pharmacology 2ppt

8/14/2019 Pharmacology 2ppt

1/119

NERVOUS SYSTEM

1.CNSBRAIN

SPINAL CORD Regulates body

function Interprets

information sent byimpulses from theperipheral nervoussystem


2/119

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)


3/119

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


4/119

ANS

Sympathetic NervousSystem

Adrenergic system

Neurotransmitter norepinephrine

Response

excitability Fight or Flight

stress

ParasympatheticNervous System

Cholinergic system

Neurotransmitteracetylcholine

Response

inhibition


5/119

drugs affecting the autonomicnervous system


6/119

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


7/119

ADRENERGIC DRUGSSympathomimetics

Stimulates the following receptor

Alpha-adrenergic

Beta adrenergic

Dopaminergic


8/119

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


9/119


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


10/119


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


11/119


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


12/119

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


13/119


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


14/119


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


15/119


Catecholamine group

Adverse Effect

Nervousness and restlessness Angina

hypertension

DRENERG C


16/119

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


17/119


Non cathecholamine

Adverse effect

Palpitations Reflex tachycardia

Hallucinations

Cardiac dysrhythmias life threathening


18/119


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


19/119


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


20/119

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


21/119


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


22/119


Ergotamine tartratewith caffeine cafergot

Common anti-migrataine drug

Prazosin (minipress)

Terazosin (hytrin) Blocks post-synaptic

alpha 1 adrenergicreceptor

Use for hypertension


23/119


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


24/119


25/119


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


26/119

drugs affecting theparasympathetic nervous system

Cholinergic agents


27/119

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


28/119


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


29/119


cholinomimetics

Lungs Stimulates bronchial smooth muscles

Contraction and increases bronchialsecretions

Striated muscles Increase neuromuscular transmission

Maintains muscle strength and tone

Cholinergic agents


30/119


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


31/119

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


32/119

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


33/119


34/119

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


35/119

Indirect Acting CholinergicAgent

Anti-cholinesterase

Inhibits action of acetlycholinesterase enzyme that break downacetylcholine

Prolong the effect of acetlycholine



36/119


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


37/119

Indirect Acting Cholinergic Aent

Pyridostigminebromide mestinon The maintenance

drug of choice formyesthenia gravis

AtSO4 Use as antidote to

counteract adverse

effects ofcholinergic agents



38/119


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



39/119


ADVERSE EFFECTS

Weakness andmuscular paralysis

Paralysis ofdiaphragm

Bronchial secretions

and spasm Respiratory arrest

PRECAUTIONS

Aggravate symptomsof:

DM CAD

Ulcerative colitis

Hypothyroidism

Gangrene

Heart block



40/119


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



41/119


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



42/119


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


43/119


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



44/119


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



45/119


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


46/119

Drugs Affecting the CNS

a. CNS Stimulant

b. CNS Depressant

A CNS stimul nt


47/119

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


48/119

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


49/119

CNS STIMULANT


50/119

CNS STIMULANT

AMPHETAMINES

Common Drugs

c. Amphetamine sulfate (adderal)d. Dextroamphetamine sulfate(dexedrine)

e. mathamphetamine HCl (desoxyn)


51/119

CNS STIMULANT


52/119

CNS STIMULANT

AMPHETAMINES

Indication

Narcolepsy

Alleviate attacks ADHDDecrease hyperactivity

Endogenous obesity obesity

resulting from dysfunction ofendocrine or metabolic systemSuppress appetite


53/119

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


54/119

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


55/119

CNS STIMULANT

2. ANALEPTICS Beta adrenergic agonist

Stimulate respiration

Stimulate epinephrine the focus is todilate bronchioles

CNS STIMULANT


56/119

CNS STIMULANT

ANALEPTICSCommon Drugs

Methylxanthine Caffeine Theophylline

theobromine

CNS STIMULANT


57/119

CNS STIMULANT

ANALEPTICS

Indication

COPD- chronic obstructive pulmonarydiseaseofthe airway

Bronchial Asthma

Infant Abnormal Apnea

ANALEPTICS


58/119

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


59/119

CNS STIMULANT

ANOREXANTS

Stimulate the appetite control center

in the hypothalamus for suppression

Increase epinephrine w/ increaseeuphoria, alertness and concentration

CNS STIMULANT


60/119

CNS STIMULANT

AnorexantsCommon Drugs

Benzphetamine HCL (didrex) Dextroamphetamine Sulfate

(dexedrine)

Dethylpropion HCl ( dospan, tenuate)

CNS STIMULANT


61/119

CNS STIMULANT

ANOREXANTSIndication

3. Overweight or obese person

5. Treat attention deficit

A t


62/119

Anorexants

Side effects Tolerance, Dependence, Abuse

Nervousness, irritability, Headache, Dizziness,

Insomnia tinnitus

Drug contain phenylpropanolaminecause hemorrhagic stroke, HPN, cardiacdysrhythmias

B. CNS Depressant


63/119

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


64/119

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


65/119

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


66/119

sedative-hypnotic

barbituratesClassification

Long-acting Immediate-acting

Short-acting

Ultrashort acting

CNS DEPRESSANTsedative-hypnotic


67/119

sedative hypnoticbarbiturates

1. LONG-ACTING

Common drugs

Phenobarbital(luminal)

Mephobarbital(mebaral)

Indication

Seizure in epilepsy(anticonvulsant)

Insomnia


68/119



69/119

ypbarbiturates

3. Short-Acting

Common drugs

Secobarbital(seconal)

Pentobarbital

(nembutal)

