CNS drugs- stimulants, depressants and general anesthesia – Flashcards
Unlock all answers in this set
Unlock answersquestion
what organs do CNS drugs act on
answer
the brain and spinal cord
question
how many receptors can the brain activate
answer
multiple. This is determined by ion channels
question
what does the BBB do
answer
protects against toxic substances
question
Is the BBB fully formed at birth
answer
nope
question
what are the monoamines
answer
epinephrine, norepinephrine, serotonin and dopamine
question
dopamine determines
answer
excitatory or inhibition
question
what are some conditions that can lower the BBB
answer
HTN, infection and brain injuries such as trauma, ischemia, inflammation or pressure and hyperosmolarity
question
what outside factors can lower the BBB
answer
microwaves, radiation
question
is glutamate excitatory or inhibitory
answer
excitatory
question
what is the major inhibitory neurotransmitter in the brain
answer
GABA
question
what neurotransmitters have a slow change on excitability
answer
monoamines and Acetylcholine
question
what neurotransmitters have a rapid inhibitory effect
answer
GABA and glycine- amino acids
question
what neuro's have a rapid excitatory affect
answer
glutamate and aspartate- amino acids
question
what neuro's are amino acids
answer
GABA, glycine, glutamate and aspartate
question
what are the seven categories of CNS drugs
answer
stimulants, depressants, antiepileptics, neuro disorder drugs, serotonin agonists, muscle relaxants and neuromuscular blocking agents
question
how how does the CNS adapt to therapy
answer
increased therapeutic effects, decreased side effects, tolerance and physical dependence
question
what do CNS drugs take so long to take effect
answer
the CNS must have time to be exposed to the drug in order to modify itself
question
why do side effects decrease with chronic drug therapy
answer
the brain modifies itself to the changes that the drug enacts
question
why does physical dependence and tolerance develop with continued drug therapy
answer
the brain adapts to the drug and creates a new "normal". This causes the brain to lose function when the drug is not present
question
what is the protoype for Methylxanthines
answer
caffeine
question
what are methylxanthines derived from
answer
xanthine
question
what are the pharmacological affects of caffeine
answer
increased alertness, decreases sedation and fatigue, vasoconstriction in CNS, vasodilation in PNS, bronchodilation and heart stimulation. It may also be used for apnea in a newborn
question
what drug may be used for neonatal apnea
answer
caffeine
question
what drug may be used to manage headaches
answer
caffeine
question
what drugs may interact with caffeine
answer
antibiotics, birth control, seizure meds and antacids
question
what is another xanthine derivative drug
answer
theophyline
question
what drug is used to promote wakefulness and is used by pilots
answer
modafinil, Provigil
question
what three conditions is Provigil used for
answer
narcolepsy, shift-work sleep disorder and obstructive sleep apnea
question
What drug inhibits actions of dopamine transportation
answer
Provigil
question
what do CNS stimulants do
answer
increase the activity of CNS neurons
question
what can happen with excessive doses of stimulants
answer
seizure activity
question
amphetamine action is similar to
answer
sympathetic response
question
what two conditions are basic CNS stimulants used for
answer
ADHD and narcolepsy
question
what is the primary action of amphetamines
answer
promoting release of norepinephrine and dopamine
question
what is a "partial" action of amphetamines
answer
inhibits the reuptake of norepinephrine and dopamine
question
what are some responses of amphetamien use
answer
euphoria, wakefulness, alertness, elevation of mood, boosting of confidence
question
what vital signs can increase with amphetamine use
answer
RR, HR
question
what bodily functions are suppressed by amphetamines
answer
appetite and pain perception
question
when should amphetamines be taken
answer
before breakfast and before lunch
question
when should a nurse intervene with amphetamine use
answer
when irregular HR occurs
question
what should be done when caring for a child taking amphetamines and why
answer
a baseline height and weight should be established because it decreases appetite
question
what should be avoided when taking amphetamines
answer
alcohol- it's effects may not be realized until it is too late- NO red bulls and vodka
question
can you stop taking amphetamines abruptly
answer
no, withdrawal may occur
question
what other stimulant should be avoided when taking amphetamines
answer
caffeine- it will potentiate effects
question
what important actions does Adderall have
answer
increased attention span, increased goal-oriented behavior and decrease in impulsiveness
question
do stimulants increase positive behavior
answer
no, the decrease negative behavior so that child can now focus and participate
question
what can amphetamines increase that would promote weight loss
answer
BMR and cellular glucose uptake
question
what can amphetamines decrease that may promote weight loss
answer
fat absorbtion
question
what are the adverse effects of amphetamines
answer
tachycardia, restlessness, impotence, dysrrythmias, thrombocytopenia and HTN
question
how can you minimize growth suppression with amphetamine use
answer
give at lunch and breakfast
question
what is the prototype for amphetamine like drugs
answer
methylphenidate- Ritalin
question
what is Ritalin approved for
answer
narcolepsy and ADHD
question
what neurotransmitters does Ritalin act on
answer
norepinephrine and dopamine; same as adderall
question
what adverse cardiac affects can Ritalin have
answer
increases AV conduction
question
is a dosing schedule essential for amphetamines and amphetamine like drugs
answer
yes
question
what is the difference between amphetamines and amphetamine like drugs
answer
the chemical structure- actions are the same and is abuse potential
question
what is an analeptic
answer
caffeine
question
what are the actions of analeptics
answer
stimulate the respiratory response center in the brain stem
question
what are the conditions that analeptics are used for
answer
neonatal resp. depression, hypercapnea ( COPD), post anesthetic resp. depression, resp. depression caused by alcohol and opioid use, bronchiopulmonary dysplasia
question
