WEEK 1 - CNS DRUGS Flashcards
(152 cards)
1
Q
A complex network collection of nerves and specialized cells known as neurons that transmit signals between different parts of the body.
A
Nervous system
2
Q
Neurons communicate with their target tissues at synapses into which they release chemical substances called
A
neurotransmitters (ligands)
3
Q
- Gamma- aminobutyric acid (GABA)
- Serotonin
- Dopamine
- Norepinephrine
- Acetylcholine
A
Major Neurotransmitters
4
Q
- Excitatory neurotransmitters
- Inhibitory neurotransmitters
A
Classification of neurotransmitters
5
Q
functions to prevent an action potential
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Inhibitory neurotransmitters
6
Q
Function to activate receptors on the postsynaptic membrane and enhance the effects of the action potential
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Excitatory neurotransmitters
7
Q
The most powerful inhibitory neurotransmitter produced by the neurons of the spinal chord, cerebellum, basal ganglia and many areas of the cerebral cortex
A
GAMMA-AMINOBUTYRIC ACID (GABA)
8
Q
Functions is closely related to mood and emotions.
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GAMMA-AMINOBUTYRIC ACID (GABA)
9
Q
function is to reduce neuronal excitability throughout the nervous system
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GAMMA-AMINOBUTYRIC ACID (GABA)
10
Q
When GABA is abnormally low this can lead to
A
ANXIETY
11
Q
an inhibitory neurotransmitter that has been found to be intimately involved in emotion and mood.
A
SEROTONIN (5-hydroxytryptamine, 5-HT)
12
Q
Released from the neurons of the brainstem, and by neurons that innervate the gastrointestinal tract (enteric nervous system), and found in platelets(thrombocytes) which release it during coagulation(hemostasis)
A
SEROTONIN (5-hydroxytryptamine, 5-HT)
13
Q
Functions is to regulates body temperature, perception of pain, emotion, and sleep cycle (search for stages)
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SEROTONIN (5-hydroxytryptamine, 5-HT)
14
Q
An insufficient secretion of serotonin may result in
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- decrease immune system function
- emotional disorders (depression, anger control probs, OCD, even suicidal tendencies)
15
Q
Regulates sleep, wakefulness and mood as well as the delusions, hallucinations and withdrawal of schizophrenia
A
SEROTONIN (5-hydroxytryptamine, 5-HT)
16
Q
neurotransmitter secreted by the neurons of the substantia nigra.
A
DOPAMINE (DA)
17
Q
considered a special type of neurotransmitter because its effects are both excitatory and inhibitory
A
DOPAMINE (DA)
18
Q
- inhibits unnecessary movements
- inhibits the release of prolactin
- stimulates the secretion of growth hormone
A
DOPAMINE (DA)
19
Q
Drugs and alcohol abuse can temporarily increase dopamine level in the blood leading to
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confusion and inability to focus
20
Q
can temporarily increase dopamine level in the blood leading to confusion and inability to focus
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Drugs and alcohol abuse
21
Q
Results from dopamine deficiency related to the destruction of the substantia nigra
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Parkinson’s disease
22
Q
Involved in regulation of and cognition, emotional responses and motivation
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Dopamine containing neurons
23
Q
Also known as noradrenaline (Nad)
A
NOREPINEPHRINE(NE)
24
Q
excitatory neurotransmitter produced by the brainstem, hypothalamus, and adrenal glands and released into the bloodstream
A
NOREPINEPHRINE(NE)
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function is to increase the level of alertness and wakefulness, stimulates various processes of the body
NOREPINEPHRINE(NE)
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implicated in mood disorders such as depression and anxiety, in which case its concentration in the body is very low
NOREPINEPHRINE(NE)
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also associated with control of arousal, attention, vigilance, mood, affect and anxiety
NOREPINEPHRINE(NE)
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Involved with thinking, planning, and interpreting
NOREPINEPHRINE(NE)
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abnormally high concentration of NOREPINEPHRINE(NE) may lead to
impaired sleep cycle
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excitatory neurotransmitter secreted by neurons that innervate muscle cells, basal ganglia, preganglionic neurons of the autonomic nervous system and post ganglionic neurons of the parasympathetic and sympathetic nervous system
ACETYLCHOLINE (Ach)
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function is to regulates the sleep cycle, essential for muscle functioning
ACETYLCHOLINE (Ach)
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main function is to stimulates muscle contraction
ACETYLCHOLINE (Ach)
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Plays a role in sleep and wakefulness
ACETYLCHOLINE (Ach)
