Term
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Definition
any chemical that affects physiologic processes of a living organism |
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Term
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Definition
study or science of drugs |
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Term
Who regulates OTC and prescription drugs? |
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Definition
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Term
Who can prescribe prescription drugs? |
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Definition
Medical doctors, Doctors of osteopathy, dentists, podiatrists, PA's and APRN/s |
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Term
Who regulates new drug development? |
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Definition
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Term
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Definition
involves the careful explanation to the human test patient or research subject of the purpose of the study, the procedures to be used, the possible benefits, and the risks involved |
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Term
What happens in each phase? |
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Definition
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Term
Examples of medical errors |
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Definition
Misdiagnosis, patient misidentification, lack of pt monitoring, wrong-site surgery, and med erros |
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Term
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Definition
any preventable adverse drug events involving inappropriate meds used by a patient or health care professional- may or may not cause harm to pt |
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Term
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Definition
Drugs that have potentially toxic nature, require special care when prescribing, dispensing, and/ or administering |
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Term
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Definition
Sound alike look alike drugs |
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Term
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Definition
Describes the drug chemical composition and molecular structure |
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Term
Generic name (nonproprietary name) |
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Definition
used by most official drug compendiums to list drugs |
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Term
trade name (proprietary name) |
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Definition
drug's registered trademark and indicates that its commercial use is restricted to the owner of the patent fro the drug |
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Term
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Definition
structure or therapeutic use |
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Term
Differences btw generic vs trade names |
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Definition
generic is often much shorter and simpler to remember compared to the chemical name while the trade name is created by the manufacter |
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Term
Important factors btw generic and trade |
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Definition
Generic is for NCLEX testing only, common general name, lowercase, less expensive agent, difficult to spell and say; Trade is pharmaceutical indenitified, capitilized, trademarked, expensive, active ingredient |
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Term
OTC medications- nonprescription |
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Definition
Meds that are legally available w/o prescription |
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Term
why are OTC meds. so dangerous? |
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Definition
own toxicity profiles, abuse |
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Term
important considerations of OTC |
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Definition
review safety labels, pros/ cons of meds |
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Term
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Definition
broad term for orally administered alternative medicines and includes the category of herbal supplements |
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Term
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Definition
come for nature and have been used for thousand of years to help maintain good health |
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Term
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Definition
lost ground to new synthetic medicines during the early part of the 20th century |
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Term
Commonly used herbal products? |
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Definition
aloe, black cohosh, garlic, ginger, valerian, saw palmetto |
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Term
What are important nursing implications to consider w/ pts using herbal products? |
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Definition
consider pregnancy, breastfeeding, infants, children |
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Term
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Definition
the science of preparing and dispensing drugs including dosage form design |
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Term
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Definition
study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body |
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Term
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Definition
study of the biochemical and physiologic interactions of drugs at their sites of activity |
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Term
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Definition
treatment of pathologic conditions through the use of drugs |
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Term
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Definition
study of poisons including toxic drug effects and applicable treatments |
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Term
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Definition
the study of drugs that are obtained from natural plant and animal sources |
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Term
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Definition
the study of economic factors impacting the cost of drug therapy |
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Term
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Definition
movement of a drug from its site of administration into the bloodstream from distribution to the tissues |
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Term
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Definition
used to express the extent of drug absorption |
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Term
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Definition
drug that is absorbed from the intestine must 1st pass through the liver before it reaches the systemic circulation; If a large proportion of a drug is chemically changed into inactive metabolites in the liver, then a much smaller amount of drug will pass into the circulation (i.e., will be bioavailable). |
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Term
what factors affect absorption? |
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Definition
how drug is given, its route, affects the rate and extent of absorption of that drug |
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Term
When will the nurse administer medications if ordered with food or on an empty stomach?? |
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Definition
