Understanding-Neuropharmacology.docx

***Understanding Neuropharmacology*** ***Exploring the ANS, PNS, and CNS*** **ANS Medications**- regulation of the heart, regulation of secretory glands (salivary, sweat,gastric bronchial glands ), regulation of smooth muscles (bronchi, blood vessels,urogenital, GI tract) - Sympathomimetics (Ad...

***Understanding Neuropharmacology*** ***Exploring the ANS, PNS, and CNS*** **ANS Medications**- regulation of the heart, regulation of secretory glands (salivary, sweat,gastric bronchial glands ), regulation of smooth muscles (bronchi, blood vessels,urogenital, GI tract) - Sympathomimetics (Adrenergic Agonists) - Parasympathomimetics (Cholinergic Agonists) - Sympatholytics (Adrenergic Antagonists) - Parasympatholytics (Anticholinergics) *MIMICS EACH SYSTEM* +-----------------------------------+-----------------------------------+ | SYMPATHOMIMETIC | PARASYMPATHOMIMETIC | | | | | (Adrenergic Agonist drugs) - | (Cholinergic drugs) releases | | Epinephrine & Norepinephrine = | Acetylcholine that is responsible | | Treatment for Shock, Hypotension | to activate the muscarinic | | and Asthma Exacerbation | receptors | | | | | DOBUTAMINE- | PYRIDOSTIGMINE= Tx for Myasthenia | | | Gravis | | DOPAMINE- | | | | Myasthenia Gravis is a decrease | | NOREPINEPHRINE- | in | | | | | EPINEPHRINE- | Acetylcholine: Cholinergic Fibers | | | in Post ganglionic membranes | | BETA 2 ADRENERGIC AGONISTS | | | | Side effects: ALL except GIT/ GUT | | Side effects: ALL except GIT/ GUT | | +-----------------------------------+-----------------------------------+ - **SYMPATHOMIMETICS (Adrenergic Agonists)** Stimulate the Adrenergic receptors (alpha & beta receptors) +-----------------------------------+-----------------------------------+ | **Alpha**- Vasoconstriction walls | **Beta**- Increases HR and | | of the blood vessels of the skin | Contractility / Vasodilation and | | | Bronchodilation | | GIT & GUT | | | | beta 1- heart | | | | | | beta 2- Smooth muscles & Lungs | +-----------------------------------+-----------------------------------+ [Mechanism of Action]: Treatment for Shock, Hypotension and Asthma Exacerbation Alpha-1 Agonists: contraction of smooth muscle in blood vessels and increased systemic vascular resistance. Alpha-2 Agonists: acts on the central nervous system to reduce sympathetic outflow, resulting in decreased blood pressure and heart rate. Beta-1 : cardiac function, increasing heart rate and contractility. Beta-2: affects the bronchial smooth muscle, leading to bronchodilation, and can also affect uterine and vascular smooth muscle. Alpha: Phenylephrine (a1 agonist)- increases BP and nasal degongestant Epinephrine (a1,a2,b1 and b2) -increases HR & BP and bronchodilates Norepinephrine (a1 & b1) - increase BP & cardiac output Beta: Dobutamine (b1 agonist)- increase heart contractility Dopamine (b1 agonist)- increase BP and renal perfusion Albuterol (Salbutamol) - (b2 agonist- acute asthmatic attacks Side effects: ALL except GIT/ GUT DOBUTAMINE- post-cardiac arrest after shock and bradycardia DOPAMINE-post cardiac arrest after shock and bradycardia NOREPINEPHRINE- hypotensive patients and shock EPINEPHRINE- anaphylactic reactions, cardiac arrest, & shock BETA 2 ADRENERGIC AGONISTS- acute asthmatic attacks [Contraindications: ] Hypertensive patients Pregnant and breastfeeding mothers Those with coronary artery disease Tachyarrhythmias Ventricular Fibrillation Angina Pectoris [Interactions: ] Combining sympathomimetics leads to sympathomimetic toxicity and cardiac problem [Nursing Considerations: ] Monitor Hemodynamic Status Titration of doses Monitor Side effects - **Parasympathomimetics (Cholinergics)** System that releases Acetylcholine that activates muscarinic receptors Produces 3S secretions Side effects: 1\. Lacrimation 2\. Hypersalivation - Secretory glands 3\. Increase Urinary frequency & Bowel Function) [Adverse effects: ] hypotension bradycardia Cholinergic toxicity- DOB, decrease HR and excessive tearing and sweating Contraindications: not given with genitourinary and gastrointestinal obstruction, asthma, copd, parkinsons and seizures [Nursing Considerations:] Review Laboratories - urinalysis Assess urinary status Increase fluid intake and empty every 4 hours Teach the patient about common side effects like diarrhea, urinary frequency, bradycardia **INHIBITS EACH SYSTEM** - **SYMPATHOLYTIC** **(Adrenergic