Pharmacology 2ppt

NERVOUS SYSTEM 1.CNS BRAIN SPINAL CORD • Regulates body function • Interprets information sent by impulses from the peripheral nervous system

• • • • • • • • • •

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 functional independence. T1 to T8 : control of the hands, but lack control of the abdominal muscles T9 to T12 : Allows good trunk and abdominal muscle control, and sitting balance is very good. lumbar or sacral region of the spinal canal are decreased control of the legs and hips, urinary system, bowel and anus.

2. PNS SOMATIC NERVOUS SYSTEM

AUTONOMIC NERVOUS SYSTEM (Visceral system) Sympathetic Nervous system Parasympathetic Nervous system • Involuntary • Control and regulates • Voluntary function of: Heart • Acts on skeletal muscles  Respiratory system produce locomotion and respiration GIT system Glands

ANS Sympathetic Nervous Parasympathetic System Nervous System • Adrenergic system • Cholinergic system • Neurotransmitter  • Neurotransmitter norepinephrine acetylcholine • Response  • Response  excitability inhibition • “Fight or Flight”  stress

drugs affecting the autonomic nervous system

ADRENERGIC DRUGS Sympathomimetics • 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

ADRENERGIC DRUGS Sympathomimetics Stimulates the following receptor Alpha-adrenergic Beta adrenergic Dopaminergic

ADRENERGICS sympathomimetics drugs Alpha 1-adrenergic Receptors Found in blood vessels Activation results in vasoconstriction resulting in: Increase in BP Increase contractility of the heart Contraction of bladder sphincter and prostate capsule – increases contraction and ejaculation Mydriasis – dilatation of the pupil Decrease salivary

secretions

Alpha 2 – adrenergic receptor Found in blood vessels Inhibits release of norephineprine Activation results in Vasodilation resulting in: Decreased BP Decreased GI tone and motility

ADRENERGICS sympathomimetics 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 lungs bronchodilation – Increase blood flow to the skeletal muscle – Relaxation of uterine muscle decease uterine contraction

ADRENERGICS sympathomimetics drugs • Direct acting

Classification

– Directly stimulate the adrenergic receptor • Epinephrine or norepinephrine

• Indirect acting

– Stimulates release of norepinephrine from terminal endings

• Mixed acting

– Both direct and indirect acting – Stimulates adrenergic receptor and stimulates release of norepinephrine from terminal endings

ADRENERGICS sympathomimetics 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 liver and skeletal muscles • Local bleeding – constrict blood vessels • OB – relaxes the uterus • Eye disorder - mydriasis • • • • • • •

ADRENERGICS sympathomimetics drug Catecholamine group

Important drugs • Epinephrine – Adrenaline

– Prototype of adrenergics – Drug of choice for anaphylaxis – Active ingredients in OTC asthma preparation – Effects: stimulates both alpha and beta receptors

• Increased BP, HR, blood flow to the brain, heart, and skeletal muscles • Constrict peripheral vessels • Relaxes GI smooth muscles

• Route of administration – IM, SC – Inhalation – Intra-cardiac – Not given p.o. – destroyed by GI enzymes

ADRENERGICS sympathomimetics drugs Catecholamine group Important drugs • Norepinephrine – Levophed – Potent vasoconstrictor – Indication : • Hypotension • Cardiac arrest

• Dopamine hydrochloride – Intropin

– Immediate precursor of norepinephrine – Effects: • Low dose – renal perfusion • Low to moderate dose – increased cardiac output • Higher dose – increased peripheral resistance and BP

ADRENERGICS sympathomimetics drugs catecholamine group • Dobutamine HCl – Dobutrex – Synthetic catecholamine – Acts directly on the heart muscle  increase force of contraction

• Isoproterenol HCl Isuprel – synthetic catecholamine – Bronchodilator – Stimulates both beta 1 and 2 receptors – Control shock and some dysrhytmias – Route of administration – parenteral and inhalation

