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Pharmacology Ch10-16
Pharmacology Chapter 10-16
| Question | Answer |
|---|---|
| What are some examples of nonpharmacologic pain mangement? | massage, accupuncture, theraputic touch, spirituality, relaxation techniques, imagery |
| What are the some of the classes of analgesics? | opioid analgesics--commonly used for moderate to severe pain. NSAIDS (non-steroidal antiinflammatory drugs)--the next most common analgesic class. |
| What is pain associated with? | either actual or potential tissue damage |
| What are the 3 factors of pain in the patient? | physical, psychologic, and emotional |
| What do we need to take into account for effective pain management? | It must be individualized to include: the cause of the pain if known, the existing concurrent medical conditions, the characteristics of the pain, and the psychological and cultural characteristics of the pt. |
| What is pain perception linked to? | The number of mu (special character pg 137) receptors in the dorsal horn. This number is controlled by the opioid receptor gene. |
| What characteristics come into play with regard to how a patient will respond to pain? | age, sex, culture, previous pain experience, and anxiety level |
| Exmple of acute pain? | postoperative pain, myocardial infarction, appedicitis, dental procedures, kidneystones, surgical procedures |
| Opioids are known to relieve what types of pain? | visceral and superficial pain |
| What type of med does somatic pain tend to respond to? | nonopioid analgesics |
| Pain by culture: African American | many believe in power of healers, prayer, and laying on of hands |
| Pain by culture: Hispanic Americans | Many believe in prayer, wearing of amulets, and use of herbs and spices. Therapies often include religious practices, massage, and cleansings (such as passing herbs over the body). |
| Pain by culture: Asain and Pacific islander | many are reluctant to express pain |
| Pain by culture: Native Americans | tx's include massage, application of heat, sweat baths, herbal remedies, and being in harmony with nature |
| What can lower a person's threshold to pain? | Anger, anxiety, depression, discomfort, fear, isolation, chronic pain, sleeplessness, and tiredness |
| What can increase a person's threshold to pain? | Diversion, empathy, rest, sympathy, medications (analgesics, antianxiety drugs, antidepressants) |
| Examples of chronic pain? | Arthritis, cancer, lower back pain, peripheral neuropathy |
| Vascular pain, examples, and tx? | EX: migraine headaches Tx: Opioids |
| Referred Pain: EX and Tx? | EX: cholecystitis (pain is referred to the back and scapula areas), myocardial infarction Tx: none given |
| Diabetes is associated with which type of pain? | neuropathic--its difficult to treat |
| Cancer pain tx? | opioids |
| What are examples of conditions that cause damage to the CNS that would result in central pain? | cancer, diabetes, stroke, or ms. |
| What substances do tissues release when injured (that some pain meds work by altering the actions and levels of)? | bradykinen, histamine, potassium, prostaglandins, and serotonin--these sustances stimulate nerve endings, starting the pain process |
| What are the 2 basic types of nerve fibers? | A and C. |
| What are the characteristics of A fibers? | Large, has myelin sheath, fast conduction, and sharp, well-localized pain |
| What are the characteristics of C fibers? | No myelin sheath, small size, slow conduction, dull and nonlocalized |
| The activation of A fibers does what? | closes the gate, causing a inhibition of impulse transmission to the brain and no pain is perceived |
| C fiber stimulation does what? | opens the gate, allows impulses to the brain and pain is perceived. |
| What are considerred to be the body's painkillers? | enkephalins and endorphins. They are capable of binding with opioid receptors and inhibiting the transmission of pain impulses by closing the spinal cord gates in a manner similar to that of opioid analgesic drugs. |
| What is responsible for a runner's high? | enkephalins and endorphins. |
| How does massage reduce pain? | A fibers are stimulated, the gate is closed. Recognition of pain impulses from small fibers is reduced. This is the same pathway used by the opioid analgesics to alleviate pain. |
| The gate works at what level? | the spinal cord |
| Where is "the gate" located? | The dorsal (posterior) horn of the spinal cord. |
| The brain does what in relation to the "gate"? | The brain controls the gate, bc the gate is innervated by nerve fibers from the brain. This allows the brain to evaluate, id., and localize the pain, and to control the gate before it is open. |
| What give the gate it's threshold? | The cells that control the gate |
