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Pharm Test 3->CNS
CNS
| Question | Answer |
|---|---|
| drugs that depress the CNS: depression of conscousness, loss of responsiveness to sensory stimulation, muscle relaxation | anesthetics |
| drugs that induce a state in which the CNS is altered to produce varying degrees of pain relief, depression of consciousness, skeletal muscle relaxation, & reflex reduction | general anesthetics |
| total analgesia, LOC, loss of memory,body movement, & sensation are signs of ___ ___ | general anesthesia |
| volatile liquids or gases that are vaporized in O2 and inhaled | inhaled anesthetics |
| ___ ___ is an example of an inhaled anesthetic | nitrous oxide |
| enflurance (Ethrane), halothane (Fluothane), isoflurane (Forane), methozyflurane (Penthrane) are all examples of ___ ___ ___ | inhaled volatile liquids |
| administered IV, used to induce or maintain anesthesia, induce amnesia, used as an adjunct to inhalation-type anesthetics | injectable anesthetics |
| this drug is used to induce & maintain monitored anesthesia care sedation during diagnostic procedures in adults, used in intubated, mechanically ventilated adults in ICU to keep them continuously sedated & control stress (doses 5-50 mcg/kg/min) | Propofol/Diprivan |
| when multiple meds are given, induce rapid unconsciousness, advantage is lower dose of inhalation anesthetic, safer for pt | balanced anesthesia |
| sedative hypnotics such as barbiturates & benzodiazepines, & opioids(narcotics): orderly & systematic reduction of sensory & motor CNS function, progressive depression of cerebral & spinal cord functions | adjunctive drugs |
| general anesthetics used during surgical procedure to produce unconsciousness, skeletal muscle relaxation, visceral smooth muscle relaxation, rapid onset, quicly metabolized | adjunctive drugs |
| adverse effects include sites primarily affected (heart,peripheral circulation,liver,kidneys,respiratory tract), myocardial depression is common, malignant hyperthermia (serious) | adjunctive drugs |
| also called regional anesthetics, used to render a specific portion of body insensitive to pain, interfere w/ nerve impulse transmission to specific areas of body, do not cause LOC, topical & parenteral(spinal) | local anesthesia |
| typer of ____ ____ include spinal or intraspinal, infiltration, nerve block, & topical | local anesthesia |
| are used for surgical, dental, & diagnostic, & treatment of certain types of chronic pain | local anesthetics |
| these are given by infiltration anesthesia and nerve block anesthesia | local anesthetics |
| increased doses can cause cardiac palpitations, difficulty breathing & swallowing | local anesthetics |
| most commonly used local anesthetic: used for nerve blocks, several strengths w/ epi. & w/o: the epi. reduces the blood loss from minor surgeries b/c of its vasoconstricting properties & reduces systemic absorption | Lidocaine (Xylocaine) |
| lidocaine is an ____ | amide |
| report any inflamed skin or mucous membranes from use of ____ | Solarcaine (Benzocaine) |
| autonomic activity is lost ___; then ___ & other ___ ___ are lost; ___ activity is lost last; as local drugs wear off, recovery occurs in ___ order | 1st: pain & sensory functions: motor: reverse |
| used for minor surgical & dental procedures, injection of solution into intradermal, SC, or submucosally across path of nerves supplying the target area, may be given in a circular pattern around the operative area | infiltration anesthesia |
| used for surgical, dental, & diagnostic procedures, used for therapeutic mngmnt of pain, injected directly into or around the nerve trunks or nerve ganglia that supply the area to be numbed | nerve block anesthesia |
| spinal HA, epidural blood patch, slow metabolic breakdown, injection into highly vascular tissue, large dose can cause ____ | adverse effects to occur |
| prevent nerve transmission in certain muscles, resulting in paralysis of the muscle, when used during surgery, artificial mechanical ventilator is required | neuromuscular blocking drugs (NMBAs) |
| short acting, intermediate acting, long acting NMBAs are called ____ ____ | nondepolarizing drugs |
| ____ ____ must be administered by highly qualified nurse anesthetists, b/c if given too rapidly, it may cause bradycardia, & rarely cardiac arrest | depolarizing drugs |
