NSG 6005 Week 2 & 3 Study Guide Graded A+ 2025

1) Know the major activating and inhibiting neurotransmitters for the CNS Activating: ACh, Dopamine, NE, Epinephrine, Serotonin, Histamine Inhibit: GABA, Glycine 2) Know the major neurotransmitters for the gut ACh, Serotonin, Dopamine 3) Know the major neurotransmitters for the sympathetic and parasympathetic nervous systems Sympathetic: NE (primary) Para: ACh ACh 4) Know the major neurotransmitter that mediates skeletal muscle activity ACh 5) Know the mechanism of action and side effects of stimulant anorexiants Stimulates release NE and/or Dopa from storage sites in nerve terminals in lateral hypothalamic feeding center which causes decreased appetite (stimulate of satiety center) r/t amphetamines (increase in NE and dopa stress hormones: increased HR, RR, decreaed GI motility, and constipation. Side Effects: CNS overstimulation, agitation, confusion, insomnia, dizzy, htn, HA, palpitations, arrhythmias, dry mouth, dilated, pupils, dysuria, constipation, n/v/d, impotence. 6) Know the major drug interactions and contraindications for anorexiant use Contra: pt on serontologic agents (increased risk Se. Synd.) Pt on MAOI (HTN crisis & lithium toxicity) ETOH (CNS depressant) Phenothiazines (psychosis) Insulin/Sulfonylureas (altered requirements: increased glucose uptake which causes decreased BG) Adrenergic blockers (antagonized with co-admin) Phentermine conta with: cardiac & HTN (causes increased HR, BP, palp, and arrhythmias) Orlistat decreased Levothyroxine, increases Warfarin Off-label use with SSRI: Prozac and Phenertime Chapter 29- Medications affecting the CNS 1) Know which medications are used in the different anxiety disorders NSRI: anxiety, panic attack, chronic pain SSRI: Depression, anxiety, Panic, OCD, social phobias Celexa: panic, PTSD, social phobia Luvox: OCD Prozac: OCD, panic, PTSD, social phobias Paxil: OCD, panic, PTSD, Social Zoloft: OCD, panic, PTSD, social SSNRI: Depression, sleep d/o, pain, general anxiety d/o (GAD) and social phobias Effexor: GAD MAOI: Nardil: PTSD (b/c no response to other drugs) Benzodiazepines: anxiety Klonopin: social phobia, GAD Xanax: Panic d/o, GAD Ativan: Panic Diazepam: GAD Azipirones: Buspar: GAD (decreased sedation and risk of tolerance; Serot. Partial agonist) Tricyclic: Elavil: PTSD Anafranil: OCD Tofranil: panic, GAD, PTSD Meds that affect ion channels of neurons: beta-adre. Blockers (propranolol and atenolol): especially helps with panic when s/s= sympta. Nerv sys (SOB, Tachy, clammy, blurred vision – think decreases flight/fight symptoms) Non-BZD GABA ergics: Depakote and Lamictal 2) Know medications that commonly cause insomnia SNRI: Effexor, Cymbalta, pristiq NDRI: Buproprion (Wellbutrin) SSRI ETOH, alpha agonists, beta-blockers, atomoxetine (stratera), bitter orange, caffeine, diuretics, cocaine, dopamine agonists, ginseng, guarana, statins, modafinil, nicotine, oral contraceptives, beta agonists, theophylline, thyroid supplements, sympathomimetics, steroids, stimulants, diet aids, decongenstants. 