Pharma Midterm, Transes PDF

TOPIC 4: THE NEURON OR NERVE CELL NERVOUS SYSTEM BASIC functional unit of the nervous system - - Sympathetic and Parasympathetic (ANS NEURON Agents) Stimulants and Depressants...

TOPIC 4: THE NEURON OR NERVE CELL NERVOUS SYSTEM BASIC functional unit of the nervous system - - Sympathetic and Parasympathetic (ANS NEURON Agents) Stimulants and Depressants DENDRITES - receive neural messages & FUNCTIONS: (one that control all over the body) transmits towards cell body/nucleus.- 1. Communications between region of the small processes body AXON - transmits neural messages away 2. Coordination of the body functions from cell body. Long processes 3. Orientation to environment - NERVE BODY OR SOMA - has nucleus & (homeostasis = balance) cytoplasm 4. Assimilation - “adjustment” NEUROPLASM - cytoplasm of the neuron NISSL BODIES - the endoplasmic reticulum CNS: of the nerve cell AXON HILLOCK - triangular region of the Brain nerve cell body that is devoid of nissl - Spinal Cord SYNAPSE - spaces between the neurons (will contain the neurotransmitters) PERIPHERAL NERVOUS SYSTEM - SYMPATHETIC N.S. - NEUROTRANSMITTER IS FUNCTIONS OF THE NEURONS EPINEPHRINE Afferent and Sensory Division - conduct - PARASYMPATHETIC N.S. - impulses to the CNS NEUROTRANSMITTER IS Efferent and Motor Division - conduct ACETYLCHOLINE impulses from the brain to the different - parts of the body Mechanism for Nerve Impulse Conduction Association or Inerneurons - located intracellular vs extracellular ions between sensory and motor and also v transmits impulses to the brain for change in the permeability of cell membrane processing. “HELP” influx of Na ion (SODIUM) v AUTONOMIC NERVOUS SYSTEM depolarization (contractions of the muscles) = action potential/ impulse - innervates glands, smooth muscles, v cardiac muscles and organs Synapse - centers in the brain for ANS; - to neuron -> to muscle/ gland (subconscious directions) - your not going to think about it SYNAPSE - Midbrain (mesencephalon) , pons, - a space between the neurons medulla oblongata = brain stem / vital - area of communication between neurons signs containing chemicals for - spinal cord neurotransmission. Neurotransmitters - chemicals in the synapse between Axon and Dendrites -  NEURONS IN THE ANS EFFERENT SENSORY NEURON NEUROGLIA OR GLIAL CELLS - Sends impulses to the Brain SWANN CELL OR NEUROLEMMOCYTE 1. Sympathetic 2. - these cells wrap around the axons 2. Parasympathetic leaving small gaps between MOTOR NEURON - successive cells called the Nodes - transmit impulses from brain to of Ranvier spinal cord and Effector organs SYMPATHETIC N.S MYELIN Other name: ADRENERGIC System - these are lipoproteins which are Neurotransmitter : EPINEPHRINE OR the main component of NOREPINEPHRINE neurolemmocyte - Function: it will PNEMONIC: sym-adre-nore speed up the conduction of electrical impulses PARASYMPATHETIC N.S MYELIN SHEETS Other name : CHOLINERGIC System - a series of Myelin. Neurotransmitter : Acetylcholine Receptors: - NICOTINIC (Nicotine) DIVISIONS OF THE NERVOUS SYSTEM - MUSCARINIC ( Muscarine) CNS - Acetylcholine - Produces the response Brain - Acetylcholinesterase - inactivates the spinal cord acetylcholine / Inhibits the response PNS Spinal nerves & ganglia NEUROTRANSMITTERS CNS sensory division They can be classified into: motor division 1. Exitatory: Dorsal root ganglia - Ach, glutamate, aspartate, Cranial nerves - 12: Olfactory, Optic, serotonin and NE. Oculomotor, Trochlear, Trigeminal, 2. Inhibitory: Abducens, Facial, Vestibucochlear, - GABA, glycin Glossopharyngeal, Vagus, Accesory, Hypoglossal (Peripheral Nervous System) CNS STIMULANTS - Stimulants are a substance which tends to INCREASE behavioral activity when SOMATIC MOTOR NERVOUS SYSTEM administered. (SOMA - it is the body) - receives impulse from the brain and EFFECTS OF STIMULANTS innervates the muscles of the body. Elevate Mood Increase Motor Activity Increase Alertness AUTONOMIC NERVOUS SYSTEM Decrease need for Sleep Sympathetic Nervous System In case of overdose, it leads to convulsion Parasympathetic Nervous System and death. Analeptics: Increase depth of respirations CNS STIMULANTS: ACTION ADVERSE EFFECTS OF AMPHETAMINE: