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106 Cards in this Set
- Front
- Back
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Relieve pain by binding to opioid receptors in the brain, spinal cord and peripheral tissues
Also activate the endogenous analgesia system |
Action of Morphine - Opioids
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Exert widespread pharmacologic effects, especially in CNS and GI
CNS effects: Analgesia, CNS depression, decreased mental and physical activity, respiratory depression, N/V pupil constriction GI effects: slow motility, constipation, bowel and biliary spasm |
Side/adverse effects of Morphine (opioids)
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-Inhibit prostaglandin synthesis in CNS and PNS
-Inhibit COX 1 and COX 2 enzymes -Relieve pain by acting centrally and peripherally to block pain impulse transmission -Relieve fever by decreasing hypothalamic response to resetting thermostat at a lower level Aspirin and non selective NSAIDS also have an antiplatelet effect |
Action of Aspirin (analgesic-anti-inplammatory-antipyretic )
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Increased risk of serious GI adverse events: bleeding, ulceration, perforation of stomach and intestines
-peptic ulcer disease, GI or other bleeding discorders, impaired renal function -hypersensitivity to ASA -Chronic alcohol abuse -associated with Reyes Syndrome |
Side effects of Aspirin (NSAIDS)
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Antiolytics, sedatives: promote relaxation
Hypnotics: produce sleep All are CNS and PNS depressents with similar effects Used to treat anxiety and insomnia |
Action of Benzodiazepam (antianxiety and sedative hypnotic drugs)VALIUM
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Physical dependence is associated with longer use and higher doses
-Milk withdrawal symptoms occur in approximately half of clients taking medication for 6-12 weeks -Severe withdrawal more likely when meds are taken in high doses for more than 4 months then abruptly discontinued |
Side effects of Benzodiazepam (antianxiety/hypnotic drugs)
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Most block the action of dopamine
-Chronic drug administration results in upregulation of dopamine receptors -Overall, meds reregulate the abnormal neurotransmission system associated with psychosis |
Action of Chlopromazine (Thorazine) 1st gen. antipsychotic
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-liver damage
-coronary artery disease -cerbrovascular disease -parkinsonism, bone marrow depression -sever hypotension, coma hypertension, severly depressed |
Side effects of Chlorpromazine (Thorazine) antipsychotic
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Most block the action of dopamine
-Chronic drug administration results in upregulation of dopamine receptors -Overall meds reregulate the abnormal neurotransmission systems associated with psychosis -Blocks both dopamine and seratonin -need weekly CBC test |
Action of Clozapine (Clozaril) Antipsychotic
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-liver damage
-coronary artery disease -cerabrovascular disease -parkinsonism, bone marrow depression -severe hypotention, coma -Hypertension, severly depressed -Seizure disorders -Diabetes Mellitus -Glaucoma -Prostatic hypertrophy -Peptic ulcer disease -Chronic respiratory disorders |
Side/adverse effects of Clozapine (Clozaril) antipsychotics
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Normalize abnormal neurotransmission systems in the brain
-May modify interactions among neurotransmission systems -May affect endocrine function -Antidepressant effects are attributed to changes in receptors rather than changes in neurotransmitters Lithium (exact mechanism of action is unknown) |
action of Imipramine & Fluoxetine (prozac) (antidepressent and mood stabilizer)
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-Acute schizophrenia
-mixed mania and depression -suicidal tendencies -severe renal, hepatic or cardiovascular disease -Seizure disorders |
side/adverse effects of Imipramine and Fluoxetine (prozac) (antidepressant and mood stabilizer)
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Newer antidrepressant-SSRI (selective serotonin reuptake inhibitor)
SNRIs (serotonin/norepinephrine reuptake inhibitor) |
Fluoxetine (prozac)
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Exact mechanism of action is unknown
-thought to suppress seizures by, decreasing ion movement into brain cells (sodium channel blockers) -alternating neurotransmitter activity, increase GABA, decrease glutamate. -Combination of both mechanisms -stabilize neuronal membranes and decrease neuronal firing in response to stimuli. |
Action of Phenytoin (Dilantin)
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-CNS: ataxia, drowsiness, lethargy
-Gingival hyperplasia -Osteoporosis -GI: Nausea, vomiting -Toxicity: (nystagmus -rapid eye movemement) -CNS depression -medication hypersensitivity -Hepatic or renal impairment -Sinus bracycardia or heart block -bone marrow depression -pregnancy |
Side/adverse effects of Phenytoin (Dilantin
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Help to correct neurotransmitter inbalance
-increase levels of dopamine -inhibits actions of acetylcholine |
action of Levodopa/carbidopa (Sinemet) Antiparkinson
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Hypersensitivity to meds, narrow-angle glaucoma, depression
-May activate malignant melanoma -Hypertensive crisis, peptic ulcer disease -Severe cardiovascular, pulmonary, renal, hepatic or endocrine disorders |
Dopaminergics (side effect of anti parkinson drugs Levodopa/carbidopa (Sinemet)
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Glaucoma, myasthenia gravis, GI obstruction, prostatic hypertrophy
-urinary bladder neck obstruction, cardiovascular disorders, hepatic or renal disease -elderly clients with cognitive impairments |
Anticholinergics: (side effect of anti parkinson drugs Levodopa/Carbidopa (Sinemet)
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Facilitating the initial and transmission of nerve impulses that excite other cells
-Increase norepinephrine, dopamine, and possibly serotonin in the brain -Large doses produce signs of excessive CNS stimulation |
Actionof Amphetamines (CNS stimulants)
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-Decrease in therapeutic use due to high potential for drug abuse and high potential for dependence.