| What types of chronic pain patients sometimes experience crises periods of acute pain? | cancer, AIDS, and sickle cell |
| What do patients with comples pain syndromes often benefit from? | A holistic clinical approach. Including opioid or nonopioid drugs (or both), and nonpharmacologic tx's like: electric nerve stimmulation, massage, medication, biofeedback, relaxation therapy, and psychologic counseling |
| Injectable forms of pain meds are not the first choice with cancer pts, why? | b/c of risk for infection |
| What is important with pain from malignancies? | Comfort, not prevention of addiction |
| What are some common adverse affects with opioid use that may need to be prevents with adjuvants? | constipation, nausea, vomiting, sedation and mental clouding, respiratory depression |
| Describe the 3-step analgesic ladder defined by the WHO. | 1. use nonopioids (with or without adjuvants) 2. use opioids (with or without non-opioids & with or without adjuvants) 3. use opioids indicated for moderate to severe pain (with or without non-opioids & with or without adjuvants) |
| mild agonists? | codeine, hydrocodone, propoxyphene |
| strong agonists? | morphine, hydromorphone, oxycodone, meperidine, fentanyl, and methadone |
| Narcotics | very strong pain relievers |
| What is the analgesic ceiling effect? | once specific dosage is reached, drug produces maximal analgesic effect. Raising dose is unpredictable, dangerous, and provides no further therapeutic effect |
| What are the opioid analgesics? | codeine sulfate, meperidine HCl (demerol), methadone HCl (Dolophine), morphine sulfate, propoxyphene HCl, hydromorphone, oxycodone, fentanyl, and others (that's what it says on the slide) |
| What are the 3 opioid analgesics based on structure? | Morphine-like, meperidine-like, and methadone-like |
| What are the 3 classifications of opioid analgesics based on action? | agonist, partial agonist, and antagonist |
| What does the term "balanced anasthesia" refer to? | using a combination of drugs rather than a single drug to produce anesthesia |
| What are some indications for the use of opioid analgesics? | moderate to severe pain, cough suppression (codeine), diarrhea (lomotil), balanced anesthesia (fentanyl) |
| What are the contraindications for opioids? | Known drug allergy, severe asthma or other respiratory insufficiency, elevated intracranial pressure, and pregnancy |
| Main opioid side effects? | euphoria, CNS depression, N+V, urinary retention, diaphoresis and flushing, pupil constriction (miosis), constipation, itching (AKA puritis) |
| What are some opiate antagonists? | Naloxone (Narcan)--drug of choice for resp. depression. Lasts for 1 hour redose as needed. It reverses respiratory depression and pain control. Naltrexone (Revia)--an adjunct for maintenance of opioid free state in addicts. |
| What are signs of opioid abuse? | Rquest drug by name, asks you what type of drug it is, states they have an allergy to others, mulitple dr.s or ER visits, calls after hours for pain meds. |
| What are the symptoms of opioid withdrawl? | anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, constipation, diarrhea |
| What types of drug interactions can occur with opioids? | Additional CNS depression with the use of: ETOH, antihistamines, barbituates, benzo's, and other CNS depressants (MAOI's). Opioids should not be taken with other hepatotoxic drugs |
| What is the most widely used nonopioid analgesic? | acetaminophen (also used are all drugs in the NSAID class). |
| What are some example of opioid/acetaminophen combinations? | Percocet, vicodin, darvocet, and fioricet |
| Characteristics of Aceteminophen (Tylenol) | analgesic and antipyretic. Little to no antiinflammatory effects. Similar to salicylates (ASA). Blocks pain impulses peripherally by inhibiting prostaglandin synthesis. |
| What are the indicationsfor aceteminohen? | mild to moderate pain, fever (acts on hypothalamus), alternative for those who cannot take aspirin products |
| What is recommended for the overdose of Aceteminophen? | acetylcysteine (Mucomyst) |
| Max acetaminophen dose for healthy adults | 4000mg per day (inadvertant excessive doses may occur when different combination drug products are taken together) |
| How does acetaminophen and NSAIDS block pain? | by inhibiting prostaglandin synthesis |
| What are some examples of NSAIDS? | Ibuprofen and Naproxen |
| what is a broad syndrome of CNS function where there is excessive discharges from the cerebral cortex? | epilepsy |
| what is the reason people become primary epileptics? | idiopathic - unknown reasons, can not be determined |
| what is a substance or procedure that prevents or reduces the severity of epileptic of other convulsive seizures? | anticonvulsant |
| what is a metabolic process that occurs when a drug increases its own metabolism over time, leading to lower drug cocncentrations? | autoindiction |
