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Nervous System Drugs


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Nursing interventions for sympathomimetic drugs
Monitor vital signs, urine output, hydrate, EKG, pupils, bowel sounds, constipated?, IV pump, monitor IV site for infiltration
Phenylephrine: Category, brand name, action, indication, s/e
Category: Alpha agonist Brand Name: Neosynephrine
Action: vasopressor for alpha receptors in vascular system (Vasoconstriction). Renal perfusion and CO are decreased, BP incr., opens nasal passages in a cold by constricting b.v. to reduce swelling
Indications: tx of vascular failure in shock, drug-induced hypotension, nasal congestion, mydriasis
S/E: ha, restlessness, bradycardia,
Isoproterenol: category, brand name, action, indication, s/e
Category: Beta agonist
Brand Name: Isuprel
Action: increases CO, decrease peripheral resistance
Indications: tx heart failure, adjunct tx for cardiac arrest, tx certain arrhythmias, tx bronchospansms in asthma and COPD
S/E: tachycardia
Albuterol: category
B-2 agonist, cause bronchodilation
Examples of indirect acting sympathomimetic drugs
Amphetamines, Ritalin
Adrenergic Antagonists
AKA: sympatholytic- block sympathetic response.

Interfere w/ transmission of impulses to adrenergic neuroeffectors
Mechanisms of sympatholytics
Block receptor site, deplete stores of NE, or inhibit sympathetic acivity directly acting on CNS
Alpha blockers: example, indication, side effects
Example: prazosin (Minipress)
Indication: tx htn, CHF
S/E: orthostatic hypotension -> avoid heat, change positions slowly, dizziness, ha, drowsiness, weakness, lethargy, tachycardia, nasal congestion
Nonselective Beta Blockers
Example: propranolol (Inderal) Affects B1 & B2
Indication: cardiac arrhythmias, MI, HTN, migraine prophylaxis, angina
Action: decreases hr (B1)-> dec. CO and BP, decr. release of renin
S/E: bronchospasm, hypoglycemia, and peripheral vasoconstricion (c/i in asthma and copd)
Nursing Mgt. for Adrenergic Blockers
Monitor BP, HR, bronchoconstriction, RR decr., ingreased GI, urination, hyperactive BS, gastric irritation (prod. too much HCl)
Nonselective adrenergic agonist (affinity and efficacy for A and B)
Cholinergic drugs
AKA: Parasympathomimetic, cholinomimetics, muscarinic

Mimic PSNS
Direct acting muscarinic agonists: Example, action, indication, s/e
Example: Pilocarpine
Indications: tx glaucoma, inducing miosis
Action: stim. cholinergic receptors, increases outflow of aqueous humor
S/E: htn, tachycardia, brochiolar spasm, pulmonary edema, salivation, diaphoresis, n/v
Tx of glaucoma
Adrenergic Agonists: decrease production of aqueous humor
Cholinergic agonists and B blockers: opens canals of Schlemm
Direct Acting Nicotinic Agonists
Example: Nicotine
Action: CNS stimulant of nicotinic receptors
S/E: peripheral vasoconstriction, tachycardia, ha, fatigue, insomnia, nervousness, nausea, hot flashes, diarrhea, dry mouth
Nursing Measures for Cholinergic Drugs
decreased BP, HR, Increased GI motility and secretions(gastric irritation), diarrhea, hyperactive b.s., increased urinary output, decreased RR
Indirect Acting Cholinergic Drugs
Interact with AchE...inhibits degradation of Ach->increased PSNS effect
Indirect Acting Cholinergics Example
Indications: postop reversal of anesthesia, tx of Myasthenia gravis, tx postop bladder distension, CHEMICAL WARFARE
Action: inhibits post-synaptic AChE->incr. Ach
S/E: n/v, diarrhea, salivation, sweating, peripheral vasodilaton, bronchial constriction, and respiratory arrest. Diarrhea, miosis, and diaphoresis, sinus bradycardia, incr. bronchial secretions
Toxic effects of anti-AchE drugs
Miosis, hypotension, vasodilation, bradycardia, salivation, intestinal spasm, n/v, bronchial secretions and spasm->resp. arrest, blockage of NM junctions->paralysis of ALL muscles incl. diaphragm
Tx of anticholinesterase poisoning
Prevent further absorption (remove clothing, wash skin w/ cool water and soap, gastric lavage), resp. assistance, Give ATROPINE and 2-PAM CHLORIDE
Muscarinic Blockers
AKA: antichoinergic drugs, anticuscarinic drugs, parasympatholytics, and cholinergic antagonists.
Ex: atropine and ipratropium
Actions: antagonize effects of acetylcholine controlled by PSNS, interrupts PSNS control,
Indication: anesthesia induction, bradycardia, PEA,
Action: inhibits autonomic postganlionic cholinergic receptors (GI, pulmonary smooth muschle, heart, and eye) Reduction in salivary, bronchial, and sweat gland secretions, mydriasis, changes in heart rate, , decr. gastric secretion and motility, inhibits vagal control
S/E: blurred vision, dry mouth, constipation, and urinary retention
Nursing considerations for muscarinic blockers
increased risk of dental problems b/c decreased oral secretions, dries up secretions, decr. urine output, increased retention
Reticular Activating System
-network of neurons throughout brainstem, regulates CONSCIOUSNESS and levels of alertness
-regulates sensory and motor activity by filtering the process that allows for concentration
-target for amphetamines, barbituates, and anesthetics
Limbic system
subcortical structure that surrounds the corpus callosum
regulates visceral motor function and emotional behavior
-target for benzodiazipines and morphine
Extrapyramidal system
somatic motor pathway located in the CNS that affects skeletal muscles
associated w/ coordination
Excitatory neurotransmitters
Ach, NE, and dop
Inhibitory Neurotransmitters
Serotonin, GABA, and Neuropeptides
Somatic Pain
Arises from skeletal muscles, ligaments, vessels, or joints
1. any analgesic derived from active opium poppy alkaloids as well as compounds similar to alkaloids
2. any drug that can produce dependance or is restricted by the Controlled Substances Act
WHO 3-step ladder for pain relief
1. Mild pain (1-3) non-opioid analgesic
2. Moderat pain (4-6) non-opiod w/ adjunctives (antidepressent, anticonvulsant, aor local anesthetic), weak opiods
3. Severe pain (7-10) all of above and strong opioids
determining equal doses when changing drugs or routes of administration. Use morphine as a base equivalent
Morphine S/E
S/E: release histamine (bronchoconstriction), decrease cough mechanism, n/v, miosis, decr. GI, decr. urine output, vasodilation (can be used w/ MI to reduce heart stress and BP), flushing, incr. glu, contraindicated in biliary spasms.
Codeine S/E
Same as morphine only w/out the vasodilation.

