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Unit 10 – Drugs for Central Nervous System (CNS) Problems (Comprehensive Study Guide – Nursing Pharmacology) ⸻ 🧩 Central Nervous System (CNS) Overview • CNS = Brain + Spinal Cord • Controls body movement, behavior, and cognitive function. • Neurotransmitters are chemicals that transmit signals between neurons. • Excitatory: Acetylcholine (ACh), epinephrine, norepinephrine • Inhibitory: Dopamine, serotonin, gamma-aminobutyric acid (GABA) ⚖️ Balance of dopamine and acetylcholine is critical for smooth movement. An imbalance leads to disorders like Parkinson’s Disease. ⸻ 🧍‍♂️ Parkinson’s Disease (PD) Cause • Progressive CNS disorder due to low dopamine production in the substantia nigra. • Too little dopamine → too much acetylcholine, causing impaired motor control. Key Symptoms Motor: • Tremors (“pill-rolling”) • Bradykinesia (slow movements) • Muscle rigidity, stiffness • Stooped posture, shuffling gait • Difficulty rising, “freezing in place” • Masklike facial expression Nonmotor: • Constipation, urinary frequency • Depression, anxiety, hallucinations • Sleep issues, fatigue • Memory problems ⸻ Drug Classes for PD Goal: Restore balance between dopamine and acetylcholine. 1️⃣ Dopamine Agonists Action: Mimic or increase dopamine. Improve movement, coordination, and muscle control. Examples: • carbidopa/levodopa (Sinemet, Rytary) • pramipexole (Mirapex ER) • ropinirole (Requip) • rotigotine (Neupro patch) Nursing Implications & Teaching: • Give 30–60 min before meals (empty stomach). • Avoid protein-rich foods (reduces absorption). • Monitor for orthostatic hypotension — rise slowly. • Don’t crush extended-release tablets. • Neupro patch: rotate sites, don’t reuse within 14 days. • Avoid vitamin B6 unless taken with carbidopa. • Takes 2–3 weeks for full effect. Side Effects: • Hypotension, headache, nausea, insomnia • Dyskinesia (abnormal movements) • “On/off effect” – medication wears off quickly • Long-term use → hallucinations, impulse control problems Adverse Effects: • Neuroleptic malignant syndrome: fever, rigidity, confusion • Psychosis, severe hypotension ⸻ 2️⃣ COMT Inhibitors Action: Block COMT enzyme → prolong dopamine activity. Examples: • entacapone (Comtan) • tolcapone (Tasmar) Nursing Implications: • Always give with carbidopa/levodopa. • Monitor liver function (q6 months) – risk of liver failure (especially tolcapone). • Harmless side effect: brown-orange urine. • Rise slowly to prevent hypotension. ⸻ 3️⃣ MAO-B Inhibitors Action: Inhibit MAO-B enzyme → prevents dopamine breakdown. Examples: • selegiline (Eldepryl) • rasagiline (Azilect) • safinamide (Xadago) Teaching: • Avoid foods high in tyramine → hypertensive crisis risk. (Aged cheese, wine, beer, cured meats, soy sauce, yogurt, avocados, bananas) • Monitor BP closely. • Avoid OTC decongestants or stimulants. • Can cause insomnia, dizziness, dry mouth, or constipation. ⸻ 🧠 Alzheimer’s Disease (AD) Cause • Progressive neurodegenerative disorder leading to memory loss, confusion, and poor judgment. • Loss of acetylcholine (ACh) and buildup of amyloid plaques and neurofibrillary tangles in the brain. Symptoms • Early: forgetfulness, confusion, mood changes. • Late: loss of reasoning, personality changes, inability to perform ADLs. ⸻ Drug Classes for AD 1️⃣ Cholinesterase Inhibitors Action: Block enzyme acetylcholinesterase (AChE) → increases ACh → improves memory and function. Examples: • donepezil (Aricept) • rivastigmine (Exelon) • galantamine (Razadyne) Side Effects: • Nausea, vomiting, diarrhea • Loss of appetite, GI discomfort • Drowsiness, headache, insomnia • Muscle cramps, bradycardia Adverse Effects: • Dysrhythmias, GI bleeding, hallucinations • Overstimulation of parasympathetic system (too much ACh) Nursing Implications: • Give at bedtime to reduce nausea. • Monitor weight, HR, and mental changes. • Report black/tarry stools or vomiting blood. • Avoid OTC anticholinergics (they reduce effectiveness). ⸻ 2️⃣ NMDA Blockers Action: Block NMDA receptor → decreases glutamate activity → prevents neuron death. Example: • memantine (Namenda) Used in: Moderate to severe AD (often combined with donepezil). ⸻ ⚡ Epilepsy / Seizure Drugs (AEDs) Purpose Reduce excessive electrical activity in the brain and prevent seizures. Common AEDs: • phenytoin (Dilantin) – prevents neuron excitation • topiramate (Topamax) – broad-spectrum seizure control Topiramate Key Points: • Side effects: dizziness, drowsiness, taste changes, paresthesias (“pins and needles”) • Adverse: metabolic acidosis, ↑ ammonia → confusion, lethargy, vomiting • Monitor: serum bicarbonate & ammonia levels • Teaching: stay hydrated, report mental status changes, don’t crush tablets • Contraindicated in pregnancy (teratogenic) ⸻ 💥 Multiple