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Pharm Unit 3 CNS
Study Guide
| Question | Answer |
|---|---|
| CNS consists of what 2 things? | Brain and spinal cord |
| The blood-brain barrier allows which substances to cross by way of a specific transport system? | Lipid-soluble agents and drugs that are able to cross by way of specific transport systems. |
| What is the precise way in which CNS drugs work? | As a rule, we do not understand with precision how CNS drugs produce their effects. |
| The enzyme for synthesis of prostaglandins is? | Cyclooxygenase (COX) |
| Inhibition of cyclooxygenase-2 (COX-2) results in what 3 things? | Suppression of inflammation, alleviation of pain, and reduction of fever. |
| Aspirin should not be used in the treatment of fever in children because of the risk of the development of? | Reye's Syndrome |
| Therapeutic uses of aspirin include what 6 things? | Suppression of inflammation, analgesia, reduction of fever, dysmenorrhea, suppression of platelet aggregation, and cancer prevention. |
| Antiulcer drugs can be used to prevent and treat aspirin-induced ulcers. For prevention, patients at high risk can take a ____ or ____. | proton pump inhibitor (PPI) or misoprostol |
| The principal indications for use of the nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are the treatment of what two things? | Rheumatoid arthritis and osteoarthritis |
| The first COX-2 inhibitor approved by the U.S. Food and Drug Administration (FDA) was? | (Celecoxib) Celebrex |
| A specific antidote to acetaminophen? | Acetylcysteine given PO or IV |
| What can antagonize the antiplatelet actions of aspirin and can thereby decrease protection against thrombotic events? | Ibuprofen |
| What is a general term defined as any drug, natural or synthetic, that has actions similar to those of morphine. | Opioid |
| Responses to the activation of _____________ include analgesia, respiratory depression, euphoria, sedation, and the development of physical dependence. | Mu receptors |
| ________________ is the prototype of the strong opioid analgesic and remains the standard by which newer opioids are measured. | Morphine |
| The most serious adverse effect of the opioids is _________; however, when administered at usual therapeutic doses, they ________________________significant respiratory depression. | respiratory depression |
| The adverse effect on the gastrointestinal system related to opioid use is what? | Constipation |
| How does the use of morphine elevate intracranial pressure? | By suppressing respiration, morphine increases the CO2 content of blood, which dilates the cerebral vasculature, causing the rise in ICP. |
| Opioid overdose causes what 3 things? | Coma, respiratory depression, and pinpoint pupils. |
| Use of meperidine is on the decline because of what 3 things? | Short-half life (causing drug to adm. in short intervals), interacts adversely with many drugs, and with prolonged use there is a risk of harm owing to accumulation of a toxic metabolite. |
| The most effective dosing schedule for morphine is? | A fixed schedule. |
| To minimize physical dependence and abuse, opioid analgesics should be administered in ______. | gradual smaller doses over a period of 3 days. |
| Multiple factors contribute to the undertreatment of patients with pain caused by cancer, including what 3 things? | Inadequate physician training in pain management, unfounded fears of addiction, and a health care system that focuses more on treating disease than relieving suffering. |
| Pain, as defined by the International Association for the Study of Pain, is | an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. |
| _________pain results from injury to tissues, whereas_______pain results from injury to peripheral nerves. | Nociceptive; neuropathic. |
| Three types of analgesics employed for the treatment of pain caused by cancer include: | nonopioid, opioid, and adjuvant analgesics. |
| Which nonsteroidal anti-inflammatory drug (NSAID) subclass does not inhibit platelet aggregation and therefore is safe for patients with thrombocytopenia? | nonacetylated salicylates (eg. choline salicylate) |
| The American Society of Addiction Medicine defines addiction as | a disease process characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm. |
| Certain antiseizure drugs, such as carbamazepine and gabapentin, can help relieve which type of pain? | neuropathic pain |
| Excessive excitability of neurons in the CNS. | Epilepsy |
| A seizure that persists for 30 minutes or longer. | Status Epilepticus |
| The goal in treating epilepsy is to | Reduce seizures to an extent that enables the patient to live a normal or near-normal life. |
| The drug most widely used to treat epilepsy is | valproic acid |
| Initial control of generalized convulsive status epilepticus is accomplished with intravenous (IV) administration of | |
| Treatment modalities for depression include what 3 things? | Pharmacotherapy, depression-specific psychotherapy, and electroconvulsive therapy (ECT) |
| What are the most widely prescribed antidepressants? | Selective serotonin reuptake inhibitors (SSRIs) |