| what are drugs that are characterized by a narrow difference between their therapeutic response and toxic doses? | narrow theraputic index (NTI) drugs |
| what is a brief episode of abnormal electrical activity in the brain? | A seizure |
| what is an involuntary spasmodic contraction of any or all voluntary muscles through out the body? | Convulsions |
| How can a person acquire secondary epilepsy? | trauma, infections, CV disorders, brain tumors, etc. |
| what term means stiffening? | Tonic |
| What term means rapid, synchronized muscular contractions? | Clonic |
| What are the worst type of seizures, which are life threatening with both tonic and clonic convulsions? | status epilepticus |
| What is the drug of choice to treat a status epilepticus seizure? | Valium (or Ativan) Valium lasts longer |
| what type of seizure has no impaired consciousness, hallucinations, personality changes and Autonomic NS responses? | Simple seizures |
| what type of seizure is most often seen in children, and has a temporary lapse in consciousness, often seems to be staring off into space, or daydreaming? | Generalized seizures |
| What type of seizure has impaired consciousness, memory impairment, behavioral effects, and either tonic, clonic, or both types of convulsions? | complex seizures |
| how long will a person need to be on AED (antiepileptic drugs) typically? | usually lifelong |
| with Carbamazepine (tegretol) what type of drugs can have adverse interactions? | anticoagulant drugs (warfarin, coumadin) |
| What is the first line agent drug of choice to keep a person from having seizures? | Dilantin-(phenytoin) then Tegretol (carbamazepine) as a |
| what are some second line agents, those used if the PT doesn’t respond well to 1st line agents? | keppra (levetiracetam), Topamax (topiramate) |
| which AED was the prototype, is the initial drug of choice, and should not be switched from generic to trade names? | Dilantin-(phenytoin) - use only normal saline for IV |
| What drug commonly causes gingival hyperplasia? | Dilantin |
| what are some patient teachings for an epileptic PT? | take meds same time each day, do not crush or chew meds, keep a seizure journal |
| What is true of all AED's concerning pregnancy? | they are all teratogenic |
| What are common adverse reactions to AED's? | dizziness, somnolence, drowsiness, eye problems, and fever |
| What is a chronic progressive degenerative disease, that is a neuromuscular disorder where there is a proble with nerve/muscle innervations? | Parkinson's Disease |
| Parkinson's disease affects that neurons in the brain causing an imbalance? | Dopamine producing neurons, causing an imbalance between dopamine and acetylcholine |
| What does dopamine control? | controls movement - in the basal ganglia (gray matter) |
| what test can indicate abnormalities within the brain for Parkinson's PT's? | PET position emission tomography scans |
| what are some classic PD symptoms? | Bradykinsia, slowing of movements, Rigidity, cogwheel, tremors, pill rolling, shuffling, slow walk |
| what type of drug blocks or impedes he activity of the neurotransmitter Ach at the cholinergic receptors of the brain? | Anticholinergic drugs |
| what is characterized by involuntary, purposeless, rapid moventmts? | Chorea |
| what is the impaired or distorted voluntary movement due to a disorder in muscle tone? | Dystonia |
| what is the impaired ability to execute voluntary movements? | dyskinesia |
| When does dyskinesia occur within the PD PT? | when there is to much dopamine- causes rapid spasmodic involuntary movements |
| What type of drugs are used to increase dopamine and slow progression of PD? | Anticholinrgic , Antihistamines, and Dopamine-receptor agents and indirect acting dopamine-receptor agonists |
| What drug is a precursor to dopamine and can cross the blood brain barrier, used for early treatment of PD? | Levodopa |
| what are some side effects of large doses of levadopa? | cardiac dysrythemia, hypotension, chorea, muscle cramps and GI distress- urine may be darkened |
| What drug is a dopaminergic therapy used as a replacement drug? | levadopa/carbidopa (Sinemet)- the mainstay of therapy |
| What Selective MAOl therapy may delay the development of serious debilitating PD for 9-18 yrs? | Selegiline- given prophylacticly |
| Which drugs work by blocking acetylcholine for PD Pt's? | Anticholinergics, like Cogentin, and Artane |
| What are some adverse effects of anticholingerics? | urinary retention, NV, constipation, disorientation, dry mouth |
| What are some S/S for PD? | masklike expressions, speech problems, dysphagia, rigidity in arms and legs |
| What are some important PT teachings for PD patients? | avoid foods high in Vitamin B6 (beans, lentils), encourage fluids, not to take other meds with PD meds, urine may be darkened |