| these drugs paralyze respiratory & skeletal muscles, pt cannot breathe on own, do not cause sedation or relief of pain, pt may be paralyzed yet conscious | NMBAs (neuromuscular blocking drugs) |
| if NMBAs are given in ___ ___, it can cause hypotension, urinary retention, & tachycardia | high doses |
| the antidote used for excessive NMBAs are ___ & ___ | atropine & neostigmine |
| the only depolarizing agent, ultra-short acting skeletal muscle relaxant, adjunct to general anesthesia, ET intubation | Succinylcholine (Anectine) |
| Pancuronium, d-tubocurarine, Vecuronium are all ___ ___ | nondepolarizing drugs |
| metabolism is slower than ACh, so as long as Succinylcholine is present, ___ cannot occur, & results in flaccid muscle prarlysis | repolarization |
| works by binding to Ach receptors at neuromuscular junctions to cause total skeletal muscle relaxation, prevents nerve transmission in certain muscles, leading to paralysis, requires artificial mechanical ventilation | Succinylcholine (Anectine) |
| prevent Ach from acting at the neuromuscular junctions, nerve cell membrane is not depolarized, muscle fibers are not stimulated, skeletal muscle contraction does not occur | nondepolarizing drugs |
| an intermediate acting nondepolarizing NMBA, used as an adjunct to general anesthesia to facilitate tracheal intubation, provides skeletal muscle relaxation during surgery or mechanical ventilation, most commonly used | Vecuronium (Norcuron) |
| long term use in ICU has resulted in prolonged paralysis & consequent difficulty weaning from the mechanical ventilation-> due to an active metabolite which tends to accumulate with prolonged use | Vecuronium (Norcuron) |
| with neuromuscular blocking drugs, the first sensation felt is ___ ___, followed by total ___ ___. Finally, ___ ___ & the ___ are affected, resulting in cessation of respirations. Recovery os muscular activity occurs in ___ order. | muscle weakness: flaccid paralysis: intercostal muscles: diaphragm: reverse |
| used mainly for maintaining controlled ventilation during surgical procedures, endotracheal intubation, reduce muscle contraction in an area that needs surgery, diagnostic drugs for myasthenia gravis | neuromuscular blocking drugs |
| these may cause hypotension & tachycardia | neuromuscular blocking drugs |
| ___ ___ may occur with overdose of NMBAs | cardiovascular collapse |
| also called conscious sedation, procedural sedation, combination of an IV benzodiazepine & an opiate analgesic used, anxiety & sensitivity to pain are reduced, & pt cannot recall procedure, preserves the pts ability to maintain own airway , safer | moderate sedation |
| a sudden increase in temperature may indicate ___ ___ | malignant hyperthermia |
| drugs that have an inhibitory effect on the CNS to the degree that they reduce nervousness, excitability, & irritability w/o causing sleep | sedatives |
| cause sleep, a sedative can become this if given in large enough dose | hypnotics |
| dose-dependent, at low doses, calm the CNS w/o inducing sleep: at high doses, calm the CNS to the point of causing sleep | sedative-hypnotics |
| anesthesia for short surgical procedures -> mephohexital,thiamylal,thiopental | ultrashort barbiturate |
| sedative-hypnotic & control of convulsive conditions -> pentobarbital, secobarbital | short barbiturate |
| sedative-hypnotic, epileptic seizure prophylaxis -> phenobarbital, mephobarbital | long barbiturate |
| sedative-hypnotic & control of convulsive conditions -> butabarbital | intermediate barbiturate |
| ___ have a very narrow therapeutic index | barbiturates |
| works at the brainstem (reticular formation): work by inhibiting GABA, nerve impulses traveling in the cerebral cortex are also inhibited, stimulate liver enzymes that cause the metabolism or breakdown of many drugs resulting in a short duration of action | barbiturates |
| can cause drowsiness, lethargy, respiratory depression, apnea, N & V, diarrhea, constipation, agranulocytosis, hypotension, Stevens-Johnson syndrome, vertigo, mental depression, cough, bronchospasms, reduced REM sleep | barbiturates |
| overdose can lead to ___ & ___ ___ | respiratory & CNS depression |
| ETOH, antihistamines, benzodiazepines, opioids, & traquilizers have ___ effects on barbiturates | additive |
