3M - Central Nervous System

central nervous system

Interprets information sent by impulses from the PNS and returns through the PNS for appropriate cellular actions.

attention deficit/hyperactivity disorder

May display poor coordination and have abnormal electroencephalogram (EEG) findings

attention deficit/hyperactivity disorder

Intelligence is not affected but learning disabilities are often present

attention deficit/hyperactivity disorder

minimal brain dysfunction, hyperactivity in children, hyperkineses, hyperkinetic synndrom with learning disorder

attention deficit/hyperactivity disorder

Characteristics

• inattentiveness

• inability to concentrate

• restlessness

• hyperactivity

• inability to complete tasks

• impulsivity

narcolepsy

Falling asleep during normal waking activities (driving, talking with someone)

sleep paralysis

usually accompanies narcolepsy and affects the voluntary muscles

narcolepsy

Unable to move and may collapse

• amphetaminse

• amphetamine-like drugs

• analeptics

• anorexiants

CNS stimulants

12 weeks

short-term use is recommended for cns stimulants. how many weeks?

• attention-deficit/hyperactivity disorder

• narcolepsy

• reversal of respiratory distress

Medically approved use of CNS stimulants is limited to the treatment of what?

amphetamine

Stimulates release of neurotransmitters, norepinephrine and dopamine, from the brain and sympathetic nervous system and BLOCKS reuptake of the transmitters

amphetamine

Ordinarily causes euphoria and increased alertness which makes it a high potential for abuse, tolerance, and dependence

amphetamine

Excessive use may lead to psychosis

• amphetamine sulfate

• dextroamphetamine sulfate

• lisdexamfetamine dimesylate

• amphetamine + dextroamphetamine

examples of amphetamine

9-15 hours

half-life of amphetamine

• attention-deficit/hyperactivity disorder

• narcolepsy

amphetamine-like drugs is used for what?

amphetamine-like drugs

To increase a child’s attention span and cognitive performance and to decrease impulsiveness, hyperactivity and restlessness

amphetamine-like drugs

Most frequently prescribed drug for ADHD: CSS II

korean ginseng

this potentiates the drug effects of amphetamine-like drugs

st john worts

this decreases the drug efficiency of amphetamine-like drugs

modafinil

Increases wakefulness in clients with sleep disorder

GI tract

where is methylphenidate well absorbed?

amphetamine-like drugs

Inhibits reuptake of dopamine and norepinephrine resulting in CNS stimulation and an augmentation of serotonin action.

amphetamine-like drugs

Generally more effective in treating ADHD

amphetamine

avoided because they have a higher potential for abuse, habituation, and tolerance

methylpenidate

potentiates the action of CNS stimulants (caffeine) inhibits the metabolism of some barbiturates (phenobarbital) which can lead to increased blood levels and potential toxicity

viloxazine

Selective norepinephrine reuptake inhibitor

anorexiants

Causes a stimulant effect on the hypothalamic and limbic regions of the brain that suppress appetite

analeptics

Affects the brain stem and spinal cord but also the cerebral cortex

stimulate respiration

what is the primary use of analepics

approx. 4 hours

half-life of analeptics

REM

Recallable dreams occur

NREM

Sleepwalking or nightmares occur

insomnia

Inability to fall asleep or remain asleep. Occurs more frequently in women and incidence increases with age

• sedative-hypnotics

• anesthetics

cns depressants

cns depressants

Cause varying degrees of depression (reduction in functional activity) within the CNS

sedative-hypnotics

Commonly ordered for treatment of sleep disorders

sedatives

were first prescribed to reduce tension and anxiety

barbiturates

were initially used for their antianxiety effect

short-acting hypnotics

Useful in achieving sleep as it allows the patient to awaken early in the morning without experiencing lingering side effects.

intermediate-acting hypnotics

Useful for sustaining sleep.

ramelteon

The only major sedative-hypnotic approved for long-term use

barbiturates

Restricted to short-term use (2 weeks or less) because of their numerous side effects, including tolerance.

