Exam 2 Flashcards
(176 cards)
1
Q
First Neurotransmitter identified? By who? What year?
A
Acetylcholine, Sir Henry Dale, 1914
2
Q
Functions of the Autonomic Nervous System
A
involuntary control over vital functions of the cardiovascular, digestive, respiratory, and genitourinary systems.
3
Q
Functions of the Somatic Nervous system
A
Voluntary control over skeletal muscles
4
Q
2 components of the PNS
A
Somatic component & Autonomic component
5
Q
Two subdivisions of the Nervous System? What do they consist of?
A
Central Nervous System (CNS) - brain and spinal cord
Peripheral Nervous System (PNS) - nerves that carry messages to and from the CNS
6
Q
3 main activities of the ANS
A
- contraction of smooth muscle of the bronchi, blood vessels, GI tract, eye, GU tract.
- contraction of cardiac muscle
- secretions of salivary, sweet, and gastric glands
7
Q
Two divisions of the ANS
A
Sympathetic & Parasympathetic
8
Q
Sympathetic Nervous System Response
A
Fight-or-Flight
9
Q
Bodies response to fight-or-flight
Brain, cardiovascular, musculoskeletal, GI
A
brain - increases alertness and readiness
cardiovascular - increased heart rate and blood pressure
musculoskeletal - ready for sudden, intense physical activity
GI - liver produces more glucose for energy & peristalsis decreases
10
Q
Bodies response to fight-or-flight cont.
respiratory, pupils, integumentary, GU
A
respiratory - dilatation of bronchi, increases respiration
pupils - dialates, increased vision
integumentary - warm, increased perspiration
genitourinary - decreased urine formation
11
Q
Parasympathetic Nervous System Response
A
Rest & Digest
12
Q
Bodies response to rest & digest
GI, Cardiovascular, Respiratory
A
GI - increased secretions & increased peristalsis
cardiovascular - decreased heart rate and blood pressure
respiratory - constriction of bronchi, decreased respirations
13
Q
3 major steps in the process by which the neuron influences behaviors in the post synaptic cell
A
- conduction of an action potential along the neuron
- release of the neurotransmitter from the axon terminal
- binding of transmitter molecules
14
Q
two processes involved in neuron function
A
- synaptic transmission - information carried across the neuron gap and the post-synaptic cell
- axonal conduction - action potential is conducted down the axon.
15
Q
what neuron function is altered most commonly by neuropharmacologic agents?
A
Most drugs alter synaptic transmission opposed to axonal conduction. drugs that alter synaptic transmission are much more selective.
16
Q
What are the only type of drugs that alter axonal conduction?
A
Local Anesthetics
17
Q
Features of Synaptic Transmission
A
- synaptic conduction - highly selective
- synapses at different sites employ different transmitters
- many transmitters have more than one receptor
18
Q
Two parts of the neuron chain
A
Preganglionic and postganglionic
19
Q
Space between the two neurons
A
Synapse
20
Q
chemicals in synaptic transmission
A
neurotransmitters
21
Q
5 steps in synaptic transmission
A
- transmitter synthesis
- transmitter storage
- transmitter release
- receptor binding
- termination of transmission
22
Q
how do ANS drugs affect synthesis?
A
inhibit or increase neurotransmitter synthesis in the preganglionic nerve
23
Q
How do ANS drugs affect storage?
A
prevent storage of the neurotramitters in the vesicles within the preganglionic nerve
24
Q
How do ANS drugs affect release?