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used to treat anxiety
ANXIOLYTIC AGENTS
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State of apprehension, tension or uneasiness that stems from anticipation of danger, the source of which is largely unknown or unrecognized
ANXIETY
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A normal emotion. Its your brains way of reacting to stress and alerting your potential danger ahead
ANXIETY
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Are group of mental illnesses that cause constant and overwhelming anxiety and fear
ANXIETY DISORDERS
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1. Primary anxiety
2. Secondary anxiety
2 CLASSIFICATION of ANXIETY
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cause is related to selected drugs, medical or psychiatric disorders
Secondary anxiety
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cause is not by medical condition or drugs
Primary anxiety
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1. Situational anxiety
2. Generalized anxiety disorder (GAD)
3. Panic Disorder
4. Phobias
5. Obsessive-compulsive disorder (OCD)
6. Post traumatic stress disorder (PTSD)
TYPES of ANXIETY DISORDERS
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Anxiety experienced by people faced with a stressful environment
Situational anxiety
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beneficial because it motivates people to accomplish tasks in a prompt manner
Situational anxiety
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A type of situational anxiety that develops in response to reexperiencing a previous life event
Post traumatic stress disorder (PTSD)
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Difficult to control, your excessive anxiety, unrealistic worry and tension with little or no reason that lasts 6 months or more
Generalized anxiety disorder (GAD)
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1. Restlessness
2. Fatigue
3. Muscle tension
4. Nervousness
5. Inability to focus or concentrate
6. Sleep disturbance
Sx of Generalized anxiety disorder (GAD)
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Most common type of stress disorder
Generalized anxiety disorder (GAD)
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Characterized by intense feelings of immediate apprehension, fearfulness, terror or impending doom accompanied by increased autonomic nervous system activities that brings panic attack
Panic disorder
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1. Break out in a sweat
2. Have chest pain
3. Have a palpitations that will last less than 10 minutes
These are experienced during panic attack
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Fearful feelings attached to situations or objects
Phobias
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Common phobias includes fear of snakes, spiders, crowds or height
Phobias
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fear of crowds
Social anxiety
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Involves recurrent, intrusive thoughts or repetitive behaviors that interfere with normal activities or relationships
Obsessive-compulsive disorder (OCD)
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1. Cognitive behavioral therapy
2. Counseling
3. Biofeedback techniques
4. Meditation and other complimentary therapies
5. Relaxation technique
6. Psychotherapy
7. Support group
NON-PHARMACOLOGICAL STRATEGIES for ANXIETY
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BENZODIAZEPINES
PHARMACOLOGICAL STRATEGIES for ANXIETY
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From root word benzo refers to an aromatic compound, one having a carbon ring structure attached to different atoms or to another carbon ring
BENZODIAZEPINES
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Drugs of choice for various anxiety disorders and short term insomnia
BENZODIAZEPINES
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Also used as anticonvulsants, sedative-hypnotics, pre operative drugs and anxiolytics
BENZODIAZEPINES
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Enhance the action of gamma aminobutyric acid (GABA)
BENZODIAZEPINES
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categorized as schedule IV drugs
BENZODIAZEPINES
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1. Chlordiazepoxide (Librium)
2. Diazepam (Valium)
3. Lorazepam (Ativan)
4. Midazolam (Versed)
5. Halazepam (Paxipam)
Benzodiazepines DRUGS
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rapid onset time to 15-30 minutes to reach peak serum levels
Midazolam (Versed)
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take 1 to 3 hours preach peak serum levels
Halazepam (Paxipam)
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First and most widely used benzodiazepines
Chlordiazepoxide (Librium) and Diazepam (Valium)
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- Used also for its sedative effect
- Given PO, IV, IM
Chlordiazepoxide (Librium)
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Drug of choice for mild to moderate anxiety
