ANS/CNS

Question 1

________ is to parasympathetic NS

…as _______ is to sympathetic NS

Answer 1

parasymp: cholinergic

sympath: adrenergic

Question 2

Symptoms of benzodiazepine withdrawals….

Answer 2

*drowsiness
*dizziness
*respiratory depression
*increased heart rate
*fever
*muscle cramps

Question 3

Symptoms of serotonin syndrome include…

Answer 3

*hyperthermia and diaphoresis
*tremor, confusion, restlessness, hyperreflexia, agitation

Question 4

Phenobarbital MOA is…

Answer 4

increasing GABA that calms down the excitability in the brain

Question 5

Two major categories of cholinergic receptors are….

Answer 5

muscarinic and nicotinic receptors

Question 6

cholinergic agent

Answer 6

*parasympathomimetic
*Prototype drug: bethanechol (Urecholine)
*MOA: induce rest/digest response
*Adverse: profuse salivation, sweating, increased muscle tone, urinary frequency, bradycardia

Question 7

Cholinergic-Blocking Agents (AKA: Anticholinergerics)

Answer 7

*Prototype drug: atropine
*Adverse: tachycardia, CNS stimulation, dry mouth, constipation, urinary retention, dry eyes, decreased sweating, photophobia

Question 8

Adrenergic Agents (Sympathomimetics)

Answer 8

*Prototype drug: phenylephrine
*Adverse: tachycardia, hypertension, dysrhythmias, CNS excitation and seizures, dry mouth, N/V, anorexia, rebound nasal congestion
*Black Box: death may occur with IV infusion

Question 9

Adrenergic-Blocking Agents

Answer 9

*Prototype drug: prazosin
*MOA: inhibit the sympathetic NS
*Use: hypertension, dysrhythmias, angina, heart failure, etc
*Adverse: dizziness, drowsiness, headache, loss of energy and strength, palpitations, dry mouth

Question 10

buspirone (BuSpar) when taken for depression may take _______________ to demonstrate effectiveness.

Answer 10

several weeks

Question 11

antidepressant

Answer 11

*Prototype drug: escitalopram
*MOA: increases availability of serotonin at postsynaptic receptor sites in the CNS
*Use: anxiety and depression
*Adverse: dizziness, nausea, insomnia, somnolence, confusion, seizures

Question 12

benzodiazepine (for seizures)

Answer 12

*Prototype drug: diazepam
*MOA: intensify effects of GABA, safer than barbs
*Use: short-term seizure control
*Adverse: drowsiness, dizziness

Question 13

benzodiazepine (for anxiety)

Answer 13

*Prototype drug: lorazepam
*MOA: increases effects of GABA , an inhibitory neurotransmitter
*Use: anxiety and insomnia
*Adverse: drowsiness, dizziness, respiratory depression

Question 14

barbituates

Answer 14

*phenobarbital
*MOA: intensifies effects of GABA
*Use: sedative/hypnotic, seizures
*Adverse: tolerance, respiratory depression, psychological and physical dependence, drowsiness, vitamin deficiencies, laryngospasm

Question 15

Nonbarbiturates and Nonbenzodiazepines

Answer 15

*Prototype: zolpidem
*MOA: binds to GABA receptors
*use: as hypnotic for anxiety
*Adverse: mild nausea, dizziness, diarrhea, daytime drowsiness, amnesia, sleepwalking, eating while asleep

Question 16

antiseizure pharmacotherapy

Answer 16

*Goal: suppress neuronal activity enough to prevent abnormal/repetitive firing AND to increase activity of GABA, stimulating the an influx of chloride ions
*Delay an influx of sodium ions
*Delay an influx of calcium ions
*Correcting neurotransmitter imbalance
*Block glutamate receptors in the brain

Question 17

antiseizure drugs that potentiate GABA action

Answer 17

*phenobarbital
*diazepam

Question 18

hydantoins

Answer 18

*Prototype drug: phenytoin
*MOA: to desensitize sodium channels
*Use: epilepsy except absence seizures. May affect the threshold of neuronal firing
*Adverse: CNS depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, and hypotension

Question 19

valproic acid

Answer 19

*phenytoin-like drug (Depakene)
*hydantoin
*MOA: desensitizes sodium channels
*Use: seizures, including absence and mixed types
*Adverse: limited CNS depression, visual disturbances, ataxia, vertigo, headache

Question 20

ethosuximide

Answer 20

*succinimide
*MOA: suppress calcium influx
*Use: absence seizures
*Adverse: rare but include drowsiness, dizziness, lethargy
*Very rare : systemic lupus erythematosus, aplastic anemia, agranulocytosis, pancytopenia

Question 21

natural therapy for seizures

Answer 21

*ketogenic diet
*chiropractor

Question 22

Nursing Considerations for Seizure Medications

Answer 22

*Monitor neurological status
*Protect from injury
*Labwork (maintain safe/effective level in the blood)
*Avoid alcohol or other CNS depressants

Question 23

sertraline

Answer 23

*Selective Serotonin Reuptake Inhibitors (SSRIs)
*MOA: inhibits reuptake of serotonin
*Use: depression
*Adverse: sexual dysfunction, nausea, HA, weight gain, anxiety, insomnia
*Less common: sedation, anticholinergic effects, sympathomimetic effects

Question 24

Duloxetine and venlafaxine and Buproprion

Answer 24

*Serotonin-Norepinephrine Reuptake Inhibitors (SNRI’s)
*Inhibit reuptake of serotonin and norepinephrine to elevate mood
*Bupropion —contraindicated in patients with seizures
*Black box: avoid taking these w/ other antidepressants or other meds (migraine drugs )
**watch for suicidal ideation when dose changed or beginning treatment

Question 25

imipramine

Answer 25

*Tricyclic Antidepressants (TCA) *MOA: blocks reuptake of norepinephrine and serotonin *Use: major depression *Adverse: orthostatic hypotension, sedation, anticholinergic effects, cardiac dysrhythmias

Question 26

phenelzine

Answer 26

*Monoamine Oxidase Inhibitors *MOA: decrease effectiveness of monoamine oxidase *Use: depression *Adverse: orthostatic hypotension, HA, insomnia, and diarrhea *Interacts w/ many foods/other meds *Hypertensive crisis = MAOI + food w/ tyramine

Question 27

foods that contain tyramine

Answer 27

Avocado, banana, raisin, papaya, canned figs, cheese (not cottage), sour cream, yogurt, beer and wine, meat, broad beans, soy sauce, all yeast, chocolate

Question 28

natural therapies for depression

Answer 28

*St. John's wart *inhibits serotonin reuptake for mild - moderate depression *Interacts with many meds (birth control), warfarin, digoxin *Photosensitive

Question 29

nursing considerations for antidepressants

Answer 29

*Antidepressants may take 1-4 weeks *Avoid use of alcohol: increases sedative effects for barbs & tranqs *Never abruptly stop med *Never miss a dose