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VEEB > Drugs Affecting the nervous system (CNS) > Flashcards

Drugs Affecting the nervous system (CNS) Flashcards

1
Q

Drugs fall into two basic categories

A
  • stimulants(analeptics) which stimulate the nervous system

- depressants, which depress activity within the nervous system

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2
Q

Central nervous system drug

A

1) Analgesic(Narcotics)
2) Sedative/Hypnotic
3) Anesthetic
4) Anticonvulsant

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3
Q

Analgesics are classified as

A

1) agonist
2) Agonist-Antagonist
3) Antagonist
4) Anticonvulsant

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4
Q

Opioid Agonist

A

Drugs that will bind well to the receptor

ex:

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5
Q

Opioid Agonist-Antagonist

A

Drugs that have properties of both the agonist and antagonist. These drugs have some agonist and antagonist activity at the receptor sites

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6
Q

Opioid Antagonist

A

Drugs that bind to the receptor site and cause no response, agonist can reverse effects

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7
Q

Opioid Agonist (Action)

A
  • do not effect nerve ending
  • increase pain threshold: opioid narcotic
  • causes euphoria
  • changes patients perception about the pain
  • alters emotional response patient has about the pain
  • attitude changes pain remains the same
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8
Q

Opioid Agonist (Indication)

A
  • treat mod-severe pain and manage opiate dependency
  • control pain during abort(obstetric analgesia)
  • mod-severe visceral pain
  • can be given post op/during surgery to manage pain
  • relieve anxiety
  • induce mild-mod sedation
  • cough suppressant
  • slows respiration(side effect): used in pt who have tachypnea to slow respirations
  • decrease g.i motility(anti-diarrheal)
  • control anxiety on patient with mi/pe because they cause euphoria, decrease fear and anxiety about death
  • decrease cardiac workload
  • support anesthesia
  • relieve anxiety in patients with dyspnea associated with pulmonary edema
  • relieve pain associated with a myocardial infarction(morphine sulfate is agent of choice)
  • induce conscious sedation before diagnostic/therapeutic procedure in the hospital setting
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9
Q

Opioid Agonist (origin)

A

obtained from opium plant. obtained from the unripe seed of the opium poppy

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10
Q

Codeine

A
  • Agonist
  • Opoid Analgesic
  • treat mod-severe pain,ANTIUSSIVE, considered a weak analgesic
  • 30-60mg
  • can be added with acetaminophen(non salicylate) or ASA(Salicylate)
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11
Q

Equianalgesic

A
  • term used to equivalate pain receiving properties to another drug
  • all narcotics are compared to morphine
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12
Q

Codeine + Acetaminophen

A

Tylenol 1= 325mg Acetaminophen + 7.5 codeine

Tylenol 2= 325mg Acetaminophen + 15 codeine

Tylenol 3= 325mg Acetaminophen + 30 codeine

Tylenol 4= 325mg Acetaminophen + 60 codeine

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13
Q

Empirin

A

Aspirin + Codeine

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14
Q

Hydromorphone(Dilaudid)

A
  • strongest opoid compound to morphine

- given 1mg can be given orally/parentally

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15
Q

Fentanyl

A
  • has oral/buccal route
  • Duragesic Fentanyl Transdermal
  • topical drug application to skin
  • systemic action
  • takes time to work, change q3days
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16
Q

Propoxyphene(Darvon,Darvon-N)

A

-Propoxyphene + Acetaminophen = Darvocet N

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17
Q

Meperidine(Demerol)

A
  • Agonist
  • Opoid Analgesic
  • treat mod-severe pain, prep sedation, anesthetic adjunct
  • last about 2-3hours
  • limited because causes greatest amount of hypotension
  • elderly can cause paradoxical reaction: effects you dont expect(causes excitement)
  • dosage 50-500mg
  • synthetic developed to treat opioid withdrawal
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18
Q

Methadone(Dolophine)

A
  • -Agonist
  • Opoid Analgesic
  • treat mod-severe pain, treat of opioid dependency
  • used frequently for heroine addicts/drug abuse, treats pain,
  • 10-20mg
  • given by mouth usually
  • used to withdraw from opioid dependency
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19
Q

Oxycodone(Roxicodone & Oxycontin)

A
  • weak analgesic compared to morphine
  • oxycodone + Ibprofen(Combunox)
  • oxycodone + acetaminophen(Percocet)
  • oxycodone + aspirin(Percodan)

-the sustained release version oxycotin, frequency q12h, effective for chronic pain=last more than 6 months, most abused opioit.

