Nursing 125- part II for test #2
Terms
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- ___________are chemical messengers between neurons that directly and indirectly control the opening or closing of ion channels
- neurotransmitters
- ___________ are chemical messengers that make the target cell membrane more or less susceptible to the effects of the primary neurotransmitter
- neuromodulators
-
________can reduce the membrane potential and enhance the transmission of the signal between neurons
-quickens in response - Excitatory neurotransmitters
- _________ can slow down nerve impulses, hold it back so you don't get as much quickness in response
- Inhibitory neurotransmitters
-
______(proteins) for the released neurotransmitters are embedded in the postsynaptic membrane. each neurotransmitter has a protein receptor for which it and only it will fit.
-make the membrane permeable and the chemical conduction begins - receptors
-
_______- is the primary cholinergic neurotransmitter. there are two groups of receptors. the receptors we're are concerened with are the muscarinic.
Functions: motor behavior
mood regulation
sleep/arousal
stimulates PNS - Acetylcholine (ACh)
- Drugs that block the receptors (________) cause the common side effects of dry mouth, blurred vision, constipation, urinary retention and tachycardia (pulse rate increases)
- anticholinergic drugs
-
Biogenic Amines-
______ is an excitatory neurotransmitter and is involved in cognition, motor and neuroendocrine functions. influences emotions, motivation, social conscience, judgment and reasoning. - Dopamine
- A secone major pathway for Dopamine involves the _______ motor system, which serves and voluntary and involuntary motor movements.
- extrapyramidal
-
a third major pathway for dopamine involves the ________ gland. It has an impact on hunger, thirst, sexual function, circadian rhythms, digestion and temperature control.
drugs that block the receptors cause EPS. problems with the third major pathwa - pituitary gland
- _________ is an excitatory neurotranmitter that plays a major role in the generation and maintenance of mood states. also involved in wakefulness and sleep and are responsible for vasoconstriction necessary to maintain BP in upright position.
- Norepinephrine
- receptors are called ________ receptors.
- adrenergic
- drugs that block the reuptake of norepinephrine (tricyclic antidepressants)may also block muscarinic receptors (__________ effects) and alpha-1 adrenergic receptors (producing orthostatic hypotension)
- anticholinergic
- ________ is primarily an excitatory neurotransmitter that plays a role in emotions, cognition, sensory perceptions and in the essential biologic functions such as sleep, appetite, sexual behavior, hormone secretion and thermoregulation.
- Serotonin
- ______________is a recently identified neurotransmitter. Functions not known but thought to be involved in autonomic and neuroendocrine regulation.
- Histamine
- Drugs that block the receptors (antihistamines) may produce the side effect of ________.
- Sedation
- ________________ is primarily an inhibitor. it has a major role in the control of neuronal excitability throughout the body.
- GABA- Gamma-Aminobutyric Acid
- ________ antianxiety drugs and sedative barbiturate drugs work because of their affinity for GABA receptor sites.
- Benzodiazepine
- __________ is the most widely distributed excitatory neurotransmitter. It may play a role in the long lasting enhancement of synaptic acitivity. However, too much _______ is harmful to neurons. May be involved in schizophrenia.
- Glutamate
-
_________ drugs -
-act specifically at receptor sites
-structure similar to neurotransmitter
-when attached may produce similar results to neurotransmitters (agonists)
-when attached may block biologic response (antoagonists)
-ma - Psychotropic drugs
-
_______- degree of chemical attraction or bond between drug and receptors.
-if weak; are easily reversed when drug is discontinued
-if strong; drug effects may take weeks to resolve when drug is discontinued. - affinity
-
__________-ability of a drug to produce a biologic response once it attaches to receptor.
-if high_______ effect or good biologic response- agonist (moves it along)
-if low _____ effect or weak biologic response- antagonist (hold back) - intrinsic activity
-
__________- block the electrical transmission through channels (secondary messenger system) to main body cell.
some calcium ____________ are being tried with mania. - channel blockers
-
____________- facilitate opening of channels.
benzodiazepines facilitate GABA to open chloride ion channel - Channel openers
-
_________- targets for some drugs.
MAOI's act by developing strong bond between medication and MAO enzyme which causes MAO enzyme to be inactivated and thereby ineffective in breaking down neurotransmitter after it has acted at the receptor site. - enzymes
- Carrier _____- carry neurotransmitter back across cell membrane of pre-synaptic call (re-uptake). Medications may block or inhibit this process.