ADRENERGICS sympathomimetics drugs Catecholamine group • Adverse Effect – Nervousness and restlessness – Angina – hypertension

ADRENERGICS sympathomimetics drugs Non-catecholamine group

• Ephedrine

– Less potent – Longer acting than epinephrine – Used as bronchodilator and nasal decongestant  in allergic reaction

• Pseudoephedrine – Neosynephrine

• 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

ADRENERGICS sympathomimetics drugs Non cathecholamine • Adverse effect – – – –

Palpitations Reflex tachycardia Hallucinations Cardiac dysrhythmias – life threathening

ADRENERGICS sympathomimetics drugs • Monitor: – – – –

Nursing Intervention

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

ADRENERGICS sympathomimetics drugs • • • • • •

Health Education Drugs pass into breast milk – avoid breast feeding Continuous used of spray can result in rebound nasal congestion Take as prescribe – avoid over dosage Avoid smoking or alcohol- precipitate adverse effect IFI – 2-3l/day Correct way of inhalant

Anti-Adrenergic Drugs Adrenergic Blockers Alpha-adrenergic blockers

– Blocks the effect of alpha recrptors – Blocks sympathomimetics agent – Vasodilation in smooth muscle – Lower peripheral vascular resistance

– Uses:

• Peripheral vascular disease – Raynauds disease and frost bites • Confused elderly • Mild to moderate hypertension • Migraine • CHF • Pheochromocytoma – tumor that release excessive amount of catecholamines

Anti-Adrenergic Drugs Adrenergic Blockers Common Drugs

• Phentolamine mesylate – Regitine – Prototype – Prevent tissue necrosis from infiltration of norepinephrine bitartrate (levophed) during IV therapy – Prevents and control hypertension caused by pheochromocytoma

• Ergotamine tartrate – • Ergostat – Vasoconstrictor – Used to treat migraine headache – Route of administration – SL, rectal suppository, inhalation

Anti-Adrenergic Drugs Adrenergic Blockers • Ergotamine tartrate with caffeine – cafergot – Common antimigrataine drug

• Prazosin (minipress) • Terazosin (hytrin)

– Blocks post-synaptic alpha 1 adrenergic receptor – Use for hypertension

Anti-Adrenergic Drugs Adrenergic Blockers Beta-adrenergic blockers •

•

•

Blocks adrenergic stimulation to beta 1 0r 2 receptors by competing with norepinephrine for 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 muscle arterioles

• Use: – Control angina pectoris – decrease O2 demand, myocardial contractility, heart rate – Lower BP – MI – decrease incidence of catecholamine-induced dysrhythmias following attack – Glaucoma – reduce IOP  decrease formation of aqueous humor – Migraine headache

Anti-Adrenergic Drugs Adrenergic Blockers Beta-adrenergic blockers Important drugs • Propranolol HCl – inderal

– Prototype for beta-adrenergic blocking agents

• Metoprolol tartrate – lopressor

– For treatment of hypertension and dysrhythmias

• Atenolol – tenormin

– For hypertension, angina & MI

• Trimolol maleate – timoptic – For treatment of glaucoma

Anti-Adrenergic Drugs Adrenergic 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

drugs affecting the parasympathetic nervous system

Cholinergic agents

parasympathomimetics 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 parasympathomimetics cholinomimetics EFFECTS • Cardiovascular – vasodilation & slows conduction of AV node – Decrease HR – Low BP

• GIT –increases tone and motility of smooth muscle of stomach and intestine – Increased peristalsis – Relaxation of sphincter muscle

• Genitourinary – contracts muscles of urinary bladder

– Increase tone of ureter – Relaxes bladder sphincter muscle – Stimulates urination

• Eye – increase pupillary constriction or miosis  pupil smaller – Increase accomodation

• Glands – increase salivation, perpiration and tears

Cholinergic agents parasympathomimetics cholinomimetics

• Lungs – Stimulates bronchial smooth muscles – Contraction and increases bronchial secretions

