Professional Documents
Culture Documents
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 AUTONOMIC NERVOUS
SYSTEM SYSTEM
(Visceral system)
Sympathetic Nervous system
Parasympathetic Nervous
system
• Involuntary
• Voluntary • Control and regulates
function of:
Heart
• Acts on skeletal muscles
produce locomotion and Respiratory system
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
Beta adrenergic
Dopaminergic
ADRENERGICS
sympathomimetics drugs
Alpha 1-adrenergic Receptors Alpha 2 – adrenergic receptor
Found in blood vessels Found in blood vessels
Activation results in Inhibits release of
vasoconstriction resulting in: norephineprine
Increase in BP Activation results in
Increase contractility of Vasodilation resulting in:
the heart Decreased BP
Contraction of bladder Decreased GI tone and
sphincter and prostate motility
capsule – increases
contraction and
ejaculation
Mydriasis – dilatation of
the pupil
Decrease salivary
secretions
ADRENERGICS
sympathomimetics drugs
Beta 1 receptor Beta 2 receptors
• Found in the heart • Found in smooth
• Stimulation results in: muscles of lung,
– Increase myocardial arterioles of skeletal
contractility and uterine muscles
– Increase HR • 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
Classification
• Direct acting
– 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
• Route of
• Epinephrine – administration
Adrenaline – IM, SC
– Prototype of adrenergics – Inhalation
– Drug of choice for – Intra-cardiac
anaphylaxis
– Not given p.o. –
– Active ingredients in destroyed by GI
OTC asthma preparation enzymes
– 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
ADRENERGICS
sympathomimetics drugs
Catecholamine group
Important drugs
• Norepinephrine – • Dopamine hydrochloride
Levophed – Intropin
– Immediate precursor of
– Potent vasoconstrictor
norepinephrine
– Indication : – Effects:
• Hypotension • Low dose – renal
• Cardiac arrest perfusion
• Low to moderate dose
– increased cardiac
output
• Higher dose –
increased peripheral
resistance and BP
ADRENERGICS
sympathomimetics drugs
catecholamine group
• Dobutamine HCl – • Isoproterenol HCl -
Dobutrex Isuprel
– Synthetic catecholamine – synthetic catecholamine
– Acts directly on the – Bronchodilator
heart muscle increase – Stimulates both beta 1
force of contraction 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 • Albuterol sulfate –
– Less potent Proventil, Salbutamol,
– Longer acting than Ventolin
epinephrine – Acts on Beta 2 receptor
– Used as bronchodilator – Produce bronchodilation
and nasal decongestant – Use for treatment of:
in allergic reaction
• Bronchospasm
• Asthma
• Pseudoephedrine – Neo- • COPD
synephrine – Side effects
• Temors
• Dizziness
• Nervousness
• restlessness
ADRENERGICS
sympathomimetics drugs
Non cathecholamine
• Adverse effect
– Palpitations
– Reflex tachycardia
– Hallucinations
– Cardiac dysrhythmias – life threathening
ADRENERGICS
sympathomimetics drugs
Nursing Intervention
• Monitor:
– VS and ECG – increased HR, BP, dysrhythmias
– RR and lung sounds – bronchial congestion and dyspnea
– blood glucose level – increase
– I & O – urinary retention can result from high dose or
continuous used
• Avoid infiltration – necrosis – possible amputation of
extremity
– Inspect IV site every 15 minutes – edema and coolness
– Observed for decreased drip rate
– Discontinue infusion immediately
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 – Uses:
blockers • Peripheral vascular
disease – Raynauds
– Blocks the effect of disease and frost
alpha recrptors bites
– Blocks • Confused elderly
sympathomimetics • Mild to moderate
agent hypertension
• Migraine
– Vasodilation in
• CHF
smooth muscle
• Pheochromocytoma –
– Lower peripheral tumor that release
vascular resistance excessive amount of
catecholamines
Anti-Adrenergic Drugs
Adrenergic Blockers
Common Drugs
• Phentolamine mesylate – • Ergotamine tartrate –
Regitine • Ergostat
– Prototype – Vasoconstrictor
– Prevent tissue necrosis – Used to treat migraine
from infiltration of headache
norepinephrine
– Route of administration –
bitartrate (levophed)
SL, rectal suppository,
during IV therapy
inhalation
– Prevents and control
hypertension caused by
pheochromocytoma
Anti-Adrenergic Drugs
Adrenergic Blockers
• Ergotamine tartrate • Prazosin (minipress)
with caffeine – • Terazosin (hytrin)
cafergot – Blocks post-synaptic
– Common anti- alpha 1 adrenergic
migrataine drug receptor
– Use for hypertension
Anti-Adrenergic Drugs
Adrenergic Blockers
Beta-adrenergic blockers • Use:
– Control angina pectoris –
• Blocks adrenergic stimulation decrease O2 demand,
to beta 1 0r 2 receptors by myocardial contractility,
competing with norepinephrine heart rate
for available beta-adrenergic
receptor sites – Lower BP
• Block to beta 1 receptor cause – MI – decrease incidence
decrease: of catecholamine-induced
– BP dysrhythmias following
– Contraction of the heart attack
muscle – Glaucoma – reduce IOP
– Cardiac output decrease formation of
• Block to beta 2 receptor cause aqueous humor
vasodilation in skeletal muscle – Migraine headache
arterioles
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 • Genitourinary –
• Cardiovascular – contracts muscles of
vasodilation & slows urinary bladder
conduction of AV node – Increase tone of ureter
