NCM 106 – FINALS
Lesson 1 – Part 1 (Week 1)
Drugs acting in the Central and Peripheral Nervous System
Review of the Nervous System
This is a complex network of nerves and cells that carry the
messages to and from the brain as well as the spinal cord to
various parts of the body. This is divided into the Central
Nervous System and the Peripheral Nervous System
The Central Nervous System is made up of the brain and the
spinal cord and the Peripheral Nervous System is made up of
the somatic and autonomic nervous system.
The Somatic nervous system consist of peripheral nerve
fibers that pick-up sensory information or sensation from the
peripheral or distant organs and carry them to the central
nervous system. The Autonomic nervous system is a control
system that acts largely, unconsciously and regulates body
function such as the heart rate, digestion, respiratory rate,
pupillary response, urination and sexual arousal. This system
is the primary mechanism in control of the fight or flight
response.
A very important structural unit of the nervous system is the
neuron or the nerve cell. This nerve cell send messages by
conducting electrical impulses called action potentials. The
basic unit of the nervous system is the neuron.
The neurons are responsible for taking information in the
central nervous system, this these are known as Afferent
neurons while
the neurons that carries the responses from the central
nervous system to the peripheral nervous system are known
as Efferent neurons
Synapsis from between the neurons allowing them to
communicate to other neurons or other systems in the body.
The general flow of information is that the peripheral nervous
system takes in information through sensory neurons that
sends it to the central nervous system to be processed and
after processing the central nervous system tells the
peripheral nervous system what to do.
Billions of nerve cell makeup the nervous system:
 To allow movement
 Realization of various sensations
 Response to internal and external stimuli
 Learning, thinking and emotion
The nervous system allows organisms to sense, organize and
react to information in the environment. These are
responsible for controlling the function of the human body,
analyzing incoming stimuli and integrating internal and
external responses.
Several drugs are used to change the mood or emotional
state of the user. These drugs importantly either promote or
decrease the action of the particular neurotransmitter. This is
a chemical messenger that transmit impulses between
neurons. A neurotransmitter is the chemical messenger that
carries, used and balance signals between neurons and target
cells throughout the body.
Neurotransmitters are the following:
 Acetylcholine
 Norepinephrine and Epinephrine
 Dopamine
 Gamma-Aminobutyric acid (GABA)
 Serotonin
Acetylcholine
 A chief neurotransmitter
 This communicates between nerves and muscles
Norepinephrine/Epinephrine
 These are catecholamines
 which functions primarily to increase cardiac output
and to raise glucose levels in the blood
Dopamine
 sometimes called the chemical messenger
 it is responsible on how we feel
 This are found in high concentrations in certain areas
of the brain and involved in coordination of impulses
and responses both motor and intellectual
Gamma-Aminobutyric acid (GABA)
 A naturally occurring amino acid that works as
neurotransmitter in your brain
 These neurotransmitters functions as chemical
messenger and the GABA is considered an inhibitory
neurotransmitter because it blocks or inhibits certain
brain signals and decreases activity in neuro nervous
system
 Inhibits nerve activity and
 is important in preventing over excitability or
stimulation. Example. Seizure
Serotonin
 key hormone that stabilizes our mood, feelings or
well-being and happiness
 this hormone impacts your entire body
 It enables cells especially brain cells another nervous
system cells to communicate with each other
 also helps with sleeping eating and digestion
 Found in limbic system and is important in arousal
and sleep as well as
 in preventing depression and promoting motivation
There are nine classifications of drugs acting in our nervous
system
There are about 5 basic ways in which the central nervous
system drugs and the peripheral nervous system drugs act:
1. drug stimulate the release of neurotransmitter and
enhances action
2. drug combines with neurotransmitters preventing
their breakdown and enhancing their action
3. drugs mimics neurotransmitter and enhance their
action
4. drugs block the release of neurotransmitter and
decrease their action
5. drugs blocks receptors so neurotransmitters are
unable to act
Drug Classifications
1. Anxiolytic and Hypnotic Agents
 These are drugs used to alter individual's responses
to the environment.
 This drugs act in the central nervous system
Anxiolytics
 which prevents the feeling of tension or fear
Sedatives
 which calm patients and make them unaware of the
environment
Hypnotic
 which induces the patient to sleep
States affected by Anxiolytic and Hypnotic drugs
Anxiety
 This is a feeling of tension, nervousness,
apprehension or fear that usually involves
unpleasant reactions to stimulus
 Overwhelming or sometimes severe
 Interferes with the person's daily activities
 Most of them lead to medical problem
Anxiolytic drug
 they are given Anxiolytic drugs to lyse or break the
feeling of anxiety
Sedation
NCM 106 – FINALS
Lesson 1 – Part 1 (Week 1)
 to loss of awareness and reaction to environment  Phentobarbital
For patients who are:  Phenobarbital (p)
 Restless  Secobarbital
 Nervous
 Irritable Actions of these two drugs
 Overreacting to stimuli
Sedation is anxiolytic and most of the time lead to
drowsiness
The extreme sedation usually results in further central
nervous system depression and sleep also this causes
hypnosis thus helping people to fall asleep.

