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Pharmacology 1 > drugs affecting the nervous system > Flashcards

drugs affecting the nervous system Flashcards

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1
Q

what is the nervous system?

A

CNS - brain and spinal cord

PNS - nerves

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2
Q

what can happen to left over neurotransmitter in the synapse?

A

taken back into cell via reuptake receptors

broken down by enzymes

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3
Q

list 5 excitatory neurotransmitters

A 
noradrenaline
dopamine
serotonin (5-HT)
acetylcholine
glutamine
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4
Q

name 2 inhibitory neurotransmitters

A

GABA

glycine

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5
Q

name 6 drugs that act mainly on the nervous system

A 
anaesthetics
anxiolytic/hypnotic 
neuromuscular blocking
antidepressants
antiparkinsonian
anticonvulsants
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6
Q

where do general anaesthetics mainly act?

A

nervous system

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7
Q

via what route can anaesthetics be given?

A

inhalation

intravenously

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8
Q

why are anaesthetics used?

A 
to promote:
analgesia
unconsciousness
amnesia
loss of reflexes
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9
Q

what happens if you have too much anaesthetic?

A

adverse effects or death

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10
Q

what 3 things can drugs in the brain do?

A

modify info carried to brain or within brain
alter release of neurotransmitters
open and close ion channels needed for impulse transmission

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11
Q

how can drugs act on the CNS?

A

promotes insensitivity which means blood is insensitive to incoming signals - depresses reticular activating system and cerebral cortex

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12
Q

are drugs which act on the brain fat soluble? and what does this mean can occur?

A

drugs that act on the brain are usually fat soluble- this means they can cross the blood- brain barrier

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13
Q

what happens when membrane receptors in the brain are acted upon by drugs?

A

reduces excitability of neurones

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14
Q

what membrane receptor does propofol bind to?

A

GABA receptor

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15
Q

what happens if ion channels in the brain are affected by drugs?

A

changes the fluidity of the cell membrane

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16
Q

what are the typical side effects of anaesthetics?

A 
nausea/vomiting
breathing shallow/rapid
reduce blood p/CO
reduced kidney profusion
loss of temp control
crosses placenta
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17
Q

name some drugs that interact with anaesthetics

A

aspirin

anticoagulants

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18
Q

name a drug that should be continued with anaesthetic

A

steroid drugs

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19
Q

in what conditions should anaesthetics be used with caution?

A

CVD
hypotension
shock

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20
Q

name the two phases of anaesthesia and how this is achieved

A

induction - IV (quick/not controllable)

maintenance - inhaled (oxygen needed/facemask)

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21
Q

describe the 4 stages of anaesthesia

A

stage 1 - analgesia
stage 2 - excitement
stage 3 - surgical anaesthesia - skeletal muscle relaxation/ loss of reflexes
stage 4 - medullary paralysis- loss of respiratory/ vasomotor control

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22
Q

name 4 types of general anaesthetic

A

barbiturates (contain bartituric acid)
non - barbiturates
gases
volatile liquids

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23
Q

what is nitrous oxide used for?

A

maintaining anaesthesia - not potent enough to induce general anaesthesia
used as analgesia during child birth
can be used in combination with other drugs

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24
Q

can nitrous oxide damage the foetus in pregnancy?

