CNS And PNS Flashcards
Central Nervous System consists of
Brain and spinal cord
Respiration’s controlled by
Pons and medulla
Neurotransmitters are
Norepinephrine, serotonin, and dopamine
CNS stimulants
Provoke release of neurotransmitters
Decrease reputable of neurotransmitters
Inhibit postsynaptic enzymes
Anxiety
Feeling tension, nervousness, apprehension, or fear involving unpleasant reactions to a stimulus
sedation
Loss of awareness and reaction to environmental stimuli
Hypnosis
Extreme sedation resulting in further CNS depression and sleep
The downers of CNS
Cause various degrees of depression
- sedative-hypnosis
- anesthetic
Sedatives
Treat sleep disorders
Sedative-hypnotics
Barbiturates
Benzodiazepines
Nonbenzodiazepines
General side effects of sedative hypnotics
Residual drowsiness Drug dependence Drug tolerance Withdrawal symptoms Respiratory depression
Benzodiazepines-AS A CLASS-
drug of choice to treat anxiety
Do not cause much sedation
Less likely to cause dependence-schedule 4 drug
Act by potentiating GABA
Benzodiazepines Indications
Anxiety disorders, alcohol withdrawal, hyper excitability, agitation, seizures, induction of anesthesia, conscious sedation, preoperative sedation
Benzodiazepines
Well absorbed GI tract, lipid soluble, metabolized by liver
Benzodiazepines Actions
Act in limbic system and the RAS Make GABA more effective Cause interference with neurons firing Lower doses assist with anxiety Higher doses cause sedation and hypnosis
Pharmacokinetics Benzo
Absorbed from GI tract Peak level 30 min to 2 hrs Lipid soluble and distributes well Cross placenta Enter breast milk Metabolize in liver Excretion in urine
Contraindications of Benzo
Allergy
Psychosis
Acute narrow angle glaucoma
Decrease liver and kidney function
Adverse effects of Benzo
CNS and anticholinergic effects
Use with causation in African Americans
Addictive effect with alcohol or narcotics
UNPREDICTABLE REACTION IN ELDERLY
Anxiolytics-used to depress CNS-of Benzo
Diazepam Chlordiazepoxide Lorazepam Aprazolam Oxazepam Clonazepam
GABA
Gamma-aminobutyric system
RAS
Reticular activating system
Benzodiazepines suffix
-zopam or -zolam
Benzodiazepine antidote
Flumazenil -romazicon
:inhibits effects of the benzodiazepines at the GABA receptors and is used to treat Benzo overdoses
NONbenzodiazepines
Zolpidem-ambien \:duration of action is 6-8 hrs Eszopiclone-lunesta Zaleplon-sonata Chloral hydrate Melatonin receptor agonist \:ramelteon-not a controlled substance
Barbiturates actions
CNS depressants
Inhibit neuroral impulse conduction in ascending RAS
Depress cerebral cortex
Depress motor output
Cause—sedation,hypnosis,anesthesia, and coma
Barbiturates Indications
Reliefs of signs and symptoms of anxiety Sedation Insomnia Preanesthesia Seizures
Pharmacokinetics barbiturates
Well absorbed, reached peak in 20-60 min, metabolizes in liver, excreted in urine
Adverse effects of Barbiturates
CNS depression Physical dependency Drowsiness Somnolence Lethargic Ataxia Vertigo Nausea/Vomiting Constipation
Long acting barbiturates
Phenobarbital and mephobarbital
Intermediate acting barbiturates
Amobarbital
Aprobarbital
Butabarbital
Short acting barbiturates
Pentobarbital
Secobarbital
Barbiturates
Controlled substance schedule 2 or 3
Many drug interactions including kava kava and valerian
Contraindications barbiturates
Allergy History of addiction to sedative Liver or kidney function Respiratory distress or depression Pregnancy
Adverse effects or barbiturates
Respiratory depression
hangover
Do NOT withdrawal abruptly or mix with alcohol
General anesthetics
CNS depressants used to produce loss of pain sensation and consciousness
Local anesthetics
Used to cause loss of pain sensation and feeling is a designated area
Does not produce systemic efforts associated with severe CNS depression
Goals of General anesthetics
Analgesia -loss of pain perception Unconsciousness -loss of awareness of ones surroundings Amnesia -inability to recall what took place
Risk factors of General
CNS factors
Cardiovascular factors
Respiratory factors
Renal and hepatic function
Balanced anesthesia
Hypnotic the night before Premedication Short acting barbiturate Inhaled gas Muscle relaxant
Stages of General
Analgesia
Excitement or delirium
Surgical
Medullary paralysis
Adverse affects w/ CNS
Suppression
Adverse effects w/local anesthetic
Loss of skin integrity
Adverse effects w/respiratory
Suppression
Adverse effects/cardio vascular
Hypotension and slow pulse
Adverse effects w/ GI
Decreased activity
Nausea
Vomiting
Malignant hyperthermia
Antidote:dantrolene
Topical/local anesthetic
NOT be absorbed systemically Topical administration Infiltration Field block Nerve block-epidural IV regional anesthesia Pain pump
Esters
Benzocaine
Procaine
Tetracaine
Amides
Bupivacaine
Dibucaine
Levobupivacaine
LIDOCAINE-xylocaine EMLA MODERATE ACTING
Spinal anesthesia
Need to monitor respiration’s and BP
Complication: terrible headache
Neuromuscular junction
