CENTRAL NERVOUS SYSTEM SPINAL CORD

- major communication link bet PNS (spinal

nerves) and brain
NEURON
- integration of incoming info and produces
- receive stimuli and transmit action potentials
responses through reflex mechanisms

AXONS (Nerve Fibers)

➢ slender processes of uniform diameter and
BRAIN
may vary in length from a few mm to more
- contained in the cranial cavity
than a meter
- control center for many of the body’s
➢ usually, there is only 1 unbranched axon per
functions
neuron
- parts of the brain:
○ Collateral Axons: rare branches
a. Brainstem
ACTION POTENTIAL
- connects spinal cord and cerebellum to the
➢ electrical impulses due to a temporary shift
remainder of the brain.
(from a negative to positive) in the neuron’s
- contains 10 pairs of cranial nerves.
membrane caused by ions suddenly flowing
- damage to small areas of the brainstem can
in and out of the neuron.
cause death
➢ when action potentials are received:
○ sensory cells: sight, hearing, and
touch
○ complex mental activities:
conscious thought, memory, &
emotions
○ contraction of muscles and the
secretion of certain glands

NEUROTRANSMITTERS
- endogenous chemical messengers which
transmit signals across a chemical synapse,
from one neuron to another “target” neuron,
muscle cell, or gland cell.
- neurotransmitters are released from synaptic
vesicles in synapses into the synaptic cleft,
where they are received by neurotransmitter
receptors on the target cells.

b. Cerebellum
➢ Flocculonodular lobe:
○ control balance and eye
movements
➢ Vermis & the medial part of the
lateral hemispheres:
○ control pressure,
locomotion, and fine motor
coordination
➢ Lateral hemispheres:
○ involved with the planning,
practice, and learning of
complex movements
(dancing, playing, sports)

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
 c. Diencephalon
➢ located bet the brainstem and cerebrum
➢ consists of: Thalamus, Subthalamus,
Epithalamus, & Hypothalamus
➢ hidden in the brain bc it hosts a lot of very
impt function
➢ Hypothalamus:
○ main visceral control center of the
body and its vitally impt to overall
body homeostasis
○ functions:
■ autonomic control center
(HR, BP, etc)
■ center for emotional
response/behavior
■ body temp regulation
■ regulation of food intake
■ regulation of water
balance
■ control of endocrine BASAL NUCLEI
system functioning - include the corpus striatum (caudate and
■ mammillary bodies are lentiform nuclei), subthalamic nuclei, and
reflex centers of olfaction substantia nigra
- impt in controlling motor functions (mobility)

LIMBIC SYSTEM
- includes parts of the cerebral cortex, basal
nuclei, the thalamus, hypothalamus, and
olfactory cortex
- involved in long-term memory, reproduction,
nutrition, emotional interpretation of sensory
input, and emotions in general

d. Cerebrum
- consists of 2 hemispheres (L & R),
separated by the longitudinal
fissure PAIN
- responsible for complex sensory
and neural functions and - unpleasant sensory and emotional
coordination of voluntary body experience associated wt either actual or
movements potential tissue damage
- management should be individualized and
has constant evaluation throughout the
treatment to determine the effectiveness of
the pain medication

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
 - Pain is subjective: it involves psychological
ACUTE sudden onset
experience from the physiologic stimulation. PAIN (min - hrs)

CHRONIC persistent &

recurring (>6
PAIN - level of stimulus to
wks)
THRESHOLD produce a painful
sensation.
- ex: you may not find a
small pinch to be painful
& a knife stab may be
painful for you. But for
some people, a small
pinch is already painful.
- quality of pain for you to
consider a stimulus to be
painful.

PAIN - amt. of pain the px can

TOLERANCE handle
- ex: when you start to lift
50 kg of rice, it becomes
painful for your back after
carrying it for 10 mins.
- amt. of pain you consider,
before you give up.

