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NERVOUS SYSTEM
1.CNSBRAIN
SPINAL CORD Regulates body
function Interprets
information sent byimpulses from theperipheral nervoussystem
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C 1-2- breathing, neck flexor
C3 & above : diaphragm function
C4 : biceps and shoulders, but weaker C5: use of shoulders and biceps, but not of
the wrists or hands.
C6 : wrist control, no hand function.
C7 and T1: straighten their arms
C7 is generally the level for functionalindependence.
T1 to T8 : control of the hands, but lackcontrol of the abdominal muscles
T9 to T12 : Allows good trunk and abdominal
muscle control, and sitting balance is verygood.
lumbarorsacral region of the spinal canalare decreased control of the legs and hips,urinary system, bowel and anus.
http://en.wikipedia.org/wiki/Diaphragm_(anatomy)http://en.wikipedia.org/wiki/Lumbarhttp://en.wikipedia.org/wiki/Sacralhttp://en.wikipedia.org/wiki/Human_leghttp://en.wikipedia.org/wiki/Hiphttp://en.wikipedia.org/wiki/Hiphttp://en.wikipedia.org/wiki/Human_leghttp://en.wikipedia.org/wiki/Sacralhttp://en.wikipedia.org/wiki/Lumbarhttp://en.wikipedia.org/wiki/Diaphragm_(anatomy)8/14/2019 Pharmacology 2ppt
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2. PNS
SOMATIC NERVOUSSYSTEM
Voluntary
Acts on skeletal musclesproduce locomotion and
respiration
AUTONOMIC NERVOUSSYSTEM
(Visceral system)Sympathetic Nervous system
Parasympathetic Nervoussystem Involuntary Control and regulates
function of:
HeartRespiratory system
GIT systemGlands
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ANS
Sympathetic NervousSystem
Adrenergic system
Neurotransmitter norepinephrine
Response
excitability Fight or Flight
stress
ParasympatheticNervous System
Cholinergic system
Neurotransmitteracetylcholine
Response
inhibition
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drugs affecting the autonomicnervous system
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ADRENERGIC DRUGSSympathomimetics
Stimulates the SNS
mimics the action of the SNS
Stimulation of SNS causes: Increase heart rate Dilation of the bronchioles and pupils
Constriction of blood vessels
Relaxation of muscles of: GIT
Bladder
Uterus
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ADRENERGIC DRUGSSympathomimetics
Stimulates the following receptor
Alpha-adrenergic
Beta adrenergic
Dopaminergic
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ADRENERGICSsympathomimetics drugs
Alpha 1-adrenergic ReceptorsFound in blood vesselsActivation results invasoconstriction resulting in:
Increase in BPIncrease contractility ofthe heartContraction of bladdersphincter and prostatecapsule increases
contraction andejaculationMydriasis dilatation ofthe pupil
Decrease salivarysecretions
Alpha 2 adrenergic receptorFound in blood vesselsInhibits release of
norephineprineActivation results inVasodilation resulting in:
Decreased BPDecreased GI tone andmotility
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ADRENERGICSsympathomimetics drugs
Beta 1 receptor Found in the heart Stimulation results in:
Increase myocardial
contractility Increase HR
Beta 2 receptors Found in smooth
muscles of lung,arterioles of skeletal
and uterine muscles Stimulation results in: Relaxation of smooth
muscle of lungsbronchodilation
Increase blood flow tothe skeletal muscle
Relaxation of uterinemuscledecease uterinecontraction
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ADRENERGICSsympathomimetics drugs
Classification Direct acting
Directly stimulate the adrenergic receptor
Epinephrine or norepinephrine Indirect acting
Stimulates release of norepinephrine fromterminal endings
Mixed acting Both direct and indirect acting Stimulates adrenergic receptor and stimulates
release of norepinephrine from terminal endings
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ADRENERGICSsympathomimetics drugs
Uses: Emergency drugs Given to treat:
Cardiac arrest stimulate the heart
Hypotension increase BP CHF increase force of contraction of the heart Bronchial asthma open the bronchioles Upper respiratory congestion as decongestants Allergic reaction for vasoconstriction
Hypoglycemia to stimulate glycogen release from liverand skeletal muscles
Local bleeding constrict blood vessels OB relaxes the uterus Eye disorder - mydriasis
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ADRENERGICSsympathomimetics drug
Catecholamine groupImportant drugs Epinephrine
Adrenaline Prototype of adrenergics
Drug of choice foranaphylaxis Active ingredients in
OTC asthma preparation Effects: stimulates both
alpha and beta receptors
Increased BP, HR, bloodflow to the brain, heart,and skeletal muscles
Constrict peripheralvessels
Relaxes GI smooth
muscles
Route ofadministration
IM, SC Inhalation
Intra-cardiac Not given p.o.