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20
Q

Oxycodone + aspirin(Percodan)

A
  • opioid/non-opiod combination oral analgesic
  • Oxycodone 5mg/aspirin 325mg
  • narcotic medicine used to relieve moderate to severe pain.
  • Percodan contains a combination of aspirin and oxycodone. Aspirin is in a group of drugs called salicylates (sa-LIS-il-ates). It works by reducing substances in the body that cause pain, fever, and inflammation. Oxycodone is an opioid pain medication. An opioid is sometimes called a narcotic.
  • Percodan is used to relieve moderate to severe pain.
  • Aspirin should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. -Aspirin can cause a serious and sometimes fatal condition called Reye’s syndrome in children.
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21
Q

Hydrocodone

A
  • can be antitussive
  • weak analgesic compared to morphine

Hydrocodone+Acetaminophen=vicodin
Hydrocodone+Ibuprofen=vicoprofen

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22
Q

Alfentanil(Alfenta)

A
  • -Agonist
  • Opoid Analgesic
  • balance analgesia used to help induce analgesia
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23
Q

Sufentanil Citrate(Sufenta)

A
  • -Agonist
  • Opoid Analgesic
  • induce and maintain analgesia
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24
Q

Morphine Sulfate

A
  • -Agonist
  • Opoid Analgesic
  • attaches to mu receptor cite
  • drug of choice for severe pain
  • duration 4-5 hrs
  • developed from plant prooduct white poppy plant
  • opium called morphine
  • all pain relieving drugs are compared to morphine
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25
Q

Long Acting morphine

A
  • for mod to sever pain
  • for acute pain that last several days
  • also for chronic pain

ex:
-Ronal SR- last 8hrs-frequency 6A,2P,10P
dose=30mg
-MS Contin= last 12hrs last long 10A,10P
-Avina=24hrs daily dosing

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26
Q

Morphine Sulfate

A

PO: 10mg(DOSE): 10-20mins(ONSET): 60mins(PEAK): 4-5hrs(DURATION

SubQ: 4-10mg(DOSE): 10-20mins(ONSET): 30-60min(PEAK): 4-5(DURATION)

IM: 4-10mg(DOSE): 1-3mins(ONSET): 20mins(PEAK): Duration(varies)

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27
Q

Morphine Sulfate is drug of choice for?

A

mi(heart attack), pe(pulmonary edema)

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28
Q

Opiate Receptors

A

cells in the nevous system that have receptor sites

-mu and kappa receptors produce the analgesic,sedative, and euphoric effects associated with analgesic drugs

  • mu,kappa, delta=located in the brain
  • kapppa and delta=located in spinal coloum
  • mu is important for analgesics and resp. depression and physical dependence(euphoria), morphine attaches to this receptor site and has a theraputic response
  • kappa=has analgesics/resp depression(dysphoria)
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29
Q

mu and kappa receptors

A

produce the analgesic,sedative, and euphoric effects associated with analgesic drugs

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30
Q

mu,kappa,delta receptors

A

located in the brain

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31
Q

kapppa and delta receptors

A

located in spinal coloum

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32
Q

mu receptors

A

important for analgesics and resp. depression and physical dependence(euphoria), morphine attaches to this receptor site and has a theraputic response

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33
Q

kappa receptors

A

Has analgesics/resp depression(dysphoria=unwell unhappy feeling)

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34
Q

Side effects of Opioid Agonist:

A

CNS:

  • Drowsiness: pronounced inthe first three days
  • light headed,dizziness,euphora,

pupils:
- myosis-constriction of pupils,
- pinpoint pupil=toxcity

Resp:
-decresed respiration: treats tachypnea

Cardio:

  • tachycardia
  • hypotention: demerol drug

GU:
-urine retention or hesitancy

Gastrointestinal:

