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NURS368 Pharmacology - Chapter 4- Central Nervous
System Exam Study Set
What are the roles of the nervous system? - ANSWER - Controlling the functions of the human body
- Analyzing incoming stimuli
- Integrating internal and external responses
The central nervous system is composed of: - ANSWER The brain and spinal cord
The peripheral nervous system is composed of: - ANSWER - Sensory nerves that bring information into the CNS
- Motor nerves that carry information away from the CNS
What does the autonomic nervous system do? - ANSWER The ANS uses components of the CNS and PNS to regulate automatic or unconscious responses to stimuli
What are the main functions of the cells that make up the nervous system? - ANSWER - Allow movement
- Allow realization of various sensations
- Provide response to internal and external stimuli
- Stimulate learning, thinking, and emotions
The structures in the central nervous system are covered by _______________. - ANSWER Meninges
What is the blood-brain barrier? - ANSWER Protects the brain from exposure to toxins.
Only medications that are ____________ ___________ are able to cross the blood brain barrier. - ANSWER Lipid soluble
Knowing what you know about the blood-brain barrier and where it is located, what must a medication be in able to work on the central nervous system? - ANSWER In order for a medication to work on the central nervous system, it must be lipid-soluble.
True or false: lipid-soluble drugs can cross the placenta. - ANSWER True
The forebrain is responsible for what? - ANSWER Personality, speech, inhibitions
The hindbrain runs from the top of the _______ ______ into the ___________. - ANSWER Spinal cord; midbrain
What is the most primitive part of the brain that also contains the brainstem? - ANSWER The hindbrain
The hindbrain is responsible for controlling what? - ANSWER Basic vital functions such as breathing, blood pressure, swallowing, and the RAS (reticular activating system)
What is the RAS and where is it located? - ANSWER The RAS is the reticular activating system is a bundle of nerves at our brainstem that filters out unnecessary information so the important stuff gets through. The RAS is the reason you learn a new word and then start hearing it everywhere.
Which part of the brain contains the thalamus, the hypothalamus, and limbic system? - ANSWER The midbrain
What is the job of the thalamus? - ANSWER The thalamus sends direct information into the cerebrum to transfer sensations
What is the job of the hypothalamus? - ANSWER The hypothalamus acts as major sensor activity in the body and is responsible for regulating:
- Temperature
- Water balance
- Appetite
- Endocrine function
The forebrain is made up of: - ANSWER The two hemispheres of the brain (telencephalon and diencephalon).
What structure joins together the two hemispheres of the forebrain? - ANSWER The corpus callosum
What is the function of the forebrain? (in depth) - ANSWER Receiving and sending nerve impulses, coordinating speech and communication, and facilitating learning
What is the function of the limbic system, and where is it located? - ANSWER The limbic system contains high levels of neurotransmitters (such as epinephrine, norepinephrine, and serotonin), and controls the expression of emotions.
The spinal cord is made up of how many pairs of spinal nerves? - ANSWER 31
Each spinal nerve has two components or roots. What are these components called, and what is their function? - ANSWER 1. Sensory fiber (dorsal root) - brings information into the CNS from the periphery
- Motor fiber (ventral root) - causes movement or reaction
system? - ANSWER - Persistent headache
- Loss of sensation (such as taste and smell)
- Memory loss
- Muscle weakness
- Tremors
- Nausea and vomiting
- Loss of bowel or urinary control
- Seizures
- Speech problems
- Irretractable pain
- Paralysis
- Blindness
There are several types of drugs used for conditions of the central nervous system. What are the different types? - ANSWER - Analgesics
- Antiseizure/antiepileptic agents
- Medications for neurodegenerative disorders
- Muscle relaxants
- Local anesthetics
What are the primary classes of analgesics? - ANSWER - Narcotics/opioids
- NSAIDs
- Acetaminophen (Tylenol)
What is the primary goal of analgesics? - ANSWER The primary goal of analgesics is to provide symptomatic pain relief.
What are the most common NSAIDs? - ANSWER Ibuprofen, advil, naproxen, aspirin
NSAIDs are very _____________ in high quantity. - ANSWER Nephrotoxic
Acetaminophen is very ___________ in high quantity. - ANSWER Hepatotoxic
True or false: narcotics are CNS sedating, while NSAIDs are not. - ANSWER True
Describe the actions of agonist narcotics/opioids and antagonist narcotics/opioids. - ANSWER Agonists promote the opioid receptor, whereas antagonists block opioid receptors.