Lorazepam (Ativan)
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Control alcohol withdrawal syndrome
Lorazepam (Ativan)
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- If given IV it should monitored carefully owing a rapid onset of CNS and possible respiratory depression
- PO, IV, IM
Lorazepam (Ativan)
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for anxiety, muscle spasm, seizure disorders
Diazepam (valium)
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For pre operative sedation/ use as induction agents for general anesthesia
Diazepam (valium)
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Diazepam (valium)
For pre operative sedation/ use as induction agents for general anesthesia
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Treatment for alcohol withdrawal symptoms
Diazepam (valium)
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- If given IV it should monitored carefully owing a rapid onset of CNS and possible respiratory depression
- Promote central muscle relaxation
- PO, IV, IM
Diazepam (valium)
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1. Lipid soluble
2. Absorbed readily in the Gl tract
3. Highly protein bound
4. Excreted in the urine
Pharmacokinetics of Benzodiazepines
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Must be prescribed no more than 3 to 4 weeks
Benzodiazepines
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1. Sedation, drowsiness, dizziness, confusion
2. Lethargy, ataxia, headache, dry mouth
3. Blurred vision, urinary incontinence
4. Memory problems, muscle weakness
Side effects of Benzodiazepines
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1. Acute hyperexcited states, hallucinations
2. Increased muscle spasticity, renal impairment, respiratory impairment due to hypersalivation
3. Congenital defects among women who are pregnant
Adverse reactions of Benzodiazepines
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Antidote for Benzodiazepines such as diazepam (valium), lorazepam (Ativan), and midazolam (versed)
FLUMAZENIL (Romazicon)
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This antidote for benzodiazepines must be administered intravenously (IV)
FLUMAZENIL (Romazicon)
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When giving benzodiazepines, assess px for ________and intensity, duration & sx.
antianxiety drugs
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When giving benzodiazepines identify factors that
1. precipitate anxiety
2. insomnia
3. physical sx
4. excessive CNS stimulation
5. excessive day time sleep
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When giving benzodiazepines, Assess for the likelihood of
drug abuse and dependence
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benzodiazepines is used cautiously with px w/
1. suicidal potential
2. impaired renal or liver function
3. elderly clients
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benzodiazepines is contraindicated to px w/
narrow angle glaucoma
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are used illegally for recreation, most often by adolescents, young adults,
and opioid or cocaine addicts
benzodiazepines
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cross the placenta and excreted in breast milk, they are not recommended in pregnant or nursing women
benzodiazepines
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When giving benzodiazepines, assess the elderly for
1. over sedation
2. confusion
3. dizziness
4. impaired mobility
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Used caution when driving or operating heavy machinery until the effect of the medication is known
benzodiazepines
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Take the medication as directed. Do not exceed the ordered dosage
benzodiazepines
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When giving benzodiazepines avoid_________ because they may cause increased drowsiness
alcohol and other CNS depressants
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Do not stop taking medications suddenly, because withdrawal symptoms may occur
benzodiazepines
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Inform that the effective response is 1 to 2 weeks
benzodiazepines client health teaching
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Disorder characterized by a sad or despondent mood
DEPRESSION
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A mood disorder that causes a persistent feeling of sadness and loss of interest
DEPRESSION
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Most common mental health disorder of elderly adults, encompassing a variety of physical, emotional, cognitive and social considerations
DEPRESSION
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1. Lack of energy, extremely tired
2. Abnormal eating patterns, feeling of despair
3. Guiltiness and hopelessness and misery
4. Sleep disturbance like difficulty sleeping or too much sleep
5. Vague physical symptoms (Gl pain, joint/muscles pains or headaches)
