Nursing Pharmacology CNS/CVS Flashcards

Terms Definitions
GABA
Neurotransmitter

Effect : Most common inhibitory neurotransmitter

Clinical use : Seizure and anxiety
Serotonin
Neurotransmitter

Effect : inhibitory

Clinical use : Anxiety, bipolarism, depression
Norepinephrine
CNS Inhibitory/excitatory
Neurotransmitter

ANS excitatory

Clincal use: Depression, memory, panic attacks
Dopamine
Neurotransmitter

Involved in locomotion, attention, learning

Clinical use : Parkinson's and psychoses
GAD
Generalized anxiety disorder

Anxiety pesists for 6 months +

Excessive worry
Panic disorder
Anxiety by intense feelings of apprehension, terror, fear.
Social anxiety
Unreasonable and persist fear of crowds
PTDS
Post traumatic stress disorder

Situational anxiety develpod in response to a stress situation

Nightmares, hallucinationsm tachycardia
Narcolepsy
Sevvere daytime sleepiness, pt is unable to stay awake
Valerian and Kava
Herbal products that produce relaxation. Interacts with many hynotic drugs.
Benzodiazepines
NonBenzodiazepines
Antidepressants
Barbiturates
Major classification of drugs for sleep or anxiety disorders
Category of drug of choice to treat GAD and short term insomnia
Benzodiazepines
Describe Benzodiazepines mechanism of action and primary clincal use
MOA: Bind to GABA receptor and intensify its effect

Insomnia and Anxiety
Bezodiazepines most common side effects and contraindications
dizziness, ataxia, drowsiness, blurred vision, vertigo, sedation.

Category D pregnancy - Fetus malformation

C/I narrow angle glaucoma, chronic obstructive pulminary disease (COPD) or psychosis
Define Nonbenzodiazepine MAO, S/E and C/I
MAO:enhance GABA,however only binds to a specificGABA receptor

S/E: Nausea, dizziness, diarreah, depression, sleepwalking, amnesia.

C/I:Use w/ cation with patients wi repiratory impairment.

Should not be taken with food. Interactis with other CNS depressants (kava, valerian, melatonin)
Barbiturates mechanism of actions and purpuse for its use in low, medium and high dosages.
Binds to GABA receptorm enhancing HABA activity

Low dosage- anxiety
mediun - seizure/hypnotic
high - anesthesia
Barbiturates S/E and C/I
S/E hang over effect, lethargy, hallucinations, hepatic diseas, hypocalcemia, even coma and angioedema

C/I pts with renal, hepatic or cardiac impairment.CODP, hyperthyroidsm

D/I other cns depressants
Dysthymic disorder
Mild chronic depression lasting 2 years
Cyclothymic disorder
A typo of bipolar that alternates between depression and mania
Depression symptoms

Whats Major depressive disorder
Lack of energy, sleep disturbances, abnormal eating patterns, hopelessness

MJD : depression lasting for at least 2 weeks. Associated with low levels of nor-epinephrine, serotonin, and dopamine.
Seasonal affective disorder
Depression associated with the lack of exposure to sun light.
Hypothyroidism
Strongly associated to depression
Alternative treatments for depression
ECT electroconvulsive therapy
rTMS repetitive transcranial stimulation
VNS vagus nerve stimulation
Primary classes of antidepressants
Tricuclic antidepressants (TCA)

Selective Serotonin Reuptake inhibitor

Atypical antidepressants
(NSRI,...)

Monoamine Oxidase Inhibitor (MOAIs)
Whats the use of drugs of TCA category, S/E, D/I and MAO.
Tricyclic antidepressants are used to treat depression.

MOA: blocks the reuptake of nor-epinephrine inhibitor

S/E: anticholinergic effects, orthostatic hypotension, acumulation in myocardium, dysrrhythmias.

Category D for pregnancy

D/I : Other CNS depressants, oral contraceptives decrease effects, avoid MAOI's
Whats the use of drugs of SSRI category, S/E, D/I and MAO.
Selective Serotonin Reuptake inhibitor, drug of choice to managa depression

MAO: blocks the uptake of serotonin, increasing amount of neurotransmitter available.