Antagonists)** = Tx for Hypertension & Anxiety BETABLOCKERS Ex. Propanolol Side Effects: HR, BP, & Bronchoconstriction - **PARASYMPATHOLYTIC** **(Anti- Cholinergic)** - Stopping the release of Acetylcholine = Tx for Asthma & COPD Airway: Ipratropium (Bronchodilation) Asthma Side Effects: HR, and Pupil Dilation after Surgery **CNS Medications** - Antidepressants - Antipsychotics - Anxiolytics - Mood Stabilizers - Stimulants - Substance Abuse: Uppers and Downers - Antiepileptics - Anti-Parkinsons - Sedatives & Hypnotics - **Antidepressants** are a type of medicine used to treat clinical depression, OCD and PTSD **1. SSRI- Selective Serotonin Reuptake** Inhibitor **(- ine**) [Side effects: ] Sexual Dysfunction Seizure Serotonin Toxicity **2. TCA - Tricyclic Antidepressants** **(- triptyline/ pramine)** Clomipramine (Anafranil) Elavil (Amitryptiline) Desipramine (Norpramine) Tofranil (Imipramine) [Side effects: ] Cardiotoxicity Cardiac Arrhythmias **3. MAOI ( Monoamine Oxidase Inhibitor)** paRnate (Tranylcypromine) naRdil (Phenelzine) maRplan (Isocarboxacid) [WOF:] Hypertensive Crisis [Avoid TYRAMINE FOODS:] Aged Cheese/ Avocado Beer/ Banana Canned foods/ Chocolates - Antipsychotics / Neuroleptics/ Major Tranquilizers +-----------------------------------+-----------------------------------+ | Typical | Atypical | | | | | (Old Generation) | (New Generation) | | | | | \- azine/peridol | \- done/pine | | | | | Haloperidol | Clozapine | | | | | Droperidol | Clozarine | | | | | | Quetiapine (seroquel) | | | | | | Risperidone | +-----------------------------------+-----------------------------------+ [Side Effects:] Acute Dystonia Pseudoparkinsonism Akathisia Tardive Dyskinesia [Adverse Effects:] NMS- Neuroleptic Malignant Syndrome (Malignant Hyperthermia) Fever Elevated VS Enzymes Risk for Seizure - **Anxiolytics / Benzodiazepines -** \- pam/ zolam/ zepine Diazepam (Valium) Alprazolam (Xanax) Lorazepam (Ativan) Clonazepam (Rivotril) Midazolam (Versed) [Side Effects: ] Dizziness Drowsiness Confusion Hypotension [Nursing Responsibilities: ] Do not drive Take before meals Taper the dose to prevent withdrawal symptoms: Course tremors,Seizures and delirium Taper the dose for 2 weeks Withdrawal symptoms: Tremors, Seizure and Delirium Antidote: Flumazenil - **Mood Stabilizers / Anti Manic** Lithium/ Eskalith Therapeutic Level: 5-1.2 mEq/L Elderly: \ Hypertensive Crisis [Nursing Considerations] Child with ADHD - inattention, hyperactivity & impulsivity Assess for the Baseline status : Height , Weight, Cardiac status, Mental Status, Sleep Pattern, Nutritional hx Laboratories: CBC, ECG and Liver and renal tests Immediate release medication: Instruct the patient to take medication twice a day: 1 tab after breakfast & 1 tab in the afternoon Extended release medication: Instruct the patient take the tablet after breakfast Transdermal patch: Clean,Dry, and non hairy skin same time each day Instruct to never discontinue the medication abruptly - **Subtance Abuse** +-----------------------------------+-----------------------------------+ | **UPPERS** | **DOWNERS** | | | | | Caffeine | Alcohol | | | | | Nicotine | Opioids | | | | | Amphetamines | Narcotics | | | | | MDMA |  | | | | | Metamphetamine | MOA: decreases CNS/ VS | | | | | Marijuana | Withdrawal: Increases CNS | | | function / VS, pupillary | | MOA: Increases CNS/ VS | constrict & dilate, seizure, | | | photosensitivity | | Withdrawal: Decrease CNS function | | | / VS | intoxication- psychosis- dopamine | | | | | intoxication- psychosis- dopamine | | +-----------------------------------+-----------------------------------+ - A**ntiepileptics** MOA: supresses discharge of neurons within a seizure focus area and decreases spread of seizure activity to other areas of the brain. Uses: Partial or generalized seizure and status epilepticus WOF: Phenytoin (Dilantin)- gingival hyperplasia Carbamazepine (Tegretoin)- Visual and balance problems Valproic Acid (Depakene) - GI upset, Hepatoxicity [Contraindications: ] Hypersensitivity Pregnancy [Nursing responsibilities:] Do not mix IV dilantin to other medications Taper doses and teach the patient to not stop abruptly Do not give Tegretol with grape fruit When taking dilantin, encourage routine prophylactic dental care - **Antiparkinsons** MOA: to alleviate the symptoms of Parkinson\'s Disease - a slow progressive movement disorder due to decrease in the neurotransmitter called DOPAMINE