Drugs that are effective hypnotics act on the Reticular

Activating System (RAS) and block the brain's response to
incoming stimuli. These are connective nuclea in the brain's
of the vertebrates that is responsible for the regulating the
wakefulness and sleep-wake transition then the person is no
longer sense or reacts to stimuli.

The drugs under this classification are the:

Benzodiazepines Used as a anxiolytics
These are the drugs commonly given under the classification
of benzodiazepines
 Alprazolam
 Clonazepam
 Diazepam (p)
 Lorazepam
 Quazepam
 Triazolam
The prototype is the original form of drug and this is
commonly used drug under this classification.
BARBITURATES
Therapeutic actions and indication
- causing interference with neuro firing
GABA – stabilizes postsynaptic cell.
- Lead to an anxiolytics effect at doses lower
than those required to induce sedation and
hypnosis.
Pharmacokinetics
- lipid soluble and well absorbed throughout the body

Contraindications
- allergy to any benzodiazepines
- psychosis, acute and narrow-angle glaucoma, shock, coma
and acute alcoholic intoxication
- pregnancy and breastfeeding

Adverse Effect
- sedation, drowsiness, depression, lethargy, blurred vision,
headaches, apathy, light-headedness and confusion
- dry mouth, constipation, nausea, vomiting and elevated liver
enzymes
- arrythmias, palpations and respiratory difficulties
- urinary retention and hesitancy, loss of libido and changes in
sexual functioning.

Nursing Considerations of Benzodiazepines and Barbiturates

 Administer as ordered
 Do not mix intravenous drugs in solution with other
drugs because of drug and drug interactions
 Give IV drugs slowly to prevent hypotension and
respiratory depression
 Maintain patients in bed for at least three hours
because some effects of benzodiazepines and
barbiturates
 Flumazenil (benzodiazepine antidote) - to treat
Barbiturates overdosage of benzodiazepines
 Amobarbital
 Butobarbital

 Mephobarbital Next Drug Classification

NCM 106 – FINALS
Lesson 1 – Part 1 (Week 1)
2. Antidepressant Common Drugs:
We all know that all people experience different affective  Maprotiline
states at various times in their lives. These states of mind,  Nortriptyline
which change in particular situations, usually do not last very  Protriptyline
long and do often involve extremes of happiness or  Trimipramine
depression - They may be described as overwhelming feelings  Imipramine (p)
of sadness, despair, hopelessness and disorganization (little  Amitriptyline
energy, sleep disturbances, lack of appetite, limited libido and  Amoxapine
inability to perform activities) and there is a fear of having  Clomipramine
patient's committing suicide, if left untreated, it can produce  Desipramine
multiple physical problems.  Doxepin
Monoamine Oxidase Inhibitors (MAOI)
The cause of depression usually is due to the: Common Drugs:
 Deficiency of Norepinephrine (NE)  Isocarboxazid
 Dopamine  Phenelzine (p)
 Serotonin (5HT)
This is explained in the Biogenic Amine Theory of
Depression.

Reasons of this Deficiencies:

1. most of the time is due to Monoamine Oxidase
(MAO) - is involved in removing neurotransmitters
from the brain. Monoamine inhibitors are given to
prevent this from happening which makes more of
these brain chemicals available to effect changes in
both cells and circuits that have been impacted by
the depression
2. Rapid fire of the neuron
3. Sensitivity of postsynaptic receptors
Selective Serotonin Reuptake Inhibitors (SSRI)
The Antidepressant drugs works in three ways: Common Drugs:
1. Inhibits the effect of Monoamine Oxidase (MAO),  Citalopram
leading to increased Norepinephrine (NE) or 5HT.  Escitalopram
(These 5HT receptors/five hydroxy tryptamine  Flouxetine (p)
receptors/Serotonin receptors are a group of G  Fluvoxamine
protein-coupled receptors and ligand-gated ion  Paroxetine
channels found in the central and peripheral nervous  Sertraline
system. They mediate both excitatory and inhibitory
neurotransmission)

2. Block reuptake by the releasing nerve, leading to

increased neurotransmitter levels

Other Antidepressants
 Bupropion (p) – Weakly blocks the reuptake of NE,
5HT and dopamine
 Mirtazapine – is rapidly absorbed from GI tract,
extensively metabolized in the liver and excreted in
the urine
 Nefazodone – has a short half-life of 2-4 hours
 Selegiline – is a MAO type B inhibitor that has been
3. Regulate receptor sites, leading to accumulation of
and is now available as a transdermal system.
neurotransmitter
 Trazodone -
 Desvenlafaxine – newest SSRIs

Tricyclic Antidepressants (TCA)

Actions of the drugs
NCM 106 – FINALS
Lesson 1 – Part 1 (Week 1)