phenobarbital

long-acting barbiturates

phenobarbital

control seizure in epilepsy

butabarbital

intermediate-acting barbiturate

butabarbital

sleep sustainers for maintaining long periods of sleep

secobarbital

short-acting barbiturates

secobarbital

produce sedation

• pentobarbital

• secobarbital

are used primarily for short-term treatment of insomnia

pentobarbital

increases hepatic enzyme action causing increased metabolism and decreased effect on drugs

pentobarbital

May cause hepatotoxicity if taken with large doses of acetaminophen.

triazolam

short-acting hypnotic with 2-5 hours half-life

triazolam

Seldom prescribed and should not be taken longer than 7-10 days

anterograde amnesia

adverse effect of triazolam

flumazenil

benzodiazepine antagonist

flumazenil

used for benzodiazepine overdose

benzodiazepines

Sedative-hypnotics for inducing sleep

benzodiazepines

Increases the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to the GABA receptors and neuron excitability is reduced.

benzodiazepines

Usually have an intermediate half-life of 8-24 hours and are highly protein bound

8-24 hours

half-life of benzodiazepines

lorazepam

sedation induction and to reduce anxiety, insomnia, and seizures

triazolam

insomnia management

• temazepam

• estazolam

• triazolam

insomnia drugs

alprazolam

treats anxeity and insomnia

lorazepam

reduces anxiety

• taking a warm bath

• listening to quiet music

• drinking warm fluids

• avoid drinks with caffeine for 6 hours before bedtime

Nonpharmacologic methods to induce sleep

• azole antifungals

• rifampin

drug interactions of zolpidem taltrate

• increased levels with

• decreased levels with

• zolpidem tartrate

• eszopiclone

• zaleplon

examples of nonbenzodiazepines

ramelteon

Newest category of sedative-hypnotics

ramelteon

First hypnotic approved by the US FDA that is NOT classified as a controlled substance

ramelteon

Acts by selectively targeting melatonin receptors to regulate circadian rhythms in the treatment of insomnia

1 to 2.6 hours

half-life of ramelteon

• estazolam

• temazepam

• triazolam

considered to be safer than barbiturates (short- to intermediate-acting)

• flourazepam

• quazepam

• diazepam

avoided (long-acting) (sedative-hypnotics)

anesthetics

Classified as general and local

anesthetics

Depress the CNS, alleviate pain, and cause loss of consciousness

balanced anesthesia

Combination of drugs frequently used in general anesthesia

balanced anesthesia

Minimizes cardiovascular problems (anesthesia)

anesthesia

decreases the amount of general anesthetic needed

balanced anesthesia

reduces possible post anesthesia nausea and vomiting

balanced anesthesia

minimizes the disturbance of organ function

• stage 1: analgesia

• stage 2: excitement or delirium

• stage 3: surgical

• stage 4: medullary paralysis

stages of general anesthesia

inhalation anesthetics

Gas or volatile liquid administered as gas (anesthesia)

inhalation anesthetics

During the 3rd stage of anesthesia, it is usually used to deliver general anesthesia

nitrous oxide

absorbed quickly, has rapid action and eliminated rapidly (anesthesia)

cyclopropane

popular inhalation anesthetic but it is highly flammable and no longer used

halothane

a non-flammable alternative to cyclopropane

• enflurane

• isoflurane

• desflurane

• sevoflurane

examples of inhalation anesthetics

intravenous anesthetics

May be used for general anesthetics of for the induction stage of anesthesia

iv anesthetic

what anesthetic is preferred for outpatient surgery of short duration

• propofol

• droperidol

• etomidate

• ketamine hydrochloride

commonly used to provide total intravenous anesthetic

• midazolam

• propofol

commonly administered for the induction and maintenance of anesthesia or for conscious sedation for minor surgery or procedures like intubation and mechanical ventilation

propofol

supports microbial growth and may increase the risk for bacterial infection (anesthesia)

topical anesthetics

Limited to mucous membranes, broken or unbroken skin surfaces, and burns (anesthesia)

• solutions

• liquid sprays

• ointments

• creams

• gels

• powders

different form of topical anesthetics

local anesthetics

Blocks pain at the site where the drug is administered by preventing conduction of nerve impulses

cocaine hydrochloride

first local anesthetic

procaine hydrochloride

synthetic of cocaine