pharm Nervous system

Acetylcholine

involved in muscle movements, memory and attentions (plays a role in memory and learning).

decreased levels in Alzheimers

Dopamine

associated with reward, motivations, pleasure (involved in involuntary movement and mood states).

decreased levels in Parkinsons & Depression

increased levels in Anxiety

Norepinephrine & Epinephrine

learning and memory

decreased levels in Depression

increased levels can cause over alertness in learning and memory and can cause Anxiety

Serotonin

role in control of appetite, sleep, mood, hallucinations, pain, vomiting

decreased levels in Anxiety and Depression

GABA

helps calm the nervous system (regulates anxiety and stress) - helping brain relax

increased levels in patients with seizures

Depression Medications

Selective Serotonin Reuptake Inhibitors (SSRI’s)

Atypical Antidepressants

Tricyclic Antidepressants (TCA’s)

Monoamine Oxidase Inhibitors (MAOI’s)

SSRI’s

block reuptake of serotonin, leaving more in the body

USES: depression, anxiety/panic disorders, PTSD

SE: sexual dysfunction, weight changes, CNS stimulation, nausea

Common SSRI meds

fluoxetine (Prozac)

Escitalopram (Lexapro)

Paroxetine (Paxil)

Sertraline (Zoloft)

Atlopram (Celexa)

*SSRIs seem to have -tine/-pram*

Atypical Antidepressants

inhibits dopamine & NE, keeping more in brain

USES: depression, smoking cessation

SE: dry mouth, GI distress, nausea, weight loss, restless, insomnia

*Bupropion HCL (Wellbutrin)*

Tricyclic Antidepressants

blocks uptake of NE and Serotonin

USES: depression, fibromyalgia, anxiety, insomnia

SE: dry mouth, constipation, tachycardia, drowsniess

*Amitriptyline (Elavil)*

Monoamine Oxidase Inhibitors (MAOs)

blocks MAO enzyme in brain preventing the breakdown of tyramine = increases NE, Dopamine, & Serotonin in brain

USES: depression, bulimia

SE: CNS stimulation (tachycardia), dry mouth, orthostatic hypotension

*Phenelzine (Nardil)*

Common Benzodiapines

Alprazolam (Xanax)

Diazepam (Valium)

Clonazepam (Klonopin)

Lorazepam (Ativan)

Chlordiazepoxide (Librium)

*Benzos seem to have -pam/-lam*

Anxiolytics-Benzodiazepines

has a calming effect, increasing GABA levels in synapse which then decreases NE and increases Glutamate

USES: anxiety, panic/seizure disorders, ETOH withdrawal

SE: low BP, drowsiness, confusion, dizziness

*reversal agent for benzos = Flumazenil IV*

Mood Stabilizers

produces changes in brain to stabilize neurons, blocks serotonin reuptake and increases neuronal growth

USES: bipolar disorder

SE: confusion exacerbated with dehydration, very narrow therapeutic index

*Lithium Carbonate*

Antipsychotics

blocks reuptake of dopamine, H2, NE, AcH

USES: psychotic disorder, schizophrenia, bipolar mania, tourette’s

SE:anticolinergic, dizzy, drowsy, anxiety, insomnia, weight gain

*Chlorpromazine (Thorazine) & Haloperidol (Haldol)*

Cholinesterase Inhibitors

FOR ALZHEIMERS

inhibits breakdown of acetylcholinesterase and prevents metabolism of AcH

SE: Gi distress, n/v/d, weight loss, no appetite

*Donepezil (Aricept)* = A for alzheimers, A for Aricept

Substance Abuse

can use Disulfiram (Antabuse) which makes alcohol not work on the body - can be very dangerous b/c patients need to avoid all forms of alcohol. can cause flushing, throbbing headache, nausea, vomiting, chest pain, sweating, anxiety

can also detox from ETOH using benzos like Lorazepram (Ativan)

Infectious Bacterial Conjunctivitis

S/S: sticky eyelids, drainage, red eyes

Treatment: antibiotics eye drops

Viral Conjunctivitis

S/S: redness and tearing, itchy eye, sensitivity to light, discharge - wake up with crusty eye in AM

Treatment: antibiotics

Chlamydial Conjunctivitis

sexually transmitted disease. affects mom can be transmitted to baby during L&D

causes scarring and ulceration of the cornea *leading cause of blindness*

Treatment: antibiotics - oral erythromycin

Herpes Simplex Keratitis

cause is HSV I & HSV II

S/S: pain, redness, rash or sores (blisters) on the eyelids & around the eyes especially forehead

Treatment: antivirals oral (acyclovir)

Primary Open Angle Glaucoma

increase in intraocular pressure that can damage optic nerve

S/S: peripheral vision loss is gradual, central visual field loss if damage continues

