Chp 12-15 Neurological Flashcards Preview

Pharmacogy > Chp 12-15 Neurological > Flashcards

Flashcards in Chp 12-15 Neurological Deck (81):
1

Benzodiazepines

Lorazepam (Ativan)

2

Nonbenzodiazepines

Zolpidem (Ambien)

3

Barbiturates

Phenobarbital

4

Muscle Relaxers

Baclofen( Lioresal)

5

There are 4 types of CNS Drugs. What are they?

1). There are benzodiapenines which is Lorazepam (Ativan)

2). There are Nonbenzodiazepines which is Zolpidem (Ambien)

3). There are Barbiturates which is Phenobarbital

4). There are Muscle Relaxers which is Baclofen (Lioresal)

6

What is sedatives?

Drugs that have an inhibitory effect on the CNS to the degree that they reduce:

*Nervousness
*Excitability
*Irritablilty

7

What are Hypnotics used for?

*It is use to cause sleep

*Much more potent effect on CNS than sedatives

* A sedative can become a hypnotic if it is given in large enough doses

8

What kind of acting is Benzodiazepines - Lorazepam (Ativan)

It is an Intermediate Acting

9

What are some mechanism of actions for the Benzodiazepines- Lorazepam (Ativan) Drug other than depressing the CNS

It affects the hypothalamic, thalamic, and limbic systems of the brain

Its receptors are GABA

Do not supress REM sleep as much as barbiturates

Do not increase metabolism of other drugs

10

Benzodiazepines - Lorazepam (Ativan) drug effects include

Calming the CNS

Useful in contolling Agitation and anxiety

Induces sleep

Induce skeletal muscle relaxation

11

Indications for the Benzodiazepines - Lorazepam (Ativan) drug include

Sedation

Anxiety and agitation

Treatment of acute seizure disorders

Treatment of alcohol withdrawal

12

Benzodiazepines - Lorazepam (Ativan) adverse effects include

Black Box Warning:
Use with other benzodiazepines or oipoids may result in sedation, respiratory depressions, coma, and death


Mild and infrequent:
*Headache

*Drowsiness - lethargy

*Dizziness

* Cognitive impairment

* Vertigo

* Fall hazard for older adults

* "Hangover" effects or daytime sleeping

13

Benzodiazepines - Lorazepam (Ativan): Toxicity and Overdose include

Confusion

Coma

Does not cause HTN and repiratory depression unless taken with other CNS depressants

Treatmentis symptomatic and supportive

14

What is the drug used for Benzodiazepines - Lorazepam (Ativan) Overdose?

Flumazenil which is and antidote

15

What are some drug interactions for Benzodiazepines - Lorazepam (Ativan)?

Azole antifungals, verapamil, diltiazem, protease inhibitors, macrolide antibiotics, grapefruit juice

CNS Depressants (alcohol, opiods)

Olanzapine

Rifampin

Barbiturates: Phenobarbital

16

What is the Doasage for the Benzodiazepines - Lorazepam (Ativan) drug?

Oral: 2-6 mg divided bid-tid

Maximum 10mg per day

Can be given IM or IV

* it is usually 1mg given

17

Nonbenzodiazepines- Zolpidem (Ambien) indications include

Insomnia

18

What are the mechanism of action for Nonbenzodiazepines- Zolpidem (Ambien) drug?

Interacts with GABA benzodiazepine receptor complex

19

What are some adverse effects for Nonbenzodiazepines- Zolpidem (Ambien)?

Common Reactions:

Headache
Drowsiness
Lethargy
Back pain
Diarrhea
Lightheadedness
Inlfuenza like s/s


Serious Reaction:

Depression exacerbation
Suicidal ideation
Agressive behavior
Complex sleep- related behavior
Impaired mental alertness( next day)
Hallucinations
Withdrawls s/s

20

What are some drug interactions for Nonbenzodiazepines- Zolpidem (Ambien)?

CYP1A2 substrate
CYP3A4 substrate
CNS depression

21

What is the Doasage for Nonbenzodiazepines- Zolpidem (Ambien) and differentiate betweeen male and female dosage

Female patients- 5mg oral every hs(evening); maximum 10mg/ day

Male patient- 5- 10 mg oral every hs; maximum 10mg /day

22

What are Barbiturates used for and when was it first introduced?