Caffeine: - Cardiovascular: Hypertension - - Cardiac stimulation; dilation of - Endocrine Metabolic: Weight loss - coronary; peripheral blood - Gastrointestinal: Abdominal pain, Loss of vessels; constriction of cerebral Appetite, Xerostomia - DRY MOUTH blood vessels; skeletal muscle - Neurologic - Headache, Insomia - stimulation - Psychiatric - Feeling nervous Modafinil: - Exact mechanism of action is not PICROTOXIN MOA: known, but drug is thought to - Non -competitive antagonist of GABA bind to dopamine thereby receptors reducing number of episodes STRYCHNINE MOA: CNS STIMULANTS: MOA - Competitive antagonist of the glycin 1. Block neurotransmitters reuptake (Most (inhibitory) receptors reuptake inhibitors affect either NE or 5-HT(Serotonin): Cocaine CNS STIMULANTS: USES 2. Promote neurotransmitters release: Attention deficit hyperactivity disorder Amphetamine drug-induced respiratory depression 3. Block Metabolism - MAO inhibitors postanesthesia respiratory depression (monoamine oxidase) ex.Phenelzine without reduction of analgesia narcolepsy 4. Antagonize the effect of inhibitory sleep apnea neurotransmitter:Picrotoxin & Strychnine exogenous obesity Fatigue CLASSIFICATION: based on their site of action 1. Cerebral stimulants (amphetamines) ADVERSE REACTIONS OF STIMULANTS 2. Medullary stimulants (picrotoxin) Excessive CNS stimulation; headache; 3. Spinal stimulants (strychnine) dizziness; apprehension; disorientation; hyperactivity AMPHETAMINE MOA: Other: Nausea; vomiting; cough; dyspnea; Block the reuptake of norepinephrine and urinary retention; tachycardia; dopamine into the presynaptic neuron and palpitations, anorexia increase the release of these monoamines CNS STIMULANTS: CONTRAINDICATIONS - into the extraneuronal space. - Hypersensitivity INDICATIONS: - Convulsive disorders NARCOLEPSY - Ventilation mechanism disorders - Person unexpectedly falls asleep in the middle of normal day NOTES: - activities. These medications should not be Attention-deficit hyperactivity disorder administred to patients with the following (sympathomimetics) : Elevate blood conditions: pressure; wakefulness; increase or Cardiac problems; severe hypertension; decrease-pulse rate; produce euphoric hyperthyroidism state Amphetamines: Contraindicated in ANOREXIANTS: Suppress appetite glaucoma  Amphetamines and anorexiants should - AMPHETAMINES: used for short not be taken concurrently or within 14 term treatment of exogenous days of antidepressant obesity - Long term use: Causes addiction DRUG INTERACTIONS and abuse Interactant Drug | Effect of interaction Anesthetics - Increased risk of cardiac DISTURBED SLEEP PATTERNS arrhythmias CNS stimulant therapy: causes insomnia; Theophylline - Increased risk of administer early in the day hyperactive behaviors Avoid: Coffee =, tea, cola drinks, chocolate Oral contraceptives and modafinil - Vital signs: checked every 6 to 8 hours Decreased effectiveness of the oral Discontinuation of drugs is needed in the contraceptive presence of adverse reactions. ASSESSMENT INEFFECTIVE BREATHING PATTERN Respiratory depression Analeptic drugs enchance breathing - Always assess the: Blood pattern pressure, pulse, respiartory rate Doxapram: Causes urinary retention; - Note: Depth of respirations: any measure intake and output pattern to respiratory rate (respiratory depression) NOTE: Older adults (geriatric) are more sensitive to - Take blood sample: For arterial CNS stimulants and may exhibit anxiety, blood gas analysis; determine nervousness, insonia, mental confusion effectiveness of analeptic IMBALANCED NUTRITION: LESS THAN BODILY Attention deficit hyperactivity disorder: REQUIREMENT - Amphetamine: Take VS and Weigh Adverse reactions: Use of CNS patient stimulants-child with ADHD decreases - Child with ADHD: Observe for appetite patterns of abnormal behavior Long term treatment: CNS stimulants-retards growth in children OBESITY Frequently check: Height, weight of child - Anorexiant or amphetamine: used to monitor growth for outpatient use Always explain to the family the adverse - Tke vital signs and weigh the reactions of these medication patient before therapy starts and at each outpatient visit ATTENTION DEFICIT HYPERACTIVITY DISORDER