| What 3 precautions can be taken to reduce the chances of suicide in the depressed patient? | Should be observed closely, scripts should be written for the smallest number of doses consistent with good patient management, and inpatient dosing should be closely observed to see that it is swallowed. |
| What is the mechanism of action of fluoxetine? | Inhibition of serotonin reuptake, thereby intensifies transmission at serotonergic synapses. |
| The risk of serotonin syndrome is increased by concurrent use of what 3 things? | An MAOI, or by use of ritonavir and other drugs that can increase fluoxetine levels. |
| Agents given to relieve anxiety are known as | antianxiety agents or anxiolytics |
| Agents given to promote sleep are known as | hypnotics |
| The three principal indications for benzodiazepines are | anxiety, insomnia, and seizure disorders |
| Withdrawal from long-term, high-dose benzodiazepine therapy can result in what 6 things? | panic, paranoia, delirium, hypertension, muscle twitches, and outright convulsions. |
| Treatment of the patient who overdoses on oral benzodiazepines includes | It rarely causes serious toxicity. Generally, if a patient shows signs of OD, it is likely to assume that it was in fact from a different drug. |
| The principal adverse effects of benzodiazepines are what 2 things? | daytime sedation and anterograde amnesia |
| The six major classes of primary anxiety disorders include | generalized anxiety disorder, panic disorder, OCD, phobic disorder, PTSD, and acute stress disorder. |
| The two classes of drugs used most commonly for anxiety disorders are | benzodiazepines and SSRIs |
| Chronic condition characterized by uncontrollable worrying. | Generalized anxiety disorder |
| Drugs of first choice for treating anxiety and insomnia. | Benzodiazepines |
| An inhibitory neurotransmitter found throughout the CNS. | GABA |
| Drugs that can directly mimic GABA. | Barbituates |
| Impaired recall of events that take place after dosing. | Anterograde amnesia |
| What drug is given to patients who have not responded to TCAs or SSRIs? | MAO inhibitors |
| Asserts that depression is caused by functional insufficiency of monoamine neurotransmitters (norepi,serotonin). | Monoamine |
| Just as effectve as the TCAs and better tolerated. | SSRIs |
| Abnormal motor phenomena | Convulsion |
| General term that applies to all types of epileptic events. | Seizure |
| Several AEDs potentiate the actions of what? | GABA |
| May be convulsive or nonconvulsive. They produce immediate loss of consciousness. | Generalized seizures |
| Excessive growth of gum tissue; characterized by swelling, tenderness, and bleeding of the gums. | Gingival hyperplasia |
| AEDs act through 4 basic mechanisms: | blockade of sodium channels, blockade of calcium channels, blockade of receptors for glutamate, and potentiation of GABA. |
| Pain that results from injury to (eg. bones, joints, muscles) | Somatic pain |
| Pain that results from injury to (eg. small intestine). | Visceral pain |
| Used to complement the effects of opioids. | Adjuvant analgesics |
| Organization charged with accrediting hospitals and other healthcare institutions in the U.S. | JCAHO |
| The purpose of the pain management standards set by JCAHO? | To make assessment and management of pain a priority in the nation's healthcare system. |
| Drugs that relieve pain without causing loss of consciousness. | Analgesics |
| A state in which an abstinence syndrome will occur if drug use is abruptly discharged. | Physical dependence |
| Drug use that is inconsistent with medical or social norms. | Abuse |
| A behavior pattern characterized by continued ude of a psychoactive substance despite physical, psychologic, or social harm. | Addiction |
| A method of drug delivery that permits the patient to self-administer parenteral opioids on an "as-needed" basis. | Patient-controlled analgesia |
| Act as antagonists at the mu receptors and at kappa receptors. | Pure opioid |
| If administered in excessive dosage to an individual who is physically dependent on opioid agonists, ______will precipitate what? | naloxone; an immediate withdrawal syndrome |
| What are used primarily to treat opioid overdose? | pure opioid |
| Found in practically all tissues, where it mediates "housekeeping" chores. | COX-1 |
| Important functions of the COX-1? (3) | Protecting the gastric mucosa, supporting renal function, and promoting platelet aggregation. |
| Produced mainly at sites of tissue injury. | COX-2 |
| What are the functions of the COX-2? (2) | Mediated inflammation and sensitizes receptors to painful stimuli. |
| Other than at sites of tissue injury, what 2 other places can COX-2 be found? | Brain and kidney. |
| Primarily mediates beneficial processes. | COX-1 "good COX" |
| Primarily mediates harmful processes. | COX-2 "bad COX" |
| Enzyme that converts arachidonic acid into prostaglandins and related compounds. | Cyclooxygenase (COX) |
| Ringing in ear | Tinnitus |
| What can acetaminophen do? Can't do? | Can reduce pain and fever; cannot suppress inflammation. |
| Inhibit COX-1 and COX-2 and are a large and widely used family of drugs. | Firs-generation NSAIDs |
| Aspirin suppresses platelet aggregation by doing what? | Causing irreversible inhibition of COX-1. |
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