• Striated muscles – Increase neuromuscular transmission – Maintains muscle strength and tone

Cholinergic agents

parasympathomimetics cholinomimetics

2 types Direct Acting Indirect Acting • Direct Acting cholinomimetic drugs

– Directly stimulate cholinergic receptor – Mimic acetlycholine

– Specific Effects; • Decreased heart rate • Increased: – Tone of GIT muscle and relaxation of sphincters – Tone of bladder and relaxation of sphincters – Respiratory secretions

• Constriction of pupil

Direct Acting Cholinergic Agents Important drugs • Bethanicol Cl – urecholine

– Use for urinary retention and atony  contracts smooth muscle of bladder – For treatment of open angle glaucoma

• Pilorcapine HCl – pilocarpine

– Use to lower IOP in glaucoma by constricting the pupil

• Carbachol intraocular – miostat

– Use to treat simple glaucoma and open-angle glaucoma

• Metoclopramide HCL – Reglan – Use to prevent chemotherapy induced nausea & vomiting

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

Direct Acting Cholinergic Agent PRECAUTIONS • Aggravate symptoms in persons with: – – – –

DM MI Gangrene Heart block • Monitor HR and rhythm

• Increase GI contraction and secretions in clients with: – Intestinal obstruction • Monitor abdominal distention, constipation, diarrhea

– Ulcerative colitis – Peptic ulcer • Report aching, burning or epigastric pain • Take before or after eating meal

Direct Acting Cholinergic Agent • Cause bronchial constriction and increase bronchial secretions in: – Respiratory disorder – Asthma • Monitor RR and breath sounds

• when given adrenergic agents – increase risk of adverse effect – Have AtSO4 at hand – to counteract drug interaction

Indirect Acting Cholinergic Agent • Anti-cholinesterase • Inhibits action of acetlycholinesterase  enzyme that break down acetylcholine • Prolong the effect of acetlycholine

Indirect Acting Cholinergic Agent IMPORTANT DRUGS • Neostigmine bromideprostigmin

– Use to treat urinary retention and paralytic ileus – Drug of choice in treatment of myesthenia gravis  characterized by neuromuscular transmission accompanied by increase weakness and fatigue of skeletal muscle

• Edrophonium CL – tensilon

– Use to diagnose myasthenia gravis – Antidote for pancuronium – Pavulon – a neuromuscular blocker – Differentiate between Myesthenia crisis – resulting from underdosage Chloinergic crisis – resulting from overdosage

Indirect Acting Cholinergic Aent • Pyridostigmine bromide – mestinon – The maintenance drug of choice for myesthenia gravis

• AtSO4 – Use as antidote to counteract adverse effects of cholinergic agents

Indirect Acting Cholinergic Agent • • • • •

USES Myasthenia gravis – improves muscle strength Glaucoma – reduces IOP Post-op bladder distention – promotes bladder emptying Post-op paralytic ileus – increase intestinal muscle tone Counteract neuromuscular blockade – caused by muscle relaxant employed for anesthesia

• • • • • • •

ADVERSE EFFECTS

Hypotension Miosis Vasodilation Intestinal spasm N&V Increase salivation Diaphoresis

Indirect Acting Cholinergic Agent ADVERSE EFFECTS • Weakness and muscular paralysis • Paralysis of diaphragm • Bronchial secretions and spasm • Respiratory arrest

PRECAUTIONS • Aggravate symptoms of: – – – – – –

DM CAD Ulcerative colitis Hypothyroidism Gangrene Heart block

Indirect Acting Cholinergic Agent • Administered cautiously to client with respiratory disorder or asthma – increases bronchial secretions – Constrict smooth muscles of bronchioles • Monitor RR, increased bronchial secretions, diminished breath sounds

• not given with ganglionic blocking agent – Can cause severe hypotension • Assess VS for changes in HR and BP

