Chapter 17 Flashcards Preview

NURS 1065 - Pharmacology > Chapter 17 > Flashcards

Flashcards in Chapter 17 Deck (53):
1

What is the highest functional area of the brain? The area concerned with creative thought, judgement, memory, and reason?

Cerebrum

2

What is the primary neurotransmitter related to thought processing?

Dopamine

3

What functions do dopamine help with (3)?

1. Coordination
2. Emotion
3. Voluntary decision making

4

What are the functions of ACh (4)?

1. Arousal
2. Coordination of movement
3. Memory acquisition
4. Memory retention

5

What is schizophrenia?
What does it interfere with?

A disturbance in thinking
- particular kind of
psychosis
- interferes with person's ability to think clearly, manage emotions, make decisions, and relate to others

6

What is dementia?

Progressive, degenerative, loss of memory and any of the following:
- language skills
- judgement, comprehension, problem solving
- recognize/identify objects
- perform motor skills

7

What is alzheimer's disease?

A form of progressive dementia
- causes gross, diffuse atrophy of the cerebral cortex

8

True or False:
There is no cure or way to prevent Alzheimer's disease

True

9

What does vascular dementia result from?

Damage to brain tissue
- caused by cerebrovascular events, such as transient ischemic attacks

10

What is delirium?

A sudden disruption in cognitive functioning, most often caused by a physical change in the body

11

True or False:
With delirium, there is a constant disturbance in the level of consciousness

False
- there is a disturbance in the level of consciousness that comes and goes throughout the day (or days) when delirium is present

12

True or False:
In order to treat delirium effectively, the underlying cause must first be identified

True
- untreated delirium can be fatal b/c the underlying condition is not diagnosed and treated

13

What is the prototype drug for antipsychotics?

Haloperidol (Haldol)

14

What is Haloperidol used for?

To treat psychotic disorders
- relief of hallucinations, delusions, and psychosis

15

Explain the pharmacodynamics of Haloperidol

Blocks the dopamine, alpha, and serotonin receptors

16

When is Haloperidol contraindicated (2)?

Hypersensitivity and Parkinson's disease

17

What are the adverse effects of Haloperidol?

- Extrapyramidal symptoms (EPS)
- Drowsiness
- Sedation
- Somnolence (strong desire to sleep)
- Lethargy
- Dysphoria

18

True or False:
Asians have a 50% higher serum level than Caucasians

True

19

When using Haloperidol, when are EPS more likely to occur?

If the patient repeatedly stops and restarts therapy

20

What should the patient avoid when using Haloperidol?

Alcohol

21

Why do EPS occur when a patient is using Haloperidol?

The relative lack of dopamine stimulation and the relative excess of cholinergic stimulation

22

Define psychosis

Inability to perceive and interpret reality accurately, think clearly, respond correctly, and function in a socially appropriate manner

23

What are the four major presentations of EPS?

1. Pseudoparkinsonism
2. Akathisia
3. Acute dystonia
4. Tardive dyskinesia

24

Describe what pseudoparkinsonism looks like (signs and symptoms)

- cog-wheeling muscle rigidity
- fine tremor
- slow motor responses
- flat affect

25

Describe what akathisia looks like (signs and symptoms)

- Constant feeling of restlessness (patient cannot control or explain it)

26

Describe what acute dystonia looks like (signs and symptoms)

- Prolonged muscular contractions and spasms
- Arching of the back
- Rolling of the eyes up toward the back of the head

27

Describe what tardive dyskinesia looks like (signs and symptoms)

- Involuntary lip smacking, chewing, mouth movements, tongue protrusion, blinking, grimacing
- Involuntary muscle twitching of the limbs

28

When does tardive dyskinesia occur?

Usually late in Haloperidol therapy
- usually irreversible

29

What is Neuroleptic Malignant Syndrome (NMS) characterized by?

- Fever
- Sweating
- Tachycardia
- Muscle rigidity
- Tremor
- Incontinence
- Stupor

30

When are patients more likely to develop NMS (2)?

1. If they are dehydrated
2. If they are taking large doses of Haloperidol

31

How do ATYPICAL anti-psychotics differ from the typical anti-psychotics?

They target only specific dopamine receptors

32

What is the major advantage of using ATYPICAL anti-psychotics?

Treat BOTH (-) and (+) symptoms of schizophrenia

33

What is the prototype drug for ATYPICAL anti-psychotics?

Olanzapine (Zyprexa)

34

What is Olanzapine used for?

To treat psychotic symptoms in schizophrenia and short-term treatment of acute bipolar disorder

35

True or False:
Olanzapine is highly protein bound

True

36

Explain the action (pharmacodynamics) of Olanzapine

Works by blocking several neuroreceptor sites:
- serotonin, dopamine, muscarinic, histamine-1, and alpha-1

37

What are the adverse effects of Olanzapine?

- Drowsiness
- Insomnia
- Agitation
- Nervousness
- Hostility
- Tardive dyskinesia
- NMS

38

How can you minimize the adverse effects of Olanzapine?

- assess fasting blood sugar before and during therapy
- give dose at night (minimize daytime drowsiness)

39

What are important things to teach your patient when they are taking Olanzapine (3)?

- Signs of hyperglycemia
- Med response is NOT immediate
- Importance of continuing drug therapy

40

What is the advantage of Olanzapine over other ATYPICAL anti-psychotic drugs?

No risk for agranulocytosis

41

True or False:
ATYPICAL anti-psychotics produce less hyperglycemia, hyperlipidemia and weight gain while increase the risk of tardive dyskinesia, and akathisia

False
- produce LESS tardive dyskinesia and akathisia
- increased risk of hyperglycemia, hyperlipidemia, and weight gain

42

What is the drug type that is used for alzheimer-type dementia?

ACh enzyme inhibitors

43

What is the action of ACh enzyme inhibitors?

Prolongs the activity of ACh on cortical cholinergic receptors and in the synapse

44

What is the prototype drug for ACh enzyme inhibitors?

Rivastigmine (Exelon)

45

What is Rivastigmine used to treat?

Mild-moderate dementia

46

Explain the pharmacodynamics of Rivastigmine

Carbamate derivate that enhances cholinergic function

47

What are the contraindications for Rivastigmine?

Hypersensitivity

48

What are the adverse effects of Rivastigmine?

- GI effects
- Dizziness
- Headache
- Chest pain
- Peripheral edema
- Vertigo

49

How can you minimize the effects of Rivastigmine (2)?

- Offer small, frequent meals or give the drug with food to offset GI effects
- monitor weight throughout therapy

50

True or False:
Rivastigmine has been shown to alter the course of Alzheimer's disease?

False
- it has not been shown to alter the course of the dementing process

51

What does AChE do?

Breaks down ACh

52

What is the most serious side effect of Rivastigmine?

Bradycardia

53

Explain the difference between (+) and (-) symptoms of Schizophrenia

(+) = in excess of or are a distortion of normal brain function
(-) = take away from the person's personality; represent a loss or a diminishing of brain function