- 1. Medications Affecting the Nervous System Adrenergic blocking
Drugs Anticonvulsants Antianxiety Antiparkinson Antipyschotic
Antidepressants Narcotic analgesics Non narcotic analgesics
Narcotic antagonists 06/03/09 Created by Amanda McBride
2. 06/03/09 Created by Amanda McBride 3. 06/03/09 Created by
Amanda McBride 4. 06/03/09 Created by Amanda McBride 5. 06/03/09
Created by Amanda McBride 6. Adrenergic effects 06/03/09 Created by
Amanda McBride Type Location Neurotrans mitter Effects
ofstimulation Alpha1 Blood vessels Kidney Intestinal smooth muscle
Liver Eye Norepinephrine EpinephrineVasoconstriction Decreased
renin secreation Relaxation glycogenolysis BlinkingAlpha2Nerve
endings Vascular smooth muscle Pancreatic beta cells platelets
NorepinephrineEpinephrineInhibit release of norepinephrine
Vasoconstriction Inhibit insulin secreation
AggregationBeta1HeartEpinephrineIncreased HR, force of contraction,
automaticity, rate of AV conduction Beta2Bronchioles Blood vessels
GI tract Liver Urinary bladder EpinephrineBronchodilation
Vasodilation Decreased motility Glycogenolysis Relaxed muscle 7.
Adrenergic Drugs
06/03/09 Created by Amanda McBride 8. Adrenergic blocking
Drugs
- Alpha adrenergic blocking
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- Drugs that block alpha adrenergic receptors
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- Drugs that block beta adrenergic receptors
- Alpha/beta adrenergic blocking
-
- Drugs that prevent the release of neurotransmitter
norepinephrine
06/03/09 Created by Amanda McBride 9. Action
- Stimulation of alpha adrenergic nerves results in
vasoconstriction
- If stimulation is interrupted or blocked the result is
vasodilation
06/03/09 Created by Amanda McBride 10. Use of Alpha adrenergic
blocking drugs
- Hypertension caused by pheochromocytoma
06/03/09 Created by Amanda McBride 11. Adverse effects
06/03/09 Created by Amanda McBride 12. Contraindications,
precautions, interactions
- Used cautiously in pregnancy, recent MI
06/03/09 Created by Amanda McBride 13. Beta adrenergic Blocking
drugs
- Decrease the stimulation of sympathetic nervous system on
certain tissues
- Decrease cardiac excitability
- Decrease cardiac workload and oxygen consumption
- Provides membrane stabilizing effects that contribute to the
antiarrhythmic activity
06/03/09 Created by Amanda McBride 14. Uses
- Used to prevent reinfarction in pts with recent MI
06/03/09 Created by Amanda McBride 15. Adverse Reactions
- Dizziness, vertigo, headache
- Bronchospasm with hx asthma
06/03/09 Created by Amanda McBride 16. Contraindications,
precautions, interactions
06/03/09 Created by Amanda McBride 17. Alpha/Beta adrenergic
blocking drugs
- Block the stimulation of both receptors, resulting in
peripheral vasodilation
06/03/09 Created by Amanda McBride 18. Use
- CHF, prevents progression of disease
06/03/09 Created by Amanda McBride 19. Adverse Reactions
06/03/09 Created by Amanda McBride 20. Contraindications,
precautions, interactions
- Decompensated heart failure
- Used cautiously in drug controlled CHF, chronic bronchitis,
impaired hepatic or cardiac function
06/03/09 Created by Amanda McBride 21. Beta blocker drugs
06/03/09 Created by Amanda McBride Non-selective beta blockers
Cardio-selective beta blockers
- At high doses this effect is lost.
22. Nursing Process
-
- When given for cardiac arrhythmias, these drugs can provoke new
or worsen existing ventricular arrhythmias
06/03/09 Created by Amanda McBride 23. Cholinergic effects
06/03/09 Created by Amanda McBride Organ Effects HeartDecreased
rate Blood vessels vasodilation GI smooth muscle Increased tone and
contractility Bronchial smooth muscle Increased tone and
contractility Increased resp secreations PupilsConstriction 24.
Uses
06/03/09 Created by Amanda McBride 25. Anti-cholinergic
drugs
- Block the action of acetylcholine on the PNS.
