Midterm (New Content) CNS stimulants and Depressants 1. What are some uses for CNS stimulants? a.

ADHD b. Narcolepsy c. Reversal of respiratory distress d. Obesity e. Migraines 2. List the drugs and their uses. a. Amphetamines i. What do they do? 1. Stimulate the release of norepinephrine and dopamine ii. Uses 1. Increase wakefulness in narcolepsy 2. Decrease hyperactivity and impulsiveness of ADHD b. Analeptics (caffeine) i. An analeptic, in medicine, is a central nervous system stimulant medication. The term analeptic may also refer specifically to a respiratory analeptic (for example, doxapram), a drug that acts on the central nervous system to stimulate the breathing muscles, improving respiration. Mostly affect the brain and spinal cord, but also affect the cerebral cortex. The primary use of an analeptic is to stimulate respiration. One subgroup of analeptics is the xanthine (methylxanthines), of which caffeine and theophylline are the main drugs ii. CNS stimulants used to stimulate respiration iii. All end in PHYLLINE iv. Got away from using these anymore because they have a really low TI v. Xanthines 1. Caffeine a. Caffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug and a reversible acetylcholinesterase inhibitor 2. Theophylline

a. Theophylline is used to prevent and treat wheezing, shortness of breath, and difficulty breathing caused by asthma, chronic bronchitis, emphysema, and other lung diseases. It relaxes and opens air passages in the lungs, making it easier to breathe c. Anorexiants i. Appetite suppressants used to treat obesity ii. Use under MD supervision and emphasis on behavior modifications iii. Amphetamines- once freely prescribed as anorexiants iv. Not currently recommended for use as appetite suppressants v. FDA has ordered Phenylpropanolamine to be removed from OTC wt loss drugs and cold remedies vi. May cause an increased risk of hemorrhagic stroke 3. What a. b. c. d. e. f. g. h. i. j. 4. What a. are some nursing considerations for meds for ADHD? Want calm, non-stimulating environments They should not be having caffeinated beverages Teach there is a potential for these meds to be abused, could be selling etc. No drug holidays you are trying to achieve a balance of neurotransmitters here They should not be given within 6hrs of bed time. Give on empty stomach 30-45 min before breakfast and lunch Dont give to kids younger than 6 Weight loss is a big potential with these drugs Avoid pseudoephedrine any CNS stimulants really is an analeptic? Give some examples. An analeptic, in medicine, is a central nervous system stimulant medication. The term analeptic may also refer specifically to a respiratory analeptic (for example, doxapram: CNS and respiratory stimulant, is used to treat respiratory depression caused by drug overdose, pre and post-anesthetic respiratory depression, and COPD), a drug that acts on the central nervous system to stimulate the breathing muscles, improving respiration. Mostly affect the brain and spinal cord, but also affect the cerebral cortex. The primary use of an analeptic is to stimulate respiration. One subgroup of analeptics is the xanthine

(methylxanthines), of which caffeine and theophylline are the main drugs b. A drug that stimulates respirations c. Use the caffeine for infants 5. What med categories are used for acute migraine attacks? What is their MOA? a. Pathophysiology for migraines and cluster headaches i. Meds for migraines vasoconstriction the blood vessels, because the migraines are actually vasodilating the vessels, the vessels are engorged the meds constrict these ii. Inflammation and dilation of blood vessels in the cranium iii. Studies suggest an imbalance in the neurotransmitter serotonin that causes vasoconstriction and suppresses migraine headaches. Foods such as cheese, chocolate and red wine can trigger an attack iv. Cluster headaches are characterized by a severe unilateral non-throbbing pain usually located around the eye. They occur in a series of cluster attacks- one or more attacks every day for several weeks. They are not associated with an aura and do not cause nausea and vomiting. Vascular Theory: Vascular disturbances leads to migraine attacks. Migraine attacks are initiated by vasoconstriction in the cranial vasculature leading to oligemia and a reduction in cerebral blood flow that could be severe enough to generate an aura. Compensatory vasodilation occurring in intraor extracranial blood vessels is assumed to result in perivascular edema and inflammation that, in turn, trigger headache pain.5 HT (serotonin) is a key mediator in the pathogenesis of migraine, especially the vascular component of migraines. However, there is no correlation between changes in blood flow and migraine symptoms. v. MOA? 1. Analgesics 2. Opioid analgesics 3. Ergot alkaloids 4. Causes vasoconstriction of cranial arteries 5. Should be taken early in migraine attack 6. Ergotamine tartrate (Ergostat) 7. Triptans (Selective serotonin1 receptor agonists) 8. Also cause vasoconstriction of cranial arteries