Within 20-30 minutes; 1 hr before and 2 hr after; administer w/food , shortly after meal w/ 6-8 oz of water |
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Term
List the 3 routes of drug administration. |
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Definition
topical- patches, paste, eyedrops, parenteral- around gi tract, enteral- gi tract |
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Term
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Definition
drug is absorbed into the systemic circulation through the mucosa of the stomach and/or small or large intestine. Orally administered drugs are absorbed from the intestinal lumen into the blood system and transported to the liver. Once the drug is in the liver, hepatic enzyme systems metabolize it, and the remaining active ingredients are passed into the general circulation. |
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Term
Name several forms of medications that are included in the enteral route. |
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Definition
Hydralazine, lithium, oral opiods, lithium propenotol, NSAID, iron, sublingual, buccal, rectal |
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Term
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Definition
general term meaning any route of administration other than the GI tract. It most commonly refers to injection. Intravenous injection delivers the drug directly into the circulation, where it is distributed with the blood throughout the body. Drugs given by intramuscular injection and subcutaneous injection are absorbed more slowly than those given intravenously. These drug formulations are usually absorbed over a period of several hours; however, some are specially formulated to be released over days, weeks, or months. |
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Term
Name several forms of medications administered via the parenteral route. |
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Definition
IV, irritating drugs, antibotics, steroids, transdermal, intramuscular |
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Term
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Definition
Refers to the transport of a drug by the bloodstream to its site of action |
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Term
What system is responsible for distribution? |
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Definition
Circulatory, heart, liver, kidneys, brain- rapid distribution Muscle, skin, feet- slow distribution |
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Term
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Definition
when taking 2 medication that are highly protein bound and the meds may compete for binding sites, blood-brain barrier-physiologic barriers that make it diffiult for drugs to pass through the brain |
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Term
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Definition
also referred to as biotransformation. It involves the biochemical alteration of a drug into an inactive metabolite, 26a more soluble compound, a more potent active metabolite (as in the conversion of an inactive prodrug to its active form), or a less active metabolite |
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Term
What is the main organ is responsible for metabolism? |
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Definition
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Term
List factors that increase or decrease metabolism. |
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Definition
Fast acetylatoyr ,phenytoin, barbiturates;CV dysfunction, renal insufficiency, starvation, obstructive jaundice, slow acetylator |
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Term
What is the danger with increased or decreased metabolism of medications? |
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Definition
Increased metabolism may require higher dosages of meds, decreased metabolism leads to decreased blood flow and enzyme production |
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Term
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Definition
elimination of drugs from the body |
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Term
main organ involved in excretion? |
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Definition
Kidney, bilary excretion, enterohepatic recirculation |
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Term
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Definition
time required for 50% of a given drug to be removed from the body |
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Term
how many half-lives does it take for most meds to be effectively removed from the body? |
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Definition
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Term
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Definition
Physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose |
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Term
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Definition
processes involved in the interaction btw a drug and a cell |
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Term
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Definition
physiologic reactions of the body to the drug |
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Term
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Definition
time required for the drug to elicit a therapeutic response |
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Term
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Definition
time required for a drug to reach its max. therapeutic response |
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Term
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Definition
length of time that the drug concentration is sufficient to elicit a therapeutic response |
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Term
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Definition
lowest blood level of a drug |
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Term
3 ways that drugs act on the body |
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Definition
through receptors, enzymes, and nonselective interactions |
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Term
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Definition
involves more intensive drug treatment& is implemented in the acutely ill (rapid onset of illness) or critically ill, needed to sustain life or treat disease |
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Term
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Definition
does not eradicate pre-existing problems the patient may have, but will prevent progression of a disease or condition. It is used for the treatment of chronic illnesses such as hypertension. |
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Term
Supplemental/replacement therapy |
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Definition
supplies the body with a substance needed to maintain normal function. This substance may be needed either because it cannot be made by the body or because it is produced in insufficient quantity. |
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Term
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Definition
to make the pt as comfortable as possible; relief from the symptoms, pain, and stress of a serious illness |
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Term
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Definition
maintains the integrity of body functions while the pt is recovering from illness or trauma |
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Term
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Definition
provided to prevent illness or other undesirable outcome during planned |
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Term
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Definition