06/03/09 Created by Amanda McBride 26. 06/03/09 Created by
Amanda McBride System EffectCNS Stimulation followed by depression
CVS Increase in heart rate Respiratory BronchodilationDecrease resp
secretions GI Antispasmodic effects d/t decreased muscle tone and
motility Miscellaneous effects Decreased salivary secretions and
sweat glands, relaxation of urinary bladder 27. Uses
- Resp disorders-bronchoconstriction. Atrovent
- Cardiac disorders- HB, brady
06/03/09 Created by Amanda McBride 28. Atropine
- Used in symptomatic bradycardia
06/03/09 Created by Amanda McBride 29. Atrovent
- Less thickening of resp secretions
06/03/09 Created by Amanda McBride 30. Scopolamine
- Depresses CNS and causes amnesia, drowsiness, euphoria,
relaxation and sleep
06/03/09 Created by Amanda McBride 31. Spiriva
- Long acting bronchodilator
- Daily maintenance tx of bronchospasm assoc with COPD
06/03/09 Created by Amanda McBride 32. Extrapyramidal reactions
06/03/09 Created by Amanda McBride 33. 06/03/09 Created by Amanda
McBride 34. Education
- Do not stop taking abruptly
- May cause dizziness or drowsiness
- Dont use OTC cold, flu or decongestants without MD advice
06/03/09 Created by Amanda McBride 35. Antianxiety Drugs and
Sedative-Hypnotic Drugs Benzodiazepines Ativan Valium
Nonbenzodiazepines Buspar Sinequan atarax 06/03/09 Created by
Amanda McBride 36. 06/03/09 Created by Amanda McBride 37. 06/03/09
Created by Amanda McBride 38. Actions
- Block certain neurotransmitter receptor sites,
norepinephrine.
- High lipid solubility enters CNS easily.
- Prevents the neurotransmission of the anxious perception and
the bodys physcial reaction to the anxiety
- Benzodiazepines exert their tranquillizing effect by
potentiating the effects of GABA
- Nonbenzodiazepines exert their action in various ways.
06/03/09 Created by Amanda McBride 39. Uses
06/03/09 Created by Amanda McBride 40. Adverse Effects
- Lightheadedness, dizziness
06/03/09 Created by Amanda McBride 41. Non benzodiazepines
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- Tolerance after 2 weeks of use.
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- Prozac, Paxil, Effexor, Zoloft.
06/03/09 Created by Amanda McBride 42. Dependence
- Long term use may result in physical drug dependence and
tolerance
- With as little as 4-6 weeks of therapy with benzos
06/03/09 Created by Amanda McBride 43. Symptoms of
withdrawal
- Involuntary leg movements
06/03/09 Created by Amanda McBride 44. Prevention of
withdrawal
- Mild symptoms occur after 6-12 weeks of therapeutic doses.
- Sever symptoms occur after 4 months of high doses.
- Dose should be tapered, reduce 10-25% every 1-2 weeks over 4-16
weeks.
06/03/09 Created by Amanda McBride 45. Antidote
- Anexate competes with benzo receptors.
- Onset within 2 mins peaks within 6-10 mins.
06/03/09 Created by Amanda McBride 46. Contraindications
06/03/09 Created by Amanda McBride 47. Precautions,
Interactions
- Used cautiously in elderly pts
- Impaired liver and kidney function
06/03/09 Created by Amanda McBride 48. Nursing Process
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- Observe pt closely for new tx
-
- Report signs of tolerance
-
- Therapeutic effect is achieved
06/03/09 Created by Amanda McBride 49. Education
- Dont discontinue abruptly
- Try to find healthier coping mechanisms.
06/03/09 Created by Amanda McBride 50. Opioids
- Rx for pain relief, post-op, cough, acute pulm edema, and
diarrhea
- Attach to opioid receptors in the brain, spinal cord and GI
tract
- Cause euphoria by affecting the brain regions that mediate what
we perceive as pleasure
06/03/09 Created by Amanda McBrideCreated by Amanda McBride 51.
Opioid Analgesics
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- Treatment of mod to severe pain
06/03/09 Created by Amanda McBride 52. How they work
- Increase norepinephrine and dopamine
- Increases BP, HR, constricts blood vessels, increases blood
glucose and opens resp pathways
- Increase Dopamine is associated with a sense of euphoria
06/03/09 Created by Amanda McBrideCreated by Amanda McBride
Created by Amanda McBride 53. The WHO Pain Ladder 06/03/09 Created
by Amanda McBride 06/03/09 Created by Amanda McBride 54. Pain
06/03/09 Created by Amanda McBride 55. Morphine
- Accumulates in pts with liver or kidney dysfunction.
- Other routes of admin, epidural, intrathecal, inhalation,
rectal.