  • N,V=more pronounced in first 3 days
  • antiemtics given if needed
  • decreases g.i. motility causing constipation, asses bowel sounds, develop bowel management plan

Integumentary:

  • puritis,rash,utiacria
  • always report rash=hypersensitivity
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35
Q

Contradiction of Opioid Agonist:

A

COPD=because causes resp depression
Head Injury:because effects cns
Pregnant females: crosses placenta barrier

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36
Q

Tolerance

A

decrease response after repeated doses

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37
Q

Dependency

A

physiological/psychological need for medication

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38
Q

Addiction

A

change in behavioral patterns

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39
Q

Withdrawal

A

cessation(abprut stopping), results in diarrhea,stomach cramps, sneezing,runny nose, yawning,irritablility,nervousness, and large pupils

  • methadone(treats withdrawal, manage pain)
  • levomethodyl given for withdrawal when methadone is not effective anymore than put back on methadone in 2 day period
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40
Q

Opoid Agonist-Antagonist(Action)

A
  • effect kappa and delta receptor sites
  • for patient who cant tolerate agonist
  • less respiratory depression and less dependency
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41
Q

Opoid Agonist-Antagonist(side effects)

A
  • sedation,N&V,headache,dizzinesss(vertigo),euphoria,hallucination
  • withdrawal can occur in patients addicted to opiates
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42
Q

Opoid Agonist-Antagonist(Drugs)

A

1-Pentazocine Lactate

  • Pentazocine and ASA (Talwin)
  • Pentazocine and Tylenol (Talacen)

2-Butorphanol (Stadol)

3-Nalbuphine(HCL)-pain manangement in pregnancy

  1. Burenorphine(Buprenex,Subutex, Butrans)
    - Buprenorphine & Naloxone(Suboxone)-C3, used to treat opoid dependency
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43
Q

Butorphanol(stadol)

A
  • Opoid Agonist-Antagonist(Drugs)
  • Butorphanol tartrate is a synthetically derived opioid agonist-antagonist analgesic of the phenanthrene series.
  • Stadol (butorphanol tartrate) Injection and Stadol NS (butorphanol tartrate) Nasal Spray are indicated for the management of pain when the use of an opioid analgesic is appropriate.

-Stadol Injection is also indicated as a preoperative or preanesthetic medication, as a supplement to balanced anesthesia, and for the relief of pain during labor.

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44
Q

Opoid Antagonist

A

action:
- prevents or revereses opiate effects
- may restore resp function in 1-2min

  • adverse effect-increase cns activity reversal of analgesic
  • indication: pain relieving ability will be reversed

Drugs:

  • Naltexone HCL(Revia,Vivitrol)
  • Revia: used to decrease cravings for alcohol
  • Naloxone HCL(Narcan)
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45
Q

Naloxone HCL(narcan)

A
  • Naloxone is an special narcotic drug that reverses the effects of other narcotic medicines.
  • Naloxone is used to reverse the effects of narcotic drugs used during surgery or to treat pain.
  • 0.4 to 2 mg/dose IV/IM/subcutaneously.
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46
Q

Non-Narcotic Analgesic

A 
NSAID=Toradol=im/iv
Acetaminophen(Tylenol)=hepatotocity, activated charcol
Acetylsalicylic acid(Asprin)
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47
Q

Migraine Headaches

A

vascular headaches caused when blood vessels dialte in head

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48
Q

3 groups of drugs used for migraine headaches

A

1-analgesics: non narcotic analgesic,saliclates(ASA),NSAIDS(Ibprofen),Acetaminophen(tylenol)
2-ergot derivatives
3-triptans

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49
Q

Ergot derivatives

A
  • cause vasoconstriction
  • direct effect on blood vessels
  • non-narcotic
50
Q

Ergot derivaticves(drugs)

A 
Dihydroergotamine Mesylate(D.H.E. 45, Migranal)- drug of choice for migraine, most effective during the first sign of migraine, route:po,sublingual,inhal)
-Ergotamine Tartrate(Ergomar)-taken early migraine for best results, route:sublingual

assessment: causes constriction of blood vessels, pale skin, cap refill,pedal pulses to be assesed
- prolonged use can cause ergotism(toxcitiy)-vommiting,decrease periphal pulses,can cause hypotension/hypertension,adverse effect