Remember: The ultimate goal of pain management is PAIN MANAGEMENT LADDER

freedom from pain.
STEP 1: nonopioid (wt or w/o adjuvant medication)
4 PROCESSES OF NOCICEPTION: STEP 2: mild to moderate pain; opioids wt or w/o
1. TRANSDUCTION non-opioids & wt or w/o adjuvants
- injured tissue emits chemical STEP 3: moderate to severe pain; opioids wt or w/o
mediators to convey the signal of non-opioids & wt or w/o adjuvants
pain. ARACHIDONIC ACID PATHWAY
2. TRANSMISSION - arachidonic acid released from
- pain sensation travels from spinal phospholipids in cell membrane from the
cord to the brain. event/injury and metabolized by either
3. PERCEPTION OF THE BRAIN prostaglandin (PG) pathway or leukotriene
- understanding of pain by the brain. (LT) pathway.
4. MODULATION - Prostaglandin: induces inflammation and
- brain stem release promotes alteration in vascular responses
neurotransmitters that block the
pain impulses. Prostaglandin Prostacyclin
- sometimes, or tolerance to pain is (Cyclooxygena (PGI2)
due to our ability for modulation. Arachidonic se)
Acid Thromboxane
A2
SOMATIC PAIN skeletal muscles,
ligaments, & joints Leukotriene Leukotrine
(Lipoxygenase
VISCERAL PAIN organs & smooth )
muscles

SUPERFICIAL PAIN skin & mucous CNS STIMULANTS

membrane

VASCULAR PAIN vascular & perivascular ➢ drugs that enhances the activities of
tissues neurotransmitters: dopamine, NE, serotonin
➢ types:
REFERRED PAIN pain extends to ○ AMPHETAMINES
neighboring tissues ○ ANALEPTICS
○ ANOREXIANTS
NEUROPATHIC PAIN nerve pains
1. AMPHETAMINES
PHANTOM PAIN body part has been
removed
(surgically/traumatically) ➢ Action: acts on cerebral cortex and
reticular activity system
CANCER PAIN pressure to organs ➢ Indication:
○ ↑wakefulness in
CENTRAL PAIN tumors, trauma, or narcolepsy***
inflammation to the ○ ↑attention span, cognition
brain
○ ↓hyperactivity,
PSYCHOGENIC PAIN psychological factors impulsiveness,
restlessness of ADHD
➢ Narcolepsy: A sleep disorder that
affects the control of sleep and

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
 causes overwhelming daytime
drowsiness.
examples of Amphetamines
CNS DEPRESSANTS
ADHD Narcolepsy
- Action: drugs that have a CNS inhibitory
- Methampheta - Modafinil
mine (Provigil) effect
(Desoxyn) - Pemoline - types of CNS depressants:
- Amphetamine (Cylert)
(Adderall)
- Dextroamphet SEDATIVES SEDATIVE-HYPNOTIC
amine S
(Dexedrine)
- Methylphenidat - reduce - Low doses:
e (Concerta, nervousness, calm CNS w/o
Rifampin) excitability, and inducing sleep
irritability - High doses:
without calm CNS and
2. ANALEPTICS causing sleep causes sleep;
also causes
➢ Action: stimulates CNS by either respiratory
increasing neuronal discharge OR depression
inhibiting neurotransmitters
➢ Indication: - classifications of CNS depressants:
○ reversal of anesthesia-induced - Barbiturates
respiratory depression - Benzodiazepines
○ stimulate respiration in newborns - Non-benzodiazepines
○ examples of Analeptics:
■ Methylxanthines 1. BARBITURATES
● Aminophylline
● Theophylline ➢ Action:
● Caffeine ○ inhibits GABA, which inhibits nerve
■ NoDoz impulses in the cerebral cortex
■ Doxapram (Dopram) ○ suppresses REM sleep
➢ Indication: hypnotics, sedatives,
anticonvulsants, anesthesia
3. ANOREXIANTS ➢ Habit forming & has low therapeutic index
➢ types:
➢ Action: suppress the appetite control center a. ULTRASHORT-ACTING
in the brain - used as GENERAL
➢ Indication: obesity ANESTHETIC
➢ example: Dextroamphetamine (Dexadrine) - ex: thiopental sodium
(Pentothal)
CNS Stimulants: Drug Interactions b. SHORT-ACTING
- +Caffeine = ↑effects - induce SLEEP, controls
- ↓effects of decongestants, antiHPN, CONVULSION, and no
barbiturates* residual drowsiness
- May alter insulin effects - ex: pentobarbital
(Nembutal), secobarbital
CNS Stimulants: SE/AD (Seconal)
- tachycardia. palpitations, dizziness, HPN c. INTERMEDIATE ACTING
- sleeplessness, restlessness, nervousness, - induce and SUSTAIN
tremors, irritability SLEEP, for CONVULSION,
- ↑ hyperactivity but causes RESIDUAL
- anorexia, dry mouth, vomiting, nausea, DROWSINESS (hangover
diarrhea, weight loss effect)
- thrombocytopenia - ex: amobarbital (Amytal),
butabarbital (Butisol)
CNS Stimulants: CI/P d. LONG-ACTING
- C: Glaucoma, severe CV diseases - used to control seizures
- P: psychosis, pregnant & breastfeeding - ex: phenobarbital
women
Remember: Barbiturates are notorious
CNS Stimulants: Nsx Action ENZYME INDUCERS; it stimulates liver enzymes,
- give before breakfast & lunch which speeds up drug metabolism resulting to
- report arrhythmias, seizures, palpitations, shortened duration of drug action.
liver problems
- Record height, weight, and growth of 2. BENZODIAZEPINES
children
- avoid alcohol and caffeine ➢ Actinon: Interacts wt GABA to
- use sugarless gum to relieve dry mouth reduce neuron excitability; DO NOT
- do not stop abruptly: taper SUPPRESS REM sleep

