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CNS and ANS Flashcards

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1
Q

Cholingeric

A

acetylcholine, excitatory

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2
Q

Dopaminergic

A

dopamine, inhibitory

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3
Q

Noradrenergic

A

norepinephrine, excitatory, increases activity

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4
Q

Serotonergic

A

serotonin, sleep/wake/pain

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5
Q

Pain

A
  • tissue damage activates free endings (nocicepters) of peripheral nerves
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6
Q

Opioid analgesics

A
  • stimulate opiate receptors and bind to the receptors in CNS causing inhibition of ascending nerve pathways
  • Receptors: mu, kappa, and delta
  • used for severe to moderate acute pain, terminal malignancy
  • most schedule II, well absorbed orally
  • oral - significant first pass
  • contraindicated: allergy, increase ICP, respiratory problems, dependence, tolerance or addiction
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7
Q

Opioid analgesics - adverse/nursing

A
  • Adverse effects: sedation, respiratory depression, postural hypotension, flushing, N/V, constipation, urinary retention, and pupil constriction
  • monitor VS
  • use: for acute and chronic pain, MI, burns, trauma, post-op
  • Use in chronic pain only when other methods fail (such as terminal cancer pain)
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8
Q

Morphine

A
  • prototype for opiods
  • po, IM, IV, SQ, IT, epidural
  • sustained release or immediate release
  • effects: 15-20 min IV, 60 min po
  • oral: roxanol
  • fentanyl patch - anesthesia, epidural, IT (duragesic, transdermal) - works for 72 hrs (up to 24 hrs after removal of patch)

IM not given often - it’s erratic

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9
Q

Types of opioids

A
  • codeine - usually with acetaminophen
  • hydrocodone - vicodin and norco
  • meperidine (Demerol) - synthetic, may cause tremors, hallucinations, and seizures
  • tramadol (Ultram) - synthetic, low potential for tolerance - may use for chronic pain
  • oxycodone (OxyContin)
  • – popular drug of abuse
  • – w/aspirin - Percodan
  • – w/acetaminophen - Percocett

-hydromorphone (Dilaudid)

  • propoxyphene (Darvon)
  • – w/acetaminophen (Darvocett) – NOW REMOVED FROM MARKET
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10
Q

Nursing Implications of Opioids

A
  • MONITOR FOR SEDATION
  • alternate with non-narcotics
  • no alcohol use!
  • do not drive, operate machinery, or smoke
  • constipation is common
  • IR vs SR
  • may be used in PCA pumps
  • unlikely to cause addiction with acute pain
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11
Q

naloxone (Narcan)

A

(opioid antagonist)

  • given when too much opioid is administered
  • uses: reverse or block anesthesia, CNA and resp depression from narcotics
  • competes with opioid receptor sites in brain
  • adverse: increased HR/BP/resp and RETURN of pain
  • produces withdrawal symptoms
  • repeated injections may be needed
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12
Q

butorphanol (Stadol)

nalbuphine (Nubain)

A

(opioid agonist/antagonist)

  • agonist at some receptors and antagonist activity at others
  • reduced potential for abuse
  • never give to someone who has received opioid analgesics (due to antagonist activity)
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13
Q

methadone (Dolophine)

A
  • use: opioid addiction
  • longer acting than morphine, abuse, wean
  • use for cancer pain
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14
Q

Analgesic-Antipyretic-Anti-Inflammatory drugs

A
  • Action: inhibit the formation of prostaglandins in inflamed tissue, preventing the stimulation of pain
  • may have anti-inflammatory, antipyretic, or anti-platelet effects
  • NSAIDs
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15
Q

Aspirin (ASA)

A
  • prototype
  • mild to moderate pain, fever, inflammation, and decrease risk of thrombus
  • low dose ASA for MI, angina, stroke, primary prevention of MI, prevent thromboembolism in surgery patients
  • non-selective cyclooxygenase (COX) inhibitor
  • adverse: stomach irritation, bleeding
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16
Q

Nursing Implications of aspirin

A
  • toxicity: salicyism (toxic effects of overdose of salicyclic acid), tinnitus (ringing in the ears)
  • avoid other OTC preparations that contain ASA
  • stop use 2 weeks before and after invasive procedures
  • take with food, drink adequate fluids
  • high bound to blood albumin
  • do not give to kids - reye’s syndrome
  • watch for signs of bleeding
  • increased effects with alcohol, anticoagulants, opioids, and steroids
  • not for use in pregnancy
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17
Q

acetaminophen (tylenol)