Sclerosis (MS) Pathophysiology • Autoimmune disease where the immune system attacks myelin (fatty sheath around neurons). • Leads to nerve signal disruption → muscle weakness and loss of coordination. • Common type: Relapsing-Remitting MS (RRMS) – periods of flare-ups and remission. Common Symptoms • Fatigue, weakness, difficulty walking • Double vision or blurred vision • Tingling or numbness • Bladder/bowel dysfunction • Depression, poor concentration ⸻ Drug Therapy for MS 1️⃣ Biological Response Modifiers (BRMs) Action: Modify immune system activity and slow disease progression. Examples: • beta-interferons (Avonex, Betaseron, Rebif, Extavia, Plegridy) • glatiramer (Copaxone) • fingolimod (Gilenya) • teriflunomide (Aubagio) Side Effects: • Flu-like symptoms, headache, fatigue • Elevated liver enzymes, slow HR • Thinning scalp hair Nursing Teaching: • Rotate injection sites. • Monitor liver enzymes, CBC, and heart rate. • Avoid live vaccines. ⸻ 2️⃣ Monoclonal Antibodies Action: Destroy lymphocytes that attack myelin. Examples: • alemtuzumab (Lemtrada) • natalizumab (Tysabri) • ocrelizumab (Ocrevus) Side Effects: • Increased risk of infection • Headache, rash, fatigue • GI upset Nursing Teaching: • Given IV every few months to yearly. • Monitor for infusion reactions and infection signs. ⸻ 3️⃣ Neurologic Drugs Examples: • dimethyl fumarate (Tecfidera) – reduces CNS inflammation • dalfampridine (Ampyra) – improves walking by increasing nerve conduction Teaching: • Take daily; don’t crush tablets. • Watch for GI symptoms and dizziness. ⸻ 💪 Amyotrophic Lateral Sclerosis (ALS) Description • Progressive, fatal disorder destroying motor neurons → paralysis. • Death usually occurs within 3–5 years of diagnosis. Drug Therapy Glutamate Antagonists Example: • riluzole (Rilutek, Tiglutik) Action: Inhibits glutamate release → slows neuron damage → prolongs life by months. Side Effects: • Weakness, nausea, dizziness • Liver toxicity (↑ liver enzymes) • Neutropenia, anemia Nursing Implications: • Monitor liver enzymes before and during therapy. • Report jaundice or dark urine. • Take on an empty stomach (1 hr before or 2 hrs after meals). • Avoid alcohol. • Don’t breastfeed while on this med. ⸻ ⚙️ Myasthenia Gravis (MG) Description • Autoimmune disease destroying acetylcholine receptors at neuromuscular junction. • Causes muscle weakness and fatigue, especially in eyes, mouth, throat. Symptoms • Ptosis (drooping eyelids) • Difficulty chewing/swallowing • Weakness in arms, legs, or respiratory muscles • Worsens with activity, improves with rest ⸻ Drug Therapy Acetylcholinesterase Inhibitors Action: Prevent breakdown of acetylcholine → improves nerve–muscle communication. Example: • pyridostigmine (Mestinon) Dosage: Usually every 4–6 hours, depending on patient response. Side Effects: • Nausea, vomiting, abdominal cramps, diarrhea • Increased salivation, sweating • Bradycardia, hypotension Adverse: • Cholinergic crisis (too much medication): → extreme weakness, bradycardia, bronchospasm, respiratory arrest. Nursing Implications: • Use with caution in asthma, COPD, bradycardia. • Give doses at same time each day to maintain muscle strength. • Monitor for myasthenic vs. cholinergic crisis. • Give meds 30–45 min before meals to prevent aspiration. Patient Teaching: • Take missed dose ASAP (but skip if close to next dose). • Don’t double dose. • Avoid alcohol and sedatives. • Report muscle weakness or breathing difficulty. • Keep atropine available (antidote for cholinergic crisis)
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Final Exam Notes Motivation — the process that initiates, guides, and maintains goal-oriented behaviors Need — a requirement for survival (e.g. food, water); unmet needs motivate behavior Need hierarchy — Maslow’s model ranking human needs (physiological, safety, love/belonging, esteem, self-actualization) Drive — an internal state created by unmet needs (biological drive) Homeostasis — tendency of body systems to maintain internal stability Drive reduction — theory that motivation arises from the desire to reduce drives (i.e. satisfy needs) Arousal — state of being physiologically alert, awake, and attentive Optimal arousal — level of arousal leading to best performance (too low or too high impairs performance) Pleasure principle — Freud’s idea that behavior is driven to seek pleasure and avoid pain Incentive — external stimulus that “pulls” behavior (rewards, goals) Intrinsic motivation — performing behavior for internal satisfaction or interest Extrinsic motivation — performing behavior to earn external reward or avoid punishment Biological factors (eating) — e.g. hunger signals from hypothalamus, genetics, metabolism Learning factors (eating) — e.g. food preferences, cultural influences, classical