NURS 3100: Unit III Neurological System Exam Outline

Central Nervous System

brain and spinal cord

Important Neurotransmitters in the brain

Acetylcholine (+/-)

Norepinephrine (+/-)

Dopamine (+)

Serotonin (-)

Histamine + H1 & H2/- H3

*GABA (-)

Endorphins/Enkephalins

Important Neurotransmitters in the spinal cord

Glutamate/Aspartate (+)

Substance P (+)

*Glycine (-)

Peripheral Nervous System

motor neurons and sensory neurons

Motor Neurons

somatic nervous system (voluntary)

autonomic nervous system (involuntary)

Sensory Neurons Neurotransmitter

acetylcholine

Sensory Neuron Receptors

Nociceptor-pain receptors

Mechanoreceptors-pressure, vibration, texture

Thermoreceptors

Proprioceptors-position of the various parts of the body inrelation to each other and the surrounding environment

Somatic NS neurotransmitter

acetylcholine

Autonomic Nervous System

sympathetic (fight or flight)

parasympathetic (rest and digest)

Sympathetic NS neurotransmitter

norepinephrine and epinephrine

Parasympathetic NS neurotransmitter

acetylcholine

Sympathetic NS receptors

Alpha (1 & 2) and Beta (1, 2, & 3) receptors

Parasympathetic NS receptors

Nicotinic and Muscarinic receptors

Cholinergic drugs

agents that stimulate the parasympathetic nervous system in the same manner as acetylcholine

Agonism of acetylcholine (cholinergic drugs)

produces pupil constriction, salivation increases, heartrate slows, and blood pressure drops, bronchioles constrict, digestion is stimulated, the gallbladder is stimulated, the bladder contracts, an erection is stimulated in males, vaginal lubrication in females.

Antagonism of acetylcholine (anticholinergic drugs)

blocks the affects of the parasympathetic NS

Adrenergic Drugs

drugs that mimic the sympathetic nervous system using norepinephrine

Agonism of norepinephrine (adrenergic drugs)

produces dilation of pupils, decreased salivation, increased heart rate and blood pressure, dilation of bronchioles, digestion is slowed, the liver releases glucose, epinephrine, and norepinephrine secreted, bladder relaxation, ejaculation in males and orgasm in females

Antagonism of norepinephrine (antiadrenergic drugs)

blocks the affects of the sympathetic NS

Cholinergic agonists treat

urinary retention, dry mouth, Alzheimer's disease, myasthenia gravis, and overdose or toxicity of anticholinergic drugs

Alzheimer's disease gets treated with

Acetylcholinesterase inhibitors (donepezil)

Cholinergic antagonists (anticholinergic) treat

asthma/COPD, overactive bladder, irritablebowel, motion sickness, peptic ulcer disease, Parkinson's disease, pupillary dilation, urinaryincontinence, reduce salivation, allergic rhinitis, depression, anxiety, muscle spasm

Anticholinergic Drugs

1. Atropine

2. Hydroxyzine, Diphenhydramine-first generation antihistamines

3. Amitriptyline-Tricyclic Antidepressants

4. First generation antipsychotic medications-chlorpromazine

5. Second generation antipsychotic medications-clozapine, olanzapine

6. Muscle relaxers-carisoprodol, cyclobenzaprine, tizanidine

Adrenergic agonists treat

cardiac arrest, asthma, nasal congestion

Adrenergic Agonist Drugs

1. Albuterol-Beta 2 agonist for asthma

2. Epinephrine-Alpha and Beta agonist for cardiac arrest and anaphylaxis

3. Phenylephrine, Oxymetazoline-Alpha 1 agonists for nasal congestion

4. Methylphenidate/Amphetamine-ADHD5. MAO inhibitors (MAOIs)-Depression

Adrenergic antagonists treat

hypertension, myocardial infarction (heart attack), glaucoma,heart failure, cardiac dysrhythmias, benign prostatic hypertrophy (BPH)

