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CNS Flashcards

1
Q

Caffeine MOA

A

reversible blockade of adenosine receptors

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2
Q

Caffeine use

A

neonatal apnea, wakefulness

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3
Q

Caffeine adverse effects

A

palpitations, dizziness, vasodilation, bronchodilation, diuresis, insomnia

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4
Q

Caffeine implications

A

Other CNS stimulants
- methylphenidate
- dextroamphetamine
- amphetamine

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5
Q

Neostigmine & Pyridostigmine MOA

A

prevent ach inactivation = increased mm strength

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6
Q

Neostigmine & Pyridostigmine class

A

cholinesterase inhibitor

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7
Q

Neostigmine & Pyridostigmine use

A

myasthenia gravis (ptosis, difficulty swallowing, weak mm)

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8
Q

Neostigmine & Pyridostigmine adverse effects

A

SLUDGE and the Killer B’s
- salivation, lacrimation, urination, diaphoresis/diarrhea, GI cramping, emesis, bradycardia, bronchospasms

DUMBELS
- diaphoresis/diarrhea, urination, miosis, bradycardia, bronchospasm, bronchorrhea, emesis, lacrimation

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9
Q

Parkinson’s disease 2 drug categories

A

Dopaminergic agents + anticholinergic agents

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10
Q

Dopaminergic agents MOA

A

stimulate dopamine by activating dopamine receptors

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11
Q

Anticholinergic agents MOA

A

stops excess ach by preventing activation of cholinergic receptors or blockage of muscarinic receptors

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12
Q

Levodopa MOA

A

promotes dopamine synthesis

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13
Q

Carbidopa MOA

A

helps decrease peripheral degradation and allows levodopa to cross BBB

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14
Q

Levodopa/Carbidopa use

A

parkinson’s disease
- treatment of choice
- levodopa 1st choice for younger patients
- “on/off” phenomenon common

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15
Q

Levodopa/carbidopa adverse effects

A

GI: n/v, dark sweat + urine
Neuro: drowsy, dyskinesia
CV: postural hypotension, dysrhythmias
Psychosis: hallucinations
- Clozapine can reduce

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16
Q

Levodopa/carbidopa interactions

A

B6 enhances destruction of levodopa

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17
Q

Levodopa/carbidopa implications

A
  • take w/food to decrease n/v
  • avoid high-protein food
  • administer w/o food if possible
  • benefits may take weeks-months
  • educate on “on-off”
  • must taper off
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18
Q

Amantadine MOA

A

dopamine agonist, promotes dopamine release and prevents reuptake

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19
Q

Amantadine use

A

parkinson’s disease - second line drug

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20
Q

Amantadine adverse effects

A

CNS: confusion, lightheadedness, anxiety
Atropine-like: blurry vision, urinary retention, dry mouth
Skin discoloration

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21
Q

Benzotropine MOA

A

anticholinergic agent - blocks muscarinic receptor in striatum and cholinergic receptors

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22
Q

Benztropine use

A

parkinson’s disease - stops tremors and mm rigidity

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23
Q

Benztropine adverse effects

A

n/v, dry mouth, blurry vision, urinary retention, constipation, mydriasis

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24
Q

Phenytoin MOA

A

stabilizes neuron membranes and limits seizure activity by selective inhibition of sodium channels