06/03/09 Created by Amanda McBride 56. Fentanyl
- High risk of resp depression, given in monitored areas.
06/03/09 Created by Amanda McBride 57. Codeine
06/03/09 Created by Amanda McBride 58. Hydrocodone
06/03/09 Created by Amanda McBride 59. Hydromorphone
06/03/09 Created by Amanda McBride 60. Meperidine
- Preferred in pts with renal or biliary colic.
- Less resp distress in newborns.
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- Accumulates with chronic use, renal failure, Dilantin,
rifamipin.
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- Produces CNS stimulation, hallucinations, seizures, agitation,
tremors.
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- Can precipitate serotonin syndrome in people who take MAOI, or
amphetamines.
06/03/09 Created by Amanda McBride 61. 06/03/09 Created by
Amanda McBride 62. Methadone
06/03/09 Created by Amanda McBride 63. Oxycodone
- Crushing and snorting or injecting has led to deaths.
06/03/09 Created by Amanda McBride 64. Drug selection
- Morphine, hydromorphone and methadone, non ceiling drugs.
- Least potent drug, in smallest dosage for least amount of
time.
06/03/09 Created by Amanda McBride 65. Drug dose
- Choose according to pain type, severity, quality, pts size,
age, health status.
- Choose smallest dose 1 st.
- IV for acute or breakthrough.
06/03/09 Created by Amanda McBride 66. Patient Controlled
Analgesic 06/03/09 Created by Amanda McBride 67. Epidural analgesia
06/03/09 Created by Amanda McBride 68. Uses
- Decrease anxiety and sedate before surgery
- Relieve anxiety in pts with dyspnea
06/03/09 Created by Amanda McBride 69. Adverse effects
- Weakness, lightheadedness
06/03/09 Created by Amanda McBride 70. Contraindication,
precautions, interactions
- Severe renal hepatic impairment
- Use cautiously in elderly
06/03/09 Created by Amanda McBride 71. Nursing Process
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- Assessment including pain
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- Long acting and breakthru
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- Constipation prevention and tx
06/03/09 Created by Amanda McBride 72. PQRST Method for Pain
Assessment
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- Crushing? ( Try to let patient describe the pain, sometimes
they say what they think you would like to hear. )
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- Where does the pain radiate?
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- Does it go anywhere else?
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- Did it start elsewhere and now localised to one spot?
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- How severe is the pain on a scale of 1 - 10?
- ( This is a difficult one as the rating will differ from
patient to patient. )
06/03/09 Created by Amanda McBride 73. Education
06/03/09 Created by Amanda McBride 74. Opioid toxicity
06/03/09 Created by Amanda McBride 75. Treatment specific
Disorders
- Biliary, renal or uretral colic
06/03/09 Created by Amanda McBride 76. Special populations
06/03/09 Created by Amanda McBride 77. Opiate Antagonist
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- Counteracts effect of narcotic
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- Competes for opiate receptors
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- Short half life, repeated dosing usually needed.
06/03/09 Created by Amanda McBride 78. Use
- Postop acute resp depression
06/03/09 Created by Amanda McBride 79. Adverse Effects
06/03/09 Created by Amanda McBride 80. Contraindications,
precautions, interactions
- Used cautiously in pregnancy
- May produce withdrawal in pts who are addicted
06/03/09 Created by Amanda McBride 81. Nursing Process
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- Attempt to stimulate postop pt
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- Balance need for pain control and resps
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- Keep suction close by for vomiting
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- If pain recurs must treat pain again
06/03/09 Created by Amanda McBride 82. Antidepressant Tricyclic
Antidepressants SSRI Misc 06/03/09 Created by Amanda McBride 83.
Depressive disorders
- Depressive disorders are mental illnesses characterized by
deep, long-lasting feelings of sadness or despair. The patient may
also lose interest in things that were once pleasurable. Changes in
sleep patterns, appetite, and mental processes may also accompany
depressive disorders. Depressive disorders are also known simply as
depression or as unipolar (one-sided) depression
06/03/09 Created by Amanda McBride 84. Tricyclic
Antidepressants
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- Increasing and decreasing sensitivity to neurotransmitters
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- Obsessive compulsive disorders
06/03/09 Created by Amanda McBride 85. Adverse Reactions
06/03/09 Created by Amanda McBride 86. Contraindications,
Precautions, Interactions
- Used cautiously in cardiac disease, hepatic, renal impairment,
glaucoma, urinary retention, risk of suicidal behaviour
06/03/09 Created by Amanda McBride 87. Selective Serotonin
Reuptake Inhibitors 06/03/09 Created by Amanda McBride 88.