Adrenergic Antagonist Drugs

1. Propranolol, metoprolol, carvedilol-Beta antagonists

2. Prazosin, tamsulosin, terazosin-Alpha antagonists

Drugs and Drug Classes FDA Approved for Anxiety

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

2. Benzodiazepines-GABA

3. Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

4. Buspirone-Norepinephrine and Dopamine

5. Hydroxyzine-First generation antihistamine

6. First Generation Antipsychotic Medications-prochlorperazine, perphenazine

7. Propranolol-Beta antagonist8. Barbiturates-GABA

Drugs and Drug Classes FDA Approved for Insomnia

1. Serotonin Modulator-trazodone

2. Benzodiazepines

3. Diphenhydramine-First Generation Antihistamine

4. Tricyclic Antidepressants (TCAs)-amitriptyline, mirtazapine

5. Melatonin-Melatonin agonist

6. Barbiturates

Drugs and Drug Classes That Activate GABA to Treat Seizures

1. Benzodiazepines

2. Barbiturates

3. Gabapentin

4. Pregabalin

5. Topiramate

FDA Approved Hydantoin Seizure Medications and Others

1. phenytoin (Dilantin)-? /Sodium/calcium channels

2. carbamazepine (Tegretol)-?

3. lamotrigine (Lamictal)-? / Glutamate

4. levetiracetam (Keppra)-?

5. oxcarbazepine (Trileptal)-? /Sodium channels

6. valproic acid (Depakote/Depakene)-? /GABA/glutamate-NMDA

7. zonisamide (Zonegran)-? /Sodium/calcium channels

8. ethosuximide (Zarontin); a Succinimide drug

Drugs and Drug Classes FDA Approved for Depression

1. SSRIs

2. SNRIs

3. Serotonin Modulators

4. Norepinephrine Dopamine Reuptake Inhibitor (NDRI)-Bupropion

5. TCAs

6. MAOIs

Drugs and Drug Classes FDA Approved for Bipolar Disorder

1. Lithium-? /Sodium channels

2. Seizure Medications-Divalproex sodium, Lamotrigine

3. Second Generation Antipsychotic Medications-aripiprazole, olanzapine,quetiapine, risperidone, ziprasidone-dopamine antagonists

Drugs and Drug Classes FDA Approved for Attention Deficit Hyperactivity Disorder (ADHD)

1. Amphetamine and Methylphenidate-Adrenergic agonists that affect dopamine

2. Bupropion-NDRI

3. Clonidine-Alpha 2 Adrenergic Agonist

4. Atomoxetine-Selective Norepinephrine Reuptake Inhibitor

Drugs and Drug Classes FDA Approved for Psychosis and Schizophrenia

First Generation (Typical) Antipsychotic Medications

Second Generation (Atypical) Antipsychotic Medications

First Generation (Typical) Antipsychotic Medications

Phenothiazine Class

Non-phenothiazine Class

Phenothiazine Class

Dopamine D2 receptor antagonists-chlorpromazine,fluphenazine, perphenazine, prochlorperazine, thioridazine

Non-phenothiazine Class

Selective dopamine D2 receptor antagonists-haloperidol, thiothixene

Second Generation (Atypical) Antipsychotic Medications

Dopamine D2 receptorantagonists and selective serotonin antagonists- aripiprazole, olanzapine,quetiapine, risperidone, ziprasidone, clozapine, lurasidone

Drugs and Drug Classes FDA Approved to Treat Pain

Opioid Medications-all work in the CNS

Nonopioid Medications

Adjuvant Analgesics

Opioid Medications

Opioid Agonists

Opioid Agonist Antagonist

Opioic Agonists

i. Strong Agonists: morphine, fentanyl, hydromorphone,meperidine, methadone

ii. Moderately Strong Agonists: codeine, hydrocodone,oxycodone, tramadol

Opioid Agonist Antagonist

buprenorphine, butorphanol, pentazocine

Nonopioid Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Acetaminophen

Nonsteroidal anti-inflammatory drugs (NSAIDs)

works at the nociceptor-aspirin, ibuprofen, naproxen, celecoxib-prostaglandininhibitors