conditioning Achievement — desire to accomplish goals, attain standards Self-efficacy — belief in one’s ability to succeed at a task Delay of gratification — ability to resist short-term temptations for long-term goals Emotion — complex reaction involving subjective experience, physiological arousal, and expressive behaviors Primary emotions — basic emotions (e.g. joy, anger, fear, disgust, surprise) Secondary emotions — more complex emotions (e.g. guilt, shame, pride) James-Lange theory — emotion results from interpreting bodily reactions (e.g. see bear → heart races → feel fear) Cannon-Bard theory — emotions and physiological reactions occur simultaneously Two-factor (Schachter-Singer) theory — emotion = physiological arousal + cognitive label Amygdala — brain region involved in processing emotions, especially fear and threat detection Emotion regulation — methods to control or influence one’s emotions Thought suppression — trying to push thoughts/feelings out of mind Rumination — repetitively focusing on negative feelings Positive reappraisal — reinterpret event in a more positive light Humor — using jokes or laughter to cope with negative emotions Distraction — shifting attention away from emotional triggers Chapter 11: Health & Well-Being Health psychology — field studying psychological influences on health, illness, and wellness Well-being — sense of physical, mental, and social flourishing Biopsychosocial model — model that health is determined by biological, psychological, and social factors Body mass index (BMI) — weight (kg) / (height (m))²; used to classify obesity / overweight Overeating factors — biological (metabolism, hormones), social (availability, norms), genetic predisposition Anorexia nervosa — eating disorder where individuals restrict food intake, fear weight gain, distorted body image Bulimia nervosa — cycle of binge eating followed by compensatory behaviors (e.g. purging, fasting, exercising) Binge-eating disorder — recurrent episodes of eating large amounts without compensatory behaviors Stress — a process by which we perceive and respond to events appraised as overwhelming Stressor — event or condition that triggers stress response Stress response — physical, emotional, and behavioral reaction to a stressor Major life stressors — big events causing substantial change (e.g. death, job loss) Daily hassles — everyday annoyances that accumulate stress (e.g. traffic, chores) General adaptation syndrome (GAS) — three-stage model of stress response GAS phases: alarm reaction → resistance → exhaustion Fight-or-flight response — physiological response to threat (sympathetic activation) Tend-and-befriend response — stress response especially in women: nurturing and social affiliation Type A behavior pattern — competitive, time-urgent, hostile personality (linked to heart disease) Type B behavior pattern — relaxed, easygoing, less competitive Coping — efforts to manage stress Primary appraisal — evaluating whether a stressor is harmful, threatening, or challenging Secondary appraisal — evaluating one’s resources to cope Emotion-focused coping — regulating emotional response to stressor Problem-focused coping — tackling the stressor directly to reduce or eliminate it Positive psychology — field focusing on strengths, well-being, and human flourishing Five ways to stay healthy — e.g. good diet, exercise, sleep, social support, stress management Chapter 12: Social Psychology Personal attributions — attributing behavior to internal traits or dispositions Situational attributions — attributing behavior to external circumstances Fundamental attribution error — tendency to overestimate personal factors and underestimate situational factors when explaining others’ behavior Actor/observer bias — tendency to attribute one’s own actions to the situation, but others’ actions to internal traits Self-fulfilling prophecy — expectation that leads you to act in ways that make it come true Stereotypes — fixed, overgeneralized beliefs about a group Prejudice — negative attitude toward a group Discrimination — negative behavior directed at a group Ingroup bias — favoring one’s own group Outgroup bias — negative attitudes toward those outside one’s group Attitudes — evaluations of people, objects, or ideas (positive/negative) Mere exposure effect — repeated exposure to something increases liking Cognitive dissonance — discomfort when beliefs, attitudes, or behavior conflict Postdecision dissonance — tension after making a choice, leading to justifying one’s decision Persuasion — process of changing attitudes Central route — persuasion via thoughtful consideration of arguments Peripheral route — persuasion via superficial cues (e.g. attractiveness, emotion) Social facilitation — improved performance in presence of