NSG3022 Pharm I: Neurological Unit Chapters 17-18
Classification and
Action
Chapter 17
CNS stimulantsAmphetamines-cause
the release of
norepinephrine and
dopamine
Prototype (and noted
drugs)
Methylphenidate
(Ritalin, Concerta)
Modafinil (Provigil)
Therapeutic Uses
ADD –allows patient to
focus on needed
activities, often used in
children. Can also be used
in adults
Used to treat narcolepsy
Chapter 18
CNS depressants
Local Anesthetics
MOA-stopping axonal
conduction by blocking
sodium channels
Blocks feelings of pain
throughout area
infiltrated
Esthers
Procaine is the
prototype
Cocaine
Amides-
Lidocaine-most widely
used
Bupivacaine
General Anesthetics
Produces unconscious
Balanced anesthesiaconcept of using more
Surgery, to treat injuries
Dental procedures
ENT procedures-causes
intense vasoconstriction
Surgeries, procedures
Post-op pain management
via epidural
Labor and delivery
epidural
Used for major surgeries
Adverse Effects
Nursing Implications
Many forms of
Methylphenidate. Short
acting, intermediate and
long acting.
ADEs are overstimulation
Weight loss, sleep
disturbances , CV effects,
Psychosis
Monitor patients weight, sleep
Family therapy
Family education
CNS stimulation followed
by CNS depression
Cardiovascular effects
Allergic reactions (rare
with Amides)
Can prolong labor if used
to treat pain in laboring
patients
Monitor patient VS, cardiac
monitoring
Effects of local anesthesia
Migration of numbness
Monitor for toxic effects, allergic
reactions
Spinal Headache-fluid
replacement, NSAIDs
and blocks painful
stimuli
Inhalation
than one type of
anesthetic to accomplish
the overarching goal of
complete anesthesia
with maintaining safety
Halothane Prototype-no
longer used
Isoflurane-widely used
Surgical anesthesia
Hypotension
Resp. Depression
Cardiac dysrhythmias
Malignant Hyperthermia
Liver damage
Nitrous Oxide-low
anesthetic property,
very high analgesic
property.
Thiopental (pentothal)
Brevital
Used as a supplement to
decrease pain in patients
undergoing general
anesthesia
Used to induce anesthesia
Nausea and vomiting
Benzodiazepines
Potentiates action of
GABA inhibitory
neurotransmitter
principle indications to
treat anxiety, insomnia,
seizures
IV anesthetic
Diazepam (Valium)
Midazolam (Versed)
Used to induce anesthesia
Can be used for Conscious
sedation
CV and Resp. depression
Monitor patient
Reversal agent for Benzos:
Flumazenil (Romazicon)
Propofol (Diprivan) most
widely used IV
anesthetic
Used to induce anesthesia
Can be used for Conscious
sedation
Monitor VS, CV and Resp status.
Dissociative anesthesia
Ketamine (Ketelar)
Children and adults
Resp. depression
Bacterial infection
Propofol infusion
syndrome
Adverse psychologic
IV anesthetics
Barbiturates
Rapidly produces
unconsciousness
CNS depression
CV and Resp depression
Toxic effects:
Pinpoint pupils, Coma,
Resp depression
Monitor patient in PACU
Frequent VS, Cardiac and Resp
status,
Labs to check liver function.
Encourage patient to take deep
breaths to aid elimination of
anesthesia
Observe patient
Keep the patient turned to side
in the event of vomiting to avoid
aspiration
Monitor patient. CV and Resp.
status
O2 saturation
Monitor patient.
patient feels
dissociated from
environment
anesthesia-used for
surgeries, procedures,
burn dressing changes.
Used to treat intractable
depression
Chapter 18 SedativeHypnotics
Treatment of anxiety, for
Sedation, and Sleep
Benzodiazepinespotentiates actions of
GABA-cause depression
of the CNS
Diazepam (Valium)
Alprazolam (Xanax)
Clonazepam (Klonopin)
Lorazepam (Ativan)
Midazolam (Versed)
Benzo-like drugs
Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)
GAD
Insomnia (although use
decreased)
Diazepam and
Midazolam: induce
anesthesia
Diazepam and Lorazepam:
Status Epilepticus
Withdrawal of alcohol
(treats withdrawal
symptoms and also
prevents seizures)
Panic Disorder
Diazepam: spasm,
spasticity
Used for insomnia
Use has increased due to
fewer ADEs than Benzos
Ramelteon (Rozerem)
Insomnia
Works more on sleep
centers in brain
Melatonin Agonist
Activates melatonin
receptors and
reactions
Keep quiet, safe
Teach principle of sleep hygiene
CNS depression-hangover
effect
Sleep related behaviors
Anterograde Amnesia
Respiratory depression
(esp. if used in
conjunction with other
CNS depressants)
ABUSE-difficult to detox
from Benzos
Schedule IV drugs
Category X drug
Monitor patient.
Reversal agent
Flumazenil (Romazicon)
Sleep related behaviors
Less hangover effect than
Benzos
Schedule IV drugs
Not controlled substance
Pt. teaching. Take immediately
prior to going to bed. Rapid
effect
Rapid onset of action
promotes sleep
Barbiturates –profound
CNS depressant drug
old drug, use less since
advent of Benzos
Chapter 21
Neuromuscular
blocking agents- binds
with Ach for binding to
nicotinicM receptors on
the motor end platethis causes muscles to
relax
Thiopental
Secobarbital
Phenobarbital
Succinylcholine
(Anectine) short acting
Pancuronium last 35 to
45 minutes
Induce anesthesia
Seizure disorders
No longer indicated for
treatment of insomnia
due to serious ADEs
Used to facilitate
intubation
To relax muscles during
ECT
Resp. Depression
Suicide
ABUSE
Hangover
Prolonged apnea
Malignant Hyperthermia
Respiratory depression
Hypotension
Long acting agents may be
used during major surgery
to relax major groups of
muscles.
Makes surgery easier for
surgeon
Allows use of less
anesthetic agents
Rarely ordered But the nurse
needs to watch for patient
effects and ADEs
Toxic Symptoms: Coma, Resp.
Depression, Pinpoint pupils
Patient is monitored closely in
PACU