Point at which motor neuron communicates with skeletal muscle fiber, and results in muscle contraction
Neuromuscular junction
Dynamic balance of excitatory and inhibitory impulses results in muscle tone
No depolarization
Acts as antagonists to ACh at NMJ and prevents depolarization of muscle cells
Depolarization
Acts as ACh agonist causing stimulation of muscle cell and preventing it from repolarizing
Nondepolarizing NMJ blockers 1
PANCURONIUM GENERIC
Actions and indications of no depolarization blockers
Adjunct to general aesthetic during surgery when reflex muscle movement could interfere w/ procedure or delivery of gas
Facilitate mechanical intubation by preventing resistance to passing of endotracheal tube
Facilitate endoscopic diagnostic procedures when reflex muscle reaction would interfere
Facilitate electroconvolsuive therapy when intense skeletal muscle contraction
No depolarization blockers pharmacokinetics
Compete with ACh for a receptor site
Metabolize in serum, dependent on liver for plasma
Excreted in urine
Differing onset/duration
Contraindications on NMJ blockers
Allergy
Myasthenia graves
Renal and haptic disease
Adverse effects of NMJ blockers
Muscle paralysis Hypotension Cardiac arythmias Gi dysfunction Pressure ulcers
Drug drug interactions
Halogenated hydrocarbon anesthetics Aminoglycoside antibiotics Ca channel blockers Xanthines Alkaline solutions
Drug herb interactions
Valerian
Melatonin
Kava
Depolarization action/indication
Attaches ACh receptor sites on muscle cell causing prolonged depolarization
Rapid onset short duration
Pharmacokinetics depolarization
Metabolized in serum by liver
Produced by plasma chokinesterates
Excreted in urine
Crosses plasma
Contraindications depolarization
Same as no depolarization Fractures Narrow angle glaucoma Penetrating eye injuries Paraplegia
Advertise effects depolarization
Muscle pain
MALIGNANT HYPERTHERMIA-Danrolene
CNS stimulants UPPERS
Amphetamines-stimulate cerebral cortex
Anorexiants-center in hypothalamic and limbic areas of brain
Analeptics and caffeine-respiration’s in brain stem and medulla
Medically approved:narcolepsy, respiratory distress, and ADHD
Narcolepsy
MODAFINIL-provigil
Anorexiante :Obesity
Prescriptive anorexiants Part of weight loss plan under care of medical provider - -benzphentamine HCI -diethylpropion HCI -phentermine -phentermine plié topiramate
Pain
Sensory and emotional experience assoc with actual or potential tissue damage
Can be acute or chronic
Drugs used to relieve pain
Narcotics:opium derivatives used to treat many types
Anti migraine drugs:reserved for treatment of migraine headaches
Gate control theory
Sensory and emotional experience
Transmission of these impulses can be modulated or adjusted
Interneurons acts as “gates”
Factors:learning experiences, cultural expectations, individual tolerance, placebo effect…activate descending inhibitory nerves from upper CNS
Opioid receptors
CNS
Nerves in the periphery
Cells in the GI tract
Narcotic Agonist 1
drugs that react with opioid receptors Cause analgesia, sedation, or euphoria Potential for physical dependence Controlled substance Rising problem of addiction
Narcotic agonist actions
Act at specific opioid receptor site sin CNS
Produce analgesia sedation and sense of well being
Narcotic agonist indication
Relief of severe acute or chronic pain
Analgesia during anesthesia
Cross placenta
Narcotic agonists pharmacokinetics
IV most reliable way to achieve therapeutic response
IM and SubQ to absorb varies between sex
Hepatic metabolism and generally excreted in Urine and bile
Narcotic agonist contraindications
Known allergy
Pregnancy, labor, lactation
Diarrhea
Opiates
Morphine
Opium
Codeine
Synthetic opioids
Oxycodone Hydrocodone Meperidine Hydromorphone Fentanyl Tramadol Methadone
Narcotic analgesics
Adverse effects
Respiratory depression Nausea Orthostatic hypotension Drowsiness and confusion Constipation Urinate retention Naive VS tolerant and dependent
Narcotic analgesics contraindications
Head injuries and increased intracranial pressure
Respiratory disorders
Shock or hypotension
Adjuvant therapy
Anti seizure meds-gabapentin
Antidepressants-tricyclics
Corticosteroids
Local anesthetics-lidocaine
Narcotic agonist-antagonist
Pentazocaine
Nalbuphine HCl
Butorphanol
Buprenorphine
Opioid antagonist actions
Drugs that bind strongly to opioid receptors but they do not activate the receptors
Reverse effects of opioids
Opioid antagonist indication
Reverse of the adverse effects of narcotics
Treat narcotic and or alcoholic dependence
Cluster headaches
Begins during sleep, involve sharp steady eye pain, sweating, tearing, nasal congestion
Tension headaches
Occur of times of stress, dull band of pain around entire head
Prevention treatment for migraine and cluster
Beta adrenergic blockers-propranolol, atenolol
Anticonvulsant-valproic acid,gabapentin,topiramate
Chemical impairment of nurses
10-15% have substance abuse problem
3-6% demonstrate impaired practice b/c of drugs