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
 ➢ Indication: agitation, anxiety, CNS Depressants: Nsx Action
alcohol withdrawal, preoperative - assess health and drug gx, monitor VS, and
sedation, insomnia, seizure, I/O: including supine & erect BPs
skeletal muscle relaxation - give 15-30 min before bedtime
- monitor “hangover effect”, use wt caution in
elderlies, and ensure safety measures (fall
types:
risk)
LONG-ACTING SHORT-ACTING - avoid alcohol and other CNS depressants
- WOF rebound insomnia 3-4 wks after drug
- Estazolam - Temazepam being discontinued
(Prosom) (Restoril)
- Flurazepam - Triazolam
(Dalmane) (Halcion) ANTICONVULSANTS
- Others
SEIZURE
➢ abnormal electrical discharges from neurons
pre-op medications characterized by loss of consciousness and
convulsive movements
Hydroxyzine (Vistaril) Lorazepam (Ativan)

- can be given - can be given Seizure Disorders

IM or PO IM, PO, or IV
- you will feel push CONVULSION EPILEPSY
relaxed then - you will feel
sleepy calmer and - sudden, - chronic
then become violent, recurrent
more sedated irregular occurrence of
movement of a 2 or more
- watch for - watch for limb/of the unprovoked
drowsiness, retrograde body, caused seizure
dry mouth. amnesia, by involuntary episodes
dizziness, unsteadiness, contraction of
ataxia, pain wt drowsiness, & muscles and
IM injection abdominal associated esp
(use z-track discomfort. wt brain
when giving disorders
IM)

➢ s/sx of seizure:
Remember: Benzodiazepines are the mOST ○ confusion
FREQUENTLY PRESCRIBED ○ aura
SEDATIVE-HYPNOTICS because of their favorable ○ sudden falls
drug effect. ○ staring
○ uncontrollable jerking movements
3. NON-BENZODIAZEPINES ○ strange sensations and emotions
○ loss of consciousness/awareness
➢ safer bc they are not habit-forming ➢ Tonic Seizure: stiffening of the body
(addictive) ➢ Clonic Seizure: abnormal jerking movement
➢ Action: neurotransmitter inhibition ➢ Nsx Action:
➢ Indication: short-term insomnia ○ maintain px’s airway
(<10 days) ○ protect px from harm
➢ ex: Zolpidem (Ambien), eszopiclone ○ do not restrain
(Lunesta) ○ do not place objects in mouth
○ observe & record event:
CNS Depressants: Drug Interaction ■ onset
- alcohol, antihistamines, benzodiazepines, ■ body part affected
opioids, tranquilizers, CNS depressants, ■ LOC
MAOIs = ↑effect, ↓respirations with ■ muscle tone
- MAOIs will prolong effects of barbiturates ■ pupils
- ↓anticoagulant response, leading to possible ■ cyanosis
clot formation ■ altered salivation
■ incontinence
CNS Depressants: SE/AD ➢ cause: abnormal electrical activity in the
- residual drowsiness (hangover effect) brain
- headache, vertigo ➢ Generalized Seizures: all of the brain is
- fall hazard for frail elderly pxs affected (px is unconscious)
- drug dependence and tolerance ➢ Focal Seizures: one area of brain is affected
- respiratory depression (px may have impaired consciousness/be
- withdrawal sx fully aware)

CNS Depressants: CI
- pregnancy
- uncontrolled pain
- acute intermittent porphyria