S/E Nausea, vomiting, insomnia, sexual dysfunction, hyperkinisia in kids. Cannot be stopped abruptly

D/I : Cardiac impaired pts, diabetics, or seizure disorder. Taking with MAOIs can result in serotonin syndrome
Serotonin syndrome
Reuptake of serotonin disease , causing mental status change, HTN, tremors, sweating, hyperpyrexia, ataxia. Resolves in 24 hours
Whats the use of drugs of SNRI category, S/E, D/I and MAO.
Selective nor-epinephrine re uptake inhibitors, atypical antidepressant.

MAO : Inhibits NE and serotonin in the CNS

S/E: Nausea, weight loss, CNS stimulation (like amphetamines), insomnia, sexual dysfunction

D/I: Serotonin syndrome is possible, MAOI's

Category C pregnancy
Whats the use of drugs of MAOI's category, S/E, D/I and MAO.
Monoamine oxidase inhibitors treats depression, but causes potentially serious adverse effects

Blocks the action of monoamine oxidase (neurotrans that destroys NE, dopamine and serotonin), enhancing their effects

Lowest safety margin out of the antidepressants..

S/E: Tachycardia, hypertensive crisis, blocks breakdown of dietary tyramine (found in beer, chocolate ..)

D/I Increase effects of diabetic, htn and cardiac drugs. Interacts with foods rich in tyramine.
Lithium - Alkali metal ion salt
Mood stabilizer used for bipolar disorder

Require Serum checkups

MOA : Acts by increasing the synthesis of serotonin.
C/I: cardiovascular/renal impairment, thyroid disease, diabetic patients

S/E : Initial : lethargy, nausea, polyuria, nocturia, tremors, confusion

Long term: kidney impairment, dysrhythmias, blood dyscresias.

D/I: Diuretics, salt depletion, NSAIDs increase lithium levels.

Should not be taken with caffeine beverages
Psychosis
Loss of contact with reality
Delusions
Firm ideas that are false and not found in reality. (believing to be Jesus)
Hallucinations
Seeing, hearing, feeling something not really there
Schizophrenia
Abnormal thoughts or thought process, disordered communication, occurs between 15 and 35 years old.

Symptoms associate with D2 receptors (dopamine)
Presents positive or negative symptons
Describe the positive and negative symptoms of schizophrenia
Positive : treatable with meds, hallucinations, paranoia, delusions, agitations, anxiety, Illusions.

Negative : Apathy, withdrawal, poor judgment, no functional speech.
Anti-psychotic classes
Phenothiazines and Nonphenothiazines
Extrapyramidal symptoms EPS
Adverse effects related to psychotic drugs

Acute dystonia, akathisia, parkinsonism, tardive dyskinesia.
Whats the use of drugs of Phenothiazine category, S/E, D/I and MAO.
Antipsychotic drugs used in the treatment of schizophrenia

Also used in treating: Nausea and vomiting, tourettes syndrome, organic brain syndrome.

MOA : blocks post-synaptic dopamine receptors.

S/E : Extrapyramidal syndrome, anticholinergic effects, blurred vision, dry ass, glaucoma. Tachycardia, laryngospasms, respiratory depression, seizures.
Whats the use of drugs of Nonphenothiazine 2nd generation category, S/E, D/I and MAO.
Drug of choice in the treatment of schizophrenia

Lower incidence of EPS

MO: dopamine antagonist

A/E : Increased salivation, constipation, impotence, hyperglacemia, glactorrhea,

D/I SSRIs and other CNS depressants
Whats the use of drugs of DSS category, S/E, D/I and MAO.
Antipsychotic. Dopamine System Stablizers work on both agonist and partial antagonist dopamine receptor

Lower incidence of S/E than phenothiazines and nonphenothiazines

Interacts with grapefruit juice
Degenerative diseases of CNS
Alzheimer's, Huntington's, Parkinson's, MG, Multiple Sclerosis
Medications can cause Parkinson's like symptoms called
Secondary PD symptoms
Parkinson's symptoms
Tremors, muscle rigidity, bradykinesia, postural instability.

