Peripheral Nervous system/ Central Nervous system

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leitogonza
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289887
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Peripheral Nervous system/ Central Nervous system
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2014-12-03 02:31:58
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parkinson alzheimers
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pharmacology
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  1. Adrenergic? cholinergic?
    • Adrenergic: everything in the sympathetic (fight-or-flight) side of the brain -- A and B receptors.
    • Cholinergic: everything in the parasympathetic (body glands in the body) side of the brain.
  2. What are common cholinergic/parasympathetic Nervous Systems.
    What do anticholinergic/sympathetic Nerves do?
    • there is total of 7 of them.
    • Slowing HR.
    • Increased gastric secretion.
    • Emptying the bladder.
    • Emptying the bowel.
    • Focusing the eye for near vision.
    • Constricting the pupil (Miosis)
    • Contracting bronchial smooth muscle.
    • Anticholinergic: do the opposite. For example, Parasy slows HR, symp accelerates HR.
  3. What are the neurotransmitters of the Peripheral Nervous System? what are cholinergic side? which ones are in the anticholinergic?
    • Neurotransmitters: acetylcholine, Norepi and epi.
    • Cholinergic: reponsible for all cholinergic receptors (Nicotinic-n, Nicotinic-m, Muscarinic)
    • Nicotinic-m: Associated w muscle or movement, only skeletal muscles. Drugs or diseases that attack this receptors paralyzed the pt.
    • Nicotinic-n: release of little epi from the adrenal medula.
    • Muscarinic: Reponsible for all the other seven cholinergic effects. -- Muscurinic antagonist acts like anticholigenic drugs (e.i speed HR, retains water, etc) -- comon drug is atropine.
    • Anticholinergic: epi and norepi. They are reponsible for flight -or-fight response.
  4. Muscarinic agonist drug? TU? AE?
    • Bethanechol.
    • TU: mainly used for Urinary retention in post op and portpartum pts.
    • AE: slowing of the HR, urination, hypotension, etc.
  5. Muscarini antagonist MOA? AKAs? Drugs?
    • MOA: block the action of acetylcholine at muscarinic receptors.
    • AKA: parasympathetic drugs, anticholinergic drugs, etc.
    • Drugs: Dipehndrydramine (Brenadryl), Atropine , etc.
  6. What is Atropine? PE? DI? SE?
    • It is a known muscurinic antagonist.
    • PE: reverse of the seven cholinergic effects. increase HR, decreases release of exocrine glands, relazes bronchi, eye mydriasis (dilatation), etc.
    • DI: other anticholinergic drugs, like benedryl and Opiods.
    • SE: anticholinergic effects, urinary retention, constipation, tahycardia, etc.
  7. What is Myasthenis Gravis cause? tX?
    • Autoimmune proccess in which antibodies attack nicotinic-m receptors on skeletal muscle.
    • Tx: Edrophonium (tensilon) drug, if they get better then it was a Myasthenis Gravis attack.
  8. Guillian Barre syndrome TX?
    • Respiratory assistance.
    • Glucocorticoids (supress immnuse system response).
  9. What are the disesases of the PNS?
    Guillian Barre, and Myasthenis Gravis.
  10. Parkinson's Disease drugs?  Levodopa DI? AE? Selegiline chs? patient teaching?
    • Levodopa: promotes dopamine synthesis (re-uptake whatever is left, not the making it of it).
    • Dopamine agonist: stimulate dopamine receptors directly (suck it into the receptors so that it doesn't get lost) 
    • Selegiline: inhibits dopamine breakdown.
    • levodopa DI: Avoid CNS drugs, Food delays absorption, high-protein foods will reduce therapeutic effects.
    • Levodopa AE: Nausea and vomiting (have it w food),
    • Selegiline: Can supress destruction of dopamine derived from levodopa and prolong the effects of dopamine.
    • PT: May take several weeks to see beneficial effects -- change position slowly -- take w food -- Do not discontinue drugs -- Avoid the use of alcohol -- AE: if the movement increases or gets worse, maybe there is something else going on.
  11. Alzheimer's Disease drugs? SE
    • Cholinesterase inhibitors: Donepezil (aricept), Galantamine (razadyne), Rivastigmine (exelon) also used in PD, Tacrine (causes liver damage).
    • SE of cholinesterase inh: GI (nausea, vomiting, diarrhea), dizziness, headache, bronchoconstriction, liver injury (tacrine).
  12. Multiple Sclerosis (MS) drugs? AE?
    • drugs: Immunomodulators and immunosuppresants (short course of high-dose IV glucocorticoids) -- Natalizumab (tysabril) used in MS and Crohn's disease.
    • Immunomodulators: recreate the immune system to not recognize there is an inflammatory response (interferon beta-1a (avonex, Rebif) 1b (betaseron), etc)
    • AE: interferon beta could cause for flu-like rxn(give late in day -- might premedicate w tylenol).
    • There are drugs to manage all the symptoms of MS.
  13. Epilepsy drug types? MOA? drugs names, SE, and serum drug level (SDL)?
    • Drugs types: Traditional antiepilectic drugs (AEDs)  and newer AEDs.
    • MOA: Supression of sodium influx, suppression of calcium influx, antagonism of glutamate, potentiation of GABA.
    • Phenytoin (dilantin): 8 to 60 hrs of half-life -- used as a antiHTN drug -- AE: sedation, cognitive impairment, CV effects (hypotension- HR increase), gingina hyperplasia -- SDL: 10 to 20 mcg/ml
    • Carbamazepine (tegreto): AE: hematologi effects (leukopenia, anemia, thrombocytopenia) -- SDL:5-12 mcg/dl
    • Valproic Acid (depakene, depakote, depacon): AE: GI probs -- SDL:50-125 mcg/dl
    • Ethosuximide (zarontin): drug of choice for small seizures. SE: initially may cause drowsiness, dizziness, and lethargy, but it goes away. SDL: 40-100 mcg/dl. not a big drug.
    • Phenobarbital (solfoton): promotes sleep and sedation, usually not the first DOC. -- SDL: 10-30 mcg/ml.
  14. Manage Epilepticus generally?
    • Start the watch.
    • Maintain ventilation, protect head, put them on the side.
    • Terminate seizures w IV benzos.
    • ** Need to know if the seizure is bc type I diabetes.
    • get the serum levels, draw 8 hrs after last dose.
  15. antiseizure drugs in children?
    • Avoid sedation. (teachers should know how to handle seizures)
    • Medic alert bracelet.
    • Chewable dosage should not ve used for once -a-day admim bc of the 1st pass effect.
    • should keep a journal of what happens in the seizure (family)
  16. Antiseizure drugs in older adults?
    • Liver and kidney function.
    • Older adults have decreased levels of serum albumin.
  17. Muscle spasms and spasticity drugs? AE?
    • Diazepam (valium): MOA through enhancing effects of GABA.
    • tizanidine (zanaflex): MOA through agonist action at presynaptic alpha2 receptors. 
    • AE: generalized CNS depression, physical dependence, hepatic toxicity.
  18. Drugs for spasticity? AE?
    • Baclofen (lioresal): CNS depressant, urinary retention, some anticholinergic side effects.
    • Diazepam (Valium): sedation.
    • Dantrolene (dantrium): MOA directly on the skeletal muscles, nicotinic-m receptors.-- AE: Diarrhea, drwosiness, muscle weakness.

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