Unit 2: Ch 23-25, 27

Question 1

What is the Blood Brain Barrier?

Answer 1

Keeps selective chemicals out of the brain

Question 2

What kinds of drug can and cannot cross the BBB?

Answer 2

Lipid soluble drugs CAN cross the BBB
Protein bound drugs CANNOT cross BBB
Highly ionized drugs CANNOT cross BBB

Question 3

What is drug tolerance?

Answer 3

Dosage response decreases over time; higher dose is needed

Question 4

What is Physical Dependence?

Answer 4

Body is dependent on drugs effects, body can go through withdrawal syndrome if stopped abruptly

Question 5

Which individual would be more sensitive to the
effects of central nervous system drugs?
A. 2 –week old infant who has pyloric stenosis
B. 16-year-old adolescent who has a spinal cord
injury
C. 58-year-old adult who has venous
insufficiency
D. 74-year-old adult who has Parkinson’s

Answer 5

A

Question 6

The nurse cares for a patient with depression who is
prescribed an anti-depressant. When would the nurse
expect the medication to reach full therapeutic effect?
A. 7 to 10 days
B. 2 to 3 weeks
C. 2 to 4 months
D. 5 to 6 months

Answer 6

B

Question 7

What causes Parkinson’s Disease?

Answer 7

Imbalance between dopamine and ACh

Question 8

What do Dopaminergic agents do?

Answer 8

Increase Dopamine in the CNS

Question 9

What do Anticholinergic agents do?

Answer 9

Decreases acetylcholine in the CNS

Question 10

What is the food interactions of Levodopa?

Answer 10

Food delays absorption
High protein foods will reduce therapeutic effects

Question 11

How should wearing off effects of Levodopa be minimized?

Answer 11

Shortening the dosing interval
Giving a drug that prolongs levodopa’s plasma half-life
Giving a direct-acting dopamine agonist

Question 12

How does Levodopa reduce symptoms of Parkinson’s?

Answer 12

increases dopamine synthesis

Question 13

What are the adverse effects of Levodopa?

Answer 13

Nausea and vomiting
Dyskinesias
CV effects
Psychosis

Question 14

What are the drug interactions of Levodopa?

Answer 14

1st gen. antipsychotics
MAOIs
Anticholinergics

Question 15

What does Carbidopa do?

Answer 15

Prevents decarboxylation of levodopa in intestine/peripheral tissues, which makes it more available to the brain

Carbidopa also enhances levodopa effects

Question 16

What does Entacapone do?

Answer 16

Inhibits metabolism of levodopa in the intestines and the peripheral tissues
Prolongs time that levodopa is available to the brain

Question 17

What is the goal of pharmacologic therapy in
Parkinson’s Disease?
A. To increase the amount of acetylcholine at the
presynaptic neurons
B. To reduce the amount of dopamine available
in the substantia nigra
C. To balance cholinergic and dopaminergic
activity in the brain
D. To block dopamine receptors in both
presynaptic and postsynaptic neurons

Answer 17

C.

Question 18

A patient taking levodopa plus carbidopa for
Parkinson’s disease should be instructed to ____
A. take the medication with breakfast.
B. avoid taking the medication with high-protein meals.
C. increase intake of vitamin B6.
D. discontinue the drug for 10 days (for a “drug
holiday”).

Answer 18

B.

Question 19

What causes Alzheimer’s Disease?

Answer 19

Degeneration of neurons
Reduced cholinergic transmission

Question 20

What is the function of cholinesterase inhibitors?

Answer 20

delay or slow the progression of AD

Question 21

What are the adverse effects of Cholinesterase inhibitors?

Answer 21

Cholinergic side effects
GI effects
Dizziness
Headache
Bronchoconstriction

Question 22

At what point are Memantine drugs used to help AD?

Answer 22

Moderate to severe AD

Question 23

Which neurotransmitter has been implicated in
the development of Alzheimer’s disease?
A. Acetylcholine
B. Dopamine
C. Epinephrine
D. Serotonin

Answer 23

A

Question 24

What are the adverse effects of Memantine?

Answer 24

Dizziness
Headache
Confusion
Constipation

Question 25

Which of these is the strongest risk factor for developing the Alzheimer’s disease? A. Heredity B. Age C. Exposure to toxins D. None of the above

Answer 25

B

Question 26

How does anti-epileptic work?

Answer 26

suppress discharge of neurons within a seizure focus suppress propagation of seizure activity from the focus to other area of the brain

Question 27

What are the mechanisms of action of anti-epileptic drugs?

Answer 27

suppression of sodium influx suppression of calcium influx promotion of potassium efflux potentiation of GABA

Question 28

Why should anti-epileptic drugs be slowly withdrawn?

Answer 28

To avoid rebound increase in seizure activity

Question 29

What are the therapeutic uses of Phenytoin?

Answer 29

Help manage all major forms of epilepsy except absence seizures

Question 30

What are the adverse effects of Phenytoin?

Answer 30

Sedation Ataxia Cognitive impairment Gingival hyperplasia Skin rash (measles like) CV effects

Question 31

What are the mechanisms of action of Valproic Acid?

Answer 31

Suppresses sodium and calcium channels Augments GABA

Question 32

What are the adverse effects of Valproic acid?

Answer 32

GI effects Hepatotoxicity Pancreatitis

Question 33

A patient is prescribed phenytoin for epileptic seizures. Which of the following is a priority nursing action? A. Educate patient to decrease the dose if using alcohol. B. Tell the patient to take the medication with meals to prevent gastric upset. C. Inform the patient about prevention of gingival hyperplasia. D. Teach the patient to avoid abrupt cessation of treatment.

Answer 33

D