based on clinical probabilities, involves drug administration when a certain pathologic condition has a high likelihood of occurrence based on the pt.'s initial presenting symptoms |
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Term
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Definition
Any pt. condition esp. a disease state that makes the se of the given medication dangerous for the pt. |
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Term
black box warning and who assigns them |
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Definition
black box warning and who assigns them? (Chapter 4, see slide %) Appears in a drug’s prescribing information and required by the FDA to alert prescribers of serious adverse events that have occurred w/ the given drug (voluntary recall); FDA |
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Term
Clinical Response or therapeutic effect |
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Definition
effectiveness of the therapy |
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Term
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Definition
predictable adverse drug reactions |
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Term
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Definition
The ratio of a drug's toxic level to the level that provides therapeutic benefits |
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Term
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Definition
important tool for evaluating the clinical response to drug therapy |
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Term
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Definition
pt’s concurrent diseases or other medical conditions |
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Term
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Definition
decreasing response to repeated drug doses |
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Term
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Definition
physiologic or psychological need for a drug |
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Term
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Definition
alteration of the action of 1 drug by another |
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Term
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Definition
4 types- any reaction to a drug that is unexpected& undesirable& occurs at therapeutic drug dosages; pharmacologic reaction, hypersensitivity, idiosyncratic, drug interaction |
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Term
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Definition
when 2 drugs w/ similar actions are given together |
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Term
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Definition
occur when 2 drugs administered together interact in such a way that their combined effects are greater than the sum of the effects for each drug given alone |
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Term
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Definition
occur when the combination of 2 drugs results in drug effects that are less than than the sum off the effects for each drug given alone |
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Term
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Definition
most commonly used to describe parenteral drugs, occurs when 2 parenteral drugs or solutions are mixed together& the result is a chem. Deterioration of 1 or both of the drugs or the formation of a phys. precipate |
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Term
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Definition
perm. Changes in the composition of living organisms& consist of alterations in chromosome structure, the # of chromosomes, or the genetic code of the DNA molecule |
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Term
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Definition
result in structural defects in the fetus |
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Term
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Definition
cancer-causing effects of drugs, other chemicals, radiation, and viruses |
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Term
When/why are medications dangerous to pregnant women? Breast-feeding? |
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Definition
Risk of drug transfer 1st and last trimester, fetal exposure Drugs cross through placenta |
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Term
How is pharmacokinetics different |
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Definition
Pediatric pts. Has lower maturity rate of vital organs, processes are still developing |
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Term
List the ways that absorption, distribution, metabolism and excretion of medications is different in neonates and pediatric patients. |
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Definition
. Gastric pH is less acidic, slower gas emptying, faster and irregular intramuscular absorption; fat content is lower due to greater total body water, protein binding is decreases, more drugs enter the brain; increased metabolism& require higher dosages, genetic differences; GFR, tubular secretion, resorption are decreased due to kidney immaturity, perfusion of kidneys may be decreased |
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Term
What are factors that affect drug dosing in pediatrics? |
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Definition
Thinner skin, lack of stomach acid, weaker mucous barriers in lungs, body temp. is less well regulated, immature kidneys and liver |
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Term
How are medications dosed in pediatrics? |
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Definition
Drug order, pt’s wt in kg, per manufacturer |
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Term
Age elderly begins? Concerns for meds |
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Definition
65, Lack of adequate patient education, use of multiple prescribers and pharmacies, polypharmacy |
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Term
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Definition
Simultaneous use of multiple medications |
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Term
What are some of the causes and solutions of polypharmacy |
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Definition
Adverse effects of other drugs, noncompliance w/ prescribed medication regimens |
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Term
What information should the nurse gather in regards to medications and culture? |
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Definition
Verbal/ nonverbal communication, family ties, biologic variations, common health beliefs |
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Term
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Definition
Meds that relieve pain w/o causing loss of conscious, known as painkillers |
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Term
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Definition
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Term
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Definition
pain relieving drugs, Also classified by mechanism of action Drugs that bind to the opiate receptors to relieve pain |
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Term
where opioids originate from? |
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Definition
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Term
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Definition
causes an action to occur, Binds to an opioid pain receptor in the brain and causes an analgesic response- reduction of pain sensation |
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Term
Mild agonist codeine- Hydrocodone (Lortab) |
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Definition
only agonist to produce ceiling effect |
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Term
