• central nervous system (CNS)- which
involves the brain and spinal cord that
regulates body functions.
•Long-term use of amphetamines can
produce psychological dependence or
tolerance, a condition in which larger and
larger doses of a drug are needed to
reproduce the initial response.
• Migraine headaches generally cause
severe throbbing pain. They are often
preceded by an aura (visual, smells,
tingling, vertigo warning).
• cluster headaches- generally considered
to be caused by the hypothalamus
activating the trigeminal nerve.
• Attention deficit/hyperactivity disorder
(ADHD)-might be caused by a
dysregulation of the transmitters of
serotonin, norepinephrine, and dopamine.
include inattentiveness, inability to
concentrate, restlessness (fidgety),
hyperactivity (excessive and purposeless
activity), inability to complete tasks, and
impulsivity.
• Narcolepsy- is characterized by falling
asleep during normal waking activities such
as driving a car or talking with someone.
The narcoleptic is unable to move and may
collapse.
• Sleep paralysis- the condition of muscle
paralysis that is normal during sleep,
usually accompanies narcolepsy and affects
the voluntary muscles.
• Amphetamines- stimulate the release of
neurotransmitters— norepinephrine and
dopamine—from the brain and
sympathetic nervous system (peripheral
nerve terminals). Amphetamines ordinarily
cause euphoria and alertness, but they can
also cause sleeplessness, restlessness,
tremors, and irritability.
• Methylphenidate (Ritalin) and
dexmethylphenidate (Focalin), classed as
amphetamine-like drugs, are given to
increase a child’s attention span and
cognitive performance (e.g., memory,
reading) and to decrease impulsiveness,
hyperactivity, and restlessness.
•Methylphenidate is also used to treat
narcolepsy.
• Modafinil (Provigil)-is another drug
prescribed for narcolepsy. It increases the
amount of time patients with narcolepsy
feel awake.
• anorexiants (appetite suppressants) for
short-term use (4 to 12 weeks), but
because of tolerance, psychological
dependence, and abuse, they are no longer
recommended for use as appetite
suppressants.
• Lipase Inhibitors- replaced anorexiants
as the drug of choice for weight loss. They
decrease GI absorption of dietary fats. The
fats are excreted in feces, leading to weight
loss.
• Analeptics- CNS stimulants, mostly affect
the brainstem and spinal cord but also the
cerebral cortex. The primary use of an
analeptic is to stimulate respiration.
• Respiratory stimulants- Doxapram
(Dopram), a CNS and respiratory stimulant,
is used to treat respiratory depression
caused by drug overdose, preanesthetic
and postanesthetic respiratory depression,
and COPD. It should be used with caution
for the treatment of neonatal apnea.
• insomnia- (inability to fall or remain
asleep) occur in 10% to 30% of Americans.
• Normal sleep is composed of two definite
phases: rapid eye movement (REM) sleep
and nonrapid eye movement (NREM)
sleep.
• REM sleep phase when individuals
experience most of their recallable dreams.
• Nightmares-If these dreams are
unpleasant
• NREM- Sleep-walking or nightmares that
occur in children take place
• sedation- which diminishes physical and
mental responses at lower dosages of
certain CNS depressants but does not
affect consciousness. Sedatives are used
mostly during the daytime.
• hypnotic effect—not hypnosis but a form
of “natural” sleep during increased drug
dose.
• Hangover- A hangover is a residual
drowsiness resulting in impaired reaction
time. Intermediate- and long-acting
hypnotics are frequently the cause of drug
hangovers. The liver biotransforms these
drugs into active metabolites that persist in
the body, causing drowsiness.
• REM rebound Dependence- which
results in vivid dreams and nightmares,
frequently occurs after taking a hypnotic
for a prolonged period and then abruptly
stopping. However, it may occur after
taking only one hypnotic dose.
• Dependence- is the result of chronic
hypnotic use. Physical and psychological
dependence can result. Physical
dependence results in the appearance of
specific withdrawal symptoms when a drug
is discontinued after prolonged use. The
severity of withdrawal symptoms depends
on the drug and dosage. Symptoms may
include muscular twitching and tremors,
dizziness, orthostatic hypotension,
delusions, hallucinations, delirium, and
seizures. Withdrawal symptoms start
within 24 hours and can last for several
days.
• Tolerance- when there is a need to
increase the dosage over time to obtain
the desired effect. It is mostly caused by an
increase in drug metabolism by liver
enzymes. The barbiturate drug category
can cause tolerance after prolonged use.
Tolerance is reversible when the drug is
discontinued.
• Excessive depression- Long-term use of a
hypnotic may result in CNS depression,
which is characterized by lethargy,
sleepiness, lack of concentration,
confusion, and psychological depression.
• Respiratory depression- High doses of
sedative-hypnotics can suppress the
respiratory center in the medulla.
• Hypersensitivity-Skin rashes and urticaria
can result when taking barbiturates. Such
reactions are rare.