It was first introduced in 1903

And it is used for insomnia and sedation

Only a handful is used because of the safety and efficacy of benzodiazepines

Low theraputic index
The effective, safe dosage range is narrow

23

Barbiturates:Phenobarbital mechanism of actions and its sites of action

Site of action: brainstem (reticular formation)

By potentiating the action of GABA, nerve impilses traveling in the cerebral cortex are inhibited.

24

Barbituates:phenobarbital drug effects include

Low doses: sedative effects

High doses: hypnotic effects

25

Barbituates: Phenobarbital included 3 types of indications. what are they?

Sedatives

Anticonvulsants

Anesthesia for surgical procedures

26

Barbituates: Phenobarbital adverse effects include

Nausea/vomiting/diarrhea

Hypotension

Respiratory Depression

Drowsiness

Thrombocytopenia

Steven- johnson's Syndrome

27

What are some drug interactions and additive effects when used with Barbituates: Phenobarbital?

Alcohol

Antihistamine

Benzodiazepines

Opioids

Tranquilizer

28

What are Barbituates: Phenobarbital recommended Dosage?

Oral: 60 mg bid- tid

IV: 10-40 mg tid

29

What are muscle relaxants Baclofen (Lioresal) used for?

It is used to relives pain associated with skeletal muscle spasms

*Majority are centrally acting
CNS is the site of action
Similar in structure and action to other CNS depressants

* Direct acting
Act directly on skeletal muscle
Closely resemble GABA


30

Muscle Relaxants - Baclofen ( Lioresal) indications include

Relief of painful musculoskeletal conditions
* muscle spasms
* management of spasticity of severe chronic disorders ( multiple sclerosis, cerbral palsy)


And it is worked best when used along physical therapy

31

What are some adverse effects for Muscle Relaxants - Baclofen ( Lioresal) thats is extension of effects on CNS and skeletal muscles?

Euphoria
Lightheadedness
Dizziness
Drowsiness
Fatigue
Muscle weakeness

32

Muscle Relaxants - Baclofen ( Lioresal) drug interactions include 3 types what are they?

CNS Depression

Hyperglycemia

Lowers seizures threshold

33

Muscle Relaxants - Baclofen ( Lioresal) doasge recommendations include

Oral: 20-80 mg daily divided tid to qid

34

What are some CNS depressants nursing implications?

Before beginning theraly, obtain a thorough history regarding allergies, use of medications, health history, and medic history. Obtain vital signs, assess for potential disorders and drug interactions

Use with caustion in elderly

Avoid drinking alcohol and other CNS depressants

35

What are some therapeutic effects for Muscle Relaxants - Baclofen ( Lioresal) that u should monitor?

Increased ability to sleep at night
Fewer awakening
Shorter sleep induction time
Few adverse effects such as Hangover effects
For muscle relaxants" decreases spasticity, decreased rigidity

36

What are CNS stimulants? And who are the people that use it

Drugs that stimulate a specific area of the brain and spinal cord

People that use it are either Anti-attention deficit disorder (ADHD), Antimigraine

37

What are some symptoms of ADHD? What is it the percentage? Who are affected often? and is the drug therapy the same?

Some symptoms of ADHD are inappropriate ability to maintain attentiom span or the presence of hyperactivity and impulsivity

It is moslty common in phychiatric children afecting 4% to 10% of school age children

Boys are affected two to nine times than girls

The drug therapy is the same for a child to adulthood

38

What kind of drug is used to treat ADHD?

The methamphetamine stimulant
* Atomoxetine (straterra)

39

Nonamphetamine stimulant- Atomoxetine (Strattera) indications include

Approbed for treating ADHD in children older than 6 years of age and adult

40

What is the mechanism of action for Nonamphetamine stimulant- Atomoxetine (Strattera)

Selectively inhibits norepinephrine reuptake

41

What is the black box warning for Nonamphetamine stimulant- Atomoxetine (Strattera)?

Increased risk of suicide in children and adolescents with ADHD, especially during the 1st month of treatment

42

Some adverse effects for Nonamphetamine stimulant- Atomoxetine (Strattera) include

Psychosis
Mania
Agressive behavior
Orthostatic hypotension
HTN, tachycardia, MI, stroke, QT prolongation

43

Nonamphetamine stimulant- Atomoxetine (Strattera) drug interacrions include 2 types. What are they?

CYP2D6 substrate

Hypertensive effects

44

What is the recommended Dosage for Nonamphetamine stimulant- Atomoxetine (Strattera)?

