Neurobio and pharm standards

what factors affects the nervous sytem as it develops during the fisrt trimester

• Maternal factors

• Environmental stress

• Exposure to toxins and hazards

• Health status

• Nutrition

When does the brain has the most rapid growth

third month of gestation through the child’s first year after birth

what is Synaptic growth

a process by which neurons in the brain connect

• will occur rapidly during the first six years of life, after which synaptic pruning occurs, which is an automatic brain function that eliminates unused synapses, following new growth.

What is the synaptic cleft

the space between the terminal button of one neuron and the dendrite of another neuron.

What is Synapse

• The area where two neurons converge.

• The terminus of one axon is called the presynaptic bulb or knob

• Inside the presynaptic bulb are small vesicles of neurotransmitters that are stimulated into release to the synapse.

What is a neurotransmitter

Chemical messenger that carries a message from one neuron to another.

What are the 4 types of connections at synpases

• Axo-axonic

• Axo-somatic

• Axo-dendritic

• Dendro-dendritic

What are excitatory effects

Promote the generation of an action potential

What inhibitory effects

Inhibit an action potential

what are the 3 main types of neurotransmitters

• monoamines

• amino acids

• neuropeptides

What are 4 monoamines

• Norepinephrine

• Serotonin

• dopamine

• histamine

What are some amino acid(3)

• Gamma-Aminocutyric acid(GABA)

• Glycine

• Glutamic acid (gluamate)

what is Glycine

Stimulant and inhibitory effect within the CNS.( amino acid)

• Affects immunity, digestion and appetite, pain response, and sleep

what is Glutamic acid or glutamate

• Major excitatory neurotransmitter in the brain(amino acids)

• Involved in sensory transmission, learning, and memory

what is acetylcholine

• Responsible for activation at the neuromuscular junction.

• Decreases in acetylcholine is implicated Alzheimer’s disease and Parkinson’s and Huntington’s.

what causes a incraese in acetylcholine

cholinergic crisis (overstimulation of the receptors in neuromuscular junctions).

• Symptoms: muscular cramping and weakness, increased salivation, lacrimation, paralysis, blurry vision

What are 2 kinds of neuropeptides and what do they do

Endorphins and enkephalins

• Act at opioid receptors and function to block pain signals

what are the 2 main parts of the Forebrain

Cerebrum and diencephalon

What is the function of the cerebrum

Divided into two hemispheres; manages sensory processing, emotions, language, and movement; the right side is more creative, the left side is logical and problem-solving

What is the main function of Diencephalon

Intermediary between cerebrum and lower brain structure; manages sensory information to the cerebrum, emotional memories, regulation of appetite and thermoregulation, and emotions

What does the midbrain(mesencephalon) function

Manages vision, hearing, motor control, sleep and wake states, and temperature regulation

What are the 3 parts of the hindbrain

• pons

• medulla

• cerebellum

what is the function of the pons

Manages respiration and skeletal muscle tone

What is the function of medulla

Manages blood pressure, heart rate, respiration, and reflexes

What is the function of cerebellum 

Manages muscle coordination, posture, and position

How does the brain regulate teh circadian cycle

The suprachiasmatic nucleus sends signals to the pineal gland

what are 3 main 1st gen anti-psychotic meds

• Chlorpromazine

• Haloperidol

• Fluphenazine

what are 4 main 2nd gen anti-psychotic meds

• Aripiprazole

• Clozapine

• Olanzapine

• Risperidone

what is Akathisia

Subjective complaints of leg or arm movements, rocking, pacing, feeling restless like they cannot sit still

• Develops within the first few weeks of starting or increasing dose of medication or reducing or removing a medication that is used to mitigate EPS

• Treatment:Reduction of dose or removal of offending medication, Benzodiazepines, Propranolol, and Mirtazapine

What is Dystonia

Involuntary contractions and spasms of the muscles, painful, starts in the face, neck, shoulders

• Develops within hours to days of starting or increasing dose of medication or reducing or removing a medication that is used to mitigate EPS