destroyed by GIenzymes
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ADRENERGICSsympathomimetics drugs
Catecholamine groupImportant drugs
Norepinephrine Levophed
Potent vasoconstrictor Indication :
Hypotension
Cardiac arrest
Dopamine hydrochloride Intropin Immediate precursor of
norepinephrine Effects:
Low dose renalperfusion
Low to moderate dose
increased cardiacoutput
Higher dose increased peripheralresistance and BP
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ADRENERGICSsympathomimetics drugs
catecholamine group Dobutamine HCl
Dobutrex Synthetic catecholamine
Acts directly on theheart muscle increaseforce of contraction
Isoproterenol HCl -Isuprel synthetic catecholamine
Bronchodilator
Stimulates both beta 1and 2 receptors
Control shock and somedysrhytmias
Route of administration parenteral and inhalation
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ADRENERGICSsympathomimetics drugs
Catecholamine group
Adverse Effect
Nervousness and restlessness Angina
hypertension
DRENERG C
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ADRENERGICSsympathomimetics drugsNon-catecholamine group
Ephedrine Less potent Longer acting than
epinephrine Used as bronchodilator
and nasal decongestant in allergic reaction
Pseudoephedrine Neo-synephrine
Albuterol sulfate Proventil, Salbutamol,Ventolin Acts on Beta 2 receptor Produce bronchodilation Use for treatment of:
Bronchospasm Asthma COPD
Side effects
Temors Dizziness Nervousness restlessness
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ADRENERGICSsympathomimetics drugs
Non cathecholamine
Adverse effect
Palpitations Reflex tachycardia
Hallucinations
Cardiac dysrhythmias life threathening
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ADRENERGICSsympathomimetics drugs
Nursing Intervention Monitor:
VS and ECG increased HR, BP, dysrhythmias RR and lung sounds bronchial congestion and dyspnea
blood glucose level increase I & O urinary retention can result from high dose or
continuous used
Avoid infiltration necrosis possible amputation of
extremity Inspect IV site every 15 minutes edema and coolness Observed for decreased drip rate Discontinue infusion immediately
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ADRENERGICSsympathomimetics drugs
Health Education Drugs pass into breast milk avoid breast
feeding
Continuous used of spray can result inrebound nasal congestion Take as prescribe avoid over dosage Avoid smoking or alcohol- precipitate adverse
effect IFI 2-3l/day Correct way of inhalant
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Anti-Adrenergic DrugsAdrenergic Blockers
Alpha-adrenergicblockers Blocks the effect of
alpha recrptors Blocks
sympathomimeticsagent
Vasodilation in
smooth muscle Lower peripheral
vascular resistance
Uses: Peripheral vascular
disease Raynaudsdisease and frostbites
Confused elderly Mild to moderate
hypertension Migraine
CHF Pheochromocytoma tumor that releaseexcessive amount ofcatecholamines
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Anti-Adrenergic DrugsAdrenergic Blockers
Common Drugs
Phentolamine mesylate Regitine
Prototype
Prevent tissue necrosisfrom infiltration ofnorepinephrinebitartrate (levophed)during IV therapy
Prevents and controlhypertension caused bypheochromocytoma
Ergotamine tartrate
Ergostat
Vasoconstrictor
Used to treat migraineheadache
Route of administration SL, rectal suppository,inhalation
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Anti-Adrenergic DrugsAdrenergic Blockers
Ergotamine tartratewith caffeine cafergot
Common anti-migrataine drug
Prazosin (minipress)
Terazosin (hytrin) Blocks post-synaptic
alpha 1 adrenergicreceptor
Use for hypertension
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Anti-Adrenergic DrugsAdrenergic Blockers
Beta-adrenergic blockers
Blocks adrenergic stimulationto beta 1 0r 2 receptors bycompeting with norepinephrinefor available beta-adrenergic
receptor sites Block to beta 1 receptor cause
decrease: BP Contraction of the heart
muscle
Cardiac output Block to beta 2 receptor cause
vasodilation in skeletal musclearterioles
Use: Control angina pectoris
decrease O2 demand,myocardial contractility,heart rate
Lower BP MI decrease incidenceof catecholamine-induceddysrhythmias followingattack
Glaucoma reduce IOP
decrease formation ofaqueous humor Migraine headache
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Anti-Adrenergic DrugsAdrenergic Blockers
Ganglionic Blocking Agents stop the delivery of both sympathetic and
parasympathetic nerve impulse through ganglia Compete with acetylcholine to occupy receptor sites
in autonomic ganglia Act to decrease arterial pressure and lower BP Important drug: Mecamylamine HCl inversine the