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side/adverse effects of Amphetamine (CNS stimulant)
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Another amphetamine?
large amount cause anxiety, agitation, irritability, insomnia, diarrhea, nausea, vomiting, hyperactivity, nervousness, restlessness, tremors, tachycardia and PVSs Toxic amounts cause delirium and seizures |
Caffeine
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Codeine, Fentanyl, Hydrocodone, Hydromorphone, Meperidine, Methadone, Oxycodone and Tramadol
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Opioids (pain relievers)
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Acetaminaphen
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Analgesic, antipyretic
(does not have anti inflammatory or anti platelet effect. New guidelines say 3 g or 3000 mg maximum dose in 24 hour period |
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Antidote for Acetaminaphen overdose
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Acetylcysteine (Mucomyst)
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Antidote for Benzodiazepine overdose
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Flumazenil (Romazison)
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Quetiapine (Seroquel)
Risperidone (Risperdal) Olanzepine (Zyprexa) Aripiprazole (Abilify) |
Other antipsychotic drugs - 2nd generation - atypical agents, new NONphenothiazines
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Lithium
Bupropion MAOIs- TCA - |
other antidepressant and mood stabilizing drugs
-Monoamine oxidase -Tricyclic Antidepressants |
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Cerebrex (fosphenytoin)
Tegretol (carbamazapine) Valium (diazepam) and Ativan (lorazepam) Zarontin (ethosuximide) Phenobarbital Neurontin (gabepentin) Trileptal (oxcarbazine) Lamictal (lamotrigine) |
Other anti-seizure meds
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Anticholinergic
Dopaminergic |
other Anti-parkinson drugs
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-Chemical substances that carry messages from one neuron to another
-synthesized and stored in presynaptic nerve terminals -Released in response to electric impulse -Bind to receptors in cell menbrane |
Neurotransmitters
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Proteins imbedded in the cell membrane of neurons that are involved in nerve function
-regulation is effected by changes in synaptic activity -constantly beng synthesized or degraded |
Receptors
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Cholinergic
Dopaminergic GABAergic Noradrenergic Serotonergic |
Major neurotransmission systems
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Associated with level of arousal, memory, motor function and speech
-high concentration if motor cortex and basal ganglia |
Neurotransmitter-Acetylcholine
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-Found in substantia nigra, midbrain,hypothalamus
-Action determined by subtype of receptor to which it binds |
Neurotransmitter-dopamine
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-Abundant in brain and spinal cord
-major inhibitory neurotransmitter in CNS |
Neurotrasmitter-GABA
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Found in relatively large amounts in hypothalamus, limbic system
-associated with mood, motor activity, regulation of arousal and reward; may hold an important role in REM sleep |
Neurotransmitter-norepinephrine
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-widely distributed in CNS
-usually an inhibitory neurotransmitter -associated with mood, anxiety, temperature regulation, sleep-wake cycle, habituation and sensory perceptions |
Neurotransmitter-serotonin
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decreases alzheimers disease
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Acetylcholine
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Psychosis, Parkinsons
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abnormal dopamine
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Anxiety, hyperarounsal states, seizure disorder
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GABA abnormalities
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epilepsy, schizophrenia, stroke, Huntingtons
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Glutamate abdormalities
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Mental depression, sleep disorders
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Serotonin abnormalities
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CNS depressants: Produce depression of CNS in sufficient doses
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antipsychotics, opioid analgesics, sedative-hypnotics
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Mild CNS depression can produce
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lack of interest in surroundings
inability to focus on a topic (short attention span) |
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CNS stimulants
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mild stimulation: wakefullness, mental alertness, decreased fatigue
increased stimulation: hyperactivity, excessive talking, nervousness, insomnia Excessive stimulation: convulsion, cardiac dysrhythmias, death |
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Other opioid agonist
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vycatin
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Opioid Antagonists
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Narcan
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Tissue damage activates nociceptors (nerve cells) which transmit signals to brain by two types of nerve cells
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Physiology of pain
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Given to relieve moderate to severe pain by inhibiting pain signal transmission from periphery to brain.