| What is a down fall of drug holidays? | may lead to relaps of symptoms while off the drug |
| what are some contraindications for PD meds? | narrow angle glaucoma, history of melanoma, undiagnosed skin conditions |
| how long can it take for levadopa-carbidopa to have a theraputic effect? | several weeks to a few months |
| What is used when a Pt's condition does not respond adequately to a single drug, or when given combos are know to have more theraputic benefits? | adjunct therapy |
| what are emotional disorders that are characterized by changes in mood that range from mania to depression? | affective disorders |
| what is the term for motor restlessness? | akathisia |
| what is the unpleasent state of mind in which real or imagines dangers are anticipated and or exaggerated state of fear? | anxiety |
| Def: capable of reducing anxiety, usually said of the medication? | anxiolytic |
| what is the most common group of psychotrophic drugs currently perscribed to alleivate anxiety and are used as the First line of treatment? | benzodiazepine |
| what is an abnormal emotional state characterized by exaggerated feelings of sadness, melancholy etc. that are out of proportion for reality? | depression |
| what are symptoms that arise adjacent to the pyrimidal portions to the brain? | extrapyramidal symptoms |
| what are the heterogeneous groups of drugs that are used primairly in the treatment od depression? | MAOI monoamine oxidase inhibitors |
| What is a serous mental illness associated with being truly out of touch with reality? | psychosis |
| what is the therapy of emotional and mental disorders? | psychotherapeutics |
| what is the group of drugs most commonly perscribed as a psychotherapeutic? | psychotrophic |
| what racial group has a lower activity of drug metabolism b/c of various enzyme deficiencies? | asians- so they need lower doses and are more sensative to psychotherapeutic drugs |
| what two groups of people have poor "mephenytoin pathways"? | chinese and japanese |
| which group of people respond better to prozac and desipramine for anxiety and depression? | mexican-americans |
| this states that mental disorders are associated with abnorma levels of endogenous (produced by the body) chemicals, like neurotransmitters with in the brain? | the Biochemical imbalance theory |
| what is a non-sedating, non-habit forming agent which can be used as adjunct therapy for antianxiety taken daily? | BuSpar (buspirone) |
| what are some common benzodiazepine anxiolytics? | Valium (or Ativan), Valium lasts longer, Xanax |
| how should benzodiazepine anxiolytics be used? | in the lowest effective dosage, and prn for symptomatic control |
| what Is the reversal for O/D of anxiolytics? | Flumazenil (Romazicon) |
| What are some uses for Valium (diazepam)? | anxitey, seizure disorders, alcohol withdrawal |
| What rate should IV valium be given? | 5mg/ min (1mL/ min) |
| What are some uses for Ativan (lorazepam), what is the push rate? | anxiety, pre-op sedation, push at 2mg/min |
| What is the drug of choice to treat mania? | lithium - push at 0.6-1.2 mEq/L |
| what does the permissive hypothesis state of depression? | depression = decreased seratonin and norepinephrine |
| what does the permissive hypothesis state of mania? | mania = increased norepinephrine, decreased seratonin |
| what does the biological amine hypothesis state (BAH)? | depression = deficiency of neural and synaptic catecholamines. Mania= excess catecholamines |
| What is said to result from a failure in the regulation of carecholamines (NE) systems? | depression and other affective disorders |
| how long until antidepressants take affect? | 3-4 weeks |
| what are first line antidepressants called? | serotonin-selective reuptake inhibitors (SSRIs) and serotonon/norepiephrine reuptake inhibitors (SNRIs) |
| what two types of drugs are superior to the first line drugs of antidepression b/c of no effects on the cardiovascular system and low side effects? | tricyclic antidepressants (TCA) and monoamine oxidase inhibitors (MAOIs) |
| What are example of SSRIs? | prozac (fluoxetine), zoloft, paxil, celexa, Cymbalta (duloxetine) |
| How do SSRIs and SNRIs work? | they inhibit serotonin and norepinephrine reuptake causeing increased seratonin |
| what are some side effects of second generation antidepressants? | sexual dysfunction, weight gain, headache, dizziness |
| how do tricyclic antidepressants work? | they correct the imbalance between serotonin and NE |
| what are some examples of tricyclics? | Elavin (amitriptyline), endep, sinequan |
| what happens with tricyclic overdoses? | 70% die before reaching the hospital from seizures or dysrythmias, it has no antidote, and will need basic life support |
