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129 Cards in this Set
- Front
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GABA
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Neurotransmitter
Effect : Most common inhibitory neurotransmitter Clinical use : Seizure and anxiety |
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Serotonin
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Neurotransmitter
Effect : inhibitory Clinical use : Anxiety, bipolarism, depression |
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Norepinephrine
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CNS Inhibitory/excitatory
Neurotransmitter ANS excitatory Clincal use: Depression, memory, panic attacks |
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Dopamine
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Neurotransmitter
Involved in locomotion, attention, learning Clinical use : Parkinson's and psychoses |
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GAD
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Generalized anxiety disorder
Anxiety pesists for 6 months + Excessive worry |
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Panic disorder
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Anxiety by intense feelings of apprehension, terror, fear.
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Social anxiety
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Unreasonable and persist fear of crowds
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PTDS
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Post traumatic stress disorder
Situational anxiety develpod in response to a stress situation Nightmares, hallucinationsm tachycardia |
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Narcolepsy
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Sevvere daytime sleepiness, pt is unable to stay awake
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Valerian and Kava
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Herbal products that produce relaxation. Interacts with many hynotic drugs.
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Benzodiazepines
NonBenzodiazepines Antidepressants Barbiturates |
Major classification of drugs for sleep or anxiety disorders
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Category of drug of choice to treat GAD and short term insomnia
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Benzodiazepines
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Describe Benzodiazepines mechanism of action and primary clincal use
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MOA: Bind to GABA receptor and intensify its effect
Insomnia and Anxiety |
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Bezodiazepines most common side effects and contraindications
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dizziness, ataxia, drowsiness, blurred vision, vertigo, sedation.
Category D pregnancy - Fetus malformation C/I narrow angle glaucoma, chronic obstructive pulminary disease (COPD) or psychosis |
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Define Nonbenzodiazepine MAO, S/E and C/I
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MAO:enhance GABA,however only binds to a specificGABA receptor
S/E: Nausea, dizziness, diarreah, depression, sleepwalking, amnesia. C/I:Use w/ cation with patients wi repiratory impairment. Should not be taken with food. Interactis with other CNS depressants (kava, valerian, melatonin) |
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Barbiturates mechanism of actions and purpuse for its use in low, medium and high dosages.
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Binds to GABA receptorm enhancing HABA activity
Low dosage- anxiety mediun - seizure/hypnotic high - anesthesia |
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Barbiturates S/E and C/I
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S/E hang over effect, lethargy, hallucinations, hepatic diseas, hypocalcemia, even coma and angioedema
C/I pts with renal, hepatic or cardiac impairment.CODP, hyperthyroidsm D/I other cns depressants |
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Dysthymic disorder
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Mild chronic depression lasting 2 years
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Cyclothymic disorder
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A typo of bipolar that alternates between depression and mania
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Depression symptoms
Whats Major depressive disorder |
Lack of energy, sleep disturbances, abnormal eating patterns, hopelessness
MJD : depression lasting for at least 2 weeks. Associated with low levels of nor-epinephrine, serotonin, and dopamine. |
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Seasonal affective disorder
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Depression associated with the lack of exposure to sun light.
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Hypothyroidism
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Strongly associated to depression
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Alternative treatments for depression
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ECT electroconvulsive therapy
rTMS repetitive transcranial stimulation VNS vagus nerve stimulation |
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Primary classes of antidepressants
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Tricuclic antidepressants (TCA)
Selective Serotonin Reuptake inhibitor Atypical antidepressants (NSRI,...) Monoamine Oxidase Inhibitor (MOAIs) |
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Whats the use of drugs of TCA category, S/E, D/I and MAO.
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Tricyclic antidepressants are used to treat depression.
MOA: blocks the reuptake of nor-epinephrine inhibitor S/E: anticholinergic effects, orthostatic hypotension, acumulation in myocardium, dysrrhythmias. Category D for pregnancy D/I : Other CNS depressants, oral contraceptives decrease effects, avoid MAOI's |
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Whats the use of drugs of SSRI category, S/E, D/I and MAO.