Strong agonist Morphine MS Contin |
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Definition
(sustained/long-acting 8-12 hrs) |
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Term
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Definition
8 times more potent than morphine |
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Term
Oxycodone (Percocet) Oxycontin |
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Definition
(sustained release for 12 hrs)- contin means continuously |
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Term
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Definition
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Term
fentanyl (Duragesic) (See fentanyl transdermal patch box) |
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Definition
used a lot on oncology floors, palliative care |
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Term
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Definition
used in a lot of rehab/ addiction centers, used on chronic pain |
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Term
Define agonist-antagonist ,partial agonist |
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Definition
binds to a pain receptor and causes a weaker pain response than does a full agonist Not generally used for chronic pain Prevent overmedication and reduce post-treatment addictive cravings Combo products treat addiction Lower risk for resp. depression Similar to agonist, but lower risk of misuse and addiction Not used as 1st line anaglesic |
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Term
List ways agonist- antagonists may be better than agonist |
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Definition
Useful in pain management of obstertical ptients |
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Term
type of agonist-antagonist |
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Definition
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Term
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Definition
Binds to a pain receptor but does not reduce pain signals |
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Term
How might they be used with opioids? |
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Definition
Also known as competitive antagonists |
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Term
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Definition
Naloxone hydrochloride (Narcan)- drug of choice for reversal of resp. depression and acute opioid overdose |
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Term
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Definition
Moderate to severe pain, often postoperative pain Used in combination with anesthetics during surgery Cough center suppression Treatment of diarrhea due to slowing of the GI tract (diphenoxylate/ atropine- Lomotil) |
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Term
List patient situations where opioid analgesics would be contraindicated and why? |
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Definition
Drug allergy- side effects Severe asthma- Resp. depression Use w/ extreme caution in pts with: Resp. insufficiency- Resp. depression Elevated ICP- CNS Depression Morbid obesity and/or sleep apnea- Resp. depression Paralytic ileus- GI tract already slowed down Pregnancy- possible harm to the baby |
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Term
List major adverse effects of opioid analgesics. |
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Definition
Orthostatic hypotension, bradycardia, flushing- can be due to histamine release (redness), sedation, nausea, vomiting, urinary retention, itching, rash, CNS depression lead to resp. depression, constipation |
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Term
What is the most serious adverse effect that leads to respiratory depression? Opioid analgesics |
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Definition
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Term
What is the serious adverse effect from toxicity? opioid analgesics |
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Definition
Resp. depression, Used in management of opioid overdose and addiction Consider withdrawal symptoms |
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Term
What drug class can be used to treat toxicity and overdose |
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Definition
Naloxone (Narcan), naltrexone (ReVia) |
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Term
Define opioid withdrawal/opioid abstinence syndrome- |
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Definition
the extent of opioid tolerance is most visible when an opioid drug is discontinued abruptly or when an opioid antagonist is administered- joint pain, anxiety, confusion, diarrhea, vomiting, abdominal cramps, hot flashes and chills, lacrimination (fear), diaphoresis |
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Term
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Definition
(A normal physiologic condition that results from long-term opioid use, in which larger doses of opioids are required to maintain the same level of analgesia and in which abrupt discontinuation of the drug results in withdrawal symptoms (same as physical dependence) |
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Term
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Definition
(A condition in which a patient takes a drug over a period of time and unpleasant physical symptoms (withdrawal symptoms) occur if the drug is stopped abruptly or smaller doses are given. The physical adaptation of the body to the presence of an opioid or other addictive substance.) |
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Term
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Definition
A pattern of compulsive use of opioids or any other addictive substance characterized by a continuous craving for the substance and the need to use it for effects other than pain relief (also called addiction). |
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Term
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Definition
Acetaminophen (Tylenol)is most widely used |
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Term
What class of medication is this drug often combined with. |
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Definition
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Term
What type of affect does this drug have? |
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Definition
Analgesic and antipyretic effects Little to no antiinflammmatory effects Able over the counter and in combination products with opioids Very dangerous |
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Term
mechanism of action for acetaminophen |
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Definition
Blocks peripheral pain impulses by inhibition of prostaglandian synthesis Lowers febrile body temps by acting on hypothalamus Don’t cause aspirin related GI tract, irritation or bleeding |
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Term
indications for acetaminophen |
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Definition
Treatment of mild to moderate pain and fever, alternative for aspirin, antipyretic drug of choice in children and adolescents with flu symptoms due to aspirin risk of Reye’s Syndrome |
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Term
Acetaminophen: Contraindications/Interactions |
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Definition
Should not be taken in the presence of…… Severe liver disease (liver dysfunction), drug allergy, genetic disease (G6PD), possible liver failure Dangerous interactions may occur if taken with alcohol or other drugs that are hepatotoxic In heavy drinkers, limit 3 drinks per day and 2000 mg of acetaminophen |
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Term
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Definition