only available ganglionic blockers currently available
Uses: Advance stage of hypertension or hypertensive crisis Pulmonary edema
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drugs affecting theparasympathetic nervous system
Cholinergic agents
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Cholinergic agentsparasympathomimetics
cholinomimetics stimulate the PSNS
Mimics the neurotransmitter acetlycholine
2 types of cholinergic receptors: Nicotinic : neuromuscular
Action resembles effects of nicotine Tachycardia
Elevated BP
Peripheral vasoconstriction Muscarinic:
Stimulate smooth muscle
Slow heart rate
Cholinergic agents
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Cholinergic agentsparasympathomimetics
cholinomimetics
EFFECTS Cardiovascular
vasodilation & slowsconduction of AV node Decrease HR Low BP
GIT increases tone andmotility of smoothmuscle of stomach andintestine Increased peristalsis Relaxation of sphincter
muscle
Genitourinary contracts muscles ofurinary bladder Increase tone of ureter Relaxes bladder
sphincter muscle Stimulates urination
Eye increase pupillaryconstriction or miosis pupil smaller
Increase accomodation Glands increase
salivation, perpirationand tears
Cholinergic agents
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Cholinergic agentsparasympathomimetics
cholinomimetics
Lungs Stimulates bronchial smooth muscles
Contraction and increases bronchialsecretions
Striated muscles Increase neuromuscular transmission
Maintains muscle strength and tone
Cholinergic agents
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Cholinergic agentsparasympathomimetics
cholinomimetics2 types
Direct Acting
Indirect Acting
Direct Actingcholinomimeticdrugs
Directly stimulatecholinergic receptor
Mimic acetlycholine
Specific Effects; Decreased heart rate
Increased: Tone of GIT muscle
and relaxation ofsphincters
Tone of bladder andrelaxation ofsphincters
Respiratorysecretions
Constriction of pupil
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Direct Acting Cholinergic Agents
Important drugs Bethanicol Cl
urecholine
Use for urinary retentionand atony contractssmooth muscle ofbladder
For treatment of openangle glaucoma
Pilorcapine HCl pilocarpine Use to lower IOP in
glaucoma by constrictingthe pupil
Carbachol intraocular miostat Use to treat simple
glaucoma and open-angleglaucoma
Metoclopramide HCL Reglan Use to prevent
chemotherapy induced
nausea & vomiting
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Direct Acting Cholinergic Agent
USES Glaucoma Postoperative atony GI reflux disease Neurogenic bladder
ADVERSE EFFECT N and V Diarrhea Wheezing and
shortness of breath Headache Increase salivation Increase sweat Poor night vision Sleep disturbance Convulsion & coma
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Direct Acting Cholinergic Agent
Cause bronchialconstriction andincrease bronchial
secretions in: Respiratory disorder
Asthma Monitor RR and
breath sounds
when givenadrenergic agents increase risk of
adverse effect Have AtSO4 at hand
to counteract druginteraction
Indirect Acting Cholinergic
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Indirect Acting CholinergicAgent
Anti-cholinesterase
Inhibits action of acetlycholinesterase enzyme that break downacetylcholine
Prolong the effect of acetlycholine
Indirect Acting Cholinergic
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Indirect Acting CholinergicAgent
IMPORTANT DRUGS Neostigmine bromide-
prostigmin Use to treat urinary
retention and paralyticileus Drug of choice in
treatmentof myestheniagravis characterizedby neuromusculartransmissionaccompanied by increaseweakness and fatigue ofskeletal muscle
Edrophonium CL tensilon Use to diagnose
myasthenia gravis
Antidote forpancuronium Pavulon aneuromuscular blocker
Differentiate betweenMyesthenia crisis resulting from under-
dosageChloinergic crisis resulting from over-dosage
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Indirect Acting Cholinergic Aent
Pyridostigminebromide mestinon The maintenance
drug of choice formyesthenia gravis
AtSO4 Use as antidote to
counteract adverse
effects ofcholinergic agents
Indirect Acting Cholinergic
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Indirect Acting CholinergicAgent
USES Myasthenia gravis
improves muscle strength Glaucoma reduces IOP Post-op bladder distention
promotes bladder emptying Post-op paralytic ileus
increase intestinal muscletone
Counteract neuromuscular
blockade caused by musclerelaxant employed foranesthesia
ADVERSE EFFECTS
Hypotension Miosis
Vasodilation Intestinal spasm N & V Increase salivation Diaphoresis
