PME Nervous System Part 1 Flashcards
(44 cards)
1
Q
autonomic nervous system (ANS)
A
- responds to stress or danger
- maintains regulatory body functions
- affects cardiac and smooth muscle and glands
2
Q
neurotransmitters in the ANS and receptors they stimulate
A
- acetylcholine | cholinergic receptors
- epinephrine | adrenergic receptors
- norepinephrine | adrenergic receptors
- dopamine
3
Q
ANS agonists
A
stimulate function, enhance effects of neurotransmitter
4
Q
antagonists
A
block effects of neurotransmitter
5
Q
drugs that being with “anti-“ and end with “-ase”
A
block degradation of neurotransmitter
6
Q
ANS receptor subtypes
A
location determines subtype
7
Q
cholinergic subtypes
A
- nicotinic
- muscarinic
8
Q
adrenergic subtypes
A
- Alpha1, 2
- Beta1, 2
9
Q
goals of CNS meds
A
- depress or increase activity of CNS
- regulate amounts of CNS neurotransmitters
- stimulate or block autonomic receptors
- treat psychiatric disorders
10
Q
CNS depressant types to treat sleep disorders
A
- benzodiazepines
- non-benzodiazepines
11
Q
benzodiazepines therapeutic use
A
- relieve insomnia
- decreased repeated awakenings at night
- relieve anxiety
- treat status epilepticus
- relax muscle spasms
- help with moderate sedation
12
Q
benzodiazepines
A
- usually end in “-pam”
- temazepam
- diazepam
- lorazepam
- flurazepam
- prototype
- temazepam
- others for sleep
- triazolam
- flurazepam
13
Q
MOA of benzodiazepines
A
- enhance inhibitory effects of GABA
- promote sleep via sedation
14
Q
side effects of benzodiazepines
A
- drowsiness
- dizziness
- confusion
- anxiety
- tolerance: develops over weeks
- withdrawal
- can cause paranoia, panic attacks, muscle twitching, hallucinations
- taper dose
15
Q
nursing interventions for benzodiazepines
A
- oversee nighttime ambulation, especially for older adults
- watch for S of toxicity
- monitor for paradoxical reactions, especially in older adults
- monitor for S of dependence and tolerance
- taper to prevent withdrawal
16
Q
s/sx of benzodiazepine toxicity
A
- weakness
- slurred speech
- ataxia: defective muscle coordination
- uncoordinated muscle movements
- respiratory depression
17
Q
administering benzodiazepines
A
give oral preparations 30 min HS
18
Q
patient education for temazepam
A
- take about 30 min HS and ensure 8 hr for sleep
- do not take with ETOH or other depressants
- stop taking and notify provider if paradoxical reaction occurs
19
Q
contraindications and precautions for benzodiazepines
A
- contra
- pregnancy (Category X)
- lactation
- glaucoma
- children < 18 yo
- caution
- renal or hepatic impairment
- suicidal ideation
- ETOH dependence
- neuromuscular disorders
- chronic respiratory disorders
- sleep apnea
20
Q
interactions with benzodiazepines
A
- other CNS depressants: severe sedation and respiratory depression
- kava kava and valerian root: ↑ sedation
- cimetidine: ↑ benzodiazepine levels
- smoking: ↓ effects of benzodiazepines
21
Q
non-benzodiazepines
A
- use: short-term Tx of insomnia
- prototype: zolpidem (Ambien)
- other
- zaleplon (Sonata)
- eszopiclone (Lunesta)
22
Q
MOA of non-benzodiazepines
A
enhance inhibitory effects of GABA
23
Q
SE of non-benzodiazepines
A
- daytime drowsiness
- headache
- anxiety
- dizziness
- diplopia
- confusion in older adults
- amnesia: ambulating, eating, driving
24
Q
nursing interventions for non-benzodiazepines
A
- monitor for adverse effects
- take precautions to prevent falls, especially in older adults
- monitor for need to ↓ dose
25
administering non-benzodiazepines
* oral form for immediate or extended-release
* oral spray: direct absorption via nasal mucosa
* give HS, ensure 8 hr for sleep
* give on empty stomach for full effect
26
