CH13 PHARM AD AI TEST

• Chapter 13 focuses on nervous system medications, including their classifications, dosages, and effects.

Learning Outcomes

• Define key terms related to nervous system medications
• The two major branches of the nervous system should be identified
• Recall the five categories of nervous system medications
• Name the four categories of medications used to treat pain and fever
• Recall at least one medication category for anxiety, insomnia, sedation, and seizures
• Identify at least one med category to treat behavioral, emotional, or mood disorders
• Discuss psychosis medications and other disorders they treat Identify one drug category for dementia and two for treatment
• Compare local and general anesthetic actions
• Discuss alcohol's influence on medication and its bodily effects

Key Terms

• Adrenergic (Sympathomimetic), mimics the sympathetic nervous system
• Analgesic, pain reliever
• Anxiolytic, anxiety reducer
• Aura, a sensory disturbance preceding a seizure or migraine
• Autonomic nervous system, regulates involuntary bodily functions
• Blood-brain barrier, protects the brain from harmful substances
• Central nervous system (CNS), brain and spinal cord
• Cholinergic (Parasympathomimetic), mimics the parasympathetic nervous system
• Drug holiday, temporary discontinuation of medication
• Gamma-aminobutyric acid (GABA), neurotransmitter that inhibits brain activity
• Hydantoins, a class of anti-seizure medications
• Monoamine oxidase inhibitors (MAOIs), antidepressants that inhibit monoamine oxidase
• Narcotic, strong pain reliever, often an opioid
• Neuroleptic, antipsychotic medication
• Neurotransmitters, chemical messengers in the brain
• Parasympathetic, the "rest and digest" part of the nervous system
• Peripheral nervous system (PNS), nerves outside the brain and spinal cord
• Psychotropic, affects mental state
• Selective serotonin reuptake inhibitors (SSRIs), antidepressants that block serotonin reuptake
• Somatic nervous system, controls voluntary muscle movements
• Status epilepticus, prolonged seizure
• Sympathetic nervous system, the "fight or flight" part of the nervous system
• Synapse, the gap between nerve cells

The Nervous System

• Divided into the Central Nervous System (CNS)
  • Contains the Brain and spinal cord
• Peripheral Nervous System (PNS)
  • Includes the somatic and autonomic nervous system

Peripheral Nervous System

• Somatic nervous system is a voluntary system
  • Controls muscles we have conscious control over
• Autonomic nervous system is a involuntary system
  • Controls internal organs
  • Broken down into
    • Sympathetic nervous system: Controls fight or flight response
    • Parasympathetic nervous system: Helps body to rest and relax

Autonomic Nervous System

• Cholinergic nerve cells release acetylocholine, which relaxes the body
• Adrenergic nerve cells release epinephrine or norepinephrine, which excites the body
• Both are naturally occurring substances
  • Artificial equivalents provided through medication when natural production is inadequate

Nervous System Medications

• These medications are used to treat:
  • Pain
  • Anxiety
  • Depression
  • Mania
  • Insomnia
  • Convulsions
  • Schizophrenia
• These medications are psychotropic and act on the CNS and PNS
• Most of these medications act at the synapse between nerves
  • Adjust the transmission of messages by neurotransmitters
• Most cross the blood-brain barrier
  • Have serious side effects

Sympathomimetics

• Mimic the sympathetic system
• Used when the body needs to be excited, mimicking the sympathetic nervous system
• Stimulate the fight or flight response
  • Restore heart rhythm during cardiac arrest
  • Increase blood pressure during shock,
  • Constrict capillaries if patient is bleeding
  • Dilate bronchioles of asthmatics
  • Dilate pupils for eye procedures
• Examples of contraindications
  • Hypersensitivity
  • Used with caution in Hypertension, Myocardial infarction, Atrial fibrillation, Hypovolemia, Children, Pregnancy and Breastfeeding
• Some examples include
  • Levophed (norepinephrine)
  • Epinephrine

Adrenergic Blockers

• Block the action of adrenergics and have a parasympathetic effect
• Are used to calm by slowing slowing heart rate, relaxing blood vessels
  • Treat cardiac arrhythmias
  • High blood pressure
  • Migraine headaches
  • Chest pain
• Broken into two groups based on muscles affected -Alpha Blockers -Affect vascular smooth muscle -Treats hypertension and BPH -Beta Blockers -Block epinephrine -Slow Heart rate and force -Treat hypertension, migraines, glaucoma

Parasympathomimetics

• Mimic parasympathetic system
  • Release acetylocholine which relaxes fight-flight mechanism
• Rarely used due to severe decrease in heart rate, constriction of respiratory passages
• Some examples include, Nerve gas, Pilocarpine (Pilopine)
  • Is used to treat open-angle glaucoma