Indirect Acting Cholinergic
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Indirect Acting CholinergicAgent
ADVERSE EFFECTS
Weakness andmuscular paralysis
Paralysis ofdiaphragm
Bronchial secretions
and spasm Respiratory arrest
PRECAUTIONS
Aggravate symptomsof:
DM CAD
Ulcerative colitis
Hypothyroidism
Gangrene
Heart block
Indirect Acting Cholinergic
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Indirect Acting CholinergicAgent
Administeredcautiouslyto clientwith respiratory
disorder or asthma increases bronchial
secretions
Constrict smooth
muscles ofbronchioles Monitor RR, increased
bronchial secretions,diminished breath
sounds
not given withganglionicblocking agent Can cause severe
hypotension Assess VS for
changes in HR andBP
Indirect Acting Cholinergic
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Indirect Acting CholinergicAgent
NURSINGINTERVENTIONS
Assess S&S of
myesthenia gravis Drooping of eyelids
Double vision
Difficulty of chewingand swalloeing
Assess for signs ofneurologic toxicity Tremor
Restlessness Confusion
Convulsion Ensure client safety
Indirect Acting Cholinergic
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Indirect Acting CholinergicAgent
Assess abdominalcramps, vomiting,diarrhea
HEALTH EDUCATION
Instruct client to: Carry ID card at all
times - detailmedication regimen
Take medicationexactly on time to
prevent myastheniacrisis or cholinergiccrisis
ANTICHOLINERGIC AGENT
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ANTICHOLINERGIC AGENT
Also called muscarinic antagonist Blocks parasympathetic impulses by competing with
acetylcholine for sites on muscarinic receptors Depress CNS
Affects : Skin Eyes GIT
Bladder Bronchi HR
ANTICHOLINERGIC AGENT
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ANTICHOLINERGIC AGENT
IMPORTANT DRUGS AtSO4
Prototype
Use: Treat bradycardia Antidote for
cholinergic drug
Antidote forinsecticidepoisoning
Trihexphenidyl Artane Use to treat
Parkinsons disease
Oxybutynin Cl Ditropan Use in neurogenic
bladder Increase bladder
capacity Decrease frequency
of voiding
ANTICHOLINERGIC AGENT
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ANTICHOLINERGIC AGENT
Scopolaminehydrobromide hyoscine
For treatment ofmotion sickness
Management of N &V with use of general
anesthesia Produce pre-operative amnesia
ADVERSE EFFECT
Dryness of themouth
Use ice chips Good oral hygiene
Chew gum or hardcandy
Constipation Fluid intake 8
cups/day
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Drugs Affecting the CNS
a. CNS Stimulant
b. CNS Depressant
A CNS stimul nt
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A. CNS stimulant
act to stimulate Respiratory system
Heart
General metabolism Small doses
Increase alertness
Impart feeling ofwellness
Large doses Produce insomnia,
tremors,restlessness
Toxic dose Produce convulsion
Cardiac
dysrhythmias Possibly death
Prolonged use Results in exhaustion
Hypertension
CNS STIMULANT
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CNS STIMULANT
MAJOR GROUP Amphetamines, Amphetamine Like
Stimulates the cerebral cortex
Analeptics and caffeineActs on brainstem and medulla
Stimulate respiration
AnorexiantsActs on cerebral cortex and hypothalamus
Suppress appetite
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CNS STIMULANT
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CNS STIMULANT
AMPHETAMINES
Common Drugs
c. Amphetamine sulfate (adderal)d. Dextroamphetamine sulfate(dexedrine)
e. mathamphetamine HCl (desoxyn)
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CNS STIMULANT
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CNS STIMULANT
AMPHETAMINES
Indication
Narcolepsy
Alleviate attacks ADHDDecrease hyperactivity
Endogenous obesity obesity
resulting from dysfunction ofendocrine or metabolic systemSuppress appetite
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Amphetamine Like drugs
Indication
-consider more effective in treatingADHD and NARCOLEPSY except
for adderal, but less SideEffects
A h t i & A h t i Lik
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Amphetamine & Amphetamine LikeDrugs
Side effects Tolerance, Dependence, Abuse
Tachyphylaxis decrease effectiveness
Nervousness, irritability, Headache, Dizziness,Insomnia
Hypertension, palpitations
Dry mouth
Weight loss prolonged used
Taken 30 mins before meal
C.I. with symphatomimetic drugs and pregnant
mother
CNS STIMULANT
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CNS STIMULANT
2. ANALEPTICS Beta adrenergic agonist
Stimulate respiration
Stimulate epinephrine the focus is todilate bronchioles
CNS STIMULANT
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CNS STIMULANT