• withdrawal symptoms- abruptly
discontinuing a high dose of hypnotic taken
over a long period
• Barbiturates- classified as long-acting,
intermediate-acting, short-acting, and
ultrashort-acting
• long-acting group- includes
phenobarbital and mephobarbital and is
used to control seizures in epilepsy.
• intermediate-acting barbiturates- such
as butabarbital (Butisol), are useful as sleep
sustainers for maintaining long periods of
sleep. Because these drugs take
approximately 1 hour for the onset of
sleep, they are not prescribed for those
who have trouble getting to sleep. Vital
signs should be closely monitored in
persons who take intermediate-acting
barbiturates.
• short-acting barbiturates- secobarbital
(Seconal) and pentobarbital (Nembutal)
are used primarily for sedation
preoperatively. Vital signs should be closely
monitored in persons who take short-
acting barbiturates.
• Benzodiazepines- increase the action of
the inhibitory neurotransmitter gamma-
aminobutyric acid (GABA) to the GABA
receptors. Neuron excitability is reduced.
To treat anxiety and insomnia.
• Zolpidem in Nonbenzodiazepines is
metabolized in the liver to three inactive
metabolites and is excreted in bile, urine,
and feces.
• Anesthetics- are classified as general and
local. General anesthetics depress the CNS,
alleviate pain, and cause a loss of
consciousness.
• Balanced anesthesia- is a combination of
drugs that are frequently used in general
anesthesia. minimizes cardiovascular
problems, decreases the amount of general
anesthetic needed, reduces possible post-
anesthesia nausea and vomiting, minimizes
the disturbance of organ function, and
decreases pain.
 Intravenous anesthetics (e.g.,
propofol [Diprivan]) to induce and
maintain anesthesia
 Benzodiazepines (e.g., midazolam decreases the sensitivity of nerve endings
[Versed]) to reduce anxiety and in the affected area.
provide sedation
• Local anesthetics- block pain at the site
 Opioids (e.g., morphine, fentanyl)
where the drug is administered, allowing
for analgesia
consciousness to be maintained. It is useful
 Neuromuscular blocking agents
in dental procedures, suturing skin
(e.g., pancuronium [Pavulon]) for
lacerations, short-term (minor) surgery at a
muscle relaxation
localized area, blocking nerve impulses
 Inhalation anesthetics (e.g.,
(nerve block) below the insertion of a
enflurane [Ethrane]) for induction
spinal anesthetic, and diagnostic
and maintenance of general
procedures such as lumbar puncture and
anesthesia. Also, inhalation
thoracentesis.
anesthetics are helpful in
producing amnesia and • Spinal anesthesia- requires that a local
unconsciousness when needed. anesthetic be injected in the subarachnoid
space at the third or fourth lumbar space.
STAGES OF ANESTHESIA
• nerve block- with a local anesthetic,
1.Analgesia- Begins with consciousness
Various sites of the spinal column can be
and ends with loss of consciousness.
used for a nerve block with a local
Speech is difficult; sensations of smell and
anesthetic
pain are lost. Dreams and auditory and
visual hallucinations may occur. This stage • spinal block- is the penetration of the
may be called the induction stage. anesthetic into the subarachnoid
membrane, the second layer of the spinal
2. Excitement or delirium- Produces a loss
cord.
of consciousness caused by depression of
the cerebral cortex. Confusion, excitement, • epidural block- is the placement of the
or delirium occur. Short induction time. local anesthetic in the outer covering of
the spinal cord or the dura mater.
3. Surgical- Surgical procedure is
performed during this stage. There are four • caudal block- is placed near the sacrum.
phases. The surgery is usually performed in
• saddle block- is given at the lower end
phase 2 and upper phase 3. As anesthesia
of the spinal column to block the perineal
deepens, respirations become more
shallow and respiratory rate is increased. area
• seizure associated with epilepsy results
4. Medullary paralysis- Toxic stage of
from abnormal electric discharges from
anesthesia. Respirations are lost, and
the cerebral neurons and is characterized
circulatory collapse occurs. Ventilatory
assistance is necessary. by a loss or disturbance of consciousness
and usually by a convulsion (involuntary
• Inhalation anesthetics- typically provide paroxysmal muscular contractions).
smooth induction. Used to deliver general
• Electroencephalogram (EEG), computed
anesthesia.
tomography (CT), and magnetic
• IV anesthetics- may be used for general resonance imaging (MRI) are useful in
anesthesia or for the induction stage of diagnosing epilepsy.
anesthesia. For outpatient surgery of short
• idiopathic- of unknown cause
duration, an intravenous anesthetic might
be the preferred form of anesthesia.
• anoxia-absence of oxygen
• topical anesthetic agents- is limited to
• types of seizures, such as grand mal
mucous membranes, broken or unbroken
(tonic clonic), petit mal (absence), and
skin surfaces, and burns. It come in
psychomotor. The international
different forms: solution, liquid spray,
classification of seizures describes two
ointment, cream, gel, and powder. It
categories of seizure: generalized and
partial.