Actions
- Increase in serotonin levels is thought to act as a stimulant
to reverse depression
06/03/09 Created by Amanda McBride 89. Uses
- Obsessive compulsive disorders
- Post traumatic stress disorder
06/03/09 Created by Amanda McBride 90. Adverse Reactions
- Constipation, dry mouth, nausea
06/03/09 Created by Amanda McBride 91. Contraindications,
Precautions, Interactions
- use cautiously in diabetes, cardiac disease, liver renal
impairment, suicidal ideation
06/03/09 Created by Amanda McBride 92. Nursing Process
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- Report any suicidal ideation
06/03/09 Created by Amanda McBride 93. Education
- If dizziness occurs, rise slowly
- Report any unusual effects
06/03/09 Created by Amanda McBride 94. Symptoms of Psychosis
- False personal beliefs that are not part of reality
- Truly believes something that doesnt make sense to others
- around them, and any reasoning and showing evidence that
contradicts
- their belief doesnt convince them that their belief is
false
- Includes the belief that they are being spied on, plotted
against,
- harmed or tormented; many report receiving messages from
the
- Sensing things that arent actually there
- Includes hearing, seeing, smelling, tasting or feeling
things
- that others dont perceive
- The most common hallucinations involve hearing voices
usually
- saying negative, critical or frightening things to the
person,
- warning of danger, or even giving orders
- Being unable to "think straight"
- Organizing thoughts is difficult, making it impossible to
- communicate clearly with others
- Unable to concentrate on one thought for very long; thoughts
may
- Unable to connect thoughts into logical sequences; thoughts
are
- often blocked and become fragmented
- Being emotionally disturbed or excited
- Includes appearing disturbed, excited, restless or
hyperactive
- Trying to seem very important
- Believe that they are powerful, wealthy, very intelligent,
famous or
- Being untrusting and guarded
- Might think they are being watched, followed, persecuted
or
- Acting unfriendly and showing ill feelings towards
- Behaving in an abusive, sarcastic and difficult manner
06/03/09 Created by Amanda McBride 95. Antipsychotic Drugs
- Act by inhibiting or blocking the release of neurotransmitter
dopamine
06/03/09 Created by Amanda McBride 96. Uses
- Acute or chronic pyschosis
- Agitated behaviours associated with dementia
06/03/09 Created by Amanda McBride 97. Adverse Reactions
- Sedation, headache, hypotension, dry mouth, urticaria
- Behavioural changes, increase in psychotic symptoms
- Lethargy, hyperactivity, paranoid reactions, agitation,
confusion
06/03/09 Created by Amanda McBride 98. Extrapyramidal
Symptoms
- Extrapyramidalsymptoms(EPS) are the variousmovement
disorderssuch astardive dyskinesiasuffered as a result of
takingdopamine antagonists , usuallyantipsychotic(neuroleptic)drugs
, which are often used to controlpsychosis ,
especiallyschizophrenia . Otherantidopaminergicdrugs like
theantiemetic metoclopramideor thetricyclic antidepressant
amoxapinecan also cause extrapyramidal side effects
06/03/09 Created by Amanda McBride 99. Tardive Dyskinesia
- Tardive dyskinesia is characterized by repetitive, involuntary,
purposeless movements. Features of the disorder may include
grimacing, tongue protrusion, lip smacking, puckering and pursing
of the lips, and rapid eye blinking. Rapid movements of the arms,
legs, and trunk may also occur. Impaired movements of the fingers
may appear as though the patient is playing an invisible guitar or
piano. Patients with Parkinson's disease have difficulty moving,
while patients with tardive dyskinesia have difficultynotmoving
.
06/03/09 Created by Amanda McBride 100. NeurolepticMalignant
Syndrome
- Hypertonicityof skeletal muscles
06/03/09 Created by Amanda McBride 101. Contraindications,
Precautions, Interactions
- Used cautiously in resp disorders, epilepsy, renal impairment,
PUD
06/03/09 Created by Amanda McBride 102. Nursing Process
06/03/09 Created by Amanda McBride 103. Education
- Report any unusual effects
06/03/09 Created by Amanda McBride 104.