• treat w/ Benztropine and Diphenhydramine

What is tardive dyskinesia

Involuntary facial movements, sucking, chewing, lip smacking, tongue protruding, blinking eyes; also affects the body and extremities

• Develops within months or years

• treatment:Reduction of dose or removal of offending medication, Valbenazine and Deutetrabenazine

What is Pseudo-parkinson’s

Shuffling gait, stiff facial muscles, tremors, bradykinesia, akinesia

• Develops within a few weeks of starting or increasing a dose of medication or reducing or removing a medication that is used to mitigate EPS

• Treatment: benzotropine

What is neuroeptic maligant syndrome

High fever (102–104 degrees Fahrenheit), irregular pulse, tachycardia, tachypnea, muscle  rigidity, confusion, hypertension, diaphoresis

• This is a medical emergency

What are s/s of lithium toxicty

Mild to Moderate	Nausea, vomiting, diarrhea, tremors, fatigue, drowsiness, weakness
Severe	Agitation, hyperthermia, tachycardia, hypotension, confusion, delirium, slurred speech, renal failure, coma, death

What are the optimum lithium values

0.6 to 1.2 mEq/L

What is the lab vaule for lithum toxcity

• 1.5 mEq/L-2.5 mEq/L

• Severe Lithium toxicity >2.5 mEq/L

What is vaproic acid and its therapeutic range

the only anti-convulsant mood stabilizer that requires monitoring of trough blood levels.

• The therapeutic range : 50-125 µg/mL with toxic levels >150 µg/ml

What are side effects of valproic acid

• Sedation

• GI issues (nausea, vomiting, diarrhea)

• Weight gain

• Alopecia

Adverse events associated with valproic acid

• Activation of suicidal thoughts

• Hepatoxicity

• Tachycardia

• Valproic acid toxicity

What are s/s of valporic acid toxicity

• Nausea

• Vomiting

• Myoclonus (Sudden, brief, involuntary muscle jerks or twitches)

• Somnolence(extreme sleepiness)

• Dizziness

• Hallucinations

• Irritability

• Headache

• Lethargy

• Respiratory depression

• Coma

What are some side effects of lamotrigine and carbmazepine

• Sedation

• Dizziness

• Nausea

• Constipation

• Blurred vision

• Adverse reactions

  • Activation of suicidal ideation

  • Potential for Stevens-Johnson syndrome

  • Carbamazepine

  • Aplastic anemia

  • agranulocytosis

what ages is lithum not for mood stablization

Children under 7

Lithium has the potential to become neurotoxic in older adult invidiuals

What ages shoudlnt get valproic acid

children under 10

What needs to be monitored when the pt is on mood stabilizers

• Assessing for medications or health conditions that might be contraindicated with the mood stabilizers.

• Assess for suicidal ideation using evidence-based assessment tools (Columbia Suicide Severity Rating Scale)

• Baseline BMI

• Labs

• Blood pressure

• Trough blood values for valproic acid and lithium

What are teh diff kinds of antidepressants(6)

• Tricyclics

• MAOI

• SSRI

• SNRI

• NDRI

• Multimodal

What food shoudl be avoided if taking MAOI

Foods high in Tyramine

• Strong or aged cheeses

• Cured meats

• Smoked or processed meats

• Pickled or fermented food, like sauerkraut and kimchee

• Soybeans, fava beans, snow peas, tofu

• Tap beer

• Yeast spread, brewer’s yeast

• Meat tenderizers, soy sauce, teriyaki sauce, miso, shrimp, and fish sauce

• Dried or overripe fruits

What are anxiolytics and what are their indciations

Anti-anxiety drugs, class of medications that decrease anxiety

Indications

• Short-term treatment for generalized anxiety disorders, anxiety, and panic.

• Buspirone is indicated for long-term anxiety management

  • not used as a prn medication

• Hydroxyzine used as needed medications for anxiety

What are soem side effects of Anxiolytics

• Sedation

• Dizziness

• Fatigue

• Confusion

• Paradoxical effect, a heightened anxiety, excitability, and nervousness

All benzodiazepines potential to create tolerance and cause abuse.

Abrupt discontinuation of long-term of benzos can result in withdrawal seizures

• These medications are tapered slowly to alleviate that dangerous situation.