Potentially lethal drug when taken in overdose Maximum daily dose for healthy adults is being lowered to 3000 mg/day 2000 mg for elderly or those with liver disease 325 mg limit in combo products (hydrocodone, oxycodone) Inadvertent excessive doses may occur when different combination drug products are taken together Be aware of the acetaminophen content of all medications taken by the patient (OTC and prescription) |
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Term
How can overdose happen of this OTC drug? (Acetaminophen) |
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Definition
Depressed patients (especially adolescents) may intentionally overdose on the drug as an attention-seeking gesture without realizing the grave danger involved |
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Term
Antidote of acetaminophen, important teaching |
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Definition
Acetylcysteine (mucomyst) , works by preventing the hepatotoxic metabolites of acetaminophen from forming, most effective when given Within 10 hours of an overdose, bad taste, rotten egg odor, vomiting of oral dose common |
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Term
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Definition
tramadol (Ultram)- weak bond to pain receptors and inhibits reuptake of norepinephrine and serotonin, used in moderate to severe pain, chronic pain |
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Term
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Definition
Lidocaine (Lidoderm)- patch used to treat postherpetic neuralgia, painful skim after outbreak of shingles, Apply to pain area, local relief, up to 3 patches may be applied, take off after 12 hours |
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Term
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Definition
Drugs that are added for combined therapy with a primary drug and may have additive or independent analgesic properties, or both NSAIDSAntidepressants Anticonvulsants Corticosteroids |
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Term
Adjuvant drugs for neuropathic pain |
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Definition
Amitriptyline (Elavil) -antidepressant Gabapentin (Neurontin) or pregabalin(Lyrica) anticonvulsants |
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Term
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Definition
Drugs that …… depress the CNS or peripheral nerves to produce decreased or loss of consciousness, or muscle relaxation |
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Term
Anesthesia is the state of |
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Definition
loss ability to feel pain resulting from the administration of an anesthetic drug |
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Term
Differentiate between general and local effects in the body |
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Definition
General-Involves complete loss of consciousness and loss of body reflexes including resp. muscles, require mechanical ventilation
Local-Doesn’t involve paralysis of resp. function, only elimination of pain sensation in the tissues innervated by anesthetized nerves |
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Term
What are general anesthetics |
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Definition
drugs that are used to produce profound neurosensory depression to allow for surgical procedures. |
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Term
when are general anesthetics used |
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Definition
Given only under controlled situations by anesthesia providers |
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Term
Who administered these medications? general anesthetics |
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Definition
Anesthesiologist, CRNA, anesthesia assistant |
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Term
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Definition
liquids or gases that are vaporized or mixed with O2 and inhaled to induce anesthesia |
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Term
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Definition
- given intravenously and used for induction and/or maintenance of general anesthesia, induction of amnesia, and as adjuncts to inhalation-type anesthetics |
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Term
What are adjunct anesthetics? |
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Definition
Any drug that enhances clinical therapy when used simultaneously w/ another drug, used simultaneously w/ general anesthetics for anesthesia initiation, sedation, reduction of anxiety, and amnesia |
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Term
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Definition
Simultaneous use of both general anesthetics and adjuncts |
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Term
Describe the overall affect and stages of anesthesia |
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Definition
Progressive reduction of sensory and motor CNS functions; loss of consciousness |
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Term
Indications of anesthesia |
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Definition
They are indicated for…. Relaxation of skeletal and visceral smooth muscles for surgical procedures To produce…. Unconsciousness, skeletal muscle relaxation, visceral smooth muscle relaxation Rapid onset, quickly metabolized Contraindications vary according to drug |
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Term
Adverse Effects of anesthesia |
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Definition
Vary according to dosage and drug used, Myocardial depression is commonly seen |
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Term
What are the sites primarily affected? anesthesia |
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Definition
Heart, peripheral circulation, liver, kidneys, and resp. tract |
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Term
Why is N/V, confusion seen less often? anesthesia |
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Definition
Due to balanced anesthesia ( use of generals and adjuncts) |
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Term
How can anesthesia affect elderly vs. pediatrics, patients with a history of substance abuse? |
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Definition
Predispose a patient to complications, may need dose adjustments |
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Term
define malignant hyperthermia |
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Definition
Uncommon, but potentially fatal, genetically linked adverse metabolic reaction to general anesthesia
Occurs during or after general anesthesia or use of the NMBD succinylcholine
Sudden elevation in body temperature, greater than 104 degrees |
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Term
nitrous oxide- laughing gas |
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Definition
inhaled gas used as general anesthetic, weakest, used in dental procedures |
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Term
malignant hyperthermia signs and symptoms |
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Definition
Rapid rise in body temp., tachycardia, tachypnea, muscular rigidity |
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Term
medication used to treat malignant hyperthemia |
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Definition
cardiorespiratory supportive care and dantrolene (Dantrium) (skeletal muscle relaxant) |
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Term
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Definition
IV only, Produces dose dependent CNS depression
Commonly used daily in OR settings General anesthetic used for induction and maintenance, sedation for mechanical ventilation in ICU
Weight based, resp. depression if given in excess |