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Selective Serotonin Reuptake inhibitor, drug of choice to managa depression
MAO: blocks the uptake of serotonin, increasing amount of neurotransmitter available. S/E Nausea, vomiting, insomnia, sexual dysfunction, hyperkinisia in kids. Cannot be stopped abruptly D/I : Cardiac impaired pts, diabetics, or seizure disorder. Taking with MAOIs can result in serotonin syndrome |
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Serotonin syndrome
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Reuptake of serotonin disease , causing mental status change, HTN, tremors, sweating, hyperpyrexia, ataxia. Resolves in 24 hours
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Whats the use of drugs of SNRI category, S/E, D/I and MAO.
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Selective nor-epinephrine re uptake inhibitors, atypical antidepressant.
MAO : Inhibits NE and serotonin in the CNS S/E: Nausea, weight loss, CNS stimulation (like amphetamines), insomnia, sexual dysfunction D/I: Serotonin syndrome is possible, MAOI's Category C pregnancy |
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Whats the use of drugs of MAOI's category, S/E, D/I and MAO.
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Monoamine oxidase inhibitors treats depression, but causes potentially serious adverse effects
Blocks the action of monoamine oxidase (neurotrans that destroys NE, dopamine and serotonin), enhancing their effects Lowest safety margin out of the antidepressants.. S/E: Tachycardia, hypertensive crisis, blocks breakdown of dietary tyramine (found in beer, chocolate ..) D/I Increase effects of diabetic, htn and cardiac drugs. Interacts with foods rich in tyramine. |
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Lithium - Alkali metal ion salt
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Mood stabilizer used for bipolar disorder
Require Serum checkups MOA : Acts by increasing the synthesis of serotonin. C/I: cardiovascular/renal impairment, thyroid disease, diabetic patients S/E : Initial : lethargy, nausea, polyuria, nocturia, tremors, confusion Long term: kidney impairment, dysrhythmias, blood dyscresias. D/I: Diuretics, salt depletion, NSAIDs increase lithium levels. Should not be taken with caffeine beverages |
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Psychosis
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Loss of contact with reality
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Delusions
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Firm ideas that are false and not found in reality. (believing to be Jesus)
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Hallucinations
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Seeing, hearing, feeling something not really there
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Schizophrenia
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Abnormal thoughts or thought process, disordered communication, occurs between 15 and 35 years old.
Symptoms associate with D2 receptors (dopamine) Presents positive or negative symptons |
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Describe the positive and negative symptoms of schizophrenia
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Positive : treatable with meds, hallucinations, paranoia, delusions, agitations, anxiety, Illusions.
Negative : Apathy, withdrawal, poor judgment, no functional speech. |
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Anti-psychotic classes
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Phenothiazines and Nonphenothiazines
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Extrapyramidal symptoms EPS
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Adverse effects related to psychotic drugs
Acute dystonia, akathisia, parkinsonism, tardive dyskinesia. |
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Whats the use of drugs of Phenothiazine category, S/E, D/I and MAO.
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Antipsychotic drugs used in the treatment of schizophrenia
Also used in treating: Nausea and vomiting, tourettes syndrome, organic brain syndrome. MOA : blocks post-synaptic dopamine receptors. S/E : Extrapyramidal syndrome, anticholinergic effects, blurred vision, dry ass, glaucoma. Tachycardia, laryngospasms, respiratory depression, seizures. |
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Whats the use of drugs of Nonphenothiazine 2nd generation category, S/E, D/I and MAO.
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Drug of choice in the treatment of schizophrenia
Lower incidence of EPS MO: dopamine antagonist A/E : Increased salivation, constipation, impotence, hyperglacemia, glactorrhea, D/I SSRIs and other CNS depressants |
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Whats the use of drugs of DSS category, S/E, D/I and MAO.
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Antipsychotic. Dopamine System Stablizers work on both agonist and partial antagonist dopamine receptor
Lower incidence of S/E than phenothiazines and nonphenothiazines Interacts with grapefruit juice |
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Degenerative diseases of CNS
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Alzheimer's, Huntington's, Parkinson's, MG, Multiple Sclerosis
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Medications can cause Parkinson's like symptoms called
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Secondary PD symptoms
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Parkinson's symptoms
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Tremors, muscle rigidity, bradykinesia, postural instability.