ANALEPTICSCommon Drugs
Methylxanthine Caffeine Theophylline
theobromine
CNS STIMULANT
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CNS STIMULANT
ANALEPTICS
Indication
COPD- chronic obstructive pulmonarydiseaseofthe airway
Bronchial Asthma
Infant Abnormal Apnea
ANALEPTICS
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ANALEPTICS
Side effects Tolerance, Dependence, Abuse Nervousness, irritability, Headache, Dizziness,
Insomnia
diuresis tinnitus
Weight loss prolonged used
C.I. with symphatomimetic drugs and pregnantmother
CNS STIMULANT
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CNS STIMULANT
ANOREXANTS
Stimulate the appetite control center
in the hypothalamus for suppression
Increase epinephrine w/ increaseeuphoria, alertness and concentration
CNS STIMULANT
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CNS STIMULANT
AnorexantsCommon Drugs
Benzphetamine HCL (didrex) Dextroamphetamine Sulfate
(dexedrine)
Dethylpropion HCl ( dospan, tenuate)
CNS STIMULANT
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CNS STIMULANT
ANOREXANTSIndication
3. Overweight or obese person
5. Treat attention deficit
A t
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Anorexants
Side effects Tolerance, Dependence, Abuse
Nervousness, irritability, Headache, Dizziness,
Insomnia tinnitus
Drug contain phenylpropanolaminecause hemorrhagic stroke, HPN, cardiacdysrhythmias
B. CNS Depressant
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B. CNS Depressant
SEDATIVE- lessen themental response but notaffect the consciousness insmall amount
HYPNOTICS- to have a
restful natural sleep thatallow the patient to awakenat usual time
SEDATIVE-HYPNOTICS-depressed the CNS
- calmness, relaxation,reduction of anxiety,sleepiness
- used also as anticonvulsant
Large doses Can suppress the
respiratory centerin medulla
Skin rash/urticaria
Prolonged use dependence
tolerance Withdrawal
syndrome onceabruptly stop
CNS DEPRESSANT
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sedative-hypnotic It produces all levels of CNS
depression- depress the sensory cortexdecrease-motor activity-by Gamma-
aminobutyric acid (GABA) - chiefinhibitory neurotransmitter in themammalian CNS.
- regulating neural excitability
throughout the nervous system.Depress the activity of all excitabletissue
treat anxiety and sedate
CNS DEPRESSANT
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MAJOR GROUP Barbiturates
Depress all levels of CNS and sensory cortex
BenzodiazepineReduced Neuron excitability
significantly less dangerous in overdose
NonbenzodiazepineReduced Neuron excitability
CNS DEPRESSANTd ti h ti
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sedative-hypnotic
barbituratesClassification
Long-acting Immediate-acting
Short-acting
Ultrashort acting
CNS DEPRESSANTsedative-hypnotic
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sedative hypnoticbarbiturates
1. LONG-ACTING
Common drugs
Phenobarbital(luminal)
Mephobarbital(mebaral)
Indication
Seizure in epilepsy(anticonvulsant)
Insomnia
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CNS DEPRESSANTsedative-hypnotic
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ypbarbiturates
3. Short-Acting
Common drugs
Secobarbital(seconal)
Pentobarbital
(nembutal)
Indication
- difficulty sleep atnight (insomnia)
- more on elderly
CNS DEPRESSANTsedative-hypnotic
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sedative hypnotic
barbiturates3. Short-Acting
Common drugs
Thiopental sodium(pentothal)
Indication
Used in operation asgeneral aesthetic
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CNS DEPRESSANTsedative hypnotic
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sedative-hypnotic
Benzodiazepine
-stimulate GABA-most widely used depressant
-less dangerous to overdose and addiction
CNS DEPRESSANTsedative-hypnotic
b di i
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benzodiazepine
Common Drugs Diazepam (Valium)
Triazolam (halcion)
Lorazepam (atevan)
Aprezolam (xanax)
INDICATION-Anxiety, convulsion
-hypnotic-insomnia
-seizure in epilepsy
-insomnia
CNS DEPRESSANTsedative-hypnotic
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sedative hypnotic
benzodiazepine Side Effects
Drowsiness, morning hangover, blurred vision,
hypotension phlebitis
Produce dependence, tolerance, and
withdrawal symptoms if stop abruptly But less addiction forming than barbiturates
CNS DEPRESSANTsedative hypnotic
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sedative-hypnotic
Nonbenzodiazepine
-comparatively new drugs whose actions aresomewhat similar to those of thebenzodiazepines, but are structurally unrelated
to the Benzodiazepines.