A
  • antipyretic effects, no inflammatory or platelet effects
  • used to reduce pain and fever
  • may use with GI problems
  • additive effects with other opioids
  • adverse: hepatic failure with high dose and nephrotoxicity with overdose
  • overdose treatement: Mucomyst (po)
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18
Q

Nursing Implications of acetaminophen

A
  • read labels
  • no more than 4g (4000mg) per day
  • drug of choice for febrile children, elderly and impaired renal function, pregnancy
  • watch for duration of use
  • avoid alcohol
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19
Q

ibuprofen (Motrin, Advil)

A

(NSAIDs)

  • used to treat fever, pain, inflammation, arthritis, and menstrual cramps
  • has less GI upset than ASA
  • Same nursing imp. as ASA
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20
Q

Indomethacin (Indocin)

A

(NSAIDs)

  • strong anti-inflammatory effect
  • higher risk of side effects than Motrin
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21
Q

naproxen (Naprosyn, Aleve)

ketorolac (Toradol)

A

(NSAIDs)

Naprosyn is prescribed
Aleve is OTC

Toradol:

  • used for severe pain
  • given IV
  • duration of use 5 days - produces bleeding
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22
Q

celecoxib (Celebrex)

A

(selective COX-2 inhibitor)

  • blocks prostaglandins associated with pain and inflammation without gastric upset, with no GI bleeding
  • use for arthritis
  • Black box warning: increased risk for adverse cardiovascular event, risk of GI bleeding with long term use - patients should be advised
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23
Q

pregabalin (Lyrica)

A

(selective COX-2 inhibitor)

  • decreases number of pain signals sent out by damaged nerves
  • use: neuropathic pain, fibromyalgia, and partial seizures
  • adverse: tiredness, dizziness, N/V
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24
Q

allopurinol (Zyloprim)
colchicine
probenecid (Benemid)

A

(anti gout agents)