- Proteins
- __________- the interaction of the endocrine and nervous systems and the role that the endocrine glands and their respective hormones play in behavioral functioning
- Neuroenocrinolgy
- ___________- regulation of biochemical functioning over periods of rhythmic cycles and their influence in predicting certain behaviors
- Circadian Rhythms (chronobiology)
- _______- hereditary factors that predispose individuals to certain psychiatric disorders
- Genetics
- _________- the influence of stress on the immune system and it's role in the susceptibility to illness.
- Psychoimmunology
-
_________-electrodes are placed on the scalp. amplitude and frequency of beta, alpha,theta and delta brain waves are graphically recorded on paper.
-measures brain electrical activity
-identifies dysrhythmias, asymmetries or suppression of brai - Electroencephalography (EEG)
-
_______- used with or without contrast medium. x-rays are taken of various transverse planes of the brain while a computerized analysis produces a precise reconstructed image of each segment.
-measures accuracy of brain structure to detect possible - Computer Tomography (CT)
-
______-within a strong magnetic field, the nuclei of hydrogen atoms absorb and reemit electromagnetic energy that is computerized and transformed into image information. No radiation or contrast median is used.
measure anatomical and biochemical st - Magnetic Resonance Imaging (MRI)
-
_______- Iv injection of a radioactive substance. The head is surrounded by detectors that relay data to a computer that interprets the signals and produces the image.
measures specific brain functioning such as glucose metabolism, oxygen utilizatio - Positron Emission Tomography (PET)
-
________-similar to PET but longer acting radioactive substance must be used to allow time for a gamma camera to rotate about the head and gather the data, which are then computer assembled into a brain image.
-measures various aspects of brain func - Single Photon Emission (SPECT)
-
_______theories-
intergenerational pattern of increase susceptibilty. Ex: alcoholism more likely to occur in children of alcoholic parents than non-alcoholic parents.
-alcohol and drug use seem to have effect on certain neurotransmitters- GABA, - Biological theories
-
______theories-
-no known addictive personality type exists, however, certain traits seemed to predominate: intolerance of frustration/pain, lack of success in life, lack of affectionate and meaningful relationships, low self esteem, and risk taking - Psychological theories
-
Examples of _________-
pain relievers
vicodin
percocet - Opiates
-
Examples of ___________-
sleeping pills
nebutol - sedatives
-
examples of _________-
-cocaine
-meth
-caffeine - stimulants
-
examples of ________-
LSD
Ecstasy - Hallucinogens
-
examples of _____-
activan
valium
xanax - anxiolytics
- Substance_____- using a drug despite negative consequences (social, physical, vocational or legal)
- Abuse
-
Substance ____________- using a drug despite negative consequences plus at least three of the following;
Tolerance
withdrawel
substance taken in larger amounts than was intended
unsuccessful efforts to control or cut down use
gre - Dependency
- _______- marked increase of amounts to achieve same desired effect.
- Tolerance
- _______- characteristic withdrawel symptoms exists with alleviation of withdrawel symptoms with use of the substance of closely related substance.
- withdrawel
- ______abuse- abuse of more than one substance which is obtained either legally or illegaly
- Poly-substance abuse
- ________- using a disease model, it is a progressive disease, chronic, incurable,treatable, and characterized by loss of control, cravings, withdrawel, biochemical changes and genetic factors.