Caused by an insufficient amount of dopamine produced by substantia nigra
Drugs used in the treatment of PD
Dopamine Replacement Agents, Dopamine Agonists, COMT inhibitors, others
Idiopathic pain
non-specific pain of unknown origin
Drugs used in conjunction with altered patterns of sleep
sedative-hypnotic
Azaspirones
• Chemically related to barbituates, benzodiazepines or other anxiolytic agents
How long (average) antidepressants take to start working ?
• All must be taken for 2 to 4 weeks before depressive symptoms improve
This class of antidepressants can be taken with food and may cause weight gain
SSRI's
Valproic acid
• Rapidly distributed with 90+% protein bound
• Treats acute manic symptoms
Main antipsychotic adverse effects
• Extrapyramidal reactions ( p. 331)
• Antimuscarinic or anticholinergic side effects
• Dermatologic
• Endocrine
• Non-reversible bone marrow depression
• Neuroleptic malignant syndrome
PD facts
• Parkinson’s disease: a chronic disorder of CNS; muscle tremors, bradykinesia, muscle weakness with rigidity, alteration in posture & equilibrium
• Symptoms caused by a dopamine deficiency in extrapyramidal system within basal ganglia.
• Drugs used to increase levels of dopamine (dopaminergic) or inhibit acetylcholine (anticholinergic )
Levodopa
Most known efficient drugs in the treatment of Parkinson's
 Epilepsy
a group of neurological disorders characterized by recurrent episodes of convulsive seizures, sensory disturbances, abnormal behavior, loss of consciousness, or any combination of these.
 Seizure
the excessive stimulation of neurons in the brain leading to a sudden burst of abnormal neurons activity results in temporary changes in brain function.
 Convulsion
characterized by spasmodic contractions of voluntary muscles.
 Secondary epilepsy:
usually in infants and children and are developmental defects, metabolic disease, or injury at birth. Some can be acquired such as head injury, infection or disease (stroke).
Major classes of antiepiletic drugs
 Barbiturates:
 Benzodiazepines:
 Hydantoins: (Depakene)
 Iminostilbenes:
 Succinimides:
 Miscellaneous
 Barbiturates
 Used for controlling tonic-clonic and partial seizures.
 Used in STATUS EPILEPTICUS and used for controlling febrile seizures.
 Side effects are sedation, and tolerance,in pediatrics the most common adverse effects are irritability, hyperactivity, depression, sleep disorders, and cognitive abnormalities.
 Therapeutic effects are seen at serum drug levels of 15 to 40 micrograms/ml. It has a long half life and therefore only dosed q 24 hours.
 Benzodiazepines
: Used as first-line agents in the treatment of status epilepticus and as second-line agents
Hydatoin
Phenytoin: Is used as of tonic-clonic and partial seizures.
 Common side effects: lethargy, abnormal movements, mental confusion, and cognitive changes
 Therapeutic drug levels are 10 to 20 micrograms/ml.
 Toxic levels can cause nystagmus, ataxia, dysarthria, and encephalopathy.
 Long term use: gingival hypertrophy, acne, hirsutism, and hypertrophy of subcutaneous facial tissue (Dilantin facies”) and osteoporosis (Vit D supplement) Vitamin K and folic acid.
 Pain Physiology has four phases
 Transduction
 Transmission
 Perception
 Modulation
Muscle spasms
Treated with muscle relaxants that work in the brain

Central acting or direct acting

Examples of Central acting


 Baclofen (lioresal)
 Cyclobenzaprine (Flexeril)
 Metaxalone (Skelaxin)
 Tizanidine (Zanaflex)
Muscle relaxants
Similar to TCA's

S/E include muscle weakness
ADHD
presents in children and may extend into adulthood

For diagnoses purpose, pt must have 6 of the common symptoms
Drugs used in the treatment of ADHD
Amphetamines (adderall)

CNS stimulant, sympathomimetic, increase attention and alertness, also used for narcolepsy. Stimulates the release of epinephrine and dopamine.

S/E loss of appetite
A/E: irritability,insomnia, palpitations
ADHD non stimulants
SNRI

frontal lobe concentration stimulation

OD causes sympathetic stimulation
Narcolepsy
Day dreaming, drowsiness.