Indirect Acting Cholinergic Agent NURSING INTERVENTIONS • Assess S&S of myesthenia gravis – Drooping of eyelids – Double vision – Difficulty of chewing and swalloeing

• Assess for signs of neurologic toxicity – – – –

Tremor Restlessness Confusion Convulsion • Ensure client safety

Indirect Acting Cholinergic Agent • Assess abdominal cramps, vomiting, diarrhea

HEALTH EDUCATION • Instruct client to: – Carry ID card at all times - detail medication regimen – Take medication exactly on time  to prevent myasthenia crisis or cholinergic crisis

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 IMPORTANT DRUGS • AtSO4

– Prototype – Use: • Treat bradycardia • Antidote for cholinergic drug • Antidote for insecticide poisoning

• Trihexphenidyl – Artane

– Use to treat Parkinson’s disease

• Oxybutynin Cl – Ditropan

– Use in neurogenic bladder

• Increase bladder capacity • Decrease frequency of voiding

ANTICHOLINERGIC AGENT • Scopolamine hydrobromide – hyoscine – For treatment of motion sickness – Management of N & V with use of general anesthesia – Produce preoperative amnesia

ADVERSE EFFECT • Dryness of the mouth – Use ice chips – Good oral hygiene – Chew gum or hard candy

• Constipation – Fluid intake – 8 cups/day

Drugs Affecting the CNS a. CNS Stimulant b. CNS Depressant

A. CNS stimulant • act to stimulate – Respiratory system – Heart – General metabolism

• Small doses – Increase alertness – Impart feeling of wellness

• Large doses – Produce insomnia, tremors, restlessness

• Toxic dose – Produce convulsion – Cardiac dysrhythmias – Possibly death

• Prolonged use – Results in exhaustion – Hypertension

CNS STIMULANT MAJOR GROUP • Amphetamines, Amphetamine Like Stimulates the cerebral cortex • Analeptics and caffeine Acts on brainstem and medulla Stimulate respiration • Anorexiants Acts on cerebral cortex and hypothalamus Suppress appetite

CNS STIMULANT A. Amphetamine & Amphetamine Like • Stimulate release of neurotransmitters Norepinephrine Dopamine • produce Euphoria and increased alertness

CNS STIMULANT AMPHETAMINES Common Drugs c. Amphetamine sulfate (adderal) d. Dextroamphetamine sulfate (dexedrine) e. mathamphetamine HCl (desoxyn)

CNS STIMULANT Amphetamine Like Drugs Common Drugs c. Methylphenidate HCl (ritalyn) d. Modafinil (provigil) e. Pemolyn (cylert)

CNS STIMULANT

• • •

AMPHETAMINES Indication Narcolepsy Alleviate attacks ADHD Decrease hyperactivity Endogenous obesity – obesity resulting from dysfunction of endocrine or metabolic system Suppress appetite

Amphetamine Like drugs Indication -consider more effective in treating ADHD and NARCOLEPSY except for adderal, but less Side Effects

Amphetamine & Amphetamine Like Drugs 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 2. ANALEPTICS • Beta adrenergic agonist • Stimulate respiration • Stimulate epinephrine the focus is to dilate bronchioles

CNS STIMULANT ANALEPTICS

Common Drugs • Methylxanthine  Caffeine  Theophylline  theobromine

CNS STIMULANT

• • •

ANALEPTICS Indication COPD- chronic obstructive pulmonary disease of the airway Bronchial Asthma Infant Abnormal Apnea

ANALEPTICS Side effects

• Tolerance, Dependence, Abuse • Nervousness, irritability, Headache, Dizziness,

Insomnia

• • • •

diuresis tinnitus Weight loss  prolonged used C.I. with symphatomimetic drugs and pregnant mother

CNS STIMULANT • ANOREXANTS • Stimulate the appetite control center in the hypothalamus for suppression • Increase epinephrine w/ increase euphoria, alertness and concentration

CNS STIMULANT Anorexants

Common Drugs • Benzphetamine HCL (didrex)