51
Q

Triptans

A

action: bind w/ vascular receptors to produce vasocontrictions
side effect:N&V,paresthesia fibrosis in heart and lungs, given for 1mont then rest period 4-6months

52
Q

Triptan(Drugs)

A
  • sumatriptan(imitex)
  • nartiptan(Amerge)
  • Rizatriptain(Maxalt)
  • Zolmitiptan(Zomig)
53
Q

Caffeine

A

-treat migraine,vasoconstriction,used in combo w/ other meds

54
Q

Cafergot

A

-caffeine+ergot, take at first sign of headache

55
Q

Betablockers(propranolol(inderal))

A

-used for several months(3 months) before they notice decrease in effect of migraine attacks

56
Q

Antiepileptic(Valproic Acid(Depakene))

A

used to treat headaches

Usual Adult Dose for Migraine Prophylaxis:

Initial dose: 250 mg valproic acid delayed release capsules orally twice daily. Valproic acid delayed release capsules must be swallowed whole.

57
Q

Pain Control Analgesia

A
  • provides analgesia controlled by the patient
  • provides more steady pain relief
  • less respiratory depression
  • less drowsiness
  • continous infusion: mg/hr
  • programmed bolus: prn
  • lock mechanism
58
Q

Nerve Pain

A
  • antidepression: amytriptyline, impramine

- anticonvulsants:carba,zepine(tegretol), Clonazepam(Klonopin), Diazepem(Valium)

59
Q

Nursing implication for analgesics:

A
  • onset action 15-30mins after SC,IM
  • onset action 1-5mins for IV
  • assess for pain
  • check when drug last given
  • provide comfort
  • give drug before pain severe
  • rqual intervals around the clock
  • vital signs hold resp. below 12
  • hold if bp lower than baseline
  • check pupils and LOC
  • withhold if frequently drowsy
  • withhold if arousable but drifts off to sleep during conversation
  • withhold if minimal somnolence
  • whithhold if no response to physical stimulus
  • safety,bed low position,rails,supervised ambulation
  • discourage use of heavy dangerous equipment
  • bowel care
  • enhance medication effect with comfort measures
  • discontinue gradually to prevent withdrawal
  • if the patient must switch drugs give an equinalgesic dose. dosing chart in all areas where doctors are written or dispensed
60
Q

Jacho recommendations

A
  • inform patient verbal or written that pain control is an important part of care
  • clear lines of authority regarding pain treatment decision
  • expert on pain management on staff
  • pain assessment and documentation
  • documentation of pain relief or revision of POC
61
Q

Nursing impplication for migraine

A
  • have the patient lie in darkened room
  • symptoms relief usual in 15-30mins
  • avoid exposure to extreme cold
  • report reduced circulation
  • discontinue if pregnancy suspected
  • watch for Ergotism: nausea,numbness,tingling,decrease peripheral pulses,hypertension/hypotension,drowsiness,stupor seizure
  • avoid migraine triggers
62
Q

Sedative

A

-allays fear and excitement, calmns

63
Q

Hypnotic(Soporifies)

A
  • induces sleep
  • same medicaiton can have both effects
  • can lead to tolerance and dependence
64
Q

Insomnia

A

-hypnotics are used to treat insomnia

65
Q

Two basic types of Sedatives/Hypnotics(Soporifies)

A
  • Barbiturate

- Non-Barbiturate

66
Q

Bariturates(indicaiton)

A
  • inhibit the uptake of GABA
  • used as a sedative
  • used as a hypnotic-to put to sleep
  • anticonvulsant-for seizure
  • anesthetic
67
Q

Barbiturates(onset of action and duraction)

A
  • Ultra short acting used as anesthetic
  • Short acting used as sedative hypnotic
  • Intermediate used as sedative hypnotic
  • Long acting used as anticonvulsant
68
Q

Barbiturates(side effects)

A
  • reduce rapid eye movement(REM) sleep
  • pinpoint pupils(signs of toxcity
  • CNS:depression,hangover(stilll feel affects over several days)
  • GI:N&V,diarrhea,constipation
  • Hypersensitivty
  • Integument:exfoliative,dermatitis,SJS
  • Resp:resp depression
  • Cardiac: decrease Bp,cause syncope
  • Hepatoxicity
  • Withdrawal:if suddenly discontinued can lead to seizures
  • dependency
69
Q