Oral: 80 mg daily, divided bid

45

Some nursing implications for Nonamphetamine stimulant- Atomoxetine (Strattera) inlcude

The last daily dose should be given 4 to 6 hrs before bedtime to reduce insomnia.

Take on an empty stomach 30 to 45 minutes before meals

Keep a journal to monitor child therapy response

Monitor child for phyocal growth, height and weight

Monitor for thereputic responses: decreased hyperactivity, increased attention span and concentration

46

In the drug Nonamphetamine stimulant- Atomoxetine (Strattera) what shouldbyou assess for?

You should assess for potential contraindications

interaction, including herbal therapies

Conditions such as abnormal cardia rhythms, seizures, palpitations, liver problems

For children assess basline height and weight

47

The patient states that she has a pulsatile recurring headache lasted 4 to 72 hours on one side of the head, and have had symptoms of nausea, vomiting, photophobia, phonophobia, and aura. What is the diagnosis for this patient

This patient has a Migraine

48

Antimigraine- Sumatriptan (Imitrex) is also called?

Triptans and it is a serotonin agonist

49

What is the indication for use for Triptans- Sumatriptan (Imitrex)?

It is used for migraine

50

The mechanism of action for Triptans- Sumatriptan (Imitrex) are to

Stimulate vascular sertonin 5 HT receptors in cerebral arteries, causing vasconstrictions and reducing headache symptoms

Reduce the production of inflammatory neuropeptides

51

What are some contraindications for Triptans- Sumatriptan (Imitrex)

Hypertension

Coronary artery disease

Cerebrovascular disease

Caurion in elderly

52

Some mild and serious adverse effects for Triptans- Sumatriptan (Imitrex) includes

Mild:

Injection site reaction
Flushing
Dizziness
Fatigue
Weakness
Diaphoresis
Drowsiness

Serious:

Coronary vasospasm
Myocardial ischemia
Ventricular tachycardia/ fibrillation
Severe hypertension
Stroke

53

What are the two drug interactions for Triptans- Sumatriptan (Imitrex)

Hypertensive effects

Serotonergic effects, strong

54

The Triptans- Sumatriptan (Imitrex) Dosage include

Multiple ways to administer:
Dissolvable wafers, nasal spray, oral, and self injectable forms

Oral: 25-100mg oral x1 dose; repeat x1 after 2 hours

Subcutaneous: 1-6mg x1 dose; may repeat x1after 1 hour

55

Sumatriptan (Imitrex) nursing implications include

Teach about correct administration

Instruct patient to keep a journal to monitor response to therapy

Monitor theraputic effects: decrease in frequency, duration, and severity of migraines

Monitor for adverse effects

56

What is epilepsy?

Epilepsy is chronic, recurrent patterns of seizures

57

What is epilepsy?

Epilepsy is chronic, recurrent patterns of seizures

58

What is a seizure?

Brief episode of abnormal electrical activity in nerve cells of the brain

59

What is a convulsion?

It is involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal, facial, and ocular muscles

60

What are primary (idiopathic) mean?

Its cause cannot be determined

Roughly 50% of epilepsy cases

61

What does secondary ( symptomatic) mean?

Distinct cause is identified

Trauma, infection, cerebrovascular disorder

62

What are some classifications of epilepsy including its generalized onset seizures and its partial onset seizures?

Generalized onset seizures:

Formerly known as GRAND MAL seizures
Tonic- clonic seizures
Absence seizures


Partial onset seizures:

Simple( formerly known as PETIT MAL seizures)
Complex
Secondary generalized tonic-clonic

63

What is the meaning of status epilepticus? And its results?

It means multiple seizured occur with no recovery between them

Its results include: hypotension, hypoxia, brain damage, and death

True medical emergency

64

What is Antiepileptic Drugs (AEDs)? And is the therapy lifelong?

Its goal of therapy is to:
* control or prevent seizures whole maintaining a reasonable quality of life
* to minimize adverse effects and drug - induced toxicity

AED therapy are usually lifelong

Combination of drugs may be used

65

What is another name for AEDs?

