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93 Cards in this Set
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Pharmacology Definition
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the study of drugs that alter functions of living organisms
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pharmacotherapy
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the use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes
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medications
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drugs given for therapeutic purposes
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basis of drug classifications (3)
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effect on body systems
therapeutic uses chemical characteristics |
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prototype
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first drug in a group, sets the standard by which all other drugs in the group are measured (penicillin for antibs, morphine for analgesics, etc.)
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generic name
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related to the chemical or official name of the drug (amoxicillin)
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trade name
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designated and patented by the manufacturer - amoxil, trimox, zoloft, etc.
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patents
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required for drugs, have a time limit, generic versions of the drug can be made after the patent expires
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high costs of drug therapy driven by:
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research, availability of ingredients, high consumer demand (think viagra)
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prescription drug requirement
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prescription signed by someone with a DEA#
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drug approval process
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4 phases of testing and clinical trials, then FDA approval
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phase 1 clinical trials
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15-20 healthy volunteers - watching absorption, metabolism, excretion, toxicity
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phase 2 clinical trials
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50-100 people with disease
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phase 3 clinical trials
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10-15,000 people with disease - do benefits outweigh the risks? Leads up to the FDA approval.
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Phase 4 clinical trials
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following FDA approval, goes on for 15 years, drug is marketed for use with continued data collection for safety - this is the phase nurses are constantly directly involved in.
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Requirements for OTC drugs
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fda approves based on:
6th grade level comprehension of instructions can consumer accurately self-diagnose? is drug effective when used as recommended? is drug safe when used as instructed? |
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strategies to study pharmacology
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concentrate on therapeutic classifications
keep a reference handy use own words in notes/cards understand how drug works in body - applies to rest of class |
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local effects of drugs
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effects only locally, such as sunscreen, ben-gay, lidocaine - exactly where placed
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systemic effects of drugs
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travels through multiple body systems
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can a client experience systemic effects of local drugs and local effects of systemic drugs?
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yes, for instance, if lidocaine is placed near an open wound, it could enter the bloodstream and have a systemic effect.
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where can you look up info on medications?
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pdr, online (epocrates, medlineplus.gov), textbook
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Modern medicines are mostly
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synthetic products made in labs
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controlled drugs are
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scheduled according to medical use and potential for abuse
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OTC Drugs vs. their prescription versions
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often differ in indications for use and recommended dosage
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with a new drug, the FDA is responsible for
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evaluating the drug for safety and effectiveness
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pharmacokinetics
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absorption, distribution, metabolism, excretion
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absorption
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process occurs from the time the drug enters the body to the time it enters the bloodstream
rate determines onset of action |
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first-pass effect
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when a drug is given orally, it is absorbed from the GI tract and carried to the liver for metabolism via portal circulation - some of the drug is metabolized in the liver
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distribution
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drugs carried by blood and tissues to sites of action, metabolism and excretion
to heart, liver and kidneys - fast, to muscle, fat, organs, skin - slower |
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protein binding
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drugs that bind to protein can be longer lasting or slow release. they are only released from their protein binding when the serum level is low. only free or unbound portion of drug can act because of size.
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metabolism
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breaking down a drug into its useable form
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drugs mainly metabolized by
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liver, kidneys
most by cytochrome P450 enzymes in liver - liver toxicity a risk (grapefruit juice) |
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other metabolism sites
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blood, lungs, and GI mucosa
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prodrugs
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these are metabolized and THEN they become active -
most drugs are metabolized to inactive metabolytes |
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what happens if 2 drugs compete for protein-binding sites?
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one drug will be displaced due to lack of adequate binding spots and therefore have a higher serum level - could be a big problem
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some drugs that are highly protein bound:
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warfarin
diazepam sulfonamides |
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effect of long term malnutrition on protein binding meds
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more drug circulates in blood due to lack of binding sites, increases serum level, has a stronger effect on the patient
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excretion requirements
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good circulation system
properly functioning kidneys, bowels, lungs and skin |
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MEC
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minimum effective concentration - minimum serum level required for drug to have pharmacologic effect on cells
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duration of action
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time taht the serum blood levels are above the MEC
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toxic concentration
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excessive levels of a drug - either from one overdose, repeated doses, or slow metabolism of properly administered doses
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serum half-life
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amount of time required for blood serum level of a drug to decrease by 50%
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pharmacodynamics
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the action of a drug on a cell
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receptor theory
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primarily agonists and antagonists (agonists stimulate a cell to do its function, antagonists block a cell from doing its function) this is how antidotes work
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nonreceptor actions
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environmental changes like acid environment, osmolality
third agents such as vit. D metal chelating agents (combine with drug and bind it) |
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drug related variables
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dosage, routes of administration, drug-diet interactions (grapefruit juice), drug-drug interactions
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enteral
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oral administration
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parenteral
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injected administration
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client related variables
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age, pregnancy, body weight, genetic and ethnic characteristics, gender, pathologic conditions, psychological conditions (placebo)
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neonate
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immature organ development - liver and kidneys.