CNS stimulants are prescribed for treatment. Contraindications include caffeine

S/E Euphoria, dry mouth, nausea, insomnia
Methylxanthines
Used in the treatment od COPD

Ability to relax bronchial smooth muscle

Caffeine is a type of Methylxanthine
Nociceptors
Pain receptors located throughout the body, initiate pain transmission. Analgesic worn on these receptors to relief pain.
Opiods and non opiods
are drugs that relief pain by interacting with mu, kappa and delta receptors in the CNS
Opiods
Relief moderated-high pain levels.

Cause analgesia, decreased GI motility, euphoria, miosis, dependence, resp. depression, sedation

May cause severe ICP and nausea/vomit

Prototype:Morphine
NSAID's
Nonsteroidal anti-inflammatory drugs

used in the treatment of mild-moderate pain

Works by unhibiting pain mediator in the peripheral site (cycloxygenase)

S/E ulcerations, dyspepsia, anorexia, vomiting
Tramadol
Analgesic drugs that produce CNS depression without respirator issues
Palliative care
used for cancer patient to help the management of extreme pain
Opiods antagonists
used in OD cases, reverse respiratory depression, compete with mu and kappa receptors
Mu and kappa receptors
Pain receptors, NSAIDs, tramadol, work on these receptors to produce analgesic
Mild Migraines treatment
Usually treated with NSAIDs and caffeine
Treatment for Moderate-severe migraines
Serotonin receptor agonists (5HT1) causing vasodialation of cranial vessels
General anesthesia
Causes loss of consciousness to entire body, loss of sensation

Analgesia, relaxation, hypnosis, amnesia, loss of reflexes
Regional anesthesia
Loss of sensation w/o LOC(loss of consciousness) - works in an entire limb.
MAC - Monitored anesthesia care
used in diagnostic procedures and minor surgeries
Stage III
Stage III - surgical anesthesia required for most procedures
Drugs used in anesthesia
Barbiturates (rapid anesthesia, short duration)
Opioids (pain relief)
Benzodiazepines (Relaxation)
Ketamine/Propolol (maintain anesthesia), depress limbic system
Inhalation anesthesia
Nitrous oxide, GABA receptors agonist, opioid agonist
Local anesthetics
surface anesthesia - sprayed on
infiltration anesthesia - injected in deeper skin layers
nerve block - surrounding a peripheral nerve, causes regional anesthesia
epideral anesthesia - obstratic
spnial anesthesia - injected in spinal cord, abdomnal anesthesia
Give examples of local anesthetics
Ester(Novacaine) and Amide (Lidocaine)

Decrease amount of sodium entering neuron, depressing depolarization, preventing conduction

epinephrine is added many times to limit blood loss and decrease anesthesia systemic absorption

C/I Cardiac impairment
Preoperative drugs
anticholinergic are given to decrease salication and glands excretion
Post operative drugs
Opiods and antiemedics
Main lipoproteins
VLDL primary carrier of triglycerides, transporting it for storage
LDL reduced sized of VLDL
HDL transports excess cholesterol back to liver (reverse cholesterol transport) for excretion via bile
HDL
Good cholesterol, assis in reverse cholesterol transport, lowering VDLD thus lowering LDL
HTN drugs - main categories
Diuretics
Adrenergic drugs (CNS and peripheral)
ACE inhibitors
Vasodialators
CCB (Calcium channel blockers)
Angiotensin II receptor blocker
Diuretics
Inhibit Na reabsorption and K+and Na reabsorption
CNS acting antihypertensive drugs
Central stimulations - stimulates alpha 2, decreasing cardiac output and dilating vessels

Peripheral - block beta 1 receptors and reduce renin
ACE drugs
Treatment of hypertension, drug of choice for heart failure patients.