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)

ANTICONVULSANTS
- Action: suppress abnormal neuron firing,
inhibiting seizure activities
- Indication: tonic-clonic seizure, status
epilepticus, complete partial seizures,
arrhythmias, trigeminal neuralgia
- classifications:
a. Suppress Na Influx
- Phenytoin (Dilantin)
b. Suppress Ca influx
- Valproic acid (Depakane)
- divalproex (Depakote)
c. Enhance action of GABA
- Clonazepam (Klonopin)
- gabapentin (Neurontin)
d. Inhibit GABA degradation
- Vigabatrin (Sabril)
➢ types of Anticonvulsants:
○ Hydantoin
○ Barbiturates
○ Benzodiazepines
○ Succinimides
○ Carbamazepine
➢ also used to treat BIPOLAR
DISORDER
➢ Carbamazepine (Tegretol)
○ “Stop the Seizures Before
They Start”
○ used prophylactically to
protect a client wt known
seizures, and also for relief
of pain from neuralgias
○ WOF: drowsiness,
nausea, vomiting, blurred
vision, and headaches.
○ do not give medication wt
GRAPEFRUIT JUICE!
Anticonvulsants: SE/AD
- SE: gingivitis, gingival hyperplasia,
nystagmus, diplopia, dizziness, slurred
speech, decreased coordination, alopecia
- AE: thrombocytopenia, Stevens-Johnson
syndrome**
Anticonvulsants: CI
- pregnancy, sinus bradycardia, sinoatrial
block, second-and-third-degree AV block,
Adam-Stokes syndrome**
Anticonvulsants: Drug Interactions
- +Cimetidine (Tagamet), INH, sulfonamides =
↑effects
- +Folic acid, antacids, calcium, sucralfate,
antineoplastics, antipsychotics, primrose,
ginkgo = ↓effects
- ↓Effects of anticoagulants, oral
contraceptives, antihistamines, dopamine,
theophylline

1. HYDANTOIN Anticonvulsants: Nsx Action

- most commonly used drug for - Monitor serum drug levels (toxicity), glucose
SEIZURE CONTROL: phenytoin levels in DM, liver enzymes, CBC (platelet),
- lesser toxic effects; non-addicting ECG
- SHOULD NOT be used in - Administer with food
PREGNANCY - Ensure safety during usage (fall risk)
- has a narrow therapeutic range - Avoid certain herbs, alcohol, and other CNS
depressants
2. BARBITURATES - For women taking oral contraceptives,
- for GRAND MAL acute episodes of advise to consider other methods
STATUS EPILEPTICUS - Promote oral hygiene and dental check-ups
- use long-acting barbiturate: - Must be taken at same time every day, taper
phenobarbital drug
- lesser teratogenic effects than - Warn of harmless pinkish red or brown urine
phenytoin
3. BENZODIAZEPINES
- primary treatment for ACUTE
SEIZURES: Diazepam NEUROMUSCULAR MEDICATIONS
- short-term effect (not for
maintenance) MYASTHENIA GRAVIS
- for PETIT MAL SEIZURES: ➢ autoimmune disease caused by lack of
clonazepam nerve impulses and muscle responses at
- high degree of tolerance** myoneural junction due to lack of ACh
- adjunctive therapy of PARTIAL reaching cholinergic receptors
SEIZURES: clorazepate ➢ characterized by:
4. SUCCINIMIDES ○ muscular weakness & fatigue
- used to treat ABSENCE or petit mal ○ respiratory muscle paralysis, ptosis,
SEIZURES difficulty chewing, and swallowing
- may be used in combination wt ➢ medication: Cholinergic Antagonist Agents
other anticonvulsants
5. CARBAMAZEPINE CHOLINESTERASE INHIBITORS
➢ works by decreasing nerve - Action: transmission of
impulses that cause seizures and neuromuscular impulses by
nerve pain, such as trigeminal preventing destruction of ACh,
neuralgia and diabetic neuropathy allowing adrenergic response

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
 - Indication: control and treatment of
CENTRAL ACTING: DIRECT ACTING:
MG CNS SKELETAL MUSCLE

