Drugs Impacting the Brain and Nervous System: Overview

Pain

Unpleasant sensory and emotional experience from tissue damage.

Pain Threshold

Stimulus level needed to perceive pain.

Pain Tolerance

Maximum pain one can endure without dysfunction.

Acute Pain

Sudden pain that subsides with treatment.

Persistent Pain

Chronic pain lasting 3-6 months or longer.

Nociceptors

Sensory nerve fibers transmitting pain signals.

Somatic Pain

Pain from skeletal muscles, ligaments, or joints.

Visceral Pain

Pain from internal organs or smooth muscles.

Analgesics

Medications relieving pain without loss of consciousness.

Opioid Analgesics

Drugs for moderate to severe pain relief.

Adjuvant Analgesic Drugs

Non-opioid drugs enhancing opioid pain relief.

Non-Opioid Analgesics

Pain relievers not classified as opioids.

WHO Analgesic Ladder

Three-step approach for pain management.

Step 1 (WHO Ladder)

Nonopioids with or without adjuvants for mild pain.

Step 2 (WHO Ladder)

Opioids with or without nonopioids for moderate pain.

Step 3 (WHO Ladder)

Strong opioids for severe pain management.

Opioid Drugs

Synthetic drugs binding to opiate receptors for pain relief.

Mild Agonists

Opioids like codeine and hydrocodone for pain.

Strong Agonists

Opioids like morphine and fentanyl for severe pain.

Meperidine

Opioid not recommended for long-term use.

Neurotoxic Metabolite

Substance causing seizures from meperidine accumulation.

Opioid Ceiling Effect

Maximum analgesic effect reached, no improvement with higher doses.

Agonists

Bind to opioid receptors, causing pain relief.

Agonists-antagonists

Bind to receptors, causing weaker pain response.

Antagonists

Reverse opioid effects without causing pain relief.

Analgesic response

Reduction of pain sensation through receptor binding.

Opioid indications

Used for moderate to severe pain relief.

Adjuvant analgesics

Assist primary drugs in enhancing pain relief.

Opioid contraindications

Known allergies and severe asthma limit use.

Opioid tolerance

Need for larger doses over time for effect.

Physical dependence

Body adapts to opioid presence, requiring dosage.

Psychological dependence

Compulsive drug use beyond pain relief.

Naloxone hydrochloride

Opioid antagonist used in overdose situations.

Naltrexone

Long-acting opioid antagonist for addiction treatment.

Opioid withdrawal syndrome

Symptoms occurring after stopping opioids abruptly.

Morphine Sulphate

Prototype opioid, high abuse potential, severe pain.

Toxic metabolites

Morphine 6-glucuronide accumulates in kidney insufficiency.

Hydromorphone

Opioid 5-8 times more potent than morphine.

Codeine Sulphate

Natural opiate alkaloid used for pain relief.

Fentanyl

Synthetic opioid for severe pain management.

Parenteral Injections

Administered via injection for rapid effect.

Transdermal Patches

Fentanyl delivery method for sustained pain relief.

Dilaudid

Brand name for hydromorphone, an opioid analgesic.

Methadone Hydrochloride

Synthetic opioid for detoxification in addiction treatment.

Acetaminophen

OTC analgesic with antipyretic properties.

Prostaglandin Synthesis

Process inhibited by acetaminophen to relieve pain.

Hepatotoxicity

Liver damage caused by excessive acetaminophen.

Acetylcysteine Regimen

Antidote for acetaminophen overdose, effective within 10 hours.

Feverfew

Herbal product with anti-inflammatory properties.

Fifth Vital Sign

Pain level measurement alongside other vital signs.

Pain Control

Administer medication before pain escalates.

Antitussive Drug

Used to suppress cough, e.g., codeine.

Ceiling Effect

Maximum effect beyond which no further response occurs.

Pharmacological approaches

Use of medications to alleviate pain.

Nonpharmacological approaches

Techniques like therapy, relaxation, and physical methods.

Oral analgesics administration

Take with food to reduce gastric upset.

Safety measures

Implement precautions to prevent patient injury.

Vital signs monitoring

Check for abnormalities, especially respiratory rate.

Respiratory rate threshold

Withhold analgesics if less than 10 breaths/min.

IM injections guidelines

Follow site rotation and proper administration techniques.

IV administration guidelines

Include dilution and rate of administration protocols.

Constipation prevention

Encourage fluid and fiber intake with analgesics.

Patient instructions

Record pain experiences and treatment responses.

Orthostatic hypotension

Change positions slowly to avoid dizziness.

Normal sleep

Cyclic and repetitive state of reduced consciousness.

Sedative-hypnotic drugs

Affect different stages of the sleep pattern.

REM sleep

Rapid eye movement stage associated with dreaming.

Non-REM sleep

Stages of sleep without rapid eye movement.

REM rebound

Increased REM sleep after discontinuing sedative drugs.

Melatonin

Hormone regulating sleep cycles, used as a supplement.

Circadian rhythm

Body's natural cycle of sleep and wakefulness.

Melatonin adverse effects

Includes daytime fatigue, drowsiness, and headaches.

Melatonin contraindications

Avoid in patients on anticoagulants or immunosuppressants.

CNS Depressants

Drugs that inhibit central nervous system activity.

Sedatives

Drugs reducing nervousness, excitability, and irritability.

Hypnotics

Drugs inducing sleep with potent CNS effects.

Sedative-hypnotics

Drugs calming CNS, inducing sleep at high doses.

Barbiturates

A group of CNS depressants used as sedatives.

Benzodiazepines

Commonly prescribed sedative-hypnotics with favorable profiles.

Non-benzodiazepine sedatives

Sedatives like Zopiclone, distinct from benzodiazepines.

Long acting benzodiazepines

Include clonazepam, diazepam, and flurazepam.

Intermediate acting benzodiazepines

Include alprazolam, bromazepam, and lorazepam.

Short acting benzodiazepines

Include midazolam, triazolam, and zolpidem.

Benzodiazepine mechanism

Depress CNS activity affecting limbic and thalamic systems.

GABA

Neurotransmitter involved in benzodiazepine action.

CNS depressant interactions

Azole antifungals and grapefruit juice prolong effects.

Indications for benzodiazepines

Used for sedation, anxiety relief, and muscle relaxation.

Adverse effects of benzodiazepines

Include headache, drowsiness, and cognitive impairment.

Benzodiazepine toxicity

Symptoms include confusion, coma, and diminished reflexes.

Flumazenil

Antidote for benzodiazepine overdose.

Zopiclone

Short-acting non-benzodiazepine for insomnia treatment.

Temazepam

Intermediate-acting benzodiazepine for sleep induction.

Diazepam

Commonly used benzodiazepine for anxiety and sedation.

Midazolam

Used preoperatively for sedation and amnesia.

Hangover effect

Daytime sleepiness following benzodiazepine use.

Fall hazard

Increased risk for older adults using benzodiazepines.

Cognitive impairment

Reduced mental function due to benzodiazepine use.

Zolpidem tartrate

Short-acting nonbenzodiazepine hypnotic for sleep.

Daytime sleepiness

Lower incidence with zolpidem compared to benzodiazepines.

Onset of action

Zolpidem acts within approximately 30 minutes.