• Dextroamphetamine Sulfate (dexedrine) • Dethylpropion HCl ( dospan, tenuate)

CNS STIMULANT ANOREXANTS Indication

3. Overweight or obese person 5. Treat attention deficit

Anorexants Side effects • Tolerance, Dependence, Abuse • Nervousness, irritability, Headache, Dizziness,

Insomnia

• tinnitus

• Drug contain phenylpropanolamine cause hemorrhagic stroke, HPN, cardiac dysrhythmias

B. CNS Depressant • SEDATIVE- lessen the mental response but not affect the consciousness in small amount • HYPNOTICS- to have a restful natural sleep that allow the patient to awaken at usual time • SEDATIVE-HYPNOTICSdepressed the CNS - calmness, relaxation, reduction of anxiety, sleepiness - used also as anticonvulsant

• Large doses – Can suppress the respiratory center in medulla – Skin rash/urticaria

• Prolonged use – dependence – tolerance – Withdrawal syndrome once abruptly stop

CNS DEPRESSANT

sedative-hypnotic It produces all levels of CNS depression- depress the sensory cortex decrease-motor activity-by Gammaaminobutyric acid (GABA) - chief inhibitory neurotransmitter in the mammalian CNS. • - regulating neural excitability throughout the nervous system. Depress the activity of all excitable tissue • treat anxiety and sedate •

CNS DEPRESSANT MAJOR GROUP • Barbiturates Depress all levels of CNS and sensory cortex

Benzodiazepine Reduced Neuron excitability significantly less dangerous in overdose • Nonbenzodiazepine Reduced Neuron excitability

CNS DEPRESSANT sedative-hypnotic barbiturates

Classification • • • •

Long-acting Immediate-acting Short-acting Ultrashort acting

CNS DEPRESSANT sedative-hypnotic barbiturates 1. LONG-ACTING

Common drugs • Phenobarbital (luminal) • Mephobarbital (mebaral)

Indication • Seizure in epilepsy (anticonvulsant) • Insomnia

CNS DEPRESSANT sedative-hypnotic barbiturates 2. IMMEDIATE-ACTING Common drugs • Amobarbital(amytal) • Aprobarbital(alurate) • Butabarbital (butisol)

Indication - insomnia -preoperational meds - seizure in epilepsy (anticonvulsant)

CNS DEPRESSANT sedative-hypnotic barbiturates 3. Short-Acting Common drugs • Secobarbital (seconal) • Pentobarbital (nembutal)

Indication - difficulty sleep at night (insomnia) - more on elderly

CNS DEPRESSANT sedative-hypnotic barbiturates 3. Short-Acting Common drugs • Thiopental sodium (pentothal)

Indication • Used in operation as general aesthetic

CNS DEPRESSANT sedative-hypnotic barbiturates • Side Effects Drowsiness, lethargy, vertigo, depression Hypotension and respiratory depression Phlebitis Produce dependence, tolerance, and withdrawal symptoms if abruptly stop • Hangover • May overuse -addiction • • • •

CNS DEPRESSANT sedative-hypnotic

• Benzodiazepine -stimulate GABA -most widely used depressant -less dangerous to overdose and addiction

CNS DEPRESSANT sedative-hypnotic benzodiazepine Common Drugs • Diazepam (Valium)

INDICATION -Anxiety, convulsion

• Triazolam (halcion)

-hypnotic-insomnia

• Lorazepam (atevan)

-seizure in epilepsy

• Aprezolam (xanax)

-insomnia

CNS DEPRESSANT 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 DEPRESSANT sedative-hypnotic

• Nonbenzodiazepine

-comparatively new drugs whose actions are

somewhat similar to those of the benzodiazepines, but are structurally unrelated to the Benzodiazepines.