– Decrease HR – Relaxes bladder
– Low BP sphincter muscle
– Stimulates urination
• GIT –increases tone and
motility of smooth • Eye – increase pupillary
muscle of stomach and constriction or miosis
intestine pupil smaller
– Increased peristalsis – Increase accomodation
– Relaxation of sphincter • Glands – increase
muscle 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 – Specific Effects;
• Decreased heart rate
Direct Acting
• Increased:
Indirect Acting – Tone of GIT muscle
and relaxation of
• Direct Acting sphincters
cholinomimetic – Tone of bladder and
relaxation of
drugs sphincters
– Directly stimulate – Respiratory
cholinergic receptor secretions
• Constriction of pupil
– Mimic acetlycholine
Direct Acting Cholinergic Agents
a. CNS Stimulant
b. CNS Depressant
A. CNS stimulant
• act to stimulate • Large doses
– Respiratory system – Produce insomnia,
– Heart tremors,
restlessness
– General metabolism
• Small doses • Toxic dose
– Produce convulsion
– Increase alertness
– Cardiac
– Impart feeling of
wellness dysrhythmias
– Possibly death
• Prolonged use
– Results in exhaustion
– Hypertension
CNS STIMULANT
MAJOR GROUP
• Amphetamines, Amphetamine Like
Stimulates the cerebral cortex
• Anorexiants
Acts on cerebral cortex and hypothalamus
Suppress appetite
CNS STIMULANT
A. Amphetamine & Amphetamine Like
• Stimulate release of neurotransmitters
Norepinephrine
Dopamine
Indication
• Stimulate respiration
ANOREXANTS
Indication
3. Overweight or obese person
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 Indication
• Phenobarbital
(luminal) • Seizure in epilepsy
(anticonvulsant)
• Mephobarbital
(mebaral) • Insomnia
CNS DEPRESSANT
sedative-hypnotic
barbiturates
2. IMMEDIATE-ACTING
Common drugs Indication
• Amobarbital(amytal) - insomnia
-preoperational meds
• Aprobarbital(alurate) - seizure in epilepsy
(anticonvulsant)
• Butabarbital (butisol)
CNS DEPRESSANT
sedative-hypnotic
barbiturates
3. Short-Acting
Common drugs Indication
• Secobarbital - difficulty sleep at
(seconal) night (insomnia)
- more on elderly
• Pentobarbital
(nembutal)
CNS DEPRESSANT
sedative-hypnotic
barbiturates
3. Short-Acting
Common drugs Indication
-stimulate GABA
-most widely used depressant
-less dangerous to overdose and addiction
CNS DEPRESSANT
sedative-hypnotic
benzodiazepine
Common Drugs INDICATION
• Diazepam (Valium) -Anxiety, convulsion
• 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
imidazopyridines
• Zolpidem (Ambien) -treatment of insomnia
-muscle relaxant
pyrazolopyrimidines -anticonvulsant
• zaleplon (Sonata)
CNS DEPRESSANT
sedative-hypnotic
Nonbenzodiazepine
• Side Effect
• Drowsiness, lethargy, hangover, dizziness,
respiratory distress, confusion and
disorientation
• 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
• 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
• Narcotic Analgesic
Opiates/ Morphinomimetics
ANALGESIC
• Nonnarcotic Analgesic
- Used to treat mild to moderate pain
- addictive / abusive
ANALGESIC
Narcotic Analgesic
• Common Drugs • Indication
2. Morphine Sulfate - Acute pain from
(Duramorph, MS acute myocardial
Cotin, Epimorph) infarction
-most potent -pain from cancer and
narcotic analgesic dyspnea
- suppress pain, - preoperative meds
respiration and
cough
ANALGESIC
Narcotic Analgesic
2. Meperidine (Demerol) • Indication
- first synthetic - Preoperative
narcotics medication
- same action w/ - Sedation
Morphine, potency - More preferred to
varies on dosage given pregnant mother than
morphine
3. Hydromorphone
(Dilaudid) - Not given with
Advance cancer
- Analgesic effect more
large dose
potent than morphine
neurotoxicity
- Less resp. depression (nervousness, tremors,
irritability)
ANALGESIC
Narcotic Analgesic
• Side Effect • Contraindicated
- Anorexia, N & V, -asthma w resp
dizziness, drowsiness, depression
urinary retention, - inc. ICP , shock,
constipation, euphoria head injury
• Adverse Effect - Renal and hepatic
disease/dysfunction
-resp. depression,
- M.I.
hypotension, increase
- Advance cancer
ICP, seizure, large dose
withdrawal syndrome 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
• Buprenorphine impulse transmitted
(Buprenex) in the CNS by binding
by the opiate
• Nalbuphine HCl receptor and
(Nubain) increase pain
- narcotic antagonist threshold
is added with a • Indication
narcotic agonist to
decrease abuse - Post operation meds
for pain
- Sedation, labor mom
Narcotic Agonist Antagonist
• Side Effects • Nursing
- dizziness, confusion, Responsibility
sedation, dry mouth, - Monitor vital sign
nausea, flushing - let the patient void or
• Adverse Effect do things before
- tachycardia, giving
hypotension and - Don’t give anything
respiratory by mouth
depression
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 • Side Effect
2. Hydantoins - Gingival hyperplasia or
(phenytoin (Dilantin), overgrowth of gum
mephenitoin ethotoin) tissue bleed
- Most common drugs to - Neurologic or
control seizure (grand mal psychiatric effects
seizure) slurred speech,
- Not used for all types of confusion, depression,
seizure
thrombocytopenia,
Leukopenia, n & v,
constipation, drowsiness
CNS Depressant
Anticonvulsant
2. Barbiturates • Nursing Responsilities
Amobarbital (Amytal) - Take the medication as
Mephobarbital prescribe
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