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Opiod analgesics
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Present with ALL opioid analgesics because of potentially fatal adverse effects and risk of drug abuse
-highest potential for abuse -highest risk of fatal overdose because of respiratory depression |
Black Box Warnings
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Antidote for Anticholinergics (atropine)
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Physostigmine
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Antidote for Benzodiazepines
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Flumazenil
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Antidote for Beta Blockers
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Glucagon
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Antidote for Calcium Channel Blockers
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Calcium Gluconate
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Antidote for Digoxin
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Digibind
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Antidote for Heparin
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Protamine sulfate
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Antidote for Iron
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Deferoxamine
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Antidote for Isoniazid
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Pyridoxine
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Antidote for Lead
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Siccumer
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Antidote for Opioid analgesics
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Naloxone
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Antidote for Phenothiazine antipsychotic agents
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Diphenhydramine (Benadryl)
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Antidote for Thrombolytics
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Aminocaproic acid
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Antidote for Tricyclic antidepressants
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Sodium Bicardonate
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Antidote for Warfarin
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Vitamin K
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Used for Pain and fever
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Acetaminaphin
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Used for OA, RA, pain, dysmenorrhea, Fever
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Ibuprophen
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Mild Gout, severe gout, hyperuricemia in clients with renal insufficiency, secondary hyperuricemia from anticancer drugs
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Allopurinol
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Acute attacks of pain
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Colchicine
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Sumatriptan
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Imitrex
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In the presence of liver disease the metabolism of most benzodiazepines is:
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slowed, which result in accumulation and inreased risk of adverse effects.
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Patients with ________
_________at risk for adverse effect if the take drugs that are higly bound to plasma proteins, |
hypoalbuminemia ( from malnutrition or liver disease)
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Used to treat anxiety and panic disorder.
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Alprazolam (Xanax, Xanax XR)
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The most serious adverse effect of prototype traditional and prototype non-traditional antypsychotic drugs is:
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Anicholinergic effects ( confusion,memory impairment, hallucination, urinary retention, onstipation, and heat stroke. Cardio vascular disease is also a great concern in older patients. BONE MARROW DEPRESSION
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Acute schizophhrenia
mixed mania and depression suicidal tendencies severe renal, hepatic or cardiovascular disease narrow-angle glaucoma seizure disorders |
Probems with MAO inhibitors
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balance with sodium. To much sodium can make it lower (won't work) or to little sodium can make it toxix.
Before therapy begins, baseline studies necassary, renal cardiac and thyroid |
Lithium Carbonate
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Causes bone marrow depression (aplactic anemia)
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Tegretol (antiseizure drug)
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Can cause dangerous rash (Stevens-Johnson syndrome)
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Lamictal
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Has a black box warning, liver failure, pancreatitis, birth defects in taken during pregnancy
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Valproic acid (Depakene, Depakote and Depacon)
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L-dopa increases availability of L-dopa, the precursor from which dopamine is synthesized by AADC,_______ aded to L-dopa increases dopamine release and blocks reuptake of dopamine into presynaptic neurons
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L-dopa and Amantadine
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L-dopa increases availability of l-dopa, the precursor from which dopamine is synthesized by AADC, ___________ inhibits the breakdown of l-dopa by AADC in the GI tract and liver so that more l-dopa enters the brain.
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Carbidopa (with Levadopa)
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2 classes of drugs used to treat Parkinsons disease
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Dopaminergics (increase the amount of dopamine in the brain ) and Anticholinergics ( decrease effects of acetylcholine)
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Two drugs used to treat spacticity in Multiple Sclerosis
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Lioresol (baclofen) and Tizanidine (zaniflex)
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Used to treat Malignant hypothermia
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Dantrium (dantrolene) Skeletal Muscle Relaxant (antispasmotic)
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Withdrawal symptoms is agitation, anxiety, tremors, sweating, nausea, tachycardia, fever, hypereflexia, postural hypotension and if severe convulsions and delirium.
