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Neuro Pharm Test I
For Jefferson BSN '11 Students. This is for our first neurological pharm test.
| Question | Answer |
|---|---|
| What are local anesthetics? | They are drugs that suppress pain by blocking impulse conduction along axons. |
| What is an advantage to local anesthetics? | Pain can be suppressed without causing generalized depression of the central nervous system. |
| What are the two major types of local anesthetics? | Ester bond & amide bond. |
| Lidocaine | -Most widely used local anesthetic. -Administered topically and by injection. -More rapid, more intense, and more prolonged than procaine. -If plasma levels are too high, CNS and cardiovascular toxicity can result. -Also used to treat dysrhythmias. |
| Procaine | -Also known as novocaine. -Not effective topically; given by injection. -Systemic toxicity is rare. -Use has sharply declined. |
| Cocaine | -First local anesthetic. -Has pronounced affects on sympathetic and CNS. -Topical administration. -Anesthesia of ear, nose, & throat. -Increases heart rate & has intense vasoconstricive effect. |
| What is the clinical use of local anesthetics? | -Topical: Sensory block of mucuous membanes. -Infiltration: Injection directly into area of surgery. -Nerve block: Injection into or near nerves that supply surgical field. -IV Regional: Used for extremities. -Epidural -Spinal |
| Local Anesthetic - Mechanism of Action | -Stop axonal conduction by blocking sodium channels in the axonal membrane. -small myelinated neurons are blocked more rapidly than large, myelinated neurons. -Pain blocked first, then cold, warmth, touch, and deep pressure. -Effected motor as well. |
| Local Anesthetic - Onset of Action | -Determined by the moecular properties of anesthetic. -Determined by: molecular size, lipid solubility, and degree of ionization at tissue pH. -Rapid = small size, high lipid, low ion. -Slow = large size, low lipid, high ion. |
| Local Anesthetic - Adverse Effects | -CNS: Excitation followed by depression, convulsions, drowsiness, LOC, resp. depression. -CV: Bradycardia, heart block, cardiac arrest, hypotension. -Allergic: Allergic dermatitis, anaphylaxis. -L & D: Prolonged labor, newborn CNS depression. |
| What are general anesthetics? | They are drugs that produce unconciousness and a lack of responsiveness to all painful stimuli. There are two groups: inhalation and intravenous. Both are used to provide balanced anesthesia. |
| What is balanced anesthesia? | -It is the use of a combination of drugs to accomplish what we cannot achieve with a inhalation anesthetic alone. |
| What is the advantage to balanced anesthesia? | Combining drugs to achieve surgical anesthesia permits full genereal anesthesia at lower (safer) doses of inhalation anesthesia. |
| What are the agents used in combination with inhalation anesthesia? | -Short-acting barbiturates, used for induction of anesthesia. -Neuromuscular blocking agents for muscle relaxation. -Opioids and nitrous oxide are analgesia. |
| What are the three stages of anesthesia? | 1. Induction 2. Maintenance 3. Emergence (sponatenous breathing, regain consciousness, pt is extubated). |
| What is the mechanism of action for general anesthesia? | Inhalation anesthetics work by enhancing transmission at inhibitory synapses and by depressing transmission at excitatory synapses. |
| What is the Minimum Alveolar Concentration? (MAC) | Is the minimum concentration of drug in the alveolar air that will produce immobility in 50% of patients exposed to a painful stimulus. A low MAC indicates high anesthetic potency. |
| How is general anesthesia eliminated from the body? | Elimination si almost entirely via the lungs; hepatic metabolism is minimal. |
| Inhalation Anesthetics - Adverse Effects | -Respiratory & cardiac depression. -Sensitization of the heart to catecolamiens. -Malignant hyperthermia. -Aspiration of gastric contents. -Hepatotoxicity |