Administer drug in the morning 30-45 minutes before breakfast and before NURSING DIAGNOSIS AND PLANNING lunch Disturbed sleep pattern; ineffective breathing pattern; imbalanced nutrition NARCOLEPSY Promoting an optimal response to Record: number of times per day of therapy: sleepless occur Amphetamines and anorexiants  EVALUATION - Mephobexital, thiamylal, Adverse reactions are identified, reported, thiopental and managed Short Weight loss is achieved - Pentobarbital, secobarbital Fewer episodes of inappropriate sleep Intermediate patterns reported - Aprobarbital, butabarbital Child’s behavior, school Long performance-improves - Phenobarbital Respiratory depression: Reversed *** with a narrow therapeutic index… Dosage above the index causes toxicity MOA OF SEDATIVE HYPNOTICS PHARMA DEPRESSANT DRUGS :by inhibiting GABA (Gamma-aminobutyric acid), nerve impulses traveling in the cerebral cortex are also inhibited (effect is you will become weak) CNS DEPRESSANTS (Other term: Sedative) Site of Action (+) inhibitory effect on the CNS resulting - Brain Stem to a DECREASES in: - Cerebral cortex - Nervousness Low doses: Sedative effects - Excitability High doses: Hypnotic effects - Irritability - Without causing sleep * Hypnosis is when you are controlled and you forget what happen SEDATIVE HYPNOTICS Calm or soothe the CNS to the point that USES they cause sleep at high doses (dose Hypnotics dependent) Sedatives Kind of depressant that make the patient A fall asleep Surgical procedures SEDATIVE HYPNOTICS: BARBITURATES SIDE EFFECTS Indication: for insomnia and sedation CNS Habit-forming (there's a chance to - Drowsiness, Lethargy, vertigo, become addictive in a certain drug = mental depression, coma overdose) RESPIRATORY Only a handful commonly used today due - Respiratory depression, apnea, in part to the safety and efficacy of bronchospasms, cough BENZODIAZEPINES GI - Nausea, vomiting, diarrhea FOUR CATEGORIES OF SEDATIVE HYPNOTICS: OTHER BARBITURATES (ends with TAL) Ultrashort  - Agranulocytosis, vasodilation, Balanced anesthesia hypotension, stevens-johnsons syndrome SIDE EFFECTS OF BENZODIAZEPINES Mild and infrequent BENZODIAZEPINES: CNS DEPRESSANT - Headache Mechanism of action - Drowsiness & dizziness Depress CNS activity - Lethargy Affect hypothalamic, thalamic and - Paradoxical excitement limbic(responsible for emotion) systems “hangover effect” of the brain Benzodiazepine receptors Most frequently prescribed sedative-hypnotics CNS DEPRESSANTS NOTES: Most commonly prescribed diagnosis Determine the presence of allergies Sedative-hypnotic or Anxiolytic Obtain baseline vital signs and I & O, [medications that relieves anxiety] including supine and erect BPs Give 10-30 minutes before bedtime for maximum effectiveness in inducing sleep. Most benzodiazepines (except BENZODIAZEPINES flurazepam) cause REM rebound and a Sedative-Hypnotic Type (end in pam) tired feeling the next day; use with caution Long-Acting in the elderly - Flurazepam (dalmane), quazepam Patients should be instructed to avoid (Doral) alcohol and other CNS depressants Short-Acting Check with physician before taking any - Estazolam (proscam), temazepam other medications including OTC (restoril) medications Anxiolytic Type It may take 2-3 weeks to notice improved alprazolam (Xanax) sleep when taking barbiturates chlordiazepoxide (Librium) Abruptly stopping these medications may diazepam (Valium) cause rebound insomnia (bumabalik) lorazepam (Ativan) = r*pe drug Safety is important, keep side rails up midazolam (Versed) THERAPEUTIC EFFECT Drug Effects - Increased ability to sleep at night Calming effect on the CNS - Fewer awakenings Useful in controlling agitation and anxiety - Shorter sleep induction time - Fe side effects, such as hangover effects - Improved sense of well-being because of Therapeutic Uses improved sleep Sedation Sleep induction Skeletal muscle relaxation Anxiety relief Treatment of alcohol withdrawal Agitation Depression Epilepsy TOPIC 5: NERVOUS SYSTEM-ADRENERGIC & ADRENERGIC BLOCKERS SYMPATHETIC NERVOUS SYSTEM AUTOMATICA= automatic - Pupil: dilation SOMA= body (always related to something - Lungs: bronchodilation skeletal) - Heart: increased HR EFFERENT= effect - Blood vessels: constrict AFFERENT= sensory - GI: relax Autonomic always has sensory and motor - Bladder: relax PARASYMPATHETIC = ex. decrease cardiac rate - Uterus: relax SYMPATHETIC= ex. increase cardiac rate AUTONOMIC is all about balancing of going up and going down, it must be always on a normal level, ADRENERGIC RECEPTORS HOMEOSTASIS ALPHA 1 Vascular tissue and muscle, vessels of SYMPATHETIC/ADREGERNIC - agonist smooth muscle EFFECTS: Blood vessel: vasoconstriction - Increase HR. BP. Mydriasis ADRENERGICS - Bladder & Prostate contraction Other names: ALPHA 2 - Adrenergic agonist Post ganglionic sympathetic nerve endings - Sympathomimitics EFFECTS: vasodilation - Adrenomimetics - Decrease in BP, Hypotension Function: mimics the sympathetic - Decrease intestinal motility and neurotransmitters (Epinephrine/Norepinephrine) tone BETA 1 = HEART DRUGS THAT AFFECT THE SYMPATHETIC NERVOUS EFFECTS: Increase H.R SYSTEM - Increase in Myocardial Adrenergic contractility (Sympathomimetics or - Increase in BP Adrenomimetics) BETA 2 = SMOOTH MUSCLES OF LUNGS Arterioles of skeletal muscles and skeletal Adrenergic blocker muscle (Sympatholytics or adrenolytic) EFFECTS: BRONCHODILATION - Increase in blood flow to the skeletal muscle - Relaxation of the uterus - Increase in blood sugar DOPAMINERGIC = Dilation of the arteries in ALBUTEROL (Proventil) Slbutamol ventolin Kidneys, Intestines, Heart and Brain. Increase in MOA: BETA ADRENERGIC agonist Blood Flow EFFECT: Bronchodilation INDICATION; Asthma, Bronchitis, COPD DOPAMINERGIC RECEPTORS CONTRAINDICATION: Don't take with Mao Arteries: Renal, Mesenteric, Coronary, Cerebral Inhibitors >>>> Hypertensive Crisis. Hypertension. Vasodilation (more blood and oxygen go the Cardiac diseases organ) ADVERSE REACTION: Increase in H.R, Tremors, *Dopamine Restlessness, nervousness Classification: NURSE NOTES: Inhalation is faster than oral, Don't Direct acting take with MAO (monoamine oxidase) - Directly stimulate the adrenergic receptors CLONIDINE(CATAPRES) METHYLDOPA (Aldomet) Indirect acting MOA: Selective Alpha adrenergic Drugs - Stimulate the release of EFFECT: Regulate release of Norepinephrine norepinephrine (emergency drug) Stimulate alpha 2 receptors Mixed acting - DECREASE IN BP - Adreneric and norepinephrine INDICATION: Hypertension (sympathetic drug) CONTRAINDICATION: ADVERSE REACTION; Tachycardia, Palpitation CATHECOLAMINES Dysrhythmias, Dizziness, Nausea and vomiting - Produce sympathomimetic response * ** it stop the release of epinephrine - Ex; Epinephrine, Norepinephrine, (parasympathetic) Dopamine (emergency drugs) - XEROSTOMIA - dry mouth - Drink water before giving medication EPINEPHRINE K: Subcutaneous, IV, Topical, Inhalation, Intracardiac, Instillation method. (NO ORAL!) Metabolized in the liver Excretion: Kidneys Purpose: EMERGENCIES - Vasoconstriction (vessel is filled with blood) - Increase cardiac output - Increase in BP - Increase in H.R ANAPHYLAXIS - bronchodilation NOTE: Cardiac dysrhythmias - Renal vasoconstriction > decrease renal perfusion, decrease cardiac output  Check every 5 minutes the BP when - When there is a decrease in blood adrenergic drugs is given to a patient pressure there is an increase in cardiac The main effect of adrenergic drugs are rate (compensatory mechanism) TACHYCARDIA, PALITATION, TREMORS inc. in BP In cardiac resuscitation, the main drug given to the patient is EPINEPHRINE The antidote for norepinephrine and dopamine is PHENTOLAMINE MESYLATE In the IV administration of epinephrine or dobutamine we need to dilute the drug. If undiluted it may cause tissue necrosis (tissue death) - Adrenergic nasal sprays may cause nasal congestion by rebound phenomena (bumabalik) The main side effect of adrenergic drugs are TACHYCARDIA, PALPITATION, DIZZINESS ADRENERGIC BLOCKER OR ANTAGONIST Other names: - Adrenergic antagonist - Sympatholytics BLOCK the Alpha and Beta receptors sites - How: occupies the alpha and beta receptors - Inhibits the release of norepinephrine and epinephrine BLOCK=VASODILATION Never give BETA BLOCKERS if patient has asthma, emphysema, chronic bronchitis Orthostatic hypotension - Sudden decrease in blood pressure due to sudden change of position or movements