  • prevent uric acid formation
  • gout = body’s inability to metabolize uric acid
  • symptoms: hyperuricemia (> 6mg/dl), severe pain, inflammation and edema in musculoskeletal system
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25
Nursing implications for anti-gout
- obtain baseline serum data - give with food - increase fluids to 3000mL/day - rest and immobilize affected area - avoid alcohol - low purine diet: anchovies, sardines, game meats, organ meats and yeast
26
pentobarbital (Nembutal) | phenobarbital
(barbiturates) - depress CNS - treat seizures, promote anesthesia, promote sedation and sleep - considered the prototype drugs - limited use today - serious dependence and withdrawl - Adverse: hangover, drowsiness and decreased resp
27
diazepam (Valium) alprazolam (Xanax) lorazepam (Ativan) midazolam (Versed)
(benzodiazepines) - release GABA substances - inhibit transmission of impulses in CNS - Use: sleep, decrease anxiety, preop, alcohol withdrawal - replaced barbiturates as drugs for insomnia - these are safer and lower potential for abuse - Valium = prototype - --decrease anxiety, break status epilecticus (ongoing seizures), alcohol withdrawl - Xanax/Ativan for anxiety - Versed = preop - --produced amnesia - used for conscious sedation - adverse: oversedation, hangover, decrease resp - caution in elderly
28
Nursing implications for benzodiazepines
- safety! - assess resp rate - Flumazenil (Romazicon) - reversal for benzos - give with food - abstain from alcohol - taper off drugs
29
zolpidem (Ambien) eszopiclone (Lunesta) diphenhydramine (Benadryl)
- sleep agents - Ambien - short term use only - -- reported problems with sleepwalking, doing things while sleepwalking and not remembering, rebound insomnia after stopping Lunesta - longer term ---tastes funny Benadryl - antihistamine ---drowsiness side effect for sleep aid
30
buspirone (BuSpar) | sertraline (Zoloft)
(anti-anxiety drugs) - episodic, situational anxiety and panic - used to reduce/relieve anxiety - cautions same as benzos
31
Nursing implications for anti-anxiety
- assess signs/symps of severe anxiety - signs of depression/suicide - safety - avoid alcohol
32
carisoprodol (Soma) baclofen (Lioresal) cyclobenzaprine (Flexeril)
(skeletal muscle relaxants) - depresses polysynaptic reflexes in the CNS - use: acute musculoskeletal pain, relieve musculoskeletal spasticity (trauma, MS, spinal injury), as an adjunct to other therapies
33
Adverse reactions and Nursing implications for skeletal muscle relaxants
Adverse: - drowsiness, dizziness, N/V, flaccid muscles, psychological/physical dependence Nursing Imp: - assess muscular strength - check I&O - safety - physical therapy
34
dantrolene (Dantrium)
(other relaxant) - interfere with the release of calcium from the sarcoplasmic reticulum, weakening the force of muscle contraction - use: malignant hyperthermia - also: spasticity with MS, cerebral palsy, and stroke
35
anti-seizure drugs
- used to treat seizures and epileps - decrease movement of ions into nerve cells, alternating activities of neurotransmitters - start with single dose - may need to add second drug - guide based on therapeutic levels
36
phenytoin (Dilantin)
(anti-seizure) - prototype - stabilizes nerve membranes - used with all types of seizures accept absence - caution: severe kidney/liver disease, elderly - therapeutic range - 5-20mcg/ml - adverse: gingival hyperplasia, cardiovascular collapse with rapid IV dose
37
Nursing implications of Dilantin
- monitor serum levels - careful IV infusion - give with food - good oral hygiene - generic/trade brands not always the same
38
other seizure drugs
- phenobarbital sodium (luminol) - decline in use - benzodiazepines - ativan, valium, and clonazepam (Klonopin) - status epilecticus, severe recurrent seizures - carbamazepine (Tegretol) - ethosuximide (Zarontin) - lamotrigine (Lamictal) - valproic acid (Depakene/Depakote) - topiramate (Topamax)
39
levodopa (Dopar) | carbidopa-levodopa (Sinemet)
(antiparkinsons drugs) Dopaminergic drugs - drug goal: strengthen dopaminergic action or decrease cholinergic action - increase amount of dopamine concentration - adverse: - --early: N/V, anorexia, orthostatic hypotension, dizziness. - --late: involuntary movements, akinetic spells, anxiety, and depression - --use with caution with patients with narrow angle glaucoma, melanoma, GI, heart disease
40
Nursing implications for antiparkinsons drugs
- assess symptoms - skin assessment - wearing off effect - give with food - watch protein intake - darkening urine - safety
41
trihexyphenidyl (Artane) | benztropine (Cogentin)
(anticholingeric - antiparkinsons) - counteract the cholingeric activity in brain - use alone in early Parkinson's, young patients - caution: glaucoma, GI-GU obstructions, heart disease, elderly, very young Nursing: - monitor I&O - taper drug - sit up slowly - watch heat, fiber/water
42
migraines
- pain associated with dilation of arteries of the scalp and face - HA with periodic attacks of nausea, pain, sensitivity to light - treatment: treat acute pain and prevention - prophylactic: use of beta blockers, calcium channel blockers, anticonvulsants and TCAs
43
Ergot alkaloids