Used commonly for cough suppressant
Nurisnt implications for narcotics
Monitor v.s. (expect decreased RR, BP, and BS, increased HR), assess LOC, encourage fluids and roughage
Narcotic Agonist-Antagonist Analgesics general
Don't know how they work, lower dependancy potential than opioids w/ fewere withdrawal symptoms
Narcotic agonist-antagonist analgesics ex.

Pharmacokinetics, adverse effectrs, and side effects similar to MSO4`
Opioid antagonists
Competitively displace the opioid analgesics from receptor sites

Reverse opioid overdose

Ex: Narcan
Non-Narcotic Analgesics Mechanisms of action
Relieve mild to moderate pain w/out altering consciousness

Inhibit the synthesis of prostaglandins and prevent bradykinin from stimulating nociceptors

Affect hypothalamic center by inhibiting the recognition of pain

Antipyretic actions by causing peripheral vasodilation

ASA and ibuprofen have anti-inflammatory properties

inhibit plt. aggregation
Aspirin category
Salicylates, NSAIDs.

Decreased incidence of AD, Colon CA, teach to monitor bleeding, don't give with coumadin

DON'T GIVE TO KIDS <16...Reye's syndrome

give to kids and pts. allergic to ASA.

Hepatotoxic (esp. kids) and nephrotoxic
(Advil) NSAID, can give to kids
Gastric lavage or emesis followed by admin. of activated charcoal, may need dialysis in severe OD
Acetaminophen OD

Gastric lavage, Mucomyst ASAP
Post-anesthesia nursing considerations
anesthesia causes vasodilation and hypothermia. Monitor LOC, neuro checks
Inhaled anesthesia, disadvantages
Nitrous oxide, Forane

Disadvantages: Bad n/v post-op
Parenteral anesthesia, disadvantages

disadvantages: needlestick, can't reverse after given (if give too much, too fast)
Nursing care for regional/local anesthetics
Example: lidocaine

don't eat or drink for 4-6 hours, monitor for safety, neurochecks
Barbituates characteristics, indications, examples, interactions
Special site on GABA receptors (esp. RAS), causes CNS depression

Indications: sleep, anticonvulsant

Example: phenobarbital

Interactions: enzyme inducers (lowers serum level of some drugs) by increasing drug metabolism, decreases effects of MAOIs, additive effect w/ CNS depressants
Benzodiazipines characteristics, indications, example, why better than barbituates
Indications: sleep, anticonvulsant, anxiety, ETOH withdrawal, preop med

Action: affects limbic system and hypothalamus, increase activity or release of GABA

Example: Lorazepam

Preferred b/c better margin of safety, less likely to react w/ other drugs, less potential for dependance
Mgt. of benzodiazipine OD
Administer IV benzo antagonist and vasopressors like NE or dop. for hypotension

Give activated charcoal

gastric lavage or promote emesis if conscious
Mgt. of barbituate OD
NO antagonists!!!

Gastric lavage and admin. activated charcoal, alkalize urine and diurese pt., mainly supportive
Nurse's role in sedative hypnotic therapy
Don't drive, safety, no ETOH or heavy machinery.

Asians are poor metabolizers and require lower doses
Anticonvulsant characteristics
Used to treat seizures

Mode of action not known

Classifications: Hydantoins (Dilantin)


Teach good oral care, hyperplasia of gums -> gingivitis, can decrease efficacy of b.c.

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