CNS DEPRESSANT sedative-hypnotic Nonbenzodiazepine Common Drugs imidazopyridines • Zolpidem (Ambien) pyrazolopyrimidines • zaleplon (Sonata)

Indication

-treatment of insomnia -muscle relaxant -anticonvulsant

CNS DEPRESSANT sedative-hypnotic Nonbenzodiazepine

• Side Effect • Drowsiness, lethargy, hangover, dizziness, respiratory distress, confusion and disorientation • Tolerance and dependence-rare

CNS Depressant ANESTHESIA • traditionally meant the condition of having sensation blocked • Use in surgery • Is a reversible lack of awareness - total lack of awareness - lack of awareness of a part of the body

Assessment before giving Anesthesia 1. The age especially the young and elderly 2. A current health disorder (renal, liver disease 3. pregnancy 4. History of heavy smoking, used of alcohol and drugs

ANESTHESIA •

Balance Anesthesia

3. The hypnotic drug-night before 4. Narcotic analgesic/Benzodiazepine and anticholinergic- 1 hr before 5. Short-acting barbiturates 6. Inhaled gas such as nitrous oxide and oxygen 7. Muscle relaxant (as needed)

ANESTHESIA • Stages of Anesthesia Stage 1 ANALGESIA- consciousness---loss of consciousness Stage 2 EXCITEMENT/DELIRIUM- produce loss of consciousness by depression of cerebral cortex

ANESTHESIA • Stages of Anesthesia Stage 3 SURGICAL- anesthesia deepen--- procedure was performed– stage maintain Stage 4 MEDULLARY PARALYSIS- toxic stage

ANESTHESIA 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 patients are not arousable, even by painful stimulation

ANESTHESIA • Local Anesthesia -You get a shot of local anesthetic directly into the surgical area to block pain

-prevent transmission of nerve impulses without causing. They act by binding to fast sodium channels from within -patient might awake or may take anxiolytic or hypnotic drug

ANESTHESIA Local Anesthesia Common Drugs • Cocaine hydrochloride • Procaine HCL (Novocain) • Lidocaine HCL (Xylocaine)

• Indication • Use in minor and diagnostic procedure • Use in episiotomy • Use also in dental procedures

ANESTHESIA • Regional Anesthesia • •

Administered with local anesthesia to peripheral nerve bundles Loss of pain sensation, with varying degrees of muscle relaxation, in certain regions of the body.

•

Types: Spinal anesthesia: subarachnoid block.

•

Epidural anesthesia:

ANESTHESIA Regional anesthesia A. Spinal Anesthesia (Subarachnoid block) - small volume of local anesthetics being injected into CSF the arachnoid mater, injected between the 4th and 5th lumbar vertebrae - loss of pain sensation and muscle strength, usually up to the level of the chest to toe

ANESTHESIA Spinal Anesthesia

•

Common Drugs

Indication

Bupivacaine (Marcaine)

-major surgical operation/ Special procedure to diminish sensation, loss of pain and muscle relaxant

2. Lignocaine (Lidocaine)

ANESTHESIA Regional anesthesia 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 or near the spinal cord.

ANESTHESIA Epidural Anesthesia Common Drugs - combination of local anesthetics and opioids Ex. - Bupivacaine + morphine - Choloprocaine + Pethidine

Indication -major surgical operation/ Special procedure to diminish sensation, loss of pain

ANESTHESIA • General Anesthesia • Drug-induced depression of consciousness/

CNS

• Drug-induced loss of consciousness - not arousable - even by painful stimulation • administer intravenously or inhalation agents

ANESTHESIA General Anesthesia Common Drugs •

Halothane

•

Nitrous Oxide

•

Sevoflurane

Indication -major surgical Operation attain complete depression of consciousness to diminish sensation, loss of pain and muscle relaxant

ANAESTHESIA •

Adverse Effect

- including agitation, confusion, dizziness, blurred vision, 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 tissue damage injured cells  produce chemical mediators (prostaglandins)  nocireceptor (all types of tissue)  transmit pain sensation  brain