6. Obsessed with death (expressing a wish to die or to commit suicide)
7. Lack of interest in personal appearance or sex
8. Delusion or hallucinations
S/Sx ASSOCIATED w/ DEPRESSION:
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1. Reactive depression
2. Major depression
3. Bipolar disorder
TYPES OF DEPRESSION
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Sudden onset after the precipitating event
Reactive depression
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Loss of interest to work and even at home and inability to complete tasks
Major depression
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Difficult to study, sleep, eat and enjoy friends and activities
Major depression
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Bipolar disorder
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Sometimes called manic depression, has mood episodes that range from extreme of high energy with an "up" mood to low "depressive" periods
Bipolar disorder
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Swings between two moods - euphoric and dysphoric
Bipolar disorder
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1. Counseling therapies
2. Interpersonal therapies
3. Cognitive behavioral therapies
4. Psychodynamic therapies
NON-PHARMACOLOGICAL TREATMENT for DEPRESSION
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focus on resolving the clients internal conflicts
Psychodynamic therapies
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help the client change the negative styles of thought
and behavior that are often associated with their depression
Cognitive behavioral therapies
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focuses on the clients disturbed personal relationship that both
cause and exacerbate the depression
Interpersonal therapies
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help clients gain insight into and resolves their problems through
verbal "give - and - take" with the therapies
Counseling therapies
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A medical treatment for clients with serious and life threatening mood disorders that are unresponsive to pharmacotherapy
Electroconvulsive therapy (ECT)
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Often used treatment for depression that is hard to treat.
Electroconvulsive therapy (ECT)
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Effective somatic treatment for major depression
Repetitive Transcranial magnetic stimulation (rTMS)
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Treat major depression by enhancing mood.
ANTIDEPRESSANTS
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Often prescribe to phobia, OCD, panic and anxiety
ANTIDEPRESSANTS
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Beneficial in treating psychological and physical signs of pain, especially in clients without major depressive disorder
ANTIDEPRESSANTS
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the most important warning about antidepressant.
"black box warning"
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- should be included at the beginning of drug package inserts and drug information sheets.
- This applies to children who are at risk for suicidal ideation
"black box warning"
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1. Tricyclic antidepressants (TCAs)
2. Selective serotonin reuptake inhibitors (SSRIs)
3. Monoamine oxidase inhibitors (MAOIs)
4. Atypical antidepressants including the serotonin-norepinephrine reuptake inhibitors (SNRis) and other atypical antidepressants
4 PRIMARY CLASSES of ANTIDEPRESSANT DRUGS
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They are example of atypical antidepressants
Duloxetine (Cymbalta) and Venlafaxine (Effexor)
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They inhibit the reabsorption of serotonin and norepinephrine and elevate mood by increasing the level of serotonin, norepinephrine, and dopamine in the central nervous system
Duloxetine (Cymbalta) and Venlafaxine (Effexor)
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Inhibit the reuptake of both norepinephrine and serotonin into presynaptic nerve terminals
TRICYCLIC ANTIDEPRESSANS (TCAs)
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Used mainly for major depression and occasionally for milder situational depression
TRICYCLIC ANTIDEPRESSANS (TCAs)
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1. Approved treatment for OCD
2. Used fort treatment of childhood enuresis (bedwetting)
Clomipramine (Anafranil)
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1. Amitriptyline(Elavil)
2. Amoxapine (Asendin)
3. Imipramine (Tofranil)
TCAs DRUGS:
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1. Orthostatic hypotension - most common
2. Drowsiness
3. Sedation
4. Dizziness
5. Dry mouth
6. Constipation
7. Urine retention
8. Blurred vision
9. Mydriasis
SIDE EFFECTSS of TCAs
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1. Cardiac dysrhythmias- the most serious adverse effects
2. heart block, MI
3. Bone marrow depression, seizures,
4. Angioedema of the face, tongue or generalized