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Term
moderate sedation/ conscious sedation |
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Definition
Doesn’t cause complete LOC and normally not resp. distress
Relax, reduce anxiety, respond to verbal commands and maintain own airway
Rapid recovery compared to general anesthesia
Combination of an IV benzodiazepine (e.g., midazolam (Versed) and an opiate analgesic (e.g., fentanyl or morphine, sometimes propofol used) |
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Term
pt affects of moderate sedation and when it is used |
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Definition
Allows patient to relax and have markedly reduced or no anxiety, yet still maintain own airway and respond to verbal commands; surgeries |
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Term
who can administer moderate sedation |
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Definition
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Term
Mild amnesia from moderate sedation is due to what med? |
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Definition
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Term
local anesthetics reduce pain where? |
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Definition
level of peripheral nerves |
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Term
local anesthetics difference btw general anesthetics |
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Definition
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Term
When are local anesthetics used? |
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Definition
Clincial settings in which loss of consciousness is undesirable or unnecessary, childbirth, spinal anesthesia, dental procedures, suturing, diagnostics –lumbar puncture, biopsy |
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Term
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Definition
Spinal is injected into the area near the spinal cord with the vertebral column (IV or spinal injection)
Topical is applied directly onto the surface of the skin, eye, or any mucous membrane to relieve pain or prevent it from being sensed |
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Term
How is spinal considered a local anesthetic? |
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Definition
It doesn’t depress the CNS at a level that causes loss of consciousness |
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Term
Local anesthetic drug effects: paralysis |
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Definition
First, autonomic activity is lost Then pain and other sensory functions are lost Last, motor activity is lost As local drugs wear off, recovery occurs in reverse order (motor, sensory, then autonomic activity are restored |
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Term
adverse effects of local anesthetic |
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Definition
Usually limited Adverse effects result if: Inadvertent intravascular injection Excessive dose or rate of injection Slow metabolic breakdown Injection into highly vascular tissue |
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Term
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Definition
(Box 11-9) result of penetration into and through the dura mater of the spinal cord, a leakage of CSF occurs from the insertion site, occurs in 70%of inadvertent Dural puncture during epidural |
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Term
treatment for spinal headache |
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Definition
Bedrest and analgesics Blood patch in severe cases |
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Term
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Definition
lidocaine (Lidoderm)- pain patch
prilocaine/lidocaine (EMLA)- numbing cream
lidocaine (Xylocaine)- common, used alone or in combo w/ epinephrine, used in infiltration and nerve block, parenteral form used to treat cardiac dysrhythmias
- caine means local anesesthia |
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Term
Neuromuscular Blocking Drugs (NMBDs) |
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Definition
Prevent nerve transmission in skeletal and smooth muscles leading to temporary paralysis |
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Term
when are Neuromuscular Blocking Drugs (NMBDs) used? |
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Definition
As adjuncts w/ general anesthetics for surgical procedures |
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Term
Why are NMBDs high alert medications? |
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Definition
Leads to death or severe injury |
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Term
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Definition
bind to cholinergic receptors in place of acetylcholine, mimic response, act as competitive agonist |
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Term
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Definition
bind to ACh receptors but block instead of mimic, competitive antagonist so as a result…muscle fibers are not stimulated, skeletal muscle contraction does not occur |
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Term
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Definition
First sensation is muscle weakness, followed by total flaccid paralysis
Small, rapidly moving muscles affected first (fingers, eyes), then limbs, neck, trunk, then intercostal muscles and diaphragm affected, resulting in resp arrest and pt cannot breath on own
Recovery of muscular activity usually occurs in reverse order
Do not cause sedation, relieve pain or anxiety |
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Term
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Definition
Maintaining skeletal muscle paralysis
Short acting? Facilitate intubation w/ an endotracheal tube |
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Term
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Definition
Few when used appropriately, depends on drug used and patient
Increase or decrease in BP and HR
Bronchospasm, excessive bronchial and salivary secretions
Key is to use only enough to block the neuromuscular receptors
Robinol- pg.338- used to decrease secretions |
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Term
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Definition
Respiratory muscle paralysis occurs with these drugs
Emergency ventilation equipment must be immediately available
Overdose causes prolonged paralysis requiring prolonged mechanical ventilation
Cardiovascular collapse may occur |
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Term
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Definition
Succinylcholine (Anectine)
Works similarly to neurotransmitter acetylcholine (Ach) causing depolarization
Metabolism is slower than Ach so as long as its present, repolarization cannot occur |
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Term
Nursing Implications pf NMBDs |
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Definition
Assess: allergies, prescriptions, OTC, herbals, supplements, use of alcohol, smoking, illicit drugs, opioids
Respiratory and neurological assessment, height/weight, diagnostics/lab testing, pregnancy?
Surgical history or problems with anesthesia, personal or family history of malignant hyperthermia
Monitor VS, temperature, pain, return of sensation
Implement safety measures, reorient your patient
Each perioperative phase has its own complex and very specific nursing actions
Provide preoperative teaching about the surgical procedure and anesthesia |
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Term
CNS Depressants- Sedatives |
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Definition
Depress the CNS to reduce….. Nervousness Excitability Irritability
does not cause sleep, but can become a hypnotic if given in large enough doses |
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Term