A
Influences the release of the neurotransmitter from the preganglionic nerve
25
How do ANS drugs affect binding?
bind to the receptor site and block action of the neutotransmitter
26
How do ANS drugs affect termination?
alters termination of transmission by preventing the normal destruction or reuptake of the neurotransmitter
27
Transmitters of the Peripheral Nervous System
1. Acetylcholine (Ach)
2. Norepinephrine
3. Epinephrine
4. Dopamine (mostly CNS but also found in PNS)
28
Cholinergic Neurotransmitter
Ach
29
Cholinergic Receptors
Nicotinic and Muscarinic
30
activation of Nicotinic receptor by Ach
Sympathetic and Parasympathetic response
| Stimulates smooth muscle and gland secretions
31
activation of Nicotinic M receptor by Ach
stimulates contraction of skeletal muscle
32
activation of Muscarinic by Ach
parasympathetic response
stimulates smooth muscles and exocrine gland secretions
inhibits heart rate and force of contraction
33
enzymes that destroys Ach and removes it from the synaptic cleft
Acetylcholinesterase (AchE)
| Pseudocholinesterase (found in the liver)
34
Adrenergic Recepters
Alpha1, Alpha2, Beta1, Beta2, dopamine
35
Functions of Alpha1 receptor
1. vasoconstriction
2. ejaculation
3. contraction of bladder neck and prostate
4. constriction of skin, mucous membranes
5. pupil dialation
36
Functions of Alpha2 receptor
located in the presynaptic junction on nerve terminals
regulates transmitter release for NE
can help reduce transmitter release when too much has accumulated in the synaptic gap
37
Functions of Beta1 receptor
increases heart rate
increases force of contraction
increases velocity of conduction in AV nodes
renin release (renin promotes synthesis of angiotensin, which is a vasoconstrictor)
38
Functions of Alpha2 receptor
located in the presynaptic junction on nerve terminals
regulates transmitter release for NE
can help reduce transmitter release when too much has accumulated in the synaptic gap
39
Functions of Beta1 receptor
increases heart rate
increases force of contraction
increases velocity of conduction in AV nodes
renin release
40
Functions of Beta2 receptor
```
bronchial dilation
decreased peristalsis
decreased urine production
glycogenolysis (increase glucose)
enhanced contraction of skeletal muscle
vasodilation in heart, lungs, skeletal muscle
```
41
Functions of dopamine receptor
dilates renal blood vessels
increased force of cardiac contraction
has much more effect int he CNS
42
Specificity of Adrenergic transmitters.
| which receptors does epinephrine bind to?
Alpha1, Alpha2, Beta1, Beta2
43
Specificity of Adrenergic transmitters.
| which receptors does Norepinephrine bind to?
Alpha1, Alpha2, Beta1
44
Specificity of Adrenergic transmitters.
| which receptors does Dopamine bind to?
Alpha1, Beta1, dopamine
45
how is NE action terminated
Reuptake - 50-80% is take back into the pre-synaptic neuron
repackaged in vesicles for future use.
destroyed by enzymes MAO & COMT
46
What enzymes destroy NE action?
Monoamine Oxidase (MAO) & Cathechol-O-methyltransferase (COMT)
47
How does the adrenal medulla effect NE?
preganglionic neurons terminate in the adrenal medulla
NE and Epinephrine are released directly into the blood supply and distributed to target organs.
80% - epi & 20% - NE
48
what drug classification stimulates the sympathetic Nervous system?
sympathomimetics, adrenergic-anonistics
49
What drug classification stimulates the parasympathetic nervous system?
parasympathomimetics, muscarinic agonists
50
What drug classification inhibits the sympathetic nervous system?
adrenergic antagonists or blockers (eg beta-blockers)
51
what drug classification inhibits the parasympathetic nervous system?
anticholinergics, parasympatholytics, muscarinic blockers.
52
Two basic actions of CNS drugs?
stimulates firing of neurons (activation) & suppresses firing of neurons (inhibition)
*Drugs can have both actions*
53
What do electrical impulses in the CNS do?
release neurotransmitters and activates receptors
54
two main neurotransmitters in the CNS
1. Acetylcholine (Ach)
| 2. Norepinephrine (NE)
55
other neutronsmitters in the CNS
Gluamate, GABA, Dopamine, Serotonin, Endorphins and enkephalins
56
Where are Adrenergic synapses distributed?
in the hypothalamus, limbic system and RAS
57
What is the primary neurotransmitter found in Adrenergic synapses?