Indication

- difficulty sleep atnight (insomnia)

- more on elderly



70/119

sedative hypnotic

barbiturates3. Short-Acting

Common drugs

Thiopental sodium(pentothal)

Indication

Used in operation asgeneral aesthetic


71/119

CNS DEPRESSANTsedative hypnotic


72/119

sedative-hypnotic

Benzodiazepine

-stimulate GABA-most widely used depressant

-less dangerous to overdose and addiction


b di i


73/119

benzodiazepine

Common Drugs Diazepam (Valium)

Triazolam (halcion)

Lorazepam (atevan)

Aprezolam (xanax)

INDICATION-Anxiety, convulsion

-hypnotic-insomnia

-seizure in epilepsy

-insomnia



74/119

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


75/119

sedative-hypnotic

Nonbenzodiazepine

-comparatively new drugs whose actions aresomewhat similar to those of thebenzodiazepines, but are structurally unrelated

to the Benzodiazepines.


Nonbenzodiazepine
http://en.wikipedia.org/wiki/Benzodiazepinehttp://en.wikipedia.org/wiki/Benzodiazepine


76/119

Nonbenzodiazepine

Common Drugs

imidazopyridines

Zolpidem (Ambien)

pyrazolopyrimidines

zaleplon (Sonata)

Indication

-treatment of insomnia

-muscle relaxant

-anticonvulsant



77/119

ypNonbenzodiazepine

Side Effect Drowsiness, lethargy, hangover, dizziness,

respiratory distress, confusion anddisorientation

Tolerance and dependence-rare

CNS DepressantANESTHESIA


78/119

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


79/119

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


80/119

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


81/119

Stages of AnesthesiaStage 1

ANALGESIA- consciousness---loss of

consciousnessStage 2

EXCITEMENT/DELIRIUM- produce loss of

consciousness by depression of cerebralcortex

ANESTHESIA


82/119

Stages of AnesthesiaStage 3

SURGICAL- anesthesia deepen--- procedure

was performed stage maintain

Stage 4

MEDULLARY PARALYSIS- toxic stage

ANESTHESIA


83/119

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
http://www.webmd.com/hw-popup/local-anesthesiahttp://www.webmd.com/hw-popup/general-regional-and-local-anesthesiahttp://www.webmd.com/hw-popup/general-anesthesiahttp://www.webmd.com/hw-popup/general-anesthesiahttp://www.webmd.com/hw-popup/general-regional-and-local-anesthesiahttp://www.webmd.com/hw-popup/local-anesthesia


84/119

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


85/119

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


86/119

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_anesthesia


87/119

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


88/119

Common Drugs

Bupivacaine

(Marcaine)

2. Lignocaine

(Lidocaine)

Indication

-major surgical

operation/ Specialprocedure to diminish

sensation, loss of pain

and muscle relaxant

ANESTHESIARegional anesthesia


89/119

g

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


90/119

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


91/119

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


92/119

Common Drugs

Halothane

Nitrous Oxide

Sevoflurane

Indication

-major surgicalOperation attaincomplete depression

ofconsciousness to

diminish sensation,loss

of pain and musclerelaxant

ANAESTHESIA


93/119

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


94/119

tissue damageinjured cellsproduce chemical mediators

(prostaglandins)

nocireceptor(all types of tissue) transmitpain sensation brain

CNS DepressantANALGESIC


95/119

pain killer- drugs used to relieve pain Nonnarcotic AnalgesicAcetaminophen/ NSAID

COX-2 Inhibitor

Narcotic Analgesic

Opiates/ Morphinomimetics

ANALGESIC Nonnarcotic Analgesic


96/119

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


97/119

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


NSAID


98/119

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


NSAID


99/119

Side Effect(Aspirin)

- Gastric

discomfort,- tinnitus, vertigo,

deafness

- increase bleeding- Allergic Reaction

Contraindicated- Pregnant

- Patient


100/119

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


NSAID


101/119

Side Effect(Mefenamic Acid)

- Gastric discomfort,

- tinnitus, vertigo,- Deafness

- Alergic reaction

Contraindicated- G.I. problem, bleeding

(gastroenteritis)

- Pregnant

- Patient


102/119

1. Ibuprofen (Advil,Motrin, Midol,Excedrin)

-new generation ofNSAID- less cause G.I.

irritant

Indication- headache, muscle

pain

- RheumatoidArthritis,osteoarthritis

- toothache


NSAID


103/119

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


104/119

Common Medication COX2 inhibitor

3. Celecoxib (celebrex)

5. Meloxicam (Mobic)

7. Nabumetone(Rafalen)

Indication- Pain from

osteoarthritis,

rheumatoidarthritis

- Patient with

surgical incision


NSAID


105/119

Side Effect(COX2 inhibitor)

- tinnitus, vertigo

- Allergic reaction

Contraindicated- Pregnant

- Patient


106/119

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



107/119

Common Drugs Acetaminophen

-(Tylenol, Panadol,

Tempra, robigesic,Atasol)

Indication- Moderate pain and

headache

- Fever especially inchildren

- Muscular ache/pain

- Fever cause by viralinfection


Nursing Responsibility


108/119

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


109/119

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


110/119

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



111/119

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)


Side Effect Contraindicated


112/119

- 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



113/119

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


114/119

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


115/119

- 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


116/119

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


117/119

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


Common Drugs

2 H d Side Effect

G l h l


118/119

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


2. Barbiturates Nursing ResponsilitiesT k h di i


119/119

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

pharmacology 2ppt

Documents