| what herbal remedie can not be taken with perscription depression drugs? | st. john's wort |
| what should be avoided with MAOIs? | cheese and wine, also food and drinks with the aa- tyramine |
| what can happen if a person on MAOIs ingeasts cheese or wine? | hypetensive crisis- which can lead to CVA, coma, or death |
| if a person is switching from a MAOI to a SSRI how long should they wait to take the new med? | at least 2-5 weeks as a "wash-out" period |
| what drugs are highly perscribed for treatment as antipsychotics? | Risperdal, zyprexa, and seroquel |
| what drug is commonly used for bipolar disorder? | abilify (aripiprazole) |
| how do antipsychotic drugs work? | they block specific dopamine receptors |
| how long will it take before a pt will feel the therapeutic effects of antidepressants? | 1-4 weeks |
| what can decrease the effectiveness of medication therapy? | smoking and caffeine |
| what are some side effects of HalDol? | tremors, NVD, uncontrolable shakes |
| how long does it take lithium to work ( therapeutic effect)? | at least 3 weeks |
| 1. What are drugs that stimulate a specific area of the brain or spinal cord? | Stimulants |
| 2. Stimulants are sympathomimetic agents that do what? | Mimic sysmpathetic nervous system |
| 3. What are some things that stimulants help with? | Elevate mood, produce increased energy and alertness, decrease appetite, enhance tasks |
| 4. What are the 5 uses for CNS Stimulants? | Analeptics, appetite suppressants, and treatment for ADHD, Narcolepsy, and Migraine headaches |
| 5. Why are stimulants used for analeptics? | Reversal of anesthesia induced respiratory depression |
| 6. Why are stimulants used for anorexiants? | It is thought to suppress the appetite control center in the brain; use for obesity |
| 7. What is the most common psychiatric disorder in children? | ADHD |
| 8. What do stimulants do for ADHD patients? | Stimulate the areas in the brain responsible for mental alertness and attentiveness |
| 9. What is it called when some someone has abnormal sleeping during normal activity? | Narcolepsy |
| 10. This is a sudden loss of voluntary skeletal muscle, except respiratory? | Cataplexy |
| 11. What are some common side effects of stimulants? | Palpitations, tachycardia, hypertension, angina, dysrythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, increased urinary frequency |
| 12. What is ADD? | Attention Deficit Disorder without the hyperactivity |
| 13. What are some common drugs used for ADD/ADHD? | Amphetamine (Adderall), Methylphenidate (Ritalin, Methylin), Dextroamphetamine (Dexadrine), Dexmethyphenidate (Focalin) |
| 14. What schedule are ADD/ADHD stimulants? | Schedule II, and are highly controlled and potentially abused |
| 15. What does SNRI stand for? | Not a stimulant, also used to treat ADHD |
| 16. What are some SNRI drugs used? | Atomoxetine (Strattera), Modafinil (Provigil) |
| 17. What drug is a wake promoting nonamphetamine that is the only medication approved to treat narcolepsy and is considered a controlled Schedule IV? | Modafinil (Provigil) |
| 18. What risks are increased in an obesity person? | Hypertension, dyslipidemia, CAD, stoke, type 2 diabetes, gallbladder disease, gout, osteoarthritis, sleep apnea, cancer |
| 19. What anorexiant stimulant is used to treat obesity is a schedule IV controlled, and may cause elevated BP and pulse? | Phenteramine (Adipex, Lonamin) |
| 20. Which medication is similar to stimulant; Schedule IV controlled, inhibits reuptake of NE and Serotonin? | Sibutramine Monohydrate (Meridia) |
| 21. What are common side effects caused by Sibutramine monohydrate (Meridia)? | Dry mouth, h/a, insomnia, constipation, can elevate BP and pulse |
| 22. What nonstimulant Anorexant blocks absorption of fat from GI tract; does not suppress appetite? | Orlistat (Xenical, Alli) |
| 23. What are common side effects with Orlistat (xenical, Alli)? | Flatlelince, oily spotting, fecal urgency, and has no effect on pulse or BP. Not controlled |
| 24. What new class of CNS medications is used in the treatment of migraines? | Serotonin Agonists “Triptans” |
| 25. What do Triptans do in helping to treat migraines? | They stimulate serotonin in the brain, constricting dilated blood vessels and decreasing inflammation. |
| 26. What are some examples of Triptans? | Sumitriptan (Imitrex), Naratriptan (Amerge), Zolmitriptan (Zomig), Rizatriptan (Maxalt), Eletriptan (Relpax), Frovatriptan (Frova), Almotriptan (Axert) |
| 27. What medication can affect height and weight in children? | Ritalin |
| What are the 3 classes of sedative-hypnotics? | barbiturates, benzodiazepiines, and misc. drugs |
| Why are sedatives considered to be dose dependant? | b/c at higher doses they become hypnotic, inducing sleep |
| What can happen if REM sleep is interrupted? | It can be dissicult to go back to sleep |