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Withdrawl symptoms of alcohol
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withdrawal symptoms include depression, drowsiness, fatigue and sleep disturbances (nightmares)
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Withdrawal symptoms of cocaine
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Two therapeutic uses for CNS stimulants:q
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ADHA and Narcolepsy
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Alprozolam/Xanax
Chlordiazepoxide/Librium Clonazepam/Klonopin Clorazepate/Tranxene Diazepam/Valium Flurazepam/Dalmene Lorazepam/Ativan Midazolam/Versed Oxazepam/Serax Temazepam/Restoril Triazolam/Halcion |
Generic/Trade names for other Benzodiazepine
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Buspirone/BuSpar
Clompramine/Anafranil Escitalopram/Lexapro Hydroxyzine/Vistaril Paroxetine/Paxil Sertraline/Zoloft Venlafaxine/Effexor Chloral Hydrate/Aquachloral, Noctec Eszopiclone/Lunestra Ramelteon/Rozerem Zaleplon/Sonata Zolpidem/Ambien |
Antianxiety/SLEEP IINDUCING (hypnotic) Generic/Trade
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Block the action of dopamine
Chronic drug administration results in upregulation of dopamine receptors Overall, med "rer-regulates" the abnormal neurotransmission system associated with psychosis. |
Action of most Antipsychotic meds.
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Do NOT give dopamine blocker (thiazine) to?
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Parkinson patients
(it can temporarily paralyze them. |
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-sexual dysfuction
-reduced seizure threshold, disrhythimias -Weight gain -Tardine dyskinesia (late movement (a permanent side effect) |
Adverse side effects of Phenothiazines (1st gen. antipsychotic meds)
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-Acute dystonia-a muscle wont work right
-Akathisia - cant sit still -Parkinsonism - looks like parkinsons but is not -Tardive Dyskinesia - late movement |
Extrapyramidal effects of 2nd gen. antipsychotic drugs
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Imipramine/Tofranil (tricyclic antidepressent)
Prozac (Fluoxetine) (SSRI) |
Prototype drugs for antidepressent/mood stabilizers
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Tricyclic Antidepressants (TCAs)MAOI- older antidepressants
SSRIs - newer antidepressants |
Antidepressant meds
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old antidepressant but still works
-used to treat bi-polar |
Lithium Carbonate (not metabolized by the body)
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Reported with sudden termination of most antidepressant meds.
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Antidepressant Discontinuation Syndrome
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Carbamazepine/Tegretol
Clonazepam/Klonopin Clorazepate/Tranxene Diazepam/Valium Ethosuximide/Zarontin Fosphenytoin/Cerebyx Gabapentin/Neurontin Lamotrigine/lamictal Levetiracetam/Keppra Lorazepam/Ativan Oxcarbazepine/Trileptal Phenobarbital Phenytoin/Dilantin Tiagabine/Gabitril Topiramate/Topamax Valporic Acid/Depakane/Depacon/Depakote Zonisamide/Zonegran |
Antizeisure meds
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Seizure classification
Consciousness not impaired |
Partial Seizure
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Seizure classification
Level of consciousness is decreased |
Complex partial seizures
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Seizure classification
Bilateral symmetric Most common type tonic-clonic (grand mall) Paralyzed, then shaking uncontrollably |
Generalized seizure
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Seizure Classification
life threatening emergency tonic-clonic lasting several minutes close intervals |
Status epilepticus
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CNS; ataxia, drowsiness, lethargy.
Gingival hyperplasia osteoporosis GI: Nausea, vomiting Toxicity/ nystagmus (eye switching) |
adverse effects of Dilantin (phenytoin) antiseizure med.
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Cocaine, methamphetamines
Methylphenidate, nicotine |
CNS stimulants
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majijuana, ecstacy, Hallucinogens (dextromethorphan, LSD, mescaline, PCP, GHB, inhalants
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Mild altering drugs
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Alcohol, antiaxiety agents, sedative-hypnotic agents, opioids
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CNS depressants
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DRUGS THAT HELP WITH WITHDRAWAL:
Librium, Catapres, Ativan, Antibuse Zyban, Nictoine, Chantix Librium, Catapres, Methadone Librium, Ativan, Haldol |
Alcohol Withdrawl
Tobacco Opioids Stimulants |