pt education for non-benzodiazepines
* take HS with 8 hr to sleep
* do not take extra doses
* report dizziness or vision changes
* do not take with ETOH or other CNS depressants
* be aware that amnesia, memory impairment, and sleep driving may occur
27
contraindications and precautions for non-benzodiazepines
* contra
* children \< 18 yo
* suicidal ideation
* L&D
* caution
* older adults
* prone to substance abuse
* Hx of depression
* chronic respiratory disorders
* sleep apnea
* hepatic or renal dysfunction
28
interactions with non-benzodiazepines
* ETOH
* other CNS depressants
* take on empty stomach
29
types of CNS depressants for muscle spasms
* centrally acting muscle relaxants
* peripherally acting muscle relaxants
30
centrally acting muscle relaxants
* relieve muscle spasms due to
* spinal cord injury
* multiple sclerosis
* cerebral palsy
* MSK injury or other disorders
* prototype: baclofen
* other
* carisoprodol
* chlorzoxazone
* cyclobenzaprine
31
MOA of centrally acting muscle relaxants
enhance inhibitory effects of GABA
32
side effects of centrally acting muscle relaxants
* drowsiness and dizziness early in therapy
* nausea
* constipation
* withdrawal
* anxiety
* restlessness
* visual hallucinations
* Sz
33
administering centrally acting muscle relaxants
* oral
* start with low dose, gradually ↑
* give oral dose with food or milk
* encourage fluids, ↑ fiber
* D/C drug: taper dose over 1-2 wks
* intrathecal infusion
* directly into spine via needle attached to pump
* do not stop abruptly
34
pt education for centrally acting muscle relaxants
* drowsiness and other CNS effects will ↓ with time
* change position slowly if dizzy
* do not drive or use heavy machinery if drowsy
* take with food or milk
* ↑ fiber and fluid intake
* report constipation
* do not stop abruptly: taper over 1-2 wks
35
contraindications and precautions for centrally acting muscle relaxants
* contra
* allergy to drug
* cyclobenzaprine
* use of MAOI in past 2 wks
* cerebral palsy
* caution
* older adults
* children
* severe mental illness
* Sz disorder
* CVA
36
interactions with centrally acting muscle relaxants
* ETOH and other CNS depressants: ↑ sedation
* DM: ↑ insulin or oral antidiabetics for ↑ BG
* hypertensive crisis: cyclobenzaprine + MAOI
37
peripherally acting muscle relaxants
* use: relax skeletal muscle spasms r/t
* CVA
* spinal cord injury
* multiple sclerosis
* cerebral palsy
* prevent and treat malignant hyperthermia
* prototype: dantrolene
38
MOA for peripherally acting muscle relaxants
* inhibit release of Ca
* block contraction of muscles
39
SE of peripherally acting muscle relaxants
* muscle weakness
* drowsiness
* dizziness
* diarrhea
* liver toxicity
40
nursing interventions for peripherally acting muscle relaxants
* assess muscle strength frequently
* monitor for CNS effects (drowsiness)
* start oral dantrolene at low doses and gradually ↑
* monitor for diarrhea, especially early in Tx
* monitor LFTs
41
administering peripherally acting muscle relaxants
* oral or IV
* for prophylaxis of MH, orally for 1-2 days before
* use IV to treat MH
42
pt education for peripherally acting muscle relaxants
* report
* muscle weakness
* prolonged diarrhea
* avoid
* driving, other activities that require alertness
* CNS depressants
* potential liver damage
43
contraindications and precautions for peripherally acting muscle relaxants
* contra: liver dz
* cardiac dz
* pulmonary dz
* neuromuscular disorder
* pts \> 35 yo
44
interactions with peripherally acting muscle relaxants
* estrogen: ↑ risk of liver toxicity in women \> 35 yo
* CNS depressants: ↑ risk of severe sedation
* IV use: calcium channel blockers ↑ risk for severe cardiac dysrhythmia