6. What a. b. c.

9. Sumatriptan (Imitrex) are some meds used for prevention? Beta-adrenergic blockers Tricyclic antidepressants Anticonvulsants

7. List some categories of CNS depressants. a. Sedative-hypnotics (sleep) b. General and local anesthetics c. Narcotic and Non-narcotic analgesics d. Anticonvulsants e. Antipsychotics f. Antidepressants g. Centrally acting muscle reactants 8. What are some groups of sedative-hypnotics? (Name some drugs from each group) a. Barbiturates (CS II) i. Short-acting barbiturates 1. Used to induce sleep on those who have difficulty falling asleep 2. Pentobarbital (Nembutal) 3. Secobarbital (Seconal) ii. Intermediate-acting barbiturates 1. Useful as sleep sustainers for maintaining long periods of sleep 2. Butabarbital (Butisol) iii. Long-Acting barbiturates 1. Includes phenobarbital and mephobarbital 2. Used to control seizures in epilepsy iv. Ultrashort-Acting barbiturates 1. Thiopental sodium (Pentothal) is used as a general anesthetic b. Benzodiazepines (CS IV) i. Tranquilizers or anxiolytics to help induce sleep ii. Selected benzodiazepines as hypnotics 1. Temazepam (Restoril) 2. Lorazepam (Ativan) 3. Diazepam (Valium) iii. Drug-drug interactions?? 1. Any other CNS depressing/opioids type drugs should be avoided d/t potentiating sedative effect a. Valerian b. ETOH c. Kava Kava d. St. Johns Wort

c. Nonbenzodiazepines i. Zolpidem (Ambien) ii. Differs in chemical structure iii. Used for short term treatment of insomnia 1. Eszopiclone (Lunesta) 2. May worsen pre-existing depression d. What are some SE? i. Hangover 1. Residual drowsiness resulting in impaired reaction time ii. REM Rebound 1. Results in vivid dreams/nightmares, frequently occurs after taking a hypnotic for a prolonged period of time and abruptly stopping iii. Dependence 1. Result of chronic hypnotic use, can be physical and psychological. Physical dependence results in the appearance of specific withdraw symptoms when a drug is discontinued after prolonged use. Severity of withdraw symptoms depends on the drug and dosage. Symptoms may include: muscular twitching and tremors, dizziness, orthostatic hypotension, delusions, hallucinations, delirium, and seizures. Withdraw symptoms can start within 24hr and can last several days iv. Tolerance 1. Results when there is a need to increase the dosage over time to obtain the desired effect. Can cause tolerance after prolonged use. Tolerance is reversible when the drug is discontinued v. Excessive Depression 1. Long-term use of a hypnotic may result in depression, which is characterized by lethargy, sleepiness, lack of concentration, confusion, and psychological depression vi. Respiratory Depression 1. Can suppress the respiratory center in the medulla vii. Hypersensitivity 1. Skin rashes and uticaria can result when taking barbiturates. Rare. e. What are some safety considerations for the patient taking these drugs?

9. What a.

b.

c.

i. Benzodiazepines (except for temazepam) can suppress stage 4 of NREM sleep, which may result in vivid dream or nightmares and can delay REM sleep. Benzodiazepines are effective for sleep disorders for several weeks longer than other sedative-hypnotics ; to prevent REM rebound, however, they should not be used for longer than 3 to 4 weeks ii. You want to make sure the patient isnt taking any other CNS depressants or any herbs that have a depressive effect iii. Record and monitor vital signs, especially blood pressure and respirations iv. Assess renal impairment and liver enzymes (AST, ALT, bilirubin) v. Suggest client to urinate prior to bedtime to prevent sleep disruption vi. Assess potential for fluid volume deficit, which would potentiate hypotensive effects vii. Recognize that continuous use of a barbiturate might result in drug abuse viii. Implement safety precautions for elderly side rails ix. Encourage client to take hypnotic 30 min before bedtime. Short-acting hypnotics take effect within 15 min 30 min x. Do not abruptly stop these types of medications are the stages (4) of general anesthesia? Stage 1 Analgesia i. Begins with consciousness and ends with loss of consciousness. ii. Speech is difficult iii. Sensations of smell and pain are lost iv. Dreams are auditory and visual hallucinations may occur v. AKA the induction stage Stage 2 Excitement or delirium hyperactivity i. Produces a loss of consciousness called depression of the cerebral cortex ii. Confusion, excitement, or delirium occur combatitive iii. Short induction time iv. Excitement and hyperactivity Stage 3 Surgical operative stage i. Surgical procedure is performed during this stage ii. There are 4 stages iii. Surgery is usually performed in phase 2 and upper phase 3