| Nitrous Oxide | -It has low anesthetic potency, but high analgesic potency. -Never used a primary anesthetic, only as a adjunct to inhalation agents. -If used with a analgesia, the dose of the primary anesthetic can be decreased and risks lowered. -Post-op N/V. |
| What are some adjunt pre-anesthetic medications used? | -Barbiturates: Employed for induction; is a weak analgesia and muscle relaxant. -Benzodiazepines: Used in conscious sedation. -Propofol: Used for maintenance of anesthesia; is a sedative-hypnotic; can cause resp. depression; do not use in egg allergy. |
| What are anti-cholinergics used for? | -Includes: Glycopyrrolate, Atropine. -Decreases secretions, reverses neuromuscular blockage, increases heart rate. |
| What are some post-anesthetic medications? | -Analgesics include opioids or aspirin-like drugs. -Antiemetics: Such as Zofran. Used to decrease nausea and aspiration risk. -Muscarinic Agonist: Such as Bethanechol (Urecholine). Used to relieve abdominal distention and urinary retention. |
| What are neuromuscular blocking agents? | They are medications that are used to control muscle contraction. They are used to provide muscle relaxation surgery, ETT intubation, and mechanial ventilation. |
| What are the three categories of neuromuscular blocking agents? | 1. Nondepolarizing neuromucular blockers I 2. Nondepolarizing neruomsucular blockers II 3. Depolarizing neuromuscular blockers |
| Tubocararine | -Is a neuromuscular blocker I med. -Is the oldest type; no longer used in the US. -Causes relaxation/paralysis of skeletal muscles. -Must be given IV, never PO. -Is a long-acting neuromuscular blocker; max paralysis occurs in 2 to 5 minutes. |
| Succinylcholine | -Is a depolarizing neuromuscular blocker; only type used in clinical use. -Is ultra short acting.; full paralysis occurs in 1 minute. -Prevents repolarization of the muscle. -Adverse: Paralysis can lat for hours; MH; post-op muscle pain; hyperkalemia. |
| What are therapeutic uses of neuromuscular blockers? | 1. Relaxation of skeletal muscles, esp. abdominal wall. 2. Reduce resistance to ventilation. 3. Used to prevent convulsive movements during ECT. 4. Suppresses gag; relaxes VC. 5. Helps with diagnosis of myasthenia gravis. |
| What are the effects of anti-epileptic drugs (AEDs)? | 1. Suppression of neuron discharge within a seizure foci. 2. Suppression of propagation of seizure activity from foci to other areas of the brain. |
| What are therapeutic considerations of epilepsy interms of medicaions? | Goal: To reduce number of seizures per day. Diagnosis: Patient and family history. Drug selection: One drug does not fit all. Trial for several months; pt. should not expect to be seizure-free, just manageable. |
| What are nursing considerations when using anti-epileptic drugs? | -Monitor plasma drug levels: high initial loading dose, then minimal increases to therapeutic level. -Promote patient adherence/compliance. -Daily seizure log is most important! -Side effect of AEDs is suicide risk. Monitor. |
| Phenytoin (Dilantin) | -For partial & tonic-clonic seizures. -Does not suppress CNS. -Very narrow therapeutic range; 10-20 mcg/mL. -Adverse: Dysrhythmias, rickets, osteomalacia. -Decreases effect of BC, warfarin; increases levels of alcohol, valproic acid. -May cause GI up |
| Carbamazepine (Tegretol) | -For partial & tonic-clonic seizures. -Fewer adverse effects than dilantin and phenobarbital. -Treats trigeminal neuralgias. -Inactivates BC & warfarin; grapefruit increases peak level of med. -Adverse: Anemia, leukopenia, thrombocytopenia. Frequent C |
| Valproic Acid (Depakote) | -For all major seizures, bipolar, migraine. -Do not drink alcohol with this med! -Pts with liver dysfunction should not taek. -Adverse: N/V most common, heptatotoxicity rare & serious. -Decreases phenobarbital metabolism; increases rate of phenytoin t |