ADVERSE EFFECTS of TCAs
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Therapeutic effects of TCAs may take_____ to occur
2 to 4 weeks
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contraindicated in client in the acute recovery phase of an MI, with heart block or with history of dysrhythmias, because of their effects on cardiac tissue
TCAs
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when giving TCAs, carefully monitor px w/ as TCAs lower threshold
epilepsy
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px w/ these may not be good candidates for TCAs because of anticholinergic side effects
1. urinary retention
2. narrow angle glaucoma or prostatic hypertrophy
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must be given with extreme caution to clients with asthma, cardiovascular
disorders, gastrointestinal disorders, alcoholism and other psychiatric disorders including schizophrenia and bipolar disorder
Tricyclics
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used during pregnancy or lactation only when medically necessary
TCAs
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may decrease the efficacy of tricyclics
oral contraceptives
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interferes with their metabolism and excretion of TCAs
Cimetidine (Tagamet)
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TCAs affect the efficacy of
1. Clonidine(catapres)
2. Guanethidine (Ismelin).
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effects of these drugs that enhance the effects of TCAs
antidysrhythmics, anti histamine, antihypertensive and CNS depressants
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increase the rate of TCAs metabolism and excretion.
1. Carbamazepine (Tegretol)
2. Phenytoin (Dilantin)
3. Rifampin (Rifadin)
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diminishes the effects of TCAs
Cigarette Smoking
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Drugs that slow the reuptake of the serotonin into presynaptic nerve terminals
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
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They are the drug of choice in the treatment of depression because of their favorable side effect profile
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
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Its function is to increase level of serotonin in the synaptic gap induce complex
neurotransmitter changes in presynaptic and postsynaptic neurons in the brain.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
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Presynaptic receptors become less sensitive and postsynaptic receptor become more sensitive
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
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a natural neurotransmitter in the CNS, found in high concentrations in certain neurons in hypothalamus, limbic system, medulla and spinal cord.
Serotonin
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s important to several body activities, including the cycling between NREM and REM sleep, pain perception and emotional states
Serotonin
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Its chemical name is 5-hydroxytryptamine (5-HT)
Serotonin
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1. Major depression
2. Obsessive compulsive disorder
3. Panic, Phobias, PTSD
SSRIs treats the following:
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1. Citalopram (Celexa)
2. Escitalopram oxalate (Lexapro)
3. Fluoxetine (Prozac)
4. Fluvoxamine (Luvox)
5. Paroxetine (Paxil)
6. Sertraline (Zoloft)
Drugs example of SSRIs
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1. Nausea, headache, nervousness, anxiety
2. Insomnia, somnolence, dizziness, fatigue
3. Gl disturbances, anorexia
4. Increased heart rate and hypertension (sympathomimetic effects)
5. Dry mouth, blurred vision, urinary retention, and constipation (anticholinergic effects)
6. Sedation
7. Sexual dysfunction-most common side effects
8. Steven-Johnson syndrome - serious adverse effects
Side effects/adverse effects: SSRIs
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A rare but serious disorder that affects the skin, mucous membrane, genitals and eyes
Steven-Johnson syndrome
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Usually caused by an unpredictable adverse reaction to certain medications.
Steven-Johnson syndrome
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May occur when the client is taking in another medication that affects the metabolism, synthesis or reuptake of serotonin, causing serotonin to accumulate in the body.
Serotonin Syndrome (SES)
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Symptoms can begin as early as 2 hours after taking first dose or as late as several weeks after the initiating pharmacotherapy
Serotonin Syndrome (SES)
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1. Mental status changes (confusion, anxiety, restlessness
2. Hypertension, tremors
3. Sweating, hyperpyrexia or ataxia
Signs and Symptoms of SES