Treatment: eye drops, laser treatments, surgery

Open Angle Glaucoma Meds

Nonselective B Blockers: blocks beta 1 and beta 2 receptors in ciliary body = less aqueous humor being produced = decreased IOP

*Timolol (timoptic)*

Prostaglandin analogs: increases outflow of aqueous humor, therefore decreasing IOP

*Latanoprost (Xalatan), Travoprost (Travatan)*

Carbonic anhydrase inhibitors: decreases aqueous humor production

*Dorzolamide (Trusopt)*

FOR EMERGENCY USE - Mannitol = decreases IOP by increasing hypertonicity of fluid which pulls extra aqueous humor out

Closed Angle Glaucoma

acute, severe eye condition. rapid increase of IOP, trapped aqueous humor. blockage of the drainage angle within eye.

S/S: severe eye & head pain, visual change, rainbow colors (halo) around bright lights, loss of vision, nausea/vomiting

Treatment: iridotomy (making surgical hole in iris for drainage), mannitol, carbonic anhydrase inhibitor

Cataract

lens of eye becomes progressively opaque

S/S: halo lights, sensitivity to light & glare, hazy

Treatment: surgery to correct cataract (lens removed and replaced with intraocular implant)

Retinopathy

disease of the retina - can effect blood vessels/nerves of retina

most common is Diabetic retinopathy: high glucose damages blood vessels in eye (controlling blood sugar is key)

non-proliferative = confined to retina, early stage

proliferative = more severe

Treatment: laser procedure (photocoagulation), glucose control

Retinal Detachment

separation of the retina from pigment epithelium, fluid accumulates between retina and inner sensory layer

S/S: floaters, flashes of light, vision change

Treatment: surgery to repair tear, hole, or full detachment

Strabismus

eyes do not properly align

could result in a lazy eye if not dealt with

Amblyopia

term for lazy eye

brain overtime is favoring one eye, leaving the other one to be “lazy”

Otitis Externa (swimmers ear)

inflammation/infection of the external ear canal

S/S: red, pain, edematous ear canal

Treatment: drops containing antimicrobial or anti-fungal.

Cortiosteriod ear drops (anti-inflammatory), Oral corticosteroids

Otitis Media

inflammation of the middle ear

S/S: irritability, sleeplessness, pulling at ear, ear pain, fever, fluid draining from ear

*common in young kids*

Treatments: oral amoxicillin, ear drops contain analgesics, ear tubes

Otosclerosis

affects middle ear (stapes bone) - abnormal bone growth

S/S: tinnitus, vertigo, hearing loss

Treatment: hearing aid or surgery

Withdrawal from ETOH

begins 4-12 hours after last drink, peaks 24-48 hours and subsides within 5-7 days

Delirium may occur 2-3 days after not drinking. signs being: severe confusion/disorientation, agitations, restlessness, fever, seizures

Withdrawal Treatments

Benzodiazepines - lowers seizure potential, increases GABA to calm body

Chlordiazepoxide (Librium)

Diazepam (Valium)

Lorazepam (Ativan)

Opioid Withdrawal

can happen one hour after discontinuing or up to several days

Treatment: Methadone, which manages cravings and reduces withdrawal symptoms

Myasthenia Gravis

autoimmune disorder, muscular weakness without atrophy. defect in AcH @ muscular junctions

*dropping eyelids is the most frequent early sign*

Myasthenia Gravis Treatment

Acetylcholinesterase Inhibitors - so more acH stays in neuromuscular junction, delays breakdown

SE: overdose can cause cholinergic crisis - increased muscle weakness that may involve muscles of respiratory system (resp depression)

*Neostigmine (Prostigmin)*

Parkinson’s Disease

inability to move muscles as patient wishes

they have tremors, rigidity, akinesia, bradykinesia *lack of dopamine*

Treatment for Parkinson’s Disease

Dopaminergic Medications - dopamine delivered across blood brain barrier

Levodopa/Carbidopa (Sinemet)

SE: dyskinesia (involuntary movement), dizziness, drowsy

Pathophysiology of Seizures

sudden, explosive, disorderly discharge of cerebral neurons

tonic-clonic (gran/mal) S/S: loss of consciousness, jaw clenching, contractions then relaxation of muscle groups

Seizure Disorders (epilepsy)

Treatments: goal is to prevent seizures, medication is not a cure

*Phenytoin (Dilantin)* - DONT use if pregnant, also decreases effect of oral contraception

Sedatives and Hypnotics

Barbiturates: Pentobarbital (used to sedate)

Benzo: Midazolam (Virset) - awake sedation

SE: over sedation requires airway management with mechanical device

Non-benzo: Zolpidem (Ambien)

SE: daytime drowsiness, dizziness, sometimes amnesia