Acetaminophen

works in the CNS

Adjuvant Analgesics

Neuropathic Pain

Skeletal Muscle Spasm

Corticosteroids

Neuropathic Pain

gabapentin, pregabalin, duloxetine (SNRI), TCAs

Skeletal Muscle Spasm

cyclobenzaprine (TCA), benzodiazepines

Corticosteroids

prednisone

Drugs and Drug Classes FDA Approved to Treat Migraine Headache

Acute Treatment

Maintenance/Prophylactic Treatment

Acute Treatment

a. NSAIDs

b. Acetaminophen

c. Triptans-selective serotonin agonist (produces vasoconstriction)-sumatriptan, zolmitriptan, others

d. Ergot alkaloids-alpha adrenergic agonist-ergotamine

Maintenance/Prophylactic Treatment

a. Seizure Medications-Valproic acid, Topiramate, gabapentin

b. Beta adrenergic antagonists-propranolol, metoprolol

c. Calcium Channel Blockers

d. TCAs-amitriptyline

e. Botulinum toxin

f. New drugs-erenumab-aooe (Aimovig)-a monoclonal antibody

Drugs and Drug Classes FDA Approved for Local and General Anesthesia

Local Anesthesia

General Anesthesia

Local Anesthesia

Blocks sodium entry into nerve cells-lidocaine,procaine, others. Forms of administration, topical, infiltration, nerveblock, spinal, epidural

General Anesthesia

Stage 1, opioids, benzodiazepines, atropine,antiemetics. Stage 2, benzodiazepines.

Stage 3, IV (propofol) orinhalational agents, paralytic agents as needed.

Postoperative/Recovery, same agents as Stage 1

Drugs and Drug Classes FDA Approved for the Treatment of Neuromuscular Disorders

Centrally Acting Muscle Relaxants

Neuromuscular (Acetylcholine) Antagonists

Centrally Acting Muscle Relaxants

1. Spinal Synaptic Inhibitor-Baclofen

2. CNS depressants-Benzodiazepines

3. Norepinephrine, Serotonin Agonist-Cyclobenzaprine

Neuromuscular (Acetylcholine) Antagonists

1. Botulinum Toxin-Blocks acetylcholine release

2. Succinylcholine-Blocks acetylcholine receptors

Drugs and Drug Classes FDA Approved for the Treatment of Parkinson's Disease

1. Dopamine agonist-Levodopa-carbidopa

2. MAO-B Inhibitors-enhance dopamine by inhibiting the enzyme that breaksdopamine down

3. Acetylcholine antagonists (anticholinergic)-benztropine

Drugs and Drug Classes FDA Approved for the Treatment of Alzheimer's Dementia

Acetylcholinesterase Inhibitors

Glutaminergic Inhibitor

Acetylcholinesterase Inhibitors

enhance acetylcholine by inhibiting theenzyme that breaks acetylcholine down, donepezil, galantamine, rivastigmine

Glutaminergic Inhibitor

memantine

Drugs and Drug Classes FDA Approved for the Treatment of Multiple Sclerosis

1. Immune Modulators-Glatiramer (Copaxone), Ocrelizumab (Ocrevus)-Monoclonal antibody

2. Immunosuppressants-Corticosteroids

Drugs FDA Approved for the Treatment of Amyotrophic Lateral Sclerosis (ALS)

Glutaminergic Inhibitor/Sodium channel inhibitor-Riluzole

Commonly abused CNS depressant drug classes

1. Sedatives and sedative/hypnotics-Barbiturates, Propofol

2. Benzodiazepines

3. Opioid Agonists

4. Ethyl Alcohol-Activates GABA

5. CNS Stimulants-Nicotine

Drugs and Drug Classes FDA Approved for the Treatment of Opioid Use Disorder

1. Opioid agonist-Methadone

2. Opioid Partial Agonist-Buprenorphine

3. Opioid antagonist-Naltrexone

4. Alpha 2 Adrenergic Agonist-Clonidine, Lofexidine-for opioid withdrawal alongwith Imodium.

Drugs and Drug Classes FDA Approved for the Treatment of Alcohol Use Disorder

1. Acamprosate

2. Disulfiram

3. Seizure Medications-Topiramate, Gabapentin

4. Opioid antagonist-Naltrexone

5. Benzodiazepines for acute alcohol withdrawal-alcohol withdrawal can befatal

Drugs and Drug Classes FDA Approved for the Treatment of Nicotine (Tobacco) UseDisorder

1. Cholinergic Agonist Antagonist-Varenicline (Chantix)

2. NDRI-Bupropion

3. Cholinergic Agonist-Nicotine Replacement