Caused by an insufficient amount of dopamine produced by substantia nigra |
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Drugs used in the treatment of PD
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Dopamine Replacement Agents, Dopamine Agonists, COMT inhibitors, others
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Idiopathic pain
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non-specific pain of unknown origin
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Drugs used in conjunction with altered patterns of sleep
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sedative-hypnotic
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Azaspirones
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• Chemically related to barbituates, benzodiazepines or other anxiolytic agents
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How long (average) antidepressants take to start working ?
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• All must be taken for 2 to 4 weeks before depressive symptoms improve
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This class of antidepressants can be taken with food and may cause weight gain
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SSRI's
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Valproic acid
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• Rapidly distributed with 90+% protein bound
• Treats acute manic symptoms |
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Main antipsychotic adverse effects
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• Extrapyramidal reactions ( p. 331)
• Antimuscarinic or anticholinergic side effects • Dermatologic • Endocrine • Non-reversible bone marrow depression • Neuroleptic malignant syndrome |
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PD facts
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• Parkinson’s disease: a chronic disorder of CNS; muscle tremors, bradykinesia, muscle weakness with rigidity, alteration in posture & equilibrium
• Symptoms caused by a dopamine deficiency in extrapyramidal system within basal ganglia. • Drugs used to increase levels of dopamine (dopaminergic) or inhibit acetylcholine (anticholinergic ) |
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Levodopa
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Most known efficient drugs in the treatment of Parkinson's
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Epilepsy
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a group of neurological disorders characterized by recurrent episodes of convulsive seizures, sensory disturbances, abnormal behavior, loss of consciousness, or any combination of these.
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Seizure
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the excessive stimulation of neurons in the brain leading to a sudden burst of abnormal neurons activity results in temporary changes in brain function.
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Convulsion
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characterized by spasmodic contractions of voluntary muscles.
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Secondary epilepsy:
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usually in infants and children and are developmental defects, metabolic disease, or injury at birth. Some can be acquired such as head injury, infection or disease (stroke).
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Major classes of antiepiletic drugs
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Barbiturates:
Benzodiazepines: Hydantoins: (Depakene) Iminostilbenes: Succinimides: Miscellaneous |
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Barbiturates
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Used for controlling tonic-clonic and partial seizures.
Used in STATUS EPILEPTICUS and used for controlling febrile seizures. Side effects are sedation, and tolerance,in pediatrics the most common adverse effects are irritability, hyperactivity, depression, sleep disorders, and cognitive abnormalities. Therapeutic effects are seen at serum drug levels of 15 to 40 micrograms/ml. It has a long half life and therefore only dosed q 24 hours. |
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Benzodiazepines
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: Used as first-line agents in the treatment of status epilepticus and as second-line agents
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Hydatoin
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Phenytoin: Is used as of tonic-clonic and partial seizures.
Common side effects: lethargy, abnormal movements, mental confusion, and cognitive changes Therapeutic drug levels are 10 to 20 micrograms/ml. Toxic levels can cause nystagmus, ataxia, dysarthria, and encephalopathy. Long term use: gingival hypertrophy, acne, hirsutism, and hypertrophy of subcutaneous facial tissue (Dilantin facies”) and osteoporosis (Vit D supplement) Vitamin K and folic acid. |
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Pain Physiology has four phases
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Transduction
Transmission Perception Modulation |
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Muscle spasms
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Treated with muscle relaxants that work in the brain
Central acting or direct acting Examples of Central acting Baclofen (lioresal) Cyclobenzaprine (Flexeril) Metaxalone (Skelaxin) Tizanidine (Zanaflex) |
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Muscle relaxants
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Similar to TCA's
S/E include muscle weakness |
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ADHD
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presents in children and may extend into adulthood
For diagnoses purpose, pt must have 6 of the common symptoms |
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Drugs used in the treatment of ADHD
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Amphetamines (adderall)
CNS stimulant, sympathomimetic, increase attention and alertness, also used for narcolepsy. Stimulates the release of epinephrine and dopamine. S/E loss of appetite A/E: irritability,insomnia, palpitations |
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ADHD non stimulants
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SNRI
frontal lobe concentration stimulation OD causes sympathetic stimulation |
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Narcolepsy
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Day dreaming, drowsiness.