iv. As anesthesia deepens, respirations become more shallow and respiratory rate is increased v. Surgical anesthesia, stage surgery begins and remains until procedure ends d. Stage 4 Medullary paralysis curtain call i. Toxic stage of anesthesia ii. Respirations are lost and circulatory collapse occurs iii. Ventilatory assistance is necessary iv. Paralysis of medulla, avoid this stage 10. What are some nursing considerations for the patient receiving regional (spinal or epidural) anesthesia? a. Clients response to anesthesia may differ according to variables related to the health status of the individual. These variables include age (young and old), a current health disorder (renal, liver), pregnancy, history of heavy smoking, obesity, and frequent use of alcohol and drugs. These problems must be identified before the surgery because the type and amount of anesthetic required might need adjustment b. Inhalation anesthetics are usually combined with a barbiturate (thiopental), a strong analgesic (morphine), and a muscle relaxant (pancuronium) for surgical procedures c. Adverse effects from inhalation anesthetics include respiratory depression, hypotension, dysrhythmias, and hepatic dysfunction. In clients at risk, these drugs may trigger malignant hyperthermia. The new drugs primarily cause less nausea and vomiting than the older anesthetics d. HYPOTENSION: increase fluid here bolus fluids. More volume = more pressure = increase in BP e. Patient must have adequate fluid onboard PRIOR to the anesthesia i. 1 L fluid: Epidural ii. 2 L fluid : Spinal f. Spinal headaches are a big deal with the Spinal ordeal g. Blood patch is what is used to correct the Spinal headaches h. Spinal anesthesia requires that a local anesthesia be injected in the subarachnoid space at the third or fourth lumbar space. If the local anesthetic is given too high in the spinal column, the respiratory muscle could be affected, and respiratory distress or failure could result. Headaches might result following spinal anesthesia (a spinal), possibly because of a decrease in cerebrospinal fluid pressure caused by a leak of fluid at the needle insertion point. Encouraging the client to remain flat following surgery with spinal anesthesia and to take

increased fluids usually decreases the likelihood of leaking spinal fluid. Hypotension can also result following spinal anesthesia. i. Various sites of spinal column can be used for a nerve block with local anesthetic. A spinal block is the penetration of the anesthetic into the subarachnoid membrane, the second layer of the spinal cord. An epidural block is the placement of the local anesthetic in the outer covering of the spinal cord, or the dura matter. A caudal block is placed near the sacrum. A saddle block is given at the lower end of the spinal column to block the perineal area. Blood pressure should be monitored during administration of these types of anesthesia, because a decrease in blood pressure resulting from the drug and procedure might occur. A saddle block is frequently used for women in labor during childbirth. j. Nurses play an important role in client assessment before and after general and local anesthesia is administered. Preparing the client for surgery by explaining the preparations and completing the preoperative orders, including premedications, are necessary to enhance the safety and effectiveness of anesthesia and surgery. k. Monitor clients post-op state of sensorium. Report if client remains nonresponsive or confused for a time. l. Check preop and postop urine output. Report deficit of hourly or 8-hour urine output. m. Record vital signs following general and local anesthesia hypotension and respiratory distress may result n. Admin of analgesic or a narcotic-analgesic with caution until client fully recovers from anesthetic. To prevent adverse reactions, dosage might need to be adjusted if client is under the influence of anesthetic.

Seizures 1. What are some considerations regarding anti-seizure meds and pregnancy? o Get their levels checked with the meds o A lot of meds decrease folic acid need extra supplementation o Most are category D, if possible we want them to switch to C

2. 3.

4. 5.

6.

o Planning is important o If you have seizure disorder you are most likely to experience seizing them o Oral contraceptives decrease effect of these meds o During pregnancy, seizures episodes increase 25% in women with epilepsy o Hypoxia that may occur during seizures places both the pregnant woman and fetus at risk o Anticonvulsants also increase the loss of folate (folic acid) in pregnant women. This, pregnant individuals should take daily folate supplements What is the overall goal for anti-seizure therapy? What is GABA? What do some anti-seizure meds do to GABA? o Neutrotransmitter gaba is o Anti-seizure meds do to gaba is.. they enhance gaba so it intensifies What is the drug category of choice for status epileptics? o Valium o Benzos What are some adverse effects and nursing considerations for Phenytoin (Dilantin)? o It is not safe o Check levels o Monitoring adverse effect, gingival hyperplasia, which can mean toxic o Hydonalitins is the category List some other drugs to treat seizures. Why do we often monitor serum levels for anti-seizures meds?

