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Basal ganglia, cerebellum, cerebral cortex.
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Name the diseases that can cause delusions and hallucinations?
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Schizophrenia, depression, mania, & alzheimers.
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How does a typical antypsychotic work?
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Blocks DA receptor site to reduce the amount of DA reaching the postsynaptic cell therefore decreasing emotional and sensory stimulation. Also blocks other receptor sites which causes traditional AE.
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Why do typical antypsychotics create EPS AE's?
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because DA is being blocked in the basal ganglia.
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Name the atypical Antipsychotics.
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Seroquel, Zyprexa, Clozaril, Risperdal, Geodon. (Superman Zooms w/Captain america Riding Goku)
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What are the AE's of Typical Antipsychotics
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Anticholinergic effects, pseudoparkinsonism, acute dystonia, akathesia, Tardive dyskinesia, Hypotension/Tachy, Agranulocytosis, Cholestatic Jaundice, Neruroleptic Malignant Syndrom.
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What are the anticholinergic side effects?
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dry mouth, urinary retention, constipation, blurred vision, dry eyes, ingibition of ejaculation, photosensitivity.
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What are the S/S of pseudoparkinsonisms?
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Masklike face, stiff and stooped posture, shuffling gait, drooling, "pill-rolling", tremor.
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What are the S/S of Acute Dystonia?
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contractions of muscles causing patient to be frozen in painful positions.
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What are the S/S of Akathesia?
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sense of inner restlessness; rocking, tapping foot, pacing
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What are the S/S of tardive dyskinesia?
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Constant movement, often lip smacking or tongue thrusting.
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What are the S/S of cholestatic jaundice?
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fever, abdominal pain, nausea, malaise occur oweek before jaundice.
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What are the S/S of neuroleptic malignant syndrome?
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Rare but fatal-- Severe EPS's; hyperpyrexia; autonomic dysfunction (HTN, Tachy, diaphoresis, incontinence)
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What can the nurse do to alleviate the anticholinergic AE's?
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Sips of water, sugarless candy; increase liquids/fiber or stool softener; wear sunscreen & sunglasses; Artificial tears.
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What can the nurse do to alleviate the pseudoparkinsonism AE's?
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administer Cogentin or Benadryl as ordered.
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What can the nurse do to alleviate Acute dystonic reactions?
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Benadryl 25-50mg IM/IV; Cogentin 1-2mg IM/IV; off set further reactions with anticholinergic medications.
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What can the nurse do to alleviate Akathesia?
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Administer anticholinergic medications; MD may change antipsychotic.
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What can the nurse do to alleviate Tardive Dyskinesia?
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No known Treatment; Discontinue drug; better for pt. to detect symptomes in early stages.
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What can the nurse do to deter agranulocytosis AE's?
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Blood work weekly, gradually progressing to monthly then quarterly then Q6mos.; Stop drus if symptom occurs.
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What can the nurse do if symptoms of Cholestatic jaundice occurs?
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Discontinue drug; bed rest and good nutrition; monitor liver function; resolves if caught early.
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What can the nurse do if symptoms of NMS occurs?
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Stop antipsychotic drug; Transfer to medical unit or ICU; treat autonomic dysfunction & fever; Early detection increases chance of survival.
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What unique effect does Geodon have that other atypical antipsychotics don't?
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Contraindicated for pts. with cardiac problems
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Which atypical antipsychotics have the highest risk of Metabolic syndrome?
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Clozaril, zyprexa
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What unique effect does clozaril have that other a typical antipsychotics don't?
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AE of agranulocytosis.
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Name the typical antipsychotics.
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Thorazine, Haldol, Prolixin. (THP)
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What makes the atypical antipsychotics more desirable than the typical antipsychotics?
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Atypicals work on the positive and negative symptoms of schizophrenia.
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Why does DA and AcH need to be in balance?
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Balance is required to maintain smooth movements. Low DA with High AcH movement becomes stiff.
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What does a nurse do if movemnets start to become stiff?
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Administer Cogentin an Anticholinergic drug that inhibits AcH.
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What is the most common AE of Atypical antipsychotics?