CNS Depressant ANALGESIC

“pain killer- drugs used to relieve pain” • Nonnarcotic Analgesic  Acetaminophen/ NSAID  COX-2 Inhibitor • Narcotic Analgesic  Opiates/ Morphinomimetics

ANALGESIC

• 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

ANALGESIC Nonnarcotic Analgesic

Nonsteroidal Anti-inflammatory Drugs - Relieve pain (Analgesic), fever (antipyretic) and anti-inflammatory - inhibit cyclooxygenase(COX1 & COX2), leading to a decrease in prostaglandin production; this reduces pain and also inflammation - COX1- protects stomach lining & regulate blood platelets - COX2- trigger pain and inflammation at site

ANALGESIC Nonnarcotic Analgesic NSAID Common Medication  COX1 & COX2 inhibitor • Aspirin(Bayer,Ecotin, Astrin) -known NSAID not used as antipyretic  effect Reye Syndrome - Decrease platelet aggregation •

• Indication -headache, muscle pain -pain from arthritis -mild anticoagulants for TIA, heart attack thromboembolism

ANALGESIC Nonnarcotic Analgesic NSAID

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• Side Effect (Aspirin) Gastric discomfort, tinnitus, vertigo, deafness increase bleeding Allergic Reaction

• Contraindicated - Pregnant - Patient <12 years old - Patient with bleeding - Patient taking acetaminophen - Alcoholic patient - Patient w/ hypersensitivity

ANALGESIC Nonnarcotic Analgesic NSAID

2. Mefenamic Acid (Istan, Revalan, Dolfenal) -new generation of NSAID - less cause G.I. irritant

• Indication - Relieved pain from incision of operation - -headache, muscle pain - toothache

ANALGESIC Nonnarcotic Analgesic NSAID

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• Side Effect (Mefenamic Acid) Gastric discomfort, tinnitus, vertigo, Deafness Alergic reaction

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• Contraindicated G.I. problem, bleeding (gastroenteritis) Pregnant Patient<12 years old Patient w/ renal/hepatic disease Patient taking acetaminophen Hypersensitive patient

ANALGESIC Nonnarcotic Analgesic NSAID

1. Ibuprofen (Advil, • Indication Motrin, Midol, - headache, muscle Excedrin) pain -new generation of - Rheumatoid NSAID Arthritis, - less cause G.I. osteoarthritis irritant - toothache

ANALGESIC Nonnarcotic Analgesic NSAID • Side Effect (Ibuprofen) -

Gastric discomfort, dyspepsia Nausea & vomitting tinnitus Allergic reaction G.I. bleeding- A.E

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• Contraindicated G.I. problem, bleeding (gastroenteritis) Pregnant Patient w/ renal/ hepatic disease Patient<12 years old Patient taking aspirin Hypersensitive patient

ANALGESIC Nonnarcotic Analgesic NSAID • Common Medication • Indication  COX2 inhibitor - Pain from 3. Celecoxib (celebrex) osteoarthritis, 5. Meloxicam (Mobic) 7. Nabumetone (Rafalen)

rheumatoid arthritis - Patient with surgical incision

ANALGESIC Nonnarcotic Analgesic NSAID

• Side Effect (COX2 inhibitor) - tinnitus, vertigo - Allergic reaction

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• Contraindicated Pregnant Patient <12 years old Patient with allergy Patient taking acetaminophen Hypersensitive patient

ANALGESIC Nonnarcotic Analgesic • ACETAMINOPHEN

- non narcotic, not NSAID - weakly inhibits prostaglandin synthesis - Inhibition of hypothalamic heat regulator center - from para aminophenol derivatives - relieve pain, discomfort, and fever but not anti-inflammatory effect

ANALGESIC Nonnarcotic Analgesic • Common Drugs • Acetaminophen -(Tylenol, Panadol, Tempra, robigesic, Atasol)

• Indication - Moderate pain and headache - Fever especially in children - Muscular ache/pain - Fever cause by viral infection

