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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 |
Created by:
kangaloo
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