CNS DEPRESSANTsedative-hypnotic
Nonbenzodiazepine
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Nonbenzodiazepine
Common Drugs
imidazopyridines
Zolpidem (Ambien)
pyrazolopyrimidines
zaleplon (Sonata)
Indication
-treatment of insomnia
-muscle relaxant
-anticonvulsant
CNS DEPRESSANTsedative-hypnotic
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ypNonbenzodiazepine
Side Effect Drowsiness, lethargy, hangover, dizziness,
respiratory distress, confusion anddisorientation
Tolerance and dependence-rare
CNS DepressantANESTHESIA
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ANESTHESIA
traditionally meant the condition ofhaving sensation blocked
Use in surgery
Is a reversible lack of awareness- total lack of awareness
- lack of awareness of a part of thebody
Assessment before givingAnesthesia
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Anesthesia
1. The age especially the young andelderly
2. A current health disorder (renal, liver
disease3. pregnancy
4. History of heavy smoking, used of
alcohol and drugs
ANESTHESIA
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Balance Anesthesia
3. The hypnotic drug-night before
4. Narcotic analgesic/Benzodiazepine and
anticholinergic- 1 hr before5. Short-acting barbiturates
6. Inhaled gas such as nitrous oxide and
oxygen7. Muscle relaxant (as needed)
ANESTHESIA
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Stages of AnesthesiaStage 1
ANALGESIA- consciousness---loss of
consciousnessStage 2
EXCITEMENT/DELIRIUM- produce loss of
consciousness by depression of cerebralcortex
ANESTHESIA
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Stages of AnesthesiaStage 3
SURGICAL- anesthesia deepen--- procedure
was performed stage maintain
Stage 4
MEDULLARY PARALYSIS- toxic stage
ANESTHESIA
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CLASSIFICATION OF ANESTHESIA Local anesthesia
numbs a small part of the body.
Regional anesthesia blocks pain to a larger part of your body.
General anesthesia
loss of consciousness during which patientsare not arousable, even by painful stimulation
ANESTHESIA
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Local Anesthesia-You get a shot of local anesthetic directly intothe surgical area to block pain
-prevent transmission of nerve impulseswithout causing. They act by binding to fastsodium channels from within
-patient might awake or may take anxiolytic orhypnotic drug
ANESTHESIALocal Anesthesia
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Common Drugs
Cocaine
hydrochloride
Procaine HCL(Novocain)
Lidocaine HCL(Xylocaine)
Indication
Use in minor and
diagnosticprocedure
Use in episiotomy
Use also in dentalprocedures
ANESTHESIA
R i l A th i
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Regional Anesthesia Administered with local anesthesia to
peripheral nerve bundles
Loss of pain sensation, with varying degrees
of muscle relaxation, in certain regions ofthe body.
Types:
Spinal anesthesia: subarachnoid block.
Epidural anesthesia:
ANESTHESIARegional anesthesia
http://en.wikipedia.org/wiki/Spinal_anesthesiahttp://en.wikipedia.org/wiki/Epidural_anesthesiahttp://en.wikipedia.org/wiki/Epidural_anesthesiahttp://en.wikipedia.org/wiki/Spinal_anesthesia8/14/2019 Pharmacology 2ppt
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g
A. Spinal Anesthesia (Subarachnoid block)
- small volume of local anesthetics being
injected into CSF the arachnoid mater,
injected between the 4th and 5th lumbarvertebrae
- loss of pain sensation and muscle strength,usually up to the level of the chest to toe
ANESTHESIASpinal Anesthesia
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Common Drugs
Bupivacaine
(Marcaine)
2. Lignocaine
(Lidocaine)
Indication
-major surgical
operation/ Specialprocedure to diminish
sensation, loss of pain
and muscle relaxant
ANESTHESIARegional anesthesia
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B. Epidural Anesthesia- injection of drugs through a catheter placed
into the epidural space outside the dura
mater- The injection can cause both a loss of
sensation and a loss of pain by blocking the
transmission of signals through nerves in ornear the spinal cord.
ANESTHESIAEpidural Anesthesia
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Common Drugs- combination of local
anesthetics andopioids
Ex.