(main class of antimigraine drugs) - reduce extracranial blood flow - ergotamine tartare (Ergomar) - --with caffeine (Cafergot) - --sublingual or inhaled - -- adverse: N/V, cramps, confusion, decreased circulation to extremities - -- contraindicated with pregnancy, severe HTN and CAD
44
sumatriptan (Imitrex) | zolmitriptan (Zomig)
(antimigraine drugs) - triptans/serotonin agonists - stimulate receptors on the basilar artery to vasoconstrict the vessels of the dura mater - adverse: nausea, HTN, dizziness, weakness - contraindications: CAD, HTN, do not give within 24 hours of ergot alkaloids
45
General anesthesia
- state of profound CNS depression - complete loss of sensation, consciousness, pain, perception and memory - Balanced anesthesia: allows anesthesiologist to not have to use too much of the potent general anesthetics - using many different types - IV - used for rapid induction and maintenance - -- etomidate (Amidate) - -- propofol (Diprivan) - -- fentanyl citrate (sublimaze) - Inhalant - -- enflurane (Ethrane) - -- nitrous oxide - Neuromuscular blocking agents - to keep patient from moving - --atracurium (Tracrium) - -- vecuronium (Norcuron)
46
Moderate or conscious sedation
- does not cause complete loss of consciousness or respiratory arrest - use: procedural areas including peds - drugs: - --Versed - benzos - -- Fentanyl, Morphine - opioids - more rapid recovery - must have advanced life support certification to administer and monitor - intubation capabilities must be available
47
lidocaine (Xylocaine) | buprivacaine (Marcaine)
- local anesthesia - no paralysis of resp function - elimination of pain sensation - --topical - --infiltration - -- field block - --nerve block - --spinal/epidural/intrathecal
48
amphtamine (Adderall) methylphenidate (Ritalin) dextroamphetamine (Dexedrine) atomoxetine (Strattera)
- CNS stimulants - use: ADHD (for kids, it has the opposite effect - rather than stimulating, it calms), narcolepsy, weight reduction - adverse: nervousenss, irritability, HA - caution: anxiety, glaucoma, pregnancy, HTN, dependence - tolerance and psychological dependence
49
substance abuse
- self administration of a drug for prolonged time periods or in excessive amounts which can lead to psychological or physical dependence - for alcohol abuse - Antabuse is used - anxiety, sedative, hypnotics - taper to withdraw - for opioids - methadone - CNS stimulants: amphetamines, nicotine, cocaine - hallucinogens
50
chloropromazine (Thorazine) fluphenazine (Prolixin) trifluoperazine (Stelazine)
(antipsychotics) - actions: occupy or block dopamine receptors - use: schizophrenia, acute mania, psychotic depression, N/V - caution: elderly Thorazine is prototype Phernergan fits in this category
51
Adverse and Nursing Imp of antipsychotics
Adverse: - excessive sedation, slurred speech, impaired mental processess - --extrapyramidal symptoms (EPS) Nursing: - assess behavior - watch for adverse effects - photosensitivity - safety - Phernergan - highly sedative
52
haloperidol (Haldol) clozapine (Clorazil) - prototype risperidone (Risperdal) olanzapine (Zyprexa)
(nonphenothaizines) - used to control flat affect and hallucinations, schizophrenia, and Touretts syndrome - adverse: agranulocytosis, seizures, decrease BP, EPS symptoms (Haldol)
53
Nursing Imp for nonphenothaizines
- determine baseline WBC - VS - assess for constipation - administer with food - watch photosensitivity - do not take with other CNS depressants
54
Lithium carbonate (Eskalith)
(mood stabilizing drugs) - use: bipolar, treat/prevent manic episodes - caution: significant cardiac/renal disease, hyponatremia, pregnancy, leukemia - interacts with Haldol, Tegretol, thiazide diuretics - therapeutic level: 0.5-1.2mEq/L
55
Adverse and Nursing Imp of mood lithium
Adverse: - metallic taste, twitching, diarrhea, thirst Nursing: - assess mood - monitor Na+ levels - increase fluid intake, monitor use of diuretics - take with food - avoid changes in salt intake
56
Antidepressants
- used: for depressed mood, feelings of sadness and emotional upset - depression occurs in all age groups - 3 types - --Tricyclic antidepressants (TCA) - --Selective Serotonin Reuptake Inhibitors (SSRIs) - --Monoamine Oxidase Inhibitors (MAO)
57
``` amitriptyline hydrochloride (Elavil) imipramine hydrochloride (Tofranil) - prototype ```
- TCA - decrease reuptake of serotonin and norepinephrine - adverse: sedation, orthostatic hypotension, decreased GI motility, dry mouth, cardiac arrythmias, urinary retention - caution: suicidal, adverse effects mimic panic Nursing: - do not give concurrently with SSRIs - take in PM - do not take with St. John's Wort
58
fluoxetine (Prozac) citalopram (Celexa) proxetine (Paxil) sertraline (Zoloft)
- SSRIs - increase available serotonin - use: depression, OCD, bulimia - adverse: anxiety, nausea, decreased appetite, weight loss, HA - caution: risk of suicide, those taking MAOIs, anticoagulants
59
phenelzine sulfate (Nardil)
- MAO Inhibitors - prevent the metabolism of neurotransmitter molecules - adverse: orthostatic hypotension, weight gain, edema, toxicity, hypertensive crisis with tyramine foods (cheese, beer, chocolate, yogurt, smoked meats) - many drug interactions
