1. Pharmacology Drug Classifications & Characteristics of CNS Drugs

2. Objectives Identify purposes and uses of opioid analgesics (narcotics). Describe the mechanisms of action of opioid analgesics. Identify one common narcotic antagonist. Identify common NSAIDs and their properties.

3. Objectives Identify common benzodiazepines and their properties. Identify common antipsychotic drugs and their properties. Identify common antidepressant drugs and their properties. Identify common anticonvulsants and their properties.

4. Opioid Analgesics (Schedule II Drugs) Purpose: Relieve moderate-severe pain by decreasing perception of pain sensations and producing sedation. Action: Bind to opiate receptors in the CNS and interrupt the transmission of pain signals. Produces CNS depression. Ex.: Morphine (Roxanol, MS Contin) Dilaudid, Demerol Uses: MI, renal colic, post-op, terminal cancer, trauma Side Effects: Confusion, sedation, hypotension, constipation, respiratory depression, urinary retention, itching.

5. Narcotic (Opioid) Antagonists Purpose: Reverse CNS depression and respiratory depression from excessive opioid usage. Action: Block the effects of opioid analgesics from binding with receptor sites or displacing those already on sites. Ex.: Narcan® Uses: Reverse post-op opioid depression, relieve CNS and respiratory depression by therapeutic doses or overdoses of opioids.

6. D - Depressed respirations D - Dizzy D - Drowsy D - Drug dependence D - Decreased blood pressure D - Decreased GI peristalsis & urine output

7. Analgesic-Antipyretic-Anti- inflammatory Drugs (NSAIDs) Purpose: Alleviate mild to moderate pain, fever, and inflammation. Action: Inhibit prostaglandin synthesis by inactivating an enzyme (prostaglandin synthetase) necessary for its formation. Refer to table 7-1 on pg. 91. Ex.: Aspirin, Ibuprofen, naproxen, Toradol® Uses: pain, fever, arthritis, musculoskeletal disorders (Aspirin-high risk for MI or stroke, after coronary bypass surgery. Side Effects: Dyspepsia, nausea, abdominal discomfort, gastric bleeding, irritation, ulceration.

8. NSAIDS N o alcohol S ee “birth” below A spirin sensitivity don’t give I nhibits prostaglandins D o take with food S top 5 to 7 days before surgery

9. Benzodiazepines (Schedule IV) Anti anxiety and Sedative-Hypnotic Purpose: To decrease anxiety, promote sedation, induce sleep. Action: Bind with a receptor complex in the brain. Together with GABA they make cells less responsive to neurotransmitters such as norepinephrine. Ex./Uses: Xanax- anxiety & panic attacks, Tranxene- anxiety, Librium-anxiety & alcohol withdrawal, Valium (diazepam)-anxiety, alcohol withdrawal, preoperative sedation, hypnotic, Ativan-anxiety, preop sedation; Versed-preop sedation, sedation before diagnostic tests; Halcion & Dalmane-insomnia (Ambien- miscellaneous-insomnia). Side Effects: Drowsiness

10. A void abrupt discontinuation after prolonged use N ot give if BP, renal/hepatic dysfunction of history of drug abuse X anax, Ativan – a few examples I ncrease in 3D’s – drowsiness, dizziness, decreased BP E nhances action of GABA (inhibitory transmitter) T each to rise slowly from supine Y es, alcohol should be avoided

11. Antipsychotic Drugs Purpose: Control behaviors associated with psychoses- hallucinations, delusions, agitation Action: Alter the effect of Dopamine in the CNS by occupying or blocking dopamine receptors in the brain. Ex.: Thorazine, Mellaril, Haldol Uses: Schizophrenia Side Effects: General-constipation, dry mouth, drowsiness, photosensitivity; Extrapyrimidal reactions (Parkinsonism)- tremors, shuffling gait, muscular rigidity, drooling; Tardive Dyskinesia- sucking & smacking of lips, tongue protrusion, facial grimaces.

12. S edation, sunlight sensitivity T ardive dyskinesia, tachycardia, tremors A nticholenergic, addiction N euroleptic malignant syndrome C ardiac arrhythmias (orthostatic hypotension) E xtrapyramidal (akathesia), endocrine (change in libido)

13. Antidepressants Purpose: To elevate someone’s mood Action: Potentiates the effect of seratonin and norepinephrine in the CNS Ex.: Tricyclic antidepressants*- Elavil; Monoamine Oxidase Inhibitor**-Nardil, Parnate; Selective Serotonin Reuptake Inhibitor-Prozac, paxil, Zoloft Side Effects: *Sedation, orthostatcic hypotension, dry mouth, constipation. **Hypertensive crisis if foods containing tyramine are eaten. Need to avoid aged cheese, alcoholic beverages, bananas, caffeine beverages, large amounts of chocolate.

14. Driving is out until response to drug has been determined Effect has a delayed onset of 7-1 days Planning pregnancy - consult with provider of care Relieves symptoms, not a CURE! Evaluate vital signs Stopping abruptly is OUT! Safety measures (i.e., change position slowly) Instruct client to report undesirable effects Observe for suicidal tendencies No alcohol of CNS depressants

16. Mood-Stabilizing Agent Purpose: Used to decrease an elevated mood (mania) Action: Influences the reuptake of neurotransmitters Ex.: Lithotabs, Eskalith (lithium) Lithium: Primary drug for bipolar disorder (Manic- Depressive disorder). Used to decrease an elevated mood. Side Effects: tremors, HA, drowsiness Special Considerations: Need high sodium diet, need 2,000 to 3000 milliliters of fluid a day.