- Bupivacaine +morphine
- Choloprocaine +Pethidine
Indication
-major surgical
operation/ Specialprocedure to diminish
sensation, loss of pain
ANESTHESIA
General Anesthesia
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General Anesthesia Drug-induced depression of consciousness/
CNS
Drug-induced loss of consciousness - notarousable - even by painful stimulation
administer intravenously or inhalation agents
ANESTHESIAGeneral Anesthesia
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Common Drugs
Halothane
Nitrous Oxide
Sevoflurane
Indication
-major surgicalOperation attaincomplete depression
ofconsciousness to
diminish sensation,loss
of pain and musclerelaxant
ANAESTHESIA
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Adverse Effect- including agitation, confusion, dizziness, blurredvision, tinnitus, a metallic taste in the mouth, and
nausea, body weakness- amnesia, neurological disorder, seizure
- paralysis, respiratory and cardiac depression,coma and even death
Pathophysiology of Pain
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tissue damageinjured cellsproduce chemical mediators
(prostaglandins)
nocireceptor(all types of tissue) transmitpain sensation brain
CNS DepressantANALGESIC
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pain killer- drugs used to relieve pain Nonnarcotic AnalgesicAcetaminophen/ NSAID
COX-2 Inhibitor
Narcotic Analgesic
Opiates/ Morphinomimetics
ANALGESIC Nonnarcotic Analgesic
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Nonnarcotic Analgesic- Used to treat mild to moderate pain
- Acts on peripheral nervous system at the
pain receptor site
- less potent than narcotic analgesic
- Not addictive / abusive
ANALGESICNonnarcotic Analgesic
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Nonsteroidal Anti-inflammatory Drugs- Relieve pain (Analgesic), fever (antipyretic)and anti-inflammatory
- inhibit cyclooxygenase(COX1 & COX2),
leading to a decrease in prostaglandinproduction; this reduces pain and alsoinflammation
- COX1- protects stomach lining & regulateblood platelets
- COX2- trigger pain and inflammation at site
ANALGESICNonnarcotic Analgesic
NSAID
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Common Medication COX1 & COX2
inhibitor
Aspirin(Bayer,Ecotin,Astrin)
-known NSAID not used
as antipyretic effectReye Syndrome
- Decrease plateletaggregation
Indication
-headache, musclepain
-pain from arthritis
-mild anticoagulants
for TIA, heart attack
thromboembolism
ANALGESICNonnarcotic Analgesic
NSAID
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Side Effect(Aspirin)
- Gastric
discomfort,- tinnitus, vertigo,
deafness
- increase bleeding- Allergic Reaction
Contraindicated- Pregnant
- Patient
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2. Mefenamic Acid(Istan, Revalan,
Dolfenal)-new generation ofNSAID
- less cause G.I.irritant
Indication- Relieved pain
from incision of
operation- -headache, muscle
pain
- toothache
ANALGESICNonnarcotic Analgesic
NSAID
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Side Effect(Mefenamic Acid)
- Gastric discomfort,
- tinnitus, vertigo,- Deafness
- Alergic reaction
Contraindicated- G.I. problem, bleeding
(gastroenteritis)
- Pregnant
- Patient
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1. Ibuprofen (Advil,Motrin, Midol,Excedrin)
-new generation ofNSAID- less cause G.I.
irritant
Indication- headache, muscle
pain
- RheumatoidArthritis,osteoarthritis
- toothache
ANALGESICNonnarcotic Analgesic
NSAID
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Side Effect(Ibuprofen)
- Gastric discomfort,
- dyspepsia
- Nausea & vomitting
- tinnitus
- Allergic reaction
- G.I. bleeding- A.E
Contraindicated- G.I. problem, bleeding
(gastroenteritis)
- Pregnant
- Patient w/ renal/hepatic disease
- Patient
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Common Medication COX2 inhibitor
3. Celecoxib (celebrex)
5. Meloxicam (Mobic)
7. Nabumetone(Rafalen)
Indication- Pain from
osteoarthritis,
rheumatoidarthritis
- Patient with
surgical incision
ANALGESICNonnarcotic Analgesic
NSAID
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Side Effect(COX2 inhibitor)
- tinnitus, vertigo
- Allergic reaction
Contraindicated- Pregnant
- Patient
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ACETAMINOPHEN- non narcotic, not NSAID
- weakly inhibits prostaglandin synthesis
- Inhibition of hypothalamic heatregulator center
- from para aminophenol derivatives
- relieve pain, discomfort, and fever butnot anti-inflammatory effect
ANALGESICNonnarcotic Analgesic
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Common Drugs Acetaminophen
-(Tylenol, Panadol,
Tempra, robigesic,Atasol)
Indication- Moderate pain and