Anticholinergics

• Inhibit parasympathetic nervous system
• Promote fight or flight symptoms, and also dry secretions
• Used to treat asthma, motion sickness, preoperative relaxation, neuromuscular blocking of spasms, antidotes for insect stings, cholinergic crisis
  • Example: Atropine (Atropen)

Analgesics

• Reduce pain without eliminating feeling or sensation
• Choices include salicylates, acetaminophen, nonsteroidal anti-inflammatory drugs, and narcotics
• Some are antipyretic (fever reducing)

Salicylates

• Relieve mild-to-moderate pain and reduce inflammation and fever
  • Aspirin causes Gl distress and should not be used in children
  • Methylsalicylate (Bengay) is a topical anti-inflammatory that irritates skin to increase blood flow and decrease pain

Acetaminophen

• Decreases pain and fever, with no anti-inflammatory effect
  • Found in cold medications
• Combined with narcotics treat moderate to severe pain
  • Such as oxycodone/acetaminophen (Percocet)

Nonsteroidal Anti-inflammatory Drugs

• Reduce pain, inflammation, fever
  • Example: Ibuprofen (Motrin, Advil)
• May be combined with narcotics to relieve moderate to severe pain
  • Oxycodone with ibuprofen (Combunox)

Opioid Analgesics

• Strong pain killers that suppress the central nervous systemactive ingredient in most narcotics is opium
• Excess causes decreased blood pressure, leading to risk of falls or death, and decreased respirations
• Examples include Morphine, Codeine, and Fentanyl
• Addiction potential with long-term use due to feelings of euphoria

Medications to Treat Anxiety, Insomnia, Sedation, and Seizures

• The limbic system of the brain is integral to emotions, memory, and level of alertness
• Anxiety, Sleeplessness, Alertness and Seizures
• Can all occur if the structures in the limbic system are not operating optimally

Anxiolytic Medications

• Reduce intensity of fears, dangers, and/or tension
• Have a calming effect from mild sedation to coma
• CNS depressants are a type of anxiolytic that treats anxiety and restlessness
  • Benzodiazepines treat anxiety, seizures, alcohol withdrawal symptoms, and muscle relaxation
  • Example: Lorazepam (Ativan), Diazepam (Valium), Alprazolam (Xanax)

Anxiolytics

• Selective serotonin reuptake inhibitors (SSRIs)
  • Example: Celexa (Citalopram), Fluoxetine (Prozac), Sertraline (Zoloft)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Example: Venlafaxine (Effexor XR)
• Tricyclic antidepressants: Amitriptyline (Elavil)

Insomnia and Medications

• Barbiturates induce sleep by depressing the CNS
• Non-narcotic benzodiazepine hypnotics
  • Zolpidem (Ambien) and Eszopicolone (Lunesta)
    • Few side effects, Possible addiction risk
    • Do not all affect entire CNS

Barbiturates and Antiseizure Medications

• Hydantoins such as phenytoin (Dilantin) delay sodium crossing neural membranes calm cells
  • Is a Drug of choice for tonic-clonic (grand mal) and partial seizures
• Barbiturates such as phenobarbital (Luminal) and are used for tonic-clonic and febrile seizures
• Succinimides such as ethosuximide (Zarontin) delay calcium moving over neurons to relax
• Gamma-aminobutyric acid (GABA)
  • Naturally occurring neurotransmitter inhibitor
  • Increased presence decreases sz activity
    • Example: Vigabatrin (Sabril)
• Benzodiazepines such as diazepam (Valium) intensify the effect of GABA transmitters in the brain
• Other anti-seizure medication include
  • Lamictal (lamotrigine), Gabitril (tiagabine)
• Some medications that reduce seizures manage alcohol withdrawal symptoms by reducing anxiety symptoms

Medications to Treat Behavioral, Emotional, and Mood Disorders

• Behavioral and emotional disorders include broad term used to include a wide variety of mental health diagnoses
  • May have difficulty initiating and maintaining relationships
• Mood Disorders
  • Are characterized by elevation or depression on one's mood

Central Nervous System Stimulants

• Used to treat ADD, ADHD, obesity, and sleep disorders
• Treats ADD and ADHD
  • With Amphetamine dextroamphetamine (Adderall), pemoline (Cylert), and methylphenidate (Ritalin)
• Obesity
  • Is treated with Amphetamines such as phentermine (Zantryl) to increase metabolism
• Narcolepsy
  • Is treated With Modafinil (Provigil) or armodafinil (Nuvigil) to stay awake and alert