| Why is REM interference sleep important? | B/c it can result in daytime fatigue since REM sleep provides a certain component of the "restfulness" of sleep. |
| What causes REM interference? | Prolonged use of sedative hypnotics |
| Characteristics of barbiturates? | produce unwanted side effects, low theraprutic profile (narrow rang between therapeutic and toxic doses). Work primarily on inhibiting GABA traveling In the cerebral cortex. Also reduce likeliehood of pt having a seizure |
| What are indications of barbiturates? | sleep aid, sedative, anticonvulsant, and anesthesia for surgical proceedures |
| Bariturates have what suffix? | they have the suffix -ITAL: pentobarbital (primarily prescribed for anxiety), phenobarbital (most commonly used to prevent seizures) |
| Bariturates are notorious enzyme inducers, what does that mean? | They stimulate liver enzymes that cause the metabolism of many drugs, so drugs are metabolized more quickly and their duration of action is shorter. |
| what are the side effects of bariturates? | lethargy, vertigo, mental depression, coma, apnea, brochospasms cough, N+V,diarrhea and constipation, agranulocytosis, vasodilation, hypotension, deprivation of REM sleep |
| Barbiturates have addittive effects with which meds? | ETOH, antihistamines, benzpdiazapines, narcotics, and tranquilizers. MAOI's prolong the effects of barbs. |
| How do bariturates effect lab tests? | Increase in bilirubi, ALT and AST |
| What are the most commonly prescribed drug classes? | benzodiazepines--a sedative for sleep--they have a favorable side effect profile (REM sleep is not altered, does not increase metabolism of other drugs so is safer than barbiturates) |
| What are the suffixes for benzodiazapines? | suffixes are -PAM and -LAM |
| What are the short acting benzos? | temazepam (Restoril), Triazolam (Halicon), Lorazepam (Ativan) and Alpranzolam (Xanax) |
| What are the 2 classes of Benzodiazepines? | Sedative or anxiolytic |
| What are the indications of benzodiazepines? | Sedation, sleep induction, skeletal muscle relaxation, anxiety relief, tx of ETOH withdrawl, depression, epilepsy, balanced ansthesia, moderate or conscious sedation |
| What are adverse effects of benzodiazepines? | headache, 'hangover effect', must be careful with pt's who are a risk for fall, dependancy (esp in geriatrics) |
| What are the signs of overdose with benzos? | somnolence (not completely awake/alert), coma, diminished reflexes, rarely hypotension and respiratory depression, toxicity usually occurs when combined with other CNS depressants |
| What can be used to stop an overdose of benzos? | Flumazenil (Romazicon)--it has a relatively short half life (1-4 hours) and may need to be given again. |
| What are the benefits of hypnotics? | they have very few side effects, usually no next day drowsiness, less addiction/dependance potential, overdose leads to fewer serious complications |
| How do most muscle relaxants work? | by enhancing the GABA's central inhibitory effects at the spinal cord--only 1 works directly on the muscle (dantrolene-it is also used for malignant hyperthermia crises) |
| What are 2 diseases where muscle relactants are indicated? | MS, cerebral palsy |
| What are side effects of muscle relaxants? | euphoria, lightheadesness, dizziness, drowsiness, fatigue, and muscle weakness |
| Which muscle relaxant drugs are commonly used today? | baclofen, cyclobenzaprine, dantrolene, and tizanidine. |
| Name some examples of OTC sleep aids | diphenhydramine (benadryl) and tylenol PM |
| What a 2 commonly prescribed sedative-hypnotics that are prescribed from the miscellaneous category? | chloral hydrate and tizanidine (a muscle relaxant) |
| What is commonly referred to as a "micky finn" | the combination of alcohol and chloral hydrate which leads to rapid loss of consciouness |
| What is the first long term drug to be approved for treatment of insomnia? | Eszoplicone (Lunesta) |
| What needs to be assessed in a pt before administering any CNS depressant drug? | vitals, including supine and erect blood pressure, and tempurature b/c a rapid drop could occur in blood pressure and other vital parameters such as respiratory rate, so administering the drug per protocol is critacal to pt. safety |
| What should be included in pt. teaching regarding sedative hypnotics? | avoid alcohol, check with physician before taking an OTCs, it may take 2-3 weeks to notice improved sleep when taking barbituates. NO SMOKING with CNS depressants. |
| Safety concerns are of the utmost importance with the use of sedative hypnotics, how can the nurse keep the pt safe? | use side rails and bed alarm. Assist pt with ambulation. Closely monitor pt level of consciousness |