CNS stimulants are prescribed for treatment. Contraindications include caffeine S/E Euphoria, dry mouth, nausea, insomnia |
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Methylxanthines
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Used in the treatment od COPD
Ability to relax bronchial smooth muscle Caffeine is a type of Methylxanthine |
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Nociceptors
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Pain receptors located throughout the body, initiate pain transmission. Analgesic worn on these receptors to relief pain.
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Opiods and non opiods
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are drugs that relief pain by interacting with mu, kappa and delta receptors in the CNS
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Opiods
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Relief moderated-high pain levels.
Cause analgesia, decreased GI motility, euphoria, miosis, dependence, resp. depression, sedation May cause severe ICP and nausea/vomit Prototype:Morphine |
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NSAID's
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Nonsteroidal anti-inflammatory drugs
used in the treatment of mild-moderate pain Works by unhibiting pain mediator in the peripheral site (cycloxygenase) S/E ulcerations, dyspepsia, anorexia, vomiting |
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Tramadol
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Analgesic drugs that produce CNS depression without respirator issues
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Palliative care
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used for cancer patient to help the management of extreme pain
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Opiods antagonists
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used in OD cases, reverse respiratory depression, compete with mu and kappa receptors
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Mu and kappa receptors
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Pain receptors, NSAIDs, tramadol, work on these receptors to produce analgesic
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Mild Migraines treatment
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Usually treated with NSAIDs and caffeine
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Treatment for Moderate-severe migraines
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Serotonin receptor agonists (5HT1) causing vasodialation of cranial vessels
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General anesthesia
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Causes loss of consciousness to entire body, loss of sensation
Analgesia, relaxation, hypnosis, amnesia, loss of reflexes |
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Regional anesthesia
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Loss of sensation w/o LOC(loss of consciousness) - works in an entire limb.
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MAC - Monitored anesthesia care
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used in diagnostic procedures and minor surgeries
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Stage III
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Stage III - surgical anesthesia required for most procedures
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Drugs used in anesthesia
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Barbiturates (rapid anesthesia, short duration)
Opioids (pain relief) Benzodiazepines (Relaxation) Ketamine/Propolol (maintain anesthesia), depress limbic system |
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Inhalation anesthesia
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Nitrous oxide, GABA receptors agonist, opioid agonist
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Local anesthetics
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surface anesthesia - sprayed on
infiltration anesthesia - injected in deeper skin layers nerve block - surrounding a peripheral nerve, causes regional anesthesia epideral anesthesia - obstratic spnial anesthesia - injected in spinal cord, abdomnal anesthesia |
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Give examples of local anesthetics
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Ester(Novacaine) and Amide (Lidocaine)
Decrease amount of sodium entering neuron, depressing depolarization, preventing conduction epinephrine is added many times to limit blood loss and decrease anesthesia systemic absorption C/I Cardiac impairment |
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Preoperative drugs
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anticholinergic are given to decrease salication and glands excretion
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Post operative drugs
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Opiods and antiemedics
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Main lipoproteins
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VLDL primary carrier of triglycerides, transporting it for storage
LDL reduced sized of VLDL HDL transports excess cholesterol back to liver (reverse cholesterol transport) for excretion via bile |
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HDL
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Good cholesterol, assis in reverse cholesterol transport, lowering VDLD thus lowering LDL
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HTN drugs - main categories
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Diuretics
Adrenergic drugs (CNS and peripheral) ACE inhibitors Vasodialators CCB (Calcium channel blockers) Angiotensin II receptor blocker |
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Diuretics
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Inhibit Na reabsorption and K+and Na reabsorption
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CNS acting antihypertensive drugs
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Central stimulations - stimulates alpha 2, decreasing cardiac output and dilating vessels
Peripheral - block beta 1 receptors and reduce renin |
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ACE drugs
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Treatment of hypertension, drug of choice for heart failure patients.
S/E dizziness, orthostatic hypotension, dry non productive cough, metallic taste, andgioedema Pregnancy contraindicated All the "prils" like Lisinopril, Captopril |
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Angiotensin receptor blocker (ARB)
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bind to angiotensin at the receptor, advantages over ACE by not causing cough, push fluid and water to maintain blood volume
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Calcium channel blocker (CCB)
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Inhibit movement of calcium ions across cell membrane
most affective in african-americans and elderly Serum digoxin may increase while on this med |
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Direct Vasodialators
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Causes direct visodialation, used in hypertensive emergencies.