headache
- Fever especially inchildren
- Muscular ache/pain
- Fever cause by viralinfection
ANALGESICNonnarcotic Analgesic
Nursing Responsibility
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Side Effect- anorexia, n & v, rash
Adverse Effect- Severe
hypoglycemia,
oliguria, urticaria- Hepatotoxicity
Nursing Responsibility
- Instruct the patientabout the effect
- Dont overdose and
over used- Take the dose as
prescribe
- Have rest- Keep out of children
ANALGESIC
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Narcotic Analgesic- Used to treat moderate to severe pain
- Acts on central nervous system does produce
also little depression by binding directly toopioid receptor in CNS and GI tract
- Suppress pain, respiration and
coughing(antitussive)- addictive / abusive
ANALGESICNarcotic Analgesic
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Common Drugs2. Morphine Sulfate(Duramorph, MSCotin, Epimorph)
-most potentnarcotic analgesic
- suppress pain,
respiration andcough
Indication- Acute pain fromacute myocardialinfarction
-pain from cancer anddyspnea
- preoperative meds
ANALGESICNarcotic Analgesic
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2. Meperidine (Demerol)- first syntheticnarcotics
- same action w/Morphine, potencyvaries on dosage given3. Hydromorphone
(Dilaudid)- Analgesic effect more
potent than morphine- Less resp. depression
Indication- Preoperativemedication
- Sedation- More preferred to
pregnant mother thanmorphine
- Not given withAdvance cancer large dose neurotoxicity(nervousness, tremors,irritability)
ANALGESICNarcotic Analgesic
Side Effect Contraindicated
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- Anorexia, N & V,dizziness, drowsiness,urinary retention,
constipation, euphoria Adverse Effect-resp. depression,hypotension, increaseICP, seizure,withdrawal syndrome
-asthma w respdepression
- inc. ICP , shock,head injury
- Renal and hepaticdisease/dysfunction
- M.I.
- Advance cancerlarge dose neurotoxicity
ANALGESICNarcotic Analgesic
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Nursing Responsibilities- administer before pain reach its peak
- Monitor v/s (BP and RR) and urine output(above 600ml/day)
- Increase fiber diet or laxative as order
- Check pinpoint pupils morphine/narcotic
overdose naloxone(narcan) available- Give the medication as prescribe
ANALGESICNarcotic Agonist-Antagonist
Common Drugs Mechanism of Action
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g Pentazocine (Talwin) Buprenorphine
(Buprenex)
Nalbuphine HCl(Nubain)- narcotic antagonistis added with a
narcotic agonist todecrease abuse
- Inhibit the painimpulse transmittedin the CNS by bindingby the opiatereceptor andincrease painthreshold
Indication- Post operation meds
for pain- Sedation, labor mom
Narcotic Agonist Antagonist Side Effects Nursing
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- dizziness, confusion,sedation, dry mouth,
nausea, flushing
Adverse Effect- tachycardia,
hypotension andrespiratory
depression
Responsibility- Monitor vital sign
- let the patient void or
do things beforegiving
- Dont give anythingby mouth
Narcotic Antagonist Common Drugs Indication
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Nalmefene (Revex)
Naloxone HCl
(Narcan)
Naltrexone HCL
(Trexan)
- Antidote for
overdose of narcotics
-have higher affinity
to opiate receptor
does displace narcotic
Agent
- Reverse CNS and
respiratory depression
CNS DepressantAnticonvulsant
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Drug use to treat epileptic seizure antiepileptic
suppress the abnormal, rapid and excessivefiring of electrical impulses from cerebral
neurons that start a seizure Acts in 3 ways- suppressing the sodium influx
- Suppressing the calcium influx- Increasing the action of GABA
CNS DepressantAnticonvulsant
Common Drugs
2 H d Side Effect
G l h l
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2. Hydantoins(phenytoin (Dilantin),mephenitoin ethotoin)- Most common drugs to
control seizure (grand malseizure)
- Not used for all types ofseizure
- Gingival hyperplasia orovergrowth of gumtissue bleed
- Neurologic or
psychiatric effectsslurred speech,confusion, depression,thrombocytopenia,Leukopenia, n & v,
constipation, drowsiness
CNS DepressantAnticonvulsant
2. Barbiturates Nursing ResponsilitiesT k h di i
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Amobarbital (Amytal)MephobarbitalPrimodone (Mysoline)
3. BenzodiazepineClonazepam (Klonopin)Clorazepate (tranxene
Diazepam (Valium)Lorazepam (Ativan)
- Take the medication asprescribe
- Monitor serum drug
level- Patient receiveadequate nutrients
- Decrease the
environmental stimulationfor active seizure