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infant
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liver function and blood-brain barrier still immature
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children
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increased metabolism of some drugs
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older adults
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GI, cardiac, liver and kidney status alter pharmacokinetics - impaired kidney and liver function greatly increase risk of adverse drug events
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drug tolerance/cross-tolerance
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body gets used to a drug eventually. cross-tolerance is getting used to related drugs
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adverse effects
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*any* undesired response to a drug
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therapeutic effects
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any desired response to a drug
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drug toxicity
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caused by excessive amounts of a drug and may cause permanent damage
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drug overdose treatments
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antagonists (antidotes), altering of environments, supportive measures
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pregnancy drug category A
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studies indicate no risk to human fetus
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pregnancy drug category B
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studies indicate no risk to animal fetus; info in humans not available
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pregnancy drug category C
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adverse effects reported in animal fetus; information in humans is not available
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pregnancy drug category D
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possible fetal risk in humans reported' however, considering potential benefits v. risk may, in selected cases, warrant the use in pregnant women.
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pregnancy drug category X
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fetal abnormalities reported and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs should NOT be used in pregnant women.
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5 Rights of Medication Administration
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right drug
right dose (including decimal) right client right route of administration right time (when was last meal?) |
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RN Legal responsibilites for medication admin
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expected to have sufficient drug knowledge to recognize and question erroneous orders
responsible to CMAs and LPNs whom they are supervising |
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LPN legal responsibilities for medication admin
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can give medications
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medication errors caused by:
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illegible writing
similar-sounding drugs pharmacist filling script nurses w/ inadequate knowledge or not following 5 rights client's OTC or polypharmacy distraction or interruptions |
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medication orders require
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clients full name
generic and/or trade name dose route frequency date, time, sig of prescriber refills -- scheduled medications (schedule II not refillable) |
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drug preparations and dosage forms
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liquids
tablets and capsules suppositories transdermal (patch) pump delivery systems (insulin) |
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routes of administration
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oral (enteral)
topical parenteral - intradermal, subcutaneous, intramuscular, or intravenous |
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critical pathway
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measurable path to healing
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herbal and dietary supplements are a major concern because
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no regulation
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goals
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must have an intended outcome in order to use a drug
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drug selection and dosage
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best drug, least side effects, individualized dosage
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drug therapy in children
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dosage based on weight
oral route preferred for IM administration, use thigh childproof containers never refer to it as candy! |
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drug therapy in older adults
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physiological funtionality is more important than the age of the client
assess drug hx and OTC use give smallest effective dose for shortest effective duration smallest number eff. dose (long-acting drugs) start low, go slow inc. nonpharmacological treatments assess for limitations in home use assess drug effectiveness and any reactions to meds |
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drug therapy in kidney impairment
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high risk for drug accumulation - impaired metabolism
monitor renal status: - increased BUN (blood, urea, nitrogen -increased serum creatinine -decreased urine output |
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drug therapy in liver impairment
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high risk for drug accumulation
monitor liver status: -bilirubin -albumin -alt and ast (liver enzymes) |
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drug therapy in critical illness
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aggressive treatment
multidrug regimens r/o multiorgan failure most meds IV dosage requirements vary hugely timing essential - around clock weigh clients' evaluate lab values frequently |
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drug therapy in home care
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short or long term drug therapy
many drugs admin by pt or family member review drugs and OTC w/ client assess home environ. for pot. safety hazards eval. for expected response and side effects |
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basic unit of the central nervous system
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the neuron (glia support and nourish the neurons)
Composed of cell body, dendrite and axon. |
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nerve fiber
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an axon together with a myelin sheath
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neurotransmittors
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chemicals that carry messages from one neuron to another or from a neuron to body tissue like heart or skeletal muscle
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afferent neuron
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conducts sensory impulses towards the brain or spinal cord
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efferent neuron
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neuron that conducts motor impulses away from the brain or spinal cord
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synapses
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microscopic gap between neurons in a chain. can be electrical or chemical. neurotransmitter release and removal occurs here
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receptors
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proteins embedded in the cell membranes of neurons. a neurotransmitter must bind to receptors to exert an effect on the next neuron in the chain
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cholinergic neurotransmitter system
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uses acetylcholine, found in CNS and ANS.
In CNS, associated with level of arousla, memory, motor conditioning, and speech. |
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dopaminergic neurotransmitter system
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uses dopamine, found in substantia nigra, the midbrain and the hypothalamus.
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GABA-ergic
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uses GABA
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Noradrenergic
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uses norepinephrine
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serotonergic
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uses serotonin
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amino acid neurotransmitters
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aspartate, glycine, glutamate
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