| Phenobarbital | -For partial & tonic-clonic seizures. -Effect, inexpensive, replaced with new AEDs with less adverse. -Causes BC & warfarin to lose effect. -Adverse: Physical dependence, congenital abnormalities in pregnancy, sedation, lethargy, depression. |
| Ethuosuximide (Zarontin) | -Only drug for absence seizures. -Suppresses neurons in thalamus. -Adverse: Drowsiness, dizziness, & lethargy in initial phase only. |
| What are the general adverse effects of the newer class of AEDs? | -Less side-effects than traditional AEDs and equally as effective. -Limited as adjunctive drugs to treat most seizure disorders, not stand alone. -Small therapeutic use until more clinical trials. -Smaller risks to fetus. |
| What can drugs used to treat headaches specifically be used for? | 1. Aborting or stopping a headache in progress. 2. Preventing future attacks. |
| What are the two types of drugs used to abort a migraine? | 1. Nonspecific analgesics: aspirin & opioids. 2. Migraine specific drugs: Ergot alkaloids & serotonin receptor agonists. |
| Ergot Alkaloids (Ergotamine) | -Aborts migraines & sometimes cluster HAs. -Alters neurotransmitters in the brain (dopamine, serotonin) & constricts vessels. -Adverse: N/V can occur. -Do not use with Triptans b/c of prolonged vasospasm. -Contraindicated: hepatic/renal failure, CAD. |
| Ergot Alkaloids (Dihydroergotamine/DHE 45/Migranal) | -Used to terminate migraine & cluster HAs. -Adverse: N/V, peripheral vasoconstriction, diarrhea definite. -Avoid HIV protease inhibitors & macrolide antibiotics with this med. -Contrainidated: CAD, hepatic/renal impairment, pregnancy, sepsis. |
| Serotonin Receptor Agonists: Triptans (Imitrex) | -Terminate a migrane attack. -Constricts blood vessels; decrease inflammation. -Adverse: Chest symptoms, coronary vasospasm, teratogenesis, malaise. -Do not take on a daily basis or else toxic! -Interacts with ergot, MAOIs. -Can change a EKG in CAD p |
| Beta Blocker (Propanolol) | Is the preferred prophylactic drug of choice for migraines; takes several weeks to work. |
| What drugs are used as prophylactic treatment for migranes and other headaches? | Beta blockers (propanolol), tricyclic antidepressants (Elavil), Antipileptic drugs (Topamax), estrogens (for menstrual migraines), calcium channel blockers (Verapamil), Candesartan, Botox. |
| Amitriptyline (Elavil) | Is the drug of choice for treating tension-type headaches. |
| Bensodiaszepines (-pam) | -Drug of choice for short-term insomnia. -Amplifies & intensifies GABA effect. -Caution: Tetragenic, do not use in glaucoma, use may decrease Xanax, Valium, Tagamet. -S/S Overdose: Lethargy, confusion, CV & resp depression, coma, death. |
| Barbiturates (-barbital, -butal) | -For anxiety, anesthesia, insomnia. -Powerful CNS depressant. -Contraindicated with porphyria dx. -Rarely prescribed for insomnia. -Lethal overdose can occur! -Adverse: Coma, death, resp. depress, tolerance to other opioids, dependence, CV collapse. |
| Benzodiazepine-like Drugs (Ambien) | -Is a sedative hyponotic. -For short-term use only. -Can reduce sleep latency, prolong sleep. |
| Lunesta (Eszopiclone) | -Is a hyponotic. -Approved for long-term use. -No tolerance, but withdrawal can occur. |
| Ramelton (Rozerem) | -For chronic insomnia; appears safe for long-term use. -Is a melatonin agonist. -Well tolerated. |
| What are some nursing implications with drugs used for insomnia/sedative hyponotics? | -Use for 7 to 10 days, then re-evaluation for primary cause of insomnia (psychiatric, medical disorder.) -Take immediately before bed. -Watch for: dizziness, short-term memory loss, coordination problems. -No other CNS depressants while using! |
| What are some alternative treatments for insomnia? | -Avoid caffeine. -Exercise early in the day. -Avoid naps. -Utilize progression relaxation techniques. |
Created by:
lgnames
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