Antidepressants

• Patient does not think clearly, and mood is depressed when neurotransmitters are depleted
• Antidepressants preserve neurotransmitters at the synapse
• Four categories of medication:
  • Monoamine oxidase inhibitors (MAOIs)
  • Tricyclic antidepressants (TCAS)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake

Monoamine Oxidase Inhibitors

• MAOIs inhibit the enzyme that stops action of neurotransmitters
  • Example: Selegiline (Eldepryl)
• It requires dietary exclusion foods containing tyramine and is rarely prescribed today

Tricyclic Antidepressants

• Three-ring chemical structure that keeps norepinephrine and serotonin at nerve terminals
• Drug of choice if patient has insomnia due to sedative side effect
  • Elavil (amitriptyline) cause many cause side effects and Drug of choice for severe depression and inpatient treatment

Selective Serotonin Reuptake Inhibitors

• SSRIs, prevent serotonin from being used up at the synapse
  • A few examples include, Celexa (citalopram), Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline)
• Have Few side effects, thus usually prescribed as first choice

Serotonin-Norepinephrine Reuptake Inhibitors

• SNRIs Block reuptake of serotonin and norepinephrine
• Increase in these levels elevates mood
  • Examples Venlafaxine (Effexor XR), Desvenlafaxine (Pritiz), Duloxetine (Cymbalta)

Mood Stabilizers

• Stabilize extreme mood shifts seen in patients with bipolar disorder and schizophrenia
• Most common is Lithium, which has a small therapeutic range
  • It is a salt, so patient should avoid table salt due to toxicity
    • Regular blood tests are necessary
  • Other examples include, Lamotrigine (Lamictal) and valproic acid

Antipsychotic Medications

• Thorazine (chlorpromazine), Clopine (clozapine), Mellaril (thioridazine)
• Treat abnormal actions and behaviors or psychoses such as talking and interacting with situation only they can see and hear
• Used for other symptoms like nausea, vomiting, dementia, agitation, spasms, etc
  • Always verify why a patient is on this drug

Dementia

• Progressive irreversible decline in mental function, and Alzheimer's disease most common cause
  • Goal of therapy is to Prevent or slow down further deterioration, with no cure
• Aricept (donepezil HCL)
  • Is a Cholinesterase inhibitor showing promise in slowing down progression

Parkinson's Disease

• In a Degenerative disorder of CNS, neurons that produce dopamine die
  • Resulting in muscle movements becoming Disorganized
• Lack of dopamine and increase in acetylcholine cause tremors, slow movement, rigid muscles, balance problems
• Antiparkinsonian drugs focus on keeping dopamine acetylcholine at the nerve synapse

Antiparkinsonian drugs

• Are Dopaminergic, they replace or increase dopamine
  • Eldepryl (selegiline), Parlodel (bromocriptine), Requip (ropinirole), Sinemet (carbidopa/levodopa
• Also Include Cholinergic agents, such as Cholinergic agents (inhibit action of acetylcholine)
  • Can take Biperiden (Akineton)
• Patients need combination to achieve sufficient dopamine levels
• Drug holiday required

Local Anesthesia

• Creates a lack of feeling without a loss of consciousness
  • Creams, EMLA (lidocaine/prilocaine)
  • Aerosol spray, Exactacain (Benzocaine/butamben/tetracaine)
  • Otic, American otic (benzocaine) and Injectable solution, Xylocaine (lidocaine)
• Classified as amides or esters:
  • Classified as amides or esters Amides last longer and adverse effects/allergies less common
    • Esters have potential severe allergic reactions and are thus used in topical preparations

General Anesthesia

• Creates loss of both feeling and consciousness
  • IV infusion, Midazolam (Versed), propofol (Diprivan), or ketamine (Ketalar)
    • Used initially for longer procedures, followed by Inhalation therapy, Desflurane (Suprane), isoflurane (Forane), sevoflurane (Ultane)
  • Are Volatile and can depress respiratory and cardiovascular function
  • Use of IV medications allows lower doses of inhalation therapy, thus reduced risk of severe side effects with inhalation therapy

Alcohol

• CNS depressant but is rarely prescribed
  • Can Interact with many medications
    • Resulting in Confusion, peripheral vasodilation, increased heart rate, electrolyte imbalances, decreased motor coordination, unsteady gait, and slurred speech
• Prolonged use can permanently damage CNS and liver
  • Signs and symptoms of chronic alcoholism include irritability, tremors, Gl disorders, frequent falls, blackouts, confusion, neural and muscle weakness, and conjunctivitis
  • treatments, Treatments range from Disulfiram (Antabuse), behavior modification, vitamin B injections, and dietary changes