CNS Depressants- Hypnotics |
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Definition
Cause sleep
Much more potent effect on CNS than sedatives
Many drugs can act as either depending on dose and patient response so they are sedative-hypnotics |
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Term
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Definition
dose dependent
At low doses calm the CNS without inducing sleep
At high doses calm the CNS to the point of causing sleep |
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Term
3 drug groups of CNS depressants |
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Definition
barbiturates, benzodiazepines, and miscellaneous drugs |
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Term
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Definition
prolonged sedative- hypnotic use may reduce the cumulative amount of REM sleep |
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Term
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Definition
patient has an abnormally large amount of REM sleep, often lead to frequent and vivid dreams |
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Term
2 ways Benzodiazepines are classified |
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Definition
sedative- hypnotics
Anxiolytics |
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Term
Benzodiazepines: Sedative-Hypnotic Types- drugs to know |
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Definition
Long-acting diazepam (Valium)- anxiety, sedation, anesthesia adjunct, anticonvulsant, skeletal muscle relaxant following ortho
Intermediate-acting alprazolam (Xanax) lorazepam (Ativan) temazepam (Restoril)- long onset, older drug
Short-acting midazolam (Versed)- moderate sedation, amnesia, reduced anxiety, sedation |
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Term
Benzodiazepines: Mechanism of Action |
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Definition
Depress CNS activity
Affect hypothalamic, thalamic, and limbic systems of the brain
Ability to inhibit stimulation of the brain
Benzodiazepine receptors Gamma-aminobutyric acid (GABA) or others
Do not suppress rapid eye movement (REM) sleep as much as barbiturates do
Do not induce hepatic enzyme activity like barbiturates do |
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Term
Benzodiazepines: Indications |
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Definition
*short-term use for insomnia
Sedation
Relief of agitation or anxiety
Skeletal muscle relaxation
Anxiety- related depression
Treatment and prevention of alcohol withdrawal
Sleep induction
Treatment of acute seizure disorders |
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Term
Benzodiazepines: Adverse Effects |
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Definition
Headache, drowsiness, dizziness, lethargy, cognitive impairment, vertigo
Harmful if given in excess with alcohol
Fall hazard for elderly, use lowest effective dose |
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Term
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Definition
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Term
Why shouldn't benzos be stopped suddenly? |
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Definition
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Term
Benzodiazepines: Toxicity and Overdose |
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Definition
Somnolence, confusion, diminished reflexes, coma
Don’t cause hypotension and resp. depression unless taken with other CNS depressants such as alcohol and barbiturates
Usually not lethal unless taken with other CNS depressants such as alcohol and barbiturates
Treatment symptomatic and supportive |
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Term
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Definition
flumazenil (Romazicon)-as an antidote |
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Term
Benzodiazepines: Interactions |
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Definition
CNS depressants- reduce bp, reduce resp. rate, sedation, confusion, diminished reflexes
grapefruit juice and grapefruit- alter drug metabolism via inhibition of the cytochrome P-450 sys. And can result in prolonged effect, increased effect, and toxicity |
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Term
Nonbenzodiazepine Hypnotics |
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Definition
Share many characteristics of benzodiazepines
Used to treat insomnia |
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Term
Nonbenzodiazepine Hypnotics drugs to know |
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Definition
zolpidem (Ambien, Ambien CR- for long term, releases drug to induce hypnotics more rapidly and again slowly throughout the night, sleepwalking, lower doses in women and elderly )
eszoplicone (Lunesta) – long term use, provide full 8 hours of sleep
zaleplon (Sonata)- used in nursing homes |
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Term
Barbiturates: Mechanism of Action |
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Definition
CNS depressants
Site of action: Brainstem (reticular formation)
Effects are dose related
Reduce nerve impulses traveling to the cerebral cortex
Inhibit nerve impulse transmission |
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Term
Barbiturates: Drug Effects |
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Definition
Low doses: sedative effects
High doses: hypnotic effects (lower resp. rate) |
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Term
Notorious enzyme inducers |
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Definition
Shortened duration of action, stimulate liver enzymes that cause metabolism or breakdown of other drugs |
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Term
Barbiturates: Indications |
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Definition
Same as sedative- hypnotic effects Or when are they used? Ultrashort acting, short acting, intermediate acting, long acting |
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Term
Barbiturates: Adverse Effects |
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Definition
Drowsiness, lethargy, dizziness, hangover, paradoxical excitement
Reduced REM sleep, resulting in agitation, inability to deal w/ normal stress |
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Term
Describe what barbiturates do to rem sleep, rem rebound. ? |
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Definition
Deprive ppl of REM sleep leading to agitation, rebound phenomenon may occur when stopped and REM sleep is increased and nightmares often ensue |
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Term
How do barbiturates affect the elderly? What might the dose be? |
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Definition
Increase in falls, reduced by half |
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Term
Barbiturates:Toxicity and Overdose |
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Definition
CNS depression from sleep to coma, death
Resp. depression progresses to cyanosis |
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Term
How might Barbiturates:Toxicity and Overdose be treated? |
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Definition
Supportive
Activated charcoal may be needed
Can be therapeutic |
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Term
Barbiturates: Drug Interactions |
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Definition
Additive effects with/ Alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers |
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Term
How does barbiturates affect the P450 metabolizing enzyme system ? |
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Definition
Increase the activity of hepatic microsomal or cytochrome P-450 enzymes |
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Term
Common Barbiturates- drugs to know |
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Definition
