Parkinson’s, Muscle relaxants, Anesthesia, Abuse and stimulants – Flashcards
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What is Parkinson's disease?
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Progressive degenerative disorder of the CNS
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What chemicals are effected with Parkinson's?
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dopamine(decreased) Acetylcholine (Increased)
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What are the Characteristics of Parkinson's?
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Bradykinesia : slow movement Postural instability: fall risk Resting tremors: when they are doing nothing there's tremors Muscle rigidity shows no emotions Can have dementia
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why can't you give dopamine?
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Dopamine doesn't cross the blood brain barrier
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what are the drug categories for Parkinson's?
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Dopaminergic and anticholinergic
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Side effects of dopaminergic
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GI upset Orthostatic hypertension Dysrythmias Dyskinesia
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Anticholinergic
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Tachycardia (fast heart rate) Constipation Dry mouth ( good oral hygiene) Urinary retention Mydriasis (dilated pupils) CNS stimulation ( can lead to seizures)
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Levodopa
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Prototype drug precursor to dopamine converted to dopamine in CNS combined with carbidopa Short action
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What does Levodopa relieve
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Bradykinesia and rigidity
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how long will levodopa work for
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looses effectiveness in 5-7 years
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Carbidopa
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never given by itself always combined with levodopa in one tablet
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Sinemet
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Carbidopa and levodopa
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Stalevoand
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Carbidopa, Levodopa, & entacapone
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Anticholinergic Medications
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Cogentin Trihexy treats tremor and rigidity
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Antiparkinson Drugs used for Restless leg syndrome
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Mirapex and Requip
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what is a reason that levodopa and carbidopa are combined
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to lower the does of levodopa (can use it longer) and to work better
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other dopaminergic Parkinson medications
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Eldepryl Symmetrel Parlodel (used in past to dry up milk in postpartum mothers)
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Cautions of Antiparkinson medications
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take a directed; wean off may take weeks to months to work avoid hazardous activity: CNS depressant take with food treat side effects: dry mouth and constipation(more common with anticholinergic) avoid alcohol, iron, increased protein & B6
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Why should increased protein be avoided
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increased protein can interfere with absorption should be avoided by about 2 hours
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Skeletal Muscle Relaxants
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treat muscle spasms or spasticity(neurological) depress CNS &/or block nerve impulses that cause increased muscle tone and contraction
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Side effects of muscle relaxants
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Euphoria drowsiness dizziness nausea and vomiting allergy
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what else can a patient do to help muscles with the muscle relaxants
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Rest physical therapy Cold/heat NSAIDs massage icy hot
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Common muscle relaxants
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Lioresal (also used for hiccups) Soma Flexeril Skelaxin Robaxin Valium
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Dantrolene
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only muscle relaxer that works directly on muscles used for Malignant hypothermia
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Cautions with Muscle relaxants
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try non-pharmacologic methods physical therapy hot/cold Avoid activates requiring alertness take with food taper off
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Neuromuscular Blockers
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prevent the nerve transmission in skeletal and smooth muscles = paralyze Depolarizing Nondepolarizing
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Depolarizing
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makes a muscle do an action so they wont do it again for a period of time competitive agonist
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Nondepolarizing
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Muscle cant react -competitive antagonist
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Neuromuscular Blockers actions
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short action acts quickly wears off quickly used mainly for intubation
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Neuromuscular Blockers medications
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Nimbex pavulon tracrium
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Anectine
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Succinylcholine- called "sucs" in the ER Neo-stigmine reverses Anectine
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Neuromuscular Blockers Cautions
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Check for excessive sedation Assess for respiratory difficulties (ability to breath on their own after surgery) Children are at greatest risk Assess for cardiovascular difficulties Monitor for Malignant Hyperthermia
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Malignant Hyperthermia
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genetic problem related to anesthesia Dantriline to treat treat fever
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what medication is used to sedate and causes Amnesia
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Versed
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Central Nervous System Stimulants
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Highly used and abused Stimulate the excitatory neurons in the brain
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Uses for Stimulants
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Narcolepsy ADHD Obesity
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Side effects of Stimulants
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Seizures Cardiac stimulation GI effects Weight loss Insomnia Irritability Tolerance and dependence
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Amphetamines
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increase norepinephrine, dopamine & serotonin increases mood and alterness Build up a tolerance Psychological dependence
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Amphetamine examples
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Dexedrine weight loss ADHD medications : Ritalin Adderall Vyvanse Concerta
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Xanthines
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stimulate cerebral cortex Increase alertness & decrease fatigue
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Examples of Xanthines
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Caffeine Theophylline(Stimulant bronchodialator)
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Analeptics
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used for respiratory depression and COPD associated hypercapnia
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Example of Analeptics
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Dopram (respiratory depression, given to paitient with a disorder with high CO2)
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Stimulant Cautions
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Mask signs of fatigue May cause weight loss use smallest effective dose Do not give before bedtime Watch for excessive CNS stimulation(irritability, talking fast seizures) avoid caffeine May develop tolerance and dependence
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Most common abused substances
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Alcohol Antianxiety Opioids Sedative-hypnotics Stimulants: amphetamines, cocaine, Nicotine Marijuana Hallucinogens
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Alcohol treatments
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Librium- DTs Antabuse - makes person sick if they drink
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Benzodiazepines
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Flumazenil- Antidote titrate benzodiazepines
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Opioids
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Narcan- antidote Methadone- wan off Catapres - deals with symptoms
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Stimulants
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sedatives- keeps patient safe while they get it out of their system
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Smoking
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Nicotine patches Zyban Chantix(Side effects hostile thoughts suicidal thoughts)
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Anesthetics
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used for surgery and procedures
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What anesthetics do
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Depress CNS function and interfere with nerve transmission Loss of sensation(can't feel) Loss of consciousness( not aware) Used to prevent pain & promote relaxation associated with surgery, childbirth and diagnostic test
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General Anesthesia
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Profound CNS depression Complete loss of sensation, consciousness, pain perception, and memory
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General Anesthesia Medications
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IV: propofol Inhalation: Nitrous oxide
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Local Regional Anesthesia
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Loss of sensation and motor activities in a localized area Peripheral nerve block Spinal (shoulders and down) Epidural(waist and down)
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Local Anesthetics
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Lidocaine: used topically Lidocaine with epinephrine: decreases bleeding prolongs the action Bezocaine Marcaine Novocaine: dentist use very ofton Emla cream: used for starting IVs and Dialysis patients
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Adjuncts to Anesthesia
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Antianxiety: benxodiazepines & barbituates Sedative-hypnotics Anticholinergics: Dry up secretions Opioids Antiemetics: helps stop vomiting Neuromuscular blockers: paralyzing agents