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25
Phenytoin Use
all major seizures
26
Phenytoin route
varied oral absorption, IV for emergencies
27
Phenytoin adverse effects
CNS: nystagmus, eye twitch, sedation, ataxia, diplopia, cognitive impairment Skin: rash Gingival hyperplasia (tender swelling gums, bleeding) Dysrhythmias Teratogen
28
Phenytoin interactions
- decrease efficacy of oral contraceptives, warfarin, glucocorticoids - increase levels when taken with diazepam, isoniazid, cimetidine, alcohol, valporic acid - can increase glucose levels
29
Phenytoin implications
- half life: 8-60 hrs - therapeutic level: 10-20 mcg/mL - toxic level: 30-50 mcg/mL - educate they must take every day and taper off - teratogenic
30
Carbamazepine MOA
limits seizure activity by selective inhibition of sodium channels
31
Carbamazepine use
Epilepsy - partial and generalized Bipolar disorder
32
Carbamazepine adverse effects
Neurologic: nystagmus, ataxia Hematologic: leukopenia, anemia, thrombocytopenia Hypo-osmolity Dermatologic: rash, photosensitivity Teratogenic - category X
33
Carbamazepine implicatiosn
- monitor CBC - Sunscreen - Childbearing age must use birth control or switch medication - monitor serum sodium and edema
34
Carbamazepine interactions
- decrease efficacy of oral contraceptives and warfarin - grapefruit juice effect
35
Levetiracetam MOA
unknown
36
Levetiracetam use
Seizures - myoclonic seizures in adults/adolescents >12 - focal-onset seizures in adults/children >4 - generalized seizures in adults/children >6
37
Levetiracetam adverse effects
possible renal injury in high doses, drowsiness, asthenia, agitation, anxiety, psychosis, depression, hallucination, depersonalization
38
Levetiracetam implication
monitor renal function, assess for drowsiness
39
Benzodiazepine meds
Lorazepam, diazepam
40
Benzodiazepine moa
decrease anxiety by acting on limbic system
41
Benzodiazepine use
manage status epilepticus, tonic-clonic seizures, anxiety, insomnia
42
Benzodiazepine adverse effects
sedation, mm relaxation
43
Benzodiazepine implications
risk for abuse in general population
44
General seizure information
- treatment goal/options: neurosurgery, vagal n stimulation, ketogenic diet - educate on seizure precautions - drug evaluation has trial period - take AEDs exactly as prescribed - monitor plasma levels - seizure frequency chart - avoid driving and wear medical bracelet - warn about CNS depression/sedation - always taper - phenytoin: with meals, shake bottle well, good oral hygiene - carbamazepine: take with meals, warn about hematologic abnormalities, do NOT take with grapefruit juice
45
Diazepam MOA
enhance GABA receptors
46
Diazepam use
anxiety, sedative/hypnotic, mm relaxant, amnestic, anticonvulsant
47
Diazepam adverse effects
cardiac and respiratory depression
48
Diazepam implications
increase risk for respiratory depression when taken with opioid analgesics
49
Lidocaine MOA
block impulses on axon by blocking sodium channels
50
Lidocaine anesthesia types
- local anesthetic - infiltration anesthesia - Nerve block anesthesia - IV regional anesthesia - epidural anesthesia - spinal anesthesia - administer by injection
51
Local anesthetics end in
caine
52
Lidocaine routes/forms
cream, ointment, jelly solution, aerosol, patch
53
Lidocaine drug
procaine - injection only
54
Lidocaine use
- suppresses pain w/o generalized CNS depression - used with vasoconstriction - prolongs anesthesia + reduces toxicity
55
Lidocaine adverse effect
- CNS excitation followed by depression - bradycardia + heart block - spinal headache - urinary retention
56
Lidocaine implications
patient should void urine within 8 hrs
57
Propofol & Ketamine class
general anesthetic
58
Propofol & Ketamine MOA
blocks impulses on axon by blocking sodium channels
59
Propofol & Ketamine route
inhaled or IV
60
Propofol & Ketamine use
- induction/maintenance of anesthesia - propofol used in ICU for sedation for intubation & mechanically ventilated adults
61
Propofol & Ketamine adverse effects
respiratory depression, hypotension, high risk for bacterial infection
62
Propofol & Ketamine implications
monitor RR and BP closely