- addiction
- ____________- need for drug in order to feel good; it dominates thinking and leads to compulsive behavior to get drug (craving)
- Psychological Dependency
-
_______-(used by both the used and user's family)
-denies-refuses to admit a problem exists
-minimizes problem(I am in control and I can stop any time I want)
Projects- blames others for the use
-Reationalizes- gives justification. Pe - Defense mechanism
-
__________(enables a person to use)
-in charge of seeing user is protected
-in charge of seeing family survives
-in charge of seeing that family secrets are kept (don't talk,don't tell)
-attempts to control user's use
-feels guil - Codependency
-
__________-
-hero(strong one) tries to take care of everything
-clown(mascot) lessens tension by eliciting laughter
-lost child- quiet one
-scapegoat- blamed for family's problems, takes attention away from user - Family roles
-
Similar amounts of alcohol
12 oz beer
______oz of wine
1 oz of whiskey - 3.5 oz of wine
- 1 drink of alcohol has about 0.5 ounces of alcohol and each drink takes about 1 hour to metabolize ______ounce.
- 0.5 ounce
-
________Phase- used to relieve every day stress.
acceptable
medicating self, tolerance developing - Pre-alcoholic phase
-
________Phase- begins to experience blackouts.
-begins to need drink
-moved over to dependency, dysfunctions arise - Early alcoholic Phase`
-
_________- lost control, physiological dependency, binge drinking is common, and drinking is the total focus.
-compulsion
-very dependent, major consequences in life - Crucial phase
-
_______phase- intoxicated more than sober, emotional/physical problems may be life threatening
-organ deterioration (liver, brain) - Chronic Phase
- individuals with _______ can have higher alcohol blood levels and less symptoms
- Tolerance
-
Symptoms of _________ include: impaired judgment, poor coordination, unsteady gait, slurred speech, inability to focus and impaired memory.
-labile or angry/sad
-flushed face- peripheral vasodilation - Intoxication
-
Effects of alcohol on the ___________:
-damage to lining of esophagus, stomach, small intestine
-lining erosion, sometimes bleeding
-increase in gastric secretion
-decrease in gastric emptying
-epigastric pain
-possible naus - Gastrointestinal
-
Effects of alcohol on ___________:
-decrease in appetite which leads to malnutrition
-vitamin/mineral deficiencies
-serious thiamine and folic acid defieiencies - appetite/nutrition
-
Effects of alcohol on___________
-alcohol modifies pancreatic enzymes (amylase, lipase) increase levels mean pancreatitis
-proteolytic enzymes released that damage pancreas
-constant, severe epigastric pain with nausea/vomiting/abdominal d - Pancreas
-
Liver involvement-
_______-revisible
-decrease in metabolism of fat with increase metabolism of alcohol
-fat build up in cells
-increase in size of liver
-pain/tenderness in right upper quadrant
-leads to hepatitis (inflamma - Fatty liver
-
Liver involvement-
___________-revisible
-liver enzymes increase
-damage to liver cells
-10-30% mortality rate
-jaundice/dark urine
-increased bleeding
-increased bilirubin that leads to jaundice - Alcoholic Hepatitis
-
________- scarring, irreversible
-increase pressure in portal circulation
can result in gastric or esophageal varices which can rupture with significant bleeds (hole in vessel)
-liver cells destroyed and replaced with scarring
-fluid - Cirrhosis
-
___________- (nerve damage)
-resultant of deficiency in vitamin B
-symptoms of pain, tingling, burning sensation - Peripheral Neuropathy
-
____________-(nerve damage in brain)
-caused by thiamine deficiency
-ataxis, sleepiness, stupor, death
Treatment: always thiamine before any IV glucose to minimize brain damage.