SHORT-ACTING ULTRASHORT- INTERMEDIATE - Baclofen - Dantrolene

ACTING FOR ACTING (Lioresal) sodium
DIAGNOSING - Diazepam - Quinine
MG - Carisoprodol
(Soma)
Neostigmine Edrophonium Pyridostigmine - Cyclobenzapri
(Prostigmin) (Tensilon) (Mestinon) ne (Flexeril)
- Methocarbamo
l (Robaxin)
MYASTHENIA CRISIS CHOLINERGIC CRISIS
MUSCLE RELAXANTS: SE/AD
- underdosed - overdosed
- drowsiness, sedation, dizziness,
- severe muscle - severe muscle
weakness cramping headaches, GI distress, fatigue,
- improves after drug dependence
Edrophonium
MUSCLE RELAXANTS: NSX ACTION
- take wt food
CHOLINESTERASE INHIBITORS: SE/AD
- monitor VS, liver function
- pupil constriction
- do not allow to drive
- GI distress, abdominal cramps
- do not take longer than 3 wks
- excess saliva, sweating
- do not stop abruptly: discontinue
- headache, dizziness, seizures
over 1 wk to avoid rebound spasms
- hypotension, bradycardia,
- avoid alcohol and other
dysrhythmias
depressants
- bronchospasm, respiratory
depression
OPIOID ANALGESICS
CHOLINESTERASE INHIBITORS: NSX
ACTION OPIOID DRUGS
- administer doses on time - derived from opium plant that imitates
- take drug before meals natural narcotics
- monitor drug effectiveness - utilized to relieve and decrease pain w/o
- antidote for cholinergic crisis: causing the px to lose consciousness
Atropine - has antitussive and antidiarrheal properties

MULTIPLE SCLEROSIS OPIOID DRUGS: Action

➢ autoimmune disorder that attacks myelin - liver metabolizes opioid drugs, thus
sheath of nerve fibers increases the liver enzymes
➢ characteristics: - acts on the medulla oblongata which control
○ weakness/spasticity in extremities respiration and coughing
○ diplopia
➢ usually familial
➢ onset: 20s-40s AGONIST - binds to opiate receptor sites in
the PNS and CNS
➢ s/sx:
- when attached, the drug mimics
○ tinnitus the effects of natural
○ decreased hearing biochemical compounds that
○ nystagmus produce body’s natural pain
○ blurred vision reliever such as endorphins
○ dysarthria
○ dysphagia ANTAGONIST - these are not pain medications;
however, it blocks the effect of
○ urinary retention
the opioid agonist and is used
○ spastic bladder for reversal of drug reactions
○ constipation - in effect, it also reverses the
○ ataxia analgesic effect of the opioid
○ vertigo agonist

MUSCLE RELAXANTS MIXED - weakly antagonize the effects of

agonists and others exert
➢ provides relief of painful
agonist to the other receptors
musculoskeletal conditions: - weaker neurologic/pain reliever
○ muscle spasms response as compared to
○ management of spasticity agonists
of severe chronic
disorders
○ multiple sclerosis, cerebral
palsy
➢ work best when used along wt
physical therapy

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
Examples: - lacrimation
- rhinorrhea
AGONIST - Morphine
- Fentanyl - diarrhea
- Meperidine - diaphoresis
- Codeine
- Methadone OPIOID DRUGS: Drug Interaction
➢ Opioid depresses the respiratory status.
ANTAGONIST - Naloxone ➢ Alcohol, antihistamines, barbiturates,
- Naltrexone benzodiazepines, phenothiazine, and CNS
depressants will INCREASE the respiratory
MIXED - Nalbuphine
- Pentazacine depressant effects.
➢ Monoamine oxidase inhibitors (MAOI) will
increase respiratory depression and
OPIOID DRUGS: Indication hypotension.
AGONIST - severe pain in acute, ○ MAOI + Meperidine = deep coma
chronic and terminal and death
illnesses
Remember: Withdrawal symptoms’ onset on
ANTAGONIST - block the effect of prolonged use of opioids will depend on the half-life of
opioids by occupying the medication.
receptor sites
- treatment for opioid
overdose OPIOID DRUGS: Nsx Action
- monitor VS (RR) including pain scale
MIXED - given to limit - oral forms should be taken wt food
dependency and toxic - encourage DOB to promote lung expansion
effects - instruct to change position slowly
- increase fluid intake and fiber to soften stool
*Morphine sulfate
- opium poppy is one of nature’s ways of Remember: For px on opioids, keep
controlling pain Naloxone and RESUSCITATION EQUIPMENT at
- most common drug for PCA — maintains bedside AT ALL TIMES.
even pain control
- route of admin: PO, IV, IM, SQ, PR, NON-OPIOID ANALGESICS
transdermal
- SE: decreased BP, respiratory depression,
NON-OPIOID DRUGS: Action
urinary retention, constipation
- aka non-steroidal antiinflammatory drugs
(NSAIDs)
OPIOID DRUGS: CI
- inhibit cyclooxygenase (COX) enzymes of
- drug allergy
prostaglandin synthesis
- severe asthma
- peripheral-acting
- hypotension
- inhibits pain receptors
- severe renal disease
- promotes peripheral vasodilation to reduce
- increased ICP — decreases RR
fever
- head injuries

