Nervous System Drugs
Terms
undefined, object
copy deck
- 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)
- Dopamine
- 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
-
Ex:Prostigmin
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
- RAS
-
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
- Narcotic
-
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 - Equianalgesia
- 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.
-
Pentazocine
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 - Acetaminophen
-
Tylenol
give to kids and pts. allergic to ASA.
Hepatotoxic (esp. kids) and nephrotoxic - Ibuprofen
- (Advil) NSAID, can give to kids
- ASA OD
- Gastric lavage or emesis followed by admin. of activated charcoal, may need dialysis in severe OD
- Acetaminophen OD
-
(Tylenol)
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
-
propofol
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)
DON'T GO COLD TURKEY!
Teach good oral care, hyperplasia of gums -> gingivitis, can decrease efficacy of b.c.