| What do therapeutic effects of muscle relaxants include? | decreased spacity, reduction of choreiform movements in Huntington's chorea, decreased rigidity in parkinsonian syndrom, and relief of pain from trigeminal neuralgia. |
| Which are the short-acting barbiturates? | pentobarbital sodium, and secobarbitol |
| What are the intermediate -acting barbituates? | amobarbital, aprobarbital, and butabarbital |
| What should be done first in trying to treat a patient with insomnia? | Try nonpharmacologic measures |
| A patient who is not sleepy after taking a barbiturate for sleep, is said to be having what type of reaction? | a paradoxical reaction |
| What is an example of an intervention that applies to the administration of a nonbenzodiazapine, such as zolpidem? | B/c of their rapid onset, they should be taken just before bedtime. They are only indicated for the short tem treatment (7 - 10 days) of insomnia, and are only available orally. |
| How should a pt be taken off of benzodiazepine? | by a gradual reduction in dosage |
| What type of barbiuate would a nurse expect to use for a brief surgical proceedure to obtain a byopsy from a superficial area? | An ultra-short barbituate |
| While monitoring a pt who took an overdose of barbiturates, the nurse keeps in mind that the cause of death would be from what? | respiratory arrest |
| A pt with back muscle spasms is being treated with a skeletal muscle relaxant. These drugs are most effective when used with what? | physical therapy |
| What drug would be used to treat an overdose of benzodiazipines? | Flumazenil (Romazicon)--it has a relatively short half life (1-4 hours) and may need to be given again. |
| If a pt has had a barbituate for insomia in the past, why would a physician be less likely to prescribe a barbiturate again now? | B/c other hypnotic drugs are now used for frquently than barbiturates b/c they have fewer side effects and are safer than the older barbiturates. They also do not suppress REM sleep |
| What might be occur when a pt experiences REM rebound after stopping barbiturates? | may lead to nightmares |
| What is a benefit of using transdermal fentanyl patches in the management of bone pain from the spread of cancer? | More analgesia for longer periods |
| Acetaminophen is contraindicated in patients with what disease? | hepatitis |
| What are the two main categories of general anesthetics based on route of administration? | inhaled (gas or volatile liquid) and injectable |
| General anesthetics commonly administered by IV anesthetic drugs include what? | etomidate and propofol |
| sedative-hypnotics that are commonly administered IV anesthetic drugs include? | barbituates (thiopental and methohexital) and benzodiazepines(eg. Diazepam, midazolam) |
| Narcotics that are commonly administered IV anesthetic drugs include what? | morphine, sulfate, fentanyl, sufentanil, propofol |
| Nuromuscular blocking agents (NBMAs) that are commonly administer IV anesthetic drugs include? | both depolarizing (succinylcholine) and nondepolarizing or competitive (eg., pancuronium, d-tubocurarine, vecuronium) |
| What is an example of a true general anesthetic drug in the sense that it is used not only to induce but also to maintain the state of anesthesia? | Propofol--most of the other drugs serve a more limited function, such as anesthesia induction, sedation, amnesia, and reduction of anxiety. Propofol is also known for it's quick onset and quick recovery |
| What are the common side effects of anesthetic drugs? | dry mouth, bradycardia, nausea, and vomiting. Using balanced anethesia where less of each drug is used reduces these effects and a more controlled state of anesthesia. |
| The greater a drugs solubility In fat… | the greater the effect it produces for anesthesia. Nerve cell membranes are high in fat as is the blood brain barrier |
| What senses are usually lost during anesthesia? | sight, touch, taste, smell, hearing, and a loss of awareness |
| What is last to be affected by anesthesia? | the medullary center is depressed last, and is to be maintained so that breathing and blood pressure are not effected. The medulla is effected in overdose causing CV/respiratory collapse. |
| Drugs ending in -ANE are a part of what group? | inhaled anesthetics that are also volatile liquids (enflurane, halothane, isoflurane, methoxyflurane, and sevofllurane). |
| There is one inhaled gas, what is it called? | nitrous oxide "laughing gas" |
| Two common general anesthetic drugs include? | ketamine (Ketalar) and thiopental (Penthothal) |
| Contraindications of anesthetic drugs? | known allergy, pregnancy (depending on drug type), narrow-angle glaucoma, and known susceptibility to malignant hyperthermia from prior experiences with anesthetics |
| What medication is known for prevention or control of postop. N+V? | droperidol |