60
other antidepressants
- burpropion (Wellbutrin, Zyban) - --Wellbutrin also used for smoking cessation, has CNS stimulant effects - causes agitation, anxiety, insomnia - --do not use Wellbutrin with seizure patients - lowers threshold - seizures more likely - venlafine (Effexor) - not to be used during pregnancy - duloxetine (Cymbalta) - not be used with alcohol dependency - liver damage - mirtazapine (Remeron) - causes weight gain, drowsiness
61
Nursing Implications for antidepressants
- therapeutic effects - 2-4 weeks - assess depression, suicide precautions - encourage diet and exercise - watch with children/adolescents - recommend counseling/support groups
62
adrenergic agents
- mimic SNS - widespread action, used in emergencies - adverse: arrhythmias, HTN, palpitations, angina, nervouseness - interactions: TCAs, MAOIs
63
``` epinephrine HCL (Adrenaline) - prototype norepinephrine (Levophed) dopamine HCL (Intropin) phenylephrine (Neo-Synephrine) albuterol (Proventil) Isoproterenol (Isuprel) ```
- Adrenaline used anaphylaxis and cardiac emergencies - Levophed - stimulates alpha - causes peripheral vasoconstriction - "leave em dead, Levophed" - last ditch effort - Intropin - results dependent on size of dose - -- Low: increased renal perfusion - -- Med: increased cardiac output - -- High: increased BP Neo-Synephrine - alpha, vasoconstrictor, nasal decongestant albuterol - beta, bronchodilator Isuprel - beta, used in shock
64
Nursing Imp for adrenergic drugs
- extreme care with calculations of meds - monitor VS, ECG, urine output, cardiac output - allergies, carry epi pen at all times - tolerance can develop
65
antiadrenergic drugs
- block SNS - whole or part - --decrease BP, increase renal perfusion - suppress pathological responses to activity, stress
66
phentolamine mesylate (Regitine) - prototype prazosin (Minipress) tamsulosin (Flomax)
alpha adrenergic blocking agents - block alpha 1 receptor sites - Regitine used for phenochromocytoma - tumor in adrenal glands - Flomax used for Benign prostatic hyperplasia (BPH) - Minipress used for hypertension - also used for Reynaud's - discoloration of fingers/toes - adverse: tachycardia, hypotension
67
Nursing implications for alpha adrenergic blocking agents
- monitor VS - supine with IV Regitine - change positions slowly - taper doses - give with food - take same time everyday
68
propranolol (Inderal) - prototype atenolol (Tenormin) carvedilol (Coreg)
beta adrenergic blocking agents - can block beta 1 and/or beta 2 - block beta 1: decrease in HR, decrease in contraction and conduction - --cardioselective beta blockers only block beta 1 - block beta 2: bronchoconstriction of smooth muscles Inderal - prototype, nonselective Tenormin - cardioselective Coreg - alpha-beta - uses: angina, post MI, dysrhythmias
69
Nursing Implications for beta blockers
- monitor VS esp HR - watch for symptoms of hypoglycemia - change position slowly - taper dose - avoid hot tubs, hot showers, saunas - interacts with alcohol
70
acetylcholine - prototype bethanechol (Urecholine) metoclopramide (Reglan)
(parasympathetic drugs) - direct acting cholinergic drugs - Urecholine - urinary retention - Reglan - delayed gastric emptying - action: decrease HR, increase GI muscle tone, increase bladder tone, relax sphincters, increase resp secretions, constrict pupils - use: glaucoma, GI reflux, neurogenic bladder, N/V with chemo
71
Adverse and Nursing Implications for parasympathetic drugs
Adverse: - bradycardia, hypotension, HA, restlessness, coma Caution: - CAD, MI, heart block, intestinal obstruction, resp disorders Nursing: - monitor HR, rest rate - watch for GI problems - can exacerbate peptic ulcers - atropine sulfate - antidote
72
neostigmine (Prostigmine) edrophonium (Tensilon) donepezil (Aricept)
(indirect acting cholingerics) - inhibit action of acetylcholinesterase and prolongs the effects of acetylcholine - use: myasthenia gravis, glaucoma, bladder distension, paralytic ileus - Prostigmin - urinary retention and myasthenia gravis - Tensilon - diagnosis of MG - Aricept - alzheimers
73
Adverse and Nursing Implications for indirect acting cholingerics
Caution: - bradycardia, parkinson's intestinal/bladder obstructions, resp disorders, ulcerative colitis Adverse: - hypotension, bradycardia, intestinal spasm, resp arrest, vasodilation Nursing: - watch for signs of neurotoxicity - monitor resp rate - assess for abdominal cramping - measure urinary output
74
atropine sulfate - prototype oxybutynin (Ditropin) tolterodine (Detrol)
(anticholinergic drugs) - block parasympathetic nerve impulses by competing withe acetylcholine for sites on muscarinic receptors - drugs used for urinary frequency - use: GI disorders that have increased motility, bradycardia, relieve spastic bladder, decreased saliva
75
Adverse and Nursing Implications for anticholingeric drugs
Caution: - glaucoma, heart disease, paralytic ileus Adverse: - dry mouth, constipation, tachycardia, difficult urination, blurred vision, and confusion Nursing: - monitor pulse, BP, urine output - encourage fluids - provide ice chips

Pharmacology (7 decks)

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