| MAOIs will ___ effects of barbiturates | prolong |
| ___ reduces anticoagulant response, leading to possible clot formation | barbiturates |
| most frequently prescribed sedative-hypnotics,anxiety reliever | Benzodiazepines |
| long acting sedative-hypnotic types -> estazolam (Prosom), flurazepam (Dalmane) | Benzodiazepines |
| short acting sedative-hypnotic types -> temazepam (restoril) & triazolam (Halcion) | Benzodiazepines |
| effects chemicals in brain that may become unbalanced & cause sleep problems: it is used to treat insomnia symptoms: stop taking this if you get hives, have difficulty breathing, swelling of face, lips, tongue, throat | Restoril |
| a hypnotic that is used 4 treating insomnia, chemically unrelated to the benzodiazepine class of meds for sleep, but has similar effects b/c it attaches to same receptors on nerve cells: can caused HA, drowsiness, stomach ache, muscle pain, amnesia | Sonata/zaleplon |
| sedative-hypnotic, causes sedation, muscle relaxation, anti-convulsants, reduce anxiety, closely related to benzodiazepines, oral spray has rapid absorption: can cause a "drugged" feeling, confusion, insomnia, euphoria, ataxia, & visual changes | zolpidem (Ambien) |
| depress CNS activity, affect hypothalamic, thalamic, & limbic systems of brain, do not suppress REM sleep, do not increase metabolism of other drugs | benzodiazipines |
| calming effect on the CNS, useful in controlling agitation & anxiety, reduce excessive sensory stimulation, inducing sleep, induce skeletal muscle relaxation | benzodiazipines |
| give benzodiazipines ___-___ ___ before bedtime for maximum effectiveness in inducing sleep | 15-30 minutes |
| most benzodiazipines cause ___ rebound & a tired feeling the next day | REM |
| act to relieve pain associated w/ skeletal muscle spasms, majority are central acting (CNS is site of action, similar in structure & action to CNS depressants), direct acting (acts directly on skeletal muscle, closely resembles GABA) | muscle relaxants |
| relief of painful musculoskeletal conditions (muscle spasms, management of spasticity of severe chronic disorders, multiple sclerosis, cerebral palsy) use w/ physical therapy | muscle relaxants |
| dantrolene (Dantrium) | muscle relaxant (malignant hyperthermia crisis) |
| these can cause euphoria, lightheadedness, dizziness, drowsiness, fatigue, muscle weakness | muscle relaxants |
| baclofen (lioresal) cyclobenzaprine (Flexeril), dantrolene (Dantrium), metaxalone (Skelaxin), tizanidine (Zanaflex) | muscle relaxants |
| a derivative of GABA primarily used to treat spasticity, especially in instances of spinal cord injury, been shown to be as effective as valium in uncomplicated alcohol withdrawal syndrome: can cause vomiting, muscular hypotonia, drowsiness, coma | baclofen (Lioresal) |
| relieves muscle spasm when it is due to local problems (problems originating in the muscle itself not in the nerves controlling the muscles), has no effect on muscle function: can cause drowsiness, dry mouth, & dizziness, nausea, constipation, tiredness | Flexeril (cyclobenzaprine) |
| medical emergency, repeated continuously, occurs w/ any type of seizure, can lead to hypoglycemia, acidosis, hypothermia due to increased metabolic needs, lactic acidosis, & heat loss: MAINTAIN AIRWAY | status epilepticus |
| also known as anticonvulsants: controls or prevents seizures while maintaining a reasonable quality of life, minimizes adverse effects & drug-induced toxicity, usually lifelong | antiepileptic drugs |
| prevents generation & spread of excessive electrical discharge from abnormally functioning nerve cells & protects surrounding normal cells, thought to alter movement of sodium, potassium, & calcium ions across nerve cells in the brain | AED therapy |
| used for a management of a variety of seizures & insomnia, supresses abnormal neuronal discharges w/o causing sedation, low margin for safety, causes profound CNS depression, high potential for dependence, Qd dosing, inexpensive, long acting | barbiturate -> Phenobarbital (Luminal) |
| S/S of this drug include drowsiness, hypotension, vitamin D deficiency, folate or B9 & B12 deficiency, laryngospasms, bruising, petechiae, epistaxis, GI bleeding, hematuria, repiratory depression | barbiturate -> Phenobarbital (Luminal) |