Hyperstat Bio-product maybe toxic to the body, dangerous on hypoglacemic pts |
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Nursing implications for patients taking HTN drugs
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Monitor BP/HR
Weight patient daily - Change positions slowly (due to orthostatic hypotention) |
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Coagulation drugs
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block formation of thrombus, embolus and fibrin.
may cause excessive bleeding Common med : Heparin |
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Anticoagulation drug
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Warfarin
Inhibit vitamin K clotting factors that are produced in the intestinal walls |
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Anti-platelet
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Affects the cyclooxygenase pathway, making the platelets "slippery", preventing coagulation
Example Aspirin |
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Thrombolytics
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Convert plasminogen to plasmin, breaking down clots
According to the professor "the good stuff" Generally administered in the ER, given within 4 hours of stroke, may prevent arterial blockage from happening |
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Nursing considerations when patients are taking anticoagulant drugs
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Monitor lab tests Hgb, HCT, PT, aPIT, INR
Careful with Vitamin K due to its influence in clotting formation |
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Hematopoetic drugs
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Used in the treatment of Anemia
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Reasons for anemia
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Iron deficientcy, bone marrow depression, folic-acid
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Iron pharmacology
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Iron is important in the formation of RBC's
do not take with milk, take with orang juice |
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Cyanocobalamin
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Vitamin B12, important in there treatment of pernicious anemia and megaloblastic anemia
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Erythropoietic drugs
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Stimulates production of blood cell on bone marrow
(erythropoetin is naturally produced in the kidneys, stimulating RBCs productions. Patients w renal failure take this meds to maintain optimal RBC count) |
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Colony stimulating factors
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stimulates blood cell production by bone marrow following bone marrow transplant or chemotherapy
Filgrastin (Neupogen) |
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Crystalloid
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clear fluids given in IV
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Types of crystalloids
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NS - Normal Saline o.9 % Na
Lactated ringers - lactate is converted by the liver to bicarbonate, to reduce acidic level after surgery (electrolyte replenisher ) D5W - 5 % dextrose Plasma-lyte (electrolyte replenisher ) |
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Concentration of crystalloids
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Isotonic 0.9 %
Hypotonic 0.45% Hypertonic 10 % dextrose |
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Colloids
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Drugs that pull fluid from edema to vascular bed
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Blood products administration
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must be administered by 2 accredited professionals (2 RNs)
May be only given with NS If A/E occur, stop infusion O- blood type maybe given to anyone |
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Potassium adm for electrolyte imbalanced
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Potassium (k+) 3.5 to 5.0 mEql/L must be diluted, otherwise it can stop the heart
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Renal system responsibilities
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Formation of urine, electrolyte balance, erythropoetin, excretion of products
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Beta-Blockers produce a significant decrease in blood pressure by decrease cardiac out put
True or False |
False, it decreases de effect of endogenous substances
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Vitamin K is antidote for __________
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Warfarin
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Vitamin K will affect action of digoxin & lasix
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False
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Aldactone/ is an example of______
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Potassium Sparing
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Vasodilation and faster heart rate
True or False |
False
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carbamazepine
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treatment of seizures and maniac episodes
GABA enhancers and sodium channel stabilizers |
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Phentolamine
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used in hypertensive crisis
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The pain gate control theory proposes
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There is a mechanism of transmission of pain in the spinal cord
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The nocirepectors are located in which receptors
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Sensory receptors and relate to pain
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Anesthetic agents
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Barbiturates
Benzodiazepines Opioids Miscellaneous agents |
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Ketamine and propolol
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Intravenous general anesthesia
Ketamine S/E HTN, and tachycardia.Respiratory depression Dellirium, hallucinations (Emergence phenomina) Administer drug slowly |
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Nitrous oxide
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Inhaled anesthesia
Stage II anesthesia, anxiety, excitement nausea, vomiting, lethargy. Caffeine or adrenergic agents may exacerbate dysrhythmia Must monitor patients pulmonary function |