Barbiturates(Antidotes)

A

drug of choice Bemegride,Picrotoxin

70
Q

Barbiturtes(Drugs)

A 
Phenobarbital Na(Luminal)
Pentobarbital Na(Nembutal sodium)
Amobarbital Na(Amytal)
71
Q

Non-Barbiturates(Benzodiazepines)

A

action: inhibit the uptake of GABA
indiaction: antianxiety,insomnia,seizures,conscious sedation
- do not interfere with REM Sleep
- less risk of tolerance
- route:po/parental

72
Q

Benzodiazepines(Non-Barbiturates)(Drugs)

A
  • Lorazpem(Ativan)
  • Alprazolam(Xanax)
  • Diazepam(Valium)
  • Clonzepam(Klonopin)
73
Q

Benzodiazepines(Non-Barbiturates)(Antidote)

A
  • Flumazenil(Romazicon)

- reverses the effect of non-barbiturates benzodiazepines, takes about 1 minute for conscious to occur(onset 1min)

74
Q

Non Benzodiazepine(Non-Barbiturates)

A
  • do not effect REM sleep
  • non barbituate
  • non benzodiazepine
  • sedative/hypnotic
75
Q

Non Benzodiazepine(Non-Barbiturates)(Drugs)

A

Chloral hydrate(Noctec)-gives nearest to normal sleep activity

  • Zolpidem(Ambien)-5-10mg po,most commonly used
  • Eszopiclone(Lunesta)-chronic insomina
  • rebound insomnia can be withdrawal effect
  • decrease in tolerance and dependence
76
Q

Non Benzodiazepine(Non-Barbiturates)(Nursing Implication)

A
  • Hypnotics are generally not given after 2am-3am
  • drugs order at bedtime prn,repeat x1
  • provide environment conductive to sleep
  • plan care to plan for uninterrupted sleep
  • provide saftery with supervised ambulation
  • avoid beverages that interfers with sleep
  • increase physical activity during the day
  • most drugs loose ability to induce sleep in 1-2weeks dailyuse
  • after 2 weeks use may lead to dependency
  • watch for addictive effect with other CNS depressants
  • need two hours between analgesic and sedative
  • dont mix barnituates in a syringe with other drugs(it will precipitate)
  • parental barbiturates once reconstituted must be used within 30mins
  • when barbiturates are given IM watch for tissue necrosis
  • long term barbiturates must be tapered off slowly or will result in dreaming,nightmares,insomnia or withdrawal
  • neither barbiturates or benzodiazepines relieve pain
  • older adults need smaller dose and must be monitored for CNS excitment,depression,and confusion
77
Q

Anesthesia

A

-causing loss of sensation, decrease sensation to pain, effecting nerve conduction,dimish pain

78
Q

Anesthesia(Two Types)

A

General: partial loss of conscious or complete , entire body free of pain

Regional/Local(often interchangeable)

  • local-effect area locally
  • regional-decrease in region its applied
  • causes a specfic area to be pain free
  • patient is conscious/awake
79
Q

Selection of Anesthesia

A

-depending on location of organ being operated on and length of procedure, and patients condition

80
Q

Balanced Anaesthesia

A

-doctors using different medication for their individual effects to help achieve anaesthesia

81
Q

General Anesthesia

A

route: inhalation/injection

- results in partial or complete loss of consciousness

82
Q

General Anesthesia(4 stages)

A

1-Analgesia: decreased awareness of sensory stimulus
2-Excitment/Delirium: Hyperreflexes and dilated
3-Surgical Anesthesia: compleete relaxation,constricted pupils, decreased reflex,normal resp. and pulse
4.Medullary Paralysis: requires life support,resp or cardiac arrest artifical ventilation needed.

