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Neuro and Analgesics
Week 4
Question | Answer |
---|---|
What are the 3 parts of neuro regulation? | 1. Conducting an action potential 2. Releasing neurotransmitter 3. Binding transmitter molecules to receptors |
How do neuro drugs produce their effects? | By altering junctional transmission |
What are the steps in junctional transmission? | 1. Synthesis 2. Storage 3. Release 4. Receptor binding 5. Termination |
In junctional transmission, what triggers release of neurotransmitter? | Action potential at axon terminal |
Is receptor binding after release reversible? | Yes |
What is termination in regards to junctional transmission? | Removal of transmitter |
What do cholinergics do? | They stimulate actions of acetylcholine and consequently stimulate parasympathetic |
What does the parasympathetic n.s. do? | (rest and digest) -Slowing of heart rate, Increased gastric secretions,Emptying of bladder, Focusing the eye for near vision, Constricting the pupil, Contracting bronchial smooth muscle |
What are some examples of cholinergic drugs? | Anticholinergics, muscarinics, ganglionics, neuromuscular blocking, cholinesterase inhibitors |
What do cholinergic blockers do? | They block neuromuscular transmissions, inhibit cholinesterase, allow SNS |
Cholinergic means it uses ____ | Acetylcholine |
What do cholinesterase inhibitors do? | They indirectly influence cholinergic receptors by preventing the breakdown of acetylcholine |
What are adrenergic agonists? | They are drugs that mimic the sympathetic system. |
What does sympathomimetic mean? | Mimic the sympathetic system (adrenergic agonists) |
What is an example of an adrenergic agonist? | Epinephrine |
What are adrenergic antagonists? | Drugs that block neurotransmitters of the SNS and block SNS effects |
What is the pathology of Parkinson’s Disease? | Depletion of dopamine, an inhibitory transmitter |
What are some examples of drugs used to treat Parkinson’s Disease? | levodopa, carbidopa-levodopa |
How do epilepsy drugs work? | They reduce the rate of discharge of neurons and prevent spread of seizures to the rest of the brain |
What are some examples of drugs used to treat seizures? | phenytoin, phenobarbital, tegretol, diazepam (valium) |
What are categories of drugs used to treat muscle spasms/spasticity? | 1. Analgesics 2. Centrally acting skeletal muscle relaxants (diazepam) |
What are 3 examples of psycho-pharmacologic drugs? | Antipsychotics, antidepressants, lithium |
What are the categories of CNS depressants? | Sedatives, hypnotics, sedative-hypnotics |
What do sedatives do? | Reduce nervousness, excitability, and irritability without causing sleep |
What do hypnotics do? | They are more potent than sedatives, cause sleep |
What are some examples of sedative-hypnotics? | barbiturate, benzodiazapines, |
What are barbiturates indicated for? | Treatment of insomnia and producing sedation |
What is the MOA of barbiturates? | CNS depressant, acts on reticular formation in brainstem. Effects dose-related. Inhibit nerve impulse transmission traveling to areas of brain. Low doses:sedatives, higher:hypnotics (lowers RR). Enzymes in liver metabolize drugs quickly, shortens actions |
Low doses of barbiturates act as ____, high doses act as ____. | Low doses act as sedatives, higher doses act as hypnotics (decreases respiratory rate) |
What do hypnotics do? | They lower resp. rate |
What actions do barbiturates have in the liver? | They cause enzymes in the liver to metabolize drugs more quickly, shortening the drugs’ actions |
What are the indications for barbiturates? | Used as hypnotics, sedatives, anticonvulsants, anesthetics |
What are ultrashort barbiturates? | Anesthetics |
What are short barbiturates? | Sedative-hypnotics |
What are intermediate barbiturates? | Anticonvulsants and sedative-hypnotics |
What are long barbiturates? | Anticonvulsants and sedative-hypnotics |
What are some side effects of barbiturates? | Drowsiness, lethargy, dizziness, hangover, restless or excitement, affects normal sleep by depriving deep REM |
How do barbiturates affect sleep? | Affects normal sleep by depriving deep REM |
What are some adverse effects of barbiturates? | Respiratory depression, CNS depression |
What is the prototype of a long acting barbiturate? | Phenobarbital |
What is the prototype of a short acting barbiturate? | Pentobarbital (Nembutal) |
What is the most commonly prescribed sedative-hypnotic and why? | Benzodiazepines, because of their favorable side effects and safety |
What is the MOA of benzodiazepines? | CNS depressants. Act on hypothalamus, thalamus and limbic system. Has calming affect, controls agitation and anxiety |
What are some side effects of benzodiazepines? | Headache, drowsiness, excitement or nervousness, dizziness, lethargy |
What are adverse effects of benzodiazepines? | Can lead to falls in the elderly due to change in sleep cycle |
What are signs of benzodiazepine toxicity? | Confusion, coma |
What is the treatment for benzodiazepine toxicity? | Symptomatic and supportive |
What are some interactions of benzodiazepines? | Other CNS depressants |
What are prototypes of benzodiazapines? | Flurazepam (Dalmane). Temazepam (Restoril) |
What are muscle relaxants used for? | Needed for trauma, inflammation, anxiety, pain |
What is the MOA of muscle relaxants? | Work with CNS. Actions come from sedative affects, rather than direct muscle relaxation. Act on nerve transmission in spinal cord |
What are muscle relaxants indicated for? | Relief of muscle-skeletal conditions such as muscle spasms, chorea movements, spasticity |
What are chorea movements? | Any of various disorders of the nervous system marked by involuntary, jerky movements, especially of the arms, legs, and face, and by incoordination |