| drugs that supress sodium influx are called ____ | hydantoins |
| most frequently prescribed AED, management of all types of seizures | phenytoin (Dilantin) |
| side effects of this drug include HA, ataxia, hypoglycemia, bradycardia, dysrhythmias, hypotension, hyperglycemia, confusion, slurred speech, blood dyscrasias | phenytoin (Dilantin) |
| long term use of this drug can cause gingival hyperplasia, acne, hirsutism, hypertrophy of subq facial tissue, & osteoporosis | phenytoin (Dilantin) |
| treatment of generalized seizures & shown to control partial seizures, can cause drowsiness, N & V, GI upset, weight gain, hair loss, HEPATOTOXICITY, PANCREATITIS, mouth sores, take w/ food to decrease GI upset, do not take w/ carbonated beverages | Valproic acid (Depakote & Depakene) |
| do not take this med with aspirin, cimetidine, erythromycin, and warfarin | Valproic acid (Depakote & Depakene) |
| used in treatment of epilepsy in adults & for treatment of trigeminal neuralgia, chemically related to tricyclic antidepressants, 1st line AED, treatment of simple-partial,complex-partial, & generalized tonic-clonic seizures | Carbamazepine/ Tegretol |
| seizures are called ____ if there is no LOC: ___ if there is LOC | simple:complex |
| medicines that inhibit seizures are called ____ | anticonvulsants |
| works as an anticonvulsant for partial and grand mal seizures by reducing or blocking certain responses in the brain | Tegretol |
| side effects of this drug include low RBC and WBC counts, skin reactions, liver abnormalities, hepatitis, jaundice, low sodium levels, thyroid abnormalities, dizziness, N & V, unsteadiness | Carbamazepine/ Tegretol |
| used as an adjunctive medication to control partial seizures, used to treat neuropathic pain following shingles, most common side effects include dizziness, drowsiness, peripheral edema, swelling of extremities, somnolence, HTN, N & V, fluid retention | Gabapentin/Neurontin |
| use only ___ ___ with IV phenytoin | normal saline |
| directly replaces the deficient neurotransmitter dopamine in the substantia nigra, is the biologic precursor of dopamine | Levodopa (Larodopa) |
| ___ can be boosted by combining it with Carbidopa (Sinemet) by preventing the early breakdown by inhibiting the enzyme that converts levodopa to dopamine prematurely | Levodopa |
| side effects of this drug include uncontrolled & purposeless movements | Levodopa |
| ___ is a precursor of dopamine: blood brain barrier does not allow exogenously supplied dopamine to enter, but does allow ___; ___ is taken up by the dopaminergic terminal, converted into dopamine, then released as needed | levodopa |
| As a result, the neurotransmitter imbalance is controlled in patients with early ___ ___ who still have functioning nerve terminals | parkinson's dz |
| levodopa no longer controls ___ ___, & pt is seriously debilitated; this generally occurs between __ & __ ___ after the start of levodopa therapy | parkinson's dz; 5&10 yrs |
| drug therapy for parkinson's dz is aimed at increasing levels of ___ as long as there are functioning nerve terminals remaining: antagonizes or blocks the effects of ___ | dopamine: Ach |
| an anticholinergic drug used to treat the symptoms of Parkinson's dz, such as muscle spasms, stiffness, sweating, drooling, & poor muscle control | Benztropine |
| side effects of this drug include dry mouth, blurred vision, cognitive changes, constipation, urinary retention, tachycardia, anorexia, & psychosis | Benztropine |
| ___ is a newer, potent, irreversible MAOI that selectively inhibits MAO-B: does not elicit the cheese effect of the nonselective MAOIs used to treat depression: causes an increase in the levels of dopaminergic stimulation in the CNS | Selegiline |
| ____ break down catecholamines in the CNS, primarily the brain | MAOIs (monoamine oxidase inhibitor) |
| only ___ to ___ of patients show a positive response to Selegiline therapy | 50-60% |
| prophylactic selegiline may delay the development of serious debilitating PD for ___ to ___ ___ | 9-18 years |
| nausea, lightheadedness, dizziness, abdominal pain, insomnia, confusion, dry mouth are all side effects of ___ | selegiline |
