Effect : Most common inhibitory neurotransmitter
Clinical use : Seizure and anxiety
Effect : inhibitory
Clinical use : Anxiety, bipolarism, depression
Clincal use: Depression, memory, panic attacks
Involved in locomotion, attention, learning
Clinical use : Parkinson's and psychoses
Generalized anxiety disorder
Anxiety pesists for 6 months +
Anxiety by intense feelings of apprehension, terror, fear.
Unreasonable and persist fear of crowds
Post traumatic stress disorder
Situational anxiety develpod in response to a stress situation
Nightmares, hallucinationsm tachycardia
Sevvere daytime sleepiness, pt is unable to stay awake
|Valerian and Kava||
Herbal products that produce relaxation. Interacts with many hynotic drugs.
Major classification of drugs for sleep or anxiety disorders
|Category of drug of choice to treat GAD and short term insomnia||
|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
Mild chronic depression lasting 2 years
A typo of bipolar that alternates between depression and mania
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.
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
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
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
Loss of contact with reality
Firm ideas that are false and not found in reality. (believing to be Jesus)
Seeing, hearing, feeling something not really there
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.
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
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
non-specific pain of unknown origin
|Drugs used in conjunction with altered patterns of sleep||
• 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||
• Rapidly distributed with 90+% protein bound
• Treats acute manic symptoms
|Main antipsychotic adverse effects||
• Extrapyramidal reactions ( p. 331)
• Antimuscarinic or anticholinergic side effects
• Non-reversible bone marrow depression
• Neuroleptic malignant syndrome
• 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 )
Most known efficient drugs in the treatment of Parkinson's
a group of neurological disorders characterized by recurrent episodes of convulsive seizures, sensory disturbances, abnormal behavior, loss of consciousness, or any combination of these.
the excessive stimulation of neurons in the brain leading to a sudden burst of abnormal neurons activity results in temporary changes in brain function.
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||
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.
: Used as first-line agents in the treatment of status epilepticus and as second-line agents
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||
Treated with muscle relaxants that work in the brain
Central acting or direct acting
Examples of Central acting
Similar to TCA's
S/E include muscle weakness
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||
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||
frontal lobe concentration stimulation
OD causes sympathetic stimulation
Day dreaming, drowsiness.
CNS stimulants are prescribed for treatment. Contraindications include caffeine
S/E Euphoria, dry mouth, nausea, insomnia
Used in the treatment od COPD
Ability to relax bronchial smooth muscle
Caffeine is a type of Methylxanthine
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
Relief moderated-high pain levels.
Cause analgesia, decreased GI motility, euphoria, miosis, dependence, resp. depression, sedation
May cause severe ICP and nausea/vomit
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
Analgesic drugs that produce CNS depression without respirator issues
used for cancer patient to help the management of extreme pain
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
Causes loss of consciousness to entire body, loss of sensation
Analgesia, relaxation, hypnosis, amnesia, loss of reflexes
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 - surgical anesthesia required for most procedures
|Drugs used in anesthesia||
Barbiturates (rapid anesthesia, short duration)
Opioids (pain relief)
Ketamine/Propolol (maintain anesthesia), depress limbic system
Nitrous oxide, GABA receptors agonist, opioid agonist
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
anticholinergic are given to decrease salication and glands excretion
|Post operative drugs||
Opiods and antiemedics
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
Good cholesterol, assis in reverse cholesterol transport, lowering VDLD thus lowering LDL
|HTN drugs - main categories||
Adrenergic drugs (CNS and peripheral)
CCB (Calcium channel blockers)
Angiotensin II receptor blocker
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
Treatment of hypertension, drug of choice for heart failure patients.
S/E dizziness, orthostatic hypotension, dry non productive cough, metallic taste, andgioedema
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
Causes direct visodialation, used in hypertensive emergencies.
Bio-product maybe toxic to the body, dangerous on hypoglacemic pts
|Nursing implications for patients taking HTN drugs||
Weight patient daily -
Change positions slowly (due to orthostatic hypotention)
block formation of thrombus, embolus and fibrin.
may cause excessive bleeding
Common med : Heparin
Inhibit vitamin K clotting factors that are produced in the intestinal walls
Affects the cyclooxygenase pathway, making the platelets "slippery", preventing coagulation
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
Used in the treatment of Anemia
|Reasons for anemia||
Iron deficientcy, bone marrow depression, folic-acid
Iron is important in the formation of RBC's
do not take with milk, take with orang juice
Vitamin B12, important in there treatment of pernicious anemia and megaloblastic anemia
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
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 %
Hypertonic 10 % dextrose
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 __________||
|Vitamin K will affect action of digoxin & lasix||
|Aldactone/ is an example of______||
Vasodilation and faster heart rate
True or False
treatment of seizures and maniac episodes
GABA enhancers and sodium channel stabilizers
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
|Ketamine and propolol||
Intravenous general anesthesia
Ketamine S/E HTN, and tachycardia.Respiratory depression
Dellirium, hallucinations (Emergence phenomina)
Administer drug slowly
Stage II anesthesia, anxiety, excitement
nausea, vomiting, lethargy.
Caffeine or adrenergic agents may exacerbate dysrhythmia
Must monitor patients pulmonary function