63
Mu opioid receptor moa
analgesia, respiratory depression, euphoria, sedation
64
Kappa opioid receptor moa
analgesia, sedation
65
Strong Opioid agonist drugs
morphine, fentanyl, meperidine, methadone
66
Strong opioid agonist Moa
reduce pain by binding to opiate receptor sites in PNS + CNS - mimic endorphins
67
Morphine route
IV, sustained release
68
Fentanyl route
PO, IV, transdermal 100x stronger than morphine
69
Methadone specific use
relieve pain and treat opioid addicts
70
Strong opioid agonist uses
analgesia, sever/chronic/acute pain, sedation, cough suppression, dilate blood vessels
71
Strong opioid agonist adverse effects
respiratory depression, constipation, n/v, hypotension
72
Strong opioid agonist implications
- must assess RR before giving (<12 bpm HOLD medication) - monitor all s/e - increase fiber - constipation affects elderly more
73
Moderate to strong opioid agonists
Oxycodone, hydrocodone, codeine
74
Moderate to strong opioid agonist MOA
reduce pain by binding to opiate receptor sites in PNS and CNS
75
Moderate to strong opioid agonists facts
- no ceiling effect of opioid analgesia - dose can be increased to overcome tolerance
76
Moderate/strong opioid agonist use
analgesia, severe/chronic/acute pain, sedation, cough suppression, vasodilation
77
Moderate to strong opioid agonist adverse effects
respiratory depression, constipation, n/v, hypotension
78
Moderate to strong opioid agonist implications
- must assess RR before giving (<12 bpm HOLD medication) - monitor all s/e - increase fiber - constipation affects elderly more
79
Meperidine facts
- strong opioid agonist - metabolized to normeperidine = normeperidine is a toxic metabolite
80
Meperidine use
analgesia, severe/chronic/acute pain, sedation, cough suppression, vasodilation
81
Adverse effects
CV: tremors, palpitations, tachycardia Renal failure CNS: excitation, delirium, neurotoxic, seizures
82
Merepidine implications
- administration for >48hrs increases risk of seizures/neurotoxic - recent decline in use
83
Morphine Use
- dilate GI smooth mm - peripheral vasodilation - decreased pre-load - shortness of breath - pulmonary edema - left sided heart failure
84
Morphine adverse effects
- respiratory depression, coma, miosis (pinpoint pupils) - periodic, irregular breathing - may trigger asthmatic attack - flushing, orthostatic hypotension
85
Morphine implications
- respiratory depression last about 4-5 hours
86
Naloxone class
opioid antagonist
87
Naloxone MOA
blocks effect of opioid agonist
88
Naloxone use
- opioid overdose - reverse postoperative opioid effect - reverse neonatal respiratory depression
89
Naloxone adverse effects
- nervous, restless, irritable - body aches - dizzy/weak - d/n/stomach pain - fever, chills, goosebumps
90
Naloxone implications
stops overdose of opioids
91
NSAIDS meds
ibuprofen, celecoxib
92
NSAIDS MOA
inhibition of enzyme cyclooxygenase (COX)
93
NSAIDs use
anti-inflammatory, pain relief, reduce fever
94
NSAIDs adverse effects
Gastric upset/ulceration, acute renal failure, bleeding
95
NSAIDs vs. acetaminophen
NSAIDs: - anti-inflammatory - not hepatotoxic - caution in patients with renal disease Acetaminophen: potentially hepatotoxic
96
Acetaminophen MOA
anti-pyretic: acts directly on heat-regulating center in hypothalamus
97
Acetaminophen use
pain, fever, drug of choice for kids with fever/flu symptoms
98
Acetaminophen adverse effects
Liver failure, increased when taken with ETOH
99
Acetaminophen interactions
warfarin (increase INR), loop diuretics (decreased efficacy)
100
Acetaminophen implications
- metabolized by liver, excreted by kidneys - potential liver damage - excessive alcohol worsens hepatotoxicity - does not affect inflammation or platelet function like ibuprofen
101
Dosing guidelines for clinical use of opioids
- evaluate pain before opioid admin and 1 hr after PO and 10-15 min after IV - adjust opioid analgesics to accommodate individual variation - should be administered on fixed schedule - 20+ days physical dependence may develop - taper drug over 7-10 days and monitor

Pharmacology (9 decks)

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