S/E dizziness, orthostatic hypotension, dry non productive cough, metallic taste, andgioedema

Pregnancy contraindicated

All the "prils" like Lisinopril, Captopril
Angiotensin receptor blocker (ARB)
bind to angiotensin at the receptor, advantages over ACE by not causing cough, push fluid and water to maintain blood volume
Calcium channel blocker (CCB)
Inhibit movement of calcium ions across cell membrane

most affective in african-americans and elderly

Serum digoxin may increase while on this med
Direct Vasodialators
Causes direct visodialation, used in hypertensive emergencies.

Hyperstat

Bio-product maybe toxic to the body, dangerous on hypoglacemic pts
Nursing implications for patients taking HTN drugs
Monitor BP/HR
Weight patient daily -
Change positions slowly (due to orthostatic hypotention)
Coagulation drugs
block formation of thrombus, embolus and fibrin.

may cause excessive bleeding

Common med : Heparin
Anticoagulation drug
Warfarin

Inhibit vitamin K clotting factors that are produced in the intestinal walls
Anti-platelet
Affects the cyclooxygenase pathway, making the platelets "slippery", preventing coagulation

Example Aspirin
Thrombolytics
Convert plasminogen to plasmin, breaking down clots

According to the professor "the good stuff"

Generally administered in the ER, given within 4 hours of stroke, may prevent arterial blockage from happening
Nursing considerations when patients are taking anticoagulant drugs
Monitor lab tests Hgb, HCT, PT, aPIT, INR
Careful with Vitamin K due to its influence in clotting formation
Hematopoetic drugs
Used in the treatment of Anemia
Reasons for anemia
Iron deficientcy, bone marrow depression, folic-acid
Iron pharmacology
Iron is important in the formation of RBC's
do not take with milk, take with orang juice
Cyanocobalamin
Vitamin B12, important in there treatment of pernicious anemia and megaloblastic anemia
Erythropoietic drugs
Stimulates production of blood cell on bone marrow

(erythropoetin is naturally produced in the kidneys, stimulating RBCs productions. Patients w renal failure take this meds to maintain optimal RBC count)
Colony stimulating factors
stimulates blood cell production by bone marrow following bone marrow transplant or chemotherapy

Filgrastin (Neupogen)
Crystalloid
clear fluids given in IV
Types of crystalloids
NS - Normal Saline o.9 % Na
Lactated ringers - lactate is converted by the liver to bicarbonate, to reduce acidic level after surgery (electrolyte replenisher )
D5W - 5 % dextrose
Plasma-lyte (electrolyte replenisher )
Concentration of crystalloids
Isotonic 0.9 %
Hypotonic 0.45%
Hypertonic 10 % dextrose
Colloids
Drugs that pull fluid from edema to vascular bed
Blood products administration
must be administered by 2 accredited professionals (2 RNs)

May be only given with NS

If A/E occur, stop infusion
O- blood type maybe given to anyone
Potassium adm for electrolyte imbalanced
Potassium (k+) 3.5 to 5.0 mEql/L must be diluted, otherwise it can stop the heart
Renal system responsibilities
Formation of urine, electrolyte balance, erythropoetin, excretion of products
Beta-Blockers produce a significant decrease in blood pressure by decrease cardiac out put
True or False
False, it decreases de effect of endogenous substances
Vitamin K is antidote for __________
Warfarin
Vitamin K will affect action of digoxin & lasix
False
Aldactone/ is an example of______
Potassium Sparing
Vasodilation and faster heart rate
True or False
False
carbamazepine
treatment of seizures and maniac episodes

GABA enhancers and sodium channel stabilizers
Phentolamine
used in hypertensive crisis
The pain gate control theory proposes
There is a mechanism of transmission of pain in the spinal cord
The nocirepectors are located in which receptors
Sensory receptors and relate to pain
Anesthetic agents
Barbiturates
Benzodiazepines
Opioids
Miscellaneous agents
Ketamine and propolol
Intravenous general anesthesia

Ketamine S/E HTN, and tachycardia.Respiratory depression

Dellirium, hallucinations (Emergence phenomina)
Administer drug slowly
Nitrous oxide
Inhaled anesthesia

Stage II anesthesia, anxiety, excitement
nausea, vomiting, lethargy.

Caffeine or adrenergic agents may exacerbate dysrhythmia

Must monitor patients pulmonary function
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