-confusion and nerve damage to brain - Wernicke's encephalopathy
-
_______________- brain (neuron) damage
-psychosis, confusion, disorientation
-tactile, visual hallucinations - Korsakoff's psychosis
-
_______effects-
-dilation of superficial vessels of skin especially on face and neck
-percipitates rosacea with "rum nose" - Cutaneous effects
-
Decrease ________ count-
-later stages
-high risk for infection - white count
-
_________- aggressive treatment with substitution therapy will decrease these symptoms.
-depends on person, amount drank and involvement (time) - Alcohol withdrawel
-
the following symptoms occur ______ hours after cessation of use or decrease in heavy use:
-coarse tremors of hands,tongue,eyelids
-n&v (tx with anti-emetic)
-sweating
-incr.BP (tx with vasodilator-catapres
-irritability/anxi - 4-12 hours will see ANS - affects vital signs
-
___or ____ day (aggressive tx with subsitution therapy will decrease probability of these symptoms)
-alcohol withdrawel delerium (delirium tremors or DT's) become psychotic
-confusion, delusional thinking, visual/
tactile hallucinations (u - 2nd or 3rd day
-
_____________- use of subsitution therapy. determined by how severe liver is damaged.
-may be instituted as routinely scheduled substitution therapy or as PRN substitution therapy
-takes 3 days to taper until body adjust
-benzodiazephines - Medical detoxification
- _________ given for increasing BP
- Vasodilator
-
CAGE questionaire is frequently used:
C
A
G
E -
C- cutting down
A- annoyed/angry
G- guilty
E- eye opener -
Usual therapy for subsitution therapy
Librium ___mg Q2H PRN
Ativan 1mg Q2H PRN
Valium 10mg Q2H PRN - 50 mg
-
______abuse- usually begins with:
-medical use for chronic pain
-recreational purposes - Opiate abuse
-
Examples of _________abuse include:
paregoric, lomotil, morphine, codeine, demeral, fentyl, duragesic patch, percodan, vicodin, oxycotin, methodone, heroin - Opiate abuse
-
Effects of _______ on brain:
-decrease in pain if using for pain control
-euphoria, mental clouding, drowsiness
-decrease in respirations (depressed centers in medulla)
-decrease cgh reflex (suppressed center in medulla)
-pupilla - Opiate
-
Opiate abuse effects on ____system:
-nausea/vomiting
-decreased peristalsis resulting in constipation - GI system
-
Opiate abuse effects on _______ functioning;
-decreased in libido
-decreased sexual pleasure - sexual functioning
-
_____ withdrawel symptoms:
-within 6-24 hrs after last dose depending on half life, usually peaks within 1-3 days also depending on the half life
-dysphoric mood
-pupillary dilation
-muscle aches (motrin)
-tearing/running nose - Opiate withdrawel symptoms
-
treatment for withdrawel (_____therapy)
-may be routine times or PRN based on severity of symptoms
-examples include: buprenex
ultram
methadone
catapres(clinidine) - Substitution therapy
-
_____-most lethal because of CNS depressant effects
-mainly barbiturates including seconal, phenobarbital, and Nembutal - Sedatives
-
________-anti-anxiety excluding buspar
all the benzodiazepines including valium, librium, dalmane, ativan, xanax, klonopin, and restoril - Anxiolytic
-
Reasons for__________abuse:
-decrease anxiety
-helps alleviate insomnia
-increase feelings of relaxation
-decrease inhibitions
-may be used with other drugs to enhance intoxication - Sedatives
-
Side effects from _________-
-drowsiness
-motor incoordination
-ataxia
-decrease in REM sleep resulting in nightmares - Sedatives
-
Side effects of __________-
-drowsiness
-motor incoordination
-ataxia
-decrease in REM sleep resulting in nightmares - Sedatives
-
Withdrawel symptoms from __________:
-hyperexcitability
-fine hand tremors
-increase in anxiety
-sleep problems
-cravings
-withdrawel seizures that may lead to delirium - Sedatives
-
________ such as cocaine and amphetamine
(methamphetimine, ICE, Ritalin, Cylert)
effects include:
-promotes high firing rate resulting in euphoria/excitement
-increase HR and BP
-may cause arrythymias in chronic and heavy use
- Stimulants
- No withdrawel treatment is necessary from _____________ use.
- Stimulant
- ________- enduring traits that don't change. Helps us function successfully in our roles
- Personality
- Type of personality trait that is positive, makes up our personality
- Function