Pharm lecture 2 exam 2

CNS stimulants

amphetamines, analeptics, anorexiants

CNS stimulants medically approved uses...

Attention-deficit/hyperactivity disorder (ADHD)

Narcolepsy

Reversal of respiratory distress

migraines

anorexiant

analeptic

Amphetamines mechanism of action

stimulate areas of the brain associated with mental alertness, stimulate release of norepinephrine and dopamine.

amphetamine drug effects...

mood elevation

euphoria

increased mental alertness

adverse effects of amphetamines

Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency

amphetamine/amphetamine like drugs for ADHD

adderall

dextroamphetamine

methylphenidate (ritalin)

uses for adhd drugs

increase attention span and cognitive performance

memory, reading

decrease impulsiveness, hyperactivity, restlessness

important teaching for amphetamines...

very addictive

stay away from other stimulants such as sugar and caffeine

keep journal for children to monitor for weight and height changes

Drugs for narcolepsy

dextroamphetamine

methylphenidate (ritalin)

modafinil

uses of narcolepsy drugs...

increase wakefulness in patients with sleep disorders

Methylphenidate (ritalin)

a stimulant used in treating ADHD, narcolepsy, and increase attention span

cardiac risk for methylphenidate

monitor for tachycardia, palpitations, hypertension

growth suppression with methylphenidate

causes anorexia/weight loss, record height/weight in children regularly

CNS stimulation with methylphenidate

causes insomnia/restlessness

administer before breakfast/lunch

Nursing interventions for methylphenidate

diet: avoid caffeine (cola, chocolate)

withdrawal: do not stop abruptly, taper to avoid withdrawal

anorexiants/obesity drugs

phentermine (lonamin)

#1 prescribed

Other (nonstimulant) obesity drugs

orlistat (xenical)

Orlistat (xenical) mechanism of action

works locally in the small and large intestines, inhibits absorption of caloric intake from fatty foods

analeptic drugs (restore health, help to breathe)

methyxanthines

DOXAPRAM (DOPRAM)

doxapram (dopram)

used for post anesthesia respiratory depression

Sedative-hypnotics

Barbiturates

Benzodiazepines

Nonbenzodiazepines

melatonin agonists

barbiturates

long, intermediate, short acting

tolerance builds quickly, limit use

Benzodiazepines

the standard

alprazolam, lorazepam, diazepam

anxiety, insomnia, pre-op

Nonbenzodiazepines

modern sleep aids

zolpidem

short term insomnia

hangover effect

melatonin agonists

rhythm regulators

When dealing with insomnia or anxiety remember...

try non-pharm meds first!

Nonbenzodiazepines

all sleeping pills, be cautious with elderly, fall risk, try other things first!

OTC hypnotics

doxylamine (unisom) and diphenhydramine (sominex), acetaminophen (extra strength tylenol)

herbals

kava, valerian

kava

used for sleep, anxiety, restlessness, and sleep disorders

potential contraindications- alcohol, barbiturates, psychoactive drugs

valerian

Used to relieve anxiety, restlessness, and sleep disorders

May cause CNS depression, hepatotoxicity, nausea, vomiting, anorexia, restlessness, insomnia

Many interactions, including with CNS depressants, MAOIs, phenytoin, warfarin, alcohol

geriatrics and sleeping medication

major risk for falls and confusion

barbiturates mechanism of action

potentiating the action of GABA, nerve impulses traveling in the cerebral cortex are inhibited

drug effects of barbiturates

Low dose = sedative effects

High dose = hypnotic effects, lower respiratory rate

uses of barbiturates

anesthesia or other sedation and as an anticonvulsant (prevent seizures)

Barbiturates adverse effects

Vasodilation,

hypotension

Drowsiness,

lethargy,

vertigo

Respiratory depression,

cough

Nausea,

vomiting,

diarrhea,

constipation

Agranulocytosis, thrombocytopenia

Hypersensitivity reactions,

Stevens-Johnson syndrome (skin disorder)

Reduced REM sleep, resulting in:

Agitation

Inability to deal with normal stress

Toxicity and OD of barbiturates

respiratory depression and subsequent respiratory arrest

treatment of overdose on barbiturates

Symptomatic and supportive

Maintain adequate airway

Assisted ventilation/oxygen therapy

Fluids

Pressor support

Activated charcoal

Common Barbiturates

pentobarbital (Nembutol)- long acting, prevent seizures

phenobarbital- epilepsy

Other barbiturates

propofol, sevoflurane

uses- general anesthesia

An older adult patient taking multiple medications has a barbiturate added to his medication regimen. When administering a barbiturate to an older adult, the nurse should expect...