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Metabolic syndrome
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What is metabolic syndrome?
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A condition where a pt. experiences weight gain; increased blood glucose; increased triglycerides.
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Antidepressants work by?
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By stimulating an increase in axons which causes new synaptic connections.
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Name the tricyclic antidepressants?
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Elavil only.
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How do Tricyclic Antidepressants work?
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Blocks the reuptake of NE, increasing the amount of NT within the synaptic cleft.
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What are typical AE's of tricyclic antidepressants?
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Cholinergic and Adrenergic blocking creating postural HTN, dry mouth, urinary retention. Also depresses cardiac conductivity and contractility. Sedating and can be toxic with OD.
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Name the SSRI's?
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Paxil, Zoloft, Prozac
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How do SSRI's work?
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Block the reuptake of serotonin leaving higher concentrations within the synaptic cleft.
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S/S of Serotonin Syndrom?
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Fever, agitation, HTN, tacky. Looks like Neuroleptic Malignant syndrome except you get aggitated as opposed to frozen.
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What are the pro's and con's of taking an SSRI?
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Fewer AE's than TCA's; may cause excessive stimulation and anorexia.
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What are the MAOI's?
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Nardil, Parnate
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How do MAOI's work?
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inhibits monoamine oxidase from breaking down the monoamines. This enables the cell to recylce the NT faster.
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What is the biggest concern of a pt. taking a MAOI?
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Blocking the enzyme that breaks down monoamines also affects breakdown of monoamines ingested with foods especially tyramine.
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Name foods that have Tyramine in them?
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aged cheeses, pickled, dried or smoked fish/meat, wine, Avocados, soybean, figs, bananas, sausages, soy sauce, ect....
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Name the types of Mood Stabilizers?
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Lithium; Aniepileptic drugs
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Name the SNRI's?
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Effexor, Cymbalta
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Name the SNDI's?
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Remeron
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Name the Aniepileptic drugs?
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Valproic Acid (Depakote); Lamictal ; tegretol; Trileptal; Topamax; Neurontin
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What is unique about the TCA Tegretol?
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Decreases post-synaptic transmission of impulses; not used much now.
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What is unique about the TCA Valproic acid?
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Makes GABA more available in the brain. therefore reduces impulse transmission. Useful in mixed episodes & rapid cycling.
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What is unique about the TCA Lamictal?
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quesitonable action on glutamate; decreases transmission of impulses; useful in maintenance therapy and for patients with depression.
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How does Lithium work?
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decreases neural conductivity (including heart) thus decreasing stimulation in manic states.
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Other things to consider when a pt. is on lithium?
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sensitive to electrolyte changes; no sedation; interacts with many drugs; blood levels need to be maintained at 0.5-1.4 mEq/L
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What are the normal AE's of Lithium?
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mild thirst, mild hand tremors, polyuria.
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What drugs are used to relieve anxiety?
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Benzodiazepines & Buspar
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Name the Benzodiazepienes?
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Valium, Ativan, Xanax, Klonopin
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How do Benzodiazepines work?
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Bind to specific receptors next to the GABA receptors thereby enhancing the action of GABA.
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What is Buspar?
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Medication that sits on the 5-HT pre-synaptic counting site turning off negative feedback. Effectively releasing more serotonin into the synaptic cleft.
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Why would you use Buspar instead of Benzodiazapines?
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Benzo's are highly addictive so this is used instead but it takes several months to start being effective. Reduces anxiety without the sedation of a Benzo.
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Other key facts to remember about Benzo's?
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Don't mix with alcohol due to severe sedation. Tolerance and dependency profile is high; need to withdraw slowly to prevent seizures.
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How do psychostimulants work?
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Stimulate the attention centers of the brain
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What are the psychostimulants and what are they used for?
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Used for ADHD and are Ritalin, Adderal, Concerta (CAR)
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What medications are used for Alzheimers and what are their class?
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Cholinesterase Inhibitor Aricept and NMDA antagonist Namenda.
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Explain drug metabolism and the P450 system?
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P450 determines how much of the drug is needed; Poor metabolism = less drug dose; fast metabolism = Higher drug dose
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