• Adverse reactions

  • CNS depression and overdose

  • Patients diagnosed with closed-angle glaucoma should not take benzodiazepines

what are the 3 main Anxiolytics

• Benzodiazepines

• Buspirone

• Hydroxyzine

What are busirpoe s/e and what is it

An anxiolytics

• Sedation

• Headache

• Nervousness

• Excitement

• Drowsiness

• Insomnia

• Dyskinesias (uncontrolled, involuntary movements ranging from shakes, tics, tremors to full body movements.)

  • Not used with serotonergic medications SSRIs

• Serotonin syndrome

what causes serotonin syndrome

The cause of serotonin syndrome is the rise of serotonin levels in the body

• Taking more than one medication that affects serotonin levels

  • SSRI, SNRI, Tricyclic, monamine oxiadse inibiotrs, serotini modulator and norephine reupatek inhibitor

• Starting or increasing the dose of medication that will increase serotonin levels

• Overdosing on one serotonin-related medication either on purpose or accidently.

• Using illegal drugs or herbal products or over the counter drugs that affect serotonin levels

What are some mild s/s of serotonin syndrome

• Nervousness

• Nausea, vomiting

• Diarrhea

• Tremor

• Dilated pupils

What are some moderate s/s of serotonin syndrome

• Agitation, restlessness

• Muscle twitching

• Sweating, shivering

• Abnormal (side to side) eye movements

What are some Severe s/s of serotonin syndrome

• Confusion, orientation, delirium

• Rapid heart rate

• High blood pressure

• High body temperature

• Seizures

• Abnormal heartbeat

• Passing out, fainting

• Untreated serotonin syndrome can cause death.

Hydroxyzine s/e

• Sedation

• Fatigue

• Dizziness

• QT prolongation

• Used with caution with patients who have a cardiac disease

What are important considerations to keep in mind when giving meds to older adults

• Nurses should be aware of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

• When assessing an older client, it is imperative that the nurse do

  • A complete drug history including prescribed and non-prescribed medications.

    • Use of over-the-counter herbal and vitamin supplements.

  • Patient medication education is key when working with older adults.

What stimulant meds are used to treat ADHD

• Methylphenidate

• Amphetamine

What non-stimulant meds are sued to treat ADHD

• Guanfacine

• Atomoxetine

what are some side effects of Guanfacine(5)

• Hypotension

• Decreased pulse

• Dry mouth

• Constipation

• Sedation

what are some side effects of Atomoxetine

• Anorexia

• Weight loss

• Tachycardia

• Hypertension

• Insomnia

• Activation

• Dry mouth

• Constipation

What is electroconvulsive threapy

The use of electrical currents under anesthesia

• FDA approved for treating resistant or severe unipolar depression

• It is theorized that the seizure activity releases neurotransmitters that are involved in major depression, namely, serotonin, dopamine, and norepinephrine.

• It may also trigger the stimulation of the brain derived neurotropic factor (BDNF). BDNF triggers neuronal growth. In addition, it has a role in learning and memory.

• The patient will be referred to a psychiatrist who is trained in the use of ECT.

What are some risk factors that need to be screened for before elctroconvulsive threapy

history of brittle hypertension, coronary artery disease, asthma, COPD, implanted pacemakers and if a women whether she is pregnant.

What doe sthe nursing care look like prior to a ECT

Ensuring that the patient understands what is going to happen and has signed the consent form.

Making sure the patien has been NPO for at least 8 hours prior to the treatment.

Removing all dentures, jewelry, eyewear (glasses or contacts), hearing aids.

Having the patient void before the treatment

Giving any perioperative medications.

What doe sthe nursing care look like during a ECT

• Monitoring vital signs and symptoms

• Placing oral/dental protection device

• Giving procedural medications

• Assessing client through out the procedure

What doe sthe nursing care look like after a Electroconvulsive therapy

• Monitoring vital signs and symptoms

• Assessing cognitive status

• Checking the gag reflex, fluids, ambulating, and toileting

• Placing the patient on fall precaution.

• Some patients may wake up confused.