Norepinephrine (NE) -
58
what effects does NE have?
Excitatory or inhibitatory
| heightens alertness, affects depressions, affects anxiety and panic, and memory
59
where are cholinergic synapses distributed?
in the CNS
60
What is the primary neurotransmitter found in cholinergic synapses?
Acetylcholine (Ach)
61
What effects does Ach have?
Stimulates
in motor cortex, basal ganglia
affect parkinson's disease, affect alzheimers, and myasthenia gravis.
62
Where are dopaminergic synapses distributed?
in the basal ganglia, limbic system
63
What is the primary neurotransmitter found in dopaminergic synapses?
dopamine
64
What effects does dopamine have?
generally excitatory
arousal and wakefulness
affect psychoses, affects parkinson's, motivation, pleasure
65
Dopaminergic synapses are a mechanism of:
cocaine, amphetamines, marijuanna
66
Where are Endorphins & Enkephalins distributed?
in the CNS & PNS
67
What effects do endophins & Enkephalins have?
opiiod receptors: affects pain transmission
68
Where are GABA synpases distributed?
in the CNS
69
What do effects does GABA have?
most common inhibatory
| seizures & anxiety
70
Where are glutamate synapses distributed?
all areas of the brain
71
What are the effects of glutamate?
always excitatory
death of neuron in high amounts
affects memory
72
What are glutamate receptor subtypes?
N-methyl D-aspartate
73
where are serotonergic synapses distributed?
brain stem and limbic system
| 98% of serotonergic synapses found outside CNS in platelets, mast cells and GI tract
74
What are the effects of serotonergic synapses?
low levels are associated with anxiety, impulsivity, suicidal ideation
synthesizes melatonin
75
Function of the Blood-Brain-Barrier
* allows for continuous flow of glucose and oxygen
* protects from pathogens or toxins
* capillaries not as porous as in other parts of the body
* form a tight barrier to many substances
76
define somatic pain
localized to muscles or joints
77
define visceral pain
pain in the organs
78
define neuropathic
injury to nerves
79
define chronic malignant pain
pain caused by cancer
80
what are the phases of pain?
1. transduction
2. transmission
3. perception
4. modulation
81
what occurs during transduction?
nociceptor nerve ending are stimulated.
82
What occurs during transmission?
nerve impulse signal travels
83
What occurs during perception?
this occurs in the brain and we become aware of the pain
84
What occurs during modulations?
neurotransmitters can inhibit pain transmission.
85
examples of nonpharmacologic interventions
relaxation, meditation, distraction, laughter, heat, cold, message, accupressure, acupuncture, therapeutic touch, biofeedback
86
Why are nonpharmocolgic therapies important?
1. used to reduce and augment analgesic drugs
2. can be used to obtain adequate pain relief
3. allow for lower doses of drugs
4. many are already standards of nursing care
87
What does JCAHO require nurses to do in regards to pain?
Pain should always be reassessed.
88
What are the nurses responsibilities for pain?
1. involve the nursing process
2. include pain assessment
3. check pain at baseline and reassess after therapy
4. include location, intensity, quality, precipitating or relieving factors
5. pain rating scales
89
What is the main goal of pain management?
to reduce pain to reasonable levels, may not be able to eliminate completely.
90
What are the classes of drugs for pain?
1. Opioid drugs
2. Nonopioids (NSAIDs, centrally acting agents or acetaminophen)
3. adjuvant analgesics
91
What are opioid drugs used for?
used to treat severe pain
92
what are nonopioids used for?
used for mild to moderate pain
93
What are adjuvant analgesics used for?
used to treat chronic pain that is neuropathic in nature
94
Action of opioid agonist drugs
activate mu and kappa receptors.
| relieves moderate to severe pain.
95
Action of mixed opioid agonist-antagonist drugs
works on one receptor but blocks or has no effect on the other.
treats moderate pain with less risk.