OPIOID DRUGS: SE/AE ACETIC ACIDS SALICYLATES PARA-AMINOP

(Nonselective (Nonselective HENOL
- constipation*** COX Inhibitors) COX Inhibitors)
- hypotension***
- respiratory depression*** Diclofenac Aspirin Acetaminophen
- nausea & vomiting sodium Paracetamol
(Voltaren)
- sedation & Mental clouding
Indomethacin
- subacute overdose
- urinary retention
- pupil constriction
COX-2 Fenamic Propionic
ANALGESIC CEILING EFFECT FOR OPIOID INHIBITORS Acids Acids
ANALGESICS: (Selective (Nonselective (Nonselective
COX Inhibitor) COX COX
a. OPIOID TOLERANCE Inhibitors) Inhibitors)
- increases tolerance that
Celecoxib Mefenamic Naproxen
makes the doses higher to
(Celebrex) Acid Ibuprofen
maintain therapeutic effect Ketoralac
b. OPIOID DEPENDENCY
- physiologic adaptation of
the body to opioids Remember: ALL NSAIDs are absorbed in the GIT,
metabolized in the LIVER, and excreted by the
OPIOID WITHDRAWAL SYNDROME KIDNEYS
- anxiety
- irritability
- chills
- hot flushes
- joint pain

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
 ANESTHESIA

➢ depress CNS/PNS which produces:

○ loss of consciousness
○ loss of responsiveness to stimuli
○ muscle relaxation

ANESTHESIA: Action

GENERAL LOCAL

- anesthesia - Absorption
absorbed by varies widely
NON-OPIOID DRUGS: Indication the blood - Metabolites
➢ relieves mild to moderate pain through the are excreted in
○ Rheumatoid and osteoarthritis lungs urine
○ most common: Ibuprofen - rapid - blocks nerve
distribution to impulses at the
○ Antipyretics, anti-inflammatory
organs point of contact
○ vascular headaches - primarily works
○ platelet inhibitions by depressing
the CNS
NON-OPIOID DRUGS: CI
- allergies wt NSAIDs
- high risk for bleeding PARENTERAL - lipid-soluble and well
- not advised to pregnant women distributed to the body
- crosses placenta and
enter breast milk
NON-OPIOID DRUGS: SE/AD
- occupy sites on
- bleeding (internal) receptors on the CNS
- nephrotoxicity and modifying release
- diarrhea, nausea, vomiting, anorexia (GI of neurotransmitters
distress) - depresses CNS,
- hepatotoxicity skeletal muscle
relaxation
Remember: Chronic salicylate toxication also known
TOPICAL - applied over the intact
as salicylism. clinical manifestations include: skin or mucous
➢ Tinnitus and hearing loss membrane
➢ Metabolic Acidosis & Respiratory - little systemic
Alkalosis absorption, however,
➢ Nausea, vomiting & diarrhea wt impaired skin
➢ Treatment: to remove the salicylate from the integrity, it increases
the systemic
GIT & prevent further absorptions
absorptions
- excreted in urine
REYE’S SYNDROME - absorbed by the skin
- when aspirin (salicylates) is given to and acts on the nerve
children wt chicken pox/flu-like sx cell membrane &
- life threatening: causes neurologic blocks transmission
deficits that can lead to coma and
liver dysfunction OVERTON-MEYER THEORY
- the greater the drug’s lipid solubility,
NON-OPIOID DRUGS: DRUG INTERACTIONS the greater the effect
- amplify effects of anticoagulants, oral
hypoglycemic agents TYPES OF ANESTHESIA:
- high risk of toxicity wt Calcium channel
blockers GENERAL ANESTHESIA
- alcohol, corticosteroids increases GIT effects
Inhalation Intravenous