What are side effects/adverse effects of muscle relaxants? | CNS and skeletal muscle effects. Dizziness, drowsiness, euphoria, muscle weakness. Often short in duration |
What are some interactions of muscle relaxants? | Caution with other CNS depressants (alcohol, benzodiazapines) |
How is muscle relaxant toxicity treated? | There is no specific treatment. Supportive therapy is used |
What are some prototypes of muscle relaxants? | Flexeril; baclofen (Lioresal) |
What are CNS stimulants? | Drugs that stimulate a specific area of the brain or spinal cord. Often triggers SNS actions |
What is the MOA of CNS stimulants? | Increase energy, alertness, mood elevation |
What are some examples of CNS stimulants? | Cocaine, amphetamines, caffeine, Ritalin, anorexiants (Phentermine aka lonamin) |
What are CNS stimulants indicated for? | Depression,suppression of appetite, narcolepsy, ADHD |
What are side/adverse effects of CNS stimulants? | Increased heart rate, hypertension, restlessness, nervousness, nausea/vomiting |
What are some contraindications of CNS stimulants? | Herbal therapies. Ephedra problems, ginseng |
Pain threshold? | |
Pain tolerance? | |
Types of pain? | |
Causes of pain? | mechanical, thermal, chemical |
Opioids | |
Non-opioids | |
What are the classes of controlled substances? | Class 1-5, C-1 with the highest abuse potential, C-5 the lowest |
What are some contraindications of aspirin? | Children, pregnant women. peptic ulcer or bleeding disorders |
What is aspirin indicated for? | Treatment of headache, neuralgia, rheumatoid arthritis (inflammation, pain, fever, prevention of MI and stroke) |
What are some SE/AE of aspirin? | Nausea/vomiting, diarrhea, GI (stomach bleeding, gastric ulceration, renal impairment, bleeding) |
What are some nursing implications for aspirin use? | Give with fluids. Throw away if smelly |
What is Tylenol indicated for? | (Acetaminophen) Pain and fever (NOT inflammation). Analgesia and antipyretic. Used as OTC for those who cannot use aspirin |
What are some signs of adverse reaction to Tylenol? | Hepatotoxicity (liver damage) rash |
When is tylenol contraindicated? | Not for use w/ liver/renal disease. Chronic use has serious consequences |
What delays NSAID absorption? | Food |
What is the duration of NSAIDs? | Up to 85 hours |
What are some examples of NSAIDs? | Lodine (for osteoarthritis), Ibuprofen (advil, Motrin, Nuprin) |
What is the only NSAID that is OTC? | Ibuprofen |
When is indocin used? | When aspirin or Tylenol don’t work |
What is a first-generation NSAID? | Aspirin |
What is a non-aspirin first generation NSAID? | Ibuprofen, naproxen, keterolac |
What is the only injectable NSAID? | Toradol |
What is naproxen (Naprosyn) used for? | Treatment of osteoarthritis |
Are there side effects of naproxen (Naprosyn)? | Seldom enough to quit use |
Nursing care for Naprosyn/naproxen? | Monitor effectiveness |
What is the difference between opioids and non-opioids? | An opioid is any drug, natural or synthetic that has actions similar to those of morphine. |
What are narcotic agonists/ opiates? | Any analgesic from opium poppy, applies only to compounds present in opium |
What are some examples of opioids? | Morphine sulfate, fentanyl, demerol (Meperidine), codeine |
Where are opioids absorbed? | Absorbed well in GI |
What is the MOA for opioids? | Act at opiate receptors. Depress respiration, cause sedation. Can cause nausea and vomiting in GI |
What are opioids used to treat? | Treatment of severe pain, pre-anesthetic |
What does narcotic mean? | General term describe morphine-like drugs (wrong: narcotic has many definitions, used to mean analgesic, CNS depressant, any drug capable of causing physical dependence. Opioid is preferable to narcotic as label for discrete family of pharmacologic agent) |
What is MS Contin? | Sustained release tab of morphine sulfate |
What is Demerol (meperidine) used for? | Synthetic, used for post-op pain. Strong analgesic, short half-life, many adverse interactions |
What can codeine be used for? | Analgesia, antitussive (suppression of cough reflex by action on CNS and PNS) |
What are some side effects of morphine? | Respiratory depression, constipation, urinary retention, orthostatic hypotension, emesis, miosis, cough suppression, biliary colic |
What is oxycodone (Oxycontin)? | Related to morphine, with comparable analgesic properties |
Is Oxycontin/oxycodone available injectable? | No |
Oxycodone is usually combined with ___ or ___ | Aspirin or Tylenol |
What is hydrocodone? | Weaker form of oxycodone, available only in tablet |
What are mixed narcotics? | Using and opioid with a non-narcotic analgesic. Using the 2 classes causes synergistic reduction of pain, while avoiding dependance on opioid. Usually less likely to cause resp depression and few antitussive effects |
What is Percocet? | Codeine with Tylenol |
What is Percodan? | Codeine with aspirin |
What is Darvon/Darvon N? | Weaker in action, analgesic. Sedative?? |
What is Vicodin? | Tylenol and opioid |
What is Stadol? | Analgesic used in MCH?, pre-op, reactions less common, usually GI if any |
Nursing care for Stadol? | Watch for overdose, change in alertness, CNS, hallucination |
What can cause opioid overdose? | Aggressive therapy, psychoactive effects. Overdose is medical emergency due to respiratory depression, cardiac arrest. |
What is used to treat opioid overdose? | Narcan |
What is Narcan’s MOA for treating opioid overdose? | Narcan is used IV for immediate action. Blocks both mu and kappa receptors to reverse opioid. Works in minutes. Used when resp rate is below 10/min |
What are the side effects of Narcan? | Increased BP, tremors, hyperventilation, nausea/vomiting |