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Neuro and Analgesics

Week 4

What are the 3 parts of neuro regulation? 1. Conducting an action potential 2. Releasing neurotransmitter 3. Binding transmitter molecules to receptors
How do neuro drugs produce their effects? By altering junctional transmission
What are the steps in junctional transmission? 1. Synthesis 2. Storage 3. Release 4. Receptor binding 5. Termination
In junctional transmission, what triggers release of neurotransmitter? Action potential at axon terminal
Is receptor binding after release reversible? Yes
What is termination in regards to junctional transmission? Removal of transmitter
What do cholinergics do? They stimulate actions of acetylcholine and consequently stimulate parasympathetic
What does the parasympathetic n.s. do? (rest and digest) -Slowing of heart rate, Increased gastric secretions,Emptying of bladder, Focusing the eye for near vision, Constricting the pupil, Contracting bronchial smooth muscle
What are some examples of cholinergic drugs? Anticholinergics, muscarinics, ganglionics, neuromuscular blocking, cholinesterase inhibitors
What do cholinergic blockers do? They block neuromuscular transmissions, inhibit cholinesterase, allow SNS
Cholinergic means it uses ____ Acetylcholine
What do cholinesterase inhibitors do? They indirectly influence cholinergic receptors by preventing the breakdown of acetylcholine
What are adrenergic agonists? They are drugs that mimic the sympathetic system.
What does sympathomimetic mean? Mimic the sympathetic system (adrenergic agonists)
What is an example of an adrenergic agonist? Epinephrine
What are adrenergic antagonists? Drugs that block neurotransmitters of the SNS and block SNS effects
What is the pathology of Parkinson’s Disease? Depletion of dopamine, an inhibitory transmitter
What are some examples of drugs used to treat Parkinson’s Disease? levodopa, carbidopa-levodopa
How do epilepsy drugs work? They reduce the rate of discharge of neurons and prevent spread of seizures to the rest of the brain
What are some examples of drugs used to treat seizures? phenytoin, phenobarbital, tegretol, diazepam (valium)
What are categories of drugs used to treat muscle spasms/spasticity? 1. Analgesics 2. Centrally acting skeletal muscle relaxants (diazepam)
What are 3 examples of psycho-pharmacologic drugs? Antipsychotics, antidepressants, lithium
What are the categories of CNS depressants? Sedatives, hypnotics, sedative-hypnotics
What do sedatives do? Reduce nervousness, excitability, and irritability without causing sleep
What do hypnotics do? They are more potent than sedatives, cause sleep
What are some examples of sedative-hypnotics? barbiturate, benzodiazapines,
What are barbiturates indicated for? Treatment of insomnia and producing sedation
What is the MOA of barbiturates? CNS depressant, acts on reticular formation in brainstem. Effects dose-related. Inhibit nerve impulse transmission traveling to areas of brain. Low doses:sedatives, higher:hypnotics (lowers RR). Enzymes in liver metabolize drugs quickly, shortens actions
Low doses of barbiturates act as ____, high doses act as ____. Low doses act as sedatives, higher doses act as hypnotics (decreases respiratory rate)
What do hypnotics do? They lower resp. rate
What actions do barbiturates have in the liver? They cause enzymes in the liver to metabolize drugs more quickly, shortening the drugs’ actions
What are the indications for barbiturates? Used as hypnotics, sedatives, anticonvulsants, anesthetics
What are ultrashort barbiturates? Anesthetics
What are short barbiturates? Sedative-hypnotics
What are intermediate barbiturates? Anticonvulsants and sedative-hypnotics
What are long barbiturates? Anticonvulsants and sedative-hypnotics
What are some side effects of barbiturates? Drowsiness, lethargy, dizziness, hangover, restless or excitement, affects normal sleep by depriving deep REM
How do barbiturates affect sleep? Affects normal sleep by depriving deep REM
What are some adverse effects of barbiturates? Respiratory depression, CNS depression
What is the prototype of a long acting barbiturate? Phenobarbital
What is the prototype of a short acting barbiturate? Pentobarbital (Nembutal)
What is the most commonly prescribed sedative-hypnotic and why? Benzodiazepines, because of their favorable side effects and safety
What is the MOA of benzodiazepines? CNS depressants. Act on hypothalamus, thalamus and limbic system. Has calming affect, controls agitation and anxiety
What are some side effects of benzodiazepines? Headache, drowsiness, excitement or nervousness, dizziness, lethargy
What are adverse effects of benzodiazepines? Can lead to falls in the elderly due to change in sleep cycle
What are signs of benzodiazepine toxicity? Confusion, coma
What is the treatment for benzodiazepine toxicity? Symptomatic and supportive
What are some interactions of benzodiazepines? Other CNS depressants
What are prototypes of benzodiazapines? Flurazepam (Dalmane). Temazepam (Restoril)
What are muscle relaxants used for? Needed for trauma, inflammation, anxiety, pain
What is the MOA of muscle relaxants? Work with CNS. Actions come from sedative affects, rather than direct muscle relaxation. Act on nerve transmission in spinal cord
What are muscle relaxants indicated for? Relief of muscle-skeletal conditions such as muscle spasms, chorea movements, spasticity
What are chorea movements? Any of various disorders of the nervous system marked by involuntary, jerky movements, especially of the arms, legs, and face, and by incoordination