NON-OPIOID DRUGS: Nsx Action Sevoflurane Barbiturates

- stop aspirin for 1 wk before surgery Desflurane (Thiopental)
- cautiously administer salicylates to Nitrous oxide (laughing Benzodiazepines
asthmatics bc of the risk of having gas) (Midazolam)
bronchospasm Dissociatives
- cautiously administer NSAIDs to high risk of (Ketamine)
Opiates (Fentanyl)
thrombotic events such as MI/Stroke

NON-OPIOIDS DRUGS: Nsx Action

LOCAL ANESTHESIA
- watch out for drug allergy
- watch out for s/sx of bleeding Amide (wt Nitrogen) Ester (wt Oxygen)
- assess auditory functions
- monitor CBC, platelet, Prothrombin time, Bupivacaine Procaine
hepatic, and renal functions Levobupivacaine Chloroprocaine
- administer NSAIDs wt food Lidocaine Tetracaine
- do not chew/crush enteric-coated tablets

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
GENERAL ANESTHESIA: CI ANESTHESIA: Drug interaction
➢ Inhalation: - Inhalation: combination wt other CNS,
○ Hypersensitivity cardiac, or respiratory depressants will
○ Liver disorder increase depressant effect
○ Malignant hyperthermia - Ketamine & nondepolarizing drugs increase
➢ Parenteral neuromuscular effect and prolonged
○ drug allergy respiratory depression
○ pregnant - Barbiturates/opioids + Ketamine: prolong
○ narrow-angle glaucoma anesthesia time
○ Malignant hyperthermia - Anticholinergics: increases potential for
confusion, tachycardia, constipation
ANESTHESIA: Indication - co-administered wt Epinephrine: to constrict
BV and thus in return, control local bleeding
INHALATION surgeries — rapid onset
and reduces anesthesia absorption (due to
PARENTERA **shorter surgical procedures vasoconstriction) which prolongs anesthetic
L (outpatient surgeries) action at site

**Ketamine — induce profound BALANCE ANESTHESIA

sense of dissociation from env - usage of minimal doses of multiple
anesthesia to achieve desired
**Benzodiazepines — produce
effects
sedation/amnesia but does NOT
relief
ANESTHESIA: Nsx Action
TOPICAL **relieve/prevent pain (minor burn - encourage deep breathing exercises,
pain) coughing, early ambulation as
postoperatively
**relieve itchiness and irritation - monitor VS and LOC, respiratory status, and
pain status
**anesthetize before giving
injection - promote safety measures & precautions

**numb mucosal surface (urinary Remember: Local anesthesia is the safer

catheter) choice than general anesthesia for elderly pxs,
respiratory disorders such as COPD and MG
ANESTHESIA: SE/AD
➢ Respiratory Depression
➢ Myocardial depression
➢ Malignant Hyperthermia — sudden & lethal ANTI-INFLAMMATORY MEDICATION
increase in body temperature
➢ failure of Calcium uptake by the muscle INFLAMMATION
➢ Ketamine: - reaction to tissue injuries
○ prolonged recovery - caused by the release of histamine,
○ irrational behavior serotonin, bradykinin, leukotrienes and
○ excessive salivation & tearing prostaglandins
➢ Propofol: - the sxs are caused by the vascular
○ respiratory depression responses such as capillary, artery, and
○ bradycardia venous dilation
○ hypotension - fluids & leukocytes migrate towards the
➢ Thiopental: injury site
○ respiratory depression - induced by Phospholipase A2
➢ Fentanyl:
○ CNS & respiratory depression PHOSPHOLIPASE A2 STIMULATION:
○ arrhythmias - tissue injury
➢ Midazolam: - thrombin
○ CNS & respiratory depression - bradykinin
○ hypotension - angiotensin II
➢ Local: - Epinephrine
○ anxiety
○ apprehension
○ restlessness
○ nervousness
○ disorientation
○ confusion
○ Spinal headache — from spinal
anesthesia
■ relieved by bedrest &
conventional analgesics
➢ Topical
○ hypersensitivity reactions
○ skin irritations
○ frostbite

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
 - taper after long-term use
RHEUMATISM - give medications during morning
- general term for disorders that is - administer wt food to prevent GIT
characterized by inflammation, irritation
degeneration, or metabolic - encourage food high in K
derangement of connective tissues
Remember: Abrupt withdrawal of
corticosteroids can cause rebound
inflammation, fever, depression,
hypotension, hypoglycemia, and adrenal
insufficiency