• anticonvulsants or antiepileptic drugs
(AEDs)- Drugs used for epileptic seizures.
stabilize nerve cell membranes and
suppress the abnormal electric impulses in
the cerebral cortex.
• Generalized Seizures-Convulsive and
nonconvulsive; involve both cerebral
hemispheres of the brain
• Tonic-clonic seizure Also called grand
mal seizure; most common form of
seizure. In the tonic phase, skeletal muscles
contract or tighten in a spasm lasting 3 to 5
seconds. In the clonic phase, there is a
dysrhythmic muscular contraction, or
jerkiness, of legs and arms lasting 2 to 4
minutes
• Tonic seizure-Sustained muscle
contraction
• Clonic seizure- Dysrhythmic muscle
contraction
• Absence seizure- Also called petit mal
seizure; brief loss of consciousness lasting
less than 10 seconds; fewer than three
spike waves on the electroencephalogram
(EEG) printout; usually occurs in children
• Myoclonic seizure- Isolated clonic
contraction or jerks lasting 3 to 10 seconds;
may be limited to one limb (focal
myoclonic) or involve the entire body
(massive myoclonic); may be secondary to
a neurologic disorder such as encephalitis
or Tay-Sachs disease
• Atonic seizure- Head drop; loss of
posture; sudden loss of muscle tone. If
lower limbs are involved, patient could
collapse
• Infantile spasms-Muscle spasm
• Partial Seizures- Involve one hemisphere
of the brain. No loss of consciousness in
simple partial seizures, but there is a loss of
consciousness in complex partial seizures
• Simple seizure- Occurs in motor, sensory,
autonomic, and psychic forms; no loss of
consciousness
• Motor- Formerly called the Jacksonian
seizure; involves spontaneous movement
that spreads; can develop into a
generalized seizure
• Sensory- Visual, auditory, or taste
hallucinations
• Autonomic response-Paleness, flushing,
sweating, or vomiting
• Psychological-Personality changes
• Complex seizure-Loss of consciousness.
Patient does not recall behavior
immediately before, during, and
immediately after seizure
• Psychomotor-Complex symptoms:
automatisms (repetitive behavior such as
chewing or swallowing motions),
behavioral changes, and motor seizures
•Cognitive-Confusion or memory
impairment
• Affective- Bizarre behavior
• Compound- May lead to generalized
seizures such as tonic-clonic, tonic
• Hydantoins- act by inhibiting sodium
influx, stabilizing cell membranes, reducing
repetitive neuronal firing, and limiting
seizures.
• sloughing- formation of dead tissue that
separates from living tissue
• gingival hyperplasia- overgrowth of the
gum tissues or reddened gums that bleed
easily
• nystagmus- (constant, involuntary,
cyclical movement of the eyeball).
• Antipsychotics and certain herbs can
lower the seizure threshold (level at which
seizure may be induced) and increase
seizure activity
• Phenobarbital, a long-acting barbiturate,
is still prescribed to treat partial seizures,
grand mal seizures, and acute episodes of
status epilepticus seizures (rapid
succession of epileptic seizures)
• succinimide drug group- is used to treat
absence or petit mal seizures, and it may
be used in combination with other
anticonvulsants to treat such seizures.
• The three benzodiazepines that have
anticonvulsant effects are clonazepam,
clorazepate dipotassium, and diazepam.
• Clonazepam is effective in controlling
petit mal (absence) seizures, but tolerance
may occur 6 months after drug therapy
starts, and consequently clonazepam
dosage must be adjusted.
• Clorazepate dipotassium is frequently
administered in adjunctive therapy for
treating partial seizures.
• Diazepam is primarily prescribed for
treating acute status epilepticus and must
be administered IV to achieve the desired
response.
• Carbamazepine, an iminostilbene, is
effective in treating refractory seizure
disorders that have not responded to other
anticonvulsant therapies. It is used to
control grand mal and partial seizures and
a combination of these seizures.
Carbamazepine is also used for psychiatric
disorders (e.g., bipolar disease), trigeminal
neuralgia (as an analgesic), and alcohol
withdrawal.
• Valproic acid- has been prescribed for
petit mal, grand mal, and mixed types of
seizures.
• Status epilepticus, a continuous seizure
state, is considered a medical emergency.
If treatment is not begun immediately,
death could result.
• Anticonvulsant drugs-tend to act as
inhibitors of vitamin K, contributing to
hemorrhage in infants shortly after birth.
Frequently, pregnant women taking
anticonvulsants are given an oral vitamin K
supplement during the last week or 10
days of the pregnancy, or vitamin K is
administered to the infant soon after birth.
Anticonvulsants also increase the loss of
folate (folic acid) in pregnant women. Thus,
pregnant individuals should take daily
folate supplements.