Levodopa - most effective medication for the early phase of Parkinson\'s disease paired with Carbidopa **LEVODOPA + CARBIDOPA = SINEMET** Carbidopa prevents the absorption of levodopa in the blood stream. This will increase the availability if levodopa to enter the brain of the patient [Side effects: ] Nausea and Vomiting Dizziness or Lightheadedness Dyskinesias Hallucinations or Confusion Sleep Disturbances Mood Changes Impulse Control Issues Dark Urine or Sweat [Nursing Responsibilities: ] Instruct the patient to not take vit B6 (Pyridoxine) it decreases the absorption of levodopa WOF signs of Psychosis - **Sedatives / Hypnotics - relieves anxiety and insomnia** +-----------------------------------+-----------------------------------+ | **Non Benzodiazepines Sedative | **Barbiturates** | | Hypnotics** -potentiate actions | | | of the inhibitory | Anxiolytics and Sedative | | neurotransmitters throughout the | Hypnotics | | CNS. Depress neuron function in | | | the CNS by enhancing the action | Preoperative sedation | | of an inhibitor of | | | neurotransmission (GAMA) | Anesthesia induction | | | | | Zolpidem (Ambien) | Convulsion | | | | | EsZopiclone (Lunesta) | Induce Coma | | | | | Zaleplon (Sonata) | (-barbital) | | | | | Uses: Insomia | Butabarbital | | | | | Contraindications: pregnancy, | Pentobarbital | | lactation | | | | Phenobarbital | | Side effects: Daytime drowsiness | | | (Zolpidem), dizziness and | Side effects: | | confusion | | | | drowsiness | | Sleep related complex behaviors - | | | no memory of an activity, | dizziness | | drowsiness, sleep driving | | | | Confusion | | Nursing Considerations: | | | | Bradycardia | | Teach the patient to not chew the | | | extended release medications | Syncope | | | | | Teach the patient to not mix the | Hypotension | | medication with alcohol | | | | Adverse reactions: | | Teach the patient the measures on | | | how to enhance sleep pattern | Steven Johnsons Syndrome- Life | | | threatening rash | | | | | | respiratory depression | | | | | | Coma | | | | | | Contraindications : Do not | | | combine with other CNS | | | depressants | +-----------------------------------+-----------------------------------+ [Nursing Considerations] Assess mental status, VS Laboratory values Teach the client why the medication is prescribed Teach the patient to avoid driving and other activities that requires thinking, and observe dangerous sleeping behaviors Obtain a pregnancy test. This can harm the fetus. Avoid mixing with grapefruit and alcohol Taper doses and do not stop abruptly watch for the development of rash PNS Medications \- Responsible for the Sensory & Motor functions **Neuromuscular Blockers** **Local Anesthetics** **Muscle Relaxants** - **Neuromuscular Blockers** Prevents the Acetylcholine at Neuromuscular Junction or inhibits the contraction of Skeletal Muscle -Depolarizing: Succinylcholine: Used for rapid sequence intubation -Non-Depolarizing: Rocuronium: Used for muscle relaxation during surgery [Side Effects:] Accumulation of Succinylcholine Severe muscle rigidity Hyperthermia [Side Effects] hypotension tachycardia prolonged paralysis [Nursing Considerations: ] requiring vigilant monitoring of neuromuscular function and reversal agents like neostigmine. - **Local Anesthetics** reversibly blocks the pain sensation especially when performing surgeries blocking sodium channels - pain that signals the brain **-caine** lidocaine tetracaine procaine cocaine Topical Anesthesia - **Muscle Relaxants** Antispastic drugs reduce tightness in the muscle through various mechanisms in the brain and directly within the muscle tissue Antispasmodic drugs stops the spontaneous or involuntary contraction of muscles (such as jerks, twitches, or cramps) that cause spasms Injury or trauma Muscle strain Poor posture Spinal conditions (eg, scoliosis) Neurological conditions (eg, multiple sclerosis and cerebral palsy) Nerve inflammation or compression (sciatica) Centrally Acting - depressing neural activity in the CNS Direct Acting - inhibits the release of calcium ions from the muscle itself. *Antispastic:* Baclofen (Lioresal) Dantrolene (Dantrium) Tizanidine (Zanaflex) Diazepam (Valium) *Antispasmodics:* Tizanidine (Zanaflex) Diazepam (Valium) Carisoprodol (Soma) Chlorzoxazone [Side effects: ] - [neuro ] restlessness anxiety seizures Loss of consciousness - [cardio]: Hypotension Bradycardia decrease cardiac output