| used to provide exogenous replacement of lost dopamine or to enhance the function of the few neurons that are still producing their own dopamine: goal is to increase levels of dopamine in the brain & reduce the most detrimental complications of PD | dopaminergic therapy |
| these drugs work presynaptically to increase brain levels of dopamine | replacement drugs (presynaptic) dopaminergic therapy |
| newer, nonergot dopamine agonist, used to treat PD, helps replace brain chemical dopamine, also used to treat RLS: can cause N, dizziness, drowsiness, constipation, trouble sleeping, weakness, GI upset & pain, HA, dry mouth | Ropinirole (requip) |
| used to treat muscle tremors & muscle rigidity associated w/ PD, does not relieve bradykinesia | anticholinergic therapy |
| benztropine mesylate (Cogentin) is | an anticholinergic drug used for PD |
| these are used in the treatment of PD to cause smooth muscle to relax, resulting in reduced muscle rigidity & akinesia: also used to treat drug-induced extrapyramidal reactions to certain antipsychotic drugs | anticholinergic therapy |
| adverse effects of these include drowsiness, confusion, disorientation, constipation, N & V, urinary retention, pain on urination, blurred vision, dilated pupils, phtophobia, dry skin, decreased salivation, dry mouth | anticholinergic drugs |
| blocks effects of Ach, anticholinergics inhibit the over activity of this neurotransmitter in the corpus striatum of the brain: relieves symptoms of PD, treats extrapyramidal side effects, suppresses tremors | Cogentin |
| side effects of this drug include sedation, dry mouth, constipation, N/V, & tachycardia | Cogentin |
| teach patient to avoid food high in ___ when taking meds for PD | vitamin B6 |
| ___ (___) in doses greater than 10 mg will reverse the effects of levodopa | pyridoxine (vitamin B6) |
| taking levodopa with ____ may result in a hypertensive crisis | MAOIs |
| levodopa preparations may ___ the pt's ___ & ___ | darken: urine & sweat |
| treats emotional & mental disorders | psychotherapeutics |
| a severe emotional disorder that impairs the mental function of the affected individual to the point that the individual cannot participate in ADLs: loss of contact w/ reality | psychosis |
| unpleasant state of mind, characterized by a sense of dread & fear, may be based on actual anticipated experiences or past experiences, exaggerated repsonses to imaginery negative situations | anxiety |
| this theory states that mental disorders are associated with abnormal levels of endogenous chemicals, such as neurotransmitters, in the brain | Biochemical imbalance theory |
| these antianxiety drugs depress activity in the brainstem & limbic system | benzodiazepines |
| these antianxiety drugs depress CNS by sedation, primarily used for allergic conditions | antihistamines |
| these were previously used to treat anxiety but replaced by newer drugs | barbiturates & carbamates |
| these drugs are potentially habit-forming & addictive & should be used at lowest effective dosages & frequencies needed for symptom control | benzodiazepines |
| the drug of choice for the treatment of mania: causes a shift in the Na ions and catecholamine metabolism | lithium |
| this states that depression & mania are due to an alteration in neuronal & synaptic catecholamine concentration at adrenergic receptor sites in the brain | biogenic amine hypothesis |
| deficiency of catecholamine, esp. norepinephrine and decrease in serotonin | depression |
| excess amines but decreased serotonin levels | mania |
| ____ have fewer adverse effects than tricyclics & MAOIs | newer-generation antidepressants (selective serotonin reuptake inhibitors & second & third generation antidepressants) |
| bupropion (wellbutrin) & SSRIs (fluoxetine)(Prozac) | second-generation antidepressants |
| mirtazapine(Remeron) | third-generation antidepressants |
| selectively inhibit serotonin reuptake, little or no effect on norepinephrine or dopamine reuptake, results in increased serotonin concentration at nerve endings, advantage over tricyclics & MAOIs b/c little or no effect on CV system | SSRIs (selective serotonin reuptake inhibitors) |
| have largely been replaced as first-line antidepressant drugs by SSRIs, considered 2nd-line, for pts who fail with SSRIs or other newer-generation antidepressants, used as adjunct therapy with newer antidepressants | tricyclics (amitriptyline)(Elavil) |