96
Action of opioid antagonist drugs
lock mu and kappa receptors.
| treatment of opioid overdose (eg. narcan)
97
What drugs work during transduction?
NSAIDs
98
What drugs work during transmission in peripheral nerves?
local anesthetics
99
What drugs work during in spinal tract?
Opioids
NSAIDs
Alpha2-adrenergic agonist
100
What drugs work during perception?
opioids
| Alpha2-adrenergic agonist
101
What drugs work during modulation?
antidepressants
| anti-epileptic agents
102
Actions and side effects of opioids
causes CNS depression, GI side effects, sedation, urinary retention, pruritus (itching), respiratory depression, physical dependence, dizziness, hallucinations, anxiety, risk for dependency.
103
Therapeutic Classification for Morphine Sulfate
Narcotic analgesic
104
Pharmacologic Classification for Morphine Sulfate
Opioid agonist
105
Pregnancy risk for Morphine Sulfate
Category C
106
Mechanism of action for Morphine Sulfate
1. Occupies mu and kappa receptor sites in brain and spinal cord that alters release of afferent neurotransmitters
2. alters perception and emotional response to pain
3. produces analgesia and euphoria
4. mimics action of endogenous endorphins
107
Indications for Morphine Sulfate
1. acute and severe chronic pain
| 2. relieving acute MI
108
Contraindications for Morphine Sulfate
1. hypersensitivity
2. Premature infants
3. Blood brain barrier
109
Precautions for Morphine Sulfate
elderly, undiagnosed abdominal pain, hepatic/renal impairments, shock, CNS depression, head injury/increased ICP, COPD
110
Morphine Sulfate drug interactions
1. increased sedation (CNS depressants)
2. reversed effects with opioid antagonist (Narcan)
3. Additive constipation (antidiarrheal)
111
Morphine sulfate adverse effects
CNS depression, respiratory depression, constipation, nausea, vomiting, urinary retention, sedation, dizziness, anxiety, disorientation, orthostatic hypotension, pruritus with IV or epidural route
112
Nursing Responsibilities for Morphine Sulfate
1. Complete assessment
2. assess respiratory function
3. vital signs
4. monitor or resp. depression, hypotension, CNS effects
5. Prevention of constipation, monitor I&O
6. evaluate effectiveness
113
why use mixed agonist-antagonist opioids
narcotic analgesics developed for strong analgesia with fewer adverse affects
1. less respiratory depression
2. lower potential for dependence
used to treat moderate pain
114
Prototype drug for mixed agonist-antagonist opioids
Buprenorphine
115
Mechanism of action for buprenorphine
Partial agonist at mu receptors
| antagonist at kappa receptors
116
Indications for buprenorphine
parenteral route - relief for moderate pain
| sublingual route - treatment for opioid withdrawal and dependence
117
Contraindications for buprenorphine
respiratory depression
| cardiac arrhythmias
118
Buprenorphine pregnancy risk
category C
119
Adverse effects for Buprenorphine
respiratory depression
| prolonged QT interval with long term use of patch form
120
Nursing consideration for Buprenorphine
protect patch site from heat
monitor EKG
may take 1-2 weeks to become effective
121
Types of nonopioid analgesics
1. NSAIDs
2. Acetaminophen
3. centrally acting agents
122
Therapeutic classification for ibuprofen
analgesic, anti-inflammatory drug, antipyretic (fever)
123
Pharmacologic classification for Ibuprofen
NSAID
124
Ibuprofen pregnancy risk
Category C (first/second trimester) & D (third trimester)
125
Mechanism of action for Ibuprofen
1. inhibits COX-1 and COX-2, which block postaglandin synthesis and modulate t-cell function.
