Unit 2: Neurological system part 1 Flashcards by Hailie Grieco

What is Myasthenia gravis?

An autoimmune disease that attacks acetylcholine

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What is the Pharmacologic Action of Benzodiazepines?

They are a CNS depressant. They enhance the effect of GABA.

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What is the prototype for Benzodiazepines?

Temazepam (Restoril)

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What are Benzodiazepines prescribed for?

Sleep, Anxiety, seizures/muscle spasms, alcohol withdrawal, and induction and maintenance of anesthesia

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What are the side/Adverse effects of Benzodiazepines?

Drowsiness, dizziness, confusion, anxiety, amnesia, respiratory depression, and tolerance.

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What is the antidote for Benzodiazepines?

Flumazenil

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Are Benzodiazepines highly addictive?

YES!
- They are commonly abused and long-term scheduling is not advised.

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How can you easily identify a Benzodiazepine drug?

-pam or -lam endings

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Withdrawal from Benzodiazepines can cause what?

Paranoia, panic attacks, muscle twitching, and hallucinations.

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If a patient needs to go off Benzodiazepines what should you do?

Taper them off slowly to help reduce withdrawal symptoms!

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What patient education should the nurse teach about Benzodiazepines?

Take before bedtime (30 minutes before) to ensure 8 hours of sleep
Do not use any other CNS depressants OR drink alcohol while on these medications
These are pregnancy and lactation category X drug
Smoking decreases the effects of benzodiazepines
Alcohol, opioids, and other benzodiazepines increase the risk of severe sedation and respiratory depression.

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What is the prototype for Non-benzodiazepines?

Zolpidem (Ambien)

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What are the contraindications for Non-Benzodiazepines?

Children younger than 18
Suicidal ideation
Smaller doses for patients with hepatic or renal disease

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What kinds of routes are there for Zolpidem?

oral or intranasal administration

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What are Non-Benzodiazepines used for?

Short-term treatment of insomnia.

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What is the number one thing the nurse should educate the patient on when taking Non-Benzodiazepines like Zolpidem?

DO NOT drive or operate heavy machinery!

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What are the two kinds of Muscle relaxants?

Centrally acting (brain) and Peripherally acting (skeletal muscles)

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What is the prototype for centrally acting muscle relaxants?

Baclofen (Lioresal)

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What is the therapeutic action for baclofen?

Spasticity related to spinal cord injuries, cerebral palsy, multiple sclerosis, and muscle injury.

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What do centrally acting muscle relaxants like baclofen do?

Enhance the effect of GABA in the CNS to reduce muscle spasticity.

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What are the side effects of baclofen?

Drowsiness, dizziness, nausea, and constipation

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What is some patient education for baclofen?

Increase fiber and fluid intake to counteract risk of constipation
Taper off to prevent withdrawal symptoms

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What is the prototype for peripherally acting muscle relaxants?

dantrolene (Dantrium)

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What do peripherally acting muscle relaxants like dantrolene do?

They act directly on skeletal muscle. They prevent calcium release which inhibits muscle contraction.

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What is the therapeutic action of dantrolene?

Spasticity related to spinal cord injuries, cerebral palsy, multiple sclerosis, and muscle injury PLUS treats malignant hyperthermia.

While taking dantrolene what should you monitor your patient for?

- Liver failure (yellow eyes and skin) - Muscle strength (falls) - Prolonged diarrhea - Drug interactions - Malignant hyperthermia family history

What are the four types of anti-epileptic drugs (AEDs)?

1. hydantoins 2. Iminostilbenes 3. Valproic acid 4. Other new drugs

What is the prototype for Hydantoins?

phenytoin (Dilantin)

What do hydantoins like phenytoin do?

Prevent tonic-clonic and partial seizures

What are the side effects of phenytoin?

Gingival hyperplasia, diplopia, nystagmus, Rash (Stevens-Johnson), hypotension, and decreases the effectiveness of oral contraceptives.

What is the therapeutic range of phenytoin?

10-20 micrograms/milliliter (narrow range!)

What is the prototype for Iminostilbenes?

carbamazepine (Tegretol)

What are Iminostilbenes like carbamazepine used for?

Partial seizures, tonic-clonic seizures, and bipolar disorder

What are the adverse effects of carbamazepine?

Visual disturbances, fluid retention, rash, daytime effects, and bone marrow suppression (easy bruising, fever, sore throat)

What education should the nurse teach the patient about carbamazepine?

Avoid grapefruit juice and note the many drug interactions

What is the prototype for valproic acid?

valproic acid (Depakote, Depakene)

What is valproic acid used for?

All types of seizures, mania associated with bipolar disorder, and migraine headache prevention.