17. L evel - therapeutic (0.6-1.2mEq/L) I ncreased urination T hirst increased H eadache and tremors I ncrease fluids U nsteady M orton’s salt -adequate intake

18. Anticonvulsants (Antiseizure) Purpose: Control seizure activity Action: Act on abnormal neurons to decrease excitability and responsiveness to stimuli; Prevent spread of impulses to normal neurons around the abnormal ones. Ex.: Dilantin, Phenobarbital, Tegretol, Depakene, Zarontin Uses: Epilepsy, seizure activity Side Effects: Drowsiness, nausea, gingival hyperplasia

19. G ingival hyperplasia U se alternative birth control M outh care - preventative dental check-up S oft tooth brush, don’t stop abruptly

20. Pharmacology 1104 Drug Classifications and Characteristics: CNS and ANS

21. Objectives Identify the purpose and usage of antiparkinson drugs and their properties. Discuss common skeletal muscle relaxants. Discuss general anesthetics. Identify common CNS stimulants and their properties.

22. Objectives Describe the mechanism of adrenergics and their properties. Identify the purpose and use of antiadrenergics. Identify mechanism of action and side effects of antiadrenergics.

23. Antiparkinson Drugs Purpose: Adjust the balance of neurotransmitters to relieve tremors and rigidity. Action: Dopaminergic drugs - increase the amount of dopamine in the brain. Anticholinergic drugs - inhibit the action of acetycholine in the brain. Ex.: Dopaminergic - Lardopa (levodopa), Sinemet, Symmetrel; Anticholinergic - Congentin, Artane Uses: Parkinson’s disease Side Effects: Dopaminergic - nausea, vomiting, orthostatic hypotension; Anticholinergic - constipation, urinary retention, blurred vision.

24. Skeletal Muscle Relaxants Purpose: Decrease muscle spasm or spasticity that occurs in some musculoskeletal or neurologic disorders. Action: General depression of CNS. Ex.: Flexeril, Robaxin Uses: Acute painful musculoskeletal conditions associated with spasms. Side Effects: Dizziness, drowsiness, GI upset.

25. Anesthetic Drugs Purpose: Prevent pain and promote relaxation during surgery, childbirth, diagnostic tests, and other treatments. Action: Depresses CNS resulting in loss of sensation, consciousness, pain perception, and memory. Ex.: General - Gas mixture and oxygen; Regional - Xylocaine (lidocaine), Novocaine Uses: Surgical, diagnostic, and therapeutic procedures Side Effects: Excessive sedation, respiratory/cardiovascular problems

26. CNS Stimulants Purpose: Control symptoms of ADHD and narcolepsy. Action: Produces CNS stimulation, increasing attention span in ADHD and motor activity and mental alertness in narcolepsy. Ex.: Ritalin Uses: ADHD and narcolepsy Side Effects: Insomnia, restlessness, anorexia, weight loss

27. Adrenergic Drugs Purpose: Produce effects in the body that occur when the sympathetic nervous system is stimulated. Action: Combine with alpha or beta adrenergic receptors on the membranes of cells. Ex.: Epinephrine (Adrenalin) - used in allergic reactions, cardiac arrest, hypotension and shock. Dopamine (Intropin) - used in hypotension and shock. Albuterol (Proventil) and terbutaline (Brethine) - used for bronchodilation in obstructive pulmonary disease. Ephedrine and phenylephrine - used for nasal decongestion. Side Effects: Nervousness, restlessness, tremor, hypertension, tachycardia.

28. Antiadrenergic Drugs Purpose: Decrease of block sympathetic nervous system stimulation. Action: Combine with alpha1, beta1, beta2 or a combination of receptors in peripheral tissues and prevent adrenergic effects. Alpha-Adrenergic Agonists and Beta- Adrenergic Blocking Agents

29. Alpha-Adrenergic Agonists Action: Inhibit the release of norepinephrine in the brain thereby decreasing the effects of sympathetic nervous system stimulation. Results in decreased blood pressure. Ex.: Clonidine (Catapres) and methyldopa (Aldomet). Uses: the treatment of hypertension. Do not stop the drug abruptly. Side Effects: Drowsiness, dry mouth, hypotension.

30. Beta-Adrenergic Blocking Agents Action: Occupy beta-adrenergic receptor sites and prevent them from responding to sympathetic nerve impulses, circulating catecholamines, and certain drugs. Ex.: Inderal, Tenormin (not used for arrythmias) Uses: to treat angina, arrythmias, hypertension, myocardial infarction, and migraine prophylaxis. Some are also used to treat glaucoma by reducing intraocular pressure (decreases formation of aqueous humor. Example - Timoptic, Betoptic)

31. Beta-Adrenergic Blocking Agents Side Effects: (Inderal) - Fatigue, weakness, impotence. It can also cause bronchospasms and wheezing. Not given to clients with asthma. It can also cause heart block, bradycardia, and congestive heart failure which can be life threatening.

32. B radycardia L ibido Decreased br O nchospasm C HF, Conduction abnormalities K onstriction E xhaustion, Emotional Depression R educes recognition of hypoglycemia

33. Questions?