pentobarbital (Nembutol)- short acting, preop anxiety, sedation, status epileptics
Phenobarbital- long acting, prevention of tonic-clonic seizures, fever induced, convulsions, monitor therapeutic blood levels (10-40 mcg/mL, above 40 may be toxic |
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Term
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Definition
Act in the CNS to relieve pain associated with skeletal muscle spasms
Relaxation of striated muscles, weakness of skeletal muscles, decreased force of muscle contraction, muscle stiffness, cns depression…sedation, somnolence, ataxia, resp and cardiac depression
Most effective when used with rest and physical therapy
Indicated for relief of painful muscle spasms often following injuries, muscle spasticity in chronic disorders |
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Term
Muscle Relaxants: Adverse Effects |
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Definition
Euphoria Lightheadedness Dizziness Drowsiness Fatigue Confusion Muscle weakness |
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Term
Muscle Relaxants - DRUGS TO KNOW |
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Definition
baclofen (Lioresal)- often used in baclofen pump to treat chronic spastic muscular conditions, paralysis
cyclobenzaprine (Flexeril)- common after muscle injury, can cause marked sedation
carisoprodol (Soma)- high abuse potential
dantrolene (Dantrium)-tx of malignant hyperthermia |
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Term
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Definition
The use of a mood- or behavior-altering substance in a maladaptive manner that often compromises health, safety, and social and occupational functioning, and causes legal problems. |
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Term
Differentiate between physical and psychological dependence. |
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Definition
A condition characterized by physiologic reliance on a substance, usually indicated by tolerance to the effects of the substance and development of withdrawal symptoms when use of the substance is terminated
A condition characterized by strong desires to obtain and use a substance |
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Term
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Definition
stimulate a specific area of the brain/spinal cord; act by simulating excitatory neurons in the brain |
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Term
CNS stimulants classified according to |
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Definition
chemical structure similarities or site of therapeutic action on CNS |
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Term
CNS 5 major therapeutic categories |
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Definition
Anti-attention deficit, antinarcoleptic, anorexiant, antimigraine, analeptic drugs |
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Term
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Definition
amphetamine (Dexedrine (dextroamphetamine aspartate)-single component, amphetamine aspartate, methylphenidate (Ritalin)- 1st prescription drug for ADHD, atomoxetine (Strattera)-nonstimulant May cause suicidal thinking and behavior |
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Term
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Definition
amphetamines- promotes wakefulness by stimulating areas of brain associated with mental alertness; modafinil (Provigil) Schedule IV, low abuse potential, alters mood, perception, thinking, protein bound, 90% metabolized in liver |
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Term
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Definition
suppresses appetite, phentermine (Lonamin)-CNS stimulant (Schedule IV), orlistat (Xenical, Alli (OTC)) |
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Term
Antimigraine Drugs- overuse may result in rebound tenderness |
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Definition
triptans/SSRA- serotonin receptor agonist, stimulate serotonin receptors in brain. naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex); Ergot Alkaloids- cafergot (Ergotamine tartrate w/caffeine), dihydroergotamine mesylate (DHE45, Migranal) |
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Term
Analeptic drugs-stimulate areas of CNS that control respiration |
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Definition
Theophylline, aminophylline, caffeine, doxapram; methylxanthines-cause build up of cAMP |
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Term
Antiepileptic drugs- anticonvulsants, used to reduce the incidence of seizures |
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Definition
1st Line- Barbiturates-phenobarbital (cns depressant), primidone (Mysoline), Hydantoins (phenytoin (Dilantin), Iminostilbenes- carbamazepine (Tegretol) Misc. AEDs- lacosamide (Vimpat), tiagabine (Gabitril), valproic acid (Depakene, Depakote) |
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Term
2nd line antiepileptic drugs |
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Definition
diazepam (Valium), gabapentin (Neurontin), pregabalin (Lyrica), lamotrigine (Lamictal), levetiracetam (Keppra), topiramate (Topamax), clonazepam (Klonopin) |
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Term
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Definition
Indirect-Acting Dopaminergic Medications (MAO-B Inhibitor) selegiline (Eldepryl)- breakdown of catecholamines |
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Term
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Definition
Direct-Acting Dopamine Receptor Agonists- amantadine (Symmetrel)-antiviral used to treat influenza, blocks reuptake of dopamine |
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Term
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Definition
Direct-Acting: Nondopamine Receptor Agonists- ropinirole (Requip)-used to treat restless leg syndrome, bromocriptine (Parlodel)-Ergok alkaloid-activate dopamine receptors to stimulate production of more dopamine |
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Term
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Definition
Direct Acting Dopamine Replacement Drugs- carbidopa-levodopa (Sinemet)- required by brain for dopamine synthesis, cannot pass through blood-brain barrier |
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Term
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Definition
Direct-Acting Anthicholinergics- benztropine mesylate (Cogentin)-treats muscle tremors and rigidity |
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Term
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Definition
benzodiazepines- depress activity in brainstem/limbic system, buspirone (BuSpar) |
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Term
Benzodiazepines/Anxiolytic drugs |
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Definition
alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), flumazenil (Romazicon)- used to reverse benzodiazepine effects |
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Term
Tricyclic Antidepressants |
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Definition
amitriptyline (Elavil)- used to treat insomnia; imipramine (Tofranil), nortriptyline (Pamelor) |
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Term
Misc. 2nd generation antidepressants |
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Definition
trazodone (Desyrel, Oleptro)- sleep,strong sedative qualities; bupropion (Wellbutrin)-used in smoking cessation, mirtazapine (Remeron)- reduce sexual dysfunction, appetite stimulant |
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Term
drugs to treat Alzheimer's |
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Definition
donepezil (Aricept)- cholinesterase in- hibitor; memantine (Namenda)-non cholinergic drug- reduce degenerative cognitive symptoms |
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