pharm Q3 - meds affecting the CNS and NS

class: neuromuscular blocking agents

depolarizing and nondepolarizing

depolarizing meds

succinylcholine

succinylcholine function (depolarizing neuromuscular blocking agent)

causes sustained depolarization of the muscle resulting in muscle paralysis, blocks the repolarization of muscles

succinylcholine onset and duration (depolarizing neuromuscular blocking agent)

onset 45 to 60sec, duration 4 to 6min

succinylcholine therapeutic use (depolarizing neuromuscular blocking agent)

adjuncts to general anesthesia, endotracheal intubation and endoscopy, control spontaneous resp mvmts, seizure control

succinylcholine complications (depolarizing neuromuscular blocking agent)

resp arrest, prolonged apnea, malignant hyperthermia, hyperkalemia - no reversal for depolarizing agents

succinylcholine contraindications (depolarizing neuromuscular blocking agent)

hyperkalemia, severe trauma, burns

non depolarizing neuromuscular agents

rocuronium, vecuronium, pancuronium

rocuronium, vecuronium, pancuronium - non depolarizing neuromuscular agents

blocks Ach at the neuromuscular junction resulting in muscle relaxation and hypotension

rocuronium, vecuronium, pancuronium reversal agent (non depolarizing neuromuscular agents)

neostigmine

rocuronium, vecuronium, pancuronium therapeutic use (non depolarizing neuromuscular agents)

same as depolarizing

rocuronium, vecuronium, pancuronium complications (non depolarizing neuromuscular agents)

resp arrest, prolonged apnea

class: muscle relaxants and antispasmodics - centrally acting

diazepam (valium), baclofen, cyclobenzaprine (flexeril)

diazepam (valium) pharm action (muscle relaxants and antispasmodics - centrally acting)

mimics GABA at receptor in spinal cord and brain

GABA

primary inhibitory neurotransmitter in the brain and spinal cord

class: muscle relaxants and antispasmodics - peripherally acting

dantrolene (ryanodex, dantrium)

dantrolene pharm action (muscle relaxants and antispasmodics - peripherally acting)

inhibit muscle contraction by preventing release of calcium in skeletal muscle

dantrolene therapeutic use (muscle relaxants and antispasmodics - peripherally acting)

spasticity relief, malignant hyperthermia by blocking release of calcium from sarcoplasmic reticulum of skeletal muscle cells

class: muscarinic agonists

bethanechol

bethanechol pharm action (muscarinic agonists)

relax trigone and sphincter muscles, contract detrusor muscle

bethanechol therapeutic use (muscarinic agonists)

underactive bladder, nonobstructive urinary retention

class: muscarinic antagonists

oxybutynin

oxybutynin pharm action (muscarinic antagonists)

prevent contractions of bladder

oxybutynin therapeutic use (muscarinic antagonists)

overactive bladder

oxybutynin complications (muscarinic antagonists)

constipation, dry mouth, blurred vision, photophobia, dry eye, tachycardia, anhydrosis

class: benzodiazepines

diazepam (valium), alprazolam (xanax), lorazepam (ativan), midazolam (versed)

diazepam pharm action (benzodiazepines)

enhance GABA in the CNS to reduce neuronal excitability

diazepam complications (benzodiazepines)

CNS depression, paradoxical response

paradoxical response manifestations

insomnia, excitation, euphoria, anxiety, rage

benzodiazepine antidote

flumazenil (romazicon)

class: non benzodiazepines

zolpidem (ambien)

zolpidem (ambien) pharm action (nonbenzodiazepines)

enhances GABA in the CNS by preferential binding to the 1a receptor subunits

zolpidem (ambien) therapeutic use (nonbenzodiazepines)

insomnia short term

class: melatonin agonist

ramelteon (rozerem)

ramelteon pharm action (melatonin agonist)

activate melatonin receptors, highly selective receptor type 1 and 2 agonist

ramelteon therapeutic use (melatonin agonist)

insomnia chronic

ramelteon interactions (melatonin agonist)

avoid high fat meals b4 taking, take 30min b4 bedtime

IV non opioid benzo anesthetics

midazolam (versed), diazepam (valium), lorazepam (ativan)

IV non opioid barbiturate anesthetics

pentobarbital sodium (nembutal)

IV non opioid anesthetics therapeutic use

moderate conscious sedation, maintain anesthesia, mechanical ventilation

IV non opioid anesthetics complications - propofol

infection

IV non opioid anesthetics complications - ketamine

psychological reactions, <15yrs and >65yrs at higher risk, avoid use in pts with history of mental illness

IV non opioid anesthetics admin - propofol

inject into large vein to decrease pain

IV opioids

fetanyl, morphine

fetanyl, morphine complications (IV opioids)

resp and cardiovascular depression with high hypotension risk

what are fetanyl and morphine overdose treated with (IV opioids)

naloxone (narcan)