- Epilepsy is a brain disorder in which clusters of nerve cells,
or neurons, in the brain sometimes signal abnormally. In epilepsy,
the normal pattern of neuronal activity becomes disturbed, causing
strange sensations, emotions, and behavior or sometimes
convulsions, muscle spasms, and loss of consciousness. Epilepsy is
a disorder with many possible causes. Anything that disturbs the
normal pattern of neuron activity - from illness to brain damage to
abnormal brain development - can lead to seizures. Epilepsy may
develop because of an abnormality in brain wiring, an imbalance of
nerve signaling chemicals called neurotransmitters, or some
combination of these factors. Having a seizure does not necessarily
mean that a person has epilepsy. Only when a person has had two or
more seizures is he or she considered to have epilepsy. EEGs and
brain scans are common diagnostic test for epilepsy .
06/03/09 Created by Amanda McBride 105. 06/03/09 Created by
Amanda McBride 106. 06/03/09 Created by Amanda McBride 107.
06/03/09 Created by Amanda McBride 108. Status Epilepticus
- A state of continuous seizures or repetitive, discrete seizures
with impaired consciousness in the interictal period
-
-
- Traditional criterion: 1530 minutes
-
-
- Practical criterion: duration prompting acute use of
anticonvulsant therapy; typically > 5 minutes
-
- May occur with all type of seizures: grand mal (tonic-clonic)
status, myoclonic status, petit mal status, and temporal lobe
(complex partial) status
-
- Associated with major cerebral and systemic physiologic
changes
-
-
- Initial stage (first 3060 minutes)
-
-
-
- Cerebral metabolism is greatly increased because of seizure
activity, but physiologic mechanisms are sufficient to meet the
metabolic demands.
-
-
-
- Cerebral: increased blood flow, increased metabolism
-
-
-
- Autonomic and cardiovascular: hypertension, increased cardiac
output, massive catecholamine release, tachycardia, arrhythmias,
hyperpyrexia
-
-
-
- Metabolic: lactic acidosis, hyperglycemia
-
-
-
- Cerebral metabolic demands cannot be fully met, resulting in
hypoxia and altered cerebral and systemic metabolic patterns.
-
-
-
- Cerebral: hypoxia, hypoglycemia, increased intracranial
pressure
-
-
-
- Autonomic and cardiovascular: hypoxia, hypotension,
hyperpyrexia
-
-
-
- Metabolic: hypoglycemia, hyponatremia, hyperkalemia, metabolic
acidosis
-
- Generalized status is life threatening when accompanied by
hyperpyrexia, acidosis (from prolonged muscle activity), and
respiratory or cardiovascular compromise.
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Amanda McBride 110. Anticonvulsants
-
-
- Stabilize the hyperexcitability
06/03/09 Created by Amanda McBride 111.
-
- Drowsiness, weakness, dizziness
-
- Slurred speech, ataxia, nystagmus
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- Nausea, vomiting, anorexia
-
- Dilantin in bradycardia and HB
06/03/09 Created by Amanda McBride 112. Dilantin
- Interacts with many medications.
06/03/09 Created by Amanda McBride 113. Gabapentin
- Adjunct therapy in post ortho pt.
06/03/09 Created by Amanda McBride 114. Phenobarbital
06/03/09 Created by Amanda McBride 115. Drug Selection
-
- Gabapentin, phenobarb, Dilantin
06/03/09 Created by Amanda McBride 116. Nursing Process
- History of seizure type/activity
06/03/09 Created by Amanda McBride 117. Monitoring
Anti-Epileptic drug therapy
- Serum drug levels periodically
- Changes made gradually over 2-3 months
06/03/09 Created by Amanda McBride 118. Toxicity
- Fatalities have been assoc with all AED
- SS are extensions of adverse effects
06/03/09 Created by Amanda McBride 119. Antiparkinsonism
Drugs
-
- Stimulate dopamine receptor sites
06/03/09 Created by Amanda McBride 120. Adverse Effects
- Dry mouth, anorexia, nausea, vomiting, abdo pain,
constipation
- Choreiform movement:ceaseless occurrence of rapid, highly
complex jerky movements that appear to be well coordinated but are
performed involuntarily
- Dystonia is a syndrome of spasms and sustained contractions of
the muscles. These muscle movements are not under voluntary control
and they result in repetitive abnormal movements of parts of the
body or persistently abnormal postures.
06/03/09 Created by Amanda McBride 121. Contraindications,
Precautions, Interactions
- Levodopa can activate malignant melanoma
- Used cautiously in CVS or pulm diseases, PUD, renal or hepatic
impairment, pychosis
06/03/09 Created by Amanda McBride 122. Nursing Process
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- Neuro muscular assessment
06/03/09 Created by Amanda McBride 123. Education
- Pts with diabetes, drug may affect urine testing
06/03/09 Created by Amanda McBride