2. inhibits inflammatory cell chemotaxis
3. decreases the release of superoxide radicals
4. increases scavenging of superoxide radicals at inflammatory sites
126
Indications for Ibuprofen
Relief of fever and mild to moderate pain associated with chronic symptomatic rheumatoid arthritis and osteoarthritis
Myalgia, headache, dental pain, and dysmenorrhea
127
Contraindications for Ibuprofen
1. allergy to aspirin or other NSAIDs
2. PUD, bleeding abnormalities, and perioperative pain related to coronary artery bypass graft
3. severe hepatic/renal impairments
128
Precautions for Ibuprofen
1. Hypertension, history of GI bleeding, diabetes, and impaired hepatic/renal function.
2. heart failure, serious HTN, history of stroke or MI
3. Diminished respiratory function in children with asthma
129
Ibuprofen drug interactions
1. Oral anticoagulants can increase bleeding
2. May increase toxicity for digoxin, lithium, methortrexate
3. other NSAIDs, alcohol, corticosteroids may cause GI events
4. reduced antihypertensive action of beta blockers, antidiuretics, and ACE inhibitors
5. garlic, ginger, feverfew, and ginko may increase bleeding
130
Adverse effects for Ibuprofen
Bleeding, anorexia, heartburn, nausea, vomiting, constipation or diarrhea, dizziness, headache, drowsiness and light-headedness, polyuria, azotemia (increase creatinine), cystitis, hematuria, and increased BUN levels
131
Serious Adverse effects for Ibuprofen
hypotension, CHF, peripheral edema, Occult blood loss, aplastic anemia, leukopenia, decrease hemoglobin and hematocrit, increased AST and ALT, renal impairment and renal failure
132
Nursing responsibility for Ibuprofen
1. monitor cardiac responses and fluid retention
2. monitor BUN and creatinine levels
3. notify prescriber before therapy is hx of PUD, bleeding abnormalities, and perioperative pain related to CABG
4. Assess CBC and Liver function blood tests
133
Patient/family teaching for Ibuprofen
1. do not take products containing aspirin or other analgesics
2. notify physician if blood in stool or vomit or GI discomfort
3. do not drink alcohol
4. refrain from smoking
5. taking with milk or food
6. report abnormal bruising
134
Therapeutic classification for Acetaminphen
nonopioid anagesic, antipyretic (fever)
135
Pharmacologic classification for acetaminophen
Para-aminophenol derivative
136
Pregnancy risk for acetaminophen
category B
137
Mechanism of action for Acetominophen
1. Inhibits COX
2. May inhibit chemical mediators of pain
3. Direct action on the heat-regulating center of the hypothalamus
.
138
Indications for Acetaminophen
1. mild to moderate pain
2. osteoarthritis of the hip or knee
3. dysmenorrhea
4. dental procedures
5. headache and myalgia and fever
139
Contraindications for Acetaminophen
allergy to acetaminophen
140
precations for acetaminophen
anemia, G6PD deficiency, hepatic disease, rheumatoid or osteoarthritis, malnutrition, bone marrow depression, immunosuppression, renal impairment
141
drug interactions for acetaminophen
1. alcohol increases risk of hepatotoxicity
2. barbiturates, carbamazepine, diphenylhydantoin, isoniazid, rigampin, and sulfinpyrazone.