3) Know the components of good sleep hygiene Limiting bed puposes to sleep and sex only Establish bedtime routine (comfort and relax measures i.e. tea and hot bath 1 hr prior to bed, also high tryptophan meal i.e. turkey) Avoid vigorous exercise 4 hr prior to sleep or eat If not asleep in 30 min - get up and read or do tasks until sleepy 4) Know the medications that enhance GABA in management of insomnia and anxiety Anxiety Benzos: alprazolam, chlordiazepoxide (Librium), clorazepate Tranzene), diazepam, lorazepam, oxazepam (serax). Insomnia: Benzos: clorazepate (Tranxene) estazolam (Prosom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), triazolam (Halcion) Non-Benzo: Eszopiclone (Lunesta), Zaleplon (Sonata), Zolpidem (Ambien) 5) Know the side effects of benzodiazepines and disadvantages of long term use CNS depressant (S/S) excessive sedation, anterograde amnesia, Resp depression (careful with hypoxia and COPD), cardiac depression (decreased HR RR), lightheadedness, reduced reaction time, impaired cognitive and motor functions, confusions, residual (daytime) sleepiness, weakness, HA, blurred vision, hallucinations/nightmares, disinhibition, paranoia and/or depression, N/V/D, pain (joint/chest), paradoxical anxiety (acute rage may occur), dependence, and tolerance. 6) Know the differences in onset and half life of the different benzodiazepine and benzodiazepine hypnotics Short acting: Clorazepate (Traxene): O: 30 Min. ½: 2 hours Triazolam (Halcion): O: 15-30 Min. ½: 2-4 hours Intermediate acting: Temazepam (Restoril): O: 45-60 Min. ½: 4-18 hours Estazolam (Prosom): O: 15-30 Min. ½: 10-24 hours Long Duration **Avoid with elderly** Flurazepam (Dalmane): O: 60-120 Min. ½: 47-100 hours Quazepam (Doral): O: 20-45 Min, ½: 25-84 hours Hypnotics: Non Benzo Intermediate: Ambien: O: 30 Min, ½: 1.4-4.5 hours Ambien CR: O: 30 Min. ½: 1.6-5.5 hours Ezopiclone (Lunesta): O: 30 Min ½: 6 hours Ultra Short duration: Zaleplon (Sonata): O: 20 Min. ½: 0.5-1 hours 7) Know the mechanism of action and advantages of ramelteon (Rozerem) use in treatment of insomnia Melatonin receptor agonist (M1, M2, and M3); more affinity to M1 than melatonin, thus promoting natural sleep Advantages: Not dose-dependent sedation, minimal ADE, non-scheduled prescription, no evidence of cognitive impairment, rebound insomnia, withdrawal effects or abuse potential. 8) Know the onset of action and duration of the herbals used for insomnia Valerian: O: 2-4 weeks, ½: 1-2 hours Chamomile tea: O: 30 Min, ½: 1-2 hours Melatonin: O: 30 min XR: 120 Min, ½: 1-2 hours 9) Know the side effects and monitoring parameters associated with the majority of the AEDs Impaired cognition Sedation Ataxia and impaired motor function Liver toxicity: Monitor LFTs Hematologic Toxicity: Monitor CBC Renal function: Monitor BMP – Keppra, zonigran, Neurontin Rash Anticonvulsant hypersensitivity syndrome: increased risk with DIs (drug Inc), rapid dose escalation, higher doses) Agent specific toxicities 10) Know which AEDs are renally eliminated Keppra (levetiracetam) Topamax (Toperiamate) Lamotrigine Gabapentin (Neurontin) Zonisamide (Zonigran) 11) Define anticonvulsant hypersensitivity syndrome Delayed ADR: metabolism of aromatic anti-convulsants to arene oxides cause cell death by directly binding to macromolecules or by acting as antigens (fever, rash, evidence of systemic organ involve (most often liver). TX: d/c medication and administer steroids 12) Know which AEDs are associated with AHS and things that can increase risk Dilantin (Phenytoin) Carbamazepine (Tegratol) Phenobarbital Lamotrigine (Lamictal) Valproic acid (Depakote) Felbamate (Felbatol) Oxcarbamazine (Trileptal) Zonixamide (Zonergan) Increased risk: Drug interactions, rapid dose escalation, and higher doses 13) Know which AEDs are used in status epilepticus Diazepam (Valium) Lorazepam (Ativan) Phenytoin (Dilantin) Fosphenytoin (Cerebyx) 14) Know which anticonvulsants interact with enteral feedings Phenytoin (Dilantin)