Which opioid is long lasting? - ANSWER Oxycontin
What are the two groups of NSAIDs? - ANSWER Salicylates (aspirin) and COX- inhibitors (reduce inflammation)
What is the only COX-2 inhibitor still on the market? - ANSWER Celebrex
What is the most common antagonist opioid? - ANSWER Narcan
True or false: codeine, a naturally derived analgesic, is easily metabolized by everyone.
- ANSWER False - some people are unable to metabolize codeine.
What are the two types of naturally derived narcotics/opioids as discussed in the powerpoint? - ANSWER Morphine and codeine
What are the two types of semi-synthetic narcotics/opioids as discussed in the powerpoint? - ANSWER Oxycodone and hydromorphone
What are the two broad categories of seizures? - ANSWER - Generalized
What are non-epileptic seizures? - ANSWER Seizures caused by physiological or psychological condition (like high fever).
What is one of the main symptoms of a seizure? - ANSWER Loss of bladder and bowel function
What is the physiological reason behind seizures? - ANSWER Seizures occur when GABA (a calming neurotransmitter) is lacking, causing hyper-firing of neurons.
Antiseizure medications replace ________ to prevent seizures. - ANSWER GABA
Which condition is the most prevalent of the neurological disorders? - ANSWER Epilepsy
Epilepsy is characterized by: - ANSWER frequent and recurring seizures, as well as a loss of control.
What is one possible reason that epilepsy may develop? - ANSWER Epilepsy may start due to a high fever or infection in which the brain is essentially rewired and epileptic seizures become frequent and recurring.
Which antiseizure medication has recently become a scheduled drug due to its abuse? - ANSWER Gabapentin
When should we expect a patient to outgrow febrile (fever) seizures? - ANSWER By the age of 5-6 years old
True or false: seizures then to be caused by abnormal neurons sensitive to stimulation or prone to over-responsiveness. - ANSWER True
What are primary seizures vs. secondary seizures? - ANSWER Primary seizures are caused by a seizure disorder such as epilepsy, whereas secondary seizures are caused by conditions in which the CNS is damaged (such as traumatic brain injury or high fever).
When classifying seizures, the seizure ___________ is very important. - ANSWER Type
Partial seizures are also known as ______________ seizures. - ANSWER Focal
Describe partial seizures. - ANSWER Involve one area of the brain, and can be classified as either simple or complex.
Because the medications used to treat generalized seizures act on the central nervous system, what is a likely side effect from taking these medications? - ANSWER Sedation and other CNS effects
True or false: absence seizures may require drugs that are different than generalized seizures. - ANSWER True
How do drugs used to treat generalized seizures work? - ANSWER They stabilize the nerve membranes by blocking channels in the cell membrane or altering receptor sites.
There are two types of antiseizure drugs in terms of when they are administered. Describe them. - ANSWER Antiseizure medications can either be used as a daily medicine as means of preventing seizures from happening, or they can be abortive drugs for active seizures.
What is the most common benzodiazapene used to abort seizures? - ANSWER Valium
What are the two anticonvulsants used to abort seizures? - ANSWER - Valium (a benzodiazapene) and phenobarbital (a barbiturate).
Parkinson's disease usually begins to effect people of what age (although it may develop at any time)? - ANSWER Usually effects those who are past middle age and entering their 60s.
Parkinson's therapy is aimed at management of: - ANSWER Signs and symptoms
When assessing the progression of Parkinson's disease, what symptoms would expect to see? - ANSWER - Lack of coordination
- Rhythmic tremors
- Rigitidy/weakness
- Trouble maintaining position or posture
- Bradykinesia (slow movement)
- Difficulty walking
- Drooling and affected speech
- Mask-like expressions (expressionless)
What is most effective drug / drug combination used to treat Parkinson's disease? - ANSWER Carbidopa-levodopa
What are the side effects of carbidopa-levodopa drug therapy? - ANSWER - Dyskinesias (abnormal and inappropriate movements)
What are the contraindications of carbidopa-levodopa treatment? - ANSWER - Pregnant or breastfeeding women
- Patients with chronic wide-angle glaucoma
Which anti-Parkinson's agent is a precursor of dopamine that crosses the blood-brain barrier, where it in then converted to dopamine? - ANSWER Levodopa
True or false: levodopa is almost always given in combination with carbidopa in the form of a fixed-combination drug (Sinemet)? - ANSWER True
How does carbidopa work with levadopa as a means of treating Parkinson's disease? - ANSWER Carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain, which is beneficial because the levodopa dosage can then be decreased, reducing adverse side effects.