| What could predispose the patient to anesthetic induced complications like liver toxicity? | substance abuse (eg. Alcohol) |
| What types of drugs are anesthetics known to have adverse reactions with? | antihypertensives, beta blockers, and tetracycline |
| What are the 2 classes of local anesthetics? | topical or parenteral |
| What is spinal anesthesia? | The injection of certain anesthetic drugs into the area near the spinal cord. This is used to block all peripheral nerves that branch out below a selected level of the spinal cord. |
| What does spinal anesthesia produce? | a temporary skeletal and smooth muscle paralysis and anesthesia within the anatomical areas of the body that are ultimately innervated by these nerve tracts lying between this selected spinal cord location and the affected organs and tissues. |
| What does PACU stand for? | Post-anesthesia care unit |
| What drug group's suffix is -INE? | Anticholinergics--they are used as adjuntive agents with anesthesia to reduce secretions. They are used so that patients don't aspirate. (atropine, glycopyrrolate, scopolamine (also used for sea sickness). They cause dry mouth. |
| What are the 2 types of local anesthesia? | Central (intrathetcal and epidural) and Peripheral (infiltration, nerve block, and topical) |
| What drug groups suffix is -CAINE? | Parenteral anesthetic agents (lidocaine, mepivacaine, procaine, tetracaine, bupivicaine, and ropivacaine |
| What can be administered to reduce the effect of a local drug in the event of toxicity/overdose? | epinephrine (vasoconstrictor) to keep at local site of action |
| Why are local anesthetics known as membrane-stabilizers? | b/c they alter the cell membrane of the nerve so that the free movement of ions is inhibited |
| How do local anesthetics produce a "sympathic blockade"? | by blocking the action of the two neurotransmitters of the sympathetic nervous system: epinephrine and norepinepherine |
| What are the two ways that local anesthesia are delivered? | Via nerve block (directly into nerve/ganglia/or around nerve trunks) or infiltration anesthesia (administered in a cirular area around the operative field). |
| What is an epidural blood patch? | Treatment for a "spinal headache" from spinal anesthesia that involves the anesthetist injecting a small volume (abt 15mL) of a venous blood sample in the pt's epidural space. |
| NMBA | Neuromuscular Blocking Agents--prevent nerve transmission in certain muscles, leading to paralysis of the muscles, often used with anesthetics for surgical proceedures. |
| What must be used when NMBAs have been administered? | artificial mechanical ventilation |
| What don't NMBAs do? | relieve pain or cause sedation therefore the healthcare provider should assume that the paralyzed patient is in pain and anxious and should take steps to relieve such symptoms with analgesics and anxiolytics |
| What were NMBAs produced in hopes of mimicing? | Snake venom |
| Two classes of NMBAs? | Depolarizing and Nondepolarizing (nonDep. Has 3 subgroups based on the duration of their action: short-, intermediate-, and long-acting.) |
| What do nondepolarizing NMBAs do? | prevent acetylcholine (Ach) from acting a neuromuscular junctions. Muscle contraction does not occur. |
| What is the only depolarizing NMBA? | Succinylcholine--it works similarly to neurotransmitter Ach, causing depolarization (muscle contraction). |
| What are the main indications for NMBAs? | maintaining controlled ventilation during surgical proceedures, to reduce muscle contraction in an area that needs surgery, endotracheal intubation |
| What drug type ends in -CURIUM? | NMBAs nondepolarizing agents: mivacurium (short acting), atracurium and rocurium (intermediate) and pancuronium (long-acting) |
| What is moderate sedation and how is it produced? | AKA "conscious sedation". Produced by the use of an IV benzodiazepine and an opiate analgesic. The pt will not be able to recall the proceedure, but will be able to respond to verbal commands. |
| General nursing considerations when anesthetics are used? | Closely monitor the ABC's, close observation of all body systems, vitals, arterial oxygen saturation, neuroligic indicators should be closely monitored and any minor change reported. |
| Patient teaching with anesthesia? | teach the pt about post operative turning, coughing, deep breathing (prevent post-operative pneumonia). Advise pt's recovering from NMBAs that during recovery they may still be paralyzed, unable to communicate, but able to hear and feel |
| What types of drugs are used to revers muscle paralysis after surgery? | Anticholinesterase drugs ie: neostigmine, pyridostigmine, and edrophonium are antidotes and used to releive muscle paralysis. |
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cspearsall
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