What are side effects/adverse effects of muscle relaxants? CNS and skeletal muscle effects. Dizziness, drowsiness, euphoria, muscle weakness. Often short in duration
What are some interactions of muscle relaxants? Caution with other CNS depressants (alcohol, benzodiazapines)
How is muscle relaxant toxicity treated? There is no specific treatment. Supportive therapy is used
What are some prototypes of muscle relaxants? Flexeril; baclofen (Lioresal)
What are CNS stimulants? Drugs that stimulate a specific area of the brain or spinal cord. Often triggers SNS actions
What is the MOA of CNS stimulants? Increase energy, alertness, mood elevation
What are some examples of CNS stimulants? Cocaine, amphetamines, caffeine, Ritalin, anorexiants (Phentermine aka lonamin)
What are CNS stimulants indicated for? Depression,suppression of appetite, narcolepsy, ADHD
What are side/adverse effects of CNS stimulants? Increased heart rate, hypertension, restlessness, nervousness, nausea/vomiting
What are some contraindications of CNS stimulants? Herbal therapies. Ephedra problems, ginseng
Pain threshold?
Pain tolerance?
Types of pain?
Causes of pain? mechanical, thermal, chemical
What are the classes of controlled substances? Class 1-5, C-1 with the highest abuse potential, C-5 the lowest
What are some contraindications of aspirin? Children, pregnant women. peptic ulcer or bleeding disorders
What is aspirin indicated for? Treatment of headache, neuralgia, rheumatoid arthritis (inflammation, pain, fever, prevention of MI and stroke)
What are some SE/AE of aspirin? Nausea/vomiting, diarrhea, GI (stomach bleeding, gastric ulceration, renal impairment, bleeding)
What are some nursing implications for aspirin use? Give with fluids. Throw away if smelly
What is Tylenol indicated for? (Acetaminophen) Pain and fever (NOT inflammation). Analgesia and antipyretic. Used as OTC for those who cannot use aspirin
What are some signs of adverse reaction to Tylenol? Hepatotoxicity (liver damage) rash
When is tylenol contraindicated? Not for use w/ liver/renal disease. Chronic use has serious consequences
What delays NSAID absorption? Food
What is the duration of NSAIDs? Up to 85 hours
What are some examples of NSAIDs? Lodine (for osteoarthritis), Ibuprofen (advil, Motrin, Nuprin)
What is the only NSAID that is OTC? Ibuprofen
When is indocin used? When aspirin or Tylenol don’t work
What is a first-generation NSAID? Aspirin
What is a non-aspirin first generation NSAID? Ibuprofen, naproxen, keterolac
What is the only injectable NSAID? Toradol
What is naproxen (Naprosyn) used for? Treatment of osteoarthritis
Are there side effects of naproxen (Naprosyn)? Seldom enough to quit use
Nursing care for Naprosyn/naproxen? Monitor effectiveness
What is the difference between opioids and non-opioids? An opioid is any drug, natural or synthetic that has actions similar to those of morphine.
What are narcotic agonists/ opiates? Any analgesic from opium poppy, applies only to compounds present in opium
What are some examples of opioids? Morphine sulfate, fentanyl, demerol (Meperidine), codeine
Where are opioids absorbed? Absorbed well in GI
What is the MOA for opioids? Act at opiate receptors. Depress respiration, cause sedation. Can cause nausea and vomiting in GI
What are opioids used to treat? Treatment of severe pain, pre-anesthetic
What does narcotic mean? General term describe morphine-like drugs (wrong: narcotic has many definitions, used to mean analgesic, CNS depressant, any drug capable of causing physical dependence. Opioid is preferable to narcotic as label for discrete family of pharmacologic agent)
What is MS Contin? Sustained release tab of morphine sulfate
What is Demerol (meperidine) used for? Synthetic, used for post-op pain. Strong analgesic, short half-life, many adverse interactions
What can codeine be used for? Analgesia, antitussive (suppression of cough reflex by action on CNS and PNS)
What are some side effects of morphine? Respiratory depression, constipation, urinary retention, orthostatic hypotension, emesis, miosis, cough suppression, biliary colic
What is oxycodone (Oxycontin)? Related to morphine, with comparable analgesic properties
Is Oxycontin/oxycodone available injectable? No
Oxycodone is usually combined with ___ or ___ Aspirin or Tylenol
What is hydrocodone? Weaker form of oxycodone, available only in tablet
What are mixed narcotics? Using and opioid with a non-narcotic analgesic. Using the 2 classes causes synergistic reduction of pain, while avoiding dependance on opioid. Usually less likely to cause resp depression and few antitussive effects
What is Percocet? Codeine with Tylenol
What is Percodan? Codeine with aspirin
What is Darvon/Darvon N? Weaker in action, analgesic. Sedative??
What is Vicodin? Tylenol and opioid
What is Stadol? Analgesic used in MCH?, pre-op, reactions less common, usually GI if any
Nursing care for Stadol? Watch for overdose, change in alertness, CNS, hallucination
What can cause opioid overdose? Aggressive therapy, psychoactive effects. Overdose is medical emergency due to respiratory depression, cardiac arrest.
What is used to treat opioid overdose? Narcan
What is Narcan’s MOA for treating opioid overdose? Narcan is used IV for immediate action. Blocks both mu and kappa receptors to reverse opioid. Works in minutes. Used when resp rate is below 10/min
What are the side effects of Narcan? Increased BP, tremors, hyperventilation, nausea/vomiting
Created by: kangaloo



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