What is patient education the nurse should do for valproic acid?

Ensure patients take the lowest effective dose

What is the prototype for the "new drugs" category of AEDs?

gabapentin (Neurontin)

What does gabapentin do?

Treats nerve pain and migraines

What is the prototype for local anesthesia?

Lidocaine

What is the mode of action for lidocaine?

blocks conduction of pain impulses in a circumscribed area

What are the side effects of lidocaine?

Hypotension, bradycardia, prolonged labor, spinal headache, and allergic reaction.

What is the prototype for general anesthesia barbiturates?

thiopental (Pentothal)

What is the mode of action for thiopental?

Significantly decreases CNS; enhances GABA

What are the adverse effects of thiopental?

Decrease HR, BP, and respiratory rate

What are important things to note about thiopental?

- Monitor respirations and VS -Inject only into a vein because it can damage tissue - Be careful using other CNS depressants with it INCLUDING herbals

What is the prototype for General Anesthesia Opioids?

fentanyl (Sublimaze)

What is the mode of action for fentanyl?

Narcotic agonists, analgesia, and sedation

What are the adverse or side effects of fentanyl?

Cardiac or respiratory depression and nausea

What should you ensure to do/ have when a patient is under the effects of fentanyl?

Naloxone (antidote) is readily available, monitor vital signs closely, have resuscitation equipment nearby, and be prepared with an antiemetic

What is a safety alert for fentanyl?

MAOI antidepressants taken within 2 weeks of fentanyl make the patient subject to hypertensive crisis!

What is the prototype for Neuromuscular Blocking Agents?

succinylcholine (Anectine)

What is succinylcholine used for?

It is used adjunct to anesthesia during surgery or intubation procedures.

What is the mode of action of succinylcholine?

Blocks acetylcholine at the neuro-muscular junction, causing skeletal muscle paralysis.

What are the adverse effects of succinylcholine?

Respiratory arrest, apnea, muscle pain after surgery

What emergent situation can succinylcholine cause?

Malignant hyperthermia

What is the treatment for malignant hyperthermia?

100% oxygen, cooling measures, muscle relaxants such as dantrolene

What are the s/s of malignant hyperthermia?

muscle rigidity and HIGH fever

What are the two types of drugs that treat ADHD and narcolepsy?

Amphetamines and Methylphenidate

What is the prototype for Amphetamines?

Adderall

What is the prototype for Methylphenidates?

Ritalin

What do Amphetamines and Methylphenidates do?

Improve alertness, energy, and mood

What are some important side effects to monitor while on Amphetamines and Methylphenidates?

- Decreased appetite - Weight loss - Insomnia - Dysrhythmias; hypertension - Tolerance and dependence

When should you administer Amphetamines and Methylphenidates?

I the morning after/right before meals

What are the 2 types of drugs to manage Parkinson's disease?

Dopamine-replacement drugs and Indirect-acting dopamine receptor agonists/MAO inhibitors

What is the prototype for Dopamine-replacement drugs to manage Parkinson's disease?

levodopa/carbidopa

What symptoms do levodopa/carbidopa help manage?

Decrease tremors and muscle rigidity

What are the side effects of levodopa/carbidopa?

n/v, drowsiness, dyskinesia, tics, orthostatic hypotension, dark urine and seat, psychosis

What kinds of foods should patients avoid when taking levodopa/carbidopa?

high-protein meals (they decrease effectiveness)

What is the prototype for Indirect-acting dopamine receptor agonists/MAO inhibitors?

selegiline (Eldepryl, Zelapar)

What is selegiline used for?

Major depression and adjunct to levodopa and carbidopa

What are anticholinergic effects?

Dry mouth, dry eyes, blurry vision, urinary retention, constipation (can't see, can't pee, can't spit, can't sh*t)

What drugs are given as treatment for Alzheimer's disease?

Cholinesterase inhibitors

What is the prototype for cholinesterase inhibitors?

donepezil (Aricept)

What are the side effects of donepezil?

N/V and GI symptoms, CNS effects like insomnia, dizziness, and headache, bradycardia, and syncope.

What medications are used as daily meds for the prevention of migraine headaches?

Beta-blockers, tricyclic antidepressants, antiepileptics, and estrogens

What is the prototype for migraine headaches?

sumatriptan (Imitrex)

What is a key side effect of sumatriptan?

Heavy chest pressure (NOT pain)

What are some interactions of sumatriptan?

MAOI's, St. John's wort, and serotonin

What are some s/s of Ethanol Withdrawal?

- Increase BP, pulse, respirations, and temperature - N/V - Insomnia and restlessness - Tremors - Agitation, irritability, depression - Alcohol withdrawal delirium (medical emergency)