3. DISEASE-MODIFYING ANTIRHEUMATIC
DRUGS (DMARDs): Action
- slows progression of diseases
associated wt arthritis
- exhibit anti-inflammatory,
antiarthritic, and immunomodulating
effects and works by inhibiting the
movement of the cells into the
damaged tissue.
anti-inflammatory medications:
- NSAIDs
Remember: DMARDs have a slow
- Steroids
onset of action that takes up to several
- Disease-Modifying Antirheumatic
weeks and usually takes 3-6 months to see
Drugs
full effects. (Slow-acting antirheumatic drugs
- Anti-Gout
[SAARDs])
DMARDs: Indication
1. NSAIDs
- rheumatoid arthritis
2. CORTICOSTEROIDS: Action
➢ suppresses immune responses and reduces
DMARDs: CI
inflammation, anti-stress, and anti-allergic
- active bacterial infection
➢ prevents leakage of plasma from the
- active herpes zoster
capillaries & the migration of leukocytes
- active/latent TB
➢ inhibit inflammation by the means of
- acute/chronic Hepa B/C
inhibiting the release of phospholipase A2
enzymes (which frees the phospholipid)
○ inhibit arachidonic acids Non-Biologic Biologic Gold Drug
DMARDs DMARDs Therapy
CORTICOSTEROIDS: Indication (Immunomod
- severe inflammations ulators)
- immunosuppression
Methotrexate Adalimumab
Leflunomide Anakinra Auranofin
CORTICOSTEROIDS: CI Etanercept (Ridaura)
- drug allergy
- fungal infections
DMARDs: SE/AD
- Pancytopenia
CORTICOSTEROIDS: SE/AD
- Infections
- hyperglycemia
- Fatigue, nausea & vomiting, and
- infection
flu-like sx
- weight gain & edema
- cushing’s syndrome
DMARDs: Drug Interaction
- should NOT be used wt OTHER
CORTICOSTEROIDS: Drug Interaction
DMARDs/immunosuppressants
- Aspirin & NSAIDs +
Corticosteroids = increased risk of
DMARDs: Nsx Action
GIT bleeding & ulceration
- report s/sx of infections to physician
- Corticosteroids + K losing
- do not administer live vaccines
diuretics = hypokalemia
- monitor for CBC and liver enzymes
- Dexamethasone decreases effect
- monitor injection site for pain,
of anticoagulants & antidiabetic
swelling, and irritation
medications
- Prednisone + Barbiturates,
4. ANTI-GOUT MEDICATIONS: Action
Phenytoin and Rifampin =
- minimize inflammation by blocking
decrease effect of Prednisone
uric acid absorptions and increases
the uric acid excretion
CORTICOSTEROIDS: Nsx Action
- live vaccines should not be given wt
ANTI-GOUT MEDICATIONS: Indication
this treatment
- hyperuricemia
- avoid individuals wt infections
- gout
- monitor for electrolytes, blood
glucose levels, daily weight, and
ANTI-GOUT MEDICATIONS: CI
HPN

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)
 - renal/hepatic disease

Colchicine Allopurinol Probenecid

Anti-gout by uric acid uricosurics

reducing inhibitors
inflammatory
responses

ANTI-GOUT MEDICATIONS: SE/AD

- bone marrow suppression
- uric acid stones
- metallic taste
- diarrhea
- nausea & vomiting

ANTI-GOUT MEDICATIONS: Drug

Interaction
- Aspirin can trigger gout attack
- Aspirin w/o anti-gout medications
causes elevated uric acid levels

ANTI-GOUT MEDICATIONS: Nsx Action

- avoid alcohol, food high in purine
- encourage increased fluid intake to
prevent kidney stones
- monitor liver functions

Colchicine ➢ use cautiously wt cardiac,

renal, GIT diseases
➢ if GIT sx occur (vomiting,
nausea, diarrhea),
withhold medications
➢ can cause renal failure

Allopurinol ➢ increases effect of

Warfarin and oral
hypoglycemic
➢ do not take large doses of
Vit C bc of the risk of
having kidney stones
increases
➢ limit exposure to sunlight

Probenecid ➢ mild GIT diseases may

occur; take wt food to
lessen distress
➢ Aspirin interfere wt
uricosuric actions

Pharmacology: Central Nervous System Medications

Transcribed by: Aly Geronga (2NU04)