What can theophylline be used for that caffeine cannot
answer
asthma- bronchodilation
question
what drug can be used for acute and chronic resp. depression
answer
theophylline
question
side effects of analeptics
answer
vago response, tachcardia, tachypnea, reflex tachycardia and flushing
question
what drug is specifically used to increase respiratory drive
answer
doxapram-analeptic
question
what drug has a narrow therapeutic window and can cause seizures
answer
doxapram
question
what is the onset of action for doxapram
answer
20-40 secs, peaks in 2 minutes
question
side effects of doxapram
answer
HTN, tachycardia, seizures, tremors
question
what natural remedies should not be taken with CNS depression
answer
kava and valarian root
question
what are CNS depressant prototype drugs
answer
barbituates
question
do barbiturates have a high abuse potential
answer
yup
question
what is the most widely abused barbiturate
answer
alcohol
question
what is the action of barbiturates
answer
enhance inhibitory actions of GABA
question
What drug can readily cause overdose because of it's ability to mimic GABA
answer
barbiturtaes
question
what are the effects of bariturates
answer
sedation, decrease in anxiety and to prevent convulsions
question
what are barbiturates used for
answer
emergency sedation, pre anesthesia, tranquilizers and seizures
question
what are sedative/hynotic drugs
answer
drugs that depress CNS function
question
what are the primary conditions that sedatives are used for
answer
anxiety and insomnia
question
what may sedatives also be used for
answer
muscle spasms
question
what are the three types of sedative drugs
answer
barbiturates, benzodiazapines and benzo-like drugs
question
what is the difference between antianxiety and hypnotics
answer
dosage, anxiety is at a lower dose and inducing sleep is at a higher dose
question
what drugs promote sleep
answer
hypnotics
question
what are the drugs of choice for anxiety and insomnia
answer
benzo's
question
what do benzos enhance
answer
the inhibitory effects of GABA-
question
what effect do benzos have on respirations
answer
little effect when taken alone but profound effect when taken with other CNS depressants
question
what are adverse effects of benzos
answer
daytime sedation, confusion and anterograde amnesia
question
what are ultra-short acting barbiturates
answer
thiopental
question
what are short -intermediate acting barbiturates
answer
secobarbital
question
what are long acting barbiturates
answer
phenobarbital
question
what is an adverse effect of barbiturates involving the skin
answer
exascerbation of intermittent porphyria
question
what are some adverse effects
answer
suicide, resp. depression, abuse, hyperalgesia and paradoxical excitement
question
what are some safety interventions for barbiturate use
answer
watch for injury, confusion and sedation, seizures
question
local anesthetics block pain by
answer
blocking sodium channels and thereby blocking impulse along conducting axons
question
where are local anesthetics effective
answer
only in neurons at site of administration
question
do local anesthetics suppress the nervous system
answer
nope
question
ester local anesthetics
answer
can cause allergic reactions
question
enzyme needed to metabolize esters
answer
pseudocholinesterase
question
where are amides metabolized
answer
in liver
question
what are the routes for local anesthetics
answer
topical and local
question
what ester drug used to be drug of choice
answer
procaine
question
what drug is the most widely used local
answer
lidocaine
question
what local is also used for cardiac dysrhythmias
answer
lidocaine
question
what types of drugs cause unconsciousness and a lack of responsiveness to painful stimuli
answer
general anesthetics
question
what are the two groups of general anesthetics
answer
inhaled and intravenous
question
what is balanced anesthesia
answer
combo of drugs to ensure that induction is rapid and smooth and muscle relaxation is adequate
question
what are the combo of drugs used for general anesthesia
answer
barbiturate for induction, a neuromuscular blocking agent for muscle relaxation and an opioid or nitrous oxide for analgesia
question
what is the uptake for inhaled general anesthesia
answer
the lungs
question
what affects the uptake of general
answer
the concentration inspired
question
what is the distribution of general
answer
to the CNS and other tissues
question
what determines the distribution of general
answer
regional blood flow
question
where do anesthetic levels rise rapidly
answer
in the organs that recieve largest blood flow- brain, kidneys, heart and liver
question
how are generals eliminated from the body
answer
expired breath
question
hepatic metabolism of generals is
answer
minimal
question
what is the prototype for generals
answer
Halothane
question
what type of general is Halothane
answer
inhaled
question
what are the adverse effects of Halothane
answer
hypotension, malignant hyperthermia, resp. depression, hepatotoxicity
question
what percentage of halothane is eliminated by the lungs
answer
60-80 percent
question
what barbiturates are used for short acting generals
answer
pentothal and brevital
question
what are barbiturates used for in general anesthesia
answer
induction
question
what is the time frame for barbiturates in terms of anesthesia
answer
1 min and last for 5
question
what are benzo's used for in general anesthesia
answer
induction
question
when will a pt lose consciousness with benzo induction
answer
1 min
question
what benzos are used for induction of general
answer
diazepam and midazolam
question
what benzo cause unconsciousness in 80 seconds but has dangerous cardiac and resp. issues
answer
midazolam
question
what are the intravenous anesthetics
answer
benzo's, barbiturates, propofol and ketamine
question
what drug is used for maintenance of analgesia during procedures and mechanical ventilation
answer
propofol
question
what are the big adverse effects of propofol
answer
resp depression ( severe) and hypotension
question
what drug has a risk of bacterial infection
answer
propofol
question
what drug causes dissociative anesthesia
answer
ketamine
question
what effects does ketamine have
answer
sedation, immobility, analgesia and amnesia
question
what are adverse reactions of ketamine
answer
hallucinations, disturbing dreams, delirium
question
what is ketamine used for
answer
anesthesia in young children