Degenerative Disorders 1. What is the pathophysiology for someone with Parkinsons disease? a. Meds for Parkinsons are trying to work with neurotransmitters, it is trying to increase dopamine and block ACH b. 2. What are the 2 main groups of drugs to treat Parkinsons? a. What drugs block ach? Anticholinergic b. What drugs block dopamine? Dopaminergic 3. What is Sinemet? What does each component do? a. Levodopa and carbadopa b. Carbodpa protects leveo enhances its effect c. One gets into the brain and increase dopamine 4. What is the patho behind Alzheimers disease?

a. What drugs treat alt? acetoginestrase inhibitors b. They want more ACH esterase inhibitors it is an indirect acting cholingeract agent c. Cognext d. Aritcept e. Namendia 5. What category of drugs is most commonly used to treat Alzheimers? 6. How does the drug class work? 7. What is another name for this drug class? 8. List some of the drugs within this category. 9. What is the patho behind someone with MG? 10. What drugs are used to treat this disease? Name some. 11. What is the patho behind multiple sclerosis? 12. What categories treat MS? How do they work? 13. What are skeletal muscle relaxants used to treat? 14. How are they classified? Name some of each type. a. How do we subdivide muscle relaxants? Centrally acting, indirecting? b. Direct acting ones works at muscle sites c. Centrally acting works in cns d. Dantrium is ONE DIRECT e. All others are centrally, flexiril is a Centrally acting 15. What education points would be important to include for a patient on a muscle relaxant? a. N/C for centrally i. Dont drive no etoh no cns depressants, dont take with kava kava st johns wort b. Pain and Inflammation 1. Differentiate between the 2 types of COX enzymes. What happens when each is stimulated? Blocked? 2. List some anti-inflammatory categories. 3. What properties do NSAIDS have? a. They are non steroidal, they are anti inflammatoryies, analgesic properties, anti p=yertic, anti platelet so it thins your blood b. S/E: they can irritate your gi tract, eat with drugs 4. What are the 2 subcategories of NSAIDS? Name drugs within each. 5. What are some SE/AE for NSAIDS? Are there any nursing interventions to help prevent them? 6. Cox enzymes? a. Cox 1: enzyme protects stomach lining, you

b. Coz 2: what happens when you block these cox 1 and 2 c. One that just blocks cox2? Celebrex. One that blocks both? Advil motrion torodol 7. Why were some of the COX-2 inhibitors removed from the market? a. Viox removed, black box warning b. Because risk of stroke and heart attack 8. Benefit of cox 2? a. They dont tear up your stomach. They block cox 2, which reduces pain and inflammation 9. What are the DMARDS? What are they used for? What categories are included? a. It is for rheumatoid arthritis b. Diease motifithying anti rheumatic c. Used for r.a d. Immuniosuressive agents: auto immune e. Gold drug therapy: not really do unless we have to f. Antivalierials: 10. What is the patho for a gout patient? What medication categories are utilized for a patient with gout? a. Gout is too much uric acid b. Drugs for tx of gout? Xyloprim? Indocen (preventative; nsaid of choice for gout) alopurinal (u.a preventitiro) ventamide (which is acid excreteor) 11. What medication can be used for an acute attack of gout? 12. Differentiate between the different meds MOAs. a. Cultazine is anti inflamm b. Alorpiutional blocks absorption of u.,a c. One ecvretes it (ventamide) d. All are for pevention e. One is for acute attack 13. What are some nursing considerations for the patient on pharmacotherapy for gout? 14. What is an analgesic? 15. What is the difference between an opioid and nonopioid analgesic? 16. What properties does Tylenol have? 17. What is the maximum Tylenol dose in a day? Why can we not give any more than this? a. 4 grams b. Can cause liver toxicity 18. What is the reversal for Tylenol overdose? 19. Which nonnarcotic med is contraindicated in young kids? Why? What is the nonnarcotic analgesic of choice for kids? 20. What are some potential uses for opioids? 21. What are SE/AE for opioids?

Sedation Think first: respiratory depression They itch Constipation n/v dependence/abuse 22. Why do we use combination opioid/nonnarcotic meds? a. Perocoset do that so we can lower the dose of opoid b. Nubain (created to reduce the abuse potential) 23. What are some of the opioid agonist-antagonist meds? Why were they created? 24. What is the most commonly used opioid antagonist? a. Narcan b. Give for reversal of respiratory depression c. After you give asses for pain d. You may have to keep giving it, has short half life may wear off before 25. Why do we use it? 26. What are some considerations?

a. b. c. d. e. f.