| block reuptake of neurotransmitters, causing accumulation at the nerve endings, thought that this increase will correct the abnormally lower levels that lead to depression | tricyclics |
| blocks norepinephrine and serotonin reuptake | tricyclics |
| decrease drug absorption w/ activated ___ if overdose of tricyclic antidepressants occurs: speed elimination by ____ ____ | charcoal: alkalinizing urine |
| highly effective, 2nd-line treatment for depression not responsive to other therapy like cyclic: disadvantage is potential to cause hypertensive crisis when taken with tyramine | MAOIs |
| inhibit the MAO enzyme system in CNS, amines are not broken down, resulting in higher levels in the brain, alleviates symptoms of depression | MAOIs |
| avoid foods that contain ___ when taking MAOIs, such as aged cheeses, smoked/pickled meats, fish, poultry, yeast extracts, red wines, italian broad beans | tyramine |
| concurrent use of MAOIs and SSRIs may lead to ___ ___ | serotonin syndrome |
| drugs used to treat serious mental illness, behavioral problems, or psychotic disorders | antipsychotics |
| block dopamine receptors in the brain (limbic system & basal ganglia)->areas associated w/ emotion, cognitive function, & motor function, decreases dopamine levels in CNS, tranquilizing effect | antipsychotics |
| risperidone (Riseperdal) & olanzapine (Zyprexa) are ____ | atypical antipsychotics: second generation antipsychotics |
| block specific dopamine receptors (D2 receptors) and serotonin receptors (S2 receptors) | newer antipsychotics |
| this can be a potentially life threatening adverse effect of antipsychotics -> characterized by high fever, unstable BP, myoglobinemia | Neuroleptic malignant syndrome |
| this is an adverse effect of antipsychotics-> characterized by involuntary muscle symptoms similar to those of PD, akathisia, acute dystonia, can be treated w/ Congentin & Artane | extrapyramidal symptoms |
| adverse effect of antipsychotic -> characterized by involuntary contractions of oral & facial muscles, choreoathetosis (wavelike movements of extremities), & occurs w/ continous long-term therapy | tardive dyskinesia (TD) |
| it may take ___ ___ to show therapeutic effects of antidepressants | several weeks |
| ___ may need to be weaned & discontinued before surgery to avoid interactions w/ anesthetic drugs | tricyclics |
| ___ & ___ may decrease effectiveness of antidepressants | caffeine & smoking |
| pts need to wear ___ when taking antipsychotics due to photosensitivity | sunscreen |
| avoid taking ___ or ___ meds within one hour of an antipsychotic drug | antacid or antidiarrheal |
| therapeutic lithium levels = | 0.6-1.2 mEq/L |
| drugs that stimulate a specific area of the brain or spinal cord, sympathomimetic drugs | CNS stimulants |
| are used to treat ADHD, narcolepsy, migraine HA, analeptics, appetite suppressants | CNS stimulants |
| reversal of anesthesia-induced respiratory depression | analeptics |
| thought to suppress the appetite control center in the brain | anorexiants |
| stimulate the areas in the brain responsible for mental alertness & attentiveness | ADHD |
| increases mental alertness | narcolepsy |
| caffeine, co-administered with other drugs, used to treat HA | migraine headaches |
| amphetamine (adderall) & methylphenidate (Concerta, Ritalin) are used to treat ___ | ADHD |
| sibutramine (Meridia) & phentermine (Lonamin) are ___ | anorexiants |
| sumatriptan (imitrex) is used as an ___ | antimigraine |
| use is less frequent, used for neonatal apnea: doxapram (Dopram) & Methylxanthines, such as aminophylline, theophylline, & caffeine are all ___ | analeptics |
| found in OTC drugs, combination prescription drugs, foods: use w/ caution in pts w/ hx of PUD, recent MI, dysrhythmias, use for neonatal apnea, respiratory depression, enhances analgesics & migraine meds | caffeine |
| drugs for ___ should be given 6 hours before bedtime to reduce problems from insomnia | ADHD |
| take meds for ___ 30-45 minutes before meals | ADHD |
| act by constricting certain intracranial vessels, cause vasoconstriction of the cranial arteries, given SQ, PO, intranasal: can cause dizziness, drowsiness, warming sensation | sumatriptan (Imitrex) antimigraine |
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