83
Q

General Anesthesia(routes)

A

inhalation/injection

-agents used volatile liquid and gases

84
Q

General Anesthesia(inhaltion/gases)

A
  • gases:cyclopropane:gases combined with oxygen,maintain/induce anesthesia-orange cyclinder
  • nitrous oxide:commonly used:weaker-combined with other meds part of balanced anesthesia
85
Q

General Anesthesia(inhaltion/volatile liquid)

A
  • vapors are inhaled
  • Enflurane(Ethrane)
  • Sevoflurane(Ultane)
86
Q

General Anesthesia(Adverse effects)

A
  • N&v
  • cardiac arrhythmia
  • resp depression
  • highly flammable
  • hepatoxicity
87
Q

General Anesthesia(injection)

A

-used prior to gases, make easier to induce anesthia, for short procedures,theoponal=ultra short acting barbituate

88
Q

General Anesthesia(Non-Barbiturates)

A

Propofol(Diprivan)

  • used for conscious sedation before diagonstic procedure w/ local anesthesia
  • used to intubate patients and patiend on vent
  • choice because post surgery less drowsiness
  • dose is determing factor if its a sedative or hypnotic

Midazolam=non barbiturate benzadiapen. used for conscious sedation

Ketamine(Ketalar)=conscious sedation,use if patient does not require skeletal muscle relaxant

89
Q

General Anesthesia(Barbiturate)

A

-Methohexital Na(brevital)

90
Q

Neuroleptic Analgesics

A

(tranquleizer w/ analgesic)

  • condition where there is going to be analgesic and anethesia
  • used for deep sedation
91
Q

Neuroleptic Analgesics(adverse effects)

A
  • coughing, laryngeal spasms,bronch-spasms
  • resp depression
  • malignant hyperthermia-temp increase,increase metabolism
  • dandrolin(antispastic/direct acting) to reduce effect of malignant hyperthermia
92
Q

Regional/Local Anesthesia

A

action: block never condition when applied locally to nerve tissue w/o loss of consciousenss
drugs: drived from coca plant, drugs end in”caine”“novacaine”

93
Q

Regional/Local Anesthesia(adverse effects)

A
  • hypersensitivity
  • hypotension
  • cause stimulating effects or depressing effects
94
Q

Regional/Local Anesthesia(types)

A

1-topical-dental procedure on gums(novacaine)
2-Infiltration-used to relieve pan before minor surgery procedures
3-nerve block(regional anesthic) injected along the course of the nerve in specfic area
-spinal-injected in the subaracnoid space,injected in 2nd-4th lumbar vertebrae,cause hypotension,monitor bp
-epidural-injected in extra/epidural space btw L1 and L2

95
Q

Regional/Local Anesthesia(nursing implication)

A
  • go to the bathroom before the procedure
  • baseline Bp/hypotension
  • urinary retention(urine 30ml after procedure)
  • assess for respirations
  • make sure sensation returns as well as movement
96
Q

Adjuncts to general anesthesia/Pre anesthetic drugs

A

-given by anesthesia to decrease anxiety

97
Q

Adjuncts to general anesthesia/Pre anesthetic drugs

A 
sedative/hypnotics: 
Hydroxyzine HCL(Vistaril)(Atarax)
Pentobarbital Na(Nembutal)

AntiAnxiety-Diazepam(Valium)

Opiates

  • morphine
  • fentanyl citrate(sublimaze)
  • meperidine(demerol)
  • Pentazocine(talwin)
  • Sufentanil(Sufental)

Antiemetics(decrease nausea/vomitting
-droperidol(inapsine)-often along with opiate to induce surgery
-
Anticholinergies
-Atropine Sulfate-effects movement and dry secretions

Skeletal muscle relaxants:
-pancronium bromide:relaxe paralyze muscle:to reverse effect use neostagmin

98
Q

Anticonvulsants

A

abnormal disturbances in electrical activity to the brain

  • classification:partial & generalized
    action: stablize nerve cell against hyperexcitabilty
99
Q

drugs used in anticonvulsants

A
  1. Hydantoins-most common used
  2. Barbiutates-long term in combination without others
  3. Benzodiazepines-status epilepticus
  4. Oxazolidinediones
  5. Succinimides
  6. Miscellaneous
100
Q

Hydantoins(action)

A

-prevent excessive electrical discharge from a epileptic foci by depressing the cerebral cortex

101
Q

Hydantoins(indication)