to administer half of the usual dose of the barbiturate

The concept of balanced anesthesia

drugs used in combination mitigate the disadvantages of an individual drug

examples for both topical and injectable anesthetics

lidocaine

topical lidocaine

to numb the skin

local lidocaine

injectable- blocks pain at the site must be awake

inhalation of general anesthesia

Halothane, Nitrous Oxide (dental), Desflurane

risk: malignant hypothermia, respiratory distress

Intravenous General Anesthesia

Propofol, midazolam, morphine

spinal column nerve blocks

paralyzes everything below the injection, ensure that the patient legs are not raised so it does not leak up spinal column

pre-op care related to anesthesia

assess drug history

assess cardiovascular system

intra-op care related to anesthesia

monitor for airway obstruction

monitor for hypotension

vitals

post-op care related to anesthesia

sensorium checks

monitor urine output

safety: assist with moving

What is a serious risk of spinal anesthesia?

fall risk

no peeing

paralysis

What should I offer older adults with insomnia before resorting to prescription drugs?

hot milk, tea, books, etc...

What may happen if an elderly person does take a benzodiazepine, temzaepam, to help sleep?

fall risk!

Epilepsy

seizure disorder, abnormal electric discharges from cerebral neurons

characteristics of epilepsy

Loss of consciousness and involuntary, uncontrolled movements.

cause of epilepsy

idiopathic (primary)- no reason

secondary to brain trauma or anoxia, infection, stroke

classifications of seizures

generalized or partial

generalized seizures

seizures that involve the entire brain

Partial Seizures

Seizures affecting only part of the brain.

eclampsia

seizure during pregnancy or soon after

status epilepticus

lasting longer than 5 minutes, medical emergency

treat with diazepam/lorazepam

anticonvulsants

antiseizure, antiepileptic

na+ channel supressor

phenytoin (dilantin)

Ca++ channel suppressors...

valproic acid (depakote)

topiramate (topamax)

pregabalin (lyrica)

carbamazepine (tegretol)

oxcarbazepine (trileptal)

GABA enhancers/increasers...

phenobarbital (luminal)

benzodiazepines

gabapentin

other anticonvulsants

Levetiracetam (Keppra)

lamotrigrine

cannabidiol

Phenobarbital (barbiturate) Uses

tonic-clonic, partial, myoclonic seizures, status epilepticus

Clonazepam (benzodiazepine)

treats absence and myoclonic seizures

Diazepam (Benzodiazepine)

treats status epilepticus

Seizure meds in pregnancy

seizure meds have teratogenic effects

What is the drug of choice for status epilepticus?

Diazepam (Valium) IV

Drug of choice for parkinsons disease

carbidopa/levodopa

CARBIDOPA

helps levodoba reach brain and adjuvant therapy to treat nausea caused by levodoba

levodoba

increases brain levels of dopamine

contraindications of levodopa/carbidopa

Angle closure glaucoma

MAOIs

Alzheimers drugs

cholinesterase inhibitors

cholinesterase inhibitors mechanism of action

allow more Ach in neuron synapses

examples of cholinesterase inhibitors

Donepezil (Aricept)

Rivastigmine (Exelon)

Galantamine (Razadyne)

MEMANTINE (NAMENDA) - MOST COMMON

autoimmune disorders examples

myasthenia gravis

multiple sclerosis

myasthenia gravis treatment...

Neostigmine

multiple sclerosis treatment...

immunomodulators

corticosteroids (anti inflammatory)

edrophonium test administered...

symptoms improve

symptoms worsen

symptoms improve after edrophonium test...

myathenic crisis (underdosed)

ANTIDOTE IS NEOSTIGMINE

symptoms worsen after edrophonium test...

cholinergic crisis (overdose)

ANTIDOTE IS ATROPINE

Muscle relaxants indications

Relief of painful musculoskeletal conditions

Muscle spasms

Management of spasticity of severe chronic disorders (multiple sclerosis, cerebral palsy)

Work best when used along with physical therapy

Muscle Relaxants: Adverse Effects

euphoria, lightheadedness, dizziness, drowsiness, fatigue, muscle weakness

Common Muscle Relaxants

baclofen (Lioresal)

cyclobenzaprine (Flexeril)- most common

dantrolene (Dantrium)

metaxalone (Skelaxin)

tizanidine (Zanaflex)

carisoprodol (Soma)

chlorzoxazone (Paraflex)

methocarbamol (Robaxin)

antidote for status epilepticus

diazepam/lorazepam

antidote for myasthenic crisis

Neostigmine

antidote for cholinergic crisis

atropine

antidote for anaphylaxis

epinephrine