3. decrease lamotrigine levels
4. can increase hypoprothrombinemic effects with warfarin
5. increase bone marrow risk with zidovudine
6. hepatotoxicity with echinacea
142
Adverse effects with acetaminophen
none at recommended doses
| *see serious adverse effects
143
serious adverse effects with acetaminophen
1. acute hepatic failure
2. acute poisoning (diarrhea, vomiting, abdominal pain)
3. decrease in blood cells
4. renal damage
5. thrombocytopenic Purpura
144
Nursing responsibility with Acetominophen
1. recent drug hx
2. effectiveness of the medication
3. baseline and periodic LFTs for signs of hepatotoxiticty
4. assess alcohol use
145
Patient family teaching for Acetominophen
1. do not increase dose
2. do not drink alcohol
3. medical attn is need for fever >3 days
4. report signs of liver toxicity
5. keep away from small children
146
Therapeutic classification for Tramadol
Analgesic
147
Pharmacologic classification for tramadol
centrally acting nonopioid analgesic
148
pregnancy risk for tramadol
category C
149
Mechanism of action for tramadol
1. drug and one of metabolites bind to mu receptor
2. causes weak opioid agonist activity
3. inhibits norepinephrine and serotonin reuptake in the spinal neurons
4. inhibits the transmission of pain impulses
150
Indications for Tramadol
1. moderate pain
| 2. off-label uses (neuropathic pain, restless leg syndrome)
151
Contraindications for Tramadol
1. hypersensitivity
2. history of depression or suicidal
3. pregnancy
152
Precautions for Tramadol
codeine allergies, history of drug use, COPD, renal/hepatic impairment, increased ICP, history of seizures
153
Drug interactions for Tramdol
1. increased risk for seizures (carbamazepine, vertain antidepressants, MAOIs)
2. sudden death if combined with alcohol
3. reduced analgesic effect
154
Adverse affects for tramadol
vertigo, dizziness, headache, nausea, vomiting, constipation, lethargy, CNS stimulation effects, seizures, respiratory depression, physical dependence
155
Nursing responsibilities for Tramadol
1. full assessment
2. history of substance abuse
3. bowel function
4. effectiveness of drug and adverse effects
156
What are adjuvant analgesics
Diverse groups of drugs used to enhance analgesia for specific indications
Primary indications - pain refractory to opioids (eg. intractable cancer pain) and neuropathic pain
157
Types of Adjuvant Analgesics
1. Antidepressants
2. antiseizure drugs
3. corticosteroids
4. local anesthetics
5. muscle relaxants
158
What are antagonist opioid agents used for?
therapeutic use for opioid overdose or reversal of opioid effects
reversal of constipation caused by opioids
159
Therapeutic classification for Naloxone
opioid (narcotic) antagonist
160
Pharmacologic classification for Naloxone
Opioid overdose agent
161
Pregnancy risk for Naloxone
category C
162
Mechanism of action for Naloxone
1. competes with opioid agonists for mu and kappa receptors
2. antagonizes all effects of morphine and other opioids
3. reverse respiratory depression and coma
163
Indications for naloxone
1. opioid overdose
| 2. postoperatively to reverse opioids given during surgery
164
Contraindications for Naloxone
Hypersensitivity
165
precautions for Naloxone
1. chronic physical dependence to opioids
2. cardiovascular disease
3. seizures disorders
166
Drug interactions for Naloxone
1. reverses all effects of opioids
| 2. use with tramadol can increase risk of seizures
167
Adverse effects for Naloxone
no common adverse effects
| * see serious adverse effects
168
Serious adverse effects for Naloxone
tachycardia, dysrhythmia, hypertension, nausea, and vomiting
169
Nursing responsibilities for Naloxone
1. assess respiratory status
2. resuscitation equip. available
3. monitor for signs of withdrawal
4. assess vital signs, pain level and pupil size
5. be prepared for respiratory arrest
170
Define mild migraine
occasional headaches, no other functional impairments
171
What meds are used for mild migraines?
1. NSAIDs
2. Acetaminophen combined with NSAID and Caffine
3. Oral Serotonin, 5-HT agonist
172
Define moderate migraines
moderate headaches, nausea, some functional impairment
173
What meds are used for moderate migraines?
1. oral, intranasal, subcutaneous serotonin (5-HT) agonists
| 2. dopamine agonist
174
Define severe migraines
severe headaches, more than 3 per month, marked nausea or vomiting, functional impairment
175
what meds are used for severe migraines?
1. subcutaneous, IM or IV serotonin agonists
2. parenteral dopamine agonist
3. narcotic analgesics for refractory pain
176
Nursing process in Pain management drugs
1. assess pain or migraines
2. analyze patients needs
3. prioritize nursing diagnosis and goals for care
4. implementation of care to achieve pain management
5. compare actual outcomes with expected outcomes