others on simple tasks Social loafing — exerting less effort when working in a group Deindividuation — loss of self-awareness/inhibition in group situations Conformity — adjusting behavior or thinking to match a group standard Compliance — changing behavior in response to a direct request Obedience — following orders from an authority figure Milgram’s study — obedience experiments where participants (under instruction) delivered shocks to a “learner” Bystander intervention effect — tendency for individuals less likely to help when others are present Chapter 14: Psychological Disorders Psychopathology — study of psychological disorders; abnormal patterns of behavior, thoughts, or feelings Diathesis-stress model — view that psychological disorders develop due to genetic vulnerability + stress Biopsychosocial approach (to disorders) — disorders result from biological, psychological, and social factors DSM-5 — Diagnostic and Statistical Manual of Mental Disorders, 5th edition (standard classification of mental disorders) Specific phobia — irrational fear of specific object or situation Social anxiety disorder — intense fear of social situations or being judged Generalized anxiety disorder — chronic, uncontrollable worry about multiple domains Panic disorder — recurrent, unexpected panic attacks Obsessive-compulsive disorder (OCD) — obsessions (intrusive thoughts) and compulsions (ritualistic behaviors) Posttraumatic stress disorder (PTSD) — disorder following exposure to traumatic event, with flashbacks, avoidance, hypervigilance Major depressive disorder — persistent sadness, loss of interest, and other symptoms interfering with daily life Bipolar I disorder — periods of mania (and usually depression) Bipolar II disorder — hypomania (less severe mania) + major depressive episodes Schizophrenia — disorder characterized by delusions, hallucinations, disorganized speech, negative symptoms Positive symptoms (in schizophrenia) — delusions, hallucinations, disorganized speech Negative symptoms — flat affect, social withdrawal, lack of motivation Hallucinations — perceptual experiences without external stimuli Delusions — false beliefs held despite evidence to the contrary Disorganized speech — incoherent or illogical thought reflected in speech Disorganized behavior — inappropriate or bizarre behavior Biological risk factors (schizophrenia) — genetics, neurotransmitter abnormalities, brain structure Environmental risk factors — prenatal exposure, stress, family environment Borderline personality disorder — instability in mood, self-image, relationships, impulsivity Antisocial personality disorder (APD) — disregard for others’ rights, lack of remorse Dissociative amnesia — inability to recall important personal information (usually after trauma) Dissociative identity disorder (DID) — presence of two or more distinct identity states Autism spectrum disorder — deficits in social communication, restricted/repetitive behaviors ADHD (attention-deficit/hyperactivity disorder) — inattention, hyperactivity, impulsivity Chapter 15: Psychological Treatment Psychotherapy — therapy involving psychological techniques to treat mental disorders Psychodynamic therapy — therapy based on psychoanalytic concepts (e.g. unconscious conflicts) Humanistic therapy — focuses on growth, self-actualization, and client potential (e.g. Rogerian) Behavior therapy — uses learning principles (classical/operant conditioning) to change behavior Cognitive therapy — focuses on changing maladaptive thoughts or beliefs Cognitive-behavioral therapy (CBT) — integrates cognitive and behavioral methods Group therapy — therapy conducted with multiple participants simultaneously Family therapy — therapeutic approach focusing on family relationships Biological therapy — treatment using biological methods (e.g. medication, brain stimulation) Psychotropic medications — drugs that affect mental processes (e.g. antidepressants, antipsychotics) Electroconvulsive therapy (ECT) — inducing seizures via electrical current to treat severe depression Transcranial magnetic stimulation (TMS) — using magnetic fields to stimulate brain regions Deep brain stimulation (DBS) — surgical implantation of electrodes to stimulate brain structures Exposure (in CBT) — confronting feared stimuli directly in safe context Systematic desensitization — gradual exposure combined with relaxation Cognitive restructuring — changing negative thought patterns Exposure-response prevention — exposure without performing compulsive behavior (used for OCD) SSRIs (selective serotonin reuptake inhibitors) — class of antidepressants (e.g. Prozac, Zoloft) Treatment for depression — CBT + SSRIs often most effective Bipolar treatment — mood stabilizers (e.g"
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