A
  • generalized and partial seizures
  • mood and behavior disorder
  • pain of trigeminal neurologia
  • delirum tremens
  • digoxin induced arrhythmia
  • prophylaxis after head trauma or crainiotomy
102
Q

Hydantoins(drugs)

A
  • phenytoin(dilantin)-dose:100-300mg/day, theuraputic levels(10-20meg.ml)
  • ethotoin(peganone)
  • fosphenytoin(cerebyx)(look alike/sound alike drug
103
Q

Phenytoin(dilantin)

A
  • hydantoin
  • theuraptic levels: 10-20mcg/ml
  • Dose: 100-300mg/day(po/parentral)
  • i/v=infuse slowly,rapid infusion can cause hypotension
  • oral care important
  • assess skin photosensitivity
  • asses skin for jaundice
  • assess urine fo color
104
Q

Hydantoins(side effects)

A

Gi:gastrotoxic/gingival,hypoxia
skin:dermatitis
CNS:drowsiness,dizzy,ataxia,parasthesia,slurred speech, nystagmus psychosis
Hematological:Bone marrow,depression,folic acid deficiency, anemia
GU:hyperglycemia,pink,green,brown urine
Hepatoxic

105
Q

Baribiiturates

A
  • effect drowsiness
  • can induce sedation/hypnosis
  • ultra short acting anesthesia
  • intermediate sedation
  • long acting seizures

drugs: phenobartital-long acting barbiturate
Na Amytal-immediate sedation/hypnotic
mephobarbital(mebaral)

106
Q

Benzodiazepines

A

use for status epilepticus(seizures for 30mins or more
drugs: Diazepam(Valium)=drug of choice for status epileptics
Lorazepam(Ativan)-subsequent choice for status epileptics

107
Q

Oxazolidinediones(anti-convulsant)

A

-petit mal seizure(general seizure) used when safer drugs are not effective

side effects:pancytopenia,effect bone marrow,effect kidneys, and cause fetal abnormality

drug: Trimethadione(tridione)

108
Q

Succinimides

A
  • used for peti mal seizures(general seizures)
  • depress motor cortex creating a higher threshold for seizures
  • drugs:ethosuximide(zarontin)
109
Q

Miscellaneous

A

Carbamazepine(Tegretol)-gran mal seizures and trigeminal neuralegic, monitor cbc cause aplastic anemia

Valproic acid(Depakene)-long term seizure control,hepatotoxcity, used for mania manic phase of bipolar

Acetazolamide(Diamox)-used because interaction of other med causing those meds to work better(potentiate effect)

Magnesium Sulfate-eletrolytes used in bg/gyn patients

Gabapentin(Neurontin)-used for partial seizures

Lamotrigine(Lamictal)-parital seizure,used for depression phase of bipolar

Tiagabine(Gabitril)-partial seizures

Levetiracetam(partial seizures),most have common therapeutic levels

110
Q

Anticonvulsants(Nursing Implication)

A
  • give with meals(because dilantin is gastrotoxic)
  • gingival hyperplasia, notify dentist, keep clean,massage gum watch for infection(dilatin causes gingival hyperplasia)
  • may need folic acid
  • IV dilantin precipitate in most IV fluids
  • IVP rate slow at 50mg/min(decrease risk of hypotention), Dilantin must infuse with NS, will preciptate with other fluids
  • rapid infusion can lead to hypotension and cardiac arrest
  • Dilantin most effective orally
  • initial therapy cause drowsiness ensure safety(take drug ontime an as ordered)
  • encourage to wear or carry medic alert
  • ensure adherence
  • drugs do not cure seizures but control one dose at a time
  • status epilepticus can be induced if missed dosage
  • status epilepticus is a medical emergency. drug of choice is valium and substitute is ativan
  • valium ivp rate not to exceed 5mg/min
  • dilantin most commonly used antiseizure(can be used for general and partial seizure)
  • cerebyx substitute for parental use
  • valprocid acid long term for generalized,partial seizures, and status eliepticus
  • comes as a sprinkle capsule can open and sprinkle on soft foods
  • need liver profile for hepatoxcity
111
Q

Central Nervous System Stimulants divided into:

A

1-Anorexiants
2-Non-Anorexiants/Analeptics

action: increase levels of neurotransmitters in the brain, increase motor activity,increase mental alertness,improve spirits,decrease fatigue,increase breathing

use:

  • Narcolepsy
  • ADHD
  • Appetite suppressant
  • resp. depression
112
Q

Anorexiants

A
  • used for obesity and appetite suppression
  • to be effective give 30-60min before meals(AC)
  • drugs are used intermetingly(for 1-3months of duration) because of tolerance, expect break in drug use
113
Q

Anorexiants(drugs)

A 
Dextroamphetamine(Dexedrine)
Benzphetamine(Didrex)
Phentermine(Adipex-P)
Phendimetrazine(Brontil)
Phenylpropanolamine-FDA removed due to hemorrhagic strokes
114
Q

Non-Anorexiants/Analeptics

A
  • used for ADHD
  • paradoxical effect(used for children 6yr n over)
  • counteract effect of narcotic narcolepsy-increase wakefulness
  • increase respirations
  • ADHD-treats complusiveness
115
Q

Non-Anorexiant/Analeptic(Drugs)

A
  • Methlyphenidate(ritalin)
  • Dextroamphetamine Sulfate(Dexedrine)
  • Methamphetamine HCL (Desoxyn)=used for narcolpsy
  • Amphetamine Sulfate(Adderall)
  • Amtomoxetine HCL(stattera)
116
Q

Methyphenidate(Ritalin)

A
  • Non-Anorexiant/Analeptic
  • (concerta,methylin,metadate,daytana,ritalin)
  • dosage:5-10mg,1-2wk/day, increasely
  • 5-10mg weekly not to exceed 60mg/day
  • must be give early before breakfast and lunch
  • daytana is a patch
  • when meds are not titrated cause seizures except for (Atomoxetine HCL(stattera))
  • may take a full month before benefits are noticed
  • sudden death and suicidal thoughts can occur, and retard growth
117
Q

Non Amphetamines for Narcolepsy

A

non-anorexiant-narcolepsy

  • use: decrease excessive daytime sleeping
  • Side effect: dry mouth,anorexia,appetite change,tachycardia,cp,headache,anxiety,parathesia

non amphetamines for narcolepsy(drugs)

  • modafinil (provigil)
  • sodium oxybate(xyrem)
  • armodafinil (nuvigil)
118
Q

Non-Anorexiants/Analeptic used as resp stimulants

A
  1. caffeine
  2. Doxapram HCL(Dopram)

used for:

  • mild resp depression due to
  • cns depressant
  • post anesthesia
  • resp depression in newborn
  • fatigue
  • must be monitored for heart rate when alert
119
Q

CNS Stimulants Side effects

A

cardiac: palpitaitons,increase heart rate,increase bp,dysrythmia
cns:restlessness,insomnia,irritability,nervous,tremor,anxiety,seizures,can be drowsy and less alert after tolerance,suicidual thought,aggressive effect
loss of appetite
impotence
children: abdominal pain,anorexia,weight loss,insomnia,tachycardia
interaction: cns stimulants,antidepressant,anticoagulants,anticholinerges,and maoi(within 15days)-can cause hypertension crisis reaction must give 2 weeks apart

120
Q

CNS Stimulants(contraindication)

A
  • heart disease=stimulating to heart
  • hyperthyroidism=elevate metabolism even more
  • diabetes
  • narrow angle glaucoma-drug dilates pupil
  • nephritis
  • renal faliure
  • h/o of drug abuse-dependency
  • pregnacy-children
121
Q

CNS Stimulants(Nursing implication)

A
  • watch for excessive CNS stimulation(agitation,irritability)
  • question when two stimulant given together
  • decrease caffeine intake(because its a cns stimulant)
  • give last dose at least 6hr before bedtime
  • adults before 6pm, children before lunch(can cause insomnia)
  • weight loss take 30-60min before meals
  • given for long time or large doses to stop wean off gradually to prevent seizures except strattera no tapering necessary
  • hyperactive children wean off q6-12 months for 2-3 weeks and evaluate need, holiday from med because not needed like in the summer
  • methyphendate(ritalin)-before breakfast and lunch

VEEB (25 decks)

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