A

with low level long term exposure

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25
name 3 inhaled anaesthetics and describe how they work
isoflurane - doesn't depress CV system, relaxes muscles desflurane - irritates airways and increases secretions sevoflurane - rapid onset and recovery
26
when using inhaled anaesthetics how is the depth of anaesthesia controlled?
by varying the concentration of drug in the vapour
27
what are the side effects of isoflurane, desflurane and sevoflurane
CV depression hypotension arrhythmias can reduce CSF pressure
28
what is etomidate? and are its pros and cons?
etomidate - general anaesthetic pros - no hangover/ less hypotension cons - muscle movements/ suppression of adrenocortical function
29
what is ketamine? and what are its pros and cons?
ketamine - general anaesthetic pros - may be used in children / shocked patients cons - increased HR + BP/ bad dreams or hallucinations on recovery
30
care should be taken when administering general anaesthetics to children, why?
risk of bronchospasm and aspiration of fluid
31
name two commonly used intravenous anaesthetics
propofol - non barbiturate | thiopental - barbiturate
32
what is propofol? and what are its pros and cons?
propofol - intravenous anaesthetic pros - rapid action / rapid recovery without hangover cons- convulsions / anaphylaxis / bradycardia
33
what is thiopental? what are its pros and cons?
thiopental - intravenous anaesthetic pros - useful for brief procedures (last 5-10mins) cons - rapid awakening / long lasting sedation (effects present up to 24hrs later)
34
what are benzodiazepines? and what routes can they be given via?
anxiolytics/ hyponotics | routes - oral, IV, IM, rectal
35
name three benzodiazepines and suggest some uses
midazolam - pre med / can be used for children temazepam - dental treatment / short acting / little hangover diazepam (valium) - widely used for anxiety / not for children
36
what are the draw backs of benzodiazepines?
no analgesic effect | causes hypotension / constipation
37
name six drugs used in surgery and their uses
anxiolytics - calm before surgery hypnotics - increase reaction time neuroleptics / anti emetics - induce artificial hibernation analgesics - pain relief antihistamines - block histamine anticholinergics (atropine/ hyoscine) - regulates breathing
38
explain the mechanism of action for anxiolytic drugs
end aim - to increase GABA (inhibitory neurotransmitter) in the brain anxiolytics cause inhibitory neurone to release GABA at synapse - this makes post synaptic neurone less excitable and neurones less easily activated
39
what are the disadvantages of hypnotics?
dependence respiratory depression benzodiazepines interact with alcohol cross placenta
40
what patients should not be given hypnotics?
patients in shock
41
what are neuromuscular drugs?
muscle relaxants
42
how do neuromuscular drugs work?
block transmission in motor nerves
43
what do neuromuscular drugs reduce the need for?
very deep anaesthesia
44
how do neuromuscular drugs allow insertion of a tracheal tube?
relax the vocal cords
45
what is required when using neuromuscular drugs?
assisted respiration - as muscle used in breathing relax
46
what are some of the disadvantages of using neuromuscular drugs?
prolonged muscle paralysis/ pain | histamine release - bronchospasm etc.
47
name two types of neuromuscular blockers
``` non-depolarising blockers (ACh antagonists) depolarising blockers (ACh agonists) ```
48
explain the mechanism of non-depolarising blockers
compete with ACh for nicotinic receptors at NMJ - prevents action potential development in muscle
49
give two examples of non-depolarising blockers
atracurium - rapid, short action | pancuronium - longer acting
50
how would the action of non-depolarising blockers be reversed?
increasing ACh concentration by inhibiting acetylcholinesterase
51
name a drug that would inhibiting acetylcholinesterase
neostigmine
52
explain the action of depolarising blockers
mimic ACh but produce sustained depolarisation of muscle - paralysis
53
give an example of a depolarising blocker
suxamethonium - short action unless given via drip
54
how is the action of depolarising blockers reversed?
metabolised by pseudocholinsterase enzyme present in NMJ
55
1 in 2000 people don't have pseudocholinsterase enzyme, what would happen in this situation?
prolonged paralysis
56
what are narcotic (opioid) analgesics and where do they act?
powerful pain kills which act directly on opioid receptors in the CNS (brain)
57
what feeling is often achieved when taking narcotic (opioid) analgesics?
euphoria - allows escape from reality
58
give 4 examples of narcotic (opioid) analgesics
fentanyl alfentanil (rapifen) remifentanil morphine - post op.
59
what are the disadvantages of using narcotic (opioid) analgesics?
nausea/vomiting reduced breathing rate risk of addiction
60
what are local anaesthetics used for?
analgesia paralysis (used mainly in minor surgical procedures)
61
what is the mechanism of action for local anaesthetics?
blocks transmission of nerve impulses carrying pain signals from nociceptors to the brain
62
at a cellular level what is the mechanism of action for local anaesthetics?
inhibits Na+ entry through v. sensitive Na+ channels - blocks transmission of nerve impulses (depolarisation of cell can not occur)
63
what are the common methods of administration for local anaesthetics?
epidural - injection into epidural space (affects nerve roots) intradermal/ topical - relieves minor irritation/ superficial pain
64
name 5 common used local anaesthetics and when they would be used
lidocaine - widely used/ dental surgery/ treats premature ejaculation priloxaine - mixed with lidocaine for EMLA cream bupivacaine ropivacaine proxymetacaine
65
what are the side effects of local anaesthetics and why might they occur?
caused by anaesthetic reaching the brain or heart - abnormal heart beat - restlessness - convulsions - cardiac arrest (severe cases)
66
why are vasoconstrictors used in combination with local anaesthetics?
- enhance potency and prolong duration of action - by restricting blood flow to area less anaesthetic is needed - increase safety margins (reduce toxicity) - reduced blood flow during surgery lessens blood loss
67
name a vasoconstrictor which is commonly used in combination with local anaesthetics
adrenaline
68
how do antidepressants work in the nervous system?
increase levels of excitatory neurotransmitters in the brain
69
how do antiparkinsonian drugs work in the nervous system?
increase levels of the neurotransmitter dopamine
70
how do anticonvulsants work in the nervous system?
treat epilepsy by reducing conduction of excitatory nerve impulses and/or increasing GABA activity
71
name three types of antidepressants
``` tricyclic antidepressants (TCAs) selective serotonin re-uptake inhibitors (SSRIs) monoamine oxidase inhibitors (MAOIs) ```
72
what is the mechanism of action of tricyclic antidepressants (TCAs) and selective serotonin re-uptake inhibitors (SSRIs) antidepressants?
inhibit re-uptake of NADR (noradrenaline), 5-HT (serotonin) or DA (dopamine) into the presynaptic receptor
73
what is the mechanism of action of monoamine oxidase inhibitors (MAOIs) antidepressants?
inhibits enzyme breakdown of 5-HT (serotonin) and NADR (noradrenaline)
74
give three examples of tricyclic antidepressants (TCAs)
imipramine nortriptyline doxepin
75
what are the side effects of tricyclic antidepressants (TCAs)?
``` dry mouth blurred vision constipation urinary retention arrhythmias mental confusion and sedation ```
76
give 4 examples of selective serotonin re-uptake inhibitors (SSRIs) antidepressants
fluoxetine citalopram sertraline paroxetine
77
what are the side effects of selective serotonin re-uptake inhibitors (SSRIs)?
``` headache nausea dizziness diarrhoea convulsions ```
78
give 2 examples of monoamine oxidase inhibitors (MAOIs) antidepressants
phenelzine | tranylcypromine
79
what are the side effects of monoamine oxidase inhibitors (MAOIs) antidepressants?
nausea dizziness insomnia
80
what do monoamine oxidase inhibitors (MAOIs) antidepressants interact with?
tyramine-containing foods (red wine, cheese, marmite)
81
what is monoamine oxidase?
an enzyme which breaks down amine neurotranimitters
82
how does inhibiting monoamine oxidase alter mood?
inhibiting the break down of neurotransmitters keeps them in the brain for longer

Pharmacology 1 (11 decks)

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