What is the drug ropinirole used for? - ANSWER Ropinirole is an anti-Parkinson's drug that is a dopamine receptor agonist (promotes the dopamine receptor).
True or false: ropinirole has similar side effects as other anti-Parkinson's medications. - ANSWER True
Ropinirole has a blackbox warning for what behaviors? - ANSWER Gambling, OCD, excessive spending
One possible side effect of ropinirole is ___________. - ANSWER Narcolepsy
What is benztropine and what is it used for? - ANSWER Benztropine is an anticholinergic drug (blocks acetylcholine) and this is used to decrease symptoms for Parkinson's patients.
Is benztropine an antagonist or agonist? - ANSWER Benztropine in an antagonist, anticholinergic drug.
What is amantadine and why is it it helpful in treating Parkinson's disease? - ANSWER Amantadine is an antiviral drug that has actually shown to help with PD, but the reason behind this is unknown.
What is one cardinal side effect of amantadine (antiviral medication used to treat PD)? - ANSWER A bright red rash
- Hypertension
- Hypotension
- Hepatic dysfunction
- Pregnancy and lactation
What are the adverse reactions of anticholinergic drugs? - ANSWER - Disorientation
- Confusion
- Agitation
- Delirium
- Nausea, vomiting, paralytic ileus
What are the drug-to-drug interactions of anticholinergic interactions that should be avoided? - ANSWER - Tricyclic antidepressants
What are some possible nursing considerations for antiparkinsonism drugs? - ANSWER
- Known allergy
- GI depression or obstruction
- urinary hesitancy or obstruction
- benign prostatic hypertrophy
- Pregnancy or lactation
- Level of orientation
- Neurological status
- Affect
- Bilateral grip strength
- Gait
- Tremors
- Spasticity
What is the most common form of dementia? - ANSWER Alzheimer's disease
True or false: there is a cure for Alzheimer's disease. - ANSWER False
What are two drug classes used to slow the disease progression of Alzheimers? - ANSWER - Cholinesterase inhibitors (stop the enzyme that breaks down acetylcholine)
- NMDA receptor antagonists (block NMDA, an amino acid that influences memory)
What are the side effects of the drugs used to treat Alzheimer's disease? - ANSWER Impaired thinking and actions
What are the four out of five drugs used to treat Alzheimer's disease, and what drug class do they belong to? - ANSWER There are four cholinesterase inhibitors that are used to treat Alzheimer's. These are:
- Tacrine (Cognex)
- Galantamine (Razadyne)
- Rivastigmine (Exelon)
- Donepezil (Aricept)
What are the two most common drugs used to treat Alzheimer's disease? - ANSWER Rivastigmine and donepezil
What is the action of indirect-acting cholinergic agonists? - ANSWER These drugs block acetylcholinesterase at the synaptic cleft, allowing for the accumulation of ACh released from the nerve endings and leads to increased and prolonged stimulation of ACh
What are the indications of indirect-acting cholinergic agonists? - ANSWER - Myasthenia gravis and Alzheimer's disease
Muscle spasticity: comes from direct injury of the CNS
What are the two classes of muscle relaxants? - ANSWER - Neuromuscular blockers
- Spasmolytics (centrally acting)
True or false: muscle relaxers are usually sedating and target acetylcholine. - ANSWER True
What is the action of centrally acting skeletal muscle relaxants (spasmolytics)? - ANSWER These work in the upper levels of the CNS to interfere with the reflexes causing the muscle spasm, in which the spasm is destroyed
What are the indications of spasmolytic or centrally acting muscle relaxants? - ANSWER Alleviation of signs and symptoms of spasticity; use in spinal cord injuries or diseases
What are the adverse reactions of centrally-acting skeletal muscle relaxants? - ANSWER
- Drowsiness
- Fatigue
- Weakness
- Confusion
- Headache
- Nausea
- Dry mouth
- Hypotension
What are the drug-to-drug interactions of centrally acting skeletal muscle relaxants? - ANSWER CNS depressants
What are the contraindications of centrally acting skeletal muscle relaxants? - ANSWER