Anticonvulsants

66

AEDs drug therapy should include

Single drug therapy which should be started before multiple drug therapy is tried

Serum drug concentrations must be measured
* Therapeutic drug monitoring

67

AEDs- Phenytonin (Dilantin) indications include

Prevention or control of seizures activity

Long term maintenance therapy for chronic, recurring seizures

Acute treatment of status epilepticus

68

What are some mechaism of actions for AEDs- Phenytonin (Dilantin)

Modulates neuronal sodium and calcium channels

Supress transmission of impulses from one nerve to the other

Decrease speed of nerve impulse conduction

69

What is the black box effect for AEDs- Phenytonin (Dilantin)?

Suicidal thoughts and behavior

70

What are some adverse efrects for AEDs- Phenytonin (Dilantin) drug?

Gingival hyperplasia

Acne*

Hirsutism

Dilantin facies

Osteoporosis

71

What are the recommended Dosage for AEDs- Phenytonin (Dilantin)?

Oral: 300mg -400mg every day divided bid-tid

IV: 100mg IV every 6 hours (maintenance)
* 15 - 20mg/kg IV x1; repeat 10mg/kg after 20 minutes(status epilepticus)

* Very irritating to veins

* Give slowly

* Diluted in normal saline(NS) for IV infusion

* Filter must be used


*** THERAPEUTIC DRUG LEVELS 10- 20 mcg/ml***

72

What are some nursing implications for AEDs- Phenytonin (Dilantin) drug for oral and IV?

Oral drugs:

Take regularly, same time each day
Take with meals to reduce GI upset
Do not crush, chew, or open extended-release forms
**If patients is NPO for a procedure, contact prescriber regarding AED dosage**


IV forms:

Follow manufacturers recommendations for IV delivery-- usually given slowly
Monitor vital signs during administration
Avoid extravasation of fluids
Use only normal saline(NS) with IV phenytoin (Dilantin)

**Instruct patient to wear a medical alert tag or ID*
*Life long therapy**
*Monitor for therapeutic effects: Decreased or absent seizure activity**

73

What is Parkinson's disease (PD)?

*It chronic, progressive, degenerative disorder

*Affects dopamine( which produces neurons in the brain)

* Caused by an imbalance of two neurotransmitters: dopamine, Acetylcholine (ACh)

* Occurs when the 80% of dopamine stored in the substantia nigra of the basal ganglia is depleted

* Rapid swings in response to levodopa occur ("on- off phenomenon")
PD worsens when too little dopamine is present
Dyskinesia occurs when too much dopamine is present

PD is associated with dementia

74

What are some symptoms of Parkinsons Disease?

Alkinesia- absencs of phychomoto acrivity resulting in mask- like facila expression

Bradykinesia- slowness of movement

Rigidity- "cogwheel" rigidity, resistance to passive movement

Tremor-

Postural instability- unsteadiness and leads to damger of falling either leaning or sitting

75

After the start of levodopa therapy it usually takes how many years?

5 to 10

76

What are some mechanism of action for Anti- Parkinson Drugs: Levodopa/Carbidopa?

Levodopa: dopamine must be admjnistered orally as levodopa as dopamine cannot pass through the blood- brain barrier

Work presynaptically to increase the levels of dopamine

Levodopa is able to cross the blood- brain barrier, where it is converted to dopamine

***CARBIDOPA IS GIVEN WITH LEVODOPA**

Carbidopa does not cross the blood-brain barrier and prevents levodopa breakdown in the periphery

77

Anti- Parkinson Drugs: Levodopa/Carbidopa adverse effects include

Confusion
Hallucination
Psychosis
Involuntary movements
GI distress
Hypotension
Cardia dysrhythmias

78

What are the two containdications for Anti- Parkinson Drugs: Levodopa/Carbidopa?

Contraindicated in cases of angle- closure glaucoma

Use cautiously in patients with open angle glaucoma

79

What are the two drug interacrions for Anti- Parkinson Drugs: Levodopa/Carbidopa?

Tricyclic antidepressants

Dietary protein

80

What is the dosage recommendations for Anti- Parkinson Drugs: Levodopa/Carbidopa?

Oral: 10mg/100mg tid

81

Anti- Parkinson Drugs: Levodopa/Carbidopa nursing implications include

Questions about the patients:
*CNS
* GI and GU tracts

Assess physiologic and emotional status

Assess for signs and symptoms of PD
* masklike expressions
* speech problems
*Dysphagia
*Rigidity of arms, legs, and neck

**Encourage the pt to force fluids at least 3000 ml/day (unless contraindicated). Pt should be taught not to discontinue aniparkinson drug suddenly