ANALGESIC Nonnarcotic Analgesic • Nursing Responsibility • Side Effect - Instruct the patient - anorexia, n & v, rash about the effect - Don’t overdose and • Adverse Effect over used - Severe - Take the dose as hypoglycemia, prescribe oliguria, urticaria - Have rest - Hepatotoxicity - Keep out of children

ANALGESIC • Narcotic Analgesic

- Used to treat moderate to severe pain - Acts on central nervous system does produce also little depression by binding directly to opioid receptor in CNS and GI tract - Suppress pain, respiration and coughing(antitussive) - addictive / abusive

ANALGESIC Narcotic Analgesic • Common Drugs 2. Morphine Sulfate (Duramorph, MS Cotin, Epimorph) -most potent narcotic analgesic - suppress pain, respiration and cough

• Indication - Acute pain from acute myocardial infarction -pain from cancer and dyspnea - preoperative meds

ANALGESIC Narcotic Analgesic 2. Meperidine (Demerol) - first synthetic narcotics - same action w/ Morphine, potency varies on dosage given 3. Hydromorphone (Dilaudid) - Analgesic effect more potent than morphine - Less resp. depression

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• Indication Preoperative medication Sedation More preferred to pregnant mother than morphine Not given with Advance cancer  large dose  neurotoxicity (nervousness, tremors, irritability)

ANALGESIC Narcotic Analgesic

• Side Effect

- Anorexia, N & V, dizziness, drowsiness, urinary retention, constipation, euphoria • Adverse Effect -resp. depression, hypotension, increase ICP, seizure, withdrawal syndrome

• Contraindicated -asthma w resp depression - inc. ICP , shock, head injury - Renal and hepatic disease/dysfunction - M.I. - Advance cancer  large dose  neurotoxicity

ANALGESIC Narcotic Analgesic • 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

ANALGESIC Narcotic Agonist-Antagonist

• Common Drugs

• Mechanism of Action • Pentazocine (Talwin) • - Inhibit the pain impulse transmitted • Buprenorphine in the CNS by binding (Buprenex) by the opiate • Nalbuphine HCl receptor and (Nubain) increase pain - narcotic antagonist threshold is added with a • Indication narcotic agonist to - Post operation meds decrease abuse for pain - Sedation, labor mom

Narcotic Agonist Antagonist • Side Effects - dizziness, confusion, sedation, dry mouth, nausea, flushing • Adverse Effect - tachycardia, hypotension and respiratory depression

• Nursing Responsibility - Monitor vital sign - let the patient void or do things before giving - Don’t give anything by mouth

Narcotic Antagonist • Common Drugs • •

•

• Indication

Nalmefene (Revex) - Antidote for overdose of narcotics Naloxone HCl -have higher affinity (Narcan) to opiate receptor does displace narcotic Naltrexone HCL Agent (Trexan) - Reverse CNS and respiratory depression

CNS Depressant Anticonvulsant • Drug use to treat epileptic seizure ‘antiepileptic’ • suppress the abnormal, rapid and excessive firing 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 Depressant Anticonvulsant

• Common Drugs 2. Hydantoins (phenytoin (Dilantin), mephenitoin ethotoin) - Most common drugs to control seizure (grand mal seizure) - Not used for all types of seizure

• Side Effect - Gingival hyperplasia or overgrowth of gum tissue  bleed - Neurologic or psychiatric effects  slurred speech, confusion, depression, thrombocytopenia, Leukopenia, n & v, constipation, drowsiness

CNS Depressant Anticonvulsant

2. Barbiturates

• Nursing Responsilities Amobarbital (Amytal) - Take the medication as prescribe Mephobarbital Primodone (Mysoline) - Monitor serum drug level 3. Benzodiazepine - Patient receive Clonazepam (Klonopin) adequate nutrients Clorazepate (tranxene Decrease the Diazepam (Valium) environmental stimulation Lorazepam (Ativan) for active seizure